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Mystery novels by P. L. Gaus, Linda Castillo, Harry Dolan, Colin Cotterill and Lars Kepler.
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Revisiones bibliográficas. Documentación científica en Ortopedia y Traumatología, medicina deportiva, artroscopia, artroplastia y de todas las patologías del sistema Músculo-Esquelético
sábado, 23 de julio de 2011
Book Review
Hantavirus Pulmonary Syndrome
Steven Q. Simpson, MD*, Leslie Spikes, MD, Saurin Patel, MD,
Ibrahim Faruqi, MD, MPH
KEYWORDS
Hantavirus Pneumonia Viral pneumonia
Acute respiratory failure Hemorrhagic fever
Hantavirus pulmonary syndrome (HPS), a disease now known to have been present
for centuries, if not millennia, in the Americas was discovered only 16 years ago in
the southwestern United States.1 Two young long-distance runners who lived together
in the New Mexican desert fell victim in early May, 1993, to what seemed to be a rapidly
progressive pulmonary infection, and both of them died within days. The unusual
circumstance of two highly fit individuals succumbing in this manner, especially in
the spring, led health officials to investigate the cause and initiate surveillance for
other, similar cases. It soon became evident that they were in the midst of an outbreak
of a seriously deadly infectious agent and that the syndrome was one that had not
been previously described by the medical community.
The causative agent for the illness was soon (<6 weeks after the index cases were
identified) determined to be an unidentified North American member of the Hantavirus
genus. The clinical syndrome caused by this agent, ultimately named Sin Nombre virus
(SNV), came to be called the hantavirus pulmonary syndrome. This designation distinguished
it from previously described hantaviral illnesses, which were characterized as
hemorrhagic fever with renal syndrome (HFRS). Early in the course of events it became
evident that cardiac function, and respiratory function, are markedly impaired by
infection with this virus. For that reason, some authors have adopted the moniker
Hantavirus cardiopulmonary syndrome. Although that name certainly has logic, the
Centers for Disease Control and Prevention (CDC) continue to refer to the illness as
HPS, as does this article.
HANTAVIRUSES
The hantaviruses are an enveloped genus of the family Bunyaviridae. Virions are spherical
and encapsulated by a bilayered phospholipid membrane. The composition of each
virion is greater than 50% protein, 20% to 30% lipid, and 2% to 7% carbohydrate,
____________________________________________________________________
Division of Pulmonary and Critical Care Medicine, University of Kansas, 3901 Rainbow
Boulevard, Mail Stop 3007, Kansas City, KS 66160-7381, USA
* Corresponding author.
E-mail address: ssimpson3@kumc.edu (S.Q. Simpson).
Infect Dis Clin N Am 24 (2010) 159–173
doi:10.1016/j.idc.2009.10.011 id.theclinics.com
0891-5520/10/$ – see front matter ª 2010 Elsevier Inc. All rights reserved
Steven Q. Simpson, MD*, Leslie Spikes, MD, Saurin Patel, MD,
Ibrahim Faruqi, MD, MPH
KEYWORDS
Hantavirus Pneumonia Viral pneumonia
Acute respiratory failure Hemorrhagic fever
Hantavirus pulmonary syndrome (HPS), a disease now known to have been present
for centuries, if not millennia, in the Americas was discovered only 16 years ago in
the southwestern United States.1 Two young long-distance runners who lived together
in the New Mexican desert fell victim in early May, 1993, to what seemed to be a rapidly
progressive pulmonary infection, and both of them died within days. The unusual
circumstance of two highly fit individuals succumbing in this manner, especially in
the spring, led health officials to investigate the cause and initiate surveillance for
other, similar cases. It soon became evident that they were in the midst of an outbreak
of a seriously deadly infectious agent and that the syndrome was one that had not
been previously described by the medical community.
The causative agent for the illness was soon (<6 weeks after the index cases were
identified) determined to be an unidentified North American member of the Hantavirus
genus. The clinical syndrome caused by this agent, ultimately named Sin Nombre virus
(SNV), came to be called the hantavirus pulmonary syndrome. This designation distinguished
it from previously described hantaviral illnesses, which were characterized as
hemorrhagic fever with renal syndrome (HFRS). Early in the course of events it became
evident that cardiac function, and respiratory function, are markedly impaired by
infection with this virus. For that reason, some authors have adopted the moniker
Hantavirus cardiopulmonary syndrome. Although that name certainly has logic, the
Centers for Disease Control and Prevention (CDC) continue to refer to the illness as
HPS, as does this article.
HANTAVIRUSES
The hantaviruses are an enveloped genus of the family Bunyaviridae. Virions are spherical
and encapsulated by a bilayered phospholipid membrane. The composition of each
virion is greater than 50% protein, 20% to 30% lipid, and 2% to 7% carbohydrate,
____________________________________________________________________
Division of Pulmonary and Critical Care Medicine, University of Kansas, 3901 Rainbow
Boulevard, Mail Stop 3007, Kansas City, KS 66160-7381, USA
* Corresponding author.
E-mail address: ssimpson3@kumc.edu (S.Q. Simpson).
Infect Dis Clin N Am 24 (2010) 159–173
doi:10.1016/j.idc.2009.10.011 id.theclinics.com
0891-5520/10/$ – see front matter ª 2010 Elsevier Inc. All rights reserved
ACUDIR AL HOSPITAL, MÁS PELIGROSO QUE VIAJAR EN AVIÓN
FRIDAY, JULY 22, 2011
Actualmente es más arriesgado y peligroso acudir a un hospital que volar en avión
ALERTA DE LA OMS | Medidas preventivas
- Unas medidas de higiene adecuadas disminuirían las infecciones hospitalarias
La Organización Mundial de la Salud (OMS) asegura que actualmente es más arriesgado y peligroso acudir a un hospital que volar en avión, sobre todo teniendo en cuenta que cada año mueren millones de personas por errores médicos o infecciones nosocomiales.
En concreto, y según ha asegurado Liam Donaldso, el nuevo representante de los pacientes de este organismo de Naciones Unidas, "si un ciudadano es ingresado en un hospital de cualquier país del mundo, tiene un 10% de probabilidades de sufrir algún error en su cuidado, que en uno de cada 300 casos puede llevarle a la muerte".
Sin embargo, añade este experto, el riesgo de morir en un accidente aéreo es muchísimo menor, ya que hay una probabilidad entre 10 millones, lo que "demuestra que la atención sanitaria en general en todo el mundo tiene todavía un largo camino por recorrer", dijo.
Actualmente, hay cientos de millones de personas que cada año sufren infecciones relacionadas con su atención sanitaria, lo que se conoce como infecciones nosocomiales, por lo que la OMS pide a los pacientes que hagan preguntas y se impliquen más en las decisiones que se toman durante su estancia hospitalaria para controlar que, por ejemplo, se tomen las medidas de higiene adecuadas, ya que, según aseguran, más de la mitad de estas infecciones se podrían prevenir si los profesionales sanitarios se lavasen las manos antes de tratar a los pacientes.
Asimismo, ha explicado Donaldson, "cuanto más tiempo pasan los pacientes en la UCI, mayor es su riesgo de contraer una infección", ya que hay determinados dispositivos, como los catéteres o los ventiladores, que se asocian a una tasa de infección más elevada.
La OMS ha destacado además que la tasa de fallecimientos por infecciones nosocomiales es mayor en Estados Unidos que en Europa. Así, mientras que en este país se producen 1,7 millones de infecciones y 100.000 muertes, en Europa hay 4,5 millones de infecciones que, en cambio, causan 37.000 fallecimientos.
"La infección es un gran problema, las lesiones después de las caídas en los hospitales son un gran problema, y hay problemas que están en una escala más pequeña pero que resultan en muertes prevenibles, como los errores en la medicación, que son comunes", ha sentenciado.
Mutual Antagonism of T Cells Causing Psoriasis and Atopic Eczema
N Engl J Med 2011; 365:231-238July 21, 2011
The simultaneous occurrence of psoriasis driven by type 1 helper T (Th1) cells and type 17 helper T (Th17) cells and atopic eczema dominated by type 2 helper T (Th2) cells is rare. Here, we describe three patients with co-occurring psoriasis and atopic eczema with an antagonistic course and distinct T-cell infiltrates in lesions from psoriasis and those from atopic eczema. Sensitized patients with psoriasis had a reaction to epicutaneous allergen challenge, with clinically and histologically verified eczema lesions containing a large number of allergen-reactive T cells. These findings support a causative role for T cells triggered by specific antigens in both psoriasis and atopic eczema. (Supported by the German Research Foundation and others.)
Supported by grants from Deutsche Forschungsgemeinschaft (EY97/1-2 and WE2678/4-1), Kommission Klinische Forschung of the Klinikum Rechts der Isar Munich, Hochschulwissenschaftsprogramm of the Technische Universität Munich, Bayerische Forschungsstiftung, the National Genome Research Network (01GS0809 and 01GS0818), and the Christine Kühne Center of Allergy Research and Education.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
Drs. S. Eyerich and Onken contributed equally to this article.
We thank Juliette Kranz for technical assistance.
SOURCE INFORMATION
From the Center of Allergy and Environment (ZAUM), Technische Universität and Helmholtz Center Munich (S.E., D.P., C.B.S.-W.), and the Department of Dermatology and Allergy, Technische Universität Munich (A.T.O., M.G., F.P., R.H., J.R., K.E.) — both in Munich; the Department of Dermatology, Allergology, and Venerology (S.W.) and the Institute of Clinical Molecular Biology (A.F.), University Hospital Schleswig–Holstein, Campus Kiel, Kiel; and the Department of Dermatology, Venereology, and Allergology, University Medicine Göttingen, Göttingen (M.M.) — all in Germany; and the Laboratory of Experimental Immunology, Istituto Dermopatico dell'Immacolata, Rome (F.N., A.C.).
Address reprint requests to Dr. Kilian Eyerich at the Department of Dermatology and Allergy, Technische Universität Munich, Biedersteiner Straße 29, 80802 Munich, Germany, or at kilian.eyerich@lrz.tum.de.
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MEDIA IN THIS ARTICLE
FIGURE 1
Patients with Concomitant Psoriasis and Atopic Eczema (AE).
Patients with Concomitant Psoriasis and Atopic Eczema (AE).
FIGURE 2
Antigen-Specific Eczematous Reactions on Epicutaneous Challenge in Patients with Psoriasis and Allergic Sensitization
Antigen-Specific Eczematous Reactions on Epicutaneous Challenge in Patients with Psoriasis and Allergic Sensitizationviernes, 22 de julio de 2011
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