Genetic characterization of the glycoprotein G of Chandipura viruses in India with emphasis on an outbreak of 2015.

Chandipura virus (CHPV) is found to be associated with sporadic encephalitis outbreaks in humans in India since 1965. We report here, the investigation of CHPV activity during the period of June-August 2015 in the state of Gujarat, which revealed 24.44% positivity among 45 referred encephalitis cases. Phylogenetic study of the G gene sequences of strains from Gujarat 2015 along with available sequences of additional strains from different geographical locations and isolation years (1965-2015), indicated the relatedness of the 2015 strain to a group of the CHPV prototype strain of 1965 and the earliest outbreak strains of 2003. Analyses of selection pressure in the G gene revealed positively selected sites within the signal peptide region and a putative CHPV epitope. These results indicate a probable role of G protein-based immune selection and underline the need for continued surveillance to monitor genetic and antigenic variations in the CHPV.

Perioperative anticoagulation in patients with chronic atrial fibrillation who are undergoing elective surgery: results of a physician survey.

OBJECTIVE: To survey physicians' anticoagulation preferences in patients with chronic atrial fibrillation who are undergoing elective surgery. MATERIALS AND METHODS: A survey was performed that asked physicians to provide pre- and postoperative anticoagulation preferences for two clinical scenarios of patients with chronic atrial fibrillation (high stroke risk, low stroke risk) undergoing elective surgery. In addition to the interruption of warfarin therapy, perioperative anticoagulation options were as follows: a) in-hospital full dose intravenous heparin; b) outpatient full dose subcutaneous unfractionated heparin or low molecular weight heparin (LMWH); c) low dose unfractionated heparin or LMWH (postoperative only); d) nothing other than stopping warfarin preoperatively and restarting it postoperatively; or e) another anticoagulant strategy. RESULTS: In the high stroke risk scenario, the proportions of respondents preferring anticoagulation options a, b, d and e in the preoperative period were 24%, 20%, 54% and 2%, respectively; the proportions preferring options a, b, c, d and e in the postoperative period were 35%, 13%, 15%, 35% and 1%, respectively. In the low stroke risk scenario, the proportions of respondents preferring options a, b, d and e in the preoperative period were 7%, 10%, 80% and 3%, respectively; the proportions preferring options a, b, c, d and e in the postoperative period were 11%, 9%, 10%, 68% and 2%, respectively. CONCLUSIONS: In patients with chronic atrial fibrillation who underwent elective surgery, perioperative anticoagulant management preferences varied widely in patients at high risk for stroke, but were more uniform and less aggressive in patients at low risk for stroke.

Physician preferences for perioperative anticoagulation in patients with a mechanical heart valve who are undergoing elective noncardiac surgery.

STUDY OBJECTIVE: To determine physicians' anticoagulation preferences in patients with a mechanical heart valve who are undergoing elective surgery, and to determine the effect of different risks of thromboembolism (TE) and postoperative bleeding on anticoagulation preferences. DESIGN: Mail survey of physicians who prescribe anticoagulant therapy. METHODS AND RESULTS: Physicians were asked to provide anticoagulation preferences in four clinical scenarios of patients with a mechanical heart valve who are undergoing elective surgery. Physicians were asked to select from three preoperative anticoagulation options (two aggressive, one less aggressive) and four postoperative anticoagulation options (two aggressive, two less aggressive). IV heparin was the most frequently selected anticoagulation option. Depending on the scenario, it was preferred by 39 to 79% of respondents for preoperative anticoagulation therapy, and by 44 to 84% of respondents for postoperative anticoagulant therapy. The risk of TE had a strong influence on anticoagulation preferences: more respondents preferred aggressive anticoagulant management in high-risk compared with low-risk TE scenarios (p < 0.001). Anticoagulation preferences were not influenced by the risk of bleeding: the proportion of respondents who preferred aggressive anticoagulant management did not differ in high-risk and low-risk bleeding scenarios (p > 0.05). Of respondents who preferred IV heparin for postoperative anticoagulation therapy, the risk of bleeding influenced the timing of heparin initiation: fewer respondents preferred early heparin initiation (within 12 h after surgery) in high-risk compared with low-risk bleeding scenarios (p < 0.01). CONCLUSIONS: (1) Preoperative and postoperative IV heparin were the most frequently selected anticoagulation options. (2) The risk of TE, but not the risk of bleeding, influenced the aggressiveness of anticoagulant management. (3) If IV heparin was selected, the risk of bleeding influenced the timing of heparin initiation.