Severe influenza infection represents a leading cause of global morbidity and mortality. Although influenza is primarily considered a viral infection that results in pathology limited to the respiratory system, clinical reports suggest that influenza infection is frequently associated with a number of clinical syndromes that involve organ systems outside the respiratory tract. A comprehensive MEDLINE literature review of articles pertaining to extra-pulmonary complications of influenza infection, using organ-specific search terms, yielded 218 articles including case reports, epidemiologic investigations, and autopsy studies that were reviewed to determine the clinical involvement of other organs. The most frequently described clinical entities were viral myocarditis and viral encephalitis. Recognition of these extra-pulmonary complications is critical to determining the true burden of influenza infection and initiating organ-specific supportive care.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/irv.12470

The hidden burden of influenza: A review of the extra-pulmonary complications of influenza infection

We describe a patient in Wuhan, China, with severe acute respiratory syndrome coronavirus 2 infection who had progressive pulmonary lesions and rhabdomyolysis with manifestations of lower limb pain and fatigue. Rapid clinical recognition of rhabdomyolysis symptoms in patients with severe acute respiratory syndrome coronavirus 2 infection can be lifesaving.

/pdf/rhabdomyolysis-as-potential-late-complication-associated-52nqg7rbsg.pdf

Rhabdomyolysis as Potential Late Complication Associated with COVID-19.

During the summer and fall of 2009, significant thrombotic events were observed in patients infected with the pandemic H1N1 influenza A virus. In a retrospective chart review of 119 individuals admitted to the hospital with H1N1 virus infection, 7 patients (5.9%) were found to have experienced thrombotic vascular events. Critically ill and hospitalized patients are at increased risk of developing vascular clots, such as venous thromboembolism (VTE) [1], primarily as a consequence of decreased mobility resulting in venous stasis. Several factors can contribute to this risk, including the presence of an acute inflammatory state. It has also been suggested that infection with seasonal influenza viruses may promote acute arterial thrombotic events, including acute coronary syndromes and stroke [2‐3], although evidence is conflicting. Since the emergence of the pandemic H1N1 influenza virus (pH1N1) in April 2009 [4], much has been learned about the risk factors associated with increased morbidity and mortality in infected individuals. In addition to its apparent predilection for causing severe disease in certain hosts, pH1N1 has been associated with a variety of extra-pulmonary complications, including encephalitis [5] and rhabdomyolysis [6]. In our practice, a number of cases of thrombotic vascular events were observed in patients with pH1N1 infection. These events were striking in terms of the extent of thrombosis in some patients, as well as the fact that a number of patients developed arterial thrombi during the acute phase of illness. The occurrence of both venous and arterial thrombosis raised the possibility that the mechanisms of thrombus formation may have been distinct from those leading to venous thrombosis alone. A review of other case series and reports of individuals with pH1N1 infection found that only a few had reported the presence of thrombotic orother vascular events [7, 8]. Whether these events were too infrequent to note or were not counted is unclear. Thus, little is known regarding the actual incidence of thrombotic vascular events inpatients with pH1N1 infectionand whether this infection confers additional risk for thrombosis. The present study was designed to determine the prevalence of vascular complications among patients admitted to the hospital with pH1N1 influenza and to describe the nature of such vascular events. We first describe a case report of a patient who developed intravascular thrombosis during acute infection with pH1N1.

/pdf/pandemic-h1n1-influenza-infection-and-vascular-thrombosis-2etmk1dcmx.pdf

Pandemic H1N1 Influenza Infection and Vascular Thrombosis

Diminished immune responses with aging predispose older adults to common and uncommon influenza complications.

https://www.ajkd.org/article/S0272-6386(10)00116-2/pdf

Acute kidney injury in critically ill patients infected with 2009 pandemic influenza A(H1N1): report from a Canadian Province.

<h3>Purpose/Objective(s)</h3> To simplify the planning process for a novel cone-beam CT-based online adaptive radiotherapy (ART) platform, its integrated treatment planning system (OA-TPS) limits user inputs to target prescription, target coverage goals, and organs-at-risk (OAR) sparing goals. As an option, the system allows for knowledge-based plan (KBP) models to aid in dosimetric optimization. By utilizing KBP models within the framework of the system's ART-focused TPS, we propose a streamlined alternative to the traditional planning paradigm of iterative fine-tuning of patient-specific optimization objectives and time-consuming discussions of multiple clinical shareholders. To this end, we have developed a physician-driven treatment planning workflow using prostate cancer OA-TPS planning templates. <h3>Materials/Methods</h3> Six external-beam prostate cancer patients' treatment plans were generated in both a traditional TPS to serve as the benchmark and the OA-TPS using the approach mentioned above. All patients were planned to be treated in two phases: 4500cGy in 25 fractions (prostate+seminal vesicles+nodes) and 3600 cGy in 20 fractions (prostate) with identical target coverage and OAR-sparing dosimetric goals. In-house KBP models were trained using 39 (phase 1) and 36 (phase 2) plans from our institutional database. OA-TPS plans were generated using (1) prescription goals (PG) and (2) PG + KBP model. Plans generated by the OA-TPS were not modified in any way. <h3>Results</h3> The OA-TPS produced clinically-acceptable plans, per physician review, for 6/6 patients (PG) and 5/6 patients (PG+KBP model) with one plan not achieving target coverage by <1.5%. Dosimetric goals were considered achieved if they either met rotely or were better or within 2% of the dosimetry achieved by the benchmark TPS. Plans generated via the PG+KBP model demonstrated improved OAR sparing for most prescription dose metrics for all patients. PG+KBP model plans also demonstrated considerable OAR sparing at dose levels not specified in prescription goals (<i>e.g.,</i> Rectum V4050cGy in the tabulated data below.) <h3>Conclusion</h3> The OA-TPS generated prostate treatment plans largely meet clinical objectives both with and without using a KBP model. However, by including KBP models, there is a potential to develop streamlined "universal" class-solution approaches to site treatment planning that increase OAR sparing and maintain target coverage without iterative adjustments of patient-specific optimization parameters. Physician-driven treatment planning workflows, facilitated by universal patient plan templates, show promise to generate clinically-acceptable plans for a variety of patient anatomies. 

Using Class-Solution Optimization and Knowledge-Based Planning, a Physician-Driven Treatment Planning Workflow Demonstrates Improved OAR-Sparing for EBRT of the Prostate

dations for the management of patients with herpes zoster recommend using antiviral therapy to decrease the incidence of PHN,” citing an article for which I am a coauthor. This article stated that antiviral therapy should be used to treat patients with herpes zoster and that it had an impact on acute neuritis. Although the guidelines concluded that the use of antiviral therapy may have an effect on “chronic pain,” this therapy was not sufficient to uniformly prevent PHN. As noted here, the FDA reached a similar conclusion. The goal of management of herpes zoster is to accelerate healing, prevent complications, and decrease pain—both acute pain and PHN. With the evidence available from existing antiviral studies, these end points have been achieved with the exception of prevention of PHN. The management of PHN is of critical importance for individuals who have herpes zoster. Consideration of combination therapy at the onset of disease, particularly in patients with severe acute pain, needs to be further evaluated. Future treatment strategies may prevent or provide more significant relief for this potentially devastating complication.

https://jamanetwork.com/journals/jama/articlepdf/184815/jlt1104_1863_1864.pdf

Rhabdomyolysis associated with 2009 influenza A(H1N1).

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Using Class-Solution Optimization and Knowledge-Based Planning, a Physician-Driven Treatment Planning Workflow Demonstrates Improved OAR-Sparing for EBRT of the Prostate

Rhabdomyolysis associated with 2009 influenza A(H1N1).