French Experience of 2009 A/H1N1v Influenza in Pregnant Women

BACKGROUND: The first reports on the pandemic influenza 2009 A/H1N1v from the USA, Mexico, and Australia indicated that this disease was associated with a high mortality in pregnant women. The aim of this study was to describe and compare the characteristics of severe critically ill and non-severe pregnant women with 2009 A/H1N1v-related illness in France. METHODOLOGY/PRINCIPAL FINDINGS: A national registry was created to screen pregnant women with laboratory-confirmed 2009 A/H1N1v influenza. Three hundred and fifteen patients from 46 French hospitals were included: 40 patients were admitted to intensive care units (severe outcomes), 111 were hospitalized in obstetric or medical wards (moderate outcomes), and 164 were outpatients (mild outcomes). The 2009 A/H1N1v influenza illness occurred during all pregnancy trimesters, but most women (54%), notably the severe patients (70%), were in the third trimester. Among the severe patients, twenty (50%) underwent mechanical ventilation, and eleven (28%) were treated with extracorporeal membrane oxygenation. Three women died from A/H1N1v influenza. We found a strong association between the development of a severe outcome and both co-existing illnesses (adjusted odds ratio [OR], 5.1; 95% confidence interval [CI], 2.2-11.8) and a delay in oseltamivir treatment after the onset of symptoms (>3 or 5 days) (adjusted OR, 4.8; 95% CI, 1.9-12.1 and 61.2, 95% CI; 14.4-261.3, respectively). Among the 140 deliveries after 22 weeks of gestation known to date, 19 neonates (14%) were admitted to a neonatal intensive care unit, mainly for preterm delivery, and two neonates died. None of these neonates developed 2009 A/H1N1v infection. CONCLUSIONS: This series confirms the high incidence of complications in pregnant women infected with pandemic A/H1N1v observed in other countries but depicts a lower overall maternal and neonatal mortality and morbidity than indicated in the USA or Australia. Moreover, our data demonstrate the benefit of early oseltamivir treatment in this specific population

Evaluation des pratiques anesthésiques pour interruption médicale de grossesse tardive

L amélioration des techniques de dépistage prénatal a conduit à une augmentation du nombre d interruptions médicales de grossesse (IMG) en France ( 6000/an). L objectif de cette étude était de connaître les pratiques anesthésiques habituelles pour IMG après 14 semaines d aménorrhée. L étude a consisté en une enquête de pratiques auprès des équipes anesthésiques des maternités françaises attachées à un centre pluridisciplinaire de diagnostic prénatal (CPDPN). Ces pratiques ont été ensuite comparées aux pratiques des maternités de Paris et de ses départements limitrophes situées dans des établissements sans CPDPN. Dans les maternités attachées à un CPDPN, les anesthésistes participent au staff de diagnostic prénatal dans 36 % des centres et sont consultés en cas d indication maternelle dans 69 % des centres. Une analgésie périmédullaire est pratiquée chez plus de 90 % des patientes. La péridurale est posée après le foeticide dans 22 % des centres et après la mise en route du travail en l absence de foeticide dans 38 % des centres. Une sédation ou une anesthésie générale pour l expulsion est systématique ou à la demande de la patiente dans 2 % et 60 % des centres respectivement. Il existe peu de différences entre les maternités attachées à un CPDPN et celles qui ne le sont pas.En conclusion, la participation des anesthésistes à la décision d IMG mérite de se développer. L analgésie périmédullaire est la pratique habituelle et utilise des protocoles similaires à ceux utilisés pour l accouchement normal. La péridurale est parfois posée trop tardivement par rapport au déclenchement du travail ou au geste foeticide. La sédation ou anesthésie générale au moment de l expulsion semble répandue et pourrait favoriser un deuil périnatal pathologique.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

Mechanical Properties of Spark Plasma Sintering-Processed Pure Ti and Ti-6Al-4V Alloys: A Comparative Study between Harmonic and Non-Harmonic Microstructures

International audienceMicrostructure characteristics and compressive property relationships of so-called harmonic (composed by fine and coarse grains) and conventional pure titanium (Ti) and Ti-6Al-4V alloy processed by powder metallurgy route are presented in the present work. Electron backscatter diffraction (EBSD) analysis was performed to characterize the as-processed microstructures. The harmonicity structure of selected samples is described, and relevant EBSD maps are presented. The bulk samples’ hardness is reported, along with compressive responses at quasi-static and intermediate strain rates, ranging from 0.005 s−1 to 16 s−1. The strain rate sensitivity of these metallic samples is discussed, and the benefits in terms of mechanical properties of the harmonic microstructures compared with the non-harmonic conventional ones are highlighted. Finally, a modified Johnson–Cook model was shown to predict fairly the experimental results

ICU-hospitalized severe patients (n = 40).

<p>Values: N (%) unless stated otherwise.</p>†<p>Respiratory failure included moderate hypoxemia (in fourteen cases), acute lung injury with 200‡</p><p>Thrombotic microangiopathy.</p>¥<p>Homozygous sickle cell anemia and vaso-occlusive crisis with acute chest syndrome (in one case), asthma (in one case), mitral stenosis and pulmonary edema (in one case).</p><p>*Other included postpartum hemorrhage.</p>○<p>Pathological pulmonary imaging including interstitial syndrome (in nineteen cases), alveolar syndrome (in twenty-eight cases), and pleural effusion (in two cases).</p>¶<p>Secondary pulmonary infection included <i>Streptococcus pneumoniae</i> (in three cases) and <i>Streptococcus sp.</i>, <i>E. coli</i>, <i>Pseudomonas</i>, <i>Haemophilus</i>, <i>Klebsiella pneumoniae</i>, <i>Cytomegalovirus</i>, and <i>Aspergillus fumigatus</i> infections (in one case each).</p>◊<p>Cardiac failure included cardiac dysfunction (in eight cases), vasoplegia (in eight cases), short cardiac arrest (in two cases), and pericarditis (in four cases).</p>††<p>Neurologic failure included ischemic cerebro-vascular disease (in one case), critical illness neuromyopathy (in two cases), hallucinations (in one case), and psychomotor agitation (in one case).</p><p>**Other included immunoglobulins for the treatment of thrombotic microangiopathy.</p

Perinatal outcome.

<p>Values: N (%) unless stated otherwise.</p><p>L&D: labor and delivery.</p><p>NA: not applicable. NS: non-significant.</p><p>*vaginal or cesarean delivery.</p>†<p>intubation in 10 cases, resuscitation in 2 cases.</p>¥<p>Apgar <4 at five minutes in 3 cases.</p

Impact of coexisting illnesses and the timing of antiviral treatment on admission to an intensive care unit.

<p>OR, odds ratio; CI, confidence interval.</p

Characteristics of pregnant or postpartum women with 2009 A/H1N1v influenza infection.

<p>Values: N (%) unless stated otherwise. NS: non-significant.</p><p>*includes asthma, restrictive syndrome.</p><p>**includes thyroid and adrenal insufficiency.</p><p>***includes bronchodilators, insulin, salicylic acid, fractionated heparin, L-thyroxin, antihypertensive agents.</p