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Background and Objective: The Haematology Service has undergone significant advances in recent years. Given the vital part played by the nurse in the care of the haematology patient, ensuring optimal management by adapting their role to meet the current healthcare needs is a priority. The aim of this study was to evaluate the level of agreement among professionals of the Haematology Service regarding the role of the nursing professional and their importance in the comprehensive management of these patients in a multidisciplinary work setting., Patients and Method: A national multicentre Delphi study with haematology specialists and nursing professionals. A two-round questionnaire was used, and consensus was reached when > 75% of the panellists scored on the same tertile (1-3: disagreement, 7-9: agreement), and the interquartile range of the median of the responses was ≤4., Results: A total of 33 professionals from the Haematology Department were invited to participate, of whom 19 were haematology specialists and 14 were nursing professionals. In the first round, 25 panellists responded (14 haematology specialists and 11 nursing professionals), and in the second round, 22 panellists responded (12 haematology specialists and 10 nursing professionals). The panel of experts agreed that haematology nurses should have specific training in haematology (96%) and on the definition of the role of nursing in the care process of the haematology patient, except in the possible participation in decision-making with regard to the most appropriate oncological treatment for a patient (58%). The role of the nursing professional as a reference for the patient throughout the healthcare process and their involvement in the process at the time of diagnosis were agreed upon in the second round (72.7% and 68.2%). Their role in the control of nutritional status (100%), visit compliance (96%), and health education for the patient and the family (96%) were included in the highly agreed upon aspects. The panel considered the improvement of adherence to treatment (96%), and the role as consultant for specific care of the haematology patient within the hospital (96%) as important aspects. Together with health education and patient follow-up, a total of 88% of the panellists considered that the haematology nurse reduces patient visits to the emergency department as well as physical visits to the outpatient clinics of the health centre., Conclusions: The current profile of the haematology nursing professional implies a high level of specialisation. The competencies of the haematology nursing professional are aimed at guaranteeing an integral management of these patients; with important healthcare functions, as well as a key element in the flow of information, and are framed within a multidisciplinary work setting., (Copyright © 2018 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: To analyse the incidence of Pneumocystis carinii pneumonia after the withdrawal of prophylaxis, in patients with AIDS who were receiving HAART (highly active antiretroviral treatment)., Patients and Methods: Prospective opened study of 85 patients with AIDS (CD4 lymphocytes < 200 x 10(6)/l) and whose CD4 counts had increased over 200 x 10(6)/l after HAART, 79 were under primary prophylaxis and six secondary., Results: Mean CD4 lymphocytes count at the time of withdrawal was 343 x 10(6)/l. Mean time of follow-up after withdrawal was 358 days (range: 93-1,487; median: 302). None of the patients have had Pneumocystis carinii or toxoplasmosis after withdrawal of prophylaxis., Conclusions: Pneumocystis carinii prophylaxis in AIDS patients might be safety withdrawn after effective HAART.

A study was conducted to investigate the relationships between the characteristics of IgA paraprotein and the clinical findings in a group of 196 patients. In 19 cases IgA paraprotein was associated with another monoclonal immunoglobulin (IgG or IgM); the other 177 patients had a single IgA paraprotein; 145 of them corresponded to multiple myeloma (MM) and the other 32 to other diagnostics. Class and type of paraproteins were identified by immunoelectrophoresis and subclass by an enzyme-immunoassay specifically developed for this study. The degree of polymerization of the protein was determined by gel filtration; quantitation of monoclonal IgA and polyclonal IgG and IgM was obtained by kinetic nephelometry. Out of 196 paraproteins, 96.4% were classified in IgA1 subclass and only 3.6% in IgG2. In 14 cases, all of them diagnosed with MM, monoclonal IgA in serum was associated with Bence-Jones protein; in more than 78% of them light chains corresponded to type lambda, whereas type kappa predominated (over 60%) in cases without Bence-Jones protein in serum. Significantly higher serum levels of monoclonal IgA were associated with the diagnosis of myeloma, with type kappa paraproteins, and with the presence of Bence-Jones protein in serum. The cases with two paraproteins (IgA and IgG or IgM) had significantly lower serum levels of IgA, with comparable levels of total paraprotein (the addition of both monoclonal immunoglobulins). Serum levels of polyclonal IgG and IgM, which appeared decreased in cases of MM, were normal in cases with other conditions. In all these cases, monoclonal IgA showed a monomeric character, whereas relevant amounts of polymerized IgA paraprotein was found in almost a third part of myeloma cases, particularly in those with higher serum levels of paraprotein, or when paraprotein belonged to type kappa. The 5 IgA2 paraproteins analyzed had a polymeric character. In conclusion, a detailed, both qualitative and quantitative, analysis of IgA paraproteins can lead to a better knowledge of conditions associated with their presence and at the same time provides useful data for a clinical evaluation of patients.

Background: The aim of the present was to study the biologic behavior of the lymphomas of the follicular mantle by analysis of different indexes of neoplastic cell proliferation and their relation with the clinical symptoms, prognosis and survival of the patients., Methods: Light microscope, ultrastructural, and frozen and paraffin immunohistochemical studies were performed including the proliferative markers Ki-67 and PC10, flow cytometry and analysis of cell cycle in biopsy samples. Clinical data of 11 patients were collected in addition to therapeutic response and survival., Results: Lymphoma of the follicular mantle is constituted by small sized cell elements with a variable pattern of tumoral growth in the lymph nodes. In normal lymphocytes of the follicular mantle the immunophenotype shows expression of IgM + IgD and a light chain in the cell surface. From a clinical point of view, massive splenomegaly and disseminated stage are the most outstanding characteristics. One third of the cases analyzed presented an aneuploid neoplastic population. According to the PC10 marker, the proliferative index ranged from 2.9 to 14.7% of neoplastic cellularity (mean 7.0). The percentage of cells in the phases S, G2 and M of the cell cycle by flow cytometry varied from 14 to 35 (mean 23%). Neither the cell ploidy nor the tumoral proliferative index were related with the survival of the patients (53 +/- 51 months)., Conclusions: Lymphoma of the follicular mantle is a clinical pathological entity of low biologic aggressivity. Cell aneuploidy or ploidy and the tumoral proliferative index did not establish differences in prognosis or survival in this series.

Variable Common Immunodeficiency (VCI) can course with non necrotizing epithelioid granulomatosis of sarcoid type. Although this entity is frequently referred, it is rare and its significance is not clear. The immunological study and response to treatment with corticoids and i.v. immunoglobulins of a patient is who suffered VIC with sarcoid granulomas on lymph node, liver and skin biopsies is here presented. The association between VCI and granulomatosis is discussed.

Antibodies to antigens codified by the env and gag genes of HIV were separately assayed for in the sera of 150 infected people. From a practical standpoint, enzyme immunoassay was a more convenient and reliable technique than Western blot. Anti-env was positive in 100% and anti-gag in 70% of the cases. A positive anti-env test was confirmatory of serological diagnosis, but lacked any prognostic value. A higher frequency of negative results for anti-gag antibody was significantly associated with the presence of more severe clinical manifestations, more profound impairment of lymphocyte subpopulations (especially CD4 cells), and the finding of HIV antigens in blood. The absence of anti-gag antibodies, which seem to behave as protective, is an unfavorable feature in the clinical and immunological evaluation of patients.

Plasma theophylline levels (mcg/ml) of 93 patients with a bronchopulmonary disease (asthma and chronic obstructive lung disease) who were on theophylline (normal or retarded) treatment, were determined on admission at the emergency ward because of acute bronchospasm. Our results show that theophylline blood levels were subtherapeutical in patients treated either with normal (2.1 +/- 0.8 mcg/ml) or retarded theophylline (9.6 +/- 1.3 mcg/ml). This was probably due to insufficient dosing and/or poor patient compliance. The necessity of monitoring this type of treatment is once again evident.

A surprise monitoring of plasma aminoglycoside level was carried out in our Hospital in 55 patients. Basal samples and samples one hour after i.m. or i.v. administration were obtained. A protocol sheet with personal, clinical and therapeutic data was filled for each patient. The FPIA analysis technique (CV less than 5%) was used. Only the data related to gentamicin were evaluated, because the number of patients receiving other aminoglycosides was very low (5 cases). The most usual dose and interval were 80 mg (91%) and 12 hours (69%), respectively. The administration routes were i.v. (52%) and i.m. (48%). Blood urea and/or creatinine levels were not measured in 22% of patients. The baseline gentamicin levels were subtherapeutic in 30%, therapeutical in 57%, and toxic in 13%, and 50%, 46% and 4%, respectively, for the levels after one hour. In patients with abnormal renal function a good correlation could be demonstrated (r = 0.96; p less than 0.001) between creatinine level and gentamicin 1/2 time. This correlation was absent in patients with normal renal function. When the dose of the antibiotic was adjusted to the weight of the patient, the frequency of therapeutic levels was higher (47%; p less than 0.03); in these cases, the most common administration interval was 8 hours (p less than 0.01). We emphasize the lack of control of the renal function in 22% of patients, stressing that the lack of monitoring systematically results in potentially subtherapeutic levels in more than one half of the investigated patients (57%).