Hospitalised Malaysian children with pandemic (H1N1) 2009 influenza: clinical characteristics,risk factors for severe disease and comparison with the 2002–2007 seasonal influenza

INTRODUCTION

The pandemic caused by the H1N1 influenza virus in 2009 resulted in extensive morbidity and mortality worldwide. As the virus was a novel virus, there was limited data available on the clinical effects of the virus on children in Malaysia. We herein describe the clinical characteristics of children hospitalised with H1N1 influenza at a tertiary care centre. We also attempted to identify the risk factors associated with disease severity.

METHODS

In this retrospective study, we compared the characteristics of the children who were admitted to the University of Malaya Medical Centre, Malaysia, for H1N1 influenza during the pandemic with those who were admitted for seasonal influenza in 2002–2007.

RESULTS

Among the 77 children (aged ≤ 12 years) admitted to the centre due to H1N1 influenza from 1 July 2009–30 June 2010, nearly 60.0% were aged < 6 years and 40.3% had an underlying medical condition. The top three underlying medical conditions were bronchial asthma (14.3%), cardiac disease (10.4%) and neurological disorders (11.7%). The risk factors for severe disease were age ≤ 2 years, underlying bronchial asthma and chronic lung disease. Two of the three patients who died had an underlying medical condition. The underlying causes of the deaths were acute respiratory distress syndrome and brain stem encephalitis.

CONCLUSION

The clinical presentation of the children infected with pandemic (H1N1) 2009 influenza virus did not differ significantly from that of children with seasonal influenza. However, there were more complaints of fever, cough and vomiting in the former group.     

Outcome of pregnancy in type 1 diabetes mellitus (T1DMP): results from combined diabetes–obstetrical clinics in Dublin in three university teaching hospitals (1995–2006)

Objective

To compare the pregnancy outcomes in all T1DMP attending at combined (diabetes?Cobstetric) outpatients clinics in three university teaching hospitals in Dublin from 1995 to 2006 with a non-diabetic control population (C) attending at antenatal outpatient clinics at the same hospitals over the same period.

Methods

T1DMP (n?=?600) were compared with control non-diabetic pregnancies (n?=?142,498).

Results

The spontaneous abortion rate was 15% in T1DMP versus 8% in C (p?p?p?Conclusions Pregnancy outcomes in T1DMP remain worse than in the general population despite management of T1DMP in combined obstetric/diabetes clinics in a single centre using similar management protocols. These outcomes in our study population of T1DMP in Dublin appear better than some previously reported studies.     

The effect of group-based cognitive behavioral therapy on inflammatory biomarkers in patients with coronary heart disease—results from the SUPRIM-trial

Abstract

Background: The Secondary Prevention in Uppsala Primary Healthcare Project (SUPRIM) is a prospective randomized controlled trial of a group-based cognitive behavioral therapy (CBT) stress management program for coronary heart disease (CHD) patients. The intervention reduced the risk of fatal or non-fatal first recurrent cardiovascular (CV) events. The aim of the present study was to analyze if the positive effects of the CBT program on clinical outcomes could have been mediated by changes in biomarkers for inflammation.

Methods: Altogether 362 patients with CHD were randomly assigned to intervention or usual care. The inflammatory biomarkers (VCAM-1, TNF-R1, TNF-R2, PTX3, and hs-CRP) were serially assessed at five time points every six months from study start until 24 months later, and analyzed with linear mixed models.

Results: Baseline levels of the inflammatory markers were near normal, indicating a stable phase. The group-based CBT stress management program did not significantly affect the levels of inflammatory biomarkers in patients with CHD. Three out of five (VCAM-1, TNF-R2, and PTX3) inflammatory biomarkers showed a slight increase over time in both study groups, and all were positively associated with age.

Conclusion: Group-based CBT stress management did not affect biomarkers for inflammation in patients with CHD. It is therefore unlikely that inflammatory processes including these biomarkers were mediating the effect the CBT program had on the reduction in CV events. The close to normal baseline levels of the biomarkers and the lack of elevated psychological distress symptoms indicate a possible floor effect which may have influenced the results.     

Effects of bisoprolol and cilazapril on the central retinal artery blood flow in patients with essential hypertension—preliminary results

Background

A growing body of evidence suggests that effective blood pressure reduction may inhibit the progression of microvascular damage in patients with essential arterial hypertension. However, the potential influence of anti-hypertensive drugs on ocular circulation has not been studied sufficiently.

Purpose

The aim of our study was to evaluate the effects of anti-hypertensive therapy on blood flow in the central retinal artery in patients with systemic arterial hypertension.

Material and methods

Twenty patients with essential arterial hypertension, aged 32–46 years, were examined with Doppler ultrasonography (10 MHz ultrasound probe). Blood flow velocities, pulsatility, and vascular resistance were determined before and 3 hours after systemic application of either bisoprolol 5 mg or cilazapril 2.5 mg.

Results

Administered bisoprolol significantly decreased maximum (9.8 ± 0.5 cm/s versus 8.5 ± 0.6 cm/s; P < 0.05) and minimum (2.75 ± 0.19 cm/s versus 1.75 ± 0.27 cm/s; P < 0.02) velocity, increased the Pourcellot''s index (0.71 to 0.79; P < 0.05) in central retinal artery. There were no statistically significant changes in central retinal artery blood flow after administration of cilazapril.

Conclusion

Systemic application of beta-blockers may unfavourably disturb the ocular blood flow.     

Molecular Detection of Ofloxacin and Kanamycin Resistance in Patients with MDR and Non-MDR TB from Suburban Districts in Hangzhou,China,2019–2020

<正>The continuing emergence and spread of drugresistant Mycobacterium tuberculosis complex(MTBC) poses a challenge to global tuberculosis (TB)control programs.Drug resistance in TB is mainly conferred by specific point mutations in the MTBC genome^[1].Multidrug-resistant TB (MDR-TB),     

University of California Santa Barbara 2007 Global Medicine Conference—Integrating Chinese and Western Medicine: The View from China

From May 3 through May 6,2007,the University of California,Santa Barbara (UCSB)'s Global Medicine Project,and Santa Barbara Cottage Hospital co- sponsored a conference entitled,"Integrating Chinese and Western Medicine:The View from China".A select group of the most prominent doctors in China accepted an invitation to visit UCSB to share their research,case studies,and specific treatment protocols that successfully     

Experience with percutaneous closure of ductus arteriosus using the Amplatzer duct occluder in 243 consecutive patients and long-term results—A single centre study

Background:

Percutaneous closure of patent ductus arteriosus (PDA) with Amplatzer duct occluder (ADO) has become increasingly popular in many cardiovascular centres. This study analysed the long-term results of percutaneous closure of PDA with ADO in a single centre.

Materials and Methods:

Between May 2004 and January 2013, 243 patients with median age of 2.5 years (range = 30 months to 38 years) and median weight of 10 Kg (range 4.5–80.5 Kg) underwent percutaneous closure of PDA using the ADO. The devices were implanted under fluoroscopic guidance. Patients were followed-up for any complications.

Results:

The mean diameter of narrow part of PDA was 6.4 ± 2.2 mm. The mean diameter of devices was 7.8 ± 2.3 mm. The devices were successfully implanted in 239 (98.3%) cases. At immediate, 1 day, 1, 6, 12 months and late follow-up, the complete occlusion rate was 33% (79 case), 97.1% (236 case), 97.5% (237 case), 98.3% (238 case), 98.3% (238 case) and 98.3% (238 case), respectively. Residual shunt remained in one case at late follow-up. The device embolisation occurred in five patients. The devices were successful retrieved in three patient and second larger devices were inserted. Two other devices were surgically retrieved and PDAs were ligated. Moderate left pulmonary artery stenosis (LPA) in one child and mild LPA stenosis in one infant were detected. Mild aortic obstruction occurred in one infant.

Conclusions:

Long-term follow-up of patients indicate that percutaneous closure of PDA using ADO is a safe and effective procedure. However, some complications, including device embolisation, left pulmonary stenosis and aortic obstruction may be observed in some cases.     

HIV prevalence and influencing factors analysis of sentinel surveillance among men who have sex with men in China, 2003–2011

Background  Men who have sex with men (MSM) have been impacted by HIV and now as an important driver of the HIV/AIDS epidemic in China. This study collected HIV sentinel surveillance system data on the MSM population to describe the characteristics and trends of the HIV epidemic among MSM in China from 2003 to 2011.

Methods  Data on HIV prevalence and risk behaviors from 2003 to 2011 were obtained from the national HIV sentinel surveillance database.

Results  MSM sentinel surveillance data for 2011 showed that proportions of MSM who consistently used condoms during anal sex in the last six months and at last anal sex encounter were 43.3% and 74.1%, respectively. Between 2005 and 2011 there were no significant changes in the proportion of consistent condom use. The proportion of MSM who had multiple male sex partners in the last six months increased. Overall HIV prevalence over the years showed a rising trend from 0.9% in 2003 to 6.3% in 2011. The syphilis antibody positive rate was 7.8% in 2011. In addition, the proportion of MSM in heterosexual marriages was rising, AIDS awareness was also increasing, and the proportion of MSM who had taken an HIV test in the last year and was aware of the results rose. The proportion who had received intervention services in the last year stabilized.

Conclusions  HIV prevalence in MSM populations is rapidly and widely distributed. MSM who are in heterosexual marriages may be a bridge group transmitting HIV to their heterosexual partners. The risky sexual behavior among MSM will remain a serious and important driver of China’s AIDS epidemic over the next period of time. Intervention need to be strengthened, as does the effective implementation of measures to control AIDS and prevent it from spreading further.