Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 18 de 18
Filtrar
1.
MethodsX ; 7: 100888, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32382521

RESUMEN

The geochemical and isotopic composition of terrigenous clays from marine sediments can provide important information on the sources and pathways of sediments. In order to extract the detrital signal from bulk marine sediments, standard sediment leaching methods are commonly applied to remove carbonate and ferromanganese oxides. In comparison to most previous studies that aimed to extract the terrestrial signal from marine sediments we additionally applied a CsCl wash throughout the sample preparation Simon et al. [1]. The motivation behind that extra step, not frequently applied, is to remove ions that are gained on the clay surface due to re-adsorption of authigenic trace metals in the ocean or during the leaching procedure and thus could alter the original composition of the detrital fraction if no cation exchange was applied. Here we present an improved and detailed step-by-step leaching protocol for the extraction of the detrital fraction of bulk deep-sea sediments including commonly used buffered acetic acid and acid-reductive mix solutions including a final cation exchange wash.•standard method to remove carbonate and ferromanganese oxides and Stokes settling to isolate the clay fractions•additional application of cation cation exchange wash (CsCl)•removal of ions that are gained on the clay surface due to adsorption of authigenic trace metals in the ocean or during the leaching procedure.

2.
Fungal Genet Biol ; 130: 72-81, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31026588

RESUMEN

Nuclear pore complex (NPC) proteins (Nups) play multiple roles during mitosis. In this study we expand these roles and reveal that in Aspergillus nidulans, compromising the core Nup84-120 subcomplex of the NPC modifies the mitotic behavior of the nuclear envelope (NE). In wildtype cells, the NE undergoes simultaneous double pinching events to separate daughter nuclei during mitotic exit, whereas in Nup84-120 complex mutants, only one restriction of the NE is observed. Investigating the basis for this modified behavior of the NE in Nup deleted cells uncovered previously unrealized roles for core Nups in mitotic exit. During wildtype anaphase, the NE surrounds the two separating daughter DNA masses which typically flank the central nucleolus, to form three distinct nuclear compartments. In contrast, deletion of core Nups frequently results in early nucleolar eviction from the mitotic nucleus, in turn causing an uncharacteristic dumbbell-shaped NE morphology of anaphase nuclei with a nuclear membrane bridge connecting the two forming G1 nuclei. Importantly, the absence of the nucleolus between the separating daughter nuclei during anaphase delays chromosome segregation and progression into G1 as nuclei remain connected by chromatin bridges. Proteins localizing to late segregating chromosome arms are observed between forming daughter nuclei, and the mitotic spindle fails to resolve in a timely manner. These chromatin bridges are occupied by the Aurora kinase until nuclei have fully separated, suggesting involvement of Aurora in monitoring mitotic spindle and nuclear membrane resolution during mitotic exit. Our findings thus reveal a novel requirement for core Nups in mediating nucleolar positioning during mitosis, which dictates the pattern of NE fissions during karyokinesis and facilitates normal chromosome segregation. The findings additionally demonstrate that the mode of mitosis can be dramatically modified by deletion of a single NPC gene and reveals surprising fluidity in mitotic mechanisms.


Asunto(s)
Aspergillus nidulans/genética , Mitosis/fisiología , Proteínas de Complejo Poro Nuclear/genética , Proteínas de Complejo Poro Nuclear/fisiología , Eliminación de Secuencia , Anafase , Aspergillus nidulans/citología , Nucléolo Celular , Núcleo Celular/metabolismo , División del Núcleo Celular/fisiología , Cromatina , Segregación Cromosómica , ADN Ribosómico , Proteínas Fúngicas/genética , Mutación , Membrana Nuclear , Huso Acromático
3.
Ann Agric Environ Med ; 20(3): 509-14, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24069856

RESUMEN

INTRODUCTION: In the autumn of 2009 the authors participated in a humanitarian operation in Western Ukraine by undertaking an epidemiological investigation of an influenza-like-illness (ILI) in the L'viv Oblast region. Mobile biological survey teams took samples from civilian patients with severe acute respiratory distress syndrome, rapid transportation of the samples, and their molecular analysis in Poland to provide accurate results. OBJECTIVE: The aim of the study was the molecular and epidemiological analysis of the biological samples collected. MATERIAL AND METHODS: Real-time reverse transcriptase polymerase chain reaction (real-time RT-PCR), multiplex PCR techniques, traditional Sanger Sequencing and classical viral culture methods were used. RESULTS: Among the 124 influenza-like illness cases, ~50% (58) were positive for influenza A virus in WHO-CDC molecular assay, including subtyping. The specimens were further analyzed to confirm results and determine the genetic sequence. Phylogenetically, the nucleotide similarity of both the Ukraine specimens and reference A/California/7/2009 (pH1N1) was 99.2-99.3%. Oseltamivir resistance was not registered. HA1 region characterization showed an overall protein identity of 98.5-99.4%. CONCLUSIONS: An unexpected high contribution of influenza A was confirmed among ILI patients, as well as a very limited number of other detected viruses, indicate that the 2009 epidemic in western Ukraine was strongly related to novel influenza A/H1N1. The importance of swift sharing of information and reference laboratories networking in surveillance, as well as serving governments and international agencies in pursuing adequate actions, should be stressed.


Asunto(s)
Subtipo H1N1 del Virus de la Influenza A/genética , Gripe Humana/epidemiología , Pandemias , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Subtipo H1N1 del Virus de la Influenza A/clasificación , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Gripe Humana/virología , Masculino , Persona de Mediana Edad , Filogenia , Reacción en Cadena de la Polimerasa , Ucrania/epidemiología , Cultivo de Virus , Adulto Joven
4.
PLoS One ; 7(7): e41435, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22859985

RESUMEN

INTRODUCTION: Following the 2009 influenza A/H1N1 (pH1N1) pandemic, both seasonal and pH1N1 viruses circulated in the US during the 2010-2011 influenza season; influenza vaccine effectiveness (VE) may vary between live attenuated (LAIV) and trivalent inactivated (TIV) vaccines as well as by virus subtype. MATERIALS AND METHODS: Vaccine type and virus subtype-specific VE were determined for US military active component personnel for the period of September 1, 2010 through April 30, 2011. Laboratory-confirmed influenza-related medical encounters were compared to matched individuals with a non-respiratory illness (healthy controls), and unmatched individuals who experienced a non-influenza respiratory illness (test-negative controls). Odds ratios (OR) and VE estimates were calculated overall, by vaccine type and influenza subtype. RESULTS: A total of 603 influenza cases were identified. Overall VE was relatively low and similar regardless of whether healthy controls (VE = 26%, 95% CI: -1 to 45) or test-negative controls (VE = 29%, 95% CI: -6 to 53) were used as comparison groups. Using test-negative controls, vaccine type-specific VE was found to be higher for TIV (53%, 95% CI: 25 to 71) than for LAIV (VE = -13%, 95% CI: -77 to 27). Influenza subtype-specific analyses revealed moderate protection against A/H3 (VE = 58%, 95% CI: 21 to 78), but not against A/H1 (VE = -38%, 95% CI: -211 to 39) or B (VE = 34%, 95% CI: -122 to 80). CONCLUSION: Overall, a low level of protection against clinically-apparent, laboratory-confirmed, influenza was found for the 2010-11 seasonal influenza vaccines. TIV immunization was associated with higher protection than LAIV, however, no protection against A/H1 was noted, despite inclusion of a pandemic influenza strain as a vaccine component for two consecutive years. Vaccine virus mismatch or lower immunogenicity may have contributed to these findings and deserve further examination in controlled studies. Continued assessment of VE in military personnel is essential in order to better inform vaccination policy decisions.


Asunto(s)
Virus de la Influenza A/inmunología , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Personal Militar , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Gripe Humana/inmunología , Gripe Humana/virología , Masculino , Vacunación Masiva , Estados Unidos , Vacunas Atenuadas/administración & dosificación , Vacunas de Productos Inactivados/administración & dosificación , Adulto Joven
5.
Biosecur Bioterror ; 9(4): 408-12, 2011 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22074350

RESUMEN

The World Health Organization's revised International Health Regulations (IHR (2005)) call for member state compliance by mid-2012. Variation in disease surveillance and core public health capacities will affect each member state's ability to meet this deadline. We report on topics presented at the preconference workshop, "The Interaction of Disease Surveillance and the International Health Regulations," held at the 2010 International Society for Disease Surveillance conference in Park City, Utah. Presenters were from the Pan American Health Organization (PAHO), the U.S. Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC), the Armed Forces Health Surveillance Center, U.S. Naval Research Unit Six, the Philippines' National Epidemiologic Center, and the French armed forces. The topics addressed were: an overview of the revised IHRs; disease surveillance systems implemented in Peru, the Philippines, and by the French armed forces; the capacity building efforts of the CDC; partnerships and contributions to IHR compliance from HHS; and the application of the IHRs to special populations. Results from the meeting evaluation indicate that many participants found the information useful in better understanding current efforts of the U.S. government and international organizations, areas for collaboration, and how the IHRs apply to their countries' public health systems. Topics to address at future workshops include progress and challenges to IHR implementation across all member states and additional examples of how disease surveillance supports the IHRs in resource-constrained countries. The preconference workshop provided the opportunity to convene public health experts from all regions of the world. Stronger collaborations and support to better detect and respond to public health events through building sustainable disease surveillance systems will not only help member states to meet IHR compliance by 2012, but will also improve pandemic preparedness and global health security.


Asunto(s)
Cooperación Internacional , Vigilancia de la Población/métodos , Salud Pública , Planificación en Desastres/organización & administración , Brotes de Enfermedades/prevención & control , Gobierno Federal , Salud Global , Regulación Gubernamental , Adhesión a Directriz , Guías como Asunto , Política de Salud , Humanos , Desarrollo de Programa , Utah , Organización Mundial de la Salud
6.
BMC Public Health ; 11 Suppl 2: S2, 2011 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-21388562

RESUMEN

The Armed Forces Health Surveillance Center, Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) has the mission of performing surveillance for emerging infectious diseases that could affect the United States (U.S.) military. This mission is accomplished by orchestrating a global portfolio of surveillance projects, capacity-building efforts, outbreak investigations and training exercises. In 2009, this portfolio involved 39 funded partners, impacting 92 countries. This article discusses the current biosurveillance landscape, programmatic details of organization and implementation, and key contributions to force health protection and global public health in 2009.


Asunto(s)
Control de Enfermedades Transmisibles , Brotes de Enfermedades/prevención & control , Medicina Militar , Salud Pública , Vigilancia de Guardia , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/organización & administración , Agencias Gubernamentales , Humanos , Medicina Militar/organización & administración , Personal Militar , Vigilancia de la Población , Administración en Salud Pública , Estados Unidos , United States Department of Defense
7.
BMC Public Health ; 11 Suppl 2: S3, 2011 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-21388563

RESUMEN

A cornerstone of effective disease surveillance programs comprises the early identification of infectious threats and the subsequent rapid response to prevent further spread. Effectively identifying, tracking and responding to these threats is often difficult and requires international cooperation due to the rapidity with which diseases cross national borders and spread throughout the global community as a result of travel and migration by humans and animals. From Oct.1, 2008 to Sept. 30, 2009, the United States Department of Defense's (DoD) Armed Forces Health Surveillance Center Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) identified 76 outbreaks in 53 countries. Emerging infectious disease outbreaks were identified by the global network and included a wide spectrum of support activities in collaboration with host country partners, several of which were in direct support of the World Health Organization's (WHO) International Health Regulations (IHR) (2005). The network also supported military forces around the world affected by the novel influenza A/H1N1 pandemic of 2009. With IHR (2005) as the guiding framework for action, the AFHSC-GEIS network of international partners and overseas research laboratories continues to develop into a far-reaching system for identifying, analyzing and responding to emerging disease threats.


Asunto(s)
Control de Enfermedades Transmisibles/métodos , Brotes de Enfermedades/prevención & control , Salud Global , Vigilancia de Guardia , Control de Enfermedades Transmisibles/organización & administración , Enfermedades Transmisibles Emergentes/epidemiología , Enfermedades Transmisibles Emergentes/prevención & control , Agencias Gubernamentales , Humanos , Cooperación Internacional , Personal Militar , Estados Unidos , Organización Mundial de la Salud
8.
BMC Public Health ; 11 Suppl 2: S4, 2011 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-21388564

RESUMEN

Capacity-building initiatives related to public health are defined as developing laboratory infrastructure, strengthening host-country disease surveillance initiatives, transferring technical expertise and training personnel. These initiatives represented a major piece of the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) contributions to worldwide emerging infectious disease (EID) surveillance and response. Capacity-building initiatives were undertaken with over 80 local and regional Ministries of Health, Agriculture and Defense, as well as other government entities and institutions worldwide. The efforts supported at least 52 national influenza centers and other country-specific influenza, regional and U.S.-based EID reference laboratories (44 civilian, eight military) in 46 countries worldwide. Equally important, reference testing, laboratory infrastructure and equipment support was provided to over 500 field sites in 74 countries worldwide from October 2008 to September 2009. These activities allowed countries to better meet the milestones of implementation of the 2005 International Health Regulations and complemented many initiatives undertaken by other U.S. government agencies, such as the U.S. Department of Health and Human Services, the U.S. Agency for International Development and the U.S. Department of State.


Asunto(s)
Gripe Humana/epidemiología , Personal Militar , Salud Pública , Infecciones del Sistema Respiratorio/epidemiología , Vigilancia de Guardia , Salud Global , Agencias Gubernamentales , Humanos , Cooperación Internacional , Laboratorios , Estados Unidos
9.
BMC Public Health ; 11 Suppl 2: S5, 2011 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-21388565

RESUMEN

Training is a key component of building capacity for public health surveillance and response, but has often been difficult to quantify. During fiscal 2009, the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) supported 18 partner organizations in conducting 123 training initiatives in 40 countries for 3,130 U.S. military, civilian and host-country personnel. The training assisted with supporting compliance with International Health Regulations, IHR (2005). Training activities in pandemic preparedness, outbreak investigation and response, emerging infectious disease (EID) surveillance and pathogen diagnostic techniques were expanded significantly. By engaging local health and other government officials and civilian institutions, the U.S. military's role as a key stakeholder in global public health has been strengthened and has contributed to EID-related surveillance, research and capacity-building initiatives specified elsewhere in this issue. Public health and emerging infections surveillance training accomplished by AFHSC-GEIS and its Department of Defense (DoD) partners during fiscal 2009 will be tabulated and described.


Asunto(s)
Control de Enfermedades Transmisibles/métodos , Brotes de Enfermedades/prevención & control , Educación en Salud Pública Profesional , Salud Global , Vigilancia de Guardia , Enfermedades Transmisibles/diagnóstico , Enfermedades Transmisibles/epidemiología , Enfermedades Transmisibles Emergentes/diagnóstico , Enfermedades Transmisibles Emergentes/epidemiología , Enfermedades Transmisibles Emergentes/prevención & control , Humanos , Personal Militar/educación , Estados Unidos , United States Department of Defense
10.
BMC Public Health ; 11 Suppl 2: S6, 2011 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-21388566

RESUMEN

The Armed Forces Health Surveillance Center's Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) supports and oversees surveillance for emerging infectious diseases, including respiratory diseases, of importance to the U.S. Department of Defense (DoD). AFHSC-GEIS accomplishes this mission by providing funding and oversight to a global network of partners for respiratory disease surveillance. This report details the system's surveillance activities during 2009, with a focus on efforts in responding to the novel H1N1 Influenza A (A/H1N1) pandemic and contributions to global public health. Active surveillance networks established by AFHSC-GEIS partners resulted in the initial detection of novel A/H1N1 influenza in the U.S. and several other countries, and viruses isolated from these activities were used as seed strains for the 2009 pandemic influenza vaccine. Partners also provided diagnostic laboratory training and capacity building to host nations to assist with the novel A/H1N1 pandemic global response, adapted a Food and Drug Administration-approved assay for use on a ruggedized polymerase chain reaction platform for diagnosing novel A/H1N1 in remote settings, and provided estimates of seasonal vaccine effectiveness against novel A/H1N1 illness. Regular reporting of the system's worldwide surveillance findings to the global public health community enabled leaders to make informed decisions on disease mitigation measures and controls for the 2009 A/H1N1 influenza pandemic. AFHSC-GEIS's support of a global network contributes to DoD's force health protection, while supporting global public health.


Asunto(s)
Salud Global , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/epidemiología , Enfermedades Respiratorias/epidemiología , Vigilancia de Guardia , Humanos , Gripe Humana/prevención & control , Medicina Militar , Pandemias , Enfermedades Respiratorias/prevención & control , Estados Unidos/epidemiología , United States Department of Defense
13.
BMC Public Health ; 10 Suppl 1: S4, 2010 Dec 03.
Artículo en Inglés | MEDLINE | ID: mdl-21143826

RESUMEN

A cornerstone of effective global health surveillance programs is the ability to build systems that identify, track and respond to public health threats in a timely manner. These functions are often difficult and require international cooperation given the rapidity with which diseases cross national borders and spread throughout the global community as a result of travel and migration by both humans and animals. As part of the U.S. Armed Forces Health Surveillance Center (AFHSC), the Department of Defense's (DoD) Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) has developed a global network of surveillance sites over the past decade that engages in a wide spectrum of support activities in collaboration with host country partners. Many of these activities are in direct support of International Health Regulations (IHR[2005]). The network also supports host country military forces around the world, which are equally affected by these threats and are often in a unique position to respond in areas of conflict or during complex emergencies. With IHR(2005) as the guiding framework for action, the AFHSC-GEIS network of international partners and overseas research laboratories continues to develop into a far-reaching system for identifying, analyzing and responding to emerging disease threats.


Asunto(s)
Creación de Capacidad , Política de Salud/legislación & jurisprudencia , Cooperación Internacional , Vigilancia de la Población , United States Department of Defense , Organización Mundial de la Salud , Control de Enfermedades Transmisibles , Humanos , Práctica Asociada , Control Social Formal , Viaje , Confianza , Estados Unidos
15.
PLoS One ; 5(5): e10722, 2010 May 19.
Artículo en Inglés | MEDLINE | ID: mdl-20502705

RESUMEN

INTRODUCTION: A novel A/H1N1 virus is the cause of the present influenza pandemic; vaccination is a key countermeasure, however, few data assessing prior seasonal vaccine effectiveness (VE) against the pandemic strain of H1N1 (pH1N1) virus are available. MATERIALS AND METHODS: Surveillance of influenza-related medical encounter data of active duty military service members stationed in the United States during the period of April-October 2009 with comparison of pH1N1-confirmed cases and location and date-matched controls. Crude odds ratios (OR) and VE estimates for immunized versus non-immunized were calculated as well as adjusted OR (AOR) controlling for sex, age group, and history of prior influenza vaccination. Separate stratified VE analyses by vaccine type (trivalent inactivated [TIV] or live attenuated [LAIV]), age groups and hospitalization status were also performed. For the period of April 20 to October 15, 2009, a total of 1,205 cases of pH1N1-confirmed cases were reported, 966 (80%) among males and over one-half (58%) under 25 years of age. Overall VE for service members was found to be 45% (95% CI, 33 to 55%). Immunization with prior season's TIV (VE = 44%, 95% CI, 32 to 54%) as well as LAIV (VE = 24%, 95% CI, 6 to 38%) were both found to be associated with protection. Of significance, VE against a severe disease outcome was higher (VE = 62%, 95% CI, 14 to 84%) than against milder outcomes (VE = 42%, 95% CI, 29 to 53%). CONCLUSION: A moderate association with protection against clinically apparent, laboratory-confirmed Pandemic (H1N1) 2009-associated illness was found for immunization with either TIV or LAIV 2008-09 seasonal influenza vaccines. This association with protection was found to be especially apparent for severe disease as compared to milder outcome, as well as in the youngest and older populations. Prior vaccination with seasonal influenza vaccines in 2004-08 was also independently associated with protection.


Asunto(s)
Brotes de Enfermedades/prevención & control , Subtipo H1N1 del Virus de la Influenza A/inmunología , Vacunas contra la Influenza/inmunología , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Personal Militar , Estaciones del Año , Adulto , Distribución por Edad , Estudios de Casos y Controles , Femenino , Hospitalización , Humanos , Masculino , Oportunidad Relativa , Estados Unidos/epidemiología , Adulto Joven
16.
Influenza Other Respir Viruses ; 4(3): 155-61, 2010 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-20409212

RESUMEN

The US Department of Defense influenza surveillance system now spans nearly 500 sites in 75 countries, including active duty US military and dependent populations as well as host-country civilian and military personnel. This system represents a major part of the US Government's contributions to the World Health Organization's Global Influenza Surveillance Network and addresses Presidential Directive NSTC-7 to expand global surveillance, training, research and response to emerging infectious disease threats. Since 2006, the system has expanded significantly in response to rising pandemic influenza concerns. The expanded system has played a critical role in the detection and monitoring of ongoing H5N1 outbreaks worldwide as well as in the initial detection of, and response to, the current (H1N1) 2009 influenza pandemic. This article describes the system, details its contributions and the critical gaps that it is filling, and discusses future plans.


Asunto(s)
Gripe Humana/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Vigilancia de Guardia , Humanos , Personal Militar , Estados Unidos
17.
Emerg Infect Dis ; 16(5): 769-75, 2010 May.
Artículo en Inglés | MEDLINE | ID: mdl-20409365

RESUMEN

In mid-May 2007, a respiratory disease outbreak associated with adenovirus, serotype B14 (Ad14), was recognized at a large military basic training facility in Texas. The affected population was highly mobile; after the 6-week basic training course, trainees immediately dispersed to advanced training sites worldwide. Accordingly, enhanced surveillance and control efforts were instituted at sites receiving the most trainees. Specimens from patients with pneumonia or febrile respiratory illness were tested for respiratory pathogens by using cultures and reverse transcription-PCR. During May through October 2007, a total of 959 specimens were collected from 21 sites; 43.1% were adenovirus positive; the Ad14 serotype accounted for 95.3% of adenovirus isolates. Ad14 was identified at 8 sites in California, Florida, Mississippi, Texas, and South Korea. Ad14 spread readily to secondary sites after the initial outbreak. Military and civilian planners must consider how best to control the spread of infectious respiratory diseases in highly mobile populations traveling between diverse geographic locations.


Asunto(s)
Infecciones por Adenovirus Humanos/transmisión , Adenovirus Humanos/aislamiento & purificación , Personal Militar , Infecciones por Adenovirus Humanos/epidemiología , Infecciones por Adenovirus Humanos/virología , Adolescente , Adulto , Brotes de Enfermedades , Femenino , Geografía , Humanos , Masculino , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Neumonía Viral/virología , Vigilancia de la Población , República de Corea/epidemiología , Factores de Tiempo , Viaje , Estados Unidos/epidemiología
18.
Am J Gastroenterol ; 102(11): 2459-63, 2007 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-17608778

RESUMEN

OBJECTIVES: Most U.S. studies of acute liver failure (ALF) patients have been conducted at tertiary care liver transplantation centers. The aim of this study was to conduct population-based surveillance for ALF. METHODS: We conducted population-based surveillance for ALF within the 8 counties comprising Metropolitan Atlanta between November 2000 and October 2004. ALF cases were defined as the presence of coagulopathy, any grade of hepatic encephalopathy within 26 wk of illness onset, and no history of underlying liver disease. A questionnaire was administered and medical records were reviewed to determine clinical features, etiologies, and outcomes. RESULTS: A total of 65 cases were enrolled, yielding an annualized incidence for all causes of ALF of 5.5 (95% CI 4.3-7.0) per million. Acetaminophen (APAP)-related ALF was the most common (41%) etiology in adults while ALF of undetermined etiology was most common (38%) in children, followed by APAP-related ALF (25%). Unintentional APAP overdose was the most common type (61%) of APAP-related cause. Blacks were more likely than other races to have ALF of undetermined etiology (32%vs 11%). Overall mortality was 40%, with 27 (42%) surviving with supportive care alone and 8 (12%) requiring orthotopic liver transplantation. CONCLUSIONS: Our population-based study suggests approximately 1,600 ALF cases occur in the United States each year. Consistent with findings from studies conducted exclusively at liver transplantation centers, APAP-related ALF was the most common etiology. Increased awareness of APAP-related ALF in the medical community may limit future cases. More research is warranted into ALF of undetermined etiology, especially in children.


Asunto(s)
Fallo Hepático Agudo/epidemiología , Adolescente , Adulto , Anciano , Distribución de Chi-Cuadrado , Niño , Preescolar , Femenino , Georgia/epidemiología , Humanos , Incidencia , Trasplante de Hígado , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Encuestas y Cuestionarios
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...