Rats it's a Virus
Filed under: Type 1, Childhood, Lifestyle, Drugs, Research
No kidding! The rats are leading researchers to triggering events causing diabetes. The new findings suggest that there is, indeed, a genetic susceptibility to diabetes, but that the precipitating event is a viral infection.
The virus in question is the Ljungan virus. Previous reports indicate that infections with the Ljungan virus can induce diabetes in laboratory rats, and that the diabetes can be reversed if the animals are treated with antiviral drugs before the destruction of insulin-secreting islet cells becomes widespread.
I'm not sure how everybody else out there got their D-card. My diagnosing event happened shortly after I had the chicken pox, back in '85. The childhood christening event apparently left me out in the cold and caused the love-hate relationship between my islets and my insulin autoantibodies. Lucky me. Thanks to all the readers out there who have already shared their sequence of diagnosis with me. What's your story? Please, share with us.
[RESEARCH] Case-control study of self reported genitourinary infections and risk of gastroschisis: findings from the national birth defects prevention study, 1997-2003
Objective To assess the association between genitourinary infections in the month before conception to the end of the first trimesterand gastroschisis.
Design Case-control study with self reported infections from a computer assisted telephone interview.
Setting National birth defects prevention study, a multisite, population based study including 10 surveillance systems for birth defects in the United States.
Participants Mothers of 505 offspring with gastroschisis and 4924 healthy liveborn infants as controls.
Main outcome measure Adjusted odds ratios for gastroschisis with 95% confidence intervals.
Results About 16% (n=81) of case mothers and 9% (n=425) of control mothers reported a genitourinary infection in the relevant time period; 4% (n=21) and 2% (n=98) reported a sexually transmitted infection and 13% (n=67) and 7% (n=338) reported a urinary tract infection, respectively. Case mothers aged <25 years reported higher rates of urinary tract infection alone and in combination with a sexually transmitted infection compared with control mothers. In women who reported both types of infection, there was a greater risk of gastroschisis in offspring (adjusted odds ratio 4.0, 95% confidence interval 1.4 to 11.6).
Conclusion There is a significant association between self reported urinary tract infection plus sexually transmitted infection just before conception and in early pregnancy and gastroschisis.
High association between hepatitis C and type 2
Filed under: Type 2, Childhood, Adult Onset, Research
A recent study by researchers in Taiwan revealed hepatitis C virus (HCV) raises the risk of type 2 diabetes. Hepatitis C is a blood-borne, infectious viral disease that messes with the liver -- capable of causing inflammation, scarring and even liver cancer.
4,958 non-diabetics aged 40 or older were followed for seven years. At the start of the study, 3,486 were seronegative (no antibodies in the blood), 812 were anti-HCV+ (positive to hepatitis C virus antibodies), 116 had HBV/HCV coinfection (HBV is hepatitis B virus), and 544 were positive for hepatitis B surface antigen (HBsAg+). The hepatitis B surface antigen is a protein antigen produced by hepatitis B, and the earliest indicator of acute hepatitis B.
474 participants developed diabetes over the next seven years. After established risk factors were adjusted for, the incidence of diabetes was 70 percent higher for participants with HCV infection. HBV/HCV coinfection and anti-HCV+ alone participants had nearly the same risk, which shows HCV increases diabetes risk while HBV does not. For younger, overweight anti-HCV+ participants, the risk was even higher. Stay away from those deep fried twinkies with chocolate syrup and powdered sugar!
Study authors note regular diabetes screenings are important for anti-HCV+ people, and should be started at a younger age, especially if overweight or with additional risk factors for the disease. Read more in Medscape. The study was published in the July 15 American Journal of Epidemiology.
Hepatitis C is the leading cause of liver transplant in the United States.
Denver Bronco running back Damien Nash dies of heart attack
Filed under: Daily news, Celebrity news, Celebrity in memorium, Men Heart Health
Damien Nash, a Denver Broncos running back, was hosting a basketball game yesterday to benefit the Darris Nash Find a Heart Foundation, a charity that raises funds for heart transplant research. Darris Nash, the brother of Damien had to have a transplant. Darris had a weakened heart muscle condition known as dilated cardiomyopathy. The ailment can be caused by a viral infection, inflammation or other causes. Damien Nash collapsed after returning home to his wife, and was pronounced dead at the hospital at 6:41 p.m. central standard time. The family of course is in shock since he had no history of heart problems. Damien is survived by his wife Judy and a 7 month old daughter. Nash was 24. Nash was a graduate of Coffeyville Community College in Kansas and University of Missouri before getting drafted by the Tennessee Titans in 2005. Denver signed him as a free agent in 2006. He played a total of 6 NFL games.
[RESEARCH] Sexual abstinence only programmes to prevent HIV infection in high income countries: systematic review
Objective To assess the effects of sexual abstinence only programmes for HIV prevention among participants in high income countries.
Design Systematic review.
Data sources 30 electronic databases without linguistic or geographical restrictions to February 2007, contacts with experts, hand searching, and cross referencing.
Review methods Two reviewers independently applied inclusion criteria and extracted data, resolving disagreements by consensus and referral to a third reviewer. Randomised and quasirandomised controlled trials of abstinence only programmes in any high income country were included. Programmes aimed to prevent HIV only or both pregnancy and HIV. Trials evaluated biological outcomes (incidence of HIV, sexually transmitted infection, pregnancy) or behavioural outcomes (incidence or frequency of unprotected vaginal, anal, or oral sex; incidence or frequency of any vaginal, anal, or oral sex; number of partners; condom use; sexual initiation).
Results The search identified 13 trials enrolling about 15 940 US youths. All outcomes were self reported. Compared with various controls, no programme affected incidence of unprotected vaginal sex, number of partners, condom use, or sexual initiation. One trial observed adverse effects at short term follow-up (sexually transmitted infections, frequency of sex) and long term follow-up (sexually transmitted infections, pregnancy) compared with usual care, but findings were offset by trials with non-significant results. Another trial observed a protective effect on incidence of vaginal sex compared with usual care, but this was limited to short term follow-up and countered by trials with non-significant findings. Heterogeneity prevented meta-analysis.
Conclusion Programmes that exclusively encourage abstinence from sex do not seem to affect the risk of HIV infection in high income countries, as measured by self reported biological and behavioural outcomes.
[RESEARCH] Preventive strategies for group B streptococcal and other bacterial infections in early infancy: cost effectiveness and value of information analyses
Objective To determine the cost effectiveness of strategies for preventing neonatal infection with group B streptococci and other bacteria in the UK and the value of further information from research.
Design Use of a decision model to compare the cost effectiveness of prenatal testing for group B streptococcal infection (by polymerase chain reaction or culture), prepartum antibiotic treatment (intravenous penicillin or oral erythromycin), and vaccination during pregnancy (not yet available) for serious bacterial infection in early infancy across 12 maternal risk groups. Model parameters were estimated using multi-parameter evidence synthesis to incorporate all relevant data inputs.
Data sources 32 systematic reviews were conducted: 14 integrated results from published studies, 24 involved analyses of primary datasets, and five included expert opinion.
Main outcomes measures Healthcare costs per quality adjusted life year (QALY) gained.
Results Current best practice (to treat only high risk women without prior testing for infection) and universal testing by culture or polymerase chain reaction were not cost effective options. Immediate extension of current best practice to treat all women with preterm and high risk term deliveries without testing (11% treated) would result in substantial net benefits. Currently, addition of culture testing for low risk term women, while treating all preterm and high risk term women, would be the most cost effective option (21% treated). If available in the future, vaccination combined with treating all preterm and high risk term women and no testing for low risk women would probably be marginally more cost effective and would limit antibiotic exposure to 11% of women. The value of information is highest (£67m) if vaccination is included as an option.
Conclusions Extension of current best practice to treat all women with preterm and high risk term deliveries is readily achievable and would be beneficial. The choice between adding culture testing for low risk women or vaccination for all should be informed by further research. Trials to evaluate vaccine efficacy should be prioritised.
[RESEARCH] Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis
Objective To determine the relative effects of open healing compared with primary closure for pilonidal sinus and optimal closure method (midline v off-midline).
Design Systematic review and meta-analyses of randomised controlled trials.
Data sources Cochrane register of controlled trials, Cochrane Wounds Group specialised trials register, Medline (1950-2007), Embase, and CINAHL bibliographic databases, without language restrictions.
Data extraction Primary outcomes were time (days) to healing, surgical site infection, and recurrence rate. Secondary outcomes were time to return to work, other complications and morbidity, cost, length of hospital stay, and wound healing rate.
Study selection Randomised controlled trials evaluating surgical treatment of pilonidal sinus in patients aged 14 years or more. Data were extracted independently by two reviewers and assessed for quality. Meta-analyses used fixed and random effects models, dichotomous data were reported as relative risks or Peto odds ratios and continuous data are given as mean differences; all with 95% confidence intervals.
Results 18 trials (n=1573) were included. 12 trials compared open healing with primary closure. Time to healing was quicker after primary closure although data were unsuitable for aggregation. Rates of surgical site infection did not differ; recurrence was less likely to occur after open healing (relative risk 0.42, 0.26 to 0.66). 14 patients would require their wound to heal by open healing to prevent one recurrence. Six trials compared surgical closure methods (midline v off-midline). Wounds took longer to heal after midline closure than after off-midline closure (mean difference 5.4 days, 95% confidence interval 2.3 to 8.5), rate of infection was higher (relative risk 4.70, 95% confidence interval 1.93 to 11.45), and risk of recurrence higher (Peto odds ratio 4.95, 95% confidence interval 2.18 to 11.24). Nine patients would need to be treated by an off-midline procedure to prevent one surgical site infection and 11 would need to be treated to prevent one recurrence.
Conclusions Wounds heal more quickly after primary closure than after open healing but at the expense of increased risk of recurrence. Benefits were clearly shown with off-midline closure compared with midline closure. Off-midline closure should become standard management for pilonidal sinus when closure is the desired surgical option.
[RESEARCH] Improved effectiveness of partner notification for patients with sexually transmitted infections: systematic review
Objective To examine the effectiveness of methods to improve partner notification by patient referral (index patient has responsibility for informing sex partners of their exposure to a sexually transmitted infection).
Design Systematic review of randomised trials of any intervention to supplement simple patient referral.
Data sources Seven electronic databases searched (January 1990 to December 2005) without language restriction, and reference lists of retrieved articles.
Review methods Selection of trials, data extraction, and quality assessment were done by two independent reviewers. The primary outcome was a reduction of incidence or prevalence of sexually transmitted infections in index patients. If this was not reported data were extracted according to a hierarchy of secondary outcomes: number of partners treated; number of partners tested or testing positive; and number of partners notified, located, or elicited. Random effects meta-analysis was carried out when appropriate.
Results 14 trials were included with 12 389 women and men diagnosed as having gonorrhoea, chlamydia, non-gonococcal urethritis, trichomoniasis, or a sexually transmitted infection syndrome. All studies had methodological weaknesses that could have biased their results. Three strategies were used. Six trials examined patient delivered partner therapy. Meta-analysis of five of these showed a reduced risk of persistent or recurrent infection in patients with chlamydia or gonorrhoea (summary risk ratio 0.73, 95% confidence interval 0.57 to 0.93). Supplementing patient referral with information for partners was as effective as patient delivered partner therapy. Neither strategy was effective in women with trichomoniasis. Two trials found that providing index patients with chlamydia with sampling kits for their partners increased the number of partners who got treated.
Conclusions Involving index patients in shared responsibility for the management of sexual partners improves outcomes. Health professionals should consider the following strategies for the management of individual patients: patient delivered partner therapy, home sampling for partners, and providing additional information for partners.
[RESEARCH] New point of care Chlamydia Rapid Test bridging the gap between diagnosis and treatment: performance evaluation study
Objective To evaluate the performance of a new Chlamydia Rapid Test with vaginal swab specimens as a potential tool for chlamydia diagnosis and screening.
Design Performance evaluation study.
Settings A young people's sexual health centre (site 1) and two genitourinary medicine clinics (sites 2 and 3) in the United Kingdom.
Participants 1349 women aged between 16 and 54 attending one of the three clinics.
Main outcome measures Sensitivity, specificity, positive predictive value, and negative predictive value of the Chlamydia Rapid Test versus polymerase chain reaction and strand displacement amplification assays; correlation between the Chlamydia Rapid Test visual signal and organism load; acceptability to participants of self collected vaginal swabs as the specimen type for Chlamydia testing.
Results Polymerase chain reaction positivity rates for Chlamydia trachomatis infection were 8.4% (56/663) at site 1, 9.4% (36/385) at site 2, and 6.0% (18/301) at site 3. Compared with polymerase chain reaction assay, the resolved sensitivity, specificity, positive predictive value, and negative predictive value of the Chlamydia Rapid Test were 83.5% (91/109), 98.9% (1224/1238), 86.7% (91/105), and 98.6% (1224/1242). Compared with strand displacement amplification assay, sensitivity and specificity of the Chlamydia Rapid Test were 81.6% (40/49) and 98.3% (578/588). Organism load of self collected vaginal swabs ranged from 5.97x102 to 1.09x109Chlamydia plasmids per swab, which correlated well with the Chlamydia Rapid Test's visual signal (r=0.6435, P<0.0001). Most (95.9%) surveyed participants felt comfortable about collecting their own swabs.
Conclusions The performance of the Chlamydia Rapid Test with self collected vaginal swabs indicates that it would be an effective same day diagnostic and screening tool for Chlamydia infection in women. The availability of Chlamydia Rapid Test results within 30 minutes allows for immediate treatment and contact tracing, potentially reducing the risks of persistent infection and onward transmission. It could also provide a simple and reliable alternative to nucleic acid amplification tests in chlamydia screening programmes.
[RESEARCH] Effect of antibiotic prescribing on antibiotic resistance in individual children in primary care: prospective cohort study
Objective To assess the effect of community prescribing of an antibiotic for acute respiratory infection on the prevalence of antibiotic resistant bacteria in an individual child.
Study design Observational cohort study with follow-up at two and 12 weeks.
Setting General practices in Oxfordshire.
Participants 119 children with acute respiratory tract infection, of whom 71 received a ?lactam antibiotic.
Main outcome measures Antibiotic resistance was assessed by the geometric mean minimum inhibitory concentration (MIC) for ampicillin and presence of the ICEHin1056 resistance element in up to four isolates of Haemophilus species recovered from throat swabs at recruitment, two weeks, and 12 weeks.
Results Prescribing amoxicillin to a child in general practice more than triples the mean minimum inhibitory concentration for ampicillin (9.2 µg/ml v 2.7 µg/ml, P=0.005) and doubles the risk of isolation of Haemophilus isolates possessing homologues of ICEHin1056 (67% v 36%; relative risk 1.9, 95% confidence interval 1.2 to 2.9) two weeks later. Although this increase is transient (by 12 weeks ampicillin resistance had fallen close to baseline), it is in the context of recovery of the element from 35% of children with Haemophilus isolates at recruitment and from 83% (76% to 89%) at some point in the study.
Conclusion The short term effect of amoxicillin prescribed in primary care is transitory in the individual child but sufficient to sustain a high level of antibiotic resistance in the population.