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Potential role of p53 on metallothionein induction in human epithelial breast cancer cells anxiety symptoms head tingling phenergan 25mg without a prescription. Zinc deficiency potentiates induction and progression of lingual and esophageal tumors in p53-deficient mice anxiety symptoms zenkers diverticulum phenergan 25mg line. Influenza virus infection induces metallothionein gene expression in the mouse liver and lung by overlapping but distinct molecular mechanisms anxiety zen youtube purchase generic phenergan on-line. The prognostic value of molecular marker analysis in patients treated with trimodality therapy for esophageal cancer anxiety care plan order phenergan us. Metallothionein promotes laminin-1-induced acinar differentiation in vitro and reduces tumor growth in vivo. Metallothionein expression in ovarian cancer in relation to histopathological parameters and molecular markers of prognosis. Laminin-1 and laminin-2 G-domain synthetic peptides bind syndecan-1 and are involved in acinar formation of a human submandibular gland cell line. An update on molecular diagnostics of squamous and salivary gland tumors of the head and neck. Immunohistochemical expression of metallothionein in benign premalignant and malignant epithelium of the larynx: correlation with p53 and proliferative cell nuclear antigen. Correlation of metallothionein expression with apoptosis in nasopharyngeal carcinoma. Proliferative potential in nasopharyngeal carcinoma: correlations with metallothionein expression and tissue zinc levels. Altered distribution and synthesis of laminin-5 (kalinin) in oral lichen planus, epithelial dysplasias and squamous cell carcinomas. Betel quid chewing, cigarette smoking and alcohol consumption related to oral cancer in Taiwan. A statistical study on oral carcinomas in Taiwan with emphasis on the relationship with betel nut chewing: a preliminary report. The upregulation of metallothionein 1 expression in areca quid chewing-associated oral squamous cell carcinomas. Modulation of gene expression in precancerous rat esophagus by dietary zinc deficit and replenishment. Metalloregulation of the tumor suppressor protein p53: zinc mediates the renaturation of p53 after exposure to metal chelators in vitro and in intact cells. Mitropoulos D, Kyroudi-Voulgari A, Theocharis S, Serafetinides E, Moraitis E, Zervas A & Kittas C. Role of lime in the generation of reactive oxygen species from betel-quid ingredients. Expression pattern of cisplatin-induced metallothionein isoforms in squamous cell carcinoma. Regulatory mechanisms controlling gene expression mediated by the antioxidant response element. Negative regulatory role of Sp1 in metal responsive element-mediated transcriptional activation. Ono Y, Nakanishi Y, Ino Y, Niki T, Yamada T, Yoshimura K, Saikawa M, Nakajima T & Hirohashi S. Clinocopathologic significance of laminin-5 gamma2 chain expression in squamous cell carcinoma of the tongue: immunohistochemical analysis of 67 lesions. Proceedings of National Academy of Sciences of the United States of America, (July 1992), Vol. Proceedings of National Academy of Sciences of the United States of America, (July 1998), Vol. Pastuszewski W, Dziegiel P, Krecicki T, Podhorska-Okolow M, Ciesielska U, Gorzynska E & Zabel M. Prognostic significance of metallothionein, p53 protein and Ki-67 antigen expression in laryngeal cancer. Metallothionein and p-Akt proteins in oral dysplasia and in oral squamous cell carcinoma: an immunohistochemical study. Hierarchical cluster analysis of myoepithelial/basal cell markers in adenoid cystic carcinoma and polymorphous low-grade adenocarcinoma. Impact of betel quid, tobacco and alcohol on three-stage disease natural history of oral leukoplakia and cancer: implication for prevention of oral cancer. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. The gamma2 chain of laminin-5 as an indicator of increased risk for recurrence in T1 stage tongue cancer. Surowiak P, Materna V, Maciejczyk A, Pudełko M, Markwitz E, Spaczyński M, Dietel M, Zabel M & Lage H. Nuclear metallothionein expression correlates with cisplatin resistance of ovarian cancer cells and poor clinical outcome. Immunohistochemical evaluation of metallothionein, Mcm-2 and Ki-67 antigen expression in tumors of the adrenal cortex. Szelachowska J, Dziegiel P, Jelen-Krzeszewska J, Jelen M, Tarkowski R, Spytkowska B, Matkowski R & Kornafel J. Correlation of metallothionein expression with clinical progression of cancer in the oral cavity. Szelachowska J, Dziegiel P, Jelen-Krzeszewska J, Jelen M, Tarkowski R, Wlodarska I, Spytkowska B, Gisterek I, Matkowski R & Kornafel J. Prognostic significance of nuclear and cytoplasmic expression of metallothioneins as related to 358 Oral Cancer proliferative activity in squamous cell carcinomas of oral cavity. Rapid Akt activation by nicotine and a tobacco carcinogen modulates the phenotype of normal human airway epithelial cells. Tobacco carcinogen-induced cellular transformation increases Akt activation in vitro and in vivo. Yamamoto M, Tsujinaka T, Shiozaki H, Doki Y, Tamura S, Inoue M, Hirao M & Monden M. Metallothionein expression correlates with the pathological response of patients with esophageal cancer undergoing preoperative chemoradiation therapy. Enhanced transcription of metallothionein genes in rat kidney: effect of uninephrectomy and compensatory renal growth. Oxidative dimerization in metallothionein is a result of intermolecular disulphide bonds between cysteines in the alpha-domain. Introduction the syndecan family is composed of four closely related proteins (syndecan-1–4) encoded by four different genes. In previous studies it has been noted that expression of syndecan-1 correlates with malignancy in various tissues including uterine cervix and esophagus. Several reports on head and neck carcinoma have suggested that reduced expression of syndecan-1 is associated with the prognosis of such neoplasms. No study has shown whether or not syndecan-1 is associated with mode of invasion, although invasion correlates to malignant behavior and prognosis. From the immunohistochemical staining pattern, the cases were divided into two groups based on expression of syndecan-1 at the supra peripheral cells of the tumor nest: Group A, completely or mainly positive; Group B, sporadically positive or negative. The number of cases where syndecan-1 expression was reduced was much greater in T3–4, and represented the majority of Group B (86. These results suggest that syndecan-1 directly contributes to the growth and invasive ability of these cells. It is apparent that alternations in cell adhesion can influence almost every stage of cellular transformation. The development of malignant epithelial neoplasm is associated with disruption of cell-to-cell and cell-to-matrix adhesion. Syndecans are family of heparan sulfate proteoglycan receptors that are thought to participate in both cell-to-cell and cell-to-matrix adhesion. The syndecans are composed of a core protein, to which sulphated and unbranched carbohydrate chains, glyosaminoglycans, are covalently attached. The core proteins contain an extracellular, a transmembrane and an intracellular domain, and their amino acid sequances are homologous, especially between the two last domains. The syndecans interact with extracellular matrix components, other cell surface components, and growth factors, including basic fibroblast growth factor (Hayashi et al.

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This claim is brought by Plaintiffs on behalf of residents of Missouri who are members of the Class anxiety symptoms in 12 year olds order phenergan 25 mg fast delivery. Each Defendant anxiety 9 year old son buy cheap phenergan 25mg, Plaintiffs anxiety joint pain phenergan 25mg with amex, and class members are “persons” within the meaning of Mo anxiety symptoms to get xanax phenergan 25mg fast delivery. Defendant engaged in “trade” or “commerce” in the State of Missouri within the meaning of Mo. Defendants are liable to Plaintiffs for damages in amounts to be proven at trial, including attorneys’ fees, costs, and punitive damages, as well as injunctive relief enjoining each Defendant’s unfair and deceptive practices, and any other just and proper relief under Mo. This claim is brought by Plaintiffs on behalf of residents of Montana who are members of the Class. Defendants, Plaintiffs, and class members are “persons” within the meaning of Mont. The sale of each drug at issue occurred within “trade and commerce” within the meaning of Mont. Because Defendants’ unlawful methods, acts, and practices have caused Plaintiffs to suffer an ascertainable loss of money and property, Plaintiffs seek from each Defendant: the greater of actual damages or $500; discretionary treble damages; reasonable attorneys’ fees. Plaintiffs additionally seek an order enjoining each Defendant’s unfair, unlawful, and/or deceptive practices, and any other relief the Court considers necessary or proper, under Mont. This claim is brought by Plaintiffs on behalf of residents of Nebraska who are members of the Class. Defendants’ actions as set forth herein occurred in the conduct of trade or commerce as defined under Neb. This claim is brought by Plaintiffs on behalf of residents of Nevada who are members of the Class. This claim is brought by Plaintiffs on behalf of residents of New Hampshire who are members of the Class. Defendants’ actions as set forth herein occurred in the conduct of trade or commerce as defined under N. This claim is brought by Plaintiffs on behalf of residents of New Jersey who are members of the Class. Plaintiffs are entitled to recover legal and/or equitable relief, including an order enjoining Defendants’ unlawful conduct, treble damages, costs, and reasonable attorneys’ fees pursuant to N. This claim is brought by Plaintiffs on behalf of residents of New Mexico who are members of the Class. Because Defendants’ unconscionable, willful conduct caused actual harm to Plaintiffs, Plaintiffs seek recovery of actual damages or $100, whichever is greater; discretionary treble damages; punitive damages; and reasonable attorneys’ fees and costs, as well as all other proper and just relief available under N. This claim is brought by Plaintiffs on behalf of residents of New York who are members of the Class. Each Defendant is a “person,” “firm,” “corporation,” or “association” within the meaning of N. Defendants’ deceptive acts and practices, which were intended to mislead consumers who purchased insulin, was conduct directed at consumers. Because Defendants’ willful and knowing conduct caused injury to Plaintiffs, Plaintiffs seek recovery of actual damages or $50, whichever is greater; discretionary treble damages up to $1,000; punitive damages; reasonable attorneys’ fees and costs; an order enjoining Defendants’ deceptive conduct; and any other just and proper relief available under N. This claim is brought by Plaintiffs on behalf of residents of North Carolina who are members of the Class. North Carolina’s Unfair and Deceptive Acts and Practices Act (the “North Carolina Act”) broadly prohibits “unfair or deceptive acts or practices in or affecting commerce. Plaintiffs seek an order for treble their actual damages, an order enjoining Defendants’ unlawful acts, costs of Court, attorney’s fees, and any other just and proper relief available under the North Carolina Act, N. This claim is brought by Plaintiffs on behalf of residents of North Dakota who are members of the Class. Code § 51-15-09, Defendants are liable to Plaintiffs for treble damages in amounts to be proven at trial, as well as attorneys’ fees, costs, and disbursements. This claim is brought by Plaintiffs on behalf of residents of Ohio who are members of the Class. As a result of the foregoing wrongful conduct, Plaintiffs have been damaged in an amount to be proven at trial, and seek all just and proper remedies, including, but not limited to, actual and statutory damages, an order enjoining Defendants’ deceptive and unfair conduct, treble damages, court costs, and reasonable attorneys’ fees, pursuant to Ohio Rev. This claim is brought by Plaintiffs on behalf of residents of Oklahoma who are members of the Class. Each Defendant is a “person,” “corporation,” or “association” within the meaning of Okla. The sale of insulin to Plaintiffs was a “consumer transaction” within the meaning of Okla. It manipulated the price of its life-saving product without regard to the impact of its scheme on consumers’ ability to afford to buy a product necessary to sustain their life. Because Defendants’ unconscionable conduct caused injury to Plaintiffs, Plaintiffs seek recovery of actual damages, discretionary penalties up to $2,000 per violation, and reasonable attorneys’ fees, under Okla. This claim is brought by Plaintiffs on behalf of residents of Oregon who are members of the Class. Each drug at issue are “goods” obtained primarily for personal family or household purposes within the meaning of Or. Plaintiffs are entitled to recover the greater of actual damages or $200 pursuant to Or. Plaintiffs are also entitled to punitive damages because Defendants engaged in conduct amounting to a particularly aggravated, deliberate disregard of the rights of others. This claim is brought by Plaintiffs on behalf of residents of Pennsylvania who are members of the Class. Defendants, Plaintiffs, and class members are “persons” within the meaning of 73 Pa. Plaintiffs purchased insulin primarily for personal, family, or household purposes within the meaning of 73 Pa. All of the acts complained of herein were perpetrated by Defendants in the course of trade or commerce within the meaning of 73 Pa. Defendants are liable to Plaintiffs for treble their actual damages or $100, whichever is greater, and attorneys’ fees and costs. Plaintiffs are also entitled to an award of punitive damages given that Defendants’ conduct was malicious, wanton, willful, oppressive, or exhibited a reckless indifference to the rights of others. This claim is brought by Plaintiffs on behalf of residents of Rhode Island who are members of the Class. Plaintiffs purchased insulin primarily for personal, family, or household purposes within the meaning of R. Plaintiffs are entitled to recover the greater of actual damages or $200 pursuant to R. This claim is brought by Plaintiffs on behalf of residents of South Carolina who are members of the Class. Because Defendants’ actions were willful and knowing, Plaintiffs’ damages should be trebled. Plaintiffs further allege that Defendants’ malicious and deliberate conduct warrants an assessment of punitive damages because Defendants carried out despicable conduct with willful and conscious disregard of the rights and safety of others, subjecting Plaintiffs to cruel and unjust hardship as a result. Defendants’ unlawful conduct constitutes malice, oppression, and fraud warranting punitive damages. Plaintiffs further seek an order enjoining each Defendant’s unfair or deceptive acts or practices. This claim is brought by Plaintiffs on behalf of residents of South Dakota who are members of the Class. Codified Laws § 37-24-31, Plaintiffs are entitled to a recovery of their actual damages suffered as a result of Defendant’s acts and practices. This claim is brought by Plaintiffs on behalf of residents of Tennessee who are members of the Class. Plaintiffs and class members are “natural persons” and “consumers” within the meaning of Tenn. Each Defendant’s conduct complained of herein affected “trade,” “commerce,” or “consumer transactions” within the meaning of Tenn. This claim is brought by Plaintiffs on behalf of residents of Texas who are members of the Class.

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The overall prognosis depends on Complications the stage of the tumor at the time of diagnosis anxiety hot flashes buy phenergan 25 mg on-line, early re these include diabetes mellitus anxiety symptoms dsm quality phenergan 25 mg, obstructive jaundice anxiety symptoms over 100 order phenergan with mastercard, sectable tumors having an excellent prognosis anxiety symptoms 24 hours day best order phenergan. Social and Physical Disability Code the symptom complex with weight loss and generalized 453. The overall prognosis even Central or paraumbilical or upper abdominal over the with modern imaging techniques is poor. Differential Diagnosis Malignancy in other organs, stricture or impacted stone in the common bile duct. X4b Page 155 Chronic Mesenteric Ischemia comes severe, weight loss results and sudden small bowel infarction may occur. Definition Main Features Pain due to chronic granulomatous disease of the gastro Progressively severe abdominal pain precipitated by intestinal tract. Associated Symptoms There may be symptoms suggestive of gastric or duode System nal ulceration or intermittent incomplete small bowel Gastrointestinal system, sometimes including liver. Signs and Laboratory Findings There may be evidence of generalized atherosclerosis as Main Features shown by absent femoral popliteal or pedal pulses, or the Becoming increasingly common in young adults but can presence of an epigastric bruit. No specific laboratory occur at any age; males and females affected equally; findings are diagnostic. Weight loss is associated with a pain usually due to obstruction in the distal ileum with severe form of this disease. Arteriographic evaluation colicky central abdominal pain in bouts; or localized indicates severe stenosis or occlusion of all three mesen inflammation (abscess formation) may cause a constant teric vessels, including the inferior mesenteric artery, the severe pain. A mean dering artery, indicating collateral blood flow to the co Associated Symptoms lon, is a common finding. Intestinal obstruction associated with distention, nausea and vomiting, alteration in bowel habit, constipation or Usual Course diarrhea or both, aggravated by eating, relieved by Progressive weight loss and abdominal pain if untreated. Signs and Laboratory Findings Social and Physical Disability Mass in right lower quadrant; central abdominal disten this unusual problem may be part of a picture of gen sion; increased bowel sounds. Differential Diagnosis Complications Small intestine—benign strictures; large intestine— There is a suggestion on epidemiological and experi ulcerative colitis. X3a Sustained pain Social and Physical Disability Severe constipation, particularly in the elderly, can cause spurious diarrhea resulting in fecal incontinence. The Abdominal pain, usually dull, due to chronic alteration Western world’s highly refined low-fiber diet predis in bowel habit resulting in fewer bowel movements and poses to small stool weights and constipation, which is diminished mean daily fecal output. Rarer causes in clude disorders of colonic muscle such as congenital Site megacolon and Hirschprung’s disease. Summary of Essential Features and Diagnostic System Criteria Gastrointestinal system. Abdominal pain, usually dull, sometimes exacerbated by eating due to chronic constipation, which is largely a Main Features disorder of Western civilization and increases with age. Common in any age group but becoming increasingly the diagnosis is made from the history and physical common in the elderly. The pain is located over the cutaneous markings of the colon, most Differential Diagnosis commonly in the left lower quadrant and upper abdomen Diverticular disease, carcinoma of the colon. The pain may vary from being constant and dull to sharp or very severe, but it never Code prevents sleep. X7a erbations associated with eating; defecation may bring partial temporary relief. However certain high-fiber foods such as Chronic abdominal pain of no apparent cause associated vegetables and bulk laxatives failing to cause defecation with alteration of bowel habit. Site Anywhere over the cutaneous markings of the colon but Signs and Laboratory Findings maximal on the left lower quadrant over the descending the abdomen may be chronically distended; colonic colon. Very common, maximum in second, third, and fourth Page 157 decades but onset at any age from first to eighth decade. Diverticular Disease of the Colon More common in females, with ratio varying from 2:1 to 5:1. It occurs daily throughout the Definition year and in some patients “never misses a day,” often for Pain, usually dull, arising in relation to multiple small many years. The pain is out of keeping with the patient’s sac-like projections from the lumen of the colon through physical condition. The pain is most commonly in the left lower abdominal There is always an alteration in bowel habit, either quadrant, related to the sigmoid colon, spreading more morning diarrhea with five to six bowel actions followed widely if the disease involves the whole colon. Main Features the pain is not a common symptom in this very com Signs and Laboratory Findings mon condition, which rarely presents before age 40, but Tenderness over part of colon. Males and fe tal examination and on sigmoidoscopy at rectosigmoid males are equally affected. Majority or acute severe pain in the left lower quadrant, associ of investigations negative. Barium enema shows colonic ated with acute inflammation (acute diverticulosis), and spasm; a small percentage are lactose intolerant. Chronic constipation, acute or chronic abdominal disten sion, rectal bleeding (in diverticulitis). Relieved by high cereal fiber diet May predispose to diverticular disease, secondary neu. Signs and Laboratory Findings Social and Physical Disability Abdominal (colonic) distension. Palpable descending the pain can be incapacitating and result in deterioration and sigmoid colons with or without tenderness. May be associated with increased Acute attacks of diverticulitis occur infrequently. Essential Features Complications Usually there is a long history of constant abdominal Acute diverticulitis, obstruction with or without spurious pain and tenderness in young women; associated with diarrhea, bleeding, peridiverticular abscess. Differential Diagnosis Social and Physical Disability Diverticular disease of the colon. X7b Pathology Hypertrophy of circular colonic muscle with penetration by sacs consisting of mucosa, connective tissue, and the serosal surface. Page 158 Summary of Essential Features and Diagnostic Cri Social and Physical Disability teria Surgical treatment may involve a permanent colostomy. A common chronic condition of the elderly resulting in constipation, colonic distension, and sometimes abdomi Pathology nal pain. The diagnosis is made by identification of di the pathology is that of adenocarcinoma, beginning in verticuli on barium enema. Differential Diagnosis Benign polyps and strictures, diverticular disease, is Site chemia colitis. Most commonly lower abdominal or perineal pain from a lesion of the rectosigmoid area. X2c Main Features One of the most common cancers in the developed coun tries, in contrast to developing countries. However it can occur rarely Dyspepsia and Other Dysfunctional in young adults and children. There are several possible mechanisms of pain: the most common is due to Code obstruction with colon distension. There may be obstruc tion with a change in bowel habit, rarely colonic perfora tion or fistula formation into another viscus such as the bladder. Page 159 Post-Gastric Surgery Syndrome, Social and Physical Disability Usually only during pain episodes. X7 Definition Recurrent abdominal pain is a syndrome consisting of References paroxysmal episodes of unexplained abdominal pain in Apley J. Associated Symptoms Carcinoma of the Liver or Biliary May be associated with nausea, vomiting, pallor, limb pains, and headache. If pain always occurs at a site other then peri umbilical the possibility of other organ system pathology. Classic features are periodic acute self Treatment limiting febrile episodes with peritonitis, pleuritis, syno Colchicine is effective. Diagnostic Criteria Site Periodic attacks of peritonitis (rarely pleuritis) occurring Abdomen or chest.

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Tere is currently for commissioning services and to anxiety symptoms and signs cheap 25mg phenergan otc Public Health England a programme of redesigning and modernizing how for providing scientifc support anxiety and panic attacks order 25 mg phenergan otc. It tions and budget requirements for the delivery of the will implement new models of delivery based on local immunization programme are agreed annually by the decision-making and leadership anxiety symptoms jelly legs buy cheap phenergan 25mg on line. Northern has specifc responsibilities for the implementation of Ireland has implemented all the Joint Committee’s rec the immunization programme anxiety symptoms rash generic phenergan 25mg without a prescription, the provision of service ommendations, although occasionally with slight varia specifcations for individual vaccines, the procurement of tions. The Department of Health tasks the cialist advice and information at national and local levels. All pre-school Health England and local government working together and most infuenza immunizations, along with adult to commission and provide leadership for screening and vaccines for pneumococcal disease, shingles and pertussis immunization services. Public Health England employs in pregnant women, are administered in general prac screening and immunization teams embedded within tice. This means that the screening and immunization programmes, and with the Child Health Information teams are accountable to both Public Health England and System to send invitations and monitor uptake. Clinical all materials to support the immunization programmes, Commissioning Groups, which are led by local general and delivers communications campaigns to the public. They apply equally to the devolved administrations of England, Wales, Scotland In addition, for children in England the Child Health and Northern Ireland. Information System (a local population register of all children including those not registered with a general Although the Joint Committee of Vaccinations and practitioner) acts as a source of data to estimate coverage Immunisations’ guidance is generally applied throughout for routine and selected childhood immunizations. In England, with its more decentralized health (including immunization) and support for statu system, decisions about eligibility also vary based on local tory functions. Similar systems exist in the areas will use catch-up vaccination following outbreaks in other jurisdictions, such as the Child Health Surveillance certain communities using various delivery strategies, and Programme in Scotland and the Northern Ireland Child develop interventions to reach specifc under-vaccinated Health System and the Child Health System in Wales. At local level, specifc area teams Targeted measures and interventions are deployed for develop strategic/operational plans for their regions to specifc groups based on an assessment conducted by local improve uptake. In England local plans are developed in public health and National Health Service teams. However, guidelines state that all health care staf should be up undocumented migrants face many barriers to obtaining to date with their routine immunizations. Tese systems difer in each of the jurisdictions, in relation to content and linkage with Tere are no sanctions for citizens or parents who refuse other data, with linkage most advanced in Scotland. The uptake of infuenza, nation, for example with payments for vaccine uptake at shingles and pneumococcal vaccines is extracted electron 2 and 6 years of age and separate specifc incentives for ically via the Apollo system and infuenza uptake can also achieving a target percentage for the cluster of three-dose be calculated from general practitioners’ fee claim data. English general practices receive an incentive pay ment if they achieve a set target for immunizing specifc Provision at-risk groups against infuenza every year as part of the Quality Outcomes Framework; this is not currently the The majority of vaccines included in the routine schedule case in Northern Ireland. The guidelines mention that vaccine coverage measurements are published quarterly as there is an opportunity to ofer unimmunized or partially offcial statistics and annually as national statistics. Reporting was originally undertaken manually, In terms of adult vaccinations against infuenza, most but by 2008–2009 it had moved to automatic extrac adults are vaccinated by their general practitioner. For tion from around 50% of practices and this has now adults a range of trivalent and quadrivalent inactivated increased to over 95%. As mentioned below, all pregnant women should provide vaccine ordering facilities for the National Health be ofered an inactivated infuenza vaccine while preg Service. In Scotland data for children are extracted from the Child Health Surveillance Programme for immunizations, to Health care professionals are generally vaccinated by nurses in the occupational health services of employers 2 The infuenza vaccine is also available in United Kingdom 179 community pharmacies, administered by pharmacists, The list in Table 1 is not exhaustive, and the health prac and since 2016 has been provided free to eligible patients titioner should apply clinical judgement to take into under the National Health Service, and to others. Pregnant women are lying disease that a patient may have, as well as the risk vaccinated either by midwives in antenatal clinics or in of serious illness from infuenza itself. Clinical risk category Examples (this list is not exhaustive and decisions should be based on clinical judgement) Chronic respiratory disease Asthma that requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission. Children who have previously been admitted to hospital for lower respiratory tract disease. Chronic heart disease Congenital heart disease, hypertension with cardiac complications, chronic heart failure, individuals requiring regular medication and/or follow-up for ischaemic heart disease. Chronic kidney disease Chronic kidney disease at stage 3, 4 or 5, chronic kidney failure, nephrotic syndrome, kidney transplantation. Clinicians should offer immunisation, based on individual assessment, to clinically vulnerable individuals including those with cerebral palsy, learning disabilities, multiple sclerosis and related or similar conditions; or hereditary and degenerative disease of the nervous system or mus cles; or severe neurological disability. Diabetes Type 1 diabetes, type 2 diabetes requiring insulin or oral hypoglycaemic drugs, diet controlled diabetes. It is diffcult to defne at what level of immunosuppression a patient could be considered to be at a greater risk of the serious consequences of infuenza and should be offered infuenza vaccination. This decision is best made on an individual basis and left to the patient’s clinician. Some immunocompromised patients may have a suboptimal immunological response to the vaccine. Asplenia or dysfunction of the spleen this also includes conditions such as homozygous sickle cell disease and coeliac syndrome that may lead to splenic dysfunction. Pregnant women Pregnant women at any stage of pregnancy (frst, second or third trimesters). However, care of patients or clients; this level remains below the 95% target set by the World Health Organization. For non-recommended groups, illness; infuenza vaccination is accessible in a pharmacy for a fee (around £12, but each pharmacy is free to set its own. National educated parents and among those living in more afuent Institute for Health and Care Excellence guidance out areas. The likelihood of catching up varied markedly involved containing its spread with daily visits by the with a number of social factors, and more so for full than same health visitor (Reynolds et al. Adult vaccinations against infuenza Regional variation: Tere are regional variations in The National Institute for Health and Care Excellence uptake. This has been attributed to higher mobility of the population in urban centres, and also to. Tese include Roma and Traveller com munities, the Somali population, and Orthodox Jewish. This requires to infuenza, regardless of their age, and this infuenced all eligible patients to be called (invited); records their views on the need for immunization. Both refusers to be kept up to date; vaccination status (or reason and defaulters overstated adverse efects from infuenza for declining a vaccine) to be recorded accurately; vaccine, so this is a potential target for an intervention. In a survey and regular monitoring and reporting of vaccina conducted in 2006, over 80% reported being infuenced tion activity; by a recommendation by a health care worker. A qualitative study of lay beliefs ing and information provision for eligible groups; about infuenza immunization in older people. Efect of mass paediatric infu 2 to 11 years who are not in a clinical risk group to enza vaccination on existing infuenza vaccination pro reduce transmission in the community and reduce grammes in England and Wales: a modelling and cost the number of cases of flu-related illnesses and effectiveness analysis. Cross-sectional survey of older immunisation people’s views related to infuenza vaccine uptake. Annual Immunisation and Vaccine Preventable Diseases Report for Northern Ireland 2016–17. Management of measles in a traveller community: Public health issues of trust, choice and communication. It has been revised in fast track by a larger group of physicians and scientists from different specialties/disciplines including experts from ScienSano (Dr Chloe Wyndham-Thomas at Chloe. It is based on the best (but very incomplete) clinical evidence that is currently available, and is purposed to become a “living guideline” which will be regularly updated each time new relevant scientific data will emerge (latest version will always be found via the same link). Readers are warmly invited to send any additional comment, relevant publication, including from the grey literature, and contribution in priority to the small core group (ideally to all six provided mails). We thank the countless readers who, since this guideline was initially released, flagged the inconsistencies, typo’s or unclarities, as well as those who sent all types of contribution with regards to this rapidly evolving field. About 20% of infected patients need to be admitted, including 5% who require intensive care. A study has shown that case severity is correlated with viral load, irrespective of symptoms duration [1]. Mortality in admitted patients reached 25% (and even 40% in overwhelmed hospitals) in the middle of the epidemic in Wuhan [2]. This document will not elaborate in detail the generic and supportive management of such infections (except if there are some pathogen-specific interventions).

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