The impact of the prevention strategies on the indirect effects of CMV infection in solid organ transplant recipients

Transplant recipients receiving immunosuppressive therapy are at increased risk of active cytomegalovirus (CMV) infection and disease. Without appropriate prophylaxis, as many as 80% of solid organ transplant recipients may experience CMV infection. In addition to the direct effects of CMV, infection may be associated with a range of indirect effects, including an increase in risk of other infections, as well as a higher incidence of rejection, graft loss and death. The indirect effects of CMV infection can vary depending on the transplanted organ. For example, CMV-infected kidney transplant recipients may be at increased risk of cardiovascular disease and diabetes, while CMV infection in liver transplant recipients may potentiate hepatitis C infection and increase the risk of post-transplant lymphoproliferative disease. Indirect effects result from a number of pathological processes, including immune modulation and immunosuppression, generation of cytotoxic, pro-inflammatory responses, and smooth muscle proliferation. Prophylactic treatment with antiviral medication can reduce the risk of CMV disease, thereby improving graft survival and overall outcomes, particularly in kidney and heart transplant recipients. Antiviral prophylaxis should be considered for all patients at risk of CMV infection after solid organ transplantation. In this paper we review the main indirect effects of CMV infection in solid organ transplant recipients, and the impact of CMV prophylaxis on these effects.     

Situation,challenges, and SEOM recommendations for the future of undergraduate education in Oncology in Spain

Clinical and Translational Oncology - The Spanish Society of Medical Oncology (SEOM, for its Spanish acronym) would like to attest to the relevance of training in Oncology as part of the...     

Early dysfunction and long-term improvement in endothelium-dependent vasodilation in the infarct-related artery after thrombolysis

Endothelial function is thought to be an important factor in the pathogenesis of atherosclerosis, hypertension and heart failure. In the 1990s, high-frequency ultrasonographic imaging of the brachial artery to assess endothelium-dependent flow-mediated vasodilation (FMD) was developed. The technique provokes the release of nitric oxide, resulting in vasodilation that can be quantitated as an index of vasomotor function. The noninvasive nature of the technique allows repeated measurements over time to study the effectiveness of various interventions that may affect vascular health. However, despite its widespread use, there are technical and interpretive limitations of this technique. State-of-the-art information is presented and insights are provided into the strengths and limitations of high-resolution ultrasonography of the brachial artery to evaluate vasomotor function, with guidelines for its research application in the study of endothelial physiology.     

Association of interleukin-1 polymorphisms with periodontal disease

BACKGROUND: Several studies have investigated genetic polymorphisms for cytokines as potential genetic markers for periodontitis. Some studies have found that interleukin (IL)-1A and IL-1B polymorphisms are associated with a higher severity of periodontitis, while others found no association. The aims of this study were to determine the prevalence of the IL-1A-889 and IL-1B+3954 (previously described as +3953) polymorphisms in Chileans and their association with periodontitis. METHODS: Subjects aged 20 to 48 were selected from people requesting dental treatment at a public health center in Santiago, Chile. A case-control study of 330 cases of periodontitis patients and 101 healthy controls was performed. A full-mouth periodontal examination was performed on each subject and a structured questionnaire was conducted to determine smoking habits. Cases were categorized as having initial, moderate, or severe periodontitis according to the percentage of sites with clinical attachment loss > or =3 mm. Genomic DNA was analyzed for polymorphism in the IL-1A gene at site -889 and IL-1B gene at site +3954 by polymerase chain reaction (PCR) amplification followed by restriction enzyme digestion and gel electrophoresis. Data were analyzed by chi square test, analysis of variance (ANOVA), and by calculating odds ratio (OR) and 95% confidence intervals (CI). RESULTS: Demographic and socio-economic characteristics of subjects were similar in cases and in controls. A higher frequency of heterozygous of the IL-1A-889 was found in cases than in controls, but the difference was not significant. The heterozygous of the IL-1B+3954 was significantly higher in cases than in controls and was associated with periodontitis (OR 3.12, 95% CI 1.59 to 6.09, P = 0.001). The homozygous for allele 1 of the IL-1B+3954 was a protective factor for periodontitis (OR 0.35, 95% CI 0.19 to 0.66, P = 0.001). The prevalence of positive genotype (at least one allele 2 present at each locus) was significantly higher in cases (26.06%) than in controls (9.9%) and was significantly associated with periodontitis (OR 3.21, 95% CI 1.60 to 6.44, P = 0.001), irrespective of the smoking status and periodontitis severity. Sensitivity of positive genotype was 26%, the specificity 90%, and the positive predictive value 89%. CONCLUSION: Within the limits of this study, the results show that individuals carrying the positive genotype have significantly greater risk for developing periodontitis.     

Accreditation of processes in hepatology

The Spanish Association for the Study of the Liver decided in 2006 to develop a project to assess the quality of the professionals, processes and medical units dealing with the management of patients with liver diseases in Spain. The current article reports the criteria proposed to assess the quality and the accreditation of the processes in hepatology. The processes considered include most patients with liver diseases and the accreditation system designed is highly specific. This document, together with a previous one published in gastroenterología y hepatología concerning the accreditation of the professionals and a third document dealing with the accreditation of liver units that will be published soon, form the basis of the quality assessment of hepatology in our country.     

A multilevel time-series model for the incidence of AIDS cases in Spain

OBJECTIVE: The main aim of this research is to study the quantitative evolution of the incidence of AIDS in the 19 Spanish Communities. The hypothesis is that incidence follows a multilevel autoregressive model, where each Community shows random variability around a general process. METHOD: On the basis of official data on the number of existing AIDS cases, an autorregressive multilevel time-series model was developed. RESULTS AND CONCLUSIONS: Analysis shows that the hypothesis is supported, indicating that overall AIDS incidence in Spain has already reached a maximum and has a tendency to remain stable or to decline in future. Long term expected values have become stable in most Communities; a slight increase is expected only in Extremadura. However, this Community has a relatively sparse population, and its contribution on the overall Spanish incidence is small.Long term expected values are estimated to be around 152.99 new cases per million inhabitants per year. This value is slightly smaller than the maximum incidence, observed in 1994 (179.4 cases).