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1.
Med Intensiva (Engl Ed) ; 44(9): 525-533, 2020 Dec.
Article in English, Spanish | MEDLINE | ID: mdl-32654921

ABSTRACT

OBJECTIVE: To describe the clinical and respiratory characteristics of a cohort of 43 patients with COVID-19 after an evolutive period of 28 days. DESIGN: A prospective, single-center observational study was carried out. SETTING: Intensive care. PATIENTS: Patients admitted due to COVID-19 and respiratory failure. INTERVENTIONS: None. VARIABLES: Automatic recording was made of demographic variables, severity parameters, laboratory data, assisted ventilation (HFO: high-flow oxygen therapy and IMV: invasive mechanical ventilation), oxygenation (PaO2, PaO2/FiO2) and complications. The patients were divided into three groups: survivors (G1), deceased (G2) and patients remaining under admission (G3). The chi-squared test or Fisher exact test (categorical variables) was used, along with the Mann-Whitney U-test or Wilcoxon test for analyzing the differences between medians. Statistical significance was considered for p<0.05. RESULTS: A total of 43 patients were included (G1=28 [65.1%]; G2=10 [23.3%] and G3=5 [11.6%]), with a mean age of 65 years (range: 52-72), 62% males, APACHE II 18 (15-24), SOFA 6 (4-7). Arterial hypertension (30.2%) and obesity (25.6%) were the most frequent comorbidities. High-flow oxygen therapy was used in 62.7% of the patients, with failure in 85%. In turn, 95% of the patients required IMV and 85% received ventilation in prone decubitus. In the general population, initial PaO2/FiO2 improved after 7 days (165 [125-210] vs.194 [153-285]; p=0.02), in the same way as in G1 (164 [125-197] vs. 207 [160-294]; p=0.07), but not in G2 (163 [95-197] vs. 135 [85-177]). No bacterial coinfection was observed. The incidence of IMV-associated pneumonia was high (13 episodes/1000 days of IMV). CONCLUSIONS: Patients with COVID-19 require early IMV, a high frequency of ventilation in prone decubitus, and have a high incidence of failed HFO. The lack of improvement of PaO2/FiO2 at 7 days could be a prognostic marker. .


Subject(s)
COVID-19/epidemiology , Pandemics , SARS-CoV-2 , Age Distribution , Aged , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/complications , Bacterial Infections/drug therapy , COVID-19/mortality , COVID-19/therapy , Chi-Square Distribution , Contraindications, Procedure , Female , Hospital Mortality , Hospitalization/statistics & numerical data , Humans , Intensive Care Units , Male , Middle Aged , Multimorbidity , Noninvasive Ventilation/adverse effects , Prospective Studies , Respiration, Artificial/methods , Spain/epidemiology , Statistics, Nonparametric , Tertiary Care Centers , COVID-19 Drug Treatment
2.
Biochimie ; 88(7): 859-67, 2006 Jul.
Article in English | MEDLINE | ID: mdl-16600467

ABSTRACT

Strain Pseudomonas sp. CR-611, previously isolated from a subtropical forest soil on tributyrine-supplemented plates, displays phenotypic and physiological properties consistent with those described for Pseudomonas fluorescens. However, no complete match to this species could be found after 16S rDNA comparison. Zymographic analysis of the strain revealed a complex lipolytic system, showing the presence of at least two enzymes with activity on MUF-butyrate. Alignment of Pseudomonas fluorescens lipase/esterase-coding sequences allowed the design of specific primers for family VI lipases, and the isolation and cloning of the resulting gene estA6. The recombinant clone obtained displayed high activity on fatty acid-derivative substrates, indicating that one of the lipolytic enzymes of the strain had been cloned. The enzyme, named EstA6, was then purified and characterized, showing maximum activity on short chain-length substrates under conditions of high temperature and neutral pH. Amino acid sequence alignment of EstA6 with other family VI esterases allowed identification of a highly conserved beta-/gamma-protobacterial cluster in family VI lipases, to which EstA6 belongs.


Subject(s)
Bacterial Proteins/genetics , Carboxylic Ester Hydrolases/genetics , Pseudomonas/enzymology , Amino Acid Sequence , Bacterial Proteins/chemistry , Bacterial Proteins/metabolism , Carboxylic Ester Hydrolases/chemistry , Carboxylic Ester Hydrolases/metabolism , Cloning, Molecular , DNA, Bacterial/chemistry , DNA, Bacterial/genetics , DNA, Bacterial/isolation & purification , Electrophoresis, Polyacrylamide Gel/methods , Hydrogen-Ion Concentration , Isoelectric Focusing/methods , Lipolysis , Molecular Sequence Data , Multigene Family/genetics , Phylogeny , Pseudomonas/genetics , Sequence Alignment , Sequence Analysis, DNA , Substrate Specificity , Temperature
3.
Clin Biochem ; 33(3): 191-6, 2000 Apr.
Article in English | MEDLINE | ID: mdl-10913517

ABSTRACT

OBJECTIVES: To evaluate a turbidimetric immunoassay for the measurement of ferritin, and to assay this method in a group of patients undergoing an autologous blood transfusion program. DESIGN AND METHODS: We used an ILab 900 analyzer. This instrument automates a particle-enhanced immunoturbidimetric assay with an analysis time of 9 min. This technique was compared with a microparticle immunoassay. The turbidimetric assay was used to measure ferritin in a group of 30 patients undergoing an autologous blood transfusion program. RESULTS: The assay was linear in the range 3-1400 microg/L (r = 0.9999). The intra- and inter-assay imprecision (CV) at 20, 97 and 469 microg/L were <3.0 and <5.0%, respectively. Recovery was 88. 7 to 97.4%. The detection limit was 3 microg/L. Hemoglobin (

Subject(s)
Evaluation Studies as Topic , Ferritins/analysis , Immunoassay/methods , Nephelometry and Turbidimetry/methods , Adult , Aged , Blood Transfusion, Autologous , Female , Ferritins/blood , Ferritins/immunology , Humans , Male , Middle Aged , Reference Values
4.
Clin Hemorheol Microcirc ; 18(4): 265-72, 1998 Jul.
Article in English | MEDLINE | ID: mdl-9741667

ABSTRACT

BACKGROUND: Clinical data suggest that autologous blood donation may prevent postsurgical venous thrombosis. If confirmed, this is probably due to beneficial effects in rheologic and hematologic variables which may be changed in patients as a result of repeated bleeding. STUDY DESIGN AND METHODS: To ascertain this point, we studied variations in hematological, hemorheological, coagulative and fibrinolytic parameters in 30 patients undergoing autologous blood donation. RESULTS: Whole blood viscosity (WBV), plasma viscosity and blood viscosity adjusted to 40% hematocrit, progressively and substantially decreased throughout the successive bleeding at all the shear rates considered. WBV was further reduced by presurgical hemodilution with autologous plasma which decreased the platelet and leukocyte count. The hemostasis and fibrinolysis variables, however, underwent no clinically significative changes. CONCLUSION: Repeated bleedings change most hemorheological variables. By decreasing cytocrit and viscosity, reducing aggregability and increasing blood cell deformability an optimal milieu to help prevent thrombosis is artificially created.


Subject(s)
Blood Coagulation , Blood Donors , Blood Transfusion, Autologous , Adult , Aged , Blood Viscosity , Female , Hematocrit , Humans , Male , Middle Aged
7.
Metabolism ; 43(5): 614-20, 1994 May.
Article in English | MEDLINE | ID: mdl-8177050

ABSTRACT

Regardless of type, uncontrolled diabetes represents a serious disruption of fuel homeostasis with consequences throughout the body. This may hamper the applicability of predeposited autologous blood transfusion in diabetic patients because metabolic changes are expected as a consequence of repeated bleeding. We undertook this study to determine whether the presence of non-insulin-dependent diabetes mellitus (NIDDM) influences the erythropoietin (EPO) response to repeated phlebotomies with respect to normal subjects. We included 22 consecutive patients scheduled for major surgery during a 2-year period in which clinical and metabolic complications were excluded and renal and liver function was considered unaffected. Selected biochemical and hematologic variables were serially measured during donation of several units of blood in a 12- to 29-day period. Bleeding produced a significant decrease in serum glucose, cholesterol, triglyceride, and apoprotein B concentration in diabetic patients. Except for glucose, this effect was not observed in controls. Both groups were comparable with respect to initial hemoglobin concentrations and all hematologic variables measured. The decrease in hemoglobin concentration did not produce clinical symptoms in these patients, and recovery was regarded as normal in both groups. Serum EPO levels in diabetic patients were negatively influenced by the initial hemoglobin A1c (HbA1c) proportion. Moreover, three nonrespondent diabetic patients with poor glycemic control responded normally 6 to 13 months later, in a second operation, when glycemic control had improved significantly. In conclusion, NIDDM may limit the donation of requested units for major surgery only if poor glycemic control is present. When possible, phlebotomies should be delayed and metabolic control reinforced.


Subject(s)
Bloodletting , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/therapy , Erythropoietin/blood , Adult , Aged , Blood Cell Count , Female , Ferritins/blood , Hemoglobins/analysis , Humans , Iron/blood , Lipids/blood , Male , Middle Aged
8.
Sangre (Barc) ; 35(3): 179-83, 1990 Jun.
Article in Spanish | MEDLINE | ID: mdl-2396165

ABSTRACT

The efficiency of an autotransfusion program was studied over two groups of patients undergoing an elective surgery. The A group (n = 41) was on dietotherapy program associated with a supplement of ferrous sulfate and the B group (n = 35) on dietary intervention only. Red cell volume (RCV), haemoglobin (Hb) and haematocrit (Ht) were determined previously to the autotransfusion, during the same and before the surgical intervention. Serum ferritin levels were measured in the B group patients previous to the autotransfusion and before the surgical intervention. No statistically significant differences were observed among the two groups with regard to the RVC variations, Hb or Ht during the autotransfusion process. Although 85% of the A group patients showed secondary digestive effects due to oral ferrous therapy, no patients from the B group showed any sign of these effects whatsoever. The results of the present study suggest that a diet rich in easily bioavailable iron could be an alternative therapy during the autotransfusion procedure.


Subject(s)
Blood Transfusion, Autologous , Diet , Ferrous Compounds/administration & dosage , Preoperative Care , Erythrocyte Volume , Female , Ferritins/analysis , Ferrous Compounds/adverse effects , Gastrointestinal Diseases/chemically induced , Hematocrit , Hemoglobins/analysis , Humans , Male , Postoperative Period
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