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【medical-news】《柳叶刀》：早期奥塞米韦（Osel
Since the first documented case of human H5N1 infection in 2003, one-third of cases world-wide have occurred in Indonesia, where the case-fatality rate is high.
Reporting in the August 30th issue of The Lancet, investigators at the Ministry of Health and the WHO Indonesia Country Office in Jakarta describe the factors associated with mortality in a case series of 127 patients with H5N1 diagnosed between June 2005 and February 2008.
The case-fatality rate rose with time, from 65% (13 of 20 cases) in 2005, to 82% in 2006 (45/55), 87% in 2007 (37/42), and 80% in the first 33 days of 2008 (8/10).
Eight-eight patients were treated with oseltamivir at a median of 7 days from symptom onset (range 0-21 days). The one patient treated within 48 hours survived. Survival was 36% in those who started treatment between 2 and 4 days, 38% for those treated between 5 and 6 days, and 19% among the remaining treated patients.
"In the absence of evidence to the contrary, oseltamivir treatment should be given as early as possible to all suspect H5N1 cases," Dr. Toni Wandra and co-authors emphasize. As they found, however, timely diagnosis is difficult because early symptoms tend to be nonspecific.
The authors identified 11 case clusters involving 28 patients. Being part of a cluster was the only factor in multivariate analysis that was negatively associated with mortality, which the researchers attribute to earlier identification and treatment in secondary cases.
Dr. Wandra's team call for development of better diagnostic methods for early detection, as well as widespread dissemination of information regarding avian outbreaks, in order to decrease mortality from H5N1 infection.
In an editorial, Dr. Sheila M. Bird at MRC Biostatistics Unit in Cambridge, UK, and Dr. Jeremy Farrar at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam, stress the need for more complete documentation of exposure history, clinical and epidemiological data, time-to-event data, and improved testing and treatment for confirmed human H5N1 cases.
By maintaining "minimum datasets," the editorialists believe that relevant clinical, laboratory, and exposure features will be identified, aiding in the development of diagnostic tests and treatment protocols.
"Consideration needs to be given now - not in the teeth of a pandemic, and not deflected by either proprietary defensiveness or opportunistic profiteering - to gauging the comprehensiveness of national surveillance..., and to ensuring the analyzability of a minimum dataset (for) every confirmed case of human H5N1."
Lancet 2008;372:696-697,744-749. 水平不行，有很多问题，还是放弃了，请其他战友来 [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-08-13 17:11
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