Sunday, June 28, 2009

Lungs that “catch fire” in a matter of hours

I mentioned the problem with A flu in Argentina. It seems to be more lethal than usual (beside the crappy government doing nothing about it) and it worries doctors that it can kill perfectly healthy teenagers and young adults in a matter of days.
The problem is very serious and the Health Minister of Argentina is expected to resign tomorrow.
I read this article in Spanish but just now found a translated version.



Lungs that “catch fire” in hours

We are seeing the internment of young patients, among 15 and 50 years, with pneumonias, some that evolve quickly towards a gravity that stops many is unusual, in which the lung “catches fire” in a matter of hours”, commented doctor Jorge San Juan, head of the Department of Intensive Therapy of the Muñiz hospital.
That has taken to that the patients of these characteristics begin to be treated in more and more aggressive form. As the NATION informed yesterday, the doctors received from the Ministry of Health the directive to take, of now in more, to all the cases of influenza like potentials of A influenza (H1N1), with the recommendation to realise x-rays of thorax to the patients with fever symptoms and fatigue and to commit quickly to which they suffer pneumonia.
“Today, that already is known that the virus is circulating massively, the attitude that has itself with the patients depends on the clinical evaluation that the doctor does, so that he is not transformed into a serious case. No longer [is necessary to make the diagnosis of laboratory that confirms the infection by the new virus] to begin the treatment”, said doctor Vilma Savy, female leader of the Respiratory Service of Virus of the Malbrán institute.
The preoccupation by how it attacks this influenza some young people was confirmed to the NATION by a forensic doctor who, in the last hours, realised two autopsies in two people passed away by influenza A.
“The bodies had the vísceras, meninges and the brain inflamed, a factor little common in which dies by influenza. In addition, the lungs were in very bad state, with spots that we have not been able to identify. We sent them to realise studies of pathological anatomy”, said the pathologist that it asked not to present his name until the sanitary authorities took note from the found thing.
The changes in the strategies of attention of the patients who arrive with advanced pictures of influenza aim at being more aggressive: to try, and later to see what happens; to burn stages. “This form of attention of the serious patient will change the evolution and will avoid more deaths and pneumonias - doctor San Juan affirmed, coordinator of the Committee of Emergencia Epidemiologist of the Buenosairean Ministry of Health.
For a serious pneumonia, San Juan explained, today the patients not only receive antibiotics in empirical form but also antiviral and the possibility is not delayed of resorting to the mechanical respiratory attendance. “Although 24 hours are expected generally to see how it evolves, we suggested not to do it and, if it is unbalanced quickly, to arrive at intubation”, it needed San Juan.
The province of Buenos Aires will count, as of the next week, with tests of fast diagnosis that will allow to discriminate, in only 15 hisopados minutes by means of, if the person is carrying of influenza A. Anyway, the final confirmation will give the Malbrán institute it. The new test will serve to begin the treatment before, informed the Buenosairean sanitary authorities.


http://babelfish.yahoo.com/translate_url?doit=done&tt=url&intl=1&fr=bf-home&trurl=http%3A%2F%2Fwww.lanacion.com.ar%2Fnota.asp%3Fnota_id%3D1144216&lp=es_en&btnTrUrl=Translate[/url]

FerFAL

9 comments:

Anonymous said...

I found a reference to Argentina on BBC: http://news.bbc.co.uk/2/hi/americas/8122262.stm

Apologies if this link has already been posted.

Anonymous said...

Ferfal,

An excellent site on the flu for you:

http://www.recombinomics.com

Sara R said...

I read a book on the 1918 flu epidemic ("The Great Influenza" by John Barry), and this sounds kind of like that. At first, in the spring of 1918, the virus was pretty mild. Then by August/September the virus mutated and caused many deaths.

The flu virus multiplies by taking over a cell, and converting that cell into a factory to duplicate the virus, killing the cell in the process.

In the 1918 flu, some people died within hours of first symptoms, some within 1-2 days, and some within a week or two. The deaths within a week or two were of normal pneumonia, the way most flu deaths are. The deaths within hours were because the virus took over so many lung cells so quickly that the lung cells couldn't exchange enough oxygen.

But the especially interesting cases were the deaths in 1-2 days. Their lungs were filled with blood. But why? Usually if the lungs fail, they are empty. What happened was that the virus got down into the lungs before the immune system could stop it, and the immune system attacked the virus there in the lungs. The lungs aren't meant to be a battleground for the immune system; usually the immune system kills the virus before it reaches the lungs. As part of that immune system battle, the lungs filled with blood. The immune system response was the immediate cause of death in those cases.

Young people have stronger immune systems, which is probably why the 1918 flu affected them in greater numbers.

Best wishes to you and your family. Thank you for your blog.

Don Williams said...

1) Ferfal, the suggestion by an earlier poster that you can sterilize a N95 mask with Lysol is probably a bad idea.

2) In 2006, the US Government recognized that it would have a severe N95 mask shortage if the Avian flu turned pandemic. It asked a Committee of our top scientists and doctors to see if there was someway to sterilize N95 masks to reuse them. The conclusion of the committee was No.

3) The problem is that N95 masks filter out small particles with special materials having an electrical static charge. The Committee concluded that any technique that rendered the mask sterile would also destroy the filter material. Part of the Committee's work included interviewing the mask manufacturers.

You might think that lightly spraying Lysol on the outer surfaces would not affect the inner filter material -- but in that case, it would not kill viruses trapped in that inner filter material.

4) The only option the Committee could offer to extend the life of the N95 was to place a Surgical mask OVER the N95 mask in order to protect the N95 mask from contamination -- with the user being careful to remove the surgical mask , dispose of it and applying a new surgical mask in next period of use. That seems to be the guidance being followed by US health departments.

Full Report is here:
http://www.premierinc.com/quality-safety/tools-services/safety/topics/influenza/downloads/facemasks-pandemic-flu.pdf

A US state health department using their guidance is here:
http://pandemic.wisconsin.gov/subcategory.asp?linksubcatid=3083&linkcatid=3124&linkid=

Don Williams said...

PS
1) The US Food and Drug Administration has now cleared several additional N95 masks for use in the flu emergency, including the common 3M 8210 model which, at least in the USA, is the common dust mask used in building construction.

2) FDA reservations re these models are what i noted earlier:
a) they require somewhat more expertise to get an airtight fit than the FDA model 3M 8612F and
b) some of the newly approved models --including the 3M 8610 -- are not as resistent to spit
or blood being sprayed onto the outer surface.

3) But I think the average person -- unlike a healthcare worker -- is unlikely to have a flu
victim spit a glob of phlegm in their face. Nor does the average person have to insert ventilation tubes down a patients throat.

FDA/CDC message at :
http://www.cdc.gov/h1n1flu/eua/summary-factsheet.htm

4) Duct tape may help if a mask has one area that is difficult to seal around your face.

vdavisson said...

FerFAL please get some Vitamin D immediately!!

Read this article.

http://journals.cambridge.org/download.php?file=%2FHYG%2FS0950268806007175a.pdf&code=b8b8a5129561fd1881bc6fe8a66d382c

It's vital that you stay healthy!

Sara this article answers your questions. It's winter in South America right now and it's likely you can't get enough sunshine at Bs.As. latitude to ward off flu.

FerFAL you need at least 5,000 IU of Vitamin D per day per person.

Praying for you all.

Here's a summary of the article:

Epidemiology and Infection, known as The Journal of Hygiene in Hope-Simpson's day, recently published our paper. The editor, Professor Norman Noah, knew Dr. Hope-Simpson and helped tremendously with the paper. In the paper, we detailed our theory that vitamin D is Hope-Simpson's long forgotten "seasonal stimulus." We proposed that annual fluctuations in vitamin D levels explain the seasonality of influenza. The periodic seasonal fluctuations in 25-hydroxy-vitamin D levels, which cause recurrent and predictable wintertime vitamin D deficiency, predispose human populations to influenza epidemics. We raised the possibility that influenza is a symptom of vitamin D deficiency in the same way that an unusual form of pneumonia (pneumocystis carinii) is a symptom of AIDS. That is, we theorized that George Bernard Shaw was right when he said, "the characteristic microbe of a disease might be a symptom instead of a cause."

more below...

vdavisson said...

continued...

In the paper, we propose that vitamin D explains the following 14 observations:

1. Why the flu predictably occurs in the months following the winter solstice, when vitamin D levels are at their lowest,

2. Why it disappears in the months following the summer solstice,

3. Why influenza is more common in the tropics during the rainy season,

4. Why the cold and rainy weather associated with El Nino Southern Oscillation (ENSO), which drives people indoors and lowers vitamin D blood levels, is associated with influenza,

5. Why the incidence of influenza is inversely correlated with outdoor temperatures,

6. Why children exposed to sunlight are less likely to get colds,

7. Why cod liver oil (which contains vitamin D) reduces the incidence of viral respiratory infections,

8. Why Russian scientists found that vitamin D-producing UVB lamps reduced colds and flu in schoolchildren and factory workers,

9. Why Russian scientists found that volunteers, deliberately infected with a weakened flu virus - first in the summer and then again in the winter - show significantly different clinical courses in the different seasons,

10. Why the elderly who live in countries with high vitamin D consumption, like Norway, are less likely to die in the winter,

11. Why children with vitamin D deficiency and rickets suffer from frequent respiratory infections,

12. Why an observant physician (Rehman), who gave high doses of vitamin D to children who were constantly sick from colds and the flu, found the treated children were suddenly free from infection,

13. Why the elderly are so much more likely to die from heart attacks in the winter rather than in the summer,

14. Why African Americans, with their low vitamin D blood levels, are more likely to die from influenza and pneumonia than Whites are.

Although our paper discusses the possibility that physiological doses of vitamin D (5,000 units a day) may prevent colds and the flu, and that physicians might find pharmacological doses of vitamin D (2,000 units per kilogram of body weight per day for three days) useful in treating some of the one million people who die in the world every year from influenza, we remind readers that it is only a theory. Like all theories, our theory must withstand attempts to be disproved with dispassionately conducted and well-controlled scientific experiments.

However, as vitamin D deficiency has repeatedly been associated with many of the diseases of civilization, we point out that it is not too early for physicians to aggressively diagnose and adequately treat vitamin D deficiency. We recommend that enough vitamin D be taken daily to maintain 25-hydroxy vitamin D levels at levels normally achieved through summertime sun exposure (50 ng/ml). For many persons, such as African Americans and the elderly, this will require up to 5,000 units daily in the winter and less, or none, in the summer, depending on summertime sun exposure.

Anonymous said...

There's a great editorial about this up on the CNN, Fox, and MSNBC sites detailing how we here in the US can expect it to possibly come to the US over the summer and also how to minimize your risk of catching it when/if it does.

Just kidding. Those websites are still stuck on the Michael Jackson stupidity and are not at all interested in telling us about things that could possibly help us to avoid similar situations here and/or how we could help people in Argentina.

SimplyTim said...

FerFal,

There is an early release original article from the New England Journal of Medicine: Severe Respiratory Disease Concurrent with the Circulation of H1N1 Influenza (http://content.nejm.org/cgi/content/full/NEJMoa0904023?query=TOC)which you and your readers may find interesting.

The authors looked at "From March 24 to April 29, 2009, a total of 2155 cases of severe pneumonia, involving 821 hospitalizations and 100 deaths, were reported to the Mexican Ministry of Health."

They noted: "During the study period, 87% of deaths and 71% of cases of severe pneumonia involved patients between the ages of 5 and 59 years, as compared with average rates of 17% and 32%, respectively, in that age group during the referent periods. Features of this epidemic were similar to those of past influenza pandemics in that circulation of the new influenza virus was associated with an off-season wave of disease affecting a younger population."

They theorized that people who were born before 1957 and therefore had some limited exposure to similar viral strains have obtained some limited immunity. That impression is supported in that there were few if any deaths in the age group 60 or older.

One of the implications was that since there was a lower probability of pneumonia in that age group, that a strategy for vaccine allocation would be to weigh the 5-50 age group more heavily.

On an accecdotal level, I was at a local hospital today having some routine laboratory work. Each waiting room, receptionist area, check-in area, etc. had bottles of hand sanitizer available, and also boxes of gauze face masks for the taking. I took a total of 4, and 2 are now in my car and 2 in my office.

Tim