Diagnosis and treatment of primary thyroid lymphoma from a surgical perspective: a multi-institutional study.

PURPOSE: Surgery of primary thyroid lymphoma (PTL) has been mostly limited to diagnostic work-up. This study aimed to further study its potential role. METHODS: This was a retrospective study from a multi-institutional registry of PTL patients. Clinical, diagnostic work-up (fine needle aspiration, FNA; core needle biopsy, CoreNB), contribution of surgery (open surgical biopsy, OpenSB; thyroidectomy), histology subtype, and outcome data were evaluated. RESULTS: Some 54 patients were studied. Diagnostic work-up included FNA in 47 patients, CoreNB in 11, and OpenSB in 21. CoreNB yielded the best sensitivity (90.9%). Thyroidectomy was performed in 14 patients with other diagnosis (incidental PTL), in 4 for diagnosis and in 4 for elective treatment of PTL. Incidental PTL was associated with not performed FNA nor CoreNB (OR 52.5; P = 0.008), mucosa-associated lymphoid tissue (MALT) subtype (OR 24.3; P = 0.012), and Hashimoto's thyroiditis (OR 11.1; P = 0.032). Lymphoma-related death (10 cases) mostly occurred within the first year after diagnosis and was associated with diffuse large B-cell (DLBC) subtype (OR 10.3; P = 0.018) and older patients (OR 1.08 for every 1-year increase; P = 0.010). There was a trend towards lower mortality rate in patients receiving thyroidectomy (2/22 versus 8/32, P = 0.172). CONCLUSION: Incidental PTL accounts for most of thyroid surgery cases and are associated with incomplete diagnostic work-up, Hashimoto's thyroiditis and MALT subtype. CoreNB appears to be the best tool for diagnosis. Most of PTL deaths occurred during the first year after diagnosis and mostly related to systemic treatment. Age and DLBC subtype are poor prognostic factors.

Ganglio centinela en la metástasis ganglionar por cáncer papilar de tiroides: validez diagnóstica y aplicación en la práctica clínica / Sentinel lymph node biopsy in papillary thyroid cancer: Accuracy and application in clinical practice

Introducción La biopsia selectiva del ganglio centinela (BSGC) puede completar el estudio preoperatorio detectando adenopatías no visibles ecográficamente. De este modo, se puede estadificar a los pacientes y estratificar el riesgo de recidiva de forma más precisa y, por tanto, ayudar a definir el tipo de tratamiento tanto quirúrgico como con 131I que debemos realizar. El objetivo fue validar la BSGC para su utilización en el diagnóstico de la metástasis ganglionar por cáncer papilar de tiroides. Métodos Estudio observacional prospectivo de cohortes que incluye a 55 pacientes intervenidos por cáncer papilar de tiroides sin sospecha de afectación ganglionar clínica o radiológica, desde febrero de 2012 hasta febrero de 2015, con un seguimiento de entre 6 y 8 años. Se utilizó 99Tc con nanocoloide intratumoral y una sonda portátil de la gammacámara para la detección de los ganglios centinelas. Variables: edad, género, histológicas, analíticas y estadificación preoperatoria y postoperatoria. Se calculó la sensibilidad, la especificidad y los valores predictivos de la técnica. La validación se determinó calculando la detectabilidad y los falsos negativos de la prueba. Resultados En 53 de los 55 (96,36%) pacientes hubo detección del ganglio centinela. Los falsos negativos fueron 4 (7,5%) pacientes. Del resto, tras aplicar la BSGC, 24 (48,9%) se mantuvieron como N0, 14 (28,5%) pasaron a ser N1a y 11 (22,4%) se clasificaron como N1b. Las diferencias observadas en el estudio fueron significativas (p<0,05). La sensibilidad fue del 86,21%, la especificidad del 100%, el VPP del 100% y el VPN del 85,71%. La precisión diagnóstica fue del 92,45%. Conclusiones La BSGC es una técnica válida para su utilización en los pacientes afectos de cáncer papilar de tiroides, con una alta precisión diagnóstica (AU)

Introduction The presence of lymph nodes metastasis in papillary thyroid cancer modifies the type of surgical resection as well as the indication of the treatment with 131I in the postoperative period. This therapeutic approach is based on the results of the diagnostic tests, like the cervical ultrasonography. Currently other methods of diagnostic are tested as selective sentinel lymph node biopsy (SLNB). It can complement to the ultrasound results. The aim was to validate the SLNB for use in the diagnosis of lymph node metastasis by papillary thyroid cancer. Methods Observational prospective cohort study of 55 patients who underwent papillary thyroid cancer without suspicion of lymph node involvement clinical or radiological, since February 2012 through February 2015, with a follow-up between 6 and 8 years. It was used 99Tc with intratumoral nanocoloid and a portable tube of the gamma camera for the detection of the sentinel node. Variables: age, gender, histological, analytical and preoperative and postoperative staging. The sensitivity, specificity and predictive values of technique was calculated. The validation was determined by calculating the detectability and the false negative results of the test. Results In 53 of the 55 patients (96.36%) there was the sentinel node detection. The false negative were 4 patients (7.5%). Of the rest, after applying the SLNB, 24 (48.9%) were kept as N0, 14 (28.5%) became N1a and 11 (22.4%) were classified as N1b. The differences observed in the study were significant (P<.05). The sensitivity was 86.21%, the specificity of 100%, the PPV was 100% and the NPV of 85.71%. The diagnostic accuracy was 92.45%. Conclusions The SLNB is a valid technique for use in patients suffering from papillary thyroid cancer with a high diagnostic accuracy (AU)

Hemoptisis como presentación atípica de un carcinoma renal / Hemoptysis: Atypical presentation of a renal carcinoma

No disponible

Fundamentación epistemológica de la taxonomía NANDA_I desde el sustento teórico de Callista Roy / Epistemological foundation of the NANDA-I toxonomy from the theoretical support of Callista Roy

Introducción: Reconocer a Enfermería como disciplina profesional, implica que sus miembros identifiquen el vínculo existente entre cuidado, desarrollo conceptual, método y lenguaje. Objetivo: Analizar la Fundamentación Epistemológica de la Taxonomía NANDA-I desde el sustento teórico de Roy como base para un lenguaje disciplinar. Metodología: A través del paradigma cualitativo fortalecido de la metodología filosófica con un diseño fenomenológico hermenéutico, se planteó a partir de la Teoría General del Conocimiento de Hessen, identificar los fundamentos epistemológicos aportados en el Modelo de Adaptación de Roy de 1973, y como se recuperan en las Taxonomía I y II de NANDA-I, así como en la última publicación del modelo en 2009. El análisis se mostró como hermeneúsis en forma de triada dialéctica. Resultados: No fue posible identificar la recuperación de los fundamentos epistemológicos aportados desde el modelo conceptual de Roy de 1973 en las taxonomías NANDA-I, a excepción de que tanto los constructos teóricos como la clasificación empírica del saber en enfermería, sostienen que a partir del Proceso Enfermero se accede al conocimiento del otro en el cuidado. El modelo de Roy del 2009 muestra concordancia entre objeto de cuidado, leyes de pensamiento y posee elementos para estructurar un lenguaje disciplinar. Conclusiones: Enfermería deberá regresar a cuestiones teóricas y a la filosofía desplazada en los últimos años, para posicionarse epistémicamente como una disciplina profesional; construir desde la epistemología de la disciplina un lenguaje que retome la visión integral del individuo, humanizada y alejada del pragmatismo.

Introduction Recognizing nursing as a professional discipline implies that its members identify the link between care, conceptual development, method and language. Objective To analyze the epistemological grounding of the NANDA-I taxonomy from the theoretical support of Roy as a basis for a disciplinary language. Methodology Through the strengthened qualitative paradigm of philosophical methodology with a phenomenological hermeneutic design, it was proposed from Hessen's General Theory of Knowledge, to identify the epistemological foundations provided in the Roy Adaptation Model of 1973, and how they are recovered in the Taxonomy I and II of NANDA-I, as well as in the last publication of the model in 2009. The analysis was shown as hermeneúsis in the form of dialectical triad. Results It was not possible to identify the recovery of the epistemological foundations contributed from the conceptual model of Roy of 1973 in the NANDA-I taxonomies, except that both the theoretical constructs and the empirical classification of the knowledge in nursing, argue that from the Nurse Process Access to the knowledge of the other in the care. Roy's model of 2009 shows agreement between object of care, laws of thought and has elements to structure a disciplinary language. Conclusions Nursing should return to theoretical issues and to the philosophy displaced in recent years, to position itself epistemically as a professional discipline; To construct from the epistemology of the discipline a language that retakes the integral vision of the individual, humanized and far from pragmatism.

Seroprevalencia de anticuerpos frente al virus de la varicela zóster tras la introducción reciente de la vacunación infantil universal en la Comunidad de Madrid / Seroprevalence of varicella-zoster virus antibodies after the recent introduction of the universal childhood immunisation schedule in the Community of Madrid

FUNDAMIENTO Y OBJETIVO: En la Comunidad de Madrid se incluyó la vacuna frente a varicela en el calendario infantil en noviembre del 2006 a los 15 meses de edad. Dicha recomendación se retiró en enero del 2014. Se estima la seroprevalencia de anticuerpos frente al virus tras los 2-3 primeros años desde la inclusión de la vacuna y su evolución desde 1999. MATERIAL Y MÉTODO: Estudio descriptivo transversal. La población diana son los residentes en la Comunidad de Madrid entre 2 y 60 años. La medición de anticuerpos IgG se realizó mediante técnicas de ELISA. Se estima la seroprevalencia según características sociodemográficas mediante regresión logística múltiple. Los resultados se comparan con encuestas previas. Asimismo, se presentan la seroprevalencia y la media geométrica de anticuerpos según el estado vacunal y los antecedentes de la enfermedad. El nivel de confianza utilizado es del 95%. RESULTADOS: Participaron 4.378 sujetos, con una tasa de respuesta del 69%. La seroprevalencia estimada es del 95,3% (IC del 95%, 94,6%-95,9%). Más del 90% de los niños a partir de los 10 años de edad presentan anticuerpos. La seroprevalencia fue mayor en personas con menor nivel educativo. La seroprevalencia de inmunidad vacunal supera el 90% en el primer año tras la vacunación pero en el segundo año desciende hasta el 82,6% (IC del 95%, 56,0-94,7). Se encontraron diferencias significativas con las encuestas anteriores atribuibles a la vacunación universal. DISCUSIÓN: Es necesario continuar la vigilancia epidemiológica para valorar el impacto de la retirada de la recomendación de vacunar a los 15 meses de edad

BACKGROUND AND OBJECTIVE: In November 2006, the Community of Madrid included the chickenpox vaccine into the immunisation schedule for children from 15 months of age. This was withdrawn in January 2014. Seroprevalence of antibodies to the virus is estimated after the first 2-3 years from the inclusion of the vaccine, and as well as its evolution since 1999. MATERIAL AND METHOD: A cross-sectional study was conducted on the target population consisting of residents in the Community of Madrid between 2 and 60 years of age. Measurement of IgG antibodies was performed using an ELISA technique. Seroprevalence was estimated according to sociodemographic characteristics using multiple logistic regressions. The results are compared with previous surveys. Also, the seroprevalence and geometric mean of the antibody according immunisation status and history of the disease are presented. The confidence level used is 95%. RESULTS: A total of 4,378 subjects were included, with a response rate of 69%. The estimated seroprevalence was 95.3% (95% CI: 94.6% - 95.9%). Over 90% of children from the age of 10 have antibodies. The seroprevalence was higher in people with less education. The seroprevalence of immunity vaccine exceeds 90% in the first year after vaccination, but in the second year decreased to 82.6% (95% CI 56.0 - 94.7). Significant differences, attributable to universal vaccination, were found compared to previous surveys. DISCUSSION: Continued surveillance is needed in order to assess the impact of the withdrawal of the recommendation to vaccinate at 15 months

[Seroprevalence of varicella-zoster virus antibodies after the recent introduction of the universal childhood immunisation schedule in the Community of Madrid]. / Seroprevalencia de anticuerpos frente al virus de la varicela zóster tras la introducción reciente de la vacunación infantil universal en la Comunidad de Madrid.

BACKGROUND AND OBJECTIVE: In November 2006, the Community of Madrid included the chickenpox vaccine into the immunisation schedule for children from 15 months of age. This was withdrawn in January 2014. Seroprevalence of antibodies to the virus is estimated after the first 2-3 years from the inclusion of the vaccine, and as well as its evolution since 1999. MATERIAL AND METHOD: A cross-sectional study was conducted on the target population consisting of residents in the Community of Madrid between 2 and 60 years of age. Measurement of IgG antibodies was performed using an ELISA technique. Seroprevalence was estimated according to sociodemographic characteristics using multiple logistic regressions. The results are compared with previous surveys. Also, the seroprevalence and geometric mean of the antibody according immunisation status and history of the disease are presented. The confidence level used is 95%. RESULTS: A total of 4,378 subjects were included, with a response rate of 69%. The estimated seroprevalence was 95.3% (95% CI: 94.6% - 95.9%). Over 90% of children from the age of 10 have antibodies. The seroprevalence was higher in people with less education. The seroprevalence of immunity vaccine exceeds 90% in the first year after vaccination, but in the second year decreased to 82.6% (95% CI 56.0 - 94.7). Significant differences, attributable to universal vaccination, were found compared to previous surveys. DISCUSSION: Continued surveillance is needed in order to assess the impact of the withdrawal of the recommendation to vaccinate at 15 months.

Effectiveness of 23-valent pneumococcal polysaccharide vaccine in adults aged 60 years and over in the Region of Madrid, Spain, 2008-2011.

Invasive pneumococcal disease (IPD) is a notifiable disease in the Region of Madrid. The 23-valent pneumococcal polysaccharide vaccine (PPV23) is recommended for children and adults aged two years or over with a high risk of disease, and for all adults aged 60 and over. We describe the evolution of IPD incidence from 2008 to 2011 in people aged 60 years and over and PPV23 vaccine effectiveness (VE). VE is estimated using both the screening method and indirect cohort method. The incidence of IPD varied from 20.0 in 2008 to 15.2 per 100,000 inhabitants in 2011 (RR: 0.8; 95% CI: 0.6­0.9). Adjusted VE estimated with the screening method was 68.2% (95% CI: 56.2­76.9). VE with the Broome method was 44.5% (95% CI: 23.8­59.6) for all PPV23 serotypes, and 64.4% (95% CI: 45.2­76.8) for PPV23 serotypes not included in conjugate vaccines. VE was lower in patients aged 80 years and older (25.5%; 95% CI:-23.2 to 55.0) and those with highrisk medical conditions (31.7%; 95% CI: -2.2 to -54.4). Adjusted VE was 44.5% (95% CI: 19.4-61.8) within 5 years of vaccination and 32.5% (95% CI: -5.6 to 56.9) after 5 years. These results are compatible with current recommendations for PPV23.

Hiperparatiroidismo primario y crisis hipercalcémica aguda tóxica / Primary hyperparathyroidism and acute toxic hypercalcaemic crisis

Objetivos: Describir las características clínicas y tratamiento quirúrgico de los pacientes con hipercalcemia aguda por hiperparatiroidismo primario (HPTP) y compararlas con las de otros pacientes con HPTP sin hipercalcemia aguda asociada. Material y métodos Estudio observacional prospectivo (1998-2010) sobre 158 pacientes con HPTP tratados mediante paratiroidectomía. Se identificaron aquellos con hipercalcemia aguda (>14mg/dl-3,5mmol/l- o >3mmol/l con síntomas de calciotoxicosis), se evaluaron sus características clínicas y terapéuticas y se compararon, mediante la U de Mann-Whitney y el test de Fisher, con los 146 pacientes con HPTP sin crisis hipercalcémicas. Resultados Doce pacientes (7,6%) presentaron hipercalcemia aguda con síntomas de calciotoxicosis y otros síntomas de cronicidad. Los valores preoperatorios de calcemia y PTH fueron 14,5±1,3mg/dl y 648,2±542pg/dl, respectivamente. Hubo 10 adenomas, una hiperplasia y un carcinoma. El peso medio de las piezas quirúrgicas fue 4.075±2.918 mg con un diámetro mayor de 27±14mm. Los gradientes de caída de PTH a los 10 y 25min fueron 79±18% y 92±6%. Las calcemias postoperatorias al alta y a los 6 meses fueron 8,2±0,7 y 9,1±0,9mg/dl. Las concentraciones plasmáticas de Ca, PTH y el peso y tamaño de las piezas quirúrgicas fueron mayores en los pacientes con crisis hipercalcémicas (p<0,001). No hubo diferencias en otros parámetros estudiados y en la tasa de curación. Conclusiones Las crisis hipercalcémicas fueron producidas por tumores más grandes, de mayor peso y que producían mayores concentraciones plasmáticas de Ca y PTH. Todos los pacientes presentaban síntomas de evolución crónica y la paratiroidectomía consiguió la curación (AU)

Objectives: To describe the clinical characteristics and surgical treatment of patients with acute hypercalcaemia due to primary hyperparathyroidism (PHPT) and compare them with other patients with PHPT without associated acute hypercalcaemia. Material and methods: A prospective, observational study (1998-2010) was conducted on 158patients with PHPT treated by parathyroidectomy. Those with acute hypercalcaemia(>14 mg/dl -3.5 mmol/L- or >3 mmol/L with symptoms of calcium toxicity) were evaluated by recording their clinical and treatment characteristics, and comparing them, using the Mann-Whitney U test and the Fisher test, with the 146 PHPT patients without hypercalcaemic crisis. Results: Twelve patients (7.6%) had acute hypercalcaemia with symptoms of calcium toxicity and other symptoms of chronicity. The preoperative calcium and PTH values were14.5 1.3 mg/dL and 648.2 542 pg/dL, respectively. There were 10 adenomas, 1 hyperplasia and 1 carcinoma. The mean weight of the surgical pieces was 4.075 2.918 mg, with a diameter greater than 27 14 mm. The gradients of PTH at 10 and 25 minutes were 79 18%and 92 6%, respectively. Post-operative calcium values on discharge and at 6 months were8.2 0.7 mg/dL and 9.1 0.9 mg/dL, respectively. The plasma concentrations of calcium, PTH, and the size of the surgical pieces were higher in patients with hypercalcaemic crisis(P<0.001). There were no differences in the other parameters studied or in the cure rate. Conclusions: Hypercalcaemic crises were caused by larger and heavier tumours that led to higher plasma Ca and PTH plasma concentrations. All patients had long-standing symptoms and parathyroidectomy led to cure of the disease (AU)

[Primary hyperparathyroidism and acute toxic hypercalcaemic crisis]. / Hiperparatiroidismo primario y crisis hipercalcémica aguda tóxica.

OBJECTIVES: To describe the clinical characteristics and surgical treatment of patients with acute hypercalcaemia due to primary hyperparathyroidism (PHPT) and compare them with other patients with PHPT without associated acute hypercalcaemia. MATERIAL AND METHODS: A prospective, observational study (1998-2010) was conducted on 158 patients with PHPT treated by parathyroidectomy. Those with acute hypercalcaemia (>14 mg/dl -3.5 mmol/L- or >3 mmol/L with symptoms of calcium toxicity) were evaluated by recording their clinical and treatment characteristics, and comparing them, using the Mann-Whitney U test and the Fisher test, with the 146 PHPT patients without hypercalcaemic crisis. RESULTS: Twelve patients (7.6%) had acute hypercalcaemia with symptoms of calcium toxicity and other symptoms of chronicity. The preoperative calcium and PTH values were 14.5 ± 1.3mg/dL and 648.2 ± 542 pg/dL, respectively. There were 10 adenomas, 1 hyperplasia and 1 carcinoma. The mean weight of the surgical pieces was 4.075 ± 2.918 mg, with a diameter greater than 27 ± 14 mm. The gradients of PTH at 10 and 25 minutes were 79 ± 18% and 92 ± 6%, respectively. Post-operative calcium values on discharge and at 6 months were 8.2 ± 0.7 mg/dL and 9.1 ± 0.9 mg/dL, respectively. The plasma concentrations of calcium, PTH, and the size of the surgical pieces were higher in patients with hypercalcaemic crisis (P<0.001). There were no differences in the other parameters studied or in the cure rate. CONCLUSIONS: Hypercalcaemic crises were caused by larger and heavier tumours that led to higher plasma Ca and PTH plasma concentrations. All patients had long-standing symptoms and parathyroidectomy led to cure of the disease.

[Incidence of pneumococcal disease in the autonomous Region of Madrid (1998--2006)]. / Incidencia de enfermedad neumocócica en la Comunidad de Madrid en el período 1998--2006.

BACKGROUND AND OBJECTIVE: The availability of antipneumococcal vaccines makes it necessary to go deeply into the knowledge of pneumococcal disease. This study aims at describing the magnitude and incidence of pneumococcal disease in the Region of Madrid from 1998 to 2006. MATERIAL AND METHOD: Retrospective study of Computerized Hospital Discharge Data registered from 1998 to 2006. Incidence per 100,000 inhabitants and lethality were calculated. Temporal evolution was analyzed. RESULTS: 20,813 cases of pneumococcal disease were registered (annual average incidence 41.87/100,000 inhabitants). Incidence was 40.65 for pneumoniae and 0.77 for meningitis. People over 64 years old (185.04) and under 1 year of age (67.22) showed the highest incidence. Lethality was 10.1% (15.8% for meningitis). Incidence in 2004--2006 was lower than 1998--2000 (before the introduction of conjugate vaccine). Incidence trend has declined slightly. CONCLUSIONS: The incidence is higher than that shown by other studies. Selected source of data can explain this difference, since our data included suspected cases. However, pneumococcal meningitis incidence is similar to that described by others.

Incidencia de enfermedad neumocócica en la Comunidad de Madrid en el período 1998-2006 / Incidence of pneumococcal disease in the Autonomous Region of Madrid (1998-2006)

Fundamento y objetivo: La disponibilidad de vacunas antineumocócicas hace necesario profundizar en el conocimiento de la enfermedad neumocócica. El objetivo del estudio ha sido describir la magnitud y la evolución de la enfermedad por Streptococcus pneumoniae en la Comunidad de Madrid durante 1998-2006. Material y método: Se ha realizado un estudio retrospectivo del Conjunto Mínimo Básico de Datos de Altas Hospitalarias en el período 1998-2006. Se calcularon las tasas de incidencia por 100.000 habitantes y la letalidad, y se analizó la evolución temporal. Resultados: En el período estudiado se registraron 20.813 casos de enfermedad neumocócica (incidencia media anual: 41,87 casos/ 100.000 habitantes). La incidencia fue de 40,65 para neumonía y de 0,77 para meningitis. La mayor incidencia se presentó en personas mayores de 64 años (185,04) y en menores de 1 año (67,22). La letalidad fue del 10,1% (el 15,8% para meningitis). La incidencia fue menor en 2004-2006 que en 1998-2000 (antes de la autorización de la vacuna conjugada). La evolución de la incidencia muestra una ligera tendencia descendente. Conclusiones: La incidencia obtenida es superior a la de algunos estudios debido a que se incluyen sospechas clínicas. La incidencia de meningitis es similar a la descrita

Background and objective: The availability of antipneumococcal vaccines makes it necessary to go deeply into the knowledge of pneumococcal disease. This study aims at describing the magnitude and incidence of pneumococcal disease in the Region of Madrid from 1998 to 2006. Material and method: Retrospective study of Computerized Hospital Discharge Data registered from 1998 to 2006. Incidence per 100,000 inhabitants and lethality were calculated. Temporal evolution was analyzed. Results: 20,813 cases of pneumococcal disease were registered (annual average incidence 41.87/100,000 inhabitants). Incidence was 40.65 for pneumoniae and 0.77 for meningitis. People over 64 years old (185.04) and under 1 year of age (67.22) showed the highest incidence. Lethality was 10.1% (15.8% for meningitis). Incidence in 2004-2006 was lower than 1998-2000 (before the introduction of conjugate vaccine). Incidence trend has declined slightly. Conclusions: The incidence is higher than that shown by other studies. Selected source of data can explain this difference, since our data included suspected cases. However, pneumococcal meningitis incidence is similar to that described by others

Tuberculosis en la Comunidad de Madrid. Incidencia en personas extranjeras y españolas durante el período 1996-2004 / Tuberculosis in the Autonomous Region of Madrid, Spain. Incidence among foreign and spanish individuals during the 1996-2004 period

Fundamento: La inmigración desde países de alta prevalenciade tuberculosis hacia otros más desarrollados afecta a la evoluciónglobal de la tuberculosis en los últimos años. El objetivode este estudio fue describir la influencia de los casos de tuberculosisen personas extranjeras sobre la incidencia de la enfermedaden la Comunidad de Madrid en el período 1996 a 2004.Métodos: Los datos procedían del Registro Regional deCasos de Tuberculosis, y del padrón de 1996 y los padronescontinuos de 1998 a 2004. Se estimó la incidencia de tuberculosissegún país de origen desde 1996 a 2004, por sexo y gruposde edad. Se calcularon c2 para tendencia lineal, razones deincidencia y proporción de casos en personas extranjeras.Resultados: La incidencia de tuberculosis pasó de 34,3casos por 105 habitantes en 1996 a 16,9 casos por 105 habitantesen 2004. Para los nacidos en España cambió de 33,2 casospor 105 habitantes en 1996 a 12,7 casos por 105 habitantes en2004, y para los extranjeros de 50,5 casos por 105 habitantesen 1996 a 42,9 casos por 105 habitantes en 2004. La razón dela incidencia entre extranjeros y españoles fue superior a 1 entodos los años, con valor máximo en 2003, en el que se detectaron4,2 casos en extranjeros por cada caso en españoles (IC95% 3,7-4,7). El porcentaje de casos extranjeros pasó del 5,2%en 1996 al 35,1% en 2004.Conclusiones: La incidencia de tuberculosis en extranjerosfue mayor que entre los españoles y no disminuyó significativamenteen el período 1996-2004, lo que está contribuyendoa que la tuberculosis se haya estabilizado. Esta situación ylas características de esta población han de ser tenidas en cuentaen los esfuerzos para el control de esta enfermedad(AU)

Backgound: Immigration from countries having a highprevalence of tuberculosis to other more highly-developedcountries has a bearing on the overall evolution of tuberculosisin the latter. This study is aimed at describing the influenceof the cases of tuberculosis among foreign individuals onthe incidence of this disease in the Autonomous Community ofMadrid during the 1996-2004 period.Methods: The data was taken from the Regional TuberculosisCase Registry and from the 1996 census and the continuouscensuses from 1998 to 2004. The tuberculosis incidencewas estimated by country of origin from 1996 to 2004, bygender and by age groups. A calculation was made of the c2for the linear trend, reasons for incidence and proportion ofcases among foreign individuals.Results: The incidence of tuberculosis went from 34.3cases per105 inhabitants in 1996 to 16.9 cases per105 inhabitantsin 2004. For those born in Spain, it changed from 33.2cases per 105 inhabitants in 1996 to 12.7 cases per 105 inhabitantsin 2004; and for foreign individuals, from 50.5 casesper 105 inhabitants in 1996 to 42.9 cases per 105 inhabitantsin 2004. The reason for the incidence between foreign andSpanish individuals was greater than 1 for all years, the maximumfigure having been in 2003, when 4.2 cases were detectedamong foreigners for every case among Spanish individuals(95% CI 3.7-4.7). The percentage of foreign cases wentfrom 5.2% in 1996 to 35.1% in 2004.Conclusions: The incidence of tuberculosis among foreignerswas greater than among Spanish individuals and did notsignificantly decrease in the 1996-2004 period, which is contributingto tuberculosis having stabilized. This situation andthe characteristics of this population must be taken intoaccount in the efforts for controlling this disease(AU)

Maltrato y discapacidad visual / Maltreatment and visual disorders

El presente artículo pretende dar a conocer una investigación, que sobre maltrato y discapacidad visual, recientemente hemos terminado un equipo de cuatro investigadores de la Universidad Autónoma de Madrid y de trabajadores de la ONCE, lo cual nos ha permitidounir en este trabajo conocimientos teóricos y experiencia profesional de muchos años detrabajo con esta población.Esta investigación se ha realizado con el 70 por ciento de la población total de alumnos discapacitados visuales escolarizados en centros ordinarios de educación, de entre 9 y 16 años de la Comunidad Autónoma de Madrid, incluyendo también a famillas y profesores.Viene a cubrir además una importante laguna inves-tigadora en este campo, aspecto este de gran relevancia, si se quieren ajustar los programas de apoyo y planificar las intervenciones con estos alumnos, teniendo en cuenta y procurando diseñar actuacionesque, partiendo de la realidad puedan mejorar la convivencia de las aulas en general y que laintegración de los alumnos con discapacidad visual y su inclusión en los centros con un menor coste personal para este colectivo

This paper presents a recent research on maltreatment and visual disorders done by a research team both from the Autonomous University of Madrid and from the ONCE[literally, Spanish Association of Blind People]. This has allowed us to put together knowledge and long experience in the field.A sample consisting of 70 percent of visually impaired students in primary and secondary education schools of the Autonomous Community of Madrid, aged 9 to 16 wasused. Families and teachers were also surveyed.This study fills an important gap in research in this field. This is very relevant for adjusting support programs, planning interventions with these students, with the aim of improving the living together in classrooms, the integration of students with visual disorders and their access to schools where they would pay a lower personal price

KIR gene in ethnic and Mestizo populations from Mexico.

Killer cell immunoglobulin-like receptors are characterized by their great diversity of genes and alleles. Population studies have identified the presence of a broad variety of genotypes. In Mexico, there are diverse ethnic groups representing 9% of the total population and the rest is composed of Mestizos with a more varied biology. For the purpose of this study, genotyping was performed in Mestizos, in Mexico City inhabitants, and in three ethnic groups. The frequencies of genes KIR2DL2, 2DL5, 2DS1-3, 2DS5, and 3DS1 showed a greater variability in the groups studied. A total of 12 different genotypes were identified, the higher number for the Mestizos and the lower number for the Tarahumaras. Genotype 1 was found at a greater frequency in all the groups, except for the Tarahumaras, in which genotype 4 was more frequent. The frequency of genotypes 4 and 8 in Mexicans was higher than that for other populations analyzed. By subtyping of KIR3DL1, 3DL2, 2DL1, and 2DL3, two B haplotypes were identified in families; both were absent in Caucasian families. Our results indicated a greater diversity of genes in the Mestizos group than in the ethnic groups.

[Evolution of meningococcal disease in the community of Madrid. Effectiveness of antimeningococcal A+C vaccination]. / Evolución de la enfermedad meningocócica en la Comunidad de Madrid. Efectividad de la vacunación antimeningocócica A + C.

BACKGROUND: In 1997 (between 22 September and 14 November) an A + C meningococcal mass vaccination campaign was carried out in Madrid, targeting the age group of from 18 months to 19 years of age, in the face of an increase in the number of cases of meningococcal disease caused by serogroup C occurring in the 1996-97 season. This study forms a part of the impact assessment of that campaign. METHODS: The evolution of the meningococcal disease, by means of the comparison of rates of incidence; and the efficacy of the vaccination campaign was determined after one year (1997-98 season) and after two years (1997-98 and 1998-99 seasons) of monitoring. The vaccine efficacy has been calculated as [1-(Incidence rate in vaccinated/Incidence rate in unvaccinated)]* 100. RESULTS: A significant drop was registered in the incidence of serogroup C meningococcal disease on comparing the 1997-98 and 1998-99 seasons with the epidemic season (1996-97). The vaccine efficacy after two years of monitoring subsequent to the vaccination campaign was 76.9% for the global population between 18 months and 19 years of age and 88.5% in the group of vaccinated individuals between 15 and 19 years of age. CONCLUSIONS: The vaccine efficacy obtained is compatible with that described in the relevant literature. The significant reduction in the incidence of meningococcal disease caused by serogroup C was due to the vaccine efficacy obtained.