Safety of inferior vena cava filter retrieval in anticoagulated patients

PURPOSES: To evaluate the safety of inferior vena cava (IVC) filter retrieval in therapeutically anticoagulated patients in comparison to prophylactically or not therapeutically anticoagulated patients with respect to retrieval-related hemorrhagic complications. MATERIALS AND METHODS: This was a retrospective study of 115 consecutive attempted IVC filter retrievals in 110 patients. Filter retrievals were stratified as performed in patients who were therapeutically anticoagulated (group 1), prophylactically anticoagulated (group 2), or not therapeutically anticoagulated (group 3). The collected data included anticoagulant and antiplatelet medications (type, form and duration of administration, dosage) at the time of retrieval. Phone interviews and chart review was performed for the international normalized ratio (INR), activated partial thromboplastin time, platelet count, infusion of blood products, and retrieval-related hemorrhagic complications. RESULTS: Group 1 included 65 attempted filter retrievals in 61 therapeutically anticoagulated patients by measured INR or dosing when receiving low-molecular-weight heparin (LMWH). Four retrievals were not successful. In patients receiving oral anticoagulation, the median INR was 2.35 (range, 2 to 8). Group 2 comprised 23 successful filter retrievals in 22 patients receiving a prophylactic dose of LMWH. Group 3 included 27 attempted filter retrievals in 27 patients not receiving therapeutic anticoagulation. Six retrievals were not successful. Five patients were receiving oral anticoagulation with a subtherapeutic INR (median, 1.49; range, 1.16 to 1.69). No anticoagulation medication was administered in 22 patients. In none of the groups were hemorrhagic complications related to the retrieval procedures identified. CONCLUSIONS: These results suggest that retrieval of vena cava filters in anticoagulated patients is safe. Interruption or reversal of anticoagulation for the retrieval of vena cava filters is not indicated.

Study of a Swiss dopa-responsive dystonia family with a deletion in GCH1: redefining DYT14 as DYT5

OBJECTIVE: To report the study of a multigenerational Swiss family with dopa-responsive dystonia (DRD). METHODS: Clinical investigation was made of available family members, including historical and chart reviews. Subject examinations were video recorded. Genetic analysis included a genome-wide linkage study with microsatellite markers (STR), GTP cyclohydrolase I (GCH1) gene sequencing, and dosage analysis. RESULTS: We evaluated 32 individuals, of whom 6 were clinically diagnosed with DRD, with childhood-onset progressive foot dystonia, later generalizing, followed by parkinsonism in the two older patients. The response to levodopa was very good. Two additional patients had late onset dopa-responsive parkinsonism. Three other subjects had DRD symptoms on historical grounds. We found suggestive linkage to the previously reported DYT14 locus, which excluded GCH1. However, further study with more stringent criteria for disease status attribution showed linkage to a larger region, which included GCH1. No mutation was found in GCH1 by gene sequencing but dosage methods identified a novel heterozygous deletion of exons 3 to 6 of GCH1. The mutation was found in seven subjects. One of the patients with dystonia represented a phenocopy. CONCLUSIONS: This study rules out the previously reported DYT14 locus as a cause of disease, as a novel multiexonic deletion was identified in GCH1. This work highlights the necessity of an accurate clinical diagnosis in linkage studies as well as the need for appropriate allele frequencies, penetrance, and phenocopy estimates. Comprehensive sequencing and dosage analysis of known genes is recommended prior to genome-wide linkage analysis.

Triggering of volcanic activity by large earthquakes

Statistical analyses of temporal relationships between large earthquakes and volcanic eruptions suggest seismic waves may trigger eruptions even over great (>1000 km) distances, although the causative mechanism is not well constrained. In this study the relationship between large earthquakes and subtle changes in volcanic activity was investigated in order to gain greater insight into the relationship between dynamic stresses propagated by surface waves and volcanic response. Daily measurements from the Ozone Monitoring Instrument (OMI), onboard the Aura satellite, provide constraints on volcanic sulfur-dioxide (SO2) emission rates as a measure of subtle changes in activity. Time series of SO2 emission rates were produced from OMI data for thirteen persistently active volcanoes from 1 October 2004 to 30 September 2010. In order to quantify the affect of earthquakes at teleseismic distances, we modeled surface-wave amplitudes from the source mechanisms of moment magnitude (Mw) ≥7 earthquakes, and calculated the Peak Dynamic Stress (PDS). We assessed the influence of earthquakes on volcanic activity in two ways: 1) by identifying increases in the SO2 time series data and looking for causative earthquakes and 2) by examining the average emission rate before and after each earthquake. In the first, the SO2 time series for each volcano was used to calculate a baseline threshold for comparison with post-earthquake emission. Next, we generated a catalog of responses based on sustained SO2 emission increases above this baseline. Delay times between each SO2 response and each prior earthquake were analyzed using both the actual earthquake catalog, and a randomly generated catalog of earthquakes. This process was repeated for each volcano. Despite varying multiple parameters, this analysis did not demonstrate a clear relationship between earthquake-generated PDS and SO2 emission. However, the second analysis, which was based on the occurrence of large earthquakes indicated a response at most volcanoes. Using the PDS calculations as a filtering criterion for the earthquake catalog, the SO2 mass for each volcano was analyzed in 28-day windows centered on the earthquake origin time. If the average SO2 mass after the earthquake was greater than an arbitrary percentage of pre-earthquake mass, we identified the volcano as having a response to the event. This window analysis provided insight on what type of volcanic activity is more susceptible to triggering by dynamic stress. The volcanoes with very open systems included in this study, Ambrym, Gaua, Villarrica, Erta Ale and, Turrialba, showed a clear response to dynamic stress while the volcanoes with more closed systems, Merapi, Semeru, Fuego, Pacaya, and Bagana, showed no response.

Missed opportunities in the prevention of perinatal human immunodeficiency syndrome virus transmission

Mother to child transmission of human immunodeficiency virus (HIV) has decreased dramatically in the United States since the mid-1990s. Without antiretroviral therapy the risk of perinatal infection is as high as 25%; with treatment the risk drops to <1-2%. However, state surveillance data show a recent rise in the percentage of babies being born with HIV in Texas. No studies of perinatal HIV transmission in Texas have focused on the individual cases and identified what social/institutional barriers stood in the way of the index woman, her support system and her health providers in negotiating access to prenatal care and HIV treatment.^ The Texas Department of State Health Services identifies the babies born in Texas with HIV infection. This two year study will use mixed methods to identify barriers to the diagnosis and treatment of maternal HIV. In-depth interviews and chart reviews will be used to conduct the study. The abstracted medical record will give us demographic data and details of the timing of testing and treatment; interviews will provide information as to the individual and environmental factors that may have delayed testing and treatment. Little research has been done to assess the factors contributing to late prenatal HIV diagnosis and care in Texas and the interventions identified by mothers of affected babies that might overcome these obstacles.^ Conclusions from this study will guide the development of interventions to better educate the public, reduce structural barriers common to the underserved, and/or educate health care professionals. The study will also serve as a model for other states to undertake evaluation of their cases of perinatal infection. ^

EVALUATION OF AN AUTOMATED AMBULATORY MEDICAL RECORD SYSTEM

This research was intended to evaluate an automated ambulatory medical record and chart review system. Chart review as conceptualized in this research is a series of statements that are made by the computer after reviewing the patients entire computer medical record. The actual chart review st