The association between vascular function-related genes and age at natural menopause

OBJECTIVE: In this study we attempted to confirm recent findings suggesting that age at natural menopause might be affected by single nucleotide polymorphisms in certain cardiovascular risk factor genes, such as genes encoding for blood clotting factors II, V, and VII and the apolipoprotein E2 gene. Such validation might increase support for the theory that ovarian aging is partly due to aging of the vascular supply to the ovary. DESIGN: We used a random sample of 742 naturally postmenopausal women from a large population-based cross-sectional study. Data on age at natural menopause, smoking, body mass index, reproductive history, and other health factors were collected through questionnaires. We studied the association between single nucleotide polymorphisms in the genes encoding for coagulation factors II, V, and VII and the apolipoprotein E2 gene and age at natural menopause using linear regression analysis. We corrected for oral contraceptive use, parity, current smoking, and body mass index. RESULTS: Only the heterozygous deletion/insertion mutation in clotting factor VII was significantly associated with an increase of menopausal age of 0.81 year (95% CI: 0.12-1.50 y). The homozygous variant, however, was not. The single nucleotide polymorphisms in the other genes studied were not significantly associated with age at natural menopause. Adjustment for various lifestyle factors did not change the associations between single nucleotide polymorphisms and age at menopause. CONCLUSIONS: Earlier findings relating specific point mutations in cardiovascular risk factor genes with age of natural menopause could not be confirmed in the present study.     

Infections caused by Scedosporium spp

Scedosporium spp. are increasingly recognized as causes of resistant life-threatening infections in immunocompromised patients. Scedosporium spp. also cause a wide spectrum of conditions, including mycetoma, saprobic involvement and colonization of the airways, sinopulmonary infections, extrapulmonary localized infections, and disseminated infections. Invasive scedosporium infections are also associated with central nervous infection following near-drowning accidents. The most common sites of infection are the lungs, sinuses, bones, joints, eyes, and brain. Scedosporium apiospermum and Scedosporium prolificans are the two principal medically important species of this genus. Pseudallescheria boydii, the teleomorph of S. apiospermum, is recognized by the presence of cleistothecia. Recent advances in molecular taxonomy have advanced the understanding of the genus Scedosporium and have demonstrated a wider range of species than heretofore recognized. Studies of the pathogenesis of and immune response to Scedosporium spp. underscore the importance of innate host defenses in protection against these organisms. Microbiological diagnosis of Scedosporium spp. currently depends upon culture and morphological characterization. Molecular tools for clinical microbiological detection of Scedosporium spp. are currently investigational. Infections caused by S. apiospermum and P. boydii in patients and animals may respond to antifungal triazoles. By comparison, infections caused by S. prolificans seldom respond to medical therapy alone. Surgery and reversal of immunosuppression may be the only effective therapeutic options for infections caused by S. prolificans.     

Identification of minimal predictors of avian pathogenic Escherichia coli virulence for use as a rapid diagnostic tool

To identify traits that predict avian pathogenic Escherichia coli (APEC) virulence, 124 avian E. coli isolates of known pathogenicity and serogroup were subjected to virulence genotyping and phylogenetic typing. The results were analyzed by multiple-correspondence analysis. From this analysis, five genes carried by plasmids were identified as being the most significantly associated with highly pathogenic APEC strains: iutA, hlyF, iss, iroN, and ompT. A multiplex PCR panel targeting these five genes was used to screen a collection of 994 avian E. coli isolates. APEC isolates were clearly distinguished from the avian fecal E. coli isolates by their possession of these genes, suggesting that this pentaplex panel has diagnostic applications and underscoring the close association between avian E. coli virulence and the possession of ColV plasmids. Also, the sharp demarcation between APEC isolates and avian fecal E. coli isolates in their plasmid-associated virulence gene content suggests that APEC isolates are well equipped for a pathogenic lifestyle, which is contrary to the widely held belief that most APEC isolates are opportunistic pathogens. Regardless, APEC isolates remain an important problem for poultry producers and a potential concern for public health professionals, as growing evidence suggests a possible role for APEC in human disease. Thus, the pentaplex panel described here may be useful in detecting APEC-like strains occurring in poultry production, along the food chain, and in human disease. This panel may be helpful toward clarifying potential roles of APEC in human disease, ascertaining the source of APEC in animal outbreaks, and identifying effective targets of avian colibacillosis control.     

The course of mental health problems in children presenting with abdominal pain in general practice

Objective

To investigate the course of mental health problems in children presenting to general practice with abdominal pain and to evaluate the extent to which abdominal pain characteristics during follow-up predict the presence of mental health problems at 12 months’ follow-up.

Design

A prospective cohort study with one-year follow-up.

Setting

53 general practices in the Netherlands, between May 2004 and March 2006.

Subjects

281 children aged 4–17 years.

Main outcome measures

The presence of a depressive problem, an anxiety problem, and multiple non-specific somatic symptoms at follow-up and odds ratios of duration, frequency, and severity of abdominal pain with these mental health problems at follow-up.

Results

A depressive problem persisted in 24/74 children (32.9%; 95% CI 22.3–44.9%), an anxiety problem in 13/43 (30.2%; 95% CI 17.2–46.1%) and the presence of multiple non-specific somatic symptoms in 75/170 children (44.1%; 95% CI 36.7–51.6%). None of the abdominal pain characteristics predicted a depressive or an anxiety problem at 12 months’ follow-up. More moments of moderate to severe abdominal pain predicted the presence of multiple non-specific somatic symptoms at follow-up.

Conclusions

In one-third of the children presenting to general practice for abdominal pain, anxiety and depressive problems persist during one year of follow-up. Characteristics of the abdominal pain during the follow-up period do not predict anxiety or depressive problems after one-year follow-up. We recommend following over time children seen in primary care with abdominal pain.Key Words: Abdominal pain, adolescent, child, cohort study, family practice, mental disorders, prognosisChildren with abdominal pain often have mental health problems; however, the prognosis of these problems is unknown. This follow-up study showed that:

• in one-third of the children depressive and anxiety problems persist over one year;
• characteristics of the abdominal pain during follow-up do not predict the presence of depressive and anxiety problems at 12 months’ follow-up;
• in children with persisting moderate to severe abdominal pain other non-specific somatic symptoms also persist.

     

The Cost of Persistent Asthma in Europe: An International Population-Based Study in Adults

Background: This study is aimed at providing a real-world evaluation of the economic cost of persistent asthma among European adults according to the degree of disease control [as defined by the 2006 Global Initiative for Asthma (GINA) guidelines]. Methods: A prevalence-based cost-of-illness study was carried out on 462 patients aged 30-54 years with persistent asthma (according to the 2002 GINA definition), who were identified in general population samples from 11 European countries and examined in clinical settings in the European Community Respiratory Health Survey II between 1999 and 2002. The cost estimates were computed from the societal perspective following the bottom-up approach on the basis of rates, wages and prices in 2004 (obtained at the national level from official sources), and were then converted to the 2010 values. Results: The mean total cost per patient was EUR 1,583 and was largely driven by indirect costs (i.e. lost working days and days with limited, not work-related activities 62.5%). The expected total cost in the population aged 30-54 years of the 11 European countries was EUR 4.3 billion (EUR 19.3 billion when extended to the whole European population aged from 15 to 64 years). The mean total cost per patient ranged from EUR 509 (controlled asthma) to EUR 2,281 (uncontrolled disease). Chronic cough or phlegm and having a high BMI significantly increased the individual total cost. Conclusions: Among European adults, the cost of persistent asthma drastically increases as disease control decreases. Therefore, substantial cost savings could be obtained through the proper management of adult patients in Europe.