Can aerobic exercise alleviate flu-like symptoms following interferon beta-1a injections in patients with multiple sclerosis?

BACKGROUND: Flu-like symptoms (FLS) are common side effects of interferon beta (IFNß) treatment, and may affect the willingness to initiate therapy, the long-term acceptability, and the adherence to the treatment. Case reports suggest that aerobic exercise is able to markedly reduce FLS following IFNß-1a injections in persons with multiple sclerosis (PwMS). OBJECTIVE: To test the hypothesis that aerobic exercise can alleviate FLS following IFNß-1a injections in PwMS, and secondarily to examine whether or not fluctuations in circulating cytokines provide a mechanism that can explain a potential positive effect. METHODS: Seventeen PwMS who frequently experience FLS following IFNß-1a injections completed four days of testing. On two of the testing days they completed 35min of aerobic exercise on a bicycle-ergometer following IFNß-1a injection. On the two other testing days, no intervention took place following the injection. FLS were assessed pre-injection and 3h, 5h, 12h and 24h post-injection. Blood samples were taken pre-injection and 1h and 3h post-injection to determine levels of circulating interleukin 6 and 17 and IFNγ. The primary study endpoint was the comparison of the change in FLS severity from pre-injection to 5h post-injection between days with injection alone and days with injection followed by aerobic exercise. RESULTS: FLS severity change was significantly lower on days with exercise compared to days with rest. IL6 was significantly increased 3h following IFNß-1a injection and exercise compared to 1h post and pre and when compared to the resting condition. Participants reported no adverse events in addition to FLS during the study period. CONCLUSION: Data from this study suggest that moderate intensity aerobic exercise following IFNß-1a injections is safe and can alleviate the FLS severity in PwMS. Based on these results, 35min of aerobic exercise should be encouraged for PwMS who often experience FLS following IFNß-1a injections.

Intervenciones de enfermería para la atención en adultos de 65 años y más con infecciones de vías respiratorias en el primero y segundo nivel de atención / Nursing interventions for care in adults 65 years and older with respiratory tract infection in the first and second level of care

OBJETIVO: Establecer intervenciones de enfermería efectivas para la atención de los adultos de 65 años y más con infecciones de vías respiratorias, para disminuir la incidencia de morbilidad y mortalidad y mejorar la calidad para contribuir a garantizar la seguridad de la atención y el autocuidado.MATERIALES Y MÉTODOS: Elaboración de las preguntas a responder y conversión a preguntas clínicas estructuradas, búsqueda y revisión sistemática de la literatura: recuperación de guías internacionales o meta análisis, o ensayos clínicos aleatorizados, o estudios observacionales publicados que den respuesta a las preguntas planteadas, de los cuales se seleccionarán las fuentes con mayor puntaje obtenido en la evaluación de su contenido y las de mayor nivel en cuanto a gradación de evidencias y recomendaciones.Protocolo sistematizado de búsqueda: Algoritmo de búsqueda reproducible en bases de datos electrónicas, en centros elaboradores o compiladores de guías, de revisiones sistemáticas, meta análisis, en sitios Web especializados y búsqueda manual de la literatura.RESULTADOS Y DISCUSIÓN: Un total de fuentes documentadas y utilizadas: 81 (Pud Med, BVS, TRIPDATA BASE, Otros sitios Web). guías seleccionadas: 4, revisiones sistemáticas: 26, ensayos clínicos aleatorizados: 14, meta análisis: 17, estudios de cohorte: 6, casos y controles: 5 y otros documentos: 9.CONCLUSIONES: La vacunación contra la influenza a los grupos más vulnerables y el constante lavado de manos, son algunas de las intervenciones que contribuyen a la prevención y control de las enfermedades respiratorias en los adultos mayores.

OBJECTIVE: Establish effective nursing interventions for the care of adults 65 years and older with respiratory tract infections, to reduce the incidence of mordidito and mortality and improve quality to help ensure the safety of care and self-care.MATERIALS AND METHODS:Development of questions to answer and conversion to questions structured clinical, research and systematic review of the literature: recovery of international or meta guides analysis or randomized clinical trials, or published observational studies that respond to the questions, of which will select the sources with the highest score obtained in the evaluation of its content and the higher level as to grading evidence and recommendations.Search systemized protocol: search algorithm reproducible electronic databases, in institutions or compilers processors guides, systematic reviews, meta analysis, specialized Web sites and manual literature search.RESULTS AND DISCUSSION:A total of documented and used sources: 81 (Pud Med, BVS, TRIPDATA BASE, Other Web sites). Selected guides: 4, systematic reviews: 26 randomized clinical trials: 14, meta analysis: 17 cohort studies: 6 cases and controls 5 and other documents: 9.CONCLUSIONS: Influenza vaccination the most vulnerable groups and constant hand washing, are some of the interventions that contribute to the prevention and control of respiratory diseases in older adults.

OBJETIVO: Estabelecer intervenções eficazes de enfermagem para o cuidado dos adultos com 65 anos e mais velhos com infecções do trato respiratório, para reduzir a incidência de morbidade e mortalidade e melhorar a qualidade para ajudar a garantir a segurança dos cuidados e auto-cuidado.MATERIAIS E MÉTODOS:Desenvolvimento de perguntas para responder e conversão às perguntas estruturadas clínica, pesquisa e revisão sistemática da literatura: a recuperação da análise de guias internacionais ou meta ou ensaios clínicos randomizados, ou publicados estudos observacionais que respondam às perguntas, das quais irá selecionar as fontes com o maior resultado obtido na avaliação do seu conteúdo e do nível superior como a classificação de evidências e recomendações.Pesquisar protocolo sistematizado: algoritmo de busca bases de dados electrónicas reprodutíveis, em instituições ou compiladores processadores guias, revisões sistemáticas, meta-análise, sites especializados e busca manual de literatura.RESULTADOS E DISCUSSÃO:Um total de fontes documentados e usados: 81 (Pud Med, BVS, TRIPDATA BASE, outros sites). guias selecionadas: 4, revisões sistemáticas: 26 ensaios clínicos randomizados: 14, meta-análise: estudos de coorte 17: 6 casos e controles 5 e outros documentos: 9.CONCLUSÕES: Vacinação contra a Gripe dos grupos mais vulneráveis e a lavagem das mãos constante, são algumas das intervenções que contribuam para a prevenção e controlo de doenças respiratórias em adultos mais velhos.

Risk of severe outcomes among patients admitted to hospital with pandemic (H1N1) influenza.

BACKGROUND: We describe the disease characteristics and outcomes, including risk factors for admission to intensive care unit (ICU) and death, of all patients in Canada admitted to hospital with pandemic (H1N1) influenza during the first five months of the pandemic. METHODS: We obtained data for all patients admitted to hospital with laboratory-confirmed pandemic (H1N1) influenza reported to the Public Health Agency of Canada from Apr. 26 to Sept. 26, 2009. We compared inpatients who had nonsevere disease with those who had severe disease, as indicated by admission to ICU or death. RESULTS: A total of 1479 patients were admitted to hospital with confirmed pandemic (H1N1) influenza during the study period. Of these, 1171 (79.2%) did not have a severe outcome, 236 (16.0%) were admitted to ICU and survived, and 72 (4.9%) died. The median age was 23 years for all of the patients, 18 years for those with a nonsevere outcome, 34 years for those admitted to ICU who survived and 51 years for those who died. The risk of a severe outcome was elevated among those who had an underlying medical condition and those 20 years of age and older. A delay of one day in the median time between the onset of symptoms and admission to hospital increased the risk of death by 5.5%. The risk of a severe outcome remained relatively constant over the five-month period. INTERPRETATION: The population-based incidence of admission to hospital with laboratory-confirmed pandemic (H1N1) influenza was low in the first five months of the pandemic in Canada. The risk of a severe outcome was associated with the presence of one or more underlying medical conditions, age of 20 years or more and a delay in hospital admission.

Correlates of severe disease in patients with 2009 pandemic influenza (H1N1) virus infection.

BACKGROUND: In the context of 2009 pandemic influenza (H1N1) virus infection (pandemic H1N1 influenza), identifying correlates of the severity of disease is critical to guiding the implementation of antiviral strategies, prioritization of vaccination efforts and planning of health infrastructure. The objective of this study was to identify factors correlated with severity of disease in confirmed cases of pandemic H1N1 influenza. METHODS: This cumulative case-control study included all laboratory-confirmed cases of pandemic H1N1 influenza among residents of the province of Manitoba, Canada, for whom the final location of treatment was known. Severe cases were defined by admission to a provincial intensive care unit (ICU). Factors associated with severe disease necessitating admission to the ICU were determined by comparing ICU cases with two control groups: patients who were admitted to hospital but not to an ICU and those who remained in the community. RESULTS: As of Sept. 5, 2009, there had been 795 confirmed cases of pandemic H1N1 influenza in Manitoba for which the final treatment location could be determined. The mean age of individuals with laboratory-confirmed infection was 25.3 (standard deviation 18.8) years. More than half of the patients (417 or 52%) were female, and 215 (37%) of 588 confirmed infections for which ethnicity was known occurred in First Nations residents. The proportion of First Nations residents increased with increasing severity of disease (116 [28%] of 410 community cases, 74 [54%] of 136 admitted to hospital and 25 [60%] of 42 admitted to an ICU; p<0.001), as did the presence of an underlying comorbidity (201 [35%] of 569 community cases, 103 [57%] of 181 admitted to hospital and 34 [76%] of 45 admitted to an ICU; p<0.001). The median interval from onset of symptoms to initiation of antiviral therapy was 2 days (interquartile range, IQR 1-3) for community cases, 4 days (IQR 2-6) for patients admitted to hospital and 6 days (IQR 4-9) for those admitted to an ICU (p<0.001). In a multivariable logistic model, the interval from onset of symptoms to initiation of antiviral therapy (odds ratio [OR] 8.24, 95% confidence interval [CI] 2.82-24.1), First Nations ethnicity (OR 6.52, 95% CI 2.04-20.8) and presence of an underlying comorbidity (OR 3.19, 95% CI 1.07-9.52) were associated with increased odds of admission to the ICU (i.e., severe disease) relative to community cases. In an analysis of ICU cases compared with patients admitted to hospital, First Nations ethnicity (OR 3.23, 95% CI 1.04-10.1) was associated with increased severity of disease. INTERPRETATION: Severe pandemic H1N1 influenza necessitating admission to the ICU was associated with a longer interval from onset of symptoms to treatment with antiviral therapy and with the presence of an underlying comorbidity. First Nations ethnicity appeared to be an independent determinant of severe infection. Despite these associations, the cause and outcomes of pandemic HINI influenza may involve many complex and interrelated factors, all of which require further research and analysis.

Extracorporeal life support for pandemic influenza: the role of extracorporeal membrane oxygenation in pandemic management.

The recent global threat of a severe pandemic influenza outbreak has suggested that extracorporeal life support will begin to play an evolving role in the care of critically ill influenza stricken patients. The highly communicable attributes of influenza could result in widespread infection and an associated increased need for advanced life support. Supply and demand equilibrium may be abruptly disrupted, and ethical decisions regarding the allocation of life saving resources will inevitably need to be made. Protocol oriented planning, research analysis, and advanced technologies are critical factors in averting catastrophe. This review article details the epidemiology, diagnostic techniques, and interventions for the influenza A virus, including H1N1.

[Convalescence and sick leave after influenza]. / Rekonvalescens og sygemelding efter influenza.

Seasonal influenza has a significant impact on individuals and society alike. In otherwise healthy adults, a typical case of seasonal influenza is associated with six to eight days of clinical symptoms, and about four to five days of sick leave. Transmission mainly takes place during the initial four days of the illness. Convalescence from disease should be expected to comprise seven days from symptom onset. In mild cases with symptoms lasting only few days, convalescence could be limited to four days unless prevention of transmission is given very high priority. Shorter duration of convalescence and workplace absence is not recommended due to risk of transmission.

Protective mechanical ventilation does not exacerbate lung function impairment or lung inflammation following influenza A infection.

The degree to which mechanical ventilation induces ventilator-associated lung injury is dependent on the initial acute lung injury (ALI). Viral-induced ALI is poorly studied, and this study aimed to determine whether ALI induced by a clinically relevant infection is exacerbated by protective mechanical ventilation. Adult female BALB/c mice were inoculated with 10(4.5) plaque-forming units of influenza A/Mem/1/71 in 50 microl of medium or medium alone. This study used a protective ventilation strategy, whereby mice were anesthetized, tracheostomized, and mechanically ventilated for 2 h. Lung mechanics were measured periodically throughout the ventilation period using a modification of the forced oscillation technique to obtain measures of airway resistance and coefficients of tissue damping and tissue elastance. Thoracic gas volume was measured and used to obtain specific airway resistance, tissue damping, and tissue elastance. At the end of the ventilation period, a bronchoalveolar lavage sample was collected to measure inflammatory cells, macrophage inflammatory protein-2, IL-6, TNF-alpha, and protein leak. Influenza infection caused significant increases in inflammatory cells, protein leak, and deterioration in lung mechanics that were not exacerbated by mechanical ventilation, in contrast to previous studies using bacterial and mouse-specific viral infection. This study highlighted the importance of type and severity of lung injury in determining outcome following mechanical ventilation.

Acute necrotizing encephalopathy of childhood associated with influenza type B virus infection in a 3-year-old girl.

Acute necrotizing encephalopathy of childhood represents a novel entity of acute encephalophathy, predominantly affecting infants and young children living in Taiwan and Japan. It manifests with symptoms of coma, convulsions, and hyperpyrexia after 2 to 4 days of respiratory tract infections in previously healthy children. The hallmark of acute necrotizing encephalopathy of childhood consists of multifocal and symmetric brain lesions affecting the bilateral thalami, brainstem tegmentum, cerebral periventricular white matter, or cerebellar medulla. The etiology and pathogenesis of this kind of acute encephalopathy remain unknown, and there is no specific therapy or prevention. The prognosis is usually poor, and less than 10% of patients recover completely. We report a 3-year-old previously healthy girl presenting with acute necrotizing encephalopathy of childhood associated with influenza type B virus infection, which resulted in severe neurologic sequelae. We also review the current knowledge of the clinical, neuroimaging, and pathologic aspects of acute necrotizing encephalopathy of childhood.