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ALL YOU NEED TO KNOW ABOUT SWINE FLU: Editor: Dr.Shashank Kumar Srivastav MICU/ICCU Incharge, Care Hospitals, Hyderabad, Former President Indian Medicos Association. Email: email@example.com INTRODUCTION The classical swine flu virus an influenza type A (H1N1) virus was first isolated from a pig in 1930. Swine flu viruses cause high level of illness, but low death rates in pigs. Like all influenza viruses, swine flu viruses change constantly. Pigs can also be infected by avian influenza and human influenza viruses. When influenza viruses from different species infect pigs, the viruses can reassort (i.e. swap genes) and new viruses that are a mix of swine, human and/or avian influenza viruses can emerge. Suspect Case: A suspect case is defined as an individual with fever (temperature 100.4°F/ 38°C) and one or more of the following manifestations- cough, sore throat, or shortness of breath. Probable Case: A probable case is defined as an individual with an influenza test that is positive for influenza A, but is unsubtypable by reagents used to detect seasonal influenza virus infection or an individual who died of an unexplained acute respiratory illness. Confirmed Case: A confirmed case is defined as an individual who is confirmed in the laboratory with PCR or virus culture for pandemic influenza virus 2009. TRANSMISSION The SO-IAV has efficiently transmitted between humans since its first detection in April 2009. So far it has spread in the Northern hemisphere outside of the flu season and in the Southern hemisphere during its flu season. It has caused mild disease, and that is in accordance with absence of the pathogenicity marker PB1- F2. As seasonal influenza A (H1N1) viruses are also circulating in humans since 1977, mild disease could also be due to partial immunity in the population. It will now be critical to watch how the virus behaves as it comes back to the Northern hemisphere in the next wave with the approaching flu season. All previously characterized pandemics have been due to viruses generated by antigenic shift involving the HA gene of avian lineage – H1 for 1918 virus, H2 for 1957 virus and H3 for 1968 virus. Though still of the H1 serotype, the HA of SO-IAV is different from the H1 HAs of seasonal influenza viruses; the inclusion of a porcine H1 in human influenza A viruses has been considered an antigenic pseudo- shift. Although SOIAV is of zoonotic origin, it’s HA may not be sufficiently divergent to call it a true antigenic shift5. Compared to viruses that caused previous pandemics, SO-IAV is at present not sufficiently virulent. But, it is already transmitting like a pandemic virus and is undergoing adaptive mutations. Whether it will remain mild or develop into a highly pathogenic fully pandemic virus remains to be seen. PREVENTION * There currently is no vaccine to protect humans against the H1N1 flu virus. The following tips will help you prevent flu infections such as the common flu and the H1N1 flu. * Wash your hands often with soap and water, especially before eating and after sneezing or coughing. * You can also use an alcohol gel product available over the counter, which is also effective in protecting against flu. * When you cough or sneeze, cover your mouth and nose with your elbow or sleeve. Or use a tissue and be sure to throw away the tissue after use. Wash your hands after you sneeze or cough. * Try to avoid close contact with sick people. Avoid touching your eyes, nose, or mouth. Germs spread this way. Try to stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. CLINICAL MANISFESTATIONS Signs Swine flu, or H1N1, is a type A influenza virus that can infect humans. It is similar to the seasonal influenza virus, but can be more severe in people who may be at high risk because of a preexisting condition. According to the Centers for Disease Control, risk factors include chronic medical conditions such as diabetes, heart disease, and asthma. Aches and Fevers Swine flu is severe body aches, this can include muscle weakness and difficulty standing up or walking. Headaches in combination with body aches are also quite common. Upper-Respiratory Symptoms A common element of swine flu is upper-respiratory symptoms. These can be similar to a cold, except more severe. A runny or stuffy nose combined with head congestion is typically present. Itchy or watery eyes may also be a symptom. Weakness Feelings of general malaise or weakness are common with swine flu, as is overall discomfort. Many people infected with the virus are tired and too weak to complete most normal day-to-day activities, and may sleep longer and more often than usual. Staying home and getting plenty of rest is the best way to fully recover from swine flu. Gastrointestinal In some cases of swine flu, people experience gastrointestinal effects. These can range from stomachaches and cramping to nausea and vomiting, and diarrhea. Swine flu may be confused with food poisoning because of the symptoms of stomach pain and upset. Warning Signs Other signs to watch for may indicate that swine flu is developing into a secondary medical condition that can be serious or life- threatening. Because swine flu involves the respiratory tract, there is a risk for developing pneumonia, respiratory failure, and bronchitis. According to the Centers for Disease Control and Prevention (CDC), in humans the symptoms of the 2009 "swine flu" H1N1 virus are similar to those of influenza and of influenza-like illness in general. Symptoms include fever, cough, sore throat, body aches, headache, chills and fatigue. * DIAGNOSIS The first cases of swine flu were diagnosed in the US in San Diego in mid-April. The discovery was serendipitous, the result of out of season. US-Mexican border surveillance and use of a new diagnostic test at the Naval Health Research Center. When the new test protocol showed infection with influenza A with undeterminable subtype, follow-up testing showed it to be an previously unknown swine flu virus. Detection of a second, apparently unlinked swine flu infection in San Diego got the outbreak (now pandemic) investigation rolling. That was just a month ago, but it established the initial diagnostic pattern that was the tail end of the flu season, but seasonal influenza was still present in the community and for the first weeks of the outbreak CDC's lab in Atlanta was the only place that had the reagents to confirm an infection was from swine flu and not seasonal flu or another virus altogether. So a make-shift case definition was set-up to take this into account. If a person with an influenza-like illness (which required sudden onset, fever and respiratory symptoms) had a rapid flu test positive for influenza (or influenza A if the test could differentiate), a nose or throat swab was sent to the state lab. As a result of preparedness activities envisioning a possible pandemic with bird flu, CDC had been training state labs to make the differentiation between the two seasonal flu subtypes, H1N1 and H3N2, and bird flu, H5N1, so the capability to do seasonal sub typing already existed outside of CDC. But neither the reagents nor the proficiency for the new swine virus did. Therefore all specimens that were positive with a rapid test at the point of visit, and so were putative influenza A, were first subtyped at the state lab level. If they could not be sub typed, they were sent on to CDC for confirmation as swine flu. CDC later determined that virtually all unsubtypable influenza A specimens turned out to be swine flu. TREATMENT The main symptoms of Swine Flu are a cough, sore throat, runny nose and fever. Usually there's more muscle pain, headache, fever and chills than seen with the common cold. If you think your child has Swine Flu, here's what you can do to make him feel better: Prescribing pattern for swine flu: 1. For a stuffy or blocked nose, use saline (or warm-water) nose drops followed by nose blowing or suctioning. 2. For throat pain, Tylenol or ibuprofen is very helpful. Children over 6 years old can also suck on hard candy. Children over 1 year old can sip warm chicken broth or other warm liquids. 3. For coughs, try to soothe the throat. For children over age 6, give cough drops. If your child is over 1 year of age, give honey. The dosage would be 1/2 to 1 teaspoon as needed. Never give honey to babies. If honey is not available, you can use corn syrup. 4. Flu can cause body aches that include leg pain, back pain, chest pain and headache. Give ibuprofen to make these sore muscles feel better. 5. For diet, mainly encourage your child to drink adequate fluids to prevent dehydration. This will also thin out the nasal secretions and loosen the phlegm in the lungs. 6. Tamiflu is an antiviral medicine that may be useful for some children. Finally: Your job is to keep your child comfortable. Determine your child's main symptoms and treat them. Antiviral Drugs for Influenza Oseltamivir: The neuraminidase inhibitor oseltamivir formulated as capsules or oral suspension (Tamiflu®) is FDA-approved for the treatment of uncomplicated acute influenza in patients 1 year and older who have been symptomatic for no more than 2 days. Zanamivir: The neuraminidase inhibitor zanamivir formulated for oral inhalation (Relenza®) is FDA-approved for the treatment of influenza in patients 7 years of age and older who, similar to approved uses for oseltamivir, have uncomplicated illness and have been symptomatic for no more than 2 days. Peramivir: A third neuraminidase inhibitor peramivir formulated for intravenous (IV) administration is an investigational product currently being evaluated in clinical trials. Children: Children younger than 2 years of age are at higher risk for influenza-related complications and have a higher rate of hospitalization compared to older children. Children aged 2 to 4 years are more likely to require hospitalization or urgent medical evaluation for influenza compared with older children and adults, although the risk is much lower than for children younger than 2 years old. Adults aged 65 years and older: Even though persons aged 65 years and older are less likely to become ill with 2009 H1N1 influenza compared to younger persons, when they do acquire influenza, they are at higher risk for severe influenza-related complications. Pregnant women: Pregnancy increases the risk of complications, hospitalization, and severe disease. One study estimated the risk of hospitalization for 2009 H1N1 to be four times higher for pregnant women than for the general population hile oseltamivir and zanamivir are "Pregnancy Category C" medications.Dr. Shashank Kumar Srivastav8 Likes8 Answers
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female /44 years has complaints of severe chest pain with slightest movement, coughing, sneezing for 10-15 days . also she has stinging pain in dorsal vertebral region on swallowing dry food like chapati etc. pain in all joints aggravated sleep during. yawning frequent associated with coldness of whole body aggravated in evening 6-9 pm. app./thirst - normal desire/aversion- n/s sleep - disturbed because of anxiety about children and family she has 2 children she is very responsible about her family. brooding about children, family... she history of migraine 8-10 years ago. ct scan of lumbosacral spine and thorax are attached which show multiple areas of ALL thickening in dorsolumber spine . plz suggest the about the case and prognosisDr. Manoj Kumar1 Like4 Answers
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Know more about the type of headache ************************************************** A headache is usually defined as a pain in the head or upper neck, and are more complicated than what we realize. There are nearly 150 different kinds of headaches, and each one has their own set of symptoms, reasons, and treatment. There are over 150 types, and some of the few known types of headache include: • Tension Headaches • Migraine Headaches • Sinus Headaches • Cluster Headaches • Thunderclap Headaches • Ice Pick Headaches • Rebound Headaches • New Daily Persistent Headaches • Spinal Headaches • Cervicogenic Headaches • Chronic Daily Headaches • Low & High-Pressure Headaches • Occipital Neuralgia • Hemicrania Continua Out of all those Tension headaches and Migraine headaches are most common TENSION HEADACHES Tension headaches are characterized by dull pain, tightness, or pressure around the forehead or the back of the head and neck. They are usually caused due to the tightening of the muscles in the head. The cause of the tension in the head muscles is not known. But poor posture, stress, repetitive neck movements, strain, or dehydration are considered some of the reasons for these Tension headaches. Adults are more susceptible to this headache type. Symptoms include • Tight feeling in the head/neck muscles • Dull, achy feeling on both the sides of the head • A headache starts slowly and gradually, often in the middle of the day Ways to Relieve Tension Headaches • Drink more water as dehydration is one of the causes of tension headache • A heat pack/ice pack on head or neck may help • Relax in a comfortable position as the wrong posture may cause headache MIGRAINE HEADACHES Migraine headaches are stronger than tension headache and usually accompanied with nausea, vomiting, and sensitivity to light. These headaches cause changes in vision and senses and feeling numbness or tingling or a general “fuzzy” feeling. A migraine headache can even last from 4 hours to 3 days, and sometimes longer. Symptoms include • Nausea or vomiting • Feeling cold or sweaty • Feeling tired, confused, or lightheaded • Intense throbbing or pounding pain on one or both sides of the head • Changes in eyesight, including blurred vision, flashing lights, or blind spots • Being bothered by light, noise, or odors • Changes in sense of smell, taste, touch Some common migraine triggers include: Food • Alcohol, especially red wine • Caffeine-too much or too little caffeine results in withdrawal • Nitrates-rich foods such as hot dogs and lunch meats • Tyramine-rich foods such as aged cheeses, soy products, hard sausages, smoked fish, fava beans and Chianti wine • Foods containing MSG (monosodium glutamate), a flavor enhancer commonly found in fast foods, spices, seasonings, instant soups • Aspartame, a sugar substitute found in many diet food products Environmental • Changes in weather • Strong odors, bright lights or loud noises Physical or Behavioral • Stress, anxiety, or rest after being stressed or anxious • Missing meals or fasting • Too much or too little sleep • Hormone changes during menstrual periods Ways to Relieve Migraine Headaches • Lie down in a dark, quiet room • Put a cold compress on your forehead • Massage your scalp and temples gently • Talk to your doctor about medications you can use Call Your Health Care Provider If: • A headache is caused by coughing, sneezing, or straining while on the toilet. • A headache get frequent or severe • A migraine lasts for 2 days or more • A migraine is different compared to the previous one that you have had • You have weakness/paralysis that lasts after the headache • You have lost weight without tryingDr. Nihal Ahmad11 Likes0 Answer
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This 5 year old girl having last night redness in eye without itching c/o fever what the Dx and Rx?Dr. Kishan Barai2 Likes20 Answers
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duration 2 days fever, difficulty in deglutition oral cavity, throat normal. no cervical lymphadenopathy. spot dx ...Dr. Manish Verma8 Likes18 Answers