This document discusses influenza viruses and pandemics. It covers the taxonomy and anatomy of influenza viruses, noting there are three types (A, B, C) that can infect humans. Type A is of most concern as it can undergo antigenic shift, resulting in new subtypes that have caused past pandemics like the 1918 Spanish flu. The document outlines the influenza virus life cycle and how it is transmitted. It also discusses diagnosis of both human and avian influenza, noting some strains of avian H5N1 can cause severe disease in humans.
What is Influenza ?
History of influenza
Influenza Classification
Structure of influenza
Types of influenza viruses
How Influenza Viruses Change
Avian influenza
Swine influenza- Influenza A 2009 H1N1 A / Mexico / 001 / 2009 (H1N1)
Seasonal flu/ Pandemic
Treatment for H1N1 flu
Influenza, commonly known as "the flu", is an infectious disease of birds and mammals caused
Influenza (the flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death.
Resistance of Virus
Inactivated by heating at 500c for 30 mt
Survive for 1 week at 0 – 40c for 1 week
Ether, formaldehyde, Phenol destroy the virus
•The first recognized pandemic occurred in July and August of 1510 when an outbreak of “gasping oppression” appeared nearly everywhere at once. It was described as a “„gasping oppression‟ with cough, fever, and a sensation of constriction of the heart and lungs”, leaving an impression strong enough for people to write of it decades later (Morens et al, 2010). At least seven contemporary and near-contemporary reports exist of the 1510 pandemic (Morens, North & Taubenberger, 2010).
• H1N1, which caused Spanish flu in 1918, and the 2009 flu pandemic
• H2N2, which caused Asian Flu in 1957
• H3N2, which caused Hong Kong Flu in 1968
• H5N1, a current pandemic threat
• H7N7, which has unusual zoonotic potential
• H1N2, endemic in humans and pigs
• H9N2
• H7N2
• H7N3
• H10N7
What is Influenza ?
History of influenza
Influenza Classification
Structure of influenza
Types of influenza viruses
How Influenza Viruses Change
Avian influenza
Swine influenza- Influenza A 2009 H1N1 A / Mexico / 001 / 2009 (H1N1)
Seasonal flu/ Pandemic
Treatment for H1N1 flu
Influenza, commonly known as "the flu", is an infectious disease of birds and mammals caused
Influenza (the flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death.
Resistance of Virus
Inactivated by heating at 500c for 30 mt
Survive for 1 week at 0 – 40c for 1 week
Ether, formaldehyde, Phenol destroy the virus
•The first recognized pandemic occurred in July and August of 1510 when an outbreak of “gasping oppression” appeared nearly everywhere at once. It was described as a “„gasping oppression‟ with cough, fever, and a sensation of constriction of the heart and lungs”, leaving an impression strong enough for people to write of it decades later (Morens et al, 2010). At least seven contemporary and near-contemporary reports exist of the 1510 pandemic (Morens, North & Taubenberger, 2010).
• H1N1, which caused Spanish flu in 1918, and the 2009 flu pandemic
• H2N2, which caused Asian Flu in 1957
• H3N2, which caused Hong Kong Flu in 1968
• H5N1, a current pandemic threat
• H7N7, which has unusual zoonotic potential
• H1N2, endemic in humans and pigs
• H9N2
• H7N2
• H7N3
• H10N7
Content & references in part including multimedia content (illustrations, videos) might be taken from the public domain, by no means, aiming at copyrights infringement. All intellectual property rights reserved with the owners.
Content & references in part including multimedia content (illustrations, videos) might be taken from the public domain, by no means, aiming at copyrights infringement. All intellectual property rights reserved with the owners.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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2. The premier john of the
drama
Pandemics
Spanish flue A (H1N1) 1918
Asian flue A (H2N2) 1957
Hong Kong flue A (H3N3) 1968
Russian flue A (H1N1) 1977
2
3. What we will speak about
Introduction
Family orthomyxoviridae
Influenza virus
Anatomy
Naming
Zoonosis
Transmission to human How?
3
9. HA protein - attachment,
fusion
HA
9
S S
S S
S S
cell enzymes
acid pH
10. anatomy
orthomyxoviridae 10
HA - hemagglutinin
NA - neuraminidase
helical nucleocapsid (RNA plus
NP protein)
lipid bilayer membrane
polymerase complex
M1 protein
type A, B, C : NP, M1 protein
sub-types: HA or NA protein
11. ORTHOMYXOVIRUSES 11
HA - hemagglutinin
NA - neuraminidase
helical nucleocapsid (RNA plus
NP protein)
lipid bilayer membrane
polymerase complex
M1 protein
17. Family
orthomyxoviridae
Influenza A B and C
Only A and B can cause Human disease
Influenza A
infect awide variety of mammals
And tends undergo antigenic changes
17
18. Virus character
Enveloped (80-120 nM )
Segmented negative stranded RNA
8 segment A and B
7 segments c
Total genome size average 13.6
Average 0.89 – 2.34 kb each segment
18
19. type A, B, C : NP, M1
protein
sub-types: HA or NA protein
19
HA - hemagglutinin
NA - neuraminidase
helical nucleocapsid (RNA plus
NP protein)
lipid bilayer membrane
polymerase complex
M1 protein
20. Influenza Asubtypes
15 hemagglutinine
9 Neuraminidase subtypes
Subtypes of type A
Important for human
H1N1
H2N2
20
21. Antigentic shift drift
Antigenic shift
Completely new HA subtype
Only with influenza A
Assocaited with pandemics
Antigenic drift
Relatively minor subtype changes
Influenza A and B
EPIDEMIC and regional out break
21
22. Influenza virus
3types
Type A
Associated with widespread epidemic
Pandemic
TYPE B infrequently associated with
regional wide spread epidemic
Type C
associated with sporadic cases
minor localized disease
22
23. How to name influenza
virus
Type ABC citystrain#year
isolatedglycoprotein
HA (1-15)
NA ( 1-9)
eg. AHONG KONG031968H3N3
World wide pandemics= pandemic
1918-1919 influenza pandemic caused
2o million deathes
1947 asian influenza
23
24. Influenza changes rapidely
Antigenic drift
substitution in HA and NA
This can increase the escape from the
immune system
Antigenic shift assortment of gene
segment in cells
Infected by different strain avian gene
substituted with human strain gene
Swine can replicate both strain
This can open up for infection of new host
Both make it difficult to obtain good
vaccine
24
25. 25
Influenza A Viruses to Humans
Human
virus
Reassortant
virus
Transmission of Avian
Non-human
virus
15 HAs
9 NAs
27. Timeline of Emergence of
Influenza Viruses in Humans
27
H9
1998/9
1918 1957 1968 1977 1997
2003
H1
H1
B
H2
H7
H5 H5
Spanish
Influenza
Asian
Influenza
Russian
Influenza
Avian
Influenza
Hong Kong
Influenza
H3
Pandemic
vaccines
Regular vaccines
1918
28. Influenza Virus Types &
Subtypes in Humans
(Trivalent Vaccine)
Type A
Seasonal epidemics caused by H3N2, H1N1, and
H1N2 subtypes
Pandemics (caused by new subtypes)
Type B
No subtypes
Seasonal epidemics only
28
29. Timeline of Emergence of
Influenza Viruses in Humans
29
H9
1998/9
1918 1957 1968 1977 1997
2003
H1
H1
B
H2
H7
H5 H5
Spanish
Influenza
Asian
Influenza
Russian
Influenza
Avian
Influenza
Hong Kong
Influenza
H3
Pandemic
vaccines
Regular vaccines
38. Influenza pandemics
Antigenic shift has occurred at least 3
times in the past, each time resulting in
highly lethal pandemics.
All three pandemics in the 20th century
spread world wide within 1 year of
detection
1918 Spanish flu (H1N1) which caused
the death of 20-40 million people
1957 Asian flu (H2N2)
1968 Hong Kong flu (H3N2). This
subtype still circulates today.
38
39. Lessons from the past
Hospital in
pandemic
Photo of the caution taken by officials during
the influenza epidemic of 1918
39
.
41. 41
TRACHEAL MUCOSA NORMAL
7 DAYS POST-INFECTION
pathogenesis
NORMAL TRACHEAL MUCOSA
3 DAYS POST-INFECTION
Lycke and Norrby Textbook of
3 DAYS DAYS POST-INFECTION
POST-INFECTION
45. Avian influenza
The highly pathogenic
form of avian
influenza A was first
recognized in Italy in
1878
45
46. Highly pathogenic
This strain
46
It is extremely
contagious and
rapidly fatal in
birds with a mortality
approaching 100%.
47. All outbreaks of the highly pathogenic form of avian
influenza have been caused by subtypes H5 and H7.
47
48. The virus multiplies in the intestines of these birds and is
shed in saliva, nasal secretions and feces.
48
49. A single gram of contaminated feces
contains enough virus to infect 1
million birds
The virus can survive in
contaminated manure for up to 3
months and in contaminated water up
to 30 days.
Birds that survive infection excrete
virus for at least 10 days, orally and
in feces, thus facilitating further
spread.
49
50. H5N1 has jumped the species barrier on 2
separate occasions in the recent past causing
severe disease in humans.
The first documented human infection by H5N1
occurred in Hong Kong, China in 1997.
18 people were hospitalized, 6 died.
The entire domestic bird population of Hong
Kong, 1.5 million birds, was culled in 3 days.
Human infection stopped after all chickens were
culled.
Limited human-to-human transmission of H5N1
was documented.
50
51. How do people die?
Unlike influenza viruses we are
more familiar with in which
respiratory symptoms dominate,
H5N1 replicates in a wide range
of cell types
This results in severe
disseminated disease affecting
multiple organs and causing
high mortality.
51
52. Presentation
Patients with documented H5N1 typically present to
the hospital 2-6 days after the onset of fever and
cough.
Other early symptoms include sore throat, runny
nose and myalgia's. SOB develops in 1 to 5 days.
At admission all patients have clinically apparent
pneumonia with either patchy or interstitial
infiltrates.
Leukocyte count is normal or decreased, and
transaminases may be mildly to moderately
elevated.
Patients go on to develop disseminated disease
affecting multiple organs
Secondary bacterial infection has not been a factor
52
54. There are 2 classes of drugs available that are
effective against the influenza virus:
The M2 inhibitors: amantidine and ramantidine
The neuraminidase inhibitors: oseltamivir and
zaminivir
In preliminary studies H1M5 has been shown to be
resistant to the M2 inhibitors
54
55. Another interesting bit of information
H5N1 infection has been confirmed in a
single household of domestic cats in
Thailand. 14 of 15 cats in the household
died.
One dead cat was known to have
contact with a dead chicken.
Up to now, domestic cats were not been
considered susceptible to infection with
influenza viruses although some older
studies from the 1970s reported
experimental infection of domestic cats
under laboratory conditions.
55
56. Diagnosis
The role of profetional
How it is down
At what level
56
57. avian
History of high
mortality
Clinical signs
nervous signs
Diarhae
Sudden death
57
58. diagnosis
PM
The respiratory
digestive system
Multiorgans
affected
58
60. identification
Procedures
Inoculation of 9-11day old emryonated
chicken eggs followed by
Haemagglutination immunodiffusion test
Confirm presence of influenza virus
Subtype determination with nonspecific
antisera
Strain virulence evaluation of
intravinouspathogencity index (IVPI) in 4-8
week old chicken
60
61. Serology
Tests available
ELISA Detect antibodies to AI virus
Doesn’t distinguish subtypes
AGID
Agar gel diffusion
Both within 1 week of infection
HI haemagglutination I inhibition test
Serotype specific test
Available for each H subtype
HI titers are positive a few days later than
ELISA
61
62. Enzyme linked
immunabsorbant assay (ELISA)
62
Sample to be tested
virus
capturing antibody
Enzyme -> colour
Detecting antibody
66. RT -PCR
Reverse transcriptase polymerase chain reaction
Able to detect virus at very low level
The presence of subtype H5or H& can be
confirmed BY using H5 or H7 specific primer
66
70. MORTALITY
MAJOR CAUSES OF INFLUENZA VIRUS- ASSOCIATED
DEATH
BACTERIAL PNEUMONIA
CARDIAC FAILURE
90% OF DEATHS IN THOSE OVER 65 YEARS OF AGE
70
73. Prevention by vaccine
inactivated
egg grown
sub-unit vaccine for children
reassortant live vaccine approved 2003
for healthy persons (those not at risk for complications from
influenza infection) ages 5-49 years
73
74. Prevention of Influenza
Avoid close contact
with people who
are sick
Stay home when
you are sick
Cover Your Cough
Frequent hand
washing
Avoid touching
eyes, nose or mouth
Antiviral drugs
74
76. Drugs preventive
RIMANTADINE (M2)
type A only
AMANTADINE (M2)
type A only
ZANAMIVIR (NA)
types A and B, not yet approved for prevention
OSELTAMIVIR (NA)
types A and B
76
77. Treatment drug
RIMANTADINE (M2)
type A only, needs to be given early
AMANTADINE (M2)
type A only, needs to be given early
ZANAMIVIR (NA)
types A and B, needs to be given early
OSELTAMIVIR (NA)
types A and B, needs to be given early
77
78. Avian influenza vaccine
Convential vaccine
Inactivated oil emulsion vaccine used
world wide
Recominant vaccine
Vector I LT vaccine or pox
Heteroglogous vaccine
In avian influenza contain the same
agglutinine
Adifferent Neuramindase
78