Antiviral treatment for SARS-CoV-2 infection in the current situation: a position paper of the Spanish Society of Emergency Medicine (SEMES). / Posicionamiento de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) ante el tratamiento antiviral frente al SARS-CoV-2 en la situación epidemiológica actual.

SUMMARY: COVID-19 continues to pose a significant threat: mortality stands at nearly twice that of influenza, and the incidence rate is growing as the population's vaccination rate decreases, particularly in Spain and other areas of Europe. Given this situation, it is vitally important know whether medical protocols are consistent and appropriately implemented by health care staff in the interest of preventing possible inefficiency or inequity. Physicians from hospital emergency departments met to study their hospitals' usual clinical practices for managing SARS-CoV-2 infection and to determine their expert opinions on the use of antiviral agents. The participating physicians then reached consensus on evidencebased recommendations for strategies that would optimize emergency treatment.

RESUMEN: Actualmente, la COVID-19 sigue representando una amenaza significativa, con una mortalidad cercana al doble de la ocasionada por la gripe y con una incidencia variable debido a una disminución en la tasa de vacunación de la población, especialmente en el contexto europeo y español. Ante este panorama, es de vital importancia comprobar que los protocolos médicos están consolidados y son debidamente implementados por los profesionales sanitarios, con la finalidad de evitar posibles ineficiencias o inequidades. A través de reuniones con profesionales de urgencias se han observado las prácticas clínicas habituales en los servicios de urgencias hospitalarios para pacientes con infección por SARS-CoV-2, con la finalidad de comprender la perspectiva de estos profesionales acerca del uso de antivirales y, tras un consenso de expertos basados en la evidencia actual, se han generado estas de recomendaciones para poder enfocar estrategias que optimicen el tratamiento de los pacientes en estos servicios.

Behavioral Study of 3- and 5-Halocytisine Derivatives in Zebrafish Using the Novel Tank Diving Test (NTT).

Anxiety is a serious mental disorder, and recent statistics have determined that 35.12% of the global population had an anxiety disorder during the COVID-19 pandemic. A mechanism associated with anxiolytic effects is related to nicotinic acetylcholine receptor (nAChR) agonists, principally acting on the α4ß2 nAChR subtype. nAChRs are present in different animal models, including murine and teleosteos ones. Zebrafish has become an ideal animal model due to its high human genetic similarities (70%), giving it high versatility in different areas of study, among them in behavioral studies related to anxiety. The novel tank diving test (NTT) is one of the many paradigms used for studies on new drugs related to their anxiolytic effect. In this work, an adult zebrafish was used to determine the behavioral effects of 3- and 5-halocytisine derivatives, using the NTT at different doses. Our results show that substitution at position 3 by chlorine or bromine decreases the time spent by the fish at the bottom compared to the control. However, the 3-chloro derivative at higher doses increases the bottom dwelling time. In contrast, substitution at the 5 position increases bottom dwelling at all concentrations showing no anxiolytic effects in this model. Unexpected results were observed with the 5-chlorocytisine derivative, which at a concentration of 10 mg/L produced a significant decrease in bottom dwelling and showed high times of freezing. In conclusion, the 3-chloro and 3-bromo derivatives show an anxiolytic effect, the 3-chlorocytisine derivative being more potent than the 3-bromo derivative, with the lowest time at the bottom of the tank at 1mg/L. On the other hand, chlorine, and bromine at position 5 produce an opposite effect.

Uso de escalas predictivas de tromboembolia pulmonar en un servicio de urgencias / Use of predictive scales for pulmonary thromboembolism in an emergency department

Antecedentes y objetivo: Diagnosticar la tromboembolia pulmonar (TEP) es difícil. Existen escalas de probabilidad clínica (EPC) que ayudan. Se quiere averiguar cuál es mejor.Pacientes y métodosSe realizó un estudio unicéntrico transversal retrospectivo que evaluó la validez de 4 EPC en 200 pacientes en los que se realizó una tomografía computarizada de arterias pulmonares: criterios Pulmonary Embolism Rule out Criteria (PERC), Wells, Ginebra y YEARS. Se estimó su grado de uso, y la posible correlación entre su puntuación y el dímero D (DD).ResultadosLas 4 EPC tienen una alta sensibilidad, cercana a uno y sin diferencias entre ellas. La escala YEARS resultó ser entre 2 y 4 veces más específica que las otras 3. El grado de uso de las escalas se estimó en un 14% (IC 95%: 9,19-18,81). Se halló una débil correlación positiva entre la puntuación de las escalas Wells y Ginebra y el DD.ConclusionesLa escala YEARS se muestra mejor que las demás por su potencial mayor número de pruebas de imagen evitadas y el grado de aplicación de las EPC es mejorable. (AU)

Background and objective: Diagnosing pulmonary thromboembolism (PTE) is difficult. Clinical probability scales (CPS) can help. The aim is to find out which one is the best.Patients and methodsA retrospective cross-sectional single-center study was conducted. It evaluated four CPS (Pulmonary Embolism Rule Out Criteria [PERC], Wells, Geneva, and YEARS criteria) validity in 200 patients who underwent computerized tomography angiography of the pulmonary arteries. Their degree of use was estimated, as well as the possible correlation between them and DD (D dimer).ResultsThe four CPS have a high sensitivity, close to 1 and without differences between them. The YEARS scale is between 2 and 4 times more specific than the others. The degree of use of the scales was estimated at 14% (95% CI: 9.19-18.81). A weak positive correlation was found between the scores on the Wells and Geneva scales and the DD.ConclusionsThe YEARS scale is shown to be better than the others due to its potential greater number of imaging tests avoided and the degree of application of the CPS could be improved. (AU)

Use of predictive scales for pulmonary thromboembolism in an emergency department. / Uso de escalas predictivas de tromboembolia pulmonar en un servicio de urgencias.

BACKGROUND AND OBJECTIVE: Diagnosing pulmonary thromboembolism (PTE) is difficult. Clinical probability scales (CPS) can help. The aim is to find out which one is the best. PATIENTS AND METHODS: A retrospective cross-sectional single-center study was conducted. It evaluated four CPS (Pulmonary Embolism Rule Out Criteria [PERC], Wells, Geneva, and YEARS criteria) validity in 200 patients who underwent computerized tomography angiography of the pulmonary arteries. Their degree of use was estimated, as well as the possible correlation between them and DD (D dimer). RESULTS: The four CPS have a high sensitivity, close to 1 and without differences between them. The YEARS scale is between 2 and 4 times more specific than the others. The degree of use of the scales was estimated at 14% (95% CI: 9.19-18.81). A weak positive correlation was found between the scores on the Wells and Geneva scales and the DD. CONCLUSIONS: The YEARS scale is shown to be better than the others due to its potential greater number of imaging tests avoided and the degree of application of the CPS could be improved.

Utilidad del dímero D en el diagnóstico de tromboembolismo pulmonar en los pacientes con COVID-19 en urgencias: estimación de su capacidad discriminativa, sensibilidad y especificidad / Usefulness of D-dimer concentration in the diagnosis of pulmonary thromboembolism in patients with COVID-19 in the emergency department: estimating its discriminative capacity, sensitivity, and specificity

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Prevención de eventos adversos cardiacos relacionados con el uso de fármacos en pacientes con trastorno mental grave: a propósito de un caso / Prevention of cardiac adverse events associated with the use of drugs in patients with severe mental illness: case report

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Electrocardiographic surveillance in a psychiatric institution: avoiding iatrogenic cardiovascular death.

OBJECTIVE: To describe a new initiative developed to optimise patient safety in a mental health setting in order to prevent serious cardiac events. MATERIALS AND METHODS: A longitudinal study of all in-patients admitted at the hospital, comprised of 197 beds distributed among three units, was conducted for 12 months. All admitted patients at the hospital underwent electrocardiogram surveillance, as it was described in our new local guideline for sudden cardiac death prevention. When electrocardiographic alterations were detected, treating physicians searched for patient's risk factors and suspicious medication and communicated the adverse event to the Pharmacy Department. These data were registered in electronic medical record system. RESULTS: Over the 12-month study period, 225 patients were evaluated and 9 cases (4%) of long QT segment were detected. A multidisciplinary evaluation was done and it resulted in treatment modification and patient close monitoring. No sudden cardiac deaths occurred during the study period. Drugs more often involved in QT segment prolongation were: olanzapine, clomipramine, clozapine and risperidone. CONCLUSION: QT segment interval enlargement is a frequent clinical problem that affects patients with mental pathology. This inexpensive initiative has allowed identifying patients at risk of sudden cardiac death and has helped to avoid mayor side effects.

Tofo tibial intraóseo en gota crónica / Intrabony tibial tophi in chronic gout

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La enfermera asistencial y la investigación / The welfare nurses and the research work

Objetivos: averiguar el nivel de conocimientos básicos sobre investigacióny grado de interés e implicación de las enfermeras en nuestro centro.• Metodología: estudio descriptivo transversal en una muestra de enfermerasasistenciales, mediante cuestionario autoadministrado en elque se consignaron: datos personales, conocimientos sobre investigaciónen el ámbito laboral, participación y grado de implicación en proyectose interés formativo en investigación.• Resultados: se cumplimentaron 110 de 240 encuestas, siendo56,6% mujeres y 43,4% hombres. Se declaró un pequeño porcentajecon conocimiento sobre metodología de investigación (12,5%), perohubo un alto acuerdo (más del 86%) sobre la necesidad, utilidad e interésde la investigación enfermera. Se conocía en general cómo obtenerasesoramiento para investigar. El 91,6% investigaría en un proyectoque le interesara. Entre los temas propuestos para formarse destacaronla búsqueda bibliográfica y cómo publicar. Como temas interesantespara investigar resaltaron la formación en Enfermería,panificación de cuidados y registros y documentación enfermera.• Conclusiones: una gran mayoría reconoce la importancia de la investigaciónenfermera, lo que mantiene la esperanza en progresar en estavía de desarrollo profesional. Conocer el estado actual del “espíritu investigador”de nuestro centro permitirá elaborar estrategias que mejorensu proceso y aumente la calidad de los trabajos que ya se realizan,proponiéndose un liderazgo mixto como sistema más apropiado