To the Editor: Between April 23, 2009, and May 15, 2009, we performed 15 autopsies on deceased patients in whom probable influenza had been diagnosed either clinically or macroscopically. Small samples of lung tissue were obtained and taken for analysis to the Institute of Epidemiological Diagnosis and Reference in Mexico City.
To the Editor: Early epidemiologic reports regarding the 2009 pandemic influenza A (H1N1) virus suggest that cases of infection and deaths are concentrated in adults between the ages of 20 and 40 years.1 This finding could reflect age-related differences in susceptibility or differential testing and diagnosis in this age group.
2009 Nov 11 - NEJM Correspondence: Emergence of Oseltamivir-Resistant Pandemic H1N1 Virus during Prophylaxis
To the Editor: Neuraminidase inhibitors (oseltamivir and zanamivir) are recommended for treatment of severe illness caused by the 2009 pandemic influenza A (H1N1) virus, and their use has also been advocated for postexposure prophylaxis in high-risk persons.1 We report the emergence of an oseltamivir-resistant virus in a familial cluster of infections with the 2009 H1N1 virus.
On October 23, 2009, Food and Drug Administration (FDA) Commissioner Margaret Hamburg issued an Emergency Use Authorization (EUA) for peramivir for intravenous injection (BioCryst Pharmaceuticals). Peramivir is an unapproved investigational neuraminidase inhibitor that may be effective in treating certain hospitalized adult and pediatric patients with suspected or confirmed cases of 2009 H1N1 influenza. The EUA allows health care providers to use peramivir, subject to specified conditions. This is the first EUA that has been issued for an unapproved drug.
To the Editor: Ribavirin, an antiviral drug with in vitro activity against both DNA and RNA viruses, is approved in the United States for the treatment of hepatitis C and respiratory syncytial virus.1 Hepatitis C is treated with approved oral formulations in combination with interferon products; respiratory syncytial virus is treated with an aerosol formulation. Intravenous ribavirin is not currently approved in the United States.
To the Editor: The outcomes of in-hospital resuscitations in elderly patients are given a thorough presentation in the article by Ehlenbach et al. (July 2 issue).1 These data relate to the larger question of our responsibility in discussions of code status with patients and their families.
Decrements in kidney function occur in more than two thirds of hospitalized patients with critical illness,1 and severe acute kidney injury complicates the care of more than 5% of patients who require intensive care.2
Background The optimal intensity of continuous renal-replacement therapy remains unclear. We conducted a multicenter, randomized trial to compare the effect of this therapy, delivered at two different levels of intensity, on 90-day mortality among critically ill patients with acute kidney injury.
Background During the spring of 2009, a pandemic influenza A (H1N1) virus emerged and spread globally. We describe the clinical characteristics of the patients who were hospitalized with 2009 H1N1 influenza in the United States from April 2009 to mid-June 2009.
Methods Using medical charts, we collected data on 272 patients who were hospitalized for at least 24 hours for influenza-like illness and who tested positive for the 2009 H1N1 virus with the use of a real-time reverse-transcriptase–polymerase-chain-reaction assay.
Figure. CXR of a patient with the 2009 pandemic human swine influenza A (H1N1) - Photo courtesy of United Christian Hospital, Hong Kong
Background Planning for the treatment of infection with the 2009 pandemic influenza A (H1N1) virus through health care systems in developed countries during winter in the Northern Hemisphere is hampered by a lack of information from similar health care systems.
Presentation of Case: Dr. Jeffrey S. Ustin (Trauma, Emergency Surgery, and Surgical Critical Care): A 26-year-old man was admitted to this hospital because of abdominal distention and shock.
Background The rate of death, including sudden cardiac death, is highest early after a myocardial infarction. Yet current guidelines do not recommend the use of an implantable cardioverter–defibrillator (ICD) within 40 days after a myocardial infarction for the prevention of sudden cardiac death. We tested the hypothesis that patients at increased risk who are treated early with an ICD will live longer than those who receive optimal medical therapy alone.
To the Editor: Bosch and colleagues (July 2 issue)1 observe that although conventional hemodialysis filters do not remove myoglobin (molecular weight, 17.8 kD), hemodiafiltration with super-high-flux dialyzers may be effective.2
Your hospital has been seeing a large number of patients with influenza-like symptoms, many of whom turn out to be infected with the novel H1N1 influenza A virus. You have been asked to consult on the case of a 28-year-old woman who is in an isolation room because of an influenza-like presentation and shortness of breath.
Renal failure is a challenging complication of cirrhosis1,2 and is one of the most important risk factors when liver transplantation is being considered. Patients with cirrhosis and renal failure are at high risk for death while awaiting transplantation and have an increased frequency of complications and reduced survival after transplantation, as compared with those without renal failure.3,4
Stuart J. Connolly, M.D., Michael D. Ezekowitz, M.B., Ch.B., D.Phil., Salim Yusuf, F.R.C.P.C., et al., and the RE-LY Steering Committee and Investigators*
Warfarin reduces the risk of stroke in patients with atrial fibrillation but increases the risk of hemorrhage and is difficult to use. Dabigatran is a new oral direct thrombin inhibitor.
To the Editor: Brent (May 21 issue)1 discusses the osmolal gap in the management of ethylene glycol and methanol poisoning. Although a high anion gap is characteristic and an elevated osmolal gap is a useful indicator of toxic alcohols in blood, an understanding of their temporal relationship is essential to avoid mismanagement of these conditions. ....
"Policy decisions regarding influenza rest on judgments about the behavior of the virus, the impact of the disease and our ability to interdict its course. But the virus is capricious, the disease elusive, and our remedies imperfect," said a report on the 1976 swine-flu epidemic at Fort Dix.1
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Background A new pandemic influenza A (H1N1) virus has emerged, causing illness globally, primarily in younger age groups. To assess the level of preexisting immunity in humans and to evaluate seasonal vaccine strategies, we measured the antibody response to the pandemic virus resulting from previous influenza infection or vaccination in different age groups.
Background The 2009 pandemic influenza A (H1N1) virus has emerged to cause the first pandemic of the 21st century. Development of effective vaccines is a public health priority.