SummaryTo investigate the incidence of dengue virus (DENV) infection in Nicaragua, a 2-year prospective study was conducted in schoolchildren 4-16 years old in the capital city of Managua. Blood samples were collected before the rainy season in 2001, 2002 and 2003, and were assayed for DENV-specific antibodies. Participants were monitored for dengue-like illness, and acute and convalescent blood samples were collected from suspected dengue cases. In 2001 and 2002, 602 and 397 students were recruited, respectively, and paired annual serum samples were available from 467 and 719 participants in 2001-2002 and 2002-2003, respectively. The overall seroprevalence of anti-DENV antibodies was 91%, increasing from 75% at age 4 to 100% at age 16. The incidence of DENV infection was 12% in Year 1 and 6% in Year 2 (P < 0.001). During Year 1, four laboratory-confirmed dengue cases were detected, with one DENV2 isolate; during Year 2, there were six confirmed dengue cases, with one DENV1 isolate. These and additional circulating serotypes were confirmed by plaque reduction neutralisation test. This study demonstrates surprisingly high transmission of DENV in urban Nicaragua.

Background The impact of anal incontinence on women’s sexual function is poorly understood. Objective To investigate the relationship between anal incontinence and sexual activity and functioning in women. Design Cross-sectional study. Settings Community-based integrated healthcare delivery system. Patients 2,269 ethnically-diverse women aged 40 to 80 years. Main Outcome Measures Self-administered questionnaires assessed accidental leakage of gas (flatal incontinence) and fluid/mucus/stool (fecal incontinence) in the past 3 months. Additional questionnaires assessed sexual activity, desire and satisfaction, as well as specific sexual problems (difficulty with arousal, lubrication, orgasm, or pain). Multivariable logistic regression models compared sexual function in women with 1) isolated flatal incontinence, 2) fecal incontinence (with or without flatal incontinence), and 3) no fecal/flatal incontinence, controlling for potential confounders. Results Twenty-four percent of women reported fecal incontinence and 43% reported isolated flatal incontinence in the prior 3 months. The majority were sexually active (62% of women without fecal/flatal incontinence, 66% with isolated flatal incontinence, and 60% with fecal incontinence; p=0.06). Compared to women without fecal/flatal incontinence, women with fecal incontinence were more likely to report low sexual desire (OR:1.41 [CI:1.10–1.82]), low sexual satisfaction (OR:1.56 [CI:1.14–2.12]), and limitation of sexual activity by physical health (OR:1.65 [CI:1.19–2.28]) after adjustment for confounders. Among sexually active women, women with fecal incontinence were more likely than women without fecal/flatal incontinence to report difficulties with lubrication (OR:2.66 [CI:1.76–4.00]), pain (OR:2.44 [CI:1.52–3.91]), and orgasm (OR:1.68 [CI:1.12–2.51]). Women with isolated flatal incontinence reported similar sexual functioning to women without fecal/flatal incontinence. Limitations Cross-sectional design prevented evaluation of causality. Conclusions While most women with anal incontinence are sexually active, those with fecal incontinence are at high risk for several aspects of sexual dysfunction. This indicates that sexual function is important to women with anal incontinence and should be prioritized during therapeutic management.

Objective: To examine the effect of previous sexual abuse or assault (SAA) on symptom severity, quality of life, and physiologic measures in women with fecal incontinence or constipation. Design: A cross-sectional study of a prospectively maintained clinical database. Setting: A tertiary referral center for evaluation and physiologic testing for pelvic floor disorders. Patients: Women with fecal incontinence or constipation examined during a 6-year period. Main Outcome Measures: Symptom severity and quality of life were measured with the Fecal Incontinence Severity Index (FISI), Fecal Incontinence Quality of Life Scale (FIQL), Constipation Severity Instrument (CSI), Constipation-Related Quality of Life measure (CR-QOL), and 12-Item Short Form Health Survey (SF-12). Physiologic variables were ascertained with anorectal manometry, electromyography, and endoanal ultrasonography. Results: Of the 1781 women included, 213 (12.0%) reported SAA. These women were more likely to be white, to report a psychiatric illness, and to have a prior hysterectomy or episiotomy. On bivariate analysis, women with prior SAA had increased symptom severity on the FISI (P = .002) and CSI (P Ͻ .001) and diminished quality of life on the FIQL (P Ͻ .001), CR-QOL (P=.009), and SF-12 (P =.002 to P=.004). Physiologic variables did not differ significantly between patients with and without prior SAA. Conclusions: A history of SAA significantly alters disease perception in fecal incontinence and constipation, but the disorders do not result from increased physiologic alterations. We must elicit a history of SAA in these patients, because the history may play a role in the discrepancy between symptom reporting and objective measurements and may modify treatment recommendations.

1. Histamine was detected in the abdominal aorta and the femoral arteries of normotensive and also DOCA-hypertensive rats. 2. Levels of total histamine (mast cell and non-mast cell histamine) were significantly reduced in both abdominal aorta and the femoral artery of the DOCA-hypertensive rats, relative to the normotensive controls. 3. It is suggested that the diminished level of vascular histamine may be related to the development and/or maintenance of the hypertensive state and is also related to the reduced magnitude of active reflex vasodilatation.