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10 Warning Signs Of Alzheimer’s Disease

Alzheimer’s disease is a progressive brain disease that has no cure. It is the most common type of dementia and it particularly affects people in older age groups. The onset of Alzheimer’s disease is slow and the symptoms worsen with the passage of time. If the disease is diagnosed early, there is a better chance for medical intervention with an aim to delay the progression and enhance the quality of life of the patient.

The following is a list of 10 symptoms or warning signs of the disease that a person must watch out for:

Loss of Memory that Affects Everyday Life

Frequent memory lapses such as forgetting how to accomplish a task that the person is actually very familiar with, forgetting the steps of one’s favorite activity or game, forgetting the directions to a common location that is otherwise very familiar, or forgetting information that has been provided repeatedly are a primary warning sign of Alzheimer’s disease.

Difficulties in Tasks that Require Concentration

If there is a change in one’s capacity to make a systematic plan and follow it, or get confused with dates, places, timings and anything else that is numerical or system-oriented in nature, such as paying household bills or even cooking an elaborate dish that one is very familiar with, this could be a symptom of AD.

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Challenges in Vision and Perception

Any picture or moving image that requires some mental concentration to comprehend may not be clearly understood by someone who is experiencing the onset of Alzheimer’s. In some cases, the patient may even get confused on seeing his or her own image in the mirror.

Poor Judgment of Distances

Driving may become a risky activity once Alzheimer’s disease has begun. There may be a difficulty in judging the distances and spaces reasonably. The brain may not be able to estimate the gaps and distances with reasonable accuracy.

Speech and Listening Difficulties

A sudden development of challenges in speech, particularly with long, complex or new words, may be a sign of Alzheimer’s disease. Difficulties in reading as well as writing of words or sentences that one was previously familiar with may also be indicative of the onset of Alzheimer’s.

Habit of Frequent Repetition

If a person begins to repeat or narrate the same facts, events or experiences frequently, without realizing that it has been told to other people several times before, it may be due to the triggering of Alzheimer’s disease in the brain.

Inability to Act Instinctively in Obvious Situations

If something is burning on the gas stove, any healthy person would instinctively act to switch off the gas. However, if the person gets confused about what course of action to take in such situations, this could be a symptom of the development of Alzheimer’s disease.

Experiencing Bouts of Silence

If a healthy person suddenly begins to undergo prolonged and unexplained bouts of silence, it could be related to Alzheimer’s. People around the patient may not realize the reason and may feel the person is brooding or sulking. However, it could be the onset of a serious medical condition and not merely a mood swing.

Sudden Changes in Personality and Behavior

With the onset of Alzheimer’s, some people may become more anxious, short tempered or irritated over small issues, or may suddenly begin to disbelieve and distrust everyone around them, or may become obstinate beyond the limits of reason, or may start avoiding social gatherings. These sudden and specific personality, behavioral and temperamental changes should not be dismissed merely as mood swings. These may be the symptoms of Alzheimer’s disease.

Other Specific Signs of Alzheimer’s Disease

An Alzheimer’s patient may typically reveal an inability to trace his own steps. He may misplace personal items or leave them wherever he goes, or he may replace things in the wrong places, and may even start imagining others as stealers of his personal things. Sudden poor performance at work and uncharacteristic silence in social settings may also be a symptom of this disease.

Creating A Culture That Values Employee Health: Promoting A Healthy Working Environment Adds Value To A Business

Your business is in many ways a machine. And your employees are the parts that make that machine go. As a business owner you want to keep your company as healthy as possible. But the health of the company doesn’t just involve the finances, customers, and suppliers it involves your employees. Their health is just as important as any other aspect of the business is. In fact it is far more important because we’re talking about the health of people.

The Situation At Many Companies

Many organizations though seem to strive for as much productivity as they can achieve without taking into account the welfare of its employees. With high stress environments, long hours, and little time to relax working is one of the worst enemies a person can have in terms of staying healthy. But as a business owner you have the chance to right this wrong at least in your own organization.

Some Possibilities To Create A Healthy Environment

So what are some of the ways that you can provide your employees with a healthy work environment? The first thing you should be doing is working to create such an environment. To do that means providing for and encouraging healthy behavior from your employees. No smoking policies, maternity/paternity leave, flex time, and vending machines that provide only healthy snacks are just a few ways this can be done. In addition proper vacation time and making sure employees take it can help keep the stress level down.

Physical Activity In The Workplace

Physical activity in the workplace should be encouraged. Many small businesses can’t afford to put in their own gyms but having a company softball team or participating in other forms of organized sports can provide that much needed break while at the same time fostering a spirit of teamwork. Having the occasional sports day with a barbeque cookout and activities for the whole family can also have the same effect.

You Need To Take The Lead

Take the lead in such pursuits. Being a cheerleader for such things does you and your company no good. You’re their leader so lead. Sponsoring gym memberships at a nearby fitness club can be used as an effective employee benefit. Encourage people to spend some time each week there. And make sure you go as well. That way when they see you they will know that you’re serious about it all. Go as a group. Often you will see the creative juices flow as people begin to loosen up.

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Ask Your Employees For Ideas

Besides leading them in such adventures in fitness you need to ask them what ideas they might have. They will probably surprise you by how many things that they would like to do but did not feel comfortable mentioning. Remember you’re doing this for them as well as yourself. Creating a culture that strives to be physically healthy also can provide the added benefit of building a less stressful work environment overall. There is absolutely no reason that your work environment needs to be an unhealthy one. So don’t let it be.

What Are Kidney Stones?: Identification, Causes, Effects, And Treatments For Kidney Stones

According to the National Kidney Foundation, more than 500,000 people in the U.S. seek medical assistance for kidney stones each year. In the presence of kidney stones, urethral pain, as well as localized abdominal and lower back pain, are a common occurrence.

Identification of Kidney Stones

The urethra is the anatomical structure that serves as the opening to the bladder. In women, the opening is located just in front of the vagina, and in men the urethra is on the tip of the penis. Urethral pain can present as a dull pain, or a throbbing pain depending on the severity of the problem. Kidney stones can be identified by taking an X-ray of the bladder and other abdominal structures in the urinary tract. On an X-ray, the kidney stones are visible as white spots.

Causes of Kidney Stones

Kidney stones are hard, stone-like objects that develop from the chemicals in a person’s urine. These “stones” can cause backups of urine in the urethra, or other parts of the urinary tract. There is a positive correlation between the amount of uric acid present in the urinary tract, and the probability of kidney stone formation.

Effects of Kidney Stones

While most small kidney stones pass without the person knowing it, the blockages from the larger stones can cause pain. It is this pain which typically motivates people to seek medical assistance. In some cases kidney stones can cause damage to the urinary tract in the form of scar tissue. The resulting scar tissue can make it difficult for urine to pass through the urinary tract at the rate it is supposed to.

Treatment of Kidney Stones

A physician can prescribe medication to manage the pain associated with kidney stones. Be sure to consult with a doctor before taking an over-the-counter pain killer when kidney stones are present. Kidney stones can be treated in a variety of ways, depending on the severity. In most cases, treatment consists of simply waiting for the stone to pass out of the body. In more extreme circumstances, when the stone cannot pass on its own, treatments can include shock wave therapy or surgical intervention to break up and remove stones.

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According to the Cleveland Clinic, increasing water intake, reducing salt intake, and including adequate calcium in the diet can help to prevent kidney stones. Also avoiding foods such as chocolate and organ meats, which raise the level of uric acid in the urine, can assist in this process. If kidney stones are a recurring problem, and lifestyle modifications alone are not managing them, a physician can prescribe medications to help prevent the stones. Overall prevention of kidney stones should be the ultimate goal. By doing so people avoid the painful effects, and potential damage to the urinary tract.

Fort Worth LVN Programs – Approved LVN Fort Worth Nursing Schools

Prospective nursing students living in Texas who want to gain the credentials necessary to become a vocational nurse must first complete a state-approved licensed vocational nurse (LVN) training program.

Every state in the U.S. is responsible for approving its own licensed practical nurse (LPN) educational programs, which in the States of Texas and California are called licensed vocational nurse programs. The Texas Board of Nursing is the state body charged with approving and regulating those LVN Fort Worth nursing schools located in the Fort Worth and Dallas areas.

This article details where interested students can find Dallas and Fort Worth LVN training programs and treats some of the licensing requirements students must fulfill in order to become a vocational nurse.

LVN Fort Worth Nursing License

Residents who have never graduated from an accredited nursing program must complete the following steps in order to practice as a Fort Worth LVN:

  • Graduate from a vocational nursing program approved by the Texas Board of Nursing
  • Pass the national licensing examination (called NCLEX-PN)
  • Complete a criminal history background check

Out-of-state nurses with a valid license who plan to move to the State of Texas can apply for an inter-state license transfer through the Texas Board of Nursing. For more information on how to properly begin this process, prospective candidates can contact the board at (512) 305-7400.

Fort Worth LVN Training Options

Approved nursing schools throughout Texas create their own curricular structures and course offerings. However, all LVN Fort Worth nursing schools approved by the state must provide the following minimal elements to students:

  • 1398 hours of combined classroom and training instruction
  • 558 hours of theory-based academic learning
  • 840 hours of experiential training in a clinical setting

Fort Worth nursing students in vocational programs learn several important content areas, including:

  • Basic nursing procedures
  • Nutrition
  • Pediatric nursing
  • Maternity nursing
  • Mental health care
  • Physical sciences
  • Social sciences
  • Microbiology
  • Human development
  • Pediatric nursing
  • Emotional health
  • Pharmacology

Along with the classroom-based learning, students participate in a clinical training program in which they treat a range of patients under the supervision of a licensed nurse. This experiential training gives students a practical background from which to draw when they begin their future vocational nursing jobs.

Read More: Elements Of Choosing A Nursing Program: From Vocational Nursing School To Doctorate Programs.

LVN Fort Worth Nursing Schools

Vocational nursing programs approved by Texas are offered by a variety of educational providers, including career institutes, community colleges and technical schools.

To find approved programs in the Dallas and Fort Worth areas, see the state’s LVN programs list and search by a desired location.

Advantage of Fort Worth LVN Programs

Those who are able to both finish an accredited LVN Fort Worth nursing school’s program and pass the national licensing exam acquire the credentials needed to work as a vocational nurse in medical facilities across Texas.

Elements Of Choosing A Nursing Program: From Vocational Nursing School To Doctorate Programs

The nursing school that you choose to attend can have more impact than just the quality of education that you receive. Graduating from a well-known and well-respected facility can add credibility to your resume as the reputation of your nursing program can speak volumes. The benefits can be realized in a higher salary and better opportunities for advancement. Choosing nursing schools that are associated with prestigious hospitals for your practice work can give you an advantage in competing for positions or may even expose you to specialties that you would have never previously considered.

The Importance of Location

There is a nursing training program accessible to nearly every locality. The most frequent consideration of many when choosing a location is how far away from home they are willing to be. However, locations that serve major metropolitan hospitals will provide training experiences that cannot be found anywhere else. Conversely, smaller local training centers can offer more personalized instruction and usually have lower student to instructor ratios. There are even online nursing programs for those who wish to complete part of their education online.

Area of Study

Areas of study that are provided by training centers are another consideration when choosing a nursing school. Are you interested in research? Do you want to practice in highly specialized areas such as immunology or oncology? Check the course listing of the training centers that you are considering to determine what educational opportunities in your chosen areas you will receive. Also inquire about clinical rotations to find out how much time will be spent in hands on experience and in what disciplines. More time spent in clinical rotation correlates with improved work capabilities and performance.


The training center that you choose should be accredited by one of two certifying bodies, either The National League of Nursing Accrediting Commission or The Commission on Collegiate Nursing Education. There are also separate accrediting bodies for Nurse Anesthesia and Nurse Midwife so be sure to verify those credentials in you are planning on entering either of these specialties.

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While most schools must be approved by a state board of nursing, that is not the same as being an accredited program of study. State board approval will allow you to take the licensing examination (called the NCLEX exam), the credits that you receive will not transfer into another learning college or university unless those credits come from an accredited institution. This would prevent you from receiving an advanced degree such as a bachelor’s, a master’s, or doctorate degree in nursing.

Examination Success

One vitally important consideration when choosing a nursing school is the rate of state board passage by graduates of the program. Make sure that you ask for data regarding your state board passage rate and ask for several years worth of data for a better evaluation of the school’s performance over time. You want to choose schools that have high state board passage rates.

Nursing School Costs

Also important to many when choosing a school is the cost of the tuition. However, don’t forget that there are many ways to finance a college education through grants, scholarships, financial aid, and work study programs. However, be prepared to be proactive in investigating these programs and doing your research. Local hospitals and community clubs and organizations can be additional sources of scholarship monies.

By keeping in mind these considerations, you will receive the best education for your money and at the same time set yourself up with the best potential for success beyond school and into the work force.

Adaptogens For Modulating The Immune System: The Role Of Herbal Medicine In Autoimmune Disease

Although adaptogens have been used in the form of tonics, rasayanas, or restoratives in Russia, China, India and the Americas for centuries, they’re fairly new to modern medicine. In the United States, adaptogens first came under medical scrutiny in the late 1940s. During these early studies, the physiological effects of adaptogens, such as increased resistance to infectious agents, were easily demonstrated. However, the immune system hadn’t been discovered. Thus, adaptogens were thought to benefit the body’s physiology through non-specific means.

Adaptogens in Mainstream Medicine

With the discovery of the immune system in the 1960s and a better understanding of white blood cell function, scientists had the means to accurately study the effects of adaptogens, which are also referred to as immunomodulators. Consequently, in 1968, the scientists Israel Brekhman and I.V. Dardymov formally described adaptogens as nontoxic; capable of increasing the body’s resistance to physical, chemical and biological stressors; and having a normalizing effect on the body.

In addition to modulating the immune system, adaptogens are reported to balance the endocrine system and help the body heal itself (maintain homeostasis). Adaptogens are also thought to help the body cope with the effects of long-term stress as well as immediate stressors.

For instance, adaptogens such as Eleutherococcus (Siberian ginseng), Avena sativa, and skullcap are reported to improve and strengthen adrenal glands exhausted by years of long-term stress.

Specific Adaptogens

In general, adaptogens are all potent antioxidants and they’re reported to improve endurance and produce effects associated with stress reduction, for instance, improved sleep and enhanced athletic performance. Specific adaptogens are associated with specific properties. For instance,Rhodiolarosea is reported to reduce the neurasthenic effects caused by physical and mental stress and has sexual-stimulating properties.

Active Ingredients

Studies show that adaptogens contain a variety of phytochemicals that are responsible for their antioxidant and immunomodulating properties. These phytochemicals include: Triterpenes, which include the plant sterols, sterolins and saponins; Phenylpropanoids, including the bioflavinoids, and lignans; and Oxylipins, including the hydroxylated fatty acids.

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Using Adaptogens

Adaptogens can have individual effects depending on the general health, constitution, and specific nutrient deficiencies, and medical conditions present in an individual. Like all herbs, adaptogens should be used under the direction of a naturopath or herbalist who can advise of interactions with other herbs and prescription medicines. Individual adaptogens may be used or tonics containing several complementary adaptogens.

As immunomodulators, adaptogens strengthen weakened immune systems, offering benefits in autoimmune disease.

Practical Care-giving For An Alzheimer’s Patient: Caring For A Person With Alzheimer’s Can Be Difficult And Intense

There are many practical implications to caring an Alzheimer’s patient. Here is a basic guide to what may be encountered.


The ability to drive is normally decided on a case by case basis. If there is any chance of the person getting lost or endangering lives, then driving should not be allowed.


Many patients hold on to this area of control. So long as they are dressed appropriately for the weather and don’t have their underwear on top of outer garments, it is best to allow them to retain this freedom as long as possible.

Grooming Issues

A patient may reach the stage where he cannot attend to any personal grooming. In this case:

  • Keep the patient’s hair in a short, easy style to manage
  • Allow male patients to grow a beard to do away with the daily shaving ritual
  • Keep nails trimmed and check for ingrown toenails
  • Dress the patient in loose, easy to fasten clothing

Personal Hygiene

Patients in advanced stages of the disease will generally require assistance to bathe. Here are some points to be aware of:

  • Fear of running water or water falling on the head is common
  • Shower or bath chairs can make the process easier
  • Use non-slip mats in baths and showers
  • Sponge baths can suffice on alternate day so long as the genital area is kept clean
  • Modesty can be an issue. Allow the person to wear a robe in the shower for this reason.

Oral Hygiene

Alzheimer’s patients will reach the stage where they need assistance with brushing their teeth. Check for raw patches and ill fitting dentures as part of daily care. Swabs impregnated with toothpaste are available if the patient will not open his mouth properly. (Be careful of being bitten).

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This occurs for two main reasons:

  • Age related conditions such as weakened pelvic muscles
  • Confusion when trying to find a bathroom and inability to get clothes off quickly

Try not to make a fuss if an accident happens. Rather schedule regular bathroom visits and look for signs that the patient needs the toilet. There is an excellent range of adult pads and diapers available if incontinence becomes a big problem.


If the patient is bedridden, turn him every three hours to prevent bedsores from forming. A sheepskin can help cushion tender flesh.

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Keep meals to a regular schedule and make sure the patient is eating enough. Swallowing becomes difficult for some in the latter stages of the disease.

  • Serve food cut into small pieces
  • Offer finger foods
  • Serve the patient in a room where he is comfortable
  • Keep distractions to a minimum


Light exercise is to be encouraged. Look at things like walking, dancing and gardening. If the patient enjoyed swimming in the past, the caregiver could swim with him, ensuring he is wearing a life jacket.

Sleeping Arrangements

Sleep problems are common and are the main reason for placing patients in residential care. To settle a patient at bedtime, try these tips:

  • Restrict caffeine to six hours before bedtime
  • Don’t allow heavy snacks close to bedtime
  • Have a bedtime routine

Keeping Track of a Loved One

In case a patient goes wandering, mark all his clothing with iron on labels giving his name, address and phone number. Mark underwear and socks as well. A medic alert or safe return bracelet are also options.

An Alzheimer’s patient generally has more than one caregiver. If they all follow the same routines and rules, life will be more settled and easier for all concerned.

Understanding Sunscreen SPF Numbers

In any pharmacy such as Boots or Superdrug, there will likely be hundreds of sunscreen products on offer in different brands and showing different numbers on specific products. These numbers refer to the level of sun protection factor and can range from very low such as factor 8 right up to factor 60, which offers all-day protection.

Understanding Sunscreen SPF Numbers

The sun protection factor number is a useful indication of the level of protection that each product is able to provide. It is well worth asking a pharmacist for advice on specific brands and which are most suitable to meet individual skin types. A simple rule of thumb is that the paler the individual’s skin tone is, then the greater the sun protection factor that is likely to be required in order to prevent sunburn and more severe forms of sun damage which may result in melanoma or other forms of skin cancer.

SPF numbers have two main uses, including:

  • to calculate minimal erythema dosage
  • to indicate absorption percentage of UVA radiation

Minimal Erythema Dose

The minimal erythema dose or MED is used to provide the individual with a measure of the length of time one may be exposed to sunlight before the skin begins to show the early signs of sunburn where the skin starts to appear very slightly pink in colour. It is the SPF number that is multiplied by the MED to work out this amount of time. An example of this is if one takes 20 minutes of exposure to the sun before exhibiting the earliest stage of sunburn, then wearing a sunscreen offering sun protection factor 10 would mean that one could remain in the sun for approximately 200 minutes before showing signs associated with sunburn.

However, if one is swimming or engaging in active sport, then even if water-resistant sunscreen has been used it will be necessary for sunscreen to be reapplied afterwards.

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Selecting Appropriate Sunscreen

It is worth taking time to consider which sunscreen is going to be most useful rather than just purchasing the nearest item or those on special offer. This is because different products offer very different levels of protection and are useful for various situations. Sunscreen must be broad-spectrum in order to protect one against the damaging effects of both UVA and UVB levels of radiation. Purchasing a sunscreen with an SPF number of at least 15 or ideally 20+ is advisable. Also, think about whether one is likely to be involved in water-sports and if this is the case, ensure the sunscreen is labelled water-resistant.

As highlighted above, SPF numbers are used to show the level of protection offered by a particular type of sunscreen. When multiplied by the MED, it is possible to identify roughly how long one may be exposed to sunlight before exhibiting early signs of sunburn. If in doubt it is always better to purchase sunscreen of around 20+.

Recognizing And Treating Deep Vein Thrombosis: It’s Important To Know What To Look For Concerning Blood Clots

The term “deep vein thrombosis” refers to blood clots that occur in deep veins, often in the legs, although they can occur in other areas as well. Blood clots can cause pain and other symptoms, but in some cases there are no symptoms. These clots sometimes disappear on their own, but there are major risks associated with them, the most serious being that a blood clot can break free and travel to the lungs, causing a pulmonary embolism.

Symptoms of Blood Clot

As mentioned above, blood clots sometimes have no obvious symptoms. When symptoms do occur, common ones are swelling in the affected leg or area, pain in area, and/or redness and warmth. If any of these symptoms are experienced, please see a doctor right away.

It’s also important to be aware of the signs of a pulmonary embolism, in case a clot were to break free. These symptoms include chest pain that worsens when the person coughs or takes a deep breath, a sudden and unexplained shortness of breath, and producing blood when coughing, according to the Mayo Clinic in their staff article, “Deep Vein Thrombosis,” on August 8, 2009. Other signs to be aware of are feeling lightheaded or dizzy, or unexplained fainting.

Causes and Prevention of Deep Vein Thrombosis

People are more likely to experience blood clots if they are immobile for long periods, such as during long car or plane rides, or when on bed rest because of illness or injury. Certain inherited blood clotting disorders can also put people at risk for deep vein thrombosis. Those who have a personal history of blood clots are also more likely to get them again.

Certain lifestyle factors also put a person more at risk for blood clots. For instance, smoking, being overweight, taking birth control pills and being pregnant all put someone at higher risk of getting clots. People who have heart failure are also more likely to develop blood clots.

To reduce the risk of developing blood clots, avoid long periods of being immobile as much as possible, lose excess weight, quit smoking and control blood pressure, as high blood pressure also increases deep vein thrombosis risk.

For those who have already had blood clots, make sure to see a doctor regularly and take any prescribed medications exactly as directed. Ask the doctor about guidelines for vitamin K intake, as it may be recommended to limit foods that are high in vitamin K, such as soybean products and leafy green vegetables.

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Treatments for Blood Clots

One of the most common treatments for blood clots is blood thinning medication, such as Coumadin. These medications will not get rid of clots, but will keep them from getting bigger and help to keep new clots from developing. Some doctors recommend compression stockings for patients with blood clots to reduce swelling.

In an article provided to Vascularweb.org by The Society of Vascular Surgery on October 14, 2009, it’s reported that another possible treatment for blood clots can be the insertion of a screen into the a large vein in the abdomen, the vena cava. The purpose of this screen is to prevent the clot from being able to travel to the lungs in the event the clot breaks free and travels. It is often used for people who for one reason or another cannot take blood thinning medication.

Deep vein thrombosis can be a very serious condition, and it’s important to see a doctor or go to the hospital if symptoms of blood clot present, such as pain, swelling or redness in legs. Preventing this condition by not remaining immobile for long periods and practicing good self care is also a good idea.

Testing For H1N1 Suspended In Many Areas: Is Tamiflu Resistance Being Underreported?

Strain-specific testing for 2009 H1N1 influenza (swine flu) has been suspended in many areas due to the high prevalence of this pandemic strain in the human population.

Public health officials report that widespread confirmatory testing is superfluous and not cost-effective: Testing can be omitted, they say, in the majority of patients who present with flu-like symptoms because 2009 H1N1 is now the most common bug around.

Unfortunately, influenza is a very adaptable virus—some would call it “sloppy,” due to the promiscuous and random nature of its genetic acquisitions. It freely shares information with other viruses that cohabit the same infected cell; its genome shifts, drifts, and recombines faster than virologists can keep up with it.

It is influenza’s propensity for rapid genetic transformation that makes vaccine development so difficult: An immunization that appeared to be a good viral match in midsummer is suddenly rendered ineffectual as new strains emerge in the fall.

Virology Basics: The Structure of Influenza A (H1N1)

Influenza A viruses all share a common structure:
  1. A viral envelope, composed of lipoproteins and glycoproteins (including the variable “H” and “N” antigens)
  2. A viral genome, consisting of eight single, highly-segmented RNA strands that contain the codes for eleven proteins needed for construction and function of a mature virus
Structure and Function Elegantly Combine
  • The manufacture of all viral proteins takes place in the hijacked nucleus of an infected cell
  • The segmented nature of influenza’s RNA allows for free exchange of entire genes between different viruses, as well as the frequent breaking and random recombining of genetic segments
  • Polymorphisms (“many forms”) exist within the population of influenza viruses; these may be due to differences in entire gene segments or to point mutations within a single gene
  • Most polymorphisms are the result of random mutation and confer no evolutionary benefit to the virus, but some allow the virus to survive and replicate more efficiently in certain environments (higher temperatures, different species, etc.)
  • Specific polymorphisms may derive survival benefits under certain environmental pressures (the development of bacterial resistance to antibiotics is a classic example of one polymorphism conferring an advantage over another due to a selective force that eliminates only the susceptible bacteria)

Emerging Tamiflu (Oseltamivir) Resistance in Novel H1N1

As of March 2009, analyses of viruses circulating in the United States revealed that 98% of the “garden-variety” flu (a different H1N1 strain) was resistant to Tamiflu, a drug commonly used to treat influenza. Scientists were puzzled by the near-universal resistance of influenza to Tamiflu, and public health experts who had stockpiled the drug in preparation for a pandemic of highly-lethal H5N1 (avian flu) were understandably concerned.

Further investigation revealed that the development of Tamiflu resistance was probably not due to the overuse of the drug, but arose instead as the result of a spontaneous mutation in the viral genome. More ominous, however, was the finding that the new mutation not only conferred resistance to oseltamivir; it seemed to increase the virus’ ability to infect people. (Dharan N, et al. Infections with oseltamivir-resistant influenza A (H1N1) virus in the United States. JAMA. 2009;301[10]:1034-41)

Enter 2009 H1N1…

On June 30, 2009, a case of Tamiflu-resistant influenza A/H1N1 (pandemic “swine flu”) was reported in Denmark.

On August 15 the World Health Organization reported Tamiflu-resistant cases in patients from Hunan, China and Singapore (where H5N1 remains endemic).

On August 22 the Centers for Disease Control and Prevention reported that six cases of Tamiflu-resistant 2009 influenza A/H1N1 had been detected in the United States.

Unfortunately, only about 1,000 samples had been tested for Tamiflu resistance in the U.S. Nearly 9,000 people with swine flu had already been hospitalized here by that time, and an untold number of infected individuals remained at home, effectively excluded from the database.

Henry Niman, PhD, of Recombinomics, Inc., reports an increasing detection rate for the H274Y polymorphism that confers Tamiflu resistance in 2009 pandemic flu. He agrees that this polymorphism—apparently the result of a random mutation—has been present in the viral genome for some time, and he summarizes reports of resistant cases in Seattle, California, Texas, and North Carolina.

In other words, all across America, drug-resistant strains of pandemic H1N1 influenza are emerging; due to limited surveillance, public health officials probably aren’t cognizant of the full breadth of the problem and there may be more surprises from this ever-changing organism that are flying just beneath the radar.