RESUMEN
La neumonía adquirida en la comunidad (NAC) continúa siendo una de las principales causas de mortalidad en Colombia, pues es responsable de 13 de cada 100.000 muertes. Su principal agente etiológico es el Streptococcus pneumoniae, seguido por Haemophilus influenzae y Staphylococcus aureus. Se han identificado algunos factores de riesgo como comorbilidades y factores de exposición epidemiológica, los cuales incrementan la posibilidad de contraer una infección por microrganismos específicos. Su diagnóstico debe basarse tanto en la clínica como en hallazgos paraclínicos e imagenológicos. Herramientas como las escalas CURB-65 y PSI asociadas al criterio clínico permiten calcular el riesgo de mortalidad y el área de atención del paciente según su clasificación. En esta revisión se consideran los diferentes elementos para una adecuada evaluación y manejo del paciente que cursa con NAC, el uso de algunos biomarcadores, situaciones especiales para apreciar, como la neumonía severa, y estrategias para una adecuada prevención.
Community acquired pneumonia (CAP) is one of the first mortality causes in Colombia it accounts for 13 of every 100,000 deaths per year. Its principal etiologic agent is still Streptococcus pneumoniae, followed by Haemophilus influenzae and Staphylococcus aureus. Several risk factors have been described for CAP and specific pathoghens, such as coomorbidities and exposition factors. Diagnosis is made by clinical findings associated to laboratory workup and radiological evidence. CURB-65 and PSI are the most known and used tools that, in association with clinical evaluation, calculate the mortality risk and evaluate the setting of management. This literature review aims to consider crucial aspects for the correct assessment of CAP patients, biomarkers used in CAP, particular situations such as severe CAP as well as prevention strategies.
Asunto(s)
Humanos , Neumonía , Índice de Severidad de la Enfermedad , Biomarcadores , Neumonía BacterianaRESUMEN
The mechanistic basis of the target-site preference of lentivirus DNA integration is not well understood. In the present in silico study, we describe the integrational profile of simultaneous HIV-1 and HIV-2 infection. A total of 352 genomic DNA sequences from human peripheral blood mononuclear cells (PBMCs) obtained from GenBank and possessing the 5' LTR of HIV were used to characterize the structure and composition of local chromatin associated with high frequency integration sites. These sequences were aligned with the draft human genome (hg18) using BLAST (NCBI) and BLAT (UCSC) in order to derive information about chromosome localization, functional aspects of coding protein genes, CpG island number, and repetitive elements flanking integration sites. No significant differences in the integrational profile between HIV-1 and HIV-2 were found. However, we observed a tendency in both lentiviruses to integrate in the vicinity of protein coding genes. Multiple regression analysis showed a strong correlation between the number of genes and the number of CpG islands in regions with high integration frequency, mainly in chromosome 17 (R = 0.95, p < 0.05). Our results provide strong evidence that HIV-1 and HIV-2 have common genomic environments in the local chromatin regions with high gene density and CpG islands. The understanding of local genomic environments with a high frequency of integration would be the starting point to develop novel antiviral strategies for lentiviral infection.
