A BRIEFING ABOUT THE FLU

By Kleovoulos Chandanos, Paediatrician

The flu, among the biggest health problems in the developed countries, is one of the main causes of death, with more than 1,000 per one million of the population, especially within the ageing. There are three antigenic types of the virus, A, B and C that, apart from people, also extend to various species of animals. The illness is rarely transmitted from animals to people.

The type B virus does not extend to animals, while C usually causes a very mild case and consequently is not important.  The type A is constantly undergoing small antigenic changes that are named "antigenic drifts," that are responsible for most of the virus' changes from season in season. The flu can also appear as a world epidemic, named pandemic, due to big antigenic changes of the type A virus and these are called antigenic shifts.

The flu is an acute respiratory illness. Its clinical picture resembles other acute respiratory infections so lab tests are essential. Most of the time it is just a mild infection, transmitted from individual to individual by coughing or sneezing or, it can be transmitted by direct contact. The symptoms of the flu are: high fever, cough, sore throat, runny nose, headaches, and muscle pain. Most people recuperate completely within one to two weeks.  Compared to other infections like the common cold, flu causes more serious complications like pneumonia, especially in children, the elderly and other vulnerable groups.  

Pneumonia is the most frequent complication and it's due to either the flu virus (primary) or some microbe (secondary). The secondary pneumonia usually appears in individuals with underlying respiratory diseases like chronic bronchitis, asthma, cystic fibrosis. The primary pneumonia appears more seldom, it can however develop rapidly and cause acute respiratory deficiency and death. Other complications are: cardiac arrhythmia, encephalitis and Reye syndrome, mainly in children who are chronically treated with aspirin. The most reliable material for a rapid detection is secretions from the nose and throat. The samples for the lab test should be taken within four days from the beginning of the symptoms.

Vaccination is expected to decrease the repercussions of a pandemic on the people, particularly in the vulnerable groups, decreasing the complications from the illness.

The vaccine should be sold to predetermined priority groups.  Vaccination priority must have: workers in health services, people in services necessary to the well-being of state and society, individuals that belong to vulnerable groups, people in old age homes, schools. The vaccination of vulnerable groups against pneumococcus can decrease considerably the frequency of pneumococcal pneumonia as a flu complication. It is estimated that the vaccine provides protection at about 80% of those vaccinated and that the immunity lasts roughly 5 years. The priority vaccination list must include: the elderly, individuals with chronic disease like cardiovascular ailments, lung deficiency, diabetes, alcoholism, cirrhosis of the liver.

With regard to the medicines that can be used, zanamiviri (Relenza) mainly confronts A and B and in order to be effective it should be taken within 48 hours from the beginning of the symptoms. It should be avoided by patients with a history of respiratory ailments. Oseltamiviri (Tamiflu) must also be given within the first 48 hours, for five days. Its side effects are diarrhea, nausea, vomiting, and headaches.

The effectiveness of these drugs has not been substantiated.

CANKER SORES (APHTHAE)

By Nikos Papadakis, Dental Surgeon

Regarding these sores in the oral cavity, we should know the following:

What are Aphthae? They are small ulcers in the mouth that hurt a lot and appear repeatedly in intervals of days, months or even years. The healing process is 10-14 days.  The word aphtha in Greek means fire or burn and implies precisely the pain in this illness.  Hippocrates was the first to quote the term aphtha. The cause of the canker sore is unknown, but the disease, which occurs in about 25 percent of the population, is not life threatening. It first appears usually in young ages, more frequently in women and a hereditary inclination appears to exist. Smoking may prevent these ulcers from appearing, probably due to the nicotine.

In diagnosing aphthae:

·        The ulcers can be large, small or herpes-like.

·        They could look like (and consequently are confused with) other mouth diseases, or general diseases, which also display symptoms in the oral cavity, like some infections, blood illnesses, peptic and skin diseases, even skin cancer.

Aphthae may constitute part of the clinical picture of a disease like Adamantiadis-Behçet. Consequently before any treatment, a correct diagnosis must be ensured.  

Generally, with regard to treatment:  

·        Because the cause of aphthae is unknown, effective treatment to prevent its re-occurrence does not exist.

·        Avoiding stress, trauma, anaemia and certain foods is recommended.

·        The main objectives of existing applied treatments are reduction of pain and of the duration of the sores. Many patients go through relapses, displaying multi sores simultaneously, with most intense pain, speech problems and difficulty in eating (plus it's psychologically taxing).

Specifically, with regard to treatment:

For localized treatment, there are many preparations like protective gels and spays, anaesthetics, and caustics which should only be applied by a doctor.

For systematic treatment, there have been various drugs used (mainly corticosteroids). They must be prescribed and supervised by a doctor.