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Respiratory Diseases
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Aref T. Senno, Ryan K. Brannon
There is limited evidence regarding the safety of oseltamivir use in pregnancy. A single cotyledon perfused placental model showed that oseltamivir is extensively metabolized by the placenta [89] with minimal accumulation of the metabolite on the fetal side. In a population of 90 Japanese women who received oseltamivir during pregnancy, the incidence of malformation (1.1%) was similar to the incidence of major malformations in the general population [90]. A retrospective cohort study of 239 pregnant women in Texas demonstrated no association of antepartum exposure to amantadine, rimantadine, or oseltamivir with adverse fetal outcomes [91]. As of 2020, the CDC continues to recommend oral oseltamivir for treatment of pregnant and postpartum women suspected of having influenza, and states that the decision to start antiviral treatment should not wait for laboratory confirmation, since “laboratory testing can delay treatment and because a negative rapid influenza diagnostic test does not rule out influenza” [92].
Zanamivir, Laninamivir, and Polyvalent Zanamivir Conjugates
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
The therapeutic efficacy of laninamivir has been compared to oseltamivir in a double-blind, randomized, controlled, noninferiority trial in adults with no comorbid conditions and influenza symptoms of < 36 hours in duration, an axillary temperature of ≥ 37.5°C, and a positive rapid influenza diagnostic test (Watanabe et al., 2010). Subjects were randomly allocated to treatment with laninamivir 20 mg or 40 mg inhaled once or oseltamivir 75 mg ingested twice daily for 5 days. Of 996 patients who were enrolled, 645 were infected with an oseltamivir-resistant A (H1N1) virus that carried the H274Y NA mutation, 322 patients were infected with A (H3N2), and 3 were infected with influenza B. The oseltamivir median IC50 of the A (H1N1) virus was 690 nmol/l (range: 89–1500) and that of laninamivir 1.70 nmol/l (range: 0.45–4.40). The median IC50 of the two drugs for the A (H3N2) viruses were 0.68 nmol/l (range: 0.27–1.40) and 2.30 nmol/l (range: 0.78–4.40), respectively.
Computational Tools
Published in Mani Lakshminarayanan, Fanni Natanegara, Bayesian Applications in Pharmaceutical Development, 2019
We end this introductory section with a basic yet illustrative demonstration of Monte Carlo methods that showcases the basic ethos of how they are used in Bayesian statistics. Suppose we are interested in the sensitivity θ of a new rapid influenza diagnostic test (RIDT). Further, suppose that of n = 30 randomly sampled individuals confirmed to have the flu, y = 25 test positive with the new RIDT. How would a Bayesian go about using the data to understand θ? First, a prior distribution is demanded. Since θ is a probability, the beta family of probability distributions is a common choice. Suppose a domain expert specifies a Beta(3, 2) prior so that p(θ) ∝ θ(3–1)(1 – θ)2–1; see Section 15.5 for how this might be obtained. Assuming the subjects have the same likelihood of testing positive and are exchangeable given θ, the likelihood of a particular θ is l(θ|y) = θ25(1 – θ)5. Thus, the un-normalized posterior is . Theoretically, the posterior itself is easily recognized from ; it is the density of the Beta(28, 7) distribution, and this fact can be used to compute expectations of interest. But this is a rarity in Bayesian statistics: typically, the posterior distribution of p(θ|y) cannot be recognized from as coming from some nice family. In these cases, Monte Carlo methods are the standard tools of practice.
A deadly capillary leak attack. Clarkson’s disease: a narrative review
Published in Acta Clinica Belgica, 2022
E De Tandt, D Van Sassenbroeck, L Heireman, J Dierick, A Luyckx, S Verelst
In search of reversible causes of his cardiac arrest, a point of care ultrasound (POCUS), chest radiograph and a transoesophageal echocardiography (TEE) were performed. A TEE showed, upon moments of return of spontaneous circulation (ROSC), a hypovolemic status and a global hyperdynamic heart without pericardial effusion. A chest radiograph excluded a tension pneumothorax and pleural effusions but showed reticular interstitial patterns conforming to pulmonary edema or acute respiratory distress syndrome (Figure 1). The POCUS showed neither free intra-abdominal fluid nor hematoma in the solid organs. Most noticeable of the blood results was a severe haemoconcentration with a haematocrit level of 72% and haemoglobin level of 22.5 g/L (ref 14.0–18.0 g/L) (Table 1). The biochemistry also showed signs of disseminated intravascular coagulation and multiple organ failure. A rapid influenza diagnostic test came back negative. COVID-19-testing was irrelevant because of the case dated from the pre-COVID-19 era.
Cost-effectiveness of baloxavir marboxil compared with laninamivir for the treatment of influenza in patients at high risk for complications in Japan
Published in Current Medical Research and Opinion, 2021
Mariia Dronova, Hidetoshi Ikeoka, Naoya Itsumura, Nobuo Hirotsu, Amir Ansaripour, Samuel Aballéa, Yoshie Onishi, Mark Hill, Ataru Igarashi
This study was performed using the adaptation of a previously developed model15. The course of influenza, and the associated costs and quality-adjusted life-years (QALYs) were described using a decision tree. The following events were considered in a patient pathway: confirmation of influenza using a rapid influenza diagnostic test (RIDT), development of drug-related adverse events (DRAEs), resistance to antiviral, occurrence of influenza-related complications, hospitalization following complications, and death due to complications or other reasons (Figure 1). The model reflects one influenza season and considers the lifetime consequences of influenza complications. A public healthcare payer perspective was applied in line with the Japanese guideline for economic evaluations10,11.
Recommended hospital preparations for future cases and outbreaks of novel influenza viruses
Published in Expert Review of Respiratory Medicine, 2020
Antigen detection-based assays and real-time polymerase chain reaction (RT-PCR)-based methods are available in most laboratories for diagnosis of influenza infection. The antigen-based rapid influenza diagnostic test (RIDT) is less sensitive but it is still applied as a point-of-care (POC) screening test especially in low resource countries [24]. The development and availability of more affordable and reliable molecular diagnostic tests such as multiplex-PCR would facilitate clinical management of patients with severe CAP due to viral or bacterial etiology [25]. Recently rapid and accurate automated molecular tests based on nucleic acid amplification have become available with high sensitivity for the detection of influenza A, B and RSV viruses [26,27]. The advantages and limitations of different diagnostic tests for influenza are summarized in Table 2 [24–27].