Resultados en Navarra del estudio nacional de sero-epidemiología ENE-COVID / Results in Navarra of the national study of sero-epidemiology ENE-COVID

Fundamento: España ha sido uno de los países europeos más afectados por la pandemiade COVID-19. La encuesta serológica ENE-COVID, estudio de base poblacional tiene comoobjetivo estimar la seroprevalencia de la infección por SARS-CoV-2 en España a nivel nacionaly autonómico y su evolución temporal. Se presentan los resultados correspondientes a laComunidad Foral de Navarra. Metodología: Se seleccionaron 864 hogares de padrones municipales mediante muestreoaleatorio estratificado bietápico. La primera fase estudió la seroprevalencia en la primeraonda epidémica mediante tres rondas, entre el 27 de abril y el 22 de junio de 2020, en las queparticiparon 1.865 personas (77,5% de respuesta). Respondieron a un cuestionario sobre elhistorial de síntomas compatibles con COVID-19 y factores de riesgo y, si estuvieron de acuerdo,donaron sangre para detección de anticuerpos en laboratorio mediante inmunoensayoquimioluminiscente de micropartículas (IQM). Tras la desescalada se realizó una cuarta rondadel estudio, entre el 16 y el 19 de noviembre de 2020, para tener una imagen más completa dela extensión epidémica. Resultados: La seroprevalencia en Navarra fue 14,3 %, sin diferencias por sexo pero sí mayoren personas de 50-64 años (18%) y en residentes en secciones censales con mayor nivel derenta. La tasa de seroconversión entre la primera fase (rondas 1 a 3) y la cuarta ronda delestudio fue del 7,1% (IC95%: 5,3-9,4). Alrededor de un tercio de los participantes seropositivosfueron asintomáticos, con un rango de 21,9 % (19,1-24,9) a 35,8 % (33,1-38,5). Conclusión: Estos resultados enfatizaron la necesidad de mantener las medidas de saludpública para evitar una nueva ola epidémica.(AU)

Access to SARS-CoV-2 diagnostic tests: are there barriers for the immigrants in Italy?

OBJECTIVES: to describe the epidemiology of SARS-CoV-2 infection in relation with the use of nasal swabs in the immigrant population in Italy, using data from the COVID-19 national surveillance system and to verify if a difference is present comparing natives and immigrant. DESIGN: descriptive study based on longitudinal health-administrative data. SETTING AND PARTICIPANTS: general population of six Italian Regions (Piedmont, Lombardy, Veneto, Emilia-Romagna, Tuscany, Lazio) covering about 55% of the resident population and 72% of foreigners' population. MAIN OUTCOME MEASURES: regional rates of access to at least a nasal swab, separately by country of origin. RESULTS: across all the periods, a lower rate in the foreigners' group was observed, with the only exception of the period May-June 2021. Considering separately High Migratory Pressure Countries (HMPCs) and Highly Developed Countries (HDCs), a higher proportion of nasal swabs performed in people coming from HDC with respect to HMPCs and natives was noticed. This observation is consistent in males and females. CONCLUSIONS: during the first wave of the pandemic, Italians have had a higher proportion of nasal swabs compared to migrants across all Regions. This difference disappeared in the following periods, probably due to a major availability of diagnostic tests.

[The incidence of COVID-19 in the worker population by economic activity in Navarre, May-December 2020]. / Incidencia casos COVID-19 en población laboral según actividad económica en Navarra, mayo­diciembre 2020.

OBJECTIVE: To identify a possible association between economic work activity of work and risk of illness in order to enable policies for more vulnerable groups of workers. METHODS: We present the incidence rates for COVID-19, confirmed through active infection diagnostic testing, by National Economic Activity Code for all workers in Navarra, registered in the social security system, for those divisions with an incidence and number of exposed persons above their respective 75th percentiles. RESULTS: Women and activities in services, food industry and construction, characterised by precarious employment, high presence of immigrants and probably worse living conditions, present a higher risk of becoming ill. CONCLUSIONS: The socio-occupational inequalities associated with COVID-19 require an integrated public health and occupational health approach.

OBJETIVO: Identificar una eventual relación entre la actividad económica del trabajo y el riesgo de enfermar para así poder habilitar políticas para colectivos laborales más vulnerables.  Métodos: Presentamos los índices de incidencia de COVID-19, confirmada por Prueba Diagnóstica de Infección Activa, por división del Código Nacional de Actividad Económica de todos los trabajadores y trabajadoras de Navarra afiliados a la Seguridad Social para las divisiones con incidencia y número de expuestos superiores a sus Percentiles75.  Resultados: Las mujeres y actividades de servicios, industria alimentaria y construcción, caracterizadas por la precariedad de contratación, gran presencia de personas inmigrantes y probablemente peores condiciones de vida, presentan mayor riesgo de enfermar.  Conclusiones: La desigualdad socio laboral de la Covid-19 requiere una aproximación integrada desde salud pública y salud laboral.

Incidencia casos COVID-19 en población laboral según actividad económica en Navarra, mayo–diciembre 2020 / The incidence of COVID-19 in the worker population by economic activity in Navarre, May-December 2020

Objetivo: La temprana aparición de brotes COVID-19 en colectivos de trabajadores despertó preocupación por la posible existencia de factores de riesgo laborales en la transmisión de la enfermedad. Identificar una eventual relación entre la actividad económica del trabajo y el riesgo de enfermar para así poder habilitar políticas para colectivos laborales más vulnerables. Métodos: Presentamos los índices de incidencia de COVID-19, confirmada por Prueba Diagnóstica de Infección Activa, por división del Código Nacional de Actividad Económica de todos los trabajadores y trabajadoras de Navarra afiliados a la Seguridad Social para las divisiones con incidencia y número de expuestos superiores a sus Percentiles75.(AU)

Objective: The early appearance of COVID-19 outbreaks in groups of workers raised concerns about the possible existence of occupational risk factors in the transmission of the disease. To identify a possible association between economic work activity of work and risk of illness in order to enable policies for more vulnerable groups of workers. Methods: We present the incidence rates for COVID-19, confirmed through active infection diagnostic testing, by National Economic Activity Code for all workers in Navarra, registered in the social security system, for those divisions with an incidence and number of exposed persons above their respective 75th percentiles.(AU)

Tricobezoar: reporte de caso / Case report: Trichobezoar

Reportamos el caso de una adolescente femenina que ingresa al Hospital Mario Catarino Rivas en San Pe- dro Sula con antecedente de tricofagia desde hace 5 años. Ingresa con historia de dolor abdominal epigás- trico de 3 meses de evolución con náuseas y vómitos de alimentos ocasionales junto a pérdida de aproxima- damente 6 kilogramos de peso en los últimos 3 meses. Paciente fue ingresada y se completaron estudios diagnosticándose tricobezoar gástrico con poste- rior intervención quirúrgica: laparotomía media supraumbilical accediendo al estómago sobre el cual se le realizó una gastrostomía antral de 6 cm de longitud por donde se extrae el bezoar en su to- talidad. Se cierra posteriormente la gastrotomía.

Síndrome de nicolau en paciente pediátrico: reporte de caso / Case report: Nicolau síndrome in a pediatric patient

El síndrome de Nicolau o Embolia cutis medicamentosa o Dermatitis livedoide, es un síndrome raro en pediatría que se presenta como complicación de una inyección intramuscular con múltiples grados de daño tisular, in- cluyendo la necrosis de la piel y de los tejidos profundos. Reportamos el caso de un paciente masculino de 2 años de edad, sin antecedentes patológicos que acudió a la emergencia de pediatría del Hospital "Mario Catarino Rivas" (HMCR) en San Pedro Sula, Cortes, con historia de presentar lesión necrótica en la extremidad inferior y glúteo izquierdo, dolorosa a la palpación, que apa- reció posterior a la administración de un medicamen- to compuesto por vía intramuscular. Al examen físico se encontró una extensa placa necrótica dolorosa a la palpación y a la movilización del miembro, con pulsos periféricos conservados y sin frialdad distal. A través de abordaje multidisciplinario se brindó limpieza qui- rúrgica, cobertura antibiótica, manejo antitrombótico e injerto, con evolución favorable, por lo que resalta- mos que la identificación y manejo multidisciplinario oportuno es fundamental, como lo fue en este caso...(AU)

Adaptación transcultural y validación del cuestionario de cultura preventiva Organizational Performance Metric / Transcultural adaptation and validation of the Organizational Performance Metric safety culture questionnaire

OBJETIVO: Los Indicadores Positivos de Esfuerzo Preventivo (IPEP) reflejan aspectos centrales de la cultura preventiva; existen evidencias respecto a la validez predictiva de algunos de estos respecto a los accidentes de trabajo. Éste es el caso del Organizational Performance Metric (OPM) desarrollado por el Institute for Work and Health (IWH) de Canadá, cuestionario en inglés, corto y ampliamente validado internacionalmente. El objetivo es obtener una versión adaptada transculturalmente de la herramienta OPM, traducida al castellano y analizar su fiabilidad estadística, validez y consistencia interna. MÉTODO: Tras un proceso de traducción y retro traducción con un panel de expertos, se cumplimentaron en Navarra, España, 478 cuestionarios. Se calculó el estadístico alfa de Cronbach, las correlaciones bivariadas, el índice de correlación intraclase (ICC) y un análisis factorial exploratorio a los ocho ítems que lo forman. RESULTADOS: el análisis muestra una alta fiabilidad (alfa de Cronbach=0,863) y validez interna (ICC = 0,842) de la herramienta. El análisis factorial confirma un único factor latente entre los ocho ítems del cuestionario. CONCLUSIONES: El cuestionario obtenido (OPM-Esp) constituye un instrumento válido como indicador positivo de esfuerzo preventivo para las empresas españolas. Su reducido tamaño y fácil aplicación lo hacen especialmente útil en el ámbito laboral. Su predictibilidad respecto a los accidentes de trabajo deberá valorarse para el entorno español

OBJECTIVE: Safety positive performance indicators (PPI) reflect key aspects of safety culture; some of them also have predictive validity for occupational injuries. This is the case of the Organizational Performance Metric (OPM), developed by the Canadian Institute for Work & Health (IWH), a short, widely validated international English language questionnaire. The objective of this study was to obtain a transculturally adapted Spanish language version of the OPM, and to analyze its statistical reliability, validity and internal consistency. METHOD: After a translation and back translation process was performed by an expert panel, 478 questionnaires were completed in Navarra, Spain. We calculated the Cronbach alpha coefficient, bivariate correlations and the intra-class correlation coefficient (ICC) and performed exploratory factorial analysis of all eight items. RESULTS: Data show the new tool has high reliability (Cronbach alpha = 0.863) and internal validity (ICC = 0.842). The factorial analysis confirmed a single latent factor among the eight items of the questionnaire. CONCLUSIONS: the adapted questionnaire (OPM-Esp) constitutes a valid instrument for use as an indicator of safety performance in Spanish companies. Its brevity and simplicity make it especially useful in the work environment. Its ability to predict occupational injuries should be tested in the Spanish context

[Transcultural adaptation and validation of the Organizational Performance Metric safety culture questionnaire]. / Adaptación transcultural y validación del cuestionario de cultura preventiva Organizational Performance Metric.

OBJECTIVE: Safety positive performance indicators (PPI) reflect key aspects of safety culture; some of them also have predictive validity for occupational injuries. This is the case of the Organizational Performance Metric (OPM), developed by the Canadian Institute for Work & Health (IWH), a short, widely validated international English language questionnaire. The objective of this study was to obtain a transculturally adapted Spanish language version ofthe OPM, and to analyze its statistical reliability, validity and internal consistency. METHOD: After a translation and back translation process was performed by an expert panel, 478 questionnaires were completed in Navarra, Spain. We calculated the Cronbach alpha coefficient, bivariate correlations and the intra-class correlation coefficient (ICC) and performed exploratory factorial analysis of all eight items. RESULTS: Data show the new tool has high reliability (Cronbach alpha==0.863) and internal validity (ICC=0.842). The factorial analysis confirmed a single latent factor among the eight items of the questionnaire. CONCLUSIONS: the adapted questionnaire (OPM-Esp) constitutes a valid instrument for use as an indicator of safety performance in Spanish companies. Its brevity and simplicity make it especially useful in the work environment. Its ability to predict occupational injuries should be tested in the Spanish context.

OBJETIVO: Los Indicadores Positivos de Esfuerzo Preventivo (IPEP) reflejan aspectos centrales de la cultura preventiva; existen evidencias respecto a la validez predictiva de algunos de estos respecto a los accidentes de trabajo. Éste es el caso del Organizational Performance Metric (OPM) desarrollado por el Institute for Work & Health (IWH) de Canadá, cuestionario en inglés, corto y ampliamente validado internacionalmente. El objetivo es obtener una versión adaptada transculturalmente de la herramienta OPM, traducida al castellano y analizar su fiabilidad estadística, validez y consistencia interna. MÉTODO: Tras un proceso de traducción y retro traducción con un panel de expertos, se cumplimentaron en Navarra, España, 478 cuestionarios. Se calculó el estadístico alfa de Cronbach, las correlaciones bivariadas, el índice de correlación intraclase (ICC) y un análisis factorial exploratorio a los ocho ítems que lo forman. RESULTADOS: el análisis muestra una alta fiabilidad (alfa de Cronbach=0,863) y validez interna(ICC=0,842) de la herramienta. El análisis factorial confirma un único factor latente entre los ocho ítems del cuestionario. CONCLUSIONES: El cuestionario obtenido (OPM-Esp) constituye un instrumento válido como indicador positivo de esfuerzo preventivo para las empresas españolas. Su reducido tamaño y fácil aplicación lo hacen especialmente útil en el ámbito laboral. Su predictibilidad respecto a los accidentes de trabajo deberá valorarse para el entorno español.

[Return to work in the context of the COVID-19 pandemic in the industrial and construction sectors in Navarre (Spain)]. / Reincorporación al trabajo en el contexto de la pandemia de COVID-19 en sectores de industria y construcción en Navarra (España).

OBJECTIVE: To analyse the compliance of the preventive instructions formulated by the Health Authority against COVID-19 for the de-escalation phase among the industrial and construction sectors in Navarre. METHODS: On the basis of those preventive instructions, questionnaires were drawn up to verify their implementation on site. The occupational risk prevention technicians of the Occupational Health Service (OHS) of the Institute of Public and Work Health of Navarre and those of the External Prevention Services (EPS), under the executive coordination of the OHS, visited the enterprises to advise, verify and require, if necessary, compliance with the instructions dictated. RESULTS: The compliance of the preventive instructions is higher in the industrial sector than in the construction sector. Cleaning practices, hygienic resources and the provision of respiratory protection equipment are widespread. The application of necessary measures in common places (restrooms, dining rooms) are less frequent. There is a lack of informative posters and written corroboration of the preventive instructions. The difference of several results between the OHS and the EPS technicians is remarkable. CONCLUSIONS: Weaknesses have been identified in achieving safe workplaces in the construction and industrial sectors during the de-escalation phase in the context of the Covid-19 pandemic. The role of Public Health in the enterprises and the integration of the prevention services in public policies against occupational risks must be reconsidered.

OBJETIVO: Analizar el grado de cumplimiento de las medidas preventivas dictadas por la Autoridad Sanitaria frente a la Covid-19 durante las fases de desescalada en empresas del sector industrial y de construcción en Navarra. MÉTODOS: Se elaboraron cuestionarios a partir de las medidas establecidas para verificar in situ el grado de aplicación. El personal técnico de prevención del Servicio de Salud Laboral (SSL) del Instituto de Salud Pública y Laboral de Navarra y de los servicios de prevención ajenos (SPA) visitaron las empresas para asesorar, comprobar y requerir, en su caso, el cumplimiento de las medidas dictadas. RESULTADOS: El grado de cumplimiento de las medidas es mayor en industria que en construcción. Se han generalizado las prácticas de limpieza, los recursos higiénicos y la disposición de elementos de protección respiratoria. La aplicación de medidas necesarias en loslugares comunes (baños, comedores) es menos frecuente. Hay carencia de cartelería informativa y de constancia escrita de las instrucciones preventivas. Se observan diferencias devarios resultados entre la labor desarrollada por los SPA y por el SSL. CONCLUSIONES: Se han detectado debilidades en la consecución de espacios seguros en eltrabajo en los sectores de la construcción e industria durante la fase de desescalada en el contexto de la pandemia de la Covid-19. Debe ser reconsiderado el papel de la salud públicaen las empresas y la integración de los servicios de prevención en las políticas públicas frente a los riesgos laborales.

Estimación de la prevalencia de infección diagnosticada y no diagnosticada por el virus de la hepatitis C en Navarra, 2014-2016 / The prevalence of diagnosed and undiagnosed hepatitis C virus infection in Navarra, Spain, 2014-2016

OBJETIVO: Estimar la prevalencia de infección por el virus de la hepatitis C (VHC) en Navarra, distinguiendo entre infecciones diagnosticadas y no diagnosticadas. MÉTODOS: Se estudiaron pacientes con cirugía programada no relacionada con la infección por VHC, a los que se les realizó de forma sistemática la determinación de anticuerpos del VHC entre enero de 2014 y septiembre de 2016. En los pacientes con enzimoinmunoanálisis positivo se confirmó el diagnóstico mediante inmunoblot y/o determinación de ARN-VHC. También se comprobó la existencia de resultados positivos previos. La prevalencia se estandarizó por sexo y edad a la población de Navarra. RESULTADOS: Se analizaron 7.378 pacientes, 50% mujeres, con una mediana de edad de 46 años. En 69 se detectaron anticuerpos del VHC, lo que supone una prevalencia poblacional estimada de 0,83% (intervalo de confianza del 95%: 0,64-1,05), mayor en hombres (1,11%) que en mujeres (0,56%; p = 0,0102). Entre los que resultaron anti-VHC positivos, 67 (97%) habían tenido alguna prueba positiva previa. La prevalencia poblacional de diagnóstico previo de anti-VHC fue del 0,80%, y la de nuevos diagnósticos, del 0,03%. El 78% de los pacientes con anti-VHC positivo habían presentado alguna determinación de ARN-VHC detectable. Se estima que el 0,65% de la población había tenido ARN-VHC detectable y el 0,51% lo seguía teniendo en el momento del estudio. CONCLUSIÓN: Estos resultados revisan a la baja las estimaciones previas de prevalencia de infección por VHC. Una proporción mínima de las personas con anti-VHC permanecen sin diagnosticar, y solo una parte mantienen infección activa

OBJECTIVE: To estimate the prevalence of hepatitis C virus (HCV) infection in Navarra, Spain, as well as to distinguish between diagnosed and undiagnosed infections. METHODS: A study was conducted on patients scheduled for surgery unrelated to HCV infection. They were all tested for HCV antibodies, under a routine scheme, from January 2014 to September 2016. Patients with a positive result by enzyme immunoassay were confirmed using immunoblot and/or HCV-RNA. Previous laboratory results were also taken into account. The prevalence was adjusted to the sex and age structure of the Navarra population. RESULTS: The study included a total of 7,378 patients with a median age 46 years, of whom 50% women. HCV antibodies were detected in 69 patients, which is a prevalence in the population of 0.83% (95% confidence interval: 0.64-1.05), and was higher in men (1.11%) than in women (0.56%; P = .0102). Among the HCV positive patients, 67 (97%) had had another previous positive result. Population prevalence of previous positive HCV was 0.80%, and was 0.03% for a new diagnosis. Of the HCV positive patients, 78% had detectable HCV-RNA. It was estimated that 0.65% of the population had had detectable HCV-RNA, and 0.51% continued to have it when recruited into the study. CONCLUSION: Previous estimates of prevalence of HCV infection should be revised downwards. Only a small proportion of HCV positive patients remain undiagnosed, and only a small part have active infection

Comparison of influenza vaccine effectiveness in preventing outpatient and inpatient influenza cases in older adults, northern Spain, 2010/11 to 2015/16.

IntroductionWe compared trivalent inactivated influenza vaccine effectiveness (VE) in preventing outpatient and inpatient influenza cases in Navarre, Spain. Methods: During seasons 2010/11 to 2015/16, community-dwelling patients with influenza-like illness aged 50 years or older were tested for influenza when attended by sentinel general practitioners or admitted to hospitals. The test-negative design was used to estimate and compare the VE by healthcare setting. Results: We compared 1,242 laboratory-confirmed influenza cases (557 outpatient and 685 inpatient cases) and 1,641 test-negative controls. Influenza VE was 34% (95% confidence interval (CI): 6 to 54) in outpatients and 32% (95% CI: 15 to 45) in inpatients. VE in outpatients and inpatients was, respectively, 41% (95% CI: -1 to 65) and 36% (95% CI: 12 to 53) against A(H1N1)pdm09, 5% (95% CI: -58 to 43) and 22% (95% CI: -9 to 44) against A(H3N2), and 49% (95% CI, 6 to 73) and 37% (95% CI: 2 to 59) against influenza B. Trivalent inactivated influenza vaccine was not associated with a different probability of hospitalisation among influenza cases, apart from a 54% (95% CI: 10 to 76) reduction in hospitalisation of influenza A(H3N2) cases. Conclusions: On average, influenza VE was moderate and similar in preventing outpatient and inpatient influenza cases over six influenza seasons in patients above 50 years of age. In some instances of low VE, vaccination may still reduce the risk of hospitalisation in older adults with vaccine failure.

The prevalence of diagnosed and undiagnosed hepatitis C virus infection in Navarra, Spain, 2014-2016. / Estimación de la prevalencia de infección diagnosticada y no diagnosticada por el virus de la hepatitis C en Navarra, 2014-2016.

OBJECTIVE: To estimate the prevalence of hepatitis C virus (HCV) infection in Navarra, Spain, as well as to distinguish between diagnosed and undiagnosed infections. METHODS: A study was conducted on patients scheduled for surgery unrelated to HCV infection. They were all tested for HCV antibodies, under a routine scheme, from January 2014 to September 2016. Patients with a positive result by enzyme immunoassay were confirmed using immunoblot and/or HCV-RNA. Previous laboratory results were also taken into account. The prevalence was adjusted to the sex and age structure of the Navarra population. RESULTS: The study included a total of 7,378 patients with a median age 46 years, of whom 50% women. HCV antibodies were detected in 69 patients, which is a prevalence in the population of 0.83% (95% confidence interval: 0.64-1.05), and was higher in men (1.11%) than in women (0.56%; P=.0102). Among the HCV positive patients, 67 (97%) had had another previous positive result. Population prevalence of previous positive HCV was 0.80%, and was 0.03% for a new diagnosis. Of the HCV positive patients, 78% had detectable HCV-RNA. It was estimated that 0.65% of the population had had detectable HCV-RNA, and 0.51% continued to have it when recruited into the study. CONCLUSION: Previous estimates of prevalence of HCV infection should be revised downwards. Only a small proportion of HCV positive patients remain undiagnosed, and only a small part have active infection.

Care patterns and changes in treatment for nonmetastatic breast cancer in 2013-2014 versus 2005: a population-based high-resolution study.

Studies on recent trends in patterns of care for breast cancer patients are scarce. This study aims to examine the patterns and trends in the treatment of women with nonmetastatic breast cancer according to major recommended treatment options. A population-based study was carried out in Navarra, Spain, including all women with a primary invasive nonmetastasized breast cancer, diagnosed in 2005 and in 2013-2014. We compared patients' characteristics and treatment patterns between periods. Factors associated with receipt of recommended treatment were examined by multivariate logistic regression. Of the 719 patients included, 90% received guideline-adherent locoregional treatment. Over the two periods, there was an increasing use of sentinel lymph node biopsy as opposed to axillary lymph node dissection as the first axillary procedure. Among women with oestrogen receptor-positive tumours, 96% received endocrine therapy. The proportion of high-risk patients who were treated with chemotherapy increased between the two periods from 65 to 74% (P=0.079) and, among patients with human epidermal growth factor receptor 2-positive tumours, the receipt of targeted treatment increased from 37 to 72% (P<0.001). The main factors associated independently with a lower probability of receiving recommended treatment were age 70 years or older for all treatment modalities and comorbidity for locoregional treatment and chemotherapy. The proportion of women with breast cancer who received treatment according to recent European guidelines in Navarra has increased from 2005 to 2013-2014, resulting in a high level of adherence to standard care. Most failures in adherence to these standards are related to older age or comorbidities.

2015/16 seasonal vaccine effectiveness against hospitalisation with influenza A(H1N1)pdm09 and B among elderly people in Europe: results from the I-MOVE+ project.

We conducted a multicentre test-negative case-control study in 27 hospitals of 11 European countries to measure 2015/16 influenza vaccine effectiveness (IVE) against hospitalised influenza A(H1N1)pdm09 and B among people aged ≥ 65 years. Patients swabbed within 7 days after onset of symptoms compatible with severe acute respiratory infection were included. Information on demographics, vaccination and underlying conditions was collected. Using logistic regression, we measured IVE adjusted for potential confounders. We included 355 influenza A(H1N1)pdm09 cases, 110 influenza B cases, and 1,274 controls. Adjusted IVE against influenza A(H1N1)pdm09 was 42% (95% confidence interval (CI): 22 to 57). It was 59% (95% CI: 23 to 78), 48% (95% CI: 5 to 71), 43% (95% CI: 8 to 65) and 39% (95% CI: 7 to 60) in patients with diabetes mellitus, cancer, lung and heart disease, respectively. Adjusted IVE against influenza B was 52% (95% CI: 24 to 70). It was 62% (95% CI: 5 to 85), 60% (95% CI: 18 to 80) and 36% (95% CI: -23 to 67) in patients with diabetes mellitus, lung and heart disease, respectively. 2015/16 IVE estimates against hospitalised influenza in elderly people was moderate against influenza A(H1N1)pdm09 and B, including among those with diabetes mellitus, cancer, lung or heart diseases.

Effect of Repeated Vaccination With the Same Vaccine Component Against 2009 Pandemic Influenza A(H1N1) Virus.

Background: The 2009 pandemic influenza A(H1N1) (A[H1N1]pdm09) vaccine component has remained unchanged from 2009. We estimate the effectiveness of current and prior inactivated influenza A(H1N1)pdm09 vaccination from influenza seasons 2010-2011 to 2015-2016. Methods: Patients attended with influenza-like illness were tested for influenza. Four periods with continued A(H1N1)pdm09 circulation were included in a test-negative design. Results: We enrolled 1278 cases and 2343 controls. As compared to individuals never vaccinated against influenza A(H1N1)pdm09, the highest effectiveness (66%; 95% confidence interval, 49%-78%) was observed in those vaccinated in the current season who had received 1-2 prior doses. The effectiveness was not statistically lower in individuals vaccinated in the current season only (52%) or in those without current vaccination and >2 prior doses (47%). However, the protection was lower in individuals vaccinated in the current season after >2 prior doses (38%; P = .009) or those currently unvaccinated with 1-2 prior doses (10%; P < .001). Current-season vaccination improved the effect in individuals with 1-2 prior doses and did not modify significantly the risk of influenza in individuals with >2 prior doses. Conclusion: Current vaccination or several prior doses were needed for high protection. Despite the decreasing effect of repeated vaccination, current-season vaccination was not inferior to no current-season vaccination.

Combined effectiveness of prior and current season influenza vaccination in northern Spain: 2016/17 mid-season analysis.

The 2016/17 mid-season vaccine effectiveness estimate against influenza A(H3N2) was 15% (95% confidence interval: -11 to 35) in Navarre. Comparing to individuals unvaccinated in the current and four prior seasons, effectiveness was 24% for current and 3-4 prior doses, 61% for current and 1-2 prior doses, 42% for only current vaccination, and 58% for 3-4 prior doses. This suggests moderate effectiveness for different combinations of vaccination in the current and prior seasons.

Caracterización de la conjuntivitis alérgica en el niño / Characterization of allergic conjunctivitis in the child

Introducción: la alergia ocular es una entidad de presentación muy frecuente en la práctica clínica de la Oftalmología. Objetivo: caracterizar los pacientes pediátricos con conjuntivitis alérgica del Servicio de Oftalmología del Hospital William Soler. Métodos: se realizó un estudio observacional, descriptivo y prospectivo, durante el bienio 2010-2011, cuyo universo de estudio estuvo constituido por los pacientes con diagnóstico presuntivo de conjuntivitis alérgica, y la muestra, aplicados los criterios de inclusión y exclusión, quedó conformada por 80 pacientes. Se analizaron las variables: edad, sexo, color de la piel, presentación clínica y factores de riesgo asociados. Se utilizó la estadística descriptiva (frecuencias absolutas y porcentaje). Resultados: predominaron los niños entre 8 y 13 años (68,8 por ciento), seguidos por aquellos entre 3 y 7 (12,5 por ciento) y entre 14 y 18 años (1,9 por ciento), los varones (72,5 por ciento) y el color blanco de la piel (71,2 por ciento). El tipo clínico de conjuntivitis alérgica más frecuente resultó la estacional y perenne (38,8 por ciento), seguido de la aguda (31,3 por ciento), y, el de menor presentación, la dermatoconjuntivitis de contacto (5,0 por ciento). La exposición al polvo se refirió por el 100 por ciento de los pacientes. Conclusiones: predominaron los niños entre 8 y 13 años, los varones y el color blanco de la piel. El tipo clínico de conjuntivitis alérgica más frecuente resultó la estacional y perenne, y el factor de riesgo asociado, la exposición al polvo(AU)

Introduction: ocular allergy is a disease that frequently presents in clinical practice in ophthalmology. Objectives: to characterize the pediatric patients with allergic conjunctivitis of the ophthalmological service of William Soler hospital. Methods: a prospective, observational and descriptive study was conducted in 2010 and 2011; the universe of study was the patients with presumptive diagnosis of allergic conjunctivitis and the sample was made up of 80 patients after the application of inclusion and exclusion criteria. The analyzed variables were age, sex, race, clinical presentation and associated risk factors. Descriptive statistics (absolute frequencies and percentages) were used. Results: children aged 8 to 13 years (68.8 percent) were predominant, followed by those of 3 to 7 years (12.5 percent) and 14 to 18 years (1.9 percent), males (72.5 percent) and Caucasians (71.2 percent). The most common clinical type of allergic conjunctivitis was the seasonal and permanent one (38.8 percent), followed by the acute one (31.3 percent) and the least observed was contact dermatoconjunctivitis (5 percent). Exposure to dust was mentioned in 100 percent of patients. Conclusions: children aged 8 to 13 years, males and Caucasians prevailed. The most frequent clinical type of allergic conjunctivitis was the seasonal and perennial one and the associated risk factor was exposure to dust(AU)

Gangliosidosis generalizada tipo 1 / Generalized gangliosidosis type 1

La gangliosidosis generalizada tipo 1 es una enfermedad de acúmulo lisosomal producida por mutaciones en el gen de la enzima b-galactosidasa, caracterizada fundamentalmente por toma del sistema nervioso central, la visceromegalia, disostosis ósea y dimorfismo facial. Se presenta el caso de un lactante varón, hijo de padres no consanguíneos, de 5 meses de edad, Apgar 6/8 debido a hipoxia neonatal, con historia de múltiples ingresos por enfermedad diarreica e infecciones respiratorias. Es remitido a la Consulta de Genética Clínica por retardo del desarrollo psicomotor, macrocráneo y hepatomegalia, además de máculas hipercrómicas en piel. En el examen físico se encontraron evidencias de una posible afectación por enfermedad metabólica lisosomal. Entre las enfermedades a descartar estaban la galactosialidosis, de características clínicas similares, y la enfermedad de Morquio, con diferente presentación clínica pero idéntico defecto enzimático(AU)

Generalized or GM 1 gangliosidosis is a lysosomal storage disease caused by mutations in the enzyme b-galactosidase gene, mainly characterized by affecting the central nervous system, visceromegalia, osseous dysostosis and facial dimorphism. This is the case of a male nursling born to non-consanguineous parents, 5 months of age, Apgar index of 6/8 due to neonatal hypoxia, with a history of several admissions to hospital because of diarrheal disease and respiratory infections. He was referred to the clinical genetic service since he presented with retarded psychomotor development, macrocrania and hepatomegalia, in addition to hyperchromic skin spots. The physical exam found evidence of possible effects by lysosomal metabolic disease. Among the diseases to be ruled out for the diagnosis were galactosialidosis of similar clinical characteristics and Morquio B disease with different clinical presentation but identical enzymatic deficiency(AU)

Caracterización de la conjuntivitis alérgica en el niño / Characterization of allergic conjunctivitis in the child

Introducción: la alergia ocular es una entidad de presentación muy frecuente en la práctica clínica de la Oftalmología. Objetivo: caracterizar los pacientes pediátricos con conjuntivitis alérgica del Servicio de Oftalmología del Hospital William Soler. Métodos: se realizó un estudio observacional, descriptivo y prospectivo, durante el bienio 2010-2011, cuyo universo de estudio estuvo constituido por los pacientes con diagnóstico presuntivo de conjuntivitis alérgica, y la muestra, aplicados los criterios de inclusión y exclusión, quedó conformada por 80 pacientes. Se analizaron las variables: edad, sexo, color de la piel, presentación clínica y factores de riesgo asociados. Se utilizó la estadística descriptiva (frecuencias absolutas y porcentaje). Resultados: predominaron los niños entre 8 y 13 años (68,8 por ciento), seguidos por aquellos entre 3 y 7 (12,5 por ciento) y entre 14 y 18 años (1,9 por ciento), los varones (72,5 por ciento) y el color blanco de la piel (71,2 por ciento). El tipo clínico de conjuntivitis alérgica más frecuente resultó la estacional y perenne (38,8 por ciento), seguido de la aguda (31,3 por ciento), y, el de menor presentación, la dermatoconjuntivitis de contacto (5,0 por ciento). La exposición al polvo se refirió por el 100 por ciento de los pacientes. Conclusiones: predominaron los niños entre 8 y 13 años, los varones y el color blanco de la piel. El tipo clínico de conjuntivitis alérgica más frecuente resultó la estacional y perenne, y el factor de riesgo asociado, la exposición al polvo

Introduction: ocular allergy is a disease that frequently presents in clinical practice in ophthalmology. Objectives: to characterize the pediatric patients with allergic conjunctivitis of the ophthalmological service of William Soler hospital. Methods: a prospective, observational and descriptive study was conducted in 2010 and 2011; the universe of study was the patients with presumptive diagnosis of allergic conjunctivitis and the sample was made up of 80 patients after the application of inclusion and exclusion criteria. The analyzed variables were age, sex, race, clinical presentation and associated risk factors. Descriptive statistics (absolute frequencies and percentages) were used. Results: children aged 8 to 13 years (68.8 percent) were predominant, followed by those of 3 to 7 years (12.5 percent) and 14 to 18 years (1.9 percent), males (72.5 percent) and Caucasians (71.2 percent). The most common clinical type of allergic conjunctivitis was the seasonal and permanent one (38.8 percent), followed by the acute one (31.3 percent) and the least observed was contact dermatoconjunctivitis (5 percent). Exposure to dust was mentioned in 100 percent of patients. Conclusions: children aged 8 to 13 years, males and Caucasians prevailed. The most frequent clinical type of allergic conjunctivitis was the seasonal and perennial one and the associated risk factor was exposure to dust

Gangliosidosis generalizada tipo 1 / Generalized gangliosidosis type 1

La gangliosidosis generalizada tipo 1 es una enfermedad de acúmulo lisosomal producida por mutaciones en el gen de la enzima b-galactosidasa, caracterizada fundamentalmente por toma del sistema nervioso central, la visceromegalia, disostosis ósea y dimorfismo facial. Se presenta el caso de un lactante varón, hijo de padres no consanguíneos, de 5 meses de edad, Apgar 6/8 debido a hipoxia neonatal, con historia de múltiples ingresos por enfermedad diarreica e infecciones respiratorias. Es remitido a la Consulta de Genética Clínica por retardo del desarrollo psicomotor, macrocráneo y hepatomegalia, además de máculas hipercrómicas en piel. En el examen físico se encontraron evidencias de una posible afectación por enfermedad metabólica lisosomal. Entre las enfermedades a descartar estaban la galactosialidosis, de características clínicas similares, y la enfermedad de Morquio, con diferente presentación clínica pero idéntico defecto enzimático

Generalized or GM 1 gangliosidosis is a lysosomal storage disease caused by mutations in the enzyme b-galactosidase gene, mainly characterized by affecting the central nervous system, visceromegalia, osseous dysostosis and facial dimorphism. This is the case of a male nursling born to non-consanguineous parents, 5 months of age, Apgar index of 6/8 due to neonatal hypoxia, with a history of several admissions to hospital because of diarrheal disease and respiratory infections. He was referred to the clinical genetic service since he presented with retarded psychomotor development, macrocrania and hepatomegalia, in addition to hyperchromic skin spots. The physical exam found evidence of possible effects by lysosomal metabolic disease. Among the diseases to be ruled out for the diagnosis were galactosialidosis of similar clinical characteristics and Morquio B disease with different clinical presentation but identical enzymatic deficiency