[Infectious endocarditis at the National Institute of Cardiology "Ignacio Chavez". Five year's experience (1990-1994)]. / Endocarditis infecciosa en el Instituto Nacional de Cardiología "Ignacio Chávez". Experiencia de cinco años (1990-1994).

BACKGROUND: Infective endocarditis (IE) is one of the most life threatening infections in both medical and surgical practices. In the last few years, changes in its epidemiology, diagnostic methods and therapeutical trends have appeared. We analysed our experience in the diagnosis and treatment of IE. METHODS: The clinical records of patients admitted to our hospital with definitive (Group I) and highly probable (Group II) diagnosis of IE, during a period of five years (1990-1994), were retrospectively reviewed. Age, sex, clinical features, risk, factors, echocardiographic abnormalities, microbiologic and surgical findings, as well as mortality were recorded. In addition, an evaluation was made of the accuracy of the diagnostic criteria proposed by Von Reyn versus those brought forward by Duke University. RESULTS: One hundred thirty one patients were included, 99 in Group I and 32 in Group II. The mean age was 35 years. Native valve endocarditis was present in 88 patients and prosthetic valve endocarditis in 43 patients. Streptococcus sp. (48%) was the most frequently causative german and 16.7% of cases were culture negative. The sensitivity of transesophageal echocardiography was higher than transthoracic echocardiography in the diagnosis of both vegetations (76% vs 55%) and abscesses (30% vs 16.5%), (p < 0.05). Vegetations (95%) were the most frequent surgical finding followed by abscesses (23%). Inpatient mortality was 22% in Group I and 45% in Group II (p < 0.05). The sensitivity of Von Reyn's diagnostic criteria and that of Duke's University group was 49% and 85.8% (p < 0.05). Mean follow up was 531 days. Two patients had a new event of IE and no outpatient deaths were recorded. CONCLUSION: IE is a medical and surgical emergency. Because of the high mortality rate, in the medically treated group, surgery should be considered in all cases as early as possible in the course of the disease.

[The prevalence of markers for hepatitis A, B and C in a hospital in Mexico]. / Prevalencia de marcadores para hepatitis A, B y C en un hospital de México.

A prospective study was carried to determine the relative frequency of hepatitis A, B and C in patients with elevated liver enzymes (transaminases greater than two times normal) who had a viral hepatitis profile requested by their physicians between August of 1990 and July of 1992 in the Angeles Hospital in Mexico City. Prevalence of serological evidence of HBsAg and anti-hepatitis C antibodies was also studied in healthy blood donors seen at the hospital's blood bank during the same period. Among the 405 patients with elevated liver enzymes, 24.7 per cent had acute hepatitis A (positive anti-hepatitis A IgM), 7.9 per cent had active hepatitis B (positive HBsAg and/or HBcAb IgM) and 14.8 per cent had active or previous hepatitis C as evidenced by the presence of anti-hepatitis C antibodies. In blood donors the incidence of anti-hepatitis C and HBsAg was 0.61 and 0.32 per cent, respectively. A percentage of 46.2 of patients with anti-hepatitis C antibodies and transaminases greater than two-times normal had a past history of one or more blood transfusions. These data suggest that infection with the hepatitis C virus is more common than that caused by the B virus in both healthy blood donors, as well as in patients with hepatitis in this hospital.