Incidence and predictive factors for cytomegalovirus infection in renal transplant recipients.

BACKGROUND: Cytomegalovirus (CMV) infection is a common cause of morbidity, graft loss, and mortality among kidney recipients due to its direct and indirect influences on organs and systems, namely, immunomodulation, which favors the appearance of opportunistic infections, vasculopathy, and decreased graft and patient survival. In Mexico the dimensions of this infection are unknown in kidney transplant recipients. We evaluated the incidence and predictive factors for CMV infection among renal transplant recipients of the Mexican Institute of Social Security in Guadalajara. METHODS: This prospective cohort analysis of patients >or=16 years of age of both genders, included transplantations from May 2006 to July 2007. Two hundred twenty-five patients were followed over 6 months to evaluate CMV infection or disease. We evaluated demographic, clinical, and paraclinical aspects, such as total lymphocyte count and quantitative CMV polymerase chain reactions (PCR). RESULTS: The overall incidence of CMV infection was 17.8%. CMV infections were associated with lymphopenia (relative risk [RR] 14.75; confidence interval [CI] 95%, 3.46-62.77), serostatus D+/R- (RR 5.53; CI 95%, 2.18-14.05), and fever (RR 4.57; CI 95%, 1.50-13.95). Receiver-operating characteristic (ROC) curves for lymphopenia versus PCR showed a sensitivity of 27% and a specificity of 98%. CONCLUSION: In our study, lymphopenia, serostatus D+/R-, and fever were good predictors of CMV infections among renal transplant recipients.

Serum IgG activity against cyclic citrullinated peptide in patients evaluated for rheumatoid factor correlates with the IgM isotype.

The purpose of this study was to evaluate the frequency of seric antibodies against cyclic citrullinated peptide (a-CCP) in patients tested for rheumatoid factor (RF) reactivity, and to analyze the correlation between their titers. We obtained serum from 112 consecutive patients (85 female), aged 47.2 +/- 13.4 years and from 46 clinically healthy subjects (CHS). Patients where stratified into four subgroups: rheumatoid arthritis (RA), probable RA (PRA), spondylarthropathies and other diagnosis. The a-CCP antibodies were determined by enzyme linked immunoassay (ELISA), RF by nephelometric test (IgM) and ELISA (IgG and IgM). Analysis of variance (ANOVA) showed statistically that a-CCP antibodies differs among RA versus CHS and other diagnosis; PRA versus CHS and other diagnosis. A significant Rho value of 0.84 (P < 0.05, Spearman's correlation) was identified between a-CCP antibodies and RF in PRA subgroup. When a correlation of a-CCP antibodies with RF (both isotypes) was done, the higher correlation was observed against IgM RF. The data suggests different pathways and times for each antibody generation.

Correlates of cognitive impairment in elderly residents of long term care institutions in the metropolitan area of Guadalajara, Mexico.

AIM: To determine the prevalence of cognitive impairment and to examine the correlation between demographic and social factors, the activities of daily living (ADL), and depression with cognitive function in elderly Mexicans living in nursing homes. DESIGN: Cross-sectional. SETTING: Fourteen nursing homes in Guadalajara. PARTICIPANTS: Data were drawn from a random sample of 451 elderly, aged 60-104 years. MEASUREMENTS: The Spanish versions of MMSE (Folstein), ADL index (Barthel), and the Geriatric Depression Screening (GDS) (Yesavage); demographic factors were obtained. RESULTS: The prevalence of cognitive impairment was 52.3%, with a cut-off of 19/20 (Bohnstedt). Cognitive impairment was significantly related to gender, educational level, activity participation, pension, ADL, and depression. CONCLUSION: The results indicate a higher prevalence of cognitive impairment than in other Mexican studies. The data are consistent with previous findings that cognitive impairment in the elderly is more common among females, those with a low level of education, the lack of participation in social/leisure activities, ADL dependencies, and depression.