Retrievable inferior vena cava filter utilization in obstetric patients

<p><b>Objectives:</b> The objective of this study is to evaluate patterns of use and outcomes of retrievable inferior vena cava filters (rIVCF) in obstetric patients.</p> <p><b>Methods:</b> A single center review of consecutive patients who underwent rIVCF placement during pregnancy/postpartum in 2005–2016. A pooled analysis of the relevant cases in the English literature was conducted.</p> <p><b>Results:</b> The current cohort comprised 24 women, median age 27 [interquartile range 24–30] years. Among 10 filters placed during pregnancy, the most common indication (<i>n</i> = 4) was the need to withhold anticoagulation therapy before delivery, in the presence of acute thrombosis. In the postpartum period, most filters (64%, 9/14) were an adjunct to catheter-directed thrombolytic therapy. Inferior vena cava filters (IVCF)-related complications occurred in seven (29.2%). Retrieval was attempted in 21 patients (87.5%), and was technically successful in 19 (90.5%), for an overall removal rate of 79.1%. Pooled analysis of the literature (<i>n</i> = 98) showed comparable rates for filter removal and complications (81.6%, <i>p</i> = .78 and 24.2%, <i>p</i> = .60, respectively). Suprarenal placement (<i>p</i> = .12) and elective cesarean section (<i>p</i> = .19) did not reduce overall complication and retrieval rates. The estimated radiation dose among pregnant patients who underwent rIVCF placement without adjunct catheter directed thrombolysis (CDT) (mean 695 Gy cm²) was significantly lower than the radiation dose used in postpartum patients (1863 Gy cm²) or in pregnant patients in whom adjunct CDT was utilized (4059 Gy cm²) (<i>p</i> = .001 for both comparisons).</p> <p><b>Conclusions:</b> Frequent rIVCF-related complications, radiation exposure, and removal failure call for their cautious utilization in obstetric patients. The role of suprarenal placement and elective cesarean section to improve outcomes has yet to be established.</p

Presence of pandemic H1N1 influenza virus by virus isolation in samples collected at 3, 5, and 7 days post infection (dpi).^*

*<p>15 pigs were infected with either the A/CA/04/2009 (CA/09) or A/Mexico/4108/2009 (MX/09) pandemic H1N1 virus isolates. Number of pigs positive out of 5 is reported from each group euthanized on 3, 5, or 7 dpi; LN = inguinal lymph node tissue sample.</p

Presence of pandemic H1N1 influenza virus by qRT-PCR in samples collected at 3, 5, and 7 days post infection (dpi).^*

*<p>15 pigs were infected with either the A/CA/04/2009 (CA/09) or A/Mexico/4108/2009 (MX/09) pandemic H1N1 virus isolates. Number of pigs positive out of 5 is reported from each group euthanized on 3, 5, or 7 dpi; LN = inguinal lymph node tissue sample.</p

Comparison of gene sequences of Pakistan H1N1 viruses with regional and global H1N1 isolates at key amino acid position in HA, NA, NS1 and PB1 genes.

<p>Comparison of gene sequences of Pakistan H1N1 viruses with regional and global H1N1 isolates at key amino acid position in HA, NA, NS1 and PB1 genes.</p

Real-Time PCR Assay data on respiratory samples collected between April 2009 and August 2010.

<p>Real-Time PCR Assay data on respiratory samples collected between April 2009 and August 2010.</p

Haemmaglutination Inhibition Assay for Pakistani A(H1N1)pdm09 viruses.

<p>ND: Not Done.</p

Phylogenetic Analysis for Haemagglutinin (HA) and Neuraminidase (NA) genes: Phylogenetic trees for HA and NA genes of Pakistan pandemic H1N1 2009 viruses.

<p>Full length sequences are included in the phylogenetic tree. The horizontal lines are proportional to the number of nucleotide changes. The trees were constructed using the Neighbor-Joining method using the Tamura 3-parameter model with Mega software version 4.</p

A High Diversity of Eurasian Lineage Low Pathogenicity Avian Influenza A Viruses Circulate among Wild Birds Sampled in Egypt

<div><p>Surveillance for influenza A viruses in wild birds has increased substantially as part of efforts to control the global movement of highly pathogenic avian influenza A (H5N1) virus. Studies conducted in Egypt from 2003 to 2007 to monitor birds for H5N1 identified multiple subtypes of low pathogenicity avian influenza A viruses isolated primarily from migratory waterfowl collected in the Nile Delta. Phylogenetic analysis of 28 viral genomes was performed to estimate their nearest ancestors and identify possible reassortants. Migratory flyway patterns were included in the analysis to assess gene flow between overlapping flyways. Overall, the viruses were most closely related to Eurasian, African and/or Central Asian lineage low pathogenicity viruses and belonged to 15 different subtypes. A subset of the internal genes seemed to originate from specific flyways (Black Sea-Mediterranean, East African-West Asian). The remaining genes were derived from a mixture of viruses broadly distributed across as many as 4 different flyways suggesting the importance of the Nile Delta for virus dispersal. Molecular clock date estimates suggested that the time to the nearest common ancestor of all viruses analyzed ranged from 5 to 10 years, indicating frequent genetic exchange with viruses sampled elsewhere. The intersection of multiple migratory bird flyways and the resulting diversity of influenza virus gene lineages in the Nile Delta create conditions favoring reassortment, as evident from the gene constellations identified by this study. In conclusion, we present for the first time a comprehensive phylogenetic analysis of full genome sequences from low pathogenic avian influenza viruses circulating in Egypt, underscoring the significance of the region for viral reassortment and the potential emergence of novel avian influenza A viruses, as well as representing a highly diverse influenza A virus gene pool that merits continued monitoring.</p></div

Avian influenza viruses analyzed in this study with subtype, collection site (Governorate in Egypt), date of collection (DOC) and amino acid sequence of the cleavage site (*) of the HA0 protein.

<p>Avian influenza viruses analyzed in this study with subtype, collection site (Governorate in Egypt), date of collection (DOC) and amino acid sequence of the cleavage site (*) of the HA0 protein.</p

Number of influenza A virus PCR positive specimen and number of embryonated chicken egg isolates.

<p>Number of influenza A virus PCR positive specimen and number of embryonated chicken egg isolates.</p