Prevalence of anemia and its impact on the state of frailty in elderly people living in the community: SADEM study

Anemia represents a global health problem that negatively impacts quality of life in elderly population; however, its impact on the geriatric syndrome of frailty is unclear. We examined the prevalence of anemia among elderly and sought a relationship between hemoglobin and the phenotype of frailty. Baseline hemoglobin quintiles and anemia were assessed in relation to frailty status in a prospective study with 1,933 older community-dwelling adults enrolled in the Study on Aging and Dementia in Mexico (SADEM). Logistic regression was used to model the relationship between frailty and Hb, adjusting for risk factors of frailty, sociodemographic data, cognitive decline, chronic diseases, and some risky habits. Prevalence of frailty was 8.3 %. Frailty risk was highest at the lowest hemoglobin quintile (<14.3 g/dL for men; <13.3 g/dL for women), and 160 (8.3 %) were anemic (<13 g/dL for men; <12 g/dL for women). The relationship between frailty and Hb levels, adjusted for age and sex, observed in the first and fifth quintiles, compared with the fourth quintile, were 1.53 (95 % confidence interval (CI), 1.46–1.60) and 1.05 (95 % CI, 1.01–1.15). After multivariate adjustment, the odds ratios (ORs) were 1.23 (95 % CI, 1.17–1.13) and 1.06 (95 % CI, 1.01–1.11). The association was not diminished by risk factors for frailty (body mass index (BMI), comorbidity, cognitive decline, smoking, alcohol consumption, etc.). In community-dwelling older adults, low hemoglobin concentrations and anemia were independently associated with increased frailty risk. This suggests that mild anemia and low Hb levels are independent, modifiable risk factors for frailty.     

Founder effect and ancestral origin of the spinocerebellar ataxia type 7 (SCA7) mutation in Mexican families

Spinocerebellar ataxia type 7 (SCA7) is an autosomal dominant disease characterized by progressive cerebellar ataxia and macular degeneration causing progressive blindness. It accounts for 1 to 11.6 % of spinocerebellar ataxias (SCAs) cases worldwide and for 7.4 % of SCA7 cases in Mexico. We identified a cluster of SCA7 families who resided in a circumscribed area of Veracruz and investigated whether the high incidence of the disease in this region was due to a founder effect. A total of 181 individuals from 20 families were studied. Four microsatellite markers and one SNP flanking the ATNX7 gene were genotyped and the ancestral origin and local ancestry analysis of the SCA7 mutation were evaluated. Ninety individuals from 19 families had the SCA7 mutation; all were found to share a common haplotype, suggesting that the mutation in these families originated from a common ancestor. Ancestral origin and local ancestry analysis of SCA7 showed that the chromosomal segment containing the mutation was of European origin. We here present evidence strongly suggesting that the high frequency of SCA7 in Veracruz is due to a founder effect and that the mutation is most likely of European origin with greatest resemblance to the Finnish population.     

Immune responses in the human female reproductive tract

Mucosal surfaces are key interfaces between the host and its environment, but also constitute ports of entry for numerous pathogens. The gut and lung mucosae act as points of nutrient and gas exchange, respectively, but the physiological purpose of the female reproductive tract (FRT) is to allow implantation and development of the fetus. Our understanding of immune responses in the FRT has traditionally lagged behind our grasp of the situation at other mucosal sites, but recently reproductive immunologists have begun to make rapid progress in this challenging area. Here, we review current knowledge of immune responses in the human FRT and their heterogeneity within and between compartments. In the commensal-rich vagina, the immune system must allow the growth of beneficial microbes, whereas the key challenge in the uterus is allowing the growth of the semi-allogeneic fetus. In both compartments, these objectives must be balanced with the need to eliminate pathogens. Our developing understanding of immune responses in the FRT will help us develop interventions to prevent the spread of sexually transmitted diseases and to improve outcomes of pregnancy for mothers and babies.     

Late and very late onset group B Streptococcus sepsis: one and the same?

Background

This study aimed to describe the clinical characteristics of group B Streptococcus (GBS) sepsis in infants aged 4–90 days [late onset (LO)] compared to infants >90 days of age [very late onset (VLO)].

Methods

Microbiology records at Children’s Medical Center Dallas were screened. Demographic, clinical, and outcome data were collected for infants with GBS recovered from blood or cerebrospinal fluid culture from January 1, 2006 to July 1, 2012.

Results

Totally 48 infants were identified (42 LO, 6 VLO). Infants with VLO sepsis had lower median gestational age (28.5 vs. 39 weeks gestation, P<0.001) and longer median nursery admissions (8.8 vs. 0.5 weeks, P=0.004). When gestational age was controlled for, there were no differences in clinical presentation, intensive care unit admission, length of stay, neurodevelopmental outcome, and mortality. Infants with VLO sepsis were more likely to receive vancomycin (83% vs. 33%, P=0.02) or third-generation cephalosporins (83% vs. 24%, P=0.009), and more likely to continue on those agents even after GBS was identified.

Conclusions

Infants with VLO sepsis had lower gestational ages and longer nursery stays than infants with LO sepsis. Beyond age at presentation, there were no significant differences in clinical presentations, hospital course, frequency of neurodevelopmental sequelae, and mortality in infants presenting with LO vs. VLO GBS sepsis. Infants with VLO sepsis were more likely to receive empiric broad spectrum antimicrobials and more likely to continue receiving broad therapy even following GBS identification.     

Tissue alterations in urethral and vaginal walls related to multiparity in rabbits

In rodents, vaginal distention after delivery or experimental manipulation affects innervations as well as the amount of striated/smooth musculature or collagen in both the urethra and vagina. These changes are associated with modifications in excretory and reproductive processes. Although successive and consecutive vaginal deliveries (multiparity) affect the contractile and functional properties of the female lower urogenital tract (LUT), its impact on LUT morphometry, including persistency, has been barely studied. The caudal urethra (CU) and cranial (V1) and caudal (V2) pelvic vaginal regions were excised from young and adult nulliparous (YN and AN, respectively) and multiparous (YM and AM, respectively) rabbits. Tissues were histologically processed and stained with Masson's trichrome. The thickness of the tissue layers and areas covered by tissue components were measured and compared using two‐way ANOVA followed by Student‐Newmann‐Keuls tests to determine statistical differences (P ≤ 0.05). Compared to YN, YM, and AN tissues showed a reduction in the thickness of the epithelium, as well as in areas covered by striated musculature, collagen, and blood vessels of the LUT. In comparison with YM, only some morphometric changes were recovered in the AM group. Our study shows that multiparity and age can be associated with epithelial and muscular atrophy of urethral and vaginal walls. The morphometry of the LUT between young and adult female rabbits varies with multiparity. These findings may help to better understand the effects of multiparity on young and adult females and its correlation with the development of pelvic dysfunctions. Anat Rec, 297:1963–1970, 2014. © 2014 Wiley Periodicals, Inc.