Smell and Taste Dysfunction in COVID-19 Is Associated With Younger Age in Ambulatory Settings: A Multicenter Cross-Sectional Study.

BACKGROUND AND OBJECTIVE: Since the initial anecdotal reports of coronavirus disease 2019 (COVID-19) from China, a growing number of studies have reported on smell and/or taste dysfunction (STD). Objective: The aim of our study was to investigate the frequency and severity of STD in COVID-19 patients and to evaluate the association with demographic characteristics, hospital admission, symptoms, comorbidities, and blood biomarkers. METHODS: We performed a multicenter cross-sectional study on patients who were positive for SARS-CoV-2 (n=846) and controls (n=143) from 15 Spanish hospitals. Data on STD were collected prospectively using an in-person survey. The severity of STD was categorized using a visual analog scale. We analyzed time to onset, recovery rate, time to recovery, hospital admission, pneumonia, comorbidities, smoking, and symptoms. RESULTS: STD was at least 2-fold more common in COVID-19-positive patients than in controls. COVID-19-positive hospitalized patients were older, with a lower frequency of STD, and recovered earlier than outpatients. Analysis stratified by severity of STD showed that more than half of COVID-19 patients presented severe loss of smell (53.7%) or taste (52.2%); both senses were impaired in >90%. In the multivariate analysis, older age (>60 years), being hospitalized, and increased C-reactive protein were associated with a better sense of smell and/or taste. COVID-19-positive patients reported improvement in smell (45.6%) and taste (46.1%) at the time of the survey; in 90.6% this was within 2 weeks of infection. CONCLUSION: STD is a common symptom in COVID-19 and presents mainly in young and nonhospitalized patients. More studies are needed to evaluate follow-up of chemosensory impairment.

Efficacy and safety of trifluridine/tipiracil in third-line and beyond for the treatment of patients with metastatic colorectal cancer in routine clinical practice: patterns of use and prognostic nomogram.

INTRODUCTION: Trifluridine/tipiracil combination has shown a benefit over placebo in the treatment of patients with chemorefractory metastatic colorectal cancer (mCRC). We evaluated the efficacy and safety of this combination in the real-life setting at eight Galician centers in Spain. PATIENTS AND METHODS: This is a retrospective study of a cohort of patients with mCRC in treatment with trifluridine/tipiracil within usual clinical practice who have been previously treated or are not considered candidates for treatment with available therapies. RESULTS: A total of 160 mCRC patients were included. Our data showed that 11.9% of patients achieved disease control. Median progression-free survival was 2.75 months; at 5.66 months follow-up, median overall survival was 7.94 months. Asthenia and neutropenia (48.1% both) were the most frequent adverse events. Overall survival was lower in patients with ECOG 2, multiple metastatic sites, platelets count 350,000/µl, alkaline phosphatase > 500 IU/l, and carcinoembryonic antigen > 10 ng/ml. CONCLUSION: The results of this study confirm the efficacy and safety of trifluridine/tipiracil in chemorefractory mCRC patients. However, patients in clinical practice differ from patients in clinical trials. Due to this, prognostic factors have special importance to offer the best therapeutic approach.

Reacción granulomatosa a cuerpo extraño en punta y dorso nasal por materiales de relleno: presentación de un caso clínico y revisión de la literatura / Granulomatous foreign body reaction in tip and nasal dorsum due to filling materials: presentation of a clinical case and review of the literature

RESUMEN Paciente de 29 años con antecedente de tres rinomodelaciones en la punta nasal con ácido hialurónico hace cinco años, evaluada por deseo de mejora estética nasal y obstrucción nasal. Al examen visual se observó una leve giba osteocartilaginosa, punta bulbosa, narinas simétricas, sin laterorrinea, no se palparon masas ni nodulaciones. Posterior al manejo de su rinitis y previo consentimiento informado, al realizar rinoseptoplastía abierta se encontró gran cantidad de tejido granulatorio tipo cuerpo extraño en la punta y dorso nasal lo que obligó a cambiar el plan quirúrgico. La biopsia diferida confirmó granuloma por cuerpo extraño por biopolímero derivado de la silicona. Evolucionó satisfactoriamente estética y funcionalmente. La rinomodelación ha aumentado en los últimos años, aunque no existen rellenos faciales aprobados por la FDA para uso nasal. La correcta utilización de los rellenos nasales continúa siendo un tema controvertido. Los granulomas nasales por cuerpo extraño son complicaciones tardías que se han incrementado con el uso de biopolímeros con dosis y técnicas inadecuadas. El uso de ecotomografía ha contribuido a mejorar la planificación quirúrgica, así como el estudio histológico diferido ha permitido identificar el material utilizado en la mayoría de los casos convirtiéndose en el estándar de oro.

ABSTRACT A 29-year-old patient with a history of three nasal fillings in the nasal tip with hyaluronic acid five years ago, reason for consultation improvement nasal aesthetics and nasal obstruction. Physical examination showed a slight osteocartilaginous hump, bulbous tip, symmetrical nostrils, no deviation nasal pyramid, no masses or nodules were palpated. After the management of his rhinitis and previous informed consent, when performing open rhinoseptoplasty, a large amount of foreign body type granulation tissue was found in the tip and nasal dorsum, which forced the surgical plan to change. The post-surgical biopsy showed foreign body granuloma by biopolymer derived from silicone. Evolved satisfactorily aesthetically and functionally. The use of nasal fillers has increased in recent years, although there are no facial fillers approved by the FDA for nasal use. The correct use of nasal fillers is a controversial issue. Nasal granulomas by foreign body are late complications that have increased with the use of biopolymers with inadequate doses and techniques. The use of ecotomography has contributed to improve the surgical planning; the deferred histological study has allowed to identify the material used in most cases becoming the gold standard

Cáncer de mama avanzado receptor de estrógeno positivo: manejo sistémico actual / Systemic therapy for estrogen receptor positive advanced breast cancer

El cáncer de mama es la primera causa de muerte por cáncer en mujeres chilenas. Mientras la mayoría de las personas logra curarse de esta enfermedad, un 5% de los casos se presenta inicialmente con enfermedad avanzada y hasta un 20-30% de pacientes con enfermedad localizada pueden sufrir recurrencias sistémicas. La mayoría de las neoplasias mamarias son dependientes del estímulo estrogénico, de allí que la deprivación de estrógenos es la principal estrategia terapéutica. Recientemente, el uso de terapias molecularmente dirigidas en combinación con la terapia endocrina ha logrado mejorar los resultados de sobrevida del cáncer de mama avanzado, con menos efectos colaterales que aquellos producidos por la quimioterapia convencional. El conocimiento de los mecanismos de acción de estas nuevas terapias, sus toxicidades, vías de resistencia y selección de pacientes para lograr los mejores beneficios terapéuticos son aspectos relevantes en el manejo de la enfermedad. Presentamos una revisión del estado actual del manejo del cáncer de mama metastásico hormonodependiente con enfásis en el uso de terapias endocrinas combinadas con terapias moleculares.

Breast cancer is the leading cause of cancer death in Chilean women. While most patientes are cured, five percent of cases present with advanced disease initially and up to 20-30% of patients with localized disease may suffer systemic recurrences. The majority of breast neoplasms are dependent on the estrogenic stimulus, hence the deprivation of estrogen is the main therapeutic strategy. Recently, the use of molecular targeted therapies in combination with endocrine therapy has been successful in improving the survival outcomes of advanced breast cancer, with fewer side effects than those produced by conventional chemotherapy. Knowledge of the mechanisms of action of these new therapies, their toxicities, resistance pathways and patient selection to achieve the best therapeutic benefits are relevant aspects in the management of the disease. We present a review of the current state of management of hormone-dependent metastatic breast cancer with emphasis on the use of endocrine therapies combined with molecular therapies.

Equipos de salud y su funcionalidad: oportunidades para el tratamiento del tabaquismo / Health teams and their functionality: opportunities for smoking cessation

Resumen Este capítulo propone acciones para una adecuada implementación de las estrategias definidas en las Primeras Guías de Práctica Clínica del Tratamiento del Tabaquismo, Chile 2017. En el subsistema público por una parte se han hecho esfuerzos importantes y progresivos para realizar la detección de fumadores y la consejería breve ABC en los distintos dispositivos de la red. En el subsistema privado por otra parte se han llevado adelante servicios especializados: Terapia Intensiva de Cesación del Tabaquismo. Se detecta un déficit de integración de servicios a partir de metas claras y compartidas que permitan alcanzar un impacto poblacional relevante. Se proponen lineamientos a seguir para lograr éxito en las intervenciones para el tratamiento de los fumadores.

This chapter proposes actions for an adequate implementation of the strategies defined in the Guidelines of Clinical Practice for Tobacco Treatment, Chile 2017. In the public subsystem, significant and progressive efforts have been made to carry out smoking detection and counseling ABC on the various devices in the network. In the private subsystem on the other hand specialized services have been carried out: Intensive Therapy for Smoking Cessation. A deficit of integration of services is detected based on clear and shared goals that allow to reach a relevant population impact. Guidelines are proposed to be followed to achieve success in the interventions for the treatment of smokers.

Actividad Física y Tabaquismo / Physical activity and Smoking

Resumen En Chile, según la Encuesta Nacional de salud 2009-10, el 88,6% de la población general no realiza deporte o actividad física en su tiempo libre, y esta conducta de inactividad física aumenta con la edad y es mayor en los niveles educacionales bajos y en las mujeres. La evidencia reporta que utilizar la AF para la cesación del tabaquismo es débil, sin embargo, existe fuerte evidencia de que la actividad física reduce los síntomas de abstinencia, el deseo de fumar y el aumento de peso durante el abandono del tabaco. Los adultos de 18 a 64 años necesitan dedicar al menos 150 min semanales a la actividad física aeróbica, de intensidad moderada, o bien 75 min de actividad física aeróbica vigorosa cada semana, o bien una combinación equivalente de actividades moderadas y vigorosas para protegerse de mortalidad por diversas causas.

The Chilean National Health Survey 2009-10, evidences that 88.6% of the general population does not engage in sports or physical activity in their free time, and this behavior increases with age, low educational levels, and in women. According to evidence, using physical activity for smoking cessation has a weak. However, there is strong evidence that physical activity reduces withdrawal symptoms, craving, and weight gain during smoking cessation. Adults aged 18-64 need to spend at least 150 minutes a week on moderate intensity aerobic physical activity or 75 minutes of vigorous aerobic physical activity each week or an equivalent combination of moderate and vigorous activities to protect thenrselves against mortality from diverse causes.

Consejo breve sobre el tabaco en atención primaria de salud en Chile: un desafío pendiente / Brief advice on tobacco in primary health care in Chile: a pending challenge

Introducción: El tabaco es la primera causa de morbimortalidad prevenible en el mundo. En Chile la prevalencia de consumo es 40,6 por ciento, la mayor a nivel continental. El consejo breve o consejería breve (CB) es una intervención simple, efectiva y de bajo costo para el cese de consumo de tabaco, que Atención Primaria en Salud (APS) ha demostrado disminuir en la prevalencia de tabaquismo. Existe escasa información sobre la utilización de CB en APS en Chile. Métodos: Estudio transversal de metodología cuantitativa. Se encuestó a 604 pacientes pertenecientes a 2 centros APS de Santiago, tras haber recibido atención clínica. Los datos fueron analizados con SPSS 21 y calculadora web Graph Pad. Resultados: La prevalencia de tabaquismo entre los encuestados fue de 32,5por ciento, de ellos, el 78,6 por ciento reportó deseo de dejar de fumar. Al 43,7 por ciento de los encuestados se le preguntó respecto al consumo de tabaco en la atención reciente, y del total de fumadores, a 37,1 por ciento se les aconsejó dejar de fumar. Los pacientes fumadores calificaron la recepción de CB como "indiferente", "agradable" o "muy agradable" en un 94,9 por ciento, y en un 90,5 por ciento, entre aquellos que no desean dejar de fumar. Conclusión: El tabaquismo es un problema escasamente abordado en las atenciones clínicas APS, lo que contrasta con la alta prevalencia de consumo nacional y de los pacientes consultantes. La mayoría de los fumadores desea dejar de fumar, y la minoría considera "desagradable" o "muy desagradable" ser aconsejada para cesar el consumo, aun en aquellos fumadores que no quieren dejar de fumar.(AU)

Introduction: Smoking is the leading cause of preventable morbidity and mortality worldwide. In Chile smoking prevalence is 40.6 percent, the highest on the continent. Brief advice or brief counseling (BC) is a simple, effective and inexpensive intervention for tobacco consumption cessation, that has been shown decrease smoking prevalence in Primary Health Care (PHC). There is little information on the use of BC in PHC in Chile. Methods: Cross-sectional study of quantitative methodology. 604 patients were surveyed from 2 PHC centers of Santiago, after receiving clinical care. Data was analyzed with SPSS 21 and Graph Pad web calculator. Results: The smoking prevalence among respondents was 32.5 percent, 78.6 percent of them expressed desire to quit 43.7 percent of respondents were asked about consumption of tobacco in a recent consultation, and a total 36.9 percent of smokers were advised to quit. Smokers patients rated reciving CB as "indifferent", "pleasant" or "very pleasant" in 94,9 percent and 90,5 percent among those who did not want to quit. Conclusion: Smoking is a problem rarely addressed in PHC, this contrasts with the high prevalence of domestic consumption and consulting patients. Most smokers want to quit and only a minority considered "unpleasant" or "very unpleasant" being advised to cease consumption, even in those smokers who do not want to quit.(AU)

Identification of a new HLA-C allele, HLA-C*08:75 in a Caucasian individual.

HLA-C*08:75 differs from C*08:02:01 by a non-synonymous mutation at codon 229 (GAG to AAG) in exon 4.

Identification of a new HLA-C allele, HLA-C*08:76 in a Caucasian individual.

HLA-C*08:76 differs from HLA-C*08:02:01 by one nonsynonymous nucleotide change at the codon 144 (CAG to AAG) in exon 3.

[Prediction model for in-hospital admission in patients arriving in the emergency department]. / Modelo predictor de ingreso hospitalario a la llegada al servicio de urgencias.

BACKGROUND: To develop a prediction model for in-hospital admission to provide an almost "real time" determination of hospital beds needed, so as to predict the resources required as early as possible. MATERIAL AND METHODS: A prospective observational study in the emergency department of a university hospital. We included all consecutive patients between 8.00-22.00 hours during one month. We analyzed 7 variables taken when the patient arrived at the emergency department: age, sex, level of triage, initial disposition, first diagnosis, diagnostic test and medication, and we performed a logistic regression. RESULTS: We included 2,476 visits of which 114 (4.6%) were admitted. A significant direct correlation was seen between: age >65 years old (odds ratio[OR]=2.1, confidence interval [CI] 95%,1.3-3.2; p=0.001); male sex (OR=1.6, IC 95%,1.1-2.4; p=0.020); dyspnea (OR=5.2, IC 95%, 2.8-9.7; p<0.0001), abdominal pain (OR=4.7, IC 95%, 2.7-8.3; p<0.0001); acute care initial disposition (OR=8.9, IC 95%, 5.4-14.9; p<0.0001), diagnostic test (OR=1.1, IC 95%,0.9-1.3; p=0.064) and treatment prescription (OR=2.6, IC95%,1.6-4.2; p=<0.0001). The model had a sensitivity of 76% and a specificity of 82% (area under curve 0.85 [IC 95% 0.81-0.88; p<0.001]). CONCLUSIONS: The in-hospital admission prediction model is a good and useful tool for predicting the in-hospital beds needed when patients arrive at the emergency department.

Modelo predictor de ingreso hospitalario a la llegada al servicio de Urgencias / Prediction model for in-hospital admission in patients arriving in the Emergency Department

Fundamento. Desarrollar un modelo de predicción de ingreso hospitalario a la llegada del paciente al servicio de Urgencias, con el fin de conocer la necesidad de camas hospitalarias casi a tiempo real, y así prever los recursos asistenciales necesarios de forma precoz. Material y métodos. Estudio observacional de cohorte prospectivo. Se incluyeron todos los pacientes consecutivos filiados para el triaje entre las 8-22 horas del servicio de Urgencias de un hospital terciario durante un mes. Se analizaron 7 variables a la llegada del paciente, que pudieran influir en el ingreso: edad, sexo, nivel de gravedad según el triaje, ubicación inicial, diagnóstico de entrada, solicitud de prueba complementaria y prescripción de medicación. Serealizó un estudio multivariable según regresión logística. Resultados. Se incluyeron 2.476 episodios de los que 114 (4,6%) ingresaron. Se asociaron de forma significativa: edad>65 años (Odds ratio [OR]=2,1, intervalo de confianza [IC] 95%, 1,3-3,2; p=0,001); sexo masculino (OR=1,6, IC 95%, 1,1-2,4;p=0,020). Diagnóstico de entrada disnea: (OR=5,2, IC 95%, 2,8-9,7; p<0,0001); dolor abdominal (OR=4,7, IC 95%, 2,7-8,3; p<0,0001); ubicación inicial en sala de agudos (OR=8,9, IC95%, 5,4-14,9; p<0,0001); solicitud de pruebas complementarias (OR=1,1, IC95%, 0,9-1,3; p=0,064) y prescripción de tratamiento (OR=2,6, IC 95%,1,6-4,2; p=<0,0001). Con dichas variables se diseñó un modelo matemático que tenía una sensibilidad del 76% y una especificidad del 82% (área bajo la curva es de 0,85 [IC 95% 0,81-0,88; p<0,001]). Conclusiones. El modelo de predicción de ingreso es una herramienta que puede ser de utilidad a la hora de preverla necesidad del recurso cama hospitalaria a la llegada del paciente al servicio de Urgencias(AU)

Background. To develop a prediction model for in-hospital admission to provide an almost «real time» determination of hospital beds needed, so as to predict the resources required as early as possible. Material and methods. A prospective observational study in the emergency department of a university hospital. We included all consecutive patients between 8.00-22.00hours during one month. We analyzed 7 variables taken when the patient arrived at the emergency department: age, sex, level of triage, initial disposition, first diagnosis, diagnostic test and medication, and we performed a logistic regression. Results. We included 2,476 visits of which 114 (4.6%) were admitted. A significant direct correlation was seen between: age >65 years old (odds ratio[OR]=2.1, confidence interval[CI] 95%, 1.3-3.2; p=0.001); male sex (OR=1.6, IC 95%, 1.1-2.4;p=0.020); dyspnea (OR=5.2, IC 95%, 2.8-9.7; p<0.0001), abdominal pain (OR=4.7, IC 95%, 2.7-8.3; p<0.0001); acute care initial disposition (OR=8.9, IC 95%, 5.4-14.9; p<0.0001), diagnostic test (OR=1.1, IC 95%, 0.9-1.3; p=0.064) and treatment prescription (OR=2.6, IC95%, 1.6-4.2; p=<0.0001). The model had a sensitivity of 76% and a specificity of 82% (area under curve 0.85 [IC 95% 0.81-0.88; p<0.001]). Conclusions. The in-hospital admission prediction model is a good and useful tool for predicting the in-hospital beds needed when patients arrive at the emergency department(AU)

Clinical accuracy of a non-contact infrared skin thermometer in paediatric practice.

BACKGROUND: Rectal thermometry is considered the most reliable method for measuring the temperature in the paediatric population. Recently, a new non-contact skin infrared thermometer for children was introduced in the market with excellent acceptance by parents. METHODS: A prospective, analytical, cross-sectional study was designed in order to assess the effectiveness of the infrared non-contact thermometer (Thermofocus) in comparison with two other known methods used to measure body temperature. Children aged 1 to 48 months were included from the emergency room and inpatient unit. All patients selected were assessed with three different thermometers: (1) non-contact infrared thermometer (Thermofocus); (2) temporal artery thermometer (Exergen); and (3) rectal glass mercury thermometer. RESULTS: Four hundred and thirty-four patients were eligible to complete the study. One hundred and sixty-seven were identified with fever. The mean age of the patients studied was 14.6 ± 10.7 months. Both devices were strongly correlated with the rectal temperature: r = 0.950 for Exergen and r = 0.952 for Thermofocus. The mean difference in temperature between the rectal temperature and the non-contact thermometer was 0.029 ± 0.01 °C (P < 0.001), while the mean difference between the temporal artery thermometer and the rectal temperature was -0.20 ± 0.27 °C (P < 0.001). The sensitivity and specificity for the non-contact thermometer is 97%. The negative predictive value is 99%, which is especially important to rule out fever and avoid unnecessary laboratory work-up. CONCLUSIONS: The non-contact infrared thermometer is a reliable, comfortable and accurate option for measurement of temperature and is very useful for the screening of fever in the paediatric population. More studies are recommended to support the evidence found in this study and compare its accuracy with more complex devices.

Affective style and eating disorders: a field study.

Eating disorders (ED) are a heterogeneous group of problems related to restraint and/or overeating. It is proposed that individual differences in affective reactivity and moods (affective style) might be related to these behaviours. Variations in affective style are expressed by differing levels of sensitivity to the motivation systems of approach and avoidance. The present study tested whether a relation exists between ED and variations in the sensitivity of motivational systems as well as mood dispositions. A total of 2020 undergraduate students completed the Eating Disorder Diagnostic Scale (EDDS), the Behavioural Inhibition System and Behavioural Activation System Scales (BIS/BAS), and the Positive and Negative Affect Schedule (PANAS). The results showed a significant within- subject interaction of Alimentary group x Motivation (F=4.056; p<0.007). It was also observed that the Overeating group had lower levels of motivation asymmetry than the Normal (p<0.01) and Restrictive (p<0.005) groups and marginally lower levels than the Purgative group (p<0.07). The study results suggest mainly that the avoidance/inhibition motivational system is related to eating problems connected with overeating, including chronic alimentary restraint (chronic dieters). The theoretical and clinical implications of these findings are discussed.

Megestrol acetate-induced adrenal insufficiency

Megestrol acetate is a synthetic progestin that has been used since the 1970s for the treatment of advanced cancer and subsequently to treat anorexia, cachexia and weight loss in AIDS patients. It has been shown that high doses or prolonged treatment with this drug may cause Cushing's syndrome, new-onset diabetes and suppression of plasma ACTH and cortisol levels. Megestrol acetate may cause suppression of the pituitary-adrenal axis due to the affinity of this compound for the glucocorticoid receptor. Recognising the glucocorticoid-like activity of megestrol and its effects at the axis level is important for the diagnosis of sub-clinical adrenal insufficiency. We present the case of a 74-year-old woman with infiltrating ductal breast carcinoma refractory to prolonged hormonal treatment with megestrol acetate, presenting with adrenal insufficiency (AU)

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El facultativo, un elemento necesario en el triaje de un Servicio de Urgencias en un hospital terciario / The physician is necessary in triage at Tertiary Hospital Emergency Department

Objetivo: Evaluar la necesidad de intervención de un facultativo en el triaje, para identificar al paciente potencialmente de alta complejidad en un servicio de urgencias que tiene implantado el sistema de triaje de Manchester (MTS). Método: Estudio observacional prospectivo, que seleccionó a los pacientes clasificados como muy urgentes (nivel 2 o naranja) y urgentes (nivel 3 o amarillo), según el MTS, en la Unidad de Primera Asistencia (UPA) del Servicio de Urgencias (SU) durante un periodo de 12 horas, para ser valorados por un médico adjunto con experiencia que decidió la ubicación inmediata según criterios médicos en una sala de agudos o en consultas de la UPA. La validez de la decisión fue establecida por el destino de los pacientes una vez visitados y medida por su índice de ingreso. Resultados: Se incluyeron un total de 100 pacientes, de los que 45 se seleccionaron para el estudio: 10 (22,22%) ubicables por el MTS en la sala de agudos como muy urgentes o naranjas y 35 (77,78%) ubicables por el MTS en la consulta de la UPA como urgentes o amarillos. El índice de ingreso de los pacientes ubicables en sala de agudos según el MTS, fue del 40% (N = 4) y el de los ubicables en consulta de la UPA del 20% (N = 7) (p = 0,23). El facultativo de triaje ubicó 12 pacientes (26,67%) en sala de agudos, 4 (8,89%) por requerir procedimientos técnicos y 8 (17,78%) por su complejidad y 33 pacientes (73,33%) en consulta de la UPA. El índice de ingreso de los pacientes ubicados, según criterio del facultativo, en sala de agudos por su complejidad fue del 87,5% (N = 7) y el de los ubicados en consulta de la UPA del 12,1% (N = 4) (p < 0,001). Conclusiones: La escasa capacidad del MTS para detectar los pacientes potencialmente complejos hace necesaria la intervención de un facultativo que asegure la ubicación inmediata de los pacientes, adecuando los servicios disponibles a la medida de las necesidades individuales y, por tanto, optimizando los recursos (AU)

Aim: To assess the need of a physician on the ED triage, with the aim of identifying high-complexity patients using Manchester Triage System (MTS) at an Emergency Department. Methods: Prospective observational study which enrolled all patients classified as very urgent (level 2 or orange) and urgent (level 3 or yellow) by the MTS in the First Assistance Unit (FAU) of the Emergency Department during a period of 12 hours, to be assessed by an experimented physician who decided the immediate location in an acute care or FAU area based on medical criteria. The validity of the decision was established according to the destiny of the patients once visited and measured by the admission index. Results: The study included 100 patients, 45 of whom were eligible for the study, 10 (22.22%) placed by the MTS in acute care area as very urgent or orange and 35 (77.78%) in FAU area as urgent or yellow. The admission index of patients placed in acute care area by MTS was 40% (N=4) and in those placed in FAU area was 20% (N=7) (p=0.23). The triage physician placed 12 patients (26.67%) in an acute care area, 4 (8.89%) due to technical procedures and 8 (17.78%) due to their complexity and 33 patients (73.33%) in a FAU area. According to the physician criteria, the admission index of the patients placed in an acute care area due to their complexity was 87.5% (N=7) and of those placed in FAU 12.1% (N=4) (p<0,000). Conclusions: The low capacity of the MTS to detect patients with potential high-complexity, makes the assessment of the physician necessary to guarantee the immediate location, adapting available services to individual necessities and therefore, optimising the resources (AU)

Derrame pleural tipo trasudado como expresión de afectación pleural por amiloidosis / Transudate type pleural effusion as expression of pleural involvement due to amyloidosis

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Tratamiento antibiótico de la neumonía adquirida en la comunidad / Antibiotic therapy of community-acquired pneumonia

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