Emergency medicine questions on the entrance examination for medical internships and residency training in Spain: analysis of changes between 2010 and 2019. / Presencia de la Medicina de Urgencias y Emergencias en el examen de médico interno residente (MIR) en España: análisis evolutivo durante el periodo 2010-2019.

OBJECTIVES: To investigate the presence of fundamental concepts in emergency medicine on the entrance examination taken by candidates for medical internships and residency training in Spain, and to identify changes over time. MATERIAL AND METHODS: Longitudinal retrospective study. Three independent researchers reviewed questions on the entrance examinations of the past 10 years (2010-2019) and classified them as directly, indirectly, or not related to emergency medicine. The topics of directly related questions were also classified according to the categories listed in Tintinalli's Emergency Medicine and subject areas in the Citation Index Expanded (SCIE) of the Web of Science. Changes in the number of questions and range of topics were analyzed with simple linear regression models. RESULTS: A total of 2300 questions were reviewed; 487 (22%) were directly related to emergency medicine, and 313 of them specifically referred to an emergency or urgent care setting. The proportion of directly related questions held steady over the 10-year period (P=.172). The most frequently mentioned categories listed by Tintinalli were cardiovascular (12.2%), infectious (11.1%), and gastrointestinal (10.9%) emergencies, and no significant differences were noted over time. However, proportions assigned to the SCIE categories did change over time, as follows. Questions about emergency care in general (11.9% during the period overall) increased significantly with time (P=.005) whereas cardiovascular questions (11.3%) decreased (P=.037). The proportion of infectious disease topics remained the same (10.7%). CONCLUSION: Even though emergency medicine is not a recognized specialty for medical residency training in the public health system, questions on emergencies are considered important for evaluating candidates, judging by the high percentage of questions on the examinations.

OBJETIVO: Investigar la presencia del cuerpo doctrinal de la Medicina de Urgencias y Emergencias (MUE) en el examen de acceso a médico interno residente (MIR) en España y su evolución en el tiempo. METODO: Estudio longitudinal retrospectivo. Tres investigadores revisaron independientemente las preguntas de los exámenes MIR de los últimos 10 años (2010-2019) y las clasificaron por acuerdo mayoritario como directamente, indirectamente o no relacionadas con la MUE. La temática de las preguntas directamente relacionadas con la MUE se clasificó según el índice del libro de texto de MUE de Tintinalli y según la clasificación de las áreas de la base Science Citation Index Expanded (SCIE) de la Web of Science. La evolución temporal de la presencia y la temática de la MUE se analizó mediante regresión lineal simple. RESULTADOS: Se revisaron 2.300 preguntas: 487 (22%) estaban directamente relacionadas con la MUE (313 citaban específicamente el escenario de urgencias o emergencias). La presencia de preguntas directamente relacionadas con la MUE se mantuvo constante entre 2010-2019 (p = 0,172). Siguiendo la clasificación de Tintinalli, las temáticas más frecuentes de estas preguntas fueron urgencias cardiovasculares (12,2%), infecciosas (11,1%) y gastrointestinales (10,9%), sin cambios significativos entre 2010-2019, mientras que siguiendo la clasificación del SCIE, estas temáticas fueron urgencias (11,9%, que aumentó significativamente durante el periodo, p = 0,005), cardiovascular (11,3%, que descendió, p = 0,037) y enfermedades infecciosas (10,7%, sin cambios durante el periodo). CONCLUSIONES: La MUE, a pesar de no estar reconocida como una especialidad formativa por la vía MIR, tiene una elevada relevancia para la administración sanitaria a la hora de seleccionar a los MIR, que inician su formación especializada en el sistema público de salud, a juzgar por su elevada presencia en el examen anual al que se somete a los candidatos.

Presencia de la Medicina de Urgencias y Emergencias en el examen de médico interno residente (MIR) en España: análisis evolutivo durante el periodo 2010-2019 / Emergency medicine questions on the entrance examination for medical internships and residency training in Spain: analysis of changes between 2010 and 2019

OBJETIVO: Investigar la presencia del cuerpo doctrinal de la Medicina de Urgencias y Emergencias (MUE) en el examen de acceso a médico interno residente (MIR) en España y su evolución en el tiempo. MÉTODO: Estudio longitudinal retrospectivo. Tres investigadores revisaron independientemente las preguntas de los exámenes MIR de los últimos 10 años (2010-2019) y las clasificaron por acuerdo mayoritario como directamente, indirectamente o no relacionadas con la MUE. La temática de las preguntas directamente relacionadas con la MUE se clasificó según el índice del libro de texto de MUE de Tintinalli y según la clasificación de las áreas de la base Science Citation Index Expanded (SCIE) de la Web of Science. La evolución temporal de la presencia y la temática de la MUE se analizó mediante regresión lineal simple. RESULTADOS: Se revisaron 2.300 preguntas: 487 (22%) estaban directamente relacionadas con la MUE (313 citaban específicamente el escenario de urgencias o emergencias). La presencia de preguntas directamente relacionadas con la MUE se mantuvo constante entre 2010-2019 (p = 0,172). Siguiendo la clasificación de Tintinalli, las temáticas más frecuentes de estas preguntas fueron urgencias cardiovasculares (12,2%), infecciosas (11,1%) y gastrointestinales (10,9%), sin cambios significativos entre 2010-2019, mientras que siguiendo la clasificación del SCIE, estas temáticas fueron urgencias (11,9%, que aumentó significativamente durante el periodo, p = 0,005), cardiovascular (11,3%, que descendió, p = 0,037) y enfermedades infecciosas (10,7%, sin cambios durante el periodo). CONCLUSIÓN: La MUE, a pesar de no estar reconocida como una especialidad formativa por la vía MIR, tiene una elevada relevancia para la administración sanitaria a la hora de seleccionar a los MIR, que inician su formación especializada en el sistema público de salud, a juzgar por su elevada presencia en el examen anual al que se somete a los candidatos

OBJETIVE: To investigate the presence of fundamental concepts in emergency medicine on the entrance examination taken by candidates for medical internships and residency training in Spain, and to identify changes over time. METHODS: Longitudinal retrospective study. Three independent researchers reviewed questions on the entrance examinations of the past 10 years (2010-2019) and classified them as directly, indirectly, or not related to emergency medicine. The topics of directly related questions were also classified according to the categories listed in Tintinalli's Emergency Medicine and subject areas in the Citation Index Expanded (SCIE) of the Web of Science. Changes in the number of questions and range of topics were analyzed with simple linear regression models. RESULTS: A total of 2300 questions were reviewed; 487 (22%) were directly related to emergency medicine, and 313 of them specifically referred to an emergency or urgent care setting. The proportion of directly related questions held steady over the 10-year period (P=.172). The most frequently mentioned categories listed by Tintinalli were cardiovascular (12.2%), infectious (11.1%), and gastrointestinal (10.9%) emergencies, and no significant differences were noted over time. However, proportions assigned to the SCIE categories did change over time, as follows. Questions about emergency care in general (11.9% during the period overall) increased significantly with time(P=.005) whereas cardiovascular questions (11.3%) decreased (P=.037). The proportion of infectious disease topics remained the same (10.7%). CONCLUSION: Even though emergency medicine is not a recognized specialty for medical residency training in the public health system, questions on emergencies are considered important for evaluating candidates, judging by the high percentage of questions on the examinations

Emergency department visits for transient global amnesia alone or in association with substance abuse. / Amnesia global transitoria y consumo de tóxicos que motivan la consulta al servicio de urgencias.

OBJECTIVES: To study the epidemiology of emergency department visits for transient global amnesia (TGA) by itself or associated with substance abuse or sexual assault. MATERIAL AND METHODS: Retrospective study of cases treated from January to December 2018. Data for all patients with TGA were extracted, and cases were classified as associated with substance abuse (TGASUB), sexual assault (TGASEX), or neither (TGAONLY). RESULTS: A total of 287 TGA cases were found: 169 (58.9%) were TGASEX, 62 (21.6%) TGAONLY, and 56 (19.5%) TGASUB. Two hundred eighteen (76%) were female and 69 (24%) were male. Ages ranged from 16 to 90 years; 174 (60.6%) were under the age of 30 years. Two hundred one patients (72.8%) reported consuming alcohol; and 105 (49.1%) were positive on testing (mean blood alcohol concentration, 0.74 g/L; maximum, 3.9 g/L. Twenty patients (7.1%) reported using cannabis, and 39 (17.3%) had positive test results; 14 reported using cocaine (4.9%) and 28 (12.4%) tested positive; 5 (1.7%) reported using amphetamines and 20 (8.8%) tested positive. Fifty-eight (20.1%) had symptoms of intoxication. Four were admitted in coma. A computed tomography scan was ordered for 66 patients (23%), 7 patients were hospitalized, and none died. CONCLUSION: The prevalence of TGA is higher if cases of substance abuse and sexual assault are counted. Toxicolgy testing changes the epidemiology of TGA in emergencies.

OBJETIVO: Conocer la epidemiología de las consultas en urgencias por amnesia global transitoria (AGT), ya sea pura, asociada al consumo de tóxicos o en el contexto de una agresión sexual. METODO: Estudio retrospectivo de enero a diciembre de 2018. Se revisaron las AGT atendidas en intoxicados (AGTtox), en víctimas de agresiones sexuales (AGTsex) y las amnesias puras (AGTpur), evaluando la presencia de tóxicos. RESULTADOS: Se identificaron 287 AGT: 169 AGTsex (58,9%), 62 AGTpur (21,6%) y 56 AGTtox (19,5%). De ellas, 218 (76%) fueron mujeres y la edad osciló entre 16 y 90 años (60,6% menores de 30 años). Reconocieron consumo de alcohol 201 casos (72,8%), con etanolemia positiva en 105 (49,1%) (media de 0,74 g/l y máxima de 3,9 g/l). Admitieron consumo de cannabis 20 pacientes (7,1%), con analítica positiva en 39 casos (17,3%); cocaína 14 (4,9%), con analítica positiva en 28 (12,4%), y anfetaminas 5 (1,7%), con analítica positiva en 20 (8,8%). Presentaron síntomas de intoxicación 58 casos (20,1%). Cuatro pacientes ingresaron en coma. Se realizó una tomografía computarizada (TC) craneal a 66 pacientes (23%), se hospitalizaron 7 y no hubo ningún fallecimiento. CONCLUSIONES: La prevalencia de AGT es mayor si se incluyen los intoxicados y las agresiones sexuales, modificando la determinación de tóxicos la epidemiología de la AGT en urgencias.

Amnesia global transitoria y consumo de tóxicos que motivan la consulta al servicio de urgencias / Emergency department visits for transient global amnesia alone or in association with substance abuse

Objetivo. Conocer la epidemiología de las consultas en urgencias por amnesia global transitoria (AGT), ya sea pura, asociada al consumo de tóxicos o en el contexto de una agresión sexual. Método. Estudio retrospectivo de enero a diciembre de 2018. Se revisaron las AGT atendidas en intoxicados (AGTtox), en víctimas de agresiones sexuales (AGTsex) y las amnesias puras (AGTpur), evaluando la presencia de tóxicos. Resultados. Se identificaron 287 AGT: 169 AGTsex (58,9%), 62 AGTpur (21,6%) y 56 AGTtox (19,5%). De ellas, 218 (76%) fueron mujeres y la edad osciló entre 16 y 90 años (60,6% menores de 30 años). Reconocieron consumo de alcohol 201 casos (72,8%), con etanolemia positiva en 105 (49,1%) (media de 0,74 g/l y máxima de 3,9 g/l). Admitieron consumo de cannabis 20 pacientes (7,1%), con analítica positiva en 39 casos (17,3%); cocaína 14 (4,9%), con analítica positiva en 28 (12,4%), y anfetaminas 5 (1,7%), con analítica positiva en 20 (8,8%). Presentaron sínto-mas de intoxicación 58 casos (20,1%). Cuatro pacientes ingresaron en coma. Se realizó una tomografía computariza-da (TC) craneal a 66 pacientes (23%), se hospitalizaron 7 y no hubo ningún fallecimiento. Conclusiones. La prevalencia de AGT es mayor si se incluyen los intoxicados y las agresiones sexuales, modificando la determinación de tóxicos la epidemiología de la AGT en urgencias

Objectives. To study the epidemiology of emergency department visits for transient global amnesia (TGA) by itself or associated with substance abuse or sexual assault. Methods. Retrospective study of cases treated from January to December 2018. Data for all patients with TGA were extracted, and cases were classified as associated with substance abuse (TGASUB), sexual assault (TGASEX), or neither (TGAONLY). Results. A total of 287 TGA cases were found: 169 (58.9%) were TGASEX, 62 (21.6%) TGAONLY, and 56 (19.5%) TGASUB. Two hundred eighteen (76%) were female and 69 (24%) were male. Ages ranged from 16 to 90 years; 174 (60.6%) were under the age of 30 years. Two hundred one patients (72.8%) reported consuming alcohol; and 105 (49.1%) were positive on testing (mean blood alcohol concentration, 0.74 g/L; maximum, 3.9 g/L. Twenty patients (7.1%) reported using cannabis, and 39 (17.3%) had positive test results; 14 reported using cocaine (4.9%) and 28 (12.4%) tested positive; 5 (1.7%) reported using amphetamines and 20 (8.8%) tested positive. Fifty-eight (20.1%) had symptoms of intoxication. Four were admitted in coma. A computed tomography scan was ordered for 66 patients (23%), 7 patients were hospitalized, and none died. Conclusions. The prevalence of TGA is higher if cases of substance abuse and sexual assault are counted. Toxicolgy testing changes the epidemiology of TGA in emergencies

Efficacy of tocilizumab in conventional treatment-refractory adult-onset Still's disease: multicenter retrospective open-label study of thirty-four patients.

OBJECTIVE: Adult-onset Still's disease (AOSD) is frequently refractory to standard therapy. Tocilizumab (TCZ) has demonstrated efficacy in single cases and in small series of patients with AOSD. The aim of this multicenter study was to assess the efficacy of TCZ in patients with AOSD refractory to conventional treatment. METHODS: This was a retrospective open-label study of TCZ treatment in 34 patients with AOSD who had experienced an inadequate response to corticosteroids and at least 1 standard synthetic immunosuppressive drug and also, in many cases, biologic agents. RESULTS: The mean ± SD age of the patients (8 men and 26 women) was 38.7 ± 16.1 years. The median duration of AOSD before TCZ was initiated was 4.2 years (interquartile range [IQR] 1-9 years). The initial dosages of intravenous TCZ were 8 mg/kg every 4 weeks in 22 patients, 4 mg/kg every 4 weeks in 2 patients, and 8 mg/kg every 2 weeks in 10 patients. TCZ treatment resulted in rapid and maintained improvement in both clinical and laboratory parameters. After 1 year of TCZ therapy, the incidence of joint manifestations had decreased from 97.1% at baseline to 32.4%, the incidence of both cutaneous manifestations and fever had decreased from 58.8% to 5.9%, and the incidence of lymphadenopathy had decreased from 29.4% to 0%. A dramatic reduction in laboratory markers of inflammation, including the C-reactive protein level, the erythrocyte sedimentation rate, and the ferritin level, was achieved. The median dosage of prednisone was also reduced, from 13.8 mg/day (IQR 5-45) at the initiation of TCZ to 2.5 mg/day (IQR 0-30) at 12 months. After a median followup of 19 months (IQR 12-31 months), only 2 patients required permanent discontinuation of TCZ therapy because of severe infections. CONCLUSION: TCZ treatment was associated with rapid and maintained clinical and laboratory improvement in patients with AOSD refractory to standard treatment. However, joint manifestations seem to be more refractory to treatment compared with systemic manifestations.