Co-infection of Influenza B and Streptococci causing severe pneumonia and septic shock in healthy women

<p>Abstract</p> <p>Background</p> <p>Since the Influenza A pandemic in 1819, the association between the influenza virus and <it>Streptococcus pneumoniae </it>has been well described in literature. While a leading role has been so far attributed solely to Influenza A as the primary infective pathogen, Influenza B is generally considered to be less pathogenic with little impact on morbidity and mortality of otherwise healthy adults. This report documents the severe synergistic pathogenesis of Influenza B infection and bacterial pneumonia in previously healthy persons not belonging to a special risk population and outlines therapeutic options in this clinical setting.</p> <p>Case Presentation</p> <p>During the seasonal influenza epidemic 2007/2008, three previously healthy women presented to our hospital with influenza-like symptoms and rapid clinical deterioration. Subsequent septic shock due to severe bilateral pneumonia necessitated intensive resuscitative measures including the use of an interventional lung assist device. Microbiological analysis identified severe dual infections of Influenza B with <it>Streptococcus pyogenes </it>in two cases and <it>Streptococcus pneumoniae </it>in one case. The patients presented with no evidence of underlying disease or other known risk factors for dual infection such as age (< one year, > 65 years), pregnancy or comorbidity.</p> <p>Conclusions</p> <p>Influenza B infection can pose a risk for severe secondary infection in previously healthy persons. As patients admitted to hospital due to severe pneumonia are rarely tested for Influenza B, the incidence of admission due to this virus might be greatly underestimated, therefore, a more aggressive search for influenza virus and empirical treatment might be warranted. While the use of an interventional lung assist device offers a potential treatment strategy for refractory respiratory acidosis in addition to protective lung ventilation, the combined empiric use of a neuraminidase-inhibitor and antibiotics in septic patients with pulmonary manifestations during an epidemic season should be considered.</p

TB research at UT-Houston--a review of cord factor: new approaches to drugs, vaccines and the pathogenesis of tuberculosis.

Tuberculosis remains a major threat as drug resistance continues to increase. Pulmonary tuberculosis in adults is responsible for 80% of clinical cases and nearly 100% of transmission of infection. Unfortunately, since we have no animal models of adult type pulmonary tuberculosis, the most important type of disease remains largely out of reach of modern science and many fundamental questions remain unanswered. This paper reviews research dating back to the 1950\u27s providing compelling evidence that cord factor (trehalose 6,6 dimycolate [TDM]) is essential for understanding tuberculosis. However, the original papers by Bloch and Noll were too far ahead of their time to have immediate impact. We can now recognize that the physical and biologic properties of cord factor are unprecedented in science, especially its ability to switch between two sets of biologic activities with changes in conformation. While TDM remains on organisms, it protects them from killing within macrophages, reduces antibiotic effectiveness and inhibits the stimulation of protective immune responses. If it comes off organisms and associates with lipid, TDM becomes a driver of tissue damage and necrosis. Studies emanating from cord factor research have produced (1) a rationale for improving vaccines, (2) an approach to new drugs that overcome natural resistance to antibiotics, (3) models of caseating granulomas that reproduce multiple manifestations of human tuberculosis. (4) evidence that TDM is a key T cell antigen in destructive lesions of tuberculosis, and (5) a new understanding of the pathology and pathogenesis of postprimary tuberculosis that can guide more informative studies of long standing mysteries of tuberculosis

Interactive sonification exploring emergent behavior applying models for biological information and listening

Sonification is an open-ended design task to construct sound informing a listener of data. Understanding application context is critical for shaping design requirements for data translation into sound. Sonification requires methodology to maintain reproducibility when data sources exhibit non-linear properties of self-organization and emergent behavior. This research formalizes interactive sonification in an extensible model to support reproducibility when data exhibits emergent behavior. In the absence of sonification theory, extensibility demonstrates relevant methods across case studies. The interactive sonification framework foregrounds three factors: reproducible system implementation for generating sonification; interactive mechanisms enhancing a listener's multisensory observations; and reproducible data from models that characterize emergent behavior. Supramodal attention research suggests interactive exploration with auditory feedback can generate context for recognizing irregular patterns and transient dynamics. The sonification framework provides circular causality as a signal pathway for modeling a listener interacting with emergent behavior. The extensible sonification model adopts a data acquisition pathway to formalize functional symmetry across three subsystems: Experimental Data Source, Sound Generation, and Guided Exploration. To differentiate time criticality and dimensionality of emerging dynamics, are applied between subsystems to maintain scale and symmetry of concurrent processes and temporal dynamics. Tuning functions accommodate sonification design strategies that yield order parameter values to render emerging patterns discoverable as well as , to reproduce desired instances for clinical listeners. Case studies are implemented with two computational models, Chua's circuit and Swarm Chemistry social agent simulation, generating data in real-time that exhibits emergent behavior. is introduced as an informal model of a listener's clinical attention to data sonification through multisensory interaction in a context of structured inquiry. Three methods are introduced to assess the proposed sonification framework: Listening Scenario classification, data flow Attunement, and Sonification Design Patterns to classify sound control. Case study implementations are assessed against these methods comparing levels of abstraction between experimental data and sound generation. Outcomes demonstrate the framework performance as a reference model for representing experimental implementations, also for identifying common sonification structures having different experimental implementations, identifying common functions implemented in different subsystems, and comparing impact of affordances across multiple implementations of listening scenarios

Compartment-directed physical examination of the knee can predict articular cartilage abnormalities disclosed by needle arthroscopy

Objective . To determine whether physical examination maneuvers that focus on each knee compartment and assess crepitus at several distinct sites can specifically disclose articular cartilage abnormalities in the compartment being assessed. Methods . Twenty patients with knee pain were examined before needle arthroscopy. Crepitus was sought from the patellofemoral compartment, medial tibiofemoral compartment, and lateral tibiofemoral compartment. Any crepitus felt in the distal tibia during a tibiofemoral stress maneuver was recorded as transmitted bony crepitus (TBC). Needle arthroscopy assessed articular cartilage (5 sites) and both menisci in each knee. Results . Crepitus by conventional assessment revealed patellar cartilage disruption (69% sensitive, 50% specific) and abnormalities of tibiofemoral cartilage (67% sensitive, 40% specific) but could not indicate their location. Tibiofemoral crepitus found cartilage disruption in the compartment at a sensitivity of 22% and a specificity of 100%, and with added tibiofemoral stress, a sensitivity of 65% and a specificity of 94% (the one “false positive” had bare bone in the other compartment). TBC was detected in 7 compartments, all of which had focal bare bone on tibial and femoral surfaces; 6 other compartments had tibial bare bone without TBC. Thus, TBC was 54% sensitive and 100% specific for tibial bare bone, and 88% sensitive and 100% specific for bone-on-bone. Conclusion . Compartment-directed physical examination of the painful knee can locate and assess the severity of certain articular cartilage abnormalities that are not reliably found by conventional methods. Transmitted bony crepitus is a specific finding for bone-on-bone in the compartment being assessed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/37803/1/1780380707_ftp.pd

Gestion par les Médecins Généralistes en soins primaires des risques de violence dirigés à leur encontre : Analyse par étude qualitative des stratégies de Prévention et de Protection

Introduction : le médecin généraliste en soins primaires peut être au cours de son exercice exposé à des violences dirigées à son encontre. Des stratégies peuvent être mises en place pour diminuer la probabilité d’occurrence ou la gravité des phénomènes violents.Objectif de l’étude : identifier les stratégies de prévention et de protection utilisés par les médecins généralistes.Matériel et Méthodes : une analyse qualitative a été menée par entretiens individuels auprès de 16 médecins généralistes exerçant dans la métropole Toulon -Provence-Méditerranée, pratiquant en cabinet ou en visite à domicile. Les entretiens étaient enregistrés, et le verbatim retranscrit était analysé à l’aide du logiciel NVIVO®.Résultats : de nombreuses stratégies étaient déployées. Les principales étaient l’évitement, qui pouvait viser spécifiquement certains patients, lieux, horaires ou pratiques jugées trop à risques.La prévention et la protection étaient réalisées par la diminution de l’attrait du médecin, la sécurisation du cabinet, les précautions prises en visites à domicile, la diminution des motifs de violence, l’amélioration de la réaction en cas d’incident violent.Les stratégies spécifiques de gestion de crise étaient la désescalade verbale, céder aux demandes, la mise à l’abri, l’appel de tiers pour l’aide à la gestion de la crise violente, l’appel aux forces de l’ordre, la fuite, et la riposte physique.Conclusion : les stratégies de prévention et de protection de la violence sont nombreuses et peuvent être intégrées à la pratique quotidienne de chaque généraliste. Elles sont principalement organisationnelles et leur déploiement est facilité par l’exercice en groupe

Creative aspects of sonification

A goal of sonification research is the intuitive audio representation of complex, multidimensional data. The authors present two facets of this research that may provide insight into the creative process. First, they discuss aspects of categorical perception in nonverbal auditory scene analysis and propose that these characteristics are simplified models of creative engagement with sound. Second, they describe the use of sonified data in musical compositions by each of the authors and observe aspects of the creative process in the purely aesthetic use of sonified statistical data