Thursday, December 24, 2009

Thick Discharge Before Period

Mortality swine flu in Italy


absolute silence in the media. Total silence from the virological surveillance. The Ministry of Health announces that the report will be updated on a weekly basis now. Everything under control? This graphic reconstruction of mortality data in Italy according to official statements of the ministry newsletter and Flu News. No comment. In order not to disturb the silence.

Monday, December 14, 2009

Are Protein Powders Bad For You

Presentation activities WEBM.org



This short video summarizes objectives and activities WEBM.org
Maria Luisa Zuccolo

Friday, December 11, 2009

Roller Skating Decorations

A note to readers of the blog and Darwinflu Marcello Pucciarelli

few days ago we analyzed the ways in which mortality data are provided in Italy. Gianfranco Bangon of Darwinflu has taken over that post integration of many useful observations. The explanations do not convince us of the ISS experts, however, very much. We give reason in post reply directly to Gianfranco Darwinflu (11/12/2009 comment today in line at post reported). The graph that we refer to in this answer (and comments on) can be found in nostre pagine facebook
Salvo Fedele

ps: (aggiornamento di sabato 12/12/09) analoga segnalazione faremo a Marcello Pucciarelli per le interessanti osservazioni fatte dal suo Blog già in precedenza e anche questa mattina .
(Tra l'altro serve davvero ringraziare anche Marcello per lo sforzo di analisi che fa, in piena solitudine, della "risposta italiana alla Pandemia").

Thursday, December 10, 2009

Bushnell® Trophy Mp Sight

To love: Ah. What would we do without you ...? The usual

The pandemic is an invention, the vaccine does not work and could still be dangerous, e. .. NO more Mr. (TJ), this time from the BMJ, in full pandemic tells us that there is no evidence that Tamiflu functions in seasonal influenza. Today, Revere, by Effect Measure that readers of this blog know well, is concerned about the serious consequences of an incorrect interpretation of the Cochrane lead to delayed administration of antiviral drugs. Revere (the collective pseudonym under which the U.S. signed the articles of epimeliogi) patiently continues to remind the EBM-zealots (as they had baptized a few weeks) that RCTs are not "automatically" best of observational studies. The real EBM invites physicians to apply the best existing evidence: the effectiveness of neuraminidase inhibitors in limiting hospitalization, serious and deaths from influenza A H1N1 swl is supported by more than an observational study (as well summarized and documented with links to sources in the post DarwinFlu we suggested yesterday). We hope (but, unfortunately, we just believe) that TJ is not yet "trend" among Italian doctors.
The first comment to the post of Revere says: "Ah. What would we do without you, Revere? Love it." That comment would be fine pronounced by EBM- zealtots Italic .
Oops! Obviously with TJ instead of Revere ...
Maria Grazia Lunetta


Wednesday, December 9, 2009

Can Hpi Rock Crawler Go In Water

mother ...

Ladies and Gentlemen read what he found this time Ulrike ...
Salvo Fedele

Dishwasher Ruining Laminate Countertop

Darwinflu analyze "the brawl on Tamiflu"


I too had the "crocodile" ready, but Gianfranco Bangon Darwinflu of this time was exceptional.
How? The article came out two hours ago! This time I do not write one word more: I support and thank you for the hard work that I do not.
Salvo Fedele

Tuesday, December 8, 2009

Minas De Gran Hermano Poringa

for editors of scientific journals: slow, fast or superfast? For

This is an informative post. An ABC for those who "ignore" the fundamental characteristics of an influenza pandemic.

So an ABC for the population?
No.

So is ABC for a medical?
No.

Then an ABC for whom?
This is an ABC to the director of a scientific journal which has declared the pandemic in Italy . The medical knowledge is vast, so too i direttori possono aver perso qualche ABC. Questo post è dunque dedicato alla sua alfabetizzazione: frasi semplici, pochi concetti essenziali, qualche grafico esplicativo, niente di complicato come nei nostri post precedenti che erano destinati a un target diverso.
ABC

1) Nei virus influenzali le mutazioni puntiformi da errori di copiatura in uno dei cinque siti antigenici maggiori della H e/o in uno dei siti della N possono verificarsi nella fase di replicazione del genoma in ogni infezione cellulare. Gli anticorpi (e le cellule T citotossiche) presenti già nel nostro organismo neutralizzano in modo poco efficiente il nuovo virus. These variations of the virus are called antigenic drift and are responsible for seasonal flu. Different is the source of the shift, very rare events, occurring for reassortment of individual genes making up the genome of the influenza virus and are responsible for the emergence of a new pandemic. (Continued explanatory figure: Figure 1)

Figure 1
(Click on image to enlarge)



2) During a The pandemic influenza virus may continue to "live" and infect because proteins H and N are three-dimensional configurations so different from those submitted by other influenza viruses of the past seasons that it is not in any way blocked by antibodies present in the population.

3) The AIDS pandemic will continue until most of the population will not make antibodies and cytotoxic T cells against the virus H1N1swl, that acquire specific immunity after infection or vaccination. It will then be inevitable immunological selection of a virus a little 'different, the new virus-derived seasonal influenza pandemic (new antigenic drift)

4) Grafico esplicativo (Figura 2). Notare l'asse delle x, che indica anni (non giorni).

Figura 2
(Click sull'immagine per ingrandire)

(tratta da Mandell et al: Principles and Practice of Infectious Diseases, 6th ed. 2005)

5) Ci sono pandemie "fast" e pandemie "slow". L'ultima pandemia iniziata nel 1968 ha interessato due stagioni (si veda Figura 3). Non sono ancora note pandemie a diffusione superfast.

Figura 3
(Click sull'immagine per ingrandire)



6) Quali sono le nuove ipotesi biologiche che possono giustificare una così anticipata conclusione della pandemia in Italia rispetto al resto del mondo? No, but I am sure that soon we will explain under what 'evidence' has made such an innovative theory.

7) I will not dwell epidemiological analysis: useful, however, go a little 'beyond the usual readings, for example, can be opened (at least) windows of the house looking for evidence ...

8) The flow-chart below (Figure 4) will enable our choosing the more appropriate title which arise in the future, to his readers.

Figure 4
(Click on image to enlarge)

Taken from Wellington Grey 2007

8) While some studies are now confident that the readers of the magazine appreciate the letter we sent (several weeks) . Letter that certainly there will be time to answer: the distance that separates Eminences and is known to mere mortals too big.
Salvo Fedele


Sunday, December 6, 2009

Red Dots Roof Of Mouth Gonorrhea

unemployed T256P search proofreaders


the Ministry of Health are in desperate need of proofreaders. Press releases moving merrily dead from week to week. We are mad: just end up a chart and graph data changes "must" change. We finish a post and we have to rewrite it had "misunderstood". But even on the outskirts of this tragic epidemic (epidemic, mind you, not pandemic) is spreading: only those who are affected transcribe data and draw charts (at risk). The mutation is stable, however: Pinocchio's nose grows as the affected officers. Anna Meldolesi is studying for Darwinflu. I will also speak with Gianfranco Bangon before they go crazy ... with the "Italian anomaly" I'm sure, is a wave anomalous hopping from office to office, the Ministry of the ISS, save ordinary mortals, but not the experts of the court and the antagonists in chorus say "is a common flu" (the same mutation). The last test?
I just finished the post on Ulrike , put in place data, comments, and graphics and voila ... an "update", even one on a separate web page, a separate URL. Is clearly a simple mistake by neo-mutation, the Mouse has become Pinocchio: T256P, but it is not a mouse is not a living being. It is not a virus, however, because those have a biological intelligence (at least).
Figure 1: URL http://www.sito.regione.campania.it/report02.pdf (page 11: Figure 10)

Figure 1
Chart 1 (click image to enlarge): The average occupancy rate of "swine flu" of pediatric intensive care units in the region, Campania in the first 20 days November was always above 18% to a peak of 50%

Figure 2
Chart 2 (click image to enlarge): The average occupancy rate of "swine flu" of the Campania region in the pediatric intensive care ...

same graph (for the first twenty days) but by an update the other a small difference (at the top).
That hard work ... the proofreader! It will
endless meetings to determine the peak ... and then the shape of the peak ... ... and then move, make sure the peak ... then lower, level, we must make ...
and think that it's all because of an amino acid at position 256. Luckily
a normal flu, the meetings cost ... however: T256P we give a cut?
Clear All, please.

ps: all this just to announce two new friends, and Gianfranco Anna Meldolesi Bangon fact that just as there have decided that everything is running, have opened a beautiful portal dedicated to the swine flu: how we, in fact are convinced that everything is just beginning in those days ...
The mutation from which they (we) love? I'm telling you a different day, I do it fast (before it reaches the Chart 3: ... as flat as the EEG would T256P of Italians)
Salvo Fedele


How To Make A Horse Sleigh

For moms really "counter": the example of Ulrike Schmidleithner, vaccine ... YES!


Ulrike is a "mother" who diligently for several weeks following this blog. A mother a little 'special devouring the web with critical intelligence worthy of a scientist. He suggests valuable references, analysis is that no one dares to imagine a science journalist in Italy, in short, a "mother" of those that when you go to a doctor ... it simply says "I've read on the internet", but cites literature sources, analyzes and mastered in such a way that ... one can only try ... sincere human solidarity for the "doctor" (certainly can not afford to "liquidate" with some nonsense of fact!)

course Ulrike immediately read our analysis on the Italian response to the pandemic ( Nostalgia Topo Gigio? Pinocchio A consolation ). He immediately started to make his checks, and within 24 hours sent us a document epidemiological observatory field that we missed: dated 2 December 2009. Ulrike actually forwarded it to us exactly when it came out on the web and that is December 4, 2009.
I'll be back later on this important document. But first Ulrike want to talk about. Some aspects that make her story emblematic (though in true sense of the meaning of the word "contrast") of what is happening in Italy.
Austrian Ulrike is 20 years and moved to Italy.
The first time I read his comment I had the chills. Like any good Sicilian
fact when I read a German surname that stuff. I omit to tell you why, I tell you just to care for these "prejudices" regularly read a short story by Doyle ("Guess Who's Coming to Dinner" from "57% Irish" Publisher Bloomsbury Publishing, 2007) strongly suggest that all unacknowledged racist (I'm not the first Sicilian racist towards a German surname).
And then a German last name with the mind inevitably leads me to the alternative medicine homeopathy ... ... the battle "antagonistic" to squalene
... So if a German Sicilians are all a bit '... or almost, for a Sicilian Germans are all a bit '... or so and more also "homeopathic."

First surprise: Ulrike studied the Nuremberg Code, read what they write American epidemiologists Jeffersson Tom and his "analysis", has analyzed the history of the buffalo WHO with a competence to be true "scientific investigator".
Why?
Ulrike few years, from his experience as a mother, began to treat the beautiful web pages breastfeeding.
pages maintained by a mother, with real powers of a mother who breastfed (if pediatricians Sicilians knew a penny to send this communication we would not have to Sicily the rate of breastfeeding than we have and I am ashamed to say) .

Second surprise: Ulrike ends in dealing with breastfeeding World vaccinations
Why?
Read his words:

"In early 2002, I was accidentally involved in a discussion on vaccination that took place in my Yahoo group. Until then, the topic does not interest me in the least, usually not even open my messages about this issue. During this discussion I was struck by the aggressive reaction to my post which were mere information that I found on the WHO web site. This made me curious and I wanted to see clearly. I was appalled by the misinformation that was circulating on vaccinations. I also noticed with horror that their environment is the promotion of a strong current anti-vaccination. Of course not all people who promote breastfeeding, are contrary to vaccinations, but many are. Evidently the word "natural" is an important feature of breastfeeding, is traded for quality assurance and then applied to things which in fact the "natural" has nothing positive. Even cancer, diabetes, allergies, earthquakes ... are perfectly natural, but man does not have anything positive. Instead, the houses, umbrellas, insulin (produced by), operations, antihistamines, anti-earthquake construction ... are the creation of man (not "natural") but are positive for the man ... "

" When I saw that often promote breastfeeding means almost inevitably aprire una porticina alla pericolosa disinformazione degli anti-vaccinisti, ho pensato che far presente la mia preoccupazione, fosse la cosa più urgente da fare. Per me era inaccettabile che gli stessi bambini che con la promozione dell'allattamento vengono salvaguardati dalla disinformazione riguardo l'allattamento, vengono esposti a pericoli ben maggiori, se non vengono vaccinati perché le loro mamme pensano che i vaccini siano più pericolosi delle malattie contro cui sono dirette"

Trovo queste parole la più bella risposta all'ignobile comportamento delle società scientifiche pediatriche italiane che stanno cavalcando in questi giorni il "facile successo" di comunicazione derived from amplification of their anti-vaccination message.

Cultural Association Pediatricians, for example, that continues to ignore our words should be read before you watch Ulrike official data Campania epidemiological observatory that has left us and now we transfer here without comment (we will be back soon) :

FIGURE 1

Figure 1 (click image to enlarge): The average occupancy rate of "swine flu" of pediatric resuscitations in the Campania region primi 20 giorni di novembre è stato sempre superiore al 18% raggiungendo picchi del 50%

FIGURA 2
Figura 2 (click sull'immagine per ingrandire): Il tasso di occupazione medio da "swine flu" delle rianimazioni per adulti nella regione Campania nei primi 20 giorni di novembre è stato sempre superiore al 5% raggiungendo picchi del 20% . Il momento più acuto si è vissuto a Napoli ove due presidi ospedalieri (Santobono e Cotugno) hanno, di fatto, sostenuto buona parte dell’ospedalizzazione della prima ondata epidemica. Infatti all’ospedale Santobono employment has been reached under the influence of resuscitation by 50% in a few days , with the functionality of the department in crisis. In suffering also Cotugno hospital resuscitation, in a few days, has reached a saturation of 88% only for influenza . should be noted that both pediatric intensive care units for adults, are always full: then the emergency flu has fallen on an already existing level of employment of the important departments.


Ulrike now has a new blog
the name is fantastic vaccine ... YES!
Obviously, his is also our Blog: The blog of the mothers really contrast, mothers who are fighting for the health of their children and antagonism against the ruling of the useful idiots.
Salvo Fedele


Thursday, December 3, 2009

Build Plans For Power Shower Dunk Tank

for epidemiology: the mortality of the pandemic in Italy


Look at these two graphs that reconstruct mortality in Italy from swine flu. The first section is the last bulletin Flunews. The second (blue: Italy, red: Campania) is drawn from our article analysis of the Italian response to the pandemic ( Nostalgia Topo Gigio? Pinocchio A consolation ). You will find in our article details the ways in which we reconstructed the chart through the official bulletins of the ministry.
We would not add anything, but one thing I just could not tacerla: "Epidemiological curves ministerial order" can very well! Congratulations to the chart for the excellent demonstration of the "theory of peak
Salvo Fedele
Pippo Bruno

ps: we would like to remind the" court expert "who is a doctor who is doing a Overtime: keep everything you say and everything they say the papers. His nickname is ironorehopper and is the director of the Italian forum FluTrackers . You can also delete all: FluTrackers retain a copy. We have something more than a bibliography entry, we Giuseppe Michieli .


Wednesday, December 2, 2009

Laura Gemser Strem Vid

For pediatricians and ICU: Important to encephalitis and SIADH syndrome

We just finished telling ( Nostalgia Topo Gigio? Pinocchio A consolation ) how does this misinformation country and now another example: the child who died tragically in Puglia was positive to the virus, but "had a different encephalitis" this is what explains the media. Some examples: here and here and here and here . We remind pediatricians that follow this blog to read one of our posts that explains the features of the pandemic virus encephalitis. Pediatricians and intensivists who have little experience with children, but that you should need to find these days to treat children with severe pulmonary manifestations remember to keep in mind the SIADH featuring massive pneumonia of children, especially very small.
Salvo Fedele

ps: obviously, if peripheral surveillance systems do not know these things will be very difficult to understand what is really happening in Italy.


Monday, November 30, 2009

Dots On Pregnancy Test Pregnant?

Nostalgia Topo Gigio? Pinocchio a consolation

We sent a new contribution to medical journals and Child that readers of our blog to read now, downloading the pdf file from this URL: http://tinyurl.com/gigiopinocchio
The title is quite long:
Nostalgia Topo Gigio? Pinocchio a consolation
analysis "documents" (30 November 2009) of the Italian response to the pandemic


do not yet know whether this intervention will be accepted for publication by the journal. But we are sure that our readers will help us to spread it, with the discretion that always ask, among their friends and doctors.
This intervention, however, should also be of interest to professional communicators (journalists, teachers at all levels) but also scholars of our society (media experts, sociologists, economists, historians).
should also be of interest to professional politicians, if the policy is still interested in what happens in society.
should be of interest to scientific societies, the companies may have in Italy is still a real scientific interest.
In fact it should mainly be of interest to ordinary people.
We wrote it with a goal of helping to understand what is happening these days around the swine flu: the mixed messages of the media, the incomprehensible difference of opinion is recorded in "opinions" of doctors, the confusion "well orchestrated "the messages of "autorità", il ruolo di quelli che abbiamo chiamato, già in tante occasioni in questo blog, "esperti di corte" e di quelli che abbiamo chiamato, in altre occasioni, "esperti antagonisti". Il lavoro che abbiamo realizzato è quello di due medici che fanno parte di una iniziativa che, fin dall'inizio, si è "schierata" a favore della ineludibile necessità di una vaccinazione di massa contro il virus pandemico. Abbiamo però cercato di realizzare la nostra analisi con onestà intellettuale e rigore scientifico. Ovviamente sono adesso i lettori che dovranno giudicare la bontà di quel che abbiamo prodotto. Speriamo di ricevere molti commenti, anzi vi saremmo grati di un vostro commento (sul Blog, sulle nostre pagine Facebook or by email). In a society like ours, where everything has a commercial value, this is a great price ... we ask you to pay:
not only have the patience to read but also write and send us your feedback. Thanks
Pippo Bruno, Salvo Fedele
In the sidebar (top right) will find the current list of posts related to this article
How to cite this article?
This article has a permanent URL (Permalink): http://tinyurl.com/gigiopinocchio
To quote him correctly after the authors' names can be used to replace the permalink URL of the Blog:
Bruno P, S Fedele: Nostalgia Topo Gigio? Pinocchio a consolation
analysis "documented" 30 November 2009 by the Italian response to the pandemic
Preview drafting WEBM.org; 2009; 30/11: http://tinyurl.com/gigiopinocchio

Notes
This paper was written thanks to the contributions and criticisms of the majority of participants in the initiative WEBM.org "Influenza A H1N1 and pandemic."
especially thank Matilde Castiglione, Enrico Corpora, Giuseppe De Santes, Rosario Ferracane, Paul Fiammengo, Caterina Lo Presti, Maria Grazia Lunetta, Daniela Vernaccini, Maria Luisa Zuccolo for the contribution of ideas, analysis of the sources and the patient work revision of the text.

Conflict of interest The authors declare "their" conflict of interest are part of the Italian National Health Service and as such committed to disclose, with intellectual honesty and rigor Scientific, effectiveness and necessity of vaccination for il virus pandemico A H1N1 swl.
Precedenti contributi inviati a Medico e Bambino
da parte di partecipanti all'iniziativa WEBM.org:
1) S. Fedele, P. Bruno: L'influenza suina
Medico e Bambino 2009;9:558-559 http://tinyurl.com/mb11webmorg
2) D. Alessi et al: Medico e Bambino e la Pandemia
anteprima redazionale WEBM.org 2009;19/11: http://tinyurl.com/mb11rwebmorg
si veda anche il post di presentazione a questo link

Sunday, November 29, 2009

Gross Profit Templates

What meaning can it have the mutation of the hemagglutinin

On 20 November 2009, the Norwegian Institute of Health has informed the 'WHO the finding of a mutation of the virus H1N1swl in three cases of severe pneumonia. This is the replacement of an amino acid nell'emoagglutinina (H1), which has glycine at position 225 instead of aspartic acid.
In reality, this mutation had been reported since the beginning of the pandemic in Brazil, China, Japan, Mexico, Ukraine and the USA in both clinical forms of mild to severe.
The cases so far reported are sporadic, not linked epidemiologically to one another. Following that report, the National Institute of Health, the revalued sequenze di 100 virus identificati in Italia , l'ha riscontrata in un solo paziente, affetto da una grave forma di polmonite risoltasi dopo ricovero in terapia intensiva e trattamento con ECMO.
Il reale impatto e significato clinico di questa mutazione è difficile da comprendere, attualmente si può ipotizzare, sulla base di precedenti studi sui virus influenzali, che l'emoagglutinina (H1) virale mutata abbia una maggiore capacità di attacco sui recettori delle basse vie respiratorie, recettori selettivamente attaccati dai virus aviari.
Da studi effettuati su virus influenzali stagionali, pandemici e aviari isolati dal 1918 ad oggi emerge anche l'ipotesi che tale mutazione riduca la trasmissione inter-umana con le gocce tract, it seems not to cause a selective advantage for the virus.
There were no changes in the amino acid sequence of the hemagglutinin antigenic determinants, so that this mutation does not change the affinity for the virus of anti-H stimulated by the vaccine.
The mutated virus remains sensitive to zanamivir and oseltamivir, antivirals that act by inhibiting the action of neuraminidase (N1) protein under the control of another gene of the virus.
The ability to bind to cellular receptors, however, characterized the virus H1N1swl, as evidenced by a study published by Childs in September 2009 in Nature Biotehnology. ll professor Shefa Zaki, pathologist of the CDC, analyzed more than 100 samples of autopsy subjects who died inflluenza Pandemic confirmed and found the virus in the cells to a greater extent even than the findings from the cases studied died of H5N1 virus infection. Zaki analyzed to compare the paintings of bird flu infections in immunocompromised to cortisone treatment.
One word about the expected changes of the virus
monitoring genetic sequences of virus isolates is justified by the high probability of mutations that is expected of the influenza virus, more than 1% of the genome of the influenza virus changes every year. Some mutations
expectations related to an increase in pathogenicity of the virus have not yet been identified, such as the release of the stop codon of the PB1-F2 gene , the killer protein, while the E627K mutation of the PB2 , which allows for optimal replication of the virus at 33 ° C (temperature human nose in winter) has already been reported in some cases.
The mutation of the gene for neuraminidase (N1), resulting in substitution of tyrosine in position 274 with histidine is responsible for the acquisition of resistance to oseltamivir (Tamiflu), which has already been reported sporadically. Resistant viruses were isolated mainly in prophylaxis in individuals at risk, it is assumed that the antiviral maintained low dose in the course of infection was not conducive to the block in viral load that any virus with the mutation may continue to replicate and infect the body.

Another exception concerns the replenishment (shift) of the virus with a virus with the seasonal or avian virus H5N1, is a possible event even more rare than the mutation. Reassortment with the emergence of a pandemic virus, which maintains that high diffusibility human to human, is even less likely, is an event that historically has occurred only three times in the last century. Professor Bruno Lina
, a French virologist, was able to get a reassortment between the two viruses H1N1, lo stagionale e il pandemico, inoculandoli in coltura di cellule e sta studiando la patogenicità e trasmissibilità nei topi di questo virus. Non è riuscito invece ad ottenere un riassortimento del virus pandemico con il virus H5N1, esperimento che aveva già provato senza successo con i virus stagionali.

Aggiungo per chi ha curiosità di sapere qualcosa ancora sulla mutazione segnalata

Gli aminoacidi in posizione 225 e 190 sono i principali determinanti dell'affinità del legame tra proteina virale H e recettore della membrana cellulare da infettare; differenti in virus influenzali di diverse specie.
L'acido sialico costituisce the end of the cellular receptor to which it attacks the influenza virus.
in human cell membranes, there are two types of sialic acid depending on whether this is linked to carbon in position 2 or 6 of galactose. The bond alpha (2.6) predominates in cells of the upper respiratory tract while the alpha (2.3) predominates in non-ciliated bronchiolar cells and alveolar type II cells. The sialic acid alpha (2.3) in birds predominate in the intestinal cells. Pig tracheal epithelial cells have both receptors, which is why it is assumed that the genetic reassortment between different species may be more likely in these animals, but also the two coexist in the lungs of man receptors.
H The avian virus has selective affinity for the receptor sialic acid-linked alpha (2.3). The H
human virus has selective affinity for the one with the sialic acid-linked alpha (2.6)
This seems to depend on different affinity dall'aminoacido in this position 225 of the H protein, is present in avian viruses glycine ( G), prevail in the human viruses aspartic acid (D). The current pandemic influenza virus has Asp225 (marked as D225), except for a few sporadic isolates reported during three severe cases in Norway.
Studies in 2006 on the 1918 influenza virus extracted from biopsy specimens, have shown that the virus A / South Carolina/1918, which has aspartic acid at position 225 (Asp225), only has an affinity for the receptors alpha (2.6), while the virus that has A/NewYork/1918 glycine (Gly225) has affinity for both receptors. The classical strains of avian origin have glycine in position 225 (Gly225) H. exclusively but have selective affinity for the receptor alpha (2.3), the non-affinity receptor alpha (2.6) seems determined by the presence of glutamine in position 190 (Glu190) instead of Asp190 present in the human viruses.
The ability to bind to receptors alpha (2.6) is an indispensable factor for a good transmissibility of the virus by air, with respiratory droplets. The avian virus, then with Glu190 and Gly225 in H, with only selective receptor alpha (2.3) are not able to be transmitted by respiratory droplets. The NY1918 human virus that had affinity for both receptor alpha (2.6) than for alpha (2.3) has a transmission capacity inefficiently. The SC1918
human virus that had affinity only for the receptor alpha (2.6) has an effective transmission capacity.
The H with increased affinity for alpha (2.3) would increase the aggressiveness of the virus but also lead to a reduction in transmission capacity. It seems, therefore, a mutation that no advantage selettivi del virus.

Maria Grazia Lunetta

Bibliografia:
- Childs RA et al. Receptor-binding specificity of pandemic influenza A (H1N1) 2009 virus determined by carbohydrate microarray. Nature Biotechnology 2009;27:797
- Brendan Maher B et al. Swine flu: One killer virus, three key questions. Nature 462, 154-157 (2009)
- Vincent Racaniello. The D225G change in 2009 H1N1 influenza virus is not a concern. Virology Blog:24 November 2009
- Vincent Racaniello. Influenza virus attachment to cells: role of different sialic acids. Virology Blog: 5 May 2009
- Stevens J et al. Glycan microarray analysis of the hemagglutinins from modern and pandemic influenza viruses reveals different receptor specificities . J Mol Biol. 2006 Feb 3;355(5):1143-55 http://www.ncbi.nlm.nih.gov/pubmed/16343533
- Revere. Trying to understand the Norwegian swine flu mutations . Effect Measure: November 21, 2009

Saturday, November 28, 2009

Laura Gemser Stream Vid

CDC: e.card on prevention of influenza



In queste 3 pagine del sito del CDC ci sono delle e.card dedicate alla vaccinazione anti-influenza pandemica. Alcune un po' troppo "americane" (capodanno, festa del papà, halloween, compleanno) ma guardate che eleganti e comunicative quelle che invitano a vaccinare i soggetti a rischio e i contatti: lattanti sotto i 6 mesi, diabetici, donna in gravidanza, persone con diabete, cancro.
Intanto ogni giorno in ambulatorio continuo a incontrare almeno un genitore a cui individualmente il ginecologo, l'oncologo, il senologo, il diabetologo ha sconsigliato "questo vaccino", senza nemmeno entrare nel merito.



Maria Grazia Lunetta

Friday, November 27, 2009

Wil Aeron Chair Fit In Car?

WHO: influenza A/H1N1 vaccine safety briefing

Fonte WHO
Safety of pandemic vaccines

L'OMS sulla base delle informazioni ricevute dalle autorità sanitarie nazionali stima che circa 65 milioni di persone sono state vaccinate per l'influenza A/H1N1. Tenuto conto di questa "scala" di somministrazione del vaccino, tra the other with an increasing trend, briefing published last Nov. 19 stressing the need for safety monitoring.
anecdotal evidence suggests, as expected, that the side effects commonly reported include swelling, redness or pain at the injection site, which usually resolves spontaneously soon after vaccination.
have been reported, albeit less frequently, including fever, headache, fatigue and muscle pain, occurring after vaccine administration and usually resolve spontaneously within 48 hours.
addition, the variety of allergic reactions observed is well within the range expected.
To date, less than ten suspected cases of Guillain-Barre syndrome have been reported in patients who received the vaccine. These numbers are consistent with background rates (background rates) normal of this disease, as reported in a recent study (see article editorial). However, these cases are under investigation to determine if these events occur randomly or can be associated with vaccination and that is why the WHO recommends continuous monitoring.
A small number of deaths occurred in people who have been vaccinated. All these deaths, the WHO reports were promptly considered. Although some investigations are ongoing, the results of investigations made have ruled out a direct link the pandemic vaccine.
In China, for example, where more than 11 million doses of pandemic vaccine have been administered, health authorities were informed of 15 cases of serious side effects and two deaths that occurred after vaccination. A thorough investigation of these deaths, including a review of the results of the autopsy, determined that the cause of death were underlying medical conditions and not the vaccine.

Safety profile of different vaccines
during the fishing season you use different types of vaccine (inactivated and adjuvanted live attenuated vaccines is not) but for these adverse events, the WHO states that have not been recognized until now differences in the profile security between the different vaccines.
Although the safety monitoring continues, all data collected to date indicate that vaccines against the pandemic have an excellent safety profile as those used against seasonal influenza for more than 60 years.

Briefing Updates (WHO-GAR)
Pippo
Bruno Joseph Bruno an article of Danielle Ofri appeared in the NEJM on November 25
Bella analysis of the history of the perception of emotional swineflu USA, where fear, impatient with the request for a solution (the vaccine), has now passed to a suspected contagious. At the emergence of a new disease, mysterious, in a third-world city that so insidious and uncontrolled spread in the "civilized" world has led to panic. In late summer has established a sort of emotional tolerance, decreased anxiety. All this for no good medical reason, indeed, the atypical and seasonal distribution of risk groups was to increase concerns. Maria Grazia Lunetta

Thursday, November 26, 2009

Memory On Wedding Program

Emotional Epidemiology of H1N1 Influenza Vaccination: Suspicion has ITS own contagion Coca

Dear friends and readers of this blog. We set ourselves the hard and fast rules in this Blog. This is an exception. The link is not ready. Missing references, but in the meantime this draft would like to post them now for sharing. I wrote in one go and I want you to read what I wrote in one go without useful turns of phrase. Read and return in prossimi giorni: troverete tutte le voci bibliografiche e i link di questo post.

ultimo aggiornamento di questo post: ore 0,15 del 25 Novembre 2009


Salvo Fedele
46a settimana: anteprima della
pandemia light Quanto è successo nella terza settimana di novembre (46a settimana) è inverosimile: un autore di un libro di fantascienza non potrebbe far di meglio. Questa invece è l'Italia di cui potrete prendere visione sui giornali di questi giorni Siamo appena alla quarta settimana di sorveglianza, l’ANSA in un lancio di agenzia riprende un convegno della rete Epiwork. (link) We talk about the world situation. The title of the launch: "The worst is over." Immediately after bulletin FluNews writes "the value of current incidence is probably reaching the epidemic peak." (Links and bibliography)
All major national newspapers take up the news: "We have reached the peak, the worst is over" (Link) (Link) All based on these simple facts: - ILI in the band ages 0-4 years reached 28.14 cases per thousand, in the age group 5-14 years reached 40.78 per thousand
- ILI in the age group 15-65 years there are virtually moved from previous weeks: 7.65 for 7.29 per thousand against one thousand.
is unaware of three or four epidemiological criteria in addition to the basic epidemiological criteria that can correctly interpret the order pandemic: the concomitant increase in all age groups of ILI. (Biblio)
Italy can then pull really a sigh of relief?
Some people with "timeliness" anticipates its editorial of December on a blog (link), sanctioning the official closing of the pandemic in Italy to December 1, 2009. Other
(link) (link) go as more "complex" to declare "it's over now, what would be vaccinated?"
(never heard of the possibility of a pandemic wave number> 1?)

.

backdrop to all this rubbish of the statements that follow the WHO after allegations by the Polish Minister of Health, junk that totally ignores the tragedy of Poland, the birth of "tourism vaccination" of the Poles toward the wealthy neighboring Hungary (where the national vaccine production can be purchased in a pharmacy to 7 euros), the difficulties of this nation bordering Ukraine, el'ormai inevitable birth of a black market for vaccines, with all the consequences that everyone will have difficult to imagine.

In fact, As is well known by all the texts of the basic epidemiology, the pandemic could not end up with an interest of less than 5% of the population, as easily obtainable by using some simple arithmetic function:

- The cases reported by the Ministry are little more than two million, given that it is in fact most of ILI A H1N1 is not even at the highest level found in European countries (30% in UK): in everything and in reality no more than 600 000 cases (i)

- 600 000 cases to a peak, the characteristic curves of Gauss where the average is also the median and fashionable should correspond to about half of the wave pandemic




- 600,000 for two is equal to 1,200,000 - Admitting the existence of curves "Gauss abnormal," to meet the desires of people who all close to 1 December 2009, we can go so far as to declare the end of pandemic on the basis of a single suspected pandemic wave affecting only 4 million people throughout the country? - It does not take long to realize that it can not be over and that a pandemic can not have a protective effect on mortality from seasonal influenza ...

What should we hope?


A pandemic every year to limit the damage of the season?


- In the long run-up the real pandemic wave (described in all texts of epidemiology as a feature of all pandemics), there was already a significant mortality and the Case Fatality Rate can now be estimated at a minimum level of 0.1% (mean 0 , 6% range from 0.1 to 5.1 depending on the country) (bibliography and links)
There was also a significant increase in hospitalizations from A H1N1 in Europe, with the expected overhead for the resuscitations.
a mortality of 0.1% for a wave pandemic that affects 15% of the Italian population is equivalent to more than 10,000 deaths.

a mortality of 0.02% (link to: ECDC current estimate obtained by accumulating data di sorveglianza di tutta Europa e cioè dando credito anche a quelli italiani!) equivale a 2000 morti.

Che cosa si aspettano i cultori della

pandemia che non c’è e quelli della
pandemia light
che questi numeri verranno fuori dai comunicati che compaiono sui giornali?

Ci vorranno anni per calcolare l’eccesso di mortalità imputabile a quello che sta succedendo in questi giorni e ancora deve succedere.

Dopo la pandemia
light
che cosa si inventeranno?


Aspettiamo fiduciosi l'avvento della pandemia zero !

47th week: preview ...
Dumb! The pandemic is zero 47 weeks, what we are experiencing: the pandemic is probably gone by the Italian media?

Tuesday, November 24, 2009

Secret Of Indian Big Boobs

Cola or pandemic?

by
BBC News, 24 November 2009
access
Maria Grazia Lunetta

How To Beat The Levelin Supertux

swine flu patients hospitalized with and without underlying disease

In Italy, mortality from influenza in an often undecipherable, never bring real data and official statistics or even externalizing unnecessary "duplication" of data, including seasonal influenza and pandemic influenza. try to go beyond the numbers up by our opinion makers and experts of "statistical media" and see what are the systems that we permetttono to assess mortality trends and possible scenarios of the "influences".
statistics of mortality and ICD classification systems Istat through the investigation of the causes of death detects all deaths in our country of the overall population. The survey is made through the use of models and ISTAT ISTAT D.4 D.5 (details of death beyond the first year of life for male and female), ISTAT and ISTAT D.5 D.4 bis bis (details of death in the first year of life for male and female).
in official statistics refers to the "root cause", ie the disease or traumatic event that, through any intermediate complications or disease states has led to the death and will follow the rules set by the International Classification of Diseases (ICD ICD-10 online
The mortality statistics are compiled from information contained in the ISTAT attributing each death to a single cause.
If the certificate is given a single morbid condition, questa sarà la causa di morte ed il processo di codifica sarà una traduzione della descrizione della condizione morbosa in codice.
Se sul certificato sono riportate più condizioni morbose, si tratta di applicare un algoritmo decisionale per individuare un’unica causa di morte ed il processo di codifica consisterà in una serie di passaggi decisionali standardizzati (algoritmo) che conducono all’attribuzione del decesso ad un’unica causa di morte. Per questa standardizzazione l'OMS raccomanda di utilizzare le tavole decisionali "ACME" pubblicate dal CDC.

ACME

I processi di revisione della classificazione previsti all'incirca con cadenze decennali, hanno determinato l'introduzione di nuove condizioni morbose, con un numero di codici quasi doppio rispetto alla precedente classificazione (ICD9), e una discontinuità formale generata dal passaggio da codici numerici a codici alfanumerici (ICD10).
A partire dal 2000, a livello internazionale le statistiche di mortalità sono ormai prodotte utilizzando la classificazione ICD10 in numerosi paesi. In Italia l'ISTAT ha utilizzato la classificazione ICD9 per la mortalità fino all'anno 2002, mentre utilizza ICD10 a partire dai decessi dall'anno 2003.
Di questa continua evoluzione bisogna tener conto per analizzare i dati di mortalità relativi all'influenza stagionale nel nostro paese.
Con i precedenti sistemi di classificazione (ICD9 and ICD8) mortality data for influenza in Italy from 1969 to 2001 were collected over the years, many studies, combining the codes for "pneumonia and influenza" (for ICD9 codes 480-487 and 470-474 for ICD8).
So let's look at the mortality tables

Istat (the most recent 2006), the "real" data for classification ICD10 concerning mortality "pneumonia and influenza (codes J10-J18).
Istat (1) gives the absolute number of deaths due to age, etc., in the form of text files that must be reworked.
From these data broken down by age (Table 1 males and females Table 2, etc.) it is confirmed that the mortality l'influenza stagionale riguarda prevalentemente la popolazione anziana (i 7047 morti rappresentano lo 0,012% della mortalità generale per l'anno 2006).
Tassi di mortalità e statistiche storiche

I dati di mortalità sotto forma di tassi sono invece pubblicati storicamente dall'ISS (rapporti Istisan) e sono disponibili per una analisi storica a partire dal 1969. I tassi di mortalità (grezzi e standardizzati) rappresentano gli indicatori epidemiologici più utili per analizzare la mortalità per cause in una popolazione, ma sono resi disponibili attualmente fino al 2002 sulla banca dati dell'ISS mentre gli ultimi dati Istat (stime preliminari aggregate per grandi gruppi) arrivano al 2007.


ISS Database



Dataset Istat
From this database it is clear that influenza mortality rates, calculated as the ratio of deaths per 100,000 population and the ISS (the latest figures for 1000 Istat) are varied to little over the years.




click to enlarge



monitoring systems rapid mortality
addition to the "rates" in the study is considered very useful to consider also the influence of excess mortality, calculated as difference between the number of deaths observed and the base value expected in the absence of influence.

A livello internazionale questo modello di analisi ha permesso anche di realizzare una efficace valutazione rapida dell'andamento della mortalità (
Fluview CDC ). Negli USA infatti per il "monitoraggio rapido" della mortalità da influenza si utilizzano due sistemi:
Reporting System – Viene valutato sul numero totale dei certificati di morte ricevuti da 122 città per gruppi di età, il numero di quelli in cui la polmonite o l’influenza vengono indicate come la causa di morte. La percentuale di tutti i decessi per polmonite e influenza (P & I) viene poi confrontata per ogni settimana con una valore soglia, calcolato utilizzando i dati di mortalità degli past five years. The observed proportion of deaths attributed to pneumonia or influenza was significantly higher than expected, when the "epidemic threshold" is exceeded.

Surveillance for Influenza-Associated Pediatric Mortality We have already commented in previous articles some of these graphs that effectively communicate the data associated pediatric mortality from pandemic influenza in progress. This monitoring system was used in the U.S. since 2004. All cases of laboratory-confirmed influenza and mortality in children are associated with reported to the surveillance system (Mortality Surveillance System).




A "quick estimate" of the trend of mortality is therefore part of the monitoring carried out in other countries, as we have seen that avoid the use of "denominations" (the number of flu cases, for example .. .'s all moot without validation). Overestimating or underestimating the "population" (denominator) which relate to the "events" will "vary" the very fact of the estimates and the reality.


analysis of historical data on the "influences" in Italy In Italy
according to some studies (ISS, University) are known historical data on excess mortality "for 32 influenza seasons studied, excess deaths were an average of 3 per 100,000 inhabitants in the years to a total of approximately 57,243 deaths caused by "pneumonia and influenza" (average 1,789 per season) "(3).




As for the possible scenarios for pandemic influenza mortality in the same study published by the CDC (3) and the relationship Istisan (4) of the same Institute of Health, have been highlighted some important data. E 'has been estimated that in Italy, in the 1918-1920 influenza has caused about 300,000 deaths, with a higher mortality than in the rest of Europe (5), in 1957-1958, excess deaths from respiratory causes seem to have been about 5,000 (6, 7), while in 1969-1970 there was an excess mortality of 20,000 deaths from pneumonia and influenza. During the pandemic of 1969-70 the excess mortality has also been:
7 times higher in the age group 0-14 years
4 times higher in people aged 15-64
2 times higher in the elderly ≥ 65
years analyzing all the data the authors (3) Check that the high rate of excess mortality in 1969 was three times higher than that of the United States and 1 times higher than in other European countries and prospects can end in Italy have to deal with increased mortality (very more pronounced between 0-64 years) in a subsequent pandemic.
Compared to the current pandemic influenza we know for months that this is recorded in the international situation prevailing mortality among young adults and children in the age group under 65 years and it is important to observe the real situation, dropping the "simple" calculations " Statistical media. "

Estimation of mortality during a pandemic To define the severity of illness and mortality during an epidemic or pandemic has been used by international institutions (8), the case fatality rate (CFR), the percentage of individuals who die every 100 confirmed cases, from Not to be confused with the mortality rate of a disease that is defined as the number of deaths per 100,000 population.

For example, if a population of 100,000 people in 20 are suffering from disease X, and a die 18 years, we have:

Mortality Rate = 18 / 100,000 = 0.00018 = 0,018%

FATALITY RATE = 18 / 20 = 0.9 = 90%






The Case fatality rate is an important epidemiological indicator combined with the attack rate (attack rate) is used to estimate the expected mortality for the current pandemic.



by NHS: Pandemic Influenza Weekly Situation Report - Planning assumptions - potential number of deaths

A common frame of reference of the overall 0.6% was calculated based on deaths registered around the world and analyzed by a team of August 2009. In the study published by Eurosurveillance (9) the CFR according to the country ranged from 0.1 to 5.1%. In Europe, the first affected country (United Kingdom), the observed rate was 0.3%, not much different from that estimated in previous studies.



When the CFR for industrialized countries fluctuates around 0.02% (20% Attack rate estimated ECDC updated 06/11/2009), but everything always depends on the quality of health care interventions and systems put in place .


Sistema di codifica della mortalità per Influenza e Polmonite
Ma in questa breve analisi vogliamo evidenziare un ulteriore elemento che deve essere preso in considerazione. Nell'aggiornamento della classificazione ICD10 sono inserite altre cause di morte, a cominciare dalla "Adult respiratory distress syndrome" (codice J80), che come abbiamo scritto rappresenta una delle complicanze più evidenti dell'influenza pandemica e motivo di ricovero nelle terapie intensive.
A guardare le stesse tavole Istat risulta chiaro che le statistiche degli anni precedenti non hanno mai "evidenziato" i dati relativi a questa causa di mortalità, ma per i decessi correlati all'influenza A/H1N1 si dovranno considerare anche questi "eventi negativi".


Conclusioni
Bisognerà dunque partire da questo tipo di dati, per definire in maniera comprensibile e misurabile "l'eccesso di mortalità" che potrà determinare l'attuale influenza pandemica. Gli scenari in corso in termini di mortalità necessitano però di essere valutati dimostrando meno "indiffirenza" e approssimazione. L' analisi dei "numeri", non deve far dimenticare che stiamo parlando di morti si misurabili ma anche evitabili, di una popolazione di bambini, giovani e adulti soprattutto under 65 con una lunga aspettativa e speranza di vita, che può essere tutelata con alcuni essenziali interventi di prevenzione... si chiama vaccination.
Rather than press releases we need to "information flow" to the occasion, also in terms of rapid surveillance "(

sr). The last round
be enough?

PS

Another round

Pippo Bruno



Bibliography and Links
Bibliography 1. Preliminary estimates of mortality by cause in the Italian regions
Year 2006. Istat
2.
The Impact of Influenza Epidemics on Mortality: Introducing a Severity Index Lone Simonsen, Matthew J. Clarke, G. David Williamson, DonnaF.Stroup, NancyH.Arden and LawrenceB.Schonberger
3.
Trends for Influenza-related Deaths During Pandemic and Epidemic Seasons, Italy, 1969-2001
Caterina Rizzo, Antonino Bella, Cécile Viboud, Lone Simonsen, Mark A. Miller, Maria Cristina Rota, Stefania Salmaso, Marta Luisa Ciofi and Acts. Istituto Superiore di Sanita, Rome, Italy, University of Bari, Italy, and National Institutes of Health, Bethesda, Maryland, USA
4.
Scenarios of diffusion and control of an influenza pandemic in Italy

EPIC Working Group. ISSN 1123-3117 Rapporti ISTISAN 06/33
5.
Mortality peaks in Italy in the late 19th and early 20th Centuries: trends by age and sex Pinnelli A, Mancini P. - Eur J Popul 1999;14(4):333-65.
6.
Epidemiological evaluation of influenza in Italy Rocchi G, Ragona G, de Felici A, Muzzi A. - Bull World Health Organ 1974;50(5):401-6.
7.
Excess mortality from influenza in a large urban population Ragona G, Giunchi G, Rocchi G, Muzzi A, de Felici A. Rome, Italy, 1956-76. J Hyg 1978;80(2):249-57.
8.
ECDC Risk Assessment aggiornamento 6.11.09 9.
Epidemiology of fatal cases associated with pandemic H1N1 influenza 2009
Eurosurveillance, Volume 14, Issue 33, 20 August 2009
Link
WHO mortality

WHO ICD
ICD-10 on line
ACME
European Health for All
(HFA-DB)

Istat demo
Tavole di mortalità Istat
Istat indicatori socio-sanitari
Istat ICD-10
Banca dati ISS
Dataset Istat
Fluview
Istat istruzioni per la compilazione scheda di morte
(2009) Sorveglianza delle ospedalizzazioni, delle forme gravi e complicate e dei decessi... Circolare 19 novembre 2009
Circolare 26 novembre 2009
La rilevazione delle cause di morte per la sanità pubblica e per la ricerca epidemiologica- AIE

Giuseppe Bruno
  Percentage of victims in relation to the total number of people with new influences: 0,003


1. As we have always repeated in Italy the mortality of this influence is overwhelmingly lower than the rest of the world where it is around 0.4%

2. As we pointed out other times there are other data that we characterize than the rest of the world: report cases in intensive care / hospital cases, "surprisingly high"
241/489 = 0.49 In the rest around the world is at 0.10, in countries with territorial system in cui il filtro territoriale è altamente efficiente si arriva allo 0,20 (fino ad ora record assoluto: UK); Questo rapporto è l'indicatore più importante per ricavare una stima attendibile del numero di polmoniti virali che necessitano della rianimazione.

3. La stima del ministero assume un tasso di necessità del ricovero in rianimazione di 1:10.000
da noi dunque circa il 50% casi ospedalizzati (polmoniti virali) finisce in rianimazione.
Deduzioni:
a) viral pneumonia - one of two things: either a virus circulating in Italy with different characteristics from the rest of the world "very bad" or report cases to the ICU / hospitalized cases provided by the ministry is wrong.
b) The Italian mortality - one of two things: either a virus in Italy is extremely mild or estimate provided by the Ministry of the denominator is clearly wrong. See our previous post

Conclusions
In the language of the law would say "the conjunction of deductions and b" leads to an obvious contradiction of the kind of virus circulating in Italy (with respect to all the rest of the world): a virus with the most extraordinary and extraordinarily bad than good.

least we should ask the virologists account of this double feature of viral population of our country ... alternative reading: a clear "communication error" the data provided.
should note in passing that in our letter to Doctor and Child, the number of viral pneumonia that was possible estimate of 1:1000.
When the ratio of cases in intensive care / hospitalized cases in Italy was in line with international literature data obtainable Italian doctors could get a very useful data for their clinical practice. According data instead of the ministry can get more data ...
You choose which ones are reliable

Pippo Bruno
Salvo Fedele

Appendix: available places in Intensive Care
There is another small as to be this moment should be monitored: the percentage of ICU beds occupied by patients with swine flu.

resources are not unlimited: it is almost impossible for the resuscitation of a warm Italian can go beyond 10% of their availability. Apart from that roof will not be able to go con molta facilità, in particolare per rianimazioni che hanno larghi bacini di utenza e debbono gestire tante gravi emergenze in contemporanea.
Ad un certo punto il numero di soggetti in rianimazione non crescerà più, questo non significherà che il tetto di gravità della malattia sarà stato raggiunto, significherà purtroppo che non ci saranno posti per accogliere tutte le richieste. A quel punto, senza la copertura di una buona campagna vaccinale, il numero assoluto di morti crescerà improvvisamente. Tenuto conto che il numero totale dei posti di Rianimazione in Italia è di 4250 l'indice di occupazione da swine flu è facile da ricavare:
241/4250 equivale a 5,90%, in crescita di un punto rispetto al dato della scorsa settimana. L'incremento della domanda però non sarà lineare