Medicina
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Acute respiratory distress syndrome (ARDS) is a life threatening condition associated with great morbidity and mortality. it is characterized initially by accumulation of fluid in the alveolar space that impairs alveolar oxygen exchange. Eventually, this syndrome leads to multiorgan failure. Therefore, rapid edema clearance has generally been associated with better outcome in patients with acute respiratory distress syndrome. ⋯ It has been demonstrated that increases in Na-K-ATPase in response to catecholamines in the alveolar epithelium are associated with increased lung edema clearance. The cellular mechanisms involve the recruitment of new Na-K-ATPase molecules to the plasma membrane from intracellular organelles. It also appears that adenovirus-mediated Na-K-ATPase gene transfer and increased Na-K-ATPase expression may provide an alternative and efficient pathway for transient increase in alveolar fluid reabsorption and resolution of pulmonary edema.
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Practice Guideline Guideline
[Guidelines for the management of bone and joint infections due to methicillin resistant staphylococci].
Bone and joint infections are a group of complicated diseases with high morbidity. Emerging resistant microorganisms and the use of prosthetic devices have increased the difficulty in the medical treatment of patients. ⋯ The guidelines mainly point to the rational use of diagnostic methods and describe the new treatment modalities. A group of experts analyzed the different strategies for diagnosing and treating bone and joint infections due to methicillin resistant staphylococci and attempted at setting a level of evidence level and the strength of each recommendation.
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Delirium or acute confusional state among hospitalized patients is a frequent and serious problem. It is characterized by acute onset symptoms, fluctuating course, impaired attention, unorganized thinking, and altered level of consciousness. Delirium, as a manifestation of acute nicotine withdrawal syndrome has been reported in the reviewed literature only in eight cases. ⋯ At the third day of nicotine abstinence, he developed delirium with a rapid improvement of his symptoms after treatment with a transdermal nicotine patch. This description suggests that in hospitalized heavy smokers who develop delirium with agitation, a simple trial with a nicotine patch can offer a dramatic therapeutic response in a few hours, constituting additionally a confirmatory test. The recognition of delirium as a manifestation of nicotine withdrawal could allow to determine the origin of symptoms and to apply the appropriate therapy, in certain complex cases that now remain undiagnosed.
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This paper analyzed the prevalence and distribution of serological reactivity to hantavirus (antibody against ANDES virus) of human population exposed to hantavirus and rodents trapped in the studied area. This study was developed in Salta (Orán and San Martín Departments), area with the highest incidence for Hantavirus Pulmonary Syndrome (HPS) in Argentina. In December 1997, 453 healthy people were studied by serology and 39 rodents by serology and PCR. ⋯ The prevalence of human cases with asymptomatic infection in Salta is higher than in other regions of the country, and we are presenting a hypothesis to explain these differences. The analyzed data suggest that in this region up to the time this study was performed, there would not have been person to person transmission of hantavirus. The transmission would be from rodent contact exclusively and mainly in ongoing deforestation areas and domestic habitat surrounding rural dwellings.