[Incidence of bacteremia among histologic groups of hematologic malignancies]. / Incidencia de bacteriemia en grupos histológicos de neoplasias hematológicas.

INTRODUCTION: Subgroups having dissimilar prognoses are being identified among cancer patients with infection. Previous studies have suggested that these differences may be related to the histologic diagnosis, but this issue has not as yet been demonstrated. METHODS: We reviewed the medical records of all patients admitted with acute leukemia (AL) or lymphoma (ML) from 1988 to 1998. Incidence of bacteremia was calculated for the following subgroups: acute lymphocytic leukemia (ALL), acute myelocytic leukemia (AML), AML following refractory anaemia with excess blasts (AML-RAEB), high-grade ML (HGML), intermediate-grade ML (IGML), low-grade ML (LGML) and indeterminate ML (IML). Kaplan-Meier curves of time to the first positive blood culture were constructed and compared by means of log-rank test. RESULTS: In the period covered there were 244 new diagnoses of AL or ML: 62 AML, 32 ALL, 20 AML-RAEB, 78 HGML, 7 IGML, 37 LGML and 6 IML. At the end of the study period, 44 patients were alive, 147 were known to have died at a certain date and 53 had been formally lost to follow-up (most of them, transferred for hospice care). Among 684 blood cultures, there were 51 contaminations and 155 significant isolates. Among the latter, gram-positive bacteria were isolated in 74 and gram-negative bacteria in 47; in 27 cases more than 1 bacterial species were recovered. Fungi were isolated in 7 cases. The incidence of bacteremia expressed as cases per 1000 patient-days was 5.80 for AML, 5.03 for AML-RAEB, 1.56 for ALL, 0.21 for HGML and 0.40 for the remaining ML. Time to the first positive blood culture was significantly shorter for AML than for any other group, and was shorted for ALL and AML-RAEB than for ML. CONCLUSION: Differences in the incidence of bacteremia were observed among histologically-defined groups of unselected patients with hematologic malignancies.

Incidencia de bacteriemia en grupos histológicos de neoplasias hematológicas / Incidence of bacteremia among histologic groups of hematologic malignancies

INTRODUCCIÓN. Se están identificando subgrupos con pronóstico diferente entre los pacientes con cáncer e infecciones. Estudios previos han sugerido diferencias relacionadas con el diagnóstico histológico que no han sido demostradas definitivamente. MÉTODOS. Se revisaron las historias clínicas de los pacientes ingresados con diagnóstico de leucemia aguda o linfoma maligno entre 1988 y 1998. Se calculó la incidencia de bacteriemia para los siguientes subgrupos; leucemia linfoblástica aguda (LLA); leucemia mieloblástica aguda (LMA); LMA con antecedente de anemia refractaria con exceso de blastos (AREB); linfoma maligno de alto grado (LMAG); linfoma maligno de grado intermedio (LMGI); linfoma maligno de bajo grado (LMBG); y linfoma maligno indeterminado (LMI). Se construyeron las curvas de Kaplan-Meier de tiempo hasta el primer hemocultivo positivo y se compararon por el test del rango logarítmico. RESULTADOS. Se diagnosticaron 244 nuevas leucemias agudas o linfomas en el período estudiado: 62 LMA, 34 LLA, 20 LMA-AREB, 78 LMAG, 7 LMGI, 37 LMBG y 6 LMI.En el momento del cierre del estudio, 44 pacientes estaban vivos, 147 tenían una fecha de fallecimiento conocida y 53 habían sido formalmente perdidos del seguimiento (la mayoría, trasladados para tratamiento paliativo). En 684 hemocultivos se detectaron 51 contaminaciones y 155 aislamientos significativos. De ellos, 74 fueron bacterias grampositivas; 47, gramnegativas; 27, polimicrobianas, y 7, hongos. La incidencia de bacteriemia en casos por 1.000 paciente-días fue 5,80 para la LMA, 5,03 para la LMA-AREB, 1,56 para la LLA, 0,21 para los LMAG y 0,40 para los restantes linfomas. El tiempo hasta el primer hemocultivo positivo fue significativamente menor para la LMA que para cualquier otro grupo; y para la LLA y LMA-AREB que para los linfomas. CONCLUSIÓN. Se observó una diferencia en la incidencia de bacteriemia entre grupos definidos histológicamente de pacientes no seleccionados con neoplasias hematológicas (AU)

[A cross-sectional study on the epidemiological and clinical characteristics of HIV-1 infection in gypsies and in other minorities in Bilbao, Northern Spain]. / Estudio transversal sobre las características clínicas y epidemiológicas de la infección por el virus de la inmunodeficiencia humana en gitanos y otras minorías en Bilbao.

BACKGROUND: The health status and needs of gypsies have been insufficiently studied. PATIENTS AND METHOD: We studied the clinicoepidemiological characteristics of all HIV-1 infected patients attending in our outpatients clinic and hospitalized who were classified according to their ethnic origin as <>, <> (Caucasian non-gypsy Spanish natives) or <>. RESULTS: Overall, there were 563 patients out of 674 previously appointed (83%). Intravenous drug use (IVDU) was the HIV acquisition mechanism in 70%, 95% and 25% (p < 0.000) and attendance was considered regular in 89%, 48% and 89% payos, gypsies and immigrants (p < 0.01), respectively. CONCLUSIONS: IVDU as the HIV transmission mechanism and lower clinic attendance rates were the most relevant differences observed between gypsy and payo subjects.