High prevalence of pulmonary hypertension in patients with hereditary hemorrhagic telangiectasia.

OBJECTIVE: Hereditary hemorrhagic telangiectasia (HHT) is a vascular disorder causing mucocutaneous telangiectases and visceral arteriovenous malformations (AVMs). Pulmonary hypertension (PH) is considered an uncommon complication of HHT whose impact on the survival of these patients is currently unknown. METHODS: From January 1995 to December 2008, 29 hospitalized patients with definite HHT were included and followed until January 2011. Data on demographics, clinical symptoms and survival were recorded. PH was classified according to echocardiographic probability. RESULTS: A CT angiogram was performed in 24 of the 29 patients with HHT and AVMs were detected in 16 of them (67%): hepatic in 58%, pulmonary in 33% and spinal in 3%; 37% had both pulmonary and hepatic AVMs. Transthoracic Doppler echocardiography (TTE) was performed in 21 patients. PH was considered possible in 4 (14%) and probable in 9 (31%). The mean age at diagnosis was lower in patients with PH than in patients without PH (54±16.5 years vs 73±8.8 years, p=0.002). PH was more prevalent in patients with AVMs (56 vs. 23%, p=0.036). The mean follow-up of the entire cohort was 6±4.4 years (range: 2 months-17 years), during this time 18 patients died (62%; mean age 73±8.1 years). Patients with PH died at a younger age (68±8.4 vs. 79±2.7 years, p=0.015) than those without PH. CONCLUSIONS: PH is a severe condition that significantly reduces survival on HHT patients. PH should be suspected in all HHT patients with dyspnea and hepatic AVMs.

Clinical significance of "anti-HBc alone" in human immunodeficiency virus-positive patients.

AIM: To determine the prevalence and clinical relevance of isolated antibodies to hepatitis B core antigen as the only marker of infection ("anti-HBc alone") among human immunodeficiency virus (HIV) type-1 infected patients. Occult hepatitis B infection frequency was also evaluated. METHODS: Three hundred and forty eight histories from 2388 HIV-positive patients were randomly reviewed. Patients with serological markers of hepatitis B virus (HBV) infection were classified into three groups: past hepatitis, "anti-HBc alone" and chronic hepatitis. Determination of DNA from HBV, and RNA and genotype from hepatitis C virus (HCV) were performed on "anti-HBc alone" patients. RESULTS: One hundred and eighty seven (53.7%) HIV-positive patients had markers of HBV infection: 118 past infection (63.1%), 14 chronic hepatitis (7.5%) and 55 "anti-HBc alone" (29.4%). Younger age [2.3-fold higher per every 10 years younger; 95% confidence intervals (CI) 1.33-4.00] and antibodies to HCV infection [odds ratio (OR) 2.87; 95% CI 1.10-7.48] were factors independently associated with the "anti-HBc alone" pattern. No differences in liver disease frequency were detected between both groups. Serum levels of anti-HBs were not associated with HCV infection (nor viral replication or HCV genotype), or with HIV replication or CD4 level. No "anti-HBc alone" patient tested positive for HBV DNA. CONCLUSION: "Anti-HBc alone" prevalence in HIV-positive patients was similar to previously reported data and was associated with a younger age and with antibodies to HCV infection. In clinical practice, HBV DNA determination should be performed only in those patients with clinical or analytical signs of liver injury.

Aplicación del proceso de enfermería en la práctica hospitalaria y comunitaria en instituciones del Distrito Federal / Application of the nursing process in the hospital and communitarian practice in institutions of the Federal District

Introducción: Este reporte forma parte del estudio multicéntrico sobre conocimiento y aplicación del proceso de enfermería en la práctica hospitalaria y comunitaria, en el que participan 12 estados de la República Mexicana. Objetivo: Analizar el conocimiento de las enfermeras sobre el proceso de enfermería y su relación con la aplicación en la práctica profesional. Metodología: Por muestreo convencional, en la región Distrito Federal, se encuestó a 2268 enfermeras que laboran en instituciones públicas y privadas, a través de un cuestionario con 73 preguntas planteadas en escala de Likert. Resultados: El índice de conocimiento en promedio fue de 83.55 con un valor mínimo de 52.0 y un máximo de 93.43 El índice de aplicación mostró una media de 82.4, valor mínimo 42.3 y máximo de 89.47. La prueba Rho de Spearman mostró una correlación positive significativa (rs=0.204, p<0.05) entre ambas variables. Al aplicar la prueba U de Mann-Whitney se encontró diferencia significativa entre los resultados del Distrito Federal, zona centro (83.55) con los de la zona norte (80.51) y zona sur (78.13), en ambas variables. Conclusiones: Un tercio de las enfermeras afirmó que la principal barrera para aplicar el Proceso de Enfermería es la sobrecarga de trabajo, otro tanto considera que es la falta de recursos humanos y materiales, y admite que el principal problema es la falta de conocimiento sobre el tema.

Introduction: This report is part of a multi-centric study about knowledge and application of the nursing process in hospital and communitarian practice in 12 participants' status from the Mexican Republic. Objective: To analyze the nurses' knowledge about the nursing process and its relation with the application in the professional practice. Methodology: For conventional sampling, within the region of the Federal District, 2268 nurses who work in private and public institutions, were surveyed through a questionnaire with 73 questions set them up in the Likert' scale. Results: The average of knowledge was83.55 with a minimum value of 52.0 and a maximum value of 93.43. The index of application showed a media of 82.4, minimum value of 42.3 and a maximum of 89.47. The Spearman Rho test showed a positive, significant correlation of (rs=0.0204, p=0.05) between both variables. When applying the Mann-Whitney U test, it was found a significant difference among the results in the Federal District, centric zone (83.55) with those from north zone (80.51) and south zone (78.13), in both variables. Conclusions: A third part of nurses agreed that the main barrier to apply the nursing process is the working overload, another umber of nurses considered that is the lack of human and material resources, and admitted that the main problem is the lack of knowledge about the topic.