Mortality due to pandemic (H1N1) 2009 influenza in England: a comparison of the first and second waves

Deaths in England attributable to pandemic (H1N1) 2009 deaths were investigated through a mandatory reporting system. The pandemic came in two waves. The second caused greater population mortality than the first (5·4 vs. 1·6 deaths per million, P<0·001). Mortality was particularly high in those with chronic neurological disease, chronic heart disease and immune suppression (450, 100, and 94 deaths per million, respectively); significantly higher than in those with chronic respiratory disease (39 per million) and those with no risk factors (2·4 per million). Greater mortality in the second wave has been observed in all previous influenza pandemics. This time, the explanation appears to be behavioural. This emphasizes the importance of maintaining public and clinical awareness of risks associated with pandemic influenza beyond the initial high-profile period.     

Hospitalization in two waves of pandemic influenza A(H1N1) in England

Uncertainties exist regarding the population risks of hospitalization due to pandemic influenza A(H1N1). Understanding these risks is important for patients, clinicians and policy makers. This study aimed to clarify these uncertainties. A national surveillance system was established for patients hospitalized with laboratory-confirmed pandemic influenza A(H1N1) in England. Information was captured on demographics, pre-existing conditions, treatment and outcomes. The relative risks of hospitalization associated with pre-existing conditions were estimated by combining the captured data with population prevalence estimates. A total of 2416 hospitalizations were reported up to 6 January 2010. Within the population, 4·7 people/100,000 were hospitalized with pandemic influenza A(H1N1). The estimated hospitalization rate of cases showed a U-shaped distribution with age. Chronic kidney disease, chronic neurological disease, chronic respiratory disease and immunosuppression were each associated with a 10- to 20-fold increased risk of hospitalization. Patients who received antiviral medication within 48 h of symptom onset were less likely to be admitted to critical care than those who received them after this time (adjusted odds ratio 0·64, 95% confidence interval 0·44-0·94, P=0·024). In England the risk of hospitalization with pandemic influenza A(H1N1) has been concentrated in the young and those with pre-existing conditions. By quantifying these risks, this study will prove useful in planning for the next winter in the northern and southern hemispheres, and for future pandemics.     

Catheter ultrasound phased-array transducers for thermal ablation: a feasibility study

The feasibility of catheter single-element ultrasound transducers for cardiac ablation has been shown previously. We describe the design and testing of catheter-sized linear phased arrays transducers for ultrasound ablation. One array has 86 PZT-4 elements operating at 8 MHz and 5 MHz. The overall array size is 14.9 mm by 3.1 mm (10 Fr). The other array has 50 PZT-5 elements operating at 4 MHz and is 17 mm by 3.1 mm (10 Fr). In order to produce the intensity needed to create lesions in heart tissue, we modified a real-time, 3D scanner to produce 100 Vpp 256-cycle transmit pulses at a pulse repetition frequency of 14.1 kHz. This made it possible for the PZT-4 and PZT-5 transducers to produce ISPTA of 3.26 W/cm2 and 142 W/cm2, respectively. When driving the transducers at high duty factor, the transmit circuitry in the scanner was damaged. A mechanically-focused transducer with the same dimensions as the PZT-4 transducer was built. When transmitting continuously at 9 MHz, it produced an ISPTA of 29.3 W/cm2. This created a lesion 5 mm across and 5 mm deep in beef tissue while raising the focal temperature 23 degrees C. Ablation is within the capabilities of a catheter phased array transducer integrated into a diagnostic ultrasound scanner.     

The use of a sentinel cerebral protection system during Impella CP removal in a patient with left ventricular thrombus

Percutaneous mechanical circulatory support (pMCS) devices are commonly being utilized for hemodynamic support in patients undergoing high‐risk percutaneous coronary interventions or stabilization for those in cardiogenic shock. Left ventricular (LV) to ascending aorta (Ao) rotodynamic pumps such as the Impella devices allow for rapid hemodynamic stabilization or support in such instances. The use of such devices is contraindicated in patients with known LV thrombus. However, it remains unclear on how to manage patients who develop an LV thrombus while on prolonged Impella support. While there are currently no cerebral embolic protection devices (CEPDs) approved for use in conjunction with LV to Ao pMCS devices or other short‐term mechanical support devices, there is a theoretical benefit for the use of such technology in the right circumstances. We present a case describing the use of the sentinel cerebral protection system (SCPS) in a patient who developed LV thrombus while on Impella CP support. The use of the SCPS in this patient suggests a potential role for CEPD in prevention of thromboembolism while on Impella support.