INFECTIOUS DISEASES

传染病
  • 文章类型: Journal Article
    俄罗斯不断记录各种传染病的流行。亚洲霍乱在流行病中占有特殊的地位。1892年,霍乱通过黑海港口传入俄罗斯帝国,同年夏天到达库班地区的领土。1892年,俄罗斯约有30万人死于霍乱。他们仍然不知道如何治疗这种可怕的疾病,不知道它的传播机制,以及其课程的特殊性。文章,根据对新罗西斯克市市政管理局档案部和Mostovsky区市政管理局档案部的文献数据的分析编写,研究了1892年和1910年席卷库班地区领土的霍乱疫情。作者描述了导致感染迅速传播的主要因素,并评估了为抗击该疾病而采取的措施:当局组织的抗霍乱措施的实施因缺乏教育而受到极大阻碍,绝大多数人口的偏见和迷信;非居民人口的代表不仅不符合个人卫生的基本标准,但也表达了不信任,有时还有对医生的敌意。使用档案数据,作者调查了传染病对这些居住区人口指标的影响。
    Epidemics of a wide variety of infectious diseases were constantly recorded in Russia. Asian cholera occupied a special place among epidemic diseases. In 1892, cholera was imported into the Russian Empire through the Black Sea ports, which reached the territory of the Kuban region by the summer of the same year. In 1892, about 300 thousand people died of cholera in Russia. They still did not know how to treat this terrible disease, did not know its mechanism of spread, as well as the peculiarities of its course. The article, prepared on the basis of an analysis of documentary data from the Archive Department of the administration of the municipal formation of the city of Novorossiysk and the archival Department of the Administration of the municipal formation of the Mostovsky district, examines the cholera epidemic that swept the territories of the Kuban region in 1892 and 1910. The authors characterize the main factors that contributed to the rapid spread of infection and assess the measures that were taken to combat the disease: the implementation of anti-cholera measures organized by the authorities was greatly hampered by the lack of education, prejudices and superstitions of the vast majority of the population; representatives of the nonresident population not only did not comply with basic standards of personal hygiene, but also expressed distrust, and sometimes and hostility towards doctors. Using archival data, the authors investigate the impact of infectious diseases on the demographic indicators of these settlements.
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  • 文章类型: Case Reports
    棕色隐居蜘蛛(Loxoscelesreclusa)是中西部中南部和美国南部特有的。棕色隐居蜘蛛咬伤可能会导致从局部皮肤坏死到全身并发症的症状,如急性溶血性贫血,播散性血管内凝血病,横纹肌溶解和死亡。虽然罕见,全身性溶血性贫血是急性自身免疫性溶血性贫血患者应考虑的排除性临床诊断.我们描述了一例年轻男子的自身免疫性溶血性贫血,继发于全身性营养不良,成功地用静脉注射免疫球蛋白和类固醇治疗。
    The brown recluse spider (Loxosceles reclusa) is endemic to the southcentral Midwest and the Southern United States. A bite from a brown recluse spider may result in symptoms that range from local skin necrosis to systemic complications such as acute haemolytic anaemia, disseminated intravascular coagulopathy, rhabdomyolysis and death. Although rare, systemic loxoscelism is a clinical diagnosis of exclusion that should be considered in a patient with acute autoimmune haemolytic anaemia. We describe a case of a young man with autoimmune haemolytic anaemia secondary to systemic loxoscelism successfully treated with intravenous immunoglobulin and steroids.
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  • 文章类型: Journal Article
    背景:传染病仍然是全球主要的健康问题,包括在中国,2019年估计有超过1000万的传染病病例。我们描述了中国成年人中特定部位传染病的负担。
    方法:从2004年到2008年,前瞻性中国嘉道理生物库从10个不同地区招募了512,726名30-79岁的成年人(5个农村,5城市)中国。在12年的随访中,101,673名参与者因任何传染病住院。描述性分析检查了标准化发生率,死亡率,和感染的病死率。
    结果:任何传染病的发病率为每100,000人年1856;呼吸道感染(1069)是最常见的。传染病死亡率为31.8/10万人年(呼吸道和非呼吸道感染分别为20.3和9.4,分别)和病死率为2.2%(呼吸道和非呼吸道感染分别为2.6%和1.6%,分别)。老年人和农村地区的传染病发病率和死亡率较高。传染病发病率没有明显的性别差异,但是男性的死亡率和病死率是女性的两倍。
    结论:传染病在中国成年人中很常见。观察到的负担,和差距,特定部位的感染可以为有针对性的预防工作提供信息.
    背景:嘉道理基金会,惠康信托基金,MRC,BHF,CR-UK,Most,NNSF。
    BACKGROUND: Infectious diseases remain a major global health concern, including in China, with an estimated >10 million cases of infectious disease in 2019. We describe the burden of site-specific infectious diseases among Chinese adults.
    METHODS: From 2004 to 2008, the prospective China Kadoorie Biobank enrolled 512,726 adults aged 30-79 years from 10 diverse areas (5 rural, 5 urban) of China. During the 12 years of follow-up, 101,673 participants were hospitalised for any infectious disease. Descriptive analyses examined standardised incidence, mortality, and case fatality of infections.
    RESULTS: The incidence of any infectious disease was 1856 per 100,000 person-years; respiratory tract infections (1069) were most common. The infectious disease mortality rate was 31.8 per 100,000 person years (20.3 and 9.4 for respiratory and non-respiratory infections, respectively) and case fatality was 2.2% (2.6% and 1.6% for respiratory and non-respiratory infections, respectively). Infectious disease incidence and mortality rates were higher at older ages and in rural areas. There were no clear sex-differences in infectious disease incidence rates, but mortality and case fatality rates were twice as high in men as in women.
    CONCLUSIONS: Infectious diseases were common in Chinese adults. The observed burden of, and disparities in, site-specific infections can inform targeted prevention efforts.
    BACKGROUND: Kadoorie Foundation, Wellcome Trust, MRC, BHF, CR-UK, MoST, NNSF.
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  • 文章类型: Journal Article
    随着全球变暖导致的极端天气的增加,加上全球化促进了传染病的传播,迫切需要提供简单性的便携式测试平台,低成本,和远程传输,特别有利于资源有限和非城市地区。我们已经开发了一种便携式设备,该设备使用环介导等温扩增(LAMP)和光谱检测来鉴定鼠伤寒沙门氏菌DNA。该设备利用LinkIt7697微控制器和微型光谱仪实时捕获和传输光谱信号,允许改进对反应进程的监测和分析。我们建造了一个装有微型光谱仪的手提箱,热电冷却器,紫外线LED,一次性反应管,和自制的热模块,全部由可充电电池供电。此外,我们进行了彻底的实验,以确保在热控制下的温度精度在1°C以内,开发了带有LinkIt7697IoT开发板的加热模块,可在3分钟内将DNA混合物加热至反应温度,集成泡沫绝缘和3D打印框架,以增强设备的热稳定性。我们成功地证明了鼠伤寒沙门氏菌DNA的扩增,其灵敏度为2.83×10-4ng/μL。远程网页界面允许在LAMP过程中监控温度和荧光,提高可用性。这种具有实时检测功能的便携式LAMP设备为检测食品中的鼠伤寒沙门氏菌提供了具有成本效益的解决方案。其独特的设计和功能使其成为确保食品安全的有前途的工具。
    With the rise in extreme weather due to global warming, coupled with globalization facilitating the spread of infectious diseases, there\'s a pressing need for portable testing platforms offering simplicity, low cost, and remote transmission, particularly beneficial in resource-limited and non-urban areas. We have developed a portable device using loop-mediated isothermal amplification (LAMP) with spectrometric detection to identify Salmonella Typhimurium DNA. The device utilizes the LinkIt 7697 microcontroller and a microspectrometer to capture and transmit spectral signals in real-time, allowing for improved monitoring and analysis of the reaction progress. We built a hand-held box containing a microspectrometer, thermoelectric cooler, ultraviolet LED, disposable reaction tube, and homemade thermal module, all powered by rechargeable batteries. Additionally, we conducted thorough experiments to ensure temperature accuracy within 1 °C under thermal control, developed a heating module with a LinkIt 7697 IoT development board to heat the DNA mixture to the reaction temperature within 3 minutes, and integrated foam insulation and a 3D-printed frame to enhance the device\'s thermal stability. We successfully demonstrated the amplification of Salmonella Typhimurium DNA with an impressive sensitivity of 2.83×10-4 ng/μL. A remote webpage interface allows for monitoring the temperature and fluorescence during the LAMP process, improving usability. This portable LAMP device with real-time detection offers a cost-effective solution for detecting Salmonella Typhimurium in food products. Its unique design and capabilities make it a promising tool for ensuring food safety.
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  • 文章类型: Journal Article
    隐球菌性脑膜炎是一个重要的全球健康问题,由于酵母隐球菌感染,尤其是新生隐球菌和加蒂隐球菌,导致一系列疾病,从肺部和皮肤损伤到危及生命的中枢神经系统受累。近年来,隐球菌性脑膜炎的诊断和治疗发生了很大变化。隐球菌性脑膜炎通常发生在患有晚期HIV感染的人中,尽管在高收入国家拥有强大的艾滋病毒检测和治疗计划,它越来越多地发生在其他群体中,特别是实体器官移植接受者,其他免疫抑制患者,甚至免疫能力强的宿主。这篇综述概述了临床表现,隐球菌性脑膜炎的治疗和预后,包括与HIV阴性患者相比,HIV感染者的显着差异。我们讨论了管理颅内压升高的重要性,并强调了改善多学科团队工作的优势,包括神经科医师。传染病专家和神经外科医生。
    Cryptococcal meningitis is an important global health problem, resulting from infection with the yeast Cryptococcus, especially Cryptococcus neoformans and Cryptococcus gattii, which cause a spectrum of disease ranging from pulmonary and skin lesions to life-threatening central nervous system involvement. The diagnosis and management of cryptococcal meningitis have substantially changed in recent years. Cryptococcal meningitis often occurs in people living with advanced HIV infection, though in high-income countries with robust HIV detection and treatment programmes, it increasingly occurs in other groups, notably solid-organ transplant recipients, other immunosuppressed patients and even immunocompetent hosts. This review outlines the clinical presentation, management and prognosis of cryptococcal meningitis, including its salient differences in people living with HIV compared with HIV-negative patients. We discuss the importance of managing raised intracranial pressure and highlight the advantages of improved multidisciplinary team working involving neurologists, infectious disease specialists and neurosurgeons.
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  • 文章类型: Journal Article
    背景:确定了媒介传播传染病的传播,除其他外,根据温度。因此,气候变化将对其全球分布产生影响。在未来,欧洲将接近ZIKV和CHIKV传输的最佳温度。气候情景和气候模型可用于描述未来的气候变化,并得出有关媒介传播传染病未来风险领域的结论。
    方法:基于RCP4.5和RCP8.5气候情景,对ZIKV和CHIKV在欧洲的未来温度适用性进行了地理空间分析。结果以地图形式显示,并计算受影响地区的百分比。
    结果:由于温度升高,ZIKV和CHIKV传播的风险区域在两种RCP情况下都有传播。对于CHIKV变速器,西班牙,葡萄牙,地中海沿岸和黑海附近地区受到主要影响。由于高温,整个欧洲的大片地区都面临ZIKV和CHIKV传播的风险。
    结论:温度只是影响媒介传播传染病传播的众多因素之一。然而,根据气候情景表示风险区域,可以评估未来的风险发展。监测和适应战略对于应对和遏制欧洲未来可能的本地传播和流行病是不可或缺的。
    BACKGROUND: The spread of vector-borne infectious diseases is determined, among other things, by temperature. Thus, climate change will have an influence on their global distribution. In the future, Europe will approach the temperature optimum for the transmission of ZIKV and CHIKV. Climate scenarios and climate models can be used to depict future climatic changes and to draw conclusions about future risk areas for vector-borne infectious diseases.
    METHODS: Based on the RCP 4.5 and RCP 8.5 climate scenarios, a geospatial analysis was carried out for the future temperature suitability of ZIKV and CHIKV in Europe. The results were presented in maps and the percentage of the affected areas calculated.
    RESULTS: Due to rising temperatures, the risk areas for transmission of ZIKV and CHIKV spread in both RCP scenarios. For CHIKV transmission, Spain, Portugal, the Mediterranean coast and areas near the Black Sea are mainly affected. Due to high temperatures, large areas throughout Europe are at risk for ZIKV and CHIKV transmission.
    CONCLUSIONS: Temperature is only one of many factors influencing the spread of vector-borne infectious diseases. Nevertheless, the representation of risk areas on the basis of climate scenarios allows an assessment of future risk development. Monitoring and adaptation strategies are indispensable for coping with and containing possible future autochthonous transmissions and epidemics in Europe.
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  • 文章类型: Journal Article
    目标:人工智能(AI)的进步使得像ChatGPT这样的平台在医学中越来越重要。本研究评估了ChatGPT在解决细菌感染相关问题和基于抗菌谱的临床病例方面的实用性。
    方法:这项研究涉及传染病(ID)专家和居民的合作。一组专家制定了六个真/假,六个开放式问题,和6例临床病例,针对四种类型的感染(心内膜炎,肺炎,腹腔感染,和血流感染)共96题。问题已提交给四名高级居民和四名ID专家,并输入到ChatGPT-4和经过培训的ChatGPT-4版本。总共获得了720个响应,并由抗生素治疗专家小组进行了审查。他们评估了回答的准确性和完整性,从抗菌谱中识别正确耐药机制的能力,以及抗生素处方的适当性。
    结果:在真/假问题的四组中没有发现显着差异,有大约70%的正确答案。训练有素的ChatGPT-4和ChatGPT-4为开放式问题提供了比居民和专家更准确和完整的答案。关于临床病例,我们观察到ChatGPT-4识别正确耐药机制的准确性较低。ChatGPT-4倾向于不开出新的抗生素,如头孢地洛或亚胺培南/西司他丁/雷巴坦,喜欢不太推荐的选择,如粘菌素。经训练的ChatGPT-4和ChatGPT-4均推荐长于必要的治疗期(p值=0.022)。
    结论:本研究强调了ChatGPT在医疗决策中的能力和局限性,特别是关于细菌感染和抗菌谱分析。虽然ChatGPT在回答理论问题方面表现出熟练的能力,在临床病例管理中,它与专家的决策并不一致.尽管有这些限制,ChatGPT作为ID教育和初步分析的支持工具的潜力是显而易见的。然而,它不应该取代专家咨询,尤其是在复杂的临床决策中。
    OBJECTIVE: Advancements in Artificial Intelligence(AI) have made platforms like ChatGPT increasingly relevant in medicine. This study assesses ChatGPT\'s utility in addressing bacterial infection-related questions and antibiogram-based clinical cases.
    METHODS: This study involved a collaborative effort involving infectious disease (ID) specialists and residents. A group of experts formulated six true/false, six open-ended questions, and six clinical cases with antibiograms for four types of infections (endocarditis, pneumonia, intra-abdominal infections, and bloodstream infection) for a total of 96 questions. The questions were submitted to four senior residents and four specialists in ID and inputted into ChatGPT-4 and a trained version of ChatGPT-4. A total of 720 responses were obtained and reviewed by a blinded panel of experts in antibiotic treatments. They evaluated the responses for accuracy and completeness, the ability to identify correct resistance mechanisms from antibiograms, and the appropriateness of antibiotics prescriptions.
    RESULTS: No significant difference was noted among the four groups for true/false questions, with approximately 70% correct answers. The trained ChatGPT-4 and ChatGPT-4 offered more accurate and complete answers to the open-ended questions than both the residents and specialists. Regarding the clinical case, we observed a lower accuracy from ChatGPT-4 to recognize the correct resistance mechanism. ChatGPT-4 tended not to prescribe newer antibiotics like cefiderocol or imipenem/cilastatin/relebactam, favoring less recommended options like colistin. Both trained- ChatGPT-4 and ChatGPT-4 recommended longer than necessary treatment periods (p-value = 0.022).
    CONCLUSIONS: This study highlights ChatGPT\'s capabilities and limitations in medical decision-making, specifically regarding bacterial infections and antibiogram analysis. While ChatGPT demonstrated proficiency in answering theoretical questions, it did not consistently align with expert decisions in clinical case management. Despite these limitations, the potential of ChatGPT as a supportive tool in ID education and preliminary analysis is evident. However, it should not replace expert consultation, especially in complex clinical decision-making.
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  • 文章类型: Editorial
    在这篇社论中,我们对Ali等人发表在最近一期的《世界临床病例杂志》上的文章进行了评论。此病例报告揭示了这种疾病的一种特别罕见的表现-原发性胃肠道结核(GTB),表现为胃出口梗阻。GTB由于其非特异性症状和缺乏高度准确的诊断算法而提出了诊断挑战。这篇社论综合了流行病学数据,危险因素,发病机制,临床表现,诊断方法,以及提高对GTB认识的治疗方法。GTB占全球所有结核病病例的1%-3%,6%-38%的患者也患有肺结核。发病机制涉及结核分枝杆菌复合体进入胃肠道系统的各种模式,末端回肠和回盲瓣常受累。临床表现各不相同,通常类似于其他腹内病变,需要高度怀疑。诊断工具包括生化,微生物,放射学,和内窥镜评估。抗结核药物仍然是治疗的基石,在严重病例中辅以手术干预。涉及胃肠病学家的多学科管理,外科医生,肺病学家,传染病专家对于最佳结果至关重要。尽管取得了进步,及时诊断和管理挑战依然存在,强调在解决原发性GTB方面需要继续研究和合作。
    In this editorial, we comment on the article by Ali et al published in the recent issue of the World Journal of Clinical Cases. This case report shed light on a particularly rare manifestation of this disease-primary gastrointestinal tuberculosis (GTB) presenting as gastric outlet obstruction. GTB presents diagnostic challenges due to its nonspecific symptoms and lack of highly accurate diagnostic algorithms. This editorial synthesizes epidemiological data, risk factors, pathogenesis, clinical presentations, diagnostic methods, and therapies to raise awareness about GTB. GTB constitutes 1%-3% of all tuberculosis cases globally, with 6%-38% of patients also having pulmonary tuberculosis. Pathogenesis involves various modes of Mycobacterium tuberculosis complex entry into the gastrointestinal system, with the terminal ileum and ileocecal valve commonly affected. Clinical presentation varies, often resembling other intra-abdominal pathologies, necessitating a high index of suspicion. Diagnostic tools include a combination of biochemical, microbiological, radiological, and endoscopic assessments. Anti-tubercular medication remains the cornerstone of treatment, supplemented by surgical intervention in severe cases. Multidisciplinary management involving gastroenterologists, surgeons, pulmonologists, and infectious disease specialists is crucial for optimal outcomes. Despite advancements, timely diagnosis and management challenges persist, underscoring the need for continued research and collaboration in addressing primary GTB.
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  • 文章类型: Journal Article
    罗伯特·H·鲁宾,医学博士是最早关注与免疫抑制相关的传染病的医生-科学家之一。一位出色的床边临床医生和老师,他提出了许多对器官移植和干细胞移植接受者的护理和提高存活率至关重要的概念。这些概念为多代传染病专家提供了临床调查和基础研究的基础,免疫学家,和移植外科医生。
    Robert H. Rubin, M.D. was among the first physician-scientists to focus attention on the infectious diseases associated with immune suppression. A superb bedside clinician and teacher, he developed many of the concepts central to the care and improved survival of organ transplant and stem cell transplant recipients. These concepts have provided the basis of clinical investigation and basic research for multiple generations of infectious disease specialists, immunologists, and transplant surgeons.
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  • 文章类型: Case Reports
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