Proposal and validation of a clinical trunk control test in individuals with spinal cord injury.

STUDY DESIGN: One of the problems that arise in spinal cord injury (SCI) is alteration in trunk control. Despite the need for standardized scales, these do not exist for evaluating trunk control in SCI. OBJECTIVE: To propose and validate a trunk control test in individuals with SCI. SETTING: National Institute of Rehabilitation, Mexico. METHODS: The test was developed and later evaluated for reliability and criteria, content, and construct validity. RESULTS: We carried out 531 tests on 177 patients and found high inter- and intra-rater reliability. In terms of criterion validity, analysis of variance demonstrated a statistically significant difference in the test score of patients with adequate or inadequate trunk control according to the assessment of a group of experts. A receiver operating characteristic curve was plotted for optimizing the instrument's cutoff point, which was determined at 13 points, with a sensitivity of 98% and a specificity of 92.2%. With regard to construct validity, the correlation between the proposed test and the spinal cord independence measure (SCIM) was 0.873 (P=0.001) and that with the evolution time was 0.437 (P=0.001). For testing the hypothesis with qualitative variables, the Kruskal-Wallis test was performed, which resulted in a statistically significant difference between the scores in the proposed scale of each group defined by these variables. CONCLUSION: It was proven experimentally that the proposed trunk control test is valid and reliable. Furthermore, the test can be used for all patients with SCI despite the type and level of injury.

Persistence on therapy is a major determinant of patient-, physician- and laboratory- reported outcomes in recent-onset rheumatoid arthritis patients.

OBJECTIVES: To evaluate impact of persistence on therapy on sustained major patient-, physician- and laboratory-reported outcomes (PROs, PHYROs and LAROs, respectively) in 112 recent-onset rheumatoid arthritis (RA) patients. METHODS: At each visit a rheumatologist interviewed patients regarding therapy, morning stiffness and fatigue, scored the 28-joint disease activity score and a visual analogue scale (VAS) and determined acute-phase-reactants. The patients completed the Hispanic version of the Rheumatoid Arthritis Disease Activity Index, the Medical Outcome Short Form 36 (SF-36), the Health Assessment Questionnaire (HAQ), a pain-VAS and an overall-disease activity-VAS. Persistence was defined by self-report through directed interview. Sustained major PROs, PHYROs and LAROs were defined according to cut-offs, when maintained for ≥6 months and until last follow-up. Descriptive statistics, Kaplan-Meier curves and Cox models were used. RESULTS: Total person-time of receiving therapy was of 375.5 patient-years. From February 2004 to June 2009, 36 (32.1%) patients were persistent. Baseline PROs/PHYROs/LAROs showed active disease and poor health status in both groups, but persistent patients (PP) had significantly lower HAQ (p=0.03) and overall-disease activity-VAS (p=0.01). More PP reached a sustained major SF-36-physical function-score (p=0.02). Persistence was the greatest independent risk factor for sustained major PROs (but absence of fatigue) and PHYROs, (p≤0.04). Time from baseline to major and sustained PROs (excluded absence of fatigue), PHYROs and C-reactive protein were shorter in PP (p≤0.04). CONCLUSIONS: Persistence was a strong predictor for major and sustained outcomes in early RA. Favourable outcomes appear earlier in persistent than in non-persistent patients.

Prevalence of antineutrophil cytoplasmic autoantibodies in patients with tuberculosis.

OBJECTIVE: To determine the prevalence of antineutrophil cytoplasmic autoantibodies (ANCA) in sera of patients with tuberculosis compared with healthy control subjects and a group of patients with atopic asthma. METHODS: The presence of ANCA was examined in patients with tuberculosis, and in asthmatic patients and healthy subjects as control groups, by means of indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assay (ELISA) to detect anti-proteinase 3 (PR3-ANCA) and antimyeloperoxidase (MPO-ANCA) antibodies. RESULTS: ANCA were present in 20 (44.4%) of 45 tuberculosis patients by IIF (16 c-ANCA, four p-ANCA) and in 18 (40%) patients by ELISA (15 PR3-ANCA, three MPO-ANCA). High odds ratios for ANCA positivity were observed for tuberculosis patients when compared with both control groups. ANCA results were not related to the category of tuberculosis, stage of disease, presence of concomitant diseases or pharmacotherapy. CONCLUSIONS: As many clinical similarities between tuberculosis and Wegener's granulomatosis exist, we propose that a positive ANCA test in patients living in countries with a high prevalence of tuberculosis must be carefully interpreted as indicative of systemic vasculitis, especially when no signs of extrapulmonary involvement occur.

Unusually high prevalence rates of obesity in four Mexican rural communities.

OBJECTIVE: To establish the nutritional status of previously studied rural populations. DESIGN AND SUBJECTS: A total of 139 households with 245 males and 301 females from four relatively isolated Mexican rural communities were randomly selected to be surveyed in 1996. RESULTS: Underweight was not a problem in either children or adults. In children <5 y only three (4.2%) were stunted but the age- and sex-specific distributions of body mass index (BMI) in children showed 17% of boys and 19% of girls exceeded the proposed International Obesity Task Force limits for classifying the overweight. Triceps skinfold values were similar to NHANESI values for white USA children. Of the adult men 42% were overweight (BMI 25.0-29.9) and 9% obese; 40% of adult women were overweight and a further 33% obese. Adjusting BMI values with corrected total heights by relating them to measured knee height reduced the BMI of women >50 y by 2.0 units; the male data were essentially unchanged. The prevalence of abdominal obesity in women, based on waist measurements and WHO cut-off points was high with 25% of women having elevated values despite a normal BMI; 43% of the overweight women had substantial increases in waist measurements, indicative of high risk, as did 91% of obese women. The men's waist measurements were greater in relation to both BMI and body fat but the prevalence of values in excess of the suggested sex-specific WHO limits was less than half that of women. CONCLUSIONS: The high prevalence of overweight and obesity is now evident in poor and relatively isolated rural communities of Mexico. SPONSORSHIP: The Chronic Disease Office, from the Ministry of Health in Mexico partially financed this study.

Nutrition and cataract in low-income Mexicans: experience in an Eye camp.

Surgical Eye-camps for cataract treatment of low-income adult Mexicans have been undertaken over the last 10 years. Despite the high prevalence of cataracts among these subjects, no assessment of their nutritional or health status has ever been made. We compare the results obtained for 81 adults (44 men and 37 women) who received treatment in May 1997 with those for a "control" group of age and sex-matched but affluent individuals in Mexico City. alpha-Tocopherol and beta-carotene were assessed and analysed by HPLC and colorimetric procedures, respectively. The plasma tocopherol to cholesterol ratio did not reveal deficiencies of this vitamin, and only 5 patients (2 men and 3 women) had low beta-carotene plasma levels. The patients had high BMI values, with 32% of men and 30% of women overweight, and 2% and 14%, respectively, obese, with higher glucose, cholesterol and triglyceride values reflecting enhanced insulin resistance and lipid abnormalities. The alkaline phosphatase values were elevated suggesting that many of these blind patients are osteomalacic because they now remain indoors. Although it has been suggested that an adequate intake of carotenes and tocopherol are associated with absence of cataract, this appears not to be the case in our study population. Surveys in Mexico have revealed, however, a highly prevalent deficiency of other vitamins such as niacin and riboflavin, both of which have been proved to be protective against cataract. It appears that nutritional deficiencies, obesity, incipient diabetes and lipid disorders co-exist in modern Mexico. We have identified a need for research to aid the design of preventive nutritional approaches at the population level that could be applied in parallel with ongoing surgical treatment.

Lipids, apoprotein B, and associated coronary risk factors in urban and rural older Mexican populations.

The objective of this comparative cross-sectional study was to determine the prevalence of dyslipidemias and examine its association with food intake and metabolic variables in urban and rural elder Mexican populations. Three different communities (urban areas of medium and low income and a rural area) were studied. A total of 344 subjects aged 60 years and older and 273 aged 35 to 59 years were included. The evaluated parameters were personal medical data, 24-hour diet recall, and fasting plasma lipids, insulin, and glucose levels. Older subjects, especially men, living in the rural area had lower cholesterol levels (5.02 +/- 0.97 v 5.6 +/- 1.07 mmol/L; P <.05) and insulin levels (12 +/- 10 v 42 +/- 68 mU/mL) and higher high-density lipoprotein cholesterol concentrations (1.31 +/- 0.36 v 1.07 +/-0.28 mmol/L) than the elders from the urban medium-income group. Possible explanations for these differences are found in the dietary habits of the groups. Rural elders had higher amounts of fiber (20 +/- 11 v 10 +/- 6 g/d) and carbohydrate (70% +/- 0.08% v 52% +/- 0.11% of calories) and lower fat (18% +/- 0.07% v 33% +/- 0.1% of calories) in their diets. In the urban groups, low-density lipoprotein hypercholesterolemia was present in 17.8% of adult and 39.1% of elderly women (P =.00001). In conclusion, environmental factors still play a prominent role in the pathophysiology of the dyslipidemias in the elderly.

Comparing easy and accessible parameters of glycemic control in type 2 diabetes.

BACKGROUND: HbA1c is considered the gold standard of long-term glycemic control and is recommended as a routine test for every diabetic patient. However, its common use in clinical practice has some problems related to lack of standardization and its relative cost. Recent studies have suggested, that postprandial blood glucose could be better than a fasting sample, as a marker of diabetes control. The objective of the present study was to evaluate the relative value of plasma glucose samples at different times of the day, and easy and accessible programs for home blood and urinary glucose measurements compared with HbA1c in assessing the mean glycemic control of type 2 diabetic patients. METHODS: Sixty type 2 diabetic patients were instructed to do home blood and urine glucose monitoring for two months, at the end, plasma glucose profiles were obtained. RESULTS: The mean of all the capillary BG measurements had the best correlation with the HbA1c (r = 0.84, p < 0.001), followed by the mean of the capillary BG measurements before breakfast and supper (r = 0.82, p < 0.001), and the 2 hr. postbreakfast plasma glucose (r = 0.79 p < 0.001). The fasting PG had a low correlation (r = 0.65, p < 0.001), but a good sensitivity to predict a fair or a poor metabolic control. Diabetes duration and type of treatment explained 17% and 28% of variance in HbA1c levels. CONCLUSIONS: A bimonthly fasting PG correlated well with the glycosylated hemoglobin and is the easiest and cheapest way of monitoring glycemic control in type 2 diabetic patients with some preserved insulin reserve (diabetes for less than 10 years and on treatment with only one hypoglycemic agent). A sample of capillary BG, fasting, once per week correlates better with the HbA1c than a fasting PG every 2-3 months. The 2 hr and 5 hr postbreakfast PG have a good correlation with the HbA1c, but are not a substitute for doing BG monitoring. Glycosuria may be a useful parameter to rule out a fair or poor metabolic control in some patients.

Geographic differences in bone mineral density of Mexican women.

The aim of this study was to generate standard curves for normal spinal and femoral neck bone mineral density (BMD) in Mexican women using dual-energy X-ray absorptiometry (DXA), to analyze geographic differences and to compare these with 'Hispanic' reference data to determine its applicability. This was a cross-sectional study of 4460 urban, clinically normal, Mexican women, aged 20-90 years, from 10 different cities in Mexico (5 in the north, 4 in the center and 1 in the southeast) with densitometry centers. Women with suspected medical conditions or who had used drugs affecting bone metabolism, were excluded. Lumbar spine BMD was significantly higher (1.089 +/- 0.18 g/cm2) in women from the northern part of Mexico, with intermediate values in the center (1.065 +/- 0.17 g/cm2) and lower values (1.013 +/- 0.19 g/cm2) in the southeast (p < 0.0001). Similarly, femoral neck BMD was significantly higher in women from the north (0.895 +/- 0.14 g/cm2), intermediate in the center (0.864 +/- 0.14 g/cm2) and lower (0.844 +/- 0.14 g/cm ) in the southeast part of Mexico (p < 0.0001). Northern Mexican women tend to be taller and heavier than women from the center and, even more, than those from the southeast of Mexico (p < 0.0001). However, these differences in BMD remained significant after adjustment for weight (p < 0.0001). A significant loss (p < 0.0001) in BMD was observed from 40 to 69 years of age at the lumbar spine and up to the eighth decade at the femoral neck. Higher and lower lumbar spine values, as compared with the 'Hispanic' population, were observed in Mexican mestizo women from the northern and southeastern regions, respectively. In conclusion, there are geographic differences in weight and height of Mexican women, and in BMD despite adjustment for weight.

Malignant neoplasms in autoimmune rheumatic diseases: examination of the risk of developing a malignancy among five different rheumatic diseases in one institution.

Relationships between autoimmune rheumatic diseases and malignant neoplasms have been discussed, but there is no study of the different rheumatic diseases examining the risk of developing cancer. Our study has examined probabilities for developing malignancy among patients with connective tissue diseases seen in a single institution. Patients with autoimmune rheumatic disease and malignancy were compared with patients with the same autoimmune rheumatic diseases without malignancy. All cases identified through record-linkage from 1964 to 1996 were selected. Four controls per case were randomly selected from a pool of 3228 patients. The rheumatic diseases considered were rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), primary Sjögren's syndrome (pSS), dermatomyositis-polymyositis (DM-PM), and systemic sclerosis (Scl). The statistical analysis was conducted by conditional logistic regression, testing rheumatic disease as main effect. We identified 72 cases and 288 controls. Fifty-three of the cases had solid tumors, and 19 had lymphoproliferative neoplasms. The risk of developing a malignancy was considerably higher in DM-PM than in SLE (odds ratio [OR] = 17.5, 95% confidence interval [CI] 4.1-75.7), in pSS than in SLE (OR = 5.7, 95% CI 2.2-15.1), and in Scl than in SLE (OR = 5.4, 95% CI 1.6-18.0). These risks persisted after controlling for rheumatic disease duration, the time the disease was active, and anti-rheumatic treatment. RA had an OR of 1.8 (95% CI 0.9-3.4) with respect to SLE. This is the first study which describes the magnitude of risks among rheumatic diseases associated with the probability of developing a malignant neoplasm whether lymphoproliferative or solid. The risks in this series depend on the primary rheumatic disease, with DM-PM, pSS, and Scl all having greater risk than SLE.

The prevalence of obesity and its determinants in urban and rural aging Mexican populations.

OBJECTIVE: To determine the prevalence of obesity and its association to different variables in urban and rural older Mexican populations. METHODS AND PROCEDURES: A cross-sectional study of three different Mexican communities. A total of 121 men and 223 women 60 years and older and 93 men and 180 women aged 35 to 59 years old were selected randomly for inclusion in the survey. A personal interview assessed demographic information, personal medical history and functional status and a 24-hour diet recall was obtained. The physical examination included anthropometric and blood pressure measurements. A fasting blood sample was obtained for measurements of lipids, insulin and glucose. RESULTS: Obesity was highly prevalent in women, in individuals from the urban communities and diminished with advancing age. A BMI > or =30 kg/m2 was observed in 23.6% younger vs. 15.6% older adult men (p=0.21) and 28.4% younger vs. 19.7% older adult women (p = 0.06). The association of obesity with other variables was estimated using a stepwise multivariate logistic regression, increased insulin levels [Odds Ratio (OR) 1.68, p=0.006] and living in an urban area (OR 5.90, p<0.007) were variables independently associated to obesity in adult older individuals. In the younger adults, obesity was associated with hypertension (OR 2.74, p<0.0009), higher insulin levels (OR 1.31, p<0.03) and central adiposity (OR 2.97, p = 0.05), these relationship were not observed with gender, distribution of food or alcohol intake or other coronary risk factors. CONCLUSIONS: The present survey confirms the high prevalence of obesity in the Mexican urban population that declines with advanced age. Studies in elderly population must consider the bias produced by increased early mortality in those individuals with a more unfavorable risk profile.

Domestic violence against patients with chronic neurologic disorders.

BACKGROUND: Violent behavior caused by some neurologic disorders has been widely studied. However, the inverse, violence suffered by patients with neurologic disorders, has not been reported. Brain disorders frequently produce a high frequency of social, psychological, or physical disabilities that could leave patients vulnerable to domestic violence. OBJECTIVES: To determine the prevalence of domestic violence among female patients with chronic neurologic disorders and to identify possible diagnoses associated with the battering syndrome. DESIGN: Cross-sectional, self-administered, anonymous survey. SETTING: Tertiary care center for neurologic disorders in Mexico. PATIENTS: One thousand consecutive adult female patients with neurologic disorders, separated by medical diagnosis of functional or structural disorders. MAIN OUTCOME MEASURES: A modified version of the Abuse Assessment Screen was administered. Statistical analysis was performed using Poisson regression to estimate the prevalence ratio by univariate and multivariate analysis. RESULTS: Overall, 31.2% of women with chronic neurologic disorders were survivors of domestic violence. When separated according to the nature of the disease, 35.3% of patients with functional disorders and 28.1% of patients with brain structural disorders were victims of domestic violence (P = .02). Risk increased in relation to duration of marriage, number of children, and work outside the home. CONCLUSIONS: One third of female patients with chronic neurologic disorders in Mexico suffer domestic violence. A higher frequency of domestic violence was endured by patients with diagnosis of functional disorders as essential epilepsy, headache, migraine, trigeminal pain, depression, or vertigo. The possibility of domestic violence should be routinely explored in patients with chronic neurologic disorders of functional origin.

Dermatoses in 156 obese adults.

BACKGROUND: Skin diseases are mentioned as a frequent finding in the obese patient. However, to our knowledge no study has been done on this subject. OBJECTIVE: To determine the prevalence of skin diseases associated with different obesity grades and if any dermatosis can be considered an obesity marker. MATERIALS AND METHODS: A cross-sectional study of 156 obese patients who were 110% to 293% overweight were included. Complete medical history and dermatological examination were done. RESULTS: In the 126 female and 30 male obese patients, grades I to V, with a body mass index (BMI) of 27-51, cutaneous findings with statistical significance for linear trend were: plantar hyperkeratosis 54 patients p = 0.00001; acanthosis nigricans 46 patients p = 0.00005; striae 67 patients p = 0.03; skin tags 69 patients p = 0.01; keratosis pilaris 33 patients p = 0.007. Patients with plantar hyperkeratosis were distributed in the obesity groups as follows: grade I = 3 patients; grade II = 7 patients; grade III = 8 patients; grade IV = 17 patients; and grade V = 19 patients. Of the 76 diabetic patients, 26 had acanthosis nigricans, 38 had skin tags, and 27 had plantar hyperkeratosis. DISCUSSION: Plantar hyperkeratosis should be considered as a cutaneous stigma of severe obesity. This is probably a result of pressure directly related to the excess weight.

Serum anti-beta2-glycoprotein-I and anticardiolipin antibodies during thrombosis in systemic lupus erythematosus patients.

PURPOSE: Antibodies to beta2-glycoprotein-I are more strongly associated with clinical antiphospholipid syndrome than are anticardiolipin antibodies. We previously found a decrease in anticardiolipin antibodies at the time of thrombosis in 6 patients with systemic lupus erythematosus (SLE). We therefore sought to determine the prevalence and levels of antibodies to beta2-glycoprotein-I and to cardiolipin before, during, and after thrombosis in patients with SLE, and to compare them with patients who did not have thrombosis. METHODS: We studied 24 patients with SLE who had at least one episode of thrombosis and 102 patients with SLE without thrombosis. Serum anticardiolipin antibodies were measured by conventional enzyme-linked immunosorbent assay (ELISA) using newborn calf serum as the blocking agent. Serum anti-beta2-glycoprotein-I antibodies were measured by ELISA on nonirradiated plates, using purified human beta2-glycoprotein-I without phospholipid. RESULTS: All patients with thrombosis had anti-beta2-glycoprotein-I antibodies, compared with only 17% of controls (P <0.0001). We observed a significant decrease in serum anti-beta2-glycoprotein-I levels at the time of thrombosis, as compared with previous and subsequent samples. The prevalence and levels of IgG and IgM anticardiolipin antibodies were similar in patients with and without thrombosis. A decrease in IgG or IgM anticardiolipin titers occurred during thrombosis in 6 patients. Anticoagulant, corticosteroid, and immunosuppressive treatments did not appear to affect anti-beta2-glycoprotein-I levels at the time of thrombosis. CONCLUSION: Anti-beta2-glycoprotein-I antibodies are strongly associated with thrombosis in patients with SLE. The decrease of anti-beta2-glycoprotein-I levels at the time of thrombosis may indicate a pathogenic role. This antibody may also be a marker of predisposition for thrombosis in these patients.

Structural basis for self-association and receptor recognition of human TRAF2.

Tumour necrosis factor (TNF)-receptor-associated factors (TRAFs) form a family of cytoplasmic adapter proteins that mediate signal transduction from many members of the TNF-receptor superfamily and the interleukin-1 receptor. They are important in the regulation of cell survival and cell death. The carboxy-terminal region of TRAFs (the TRAF domain) is required for self-association and interaction with receptors. The domain contains a predicted coiled-coil region that is followed by a highly conserved TRAF-C domain. Here we report the crystal structure of the TRAF domain of human TRAF2, both alone and in complex with a peptide from TNF receptor-2 (TNF-R2). The structures reveal a trimeric self-association of the TRAF domain, which we confirm by studies in solution. The TRAF-C domain forms a new, eight-stranded antiparallel beta-sandwich structure. The TNF-R2 peptide binds to a conserved shallow surface depression on one TRAF-C domain and does not contact the other protomers of the trimer. The nature of the interaction indicates that an SXXE motif may be a TRAF2-binding consensus sequence. The trimeric structure of the TRAF domain provides an avidity-based explanation for the dependence of TRAF recruitment on the oligomerization of the receptors by their trimeric extracellular ligands.

The prevalence of diabetes and associated coronary risk factors in urban and rural older Mexican populations.

OBJECTIVE: To determine the prevalence of diabetes and examine its association with food intake, anthropometric and metabolic variables, and other coronary risk factors in urban and rural older Mexican populations. DESIGN: A cross-sectional study. SETTING: Three Mexican communities (urban areas of medium and low income and a rural area). PARTICIPANTS: A total of 121 men and 223 women aged 60 years and older and 93 men and 180 women aged 35 to 59 years were selected randomly for inclusion in the survey, which was derived from the CRONOS study (Cross-Cultural Research on Nutrition in the Older Adult Study Group) promoted by the European Economic Community. MEASUREMENTS: A personal interview assessed demographic information, personal medical history, and functional status, and a 24-hour diet recall was obtained. A physical examination included anthropometric and blood pressure measurements. A fasting blood sample was obtained for measurements of lipids, insulin, and glucose. RESULTS: Diabetes prevalence was higher in men than in women for all age groups: 16.7% versus 9.5% in younger adults and 30.8% versus 22.8% in older adults. For all age groups, diabetes was more highly prevalent in urban communities. Using a multivariate stepwise logistic regression, variables associated independently with diabetes in older individuals were: gender (male sex: OR = 2.1; P < .009); diminished carbohydrate intake in the diet (OR = 0.77; P < .03); central distribution of adiposity (OR = 1.9; P < .03); and functional disability (OR = 2.3; P < .01). This relationship was not observed with living area, income, education, fiber and alcohol intake, body mass index, or age. Individuals 80 years and older had a diminished atherogenic risk profile. Diabetes in older people was associated significantly with hypertriglyceridemia, impaired functional status, and an increased prevalence of ischemic heart disease; in younger adults diabetes was associated with low density lipoprotein (LDL) hypercholesterolemia, hypertriglyceridemia, and a proportionally higher fat intake. CONCLUSION: This survey confirms the high prevalence of diabetes in the older Mexican population - particularly in men and in individuals living in urban areas - associated with an increased prevalence of other coronary risk factors. Diabetes was associated with higher fat, low carbohydrate, low fiber diets and increased prevalence of central distribution of adiposity. In the older subjects, diabetes was associated significantly with hypertriglyceridemia, impaired functional status, and increased prevalence of ischemic heart disease. A bias produced by early mortality and a survivorship effect must be considered in studies of older individuals. The health situation in the older Mexican population presents a complex problem that needs correct diagnosis and better strategies to benefit those segments of the population at increased risk.

Development, recurrence, and severity of infections in Mexican patients with rheumatoid arthritis. A nested case-control study.

OBJECTIVE: To determine factors associated with development, recurrence, and severity of infections in patients with rheumatoid arthritis (RA). METHODS: A hospital based nested case-control study in a referral center. The same evaluator reviewed clinical charts of 195 consecutive patients with RA seen in our clinic during 1993. Patients who had had at least one infection were classified as "cases" and the others as "controls." We examined 24 demographic, clinical, therapeutic, and infection related variables. A severity index was developed according to scores provided by 12 independent multidisciplinary evaluators. Recurrent infection was defined as > 2 different infections in the same patient during followup. Descriptive statistics were employed, with comparison between cases and controls by univariate analysis and multiple logistic regression. RESULTS: Two hundred eleven infections were detected in 1274 patient-years (incidence of 0.17 new infections per patient-year). We studied 174 women and 21 men, mean 41 years of age, with a mean duration of symptoms of RA of 5 years. Ninety-five were cases and 100 controls. Cases had longer disease duration before admission and followup (p < 0.05). Infections most commonly seen were upper respiratory tract (n = 74), skin (41), urinary tract (27), and herpes zoster (15). Steroids and/or methotrexate (MTX) were associated in 95% of infections. Infection was associated with duration of RA before admission and followup, comorbidity, extraarticular disease, mean cumulative dose of MTX, time taking steroids, and mean daily dose of D-penicillamine, by univariate analysis. Severity of infection was related to the same variables and years of formal education, and recurrence of infection was related to time of followup and mean dose of MTX and steroids. Multiple logistic regression showed that variables associated with infection were cumulative MTX dose, time taking steroids, and mean daily dose of D-penicillamine. CONCLUSION: Infections were frequent in our RA population. The risk factors associated with infections were the cumulative dose of MTX, duration taking steroids, and mean daily dose of D-penicillamine.

Oral manifestations in patients with Sjögren's syndrome.

OBJECTIVE: To investigate oral signs and symptoms in patients with Sjögren's syndrome (SS), and to compare results with a group of healthy individuals. METHODS. Each individual completed a questionnaire designed to investigate his/her perception of oral health and dryness, as well as a list of signs and symptoms associated with xerostomia. An oral clinical evaluation was performed. RESULTS: A total of 81 subjects were studied, 21 with primary SS, 29 with secondary SS, and 31 healthy individuals. Patients with SS considered that their oral health was poor. Oral dryness was perceived as intense. Symptoms most commonly expressed were: sensitivity to acids (68%), difficulty eating dry foods (66%), and sensitivity to spicy foods (58%). Dryness of the lips (76%) and the tongue (68%) were also among the most frequent complaints. Oral findings of patients with SS included cervical or atypical caries in 83%, fissured erythematous tongue in 70%, and oral candidiasis in 74%. Significant differences were found when results obtained from patients with SS were compared with the healthy group. CONCLUSION: The oral health of this group of patients with SS was deficient. Adequate management of dry mouth was not achieved, mainly for the modifiable components such as dental decay and oral candidiasis. Therefore. treatment and prevention plans are mandatory. These measures might help to reduce the discomfort associated with oral dryness and to reduce dental loss.

Oral candidiasis and Sjögren's syndrome.

OBJECTIVE: To determine the prevalence of oral candidiasis (OC) in patients with Sjögren's syndrome (SS), to identify oral signs and symptoms associated with OC, and to compare them with a healthy group. METHODS: Patients with primary SS, and with SS associated with autoimmune disease were identified according to established criteria. Each individual had: (1) a questionnaire, (2) an oral clinical evaluation, (3) a set of microbiological tests: tongue smear, culture of tongue smear, and saliva sample. Diagnosis of OC was established with 2 positive results and the presence of any sign or symptom. RESULTS: A total of 81 subjects were studied, 21 with primary SS, 29 secondary SS, and 31 healthy subjects. We diagnosed OC in 74% of patients with SS, which was statistically significant compared to the healthy group (23%) p < 0.001. Frequent symptoms associated with OC were increased sensitivity to spicy foods (58%) and unpleasant metallic taste (40%). Common signs of OC were erythematous lesion on the dorsum of the tongue (68%) and angular cheilitis (24%). CONCLUSION: Prevalence of OC was high in patients with SS. The frequency of signs and symptoms associated with OC may explain some of the clinical manifestations. If chronic erythematous OC is found in patients with SS an oral assessment at every appointment may help provide appropriate treatment.