#Epidemiology, Patterns of #Care, and #Mortality for #Patients With #ARDS in #ICUs in 50 Countries (JAMA, abstract)

[Source: The Journal of the American Medical Association, full page: (LINK). Abstract, edited.]

Original Investigation | February 23, 2016 | Caring for the Critically Ill Patient

Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries [      ]

FREE

Giacomo Bellani, MD, PhD1,2; John G. Laffey, MD, MA3,4; Tài Pham, MD5,6,7; Eddy Fan, MD, PhD8,9; Laurent Brochard, MD, HDR10,11; Andres Esteban, MD, PhD12; Luciano Gattinoni, MD, FRCP13; Frank van Haren, MD, PhD14; Anders Larsson, MD, PhD15; Daniel F. McAuley, MD, PhD16,17,18; Marco Ranieri, MD19; Gordon Rubenfeld, MD, MSc20,21; B. Taylor Thompson, MD, PhD22; Hermann Wrigge, MD, PhD23; Arthur S. Slutsky, MD, MASc24; Antonio Pesenti, MD13 ; for the LUNG SAFE Investigators and the ESICM Trials Group

Author Affiliations: 1School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy 2Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy 3Departments of Anesthesia and Critical Care Medicine, Keenan Research Centre for Biomedical Science, St Michael’s Hospital 4Departments of Anesthesia, Physiology and Interdepartmental division of Critical Care Medicine, University of Toronto, Canada 5AP-HP, Hôpital Tenon, Unité de Réanimation médico-chirurgicale, Pôle Thorax Voies aériennes, Groupe hospitalier des Hôpitaux Universitaires de l’Est Parisien, Paris, France 6UMR 1153, Inserm, Sorbonne Paris Cité, ECSTRA Team, Université Paris Diderot, Paris, France 7UMR 915, Inserm, Université Paris Est Créteil, Créteil, France 8Department of Medicine, University Health Network and Mount Sinai Hospital 9Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada 10Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Canada 11Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada 12Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, Madrid, Spain 13Istituto di Anestesia e Rianimazione, Università degli Studi di Milano, Ospedale Maggiore, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy 14Intensive Care Unit, Canberra Hospital, and Australian National University, Canberra, Australia 15Section of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden 16Centre for Experimental Medicine, Queen’s University of Belfast, Belfast, Northern Ireland 17Wellcome-Wolfson Institute for Experimental Medicine, Belfast, Northern Ireland 18Regional Intensive Care Unit, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland 19SAPIENZA Università di ROMA, Dipartimento di Anestesia e Rianimazione, Policlinico Umberto I, Viale del Policlinico 155, 00161 Roma, Italy 20Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
21Program in Trauma, Emergency and Critical Care, Sunnybrook Health Sciences Center, Toronto, Canada 22Division of Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston 23Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Liebigstr. 20, D-04103 Leipzig, Germany 24Keenan Research Center at the Li Ka Shing Knowledge Institute of St Michael’s Hospital, the Interdepartmental Division of Critical Care Medicine, and the Department of Medicine, University of Toronto, Toronto, Canada

JAMA. 2016;315(8):788-800. doi:10.1001/jama.2016.0291. Published online

 

ABSTRACT

Importance

Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS).

Objectives

To evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation management, and use of adjuncts—for example prone positioning—in routine clinical practice for patients fulfilling the ARDS Berlin Definition.

Design, Setting, and Participants

The Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients undergoing invasive or noninvasive ventilation, conducted during 4 consecutive weeks in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across 5 continents.

Exposures

Acute respiratory distress syndrome.

Main Outcomes and Measures

The primary outcome was ICU incidence of ARDS. Secondary outcomes included assessment of clinician recognition of ARDS, the application of ventilatory management, the use of adjunctive interventions in routine clinical practice, and clinical outcomes from ARDS.

Results

Of 29 144 patients admitted to participating ICUs, 3022 (10.4%) fulfilled ARDS criteria. Of these, 2377 patients developed ARDS in the first 48 hours and whose respiratory failure was managed with invasive mechanical ventilation. The period prevalence of mild ARDS was 30.0% (95% CI, 28.2%-31.9%); of moderate ARDS, 46.6% (95% CI, 44.5%-48.6%); and of severe ARDS, 23.4% (95% CI, 21.7%-25.2%). ARDS represented 0.42 cases per ICU bed over 4 weeks and represented 10.4% (95% CI, 10.0%-10.7%) of ICU admissions and 23.4% of patients requiring mechanical ventilation. Clinical recognition of ARDS ranged from 51.3% (95% CI, 47.5%-55.0%) in mild to 78.5% (95% CI, 74.8%-81.8%) in severe ARDS. Less than two-thirds of patients with ARDS received a tidal volume 8 of mL/kg or less of predicted body weight. Plateau pressure was measured in 40.1% (95% CI, 38.2-42.1), whereas 82.6% (95% CI, 81.0%-84.1%) received a positive end-expository pressure (PEEP) of less than 12 cm H2O. Prone positioning was used in 16.3% (95% CI, 13.7%-19.2%) of patients with severe ARDS. Clinician recognition of ARDS was associated with higher PEEP, greater use of neuromuscular blockade, and prone positioning. Hospital mortality was 34.9% (95% CI, 31.4%-38.5%) for those with mild, 40.3% (95% CI, 37.4%-43.3%) for those with moderate, and 46.1% (95% CI, 41.9%-50.4%) for those with severe ARDS.

Conclusions and Relevance

Among ICUs in 50 countries, the period prevalence of ARDS was 10.4% of ICU admissions. This syndrome appeared to be underrecognized and undertreated and associated with a high mortality rate. These findings indicate the potential for improvement in the management of patients with ARDS.

Trial Registration clinicaltrials.gov Identifier: NCT02010073

Keywords: Research; Abstracts; ARDS.

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The #Hemagglutinin Stem-Binding #mAb VIS410 Controls #Influenza #Virus–Induced #ARDS (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

The Hemagglutinin Stem-Binding Monoclonal Antibody VIS410 Controls Influenza Virus–Induced Acute Respiratory Distress Syndrome [      ]

Tatiana Baranovich a, Jeremy C. Jones a, Marion Russier a, Peter Vogel b, Kristy J. Szretter c, Susan E. Sloan c#, Patrick Seiler a, Jose M. Trevejo c, Richard J. Webby a and Elena A. Govorkova a#

Author Affiliations: Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USAa Department of Veterinary Pathology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USAb Visterra, Inc., Cambridge, Massachusetts, USAc

 

ABSTRACT

Most cases of severe influenza are associated with pulmonary complications, such as acute respiratory distress syndrome (ARDS), and no antiviral drugs of proven value for treating such complications are currently available. The use of monoclonal antibodies targeting the stem of the influenza virus surface hemagglutinin (HA), is a rapidly developing strategy for controlling viruses of multiple HA subtypes. However, the mechanisms of action of these antibodies are not fully understood, and their ability to mitigate severe complications of influenza has been poorly studied. We evaluated the effect of treatment with VIS410, a human monoclonal antibody targeting the HA stem region, on the development of ARDS in BALB/c mice after infection with influenza A(H7N9) viruses. Prophylactic administration of VIS410 resulted in complete protection of mice against lethal A(H7N9) virus challenge. A single therapeutic dose of VIS410 given 24 h after virus inoculation resulted in dose-dependent protection of up to 100% of mice inoculated with neuraminidase inhibitor–susceptible or –resistant A(H7N9) viruses. Compared to the outcomes in mock-treated controls, a single administration of VIS410 improved viral clearance from the lungs; reduced virus spread in lungs in a dose-dependent manner, resulting in a lower lung injury score; reduced the extent of the alteration in lung vascular permeability and protein accumulation in bronchoalveolar lavage fluid; and improved lung physiologic function. Thus, antibodies targeting the HA stem can reduce the severity of ARDS and show promise as agents for controlling pulmonary complications in influenza.

 

FOOTNOTES

#Correspondence should be addressed to: Elena A. Govorkova (Primary Corresponding Author), Department of Infectious Diseases, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; FAX: (901)-595-8559, Phone: (901)-595-2243, E-mail: elena.govorkova@stjude.org.

#Susan Sloan, Visterra, Inc., One Kendall Square, Suite B3301 Building 300, Cambridge, MA 02139, USA; FAX: (617)-498-1073. Phone: (617)-498-1070 x313, E-mail: ssloan@visterrainc.com.

Copyright © 2016, American Society for Microbiology. All Rights Reserved.

Keywords: Research; Abstracts; Influenza; Monoclonal Antibodies; ARDS.

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#ARDS and acute #myocarditis developed in a previously healthy #adult with #influenza B (BMC Pulm Med., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

BMC Pulm Med. 2016 Jan 4;16(1):1. doi: 10.1186/s12890-015-0163-3.

Acute respiratory distress syndrome and acute myocarditis developed in a previously healthy adult with influenza B. [      ]

Chang HL1,2, Hsu JF3, Tsai YM4,5, Lin SY6, Kuo HF7, Yang CJ8,9,10.

Author information: 1Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. hsliac@cc.kmu.edu.tw. 2Division of Pulmonary and Critical Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, #100, Tzyou 1st Road, Kaohsiung 807, Taiwan. hsliac@cc.kmu.edu.tw. 3Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. 940360@mail.kmuh.org.tw. 4Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. yingming@kmu.edu.tw. 5Division of Pulmonary and Critical Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, #100, Tzyou 1st Road, Kaohsiung 807, Taiwan. yingming@kmu.edu.tw. 6Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. 960017@mail.kmuh.org.tw. 7Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. medsnail@hotmail.com. 8Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. chjeya@cc.kmu.edu.tw. 9Division of Pulmonary and Critical Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, #100, Tzyou 1st Road, Kaohsiung 807, Taiwan. chjeya@cc.kmu.edu.tw. 10School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. chjeya@cc.kmu.edu.tw.

 

Abstract

BACKGROUND:

Influenza B virus infection is generally considered to be mild and is rarely associated pulmonary cardiovascular involvement in adults. However fatal complications may occur.

CASE PRESENTATION:

A 43-year-old previously healthy Taiwanese male came to our emergency department due to high fever, chills, general malaise and myalgia for about 4 days. An influenza rapid test from a throat swab was negative. Chest radiography showed mild left lung infiltration and levofloxacin was prescribed. However, progressive shortness of breath and respiratory failure developed 48 h later after hospitalization. Emergent intubation was performed and he was transferred to the intensive care unit where oseltamivir (Tamiflu, Roche) 75 mg orally twice daily was given immediately. In the intensive care unit, cardiac catheterization revealed normal coronary arteries. However, a markedly elevated cardiac enzyme level (Troponin I level was up to 71.01 ng/ml), a positive cardiac magnetic resonance imaging findings and no coronary artery stenosis led to the diagnosis of acute myocarditis. Subsequent real-time polymerase chain reaction of endotracheal aspirates was positive for influenza B. His condition gradually improved and he was successfully weaned from the ventilator on day 22. He was discharged without prominent complications on day 35.

CONCLUSION:

Influenza B infection is not always a mild disease. Early detection, early administration of antiviral agents, appropriate antibiotics and best supportive care, is still the gold standard for patients such as the one reported.

PMID:  26728359 [PubMed – in process]

Keywords: Research; Abstracts; Influenza B; ARDS.

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Acute #Management and Long-Term #Survival Among Subjects With Severe #MERS #Coronavirus #Pneumonia and #ARDS (Respir Care., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Respir Care. 2015 Dec 23. pii: respcare.04325. [Epub ahead of print]

Acute Management and Long-Term Survival Among Subjects With Severe Middle East Respiratory Syndrome Coronavirus Pneumonia and ARDS. [      ]

Khalid I1, Alraddadi BM2, Dairi Y2, Khalid TJ2, Kadri M2, Alshukairi AN2, Qushmaq IA2.

Author information: 1King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia. John D Dingell Veterans Affairs Medical Center, Detroit, Michigan. dr.imrankhalid@yahoo.com. 2King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.

 

Abstract

BACKGROUND:

Data on the management, clinical course, and outcome of critical patients with Middle East respiratory syndrome coronavirus are scarce. We report here our experience and long-term outcome of such patients.

METHODS:

Subjects intubated for management of ARDS from Middle East respiratory syndrome coronavirus pneumonia and ARDS during the April-May 2014 outbreak were included. Their characteristics, ICU course, management, and outcome were evaluated.

RESULTS:

Fourteen subjects, including 3 health-care workers, met study criteria. Besides 2 health-care workers, all subjects had comorbidities. Predominant symptoms were fever, cough, and dyspnea. The worst median PaO2 /FIO2 ratio of 118 post-intubation was seen on the third day, and median APACHE II score was 27. All subjects received lung-protective ventilation and 1 mg/kg/d methylprednisolone infusion for ARDS. Eleven subjects received ribavirin and peginterferon α-2a. Subjects had a critical ICU course and required neuromuscular blockade (n = 11; 79%), required rescue therapy for respiratory failure (n = 8; 57%), developed shock (n = 10; 71%), and required renal replacement therapy (n = 8; 57%). Declining C-reactive protein levels correlated with clinical improvement despite continued positive real-time polymerase chain reaction results. Nine subjects died in ICU. Five subjects, including 3 health-care workers, were discharged from hospital and were alive after 1 y.

CONCLUSIONS:

Middle East respiratory syndrome coronavirus pneumonia with ARDS has high mortality in subjects with comorbidities. The mainstay of treatment is meticulous ARDS management. Those who survived the acute infection and its complications remained well after 1 y in our study. The role of ribavirin and interferon warrants urgent further evaluation.

Copyright © 2015 by Daedalus Enterprises.

KEYWORDS: Middle East respiratory syndrome coronavirus; acute respiratory distress syndrome (ARDS); pneumonia; respiratory failure

PMID: 26701365 [PubMed – as supplied by publisher]

Keywords: Research; Abstracts; MERS-CoV; ARDS; Pneumonia.

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The #effectiveness of #Corticosteroids on #mortality in #patients with #ARDS or acute #lung #injury: a secondary analysis (Sci Rep., abstract)

[Source: Scientific Reports, full page: (LINK). Abstract, edited.]

Article | Open

The effectiveness of Corticosteroids on mortality in patients with acute respiratory distress syndrome or acute lung injury: a secondary analysis [   R   ]

Zhongheng Zhang1 , Lin Chen1  & Hongying Ni1

Scientific Reports 5, Article number: 17654 (2015) / doi:10.1038/srep17654

Received: 10 September 2015 – Accepted: 03 November 2015 – Published online: 02 December 2015

 

Abstract

The development of acute respiratory distress syndrome (ARDS) is associated with dys-regulated inflammation. Since corticosteroids are potent anti-inflammatory drugs, they are thought to be beneficial for ARDS patients. The study aimed to investigate the effectiveness of corticosteroids on mortality outcome in ARDS patients. The study was a secondary analysis of a prospective randomized controlled trial (NCT00979121). ARDS patients with invasive mechanical ventilation were enrolled. Corticosteroids use was defined as IV or PO administration of corticosteroids totaling more than 20 mg methylprednisolone equivalents during one calendar day. Missing data were handled using multiple imputation technique. Multivariable model was built to adjust for confounding covariates. A total of 745 patients were enrolled, including 540 survivors and 205 non-survivors. Patients in the non-survivor group were more likely to use corticosteroids (38% vs. 29.8%; p = 0.032). After adjustment for other potential confounders, corticosteroids showed no statistically significant effect on mortality outcome (OR: 1.18; 95% CI: 0.81–1.71). Furthermore, we investigated the interaction between corticosteroid use and variables of vasopressor and PaO2. The result showed that there was no significant interaction. In conclusion, the study failed to identify any beneficial effects of corticosteroids on mortality outcome in patients with ARDS.

Keywords: Research; Abstracts; ARDS; Acute Lung Injury; Corticosteroids.

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Loss of CARD9-mediated innate #activation attenuates severe #influenza #pneumonia without compromising host #viral #immunity (Sci Rep., abstract)

[Source: Scientific Reports, full page: (LINK). Abstract, edited.]

Article | Open

Loss of CARD9-mediated innate activation attenuates severe influenza pneumonia without compromising host viral immunity [      ]

Takayuki Uematsu1, 2 , Ei’ichi Iizasa1, 3 , Noritada Kobayashi2 , Hiroki Yoshida1 […] & Hiromitsu Hara1, 3

Scientific Reports 5, Article number: 17577 (2015) / doi:10.1038/srep17577

Received: 30 May 2015 – Accepted: 02 November 2015 – Published online: 02 December 2015

 

Abstract

Influenza virus (IFV) infection is a common cause of severe viral pneumonia associated with acute respiratory distress syndrome (ARDS), which is difficult to control with general immunosuppressive therapy including corticosteroids due to the unfavorable effect on viral replication. Studies have suggested that the excessive activation of the innate immunity by IFV is responsible for severe pathologies. In this study, we focused on CARD9, a signaling adaptor known to regulate innate immune activation through multiple innate sensor proteins, and investigated its role in anti-IFV defense and lung pathogenesis in a mouse model recapitulating severe influenza pneumonia with ARDS. We found that influenza pneumonia was dramatically attenuated in Card9-deficient mice, which showed improved mortality with reduced inflammatory cytokines and chemokines in the infected lungs. However, viral clearance, type-I interferon production, and the development of anti-viral B and T cell immunity were not compromised by CARD9 deficiency. Syk or CARD9-deficient DCs but not macrophages showed impaired cytokine but not type-I interferon production in response to IFV in vitro, indicating a possible role for the Syk-CARD9 pathway in DCs in excessive inflammation of IFV-infected lungs. Therefore, inhibition of this pathway is an ideal therapeutic target for severe influenza pneumonia without affecting viral clearance.

Keywords: Research; Abstracts; Influenza; Pneumonia; ARDS; Interferons.

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#Clinico-#Radiological #Profile and #Outcome of #H1N1pmd09 Infected #Patients During 2009 to 2014 #Pandemic at Tertiary Referral Hospital in #Rajasthan (J Assoc Physicians India, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Assoc Physicians India. 2015 May;63(5):42-5.

Clinico-Radiological Profile and Outcome of Novel H1N1-Infected Patients During 2009 to 2014 Pandemic at Tertiary Referral Hospital in Rajasthan. [      ]

Maheshwari M, Maheshwari S.

 

Abstract

BACKGROUND:

The 21st century Influenza A (H1N1) pandemic arrived during spring of 2009 and has posed a serious public health challenge world-wide. We describe the clinic-radiological profile and outcome of patients who were found H1N1 positive in Jawahar Lal Nehru Hospital, Ajmer of Rajasthan from 5th August 2009 to 31st May 2014.

AIMS AND OBJECTIVES:

Primary objective was to study clinical and radiological profile of the patients admitted with confirmed H1N1 infection. Secondary objective was to observe the risk factors and associated comorbid conditions with complications and need of mechanical ventilation and / or death among H1N1-infected patients

MATERIALS AND METHODS:

Hospitalized patient with laboratory-confirmed H1N1 flu by reverse transcriptase PCR during August 2009 to May 2014 in JLN Hospital, Ajmer, were included in this retrospective study. Data was collected from hospital isolation ward admission register. Statistical analysis was done by SPSS, version 16. Binary logistic regression was used to find out independent risk factors for morbidity.

RESULTS:

A total of 94 PCR-confirmed H1N1-infected patients were included in the study, of them 32 (34%) males and 62 (66%) females. Median age was 35 years and median duration of symptoms before hospitalization was 5 days. Common presenting symptoms include fever 83 (88%), cough 79 (84%), breathlessness 67 (71%), rhinnorrhoea/ common cold 25 (26.5%), throat pain 13 (13.8%), chest pain 5 (5.3%) and haemoptysis 4 (4.2%). Bilateral crepitations were audible in 86 (91.4%) and tachypnoea in 73 (78%) cases. Co-morbidities were seen in 75 (79.7%) patients. Ventilatory support was required in 57 (60.6%) patients. On presentation, chest x-ray showed pulmonary opacities in 72 (76.5%) patients. We observed no significant side effects of oseltamivir 150 mg twice day dose for 5-7 days. Forty-one (43.6%) patients were cured and discharged from hospital, 53 (56.3%) patients died. Development of ARDS, involvement of bilateral lower zones of lungs in chest skiagram, requirement of mechanical ventilator and associated pregnancy (third trimester) were independent predictors of mortality.

CONCLUSION:

During evaluation period from 2009 to 2014, H1N1 influenza caused severe illness requiring hospitalization, including pneumonia, acute respiratory distress and complications involving renal, liver and cardiac dysfunction. Maximum patients were between age group of 20-40 year. Fever and cough were most common presenting symptoms. Common comorbidities were pregnancy, diabetes, hypertension, and obesity. Mortality rate was high in H1N1-infected patients with development of ARDS, associated pregnancy and patients who required ventilatory support.

PMID: 26591144 [PubMed – in process]

Keywords: Research; Abstracts; Pandemic Influenza; H1N1pdm09; ARDS; Pregnancy; India; Rajastan.

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