Kaempferol attenuates acute lung injury in mice induced by swine-origin influenza A H9 N2 virus via down-regulation of NF-κB signaling pathway / 中国病理生理杂志

[ ABSTRACT] AIM:To investigate whether kaempferol protects against acute lung injury induced by swine -origin influenza A H9N2 virus via down-regulation of NF-κB signaling pathway .METHODS:BALB/c mice were used to estab-lish the animal model of acute lung injury by nasal inoculation of swine-origin influenza A H9N2 virus.After the interven-tion with kaempferol , the pulmonary edema was evaluated by determining the lung wet weight /dry weight ( W/D) ratio, the pathological changes of the lung tissues were observed , the concentrations of TNF-α, IL-1βand IL-6 in the bronchoalveolar lavage fluid (BALF) were measured, and superoxide dismutase (SOD) activity, myeloperoxidase (MPO) activity and MDA content in the homogenate of the lung tissues were detected .NF-κB P65 levels were determined by Western blot , and the NF-κB P65 and NF-κB P50 nuclear translocation in the nuclear extracts from mouse lung tissue homogenate was detec-ted by ELISA .RESULTS:Treatment with kaempferol decreased the morality of infected mice , and significantly prolonged the survival time of the infected mice .Kaempferol also relieved the pathological changes of the lung tissues , the lung W/D ratio and the lung index in swine-origin influenza A H9N2 virus-infected mice.Treatment with kaempferol significantly de-creased the infiltration of inflammatory cells including macrophages , lymphocytes and neutrophils in the BALF .The levels of TNF-α, IL-6, IL-1βand MDA and the activity of MPO were also decreased .Treatment with kaempferol also significantly increased the SOD activity .NF-κB P65 levels were decreased , and the NF-κB P65 and NF-κB P50 nuclear translocation in the nuclear extracts from the mouse lung tissue homogenate were also decreased by treatment with kaempferol .CONCLU-SION:The protective effect of kaempferol on the mice with acute lung injury induced by swine -origin influenza A H9N2 vi-rus is related to suppression of the oxidative stress and inflammatory responses by down-regulation of NF-κB signaling path-way.

Clinical Profile and Outcome of Swine Flu in Indian Children.

Objective: To describe the clinical characteristics and outcome of Indian children infected with 2009 H1N1 influenza virus. Study design: Retrospective chart review. Setting: Outpatient department and hospitalized patients in a tertiary care hospital. Methods: Clinical details of 85 children (positive for the 2009 H1N1 virus infection tested by real-time reversetranscriptase– polymerase-chain-reaction assay) were analyzed from medical charts. Results: Of the 85 (55 boys) children positive for 2009 H1N1 virus infection, 64.7% were between 5 years to 16 years, and 35.3% were below 5 years age. The mean age of these children was 7.5±3.5 yr. Contact history was positive only in 22 (26%) cases. High grade fever was the most common symptom, followed by cough and rhinorrhea. Twenty-nine (34%) patients had an underlying co-morbid condition. Of the 34 patients who underwent chest radiography during evaluation, 18 children (52.9%) had findings consistent with lower respiratory tract infection. Antiviral therapy was initiated in 76 patients. Hospitalization was required in 30 (35.3%) children. Risk factors for hospitalization included underlying co-morbid condition, respiratory distress, vomiting, wheezing, diarrhea, hypotension and infiltrates/consolidation on chest radiograph. Mean length of hospitalization was 131+76 hours, irrespective of underlying disease. Three children developed Acute Respiratory Distress Syndrome and died. Conclusions: Clinical features and routine laboratory investigations in children with swine origin influenza were non-specific. Children with co-morbid condition, respiratory distress, vomiting, wheezing, diarrhea, hypotension and infiltrates/consolidation on chest radiograph were at higher risk of hospitalization.

Follow-up after acute respiratory distress syndrome caused by influenza a (H1N1) virus infection

BACKGROUND: There are no reports on the long-term follow-up of patients with swine-origin influenza A virus infection that progressed to acute respiratory distress syndrome. METHODS: Four patients were prospectively followed up with pulmonary function tests and high-resolution computed tomography for six months after admission to an intensive care unit. RESULTS: Pulmonary function test results assessed two months after admission to the intensive care unit showed reduced forced vital capacity in all patients and low diffusion capacity for carbon monoxide in two patients. At six months, pulmonary function test results were available for three patients. Two patients continued to have a restrictive pattern, and none of the patients presented with abnormal diffusion capacity for carbon monoxide. All of them had a diffuse ground-glass pattern on high-resolution computed tomography that improved after six months. CONCLUSIONS: Despite the marked severity of lung disease at admission, patients with acute respiratory distress syndrome caused by swine-origin influenza A virus infection presented a late but substantial recovery over six months of follow-up.

Acute Hemorrhagic Colitis Associated with the Use of Oseltamivir / 대한내과학회지

Oseltamivir is a potent selective neuraminidase enzyme inhibitor and effective against nearly all strains of influenza A and B. The importance of treating influenza has been recognized, and oseltamivir has been prescribed frequently at the onset of the H1N1 influenza A pandemic this year. However, oseltamivir can cause hemorrhagic colitis as a rare adverse effect. Until now, only two cases of hemorrhagic colitis following the use of oseltamivir have been reported in Japan, and none have been reported in Korea. We report a case of acute hemorrhagic colitis in a 15-year-old boy after the oral administration of oseltamivir for swine originating influenza A.

Ventilação mecânica não invasiva em pacientes com síndrome respiratória aguda grave, suspeitos de infecção por influenza A - H1N1: relato de casos / Non invasive mechanical ventilation in acute lung injury and swine-origin influenza A H1N1 suspicion: case report

Objetivo: Apresentar, através de relato de caso, a aplicação da ventilação mecânica não invasiva (VMNI) em pacientes com Síndrome Respiratória Aguda Grave (SRAG), suspeitos de H1N1, internados no Centro de Terapia Intensiva (CTI) do Hospital Eduardo de Menezes (HEM). Materiais e Métodos: Quatro mulheres com idades entre 16 e 50 anos, com SRAG, foram submetidas à VMNI em ventiladores micro processados utilizando a máscara full face, com parâmetros mínimos a fim de melhorar a taquidispnéia e a queda da saturação de oxigênio, conforme protocolo criado pela equipe do CTI do HEM. Resultado: após aplicação da VMNI houve melhora do padrão respiratório e da saturação, observados clinicamente e através de gasometria e RX, menor permanência no CTI (3-5 dias), e não houve necessidade de intubação orotraqueal, diminuindo complicações e custos da mesma. Conclusão: Embora a VMNI tenha sido evidenciada como uma pratica controversa para os pacientes sob investigação de H1N1, neste relato de caso mostrou-se eficaz quando aplicado criteriosamente e bem indicado.(AU)

Objectives: To present, in a series of case reports, the use of non invasive ventilation (NIV) in patients with acute lung injury (ALI) and swine-origin influenza A H1N1 suspicion, in Intensive Care Unit of Eduardo de Menezes Hospital (HEM). Materials and Methods: Four women, aged between 16 and 50, with ALI, underwent a protocol of NIV in micro processed ventilators, using full face mask and minimal parameters to obtain an improvement of tachidispnoea and drop of oxygen saturation; according to protocol created by UCI team. Results: There was an improvement of respiratory pattern and saturation, seen clinically and through arterial blood gas analyses and chest radiography; shorter stay in UCI (3-5 days), and there was no need of endotracheal intubation, decreasing complications and costs. Conclusion: Although NIV has been a controversial practice to patients under suspicion of swine-origin influenza, this case report showed efficacy when carefully applied and indicated.(AU)

Stress-induced Cardiomyopathy Associated with Swine Influenza Infection Which Exacerbated Underlying Emphysema: A Case Report / 대한구급학회지

Stress-induced cardiomyopathy (SICM) is an acute cardiac condition that causes left ventricular apical ballooning which mimicks acute coronary syndrome. The risk of in-hospital mortality with SICM is generally low (1% to 3%) and supportive care is usually sufficient for resolution. Swine-origin influenza A (H1N1, S-OIV) is a recently spreading pandemic and a serious public health problem. Although most S-OIV infections have a mild, self-limited course, clinical cases resulting in fatalities and associated with variable co-morbidities remain as a serious concern in some individuals. Among such serious complications, there have been few reports of SICM caused by S-OIV infection. We herein report, for the first time in the literature, a case with fatal hemodynamic instability secondary to SICM caused by S-OIV infection with viral pneumonia.

Outbreak of Swine-Origin Influenza A (H1N1); Experience of a Regional Center in Seoul during a Month, August-September 2009 / 대한임상미생물학회지

BACKGROUND: The aim of this study is to clarify the epidemiology of swine-origin influenza A (H1N1) virus 2009 (S-OIV) during the first month of outbreak at one of influenza clinic in Seoul, Korea. METHODS: We documented the epidemiologic and clinical features of S-OIV-confirmed cases who visited a university hospital in Northeastern Seoul between August 21 and September 20, 2009. Nasopharyngeal swab of patients with acute febrile respiratory illnesses were evaluated with rapid influenza antigen tests and multiplex RT-PCR for S-OIV and seasonal influenza A. RESULTS: A total of 5,322 patients with acute febrile respiratory illnesses were identified at our influenza clinic for the study period. S-OIV was confirmed in 309 patients by RT-PCR. The patients ranged from 2 months to 61 years of age and 189 patients (61.2%) were teenagers. Eighty-one patients had known contact with S-OIV-confirmed patients in schools (N=61), households (N=15), and healthcare facilities (N=3). Frequent symptoms were fever (94.5%), cough (73.1%), sore throat (52.1%), and rhinorrhea (50.5%). Gastrointestinal symptoms were also present in 10 patients (4.9%). Ten patients (4.9%) required hospitalizations. Seventy patients (22.7%) could not take oseltamivir at the first visits, however, all of them recovered without complication. Rapid antigen tests showed the sensitivity of 44.4% (130/294). Patients with positive antigen tests, compared with negative antigen tests, showed higher frequencies of rhinorrhea (60.8% vs 43.3%, P=0.004) and stuffy nose (33.8% vs 20.1%, P=0.012). CONCLUSION: S-OIV infections spread predominately in school-aged children during the early accelerating phase of the outbreak. Rapid influenza antigen tests were correlated with nasal discharge and obstruction.

Swine Influenza A (H1N1) Infection in Renal Transplant Recipients / 대한이식학회지

BACKGROUND: Novel H1N1 influenza A was a pandemic disease in 2009. However, limited data are available on renal transplant recipients undergoing long-term immunosuppression who contracted novel H1N1 influenza A. METHODS: We analyzed 2,345 patients who had been tested with H1N1 swab real-time reverse transcriptase-polymerase chain reaction test (rRT-PCR) between May 2009 and February 2010. Of them, 30 were kidney recipients who underwent kidney transplantation between April 1979 and 2, May 2009 before the first diagnosis of H1N1 influenza A in Korea. The clinical characteristics, treatment, and outcome of renal transplant recipients with confirmed H1N1 influenza were reviewed retrospectively. RESULTS: A total of 1,543 (66.7%) general patients were swine influenza A confirmed. Of the 30 transplant patients, 19 (63.3%) were confirmed with swine influenza A. The mean age of the general patients at diagnosis of swine influenza A was younger than that of renal recipients (16.5+/-16.1 vs. 39.7+/-11.5 years, P<0.0001). More patients died in the transplant group than in the general patient group even after oseltamivir (Tamiflu) treatment. When comparing the cured group with the dead group of transplant patients, the dead group had a longer duration between symptom manifestation and the beginning of treatment than the cured group (7 [5-7] vs. 2 [1-14] days, P=0.007). The dead group presented more complications such as pneumonia (P=0.009). CONCLUSIONS: H1N1 influenza A can cause severe illness in kidney transplant recipients. We suggest that early diagnosis and treatment with an antiviral agent produces good results in kidney transplant recipients as in the general population.

Constrictive Pericarditis Accompanied by Swine-Origin Influenza A (H1N1) Infection

Swine-origin influenza A (H1N1) is caused by a new strain of the influenza virus. The disease has spread rapidly and was declared a pandemic in April, 2009. So far, however, there is a scarcity of information regarding the complications of swine influenza. A report of the disease in the winter of 2009 in the Southern Hemisphere found that the most common manifestations of influenza A virus infection are upper respiratory tract infection and pneumonia. Although there may be an association between fulminant myocarditis and Swine influenza, cardiovascular complications resulting from swine Influenza A infection are exceedingly rare. We report a case of acute constrictive pericarditis in a healthy subject infected by the swine-origin influenza A (H1N1) virus.

An update of 2009 influenza A (H1N1) virus / 医学研究生学报

Swine influenza A virus belongs to the family of Orthomyxoviridae,which can cause upper respiratory tract infection in swine,avian and human.The influenza A virus that could not be sub-typed was detected from the respiratory tract specimens of patients with influenza-like symptoms in March 2009 in USA and Mexico,followed by identification of a novel swine-origin influenza A (H1N1) virus (S-OIV),which led to an epidemic outbreak in the above two countries and then spread all over the world,causing quite a few deaths.S-OIV differs from other influenza viruses in genotyping,antigenic characteristics,propagating characteristics,pathogenic characteristics and therapies.