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6,100 |
Advanced In Silico Tools for Designing of Antigenic Epitope as Potential Vaccine Candidates Against Coronavirus
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Vaccines are the most economical and potent substitute of available medicines to cure various bacterial and viral diseases. Earlier, killed or attenuated pathogens were employed for vaccine development. But in present era, the peptide vaccines are in much trend and are favoured over whole vaccines because of their superiority over conventional vaccines. These vaccines are either based on single proteins or on synthetic peptides including several B-cell and T-cell epitopes. However, the overall mechanism of action remains the same and works by prompting the immune system to activate the specific B-cell- and T-cell-mediated responses against the pathogen. Rino Rappuoli and others have contributed in this field by plotting the design of the most potent and fully computational approach for discovery of potential vaccine candidates which is popular as reverse vaccinology. This is quite an unambiguous advance for vaccine evolution where one begins with the genome information of the pathogen and ends up with the list of certain epitopes after application of multiple bioinformatics tools. This book chapter is an effort to bring this approach of reverse vaccinology into notice of readers using example of coronavirus.
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6,101 |
Sepsis: Clinical Approach, Evidence-Based at the Bedside
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Sepsis is a common disease in intensive care medicine representing almost one third of patient admissions. Its incidence has substantially increased over the past decades and overall mortality has declined during this period of time. It was reported that sepsis incidence increased from 82.7 to 240.4 per 100,000 population between 1979–2000. At the same time, sepsis global mortality decreased from 27.8 to 17.9% [1–3]. However, the absolute number of deaths significantly increased from 21.9 to 43.9 per 100,000 population. Male gender, some chronic diseases like diabetes, immunosuppressive states, human immunodeficiency virus infections, and malignancies are factors that increase the risk for sepsis. Some particular conditions like progressive number of organ dysfunctions, in-hospital-acquired infections and increasing age are associated with higher risk of death [1,4]. On the other hand, septic shock mortality only diminished from 61.6 to 53.1% [5]. This slight decline in mortality observed during recent decades could be attributable to improvements in supportive care and/or avoidance of iatrogenic complications. For example, the instrumentation of early goal resuscitation protocols not aiming at supranormal targets for cardiac output and oxygen delivery, and the use of lung protective strategies could explain at least in part this favorable change. Other strategies directed to treat the pathophysiological mechanisms involved in the septic process like recombinant human-activated protein-C (rhAPC), have also contributed to improve survival. However, mortality remains unacceptably high and further improvement in sepsis management is needed.
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6,102 |
Holistic Trinity of Services Sciences: Management, Social, and Engineering Sciences
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Services industries comprise about 75% of the economy of developed nations. To design and operate services systems for today and tomorrow, we need to educate a new type of engineer who focuses not on manufacturing but on services. Such an engineer must be able to integrate 3 sciences-management, social and engineering — into her analysis of services systems. Within the context of a new research center at MIT — CESF (Center for Engineering Systems Fundamentals) — we show how newly emerging services systems require such a 3-way holistic analysis. We deliberately select some non-standard services, as many business services such as supply chains have been studied extensively.
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6,103 |
Infectious Diseases
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This list is not exclusive, but highlights some important causes of FUO after the common causes of fever have been excluded:
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6,104 |
Nutritional Supplements and Upper Respiratory Tract Illnesses in Young Children in the United States
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KEY POINTS: In the United States, children have lower blood levels than adults of eicosapentaenoic acid (EPA), an important ω-3 fatty acid that helps decrease inflammation; vitamin A, the “anti-infective” vitamin; and selenium (Se), a trace metal that is an intrinsic part of glutathione peroxidase, an important free-radical scavenging enzyme. EPA, vitamin A, and Se are important in controlling inflammation and can be supplied by oral nutritional supplements. Cod liver oil contains EPA (and other important ω-3 fatty acids), and vitamin A as well as vitamin D. Fish oil contains ω-3 fatty acids (including EPA) but no vitamins. Our clinical research demonstrates that daily supplementation with a flavored cod liver oil (which meets European purity standards) and a children’s multivitamin-mineral with trace metals, including Se, can decrease morbidity from upper respiratory tract illnesses, otitis media, and sinusitis in young children living in the United States. These supplements can be used by practitioners on an individual basis, when clinically indicated; the supplements can be purchased in the United States without a prescription. Socioeconomically disadvantaged children are at risk for micronutrient deficiencies. However, their families may not be able to afford to purchase these supplements, which are not available through Medicaid, The Special Supplemental Nutrition Program for Women, Infants and Children, or the Food Stamp Program. If our results are confirmed in larger studies, a system change will be needed to provide these supplements to nutritionally vulnerable, socioeconomically disadvantaged children living in the United States.
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6,105 |
The Genera Staphylococcus and Macrococcus
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6,106 |
Defining Natural Hazards – Large Scale Hazards
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The natural forces at work on planet Earth have been an integral part of life since the dawn of mankind. The impacts of hazards of natural origin can range from affecting infrastructure, personal possessions, and ecosystems to negatively affecting individuals’ psychosocial wellbeing. Disasters are the aftermath of hazards caused by natural phenomena, set off by shifts in tectonic plates or atmospheric interactions in populated areas. The extant literature offers a variety of ways to classify natural hazards. For example, they can be categorized by their origin – geological, hydrometeorological or biophysical; by their nature and speed – permanent, ephemeral or episodic; or on the basis of their size or scale – large, medium or small. Adopting the last of the three classification schemes, this chapter presents large scale hazards, which are more likely to occur on the North American continent, in alphabetical order. The list of hazards includes biophysical hazards, droughts, earthquakes, extreme weather, floods, forest fires, ice storms and hurricanes. To help readers follow the material, the chapter draws heavily on recent examples.
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6,107 |
Therapie und Prophylaxe von Infektionen bei Neutropeniee
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Die zytostatische Chemotherapie bösartiger Erkrankungen führt häufig zum Abfall der neutrophilen Granulozyten und zur mehrtägigen Granulozytopenie bzw. Neutropenie. Das Risiko einer Infektion nimmt unterhalb von 1000/μl neutrophilen Granulozyten signifikant zu. Ausmaβ und Dauer der Neutropenie beeinflussen ebenfalls die Wahrscheinlichkeit von Infektionen. Patienten mit einer länger als 10 Tage anhaltenden schweren Neutropenie (<100/μl) entwickeln in mehr als 80% der Fülle Infektionen.
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6,108 |
Summary and Results: Facing Global Environmental Change and Sectorialization of Security
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The previous 99 chapters contain diverse theoretical and conceptual approaches and empirical results that are briefly summarized below following the ten parts of the book.
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6,109 |
Postoperative Management of Composite Tissue Graft Transplantation
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Composite tissue allotransplantation (CTA) is the transplantation of body structures such as the limbs, larynx, abdominal wall, tendons, and face. This chapter discusses the general and specific postoperative management of patients following CTA.
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6,110 |
Airplanes and Infectious Disease
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Air travel is associated with crowded conditions that can facilitate the transmission of airborne infectious diseases. The risk of contracting such diseases depends on the presence of an infected person who is shedding infectious particles and sufficient exposure of a sensitive person to achieve an adequate dose to cause disease. Proximity to the infectious person and the length of time spent near the person are the most important risks for contracting a disease. Ventilation patterns play a lesser role in disease transmission. Well-documented outbreaks of influenza, severe acute respiratory syndrome (SARS), and tuberculosis have occurred. Other common respiratory illnesses have probably also been spread via aircraft, but outbreaks remain unrecognized. Research on the spread of infectious disease in aircraft has focused on sampling for microorganisms in air (which has little relevance), and on the development of models to predict the risks for specific diseases.
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6,111 |
Enhancing Students’ Understanding of the Nature of Science and the Interconnection Between Science, Technology and Society Through Innovative Teaching and Learning Activities
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Understanding the nature of science (NOS) and the interconnection between science, technology and society (STS) has been a prominent objective of science curricula worldwide (e.g. American Association for the Advancement of Science, 1993; Council of Ministers of Education, 1997; Millar & Osborne, 1998). Research confirms the contention that sound knowledge of the NOS and STS will enhance students’ learning of science content, interest in science, and ability to make informed decisions based on evidence (Driver, Leach, Miller, & Scott, 1996; McComas, Clough, & Almazroa, 1998; Aikenhead, 1994).
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6,112 |
Economic Importance
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The beneficial effects of liquorice in treating chills, colds, and coughs have been fully discussed in Ayurveda, as well as in the texts of ancient Egyptians, Greeks, and Romans. The plant has been prescribed for dropsy during the period of famous Hippocrates. The reason being that it was quite helpful as thirst-quenching drugs (Biondi et al. in J Nat Prod 68:1099–1102, 2005; Mamedov and Egamberdieva in Herbals and human health-phytochemistry. Springer Nature Publishers, 41 pp, 2017). No doubt, the clinical use of liquorice in modern medicine started around 1930; Pedanios Dioscorides of Anazarba (Adana), first century AD-Father of Pharmacists, mentions that it is highly effective in the treatment of stomach and intestinal ulcers. In Ayurveda, people in ancient Hindu culture have used it for improving sexual vigor.
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6,113 |
Sind wir gefährdet?: Krisenkommunikation für ein Bundesinstitut auf dem Gebiet des Gesundheitsschutzes
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Freitag, 24. April 2009, kurz nach 9 Uhr. Eine Nachrichtenagentur meldet, dass Mexiko wegen eines „tödlichen Grippevirus“ mit „mindestens 20 Toten“ alle Schulen und Universitäten in Teilen des Landes schließt (AFP 2009a). Um 15 Uhr wird gemeldet: „die Erreger breiteten sich bis in den Südwesten der USA aus, wo sich die Gesundheitsbehörden ´äußerst besorgt` zeigten“ (AFP 2009b). Die Weltgesundheitsorganisation (WHO) weist darauf hin, dass die am meisten betroffene Altersgruppe junge Erwachsene sind, und Influenzaviren normalerweise diese Gruppe nicht besonders betreffen (vgl. WHO 2009). Schnell etabliert sich der Begriff Schweinegrippe, der bleibt, obwohl Behörden und Wissenschaftler den Erreger später weltweit umbenennen in Neues Influenzavirus und danach in (Pandemische) Influenza H1N1 2009.
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6,114 |
Safeguards
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The multiplicity of threats and vulnerabilities associated with AmI will require a multiplicity of safeguards to respond to the risks and problems posed by the emerging technological systems and their applications. In some instances, a single safeguard might be sufficient to address a specified threat or vulnerability. More typically, however, a combination of safeguards will be necessary to address each threat and vulnerability. In still other instances, one safeguard might apply to numerous treats and vulnerabilities. One could depict these combinations in a matrix or on a spreadsheet, but the spreadsheet would quickly become rather large and, perhaps, would be slightly misleading. Just as the AmI world will be dynamic, constantly changing, the applicability of safeguards should also be regarded as subject to a dynamic, i.e., different and new safeguards may need to be introduced in order to cope with changes in the threats and vulnerabilities.
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6,115 |
From Medical Geography to Computational Epidemiology – Dynamics of Tuberculosis Transmission in Enclosed Spaces
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Medical geographers study the geographic distribution of health and health-related phenomena such as diseases, and health care facilities. Seeking to understand who is getting what diseases or health services where and why, they examine spatial disparities in access to health care services, and the geographic distribution of health risks. Medical geographers apply tools of geographic enquiry such as disease mapping and geographical correlation studies to health-related issues (Elliot et al., 2000; Pickle, 2002). Some have called this research endeavor spatial epidemiology (Cromley, 2003; Rushton, 2003a).
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6,116 |
Acute Lung Injury: The Injured Lung Endothelium, Therapeutic Strategies for Barrier Protection, and Vascular Biomarkers
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The vascular endothelium can be considered as an organ/tissue which comprises a monolayer of endothelial cells which serve as a semipermeable cellular barrier separating the inner space of blood vessels from its surrounding tissue and to control the exchange of fluids and cells between the two compartments. Since the pulmonary circulation receives the entire cardiac output, the large surface area of the lung microvasculature is well suited for sensing mechanical, chemical, and cellular injury by inhaled or circulating substances. This endothelial barrier is dynamically regulated through exposure to these various stimuli of physiological and pathological origin and serves to regulate multiple key biological processes (including lung fluid balance and solute transport between vascular compartments). For example, an increase in vascular permeability is a necessary feature of the body’s defense mechanism to provide injured tissues with access to leucocytes, resulting in tissue edema due to fluid extravasation. However, during conditions of intense lung inflammation such as observed in acute lung injury or its severer form of acute respiratory distress syndrome, the large surface area becomes a liability and provides the opportunity for profound vascular permeability resulting in massive fluid accumulation in the alveolar space and progressively leading to pulmonary failure. Alterations in vascular permeability occur not only in acute inflammatory lung disorders primarily caused by sepsis, pneumonia, and trauma which result in high rates of patient morbidity and mortality, but are an attractive target for therapeutic intervention in subacute lung inflammatory disorders such as ischemia–reperfusion injury, radiation lung injury, and asthma. Thus, understanding the mechanisms of endothelial barrier dysfunction is vital for the management and treatment of key and enigmatic pulmonary disorders.
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6,117 |
PET-CT Imaging of Lymphoma
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PET-CT is now the mainstay for imaging lymphoma patients. The complimentary nature of the metabolic and anatomic information provided by a PET-CT examination has become an essential component of patient management, complimenting clinical and laboratory criteria used in staging, restaging, and therapy monitoring. The nature of a particular lymphoma subtype and the patient’s clinical presentation will determine the extent PET-CT imaging is best employed in a particular patient’s management.
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6,118 |
Novel Molecular Diagnostics and Therapeutic Tools for Livestock Diseases
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Recent novelties in diverse diagnostics and therapeutic tools in animal health sector have paved a brighter and clearer way ahead. These are proved to be better in detection, management, control and eradication of animal sufferings caused by various infectious and non-infectious diseases. These innovations have potential impact that extends beyond the animal health and welfare. The advancements have significantly contributed towards improvement in the economy of the country as well as food security. In the present competitive era of evolution, the organisms have inculcated a number of new strategies for survival and spread. Therefore, science needs to continuously evolve more sensitive, specific and high-throughput tools to overcome pathogen cleverness to escape from host immune surveillance. For visible or remarkable changes, it is necessary to use full potential of these advanced molecular techniques into current animal health standards and practices. Under ‘One Health’ concept, the health of animals and humans has to be taken care simultaneously. At present, these advanced molecular diagnostic methods play a significant role in the detection of new and emerging pathogens of livestock. The acquired information also helps to study the interrelationships of pathogens, their hosts and their surroundings. Additionally new vaccines bridging human and animal health development may be discovered. Latest developments in the field of diagnostics and vaccine design through genomics approach have also laid the foundation to enhance the diagnosis and surveillance and in turn helped in the control of infectious diseases. Latest high-throughput DNA sequencing platforms are currently being used for identification and detailed analysis of both disease pathogen and host genomes. The high-throughput data generated using these platforms need to be analysed adopting the bioinformatics and computational genomics that have taken a very high pace nowadays. In the context of animal health, the data analysis may provide some key opportunities for the development of better diagnostic and therapeutic tools for emerging or re-emerging diseases. Such novel and potent technologies put forward a significantly new scenario of disease knowledge, which enables more accurate predictions leading to faster and greater management responses to combat potentially devastating disease crises.
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6,119 |
The Ligands of C-Type Lectins
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In this chapter, a comprehensive overview of the known ligands for the C-type lectins (CTLs) is provided. Emphasis has been placed on the chemical structure of the glycans that bind to the different CTLs and the amount of structural variation (or overlap) that each CTL can tolerate. In this way, both the synthetic carbohydrate chemist and the immunologist can more readily gain insight into the existing structure-activity space for the CTL ligands and, ideally, see areas of synergy that will help identify and refine the ligands for these receptors.
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6,120 |
Artificial Intelligence Technology and Social Problem Solving
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Modern societal issues occur in a broad spectrum with very high levels of complexity and challenges, many of which are becoming increasingly difficult to address without the aid of cutting-edge technology. To alleviate these social problems, the Korean government recently announced the implementation of mega-projects to solve low employment, population aging, low birth rate and social safety net problems by utilizing AI and ICBM (IoT, Cloud Computing, Big Data, Mobile) technologies. In this letter, we will present the views on how AI and ICT technologies can be applied to ease or solve social problems by sharing examples of research results from studies of social anxiety, environmental noise, mobility of the disabled, and problems in social safety. We will also describe how all these technologies, big data, methodologies and knowledge can be combined onto an open social informatics platform.
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6,121 |
Risk Assessment and Contingency Planning for Exotic Disease Introductions
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Globalisation has greatly enhanced opportunities for the spread of infectious diseases throughout the world, giving rise to serious threats to human and animal health. This is illustrated by the recent introduction and subsequent spread of West Nile virus in the USA, and outbreaks of Severe Acute Respiratory Syndrome (SARS) in South-East Asia. It is therefore becoming increasingly important that national (and potentially regional) governments should not only have robust systems in place to reduce the risk of disease introductions, but that they need to also consider how to identify and deal with outbreaks of pathogens in wild and domestic animals. In this chapter we will discuss the roles of risk assessment and contingency planning in the management of exotic disease risks involving wild mammals. The principal purpose of contingency planning is to ensure that a State of preparedness exists in the event of a disease introduction. This requires that the most likely risks of pathogen introduction are identified, that there are adequate means of detecting the pathogen's presence, and that a set of instructions exists describing the best available methods for its rapid and cost-effective containment and control. Contingency planning will involve some of the approaches to disease surveillance (Chapter 10) and management (Chapters 6–8) discussed in other chapters, and so will entail many of the associated challenges, costs and benefits. However, as the aim of a contingency plan is likely to be the rapid containment and subsequent elimination of a pathogen (that is either exotic or endemic but emergent) within a restricted area, the methods of management should reflect this urgency. This may mean that it is appropriate to deploy more severe or costly measures over a short period than would be considered for the sustained control of an endemic pathogen.
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6,122 |
The University-Driven LISs
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Theoretical conceptions of the role of universities in local innovation systems have evolved over the past 20 years, from an initial approach that stressed the importance of knowledge spillovers from university educational and research activities into their regional knowledge spaces, towards a new emphasis on the “third role” of universities, as animators of regional economic and social development. However the typical conception is that universities and research centres in developing countries take little part in stimulating the formation of LISs, with this mission instead being substituted by the state or large companies. This chapter analyses the role and the mechanisms through which universities can contribute to creation of LISs, first from a theoretical point of view. The theoretical arguments are then supported by an analysis of the role of the National University of Singapore, in driving the development of the “Biopolis” biotech LIS.
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6,123 |
AIDS Patients in the ICU
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At the beginning of the AIDS epidemic, there were higher mortality rates in patients requiring admission to an intensive care unit (ICU) most likely due to acute respiratory failure. Whereas the use of prophylaxis and corticosteroids for Pneumocystis jiroveci pneumonia and highly active antiretroviral therapy has changed this outcome and has improved survival rate. However, respiratory failure has remained the most common indication for an ICU admission. When HIV-infected patients are admitted to the ICU, intensivists need to be knowledgeable about the manifestations of common diseases and the new manifestations related to antiretroviral therapy. Much HIV mortality has been linked directly to late diagnosis and late initiation of appropriate antiviral therapy. This l, the most important cause of ICU admission for AIDS patients. We analyzed the characteristics of P. jiroveci pneumonia, bacterial pneumonia, cytomegalovirus pneumonia, mycobacterial infections, pulmonary invasive fungal infections, Kaposi’s sarcoma, and the immune reconstitution inflammatory syndrome.
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6,124 |
Anaplasmose und Ehrlichiose
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Die humane Anaplasmose und die humane Ehrlichiose werden durch Zeckenstich auf den Menschen übertragen. Es handelt sich um unspezifische akut fieberhafte Erkrankungen. An Laborveränderungen werden am häufigsten eine Leukopenie, eine Thrombozytopenie und erhöhte Transaminasen gefunden. Hautmanifestationen sind bei der humanen Anaplasmose selten. Bei der humanen Ehrlichiose können makulopapulöse Exantheme und Petechien auftreten. Die Therapie besteht bei beiden Erkrankungen in der Gabe von Doxycyclin.
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6,125 |
Acute Pneumonia and Importance of Atypical Bacteria
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The term and concept of atypical pneumonia appeared in the 1940s following observations of penicillin-resistant pneumonia [1]. Despite the identification of a large number of microorganisms, the challenge of isolating so-called ‘atypical’ bacteria is the principal cause of failure of the etiologic diagnosis of pneumonia. These pathogenic agents in the tracheobronchial tree include a large variety of bacteria, viruses and even protozoa. Among atypical bacteria, Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella pneumoniae, Bordetella pertussis, and Coxiella burnetii are the most widespread. Numerous other bacteria are emerging pathogenic species whose virulence is currently being evaluated. Clinical examination only provides a diagnostic orientation in a restricted number of cases. The availability of rapid and specific microbiologic examination improves the diagnostic performance for this type of pneumonia (Table 1) [2]. Since most of these bacteria are intracellular, diagnosis is based principally on serology.
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6,126 |
Acute Chest Infections in Children
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Radiation dose is a contentious issue in pediatrics, as it is well-established that the lifetime cancer mortality risks attributable to CT examinations are considerably higher than for adults. As proposed by the ALARA principle ‘as low as reasonably achievable’, the selection of appropriate scanning parameters focuses on the optimization of image quality whilst delivering the lowest possible radiation dose and shifting the risk-benefit balance towards benefit.
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6,127 |
Blood Transfusion-Associated Infections in the Twenty-First Century: New Challenges
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Blood transfusions are vital components of modern medical treatment to which there is no viable alternative despite efforts to create artificial blood. Each year thousands of lives are saved by blood transfusions in every country of the world. However, blood and blood products can result in significant adverse events including immunologic reactions, infections, inefficacy, and others which can sometimes result in death and severe disability. Thus, the sustainability of safe blood systems and costs are considered to be at crisis level. In industrialized countries, the risk of transfusion-transmitted infections such as HIV, syphilis, hepatitis viruses B and C are very low [generally [<1 in a million units], but in developing countries [especially in Africa] blood safety is still not assured. Compounding the problem of blood/product safety with respect to infectious agents are new emerging infectious microbes that are not being routinely tested for in blood that are donated. This chapter reviews the infectious risk of blood transfusions, types, mode and geographic variation, and the methods being used by blood services to attenuate and prevent these risks.
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6,128 |
Meaning of dangerous goods
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The parties to a contract for the carriage of goods by sea, whether this is embodied in a bill of lading or one of the standard charterparty forms, customarily negotiate its terms against a background of both commercial and legal considerations. The parties’ respective liability for risks to which the vessel and its cargo might be exposed during the course of the contracted voyage will be of paramount importance. Should they arise, the potential risks might expose the parties, through their insurance, to expensive damage claims. Therefore, the description of the cargo for shipment is one of the crucially important components of the negotiations between the parties to any shipping contract.(1) This requirement becomes especially relevant when it has been estimated that more than 50% of the cargoes transported by sea today may be regarded as dangerous, hazardous, and/or harmful and need to be handled with special care. As a result, a shipper does not have unlimited freedom as to what he may transport by sea. Restrictions on goods which a charterer or shipper may ship are imposed by law, the terms of the contract and statutes. These restrictions are commonly elided into a general proposition that a person sending goods by sea must not ship dangerous goods. Yet it is the case that dangerous goods are often shipped and legitimately so; and the carrier should discharge his normal duties in respect of whatever cargo he has agreed to carry. The real issues, therefore, are to identify what risks are involved in the carriage of the cargo in question, how these risks are allocated between the parties and what the consequences of shipping dangerous goods are.(2)
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6,129 |
Metabolic Engineering of Fungal Strains for Efficient Production of Cellulolytic Enzymes
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Filamentous fungi are widely used for production of cellulase and other cellulolytic enzymes. Metabolic engineering of filamentous fungal strains has been applied to improve enzyme production, and rapid progress has been made in the recent years. In this chapter, genetic tools and methods to develop superior enzyme producers are summarized, which includes establishment of genetic modification systems, selection and redesign of promoters, and metabolic engineering using either native transcription factors or artificial ones. In addition, enhancement of cellulase production through morphology engineering was also discussed. Emerging tools including CRISPR-Cas9-based genome editing and synthetic biology are highlighted, which are speeding up mechanisms elucidation and strain development, and will further facilitate economic cellulolytic enzyme production.
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6,130 |
Prospects of brassinosteroids in medicinal applications
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Steroids are an imperative group of hormones which play a key role in the transmission of signals that mediate growth and physiological responses in most pluricellular organisms. Brassinosteroids (BRs), a class of plant-specific steroid hormones, control many of the developmental and physiological processes like their animal counterparts, including regulation of gene expression, cell division and expansion, differentiation, programmed cell death, and homeostasis. Recent studies have indicated that these hormones have antiviral, antifungal, antiproliferative, antibacterial, neuroprotective and immunomodulatory properties in animal system. BRs analogues have been reported to have antiviral activity against herpes simplex virus type 1 (HSV-1), arenaviruses as well as against replication of vesicular stomatitis virus (VSV) in Vero cells. Also, antiherpetic activities both in a human conjunctive cell line (IOBA-NHC) and murine herpetic stromal keratitis (HSK) experimental models have been reported. In human cells, anticancer structure-activity relationship of natural BRs revealed their high cytotoxic activity. Since, BRs and their analogues are reported to inhibit cell growth in cancer cell lines, they may be considered as promising phytohormones for potential anticancer drugs. The use of pollens in folk medicine also indicates scope of steroids of plant pollens in medicines. An attempt has been made in this paper to document the information available on the prospects of BRs in therapeutics.
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6,131 |
CT Imaging of Interstitial Lung Diseases
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Until today, computed tomography (CT) is the most important and valuable radiological modality to detect, analyze, and diagnose diffuse interstitial lung diseases (DILD), based on the unsurpassed morphological detail provided by high-resolution CT technique. In the past decade, there has been a shift from an isolated histopathological diagnosis to a multidisciplinary acquired diagnosis consensus that is nowadays regarded to provide the highest level of diagnostic accuracy in patients with diffuse interstitial lung diseases. The 2002 ATS/ERS statement on classification of idiopathic interstitial pneumonias assigned a central role to high-resolution CT (HRCT) in the diagnostic workup of idiopathic interstitial pneumonias (ATS/ERS consensus classification 2002). The more recent 2013 ERS/ATS statement reinforced that combined clinical data (presentation, exposures, smoking status, associated diseases, lung function, and laboratory findings) and radiological findings are essential for a multidisciplinary diagnosis (Travis et al., Am J Respir Crit Care Med 188(6):733–748, 2013). The traditional HRCT consisted of discontinuous 1 mm high-resolution axial slices. The primary focus was on visual pattern analysis demanding for the highest possible spatial resolution. Because of the intrinsic high structural contrast of the lung, it has been possible to substantially reduce dose without losing diagnostic information. This development has been supported by new detection and reconstruction techniques. Not only detection of subtle disease and visual comparison of disease stage but also disease classification and quantification nowadays take advantage of continuous volumetric data acquisition provided by multidetector row (MD) CT technique. The following book chapter will focus on acquisition technique with special emphasis on dose and reconstruction, advantages, and new diagnostic options of volumetric MDCT technique for interstitial lung diseases. Based on evidence from the literature, certain diseases will be covered more specifically, but it has to be noted that for the pattern analysis of the various interstitial lung diseases, the plethora of other publications and books is recommended.
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6,132 |
Functionalised Nanoliposomes for Construction of Recombinant Vaccines: Lyme Disease as an Example
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Liposomes (phospholipid bilayer vesicles) represent an almost ideal carrier system for the preparation of synthetic vaccines due to their biodegradability and capacity to protect and transport molecules of different physicochemical properties (including size, hydrophilicity, hydrophobicity, and charge). Liposomal carriers can be applied by invasive (e.g. i.m., s.c., i.d.) as well as non-invasive (transdermal and mucosal) routes. In the last 15 years, liposome vaccine technology has matured and several vaccines containing liposome-based adjuvants have been approved for human and veterinary use or have reached late stages of clinical evaluation. Given the intensifying interest in liposome-based vaccines, it is important to understand precisely how liposomes interact with the immune system and how they stimulate immunity. It has become clear that the physicochemical properties of liposomal vaccines – method of antigen attachment, lipid composition, bilayer fluidity, particle charge, and other properties – exert strong effects on the resulting immune response. In this chapter we will discuss some aspects of liposomal vaccines including the effect of novel and emerging immunomodulator incorporation. The application of metallochelating nanoliposomes for development of recombinant vaccine against Lyme disease will be presented as a suitable example.
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6,133 |
Life-Threatening Complications of Biological Therapies
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The last decade was characterized by the successive introduction of several biological agents for the treatment of autoimmune rheumatic diseases (ARD). Randomized controlled trials (RCT) proved them to have globally acceptable safety and tolerability profiles. However, life-threatening complications are rare events and RCT are underpowered to detect them. As these drugs became more widely prescribed in clinical practice, and particularly, having the information from multiple national biologics registries available, serious adverse events became perceptible. Infection remains the major concern, but other serious and life-threatening complications have emerged, such as malignancies, congestive heart failure, demyelinating disorders, and drug-induced autoimmune syndromes. Several of these are correlated with either the underlying disease or concomitant immunosuppressive medication. Most of them can be avoided by the adoption of preventive measures and an early proper management might significantly change the outcome. Awareness of the possible serious side effects is of utmost importance for a safer use of biological agents. In this chapter, we aim to describe the most commonly reported life-threatening complications of biological therapies in the literature – including those with antitumor necrosis factor agents, rituximab, abatacept, tocilizumab, and anakinra. Risk groups are identified and strategies for the prevention and initial management are included.
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6,134 |
Bird Flu, SARS and Beyond
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In the politically sensitive year of 1997, Hong Kong experienced an outbreak of avian flu when the deadly H5N1 virus unprecedentedly jumped the species barrier from chickens and infected human beings. Hong Kong decided to slaughter over a million chickens, and the virus was stopped in its tracks. In 2003, Hong Kong was the epicenter of the SARS pandemic, which originated in Guangdong province. The Faculty of Medicine played key roles in both instances, with its Microbiology Department successfully identifying a novel coronavirus as being responsible for SARS. Hong Kong learned from its experience and took action to combat the emergence of new infectious diseases. Such vigilance paid off in 2009, when swine flu swept the world, and in 2013, when a novel avian flu H7N9 emerged in China.
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6,135 |
Bridging the Gap Between Conservation and Health
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Health is frequently in the news, whether it is the “bird flu” headlines or woven into the core of climate change reports. And in these articles, health is the common thread that connects humans, animals, and the environment; however, this underlying link is often undervalued, leaving a “gap” that challenges our ability to prevent and mitigate major global catastrophes. The Ebola virus disease has ravaged West Africa, leaving a swath of devastation and unanswered questions in its wake, but it highlights the alarming potential of a zoonotic disease, one of hundreds that pass between animals and humans. Climate change continues to fuel controversy, but it is undeniable that our exploitation of the Earth is impacting the fundamental resources that form the foundation of our existence. The state of our ecosystems is integral to the conservation and sustainable management of our wildlife and natural resources. The health of the environment cannot be segregated from our own health; thus, we need to examine health from a global stance. Our traditional perspectives of “health” and “disease” are outdated, and it is prime time for us to reevaluate our approaches to engage a comprehensive audience as well as holistic strategies to address these issues as “One Health.”
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6,136 |
The Impact of Infectious Diseases on the Development of Africa
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Despite the success of vaccination programs for polio and some childhood diseases, other diseases like HIV/AIDS, malaria, tuberculosis, acute respiratory infections and diarrheal disease are causing high mortality rates in Africa. However, mortality figures give only a partial measure of the toll asked by infectious diseases, and the global burden includes also health impact measured by disabilities, deformities, loss of productivity, care and treatment caused by a multitude of diseases like lymphatic filariasis, leishmaniasis, schistosomiasis, sleeping sickness and others. The impact of infectious diseases can be traced according to economic performance of African countries, showing that 34 out of 53 countries are classified as low-income economies. The disease burden is, however, more devastating since it affects all components of human development, including income, health and education. The impact of infectious diseases on African countries is no longer a crisis only for the healthcare sector, but presents a challenge to all sectors. It has the potential to reverse those gains made in human development in the last few years. Consequently, beyond health issues, these diseases should and must globally be seen as a development concern, affecting education and knowledge acquisition, income and social status, productivity and economic growth and other direct and indirect components of human development such as gender equality and human rights. For health strategies to be successful, international solidarity and public-private partnerships are needed to tackle the problems of shortage and lack of treatments, resistance and the need for new drugs, vaccines and diagnostic procedures. However, the output of international initiatives will remain limited without the national and local implication.
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6,137 |
Acronyms and Abbreviations
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6,138 |
Trophoblast Cells as Immune Regulators
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Medawar, in the early 1950s, recognized for the first time, the unique immunology of the maternal-fetal interface and its potential relevance for transplantation. In his original work, he described the “fetal allograft analogy” whereby the fetus may be viewed as a semi-allogeneic conceptus that has evaded rejection by the maternal immune system. Although numerous hypotheses have been proposed to prove this observation, none have demonstrated that the maternal immune system is antagonist to the invading trophoblast. In the present manuscript we have reviewed recent studies demonstrating the expression and function of TLRs in trophoblast cells and based on this data we propose an alternative view for maternal-fetal immune interactions.
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6,139 |
Infectious Diseases of the Nervous System
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In this chapter infectious diseases of the nervous system are discussed. These include bacterial, viral, fungal, spirochetal, and parasitic infections. Although the central nervous system (CNS) is protected from bacterial invasion by the intact blood-brain barrier, bacterial invasion is enhanced by the special surface properties of bacteria as well as host immune deficiencies. Similar to any type of infection of the nervous system, bacteria may involve any of the nervous system compartments: the epidural space (epidural abscess); the dura (pachymeningitis); the subdural space (subdural empyema); the leptomeninges and the subarachnoid space containing cerebrospinal fluid (meningitis or leptomeningitis); and the brain parenchyma (brain abscess). The clinical manifestations, pathogenesis, pathology, etiology, epidemiology, diagnosis, differential diagnosis, and treatment of these syndromes are presented.
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6,140 |
Viral Diseases of the Liver
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Viruses other than the classic hepatotropic viruses, hepatitis A through E, may cause hepatic injury [1]. Among these are Epstein–Barr virus (EBV), cytomegalovirus (CMV), herpes simplex virus (HSV), varicella zoster virus (VZV), human herpes viruses (HHV) 6, 7, and 8, human parvovirus B19, and adenoviruses (Table 11.1). The clinical presentation of infections with these viruses may be indistinguishable from that associated with infection with classic hepatotropic viruses. The presentation ranges from mild and transient elevation of aminotransferases to acute hepatitis and can also lead to acute liver failure [1]. These viruses should be considered as possible etiologic agents in patients who have acute liver injury and whose serologic markers for the classic hepatotropic viruses are not indicative of an active infection [1]. In the present chapter, we review the clinical manifestations and the potential for immune-mediated liver injury associated with several of these viruses (see summary Table 11.2).
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6,141 |
Kulturgeschichte der Angst
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Man kann eine »Kulturgeschichte der Angst« kaum epochal ordnen. Bildet die Sattelzeit um 1800 hinsichtlich der Angst wirklich einen Epocheneinschnitt? Wird dies bejaht, so folgt man Parametern, die mit der Geschichte der Modernisierung verbunden sind: Werden die traditionalen von funktional differenzierten Gesellschaften systemisch unterschieden, dann ist 1800 ein Epochendatum, das auch für die Geschichte der Angst gelten muss. Wir werden zeigen, dass diese Annahme berechtigt ist. Dennoch ist dieser von Niklas Luhmann inspirierte Ansatz hinsichtlich der Geschichte von Gefühlen nur bedingt ein probater Weg; und er ist aussichtsreich eher für die Liebe als für die Angst, eher für die Sympathie als für die Wut. Sofern sich in der Moderne neue Felder der Angst und vielleicht auch neue Angsttypen ausmachen lassen, so gilt dennoch das, was eine der großen Entdeckungen Sigmund Freuds war, nämlich der Erhaltungssatz psychischer Energien.
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6,142 |
Pathogenesis of Fever
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#x203A; Although infection is the most common cause of fever, fever is also a common finding in hypersensitivity reaction, autoimmune diseases, and malignancy. › Febrile response is mediated by endogenous pyrogens (cytokines) in response to invading exogenous pyrogens, primarily microorganisms or their direct products (toxins). › These endogenous pyrogens act on thermosensitive neurons in the hypothalamus, which ultimately upgrade the set point via prostaglandins. › The body reacts by increasing the heat production and decreasing the heat loss until the body temperature reaches this elevated set point. › Fever, in contrast to hyperthermia, will not climb up relentlessly because of an effective central control of the hypothalamic center. › Cytokines play a pivotal role in the immune response by activation of the B cells and T lymphocytes. The production of fever simultaneously with lymphocyte activation constitutes the clearest and strongest evidence in favor of the protective role of fever. › The protective processes of the immune response are optimal at high temperature (around 39.5°C). › Not all effects resulting from fever generation benefit the host; some are harmful and even lethal. This occurs mainly by overproduction of the cytokines or imbalance between cytokines and their inhibitors, such as severe and fulminate infections and septic shock.
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6,143 |
La ventiloterapia non invasiva nel trattamento dell’insufficienza respiratoria acuta: indicazioni controverse
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La polmonite che richiede il ricorso alla ventilazione, sia essa invasiva o NIV, è sempre un evento grave associato a una elevata mortalità, soprattutto nell’anziano, nonostante questa patologia venga dai media spesso considerata come malattia di “facile” risoluzione.
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6,144 |
Rabbit Coronavirus-like Viruses(‡): Coronaviridae
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6,145 |
Smallpox as a Weapon for Bioterrorism
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Smallpox, the only disease ever eradicated, is one of the six pathogens considered a serious threat for biological terrorism (Henderson et al., 1999; Mahy, 2003; Whitley, 2003). Smallpox has several attributes that make it a potential threat. It can be grown in large amounts. It spreads via the respiratory route. It has a 30% mortality rate. The potential for an attack using smallpox motivated President Bush to call for phased vaccination of a substantial number of American health care and public health workers (Grabenstein and Winkenwerder, 2003; Stevenson and Stolberg, 2002). Following September 11, 2001, the United States rebuilt its supplies of vaccine and Vaccinia Immune Globulin (VIG), expanded the network of laboratories capable of testing for variola virus, and engaged in a broad education campaign to help health care workers and the general public understand the disease (Centers for Disease Control and Prevention, 2003a). This chapter summarizes the scientific and theoretical bases for use of smallpox as a bioweapon and options for preparation for defense against it.
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6,146 |
Introduction to the Economic, Financial, Political and Legal Implications of Global Pandemics
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In this chapter, we begin with an assessment of the risks posed by fast-moving global pandemics. We then examine the origin and nature of the slow-moving global HIV/AIDS pandemic. The remainder of this chapter summarizes the topics that will be covered in the subsequent chapters of this book.
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6,147 |
Pulmonary Disorders in Pregnancy
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Pregnancy is associated with some profound changes in the cardiovascular, respiratory, immune, and hematologic systems that impact the clinical presentation of respiratory disorders, their implications in pregnancy, and the decisions to treat. In addition, concerns for fetal well-being and safety of various interventions complicate the management of these disorders. In many circumstances, especially life-threatening ones, decisions are based upon a careful assessment of the risk benefit ratio rather than absolute safety of drugs and interventions. In this chapter, we review some of the common respiratory disorders that internists or obstetricians may be called upon to manage.
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6,148 |
Types of Human Disease by Source of the Infectious Agent
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In general, the source of infection for human beings is another human, or an animal, or the environment (extra-animal substrate). In line with this we can distinguish human infectious diseases as anthroponoses, zoonoses and sapronoses, respectively.
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6,149 |
Critical Illness Stress-induced Immune Suppression
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Despite the use of Centers for Disease Control and Prevention (CDC) recommended practices to minimize infection risk, nosocomial sepsis and multiple organ failure (MOF) remain a leading cause of morbidity and mortality in critically ill patients. It is well documented that the use of immunosuppressant therapies dramatically increases this risk in patients with cancer, transplantation, and immunologic disease. Although immune monitoring has yet to be universally embraced, withdrawal of immunosuppressant therapies and use of immune restoration therapies is the standard of care when these patients develop sepsis. Critical illness stress can also induce a level of immunosuppression which is as life-threatening as is seen in the purposefully immunosuppressed patient. This chapter reviews the role of critical illness stress-induced immunosuppression in the development of nosocomial sepsis and MOF, and outlines clinical strategies which can be employed to maintain and restore immune function, and reduce morbidity and mortality in critically ill patients.
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6,150 |
Potential of Tree Endophytes as Sources for New Drug Compounds
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The novel or designer metabolites produced by fungal endophytes are increasingly recognized by natural chemists due to their diverse structures and as candidates for drug discovery and development. Many of the metabolites belong to different classes i.e. alkaloids, benzopyranones, coumarins, chromones, cytochalasines, enniatines, isocoumarin derivatives, quinones, peptides, phenols, phenolic acids, semiquinones, steroids, terpenoids, xanthones and lactones. One of the most widely studied endophytic genera is Pestalotiopsis, from which more than 140 metabolites are reported with antimicrobial, antioxidant and antitumor activities. Besides reviewing the advances made in identifying bioactive metabolites with drug development potential from endophytic fungi, this chapter discusses possibilities and bottlenecks involved in employment of endophytic fungi and their products by the pharmaceutical industry. Furthermore, issues involved in anti-infective discovery and timeline of drug development are discussed in the view of developing new drug compounds from endophytic products.
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6,151 |
Emergency Triage of Highly Infectious Diseases and Bioterrorism
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Emergency medical services are a key element in health systems for the evaluation and treatment of patients exposed to highly infectious diseases or bioterrorism agents. Triage and early identification at any point of care can have a significant impact on the prevention and management of these diseases. This chapter reviews triage practices, including early isolation and decontamination, of highly infectious diseases and bioterrorism agents at different health system levels.
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6,152 |
An Oral Vaccine for TGEV Immunization of Pigs
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Transmissible gastroenteritis virus (TGEV) is a commercially important pathogen of hog farms and causes contagious, lethal diarrhea in piglets. While orally and parenterally administered vaccines made from inactivated or attenuated TGEV are commercially available, they require individual administration to piglets, which is time and labor intensive, and run the risk of reversion to pathogenicity. Also, parenteral vaccines produce neutralizing serum antibodies which may be less effective against an orally transmitted pathogen, compared to an oral vaccine that would induce the production of mucosal antibodies. There has been an effort to produce subunit vaccines in an edible form in plants for convenient administration through feed. These efforts towards the expression of the S-antigen of TGEV in maize seed, its effectiveness at inducing neutralizing antibody production in the colostrum of gilts, and its efficacy in protecting piglets against challenge by virulent TGEV are summarized here.
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6,153 |
Real-Time Reverse Transcription-Polymerase Chain Reaction for Detection and Quantitation of Turkey Coronavirus RNA in Feces and Intestine Tissues
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Turkey coronavirus (TCoV) infection causes acute atrophic enteritis in turkey poults, leading to significant economic loss in the turkey industry. Rapid detection, differentiation, and quantitation of TCoV are critical to the diagnosis and control of the disease. A specific one-step real-time reverse transcription-polymerase chain reaction (RT-PCR) assay using TCoV-specific primers and dual-labeled fluorescent probe for detection and quantitation of TCoV in feces and intestine tissues is described in this chapter. The fluorogenic probe labeled with a reporter dye (FAM, 6-carboxytetramethylrhodamine) and a quencher dye (Absolute Quencher™) was designed to bind to a 186 base-pair fragment flanked by the two PCR primers targeting the 3′ end of spike gene (S2) of TCoV. The assay is highly specific and sensitive and can quantitate between 10(2) and 10(10) copies/mL of viral genome. It is useful in monitoring the progression of TCoV-induced atrophic enteritis in the turkey flocks.
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6,154 |
Demand for Tourism in Malaysia by UK and US Tourists: A Cointegration and Error Correction Model Approach
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6,155 |
Non-vaccine-Preventable Infections
|
There are many potentially serious infections that may pose a risk to travellers for which no vaccines are available. Following discussions on vaccines, malaria prevention and travellers’ diarrhoea at the consultation, the travel-medicine practitioner should identify other infectious risks that may apply to the traveller, whether because of destination/s and duration of travel, occupational or other activities, or individual susceptibility. Information should be provided about these infections, their relevance, modes of transmission and methods of prevention, or the traveller should be referred to an authoritative source of information. In this chapter, advice will be given on both destination- and activity-related infections. The risk, distribution, clinical features and methods of prevention of a number of specific infections for which no vaccines are available are then outlined. This includes information on emerging viral infections such as Zika, MERS, Ebola and Chikungunya.
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6,156 |
Conclusion: Contributions of Multiple Representations to Biological Education
|
Our book project began in 2009 with the intent to bring together international biology educators and biology education researchers who are involved in improving biological education from the perspective of multiple representations. It was also our goal that this volume would be able to address how biological education could meet the challenges of the twenty-first century, in which the breakthroughs in biological research would necessitate the integration of research and education with global economics and human social structures (Kress & Barrett, 2001).
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6,157 |
Scopulariopsis brevicaulis
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Scopulariopsis hominis, Scopulariopsis rufulus, Penicillium brevicaulis
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6,158 |
Pulmonary Infections: Imaging with CT
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Computed tomography (CT) plays a key role in various kinds of pulmonary infections especially in immunocompromised patients, owing to its much higher sensitivity and specificity than the traditionally performed chest X-ray. CT permits the detection of the main infectious pattern and associated findings with high confidence and allows for the precise assessment of all involved structures, to potentially guide a bronchoalveolar lavage or another diagnostic procedure, and to ensure a reliable follow-up. It may be performed at a carefully chosen dose, which may nearly reach that of a chest X-ray in specific situations. The importance of post-processing tools is undeniable in some conditions, in particular for the evaluation of micronodules in the immunocompromised population. The wide spectrum of features of specific organisms according to the immune status, such as in aspergillosis or tuberculosis, must be known, as well as the potential of atypical presentations in case of Pneumocystis jirovecii (PCP) pneumonia when occurring in non-HIV immunocompromised patients. In all cases, underlying disorders must be considered as well as all the differential diagnoses. Overall, CT definitely helps clinicians to diagnose pulmonary infections and to make treatment decisions, especially in vulnerable patients.
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6,159 |
A New Approach to Ventilator-associated Pneumonia Based on the PIRO System
|
Several new scoring systems have been developed over recent years to assess the degree of organ failure (e.g., Acute Physiology and Chronic Health Evaluation [APACHE] II, APACHE III, Sequential Organ Failure Assessment [SOFA], Simplified Acute Physiology Score [SAPS] II, and Multiple Organ Dysfunction Score [MODS]). Most of these were models generated based on the concepts of sepsis, severe sepsis and septic shock. In 2001, an International Sepsis Definition Conference updated these terms in order to facilitate standardized enrolment into clinical trials, but due to their simplicity and easy use physicians rapidly adopted them for daily clinical practice [1].
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6,160 |
Viruses
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6,161 |
The Challenge of Emerging Infections and Progressive Antibiotic Resistance
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6,162 |
Hospital Wastewater Treatments Adopted in Asia, Africa, and Australia
|
This chapter provides an overview of the current management and treatment of hospital wastewater in Asia, Africa, and Australia. Twenty peer reviewed papers from different countries have been analyzed, highlighting the rationale behind each study and the efficacy of the investigated treatment in terms of macro- and micro-pollutants. Hospital wastewaters are subjected to different treatment scenarios in the studied countries (specific treatment, co-treatment, and direct disposal into the environment). Different technologies have been adopted acting as primary, secondary, and tertiary steps, the most widely applied technology being conventional activated sludge (CAS), followed by membrane bioreactor (MBR). Other types of technology were also investigated. Referring to the removal efficiency of macro- and micro-pollutants, the collected data demonstrates good removal efficiency of macro-pollutants using the current adopted technologies, while the removal of micro-pollutants (pharmaceutical substances) varies from low to high removal and release of some compounds was also observed. In general, there is no single practice which could be considered a solution to the problem of managing HWWs – in many cases a number of sequences are used in combination.
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6,163 |
Notfall- und Intensivmedizin bei speziellen Krankheitsbildern
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Ein 63-jähriger Mann bricht beim Tennisspielen zusammen und bleibt reglos liegen. Die anwesenden Personen können keine Atmung feststellen und beginnen mit der Herz-Lungen-Wiederbelebung. Die sofort alarmierte Rettung trifft 12 min nach dem Kollaps ein und setzt die Reanimationsmaßnahmen fort. Der EKG-Monitor zeigt Kammerflimmern, der Patient wird sofort defibrilliert und die Reanimation fortgesetzt. Kurz darauf ist ein Puls tastbar, das EKG zeigt einen Sinusrhythmus mit zahlreichen ventrikulären Extrasystolen. Der Patient wird daraufh in intubiert und analgosediert. Der angeforderte Notarzthubschrauber transportiert den Patienten ins Krankenhaus. Dort wird ein ausgedehnter Vorderwandinfarkt festgestellt; der Patient erhält sofort eine PTCA mit Stentimplantation und wird für weitere 24 h auf 33 °C gekühlt. Wenige Tage nach dem Ereignis kann er ohne neurologisches Defi zit die Rehabi litation antreten.
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6,164 |
Malaria
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Malaria is a significant cause of morbidity and mortality throughout the world, and environmental changes are likely to increase its importance in the coming years. Diagnosing this disease is difficult and requires a high index of suspicion, especially in non-endemic countries. Critical care providers play a major role in treating severe malaria and its complications, which has management particularities that might not be readily apparent. Fluid resuscitation should be carefully tailored to avoid complications, and dysperfusion seems more related to degree of parasitemia than hypovolemia. Antimalarial agents are effective, but resistance is growing. Complications can be found in nearly every organ, including cerebral malaria, acute respiratory distress syndrome, and acute kidney injury. As such, a critical care unit is frequently required for organ support when they appear. Superimposed infections are not infrequent. Despite all of this, mortality is encouragingly low with a timely diagnosis and access to appropriate treatment.
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6,165 |
Migration in Saudi Arabia: Present and Prospects
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As compared with other Gulf Cooperation Council (GCC) countries, Saudi Arabia has distinct demographic features. This leads the Saudi government to take measures to revisit its existing policies and schemes concerned with population. With this brief outline, migration data used in this article are pitched to understand five dimensions: (1) to look at the Saudi citizens’ migration trends within the Kingdom, (2) to analyse the impact of migration on the Kingdom’s population growth and also on the neighbouring GCC countries, (3) to look at the changes taking place annually in the Kingdom’s migration trends and in the other GCC countries, (4) to examine the migrants, looking at their origin place and (5) to analyse the variation between immigrants and Saudi Arabia citizens in terms of demographic parameters like population growth, sex ratio, broad age groups and age-sex distribution. Various databases available at both national and international levels were taken to address the five dimensions. The findings showed that push and pull factors and infrastructure differentials are taken into consideration while Saudi population internally migrate. All the GCC countries, including Saudi Arabia, experience international migration streams subject to the labour requirements and governmental regulations for both Arabs and non-Arabs. Immigrant demographics are characterized by Saudi Arabia’s labour demand controlled by adult males from other countries.
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6,166 |
Mo-Buzz: Socially-Mediated Collaborative Platform for Ubiquitous Location Based Service
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This paper describes a middleware platform for user-generated multimedia contents which facilitates visualization and communication of vector-borne diseases (dengue, malaria, etc.). It acts as a community platform, where diverse users from geographically distributed locations can collaborate to seek and contribute multimedia contents of such diseases and related issues (breeding sites, etc.). Some of the essential services supported by the system are display of live hotspots, timeline, multimedia and Twitter-feed visualization, and location based services for both users and authorities. As a proof-of-concept, dengue disease was selected to build services using this platform to observe its capabilities.
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6,167 |
Immunologie
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Die Mechanismen der Immunabwehr, mit denen ein Organismus Virusinfektionen bekämpft, können in zwei Gruppen eingeteilt werden. Zum einen gibt es die unspezifischen, nichtadaptativen Immunreaktionen, die eindringende Erreger als fremd erkennen und eliminieren. Diese sogenannte natürliche oder angeborene Immunabwehr wird als erste aktiv, nachdem ein Virus die äußeren physikalischen Schutzschranken des Körpers (Haut, Schleimhaut) überwunden hat. Sie besteht aus bestimmten Zellen, nämlich aus den dendritischen Zellen, den Granulocyten, den Monocyten und Makrophagen sowie den natürlichen Killerzellen. Diese verfügen über Proteine, die als Rezeptoren (beispielsweise toll-like-Rezeptoren, Komplementrezeptoren) für bestimmte Erregerstrukturen und für die löslichen Produkte des unspezifischen Immunsystems (Akutphaseproteine, die Faktoren des Komplementsystems, Cytokine, Chemokine und Interferone) dienen. Auf die Wirkung und Funktion der Cytokine, Chemokine und Interferone wird in ▸ Kapitel 8 gesondert eingegangen.
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6,168 |
Serine Proteases in the Lectin Pathway of the Complement System
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The complement system plays a crucial role in host defense against pathogen infections and in the recognition and removal of damaged or altered self-components. Complement system activation can be initiated by three different pathways—classical, alternative, and lectin pathways—resulting in a proteolytic cascade, which culminates in multiple biological processes including opsonization and phagocytosis of intruders, inflammation, cell lysis, and removal of immune complexes and apoptotic cells. Furthermore, it also functions as a link between the innate and adaptive immune responses. The lectin pathway (LP) activation is mediated by serine proteases, termed mannan-binding lectin (MBL)-associated serine proteases (MASPs), which are associated with the pattern recognition molecules (PRMs) that recognize carbohydrates or acetylated compounds on surfaces of pathogens or apoptotic cells. These result in the proteolysis of complement C2 and C4 generating C3 convertase (C4b2a), which carries forward the activation cascade of complements, culminating in the elimination of foreign molecules. This chapter presents an overview of the complement system focusing on the characterization of MASPs and its genes, as well as its functions in the immune response.
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6,169 |
Entwicklung von Arzneistoffen
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Die Entwicklung von Arzneistoffen stellt eine der wichtigsten Schnittstellen zwischen der Biochemie und der Medizin dar. In den meisten Fällen entfalten die Arzneistoffe ihre Wirkung, indem sie an spezifische Rezeptoren oder Enzyme binden und diese inhibieren oder deren Aktivität auf eine andere Weise verändern. Deshalb ist das Wissen über diese Moleküle und die Stoffwechselwege, in die sie eingreifen, von entscheidender Bedeutung für die Arzneistoffentwicklung. Ein effektiver Arzneistoff ist jedoch weit mehr als ein stark wirkender Modulator. Arzneistoffe müssen sich den Patienten einfach verabreichen lassen, vorzugsweise als kleine, oral gegebene Tabletten, und sie müssen im Körper lange genug überdauern, damit sie ihr Ziel erreichen können. Um unerwünschte physiologische Wirkungen zu verhindern, dürfen die Arzneistoffe zudem nicht die Eigenschaften von anderen Biomolekülen verändern, die nicht ihre Zielmoleküle sind. Diese Anforderungen schränken die Anzahl der Verbindungen, die klinisch von Nutzen sein können, enorm ein.
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6,170 |
Study on Efficient Complex Network Model
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This paper summarizes the relevant research of the complex network systematically based on Statistical Property, Structural Model, and Dynamical Behavior. Moreover, it emphatically introduces the application of the complex network in the economic system.
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6,171 |
The Pharmaceutical Company Approach to Antibiotic Policies
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6,172 |
Metabolic disorders and storage diseases
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Primary metabolic disorders and storage diseases are caused by endogenous factors, usually a gene mutation. Since the congenital defect is predominantly or exclusively located in the liver, the resulting diseases also become manifest in this organ.
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6,173 |
Kawasaki Disease
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Kawasaki disease (KD) is a systemic vasculitis mainly affecting children below 5 years of age. Diagnosis is made upon a combination of criteria, including persistent fever; edema, erythema, or desquamation of the extremities; polymorphous exanthema; conjunctival injection; erythema of the lips and oral mucosa; and lymphadenopathies. Many cases do not meet all diagnostic criteria but should also be considered for therapy. IVIG and aspirin are the main therapeutic measures.
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6,174 |
Edible Vaccines
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In recent years edible vaccine emerged as a new concept developed by biotechnologists. Edible vaccines are subunit vaccines where the selected genes are introduced into the plants and the transgenic plant is then induced to manufacture the encoded protein. Foods under such application include potato, banana, lettuce, corn, soybean, rice, and legumes. They are easy to administer, easy to store and readily acceptable delivery system for different age group patients yet cost effective. Edible vaccines present exciting possibilities for significantly reducing various diseases such as measles, hepatitis B, cholera, diarrhea, etc., mainly in developing countries. However, various technical and regulatory challenges need to overcome in the path of this emerging vaccine technology to make edible vaccine more efficient and applicable. This chapter attempts to discuss key aspects of edible vaccines like host plants, production, mechanism of action, advantages and limitations, applications, and different regulatory issues concerned to edible vaccines.
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6,175 |
Fundamentals of XML and BSML
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6,176 |
Early Warning Systems Defined
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This chapter defines and describes early warning systems (EWS) by examining structures and functions of EWS. The focus of this book is on climate change, but other hazards help to better illustrate and understand EWS in the context of climate change. These include hazards which manifest rapidly, such as tsunamis, as well as creeping hazards which manifest slowly, such as drought. The fundamental tenet is that each EWS needs to be viewed as a social process which often involves technical components embedded in their social context. That leads to a preference for a ‘First Mile’ approach for designing EWS, which involves communities from the beginning of developing an EWS, rather than a ‘Last Mile’ approach, which adds people and communities towards the end of the design process. By keeping people and communities at the centre of an EWS from the beginning, the EWS can contribute to daily life and livelihoods, thereby supporting wider disaster risk reduction and sustainable development endeavours, rather than being a separate system waiting to be triggered only when a hazard appears. Yet any EWS has limitations. Those limitations need to be recognised and overcome through other approaches, with possibilities being to consider ‘medium warning’ and ‘late warning’ systems rather than just early warning.
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6,177 |
Rural Livelihood
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In most rural areas of the world, approximately 90 % of the population is involved in farming as a way of earning a living. Small-scale farming, fishing, raising livestock and non-farm activities are some of the common livelihoods that these populations survive on. Rural livelihood poses a great challenge as these populations are often in a state of poverty where they lack the basic necessities for survival. A rural household with diverse sources of income earning activities has better chances of survival financially than a household which has only one source. Delivery of quality education and training in a variety of skills in rural areas is therefore needed to attain sustainable rural livelihoods. In order for a rural population to strive there is need for livelihoods that would sustain and support their households and communities.
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6,178 |
Discoveries in Molecular Genetics with the Adenovirus 12 System: Integration of Viral DNA and Epigenetic Consequences
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Starting in the 1960s, the human adenovirus type 12 (Ad12) system has been used in my laboratory to investigate basic mechanisms in molecular biology and viral oncology. Ad12 replicates in human cells but undergoes a completely abortive cycle in Syrian hamster cells. Ad12 induces neuro-ectodermal tumors in newborn hamsters (Mesocricetus auratus). Each tumor cell or Ad12-transformed hamster cell carries multiple copies of integrated Ad12 DNA. Ad12 DNA usually integrates at one chromosomal site which is not specific since Ad12 DNA can integrate at many different locations in the hamster genome. Epigenetic research occupies a prominent role in tumor biology. We have been using the human Ad12 Syrian hamster cell system for the analysis of epigenetic alterations in Ad12-infected cells and in Ad12-induced hamster tumors. Virion or free intracellular Ad12 DNA remains unmethylated at CpG sites, whereas the integrated viral genomes become de novo methylated in specific patterns. Inverse correlations between promoter methylation and activity were described for the first time in this system and initiated active research in the field of DNA methylation and epigenetics. Today, promoter methylation has been recognized as an important factor in long-term genome silencing. We have also discovered that the insertion of foreign (Ad12, bacteriophage lambda, plasmid) DNA into mammalian genomes can lead to genome-wide alterations in methylation and transcription patterns in the recipient genomes. This concept has been verified recently in a pilot study with human cells which had been rendered transgenomic for a 5.6 kbp bacterial plasmid. Currently, we study epigenetic effects on cellular methylation and transcription patterns in Ad12-infected cells and in Ad12-induced hamster tumor cells. These epigenetic alterations are considered crucial elements in (viral) oncogenesis.
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6,179 |
Organizing Pneumonias
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Organizing pneumonia is a particular type of inflammatory and reparative reaction of the lung parenchyma characterized by fibroblast proliferation in the distal airspaces with overall preservation of the lung architecture. When microscopic, it is an asymptomatic and nonspecific reaction of little clinical significance accompanying many pathological processes. When macroscopic and affecting large portions of the lung parenchyma, it manifests by restrictive ventilatory defect and gas exchange impairment leading to dyspnea, cough, hypoxemia, alveolar opacities at chest imaging, and symptoms of systemic inflammation such as fever, malaise, and weight loss. This picture constitutes the clinico-pathological syndrome of organizing pneumonia, which has been recognized and characterized as a distinct entity in the past 30 years. Although the classical features of organizing pneumonia are increasingly familiar to chest physicians, and the efficacy of corticosteroid treatment makes it appear at first sight as an easy problem to resolve, atypical clinical presentations, similarities with other diseases, severe forms, histological variants, side effects of therapy, and relapses can make the management more difficult than initially expected. This chapter will address the classical and less common features of organizing pneumonia, and will provide practical clues to the diagnosis and management of this disorder.
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6,180 |
Animal Coronaviruses: A Brief Introduction
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Coronaviruses (CoVs) are single-stranded positive-sense enveloped RNA viruses. Among RNA viruses, CoVs have the largest genome. CoVs infect diverse animal species including domestic and wild animals. In this chapter, we provide a brief review on animal CoVs by discussing their receptor, host specificity, reverse genetics, and emerging and re-emerging porcine CoVs.
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6,181 |
The Role of Humoral Immunity in Mouse Hepatitis Virus Induced Demyelination
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Pathogenesis induced by mouse hepatitis virus (MHV) infection of rodents is characterized by acute viral encephalomyelitis and demyelination which progresses to a persistent CNS infection associated with ongoing myelin loss, pathologically similar to multiple sclerosis (MS). Although humoral immunity appears redundant for the control of acute virus replication, it is vital in maintaining virus at levels detectable only by RNA analysis. T cell mediated control of acute infection cannot be sustained in antibody (Ab) deficient mice, resulting in virus reactivation. The protective role of Ab during persistence is strongly supported by detection of Ab in the cerebrospinal fluid of MHV infected rodents and maintenance of virus specific Ab secreting cells (ASC) in the CNS long after virus clearance. Ab mediated neutralization constitutes the major mechanism of protection, although fusion inhibition also plays a minor role. Delayed accumulation of ASC, concomitant with a decline in T cell function, assures control of residual virus while minimizing T cell mediated pathology. Although there is little evidence for a detrimental role of Ab in demyelination, an association between Ab mediated protection and remyelination is unclear.
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6,182 |
Intensive Patient Treatment
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Intensive care units (ICUs) are treating hospital’s poorest patients that need medical assistance during the most extreme period of their life. Intensive patients are treated with extensive invasive procedures, which may cause a risk of hospital infections in 10–30% of the cases. More than half of these infections can be prevented. The patients are often admitted directly from outside the hospital or from abroad with trauma after accidents, serious heart and lung conditions, sepsis and other life-threatening diseases. Infection or carrier state of microbes is often unknown on arrival and poses a risk of transmission to other patients, personnel and the environment. Patients that are transferred between different healthcare levels and institutions with unknown infection may be a particular risk for other patients. In spite of the serious state of the patients, many ICUs have few resources and are overcrowded and understaffed, with a lack of competent personnel. ICU should have a large enough area and be designed, furnished and staffed for a good, safe and effective infection control. The following chapter is focused on practical measures to reduce the incidence of infections among ICU patients.
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6,183 |
Targeting Viral Heart Disease by RNA Interference
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Viral heart disease (VHD) is an important clinical disease entity both in pediatric as well as adult cardiology. Coxsackieviruses (CVBs) are considered an important cause for VHD in both populations. VHD may lead to dilated cardiomyopathy and heart failure which can ultimately require heart transplantation. However, no specific treatment modality is so far available. We and others have shown that coxsackieviral replication and cytotoxicity can be successfully targeted by RNA interference, thus leading to increased cell viability and even prolongation of survival in vivo. However, considerable limitations have to be solved before this novel therapeutic approach may enter the clinical trials arena.
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6,184 |
Kratzwürmer
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6,185 |
Highly Pathogenic Avian Influenza
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Highly pathogenic avian influenza is an acute respiratory infectious disease caused by some viral strains of avian influenza virus A. Its severity is highly diverse ranging from common cold-like symptoms to septicemia, shock, multiple organ failure, Reye syndrome, pulmonary hemorrhage, and other complications leading to death. According to the laws, human infection of highly pathogenic avian influenza has been legally listed as class B infectious diseases in China. And it has been stipulated that it should be managed according to class A infectious diseases in China.
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6,186 |
Noninvasive Mechanical Ventilation in Patients with High-Risk Infections in Intermediate Respiratory Care Units and on the Pneumology Ward
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Several studies have examined the benefit of noninvasive ventilation (NIV) as first-line therapy in some critically ill patients versus conventional therapy [1]. Currently, NIV is frequently started outside the intensive care unit (ICU)—not only in the emergency department but also in general wards with less-extensive monitoring facilities [2, 3]. Plant et al. [4] showed that it is possible to apply NIV to patients with chronic obstructive pulmonary disease (COPD) and hypercapnic acute respiratory failure (ARF) in the general ward provided the respiratory failure is not severe (assessed by pH>7.30). A European survey of a European Respiratory Society Task Force [5] defined the ICU as a location with a high staff-to-patients ratio and facilities for performing invasive ventilation and monitoring. It defined a respiratory intermediate ICU (RIICU), or a high-dependency unit, as a specific clinical area that has the capability of performing continuous vital sign monitoring and a staff-to-patient ratio somewhere between those for an ICU and a general ward (usually 1:4). Clinical criteria for performing NIV in an RIICU are based on mental status and the presence (or absence) of multi-organ failure [1].
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6,187 |
Reading an uncertain future
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assess the limitations of the information available for strategy making; recognize what kind of information is relevant to strategy making; learn how to read the general environment; understand what is involved in forecasting the future; identify the different kinds of risks to which the enterprise is exposed; build different scenarios of the future.
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6,188 |
Bis an die Grenzen der Vorstellungskraft? Sicherheitspolitische Bedrohungsanalysen
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Eine Analyse der gegenwärtigen sowie der in der Zukunft zu erwartenden sicherheitspolitischen Bedrohungen bildet die Basis für die Konzipierung nationaler Sicherheits- und Verteidigungspolitik. Konsequenterweise ist die Analyse sicherheitspolitisch relevanter Bedrohungen nicht nur fester Bestandteil entsprechender Grundsatzdokumente und findet sich sowohl im deutschen Weißbuch aus dem Jahr 2006 als auch in Livre Blanc und NSS von 2008 jeweils im vorderen Teil des Dokuments, sondern stellt auch einen grundlegenden Teilbereich nationaler Sicherheits- und Verteidigungspolitik dar.
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6,189 |
Transfusion Medicine
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Anemia is common in pediatric intensive care units (PICU). Severe anemia can significantly increase the risk of death. Only a red blood cell (RBC) transfusion can rapidly treat a severe anemia. In stable PICU patients, RBC transfusion is probably not required if the hemoglobin concentration is above 7 g/dL, unless the patient has a cyanotic cardiac condition. The trigger or goal that should be used to direct RBC transfusion therapy in unstable critically ill children remains undetermined, although some data suggest that RBC transfusion may help in the early treatment of unstable patients with sepsis if their ScvO(2) is below 70 % after mechanical ventilation, fluid challenge, and inotropes/vasopressors perfusions have been initiated. Plasma and platelets are used to prevent or to treat hemorrhage attributable to a coagulopathy, thrombocytopenia or platelet dysfunction. The risks and benefits of plasma and platelet concentrates in PICU patients are discussed. There is almost no evidence at the present time that might permit a strong recommendation with regard to the use of plasma and platelets in PICU. Good knowledge of transfusion reactions is required in order to appropriately estimate the cost/benefit ratio of transfusion. Nowadays, non-infectious serious hazards of transfusion (NISHOT) are more frequent and more challenging for pediatric intensivists than transfusion-transmitted infectious diseases. The decision to prescribe a transfusion must be tailored to individual needs and repeated clinical evaluation of each critically ill child.
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6,190 |
Vascular Lung Diseases
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Here we will discuss infarct and thromboembolic disease, vasculitis, vascular malformations, and pulmonary hypertension. Vascular tumors have already been discussed.
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6,191 |
Hoe zoekt PubMed? (vervolg)
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Hier volgt een korte opsomming van de diverse mogelijkheden om in PubMed te zoeken. Er is een aantal eenvoudige en tevens snelle varianten die heel bruikbaar zijn voor bepaalde vragen. Ook de gecompliceerdere mogelijkheden van de MeSH worden behandeld.
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6,192 |
Trait-Mediated Effects of Parasites on Invader-Native Interactions
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Parasites have a variety of behavioural effects on their hosts, which can in turn affect species with which the host interacts. Here we review how these trait-mediated indirect effects of parasites can alter the outcomes of invader-native interactions, illustrating with examples from the literature and with particular regard to the invader-native crustacean systems studied in our laboratories. Parasites may potentially inhibit or exacerbate invasions via their effects on host behaviour, in addition to their direct virulence effects on hosts. In several crustacean systems, we have found that parasites influence both host predation rates on intra- and inter-guild prey and host vulnerability to being preyed upon. These trait effects can theoretically alter invasion impact and patterns of coexistence, as they indirectly affect interactions between predators and prey with the potential for further ramifications to other species in the food web. The fitness consequences of parasite-induced trait-mediated effects are rarely considered in traditional parasitological contexts, but demand attention in the context of ecological communities. We can regard these trait effects as a form of cryptic virulence that only becomes apparent when hosts are examined in the context of the other species with which they interact.
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6,193 |
The Usual Suspects: Chemokines and Microbial Infection of the Central Nervous System
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For many years, the central nervous system (CNS) was considered an “immunologically privileged site” — a perspective based on limited immune surveillance when compared to peripheral tissue, muted expression of MHC molecules in the context of an apparent lack of professional antigen presenting cells, and the absence of a classical lymphatic drainage system. Together, these observations supported the notion that the CNS was unable to mount and/or support an immune response. However, over time this view evolved and it is now clear that CNS tissue is neither immunologically inert nor privileged, rather, its immune response is exquisitely sensitive to antigenic challenge. Indeed, overwhelming evidence now indicates that upon microbial infection of the CNS there is often a dynamic and orchestrated localized immune response that culminates with infiltration of antigen-specific lymphocytes, usually resulting in control and elimination of the invading pathogen. It is important to note that not all effective immune responses originating in the CNS are completely beneficial to the host; alternatively, there are instances where immune cell infiltration following infection is associated with severe neuropathology resulting in death or chronic neurodegenerative disease.
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6,194 |
Critical Care Pandemic Preparedness Primer
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The first half decade of the 21(st) century has brought with it infectious outbreaks such as severe acute respiratory syndrome (SARS) [1], bioterrorism attacks with anthrax [2], and the spread of H5N1 influenza A in birds across Asia and Europe [3, 4] sparking concerns reminiscent of the days of the Black Plague. These events, in the context of an instantaneous global-media world, have placed an unprecedented emphasis on preparing for a human influenza pandemic [5, 6]. Although some argue that the media have exaggerated the threat, the warnings of an impending pandemic are not without foundation given the history of past influenza pandemics [7], incidence of H5N1 infections among humans [8], and the potential impact of a pandemic. Reports of the 1918 pandemic vary, but most suggested that approximately one third of the world’s population was infected with 50 to 100 million deaths [9]. Computer modeling of a moderate pandemic, less severe then in 1918, in the province of Ontario, Canada predicts 73,252 admissions of influenza patients to hospitals over a 6-week period utilizing 72% of the hospital capacity, 171% of intensive care unit (ICU) capacity, and 118% of current ventilator capacity. Pandemic modeling by the Australian and New Zealand Intensive Care Society also showed that critical care resources would be overwhelmed by even a moderate pandemic [10]. This chapter will provide intensivists with a review of the basic scientific and clinical aspects of influenza as well as an introduction to pandemic preparedness.
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6,195 |
Interleukin-22: A Bridge Between Epithelial Innate Host Defense and Immune Cells
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Interleukin-22 (IL-22), an IL-10 family cytokine, is produced by various leukocytes. The receptor of IL-22, however, is preferentially detected on peripheral tissue epithelial cells. IL-22 functions as a unique messenger from immune system to tissue epithelial cells and to regulate homeostasis of epithelia. IL-22 is able to directly enhance antimicrobial defense mechanisms in epithelial cells and to facilitate epithelial barrier repair and wound healing process. It, therefore, possesses an irreplaceable role in host defense against certain pathogens that specifically invade epithelial cells. In addition, IL-22 can help to preserve the integrity and homeostasis of various epithelial organs during infection or inflammation. The importance of its tissue-protective function is manifested in many inflammatory situations such as inflammatory bowel diseases (IBD) and hepatitis. On the other hand, as a cytokine, IL-22 is capable of induction of proinflammatory responses, especially in synergy with other cytokines. Consequently, IL-22 contributes to pathogenesis of certain inflammatory diseases for example psoriasis.
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6,196 |
Lessening the Impacts from Non-Tectonic (Natural) Hazards and Triggered Events
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Floods are a global problem. They are predictable to some degree by weather forecasting but to a greater degree and with more accuracy when drainage basin monitoring equipment is in place. This includes stream gauges that telemeter the elevation of stream/river surface in a channel and the rate of water flow to a central computing station. The computed data from the telemetered sites plus the input of stream/river channel cross-sections data allow prediction of where flooding will be a problem, when the flooding will reach an area, and to what level out of a channel (magnitude) the flood is estimated to reach. This gives the populations at risk of the flooding early warnings (hours, days) and time to prepare for the floodwaters or to gather important documents and evacuate to safe higher ground.
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6,197 |
Strict Isolation
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Strict isolation: suspected highly infectious and transmissible virulent and pathogenic microbes, highly resistant bacterial strains and agents that are not accepted in any form of distribution in the society or in the environment. Examples are completely resistant Mycobacterium tuberculosis, viral haemorrhagic fevers like Ebola and Lassa, pandemic severe influenza and coronavirus like SARS, MERS, etc. In most countries, strict isolation is a rarely used isolation regime but should be a part of the national preparedness plan. For instance, in Norway, strict isolation has not been used for the last 50–60 years, except for one case of imported Ebola infection in 2014. Patients in need of strict isolation should be placed in a separate isolation ward or building. Infection spread by contact, droplet and airborne infection, aerosols, re-aerosols, airborne microbe-carrying particles, skin cells, dust, droplets and droplet nuclei. At the same time, it is always contact transmission (contaminated environment, equipment, textiles and waste). The source of infection is usually a patient but may also be a symptomless carrier or a zoonotic disease.
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6,198 |
Community-Acquired Pneumonia
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Community-acquired pneumonia is an infection of the small airways and pulmonary parenchyma that develops in the outpatient setting. Despite the development of new antibiotics and vaccines, pneumonia is still a disease that occurs frequently in children under 5 years of age and is one of the main causes of mortality, especially in developing countries. The biggest challenge in treating pneumonia is to determine the agent, which depends on age, disease severity, immunological condition, geographic location, epidemiological situation, and immunizations. The classic clinical picture presents with fever, coughing, and difficulty in breathing. The physical examination shows tachypnea, reduced breath sounds, and fine crackles. Wheezing may be present in infants with viral pneumonia. The chest X-ray is considered an important tool to confirm the disease diagnosis and may guide specific treatment. Acute-phase reactants have a low sensitivity and specificity to distinguish between virus and bacteria. Microbiological identification does not have a clinical impact for most children with community-acquired pneumonia. Bronchoalveolar lavage may be considered for immunocompromised patients. Antibiotic treatment is empirical based on the best possible etiology, depending on the patient’s age and epidemiological timing. Amoxicillin is the treatment of choice for Streptococcus pneumoniae, and azithromycin is preferred for Mycoplasma pneumoniae.
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6,199 |
Novel Blue- and Red-Shifted Internally Quenched Fluorogenic Substrates for Continuous Monitoring of SARS-CoV 3CL(pro)
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