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NEJM -- Prevention and Treatment of Seasonal Influenza

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clinic practice nejm on 2009-01-26
- oseltamivir
- influenzaA/New Caledonia (H1N1)
- 9 more annotations...
- - This increase, as well as an increase over time in deathsfrom any cause attributed to influenza,⁶ occurred despite
  - Onereason is that many older persons and persons with debilitatingchronic conditions have a reduced ability to respond immunologicallyto the currently available influenza vaccines.¹
  - According to the Advisory Committee on Immunization Practices(ACIP),¹³ influenza vaccination is currently recommended forall persons 50 years of age or older, all children between 6months and 18 years of age, and persons 19 to 49 years of agewho have underlying medical conditions, are pregnant, are employedas health care workers, or are household contacts of high-riskpersons (a group that includes all children in the householdwho are younger than 5 years of age)
  - The province of Ontario, Canada
  - Inthe past 5 years, a new variant that was not contained in thevaccine has been the major virus involved in 80% of the epidemics.
  - For maximumeffectiveness, the vaccine should be administered before influenzaviruses begin to spread; structured programs for the deliveryof the vaccine are needed.
  - Both the trivalentinactivated vaccine and the live attenuated influenza vaccineare well tolerated; the most common side effects are tendernessat the site of injection in the case of the trivalent inactivatedvaccine and transient sore throat or nasal stuffiness in thecase of the live attenuated influenza vaccine.
  - the live attenuated influenza vaccine
  - real-timeregional or community surveillance of influenza virus activity
NEJM -- Case 2-2009 -- A 25-Year-Old Man with Pain and Swelling of the Right Hand and Hypotension

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clinic nejm case on 2009-01-26
- Jugular venous distentionwas 10 cm, measured at a 45-degree angle.
- A chest radiograph showed perihilar opacitiesand blurring of the pulmonary vasculature, findings that wereconsistent with interstitial edema.
- 16 more annotations...
- - Vancomycin and clindamycin
  - This patient has severe sepsis, a diagnosis basedon a temperature greater than 38.0°C, a heart rate of morethan 90 beats per minute, respirations of more than 20 breathsper minute, a white-cell count of more than 12,000 per cubicmillimeter, and evidence of organ dysfunction; the organ dysfunctionplaces him at increased risk for death
  - Septic shock is associated with a mortality rate of 30 to 50%
  - pulmonary capillary dysfunction
  - The third objective is to achieve adequate tissue perfusion,as measured by central venous oxygen saturation.
  - timely and appropriateantibiotic administration has been shown to reduce the mortalityrate significantly.
  - simple cellulitis
  - Necrotizing fasciitis
  - spontaneous, traumatic, or surgical disruption of bowelintegrity
  - unfavorableprognostic sign
  - streptococcaltoxic shock syndrome
  - those with low levels of specific antibodiesagainst the infecting strain and against streptococcal superantigensproduced by that strain
  - Clindamycin,
  - Intravenous immune globulin
  - hyperimmunoglobulinemia E syndrome
  - rattlesnakes
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Updated on 2009-01-26
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tgkuo1 Kuo's List: clinic

NEJM -- Prevention and Treatment of Seasonal Influenza

NEJM -- Case 2-2009 -- A 25-Year-Old Man with Pain and Swelling of the Right Hand and Hypotension

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