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Gram-stained smear (original magnification, ×1000) of expectorated sputum from an adult experiencing an exacerbation of chronic obstructive pulmonary disease caused by . Note the abundance of neutrophils, gram-negative diplococci as the exclusive bacterial form, and intracellular bacteria ().

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Gram-stained smear (original magnification, ×1000) of expectorated sputum from an adult experiencing an exacerbation of chronic obstructive pulmonary disease caused by . Note the abundance of neutrophils, gram-negative diplococci as the exclusive bacterial form, and intracellular bacteria ().

Point-prevalence studies suggest that M. catarrhalis is an important cause of exacerbations of COPD [ 19-21 ]. However, because M. catarrhalis is isolated from the sputum of adults with COPD even during clinically stable periods, one cannot conclude that the presence of the bacterium in the sputum of an adult with an exacerbation of COPD indicates that M. catarrhalis is the cause of the exacerbation. Four main lines of evidence support the conclusion that M. catarrhalis causes exacerbations of COPD.

Lower respiratory tract bacteriology . Bacterial pathogens are present in the airways in concentrations associated with respiratory tract infection in approximately one-half of adults with exacerbations of COPD when the distal airways are sampled using bronchoscopy with the protected specimen brush or transtracheal aspiration. M. catarrhalis is among the bacterial species that are isolated from the distal airways in such studies [ 20 , 22-24 ].

Lower respiratory tract bacteriology

Acquisition of new strains . Molecular typing of longitudinally collected strains reveals that, rather than increases in the numbers of a persistent colonizing strain, the acquisition of a new bacterial pathogen plays a central role in the pathogenesis of bacterial exacerbations [ 25 ]. In approximately one-half of the instances when an adult with COPD acquires a new strain of M. catarrhalis , clinical symptoms of exacerbation are observed [ 25 , 26 ]. This rate is similar to that observed for exacerbations after acquisition of new strains of H. influenzae and Pseudomonas aeruginosa and somewhat higher than that observed for S. pneumoniae .

Acquisition of new strains

Immune responses . Adults with COPD who experience exacerbations associated with acquisition of new strains of M. catarrhalis develop immune responses after infection. In a longitudinal study, we examined monthly sputum cultures from 104 patients with COPD over a period of 81 months and demonstrated that, of the 50 patients who acquired M catarrhalis , 72% generated new systemic or mucosal antibody responses to their homologous isolates [ 26 ]. Clearance of the strain from the respiratory tract was associated with strain-specificprotection.

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Diseñado para proporcionar el entendimiento de lo que son los patógenos que son llevados en la sangre y como reducir el riesgo de exponerse uno mismo o a los demás. Se recomiendan las indicaciones de OSHA y CDC.

Nota: OSHA requiere que las personas que tomen éste curso tengan acceso directo a un entrenador en vivo que pueda contestar alguna pregunta que usted tenga. Por ello, esta clase debe tomarse entre las 10 AM y las 5 PM, (Hora estándar del Pacífico), y de Lun-Vier. Tiene preguntas? Lláme all:1-800-346-4915, ext 205(Aquellos que deseen tomar esta clase fuera del horario descrito, deben llamar al número arriba y asegurarse que un entrenador esté dispobible.)
Plan de Control de Expocisión


Capítulo 1:Introducción

Esta clase está diseñada para darle:

Patógenos Sanguíneos son materiales infecciosos en la sangre que causan serias enfermedades en los seres humanos. Más comunmente son el Hepatitis B y C, y el VIH (virus de inmunodeficiencia humana).

Personas que sostienen un trabajo donde puedan estar rasonablemente expuestas a sangre o también a O tros M ateriales P otencialmente I nfecciosos (OMPI) se beneficiarán con éste entrenamiento.

Iniciando 1992, OSHA (La Administración Ocupacional de Seguridad y Salud) anunció un nuevo estándar titulado: Exposición ocupacional a Patógenos Sanguíneos. Desde entonces a tenido algunas revisiones y actualizaciones.

un conocimiento básico sobre

cómo se transmiten

se transmiten

Qué pude hacer usted para protegerse

Este estándar detalla “qué deben hacer las compañías para proteger a sus trabajadores cuyas labores los pongan en riesgo razonable de entrar en contacto con sangre u otros materiales potencialmente infecciosos.” (

Aunque el estándar solo aplica específicamente a aquellas personas cuyas labores requieren administrar primeros auxilios y no , sí es una importante guía que puede seguirse para cualquier exposición ocupacional a patógenos sanguíneos.

Para clarificar: Empleados cuya descripción d trabajo y responsabilidad les requiera, como parte de sus labores, prestar primeros auxili sí son cubiertos por el estándar. Por ejemplo

Aquellos empleados, entrenados en primeros auxilios, pero que su trabajo no les prestar ayuda, no son cubiertos.Sin embargo, se les sugiere a las compañías, que ofrezcan cursos e información a los que responden bajo la ley del “Buen Samaritano” así como para quienes están entrenados para responder a emergencias.

Tres áreas cubiertas por el estándar para reducir y controlar exposiciones ocupacionales son:

El estándar también:


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Exploring the World After September 11

Thomas L. Friedman

Farrar, Straus and Giroux



ISBN: 9781429916349

As the Foreign Affairs columnist for the , Thomas L. Friedman is in a unique position to interpret the world for American readers. Twice a week, Friedman's celebrated commentary provides the most trenchant, pithy,and illuminating perspective in journalism.

contains the columns Friedman has published about the most momentous news story of our time, as well as a diary of his experiences and reactions during this period of crisis. As the author writes, the book is "not meant to be a comprehensive study of September 11 and all the factors that went into it. Rather, my hope is that it will constitute a 'word album' that captures and preserves the raw, unpolished, emotional and analytical responses that illustrate how I, and others, felt as we tried to grapple with September and its aftermath, as they were unfolding."

Readers have repeatedly said that Friedman has expressed the essence of their own feelings, helping them not only by explaining who "they" are, but also by reassuring us about who "we" are. More than any other journalist writing, Friedman gives voice to America's awakening sense of its role in a changed world.

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Listen to this audiobook excerpt to hear Thomas L. Friedman read from his book Longitudes and Attitudes: Exploring the World After September 11. In this excerpt, he speaks about the Supreme Court decision that ended the contentious 2000 election between Al Gore and George W. Bush.


“This lucid book, consisting of Friedman's exceptionally frank and convincing columns and an insightful post-September 11 diary, prods at the questions surrounding that day and offers an invaluable reporter's perspective on the world from outside U.S. borders. The previously unpublished diary offers the most insight to the state of the world after September 11.” —

Thomas L. Friedman has been awarded the Pulitzer Prize three times for his newspaper reporting, and is the author of two bestselling books, The Lexus and the Olive Tree: Understanding Globalization (FSG, 1999) and From Beirut to Jerusalem (FSG, 1989), winner of the National Book Award in Nonfiction. He lives in Bethesda, Maryland, with his family.

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