Impact of multidisciplinary team meetings on the management of venous thromboembolism. A clinical study of 142 cases.

OBJECTIVE: Numerous guidelines have been published on the management of venous thromboembolism (VTE). However, therapeutic decision-making may prove challenging in routine clinical practice. With this in mind, multidisciplinary team (MDT) meetings have been set up in Rennes University Hospital, France. This study sought to describe the situations discussed during MDT meetings and to assess whether the meetings bring about changes in the management of these patients. MATERIALS AND METHODS: A retrospective single-center study conducted at the Rennes University Hospital included cases presented from the beginning of the MDT meetings (February 2015) up to May 2017. RESULTS: In total, 142 cases were presented in 15 MDT meetings, corresponding to a mean of 10±4 cases per meeting. Of these, 129 related to VTE patients: 33 provoked VTEs, 22 unprovoked VTEs, 49 cancer-related VTEs, and 25 unspecified VTEs. MDT meetings led to significant changes in the anticoagulation type (therapeutic, prophylactic, or discontinuation) and duration, but not in the anticoagulant choice (direct oral anticoagulants, vitamin K antagonists, heparins, etc.). CONCLUSION: Requests for MDT meetings are made for all VTE types, and these meetings have an impact on VTE management.

Molecular, clinical and neuropsychological study in 31 patients with Kabuki syndrome and KMT2D mutations.

Kabuki syndrome (KS-OMIM 147920) is a rare developmental disease characterized by the association of multiple congenital anomalies and intellectual disability. This study aimed to investigate intellectual performance in children with KS and link the performance to several clinical features and molecular data. We recruited 31 children with KMT2D mutations who were 6 to 16 years old. They all completed the Weschler Intelligence Scale for Children, fourth edition. We calculated all indexes: the Full Scale Intellectual Quotient (FSIQ), Verbal Comprehension Index (VCI), Perceptive Reasoning Index (PRI), Processing Speed Index (PSI), and Working Memory Index (WMI). In addition, molecular data and several clinical symptoms were studied. FSIQ and VCI scores were 10 points lower for patients with a truncating mutation than other types of mutations. In addition, scores for FSIQ, VCI and PRI were lower for children with visual impairment than normal vision. We also identified a discrepancy in indexes characterized by high WMI and VCI and low PRI and PSI. We emphasize the importance of early identification and intensive care of visual disorders in patients with KS and recommend individual assessment of intellectual profile.

Air nicotine and saliva cotinine as indicators of workplace passive smoking exposure and risk.

We model nicotine from environmental tobacco smoke (ETS) in office air and salivary cotinine in nonsmoking U.S. workers. We estimate that: an average salivary cotinine level of 0.4 ng/ml corresponds to an increased lifetime mortality risk of 1/1000 for lung cancer, and 1/100 for heart disease; > 95% of ETS-exposed office workers exceed OSHA's significant risk level for heart disease mortality, and 60% exceed significant risk for lung cancer mortality; 4000 heart disease deaths and 400 lung cancer deaths occur annually among office workers from passive smoking in the workplace, at the current 28% prevalence of unrestricted smoking in the office workplace.

Respiratory health effects of exposure to environmental tobacco smoke.

During the last 25 years, several hundred papers have been published on the respiratory health effects of environmental tobacco smoke (ETS). Various independent assessments have concluded that ETS causes lung cancer in adult nonsmokers and increases the risk of various noncancer effects, principally in children. The effects on children include pneumonia, bronchitis and bronchiolitis in young children; chronic middle ear effusion; increased frequency and severity of attacks among asthmatics; possible induction of asthma in previously asymptomatic individuals; small reductions in lung function; and symptoms of upper respiratory tract irritation. In nonsmoking adults, ETS exposure is associated with irritation of the eyes, nose, and throat, and with wheezing, symptoms of bronchitis, shortness of breath, and decreased lung function. The results of recent studies not only confirm and strengthen the above findings but also provide strong suggestive evidence that ETS causes sinonasal cancer and is a risk factor for sudden infant death syndrome. To mitigate such a preventable environmental health impact, public health measures to reduce involuntary ETS exposure are warranted.

Respiratory health effects of passive smoking: EPA's weight-of-evidence analysis.

After an extensive review and assessment of the scientific evidence on the respiratory health effects of passive smoking, the U.S. Environmental Protection Agency has determined that the widespread exposure to environmental tobacco smoke in the United States presents a serious and substantial public health impact. The Environmental Protection Agency concluded that environmental tobacco smoke causes lung cancer in adult nonsmokers and increases the risk for a variety of noncancer respiratory disorders, especially in children. This article reviews evidence presented in the Environmental Protection Agency's 1992 report on the respiratory health effects of passive smoking and responds to critical allegations levied by Gio Gori in his article "Science, policy, and ethics: the case of environmental tobacco smoke", appearing in the same issue of this journal. Several recent studies appearing since the cutoff date for inclusion in the EPA report are also discussed.

La legislación panameña en relación con la epidemiología del Síndrome de InmunoDeficiencia Adquirida (SIDA) / The panamanian law and its relation to the epidemiology of the Acquired ImmunoDeficiency Syndrome (AIDS)

Con la introducción del Síndrome de InmunoDeficiencia Adquirida (SIDA), la más reciente de las enfermedades de transmisión sexual, la legislación panameña vigente, en vez de estigmatizar al enfermo o infectado, al tipificar la transmisión sexual como un delito a la salud pública, debería orientarse a garantizar para el paciente, el pleno derecho a una vida social y económicamente productiva. Esto permitiría respetar la condición humana y evitar prácticas descriminatorias y alienantes

Cancer risk assessment of 1,3-butadiene.

This paper discusses the Environmental Protection Agency's (EPA) risk assessment of 1,3-butadiene. The assessment focuses on estimation of increased cancer risk to populations living near industrial sources of 1,3-butadiene emissions rather than occupationally exposed populations. Incremental cancer risk estimates based on extrapolation from laboratory animal data are presented. Pharmacokinetic data published since the EPA's 1985 assessment are incorporated, which somewhat alters the earlier assessment of cancer risk. Characterization of emission sources, estimates of ambient air concentrations, and population exposure are also discussed. The estimate presented in this paper of excess cancer cases resulting from point source exposure to 1,3-butadiene is decreased to approximately 40% of the estimate published in 1985 from 6.4 in 10 to 2.5 chances in 10 for a lifetime exposure to 1 ppm. The current estimate is no more than eight additional cancer incidences in the general population. Increased risk to the most exposed individuals is not anticipated to be greater than 1 in 10. This reduction in the risk estimate is due to a change in the estimate of 1,3-butadiene potency (i.e., incremental unit risk estimate) based on incorporation of new pharmacokinetic data.