[National guidelines of diagnosis and treatment of the non-Hodgkin lymphoma]

Non-Hodgkin lymphoma comprises a heterogeneous group of haematological malignancies, classified according to their clinic, anatomic-pathological features and, lately, to their molecular biomarkers. Despite the therapeutic advances, nearly half of the patients will die because of this disease. The new diagnostic tools have been the cornerstone to design recent therapy targets, which must be included in the current treatment guidelines of this sort of neoplasms by means of clinical trials and evidence-based medicine. In the face of poor diagnoses devices in most of the Mexican hospitals, we recommend the present diagnose stratification, and treatment guidelines for non-Hodgkin lymphoma, based on evidence. They include the latest and most innovative therapeutic approaches, as well as specific recommendations for hospitals with limited framework and therapy resources.

[Clinical and epidemiologic characteristics of dengue cases: the experience of a general hospital in Culiacan, Sinaloa, Mexico]

OBJECTIVES

To document the clinical and epidemiological characteristics present in dengue patients served by a hospital in Culiacan, Sinaloa, Mexico.

METHODS

A cross-sectional, observational, and analytical study was carried out at the Hospital General Dr. Bernardo J. Gastélum de Culiacan from 1 October to 2 December 2003. Associations between the independent variables (the patients' clinical and epidemiological characteristics) and the dependent variable (confirmed hemorrhagic dengue) were determined through simple regression analysis. The variables that were significantly associated (P < 0.05) were submitted to multifactorial logistic regression analysis.

RESULTS

Of the only 241 cases that met the study's inclusion criteria (207 dengue and 34 hemorrhagic dengue), the mean age was 34.7 +/- 15.1 years. According to the results of the multifactorial analysis (adjusted by age, sex, and the presence of dengue cases at the geographic location), the variables predictive of major complications of the disease were: the presence of ascites (odds ration [OR] = 22.12; 95% confidence interval [95%CI]: 5.00-97.87), gingivorrhagia (OR = 7.35; 95%CI: 2.11-25.61), hematemesis (OR = 7.40; 95%CI: 1.04-52.42), thrombocytopenia (platelets from 40,001/mm(3)-60,000/mm(3)) (OR = 5.43; 95%CI: 1.58-18.72), conjunctival hyperemia (OR = 4.27; 95%CI: 1.37-13.28), persistent vomiting (OR = 3.04; 95%CI: 1.05-8.80), and the absence of nasal congestion (OR = 0.015; 95%CI: 0.0004-0.473).

CONCLUSIONS

The presence of ascites, gingivorrhagia, hematemesis, thrombocytopenia (with platelet values from 40,001/mm(3)-60,000/mm(3)), and persistent vomiting were confirmed as warning signs of an imminent dengue attack. Platelet counts of > 100,000/mm(3) were confirmed in cases with acute clinical symptoms (capillary leak) that were not classified as hemorrhagic dengue due to falling short of the criteria established by WHO.

Manifestaciones hemorrágicas en el dengue

Objetivo.- Describir las manifestaciones clínicas y epidemiológicas en pacientes con fiebre por dengue (FD) y fiebre hemorrágica por dengue (FHD). Material y Métodos.- Estudio transversal de 231 casos de dengue atendidos en el Hospital General de Culiacán "Dr. Bernardo J. Gastelum", de septiembre a noviembre de 2003, clasificados según los criterios de la OMS. Se utilizó el programa estadístico Stata v6. Resultados.- 209 (90.48%) fueron FD y 22 (9.52%) FHD. La edad promedio fue de 34.5±15 años. La FD predominó en mujeres, con 129 casos (61.7%) y la FHD en hombres con 17 casos (77.3%). En la FHD acudieron al hospital en 4.7 ± 2 días contra 3.4 ± 2.2 en la FD (p = 0.004). La cefalea, dolor retroocular, artralgias, mialgias, tos, dolor faríngeo, congestión nasal y conjuntivitis fue similar en ambas formas de dengue. La diarrea y el vómito fueron más frecuentes en FHD (p‹0.05). En FD las manifestaciones hemorrágicas, fuga capilar y trombocitopenia ocurrieron en 24.8, 6.7 y 36.7%, respectivamente; petequias, gingivorragia y epistaxis se asociaron a trombocitopenia menor de 20,000/μL (p‹0.05). Las demás manifestaciones hemorrágicas no se asociaron a trombocitopenia. Neutropenia, TTPA alargado, elevación de la TGO ocurrieron más en la FHD (p‹0.05). Conclusiones.- El género masculino, fiebre, vómito y gingivorragia se asocian fuertemente a FHD, pero no el haber padecido dengue; a mayor hemoconcentración, mayor severidad de la trombocitopenia.