Cytogenetic abnormalities in patients with hematological malignancies in Lahore city, Pakistan / Anormalidades citogenéticas em pacientes com neoplasias hematológicas na cidade de Lahore, Paquistão

Abstract Hematological and hematopoietic cells malignancies of the genes and hematopoietic cells are associated with the genetic mutation, often at the chromosomal level. The standard cytogenetic study is widely accepted as one of the main diagnostics and prognostic determinants in patients. Therefore, the current descriptive and cross-sectional study sought to determine the cytogenetic analysis of frequent hematological malignancies in Pakistan. A total of 202 peripheral bone marrow or blood samples from patients with benign and malignant hematological malignancy were taken using a conventional G-banding technique. Among enrolled patients, the mean age was 21.5 years ± 23.4, and gender-wise distribution showed a marked predominance of the male 147 (73%) population compared to the female 55 (27%). Patients in the age group (2-10 years) had the highest frequency, 48 (24%), of hematological neoplasms, followed by age (11-20 years) with 40 (20%). Normal karyotypes (46, XX/46, XY) was found in 51% (n=103) patients. Furthermore, the frequency of complex karyotype was 30 (15%), while normal was seen in 171 (85%) patients. Pre-B Acute Lymphoblastic Leukemia (Pre-B ALL) was the most prevalent malignancy of 66 (33%), followed by Chronic Myelogenous Leukemia (CML) of 41 (20%) and Acute Lymphocytic Leukemia of 29 (14%). Translocation was the most prevalent 50 (25%), followed by hypotriploidy 14 (7%) and monosomy 8 (4%) on chromosome aberration analysis. In addition, t(9:22) translocation was found to be 20 (10%) in CML, with the majority in the age group (31-40 years). This study recommends that karyotyping should be tested frequently in hematological conditions because it may provide insight into the relative chromosomal changes associated with particular malignancies.

Resumo As neoplasias hematológicas e de células hematopoiéticas dos genes e as células hematopoiéticas estão associadas à mutação genética, geralmente em nível cromossômico. O estudo citogenético padrão é amplamente aceito como um dos principais determinantes diagnósticos e prognósticos em pacientes. Portanto, o presente estudo descritivo e transversal buscou determinar a análise citogenética de neoplasias hematológicas frequentes no Paquistão. Um total de 202 amostras de medula óssea periférica ou sangue de pacientes com malignidade hematológica benigna e maligna foi coletado usando uma técnica convencional de banda G. Entre os pacientes inscritos, a média de idade foi de 21,5 anos ± 23,4, e a distribuição por gênero mostrou uma marcada predominância da população masculina de 147 (73%) em comparação com a feminina de 55 (27%). Pacientes na faixa etária (2-10 anos) tiveram a maior frequência, 48 (24%), de neoplasias hematológicas, seguida da idade (11-20 anos) com 40 (20%). Cariótipos normais (46, XX / 46, XY) foram encontrados em 51% (n = 103) dos pacientes. Além disso, a frequência de cariótipo complexo foi de 30 (15%), enquanto normal foi observada em 171 (85%) pacientes. Leucemia linfoblástica aguda pré-B (LLA Pré-B) foi a doença maligna mais prevalente de 66 (33%), seguida por leucemia mieloide crônica (LMC) de 41 (20%) e leucemia linfocítica aguda de 29 (14%). A translocação foi o 50 mais prevalente (25%), seguido por hipotriploidia 14 (7%) e monossomia 8 (4%) na análise de aberração cromossômica. Além disso, a translocação t (9:22) encontrada foi de 20 (10%) na LMC, com a maioria na faixa etária (31-40 anos). Este estudo recomenda que o cariótipo deve ser testado com frequência em condições hematológicas porque pode fornecer informações sobre as alterações cromossômicas relativas associadas a doenças malignas específicas.

A consensus document for the clinical management of invasive fungal diseases in pediatric patients with hematologic cancer and/or undergoing hematopoietic stem cell transplantation in Brazilian medical centers

ABSTRACT In the present paper we summarize the suggestions of a multidisciplinary group including experts in pediatric oncology and infectious diseases who reviewed the medical literature to elaborate a consensus document (CD) for the diagnosis and clinical management of invasive fungal diseases (IFDs) in children with hematologic cancer and those who underwent hematopoietic stem-cell transplantation. All major multicenter studies designed to characterize the epidemiology of IFDs in children with cancer, as well as all randomized clinical trials addressing empirical and targeted antifungal therapy were reviewed. In the absence of randomized clinical trials, the best evidence available to support the recommendations were selected. Algorithms for early diagnosis and best clinical management of IFDs are also presented. This document summarizes practical recommendations that will certainly help pediatricians to best treat their patients suffering of invasive fungal diseases.

Epidemiological and cytogenetic profiles of patients with hematological malignancies and their relationship with aging

ABSTRACT Background: Hematologic neoplasms are associated with mutations in hematopoietic cells and chromosomal abnormalities. During aging, about 2-3% of the elderly have chromosomal abnormalities arising from clonal mosaicism, the immune system is impaired and the bone marrow loses its ability to replace blood cells. Objective: To describe the epidemiological and cytogenetic profile of hematological malignancies, highlighting the frequency of chromosomal alterations in these neoplasms associated with aging. Method: A retrospective cross-sectional study with analysis of karyotype exams results was performed in the Cytogenetic Laboratory of thee Blood Center of the Faculdade de Medicina de Marilia (FAMEMA) between 1998 and 2016. Blood samples from child and adult patients with different hematological malignancies treated in the Onco-hematology Outpatient Clinics of the local blood center and hospitals, and external clinics were tested. Results: Karyotype exam results of 746 patients with a mean age of 54.7 years (±23.1) were analyzed. The elderly had the highest frequency of hematological malignancies (50.9%), followed by adults (38.3%) and young people (10.7%); elderly women had the highest percentage (55.0%). Normal karyotypes (46,XX/46,XY) were more common (61.8%) compared to abnormal karyotypes, especially among the elderly (56.4%). Myeloproliferative neoplasms were an exception with 67.4% of abnormal karyotypes. Conclusion: There is a higher frequency of hematological malignancies among the elderly. It is possible to conclude that failures in genomic mechanisms and hematopoiesis with aging lead to the formation of cells with the chromosomal alterations found in hematological malignancies.

Central venous catheter-related infections caused by Corynebacterium amycolatum and other multiresistant non-diphtherial corynebacteria in paediatric oncology patients

ABSTRACT Bloodstream and venous catheter-related corynebacterial infections in paediatric patients with haematological cancer were investigated from January 2003 to December 2014 at the Brazilian National Cancer Institute in Rio de Janeiro, Brazil. We observed that during cancer treatment, invasive corynebacterial infections occurred independent of certain factors, such as age and gender, underlying diseases and neutropenia. These infections were ssscaused by Corynebacterium amycolatum and other non-diphtherial corynebacteria. All cases presented a variable profile of susceptibility to antimicrobial agents, except to vancomycin. Targeted antibiotic therapy may contribute to catheters maintenance and support quality of treatment. Non-diphtherial corynebacteria must be recognized as agents associated with venous access infections. Our data highlight the need for the accurate identification of corynebacteria species, as well as antimicrobial susceptibility testing.

Câncer e poluição do ar relacionada ao tráfego veicular no município de São Paulo: análise espacial em pequenas áreas / Cancer and traffic-related air pollution in São Paulo spatial analysis in small areas units

Introdução: A poluição do ar relacionada ao tráfego veicular é um grave problema nos centros urbanos, expondo parcela considerável da população ao risco de efeitos adversos à saúde. Estudos epidemiológicos e toxicológicos têm encontrado evidências que associam a exposição aos poluentes do tráfego veicular e a incidência de câncer. Objetivo: Realizar uma análise espacial dos casos de cânceres do trato respiratório e hematológico e de sua relação com a densidade de tráfego veicular no município de São Paulo. Métodos: Foram utilizados os dados de três bases distintas: dados de incidência de câncer do Registro de Câncer de Base Populacional do Município de São Paulo (RCBP) de 2002 a 2011; dados de internações hospitalares por câncer do sistema público e particular de 2004 a 2006; dados de mortalidade por neoplasias do Sistema de Informação de Mortalidade de 2002 a 2013, da Secretaria Municipal de Saúde. Para a avaliação da exposição foi utilizada a densidade de tráfego veicular e, como indicador de status socioeconômico, o Índice de Desenvolvimento Humano Municipal (IDHM). Foram utilizadas como unidade espacial as áreas de ponderação do Censo 2010 e uma grade de 500m x 500m. Mediante um modelo ecológico de Besag-York-Mollié foi avaliada a variabilidade espacial do risco de incidência, internação hospitalar e mortalidade por câncer do aparelho respiratório e hematológico, sendo os resultados expressos em termos de risco relativo (RR). Utilizou-se também um modelo de regressão Binomial Negativo e Poisson para quantificar a associação do desfecho estudado às categorias crescentes de exposição à densidade de tráfego obtendo-se estimativas da razão da taxa de incidência (IRR). Resultados: A variabilidade espacial do risco foi influenciada pelas covariáveis padronizadas: densidade de tráfego veicular e IDHM. Para cada aumento de um desvio padrão da densidade de tráfego obteve-se um RR= 1,07 (IC 95%: 1,02-1,13), RR= 1,09 (CI 95%: 1,02-1,15) e RR= 1,04 (CI 95%: 0,99-1,09), para incidência, internação hospitalar e mortalidade por câncer do aparelho respiratório para indivíduos > 20 anos de idade, respectivamente. Para a incidência de câncer hematológico em jovens obteve-se um RR= 1,09 (IC 95%: 1,00-1,18) para este mesmo aumento da densidade de tráfego. A avaliação da exposição por categorias crescentes de densidade de tráfego evidenciou um claro e significante gradiente de exposição-resposta para incidência e mortalidade por câncer respiratório em regiões com baixo IDHM, independente do sexo analisado. Na categoria mais alta de densidade de tráfego, homens de regiões com baixo IDHM apresentaram IRR= 3,29 (IC 95%: 2.34-4,64) comparado a IRR= 1,18 (IC 95%: 1,03-1,36) referente aos homens de regiões com alto IDHM. Conclusões: Os resultados mostraram uma associação positiva significante entre residir em áreas com alta densidade de tráfego e incidência, internação hospitalar e mortalidade por câncer respiratório em > 20 anos e incidência de câncer hematológico em indivíduos jovens. As pessoas de baixo status socioeconômico, embora não residam em áreas de maior exposição aos poluentes do tráfego, sofreram mais os efeitos da poluição do ar, provavelmente devido a fatores de vulnerabilidade

Introduction: Traffic-related air pollution is a serious problem in urban centers, exposing a considerable part of the population to the risk of adverse health effects. Epidemiological and toxicological studies have found evidence associating exposure to traffic pollutants and the incidence of cancer. Objective: To perform a spatial analysis of cases of respiratory and hematological cancers and its relation with traffic density in the city of São Paulo. Methods: Data from three different databases were used: cancer incidence data from the Population- Based Cancer Registry of the Municipality of São Paulo (RCBP) from 2002 to 2011; data from hospital admissions for cancer of the public and private system from 2004 to 2006; mortality data from the Mortality Information System (SIM) from 2002 to 2013, from the Municipal Health Department. The traffic density was used for exposure assessment, and the Municipal Human Development Index (MHDI) as an indicator of socioeconomic status. As a spatial unit, the weighting areas of the 2010 Census and a grid of 500 m x 500 m were used. The spatial variability of risk for incidence, hospital admission and mortality from respiratory and hematological cancers was assessed using an ecological model from Besag-York-Mollie. The results were expressed in terms of relative risk (RR). A Negative Binomial and Poisson regression model was used to quantify the association of the endpoint studied with the increasing categories of exposure to traffic density, obtaining estimates of the incidence rate ratio (IRR). Results: The spatial variability of the risk was influenced by the standardized covariates: traffic density and MHDI. For each increase of a standard deviation of the traffic density was obtained an RR = 1.07 (95% CI: 1.02-1.13), RR = 1.09 (95% CI: 1.02-1, 15) and RR = 1.04 (CI 95%: 0.99-1.09), for incidence, hospital admission and mortality from respiratory cancer, respectively, among individuals over 20 years of age. The RR = 1.09 (95% CI: 1.00-1.18) for this same increase in traffic density was obtained for the incidence of hematological cancer in youngsters. The exposure assessment by increasing categories of traffic density evidenced a clear and significant exposure-response gradient for incidence and mortality from respiratory cancer in regions with low MHDI, regardless of the sex analyzed. In the highest category of traffic density, men from regions with low MHDI regions presented IRR = 3.29 (95% CI: 2.34-4.64) compared to IRR = 1.18 (95% CI: 1.03-1, 36) for men from regions with high MHDI. Conclusions: The results showed a significant positive association between residing in areas with high traffic density and incidence, hospital admission and mortality from respiratory cancers in individuals over 20 years, and the incidence of hematological cancer in young individuals. People with low socioeconomic status, although not residing in areas of greater exposure to traffic pollutants, have been more affected by air pollution, probably due to vulnerability factors

Hémopathies malignes à Brazzaville (Congo) : analyse de situation

L'épidémiologie des hémopathies malignes au Congo n'est pas connue. L'objectif de cette étude était de rapporter la distribution des hémopathies malignes à Brazzaville.Patients et méthodes : Il s'agissait d'une étude transversale descriptive réalisée dans le Service d'Hématologie Clinique du CHU de Brazzaville au Congo. La période étudiée est de 10 ans (du 1er janvier 2006 au 31 décembre 2015). Ont été inclus dans l'étude tous les dossiers de consultation et d'hospitalisation portant le diagnostic d'hémopathie maligne.Résultats : Deux cent-soixante-deux cas d'hémopathies malignes ont été diagnostiquées durant la période d'étude.Les hémopathies malignes ont été de typelymphoprolifératif chronique dans 57,3% (n = 150), leucémie aiguë dans 24, 4% (n = 64) et myéloprolifératif dans 18,3% (n = 48) des cas. Le myélome multiple et la leucémie aigüe lymphoblastique représentaient respectivement 29,8% (n = 70) et 19,1% (n = 50) des groupes nosologiques lymphoprolifératifs chroniques et leucémies aiguës. La leucémie myéloïde chronique représentait 100% du groupe myéloprolifératif. Une prédominance féminine a été observée (sex-ratio = 0,65). Les pathologies lymphoprolifératives chroniques intéressaient la tranche d'âge de 45 à 59 ans (66,7%), a leucémie myéloïde chronique celle de 15-29 ans (45,8%) et la leucémie aiguë lymphoblastique avait une distribution pédiatrique : 0-14 ans (68%).Conclusion : Les hémopathies malignes constituent par leur fréquence un problème sanitaire. Elles plaident pour des études épidémiologiques analytiques afin de mettre en place une politique préventive de celles-ci

Epidemiology and subtype distribution of lymphoid neoplasms from a single institution in Lebanon between 2010 and 2014

The 2008 WHO classification is the gold standard for classifying hematopoietic neoplasms. Our study reviewed 1256 cases between the years 2010 and 2014. It aimed to establish a descriptive status of lymphoma cases in Lebanon. Hodgkin lymphomas [HL] accounted for 21% of all cases whereas non-Hodgkin lymphomas [NHL] accounted for 79%. In NHL, mature B-cell neoplasms accounted for 85% and mature T-cell neoplasms accounted for 9%. For mature B-cell neoplasms, the majority of cases [48%] were diffuse large B-cell lymphomas [DLBCL]. Within T-cell lymphomas, anaplastic lymphoma [ALCL 40%] was the most prevalent. The distribution within subtypes confirmed the findings of two previous Lebanese studies. Our figures of HL are higher than in Eastern and Western countries. This could probably be related to EBV infection among other etiologies. Our NHL figures are close to the Western world. Westernization of the way of life of the Lebanese society could explain this result

Aspectos clínicos y epidemiológicos de las leucemias / Clinical and epidemiological aspects of leukemias

Leukemia is a group of clonal diseases derived from a single cell with a genetic alteration in bone marrow or peripheral lymphoid tissue, and each type is determined by the specificity of the source cell. The objective of this research was to synthesize studies that characterize the clinical and epidemiological profile of patients with leukemia, the types of treatments used, duration and outcomes for the cases. This study is an integrative review of literature through databases Medical Literature Analysis and Retrieval System Online (MEDLINE), SCOPUS, Cumulative Index to Nursing & Allied Health Literature (CINAHL) and Science Direct. There were 4,274 articles rescued in the initial search, 188 were selected to compose the review sample after applying all the criteria for inclusion and exclusion adopted. Full articles were grouped into four categories, according to the variables of research: (a) more frequent subtypes of leukemia; (b) most widely used treatment; (c) duration of treatment; and (d) endpoint of the cases. It is concluded a prevalence of leukemia in pediatric patients, with a predominance of the subtype Acute Lymphoblastic Leukemia (ALL). In general, the male population is more affected by hematological malignancies. As the therapy is used, each leukemia subtype had its peculiarities regarding the treatment, especially the introduction of imatinib for chronic myeloid leukemia (CML) and prophylactic cranial irradiation for cases of ALL. Chronic leukemia showed higher treatment duration. There was a significant improvement in survival of Acute Myeloid Leukemia, Chronic Lymphoid leukemia, CML and ALL, the latter approximately with 90% cure rate in children.

La leucemia es un grupo de enfermedades clonales derivadas de una única célula con una alteración genética en la médula ósea o tejido linfoide periférico, y cada tipo se determina por la especificidad de la célula de origen. El objetivo de esta investigación fue sintetizar los estudios que caracterizan el perfil clínico y epidemiológico de los pacientes con leucemia, los tipos de tratamientos usados, la duración y los resultados para los casos. Este estudio es una revisión integradora de la literatura a través de bases de datos de análisis médicos, literatura y recuperación de sistema en línea (MEDLINE), SCOPUS, Cumulative Index de Enfermería y Salud Aliada Literatura (CINAHL) y Science Direct. Había 4 274 artículos rescatados en la búsqueda inicial, se seleccionaron 188 para componer la muestra de revisión después de aplicar todos los criterios de inclusión y exclusión adoptada. Los artículos completos se agruparon en cuatro categorías, según las variables de investigación: (a) los subtipos más frecuentes de leucemia; (b) el tratamiento más utilizado; (c) la duración del tratamiento; y (d) el punto final de los casos. Se concluye una prevalencia de leucemia en pacientes pediátricos, con predominio del subtipo de leucemia linfoblástica aguda (LLA). En general, la población masculina se ve más afectada por neoplasias hematológicas. Como se utiliza la terapia, cada subtipo de leucemia tenía sus peculiaridades con respecto al tratamiento, especialmente la introducción de imatinib para la leucemia mieloide crónica (CML) y la irradiación craneal profiláctica para los casos de ALL. La leucemia crónica mostró una mayor duración del tratamiento. Hubo una mejora significativa en la supervivencia de la leucemia mieloide aguda, leucemia linfoide crónica, LMC y LLA, aproximadamente, este último con la tasa de curación del 90% en los niños.

Prevalence of occult hepatitis b infection in iranian cancer patients before chemotherapy treatment / Prevalência de infecção oculta da hepatite B em pacientes iranianos com câncer antes do tratamento de quimioterapia

ABSTRACT Background Occult hepatitis B infection is characterized by negative hepatitis B surface antigen (HBsAg) and also detectable hepatitis B virus (HBV) -DNA, with or without hepatitis B core antibody (anti-HBc). HBV reactivation in individuals under immunosuppressive therapy is critical, occurring in occult HBV. Objective In this study, we aimed to determine the prevalence of occult HBV infection among hepatitis B surface antigen negative in cancer patients before receiving chemotherapy. Methods Sera from 204 cancer patients who were negative for HBsAg, were tested for anti-HBc antibodies. The samples that were negative for HBsAg but positive for anti-HBc also examined for HBV-DNA by polymerase chain reaction (PCR). Results Of the 204 HBsAg negative blood samples, 11 (5.4%) samples were positive for anti-HBc antibodies. HBV-DNA was detected in 9/11 (81%) of anti-HBc positive samples. Occult HBV infection in hematological cancers was more than solid cancers, 4.8% and 4.3% respectively. There was no significant difference in HBc antibody positivity based on vaccination, previous blood transfusions, history of familial hepatitis or biochemical parameters (ALT, AST, total and direct bilirubin levels) (P>0.05). Conclusion Screening of occult HBV infection by HBsAg, HBV DNA and anti HB core antibody should be suggested as a routine investigation in cancer patients before receiving chemotherapy.

RESUMO Contexto A infecção oculta da hepatite B caracteriza-se por antígeno de superfície da hepatite B (AgHBs) negativo com vírus detectável da hepatite B (HBV) -DNA, com ou sem anticorpo de núcleo da hepatite B (anti-HBc). A reativação do HBV em indivíduos sob terapia imunossupressora é crítica, originando a infecção oculta pelo VHB. Objetivo Este estudo teve como objetivo determinar a prevalência de infecção oculta pelo VHB entre em pacientes com câncer e com antígeno de superfície da hepatite B negativo antes de receber quimioterapia. Métodos Soro de 204 pacientes com câncer que foram negativos para AgHBs, foram testados para anticorpos anti-HBc. As amostras que foram negativos para AgHBs, mas positivo para anti-HBc foram também examinadas para HBV-DNA, por reação em cadeia da polimerase. Resultados Entre 204 amostras de sangue AgHBs negativas, 11 (5,4%) foram positivos para anticorpos anti-HBc. HBV-DNA foi detectado em 9/11 (81%) das amostras positivas de anti-HBc. Infecção oculta de VHB em câncer hematológico foi maior que em cânceres sólidos, 4,8% e 4,3% respectivamente. Não houve diferença significativa na positividade anti-HBc, com base na vacinação, transfusões de sangue anteriores, história de hepatite familiar ou parâmetros bioquímicos (ALT, AST, total e níveis de bilirrubina total) (P & gt; 0,05). Conclusão A triagem de infecção oculta por AgHBs, HBV-DNA e anti-anticorpo de núcleo HB deve ser sugerida como uma investigação de rotina em pacientes com câncer antes de receber a quimioterapia.

Oncohematological diseases in the Vale do Paraíba, State of São Paulo: demographic aspects, prevalences and incidences

BACKGROUND: Based on the necessity of detailed information that supports effective strategies to improve cancer outcomes in the different regions of Brazil, the aims of this study were to report demographic aspects and to calculate the prevalence and incidence rates of oncohematological diseases in the region of Vale do Paraíba. METHODS: This is a multicentric prospective study carried out from October 2009 to March 2010. A total of 500 over 19-year-old patients were enrolled. Data such as type of healthcare insurance, gender, age, ethnic classification, place of residence, schooling, income, body mass index, new cases and the period between the first symptoms and a definite diagnosis were collected. The prevalence and incidence rates were calculated according to an estimated number of 1,319,800 inhabitants. RESULTS: The prevalence and incidence rates per 100,000 inhabitants in the period of six months were, respectively: acute myeloid leukemia 1.5 and 0.7; acute lymphoblastic leukemia 0.5 and 0.1; chronic lymphocytic leukemia 2.4 and 0.4; chronic myeloid leukemia 6.2 and 0.8; Hodgkin's lymphoma 2.9 and 0.9; non-Hodgkin lymphoma 9.8 and 4.3; multiple myeloma 5.7 and 0.7; myelodysplastic syndromes 2.1 and 0.2 and myeloproliferative syndromes 5.1 and 0.3. CONCLUSION: Giving the paucity of data in this field of investigation, our data may be useful for comparisons with those of other regions of Brazil and will assist in the implementation of treatment programs of oncohematological diseases in this region.

Infección por el HTLV-I en pacientes con síndromes linfoproliferativos en dos sitios centinela de Cuba / Human T-cell lymphotropic virus type I infection in patients with lymphoproliferative disorders at two sentinel sites in Cuba

OBJETIVO: Determinar la frecuencia de la infección por el HTLV-I en pacientes con síndromes linfoproliferativos, así como en sus familiares y contactos sexuales, en dos sitios de vigilancia centinela en Cuba. MÉTODOS: Se analizaron todos los pacientes que tenían un diagnóstico presuntivo de neoplasias hematológicas entre enero de 1996 y enero de 2007 atendidos en los servicios de hematología del Hospital Hermanos Ameijeiras (HHA), de Ciudad de La Habana, y el Hospital Provincial Comandante Faustino Pérez (HPCFP), de Matanzas, Cuba. Se determinó la seropositividad al HTLV-I por ELISA y western blot y se confirmó la infección mediante la reacción en cadena de la polimerasa. Se estudiaron también los familiares y los contactos sexuales de los pacientes positivos. Se utilizó la prueba de la Z para la comparación de proporciones. RESULTADOS: La seroprevalencia de la infección por el HTLV-I en pacientes con síndromes linfoproliferativos fue de 0,4 por ciento, mayor en el HPCFP que en el HHA (6,1 por ciento frente a 0,2 por ciento; P < 0,001). No se encontraron diferencias significativas en la frecuencia de la infección según la edad, el sexo y el color de la piel. De los 53 familiares y contactos sexuales estudiados, 8 (15,1 por ciento) tuvieron diagnóstico positivo de infección por el HTLV-I. CONCLUSIÓN: La frecuencia de la infección por el HTLV-I en el grupo estudiado fue superior a la encontrada con anterioridad en Cuba. Se confirmó la utilidad de la vigilancia seroepidemiológica mediante centros centinela.

OBJECTIVE: To determine the prevalence of human T-cell lymphotropic virus type I (HTLV-I) infection among patients with lymphoproliferative disorders, as well as among their family members and sexual contacts, at two sentinel sites in Cuba. METHODS: An analysis was conducted of all the patients with a presumptive diagnosis of hematological malignancies seen by the hematology departments of the Hospital Hermanos Ameijeiras (HHA), City of Havana, and the Hospital Provincial Comandante Faustino Pérez (HPCFP), Matanza, Cuba, in January 1996-January 1997. HTLV-I seropositivity was determined by ELISA and Western Blot, and infection was confirmed by polymerase chain reaction. The positive patients' family members and sexual contacts were also assessed. The Z-test was used to compare proportions. RESULTS: Seroprevalence of HTLV-I infection in patients with lymphoproliferative disorders was 0.4 percent higher at the HPCFP than at the HHA (6.1 percent versus 0.2 percent, P < 0.001). There were no significant differences in prevalence by age, sex, or skin color. Of the 53 family members and sexual contacts studied, 8 (15.1 percent) were positive for HTLV-I infection. CONCLUSION: The prevalence of HTLV-I in the study group was higher than previously found in Cuba. The value of seroepidemiological surveillance through sentinel sites was confirmed.

Nosocomial infections and fever of unknown origin in pediatric hematology/oncology unit: a retrospective annual study

Pediatric hematology / oncology patients are faced with an increased risk of nosocomial infections [NIs] that vary in different populations and different institutes with considerable morbidity and mortality. Our aims were to assess the frequency and patterns of NIs in this group of patients relation to the risk of neutropenia and to determine the prevalence of causative organisms and their antimicrobial sensitivities. A retrospective analysis of the data for all children admitted to pediatric hematoloy/oncology unit of Mansoura University, Egypt, was done over one year from January, 2007 to January, 2008. A total of 1564 patients were included [173 children with leukemia, 39 with lymphoma, 49 with other solid tumors, 1293 with thalassemia and 10 withaplastic anemia] corresponding to 2084 admissions and 27092 inpatient days. The Centers for Disease Control and Prevention criteria were used as standard definition for NI. The overall incidence density rates of NIs in all patients and neutropenic patients were 8.6 and 25.3 per 1000 patient-days respectively. The most frequent sites of microbiologically and or clinically documented NIs were blood stream [42.7%], respiratory [25.3%], Urinary [22.2%] and CNS infections [9.8%] whereas nosocomial fever of unknown origin [nFUO] constituted 52.9% of defined cases with incidence density rates of 9.7 and 15.4 per 1000 patient-days in, all patients and neutropenic patients respectively. The frequency of NIs and nFUO were significantly higher during neutropenic days [p<0.001]. Gram-positive organisms represented 64.5% of isolated pathogens [Staphylococci 71.5%, Streptococci 16%, Pneamococci 7% and Enterococci 5.5%], gram-negative organisms represented 30% [E coli 48.6%, Klebsiella 15.7%, and Pseudomonas 35.7%], and Candida 5.5%. Positive cultures were more frequent in summer months [July to September]. The antimicrobial susceptibilities of the isolated organisms were relatively low [cefoperazone/sulbactam 49.9%, amikacin 35.9%, imipenem/cilastatin 34.4%, cefoperazone 33.6% and vancomycin 36.5%]. Blood stream infection and fever of unknown origin are the most common nosocomial infections in pediatric hematology / oncology patients with a higher risk during neutropenic days. Isolated organisms are multi-drug resistant, predominantly gram-positive pathogens

Audit of pediatric hematology-oncology outpatients in Kuala Lumpur.

The aims of this study were to determine the types of cancers and hematological disorders in patients attending a pediatric hematology-oncology clinic. This was a prospective study at the Pediatric Institute, General Hospital Kuala Lumpur, Malaysia from June 2005-November 2006. During the 18-month study, 803 patients attended the clinic, 730 had oncological problems and 73 had hematological problems. The age range was from 2 months to 28 years (median 6 years). The patients were Malay (66%), Chinese (23%), Indian (10%) and other races (1%). Of the oncological patients, 51% had either leukemia (n=293) or lymphoma (n=77). The other most common diagnoses were retinoblastoma, followed by Wilm's tumor and germ cell tumors. Six patients (0.8%) developed a second malignant neoplasm. Of the hematological patients, 60% had platelet disorders, most commonly chronic immune thrombocytopenic purpura. Twenty-four per cent had bone marrow failure and 16% had red cell disorders.

Esplenectomía laparoscópica: experiencia de 12 años en dos instituciones privadas / Laparoscopic splenectomy: twelve-year experience in two private institutions

Introducción: en 1991, Delaitre y colaboradores reportaron la primera esplenectomía laparoscópica exitosa. Ésta se ha convertido en el procedimiento de elección en pacientes con enfermedades hematológicas que requieren tratamiento quirúrgico. Las ventajas potenciales del abordaje laparoscópico sobre el convencional son menor estancia intrahospitalaria, retorno más rápido a la vía oral y disminución en las tasas de morbilidad y mortalidad. Material y métodos: de junio de 1993 a diciembre de 2004, 42 pacientes fueron sometidos a esplenectomía laparoscópica tanto en el Texas Endosurgery Institute como en el Hospital “San José” del Tecnológico de Monterrey. Las variables utilizadas para valorar eficacia y seguridad fueron tiempo quirúrgico, estancia intrahospitalaria, inicio de la vía oral, conversión a procedimiento abierto, morbilidad y mortalidad. Resultados: las enfermedades hematológicas representaron el diagnóstico más común. El procedimiento fue técnicamente exitoso en 95 % de los casos. Solamente hubo dos conversiones a cirugía convencional. El tiempo quirúrgico promedio fue de 120 minutos. La tasa de mortalidad fue de 2.3 % y la estancia intrahospitalaria y el inicio de la vía oral promedios, de cuatro y dos días, respectivamente. Conclusiones: nuestra serie contribuye a reafirmar que actualmente la esplenectomía laparoscópica representa un método seguro y efectivo, conservando además algunas de las ventajas de los procedimientos mínimamente invasivos.

BACKGROUND: In 1991, Delaitre et al. reported the first successful laparoscopic splenectomy. This procedure has become the best option in patients with hematological diseases and who require surgical treatment. The potential advantages of the laparoscopic approach over the conventional surgery are shorter length of hospital stay, shorter time to resume normal diet and decreased rates of morbidity and mortality. METHODS: From June 1993 to December 2004, 42 patients underwent laparoscopic splenectomy in our two surgical care centers: Texas Endosurgery Institute and Hospital San José-TEC de Monterrey. The measured variables to evaluate efficacy and safety were operating time, length of hospital stay, time to resume normal diet, conversion to open procedure, morbidity and mortality. RESULTS: Hematological diseases were the most common diagnosis. The procedure was technically successful in 95% of the patients. There were two conversions to open surgery. The mean operating time was 120 min. Mortality rate was 2.3%. The mean length of hospital stay and time to resume normal diet were 4 and 2 days, respectively. CONCLUSIONS: We regard that our series contributes to supporting laparoscopic splenectomy as a safe and effective method, retaining some advantages of minimally invasive techniques.

Breast feeding and childhood hematological malignancy.

Breast milk is known to have anti-infective and immunomodulating effects on infants, but its association with childhood cancer has not been well studied. Artificial feeding may affect the immune response in carcinogenesis. In this communication the authors have reviewed different articles describing the association between breast feeding (BF) and subsequent development of childhood hematological malignancy. It appears that BF may have a protective effect on childhood cancer, both the duration of BF as well as the quantity of milk ingested is probably critical to the beneficial immunological effects of BF against childhood cancer if any.

Medical admissions of oncology patients to the University Hospital of the West Indies

A prospective study of 80 oncology patients (42 men, 38 women; mean age 50.3 years) admitted to the University Hospital of the West Indies, Jamaica, was conducted over a six month period (August 1, 1995 to January 31, 1996). There were 103 admissions representing 8.7of total admissions to the medical wards. Solid tumours and haematological malignancies accounted for equal proportions of admissions. 62were emergency admissions. Investigation of constitutional symptoms, abnormal physical findings, infection and chemotherapy were the commonest reasons for admission. Complications developed in 42.7of admissions, the commonest being renal and/or hepatic impairment; anaemia, leukopaenia and thrombocytopenia; and nosocomial infections. 35of the patients died during the study period. The mean length of stay was 12.9 days (SD 12.8). Mean hospital stay was significantly longer in admissions involving an initial diagnosis of cancer and in those resulting in complications (p < 0.001).

Epidemiología de las leucemias en la infancia y la adolecencia

Objetivos: Establecer la frecuencia de presentación de las leucemias en niños y adolecentes según tipos nosológicos y morfológicos, y postular hipótesis sobre el predominio de ciertas subclases de leucemias en diferentes edades. Adicionalmente, discutir las diferentes consideraciones que pueden llevar a interpretaciones erróneas de los hallazgos citomorfológicos en leucemias. Tipo de Estudio: poblacional, descriptivo de variables y de patrones de distribución. Lugar y tiempo de estudio: Unidad de Hematología del hospital Lorencita Villegas de Santos de Santafé de Bogotá, durante el período comprendido entre enero de 1984 y diciembre de 1997. Pacientes y métodos: pacientes con edad igual o inferior a 18 años, con diagnóstico de leucemia, establecido según criterios del grupo Cooperativo Francés-Americano-Británico (FAB) para la clasificación de las leucemias linfoblástica y mielocítica agudas los síndromes mielodisplásicos (SMD). Se definió leucemia congénita como aquélla diagnosticada en las cuatro primeras semanas de vida. Los datos corresponden a una población perfectamente definidad de pacientes leucémicos y por tanto los resultados obtenidos son evidencia de parámetros de dicha población; por ende, la estadística empleada es solamente descriptiva. Resultados: se diagnosticaron 522 casos de leucemias, de los cuales 511 (97.9 por ciento) correspondieron a leucemias agudas, 10 (1.9 por ciento) a leucemia mieloide crónica y 10 (0.2 por ciento) a SMD> De las leucemias agudas, 85.1 por ciento (435/511) correspondió a LLa y 14.9 por ciento (76/511 a LMA, con una relación LLA: LMA de 57.7:1. La distribución total de casos de leucemias por sexos fue equiparable, con 242 (46.4 por ciento) en mujeres y 280 (53.6 por ciento) en hombres. Igualmente equiparable fue la distribución de las subclases de leucemia por sexos. La edad promedio de la población con leucemia fue 6.4 años (DE 4.2 años). La mayor frecuencia de LLA correspondió a la subclase L1 con 239 Pacientes (54.9 por ciento), seguida por la subclase L2 con 176 pacientes (40.4 por ciento) y 20 pacientes con la subclase L3 (4.6 por ciento). La distribución de LLa por subclase mostró el predominio de L1 en el intervalo de uno a nueve años de edad. El 40 por ciento de los casos de LMA correspondió a la suma de frecuencias de las subclases con componente monocítico, M4 y M5. El intervalo de edad de mayor presentación de casos de LMA fue el comprendico entre cinco y 14 años. TRUNCADO A 2.500 CARACTERES

Malignancies in Down syndrome.

Down Syndrome (DS) is associated with an increased incidence of malignancies, especially leukaemias. We came across 8 DS children presenting with malignancies and having trisomy 21 as the sole cytogenetic abnormality. Of these 8 DS cases, 4 presented with acute lymphocytic leukaemia, 2 with acute myeloid leukaemia and one case each with Hodgkin's disease and Wilms' tumour. There are contradictory reports regarding the distribution of myeloid versus lymphoid malignancies in DS children and their response to therapy. The exact mechanism by which patients with DS are predisposed to develop malignancies is unclear. However, presence of the extra chromosome no. 21 is presumed to disrupt the genetic balance which increases generalized susceptibility to genetic and environmental trauma. Furthermore, an increased methotrexate toxicity observed in these patients should also be taken into consideration in designing treatment for DS children with malignancies.