1. سورة البقرة ( ۳۲ )

4. Influenza is a serious respiratory illness which can be debilitating and causes complications that lead to hospitalization and death, especially in the elderly. Influenza virus is a genus of the orthomyxoviridae family of viruses. Influenza A virus causes influenza in bird and some mammals. There are three groups of influenza virus: influenza A, B, and C. Influenza B and C viruses are associated with low- level sporadic disease and are never causes of pandemic influenza. influenza A is responsible for most seasonal influenza and all known pandemics.

5. On the surface of influenza virus reside two major proteins; Haemagglutinin (HA) and Neuraminidase (NA). Sixteen subtypes of HA (H1 to H16) and nine subtypes of NA (N1 to N9) are recognized in aquatic birds. Death mostly occurs as a consequence of primary viral pneumonia or of secondary respiratory bacterial infections, especially in patients with underlying pulmonary or cardiopulmonary diseases.

7. The aim of this work is to study the current status of emerging influenza viruses infections and their clinical implications.

13. Isolation  Nose, Throat Swab  Tissue culture

16. The WHO advises travelers to avoid contact with high- risk environments in affected countries. The WHO continues to recommend that travelers to affected areas avoid contact with live animal markets and poultry farms. Populations in affected countries are advised to avoid contact with dead migratory birds or wild birds showing signs of disease. Avoid contact with infected poultry or with surfaces and objects contaminated by their droppings.

20. Swine influenza is an infection by any one of several types of swine influenza virus. Swine Influenza Virus is any strain of the influenza family of viruses that is endemic in pigs. As of 2009, the known SIV strain include influenza C and the subtypes of influenza A known as H 1 N 1, H 1 N 2, H 3 N 1, H 3 N 2 and H 2 N 3. The virus appears to have emerged first in Mexico in late February 2009, this likely represents the first large- scale transmission of this virus.

22.  Chronic respiratory diseases (eg, asthma, COPD, bronchiectasis, lung surgery)  Obesity  Pregnancy  Smoking  Diabetes mellitus  Chronic cardiovascular diseases  Renal diseases  Immunosuppression (such as blood disorders, malignancy)  Delay in presentation to hospital (and hence delay in initiating antiviral therapy)

23.  Dyspnea  Cyanosis  Bloody or colored sputum  Chest pain  Altered mental status  High fever that persists beyond 3 days  Hypotension  In children, danger signs include tachypnea or dyspnea, drowsiness, and no desire to play

24. Diagnosis 1- CBC:  Relative lymphopenia 2- Serum enzymes: -(AST/ALT) are often elevated - Creatine phosphokinase  elevated 3- Radiographic: -Initially (CXR)  shows no or minimal infiltrates. -Later  bilateral patchy interstitial infiltrates

27. Antiviral agents Drugs indicated for treatment of H1N1 influenza A virus include neuraminidase inhibitors (i.e. oseltamivir and zanamivir). Oseltamivir (Tamiflu)  Treatment for acute illness :75 mg capsule twice daily for 5 days.  Prophylaxis :75 mg capsule twice daily for 5 days. Zanamivir  Treatment for acute illness : 10 mg inhaled orally twice daily for 5 days.  Prophylaxis of household contact: 10 mg inhaled orally twice daily for 10 days.

28. Available as monovalent, inactivated influenza A virus vaccine (H 1 N 1 ) for IM injection. Indicated for active immunization against influenza caused by pandemic (H 1 N 1 ) 2009 virus. Stimulates active immunity to influenza virus infection by inducing production of specific antibodies. U.S. President Barack Obama Being vaccinated against H1N1 flu

30. Chance of transmission is also reduced by disinfecting household surfaces, which can be done effectively with a diluted chlorine bleach solution. Recommendations to prevent spread of the virus among humans include using standard infection control against influenza. This includes frequent washing of hands with soap and water or with alcohol-based hand sanitizers, especially after being out in public