Risk Factors of Household Transmission of Pandemic (H1N1) 2009 among Patients Treated with Antivirals: A Prospective Study at a Primary Clinic in Japan

Background: Household transmission of influenza can affect the daily lives of patients and their families and be a trigger for community transmission, thus it is necessary to take precautions to prevent household transmission. We aimed to determine the risks of household transmission of pandemic (H1N1) 2009 influenza virus from an index patient who visited a primary clinic and was treated with antiviral drugs. Methods: We followed up all the patients who were diagnosed with influenza A by rapid diagnostic test with a questionnaire or interview from July 2009 to April 2010. Secondary cases were defined as patients visiting the clinic or other clinics and being positive for influenza A by rapid diagnostic test within 7 days of onset of an index patient. Logistic regression analysis was used to explore the association between household transmission and the studied variables. Results: We recruited 591 index patients and 1629 household contacts. The crude secondary attack rate was 7.3 % [95% confidence interval (CI): 6.1–8.7]. Age of index patients (0–6 years old: odds ratio 2.56; 95 % CI: 1.31–4.01; 7–12 years old: 2.44, 1.31–3.72; 30–39 years old 3.88; 2.09–5.21; 40 years old or more 2.76; 1.17–4.53) and number of household members with five or more (3.09, 2.11–4.07), medication started 48 hours from the onset of fever (2.38, 1.17–3.87) were significantly associated with household transmission. Conclusions: Household transmission was associated with index patients aged #12 years old and adults 30 years wit

Improving the identification of cancer in young people: A scoping review

peerreview_statement: The publishing and review policy for this title is described in its Aims & Scope. aims_and_scope_url: http://www.tandfonline.com/action/journalInformation?show=aimsScope&journalCode=terq2

Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes?:Systematic review

background: It is unclear whether more timely cancer diagnosis brings favourable outcomes, with much of the previous evidence, in some cancers, being equivocal. We set out to determine whether there is an association between time to diagnosis, treatment and clinical outcomes, across all cancers for symptomatic presentations. methods: Systematic review of the literature and narrative synthesis. results: We included 177 articles reporting 209 studies. These studies varied in study design, the time intervals assessed and the outcomes reported. Study quality was variable, with a small number of higher-quality studies. Heterogeneity precluded definitive findings. The cancers with more reports of an association between shorter times to diagnosis and more favourable outcomes were breast, colorectal, head and neck, testicular and melanoma. conclusions: This is the first review encompassing many cancer types, and we have demonstrated those cancers in which more evidence of an association between shorter times to diagnosis and more favourable outcomes exists, and where it is lacking. We believe that it is reasonable to assume that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers

ICAR: endoscopic skull‐base surgery

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Clinical Presentations and Outcome of Hospitalised Paediatric Oncology Patients with Laboratory-confirmed Pandemic H1N1 Influenza Infection in Hong Kong MMK SHING Pandemic H1N1 Infection in Paediatric oncology Patients 199

Abstract Objective: The clinical course of hospitalised paediatric oncology patients and haematopoietic stem cell transplant (HSCT) recipients with laboratory-confirmed pandemic H1N1 influenza infection were studied. Methods: Data from oncology patients and HSCT recipients with hospitalised laboratory-confirmed pandemic H1N1 influenza infection in Hong Kong were collected. Parameters on initial presentations, clinical course, treatment regimens and outcome were studied. Results: Sixteen patients were studied, the median age was 12.4 years. Fever (100%), cough (75.0%), runny nose (56.3%) and sore throat (50.0%) were the most common presenting symptoms. Antiviral therapy was started at median 1 day after onset of fever. HSCT recipients were more common to require a repeated or prolonged course of antiviral therapy due to persistent respiratory symptoms. Our cohort recovered without severe complications. Conclusion: Fever, cough, runny nose and sore throat were the most common presenting symptoms. HSCT recipients were more likely to develop persistent or recurrent respiratory symptoms and required repeated course of antiviral therapy. The uncomplicated course of pandemic H1N1 infection of paediatric oncology and HSCT recipients might be related to the early initiation of antiviral therapy

Cardiac Magnetic Resonance Assessment of myocardial iron load and fibrosis in adult survivors of childhood leukaemias

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