An Australian experience of retrievable inferior vena cava filters in patients with increased risk of thromboembolic disease

AIM

Pulmonary embolism (PE) is a common cause of death and morbidity. Anticoagulant therapy reduces the risk of PE but is associated with bleeding. Inferior vena caval (IVC) filters protect against PE but have an increased long term risk of deep vein thrombosis (DVT). Temporary IVC filters allow protection against PE during high risk situations and may be later removed avoiding the need for long term anticoagulation.

METHODS

We present our experience with the Recovery (Bard, Tempe, AZ) and Tulip (Cook, Bloomington, IN) optionally retrievable filters.

RESULTS

Retrievable filters were planned for 121 patients. Mean age: 58.8 years; 72 male. The indications included: Established venous thromboembolism (VTE) and contraindication to anticoagulation; high risk of VTE and need for surgery with high risk of bleeding; VTE extension despite anti-coagulation. A retrievable filter was placed without significant incident in 113 patients. There were two proven cases of PE. In total there were 27 deaths of patients during the period of their follow up. There was 1 death related to confirmed filter migration. There was 1 sudden unexplained death in a patient with suspected malignancy. Filter removal was attempted in 58 cases at a mean of 44 days and was performed successfully in 52. Thromboembolus was found in the retrieved filter in 30 cases but did not prevent removal in 29.

CONCLUSION

Retrievable IVC Filters are safe and effective in preventing PE in high risk patients. We have demonstrated success in retrieving filters up to 182 days following insertion, avoiding the need for long term anticoagulation.

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis. Based on the limited evidence available, inhaled short-acting beta(2)-agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop. Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit. Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.

Awareness of risk factors amongst first degree relative patients with colorectal cancer

BACKGROUND

The association between family history of colorectal cancer (CRC) in first degree relatives (FDRs) and the risk of developing the disease has been well established. However, little is known about the degree of awareness of CRC risk factors amongst FDRs. This study examined awareness of familial, dietary and lifestyle risk amongst FDRs.

METHOD

Consent to approach relatives was obtained from CRC patients who attended outpatients following surgery for CRC. A study specific questionnaire was sent by post to their FDRs. The dietary and lifestyle risk factors tested in the questionnaire were those promoted in CRC educational material.

RESULTS

One hundred and four questionnaires were returned out of 137 sent (76%). Fifty-nine per cent (n = 61) of FDRs were aware of their increased risk. Fifty-five per cent (n = 57) were aware of the link between CRC and smoking; however, knowledge of association of CRC with excessive alcohol consumption (32%) and lack of exercise (40%) was less well appreciated. Higher awareness scores were obtained by those with a university education (P < 0.001). Ninety four per cent believed that relatives of CRC patients were not provided with enough information as to their being at risk and risk factors.

CONCLUSIONS

This study provides an initial assessment of the awareness of CRC risk factors in a population at increased risk. It demonstrates a poor level of knowledge. Improved education strategies allowing FDRs to make dietary and lifestyle modifications that could reduce their lifetime risk of developing CRC are necessary.

Aquaculture practices and potential human health risks: current knowledge and future priorities

Annual global aquaculture production has more than tripled within the past 15 years, and by 2015, aquaculture is predicted to account for 39% of total global seafood production by weight. Given that lack of adequate nutrition is a leading contributor to the global burden of disease, increased food production through aquaculture is a seemingly welcome sign. However, as production surges, aquaculture facilities increasingly rely on the heavy input of formulated feeds, antibiotics, antifungals, and agrochemicals. This review summarizes our current knowledge concerning major chemical, biological and emerging agents that are employed in modern aquaculture facilities and their potential impacts on public health. Findings from this review indicate that current aquaculture practices can lead to elevated levels of antibiotic residues, antibiotic-resistant bacteria, persistent organic pollutants, metals, parasites, and viruses in aquacultured finfish and shellfish. Specific populations at risk of exposure to these contaminants include individuals working in aquaculture facilities, populations living around these facilities, and consumers of aquacultured food products. Additional research is necessary not only to fully understand the human health risks associated with aquacultured fish versus wild-caught fish but also to develop appropriate interventions that could reduce or prevent these risks. In order to adequately understand, address and prevent these impacts at local, national and global scales, researchers, policy makers, governments, and aquaculture industries must collaborate and cooperate in exchanging critical information and developing targeted policies that are practical, effective and enforceable.

Evidence supporting nutritional interventions for persons in early stage Alzheimer's disease (AD)

The purpose of this paper is to grade research evidence supporting nutritional interventions for persons with early stage dementias and to report the recommendations of a consensus panel. Thirty four studies were reviewed in the areas of dietary restriction, antioxidants, and Mediterranean diet with strong support from epidemiological studies found in all three areas. The body of evidence to support nutritional interventions in the prevention and treatment of AD is growing and has potential as a treatment modality following translational studies.

Chronic exposure to schistosome eggs reduces serum cholesterol but has no effect on atherosclerotic lesion development

Previous studies have shown that people infected with schistosomiasis have lower levels of serum cholesterol than uninfected controls. To better understand the impact of this parasitic infection on serum cholesterol levels and on atherosclerotic lesion development induced by hypercholesterolemia, apolipoprotein E (ApoE)-deficient mice were chronically exposed to the eggs of Schistosoma mansoni over a period of 16 weeks. Total serum cholesterol and low-density lipoprotein (LDL) were reduced in egg-exposed ApoE-deficient mice fed a diet high in cholesterol compared to unexposed controls. However, exposure to eggs had no effect on atherosclerotic lesion size or progression in ApoE-deficient mice. Macrophages isolated from egg-exposed mice had an enhanced ability to take up LDL but not acetylated LDL (acLDL). This study suggests that schistosome eggs alone may alter serum lipid profiles through enhancing LDL uptake by macrophages, but these changes do not ultimately affect atherosclerotic lesion development.

What do we feed to food-production animals? A review of animal feed ingredients and their potential impacts on human health

OBJECTIVE

Animal feeding practices in the United States have changed considerably over the past century. As large-scale, concentrated production methods have become the predominant model for animal husbandry, animal feeds have been modified to include ingredients ranging from rendered animals and animal waste to antibiotics and organoarsenicals. In this article we review current U.S. animal feeding practices and etiologic agents that have been detected in animal feed. Evidence that current feeding practices may lead to adverse human health impacts is also evaluated.

DATA SOURCES

We reviewed published veterinary and human-health literature regarding animal feeding practices, etiologic agents present in feed, and human health effects along with proceedings from animal feed workshops.

DATA EXTRACTION

Data were extracted from peer-reviewed articles and books identified using PubMed, Agricola, U.S. Department of Agriculture, Food and Drug Administration, and Centers for Disease Control and Prevention databases.

DATA SYNTHESIS

Findings emphasize that current animal feeding practices can result in the presence of bacteria, antibiotic-resistant bacteria, prions, arsenicals, and dioxins in feed and animal-based food products. Despite a range of potential human health impacts that could ensue, there are significant data gaps that prevent comprehensive assessments of human health risks associated with animal feed. Limited data are collected at the federal or state level concerning the amounts of specific ingredients used in animal feed, and there are insufficient surveillance systems to monitor etiologic agents "from farm to fork."

CONCLUSIONS

Increased funding for integrated veterinary and human health surveillance systems and increased collaboration among feed professionals, animal producers, and veterinary and public health officials is necessary to effectively address these issues.

Cyclooxygenase-2 expression and its association with increased angiogenesis in human abdominal aortic aneurysms

Although the mechanism whereby non-steroidal anti-inflammatory drugs may reduce abdominal aortic aneurysm (AAA) development is unknown, one potential route is via inhibition of the cyclooxygenase (COX) enzyme. Despite the fact that evidence from animal models suggests a role for the COX-2 isoform in promotion of AAA development, only very limited data exist on COX-2 expression in human AAAs. Semiquantitative immunohistochemistry for COX-2 was performed on a series of formalin-fixed, paraffin-embedded human AAAs (n = 49). Associated clinicopathological data, including the degree of inflammatory cell infiltration and neorevascularization, were obtained. COX-2 protein was detected in 46 of 49 (94%) human AAAs. Expression of COX-2 protein varied widely between AAAs. COX-2 protein localized to cells in the inflammatory infiltrate with a morphology characteristic of macrophages. COX-2 expression increased with the extent of inflammatory cell infiltration (P < 0.001) and with the degree of AAA neorevascularization (P < 0.001). Logistic regression analysis identified neorevascularization (P < 0.001) as the only significant independent predictor of COX-2 positivity in human AAAs. COX-2 protein is present at increased levels in the majority of human AAAs and is expressed by mononuclear cells in the inflammatory cell infiltrate. Promotion of angiogenesis by COX-2 may play a role in AAA development.

Monitoring change in diabetes care using diabetes registers--experience from divisions of general practice

BACKGROUND

The quality of care for patients with type 2 diabetes has been the subject of a number of government initiatives over the past decade. General practice has an especially important role in diabetes care.

METHODS

The National Integrated Diabetes Program was introduced in 2001. Changes in the frequency of assessment and the physiological markers of diabetic control were assessed in a cohort of 2731 patients with type 2 diabetes from 16 general practice diabetes registers during 2000-2002.

RESULTS

Frequency of assessment was better in patients living in low socioeconomic postcodes but did not change significantly over the 3 years. There were improvements in intermediate outcomes (HbA1c, systolic and diastolic blood pressure, lipid levels) over the period.

DISCUSSION

These data provide a benchmark for improvement in the quality of diabetes care in general practice.

Public health implications of meat production and consumption

The high level of meat and saturated fat consumption in the USA and other high-income countries exceeds nutritional needs and contributes to high rates of chronic diseases such as cardiovascular disease, diabetes mellitus and some cancers. Affluent citizens in middle- and low-income countries are adopting similar high-meat diets and experiencing increased rates of these same chronic diseases. The industrial agricultural system, now the predominant form of agriculture in the USA and increasingly world-wide, has consequences for public health owing to its extensive use of fertilisers and pesticides, unsustainable use of resources and environmental pollution. In industrial animal production there are public health concerns surrounding feed formulations that include animal tissues, arsenic and antibiotics as well as occupational health risks and risks for nearby communities. It is of paramount importance for public health professionals to become aware of and involved in how our food is produced.