Cultural Competence in the Undergraduate Nursing Curriculum

Although health care providers and health care systems have increasingly acknowledged the need for culture-specific care in a global society, its implementation has remained daunting. Thus, integrating cultural competence into nursing education is no longer a choice but a requirement that builds on the values of the racially and culturally diverse population of the United States for optimal health care. The need has never been greater for nurses who understand the health implications of the demographic shifts that are shaping an American society whose African American, Hispanic, Asian, and Native American constituents compose a significantly growing portion of the population and whose health care needs will need to be served in health care settings that range from their homes to health care institutions. This article provides a blueprint on how our undergraduate program integrated cultural competence education throughout the curriculum.     

Impact of dietary intake and nutritional status on outcomes after liver transplantation.

OBJECTIVE: The aim of our study was to examine, in a prospective way, whether any nutritional parameter could predict outcomes after liver transplantation. MATERIAL AND SUBJECTS: A nutritional assessment was performed in 31 consecutive patients six months prior to undergoing orthotopic liver transplantation (OLT) at a single center (Hospital U. Río Hortega) and after six months of OLT (December 2002-June 2004). The nutritional evaluation included Subjective Global Assessment (SGA), Mini Nutritional Assessment test (MNA), anthropometry, laboratory tests, and three-day diet diary completed. The body composition analysis was performed by tetrapolar body electrical bioimpedance and skin folds in a standard way. RESULTS: Our patients had an average age of 56.2 +/- 8.11 years; weight was 72.9 +/- 15.3 kg, and body mass index was 26.6 +/- 4.1. The anthropometric evaluation showed the following data: tricipital skin fold 12.2 +/- 6.1 mm, mid-arm circumference 24.5 +/- 4.1 cm, fat-free mass 54.5 +/- 10.9 kg, fat mass 18.4 +/- 6.5 mm, and body water 41.4 +/- 9.1 kg. After six months from liver transplantation, these parameters remained unchanged. Energy intake, as corrected by weight, was similar pre- and post-liver transplantation (28.1 +/- 6 kcal/kg vs. 27.5 +/- 5.8 kcal/kg: ns). Albumin, prealbumin and transferrin improved after 6 months from transplantation. Length of stay in hospital was 22.4 +/- 14.9 days, and length of stay in ICU was 0.7 +/- 1.7 days. The nutritional status (SGA and MNA tests) of patients did not influence length of stay in either hospital or ICU. No intercurrent events (infections: urinary tract infection, pneumonia, and peritonitis) were recorded during the 6-month study period. Two patients died after liver transplantation (6.5%), and 3 patients had acute rejection (9.6%). Patients with malnutrition (SGA and MNA tests classification) showed no differences in rejection and mortality. CONCLUSIONS: Our liver transplantation population had normal nutritional status and dietary intake. Nutritional parameters showed no association with outcomes after liver transplantation. Liver transplantation improved serum protein levels and did not modify weight or dietary intake. Further studies are needed to clarify the role of liver transplantation on nutritional status and of nutritional status on liver transplantation outcomes, considering different populations of patients.     

MODERN LINES OF MANAGEMENT OF ECTOPIC PREGNANCY

The recent increase in the incidence of ectopic pregnancies was associated with rapid improvement in the diagnostic and therapeutic techniques. Quantitative serum B-HCG radioimmunoassay and high resolution vaginal ultrasonography have facilitated early diagnosis of ectopic pregnancy allowing a more conservative approach to patient management. Different conservative surgical and medical lines of management recently developed were associated with and increased chance of subsequent intrauterine pregnancy with no increase in the incidence of repeat ectopic pregnancy. Outpatient systemic medical treatment seems to be a preferred alternative to conservative surgery. In selected cases, it is associated with a lower complication rate and promising result for fertility. (Br J Clin Pract 1996; 50(7) : 376-380.)     

Levocarnitine Decreases Intradialytic Hypotension Episodes: A Randomized Controlled Trial

Intradialytic hypotension is common complication in stage 5 chronic kidney disease patients on hemodialysis. Incidence ranges from 15 to 30%. These patients have levocarnitine deficiency. A randomized, placebo‐controlled quadruple‐blinded trial was designed to demonstrate the levocarnitine efficiency on intradialytic hypotension prevention. Patients were randomized into four groups, to receive levocarnitine or placebo. During the intervention period, levocarnitine and placebo was administered 0 and 30 min before each hemodialysis session, respectively. During the trial, 33 patients received 1188 hemodialysis sessions. We identified 239 (21.3%) intradialytic hypotension episodes. The intradialytic hypotension episodes were less frequent in the levocarnitine group (9.3%, 60 IH events) (P < 0.001). Hemodialysis is frequently perplexed by intradialytic hypotension episodes. Levocarnitine supplementation before each hemodialysis session efficiently diminishes the intradialytic hypotension episodes. This is a new application method that must be considered and explored.     

Chagasic patients are able to respond against a viral antigen from influenza virus

ABSTRACT: BACKGROUND: Trypanosoma cruzi, the etiological agent of Chagas' disease, is an obligate intracellular parasite which induces a CD8+ T cell immune response with secretion of cytokines and release of cytotoxic granules. Although an immune-suppressive effect of T. cruzi on the acute phase of the disease has been described, little is known about the capacity of CD8+ T cell from chronic chagasic patients to respond to a non-T. cruzi microbial antigen.Methods and resultsIn the present paper, the frequency, phenotype and the functional activity of the CD8+ T cells specific from Flu-MP*, an influenza virus epitope, were determined in 13 chagasic patients and 5 healthy donors. The results show that Flu-MP* peptide specific CD8+ T cells were found with similar frequencies in both groups. In addition, Flu-MP* specific CD8+ T cells were distributed in the early or intermediate/late differentiation stages without showing enrichment of a specific sub-population. The mentioned Flu-MP* specific CD8+ T cells from chagasic patients were predominately TEM (CCR7- CD62L-), producing IL-2, IFNgamma, CD107a/b and perforin, and did not present significant differences when compared with those from healthy donors. CONCLUSIONS: Our results support the hypothesis that there is no CD8+ T cell nonspecific immune-suppression during chronic Chagas disease infection. Nonetheless, other viral antigens must be studied in order to confirm our findings.     

Granulocyte colony-stimulating factor crosses the placenta and stimulates fetal rat granulopoiesis

We studied the effect of recombinant human granulocyte colony- stimulating factor (rhG-CSF) administration to pregnant rats upon fetal and neonatal myelopoiesis. Pregnant rats were treated with rhG-CSF twice daily for 2, 4, and 6 days before parturition. rhG-CSF crossed the placenta and reached peak fetal serum concentrations 4 hours after administration. Peak fetal serum levels were 1,000-fold lower than levels detected in the dam. Hematopoietic effects of rhG-CSF were assessed by cytologic analysis of the newborn blood, spleen, bone marrow, thymus, and liver. White blood cell counts were increased twofold to fourfold in newborns. This increase was due to circulating numbers of polymorphonuclear cells (PMN). rhG-CSF induced a myeloid hyperplasia in the newborn marrow consisting of immature and mature myeloid cells in the day-2 and day-4 treated pups. Bone marrow of pups treated for 6 days contained mostly hyper-segmented PMN with little or no increase in myeloid precursors. An increase in the number of postmitotic (PMN, bands, and metamyelocytes) and mitotic (promyeloblasts, myeloblasts, and metamyeloblasts) myeloid cells in the spleen of neonates was observed. No change was detected in splenic lymphocytes or monocytes. No effect of rhG-CSF was noted in the newborn liver or thymus. These results demonstrate that maternally administered rhG-CSF crosses the placenta and specifically induces bone marrow and spleen myelopoiesis in the fetus and neonate. The significant myelopoietic effects of rhG-CSF at low concentrations in the fetus suggest an exquisite degree of developmental sensitivity to this cytokine and may provide enhanced defense mechanisms to the neonate.     

B-cell lymphoma after angioimmunoblastic lymphadenopathy: a case with oligoclonal gene rearrangements associated with Epstein-Barr virus

We describe a patient with angioimmunoblastic lymphadenopathy with dysproteinemia (AILD), who subsequently developed large-cell immunoblastic lymphoma of B-cell immunophenotype. At the time of the initial diagnosis, histologic examination of an inguinal lymph node showed typical features of AILD, and there was no evidence of a monoclonal B-cell population by immunohistochemical analysis. In situ hybridization and Southern blot analysis for Epstein-Barr virus (EBV) were negative. At autopsy 2 years later, the patient had widespread lymph node and organ involvement by large-cell immunoblastic lymphoma of B-cell immunophenotype. Southern blot analysis performed on DNA extracted from lymph nodes, liver, and spleen showed two patterns of Ig heavy chain and kappa light chain gene rearrangements. The T-cell receptor beta chain gene was in the germline configuration. Analysis with an EBV terminal repeat region probe showed two clonal populations that paralleled the Ig gene rearrangement studies. Double-labeling immunohistochemistry and in situ hybridization confirmed the presence of EBV within the neoplastic B cells. The data support the hypothesis that EBV was not etiologically related to AILD in this case, and that EBV proliferation may occur after the onset of the disease. Further, the data suggest that some B-cell lymphomas that arise in the setting of AILD resemble EBV-associated B-cell lymphomas that arise in other immunodeficiency states.     

Primary Headache and Helicobacter Pylori

H. pylori infection has recently been associated with various vascular disorders. The aim of this study was to investigate its role in primary headache, a pathology strictly associated with vascular alterations. A total of 200 subjects affected by primary headache were evaluated. H. pylori infection was diagnosed by the 13C urea breath test. Headache was classified in tension-type headache, cluster headache, and migraine with or without aura. Prevalence of H. pylori infection and gastrointestinal (GI) symptoms were evaluated. H. pylori infection was found in 40% of the patients; prevalence of migraine without aura was found to be significantly greater in infected patients. The positive group showed no significant differences in the prevalence of the GI symptoms evaluated. In 30 infected patients, it was assessed whether the eradication of the bacterium was able to reduce frequency, intensity, and duration of clinical attacks of headache. After eradication, clinical attacks of headache completely disappeared in 17% of patients. Moreover, intensity, duration, and frequency of headache attacks were reduced in 69% of the remaining subjects. In conclusion, H. pylori infection is common in primary headache; bacterium eradication appears to be related to a significant reduction in clinical attacks of the disease.