byron ( 2 nov 2009) disait:
Oui, enfin, sauf à dire qu'on est dans la phase ascendante, je n'ai toujours pas de réponse aux questions que je t'ai posées, à savoir si elle est VRAIMENT dangereuse comparée à une grippe habituelle... Les risques de l'habituelle grippe saisonnière et ceux du h1n1... Le genre d'étude qui doit pulluler !!!
Et ça ne t'a pas traversé l'esprit que tu pouvais chercher toi même des arguments à l'appui de tes doutes, au lieu de te contenter d'être agressif avec les gens qui étayent leurs propos ?
On va toutefois créer un appel d'air pour la prochaine question :
Published 20 October 2009, doi:10.1136/bmj.b4279
Cite this as: BMJ 2009;339:b4279
Short Cuts
All you need to read in the other general journals
Authorities must plan for a surge in critical illness caused by swine flu
JAMA 2009; doi:10.1001/jama.2009.1496
JAMA 2009; doi:10.1001/jama.2009.1536
JAMA 2009; doi:10.1001/jama.2009.1535
One major difference between the current influenza pandemic and previous pandemics is the rapid and systematic reporting of data describing the patients affected, how they were treated, and what happened. Observational studies of the first months of the pandemic are already available from Canada, Mexico, and Australasia. All three describe the sickest patients with H1N1 infections—those who had a short illness characterised by fever followed by rapid respiratory failure, refractory hypoxaemia, and often shock and multiorgan failure. These patients were typically young adults or adolescents who were reasonably healthy, although a substantial minority had chronic health problems such as asthma, diabetes, or obesity. All were admitted to intensive care units where they needed prolonged ventilation, vasopressors, and a range of sophisticated supportive treatments.
Mortality for these patients was higher in Mexico (41.4% (24/58) at 60 days; 95% CI 28.9% to 55.0%) than in Canada (17.3% (29/168) at 90 days, 12.0% to 24.0%). The Australasian study reported a mortality of 21% (14/68; 11% to 30%) among people who were sick enough to need extracorporeal membrane oxygenation.
The Mexican study included 58 people treated in six units in April and May. The Canadian study included 168 people treated in 38 units between April and August. Resources were stretched to the limit in both countries despite the modest numbers, says an editorial (doi:10.1001/jama.2009.1539). Planners may need to reconfigure services to make more efficient use of available beds, equipment, and expertise. Failing that, they will have to decide openly and explicitly who will and who will not receive life support.
Malheureusement, je n'ai pas de codes pour le JAMA.
Un petit New England (abstract seulement, mais comme je l'ai déjà proposé, je peux proposer le texte intégral en PDF) :
Published at
www.nejm.org October 8, 2009 (10.1056/NEJMoa0906695)
Hospitalized Patients with 2009 H1N1 Influenza in the United States, April–June 2009
Seema Jain, M.D., et al., for the 2009 Pandemic Influenza A (H1N1) Virus Hospitalizations Investigation Team
ABSTRACT
Background
During the spring of 2009, a pandemic influenza A (H1N1) virus emerged and spread globally. We describe the clinical characteristics of the patients who were hospitalized with 2009 H1N1 influenza in the United States from April 2009 to mid-June 2009.
Methods
Using medical charts, we collected data on 272 patients who were hospitalized for at least 24 hours for influenza-like illness and who tested positive for the 2009 H1N1 virus with the use of a real-time reverse-transcriptase–polymerase-chain-reaction assay.
Results
Of the 272 patients we studied, 25% were admitted to an intensive care unit and 7% died. Forty-five percent of the patients were children under the age of 18 years, and 5% were 65 years of age or older. Seventy-three percent of the patients had at least one underlying medical condition; these conditions included asthma; diabetes; heart, lung, and neurologic diseases; and pregnancy. Of the 249 patients who underwent chest radiography on admission, 100 (40%) had findings consistent with pneumonia. Of the 268 patients for whom data were available regarding the use of antiviral drugs, such therapy was initiated in 200 patients (75%) at a median of 3 days after the onset of illness. Data suggest that the use of antiviral drugs was beneficial in hospitalized patients, especially when such therapy was initiated early.
Conclusions
During the evaluation period, 2009 H1N1 influenza caused severe illness requiring hospitalization, including pneumonia and death. Nearly three quarters of the patients had one or more underlying medical conditions. Few severe illnesses were reported among persons 65 years of age or older. Patients seemed to benefit from antiviral therapy.
Toujours dans le New England :
Original Article Volume 361:674-679 August 13, 2009 Number 7
Severe Respiratory Disease Concurrent with the Circulation of H1N1 Influenza
Gerardo Chowell, Ph.D., Stefano M. Bertozzi, M.D., Ph.D., M. Arantxa Colchero, Ph.D., Hugo Lopez-Gatell, M.D., Ph.D., Celia Alpuche-Aranda, M.D., Ph.D., Mauricio Hernandez, M.D., Ph.D., and Mark A. Miller, M.D.
ABSTRACT
Background
In the spring of 2009, an outbreak of severe pneumonia was reported in conjunction with the concurrent isolation of a novel swine-origin influenza A (H1N1) virus (S-OIV), widely known as swine flu, in Mexico. Influenza A (H1N1) subtype viruses have rarely predominated since the 1957 pandemic. The analysis of epidemic pneumonia in the absence of routine diagnostic tests can provide information about risk factors for severe disease from this virus and prospects for its control.
Methods
From March 24 to April 29, 2009, a total of 2155 cases of severe pneumonia, involving 821 hospitalizations and 100 deaths, were reported to the Mexican Ministry of Health. During this period, of the 8817 nasopharyngeal specimens that were submitted to the National Epidemiological Reference Laboratory, 2582 were positive for S-OIV. We compared the age distribution of patients who were reported to have severe pneumonia with that during recent influenza epidemics to document an age shift in rates of death and illness.
Results
During the study period, 87% of deaths and 71% of cases of severe pneumonia involved patients between the ages of 5 and 59 years, as compared with average rates of 17% and 32%, respectively, in that age group during the referent periods. Features of this epidemic were similar to those of past influenza pandemics in that circulation of the new influenza virus was associated with an off-season wave of disease affecting a younger population.
Conclusions
During the early phase of this influenza pandemic, there was a sudden increase in the rate of severe pneumonia and a shift in the age distribution of patients with such illness, which was reminiscent of past pandemics and suggested relative protection for persons who were exposed to H1N1 strains during childhood before the 1957 pandemic. If resources or vaccine supplies are limited, these findings suggest a rationale for focusing prevention efforts on younger populations.
byron ( 2 nov 2009) disait:
Et si tu pouvais m'épargner les pleurnicheries niaises et émotionnelles de tes enfants sur les fauteuils entre vie et mort parce que des grands méchants cyniques posent des questions sur un forum, je t'en serai reconnaissant...
Encore bloqué là-dessus ?
inscrit le 29/09/09
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