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6,800 |
Old and New Pestilences
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a. “Any fatal epidemic disease, affecting man or beast, and destroying many victims.” The Oxford Universal Dictionary, 3(rd) edition, 1955, Oxford Press, 2515 pp. b. “A contagious or infectious epidemic disease that is virulent and devastating.” Webster’s Seventh New Collegiate Dictionary, 1965. G. & C. Merriam Co., Springfield, Mass., 1221 pp. Accordingly, a pestilence should be an infectious disease, devastating (killing) a large number of people (or animals).
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6,801 |
On Viruses, Bats and Men: A Natural History of Food-Borne Viral Infections
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In this chapter, cross-species infections from bats to humans are reviewed that do or do not use intermediate animal amplification hosts and that lead to human-human transmissions with various efficiencies. Rabies infections, Hendra virus infections in Australia, Nipah virus infections in Malaysia and Bangladesh and SARS coronavirus infection in China are explored from the public health perspective. Factors of bat biology are discussed which make them ideal virus reservoirs for emerging diseases. In line with the book theme, it is asked whether even in these epidemic conditions, viruses can be seen as essential agents of life where host species use their viruses to defend their ecological position against intruders. It is asked whether another essential function of animal viral infections could be the “killing the winning population” phenomenon known from phage biology which would stabilize species diversity in nature.
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6,802 |
Importziekten
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In dit hoofdstuk worden de ziektebeelden op het gebied van de importziekten op een beknopte, heldere wijze behandeld. Het zijn allemaal infectieziekten die in eigen land (= inheems) niet voorkomen, maar tijdens een verblijf in het buitenland (= uitheems) zijn opgelopen. De volgorde van de paragrafen is alfabetisch.
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6,803 |
Bilateral and Multilateral Financing of HIV/AIDS Programs: The World Bank, the International Monetary Fund, the Global Fund, Bilateral Donors and the Private Sector
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This chapter examines the operations of the World Bank (a multilateral development institution), the International Monetary Fund (a multilateral financial institution) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (a multilateral fundraising and financing institution) to fight HIV/AIDS. We also examine the role of bilateral donors and the private sector in financing the fight against HIV/AIDS. We examine the relationships among bilateral donors and international organizations, what distinguishes their roles in the global HIV/AIDS pandemic and the extent to which their activities overlap. In addition, we consider how funding strategies and parameters may affect the effectiveness of AIDS funding in preventing transmission and providing treatment.
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6,804 |
Risk Perception, Heuristics and Epidemic Spread
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During an outbreak of an infectious disease, people often change their behaviour to reduce their risk of infection. In a given population, the levels of perceived risk of infection vary greatly among individuals. The difference in perception could be due to a number of different factors including varying levels of information regarding the pathogen, quality of local healthcare, availability of preventive measures, individual and group usage of heuristics in the decision-making process. First we discuss the rigorous assessment of the risk, then we describe how our brain assesses the risk through the use of heuristics that are still rooted in animal evolution. Then we discuss the impact and the role of mass media and social networks in modulating risk perception. Next, we show how mathematical modelling is challenged by multi-scale epidemiological problems where the risk perception level is coupled with all the other microscopic and macroscopic levels. Finally, we draw future scenarios of personal risk evaluation through self-monitoring devices and personal genomics. The aim of this chapter is to discuss the importance of risk perception related to the spreading of a disease and to present a variety of ideas that could be fruitfully explored through modelling.
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6,805 |
Alignment-Free Analyses of Nucleic Acid Sequences Using Graphical Representation (with Special Reference to Pandemic Bird Flu and Swine Flu)
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The exponential growth in database of bio-molecular sequences have spawned many approaches towards storage, retrieval, classification and analyses requirements. Alignment-free techniques such as graphical representations and numerical characterisation (GRANCH) methods have enabled some detailed analyses of large sequences and found a number of different applications in the eukaryotic and prokaryotic domain. In particular, recalling the history of pandemic influenza in brief, we have followed the progress of viral infections such as bird flu of 1997 onwards and determined that the virus can spread conserved over space and time, that influenza virus can undergo fairly conspicuous recombination-like events in segmented genes, that certain segments of the neuraminidase and hemagglutinin surface proteins remain conserved and can be targeted for peptide vaccines. We recount in some detail a few of the representative GRANCH techniques to provide a glimpse of how these methods are used in formulating quantitative sequence descriptors to analyse DNA, RNA and protein sequences to derive meaningful results. Finally, we survey the surveillance techniques with a special reference to how the GRANCH techniques can be used for the purpose and recount the forecasts made of possible metamorphosis of pandemic bird flu to pandemic human infecting agents.
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6,806 |
Respiratory Diseases
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Upper respiratory tract infections are the most common type of infectious diseases and a leading cause of outpatient illness (1,2).
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6,807 |
Disaster Studies at 50: Time to Wear Bifocals?
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Other writers have cataloged the many contributions to understanding and practice that disaster studies have produced over the years, many of them, and the earliest, coming from sociology. The Disaster Research Center at the University of Delaware was founded in 1963 by, and is still inhabited by sociologists, but has embraced an interdisciplinary approach over time, including core and affiliated faculty from English, history, political science, civil engineering, and environmental policy). My thoughts in this essay are not confined to the DRC’s corpus of work, but ‘disaster studies’ more broadly defined below. This said, the roots of disaster studies in sociology are deep, the classic Ur-source being an unpublished PhD study of the 1917 explosion in Halifax, Nova Scotia. This disaster continues to be a source of continuing research that provide lessons for our time. My own essay will mention some of these contributions, and they are truly something to celebrate; however, the central theme I will emphasize is what has been missed and could be added to the research agenda over the next decade or so. I employ an optical metaphor that has as much to do with philosophy of science (‘vision’ and Mao’s famous question, ‘Where do ideas come from?’) as it does with optics, optometry and the detailed application of methods at micro and macro scale. The lens is a remarkable human invention. Glass shaped and polished in one way opened up the microscopic world. Treated in another, the lens gave us the telescope. I will argue that politics – the creation, use and maintenance of power to influence other people and to control space and resources – has been a largely missing raw material, like glass, from which disaster studies could shape lenses for its own tools of inquiry. Consideration of power has not been totally missing. Yet lenses fashioned from an understanding of power have not been used sufficiently in a number of critical areas of research.
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6,808 |
Potentiality of DNA Sensors in Activating Immune System in Emerging Viral Infectious Diseases
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Viruses are obligatory intracellular parasites and hijack the host cell machinery to make more identical copies of it and continue self-propagation. They attach and replicate in the susceptible and permissive hosts and host derived cell lines. They enter the cells either through direct attachment, receptor-mediated endocytosis, or phagocytosis. Hence, to thwart the invasion by viruses, hosts have developed immunity in ascending stages—intrinsic, innate and adaptive immunity. A robust intrinsic and innate immune response governs an effective adaptive immune response, should that be needed. Both enveloped as well as non-enveloped viruses are subject to distinct types of DNA sensors, subject to their site of replication. DNA sensors of viral PAMPs can be classified into three types, based on the location of their PAMPs in the host cellular compartment viz. cell surface, cytoplasmic and nuclear. The host cell membrane both, surface as well as intra cellular, is continuously monitored for the non-host, pathogenic components or PAMPs. Among the intracellular sensors of the viral genome, there are two types—essentially due to the two types of major viral genomes i.e. RNA and DNA sensors. The cytosolic DNA sensors include AIM2, IFI16, cGAS, RNA Pol III, DNA-PK, DDX9, DHX36, DDX41, DDX60, DAI, LRRFIP1, HMGB, ABCF1 and MRE11. PYHIN family of sensors include AIM2, IFI16, IFIX and MNDA. Another recently discovered family of sensor called stimulator of interferon (IFN) genes (STING), specifically houses on the endoplasmic reticulum (ER) and functions in association with its upstream sensor, cGAS. Some DNA sensors shuttle between the cytosol and nucleus pre- and post-extraneous DNA binding. These include IFI16, IFIX, RNA Pol III, etc. There is no exclusive nuclear DNA sensor. Many enzymes known to be present in the cells for their obvious primary functions also additionally function as DNA sensors. The DNAse family of sensors include DNAse II and TREX1, which are ubiquitously present in the cell for their housekeeping functions. The RNAse family of sensor includes one member—RNA Pol III. Additionally, DNA-PK also functions to cater to viral DNA sensing. The endosomal DNA sensors include TLR7 and TLR9, which belong to the Toll-like receptor (TLR) family. The DExD/H-box helicase family include the putative DNA sensors recently discovered including DDX9, DHX36, DDX41 and DDX60. Several other sensors remain to be characterised or are less classified viz. DAI, LRRFIP1, HMGB, ABCF1, MRE11. In general, response to a viral RNA or DNA produces three types of responses, namely, production of antiviral cytokines including Types I and III IFNs, release of pro-inflammatory and inflammatory cytokines and chemotactic factors. This chapter discusses the structure, function and mechanism of action of the viral DNA sensors explored till date.
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6,809 |
Life-Threatening Diseases of the Upper Respiratory Tract
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Acute airway obstruction is one of the most common causes of acute respiratory failure in children. Left untreated, it can rapidly progress to cardiopulmonary arrest and death. There are several important anatomical differences between pediatric and adult patients that render children more susceptible to acute airway obstruction. In addition, there are several diseases that can cause life-threatening acute airway compromise. An understanding of the developmental anatomy and physiology, as well as the myriad diseases that can cause airway compromise in children is therefore essential for all healthcare personnel that provide care for critically ill children.
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6,810 |
Nuclear Proliferation and Terrorism
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In a dramatic moment before the United Nations, Bernard Baruch described the American plan to internationalize and control the atom. He described in biblical fashion the choice between “the quick from the dead” (taken from the Apostle’s Creed) resulting from the global spread of nuclear weapons. This prediction came to fruition 15 years later when presidential candidate John F. Kennedy gave a warning in the third debate with Vice President Richard Nixon:
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6,811 |
Emergencies/Resuscitation
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This chapter discusses neonatal infection, the different causes of shock, hypoglycemia, acid-base balance, and resuscitation. The etiology, signs, investigations, and treatment of these items are addressed. A large number of Tables are added for clinical use to list signs, normal values and treatment guides. Resuscitation is subdivided into clinical assessment of neonates, clinical assessement of children and infants, airway management, ventilation, circulatory resuscitation, and defibrillation. Advices of Advanced Paediatric Life Support (APLS) are the basis of the guide lines for resuscitation in this chapter. Next to ventilatory support without equipment, various types of mechanical ventilation with advantages and disadvantages listed. A large number of figures and drawings visualise the techniques for airway management, ventilation and cardiac compression so that the clinical application of described techniques becomes clear with one glance.
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6,812 |
FIV as a Model for HIV: An Overview
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Animal models for human immunodeficiency virus (HIV) infection play a key role in understanding the pathogenesis of AIDS and the development of therapeutic agents and vaccines. As the only lentivirus that causes an immunodeficiency resembling that of HIV infection, in its natural host, feline immunodeficiency virus (FIV) has been a unique and powerful model for AIDS research. FIV was first described in 1987 by Niels Pedersen and co-workers as the causative agent for a fatal immunodeficiency syndrome observed in cats housed in a cattery in Petaluma, California. Since this landmark observation, multiple studies have shown that natural and experimental infection of cats with biological isolates of FIV produces an AIDS syndrome very similar in pathogenesis to that observed for human AIDS. FIV infection induces an acute viremia associated with Tcell alterations including depressed CD4 :CD8 T-cell ratios and CD4 T-cell depletion, peripheral lymphadenopathy, and neutropenia. In later stages of FIV infection, the host suffers from chronic persistent infections that are typically self-limiting in an immunocompetent host, as well as opportunistic infections, chronic diarrhea and wasting, blood dyscracias, significant CD4 T-cell depletion, neurologic disorders, and B-cell lymphomas. Importantly, chronic FIV infection induces a progressive lymphoid and CD4 T-cell depletion in the infected cat. The primary mode of natural FIV transmission appears to be blood-borne facilitated by fighting and biting. However, experimental infection through transmucosal routes (rectal and vaginal mucosa and perinatal) have been well documented for specific FIV isolates. Accordingly, FIV disease pathogenesis exhibits striking similarities to that described for HIV-1 infection.
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6,813 |
Intellectual Property and Human Security
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This chapter discusses the interrelatedness between intellectual property and human security. There are two sides of this interrelationship. In the first place, IP issues are closely related to the hard security of nations. In the second place, the application of the regime of international intellectual property laws can help promote economic and social development and, at the same time, can result in major hardships when it comes to protection of the right to life and realization of the rights to health, food, and education. In the pages that follow, different aspects of these issues are explored.
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6,814 |
Minimizing the Impact of Complex Emergencies on Nutrition and Geriatric Health: Planning for Prevention is Key
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Complex emergencies (CEs) can occur anywhere and are defined as crisis situations that greatly elevate the risk to nutrition and overall health (morbidity and mortality) of older individuals in the affected area. In urban areas with high population densities and heavy reliance on power-driven devices for day-to-day survival, CEs can precipitate a rapid deterioration of basic services that threatens nutritionally and medically vulnerable older adults. The major underlying threats to nutritional status for older adults during CEs are food insecurity, inadequate social support, and lack of access to health services. The most effective strategy for coping with CEs is to have detailed, individualized pre-event preparations. When a CE occurs, the immediate relief efforts focus on establishing access to food, safe water, and essential medical services.
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6,815 |
Mining Semantic Descriptions of Bioinformatics Web Resources from the Literature
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A number of projects (myGrid, BioMOBY, etc.) have recently been initiated in order to organise emerging bioinformatics Web Services and provide their semantic descriptions. They typically rely on manual curation efforts. In this paper we focus on a semi-automated approach to mine semantic descriptions from the bioinformatics literature. The method combines terminological processing and dependency parsing of journal articles, and applies information extraction techniques to profile Web services using informative textual passages, related ontological annotations and service descriptors. Service descriptors are terminological phrases reflecting related concepts (e.g. tasks, approaches, data) and/or specific roles (e.g. input/output parameters, etc.) of the associated resource classes (e.g. algorithms, databases, etc.). They can be used to facilitate subsequent manual description of services, but also for providing a semantic synopsis of a service that can be used to locate related services. We present a case-study involving full text articles from the BMC Bioinformatics journal. We illustrate the potential of natural language processing not only for mining descriptions of known services, but also for discovering new services that have been described in the literature.
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6,816 |
Multidimensional Analysis of the News Consumption of Different Demographic Groups on a Nationwide Scale
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Examining 103,133 news articles that are the most popular for different demographic groups in Daum News (the second most popular news portal in South Korea) during the whole year of 2015, we provided multi-level analyses of gender and age differences in news consumption. We measured such differences in four different levels: (1) by actual news items, (2) by section, (3) by topic, and (4) by subtopic. We characterized the news items at the four levels by using the computational techniques, which are topic modeling and the vector representation of words and news items. We found that differences in news reading behavior across different demographic groups are the most noticeable in subtopic level but neither section nor topic levels.
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6,817 |
Severe Acute Respiratory Syndrome
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Early in 2003, an outbreak of the until then unknown severe acute respiratory syndrome (SARS) was reported in southeastern People’s Republic of China. The outbreak was thought to have first emerged in the Guangdong province in November 2002. Subsequently, the infections spread to Hong Kong (February 2003) and other countries of Southeast Asia, including Vietnam, Taiwan, and Singapore, as well as to Canada and the United States (http://www.fda.gov/oc/opacom/hottopics/sars/).
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6,818 |
Noninvasive Mechanical Ventilation in Patients with High-Risk Infections and Mass Casualties in Acute Respiratory Failure: Pediatric Perspective
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Respiratory problems are common symptoms in children and common reason for visits to the pediatric emergency department (PED) and admission to the pediatric intensive care unit (PICU). Although the great majority of cases are benign and self-limited, requiring no intervention, some patients need respiratory support. Invasive mechanical ventilation (IMV) is a critical intervention in many cases of acute respiratory failure (ARF), but there are absolute risks associated with endotracheal intubation (ETI). On the other hand, noninvasive ventilation (NIV) is an extremely valuable alternative to IMV. A major reason for the increasing use of NIV has been the desire to avoid the complications of IMV. It is generally much safer than IMV and has been shown to decrease resource utilization. Its use also avoids the complications and side effects associated with ETI, including upper airway trauma, laryngeal swelling, postextubation vocal cord dysfunction, nosocomial infections, and ventilator-associated pneumonia. There are a number of advantages of NIV including leaving the upper airway intact, preserving the natural defense mechanisms of the upper airways, decreasing the need for sedation, maintaining the ability to talk while undergoing NIV, and reducing the length of hospitalization and its associated costs [1–3].
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6,819 |
What the Intensivist Needs to Know About Hematopoietic Stem Cell Transplantation?
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Hematopoietic stem cell transplantation (HSCT) is a potential curative therapy for some patients with hematologic conditions. There are two main types of HSCT. This includes autologous HSCT, for which the stem cells are obtained from the patient, and allogeneic HSCT, for which the stem cells are obtained from a related or unrelated donor. The most common indications for autologous stem cell transplant are multiple myeloma and relapsed/refractory lymphoma, whereas leukemia and bone marrow failure syndromes remain the most common indications for allogeneic stem cell transplant. This chapter will review the different types, indications, processes, and main complications of HSCT. This chapter will also discuss end-of-life issues that patients and providers face when transplant patients are admitted for the intensive care unit.
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6,820 |
Research and Application on Key Technologies of J2EE-Oriented Urban Emergency Response System
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With experience of Emergency Response System implement, the exist problem and research status in china is analyzed. Based on these conclusions, the Emergency Response System is constructed which used the J2EE tool, faced to small and medium-size cities, moreover, the research on key technologies related in this architecture are introduced in detail.
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6,821 |
Optimization of Ligand Surface Concentration for Biosensor based on Imaging Ellipsometry
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the biosensor based on imaging ellipsometry for bio-molecular interactions has been developed for more than ten years and used to several biological applications successfully, such as detection of five markers of Hepatitis B, tumor markers and virus infection. Ligand surface concentration which might be related with its spatial configuration and bioactivity is an important factor to affect the biosensor sensitivity and dynamic range. In this investigation, IgG and its corresponding antibody are selected as a couple of model molecules for the optimization of ligand surface concentration. The optimization result of ligand surface concentration is achieved by analyzing the surface concentration increase of antigenantibody complex on sensing surface with various ligand surface concentrations.
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6,822 |
Walging: ‘Het went nooit helemaal’
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‘Toen ik verzorgingsassistente werd, moest ik erg wennen aan al die onaangename geuren. Maar na een poosje raakte ik er meer mee vertrouwd. De poep van sommige patiënten vond ik stinken, maar van de uitwerpselen van anderen had ik weer geen enkele last. Dat was te vergelijken met de poep-en pieslucht van mijn kinderen toen die nog klein waren.’
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6,823 |
Chikungunya Virus and Zika Virus Expansion: An Imitation of Dengue Virus
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Dengue viruses are the most important arboviral pathogens in the world, which have adapted to human transmission and replication over several hundred years and were initially recognized to cause outbreaks of clinical disease in tropical and subtropical countries by Aedes aegypti mosquitoes. Subsequent global expansion of dengue infection outbreaks has occurred, with millions of cases yearly, probably from a combination of factors including proliferation of international travel and trade, possibly global climate changes, adaptation of the vectors to new environment, and emergence of a new mosquito vector, Aedes albopictus. Chikungunya virus, also transmitted by Aedes mosquitoes, causes a very similar clinical disease but with more prominent arthralgia or arthritis and was originally described in Africa in the 1960s. After a quiescent period of several decades, it reemerged in Africa in 2004 and rapidly spread across the Indian Ocean to involve Asian countries and parts of Europe. However, the past 2 years have seen the emergence of chikungunya virus in the western hemisphere with major outbreaks in the Caribbean and the Americas. Similar to dengue virus, chikungunya virus has adapted to Ae. albopictus mosquitoes which can transmit the disease. Although dengue infection is a more deadly disease especially in young children, chikungunya infection can cause prolonged severe disability and occasionally rare fatalities from encephalitis. No specific treatment is available for either diseases, but development of an effective vaccine for dengue infection is in progress. Until 2007, Zika virus [also transmitted by Aedes species] was associated with only sporadic mild infections in Africa and Asia. In 2007, Zika virus for the first time caused an outbreak beyond Africa and Asia to the Yap Island in the Federated States of Micronesia. Since then Zika virus has spread to French Polynesia, New Caledonia, Cook Islands, and Easter Island in the southeastern Pacific Ocean [Chile] in 2014 and by 2015 to Brazil. By January 2016, it became evident that Zika virus had caused an explosive outbreak in the Americas and the Caribbean with over 30 countries affected. On February 1, 2016, the World Health Organization declared Zika outbreak a global public health emergency. Zika virus infection is most commonly asymptomatic, and 20% of patients may develop a mild viral disease, but of major concern is the reported association of microcephaly in infected pregnant women in Brazil. This chapter explores the history, epidemiology, pathogenesis, clinical features, treatment, and prevention of these rapidly emerging zoonoses.
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6,824 |
Impacts and Challenges of Advanced Diagnostic Assays for Transplant Infectious Diseases
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The advanced technologies described in this chapter should allow for full inventories to be made of bacterial genes, their time- and place-dependent expression, and the resulting proteins as well as their outcome metabolites. The evolution of these molecular technologies will continue, not only in the microbial pathogens but also in the context of host-pathogen interactions targeting human genomics and transcriptomics. Their performance characteristics and limitations must be clearly understood by both laboratory personnel and clinicians to ensure proper utilization and interpretation.
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6,825 |
Adsorption of Proteins at Solid Surfaces
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Ellipsometry has a very high thin film sensitivity and can resolve sub-nm changes in the thickness of a protein film on a solid substrates. Being a technique based on photons in and photons out it can also be applied at solid-liquid interfaces. Ellipsometry has therefore found many in situ applications on protein layer dynamics but studies of protein layer structure are also frequent. Numerous ex situ applications on detection and quantification of protein layers are found and several biosensing concepts have been proposed. In this chapter, the use of ellipsometry in the above mentioned areas is reviewed and experimental methodology including cell design is briefly discussed. The classical ellipsometric challenge to determine both thickness and refractive index of a thin film is addressed and an overview of strategies to determine surface mass density is given. Included is also a discussion about spectral representations of optical properties of a protein layer in terms of a model dielectric function concept and its use for analysis of protein layer structure.
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6,826 |
Case Study – Bulgaria
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The aim of this paper is to map the current situation in Bulgaria’s public healthcare system with regard to bioterrorism response. It explores the main public health threats and focuses specifically on the changing perception of bioterrorism as a potential threat to the country. Furthermore, it explains how this perception is reflected in the existing legal framework and administrative structures. The paper makes the case for the further development of an integrated, flexible and sustainable national management system to respond effectively to emergencies and presents the major challenges for the country in this field. It makes a comparison between military and civilian agencies in their preparedness to respond to naturally occurring emergencies and threats of biological attack. This review points out the higher but still limited capacity of the military medical facilities in Bulgaria. The overall evaluation underlines the need for further strengthening of the relationship between military and civil capabilities and between public healthcare and security and law enforcement structures. As a result the authors make the case for stronger cooperation between military and civil medical facilities as well as for inter-institutional and interdisciplinary dialogue on the expert and political level on biopreparedness in Bulgaria.
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6,827 |
Cisplatin Derivatives as Antiviral Agents
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The use of polymeric derivatives of cisplatin as antiviral drugs is reviewed. Some of these drugs inhibit a wide variety of both RNA and DNA viruses including those responsible for herpes, common colds, chickenpox, and smallpox. The desirability of polymeric drugs is described as is the mode(s) of action of cisplatin itself. A description of viruses and methods of combating viruses is presented. Included is a review of current antiviral agents as well as modes of action of these antiviral agents.
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6,828 |
Relevante Nebenerkrankungen zu Notfallindikationen und Notfalloperationen in der Viszeral- und Allgemeinchirurgie
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Die Adipositas ist eine über das Normalmaß hinausgehende Vermehrung des Körperfetts und wird über den Body-Mass- Index (BMI = kg/m) bestimmt. Ab einem BMI von 30 kg/m liegt definitionsgemäß eine Adipositas vor. Der Krankheitswert ergibt sich aus der Assoziation von Folgeerkrankungen, deren Risiko mit der Prävalenzdauer und dem Schweregrad der Adipositas ansteigt (Tab. 28.1). Dabei korreliert das kardiovaskuläre Risiko besonders mit dem Vorliegen einer viszeralen Adipositas (>88/102 cm Taillenumfang bei Frauen/ Männern). Die Prävalenz der Adipositas steigt in Deutschland kontinuierlich an. Derzeit ist knapp ein Viertel der deutschen Bevölkerung als adipös einzustufen.
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6,829 |
Pesticides
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6,830 |
Predicting RNA Secondary Structures: One-grammar-fits-all Solution
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RNA secondary structures are known to be important in many biological processes. Many available programs have been developed for RNA secondary structure prediction. Based on our knowledge, however, there still exist secondary structures of known RNA sequences which cannot be covered by these algorithms. In this paper, we provide an efficient algorithm that can handle all RNA secondary structures found in Rfam database. We designed a new stochastic context-free grammar named Rectangle Tree Grammar (RTG) which significantly expands the classes of structures that can be modelled. Our algorithm runs in O(n (6)) time and the accuracy is reasonably high, with average PPV and sensitivity over 75%. In addition, the structures that RTG predicts are very similar to the real ones.
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6,831 |
Infectious Complications of Transplantation
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Post-transplant infection is a common cause of graft deterioration, morbidity and mortality. It is also responsible for delayed discharge, multiple, often prolonged admissions and thus a significant clinical challenge. Infections can be donor derived, pre-existing in the recipient, nosocomial and opportunistic. For each of these categories, it is often possible to significantly reduce hazard and thus the adverse consequences by first identifying patients at high risk. As always, clinical vigilance is vital, but equally important is the establishment of robust clinical systems for prevention, screening and rapid treatment.
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6,832 |
Immunohistochemical Staining for Detection of Porcine Epidemic Diarrhea Virus in Tissues
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Porcine epidemic diarrhea virus (PEDV), a member of the genus Alphacoronavirus, has resulted in significant economic losses in the European, Asian, and North American swine industries in previous years. PEDV infection causes acute diarrhea/vomiting, dehydration, and high morbidity and mortality in seronegative neonatal piglets. In this chapter, materials and methods for performing immunohistochemistry (IHC) for the detection of PEDV antigens in frozen or formalin-fixed, paraffin-embedded (FFPE) tissues are provided. In IHC of frozen tissues where viral antigens are well preserved, the use of specific antibodies labeled with fluorescence dyes provides excellent advantages and convenience, resulting in high sensitivity and specificity of IHC and reduction of operation time. In IHC of FFPE tissues where tissue or cell morphology is well preserved, the use of specific antibodies labeled with enzymes, such as alkaline phosphatase, also gives rise to significant advantages in defining the correlation of viral antigens with histopathologic lesions. PEDV antigens in frozen tissues are visualized as green staining in the cytoplasm of infected cells by fluorescent dyes conjugated with antibodies when activated by exciting light of a specific wavelength under a fluorescence microscope. In FFPE tissues, PEDV antigens are visualized as red staining in the cytoplasm of infected cells by the deposition of the substrate chromogen, Fast Red.
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6,833 |
Systemic and Systematic Risk
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The main goal of any risk management practice is to be able to insure an acceptable level of predictability in order to gain a lead-time to mitigate a possible risk. However, until new risk management approaches are employed to fill the gap between the known and unknown, most crises will continue to come as a surprise. Risk is latent until an external event or an internal process will reveal its existence. Predictive analysis is an indispensable tool that can help decision makers preemptively test all possible or even some perceived impossible operational scenarios before a risk transforms into crisis or disaster. To be prepared is a better position than to discover the risk too late for business continuity or disaster recovery measures. In this way, predictive emulation becomes necessary for appropriate risk mitigation.
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6,834 |
Diseases with Limited Research of Plant-Based Vaccines
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There are a number of diseases which are important globally in terms of the effect they have on livestock but for which the development of recombinant plant-produced vaccines is preliminary. For many of these diseases such as bovine viral diarrhoea (BVD), bovine rotavirus (BRV), bovine herpes (BoH), transmissible gastroenteritis (TGE) in pigs, infectious bronchitis (IB) in chickens, bluetongue (BT) in sheep, Rift Valley fever (RVF) in sheep and coccidiosis in chickens, commercially available live-attenuated or killed vaccines are available. Although most are effective to varying degrees, there are numerous issues with manufacture and potential reassortment of the vaccine strains. For some diseases such as bovine papillomavirus (BPV) infections and Crimean-Congo haemorrhagic fever (CCHF), there are no commercially available vaccines, and limited studies have been conducted on their development. This chapter discusses some of the research developments in plant-produced vaccine candidates which have potential for further development towards commercialisation.
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6,835 |
IDENTIFICATION AND CHARACTERIZATION OF BIOLOGICAL RISKS FOR WATER
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Life on this planet is dependent on water but our health is greatly impacted by the quality of that water. The global water crisis is clear, one only needs to quote the statistics on the billions of people without access to safe water, sanitation and the global estimates of the burden of waterborne disease. The greatest sources of biological contaminants associated with this disease burden in water remains human and animal feces. There is a critical need to develop a science-based program to address both water quantity and quality of water, water uses and discharges. Recommendations to achieve better access to scientific information for decision making include: 1) develop watershed approaches for determining the source and the behaviour of water-borne biological contaminants which can be used within Water Safety Plans, 2) utilize new tools and technologies for measuring the hazards and the exposure within a risk assessment framework and 3) develop a global data base and goals for biological contaminant loading for achieving safe water.
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6,836 |
Viral bioinformatics
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Pathogens have presented a major challenge to individuals and populations of living organisms, probably as long as there has been life on earth. They are a prime object of study for at least three reasons: (1) Understanding the way of pathogens affords the basis for preventing and treating the diseases they cause. (2) The interactions of pathogens with their hosts afford valuable insights into the working of the hosts’ cells, in general, and of the host’s immune system, in particular. (3) The co-evolution of pathogens and their hosts allows for transferring knowledge across the two interacting species and affords valuable insights into how evolution works, in general. In the past decade computational biology has started to contribute to the understanding of host-pathogen interaction in at least three ways which are summarized in the subsequent sections of this chapter.
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6,837 |
History of Influenza Pandemics
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Influenza pandemics have been amongst the largest and the deadliest epidemics in the history of man, and were observed already in ancient times. For example, records from the fifth century B.C. suggest that influenza pandemics were observed in ancient Greece. In Europe, during the Middle Ages and the Renaissance, numerous concordant reports from different countries describe epidemics of respiratory infections that resemble influenza pandemics. However, it is not possible to be certain that these epidemics were due to influenza. In the twentieth century, three influenza pandemics have occurred, including the deadly Spanish flu pandemic. Modern virology has unravelled the mechanisms of emergence of pandemic viruses, and considerable knowledge on influenza viruses has been accumulated. The picture is now clear: influenza A is a zoonotic virus whose reservoir is in wild birds. In rare cases, these avian viruses are introduced into man and, eventually, become pandemic viruses. Although these mechanisms are now understood, the time frame required for adaptation of the avian virus to its new host remains unknown. Maybe the next pandemic will show us how rapid this adaptation can be.
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6,838 |
Environmental Toxicology: Children at Risk
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Children today live in a world that is vastly different from a few generations ago. While industrialization has maximized (for many) children’s opportunities to survive, develop and enjoy high levels of health, education, recreation, and fulfillment, it has also added significant challenges to their development.
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6,839 |
Viral Infections of the Central Nervous System
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Viral-mediated central nervous system (CNS) disease is a complex spectrum of clinical syndromes that result from viral tropism and individual immune responses and genetic susceptibility of patients. The epidemiology of the pathogens is constantly influenced by the availability, or non-availability, of health care services; preventative strategies; and the process of globalization, with rapid movement of people, animals and products. It is further complicated by natural disasters, wars and changes in lifestyle. The effects of the neurotropic viruses are discussed against the background of the epidemiology. The pathogenesis is a chain of events with the point of departure when the virus enters the body to spread and reach the different sites of the CNS. The blood-brain barrier and blood-cerebrospinal fluid barrier are then overcome by captivating mechanisms. Once the different viruses have settled at the preferred site or sites, and have sidestepped the initial immune surveillance, the phases of injury commence. The cytopathic effect of the viruses elicits a para- and post-infectious inflammatory response and a vicious circle of continued damage, viral entry and inflammation results in a process not merely of inflammation, but of intense inflammation. The different clinical syndromes are then identifiable and should be interpreted against their own specific and appropriate epidemiological backgrounds. Clinicians face the challenge of problematic management decisions while awaiting results on gravely ill patients and differential diagnostic considerations have to be taken into account. Establishing a diagnosis is a two-tier process: first it requires the integration of cerebrospinal fluid findings, imaging results, electrophysiological studies, serology and ancillary blood tests, for example full blood count, liver function tests and other appropriate microbiological investigations, and then these should be correlated with the clinical condition of the patient. Treatment should be initiated as soon as possible. General treatment principles for stabilizing and maintaining vital functions are crucial and empiric treatment should be initiated as soon as possible. This usually includes a broad-spectrum antibiotic, such as third-generation cephalosporin and acyclovir. As soon as specific etiologies have been excluded antibiotics can be stopped. The use of acyclovir is discussed. In the last section of the chapter specific characteristics of the neurotropic viral families are summarized.
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6,840 |
Infectious Diseases and the Kidney in Children
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The kidney is involved in a wide range of bacterial, viral, fungal, and parasitic diseases. In most systemic infections, renal involvement is a minor component of the illness, but in some, renal failure may be the presenting feature and the major problem in management. Although individual infectious processes may have a predilection to involve the renal vasculature, glomeruli, interstitium, or collecting systems, a purely anatomic approach to the classification of infectious diseases affecting the kidney is rarely helpful because most infections may involve several different aspects of renal function. In this chapter, a microbiological classification of the organisms affecting the kidney is adopted. Although they are important causes of renal dysfunction in infectious diseases, urinary tract infections and hemolytic uremic syndrome (HUS) are not discussed in detail because they are considered separately in chapters XX and XX, respectively.
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6,841 |
Oligonucleotide and DNA Microarrays: Versatile Tools for Rapid Bacterial Diagnostics
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The rapid and unambiguous detection and identification of microorganisms, historically a major challenge of clinical microbiology, gained additional importance in the fields of public health and biodefence. These requirements cannot be well addressed by classical culture-based approaches. Therefore, a wide range of molecular approaches has been suggested. Microarrays are molecular tools that can be used for simultaneous identification of microorganisms in clinical and environmental samples. Main advantages of microarrays are high throughput, parallelism and miniaturization of the detection system. Furthermore, they allow for both high specificity and high sensitivity of the detection. Microarrays consist of set of probes immobilized on a solid surface. Even though the first application of the microarrays can be seen as relatively recent (Schena et al. 1995), the technology developed rapidly reaching the milestone of 5,000 published papers in 2004 (Holzman and Kolker 2004). This development encompasses both the successful transfer of various technological aspects as well as the expansion of the application scope. The most important technological elements of custom-made platforms as well as the characteristics of the commercially available formats are reviewed in this chapter. Furthermore, application potential is presented together with considerations about quality control.
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6,842 |
Industrial Production of Therapeutic Proteins: Cell Lines, Cell Culture, and Purification
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A central pillar of the biotechnology and pharmaceutical industries continues to be the development of biological drug products manufactured from engineered mammalian cell lines. Since the hugely successful launch of human tissue plasminogen activator in 1987 and erythropoietin in 1988, the biopharmaceutical market has grown immensely. In 2014, biotherapeutics made up a significant portion of global drug sales as 7 of the top 10 and 21 of top 50 selling pharmaceuticals in the world were biologics with over US$100 billion in global sales (Table 1, [1]).
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6,843 |
The Lung and Its Transplantation and Artificial Replacement
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The human thoracic cavity houses a pair of lungs, the left lung and the right lung. The left lung is slightly smaller (since the heart is placed a bit to the left in the body) and has two lobes, and the right lung is bigger, with three lobes. They are spongy and elastic organs that are broad at the bottom and taper at the top. They consist of air sacs, the alveoli. Many alveoli group together and open into a common space. From this space arise the alveolar ducts, which join together to form bronchioles. The bronchioles connect them to the respiratory tract. The lungs also have blood vessels, the branches of the pulmonary artery and veins (Fig. 15.1).
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6,844 |
Angiotensin II Signaling in Vascular Physiology and Pathophysiology
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Initially recognized as a physiologic regulator of blood pressure and body fluid homeostasis, angiotensin (Ang) II has now been shown in innumerable experiments and clinical studies to contribute to the development and maintenance of cardiovascular disease. Dissection of its signaling mechanisms over the past decades has led to the discovery of several novel concepts, such as tissue-specific metabolism of Ang peptides. Identification and cloning of the various receptors through which Ang II acts on almost all tissues has led to the development of specific pharmacologic inhibitors with proven clinical benefit in patients with cardiovascular disorders. Work on the G-protein-coupled Ang II Type 1 receptor has demonstrated that different receptors interact through oligomerization, compartmentalization, and transactivation, and may explain how Ang II can activate G-protein-independent pathways. Unraveling the downstream effects of Ang II in specific cell types corroborates the importance of the cellular redox state on certain signaling pathways. Finally, the effects of Ang II on cell function and phenotype, such as the expression of inflammatory cytokines and receptors promoting the recruitment of inflammatory cells into vascular tissues, have indicated its role in local inflammation as a general pathogenetic basis of cardiovascular disease. The recognition of Ang II as a contributor to such fundamental pathophysiologic mechanisms, which are believed to be a common pathway for diverse cardiovascular risk factors like hypertension and diabetes, has greatly advanced our knowledge of pathologic signaling in vascular tissues and may help to eventually define novel targets for pharmacologic interventions.
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6,845 |
Hemorrhage and Transfusions in the Surgical Patient
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Hemorrhage is the leading cause of intraoperative deaths. Many cardiovascular and hepatobiliary procedures result in massive hemorrhage and postpartum hemorrhage events in labor and delivery place the patient at a high risk for mortality. Gastrointestinal bleeding from diverticulosis, varices, and ulcer disease can result in significant blood loss requiring massive transfusion and resuscitation from hemorrhagic shock. Timely and effective transfusion of blood products is of critical in these scenarios. The frequency in which blood component products are transfused in surgical patients begs for a greater understanding of them. The aim of this chapter is to provide clinicians with a discussion of the current literature on the various blood component products, their indications, and unique hemostatic conditions in the surgical patient. While the majority of data concerning optimal management of acquired coagulopathy and hemorrhagic shock resuscitation is based on trauma patients, many of the principles can and should be applied to the surgical patient (or likely any patient) with profound hemorrhage.
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6,846 |
Blood Products Transfusion
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Transfusion of blood products may be required during the perioperative period. Despite a well-established safety record, transfusion of blood and its components is not risk free. Indication for each of the blood components needs to be established based on the laboratory investigation and/or clinical picture. In general terms, when there is a clinical evidence of a deficiency in oxygen-carrying capacity, red cell transfusion should be considered; and in the situations of clinically significant coagulopathy, hemostatic blood products (frozen plasma, platelets, cryoprecipitate, factor concentrates) transfusion should be considered. Complications of blood administration range from rare but severe reactions (hemolytic transfusion reactions) to more common, and also associated with significant morbidity and mortality, such as transfusion-related acute lung injury (TRALI), transfusion-related circulatory overload (TACO), and changes in immune system (transfusion related immunomodulation [TRIM]).
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6,847 |
Medical Management of Acute Liver Failure
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Pediatric acute liver failure is a rapidly progressive, life-threatening, and devastating illness in children without preexisting liver disease. Due to the rarity and heterogeneity of this syndrome, there is a significant lack of data to guide evaluation and management of this disease. Most of our practice is extrapolated from adult literature and guidelines. This leads to significant controversies in medical management of acute liver failure in children. With advances in critical care, there has been a tremendous improvement in outcomes with decreased morbidity and mortality; however, there is a dire need for more research in this field. This chapter discusses challenges as well as controversies in diagnostic evaluation and management of this rare but potentially fatal disease. Latest developments in supportive care of liver failure, including advances in the area of liver support systems, are also discussed.
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6,848 |
Corynebacterium diphtheriae
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Diphtheriebakterium
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6,849 |
Medical Classifications and Terminologies
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This chapter presents the different medical classifications and terminologies as ICD diagnosis codes, SNOMED CT, MeSH, UMLS, ATC etc.
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6,850 |
Replication Cycle of Astroviruses
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Astrovirus infections cause gastroenteritis in mammals and have been identified as causative agents of diverse pathologies in birds such as hepatitis in ducks and poult enteritis mortality syndrome (PEMS), which causes enteritis and thymic and bursal atrophy in turkeys. Human astroviruses are recognized as the second leading cause of childhood viral gastroenteritis worldwide. Eight traditional astrovirus serotypes have been identified in humans, but recently novel astrovirus strains isolated from humans have been associated with diseases other than gastroenteritis. Herein we summarize our current knowledge of the astrovirus life cycle. Though there are gaps in our understanding of astrovirus replication, similarities can be drawn from Picornaviridae and Caliciviridae virus families. There are, however, unique characteristics of the astrovirus life cycle, including intracellular proteolytic processing of viral particles by cellular caspases, which has been shown to be required for the maturation and exit of viral progeny.
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6,851 |
1 Inleiding
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In augustus 2011 wijdde de Journal of the American Medical Association (JAMA) een redactioneel commentaar aan het groeiende probleem van morbide obese kinderen: kinderen die aan een dusdanig ernstige obesitas lijden dat hun gezondheid er direct door wordt bedreigd. In toenemende mate wordt bij deze kinderen zogenoemde bariatrische chirurgie toegepast, waarbij een maagband of een maagbypass wordt aangebracht om de voedselopname te verminderen. In het redactionele commentaar werd de vraag opgeworpen of voor deze kinderen niet een alternatieve benadering moet worden overwogen, namelijk het uit de ouderlijke macht ontzetten van hun ouders. In de Verenigde Staten is dit al een aantal malen daadwerkelijk gebeurd, zoals bij het 4 jaar oude en 138 pond wegende meisje Cory Andis.
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6,852 |
RNA Interference: RNAid for Future Therapeutics?
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RNA interference (RNAi) is an evolutionarily conserved phenomenon of double-stranded (ds)RNA-mediated mRNA degradation that leads to the posttranscriptional silencing of the corresponding gene. First reports on RNAi emerged in 1998, and since then, it has become one of the most fascinating fields of molecular biology. RNAi has provided important insights about the diversity of RNA molecules and their implication in many biological processes such as the regulation of developmental genes in eukaryotic organisms. Furthermore, RNAi has rapidly developed into a powerful instrument with a great potential for functional genomics and therapeutic applications by silencing normal and disease-related gene functions. To date, the use of RNAi for genetic-based therapies is widely studied, especially in viral infections, cancers, and inherited genetic disorders. Despite the many unanswered questions on how this technology can be efficiently applied to humans, the development of novel approaches, such as vaccines or novel delivery agents, is certainly one of the major goals in RNAi research.
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6,853 |
Advancements in Parasite Diagnosis and Challenges in the Management of Parasitic Infections: A Mini Review
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Intestinal parasitic infections (IPIs) remain a widespread public health concern causing severe implications in both developed and developing countries. Globally, numerous studies have been carried out ranging from various communities to schoolchildren as well as indigenous communities. The infections are commonly caused by helminths (e.g. Ascaris lumbricoides, Trichuris trichiura and hookworm) and protozoa (e.g. Blastocystis hominis, Cryptosporidium sp., Entamoeba histolytica and Giardia duodenalis). Poor sanitation and poverty are some of the factors associated with IPIs. With the ever-increasing impact of IPIs, newer detection approaches have been developed and studied. The efficacy of diagnostic method is crucial to give an accurate identification of these parasites. Recent developments of diagnostic tools such as serology- and molecular-based assays are assisting the conventional method of microscopy in detecting and further confirming current or past infections and the specific species of parasites. Ongoing investigations in parasitic infections using these advanced tools will provide useful information that will enable the evaluation of the effectiveness of the current control program and thus, assist future planning for improved strategies in eradicating these parasitic infections.
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6,854 |
22 Levertransplantatie
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In 1963 verrichtte Thomas Starzl in Denver de eerste levertransplantatie bij de mens. In 1966 werden in Nederland de eerste twee (auxiliaire, zie par. 22.3.6) levertransplantaties verricht in Leiden en Arnhem, in 1968 startte Cambridge. Helaas resulteerden de eerste levertransplantaties niet in langetermijnoverleving als gevolg van niet-optimale operatietechniek, matige immuunsuppressie en onbekendheid met complicaties.
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6,855 |
Bronchitis and Pneumonia
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The incidence, morbidity, and mortality of both bronchitis and pneumonia are high in older adults and increase with age. The clinical manifestations of bronchitis and pneumonia in older adults may not be typical (e.g., cough, fever, dyspnea). Many older adults, particularly nursing home residents, may present with altered mental status and with or without fever. Obtaining a chest X-ray is often critical to make the distinction between the two clinical entities. Unique risk factors for pneumonia in older adults include multiple comorbidities (e.g., COPD, DM, CHF), poor oral hygiene, lack of vaccinations (e.g., S. pneumoniae, influenza), and swallowing difficulty. Empirical treatment decisions for pneumonia should be based on site of care. Recent information suggests that in-home therapy for community dwellers and therapy within the nursing home for long-term care residents is feasible with good outcomes in selected patients. Prevention strategies for pneumonia should be targeted towards providing vaccinations, improving oral hygiene, and improving swallowing difficulty.
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6,856 |
Viruses Present Indoors and Analyses Approaches
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Through human history viruses have shown enormous epidemiological and pandemic potential as the occurrence and spread of viruses in pandemic dimensions poses a threat to the health and lives of seven billion people worldwide. Scientific evidence has associated harmful health effects to indoor air hazards recognizing the existence of a vital concern in public health sector. Thus the assessment of human exposure to biological aerosols and droplets indoor became an imperative requirement of investigation. Environmental bioburden assessment of viruses relies in both culture-dependent approaches that comprise classical methodologies, still prominent and vital in the field of modern biotechnology, and culture-independent approaches based on nucleic acid amplification techniques, which are considered the gold standard in clinical virology. The main factor influencing indoor microbiology is the human being and their activities. Indoor environments to be considered are those regularly occupied by humans: residences, offices, schools, industrial buildings, health care facilities, farming activities and other settings occupied all the time, or in which occupant density is high. It’s well known that approximately 60% of total human respiratory and gastrointestinal infections are acquired indoor, since viruses have a rapid spread in the community and can be transmitted easily, especially in crowded and poorly ventilated environments, causing high morbidity and decline in quality of life and productivity. Studies have shown that respiratory syncytial virus, rhinovirus, metapneumovirus, influenza and parainfluenza virus, and human enterovirus infections may be associated with virus-induced asthma, leading to diseases such as pneumonia. Gastroenteritis infectious (about 30±40% of cases) is attributable to viruses. Rotavirus, Astrovirus, Norwalk-like viruses and other caliciviruses are responsible for 48% of all reported outbreaks of infectious intestinal disease. Safe working conditions are essential for healthy living, that’s why the programmes conceived as a result of strategic and preventive policy maintenance, in refrigeration and ventilation systems, are the determining factor for the control of biological pollutants. Moreover, the development of highly sensitive and specific detection and identification methodologies with capacity to be used in diverse applications, such as diagnosis, public health risk assessment, research and for the implementation of preventive measures and protocols are imperative.
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6,857 |
Diagnosis and Monitoring of Infections
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As molecular techniques for identifying and detecting microorganisms in the clinical microbiology laboratory have become routine, questions about the cost of these techniques and their contribution to patient care need to be addressed. Molecular diagnosis is most appropriate for infectious agents that are difficult to detect, identify, or test for susceptibility in a timely fashion with conventional methods. During the last 10 years, the detection of infectious disease agents has begun to include the use of nucleic acid-based technologies. Diagnosis of infection caused by parasitic organisms is the last field of clinical microbiology to incorporate these techniques and molecular techniques (e.g., PCR and hybridization assays) have recently been developed for the detection, species differentiation, and phylogenetic analysis.
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6,858 |
Management of Burns and Anesthetic Implications
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Burn injuries are highly complex and affect almost every major organ system in the body. The treatment of burn patients requires the presence of a well-organized team of caregivers who understand the multifaceted consequences of burn injuries and who are adept at coordinating care. An understanding of the multitude of abnormalities that must be addressed helps to guide therapy in these patients. Careful anesthetic and perioperative management of these patients carries special importance in this fragile patient population as a part of their often lengthy recovery and rehabilitation.
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6,859 |
Case Study – Italy
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After the peak of interest in 2001, the threat of bioterrorism is now considered just one of the diverse risks Italy’s society faces endangering public health. Without major investments, the effort has been to integrate existing resources, to implement tight links among national and supranational agencies and to make plans for their most efficient involvement in case of need. The mainstay for the response to a biological attack is represented by the public health system, entrusted to Italy’s national health service, centrally coordinated but put into action by the Regions. The emerging threat of emerging infectious diseases and of bioterrorism has shown the need for a change in the education curricula of sanitary professions and for specific training of first line operators. Specific courses have been activated by universities and other bodies, but attendance has been limited by the lack of ad hoc funds.
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6,860 |
Viren überlisten: Globale Virusinfektionen werden beherrschbar – aber neue Gefahren drohen
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Infektionen begleiten und beschäftigen die Menschheit seit vielen Jahrhunderten. Derzeit zählen allein fünf von den zehn häufigsten Todesursachen weltweit zu den Infektionskrankheiten. Oft ausbruchsartig haben besonders Viruserkrankungen seit dem Beginn aufgezeichneter Historie viele Todesopfer gefordert, so zum Beispiel die „Spanische Grippe“ 1918 (Influenzavirus), AIDS (Human Immunodeficiency Virus) und erst vor Kurzem in bisher nie gesehenem Ausmaß das Ebolavirus. Warum besonders virale Erreger für die Wissenschaft ein große Herausforderung darstellen und wie virale Erreger das menschliche Immunsystem überlisten, zeigen die folgenden Überlegungen. Das Kapitel beschreibt darüber hinaus an konkreten Beispielen erfolgreiche Gegenmaßnahmen im Kampf gegen Viren.
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6,861 |
Population and Public Health
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The role of public health is to contribute to the health of the public through assessment of health and health needs, policy formulation, and assurance of the availability of services. While the scope of a medical manager’s work and training is different from that of a public health physician, most will often find that their work overlaps quite significantly, especially when the manager’s influence starts to go beyond his or her own organisation. It is thus important for medical managers who contribute to the development of health systems, to understand key public health issues that face Australia in the coming years.
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6,862 |
5 Koorts bij volwassenen
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Koorts wordt bij niet-immuungecompromitteerde volwassenen in de eerste lijn zonder recent verblijf in het buitenland meestal veroorzaakt door een luchtweginfectie. Bij ouderen vormen urineweginfecties een relatief frequente oorzaak van koorts. Bij ontbreken van richtinggevende voorgeschiedenis, klachten of verschijnselen volstaat men in eerste instantie met lichamelijk onderzoek van KNO-gebied en longen. Bij negatieve bevindingen volgt urineonderzoek. Wanneer geen afwijkingen gevonden worden, gaat men uit van een onschuldige virale oorzaak. Bij een ernstig zieke indruk of verminderd bewustzijn is het lichamelijk onderzoek allereerst gericht op eventuele stoornissen in de vitale functies, omdat deze onmiddellijke therapeutische implicaties hebben. Als de koorts een week aanhoudt of eerder bij verandering van het beeld, dient een uitgebreide anamnese en algemeen lichamelijk onderzoek plaats te vinden om diagnostische aanknopingspunten op te sporen. Ook kan de arts dan aanvullend onderzoek laten verrichten: in eerste instantie bloed-, urine- en fecesonderzoek en een X-thorax, eventueel gevolgd door X-sinussen en een mantouxreactie. Medicatie wordt zoveel mogelijk gestaakt om een allergie aan te tonen of uit te sluiten. Na enkele dagen herhaalt men anamnese en lichamelijk onderzoek. Twee weken onbegrepen koorts is reden voor verdere (poli)klinische evaluatie. Concrete aanwijzingen op grond van steeds herhaalde anamnese en lichamelijk onderzoek zijn richtinggevend voor de inzet van complex aanvullend onderzoek. Dit bestaat onder meer uit bloedkweken, uitgebreider bloedonderzoek, leverbiopsie, beenmergpunctie en CT-scan buik en thorax. Bij patiënten ouder dan 55 jaar met koorts en een verhoogde bezinking is een biopsie van de arteria temporalis zinvol.
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6,863 |
Identity Health
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Identity health has especially specific meanings for social relationships in contemporary digital age. First, computerized digital communication makes many citizens in severe maladaptation. The WHO often warns mental addictions of internet usages and online gaming among the youth. The advent of social media and online networking has endangered them in ambiguous situations which are not stabilizing in those basic grounds for human relationships. Further, because social networking sites and social gaming frequently enforce each member to interconnect with the others, many of participating members often hold harder mental debts to respond and maintain their interconnections. In this situation, in other words, it can say that all of users simultaneously might share common conditions under mental illness.
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6,864 |
The Role of T Cells in Corona-Virus-Induced Demyelination
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Mice infected with neurotropic strains of coronavirus develop acute encephalomyelitis and eliminate infectious virus. However, control of acute infection is incomplete resulting in persistence of viral RNA in the central nervous system (CNS) associated with ongoing primary demyelination. A high prevalence of virus specific CD8 and CD4 T cells within the CNS correlates with ex vivo cytolytic activity and IFN-γ secretion, which are both required for virus reduction during the acute infection. Although most infected cell types are susceptible to perforin mediated clearance, IFN-γ is required for controlling infection of oligodendrocytes. Furthermore, by enhancing class I expression and inducing class II expression within resident CNS cells IFN-γ optimizes T cell receptor dependent functions. In addition to its direct anti viral activity, these multifactorial effects make IFN-γ more essential than perforin for viral control. CD4 T cells enhance CD8 T cell expansion, survival and effectiveness. Although both CD8 and CD4 T cells are retained within the CNS during persistence, they cannot control viral recrudescence in the absence of humoral immunity. Demyelination can be mediated by either CD8 or CD4 T cells; however, although a variety of effector molecules have been excluded, a dominant common denominator remains elusive. Thus concerted efforts to control infection coincide with a variety of potential mechanisms causing chronic demyelinating disease.
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6,865 |
Apoptosis in Critical Illness: A Primer for the Intensivist
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The complexities of the cell cycle have occupied a prominent place in the history of cellular biology. Recognition of the process of mitosis dates back over a century, when Fol, Butschli, and Strasburger identified a network of intracellular points and lines, then called the karyokinetic figure, and today known as the mitotic apparatus. This discovery, dating to 1873, laid the foundation for the discovery of chromosomes and, later, the fundamental biologic processes of mitosis and meiosis [1]. But, while cellular growth and proliferation were understood to be essential to the emergence of multicellular organisms, the corollary — that controlled cell death must be part of this calculus of cellular homeostasis — was not appreciated until quite recently. Although cell death was first described in 1859 by Virchow, it took more than a century to appreciate the importance of programmed cell death as a physiological process that eliminated unwanted cells [2]. The term ‘apoptosis’ was coined in 1972 by Kerr, Wyllie, and Currie to describe a distinct type of cell death characterized by the degradation of cellular constituents into membrane-bound apoptotic bodies [3]. Since then, recognition of the importance of apoptosis in health and disease, and an understanding of its cellular mechanisms, has increased exponentially.
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6,866 |
The Genetics of Sepsis: The Promise, the Progress and the Pitfalls
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Physicians are used to taking a family history of cardiovascular disease because of the known significant hereditary risk; yet the familial risk of dying from infection is even greater than that for atherosclerotic disease (Sorensen et al. 1988). There is certainly no doubt that genetic differences impact on the risk of developing or dying from infection. Obvious but rare examples include selective immunoglobulin deficiencies, complement deficiencies, and neutrophil function abnormalities. Genetic factors may also be protective, such as with sickle cell trait and malaria or mutations conferring resistance to human immunodeficiency virus infection. Much more subtle differences in immune responses are now being described, usually as the result of one or more single nucleotide polymorphisms (SNP) in a gene. Rather than causing the failure of production of a protein or the production of a nonfunctional protein, SNPs are usually associated with changes in the rate of transcription, producing a much less severe phenotype than the classical examples of genetic defects mentioned above. It is now being appreciated that for many complex diseases, such as sepsis, the ultimate phenotype is the result of the interaction of genetic differences across many loci, not the dominant effect of a few key mutations. As seen in Fig. 3.1, since the mid 1990s, an increasing body of literature has focused on the role that gene polymorphisms in key inflammatory genes play in sepsis. Indeed, with advances in knowledge of the human genome, greater understanding of the inflammatory response, and the development of high throughput genotyping technologies, so many genetic associations have been described that discussion of each one is well beyond the scope of this chapter. I will however summarize those findings that have been reported by multiple groups, as well as give an overview of the major groups of genes that have been implicated in genetic predisposition to sepsis and its adverse outcomes.
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6,867 |
Lung Transplantation for Idiopathic Pulmonary Fibrosis
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Despite advances in the development of novel pharmaceutical agents to treat idiopathic pulmonary fibrosis (IPF), there are no medical therapies known to resolve fibrosis or improve lung function in IPF. Therefore, lung transplantation remains the only life-saving therapy available to treat patients with IPF. However, a shortage of suitable donor organs limits the number of affected individuals who can undergo this procedure, and this shortage highlights the need to allocate donor lungs to those who are in the greatest need of a life-saving therapy yet ensure that those who undergo transplantation will have a reasonable expectation of long-term survival. Still, outcomes remain relatively poor for many patients after lung transplantation, although a sizable minority of patients can enjoy long-term survival after lung transplantation.
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6,868 |
Severe Sepsis and Septic Shock
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This chapter reviews the remarkable recent advances in the understanding of the molecular basis that underlies the pathophysiology of sepsis. This knowledge has improved diagnostic techniques and introduced new therapeutic agents into the standard management of patients with severe sepsis/septic shock. The current treatment regimens for sepsis are discussed, and the evidence to support each major treatment strategy is outlined in detail. Research priorities to further the optimal management of septic shock in the future are highlighted.
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6,869 |
Mechanisms of Acute Liver Failure
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Acute liver failure is characterized by the sudden onset of liver failure in a patient without evidence of chronic liver disease. This definition is important, as it differentiates patients with acute liver failure from patients who suffer from liver failure owing to end-stage chronic liver disease.
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6,870 |
Vitamin D: Photobiological and Ecological Aspects
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Vitamin D was discovered as a result of its ability to cure rickets, but recently a wide range of other functions for it in the human body has been suggested. Vitamin D is not a vitamin in the strict sense as it can be synthesised in the human body following exposure of the skin to ultraviolet radiation. Provitamin D (7-dehydrocholesterol) is converted to previtamin D which is further modified by a series of reactions to the active form, 1,25-dihydroxyvitamin D. This Chapter summarises the discovery of vitamin D and reviews the chemistry and photochemistry of its precursors, transformations and metabolites. The production of vitamin D in various human populations is described, and how to assess vitamin D status. The skeletal and non-skeletal effects of vitamin D are discussed, particularly its role in immunomodulation with consequences for protection against a variety of human diseases. The Chapter concludes with evolutionary aspects, the occurrence and role of vitamin D in the plant kingdom, biogeographical considerations, and the nonphotochemical production of vitamin D in certain plants.
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6,871 |
Preventing Airborne Disease Transmission: Implications for Patients During Mechanical Ventilation
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The organisms causing respiratory infections such as influenza are spread in droplets or aerosols or by direct or indirect contact with contaminated surfaces. Certain medical procedures have been termed aerosol generating because they are associated with high or augmented inspiratory and expiratory flows, which can increase microbial dissemination. Invasive ventilation maneuvers and noninvasive ventilation (NIV) fall into that category. We discuss the risk of transmitting these procedures and the strategies for mechanical ventilation in future airborne epidemics with special consideration given to the issue of protecting health care workers (HCWs).
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6,872 |
Infections Diseases in the Context of Terrorist Threat
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From the great number of pathogenic and conventionally pathogenic for human beings microorganisms, only some of them can be used for terroristic purposes, since they should meet a lot of the relevant properties. Today priority is given to those biological agents, which have undergone successful tests, and are characterized by high index of morbidity, pathogenicity, low lethal doses, high contagiousness with short incubation period, and which result in high social and economic costs.
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6,873 |
Otitis Media and Sinusitis
|
Otitis media (OM) and sinusitis are common and costly maladies that are often preceded by the development of a viral upper respiratory infection (vURI). Although antibiotics have been shown to be somewhat effective in the treatment of these disorders, increasing concern over the emergence of pathogen resistence to these agents underscores the need for the development of other treatment options, including agents to treat and/or prevent vURIs. Earlier research implicated roles for cytopathology, cellular infiltration, and inflammatory mediators such as bradykinin, in the pathogenesis of vURIs and its complications, including OM and sinusitis, but these factors are now recognized as late events with specific and limited contributions to disease expression. Current therapies are relatively ineffective and aimed at reducing symptoms rather than moderating underlying mechanisms. Nasal elevations of proinflammatory cytokines and leukotrienes track symptom expression during vURIs, and it is hypothesized that these chemicals orchestrate a common response to infection with many different viruses causing vURIs. Moreover, recent evidence demonstrates that specific cytokine gene polymorphisms may modulate the severity of illness and incidence of complications during episodes of vURI. Additionally, other evidence supports a role for neurogenic inflammation in the development of complications. Future studies should dissect the role of proinflammatory cytokines, leukotrienes, and neuropeptides in the expression of symptoms, signs, pathophysiologies, and complications of vURIs.
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6,874 |
Virological Synapse for Cell-Cell Spread of Viruses
|
Cell-to-cell spread of retroviruses via virological synapse (VS) contributes to overall progression of disease. VS are specialized pathogen-induced cellular structures that facilitate cell-to-cell transfer of HIV-1 and HTLV-1. VS provide a mechanistic explanation for cell-associated retroviral replication. While VS share some common features with neurological or immunological synapses, they also exhibit important differences. The role of VS might not be limited to human retroviruses and the emerging role of a plant synapse suggests that VS might well be conserved structures for cell-cell spreading of both animal and plant viruses. Dissection of the VS is just at its beginning, but already offers ample information and fascinating insights into mechanisms of viral replication and cell-to-cell communication.
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6,875 |
Chemical, Biological, Radiological and Nuclear (CBRN) Casualty Management Principles
|
Chemical, biological, radiological or nuclear (CBRN) weapons have been used since antiquity. Examples of their recent use include war fighting, ethnic conflict, terrorism and assassination. In addition, CBRN incidents have also included accidental releases during peace time operations, and many of the principles for CBRN incident response can be applied to other hazardous material (HAZMAT) incidents. The impact of such weapons may have a range of implications for medical personnel both military and civilian.
|
6,876 |
Acute Disseminated Encephalomyelitis
|
Acute disseminated encephalomyelitis (ADEM) is an autoimmune demyelinating disease of central nervous system (CNS). ADEM is most commonly seen in children, although adults can also be affected. The disease typically starts with an abrupt onset within day to weeks after a viral infection or immunization. Presenting features include an acute encephalopathy with multifocal neurologic signs and fever. ADEM generally has a monophasic course, although recurrent ADEM has also been described and is defined as multiphasic ADEM. MRI shows widespread lesions located in both brain and spinal cord. An involvement of basal ganglia and thalami has also been described. Analysis of cerebrospinal fluid (CSF) may reveal mild lymphocytic pleocytosis and increased proteins, whereas oligoclonal bands are usually negative. In the absence of specific biologic markers, ADEM remains a diagnosis of exclusion and it is still based on clinical manifestations, imaging, and laboratory features. Therapy is based on steroid administration and the prognosis is usually favorable.
|
6,877 |
The Efficacy of Vaccines to Prevent Infectious Diseases in the Elderly
|
Infectious diseases still represent a major challenge to human progress and survival. Especially elderly persons are more frequently and severely affected by infectious diseases and they display distinct features with respect to clinical presentation and treatment. Although vaccinations are considered a vital medical procedure for preventing morbidity and mortality caused by infectious diseases, the protective effect of vaccinations is abrogated in elderly persons. This is due to a decline in the functions of the immune system referred to as immunosenescence. The first part of this chapter will therefore summarize the status quo of the efficacy of vaccines in preventing morbidity and mortality caused by typical infectious diseases in the elderly, such as influenza, pneumonia and tuberculosis. The second part will then elucidate the underlying age-related mechanisms which may contribute to the decreased efficacy of vaccines. Based on the complex mechanisms involved in immunosenescence, strategies will be outlined which may be succesfful in enhancing protective immune responses following vaccination in elderly persons.
|
6,878 |
The Role of the Renin-Angiotensin System in Hepatic Fibrosis
| null |
6,879 |
Risk Communication and the Community Response to a Bioterrorist Attack: the Role of an Internet-Based early warning system A.K.A “The Informal Sector”
| null |
6,880 |
Modification of Bone Marrow Stem Cells for Homing and Survival During Cerebral Ischemia
|
Over the last decade, major advances have been made in stem cell-based therapy for ischemic stroke, which is one of the leading causes of death and disability worldwide. Various stem cells from bone marrow, such as mesenchymal stem cells (MSCs), hematopoietic stem cells (HSCs), and endothelial progenitor cells (EPCs), have shown therapeutic potential for stroke. Concomitant with these exciting findings are some fundamental bottlenecks that must be overcome in order to accelerate their clinical translation, including the low survival and engraftment caused by the harsh microenvironment after transplantation. In this chapter, strategies such as gene modification, hypoxia/growth factor preconditioning, and biomaterial-based methods to improve cell survival and homing are summarized, and the potential strategies for their future application are also discussed.
|
6,881 |
Toxic Shock Syndromes
|
Staphylococcal toxic shock syndrome (TSS) was first described in seven children aged 8–17 years by Todd et al. in 1978 [1]. It shortly thereafter became well known as an illness of menstruating women who used tampons [2, 3]. The syndrome is characterized by rapid onset of fever, hypotension, and multisystem failure with desquamating rash occurring in convalescence [4]. The majority of early cases reported were menstrually associated (MTSS) but this has been changing with an increasing proportion of cases non-menstrually associated (NMTSS) [5].
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6,882 |
Gefährderkonzepte im Bereich des Terrorismus
|
Die Terrorismusbekämpfung ist der Bereich, anhand dem sich die in dieser Studie erforschte Strategie zur Prävention von schwerer Gewalt am besten schildern lässt. Die gezielte Sicherheit gegen die Drohung von Terroranschlägen hat zu einer kontinuierlichen Einführung von gesetzlichen Vorschriften und der Entwicklung von Praktiken der Sicherheitsbehörden geführt.
|
6,883 |
Vegetables
|
The conscious promotion of health by an appropriate, balanced diet has become an important social request. Vegetable thereby possesses a special importance due to its high vitamin, mineral and dietary fibre content. Major progress has been made over the past few years in the transformation of vegetables. The expression of several genes has been inhibited by sense gene suppression, and new traits caused by new gene constructs are stably inherited. This chapter reviews advances in various traits such as disease resistance, abiotic stress tolerance, quality improvement, pharmaceutical and industrial application. Results are presented from most important vegetable families, like Solanaceae, Brassicaceae, Fabaceae, Cucurbitaceae, Asteraceae, Apiaceae, Chenopodiaceae and Liliaceae. Although many research trends in this report are positive, only a few transgenic vegetables have been released from confined into precommercial testing or into use.
|
6,884 |
The SARS Coronavirus receptor ACE 2 A potential target for antiviral therapy
| null |
6,885 |
Adenovirus-Based Vectors for the Development of Prophylactic and Therapeutic Vaccines
|
Emerging and reemerging infectious diseases as well as cancer pose great global health impacts on the society. Vaccines have emerged as effective treatments to prevent or reduce the burdens of already developed diseases. This is achieved by means of activating various components of the immune system to generate systemic inflammatory reactions targeting infectious agents or diseased cells for control/elimination. DNA virus-based genetic vaccines gained significant attention in the past decades owing to the development of DNA manipulation technologies, which allowed engineering of recombinant viral vectors encoding sequences for foreign antigens or their immunogenic epitopes as well as various immunomodulatory molecules. Despite tremendous progress in the past 50 years, many hurdles still remain for achieving the full clinical potential of viral-vectored vaccines. This chapter will present the evolution of vaccines from “live” or “attenuated” first-generation agents to recombinant DNA and viral-vectored vaccines. Particular emphasis will be given to human adenovirus (Ad) for the development of prophylactic and therapeutic vaccines. Ad biological properties related to vaccine development will be highlighted along with their advantages and potential hurdles to be overcome. In particular, we will discuss (1) genetic modifications in the Ad capsid protein to reduce the intrinsic viral immunogenicity, (2) antigen capsid incorporation for effective presentation of foreign antigens to the immune system, (3) modification of the hexon and fiber capsid proteins for Ad liver de-targeting and selective retargeting to cancer cells, (4) Ad-based vaccines carrying “arming” transgenes with immunostimulatory functions as immune adjuvants, and (5) oncolytic Ad vectors as a new therapeutic approach against cancer. Finally, the combination of adenoviral vectors with other non-adenoviral vector systems, the prime/boost strategy of immunization, clinical trials involving Ad-based vaccines, and the perspectives for the field development will be discussed.
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6,886 |
Strategic Actionable Net-Centric Biological Defense System
|
Technologies required for strategic actionable net-centric biological defense systems consist of : 1) multiplexed multi-array sensors for threat agents and for signatures of the host response to infection; 2) novel vaccines and restricted access antivirals/bacterials to reduce emergence of drug resistant strains pre- and post-event; 3) telemedicine capabilities to deliver post-event care to 20,000 victims of a biological strike; and 4) communication systems with intelligent software for resource allocation and redundant pathways that survive catastrophic attack. The integrated system must detect all threat agents with minimal false positive/negative events, a seamless integrated broad-band communications capability that enables conversion of data to actionable information, and novel pre- and post-event treatments. The development of multiplexed multi-array sensors, appropriate vaccines and antibiotics, and integrated communication capabilities are critical to sustaining normal health, commerce, and international activities.
|
6,887 |
Streptococcal Infections
|
The streptococci are a large heterogeneous group of gram-positive spherically shaped bacteria widely distributed in nature. They include some of the most important agents of human disease as well as members of the normal human flora. Some streptococci have been associated mainly with disease in animals, while others have been domesticated and used for the culture of buttermilk, yogurt, and certain cheeses. Those known to cause human disease comprise two broad categories: First are the pyogenic streptococci, including the familiar β-hemolytic streptococci and the pneumococcus. These organisms are not generally part of the normal flora but cause acute, often severe, infections in normal hosts. Second are the more diverse enteric and oral streptococci, which are nearly always part of the normal flora and which are more frequently associated with opportunistic infections.
|
6,888 |
Reverse Genetics of Mononegavirales: The Rabies Virus Paradigm
|
The neurotropic rabies virus (RABV) is a prototype member of the Mononegavirales order of viruses and is the most significant human pathogen of the Rhabdoviridae family. A reverse genetics system for RABV was established almost 20 years ago, providing a paradigm for other Mononegavirales members as well. The availability of engineered recombinant viruses opened a new era to study common aspects of Mononegavirales biology and specific aspects of the unique lifestyle and pathogenesis of individual members. Above all, the knowledge gained has allowed engineering of beneficial biomedical tools such as viral vectors, vaccines, and tracers. In this chapter, the development of the classical rabies virus reverse genetics approach is described, and some of the most exciting biomedical applications for recombinant RABV and other Mononegavirales are briefly addressed.
|
6,889 |
Extracorporeal Circulation Membrane Oxygenation Therapy for Acute Respiratory Diseases
|
Extracorporeal circulation membrane oxygenation provides pulmonary and/or cardiac support over a limited period of time for severe reversible cardio pulmonary diseases. It is an invasive technique with large risks associated but an improved survival rate of around 80%. It has strict selection criteria for neonatal and pediatric patients. The main complications are hemorrhage, stroke, convulsions, cardiac failure, kidney failure, arterial hypertension, and hemolysis. Extracorporeal circulation membrane oxygenation must be implemented only in high-complexity neonatal and pediatric centers with trained personnel.
|
6,890 |
Infections of the Liver
|
The portal vein carries blood from the gastrointestinal tract to the liver and in so doing carries microbes as well. The liver may therefore be involved in infections with a myriad number of microbial organisms. While some of these infections most commonly occur in the immunocompromised host, others affect the immune competence. Hepatic infections may be primary in nature or secondary, as part of systemic or contagious disease. The purpose of this chapter is to provide a brief overview of the various infections of the liver in the pediatric patient.
|
6,891 |
Lungenerkrankungen
| null |
6,892 |
Economic Migrants and Health Vulnerability
| null |
6,893 |
GIS in Health and Human Services
|
The chapter begins with a general overview of how GIS has evolved in the health and human services over the last several decades providing readers with important definitions and descriptions (Sects. 29.1, 29.2). Sections 29.3, 29.4 uncovers how GIS became an important tool for epidemiologists in the work of tracking infectious diseases and perfecting the study of population health. Readers will also learn that GIS adoption by hospital marketers and planners in the United States accelerated rapidly after the 1970, when US Census data became relatively freely available in digital form. The importance of the legendary work of the Dartmouth Health Care Atlas Project and its founder Jack Wennberg. In areas where high GIS adoption rates occurred, such as in public health, we feature key applications such as immunization management, disease tracking, outbreak analysis, disease surveillance, syndromic surveillance, emergency preparedness and response, community health assessment, environmental health, chronic disease prevention, and animal and veterinary health. The final Sect. 29.5 describes how GIS education has expanded across the academic fields of public health, healthcare administration, and social services. It is pointed out that the material presented in this chapter is not intended to be an exhaustive examination of the history of GIS, but rather, a brief introduction and overview which will generate further interest and self-discovery.
|
6,894 |
Acute Chest Diseases: Infection and Trauma
|
Acute chest diseases include clinical situations with infectious and traumatic etiology. Pulmonary infection is the most common indication for performing chest radiography. Radiological imaging often confirms the diagnosis and allows the evaluation of the location and extent of infection. Chest radiography is the primary imaging procedure and the starting point for the evaluation of all children with acute chest disease. Accurate interpretation of pediatric chest films also requires a basic understanding of the physiologic and anatomic differences among adults, neonates, and infants and their most important differences will be referred. Characterization of pulmonary infiltrates is important, because patterns of abnormality suggest specific organisms and aetiologies. Although providing evidence suggestive of the causative agent, the chest radiograph cannot confirm viral infection, confirm or exclude bacterial etiology. In fact, in infancy, pneumonia usually produces a combination of alterations of the airspace and interstitium. However, some aspects may be useful in distinguishing between viral and bacterial pneumonia. Close attention to CT technique is crucial for imaging evaluation of pneumonia in pediatric patients, namely those with persistent symptoms and/or progressive symptoms despite medical or surgical therapy, or in immunocompromised patients. CT with low radiation dose technique should be carefully performed in these cases. CT examination with IV contrast is very useful for the evaluation of complications of chest infection. Thoracic trauma in children is rare, only 4–6 % of children are hospitalized following severe trauma. Only a small number of children with trauma have thoracic injury (14 %), but the injuries tend to be of serious nature. About 25–50 % of thoracic trauma cases occur in combination with other trauma locations. Pulmonary contusion and lacerations, tracheobronchial injuries, pneumothorax, and esophageal rupture are referred as the main consequences of trauma. The decision for the appropriate use of imaging techniques must consider the specific case under review. Chest radiography should be the initial screening method. The decision to use CT is determined by the nature of the trauma, the clinical circumstances, and the prediction of future revaluation, always taking into account the radiation dose applied to the child.
|
6,895 |
Risiko-Akteur-Netzwerke
|
Einen Monat nach dem globalen Ausbruch einer bisher unbekannten, jedoch hochgradig ansteckenden und lebensbedrohlichen atypischen „Lungenkrankheit“ – die Rede ist von SARS, einer Krankheit, die zum ersten Mal im Februar 2003 in einer südchinesischen Provinz beobachtet wurde – beschreibt David L. Heymann, Leiter der Abteilung Emerging and other Communicable Diseasesder World Health Organization(WHO), das spezifische Risiko- und Gefahrenpotential des Severe Acute Respiratory Syndrom: „SARS is emerging in ways that suggest great potential for rapid international spread under the favorable conditions created by a highly mobile, closely interconnected world. Anecdotal data indicate an incubation period of 2 to 10 days (average 2 to 7 days), allowing the infectious agent to be transported, unsuspected und undetected, in a symptomless air traveler from one city in the world to any other city having an international airport. Person-to-person transmission through close contact with respiratory secretions has been demonstrated. The initial symptoms are nonspecific and common. The concentration of cases in previously healthy staff and the proportion of patients requiring intensive care are particularly alarming. The „21 century“ disease could have other consequences as well. Should SARS continue to spread, the global economic consequences – already estimated at around US $ 30 billion – could be great in a closely interconnected and interdependent world.“ (WHO 2003: 5)
|
6,896 |
The Zincins: Collagen Fiber Processing and Degradation
|
This chapter discusses the zinc-containing metalloendoproteinases. These enzymes remodel the stroma during development and around tissues that have been injured or stressed. Section 1 describes the three major classes of metalloproteases, their metal ion cofactors, their functions in biology, and the metzincin catalytic mechanism in procollagen and stromal protein processing. Section 2 describes the astacin and adamalysin metzincin subclasses and how they process procollagen to tropocollagen. Section 3 describes the matrilysin metzincin subclass and their roles in collagen and stromal tissue degradation and in enamel synthesis.
|
6,897 |
Noninvasive Respiratory Support in Pediatrics
|
The conventional management of acute respiratory failure (ARF) consists of endotracheal intubation; this carries potential risks, including ventilator-associated pneumonia and laryngeal-tracheal damage [1,2]. Noninvasive respiratory support (NRS) is an alternative form of respiratory treatment which incorporates various techniques aimed at improving alveolar ventilation, oxygenation, and unloading of the respiratory muscles without the need for an invasive tracheal device. Because of its safety and effectiveness, the use of NRS has been adopted throughout the world. During the last 25 years, NRS techniques have increasingly been used in the treatment of both chronic respiratory failure and ARF in adult patients in several pathological conditions. NRS applied to adults in the acute setting has been found to improve outcome, reduce the rate of intubation, and decrease the rate of complications [3].
|
6,898 |
Coronaviruses and Neuroantigens: myelin proteins, myelin genes
|
Multiple sclerosis (MS) is an autoimmune disease in which autoreactive T cells specific to central nervous system (CNS) myelin antigens are activated. Although disease etiology remains unknown, coronaviruses are suspected to be involved in MS pathology. Molecular mimicry, the recognition of two antigens by a single immune cell, could be the mechanism explaining the link between a viral infection and MS through activation of myelin-reactive T cells by a virus infection in a genetically predisposed individual. Evidence supporting this hypothesis in humans has been accumulated in our laboratory. Human coronavirus (HCoV) — myelin cross-reactive T-cell lines (TCL) were predominantly found in MS patients compared to patients with other neurological or inflammatory diseases, or healthy controls. Moreover, virus-myelin T cell cross-reactivity was confirmed at the clonal level. Molecular mimicry between infectious pathogens such as the ubiquitous human respiratory coronaviruses could, in genetically susceptible individuals, play a role leading to the development of MS. Together with other possible mechanisms such as bystander effects, epitope spreading or even superantigenic activities, this pathogen-associated immune induction could play a role in maintaining and broadening the autoimmune response associated with MS pathology.
|
6,899 |
Ziektebeelden van importziekten
|
In dit hoofdstuk worden de ziektebeelden op het gebied van de importziekten op een beknopte, heldere wijze behandeld. Het zijn allemaal infectieziekten die in eigen land (= inheems) niet voorkomen, maar tijdens een verblijf in het buitenland (= uitheems) zijn opgelopen. De volgorde van de paragrafen is alfabetisch.
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