Influenza: vaccination and treatment.

Few conditions exert such an enormous toll of absenteeism, suffering, medical consultations, hospitalization, death and economic loss as influenza. Patients at high risk of complications and mortality include the elderly and those with pre-existing cardiopulmonary disease. The outbreak in 1997 in Hong Kong, of avian H5N1 influenza in man, which resulted in six deaths among 18 hospitalized cases, and the recent isolation of H9N2 viruses from two children in Hong Kong, are reminders that preparation must be made for the next pandemic. Since the 1970s, efforts to control influenza have mostly focussed on the split product and surface antigen vaccines. These vaccines are of proven efficacy in healthy adults and are effective in elderly people with and without medical conditions putting them at high risk of complications and death following influenza infection. However, vaccine coverage is patchy and often low, and outbreaks of influenza are not uncommon in well-immunized residents of nursing homes. New vaccines and methods of vaccine delivery are being developed in attempts to overcome the limitations of existing vaccines. The antiviral drugs amantadine and rimantadine were developed in the 1960s, but have not been used widely due to their spectrum of activity, rapid emergence of resistance, and adverse effects associated with amantadine. The site of enzyme activity of the influenza neuraminidase is highly conserved between types, subtypes and strains of influenza and has emerged as the target of an exciting new class of antiviral agents that are effective both prophylactically and as therapy.     

Minimal anatomical disruption in stoma formation: the lateral rectus abdominis positioned stoma (LRAPS)

Aim Parastomal hernias are difficult to manage and recent attention has focused on their prevention including the use of prophylactic mesh at the time of initial surgery. Method A novel ‘anatomical’ approach to stoma formation, the lateral rectus abdominis positioned stoma (LRAPS), involving minimal anterior abdominal wall disruption is described. Results LRAPS was carried out electively (n = 25) or as an emergency (n = 4) for benign or malignant pathology. Twenty‐two had a midline laparotomy and all types of stomas were fashioned. There were two early and three later deaths from advanced malignancy. No parastomal hernias have been detected at a mean follow‐up of 13 (range 7–18) months and none detected by CT scanning in 20 of 24 patients with colorectal cancer at a mean follow‐up of 14 (range 10–18) months. Conclusion LRAPS reduces the incidence of early stomal herniation.     

Anxiety sensitivity and posttrauma stress symptoms in female undergraduates following a campus shooting

Participants were recruited from female undergraduate students participating in an ongoing longitudinal study at the time of a campus shooting. Eighty‐five percent (N = 691) of the 812 students who were invited to participate in the current study completed questionnaires an average of 27 days following a campus shooting. In a mixed cross‐sectional and longitudinal design, the cognitive and the physical concerns dimensions of postshooting anxiety sensitivity accounted for unique variance in posttrauma stress symptom severity (cross‐sectional), after controlling for preshooting psychological symptoms (longitudinal). The cognitive concerns dimension showed the strongest relationship. Anxiety sensitivity also appeared to moderate the relationships of hyperarousal symptoms with reexperiencing and numbing symptoms.