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Little is known about genetic susceptibility to infectious disease. This study implicates variation in genes encoding molecules in the NOD2 (nucleotide-binding oligomerization domain containing 2) signaling pathway (which regulates innate immunity) in susceptibility to infection with Mycobacterium leprae and leprosy.
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Factors relating to the transmission of the 2009 H1N1 virus from an index patient to a household contact are poorly understood. This study shows that when a member of the household became infected with the 2009 H1N1 influenza virus, younger household contacts (<18 years of age) were twice as susceptible to an acute respiratory illness as were those 19 to 50 years of age, whereas contacts older than 50 years were less susceptible. A smaller household was associated with (proportionally) increased transmission to household contacts.
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Once introduced into a high school in New York City, the 2009 H1N1 virus spread quickly among students and staff, with an influenza-like illness developing in more than 800 people during a 2-week period. In this population, which had no previous exposure to this virus, the incubation period was estimated to be about 2 days, the median generation time 2.7 days, and the within-school reproduction number 3.3.
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Health policy experts are focusing on the prevention of hospital readmissions as a way to improve quality and reduce costs. This study showed wide variation in hospital readmission rates but only a weak association between discharge planning and readmission. The publication of discharge-planning data is unlikely to reduce readmission rates.
A 55-year-old man presents with a small-bowel perforation, and sepsis develops. Treatment with recombinant human activated protein C is recommended. Activated protein C inhibits the procoagulant state in sepsis and may also inhibit the systemic inflammatory response. The clinical benefit and recommendations for use of recombinant human activated protein C are controversial. The risk of bleeding is increased with use of the drug.
A 16-year-old boy was admitted to the hospital after being found unconscious in a snowbank at 6 a.m., approximately 7 hours after leaving a party at which alcohol was being served. He was partially undressed; his limbs were buried in the snow, and a layer of ice surrounded his right foot. On initial examination, he was drowsy and slow to respond but oriented, with spontaneous respirations and no shivering. The rectal temperature was 31.3°C. Both hands and the right foot were cold and hard to palpation; the left foot was cold but soft. A management decision was made.
Caloric restriction and the inhibition of molecular pathways extend life in certain animal models. Female mice deficient in a molecule downstream of the TOR (target of rapamycin, now known as sirolimus) pathway not only have longer lives than control mice but also are protected against age-related decline that affects bone, muscle, and immunity.
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