Medicine for the senses.
Thursday, September 3, 2009
How Long A Pregnant Women Can Work
Influenza A (H1N1), patience and tranquility
response to the comment on my previous post, you "Influenza and Calm" comments:
"As a blogger reference in your field, you do get this information if you consider it appropriate to disseminate your work log initiative and the recommendations, thus helping to put your two cents to send a message of quietness and common sense. "
Several days ago I received a document that I found interesting, if you herein may be of interest.
Best Regards.
TO INFLUENZA A, PATIENCE AND PEACE By Juan Gérvas, jgervasc@meditex.es www.equipocesca.org Medical Canencia de la Sierra , Garganta de los Montes and El Cuadrón (Madrid). Honorary Professor of Public Health in the Faculty of Medicine of the Autonomous University of Madrid, and Visiting Professor of Primary Care International Health at the National School Health (Madrid) Buitrago de Lozoya (Madrid), August 12, 2009. The problem is flu a viral disease that often suffers during the winter, as an epidemic (seasonal epidemic) that affects a large proportion of the population. As well the saying goes, "the flu lasts seven days of treatment, and a week without him." The flu is mild illness with fever and symptoms vary as headache and muscle pain, nausea, diarrhea and malaise, which requires keeping a couple of days of rest. Should not lower the fever (or even children), and the treatment is for pain and discomfort. Despite the lightness of the flu, it can be shown that mortality increases in the population with two annual peaks, one in the summer days with maximum heat, and another in the days the winter flu epidemic. It is therefore recommended a flu shot, although it is discussed whether this vaccination is useful. The influenza epidemic that began in Mexico in 2009, is less serious than the usual epidemic. Is flu that spreads easily, and is therefore a "pandemic" because it could affect up to half of the population. But the infectivity of influenza A says nothing about its severity, and in fact less serious than any previous flu. It affects many people, but unless you kill the flu each year. The figures vary according to the data source, but for example in the UK have been hundreds of thousands of cases and only about 30 deaths and one million U.S. case only 302 dead. In the austral winter (which coincides with summer in Spain), Argentina 350 people have died and some 77 people in Australia. With the southern winter nearly over, the world has been so far 1,735 dead. To put in a situation, it is estimated that in Spain for a winter die "normal" seasonal flu around 1,500 people. We have had many pandemics, and more lethal, "English" of 1918 killed mostly by the poor bacterial pneumonia (poorly fed, overcrowded, with poor housing and ill-protected from the cold). In the other two major pandemics of 1957 and 1968 there was no such lethality, among other things the existence of antibiotics to treat bacterial pneumonia. What can you do about the flu? When in 2005 the World Health Organization (WHO) predicted that bird flu might kill up to seven million people, was sparked panic in the world. Then there were only 262 deaths. So there was a huge mistake prognosis. In 2009, influenza A, should not repeat the same mistake. It is therefore central to panic. It is absurd to panic in front of the influenza epidemic, even though we come to affect (slightly) to many. Before the flu should do what we always do to Influenza: care with prudence and calm. Good hydration good food, good hygiene and seek medical advice when symptoms of importance, such coughing with expulsion of blood and severe deterioration of breathing. It should be no "toserle" to anyone touching your nose, cover the mouth when sneezing and washing hands before eating, after using the toilet and if you stain the mucus. The virus is shed in nasal mucus for about the first five days of illness. Masks do not seem to help prevent the spread of the epidemic. It does not make much of social life those early days, like we always do in case of flu. Respect to pregnancy, there is nothing to say, it is healthy in any case, nothing prevents nor worse during the epidemic of influenza A. There is no preventive treatment at all: the flu drugs do not prevent disease (or oseltamivir and zanamivir). Once the disease has these same drugs are also almost useless (noon shorten the course of the disease). There are also no studies demonstrating their effectiveness in their own influenza A. They also have adverse effects. For example, during the epidemic of influenza in children treated with oseltamivir in London, half had adverse effects, usually vomiting, and 18% were neuropsychiatric disorders. Perhaps in some cases worth your use as a treatment, for example in critically ill patients and in patients major chronic diseases, but are not useful in children or healthy adults. The flu vaccine is of little use in children and adolescents, with an effectiveness of 33%, and absolutely useless in less than two years. There are doubts about its effectiveness in adults and the elderly. On the flu vaccine does not know anything, but in 1976 a vaccine produced in the U.S. Similarly, also with all the haste of the world about the danger of a pandemic, and the result was an epidemic of serious adverse events (Guillain- Barré, neurological disease) that forced stop vaccination. The rush is not good for anything, let alone to stop the flu as A, which has such low mortality. We should not repeat the mistake of 1976. In any case, it required the signing of an "informed consent" to make clear the benefits and risks, and the procedure before the damage effects. Given the rush of vaccine production and to avoid the legal consequences of security problems, respond to claims, damages to the States, not the pharmaceutical industry. Anything else? Rapid diagnostic tests for influenza have low sensitivity (10 to 60%). That is, it's not worth making a determination of whether one is actually influenza. Anyway, since the advice is the same, and the evidence does not add up no have influenza A. Both the influenza A virus as the seasonal flu may mutate leaving completely useless vaccines. No protection against influenza by vaccination against seasonal influenza. We should not forget that a child (and adult) may have other diseases, and influenza A. In the UK there have been cases of children dying from meningitis after being falsely diagnosed influenza A. During the influenza pandemic will remain myocardial infarction, appendicitis, heart failure, diabetes, asthma, suicide attempts, hip fractures, depression, schizophrenia and a thousand other illnesses requiring medical attention. The behavior serene, patient and quiet patients with influenza A is essential for well-functioning health services and your doctor can devote to patients who need it, with or without influenza A. Note The author has no desire to make clear the state of knowledge on influenza A at the time of this writing, and it has reviewed the literature about it. This text is purely informative. The author regrets that many government agencies, scientific societies and the media convey another message, have their reasons. Ten selected REFERENCE • Burch J, Corbett M, Stock C et al. Prescription of anti-influenza drugs for healthy adults: a Systematic review and metaanalysis. Lancet Infectious Dis. 2009, doi: 10.1016/S14733099 (09) 70199-9. • Ellis C, McEven R. Who should receive Tamiflu for swine flu?. BMJ. 2009;339:b2698. • Evans D, Cauchemez S, Hayden FG. “Prepandemic” immunization for novel influenza viruses, “swine flu” vaccine, Guillain-Barré syndrome and the detection of rare severe adverse affects. J Infect Dis. 2009;200:321-8. • Kitching A, Roche A, Balasegaran S et al. Oseltamivir adherence and side effects among children in three London schools affected by influenza A (H1N1), May 2009. An Internet based cross sectional survey. Eurosurvillance 2009;29:1-4. • Jefferson TO, Demicheli V, Di Pietrantonj C et al. Inhibidores de neuraminidasa para la prevención y el tratamiento de la influenza en adultos sanos. www.cochrane.es/gripe/revisiones/CD001265.pdf • Sheridan C. Flu vaccine makers upgrade technology and pray for it. Nature Biotechnolgy. 2009;27:489-91. • Shun-Shin M, Thompson M, Heneghan C et al. Neuraminidase inhibitors for treatment and prophylasis of influenza in children: systematic review and meta-analysis of randomized controlled trials. BMJ. 2009;339;b3172. • Simonsen L, Taylor RJ, Vibourd C et al. Mortality benefits of influenza vaccine in elderly people: an ongoing controversy. Lancet Infect Dis. 2007;7:658-66. • Smith S, Demicheli V, Di Pietrantonj C, Harden AR et al. Vaccines for preventing influenza in healthy children. Cochrane Database Syst Rev. 2008;(2):CD004879. • White N, Webster R, Govorkovs E et al. What is the optimal therapy for Patients with H5N1 Infection? PLoS Med 2009; 6: e1000091. 
response to the comment on my previous post, you "Influenza and Calm" comments:
"As a blogger reference in your field, you do get this information if you consider it appropriate to disseminate your work log initiative and the recommendations, thus helping to put your two cents to send a message of quietness and common sense. "
Several days ago I received a document that I found interesting, if you herein may be of interest.
Best Regards.
TO INFLUENZA A, PATIENCE AND PEACE By Juan Gérvas, jgervasc@meditex.es www.equipocesca.org Medical Canencia de la Sierra , Garganta de los Montes and El Cuadrón (Madrid). Honorary Professor of Public Health in the Faculty of Medicine of the Autonomous University of Madrid, and Visiting Professor of Primary Care International Health at the National School Health (Madrid) Buitrago de Lozoya (Madrid), August 12, 2009. The problem is flu a viral disease that often suffers during the winter, as an epidemic (seasonal epidemic) that affects a large proportion of the population. As well the saying goes, "the flu lasts seven days of treatment, and a week without him." The flu is mild illness with fever and symptoms vary as headache and muscle pain, nausea, diarrhea and malaise, which requires keeping a couple of days of rest. Should not lower the fever (or even children), and the treatment is for pain and discomfort. Despite the lightness of the flu, it can be shown that mortality increases in the population with two annual peaks, one in the summer days with maximum heat, and another in the days the winter flu epidemic. It is therefore recommended a flu shot, although it is discussed whether this vaccination is useful. The influenza epidemic that began in Mexico in 2009, is less serious than the usual epidemic. Is flu that spreads easily, and is therefore a "pandemic" because it could affect up to half of the population. But the infectivity of influenza A says nothing about its severity, and in fact less serious than any previous flu. It affects many people, but unless you kill the flu each year. The figures vary according to the data source, but for example in the UK have been hundreds of thousands of cases and only about 30 deaths and one million U.S. case only 302 dead. In the austral winter (which coincides with summer in Spain), Argentina 350 people have died and some 77 people in Australia. With the southern winter nearly over, the world has been so far 1,735 dead. To put in a situation, it is estimated that in Spain for a winter die "normal" seasonal flu around 1,500 people. We have had many pandemics, and more lethal, "English" of 1918 killed mostly by the poor bacterial pneumonia (poorly fed, overcrowded, with poor housing and ill-protected from the cold). In the other two major pandemics of 1957 and 1968 there was no such lethality, among other things the existence of antibiotics to treat bacterial pneumonia. What can you do about the flu? When in 2005 the World Health Organization (WHO) predicted that bird flu might kill up to seven million people, was sparked panic in the world. Then there were only 262 deaths. So there was a huge mistake prognosis. In 2009, influenza A, should not repeat the same mistake. It is therefore central to panic. It is absurd to panic in front of the influenza epidemic, even though we come to affect (slightly) to many. Before the flu should do what we always do to Influenza: care with prudence and calm. Good hydration good food, good hygiene and seek medical advice when symptoms of importance, such coughing with expulsion of blood and severe deterioration of breathing. It should be no "toserle" to anyone touching your nose, cover the mouth when sneezing and washing hands before eating, after using the toilet and if you stain the mucus. The virus is shed in nasal mucus for about the first five days of illness. Masks do not seem to help prevent the spread of the epidemic. It does not make much of social life those early days, like we always do in case of flu. Respect to pregnancy, there is nothing to say, it is healthy in any case, nothing prevents nor worse during the epidemic of influenza A. There is no preventive treatment at all: the flu drugs do not prevent disease (or oseltamivir and zanamivir). Once the disease has these same drugs are also almost useless (noon shorten the course of the disease). There are also no studies demonstrating their effectiveness in their own influenza A. They also have adverse effects. For example, during the epidemic of influenza in children treated with oseltamivir in London, half had adverse effects, usually vomiting, and 18% were neuropsychiatric disorders. Perhaps in some cases worth your use as a treatment, for example in critically ill patients and in patients major chronic diseases, but are not useful in children or healthy adults. The flu vaccine is of little use in children and adolescents, with an effectiveness of 33%, and absolutely useless in less than two years. There are doubts about its effectiveness in adults and the elderly. On the flu vaccine does not know anything, but in 1976 a vaccine produced in the U.S. Similarly, also with all the haste of the world about the danger of a pandemic, and the result was an epidemic of serious adverse events (Guillain- Barré, neurological disease) that forced stop vaccination. The rush is not good for anything, let alone to stop the flu as A, which has such low mortality. We should not repeat the mistake of 1976. In any case, it required the signing of an "informed consent" to make clear the benefits and risks, and the procedure before the damage effects. Given the rush of vaccine production and to avoid the legal consequences of security problems, respond to claims, damages to the States, not the pharmaceutical industry. Anything else? Rapid diagnostic tests for influenza have low sensitivity (10 to 60%). That is, it's not worth making a determination of whether one is actually influenza. Anyway, since the advice is the same, and the evidence does not add up no have influenza A. Both the influenza A virus as the seasonal flu may mutate leaving completely useless vaccines. No protection against influenza by vaccination against seasonal influenza. We should not forget that a child (and adult) may have other diseases, and influenza A. In the UK there have been cases of children dying from meningitis after being falsely diagnosed influenza A. During the influenza pandemic will remain myocardial infarction, appendicitis, heart failure, diabetes, asthma, suicide attempts, hip fractures, depression, schizophrenia and a thousand other illnesses requiring medical attention. The behavior serene, patient and quiet patients with influenza A is essential for well-functioning health services and your doctor can devote to patients who need it, with or without influenza A. Note The author has no desire to make clear the state of knowledge on influenza A at the time of this writing, and it has reviewed the literature about it. This text is purely informative. The author regrets that many government agencies, scientific societies and the media convey another message, have their reasons. Ten selected REFERENCE • Burch J, Corbett M, Stock C et al. Prescription of anti-influenza drugs for healthy adults: a Systematic review and metaanalysis. Lancet Infectious Dis. 2009, doi: 10.1016/S14733099 (09) 70199-9. • Ellis C, McEven R. Who should receive Tamiflu for swine flu?. BMJ. 2009;339:b2698. • Evans D, Cauchemez S, Hayden FG. “Prepandemic” immunization for novel influenza viruses, “swine flu” vaccine, Guillain-Barré syndrome and the detection of rare severe adverse affects. J Infect Dis. 2009;200:321-8. • Kitching A, Roche A, Balasegaran S et al. Oseltamivir adherence and side effects among children in three London schools affected by influenza A (H1N1), May 2009. An Internet based cross sectional survey. Eurosurvillance 2009;29:1-4. • Jefferson TO, Demicheli V, Di Pietrantonj C et al. Inhibidores de neuraminidasa para la prevención y el tratamiento de la influenza en adultos sanos. www.cochrane.es/gripe/revisiones/CD001265.pdf • Sheridan C. Flu vaccine makers upgrade technology and pray for it. Nature Biotechnolgy. 2009;27:489-91. • Shun-Shin M, Thompson M, Heneghan C et al. Neuraminidase inhibitors for treatment and prophylasis of influenza in children: systematic review and meta-analysis of randomized controlled trials. BMJ. 2009;339;b3172. • Simonsen L, Taylor RJ, Vibourd C et al. Mortality benefits of influenza vaccine in elderly people: an ongoing controversy. Lancet Infect Dis. 2007;7:658-66. • Smith S, Demicheli V, Di Pietrantonj C, Harden AR et al. Vaccines for preventing influenza in healthy children. Cochrane Database Syst Rev. 2008;(2):CD004879. • White N, Webster R, Govorkovs E et al. What is the optimal therapy for Patients with H5N1 Infection? PLoS Med 2009; 6: e1000091.
Tuesday, September 1, 2009
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