Predictive usefulness of qSOFA, NEWS and GYM scores in the elderly patient: EDEN-5 study.

OBJECTIVE: To analyze the prognostic accuracy of the scores NEWS, qSOFA, GYM used in hospital emergency department (ED) in the assessment of elderly patients who consult for an infectious disease. METHODS: Data from the EDEN (Emergency Department and Elderly Need) cohort were used. This retrospective cohort included all patients aged ≥65 years seen in 52 Spanish EDs during two weeks (from 1-4-2019 to 7-4-2019 and 30/3/2020 to 5/4/2020) with an infectious disease diagnosis in the emergency department. Demographic variables, demographic variables, comorbidities, Charlson and Barthel index and needed scores parameters were recorded. The predictive capacity for 30-day mortality of each scale was estimated by calculating the area under the receiver operating characteristic (ROC) curve, and sensitivity and specificity were calculated for different cut-off points. The primary outcome variable was 30-day mortality. RESULTS: 6054 patients were analyzed. Median age was 80 years (IQR 73-87) and 45.3% women. 993 (16,4%) patients died. NEWS score had better AUC than qSOFA (0.765, 95CI: 0.725-0.806, versus 0.700, 95%CI: 0.653-0.746; P < .001) and GYM (0.716, 95%CI: 0.675-0.758; P = .024), and there was no difference between qSOFA and GYM (P = .345). The highest sensitivity scores for 30-day mortality were GYM ≥ 1 point (85.4%) while the qSOFA score ≥2 points showed high specificity. In the case of the NEWS scale, the cut-off point ≥4 showed high sensitivity, while the cut-off point NEWS ≥ 8 showed high specificity. CONCLUSION: NEWS score showed the highest predictive capacity for 30-day mortality. GYM score ≥1 showed a great sensitivity, while qSOFA ≥2 scores provide the highest specificity but lower sensitivity.

Decalogue to promote the implementation and improvement of recommendations for the early diagnosis of HIV in Emergency Departments.

Early diagnosis of HIV is still a challenge. Emergency Departments (EDs) suppose ideal settings for the early detection of HIV, since patients with high prevalence of hidden HIV infection are frequently attending those services. In 2020, the Spanish Society of Emergency and Emergency Medicine (SEMES) published a series of recommendations for the early diagnosis of patients with suspected HIV infection and their referral and follow-up in the EDs as part of its "Deja tu huella" program. However, the application of these recommendations has been very heterogeneous in our country. Considering this, the working group of the HIV hospital network led by the SEMES has motivated the drafting of a decalogue, with the aim of promoting the implementation and improvement of protocols for the early diagnosis of HIV in Spanish EDs.

Recommendations for the early diagnosis of suspected human immunodeficiency virus infection in the emergency department and the referral of patients for follow-up: a consensus statement of the Spanish Society of Emergency Medicine (SEMES). / Recomendaciones dirigidas a los servicios de urgencias para el diagnóstico precoz de pacientes con sospecha de infección por VIH y su derivación para estudio y seguimiento.

Almost half of new diagnoses of human immunodeficiency virus (HIV) infection are made late, leading to increased morbidity and mortality, greater spread of infection, and higher public health care costs. Emergency services care for many patients who share behaviors associated with HIV transmission risk who arrive in clinical situations that are associated with HIV infection. A strategy to increase the rates of early diagnosis by promoting serology for HIV when caring for patients with certain clinical profiles might therefore be the key to improvement. This approach is hardly used at present, however, unless the result of serology would change the management of the acute complaint that led to the visit. These recommendations based on evidence from a search and review of recent publications were developed by a group of experts appointed by the Spanish Society of Emergency Medicine (SEMES). The resulting statement aims to support decision-making by emergency physicians and promote HIV screening and referral to appropriate specialists for follow-up in patients with certain conditions (sexually transmitted infections, herpes zoster, community-acquired pneumonia) or reporting certain scenarios (practice of chemsex, need for post-exposure prophylaxis). These 6 settings were selected because they are often seen in emergency departments and are common in patients with HIV-positive tests. The recommendations address when to order serology for HIV and how to manage the referral process. Included are decision-making tools for emergency physicians.

Casi la mitad de los nuevos diagnósticos de infección por el virus de la inmunodeficiencia humana (VIH) se realizan de forma tardía, lo cual provoca un aumento en la morbimortalidad, una mayor expansión de la epidemia y un incremento en los costes sanitarios públicos. En los servicios de urgencias se atiende a muchos de los pacientes que presentan situaciones indicadoras de infección por VIH o que comparten su misma vía de transmisión. Por lo tanto, pueden ser clave en una estrategia que mejore las tasas de diagnóstico precoz mediante la promoción de la solicitud de serologías frente al VIH durante la atención de determinados perfiles clínicos. Sin embargo, esto en la actualidad se produce escasamente a no ser que el resultado de la serología vaya a modificar el manejo del proceso agudo que ha motivado la consulta en urgencias. Las presentes recomendaciones se han desarrollado por un grupo de expertos designados por la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) en base a la identificación y revisión de la evidencia científica más reciente. El objetivo de este documento es dar soporte a los médicos de urgencias en la toma de decisiones, promoviendo el cribado del VIH y la derivación de los pacientes al especialista adecuado para su seguimiento posterior en seis entidades clínicas seleccionadas por su elevada prevalencia en pacientes VIH positivos y la alta frecuencia con la que son atendidas en urgencias: 1) infecciones de transmisión sexual; 2) profilaxis post exposición; 3) herpes zoster; 4) práctica del chemsex; 5) neumonía adquirida en la comunidad, y 6) síndrome mononucleósico. Las recomendaciones incluyen indicaciones sobre en qué pacientes debe realizarse una serología, el proceso de derivación y herramientas para ayudar a los médicos de urgencias en la toma de decisiones.

Recomendaciones dirigidas a los servicios de urgencias para el diagnóstico precoz de pacientes con sospecha de infección por VIH y su derivación para estudio y seguimiento / Recommendations for the early diagnosis of suspected human immunodeficiency virus infection in the emergency department and the referral of patients for follow-up: a consensus statement of the Spanish Society of Emergency Medicine (SEMES)

Casi la mitad de los nuevos diagnósticos de infección por el virus de la inmunodeficiencia humana (VIH) se realizan de forma tardía, lo cual provoca un aumento en la morbimortalidad, una mayor expansión de la epidemia y un in-cremento en los costes sanitarios públicos. En los servicios de urgencias se atiende a muchos de los pacientes que presentan situaciones indicadoras de infección por VIH o que comparten su misma vía de transmisión. Por lo tanto, pueden ser clave en una estrategia que mejore las tasas de diagnóstico precoz mediante la promoción de la solicitud de serologías frente al VIH durante la atención de determinados perfiles clínicos. Sin embargo, esto en la actualidad se produce escasamente a no ser que el resultado de la serología vaya a modificar el manejo del proceso agudo que ha motivado la consulta en urgencias. Las presentes recomendaciones se han desarrollado por un grupo de expertos designados por la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) en base a la identificación y revisión de la evidencia científica más reciente. El objetivo de este documento es dar soporte a los médicos de urgencias en la toma de decisiones, promoviendo el cribado del VIH y la derivación de los pacientes al especialista adecuado para su seguimiento posterior en seis entidades clínicas seleccionadas por su elevada prevalencia en pacientes VIH positivos y la alta frecuencia con la que son atendidas en urgencias: 1) infecciones de transmisión sexual; 2) profilaxis post exposición; 3) herpes zoster; 4) práctica del chemsex; 5) neumonía adquirida en la comunidad, y 6) síndrome mononucleósico. Las recomendaciones incluyen indicaciones sobre en qué pacientes debe realizarse una serología, el proceso de derivación y herramientas para ayudar a los médicos de urgencias en la toma de decisiones

Almost half of new diagnoses of human immunodeficiency virus (HIV) infection are made late, leading to increased morbidity and mortality, greater spread of infection, and higher public health care costs. Emergency services care for many patients who share behaviors associated with HIV transmission risk who arrive in clinical situations that are associated with HIV infection. A strategy to increase the rates of early diagnosis by promoting serology for HIV when caring for patients with certain clinical profiles might therefore be the key to improvement. This approach ishardly used at present, however, unless the result of serology would change the management of the acute complaint that led to the visit. These recommendations based on evidence from a search and review of recent publications were developed by a group of experts appointed by the Spanish Society of Emergency Medicine (SEMES). The resulting statement aims to support decision-making by emergency physicians and promote HIV screening and referral to appropriate specialists for follow-up in patients with certain conditions (sexually transmitted infections, herpes zoster, community-acquired pneumonia) or reporting certain scenarios (practice of chemsex, need for post-exposure prophylaxis). These 6 settings were selected because they are often seen in emergency departments and are common in patients with HIV-positive tests. The recommendations address when to order serology for HIV and how to manage the referral process. Included are decision-making tools foremergency physicians

Stoppering/unstoppering of a rotaxane formed between an N-hetorycle ligand containing surfactant: ß-cyclodextrin pseudorotaxane and pentacyanoferrate(II) ions.

The assembly of a surfactant-based rotaxane by adding the labile aquopentacyanoferrate(II) ion to the previously formed pseudorotaxane between the surfactant 11-(isonicotinoyloxy)-N,N,N-triethyl-1-undecanaminium bromide and ß-cyclodextrin was investigated by 1H NMR and kinetic measurements. NMR spectroscopy has showed that the rotaxane can be formed through two different mechanisms. The rotaxane can be unstoppered by using the pyridine ligand substitution reaction by the high-field cyanide ligand. In this work a new method is developed for the preparation of several new surfactant-based rotaxanes by changing the hydrophilic and hydrophobic regions of the surfactants and the nature of the macrocycle.