RESUMEN
OBJECTIVES: to describe the characteristics, treatment and outcome of critically ill patients with influenza A(H1N1) infection at St Pierre Hospital in Reunion Island during the 2009 outbreak, as well as the measures of care reorganization implemented to face them. PATIENTS AND METHODS: prospective observational study of probable and confirmed cases of influenza A (H1N1)/2009 infection concerning hospitalized patients in a polyvalent intensive care unit (ICU). RESULTS: thirteen patients have been included between August and September 2009. Three (23 %) didn't have any medical history. The median age was 42 [22-69]. Eleven have required pulmonary ventilation for 10.3 days (± 8). Three (23 %) have developed an ARDS. Three patients (23 %) died. To cope with the influx of cases and considering our situation of geographic isolation, it has been needed to totally rework the organization of care: set-up of a specific welcoming channel, division into sectors of the department, opening of additional beds, new on-duty assignment, inter and intra hospital cooperation. CONCLUSION: reunion Island has been an experimental lab of crisis management during the H1N1/2009 epidemic, several months ahead of the mother country. To anticipate the reorganization of care in intensive care units during an outbreak period, particularly in small units or units isolated like ours, looks to us a must so to quietly face a sharp influx of patients.
Asunto(s)
Brotes de Enfermedades , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/epidemiología , Adulto , Anciano , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reunión/epidemiología , Adulto JovenRESUMEN
Previous observations have suggested that lipoproteins may be involved in the transport of selenium in humans. To further investigate this question, selenium was measured in lipoprotein fractions isolated from plasma of healthy adults. A gas chromatographic-mass spectrometric method using the isotopic dilution technique was developed to ensure a reliable measurement of low amounts of selenium. About 3% of total plasma selenium was bound to lipoproteins, mainly to the LDL fraction. After solvent fractionation of LDL and HDL, the major part of the selenium was recovered in the protein extract, suggesting that it may be incorporated in apolipoproteins. The exact form of Se is not yet clearly established. Considering the different Se compounds found in proteins, it is postulated to be selenomethionine, and/or participating in a selenium-sulphur bond. This could explain why the amount of selenium bound to apolipoprotein B in LDL was about twice that which could be expected from a random substitution of selenomethionine for methionine.
Asunto(s)
Lipoproteínas/sangre , Lipoproteínas/química , Selenio/análisis , Adulto , Apolipoproteína A-I/sangre , Apolipoproteína A-I/química , Apolipoproteínas B/sangre , Apolipoproteínas B/química , Colesterol/sangre , Cromatografía de Gases y Espectrometría de Masas , Humanos , Indicadores y Reactivos , Lipoproteínas HDL/sangre , Lipoproteínas HDL/química , Lipoproteínas LDL/sangre , Lipoproteínas LDL/química , Selenio/sangre , Triglicéridos/sangreAsunto(s)
Dimensión del Dolor , Dolor/enfermería , Adulto , Humanos , Masculino , Relaciones Enfermero-Paciente , Dolor/diagnóstico , Dolor/psicologíaRESUMEN
Two digestion methods for the determination of selenium in biological samples have been compared: a classic digestion in a heating block by means of wet acid-ashing (HNO3-HClO4) and a microwave digestion in an open-vessel system by heating under reflux with HNO3-H2O2. The two methods were used to determine Se in plasma samples and different reference materials. There was no difference between the mean results, and the correlation coefficient for wet acid-ashing versus microwave digestion was 0.94. The two methods yielded accurate results for the certified materials analysed.