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7,800 |
Setting the Ventilator in the NICU
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Success in providing respiratory support to the neonate requires a clear understanding of the context in which it is being applied. Perhaps more than for any other age group, the array of different situations in which ventilation is applied to the newborn infant is extremely broad, with in each case different pathophysiological disturbances and often the need to use a specific approach to apply ventilation optimally. Table 42.1 provides a list of the more common situations in which conventional ventilation is used in the neonate and includes some considerations regarding ventilator settings for each situation. For each situation, a suggested mode of ventilation is indicated, along with target ranges for positive end-expiratory pressure (PEEP) and tidal volume (V (T)). Further discussion of the physiological rationale and available evidence for ventilator settings is set out below.
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7,801 |
Inflammatory and Infectious Disorders
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7,802 |
Trachom
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7,803 |
Influenza A (H1N1)
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In March 2009, an outbreak of human-infected swine influenza occurred in Mexico, with reports of deaths. Soon afterward, such cases were reported worldwide, namely, a pandemic outbreak. The prevailing disease is then defined as an acute respiratory infectious disease caused by swine-origin influenza A (H1N1) virus, a new variant of influenza virus. Its viral strains contain gene segments of three types of influenza viruses, namely swine influenza virus, avian influenza virus and human influenza virus. And the virus is mainly transmitted among humans via direct and indirect contact or respiratory tract.
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7,804 |
Medikamentenprofile – alphabetisch nach Substanzname
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In diesem Kapitel werden 184 onkologische Medikamente in alphabetischer Reihenfolge beschrieben. Zu jedem Medikament finden sich strukturierte, für die Pflege wichtige Angaben, bspw. zu Auflösung und Verdünnung, zu Verabreichung, zu Lagerung, zu Maßnahmen bei Extravasation, zu unerwünschten Wirkungen sowie für die Patienten nützliche Informationen.
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7,805 |
Network Analysis of Comorbidities: Case Study of HIV/AIDS in Taiwan
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Comorbidities are the presence of one or more additional disorders or diseases co-occurring with a primary disease or disorder. The purpose of this study is to identify diseases that co-occur with HIV/AIDS and analyze the gender differences. Data was collected from 536 HIV/AIDS admission medical records out of 1,377,469 admission medical records from 1997 to 2010 in Taiwan. In this study, the comorbidity relationships are presented in the phenotypic disease network (PDN), and φ-correlation is used to measure the distance between two diseases on the network. The results show that there is a high correlation in the following pairs/triad of diseases: human immunodeficiency virus infection with specified conditions (042) and pneumocystosis pneumonia (1363), human immunodeficiency virus infection with specified malignant neoplasms (0422) and kaposi’s sarcoma of other specified sites (1768), human immunodeficiency virus acquired immunodeficiency syndrome, and unspecified (0429) and progressive multifocal leukoencephalopathy (0463), and lastly, human immunodeficiency virus infection with specified infections (0420), meningoencephalitis due to toxoplasmosis (1300), and human immunodeficiency virus infection specified infections causing other specified infections (0421).
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7,806 |
The Impact of Community Structure of Social Contact Network on Epidemic Outbreak and Effectiveness of Non-pharmaceutical Interventions
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The topology structure of social contacts network has a big impact on dynamic patterns of epidemic spreading and effectiveness of non-pharmaceutical interventions. Corresponding to individuals’ behavioral or functional units, people are commonly organized in small communities, meaning that most of social contacts networks tend to display community structure property. Through empirical investigation and Monte-Carlo simulation on a big H1N1 outbreak in a Chinese university campus, this paper explores the impact of community structure property of social contacts network on epidemic spreading and effectiveness of interventions. A stochastic model based on social contacts networks among students is constructed to simulate this outbreak, revealing that epidemic outbreaks commonly occur in local community. Moreover, effectiveness of three quarantine-based interventions is quantitatively studied by our proposed model, finding that community structure of social networks determines the effects these measures.
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7,807 |
The Burden of Communicable and Non-Communicable Diseases in Developing Countries
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Worldwide, developed and developing countries are facing the double burden of communicable and 10.1007/978-0-387-78665-0_6205. However, developing countries are more exposed and more vulnerable due to a multitude of factors, including geographic, demographic and socio-economic factors. Noncommunicable diseases like cardio-vascular diseases, cancer, diabetes, chronic obstructive pulmonary disease and mental disorders are affecting developing countries with an increasing trend. In parallel, 10.1007/978-0-387-78665-0_5343 such as HIV/AIDS, malaria, tuberculosis, acute respiratory infections and diarrheal disease are causing high mortality rates especially in low and middle income countries. Other diseases like the so-called neglected diseases are exclusively afflicting developing countries. Low-income countries are particularly affected by lymphatic filariasis, leishmaniasis, schistosomiasis, Buruli ulcer, cholera, cysticercosis, dracunculiasis, foodborne trematode infections, hydatidosis, soil-transmitted helminthiasis (ascariasis, trichuriasis, hookworm diseases), trachoma, sleeping sickness, onchocerciasis, Chagas disease, dengue and others. Beyond the high mortality and morbidity rates caused by communicable and/or noncommunicable diseases in developing countries, the global burden includes economic losses due to care for diseases and disabilities but also as a lack of productivity. More generally, communicable and noncommunicable diseases are impeding human development in developing countries by their negative impact on education, income and life expectancy and other health indicators. In sub-Saharan African countries, devastating consequences are already strikingly apparent in terms of life expectancy and 10.1007/978-0-387-78665-0_5839 (HDI) in general. A large part of the burden caused by noncommunicable diseases like cardio vascular diseases, cancer, diabetes, obesity and others can be avoided by preventive measures, early diagnosis and detection and mainly by controlling risk factors such as smoking, alcohol, diet, and physical inactivity. Similarly, the impact of communicable diseases can be alleviated by efficient strategies, including affordability of treatments, development of new vaccines and medicines, improvement of environmental conditions and general incentives and sensitization.
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7,808 |
Toxoplasma gondii
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Toxoplasma gondii
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7,809 |
Computational Tools: RNA Interference in Fungal Therapeutics
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There is steady rise in the number of immunocompromised population due to increased use of potent immunosuppression therapies. This is associated with increased risk of acquiring fungal opportunistic infections in immunocompromised patients which account for high morbidity and mortality rates, if left untreated. The conventional antifungal drugs to treat fungal diseases (mycoses) are increasingly becoming inadequate due to observed varied susceptibility of fungi and their recurrent resistance. RNA interference (RNAi), sequence-specific gene silencing, is emerging as a promising new therapeutic approach. This chapter discusses various aspects of RNAi, viz., the fundamental RNAi machinery present in fungi, in silico siRNA features, designing guidelines and tools, siRNA delivery, and validation of gene knockdown for therapeutics against mycoses. Target gene identification is a crucial step in designing of gene-specific siRNA in addition to efficient delivery strategies to bring about effective inhibition of fungi. Subsequently, designed siRNA can be delivered effectively in vitro either by soaking fungi with siRNA or by transforming inverted repeat transgene containing plasmid into fungi, which ultimately generates siRNA(s). Finally, fungal inhibition can be verified at the RNA and protein levels by blotting techniques, fluorescence imaging, and biochemical assays. Despite challenges, several such in vitro studies have spawned optimism around RNAi as a revolutionary new class of therapeutics against mycoses. But, pharmacokinetic parameters need to be evaluated from in vivo studies and clinical trials to recognize RNAi as a novel treatment approach for mycoses.
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7,810 |
The Role of Context for Crisis Management Cycle
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This chapter establishes the major role of the sense making and situation-understanding process in crisis management, and outlines the importance of the contextualisation of information in this process. As a result of a wider analysis of past crisis-management feedback, we define the term crisis and propose a crisis-management cycle, along with a set of decision support activities. From a system point of view, crisis management functionalities are structured along three crucial steps: information gathering, situation understanding, and decision making. For each step, the processes involved are described and for each one some relevant techniques are proposed to implement the processes. For the information-gathering step, the use of ontology allows the building and structuring of a coherent situation model. The initial overall picture of the situation, obtained by some on-line information extraction and fusion, is then consolidated in the situation understanding step to provide meaningful real-time situation awareness. This provides the essential base to derive the final decision-making step. In the decision phase, the context has a dual impact on the decision-making process; the context first constrains the resolution of the resource allocation problem, but it also contributes to discriminate between several resource allocation solutions. It is thus shown that each step of the crisis management process relies on the availability and quality of the crisis context, and that this in-time contextualisation is required to enhance the overall process of crisis management. To summarise, this chapter highlights the key role of situation understanding for crisis management and reveals the crucial necessity of in-time contextualisation at each step of the crisis management process.
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7,811 |
Development of Nano-Antimicrobial Biomaterials for Biomedical Applications
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Around the globe, there is a great concern about controlling growth of pathogenic microorganisms for the prevention of infectious diseases. Moreover, the greater incidences of cross contamination and overuse of drugs has contributed towards the development of drug resistant microbial strains making conditions even worse. Hospital acquired infections pose one of the leading complications associated with implantation of any biomaterial after surgery and critical care. In this regard, developing non-conventional antimicrobial agents which would prevent the aforementioned causes is under the quest. The rapid development in nanoscience and nanotechnology has shown promising potential for developing novel biocidal agents that would integrate with a biomaterial to prevent bacterial colonization and biofilm formation. Metals with inherent antimicrobial properties such as silver, copper, zinc at nano scale constitute a special class of antimicrobials which have broad spectrum antimicrobial nature and pose minimum toxicity to humans. Hence, novel biomaterials that inhibit microbial growth would be of great significance to eliminate medical device/instruments associated infections. This chapter comprises the state-of-art advancements in the development of nano-antimicrobial biomaterials for biomedical applications. Several strategies have been targeted to satisfy few important concern such as enhanced long term antimicrobial activity and stability, minimize leaching of antimicrobial material and promote reuse. The proposed strategies to develop new hybrid antimicrobial biomaterials would offer a potent antibacterial solution in healthcare sector such as wound healing applications, tissue scaffolds, medical implants, surgical devices and instruments.
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7,812 |
Electroporation-Mediated DNA Vaccination
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There are many positive attributes to DNA vaccination that make it a conceptually desirable platform. In clinical studies, however, standard DNA injection alone generally induces low levels of transgene-specific immunity when compared to other vaccine approaches. In order to boost the immunogenicity of this platform, next-generation DNA vaccines require additional techniques such as the administration of electroporation. This new method involves the generation of a brief electric field in tissue around a local injection site that results in the transient poration, or permeabilization, of the cellular membranes. As a result, antigen-specific immune responses are greatly enhanced and are likely due to increased DNA uptake and antigen expression. Thus, electroporation-mediated DNA vaccination represents a promising new strategy for the elicitation of strong immune responses directed against the expressed antigen(s) and not the vector, and ongoing studies are currently underway to optimize the working parameters of this technique. Here, we review the uses of this technology in conjunction with vaccination and suggest future directions for its further exploration.
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7,813 |
Exam 4 Questions
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1. A 73-year-old male with a history of hypertension and hyperlipidemia is currently in the stroke unit after suffering a right middle cerebral artery infarct. His symptoms started 2 h prior to arrival at the hospital, and tPA was administered. The patient is plegic on the left side and with mild dysarthria, but is otherwise neurologically intact. His labwork is within normal limits. Which of the following describes the optimal deep venous thrombosis (DVT) prophylaxis regimen for this patient? A. Wait 6 h post tPA, then administer unfractionated heparin (UFH) along with intermittent pneumatic compression (IPC). B. Wait 24 h post tPA, then administer UFH along with IPC. C. Wait 6 h post tPA, then administer low molecular weight heparin (LMWH) along with IPC. D. Wait 24 h post tPA, then administer LMWH along with IPC. E. IPC only for the first 72 h, then LMWH or UFH after obtaining follow-up imaging. 2. All of the following causes of acute encephalitis have the matching characteristic radiological features except: A. Autoimmune limbic encephalitis: T2/FLAIR hyperintensity in the mesial temporal lobes. B. Cytomegalovirus: T2/FLAIR hyperintensity in the subependymal white matter. C. JC virus: T2/FLAIR hyperintensity in the parieto-occipital lobes and corpus callosum. D. Herpes simplex virus type 1: restricted diffusion in frontal/temporal lobes and insular cortex. E. Varicella zoster: T2/FLAIR hyperintensity in the brainstem. 3. Which of the following categorizations is most accurate regarding acute respiratory distress syndrome (ARDS) in the setting of subarachnoid hemorrhage (SAH)? A. Non-neurogenic, non-cardiogenic. B. Neurogenic, non-cardiogenic. C. Neurogenic, cardiogenic. D. Non-neurogenic, cardiogenic. E. None of the above accurately reflect ARDS in SAH. 4. A 52-year-old female is admitted to the ICU with a Hunt-Hess 1, modified Fisher 2 subarachnoid hemorrhage. Her past medical history is significant for hypertension, diabetes mellitus, and chronic renal insufficiency. She undergoes craniotomy for surgical clipping of an anterior cerebral artery aneurysm, and does not experience any additional complications. Two weeks later, she begins complaining of left calf pain, and a lower extremity sonogram demonstrated a proximal deep venous thrombosis (DVT). The patient weighs 60 kg. Her laboratory values are as follows: sodium 142 mEq/L, potassium 3.4 mEq/L, carbon dioxide 18 mEq/L, blood urea nitrogen (BUN) 70 mg/dL, and serum creatinine 2.5 mg/dL. What would be the optimal treatment for this patient’s proximal DVT? A. Unfractionated heparin infusion for at least 5 days concomitantly with warfarin therapy. B. Low molecular weight heparin 60 mg twice a day for at least 5 days concomitantly with warfarin therapy. C. Fondaparinux 7.5 mg daily for 5 days followed by warfarin therapy. D. Apixaban 10 mg twice daily for 7 days followed by 5 mg twice daily. E. Rivaroxaban 15 mg twice daily for 21 days followed by 20 mg once daily. 5. All of the following are currently implicated in uremic encephalopathy except: A. Derangements in cerebral metabolism. B. Alterations in the blood-brain barrier. C. Accumulation of circulating toxins. D. Imbalance of endogenous neurotransmitters. E. Recurrent lobar hemorrhages. 6. A 70-year-old female is hospitalized with a recent ischemic infarct. As part of stroke core measures, you obtain a hemoglobin A1c of 10.0. What is an approximate estimation of this patient’s average blood glucose level over the last several months? A. 70 mg/dL. B. 100 mg/dL. C. 130 mg/dL. D. 190 mg/dL. E. 240 mg/dL. 7. A 28-year-old female with no known past medical history is in the ICU in status epilepticus, with anti-N-methyl D-aspartate (NMDA) receptor antibodies isolated in the cerebrospinal fluid. Which of the following is most likely to identify the root cause of her illness? A. Transvaginal ultrasound. B. Contrast-enhanced CT of the chest. C. Contrast-enhanced CT of the brain. D. Virtual colonography. E. Thorough examination of the skin, particularly in sun-exposed areas. 8. A 17-year-old male with no significant past medical history collapses during a high school football game, and goes into cardiac arrest. He did not have any complaints earlier in the day. The patient is brought to a nearby hospital, where is he resuscitated, intubated, and transferred to the ICU for further management. The patient is currently undergoing therapeutic hypothermia, and a work-up is underway to determine the cause of his sudden collapse. Which of the following is the most likely diagnosis? A. Rupture of a previously undiagnosed cerebral aneurysm. B. Hypertrophic cardiomyopathy. C. Commotio cordis. D. Severe hyponatremia and cerebral edema. E. Brugada syndrome. 9. A 31-year-old female at 38 weeks gestation is currently hospitalized for the treatment of preeclampsia. Due to her medical condition, her obstetrician is currently considering induced labor. At which point will this patient no longer be at risk for developing frank seizure activity as a result of her condition? A. 48 h postpartum. B. 1 week after delivery. C. 2 weeks after delivery. D. 4 weeks after delivery. E. 6 weeks after delivery. 10. A 38-year-old male with no prior medical history presents to the emergency department with fever and severe headaches for several days. A CT scan of the brain is unremarkable, and the results of a lumbar puncture are pending. What is the most appropriate empiric antimicrobial regimen at this time? A. Cefazolin and vancomycin. B. Ceftriaxone and vancomycin. C. Ceftriaxone, vancomycin and ampicillin. D. Piperacillin/tazobactam and vancomycin. E. Meropenem and vancomycin. 11. The majority of intramedullary spinal cord neoplasms are: A. Astrocytomas. B. Meningiomas. C. Metastatic lesions. D. Ependymomas. E. Hemangioblastomas. 12. Which of the following derived parameter formulas is correct? A. Cardiac index = cardiac output x body surface area. B. Stroke volume = cardiac output/heart rate. C. Systemic vascular resistance = 80 × (mean arterial pressure/cardiac output). D. Pulmonary vascular resistance = 80 × (mean pulmonary artery pressure/cardiac output). E. All of the above are correct. 13. A 23-year-old female marathon runner is currently in the ICU after suffering from heat stroke following an outdoor run on a particularly hot summer day. She was initially delirious in the emergency department, but progressed to coma and respiratory failure requiring mechanical ventilation. Her oral temperature is 42.1 °C. Which of the following would be most effective in reducing this patient’s severe hyperthermia? A. Regularly scheduled alternating acetaminophen and ibuprofen. B. Spraying room temperature water on the patient, followed by fanning. C. Ice water immersion. D. Dantrolene sodium, 2.5 mg/kg. E. Application of ice packs to the groin and axilla. 14. Hyperinsulinemia-euglycemia (HIE) therapy may be useful for toxicity related to which of the following? A. Tricyclic antidepressants. B. Calcium channel blockers. C. Aspirin. D. Digoxin. E. Lithium. 15. A 71-year-old female with a history of alcohol abuse is currently intubated in the ICU following a catastrophic spontaneous left basal ganglia hemorrhage with resultant herniation. You have just declared her brain dead. The patient’s family agrees to make her an organ donor, and the organ donation coordinator requests you initiate levothyroxine therapy. Which of the following benefits would be expected with this treatment? A. Increase the number of solid organs available for transplant. B. Eliminate the need for hepatic biopsy prior to liver transplant. C. Eliminate the need for cardiac catheterization prior to heart transplant. D. Eliminate the need for bronchoscopy prior to lung transplant. E. Reduce the need for supplementation of sodium, potassium, calcium, and magnesium. 16. Which of the following is not an element of the Full Outline of Unresponsiveness (FOUR) score? A. Eye opening. B. Respiratory function. C. Brainstem reflexes. D. Motor response. E. Verbal response. 17. A 23-year-old female is currently in the ICU with status asthmaticus. She was initially on noninvasive positive pressure ventilation, with an arterial blood gas (ABG) as follows: pH 7.13, pCO(2) 60 mmHg, PaO(2) is 61 mmHg, HCO(3) 24 mmol/L, and oxygen saturation of 90%. She is given continuous inhaled albuterol, intravenous steroids, and magnesium sulfate. She subsequently becomes more lethargic and is intubated, with settings as follows: volume assist-control, rate of 12 breaths/min, tidal volume of 500 cc, PEEP of 5 cm H(2)O, and FiO(2) of 50%. Peak airway pressure is 50 cm H(2)O and plateau pressure is 15 cm H(2)O. A stat portable chest x-ray shows hyperinflation with no pneumothorax. A repeat ABG after 30 min of invasive ventilation shows the following: pH of 7.24, pCO(2) 49 mmHg, PaO(2) 71 mmHg, HCO(3) A. Increase rate to 16. B. Increase tidal volume to 600 cc. C. Initiate bicarbonate infusion. D. Switch to pressure assist-control. E. Maintain current settings. 18. Which of the following mechanisms is implicated in super-refractory status epilepticus? A. Influx of proinflammatory molecules. B. Upregulation of NMDA receptors. C. Upregulation of molecular transport molecules. D. Downregulation of GABA receptors. E. All of the above. 19. A 85-year-old male with a history nephrolithiasis, mild dementia, and alcohol abuse presented to the emergency department after a fall from standing, and was found to a right holohemispheric subdural hematoma. His clot was evacuated successfully, in spite of his oozing diathesis in the operating room (INR on arrival was 1.4 with a platelet count of 88 × 10(3)/μL). His serum transaminases are twice the normal value, and he has had refractory chronic hyponatremia. He has had three convulsions during this week of hospitalization, in spite of levetiracetam therapy at 1.5 g twice a day. Over the past 24 h, he has had a marked increase in agitation. He has also just had a 5-s run of non-sustained ventricular tachycardia, and his systolic blood pressure is now 85 mmHg. You are considering discontinuing his levetiracetam and starting a new agent. Which of the following would be the best choice in this scenario? A. Carbamazepine. B. Phenytoin. C. Valproate. D. Lacosamide. E. Topiramate. 20. A 65-year-old male with a history of COPD on rescue albuterol and ipratropium is diagnosed with myasthenia gravis, and started on an acetylcholinesterase inhibitor. He returns several days later complaining of increased salivation and worsening bronchial secretions in the absence of fevers, purulent sputum, or increasing dyspnea. These symptoms are not relieved by use of his albuterol. On exam, he has slightly decreased air movement throughout both lung fields without any clear wheezing, no focal rales, and a normal inspiratory to expiratory ratio. Which treatment option is most likely to be beneficial? A. Increase frequency of short-acting ß(2) agonist use. B. Add a standing long-acting inhaled ß(2) agonist. C. Add glycopyrrolate as needed. D. Add inhaled corticosteroids. E. Add oral systemic corticosteroids. 21. Regarding states of impaired consciousness, which of the following statements regarding arousal and awareness is correct? A. Coma: intact arousal, but impaired awareness. B. Minimally conscious state: impaired arousal and impaired awareness. C. Persistent vegetative state: intact arousal, but impaired awareness. D. Locked-in state: intact arousal, but impaired awareness. E. All of the above are correct. 22. A 62-year-old female is currently in the ICU following craniotomy for clipping of a cerebral aneurysm. Postoperatively, she is noted to have an oxygen saturation of 92% on 50% non-rebreather face mask, and her respiratory rate is 32 breaths/min. She denies chest pain. Her blood pressure is 96/72 mmHg and heart rate is 120 beats/min. Nimodipine has been held according to blood pressure parameters. A portable chest x-ray shows hazy opacities bilaterally, and bedside echocardiogram shows decreased left ventricular systolic function with apical, septal, lateral, anterior, anteroseptal and inferolateral wall akinesis, along with apical ballooning. Which of the following should be performed next? A. Intubate the patient and begin mechanical ventilation. B. Call urgent cardiology consult for cardiac catheterization. C. Start noninvasive positive airway pressure ventilation. D. Administer broad spectrum antibiotics. E. Administer albuterol and systemic corticosteroids. 23. Which of the following is the most common etiology of acute spinal cord ischemia and infarction? A. Atherosclerotic disease. B. Rupture of an abdominal aortic aneurysm. C. Degenerative spine disease. D. Cardioembolic events. E. Systemic hypotension in the setting of other disease processes. 24. A 62-year-old female with a history of coronary artery disease has just been admitted to the ICU with a left-sided spontaneous basal ganglia hemorrhage. The patient takes 325 mg of aspirin daily at home, and you are considering platelet transfusion. Which of the following has been demonstrated regarding platelet transfusion in this setting? A. Improved chances of survival to hospital discharge. B. Decreased hospital length-of-stay. C. Improved chances of survival at 3 months. D. Improved modified Rankin scale at 3 months. E. None of the above. 25. Which of the following therapies has been shown to decrease the incidence of delayed cerebral ischemia (DCI) in the setting of subarachnoid hemorrhage (SAH)? A. Atorvastatin. B. Magnesium. C. Methylprednisolone. D. Nicardipine. E. None of the above. 26. A 70-year-old male with a history of diabetes, hypertension, and cigarette smoking (one pack per day for the last 40 years) is currently in the ICU with a COPD exacerbation. This is his third exacerbation this year, and was discharged from the hospital only 3 weeks prior. On your examination, he is alert, his breathing is labored, and he has rales at the right lung base. His vital signs are as follows: blood pressure 90/60 mmHg, heart rate 120 beats per minute, respirations 28 per minute, and temperature 38.3 °C. His oxygen saturation on 50% face mask is 93%, and his most recent PCO(2) is 55 mmHg. Labs are notable for the following: white blood cell count 14.4 × 10(9)/L with 90% neutrophils, blood urea nitrogen (BUN) 30 mg/dL, serum creatinine 1.2 mg/dL, and glucose 240 mg/dL. Ketones are negative. He is currently on noninvasive positive pressure ventilation at 10/5 cm H(2)O and 50% FiO(2), and broad spectrum antibiotics have been administered. An hour later, the nurse pages you because his heart rate is now 140 beats per minute and irregular, blood pressure is 85 systolic, oxygen saturation is 85%, and he is minimally responsive. You now hear bilateral rales, most prominently in the right lung base, and scattered wheezes. Which of the following should be performed next? A. Increase inspiratory pressure to 15 and FiO(2) to 100%. B. Start a continuous diltiazem infusion and give intravenous furosemide. C. Start a continuous phenylephrine infusion targeting a mean arterial pressure (MAP) > 65. D. Give 125 mg of solumedrol and administer albuterol via nebulizer. E. Intubate the patient and initiate mechanical ventilation. 27. A 57-year-old male with a history of epilepsy is currently in the stroke unit following a large right middle cerebral artery infarction. A nasogastric tube has been inserted, and 24 h continuous enteral feeds have been initiated. The patient is currently on 100 mg of phenytoin every 8 h for seizure prophylaxis. Which of the following measures should be taken to prevent the patient from developing subtherapeutic phenytoin levels? A. Change to 18 h tube feeds, and only administer phenytoin at night. B. Change to 18 h tube feeds, and only administer phenytoin twice daily. C. Switch from standard to hydrolyzed tube feeds. D. Switch from standard to glycemic control tube feeds. E. Hold tube feeds for 2 h before and after phenytoin administration. 28. A 37-year-old female presents to the emergency department with approximately 2 weeks of progressively worsening clumsiness and drastic mood swings. Her past medical history is significant only for Crohn’s disease, for which she takes both natalizumab and infliximab. A contrast-enhanced CT scan of her head is performed, revealing hypodense, non-enhancing lesions in the cortical white matter of the frontal and parietal lobes. Despite treatment, the patient expires 1 month later. Which of the following is true regarding the most likely diagnosis? A. The diagnosis may be confirmed via CSF analysis. B. The pathologic process spares oligodendrocytes. C. It is a prion-based disease. D. The condition is universally fatal despite treatment. E. All of the above. 29. A 58-year-old female presents to the emergency department with dry cough, fever and rapidly progressive dyspnea over 1 week. She has a history of rheumatoid arthritis (RA) and is maintained on weekly methotrexate and daily prednisone (which was increased to 30 mg starting 1 month ago for an acute flare). She takes no other medications. Her vital signs are as follows: blood pressure 100/70 mmHg, heart rate 110 beats/min, respiratory rate 20 breaths/min, and temperature 38.0 °C. In the ED she develops progressive hypoxemia with oxygen saturation 92% on 100% nonrebreather, and is increasingly diaphoretic. She is emergently intubated, and a chest x-ray post intubation shows extensive bilateral lung opacities. Which of the following should be administered at this time? A. Ceftriaxone and azithromycin. B. Vancomycin and piperacillin-tazobactam. C. Vancomycin, cefepime, and fluconzole. D. Ceftriaxone, levofloxacin, and trimethoprim-sulfamethoxazole. E. Tigecycline only 30. A 45-year-old woman undergoes uncomplicated transsphenoidal resection of a pituitary macroadenoma. She appears well hydrated and is not complaining of excessive thirst. Post-operatively, she is noted to have increased urine output. Serum sodium is 137 mEq/L, and serum osmolarity is 275 mOsm/kg. What is the most likely cause of her polyuria? A. Syndrome of inappropriate antidiuretic hormone. B. Diabetes insipidus. C. Cerebral salt wasting. D. Fluid mobilization. E. All of the above are equally likely. 31. A 36-year-old female with a recent lumbar puncture to rule out subarachnoid hemorrhage is now complaining of a severe headache unlike anything she has experienced previously. She reports her headache is worse when standing, and better upon lying flat. She is otherwise neurologically intact. All of the following medications may be beneficial in this scenario except: A. Acetaminophen. B. Ibuprofen. C. Caffeine. D. Aminophylline. E. Methylprednisolone. 32. Which of the following is the most common overall cause of acute myocardial infarction? A. Coronary dissection. B. Plaque rupture. C. Imbalance between oxygen demand and supply across a fixed obstruction. D. Coronary vasospasm. E. Ischemia related to hypotension and decreased perfusion. 33. A 78-year-old male is in the ICU recovering from sepsis and pneumonia. He was just recently extubated after 2 days of mechanical ventilation and sedation with a fentanyl infusion. Over the ensuing days, he develops worsening abdominal distention, poor bowel sounds, and no stool output. CT scan reveals significant colonic distention, but no mass or obstruction. Records demonstrate a normal routine colonoscopy performed 6 weeks ago. You have appropriately hydrated the patient, corrected any electrolyte abnormalities, placed a rectal tube, withheld all opiates, and given intravenous erythromycin, but to no avail. Abdominal x-rays continue to demonstrate marked cecal dilatation greater than 12 cm in diameter. What is the next best appropriate therapy for this patient? A. Neostigmine. B. Naloxone. C. Metoclopromide. D. Surgical consultation for hemicolectomy. E. Endoscopic percutaneous cecostomy tube placement. 34. Which of the following is the most common cerebral vascular malformation in the general population? A. AV malformation. B. Dural AV fistula. C. Developmental venous anomaly. D. Cavernous malformation. E. Vein of Galen malformation. 35. A 49-year-old female with a history of acute lymphoblastic leukemia and recent subcutaneous cerebrospinal fluid (CSF) reservoir placement presents to the emergency department with fever, chills, and increased confusion for the past 3 days. Her CSF reservoir was last accessed 1 week ago. A thorough work-up reveals no other obvious infectious source, and there is concern for CSF reservoir-associated meningitis. Which of the following is the most likely causative organism? A. Coagulase-negative staphylococci. B. Propionobacterium acnes. C. Methicillin-resistant Staphylococcus aureus. D. Klebsiella pneumoniae. E. Neisseria meningitidis. 36. A 47-year-old woman presents to the emergency department with headache, nausea, and vomiting. Non-contrast head CT is performed, revealing subarachnoid blood in the right Sylvian fissure, and conventional angiography reveals the presents of a large right-sided MCA aneurysm. The patient undergoes successful surgical clipping of her aneurysm, and is being observed in the ICU. On admission, the patient’s serum sodium was 142 mEq/L and the hematocrit was 37%; by the seventh post-operative day, the serum sodium is 127 mEq/L and the hematocrit is 44%. Bedside ultrasonography demonstrates an IVC diameter of approximately 0.9 cm. Which of the following interventions would be least reasonable at this time? A. Fludrocortisone, 0.2 mg twice a day. B. 2% hypertonic saline, infused peripherally. C. 3% hypertonic saline, infused centrally. D. Sodium chloride oral tablets. E. 1500 mL daily fluid restriction. 37. Which of the following is true regarding central (non-infectious) fever? A. Less common in subarachnoid hemorrhage. B. More common versus infectious fever. C. Earlier onset versus infectious fever. D. Easier to confirm versus infectious fever. E. All of the above. 38. Flaccid paralysis is most commonly associated with which of the following forms of encephalitis? A. West Nile. B. Varicella zoster. C. Rabies. D. Herpes simplex. E. Epstein-Barr. 39. Which of the following would not be considered appropriate therapy for heparin-induced thrombocytopenia (HIT)? A. Discontinuation of heparin products alone. B. Danaparoid. C. Fondaparinux. D. Argatroban. E. All of the above are acceptable treatment options. 40. A 45-year-old male with severe blunt traumatic brain injury (TBI) from a motor vehicle collision suffered a ventricular fibrillation cardiac arrest at the time of injury with return of spontaneous circulation (ROSC) in the field after endotracheal intubation and one dose of epinephrine. On arrival to the emergency department, no regional wall motion abnormalities were noted on surface echocardiography and no ST segment changes were seen on the presenting EKG. Head CT revealed cerebral contusions but no extra-axial mass lesions. The patient is now in the ICU and found to be comatose without sedation. Mild therapeutic hypothermia to 33° is being considered in the management of this post-arrest patient. Which of the following statements is true? A. Mild therapeutic hypothermia is contraindicated due to the risk of induced epilepsy. B. Mild therapeutic hypothermia is contraindicated with any intracranial pathology on CT imaging. C. Mild therapeutic hypothermia does not induce a clinically significant coagulopathy. D. Patients who have sustained ROSC after an arrest associated with TBI do not benefit from therapeutic hypothermia. E. Endovascular cooling is superior to surface cooling in young patients with ROSC. 41. A 35-year-old male is in the intensive care unit following resection of a large right-sided meningioma. He is currently intubated and sedated on a continuous fentanyl infusion. The nurse calls you to the bedside due to concerns over “unusual ventilator waveforms”. Upon arrival, you note the following (see Image 1). What is the best way to describe this phenomenon? A. Reverse triggering. B. Double triggering. C. Breath stacking. D. Missed triggering. E. None of the above; normal ventilator waveforms are present;
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7,814 |
Platelets and Inflammation
|
Platelets play a major physiological role in control of vascular integrity at the site of vascular lesions. However, the pathophysiological role of platelets is much broader than regulation of hemostasis and thrombosis. Platelets are critical elements in linking and modulating thrombosis, inflammation, and tissue repair. Platelets are stimulated by a variety of agonists including thrombin or ADP and also by inflammatory agents such as antibodies, complement, bacteria, and others. Platelets contribute to inflammation by interacting with inflammatory cells via adhesion and secretion of prestored proinflammatory mediators. Thus, platelets are critical elements in the pathophysiology of inflammation and modulate significantly a variety of inflammatory diseases. A profound understanding of the molecular mechanisms underlying the role of platelet in inflammation may result in new therapeutic strategies in acute and chronic inflammatory diseases.
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7,815 |
Immunomic Discovery of Adjuvants, Delivery Systems, and Candidate Subunit Vaccines: A Brief Introduction
|
Mass vaccination, when coupled to profound improvements in general sanitation, has given rise to the most remarkable transformation in public health in human history. Yet the development of vaccines remains largely trapped in the past, a hostage to the methodology of Pasteur. Infectious disease continues to threaten humanity, with new and renascent diseases emerging continually. The last two decades have seen a breath-taking revival in the commercial market for vaccines and the simultaneous emergence of a whole tranche of new technologies that promise to free vaccine development from the muddle of empirical thinking. In this short introduction, we set the scene for this renaissance, and explore how the combination of computational and experimental techniques promise so much for the future development of vaccines and the science of vaccinology.
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7,816 |
Characterization of Viral Exposures in United States Occupational Environments
|
Viruses are considered to be the most abundant biological particles and have the capability to infect all forms of life leading to a variety of diseases. American workers in specific occupational environments are threatened by viral exposures, highlighting the importance to recognize the type and risk of exposure, as well as the preventive measures that can be taken to reduce the risk of exposure. For example, healthcare workers can potentially be exposed to air and blood-borne pathogens, such as hepatitis and the human immunodeficiency virus. These types of exposures have led to the development of preventive equipment and regulations intended to reduce viral exposures in occupational settings. This chapter will discuss the characteristics of viruses and the occupationally relevant viruses of which people in varying occupations can potentially encounter. Regulatory guidelines and protective strategies will also be reviewed.
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7,817 |
Globalizzazione e salute: nuove prospettive e nuovi rischi nell’era della genomica
|
Il binomio globalizzazione/salute salta usualmente alla ribalta di fronte alle emergenze sanitarie come la SARS(1), o più recentemente l’influenza aviaria, che godono fin troppo spesso dell’onore delle cronache. Considerata la velocità con cui si possono diffondere nuovi germi patogeni, giustamente è cresciuta la preoccupazione per il rischio di pandemie. Tuttavia, possiamo sentirci rassicurati, almeno in parte, dal fatto che la globalizzazione si porta dietro anche un’elevata capacità di rispondere alle emergenze su scala planetaria, com’è successo per il controllo della diffusione della SARS e si spera che succeda nel caso dell’influenza aviaria.
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7,818 |
Nanobiotechnology and Ethics: Converging Civil Society Discourses
|
Nanobiotechnology as a “converged” technological platform (CT = Converging Technologies) is discussed in relation to discourse within civil society. The conflicts and ethical debates surrounding nanobiotechnology can be intuited from these larger discursive frames of reference. Complimenting Glimell and Fogelberg's (2003) research documenting an emergent epistemic culture amongst scientists researching and working on nanotechnologies, and more recent research on the multiple meanings of nanotechnology in the political economy (Wullweber, 2007), this paper traces an emergent ethnography of engaged actors within civil society as they develop discursive and mobilization repertoires. Whilst on occasion ambivalent about the combination of specific promises and risks in relation to nanobiotechnology, in general a broad critique of the politics of technology is emerging as a counter epistemology or “Master Frame” (Snow & Benford, 1992) amongst certain predisposed UK civil society groups. Converging Technologies provide the issue around which this broad critique is solidifying. Thus whilst many of the specific risks raised by nanobiotechnology (and other CT) are definitively new, many of the p?tential risks and grievances, have been raised before in relation to other issues of scientific and environmental controversy, often by the same actor groups. Thus convergence is a useful metaphor for appreciating that broader frame of reference from within which the emerging conflicts and ethical debates about nanobiotechnology are being situated. If you go ten, fifteen years in the future, you're not going to be able to distinguish between what's nano technology, what's bio technology, what's information technology or what's genetic engineering. They're all going to be the same kind of technologies … just employed in different ways and different places. (“Mike”, technology watchdog campaigner, in interview January 2004)
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7,819 |
Food Safety and Bioterrorism from Public Health Perspective
|
The chapter discusses the issues of food safety and bioterrorism from the position of public health. The author gives the overview of the problem focusing on agricultural sector as a particularly vulnerable element in the farm-to-table food continuum, describes the possible scenarios of bioterroristic attacks and the necessary preventive activities to provide food safety. The article also contains the results of the original study conducted in two Russian regions on the perception of risk related to food safety by consumers.
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7,820 |
Silver Nanoparticles: Synthesis and Applications
|
Nanotechnology involves the production, manipulation, and use of materials ranging in size from less than a micron to that of individual atoms, is an emerging field of modern science, and utilizes nanoscaled systems. Nanoparticles (NPs) are being viewed as fundamental building blocks of nanotechnology. Although nanomaterials may be synthesized using chemical approaches, it is now possible to include the use of biological systems such as bacteria, fungi, and plants. Currently, silver nanoparticles have shown great importance due to its large surface ratio and unique properties with myriad activities applicable in a number of applied sectors including microbial resistant applications (antibacterial/antifungal/anticancer/antiviral), water treatment, protective dressings, catalysis, and optical devices. This chapter encompasses the fabrication methods and dispersed applications of silver nanoparticles.
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7,821 |
13 Infectieziekten
|
welke verschillende ziekteverwekkers infectieziekten kunnen veroorzaken; welke geneesmiddelen worden gebruikt bij de behandeling van infectieziekten; welk gevolg onoordeelkundig gebruik van deze geneesmiddelen kan hebben; welke gebruiksadviezen je moet geven bij de verschillende middelen tegen infectieziekten.
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7,822 |
Influenza A (H1N1)
|
Influenza A (H1N1) is an acute respiratory infectious disease caused by mutant influenza A virus subtype H1N1. The pathogen is a new virus emerging after virus gene recombination of swine influenza, avian influenza, and human influenza. Influenza A (H1N1) is transmitted commonly via respiratory droplets and direct or indirect contact. Clinically, influenza A (H1N1) is characterized by influenza-like symptoms such as fever, cough, and rhinorrhea. But in rare serious cases, the condition may progress rapidly, with occurrence of viral pneumonia, respiratory failure, and multiple organ failure. Even death occurs in serious cases, with a mortality rate of 23–25 %. On April 30, 2009, influenza A (H1N1) was officially listed into Class B infectious diseases in China. Since then, it has been managed according to the Infectious Disease Prevention and Control Act in China. Meanwhile, it has been introduced into the category of quarantinable infectious disease for management based on the Frontier Health and Quarantine Law of China.
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7,823 |
Epidemiology of Highly Pathogenic Avian Influenza Virus Strain Type H5N1
|
Highly pathogenic avian influenza (HPAI) is a severe disease of poultry. It is highly transmissible with a flock mortality rate approaching 100% in vulnerable species (Capua et al. 2007a). Due to the potentially disastrous impact the disease can have on affected poultry sectors, HPAI has received huge attention and is classified as a notifiable disease by the World Organisation for Animal Health (OIE).
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7,824 |
Acute Respiratory Distress Syndrome
|
Acute Respiratory Distress Syndrome (ARDS) is a well-described disease process that can have numerous underlying causes, is commonly seen in the critical care setting, and is often under-recognized. ARDS is characterized by pulmonary edema with refractory hypoxemia, and was traditionally associated with a high mortality rate. The past few decades have generated many studies examining therapeutic interventions for ARDS; however, there are few Level 1 evidence-based interventions to this day that have been shown to improve mortality and outcomes. Lung protective ventilation remains the most studied and evidence-based intervention for the treatment of ARDS.
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7,825 |
Pain, Fatigue, and Trauma
|
Neurological function figures prominently in essentially all of the 11 symptoms related to cancerrelated fatigue in the proposed diagnostic criteria. Some studies have suggested that quality-of-life measures may be as important as predictors of survival in cancer as is response to chemotherapy.
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7,826 |
Openbare gezondheid en preventie
|
In dit hoofdstuk staat de wetgeving op het gebied van de openbare gezondheidszorg en gezondheidspreventie centraal. Het zal duidelijk worden dat openbare gezondheidszorg een heel scala van activiteiten omvat. Dit varieert van bevolkingsonderzoeken tot aan de bestrijding van infectieziekten.
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7,827 |
Genomics of Acute Lung Injury and Vascular Barrier Dysfunction
|
Acute lung injury (ALI) is a devastating syndrome of diffuse alveolar damage that develops via a variety of local and systemic insults such as sepsis, trauma, pneumonia, and aspiration. It is interestingly to note that only a subset of individuals exposed to potential ALI-inciting insults develop the disorder and the severity of the disease varies from complete resolution to death. In addition, ALI susceptibility and severity are also affected by ethnicity as evidenced by the higher mortality rates observed in African-American ALI patients compared with other ethnic groups in the USA. Moreover, marked differences in strain-specific ALI responses to inflammatory and injurious agents are observed in preclinical animal models. Together, these observations strongly indicate genetic components to be involved in the pathogenesis of ALI. The identification of genes contributing to ALI would potentially provide a better understanding of ALI pathobiology, yield novel biomarkers, identify individuals or populations at risk, and prove useful for the development of novel and individualized therapies. Genome-wide searches in animal models have identified a number of quantitative trait loci that associate with ALI susceptibility. In this chapter, we utilize a systems biology approach combining cellular signaling pathway analysis with population- based association studies to review established and suspected candidate genes that contribute to dysfunction of endothelial cell barrier integrity and ALI susceptibility.
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7,828 |
Heat Shock Proteins in Inflammation
|
HSPs are important mediators of a number of key intracellular reactions. Of importance to the care of the critically ill are their involvement in protein repair and tertiary structure. HSP70 is known to modulate inflammation and apoptosis. In models of acute lung injury and ARDS, over-expression of HSP70 improves outcome, ameliorates lung injury and attenuates inflammation. The involvement of HSP70 in other aspects of lung injury and in other components of MODS is under investigation.
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7,829 |
Complication from Desensitization
|
Sensitization to human leukocyte antigens (HLAs) has been one of the major clinical challenges for successful kidney transplantation. In end-stage renal disease, kidney transplantation provides benefits compared with dialysis in terms of improved patient survival better quality of life, and lower ongoing costs after the first year. Living donor kidney transplantation has an advantage with improved allograft survival, and performed earlier and electively compared with deceased donor transplantation. However sensitized patients are increasing in number on transplant waiting lists, and their prospect of getting a transplant is less than nonsensitized patients due to immunological incompatibility with the donor. Strategy for sensitized patients are listing for a compatible deceased donor transplant or, if they have a living donor, either selecting a kidney exchange program or undergoing a desensitization procedure. Desensitization procedures may be undertaken to increase access to either living or deceased donor transplants, and in some situations may also be employed to facilitate participation in a kidney exchange, in less immunological barrier to be overcome. The question of whether individuals are better off with a desensitization treatment followed by HLA-incompatible living donor transplantation or waiting on the deceased donor kidney transplant list for a compatible transplant has recently been addressed by two large multicenter studies, with conflicting results. A multicenter study from the United States published in the New England Journal of Medicine [365;318 326.2011] concluded that there was a strong survival benefit for sensitized patients undergoing desensitization followed by HLA-incompatible living donor kidney transplant compared with those remaining on the waiting list. Of interest, a second study, published in the Lancet, [389;727 734.2017] found no significant survival advantage for desensitized patients compared with similar patients remaining on the waiting list in the United Kingdom. Controversies still remain regarding how desensitization can be achieved and which techniques are effective and safe. In this chapter various complications from the desensitization will be dealt with in current use of medications or armamentum.
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7,830 |
Pathology of Lung Rejection: Cellular and Humoral Mediated
|
Acute rejection is an important risk factor for bronchiolitis obliterans syndrome, the clinical manifestation of chronic airway rejection in lung allograft recipients. Patients with acute rejection might be asymptomatic or present with symptoms that are not specific and can be also seen in other conditions. Clinical tests such as pulmonary function tests and imaging studies among others usually are abnormal; however, their results are also not specific for acute rejection. Histopathologic features of acute rejection in adequate samples of transbronchial lung biopsy of the lung allograft are currently the gold standard to assess for acute rejection in lung transplant recipients. Acute alloreactive injury can affect both the vasculature and the airways. Currently, the guidelines of the 2007 International Society of Heart and Lung Transplantation consensus conference are recommended for the histopathologic assessment of rejection. There are no specific morphologic features recognized to diagnose antibody-mediated rejection (AMR) in lung allografts. Therefore, the diagnosis of AMR currently requires a “triple test” including clinical features, serologic evidence of donor-specific antibodies, and pathologic findings supportive of AMR. Complement 4d deposition is used to support a diagnosis of AMR in many solid organ transplants; however, its significance for the diagnosis of AMR in lung allografts is not entirely clear. This chapter discusses the currently recommended guidelines for the assessment of cellular rejection of lung allografts and summarizes our knowledge about morphologic features and immunophenotypic tests that might help in the diagnosis of AMR.
|
7,831 |
The Darkened Horizon: Two Modes of Organizing Pandemics
|
This chapter deals with the recent darkening of the future horizon in the global fight against pandemics. Since roughly the year 2000, the World Health Organization has collaborated with a large number of local actors and made a concentrated effort to protect the world’s population against emerging infectious diseases, such as severe acute respiratory syndrome (SARS), swine flu, Ebola and Zika. Although efforts have been made so that the spread of future infectious diseases will be contained through early intervention, the actors in charge anticipate that the extant measures will fail to some degree. They believe it is simply impossible to prevent all pandemics from happening. But steps can and should be taken to lessen the impact of an unavoidable pandemic through emergency preparation. This chapter deals with organizations and organizational networks as key actors in these processes of emergency planning. Without the capacity of organizations to produce binding decisions for their members, which makes planning for an uncertain future possible, pandemic preparedness would not be feasible—especially not on a global scale.
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7,832 |
Civil and Criminal Legislation Regarding Money Laundering and the Protection of Cultural Heritage
|
The aim of this chapter is to understand how States combat money laundering and its possible links to organized crime and other financial crimes. The illegal flow of capital poses a great threat to States. Through international joint actions, States can fight crime and curtail the enjoyment of property illegally acquired through criminal activity, particularly with respect to the acquisition of works of art on the black market.
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7,833 |
Risk Assessment in Smallpox Bioterrorist Aggression
| null |
7,834 |
Immunological Detection and Characterization
|
Immunological methods have been used for viral diagnosis for more than 100 years. Although molecular methods are replacing many older methods of viral diagnosis, there is still a significant role for immunological methods to guide patient care and in the performance of epidemiologic studies. Identification of viral antigens in clinical samples can be accomplished rapidly through the use of point-of-care lateral immunoassays or through the use of more traditional immunofluorescence and enzyme immunoassays in the virology laboratory. Serological assays are also a valuable tool for the clinician and epidemiologist. Many of the available diagnostic assays have enzyme immunoassay formats, but functional assays such as hemagglutination-inhibition and neutralizing antibody tests are also available. In some instances, virus infection can be diagnosed with a single serum sample (e.g., HIV and hepatitis C virus infections) while in other instances paired sera are needed (e.g., those caused by common respiratory viruses). Point-of-care antibody assays are also available for testing blood and saliva samples for some viruses. An understanding of the principles of immunological detection methods is important in the application and interpretation of test results.
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7,835 |
Afwijkingen van het respiratoire systeem
|
Respiratoire afwijkingen komen zeer frequent voor als primaire aandoening of secundair aan een maligniteit, infectie of systeemziekte. Zoals voor veel inwendige aandoeningen geldt, is een goede anamnese en lichamelijk onderzoek onontbeerlijk bij de analyse van pulmonale aandoeningen. De eerste paragrafen van dit hoofdstuk zullen hier dieper op ingaan. Helaas zijn de klachten vaak weinig specifiek en noodzaken dikwijls tot verder beeldvormend onderzoek. De X-thorax is vaak het beginpunt van een dergelijk diagnostisch traject. In de latere paragrafen zullen specifieke bevindingen op de X-thorax verder worden uitgediept. In veel gevallen is naast laboratoriumonderzoek ook functieonderzoek en computertomografie van de thorax noodzakelijk om de differentiële diagnose verder te versmallen. Het verkrijgen van weefsel is bij interstitiële longaandoeningen, tuberculose en maligniteit vaak het sluitstuk van de diagnostiek. Nieuwe endoscopische echogeleide technieken komen steeds meer in de plaats van invasief onderzoek zoals mediastinoscopie of thoracotomie. Ook kan met behulp van PCR-technieken sneller en meer specifiek een juiste diagnose worden verkregen.
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7,836 |
Respiratory Disorders
|
Like it or not, patients with respiratory complaints are a part of our practice. The common cold is often referred to as the most frequent illness occurring in humans: over 40% of Americans suffer from a “cold” each year, accounting for more lost productivity than any other illness. Pharyngitis affects almost 30 million patients annually, with over 10% of all school-aged children seeking medical care each year. Seventeen million patients a year are diagnosed with asthma, with more females than males among adult-onset patients. Whether it is the reason for our patient’s visit or an incidental complaint, we are involved with the diagnosis and management of these problems.
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7,837 |
Prevention of Postoperative Wound Infections
|
Surgery creates most hospital infections, injuries, accidents, invalidity and death in the global healthcare system. The number of surgically treated patients per year is high and increasing. Surgical site infection (SSI) is dependent on type of operation and may occur in 5–20% after surgery, triggers 7–11 extra postoperative days in hospitals and results in 2–11 times higher risk of death than comparable, noninfected patients. Up to 60% of SSI can be prevented. Prevention of postoperative wound infection is done by good general hygiene, operative sterility and effective barriers against transmission of infections, before, during and after surgery. A basic support by hospital leaders, knowledge and skill of the surgical teams, enough resources, excellent treatment of the complete patient admission and monitoring patients after discharge may lead to significant reduction of SSIs, lower death rates and a less expensive health system.
|
7,838 |
Defending Against Catastrophic Terrorism
| null |
7,839 |
Longziekten
|
Longziekten komen zeer frequent voor. De meeste longaandoeningen ontstaan in de luchtwegen. Aandoeningen die zich vooral in het longparenchym afspelen, zijn veel zeldzamer. Aandoeningen van de longvaten komen als geïsoleerde ziekte weinig voor. Ziekteprocessen in de luchtwegen of in het longweefsel, of afwijkingen in de longcirculatie, hebben een groot effect op het functioneren van het lichaam. Een stoornis in de longfunctie leidt al snel tot een vermindering van de inspanningscapaciteit evenals tot het ontstaan van kortademigheidsklachten. Ondanks de goede afweer van de longen kunnen door de expositie aan de buitenwereld veel ziekten ontstaan die worden bepaald door een verminderde of een afwijkende afweer tegen partikels en micro-organismen in de ingeademde lucht. Bij systeemziekten zijn verschillende organen aangedaan, en staan soms de symptomen, verschijnselen en functiestoornissen van de longen op de voorgrond. Deze symptomen kleuren het klinische beeld en daarom worden deze systeemziekten vaak ook als longziekten besproken. ELEKTRONISCH AANVULLEND MATERIAAL: De online versie van dit hoofdstuk (doi:10.1007/978-90-368-1841-4_16) bevat aanvullend materiaal, dat beschikbaar is voor geautoriseerde gebruikers.
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7,840 |
Biogenesis of Dense-Core Secretory Granules
|
Dense core granules (DCGs) are vesicular organelles derived from outbound traffic through the eukaryotic secretory pathway. As DCGs are formed, the secretory pathway can also give rise to other types of vesicles, such as those bound for endosomes, lysosomes, and the cell surface. DCGs differ from these other vesicular carriers in both content and function, storing highly concentrated cores’ of condensed cargo in vesicles that are stably maintained within the cell until a specific extracellular stimulus causes their fusion with the plasma membrane. These unique features are imparted by the activities of membrane and lumenal proteins that are specifically delivered to the vesicles during synthesis. This chapter will describe the DCG biogenesis pathway, beginning with the sorting of DCG proteins from proteins that are destined for other types of vesicle carriers. In the trans-Golgi network (TGN), sorting occurs as DCG proteins aggregate, causing physical separation from non-DCG proteins. Recent work addresses the nature of interactions that produce these aggregates, as well as potentially important interactions with membranes and membrane proteins. DCG proteins are released from the TGN in vesicles called immature secretory granules (ISGs). The mechanism of ISG formation is largely unclear but is not believed to rely on the assembly of vesicle coats like those observed in other secretory pathways. The required cytosolic factors are now beginning to be identified using in vitro systems with purified cellular components. ISG transformation into a mature fusion-competent, stimulus-dependent DCG occurs as endoproteolytic processing of many DCG proteins causes continued condensation of the lumenal contents. At the same time, proteins that fail to be incorporated into the condensing core are removed by a coat-mediated budding mechanism, which also serves to remove excess membrane and membrane proteins from the maturing vesicle. This chapter will summarize the work leading to our current view of granule synthesis, and will discuss questions that need to be addressed in order to gain a more complete understanding of the pathway.
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7,841 |
Trichomonas
|
The most widely known trichomonad in veterinary medicine is Tritrichomonas foetus. It is the etiologic agent of bovine tritrichomonosis, a sexually transmitted disease in extensively managed herds throughout many geographic regions worldwide. The same trichomonad species is also regarded as the causative agent of chronic diarrhea in the domestic cat, although more recent studies observed molecular differences between bovine- and feline-derived T. foetus. Trichomonosis in cats has a worldwide distribution and is mainly present among cats from high-density housing environments. Other trichomonads are found as inhabitants of the gastrointestinal tract in birds, such as Trichomonas gallinae. Particularly, Columbiformes, Falconiformes, Strigiformes, and wild Passeriformes can be severely affected by avian trichomonads. Diagnosis of trichomonosis is often complicated by the fragility of the parasite. To ensure valid test results, it is essential to collect and handle specimens in the right way prior to analysis. Cultivation tests, the specific amplification of parasites, or a combination of both test methods is the most efficient and most commonly used way to diagnose trichomonosis in animals. Bovine tritrichomonosis is mainly controlled by the identification and withdrawal of infected animals from bovine herds. The control of feline and avian trichomonosis relies mainly on preventive measures.
|
7,842 |
Infection Control in the Intensive Care Unit
|
Many patients admitted to critical care units carry healthcare-associated multiresistant organisms, such as methicillin-resistant Staphylococcus aureus (MRSA), or may have a communicable infectious disease, such as pulmonary tuberculosis (TB). Special measures are, therefore, frequently required to prevent the spread of these pathogens to other patients on the unit. In general, these are referred to as infection control procedures.
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7,843 |
The Epidemic Process in Zoonoses and Sapronoses
|
This chapter could also be called eco-epidemiological basics or background information for zoonoses and sapronoses. Epidemiology is the study of the process of the origin and spread of transmissible (communicable) infectious diseases of man, and their control. The modern conception of epidemiology is broader in that it also includes non-infectious diseases (such as diabetes, heart attack, cardiovascular diseases and carcinomas) and variables that influence their distribution in the human population. In both the classical and modern conception of epidemiology, these factors include variables concerning the host (age, sex, nutrition, occupation), the agent (virulence, antigenic variability), and the environment (chemical factors, contamination, emissions, temperature, precipitation and humidity, illumination, ionising radiation, noise etc.). Epidemiological data are then analysed, and the results of these studies can then be used for the prevention and control of these human diseases.
|
7,844 |
Falciparum Malaria
|
Malaria is one of the most common infectious diseases in the world today, being the most important parasitic infection, and Plasmodium falciparum is the organism responsible for most of the mortality [1]. It has been estimated that approximately 300–500 million people contract malaria every year, with approximately 1–2 million deaths, most of these occurring in children [1–5]. Plasmodium falciparum, Mycobacterium tuberculosis and measles currently compete for the title of the single most important pathogen causing human morbidity and mortality [2, 3]. Infection with Plasmodium falciparum has a wide variety of potential clinical consequences [4, 6, 7].
|
7,845 |
Sequences Promoting Recoding Are Singular Genomic Elements
|
The distribution of sequences which induce non-standard decoding, especially of shift-prone sequences, is very unusual. On one hand, since they can disrupt standard genetic readout, they are avoided within the coding regions of most genes. On the other hand, they play important regulatory roles for the expression of those genes where they do occur. As a result, they are preserved among homologs and exhibit deep phylogenetic conservation. The combination of these two constraints results in a characteristic distribution of recoding sequences across genomes: they are highly conserved at specific locations while they are very rare in other locations. We term such sequences singular genomic elements to signify their rare occurrence and biological importance.
|
7,846 |
Schwimmerulkus
| null |
7,847 |
Intellectual Property Rights in Animal Biotechnology
|
Highlights: Animal biotechnology is oriented toward developing products at commercial scale. IPRs are essential components of animal biotechnology research and development.
|
7,848 |
Introduction to Bioterrorism Risk Assessment
| null |
7,849 |
Main Factors Influencing College Student Health and Countermeasures Proposal in Network Environment—From Physical Health Education Perspective
|
This dissertation adopts document-data method, comparative analysis method and Inductive deductive method to analyze main factors influencing college students’ physical and mental health from physical health education perspective. It elaborates the significance of physical health education and put up “health first” guideline for promoting health knowledge and cultivate sports skills, creating favorable conditions for physical health education implementation and switching college physical education focus to reform colleges and universities physical education assessment system.
|
7,850 |
Surveillance and Control of Communicable Disease in Conflicts and Disasters
|
To describe the principles of health surveillance in conflict and disaster situations. To assist in organising a health surveillance system in conflict and disaster situations. To describe the principles of control of communicable diseases in conflict and disaster situations. To assist in organising a response to outbreaks and epidemics. To introduce the challenges associated with health surveillance and communicable diseases in conflict and disaster situations.
|
7,851 |
Introduction to Socioecological Dimensions of Infectious Diseases and Health in Southeast Asia
|
Global changes affect host-pathogen interactions, through the modification of the epidemiological environment (climate, land use, biodiversity), leading to new and sometimes unexpected risks. Epidemics, emergence and re-emergence of infectious diseases are outcomes of these changes, and they constitute serious global threats for health. Although some local emergences have a potential for global threat (i.e. SARS, avian influenza, etc.), most of infectious diseases affect rural and poor populations particularly in developing countries, which are particularly vulnerable to the consequences of global change. Southeast Asia is both a hotspot of infectious emerging diseases of potential global pandemics and of biodiversity, particularly at threat due to dramatic changes in land use (Morand et al. 2014). These may explain why international organizations, developmental agencies and non-governmental conservationist organizations have specially focused on Southeast Asia. Infectious diseases are still a major concern in most Southeast-Asian countries (Coker et al. 2011).
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7,852 |
Picornaviruses
|
The picornavirus family contains several major human and animal pathogens. Vaccines against some of these pathogens are available. However, the availability of potent antiviral compounds would be an appreciable advantage in fighting these pathogens. Inside their non-enveloped capsid, picornaviruses possess a positive sense RNA genome with a single open reading frame. Upon release into the cytoplasm, the genome is translated into a single polyprotein that is processed by virally encoded proteinases. These proteinases represent excellent targets for the development of anti-virals for two reasons. First, efficient polyprotein processing is essential for successful viral replication. Second, the picornaviral proteinases show notable differences to cellular proteinases. To aid in the development of anti-virals, detailed knowledge of the mechanisms, substrate specificities and structures of these proteinases is needed. This chapter reviews recent progress, discusses selected substances with antiviral activity against picornavirus proteinases and outlines several new avenues for the design of novel anti-virals.
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7,853 |
Epidemiology and Control: Principles, Practice and Programs
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Infectious disease epidemiology is concerned with the occurrence of both infection and disease in populations and the factors that determine their frequency, spread, expression and distribution. Viruses show characteristic infectivity, virulence and pathogenicity. The most well established host factors are age, sex and race, but other host biological and behavioral factors affect acquisition of viral infection and/or its course and manifestations. The physical, chemical and biological environment operates on the virus itself and may also alter the host biological or behavioral response. Viral infections have incubation periods lasting days or weeks, while their pathologic sequelae may not manifest for years or decades. Likewise the degree or intensity of host response and clinical expression may range from largely inapparent to highly lethal. The degree of cell, tissue and organ specificity is high. Common syndromes involve the respiratory, gastrointestinal, and central nervous systems, the liver, and mucocutaneous surfaces. Vertical transmission may produce a variety of congenital and perinatal conditions. Viruses spread by multiple modes, using nearly every bodily surface or fluid as a route of exit or entry, either by direct contact or indirectly through an animal vector or other inanimate vehicle. Different viral Infections occur nearly ubiquitously or sporadically; they may be present continuously throughout a population (endemic) or occur in seasonal rhythm or in unexpectedly explosive form (epidemic). Many viruses are refractory to all known therapeutic agents, while for a few, the increasing number of highly effective agents holds great promise. Vaccines have produced many historical successes including the ultimate goal of eradication, but many viral infections continue to elude effective vaccine development. Major government and private sector programs for treatment and prevention have raised expectations of successful control for certain widespread and serious viral diseases; however, in every case a unique set of scientific, socioeconomic, political and behavioral barriers remains to be overcome.
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7,854 |
Management of Fluid Overload in the Pediatric ICU
|
The implications and management of fluid overload in pediatric critical care remain areas of ongoing controversy. Consensus definitions and methods of quantitating fluid overload continue to evolve, paralleling our growing understanding of fluid dynamics in critically ill patients. Fluid overload has been associated with adverse outcomes in some patient populations; guidelines for fluid management therapies are sparse and have little supporting data. Conflicting data for efficacy of therapies such as diuretic medications and renal replacement therapy are likely reflective of an incomplete understanding of the dynamic relationship between critical illness and fluid overload. Although some guidance regarding diuresis, continuous renal replacement therapy, and fluid balance goals is elucidated in the following chapters, it is important to recognize that further research into these management strategies is required before standardized approaches to management can be established.
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7,855 |
Nanotechnology — In Relation to Bioinformatics
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The first use of word “Nanotechnology” has been attributed to Norio Taniguchi in a paper published in 1974. Eric Drexler, in 1986, published book “Engines of Creation” in which he described his ideas of molecular nanotechnology used to build miniature machines and devices from the bottom up using self-assembly. Many scientists from mainstream disciplines—biology, chemistry or physics—will argue of course that they are and have been ‘doing’ nanotechnology for years and that it is nothing new. Indeed chemists play with atoms and molecules which are sub-nano and molecular biology deals with the understanding and application of biological nano-scale components. Nature has used nanotechnology and, in fact, it has taken millions of years to develop this by a process of evolution and natural selection. Nanotechnology is an emerging research field which promises to have a wide range of interesting applications. Nanotechnology, encompasses all technology that aims to create nanometre-scaled structures or is able to address or manipulate matter at the nanometre level.
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7,856 |
Fundamental Principles for Luminescence Sensing Measuring Devices Used for the Detection of Biological Warfare Agents
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This chapter surveys the current detection technologies used in commercially available luminescence biosensor detection equipments currently employed for identifying warfare biological agents (BAs). Brief technical descriptions of these technologies are presented with emphasis placed on the principles of detection. Much of the content presented was obtained from the open-source literature and is an introduction to biosensor fundamentals
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7,857 |
Infection Prevention in Pediatric Oncology and Hematopoietic Stem Cell Transplant Recipients
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Pediatric patients with malignancies and transplant recipients are at high risk of infection-related morbidity and mortality. Children at the highest risk for infections are those with acute myeloid leukemia (AML), relapsed acute lymphoblastic leukemia (ALL), and hematopoietic stem cell transplant recipients (HSCT). These patients are at high risk for life-threatening bacterial, viral, and fungal infections which are associated with prolonged hospital stay, poor quality of life, and increased healthcare cost and death. Recognition of risk factors which predisposes them to infections, early identification of signs and symptoms of infections, prompt diagnosis, and empiric/definitive treatment are the mainstay in reducing infection-related morbidity and mortality. Infection control and prevention programs also play a crucial role in preventing hospital-acquired infections in these immunosuppressed hosts.
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7,858 |
Life Threatening Tropical Infections
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Infectious diseases are among the most common pediatric illnesses and are frequently encountered in the pediatric intensive care unit. Tropical infections, on the other hand, are relatively uncommon in children in developed countries, except those with pertinent travel histories or recent immigration. Clinicians who participate in mission work and disaster relief work also encounter these diseases as they are endemic in many developing nations. For the most part these infections do not result in critical illness however some do and this chapter will focus on a few of the more common infections with potential to be acutely life threatening. The epidemiology, pathophysiology, clinical manifestations, and current clinical management are presented for severe malaria, dengue fever, typhoid, and leptospirosis.
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7,859 |
Cryptococcosis
|
Cryptococcosis is an infectious disease caused by the encapsulated fungi Cryptococcus neoformans and Cryptococcus gattii. Once a relatively uncommon cause of human disease, cryptococcal infection can develop in apparently immunocompetent hosts and has emerged as an important opportunistic infection in humans over the past several decades as immunocompromised populations expand in the setting of HIV/AIDS, organ transplantation, malignancies, and treatment for other conditions. Clinical manifestations are myriad but pulmonary and central nervous system (CNS) infections are the most common. Improvements in diagnostic testing and standardized approaches to antifungal therapy, when available, have made considerable impact in the management of this infection. While the widespread use of highly active antiretroviral therapy (HAART) has improved the outcome of cryptococcosis in many HIV-infected patients, cryptococcosis remains an entity of considerable morbidity and mortality in many parts of the world, and restoration of host immunity can present management challenges that require individualized management. As immunocompromised populations continue to expand, it is likely that cryptococcosis will remain an important opportunistic fungal infection of humans requiring ongoing investigation.
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7,860 |
Grid Computing for Disaster Mitigation
|
The infamous 2004 Andaman tsunami has highlighted the need to be prepared and to be resilient to such disasters. Further, recent episodes of infectious disease epidemics worldwide underline the urgency to control and manage infectious diseases. Universiti Sains Malaysia (USM) has recently formed the Disaster Research Nexus (DRN) within the School of Civil Engineering to spearhead research and development in natural disaster mitigation programs to mitigate the adverse effects of natural disasters. This paper presents a brief exposition on the aspirations of DRN towards achieving resilience in communities affected by these natural disasters. A brief review of the simulations of the 2004 Andaman tsunami, with grid application is presented. Finally, the application of grid technology in large scale simulations of disease transmission dynamics is discussed.
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7,861 |
Structural and Functional Properties of Viral Membrane Proteins
|
Viruses have developed a large variety of transmembrane proteins to carry out their infectious cycles. Some of these proteins are simply anchored to membrane via transmembrane helices. Others, however, adopt more interesting structures to perform tasks such as mediating membrane fusion and forming ion-permeating channels. Due to the dynamic or plastic nature shown by many of the viral membrane proteins, structural and mechanistic understanding of these proteins has lagged behind their counterparts in prokaryotes and eukaryotes. This chapter provides an overview of the use of NMR spectroscopy to unveil the transmembrane and membrane-proximal regions of viral membrane proteins, as well as their interactions with potential therapeutics.
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7,862 |
Whistleblowing and Research Integrity: Making a Difference Through Scientific Freedom
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Whistle-blowers, who speak out in the public interest, are important players in challenging abuses of power. In science, where trust in processes and outcomes is vital, whistle-blowing is especially important. Case studies of US research whistle-blowers show the challenges they face, the reprisals they suffer, and the significant difference they make through their efforts. Legal protections for whistle-blowers are valuable but not enough on their own. Key potential allies for whistle-blowers are scientific peers, government agencies, legislators, media, and NGOs. These allies can provide corroboration, advocacy, and solidarity.
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7,863 |
Introduction to Bioterrorism Risk Communication
| null |
7,864 |
A Web Search Method Based on the Temporal Relation of Query Keywords
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As use of the Web has become more popular, searching for particular content has been refined by allowing users to enter multiple keywords as queries. However, simple combinations of multiple query keywords may not generate satisfactory search results. We therefore propose a search method which automatically combines query keywords to generate queries by extracting the relations among query keywords. This method consists of two Web search processes: one to determine the temporal relations between query keywords, and one to generate queries based on the obtained temporal relations. We discuss these two processes along with experimental results and implementation issues regarding a prototype system.
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7,865 |
Current Status and Future Outlook for Nonwovens in Japan
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More than half a century has already passed since the production of nonwovens began in Japan. In January 1996, the Ministry of International Trade and Industry (presently the Ministry of Economy, Trade and Industry) modified the contents of production dynamics, and statistical surveys of nonwovens have come to be independently reported. Up to 2000, the nonwoven industry in Japan had been developing steadily. After the industry experienced a slowdown, it began to grow again and marked historical records consecutively in 2007 and 2008. However, the industry stopped growing and decreased in 2009 due to simultaneous declines of the world’s economies. At present, there are certain signs of a recovery, but people engaged in the industry are uncertain whether the business will continue to grow in the future.
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7,866 |
DCD for Islet Transplantation
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Pancreatic islet transplantation has the potential to become the most physiologically advantageous and minimally invasive procedure for the treatment of type 1 diabetes mellitus. Since the first clinical islet transplantation was performed at the University of Minnesota in 1974 [1], the results have been far from ideal for more than two decades in spite of an improvement of islet isolation technique by Ricordi et al. [2–4]. The introduction of the Edmonton protocol, with a highly improved rate of insulin independency, encouraged us to promote clinical islet transplantation [5, 6]. In Japan, we organized the Working Group (The Japanese Islet Transplant Registry) in 1997 under the Japanese Society for Pancreas and Islet Transplantation for the purpose of starting clinical islet transplantation. The first issue of the Working Group was to construct a system of clinical islet transplantation in Japan including the registration of the recipients, procurement of the pancreas for islet isolation and transplantation of the isolated islets. In Japan, afterwards, various problems facing to a start of clinical islet transplantation have been discussed and we completed the guideline for clinical islet transplantation in Japan. The Japanese Organ Transplant Law was enforced in 1997 and organ transplantations using brain dead (DBD) donors were finally started. Since the islet transplantation was not included in the Japanese Organ Transplant Law because it was categorized as tissue transplantation, we were able to use the pancreas only from DCD donors for islet transplantation. The first islet isolation from the human pancreas was performed in 2003.9 and the first islet transplantation was performed in 2004.4 [7–9]. Sixty-five islet isolations and 34 islet transplantations were performed in our country from 2003.9.12 to 2007.3.11 [10]. In this chapter, we describe the current status of clinical islet transplantation using DCD donors in Japan.
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7,867 |
Update on Avian Influenza for Critical Care Physicians
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Human influenza pandemics over the last 100 years have been caused by H1, H2, and H3 subtypes of influenza A viruses. More recently, avian influenza viruses have been found to directly infect humans from their avian hosts. The recent emergence, host expansion, and spread of a highly pathogenic avian influenza (HPAI) H5N1 subtype in Asia has heightened concerns globally, both in regards to mortality of HPAI H5N1 in humans and the potential of a new pandemic. In response, many agencies and organizations have been working collaboratively to develop early detection systems, preparedness plans, and objectives for further research. As a result, there has been a large influx of published information regarding potential risk, surveillance, prevention and control of highly pathogenic avian influenza, particularly in regards to animal to human and subsequent human to human transmission. This chapter will review the current human infections with avian influenza and its public health and medical implications.
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7,868 |
A Multiplex Polymerase Chain Reaction for Differential Detection of Turkey Coronavirus from Chicken Infectious Bronchitis Virus and Bovine Coronavirus
|
A multiplex polymerase chain reaction (PCR) method for differential detection of turkey coronavirus (TCoV), infectious bronchitis virus (IBV), and bovine coronavirus (BCoV) is presented in this chapter. Primers are designed from the conserved or variable regions of nucleocapsid (N) or spike (S) protein genes of TCoV, IBV, and BCoV and used in the same PCR reaction. Reverse transcription followed by PCR reaction is used to amplify a portion of N or S gene of the corresponding coronaviruses. Two PCR products, a 356-bp band corresponding to N gene and a 727-bp band corresponding to S gene, are obtained for TCoV. In contrast, one PCR product of 356 bp corresponding to a fragment of N gene is obtained for IBV strains and one PCR product of 568 bp corresponding to a fragment of S gene is obtained for BCoV.
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7,869 |
Myroides odoratus/odoratimimus
| null |
7,870 |
Phenotypes of Liver Diseases in Infants, Children, and Adolescents
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Liver disease in childhood is rare and is frequently the cause of dismay as the medical care provider attempts to recall the myriad of diagnoses that they read about during their training but may never have encountered. The aim of this chapter is to describe hepatic disease phenotypes based on age and primary manifestation of liver disease such as cholestasis, hepatomegaly, or acute liver failure and to provide a reasonably comprehensive list of hepatic diseases that may present with the clinical phenotypes. The hope is to help primary medical providers determine the differential diagnosis and thus guide early studies and appropriate referral and pediatric gastroenterologists and trainees to determine a comprehensive differential diagnosis for their patients on which to base a rational work-up and management plan. Our patients range from day-old premature infants to 18-year-old postpubescent teens and from seemingly healthy children in the outpatient clinic to profoundly sick infants in ICU on life support. The best way to determine a diagnosis safely and efficiently is to develop a deep understanding of the pathophysiology of liver disease, but even for the most experienced, a checklist of diagnostic possibilities may be helpful to ensure no oversights.
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7,871 |
The Acute Respiratory Distress Syndrome: Diagnosis and Management
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Acute respiratory distress syndrome (ARDS) is characterized by a new acute onset of hypoxemia secondary to a pulmonary edema of non-cardiogenic origin, bilateral lung opacities and reduction in respiratory system compliance after an insult direct or indirect to lungs. Its first description was in 1970s, and then several shared definitions tried to describe this clinical entity; the last one, known as Berlin definition, brought an improvement in predictive ability for mortality. In the present chapter, the diagnostic workup of the syndrome will be presented with particular attention to microbiological investigations which represent a milestone in the diagnostic process and to imaging techniques such as CT scan and lung ultrasound. Despite the treatment is mainly based on supportive strategies, attention should be applied to assure adequate respiratory gas exchange while minimizing the risk of ventilator-induced lung injury (VILI) onset. Therefore will be described several therapeutic approaches to ARDS, including noninvasive mechanical ventilation (NIMV), high-flow nasal cannulas (HFNC) and invasive ventilation with particular emphasis to risks and benefits of mechanical ventilation, PEEP optimization and lung protective ventilation strategies. Rescue techniques, such as permissive hypercapnia, prone positioning, neuromuscular blockade, inhaled vasodilators, corticosteroids, recruitment maneuvers and extracorporeal life support, will also be reviewed. Finally, the chapter will deal with the mechanical ventilation weaning process with particular emphasis on extrapulmonary factors such as neurologic, diaphragmatic or cardiovascular alterations which can lead to weaning failure.
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7,872 |
Lungenparenchymerkrankungen
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Das Lungenemphysem ist pathologisch-anatomisch definiert. Man versteht darunter eine irreversible abnorme Erweiterung der lufthaltigen Räume distal der Bronchioli terminales, die mit einer Destruktion der Alveolarsepten einhergeht. Neben der chronischen Bronchitis und der Bronchiolitis ist das Lungenemphysem eine der morphologischen Komponenten der chronisch-obstruktiven Lungenkrankheit (COPD). Bei fortgeschrittenen Formen der COPD besteht mit Regelmäßiigkeit ein erhebliches Lungenemphysem.
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7,873 |
Study of Inhibitors Against SARS Coronavirus by Computational Approaches
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Called by many as the biology's version of Swiss army knives, proteases cut long sequences of amino acids into fragments and regulate most physiological processes. They are vitally important in life cycle and have become a main target for drug design. This Chapter is focused on a special protease that plays a key role in replicating SARS (Severe Acute Respiratory Syndrome) coronavirus, the culprit of SARS disease. The progresses reported here are mainly from various computational approaches, such as structural bioinformatics, pharmacophore modelling, molecular docking, and peptide-cleavage site prediction, among others. It is highlighted that the compounds C(28)H(34)O(4)N(7)Cl, C(21)H(36)O(5)N(6) and C(21)H(36)O(5)N(6), as well as KZ7088, a derivative of AG7088, might be the promising candidates for further investigation, and that the octapeptides ATLQAIAS and ATLQAENV, as well as AVLQSGFR, might be converted to effective inhibitors against the SARS protease. Meanwhile, how to modify these octapeptides based on the “distorted key” theory to make them become potent inhibitors is explicitly elucidated. Also, a brief introduction is given for how to use computer-generated graphs to rapidly diagnose SARS coronavirus. Finally, a step-by-step protocol guide is given on how to use ProtIdent, a web-server developed recently, to identify the proteases and their types based on their sequence information alone. ProtIdent is a very user-friendly bioin-formatics tool that can provide desired information for both basic research and drug discovery in a timely manner. With the avalanche of protein sequences generated in the post-genomic age, it is particularly useful. ProtIdent is freely accessible to the public via the web-site at http://www.csbio.sjtu.edu.cn/bioinf/Protease/.
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7,874 |
Glycyrrhiza glabra
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Liquorice foliage
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7,875 |
Abkürzungen
| null |
7,876 |
Stevens–Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN): Immunologic Reactions
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Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are immunologic reactions to several stimuli, mostly medications, which present as a spectrum of primarily widespread mucocutaneous lesions, but also with other organ involvement. Pathology is characterized by full thickness necrosis of the epithelial layer of the involved organ due to immune-mediated apoptosis of the resident keratinocytes. High suspicion for early detection and quick withdrawal of the culprit medication are the most important steps in stopping this reaction. Aggressive supportive care is often necessary as the patient recovers. Steroids, other immunosuppressants, and plasmapheresis have all been studied as treatments, but high-quality evidence supporting their contributions, either together or separately, in decreasing length of hospital stay or prolonging survival have not been consistently demonstrated. Further studies of the mechanism of action and novel treatment modalities are still needed to improve outcomes in patients with this rare but often fatal condition.
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7,877 |
Communicable Diseases and Emerging Pathogens: The Past, Present, and Future of High-Level Containment Care
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High-level containment care involves the management of patients with highly hazardous communicable diseases in specialized biocontainment units possessing a unique collection of engineering, administrative, and personnel controls. These controls are more stringent than those found in conventional airborne infection isolation rooms and provide additional safeguards against nosocomial disease transmission. Borne amidst a convergence of events in 1969, the employment of HLCC units was validated during the 2014–2016 Ebola virus disease outbreak, and the United States (as well as many other nations) is in the process of expanding its HLCC capacity. Beyond Ebola, however, the specific diseases that might warrant care in a HLCC unit remain unclear. We review here the fascinating history of HLCC and of biocontainment units and make recommendations regarding those highly hazardous communicable diseases that might optimally be managed in these units.
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7,878 |
Spezifische Infektionen
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Die Tuberkulose ist die weltweit häufigste infektionsbedingte Todesursache und führt nur selten zur Aufnahme auf der Intensivstation. Hauptgründe für eine Intensivtherapie sind eine respiratorische Insuffizienz, Thoraxeingriffe, fortgeschrittene Tbc-Meningitis, tuberkulöse Perikarditis, Nebenwirkungen von Tuberkulostatika und eine tuberkuloseassoziierte Addison-Krise [11].
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7,879 |
Infectious Atypical Pneumonia
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Infectious atypical pneumonia, also known as severe acute respiratory syndrome (SARS), is an acute respiratory infectious disease caused by SARS coronavirus (SARS-CoV). Clinically, it is characterized by fever, headache, muscular soreness, fatigue, dry cough rarely with phlegm, and diarrhea. Most patients experience accompanying pneumonia. In severe cases, the conditions may develop into acute lung injury, acute respiratory distress syndrome (ARDS), or even multiple organ failure that causes death. In China, SARS has been legally listed as one of the class B infectious diseases but is managed as class A infectious diseases, like anthrax and human infection of avian influenza.
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7,880 |
Surgical Complications of Childhood Tumors
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Most childhood tumors will first present to a physician; some tumors will present in an atypical manner and may mimic a surgical condition. The diagnosis may be missed if the surgeon is not aware of the possibility of cancer. A very great number of rare presentations of childhood cancer have been described in the literature. It is important that the surgeon who is not experienced in the management of childhood cancer is aware that an apparently benign condition could be a manifestation of an underlying malignancy [71, 83] (Table 22.1).
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7,881 |
Methods to Induce Cardiac Hypertrophy and Insufficiency
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Animal models of cardiac hypertrophy and insufficiency have been reviewed by Hasenfuss (1988), Muders and Elsner (2000), Vanoli et al. (2004), Patten and Hall-Porter (2009), Dubi and Arbel (2010), Gomes et al. (2013), and Szymanski et al. (2012).
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7,882 |
Chemokines in Coronavirus-Induced Demyelination
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Inflammation within the central nervous system (CNS) is critical in the development of the neuropathology associated with the human demyelinating disease multiple sclerosis (MS). Recent studies have identified a family of soluble proinflammatory molecules called chemokines that are able to direct leukocyte infiltration into the CNS in response to infection or injury. Identification of chemokines within and around demyelinating lesions in MS patients indicate a potential role for these molecules in contributing to the pathogenesis of MS. To address this issue, we have used mouse hepatitis virus (MHV) infection of the CNS to understand the dynamic interaction of chemokine expression as it relates to inflammation and neuropathology. Our results indicate that chemokine expression within the CNS results in persistent recruitment of both T lymphocytes and macrophages and results in subsequent myelin destruction. Herein, we demonstrate the complexity of the chemokine response to MHV infection of the CNS and the delicate balance that exists between host defense and development of disease.
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7,883 |
Brain and the Liver: Cerebral Edema, Hepatic Encephalopathy and Beyond
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Occurrence of brain dysfunction is common in both chronic liver disease as well as acute liver failure. While brain dysfunction most commonly manifests as hepatic encephalopathy is chronic liver disease; devastating complications of cerebral edema and brain herniation syndromes may occur with acute liver failure. Ammonia seems to play a central role in the pathogenesis of brain dysfunction in both chronic liver disease and acute liver failure. In this chapter we outline the pathophysiology and clinical management of brain dysfunction in the critically ill patients with liver disease.
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7,884 |
Heat Shock Proteins and the Resolution of Inflammation by Lymphocytes
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Depletion of phagocytes that infiltrate host organs like the lungs reduces inflammatory damage to tissues. Understanding the mechanisms by which this process occurs could lead to new therapeutic approaches to limit the detrimental effects of inflammation. The lungs, gastrointestinal tract, and skin are particularly prone to infection. Specialized immune cells protect these organs from tissue damage by eliminating phagocytes from inflamed tissues by recognizing signals produced by the phagocytes. One such signal is heat shock proteins (HSP) expressed on the cell surface of phagocytes. These HSP closely resemble their microbial equivalents, and therefore phagocytes that are labeled by HSP are recognized as target cells. T lymphocytes bearing γδT cell receptor (TCR) elicit fast responses to invading pathogens. Since the γδTCR has limited germline-encoded diversity, HSP are an ideal target for recognition by these cells. γδT cells exert cytotoxic actions towards macrophages and neutrophils that express Hsp60 or Hsp70, respectively, on their cell surface. Through the recognition of HSP on the cell surface of inflamed cells, γδT cells eliminate phagocytes from inflammatory sites, thereby preventing host tissue damage
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7,885 |
Bioinformatics
|
After reading this chapter, you should know the answers to these questions:
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7,886 |
Cardiovascular Activity
| null |
7,887 |
Reisemedizin
|
Tauchgebiete befinden sich oft in exotischen, subtropischen oder tropischen Gebieten. Der Taucherarzt sollte neben Ratschlägen zum Tauchen auch Information über Krankheiten und deren Prophylaxe vermitteln.
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7,888 |
The Ecology of Eating Systems
| null |
7,889 |
Waterborne Viral Gastroenteritis: An Introduction to Common Agents
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Acute gastroenteritis is among the most common illnesses of human beings, and its associated morbidity and mortality are greatest among those at the extremes of age; children and elderly. During the 1970s, several viruses were associated with this syndrome, which are now known to be caused mainly by viruses belonging to four distinct families—rotaviruses, caliciviruses, astroviruses, and adenoviruses. Other viruses, such as the toroviruses, picobirnaviruses, coronavirus, and enterovirus 22, may play a role as well. Transmission by food or water has been documented for astroviruses, caliciviruses, rotaviruses, and norovirus. In developing countries, gastroenteritis is a common cause of death in children <5 years, while deaths from diarrhea are less common, much illness leads to hospitalization or doctor visits. Laboratory confirmation of waterborne illness is based on demonstration of virus particles or antigen in stool, detection of viral nucleic acid in stool, or demonstration of a rise in specific antibody to the virus. Newer methods for syndrome surveillance of acute viral gastroenteritis are being developed like multiplex real-time reverse transcriptase PCRs. Application of these more sensitive methods to detect and characterize individual agents is just beginning, but has already opened up new avenues to reassess their disease burden, examine their molecular epidemiology, and consider new directions for their prevention and control through vaccination, improvements in water quality, and sanitary practices.
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7,890 |
Role of Zinc and Selenium in Oxidative Stress and Immunosenescence: Implications for Healthy Ageing and Longevity
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Ageing is an inevitable biological process with gradual and spontaneous biochemical and physiological changes and increased susceptibility to diseases. Some nutritional factors (zinc and selenium) may remodel these changes leading to a possible escaping of diseases with subsequent healthy ageing, because they are especially involved in improving immune functions as well as antioxidant defense. Experiments performed “in vitro” (human lymphocytes exposed to endotoxins) and “in vivo” (old mice or young mice fed with low zinc dietary intake) show that zinc is important for immune response both innate and adoptive. Selenium provokes zinc release by Metallothioneins (MT), via reduction of glutathione peroxidase. This fact is crucial in ageing because high MT may be unable to release zinc with subsequent low intracellular free zinc ion availability for immune response. Taking into account the existence of zinc transporters (ZnT and ZIP family) for cellular zinc efflux and influx, respectively, the association between ZnT and MT is important in maintaining satisfactory intracellular zinc homeostasis in ageing. Improved immune performance occur in elderly after physiological zinc supplementation, which also induces prolonged survival in old, nude and neonatal thymectomized mice. The association “zinc plus selenium” improves humoral immunity in old subjects after influenza vaccination. Therefore, zinc and selenium are relevant for immunosenescence in order to achieve healthy ageing and longevity.
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7,891 |
The Role of Metalloproteinases in Corona Virus Infection
|
Infection with neurotropic strains of mouse hepatitis virus (MHV) results in rapid leukocyte infiltration into the central nervous system (CNS). The inflammatory response controls virus replication but fails to mediate sterile clearance. The persistence of viral RNA and inflammatory cells within the CNS is associated with the development of ongoing demyelination. Matrix metalloproteinases (MMPs) are a family of proteases involved in degradation of the extracellular matrix (ECM). During inflammatory responses MMPs are thought to play a significant role in breaking down the basement membrane surrounding blood vessels as well as parenchymal ECM thereby facilitating leukocyte infiltration. MMPs have also been associated with activation of chemokines and perhaps more significantly the degradation of myelin proteins and generation of autoantigens. Recent examination of MMP expression during MHV infection suggests that MMP-3, -9 and -12 are involved in the inflammatory response. The proinflammatory effects of these MMPs are likely tempered by induction of tissue inhibiter of metalloproteinase-1 expression.
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7,892 |
A Practical Way to Improve Access to Essential Medicines Against Major Infectious Diseases
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With the frequent outbreak of major infectious diseases such as HIV/AIDS, SARS, and H1N1, it is increasingly important for countries to have the capability to safeguard the health of their citizens and manage public health crises. The key to success lies in the availability and accessibility of essential medicines. Pushed by developing countries and international nongovernmental organizations, the conflicts regarding public access to essential medicines and protection of patented drugs have gained global attention. This chapter briefly introduces the history of the global response to the above challenges, beginning with the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement through the adoption of the Doha declaration and the protocol amending the World Trade Organization’s (WTO) agreement on TRIPS. Then, it discusses the practice of compulsory licenses in both developing and developed countries and describes the huge market demand for generic drugs against infectious disease in developing countries. Finally, the chapter describes the capacity of generic drug production in major developing countries, such as India and China, as well as the roles of these countries in providing generic drugs to patients at home and to other developing countries. History has repeated itself many times due to a continued lack of essential medicines; the initial epidemic of infectious disease in developing countries has become pandemic, spreading throughout the globe. Therefore, any efforts taken by developing countries to increase access to essential medicines against infectious disease are beneficial to people in both developing and developed countries. The developing countries with the capacity and experience to develop generic drugs for public use should learn from each other and collaborate in the research, production, and distribution of generic drugs under the rights granted by the WTO agreement. Developed countries and big pharmaceutical companies should be allies rather than opponents for the ultimate goal of health promotion for all of mankind.
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7,893 |
Fever Management in Intensive Care Patients with Infections
|
Fever is one of the cardinal signs of infection and, nearly 120 years after William Osler’s statement in his address to the 47(th) annual meeting of the American Medical Association [1], infectious diseases remain a major cause of morbidity and mortality. Despite this, it is unclear whether fever itself is truly the enemy or whether, in fact, the febrile response represents an important means to help the body fight infection. Furthermore, it is unclear whether the administration of antipyretic medications or physical cooling measures to patients with fever and infection is beneficial or harmful [2, 3]. Here, we review the biology of fever, the significance of the febrile response in animals and humans, and the current evidence-base regarding the utility of treating fever in intensive care patients with infectious diseases.
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7,894 |
eMicrob: A Grid-Based Spatial Epidemiology Application
|
The use of Grid technologies allows us to make progress in the prediction accuracy of epidemiological patterns, epidemiological modeling, risk predictions of infectious diseases etc by combining the geo-information and molecular simulation analysis methods. In this paper, we mainly design the eMicrob, in particular, build up the e-Microbe miniGrid deployed in IRSA, CAS and IME, the Chinese PLA. The architecture is as follows: Firstly we review related grid applications that are motivating widespread interest in Grid concepts within the scientific and engineering communities. Secondly we talk about the key methodologies and strategies involved in the construction of eMicrob. In the third section, the system design of the eMicrob, in particular about the architecture of the eMicrob miniGrid is discussed. Finally, we draw some conclusion in the process of the building of eMicrob and make some discussion about the challenges. It has been proven that the methods based on the Grid technologies are revolutionary and high efficient through the experience of the establishment and deployment of the e-Microbe miniGrid.
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7,895 |
Antiviral Resistance in Influenza Viruses: Clinical and Epidemiological Aspects
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There are three classes of antiviral drugs approved for the treatment of influenza: the M2 ion channel inhibitors (amantadine, rimantadine), neuraminidase (NA) inhibitors (laninamivir, oseltamivir, peramivir, zanamivir), and the protease inhibitor (favipiravir); some of the agents are only available in selected countries [1, 2]. These agents are effective at treating the signs and symptoms of influenza in patients infected with susceptible viruses. Clinical failure has been demonstrated in patients infected with viruses with primary resistance, i.e., antivirals can be present in the virus initially infecting the patient, or resistance may emerge during the course of therapy [3–5]. NA inhibitors are active against all nine NA subtypes recognized in nature [6], including highly pathogenic avian influenza A/H5N1 and recent low-pathogenic avian influenza A/H7N9 viruses [7]. Since seasonal influenza is usually an acute, self-limited illness in which viral clearance usually occurs rapidly due to innate and adaptive host immune responses, the emergence of drug-resistant variants would be anticipated to have limited effect on clinical recovery in otherwise healthy patients, as has been demonstrated clinically [3, 8, 9]. Unfortunately, immunocompromised or immunologically naïve hosts, such as young children and infants or those exposed to novel strains, are more likely to have mutations that confer resistance emergence during therapy; such resistant variants may also result in clinically significant adverse outcomes [10–13].
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7,896 |
Killing More than Pain: Etiology and Remedy for an Opioid Crisis
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The search for effective pain relief has been ever present across human history. The discovery of opium’s ability to relieve pain stimulated the refinement of opium and generation of synthetic analogues to create more effective, potent, and faster-acting analgesics. The social and economic value of opioids has remained high not only due to their demonstrated efficiency in mitigating pain but also their noteworthy ability to reliably produce rewarding psychological effects. Consequently, at various times during the past several hundred years, opioids have sparked wars, fueled black markets and cartel crime, and triggered numerous opioid addiction and overdose death epidemics around the world. The increased therapeutic desire to address pain together with pharmaceutical discoveries in medication design, rapid manufacture, and highly effective opioid marketing and distribution has led more recently to increased availability and accessibility to potent prescription opioids, which has sparked the deadliest overdose crisis in human history. This chapter describes the etiology and epidemiology of the opioid crisis using public health and Health Belief Model frameworks and reviews approaches that have been applied to address supply (e.g., overprescribing) and demand (e.g., medication treatments) sides of the equation. Causes of the growth and spread of the overdose epidemic are analyzed as a way to inform a successful end to the current crisis as well as to prevent future epidemics.
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7,897 |
Airway Anatomy, Physiology, and Inflammation
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Approximately 10,000 l of air and 8,000 l of blood transit the respiratory system each day driven by small pressure gradients developed in response to rhythmic contraction and relaxation of striated muscle under both voluntary and involuntary control of the central nervous system. Matching of air- and blood flow results from central and local reflexes responding to both internal and external stimuli and subsequently controlling the pumps, as well as the smooth muscle in walls of the airways and blood vessels. A wide range of neural and immune mechanisms protect the lungs against environmental insults, and many are adaptive in nature, resulting in memory that increases sensitivity and responsiveness upon repeated exposure to stimuli. In over 10 % of the population, the responses to environmental stimuli become pathological, resulting in excessive sensitivity and aberrant responses to both specific and nonspecific stimuli, and culminate in physical remodeling of the airways and lungs. Prevention, definitive diagnosis, and effective treatment of the disorders require a better understanding of the mechanisms underlying excessive responses to environmental stimuli.
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7,898 |
Medical Management of Acute Rhinosinusitis in Children and Adults
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Acute rhinosinusitis is a commonly seen disease that is frequently diagnosed based on clinical symptomatology without any objective evidence. The most common form of treatment is antibiotics, even though many cases may not have a bacterial etiology. The most common bacterial organisms in childhood sinusitis belong to the group that cause many childhood upper respiratory and lower respiratory infections and include Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. Besides antibiotics, other treatments are aimed at assisting with drainage, and this can be accomplished by reducing the inflammation and edema that prevents venting of the sinus structures. These medications can include antihistamines, decongestants, intranasal steroids, nasal saline irrigation, and, in some countries, mucolytics. Complementary and alternative medicine (CAM) techniques including Chinese herbal medications are often used, but there is little scientific evidence to support their use. The use of immunotherapy has not been found to be effective in the management of acute rhinosinusitis in children or adults.
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7,899 |
Haut und Tiere
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Tiere spielen in der Pathogenese zahlreicher Hautkrankheiten eine bedeutende Rolle. Für den Hautarzt sind klinische Angaben zu vorausgegangenem Tierkontakt von großer klinischer und differenzialdiagnostischer Bedeutung. Tiere können als Vektoren gefährlicher pathogener Krankheitserreger wie Viren, Bakterien, Protozoen, Pilze und Würmer fungieren, Ektoparasiten auf die Haut übertragen, selbst auf beziehungsweise in der Haut parasitieren, aber auch durch Tierallergene und Toxine lokale kutane Intoleranzreaktionen, systemische toxische sowie anaphylaktische Reaktionen mit tödlichem Ausgang herbeiführen [9, 43, 111, 114]
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