PURPOSE: The sequence variations of the Der p 2 allergen of Dermatophagoides pteronyssinus diverge along 2 pathways with particular amino acid substitutions at positions 40,47,111, and 114. The environmental prevalence and IgE binding to Der p 2 variants differ among regions. To compare IgE binding to Der p 2 variants between sera from Bangkok, Thailand and Perth, Western Australia with different variants and to determine the variant-specificity of antibodies induced by vaccination with recombinant variants. METHODS: The structures of recombinant variants produced in yeast were compared by circular dichroism and 1-anilinonaphthalene 8-sulfonic acid staining of their lipid-binding cavity. Sera from subjects in Bangkok and Perth where different variants are found were compared by the affinity (IC50) of IgE cross-reactivity to different variants and by direct IgE binding. Mice were immunized with the variants Der p 2.0101 and Der p 2.0110, and their IgG binding to Der p 2.0103, 2.0104, and 2.0109 was measured. RESULTS: The secondary structures of the recombinant variants resembled the natural allergen but with differences in ANS binding. The IC50 of Der p 2.0101 required 7-fold higher concentrations to inhibit IgE binding to the high-IgE-binding Der p 2.0104 than for homologous inhibition in sera from Bangkok where it is absent, while in sera from Perth that have both variants the IC50 was the same and low. Reciprocal results were obtained for Der p 2.0110 not found in Perth. Direct binding revealed that Der p 2.0104 was best for detecting IgE in both regions, followed by Der p 2.0101 with binding to other variants showing larger differences. Mouse anti-Der p 2.0101 antibodies had a high affinity of cross-reactivity but bound poorly to other variants. CONCLUSIONS: The affinity of IgE antibody cross-reactivity, the direct IgE binding, and the specificities of antibodies induced by vaccination show that measures of allergic sensitization and therapeutic strategies could be optimized with knowledge of Der p 2 variants.
Amino Acid Substitution ; Animals ; Antibodies ; Circular Dichroism ; Dermatophagoides pteronyssinus ; Dust* ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulin G ; Inhibitory Concentration 50 ; Mice ; Prevalence ; Pyroglyphidae* ; Thailand ; Vaccination ; Western Australia ; Yeasts

INTRODUCTIONThe emergency department (ED) is often the initial site of identification of patients with sepsis. We aimed to determine the characteristics of ED attendances that predict poor hospital outcomes.

METHODSWe conducted a retrospective cohort study of adult patients in eight metropolitan EDs in Perth, Western Australia, from 2001 to 2006. Patients diagnosed with sepsis in the ED were identified using the International Classification of Diseases, 10th Revision-Australian Modification code in the Emergency Department Information System (EDIS) database. The EDIS database was subsequently linked to mortality and hospital morbidity records. The following characteristics were examined: triage category, mode of arrival, source of referral and hospital of presentation. Multivariate logistic regression was performed to identify predictors of hospital mortality, prolonged length of stay, and admission to the intensive care unit (ICU).

RESULTSIn the 1,311 patients diagnosed with sepsis in the ED, the hospital mortality and ICU admission rates were 19.5% and 18.5%, respectively. The mean hospital length of stay was 12 ± 15 days. Acute triage categories predicted both hospital mortality and ICU admissions, while mode of arrival by ambulance was a predictor of all poor hospital outcomes (p < 0.001). Patients who presented to non-teaching hospitals had similar hospital outcomes as patients who presented to teaching hospitals. The source of referrals was not a predictor of poor hospital outcomes (p > 0.05).

CONCLUSIONMode of arrival and triage score, which are characteristics unique to the ED, may predict poor hospital outcomes in patients with sepsis.

Adult ; Aged ; Australia ; Cohort Studies ; Confidence Intervals ; Emergency Service, Hospital ; Emergency Treatment ; methods ; Female ; Hospital Mortality ; trends ; Humans ; Intensive Care Units ; utilization ; Length of Stay ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Risk Assessment ; Sepsis ; diagnosis ; mortality ; therapy ; Survival Rate ; Treatment Outcome ; Triage ; methods ; Western Australia

OBJECTIVE: To assess the association between condom use and oral contraceptive consumption and the risk of cervical intraepithelial neoplasia (CIN). METHODS: A cross-sectional study was conducted in Perth clinics. A total of 348 women responded to the structured questionnaire. Information sought included demographic and lifestyle characteristics such as the use of condom for contraception, consumption of oral contraceptive, and duration of oral contraceptive usage. Crude and adjusted odds ratio (OR) and associated 95% confidence interval (CI) were calculated using unconditional logistic regression models and reported as estimates of the relative risk. RESULTS: The prevalence of CIN was found to be 15.8%. The duration of oral contraceptive consumption among women with abnormal Papanicolaou (Pap) smear result indicating CIN was significantly shorter than those without abnormal Pap smear result (mean+/-SD, 5.6+/-5.2 years vs. 8.2+/-7.6 years; p=0.002). Comparing to < or =3 years usage, prolonged consumption of oral contraceptive for > or =10 years reduced the risk of CIN (p=0.012). However, use of condom for contraception might not be associated with a reduced risk of CIN after accounting for the effects of confounding factors (adjusted OR, 0.52; 95% CI, 0.05 to 5.11; p=0.577). CONCLUSION: Use of oral contraceptives, but not condoms, for contraception appeared to be inversely associated with CIN. Prolonged use of oral contraceptive demonstrated its benefits of reducing the risk of CIN.
Adult ; Cervical Intraepithelial Neoplasia/epidemiology/*prevention & control ; Condoms/*utilization ; Contraception Behavior/*statistics & numerical data ; Contraceptives, Oral/*administration & dosage ; Cross-Sectional Studies ; Drug Administration Schedule ; Drug Utilization/statistics & numerical data ; Female ; Humans ; Middle Aged ; Prevalence ; Risk Assessment/methods ; Socioeconomic Factors ; Western Australia/epidemiology