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Study - Antivirals Not Effective in Severe H1N1 Cases & mention of acute myocarditis with neutrophils - Yuen Kwok-yung

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  • Study - Antivirals Not Effective in Severe H1N1 Cases & mention of acute myocarditis with neutrophils - Yuen Kwok-yung

    (Joint 早报网News) Hong Kong Duke news report, the influenza A H1N1 influenza virus lethal surprising, a study showed Tamiflu, Relenza for a severely ill patient ineffective.
    港大微生物学系系主任袁国勇表示,严重患者的病毒数量下降速度慢,但引发自然炎症的因子非常高,器官受严重 破坏,情况与感染禽流感「H5N1」病毒类似,建议高危人士尽快接种甲型H1N1流感疫苗。

    Head of the Department of Microbiology University of Hong Kong, said Yuen Kwok-yung, a severely ill patient's viral load decline was slow, but the cause of natural inflammatory factors is very high, serious damage to organs, the situation with the avian flu "H5N1" virus, similar to the proposed high-risk people vaccinated as soon as possible A type H1N1 influenza vaccine.
    港大最近联同十一间公立医院和一间私家医院进行研究,比对三十七名严重患者和三十七名轻微患者 的情况。



    University of Hong Kong recently in conjunction with the 11 public hospitals and one private hospital study compared 37 severe patients and 37 patients with mild situation.
    袁国勇说,三十七名严重患者中,两成并无高危因素,而当中二十三人有严重呼吸系统衰竭,十三人更需要「插喉 」,但最终不治,「余下十人虽然无死,但肺部功能已严重受损」,需接受三至六个月时间观察。



    Yuen Kwok-yung said the 37 severe patients, no risk factors into two, of which 23 people have severe respiratory failure, 13 of whom need to "intubation", but ultimately died, "The remaining 10 people who, though no dead, but has been seriously impaired lung function, "subject to three to six months time to observe.
    可致肺部积水缺氧亡
    Hypoxia-induced pulmonary accumulation of water could be dead
    研究显示,十三名死者的器官受病毒攻击后,自然炎症反应非常严重,情况与患上「H5N1」禽流 感相似。



    Research shows that 13 organs of the deceased by the virus attack, a natural inflammatory response is very serious, the situation with the risk of "H5N1" bird flu similar to.
    袁国勇说,他们的肺部组织严重受损,出现肺部气泡积水,有发炎迹象,令患者「透不过气」,缺氧 死亡。



    Yuen Kwok-yung said that their severely damaged lung tissue, there lungs bubble water, there are signs of inflammation, so that patients "breath" oxygen-starved dead.
    除肺部受攻击外,心脏肌肉组织亦有发炎情况,在心脏内有很多白血球细胞,即是急性心肌炎,令正常细胞死亡, 估计最近多宗青年死亡个案,可能与此有关。



    In addition to the lung under attack, the heart muscle tissue is also inflamed the situation, in the heart There are many white blood cells, that is, acute myocarditis, so that normal cell death, the estimated number of recent cases of young deaths may be related to this.
    他表示,在患者的骨髓样本中,发现单核吞噬细胞增生和噬血症。



    He said that in the patient's bone marrow samples and found that proliferation of mononuclear phagocytes and bite hyperlipidemia.
    同时,研究显示,即使患者获处方特敏福、乐感清,其治疗亦不理想。



    At the same time, research shows that even though patients have been prescribed Tamiflu, Relenza, its treatment is not ideal.




    袁国勇指出,他们的呼吸道病毒量下降速度缓慢,当病毒下跌时,自然炎症反应因子仍维持高水平,严重破坏肺部 组织,令特敏福、乐感清治疗效用低,但暂时未知原因,不排除与高危因素、入院太迟有关。



    Yuen Kwok-yung, and their slow decline in respiratory virus, when the virus down, the natural inflammatory response factor remains high, serious damage to lung tissue, to make Tamiflu, Relenza treatment effectiveness is low, but in the meantime an unknown reason, does not exclude high-risk factors, the hospital too late.
    他说,特敏福、乐感清对治疗轻微个案是很有效,尤其四十八小时内,但不少严重患者入院时,已经是发病五至七 日后,即使处方双倍抗流感药物,作用亦不大。



    He said, Tamiflu, Relenza for treatment of mild cases is very effective, especially within 48 hours, but many severely ill patient admission, it is already five to seven days after onset, even if the prescription of the double anti-influenza drugs, the role of not Great.




    至于严重患者的最好治疗方法,他说,仍要进一步研究,暂时未有方案,强调会继续寻求更好的治疗 方法。



    As for the best treatment for a severely ill patient, he said that warrants further study is not yet known program, stressed that they would continue to seek better treatment.
    尽快接种疫苗即可预防


    Vaccinated as soon as possible that can be prevented
    抗流感药物治疗不理想,接种甲型H1N1流感疫苗是唯一的预防方法。



    Anti-influenza drug therapy is not satisfactory, influenza A H1N1 influenza vaccine inoculation is the only way to prevent it.
    袁国勇说,「这批死亡个案,其实无一个需要死」,若他们接种甲型H1N1流感疫苗,便可预防病 毒入侵。



    Yuen Kwok-yung said, "These deaths, in fact, no one needs to die", if they vaccination Influenza H1N1 influenza vaccine can prevent viruses.
    他引述加拿大和澳洲数据说,估计第二波疫情来临时,可能会有十四至五十六名健康人士死亡,高危人士的死亡人 数可能高达七十二至二百八十八人。



    He cited data on Canada and Australia, said the epidemic is estimated that the second wave comes, there may be 14-56 healthy people were killed, the death toll may be high-risk groups of up to 72-288 people.
    他呼吁高危人士应及早接种疫苗。



    He called for high-risk persons should be vaccinated as soon as possible.


    http://www.zaobao.com/wencui/2009/12...g091222m.shtml


  • #2
    Re: Study - Antivirals Not Effective in Severe H1N1 Cases - Yuen Kwok-Yung

    Originally posted by sharon sanders View Post
    (Joint 早报网News) Hong Kong Duke news report, the influenza A H1N1 influenza virus lethal surprising, a study showed Tamiflu, Relenza for a severely ill patient ineffective.

    (...)

    University of Hong Kong recently in conjunction with the 11 public hospitals and one private hospital study compared 37 severe patients and 37 patients with mild situation.
    (...)

    In addition to the lung under attack, the heart muscle tissue is also inflamed the situation, in the heart There are many white blood cells, that is, acute myocarditis, so that normal cell death, the estimated number of recent cases of young deaths may be related to this.

    (...)

    He said, Tamiflu, Relenza for treatment of mild cases is very effective, especially within 48 hours, but many severely ill patient admission, it is already five to seven days after onset, even if the prescription of the double anti-influenza drugs, the role of not Great. [LEFT]

    (...)
    [/B]


    Sharon,
    thank you for that post

    I?d like to point out that

    1. the ?poor outcome? of Tamiflu in the patients of that study mainly was not related to the antiviral properties of Oseltamivir (Tamiflu) but to the delay of time in starting the antiviral treatment, i.e. the fact that at the time of admission to the hospital a (multi-) organ failure already had been in an advanced state in those seriously ill patients due to a systemic inflammatory syndrome.

    2. the study confirmed ?acute myocarditis? as a severe influenza related complication and possible cause of death. In Germany, there had been at least three cases of fatal H1N1 infections in children and young adults with acute myocarditis as the cause of death (autopsy findings).






    related thread:


    Antiviral Treatment for Patients Hospitalized with 2009 Pandemic Influenza A (H1N1) (N Engl J Med, edited)

    Posted by NEJM Editors ? November 18th, 2009

    With the 2009 H1N1 pandemic well under way, many clinicians are providing care to patients with influenza. Previously, although antiviral treatment was recommended,1,2 clinicians may not always have prescribed it to patients hospitalized with seasonal influenza, perhaps because of a perception that antiviral treatment had limited benefit.
    (...)
    evidence from observational studies supports the benefit of neuraminidase inhibitors (oseltamivir or zanamivir) in reducing complications, including deaths, among hospitalized patients with 2009 pandemic influenza A (H1N1).
    (...)

    Observational data from the United States and Mexico suggest that neuraminidase inhibitor treatment (primarily oseltamivir) of hospitalized patients with 2009 H1N1 may reduce disease severity and mortality. Starting treatment with a neuraminidase inhibitor within 2 days after symptom onset was significantly associated with a lower risk of ICU admission or death in hospitalized 2009 H1N1 patients (N=272; median age, 21 years), as compared with later treatment (P <0.05).10 In ICU patients with 2009 H1N1 (N=58; median age, 44 years), survivors were more likely to have received neuraminidase inhibitor treatment than nonsurvivors (OR, 8.5; P=0.04).11
    (...)

    Taken together, although data are limited, findings of observational studies all point in the same direction, suggesting benefit of early neuraminidase inhibitor treatment for hospitalized influenza patients as well as for patients presenting >48 hours after illness onset. In the setting of 2009 pandemic influenza A (H1N1) virus activity in a community, empiric neuraminidase inhibitor treatment should be started as soon as possible for any hospitalized patient who presents with influenza that is suspected (e.g., acute respiratory illness, acute exacerbation of chronic conditions, or other complications) or confirmed, in addition to initiating antibiotic treatment as indicated for suspected bacterial coinfection.

    (...)


    http://h1n1.nejm.org/?p=1188&query=TOC

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