Current evidence for human yersiniosis in Ireland.

Yersiniosis associated with abdominal pain was commonly reported in Ireland in the 1980s. However, the Health Protection Surveillance Centre (HPSC) currently records only three to seven notified cases of yersiniosis per year. The most common cause of yersiniosis worldwide is Yersinia enterocolitica, and the leading source for this organism is consumption of pork-based food products. In contrast to the apparent current scarcity of yersiniosis cases in humans in Ireland, pathogenic Y. enterocolitica are detectable in a high percentages of pigs. To establish whether the small number of notifications of human disease was an underestimate due to lack of specific selective culture for Yersinia, we carried out a prospective culture study of faecal samples from outpatients with diarrhoea, with additional culture of throat swabs, appendix swabs and screening of human sewage. Pathogenic Yersinia strains were not isolated from 1,189 faeces samples, nor from 297 throat swabs, or 23 appendix swabs. This suggested that current low notification rates in Ireland are not due to the lack of specific Yersinia culture procedures. Molecular screening detected a wider variety of Y. enterocolitica-specific targets in pig slurry than in human sewage. A serological survey for antibodies against Yersinia YOP (Yersinia Outer Proteins) proteins in Irish blood donors found antibodies in 25 %, with an age-related trend to increased seropositivity, compatible with the hypothesis that yersiniosis may have been more prevalent in Ireland in the recent past.

ACE up the sleeve - are vascular patients medically optimized?

OBJECTIVE: To examine the current medical management of arteriopathic patients attending a vascular surgical service at a university teaching hospital over a 6-month period. The prescribing of antiplatelets, statins, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers and beta-blockers was specifically examined. Vascular patients are often under the care of multiple specialties, and therefore the influence of different medical specialties on the patients' medical management was also examined. DESIGN: Between January and June 2009, data were recorded on sequential patients with arterial disease attending the vascular surgical service. Patients' demographics, type of arterial disease, medical consultations within the previous 12 months, and current medications were recorded. RESULTS: The study included 180 patients with a mean age of 69 years (39-88 years). All but 4% were taking an antiplatelet or anticoagulant, predominantly aspirin. There were 86% taking a statin, 44% taking a beta-blocker, and 51% taking an ACE inhibitor. Suboptimal prescription of ACE inhibitors and beta-blockers was evident regardless of the type of medical consultations in the previous year. No specialty group differed significantly from vascular surgeons in their prescribing pattern. CONCLUSIONS: While almost all arteriopaths receive some form of antiplatelet and statin in line with clinical evidence, ACE inhibitors and beta-blockers appear to be under-prescribed in this arteriopathic population. We conclude that opportunity exists for vascular surgeons to embrace recent guidelines and lead the way in both surgical and medical optimization of arteriopathic patients through improving links with primary care physicians or taking greater responsibility themselves for the medical as well as the surgical care of their arteriopathic patients.