Flu Episodes Research Articles

A CASE OF CHRONIC PERICARDITIS IN A YOUNG PATIENT

Abstract A 25–year–old woman was admitted to our department with a diagnosis of pericarditis and pericardial effusion. She reported a flu episode 5 months earlier followed by persistent dry cough, dyspnoea on exertion and palpitations. Due to the persistence of symptoms, she consulted a cardiologist and it was observed a mild to moderate pericardial effusion with a raised C reactive protein at lab test. At first she was treated with ibuprofen and colchicine. After 2 months, prednisone was added to the therapy for effusion worsening. During steroids descalation she started complaining of night fever. Few weeks later an echocardiogram revealed increased pericardial effusion (21 mm) with signs of right atrial compression, so she was admitted to our department. No cardiovascular risk factors were reported but overweight and smoking habit. ECG at admission showed a slight depression of PR in inferior leads. Given the history, persistence of elevated inflammatory markers and fever on admission, despite prolonged therapy with NSAIDs, the patient was treated for high–risk pericarditis, with ibuprofen and colchicine. In addition, aetiological research was pursued: autoantibody and viral panel were negative; chest X–ray showed mediastinal enlargement and swelling in the right hilar region. So an urgent chest CT scan was performed and it showed a 8x9 cm mediastinal mass extending to the pectoral muscles and sternum. The mass biopsy revealed a classical Hodgkin lymphoma so she was transferred to Hematology department and chemotherapy was started. During her hospital stay, the effusion remained stable (17 mm). This clinical case demonstrates that pericarditis, even in a young patient, with a lack of response to NSAIDs therapy and with an unremitting course, must raise the suspicion of an occult cancer. In fact, according to the latest guidelines, in case of high–risk pericarditis, i.e. in the presence of at least one negative prognostic predictor between fever higher than 38°C, subacute onset, severe pericardial effusion, tamponade or failure of medical therapy after one week, aetiological research is indicated, in addition to hospitalization. It shouldn‘t be forgotten that pericarditis may be the first manifestation of an occult extracardiac tumor. In particular, the primary tumors associated with pericarditis are breast cancer, lung cancer and lymphomas. Probably better case management would have allowed an earlier diagnosis and treatment of our patient‘s cancer.

Neighborhood disadvantage and immune-related illnesses among residents living in the US Gulf States

PurposeNeighborhood disadvantage has been associated with increased risk for pneumonia and influenza-associated hospitalizations. Few studies, however, have investigated how neighborhood disadvantage may influence immune-related illnesses.The aim of this study was to examine the association between neighborhooddisadvantage and immune-related illnesses. MethodsWe used data from the Gulf Long-term Follow-up (GuLF) Study (n = 32,608). Our analytic sample included home visit participants (n = 11,193) who had complete information on exposure and covariates (n = 10,543). Neighborhood disadvantage was assessed using the 2013 Area Deprivation Index (ADI), which assigns a ranking of 1 to 100 for lowest to highest disadvantage. We linked ADI to participants’ geocoded enrollment addresses at the census block group level. ADI was categorized into quartiles based on the national distribution with the first quartile as the referent. Immune-related illnesses self-reported at the home visit (May 2011–May 2013) included occurrence of shingles, pneumonia, cold sores, flu, and colds since the Deepwater Horizon oil spill (April 2010). Frequent colds and frequent flu were defined as ≥4 colds and ≥2 episodes of flu since the spill. An aggregated outcome, based on occurrence of any pneumonia, cold sores, flu, and ≥4 colds since the spill, was also examined. We assessed the association of each outcome with ADI using multivariable log-binomial regression adjusting for individual-level demographics, behavioral factors, kids at home, and season of interview completion. ResultsWe found elevated prevalence ratios (PR) and 95% confidence intervals (CI) for pneumonia associated with ADI in the third (PR: 2.04, 95% CI: 1.04, 4.02) and fourth (PR: 2.00; 95% CI: 1.00, 3.98) quartiles. PRs for frequent colds were also elevated for increasing ADI quartiles, but with confidence intervals including the null value. ConclusionsThe observed associations of frequent colds and pneumonia with increasing neighborhood disadvantage may warrant further research on this topic

Cute Cats, Disastrous Nightmare

Abstract We reported a rare case of neuroretinitis secondary to cat scratch disease, which was successfully treated with steroids and antibiotic. A healthy young lady presented with a 6-day history of central blurring of vision over her right eye (OD) after an episode of flu. Visual acuity over the OD was 6/60 with positive relative afferent pupillary defect. There were no features of anterior uveitis. Fundus of the OD showed swollen, hyperemic optic disc with disc hemorrhages and early macular star but clear vitreous, with the absence of retinochoroiditis or vasculitic changes. The serum Bartonella henselae immunoglobulins M and G were raised. Magnetic resonance imaging of the brain and orbit showed a normal result. Our impression was neuroretinitis secondary to cat scratch disease. Her OD’s vision improved to 6/9 after completing a course of doxycycline and systemic corticosteroids. Early commencement of antibiotic and corticosteroids is essential to impede potentially blinding ocular complications despite its rarity.

1345. Patient Perspectives and Journey with Influenza and Seeking Care from US National Survey

BackgroundIn the 2017-2018 influenza season, 49 million people in the US presented with influenza symptoms, resulting in substantial morbidity, mortality, and a significant humanistic and economic burden. Although there are currently four FDA-approved antivirals for influenza, such treatments continue to be widely underutilized. The aim of this study was to better understand the patients’ perspective and experience with a flu episode and seeking care during the 2019-2020 influenza season.MethodsData were obtained from an online quantitative survey of influenza patients. Participants were recruited from two data sources: A pool of respondents who previously completed the National Health and Wellness Survey (NHWS) (N=74,977) or from Lightspeed M3 Global online “General Panel” (N=500,000+) in the US from January 2020 through May 2020. The sample included patients >18 years of age and having a self-reported diagnosis of influenza by a healthcare professional within the last 90 days. Outcomes related to patient demographics, health-related characteristics and perspectives on the influenza episode were collected.Results1,005 patients were included. Of those, 30.2% visited their primary health care professional (HCP) in person, 20.2% visited urgent care walk-in facility and 19.2% called their HCP. Important aspects of flu treatment included: feeling better quickly (69.5%), not transmitting to others (51.5%), and ease of administration (40.7%); 375 patients were treated with an antiviral. Of those, it took~4.6 days to feel generally better and ~8.8 days to feeling totally better. About 73% of patients took all of their antiviral medication, 9% took “some”. 43.9% of respondents considered themselves to be more likely to get serious flu-related complications, 52.5% reported that they were told by an HCP that they belong to a high-risk group that may be more likely to get flu-related complications. 41.3% reported they did not experience any high risk factors while experiencing influenza.ConclusionInfluenza patients reported different attitudes and treatment approaches to handling their infection. It is critical to understand what matters most to patients regarding both influenza and treatment to optimally provide outreach and care.Disclosures Nate Way, PhD, Genentech, Inc. (Grant/Research Support)Kantar Health (Employee) Ashley Martin, PhD, Genentech, Inc. (Grant/Research Support)Kantar Health (Employee) Chris Wallick, PharmD, MS, Genentech, Inc. (Employee, Shareholder) Edward Neuberger, PharmD, MBA, MS, Genentech, Inc. (Employee, Shareholder) Mitra Corral, MS, MPH, Genentech, Inc. (Employee, Shareholder)

Influenza vaccination 2021/22: why is it important?

Each year during the months of September–March we vaccinate against influenza which is caused by the RNA viruses of the family Orthomyxoviridae (influenza viruses) ( National Institute for Health and Care Excellence, 2020 ). There are two main types that cause a significant infection – influenza A and influenza B. Influenza A usually causes a more severe illness ( Public Health Agency (PHA), 2021 ). Influenza can be a mild self-limiting infection but in some at risk groups it can lead to increased morbidity or mortality. The World Health Organization (2021) recommends which viruses need to be included in influenza vaccines for the northern hemisphere flu seasons. Last year was the biggest NHS influenza vaccination programme ever, with a low incidence of recorded episodes of flu ( Public Health England (PHE) et al, 2021a ). This low level of cases of influenza is thought to be due to social-distancing, mask wearing, and increased handwashing ( Rubin, 2021 ). The reduction could also be due to the increased influenza vaccination rates, which reached a record high in 2020–2021 ( Jones, 2020 ; PHE et al, 2021b ). It is unclear what impact influenza will have this year. Nurses in general practice need to encourage all the preventative measures at their disposal.

Determining the impact of vitamin C use with the common cold on loss of labour and medical treatment costs for Turkey

Abstract Objectives As one of the most common health problems, the common cold may lead to negative consequences such as work or school absenteeism, poor productivity and labour loss. Vitamin C supports immune system defences by supporting the various cellular functions of the immune system, both congenital and adaptive. The purpose of this study is to evaluate the use of vitamin C in white-collar workers and its impact on medical care costs and its impact on the workforce in association with the common cold. Methods For calculation of the effect of 1000 mg vitamin C daily on the workforce and possible healthcare services costs, a Markov-based model was simulated with 6 cycles consistent with the literature that constituted the model input for the 6-month common cold season. The simulated Markov model included parameters for the number of seasonal flu episodes with or without vitamin C use, the duration of the episodes, productivity loss and daily labour costs. The TreeAge Healthcare Pro 2020 program was used for the Markov model. Key findings The calculations revealed that the common cold lasted 0.47 days less with vitamin C use. The calculations revealed that the number of days absent from work is 0.38 days more without vitamin C use compared with vitamin C use. The calculations revealed that the medical treatment costs for the common cold is TL 1723.98. According to the analysis conducted based on the Markov model, the total cost of lost productivity and medical treatment that would occur in case of a common cold is TL 3704.97 with vitamin C use and TL 4223.26 without vitamin C use. Conclusion Based on the results of the analysis, we can suggest that regular vitamin C supplementation may prevent the impact of the common cold on public health and the resulting economic burden.

An Oral Combination of Turmeric-Pomegranate (With Ginger) Prevents Viral (Cold/ Flu) Episodes in Immunocompromised Patients

The aim of this pharma standard (“PS”) supplement, registry was the evaluation – in a period of 3 months – of the effects of the use of a standardized combination (oral supplement including turmeric, pomegranate and ginger) in preventing common, winter, viral events (cold and flu episodes). Results: No safety or tolerability problem was observed with the supplement. The two resulting registry management groups – standard management (SM) and SM+the supplement combination – were comparable. The number of viral (cold/flu) episodes (lasting more than 3 days), and the total number of subjects with any episode was in favor of the group managed with the preventive supplement combination (p<0.05). The average number of days of disease and the lost working days were lower with the combination (Phyto Relief). The use of other OTC products and the number of complications were significantly lower (<0.05) with the supplement combination. The number of subjects with a clinical extension of the disease to more than 7 days with bronchial or tracheal complications was also lower (p<0.05) with the supplements in comparison with the SM group. Salivation was improved more in the supplemented group (p<0.05). The results of this concept, preliminary study in mildly immuno-compromised subjects shows that Phyto Relief may help prevent some episodes of cold/flu and help (by shortening the length of the episodes) the evolution of viral episodes when used early, when the initial symptoms can be identified. More specific evaluations and larger prevention studies are needed, in a more heterogenous population. The extension of this supplementary prevention to more subjects and for longer periods may indicate a more permanent effect of this supplement combination on improving local, mucosal immunity and resistance to viral spread. Conclusions: The evaluation of immunocompromised subjects is significant in clinical conditions prevention (winter viral episodes) with this natural combination which may also avoid prolonged respiratory complications.

Oral Phytorelief: Prevention of Upper Respiratory Tract Viral Conditions; Virucidal (Covid) and Germicidal Activity

This review presents results from recent supplement studies on PhytoRelief, an oral product including standardized natural extracts of pomegranate, curcuma and ginger. PhytoRelief (PF) lozenges dissolve slowly in the mouth producing a protective mucosal gel/film acting as a barrier against the most common upper respiratory tract (URT) viral infection. GLOBAL EVALUATION: PR (as a pharma-standard supplement) appears to be effective – according to recent, controlled and prospective registry studies - as a virucidal (on Covid-19) and a germicidal (bactericidal) product – but more clinical studies in patients with different conditions are needed. Clinically, PR helps preventing a number of episodes of cold and flu and limits symptoms and the duration of the URT problem. This OTC product can be used without prescription – without risks of side effects - and it appears to be generally effective on most signs and symptoms of viral infections. PR has a good preventive value. No side effects or tolerability problem were observed in any patient. The important virucidal and germicidal activities to be better defined need larger and a more prolonged evaluation period in different contexts associated to viral infections. With predictive analytics and careful planning, it is possible to show the virucidal-bactericidal effects (and their clinical preventive efficacy) of PR in weeks. The planning of new studies – also evaluating the effects of PR on the immune system - is in progress.

Safety and Dose-Dependent Effects of Echinacea for the Treatment of Acute Cold Episodes in Children: A Multicenter, Randomized, Open-Label Clinical Trial.

Background: Due to the frequency and severity of cold symptoms in children, and the risk of associated complications, effective treatments are urgently needed. Here we evaluated the safety profile and treatment benefits of Echinacea in children with acute cold and flu symptoms. Methods: A total of 79 children (4–12 years) were randomized to a treatment regimen of three or five times daily Echinaforce Junior tablets (total of 1200 or 2000 mg Echinacea extract, EFJ) for the prospective treatment of upcoming cold and flu episodes at first signs. Parents recorded respiratory symptoms daily during episodes in their child and physicians and parents subjectively rated tolerability. Results: EFJ was used to treat 130 cold episodes in 68 children and was very well tolerated by more than 96% positive physician’s ratings. EFJ-treated cold episodes lasted 7.5 days on average, with nine out of 10 episodes being fully resolved after 10 days. Five EFJ tablets daily reduced the average episode duration by up to 1.7 days (p < 0.02) in comparison to three EFJ tablets daily regimen. Effective symptom resolution finally contributed to a low antibiotic prescription rate in this study of 4.6%. Conclusions: EFJ tablets present a valuable option for the treatment of acute cold episodes in children showing a wide safety margin and increased therapeutic benefits at five tablets daily.

PIN27 Economic IMPACT of Use of Preventive 1000 MG/Day Vitamin C in FLU Season Depending on Markov a MODEL for Turkey

Vitamin C could decrease the incidence of the common cold and the duration of symptoms if taken regularly in the flu season. This study aims to develop a Markov model to demonstrate the burden of absenteeism and presenteeism cases caused by preventable common cold and flu using 1000 mg/day Vitamin C vs doing nothing in Turkey. The models were conducted for understanding the possible loss of productivity of white-collar professionals and healthcare costs. employer spending per employee, healthcare usage, possible changes in seasonal flu episodes, length of flu episodes, productivity loss depending on absenteeism, and presenteeism have been retrieved from the literature search. The effect of 1000 mg/day Vitamin C on the workforce and possible healthcare was calculated depending on a Markov based model which was conducted for 6 months of flu season calculating as 6 cycles. According to the Markov model, the cost of 1000 mg/day Vitamin C arm including loss of efficiency and medical treatment was calculated as 3.529,00 TL and the cost of the doing nothing arm was calculated as 4.223,00 TL. The economic benefit of using 1000 mg/day Vitamin C on productivity and healthcare per flu season depending on the model has been calculated as 694,00 TL. A two-way Tornado Sensitivity Analysis has been conducted for the Markov model to understand the major and minor impact factors to calculation with 15% differentiation for both ways. It is seen that the major impact factor is episode number. It is followed by the costs of employees per day and the cost of medical treatment, respectively. According to the results of the Markov model, 1000 mg/day Vitamin C has been shown to provide economic benefits for productivity and healthcare costs.

P1733 Late onset of arrhytmogenic cardiomyopathy, unmasked by myocarditis - when multimodality imaging solves the puzzle

Abstract Introduction Arrhythmogenic cardiomyopathy (AC) is a genetic disease, associated with arrhythmic sudden death in young people. Since inflammation might be also present, differential diagnosis with myocarditis is necessary. We present a challenging case, initially diagnosed with ventricular tachycardia (VT) and acute myocardial infarction (AMI), in which multimodality imaging changed the initial diagnosis. Clinical case. A 68-year old woman with dyslipidaemia and hypertension was admitted with chest pain, negative T waves in anterior leads, epsilon wave in V1, V2 (Fig. A, B), negative troponin I (TpI), and elevated NT-proBNP (342 ng/ml). One month before, she was hospitalized for a monomorphic VT with left bundle branch block (LBBB) pattern, with hemodynamic instability, cardioverted electrically to sinus rhythm. Increased TpI suggested an AMI. She recalls an episode of flu with high fever (39°C) before admission. At current admission, transthoracic echo (TTE) revealed LVEF 52%, severe lateral wall hypokinesia, severe RV dysfunction with fractional area change 23%, and TAPSE 15 mm. Coronary angiography excluded significant lesions. Speckle tracking echo(STE) revealed patchy areas of decreased LV myocardial deformation (Fig. C), and decreased basal deformation in RV free wall(Fig. D). Cardiac magnetic resonance (CMR) revealed LVEF 59%, lateral and septal wall hypokinesia, late gadolinium enhancement (LGE) in mid-ventricular lateral wall and interventricular septum (Fig. F), with correspondent increased extracellular volume (ECV) &amp;gt;30%, increased native T1 time, increased T2 mapping, and small pericardial effusion (7 mm); RV was dilated (diastolic volume 107 ml/m2 and systolic volume 69 ml/m2), with severely decreased RV ejection fraction (RVEF) of 35%, hypokinesia of free wall, dyssynchronous contractions, and microaneurysms (Fig. E, F). Diagnosis was concluded for AC with delayed onset, revealed by an acute myocarditis. Betablocker, ACEI, and implantable cardioverter defibrillator (ICD) in secondary prevention were decided. Relatives were screened for the presence of AC. Patient`s daughter presented 8000 isolated monomorphic ventricular ectopic heart beats with LV origin, no echo signs, but incipient signs of AC on CMR (increased ECV on T1 mapping in 7 LV myocardial segments, without LGE). Discussion We presented a rare case of late arrhythmic onset of AC in a patient, in which the first aetiology of VT was considered to be ischaemic. VT with LBBB morphology can be caused by myocarditis, AMI, or AC. Similarly, epsilon wave with negative T waves in precordial leads may have multiple aetiologies. In our case, multimodality imaging approach excluded AMI and suggested an inflammatory cause for VT. CMR allowed the identification of morphologic condition AC and the trigger condition of myocarditis. Conclusions Our case highlights the importance of a multimodality imaging approach in diagnosing AC and myocarditis, for a correct and complete management. Abstract P1733 Figure.

1784. The Value of a Systematic Screening of Influenza Virus and Vaccination on Emergent Admissions to a Cardiac Intensive Care Unit (C-ICU)

BackgroundInfluenza is a potential inducer of acute cardiac events. However, the incidence of influenza in patients admitted to a C-ICU, the accuracy of clinical suspicion and the compliance of influenza vaccination of high-risk patients, are not well known. Objectives: To evaluate the incidence of influenza at C-ICU admission during influenza season, the potential underdiagnosis and the vaccination rate.MethodsProspective study at a tertiary institution including all patients admitted to a C-ICU during 2017–2018 flu season. A nasopharyngeal swab was collected at admission from all patients who consented (198/201, 98.5%) and tested using Xpert® Flu/RSV assay. Clinical data were registered.ResultsInfluenza was detected in 14/198 (7.1%) patients (11 FluA, 3 FluB) and initially suspected by the cardiologist in 57.1% cases. When compared with patients without influenza, flu-positive patients had more respiratory (21.4% vs. 6.0%, P = 0.03) or neurologic diseases (21.4% vs. 4.3%, P < 0.01), contact with relatives with flu-like illnesses (35.7% vs. 14.4%, P = 0.03), antimicrobials use (71.4% vs. 36.4%, P = 0.01) and need for mechanical ventilation (28.6% vs. 3.3%, P < 0.01). Reasons for C-ICU admission between both groups were similar. All patients promptly received oseltamivir and no patient with flu died (0 vs. 3.8%, P = 0.46) despite a high rate of severe presentations (85.7%) and related complications (78.6%). Seasonal flu vaccination was received by 44.9% of the patients admitted to the C-ICU and 52.0% of patients who had indication for flu vaccination. The incidence of influenza in the vaccinated and non-vaccinated population (with flu vaccine indication) was, respectively 12.6% vs. 4.1% (P = 0.08). Flu episodes in vaccinated patients required less mechanical ventilation (20% vs. 75%, P = 0.05) and showed a trend toward shorter length of in-hospital stay (6 vs. 15d, NS). Risks factors for no vaccination despite indication were: younger age (67 vs. 75y-o, P < 0.05) and less comorbidity (Charlson index 4 vs. 5, P < 0.01).ConclusionSeven percent of patients admitted to the C-ICU had influenza, only half of the influenza cases diagnosed were suspected at admission and only half of the patients with indication for flu vaccination, received the vaccine. A clinical score to recognize influenza in these patients is needed.Disclosures All authors: No reported disclosures.

Influenza and ARVI: challenges and solutions

ARVI and influenza are one of the topical problems of pediatrics, which is due to the high level of morbidity in the child population, a significant incidence of severe and complicated forms of disease, especially in young children. In the structure of infectious pathology in children, this group of diseases still retains its leading position, accounting for up to 70% of all registered cases. Almost every child annually and more than once endures ARVI or flu episodes. This group of infections causes significant economic damage both to the household budget and the national budget as a whole. In order to improve the provision of medical care for children, improve the qualifications of pediatricians and share experience of the Department of Pediatrics named after Academician G.N. Speranskiy RMACPE (Head of Department Dr. of Sci. (Med), Professor I.N. Zakharova), a scientific and practical seminar «Influenza and acute respiratory infections 2018/2019: challenges and solutions» was held. Within the framework of the event, supported by «Valenta Pharm», specialists considered a number of topical issues, including vaccine prophylaxis and treatment of ARVI and influenza, taking into account modern epidemiological, microbiological and virological data. The seminar participants paid special attention to the validity of antiviral therapy in children, in particular, such drug as Ingavirin®.

2495. Real-World Burden of Transmission and Care Seeking Among Family Members With a Primary Influenza Infection

BackgroundSeasonal influenza is known to be a significant burden to patients and the healthcare system. Understanding how this highly contagious infection is spread, particularly among family members, is important for quantifying the burden of flu and potential impact of upcoming therapeutic agents that limit transmission. This study used real-world US claims data to understand families’ medical care seeking behavior for flu infection and the relationship between family size and days families are burdened with flu within their household.MethodsThis was a retrospective analysis of US commercial claims data from the 2014–2016 flu seasons. Patients with enrolled family members and a diagnosis code for flu were identified and required to have continuous coverage during each influenza episode (defined as 14 days from the first flu case in a family).ResultsWe identified 1,224,808 primary cases of flu among families of 2 or more members. The median family size was 4 members (25th, 75th percentiles = 3, 4). Of these families with at least one case of flu, 119,883 (9.8%) had additional member(s) who sought care for flu within the same flu episode. 70.8% (84,903) of these cases occurred within 3 days after the first member’s claim for influenza (Figure 1).Increased family size was associated with a higher percentage of families where flu spread to other members of the family beyond the first member diagnosed (6.4% of families of size 2 or 3 vs. 12.6% of families of size 4 or greater, P < 0.001). Family size was also positively correlated with the number of days between the first and last flu-related office visit within a family (Spearman coefficient = 0.09, P < 0.001). The majority of family members who sought care for flu were children (n = 810,867; 59.5%), followed by employees (n = 323,277; 23.7%) and their spouses (n = 228,775; 16.8%).ConclusionIn data for the last 3 available flu seasons, we identified a significant number of secondary cases of flu among families with a primary case. Larger families had higher likelihood for subsequent flu infections and more number of days for dealing with flu. Transmission of flu between family members represents a large burden on the healthcare system and reveals an unmet need for treatment options that limit transmission. Disclosures All Authors: Roche: Employee, Salary.

Meat in the post-truth era: Mass media discourses on health and disease in the attention economy

The debate on meat's role in health and disease is a rowdy and dissonant one. This study uses the health section of the online version of The Daily Mail as a case study to carry out a quantitative and qualitative reflection on the related discourses in mass media during the first fifteen years of the 21st century. This period ranged from the fall-out of the bovine spongiform encephalopathy (BSE) crisis and its associated food safety anxieties, over the Atkins diet-craze in 2003 and the avian flu episode in 2007, to the highly influential publication of the report on colon cancer by the International Agency for Research on Cancer (IARC) in 2015. A variety of conflicting news items was discernible, whereby moments of crisis, depicting the potential hazards of meat eating, seemed to generate reassuring counter-reactions stressing the benefits of meat as a rich source of nutrients. In contrast, when the popularity of meat-rich diets was on the rise due to diets stressing the role of protein in weight control, several warnings were issued. Meat's long-standing and semiotic connotations of vitality, strength, and fertility were either confirmed, rejected or inverted. Often this was achieved through scientification or medicalisation, with references to nutritional studies. The holistic role of meat within human diets and health was thus mostly reduced to a focus on specific food components and isolated biological mechanisms. The narratives were often histrionic and displayed serious contradictions. Since several interests were at play, involving a variety of input from dieticians, (health) authorities, the food industry, vegan or vegetarian movements, and celebrities, the overall discourse was highly heterogeneous.

Homeopathic medicines for prevention of influenza and acute respiratory tract infections in children: blind, randomized, placebo-controlled clinical trial

Influenza and its complications are common at all ages, especially in children. Vaccines and anti-influenza drugs aim to prevent it. Preventative approaches with favorable risk profiles should be considered for flu, particularly since the evidence of the efficacy of anti-viral drugs is debated. This pragmatic clinical trial was conducted in the Brazilian Public Health System in Petrópolis (BPHSP) with children aged from 1 to 5 years old. The medications used were mainly selected based on in vitro experiments (InfluBio), and in successful qualitative clinical experiences (Homeopathic Complex). Following informed parental consent, subjects were randomly distributed, in a blind manner, to three experimental groups: Homeopathic Complex, Placebo, and InfluBio. BPHSP health agents collected flu and acute respiratory infection symptomatic episodes monthly following the established protocol. The number of these episodes was registered in one year (2009-2010). Out of the 600 children recruited, 445 (74.17%) completed the study (149: Homeopathic complex; 151: Placebo; 145: InfluBio). The number of flu and acute respiratory infection symptomatic episodes detected in this clinical trial was low; however, it was different between homeopathic groups and placebo (p < 0.001). In the first year post-intervention, 46/151 (30.5%) of children in the placebo group developed 3 or more flu and acute respiratory infection episodes, while there was no episode in the group of 149 children who used Homeopathic Complex, and only 1 episode in the group of 145 (1%) children who received InfluBio. These results suggested that the use of homeopathic medicines minimized the number of flu and acute respiratory infection symptomatic episodes in children, signalizing that the homeopathic prophylactic potential should be investigated in further studies.

Spleen-preserving Distal Pancreatectomy or Distal Pancreatectomy With Splenectomy?

Goals:We designed this study to evaluate the efficacy of spleen salvage during distal pancreatectomy for patients with benign and borderline malignant tumors.Background:Despite the emphasis on its role, the spleen has commonly been removed in distal pancreatectomy.Study:From January 2005 to July 2009, 82 patients underwent distal pancreatectomy with splenectomy (DPS) and 78 patients underwent spleen-preserving distal pancreatectomy (SPDP). Medical records were retrospectively reviewed.Results:There were no significant differences in demographics, final diagnoses, estimated blood loss, intraoperative transfusion, and operative time between the 2 groups. More perioperative complications occurred in the DPS group than in the SPDP group (P=0.0344). Consequently, postoperative hospital stay was significantly shorter in the SPDP group than in the DPS group (P=0.0273). In the follow-up survey, episodes of common cold or flu were apparently more frequent in the DPS group (P=0.047). More patients in the DPS group felt fatigue (P=0.0481) and poor health condition (P=0.0371). Less newly developed (P=0.0193) and aggravated diabetes mellitus (P=0.0361) were also observed in the SPDP group. Platelet counts on postoperative day (POD) 5, hemoglobin on POD 3, WBC counts, and CRP level on POD 2 were significantly higher in the DPS group than in the SPDP group and these differences continued to be significant for months after surgery.Conclusions:In addition to frequent higher grade complications, prolonged hospital stays, and severe hematological abnormalities, DPS seemed to result in poor health condition based on the follow-up survey. Even an effort to preserve an adult spleen in distal pancreatectomy is worthwhile.

Spleen-preserving distal pancreatectomy: perioperative and long-term outcome analysis.

Despite the emphasis on its role, the spleen has commonly been removed in distal pancreatectomy. We aimed to evaluate the efficacy of spleen salvage during distal pancreatectomy for patients with benign and borderline malignant tumors. 82 patients underwent distal pancreatectomy with splenectomy (DPS) and 78 patients underwent spleen-preserving distal pancreatectomy (SPDP). Medical records were retrospectively reviewed. There were no significant differences in demographics, final diagnoses estimated blood loss, intraoperative transfusion and operative time between the two groups. More perioperative complications occurred in DPS group than in the SPDP group (p = 0.0344). Consequently, postoperative hospital stay was significantly shorter in SPDP group than in DPS group (p = 0.0273). On the follow-up survey, episodes of common cold or flu were apparently more frequent in the DPS group (p = 0.047). More patients in the DPS group felt fatigue (p = 0.0481) and poorer health condition (p = 0.0371). Less newly developed (p = 0.0193) and aggravated diabetes mellitus (p = 0.0361) were also observed in SPDP group. In addition to frequent higher-grade complications, and prolonged hospital stays, DPS appeared to result in poorer health condition based on follow-up survey. Even an effort to preserve adult spleen in distal pancreatectomy is worthwhile.

Incidence of acute respiratory infections in Australia.

We used a national survey of 7578 randomly selected respondents in 2008-2009 to identify the period prevalence of acute respiratory infection (ARI) by season and state, and to estimate the incidence of ARI in the Australian community. A case was defined as any episode of cold or flu with at least one of the following symptoms: fever, chills, sore throat, running nose, or cough in the past 4 weeks. Frequency data were weighted to the Australian population. The response rate to the survey was 49%, and 19·9% (1505/7578) of respondents reported an ARI in the previous 4 weeks, which extrapolated to 68·9 million cases [95% confidence interval (CI) 65·1-72·7] of ARI in Australia annually. The incidence was 3·2 (95% CI 3·0-3·4) cases of ARI/person per year, and was highest in young children and lowest in older people. ARI imposes a significant burden on Australian society.

Autosomal recessive paediatric sick sinus syndrome associated with novel compound mutations in SCN5A

We report the case of a boy who was first addressed to medical attention when he was 2-years-old because of an episode of Salmonellosis. His cardiologic evaluation was normal. There were no clinical signs of myocarditis. Three years later he was admitted to the hospital due to a prolonged episode of flu with persistent fever. At that time, his electrocardiogram (ECG) showed junctional rhythm (JR) at 35bpm. Further ECGs revealed sinus rhythm (SR) with first degree atrio-ventricular block, episodes of sinoatrial (SA) exit blocks, sinus arrests and phases of JR, supporting the diagnosis of sick sinus syndrome (SSS) [1].