[The Moodle platform: A useful tool for training in life support. Analysis of satisfaction questionnaires from students and instructors of the semFYC advanced life support courses]. / La plataforma Moodle: Una herramienta útil para la formación en soporte vital. Análisis de las encuestas de satisfacción a los alumnos e instructores de los cursos de soporte vital avanzado del programa ESVAP de la semFYC.

OBJECTIVE: The aim of this study is to assess the validity and use of a mixed method of training in life support. The use of Moodle to implement an online pre-sessional phase prior to a "classic" classroom phase of teaching in this type of course is the main novelty. DESIGN: Analysis of satisfaction questionnaires of students and instructors of a mixed course in the advanced life support program of SemFYC (ESVAP). SETTING: Moodle platform. semFYC Virtual Classroom. PARTICIPANTS AND/OR CONTEXTS: Students and instructors participating in the semFYC advanced life support program, ESVAP. METHOD: Qualitative analysis. RESULTS: The majority of students rate as very useful (50%) or useful (45.37%) the existence of an online pre-sessional phase, and consider that it has helped them very much (42.20%) or quite a lot (48.62%) to make the most of the face-to-face sessions. For instructors, they considered that the existence of an online pre-sessional phase was very useful (89%) or useful (11%) for the development of the face-to-face sessions. DISCUSSION: The analysis of the results concluded that: 1) the students considered a prior non-face to face phase as very useful, and it helped them much/very much in the face to face phase, and 2) the instructors believe that the non-face to face phase had helped them a lot in the presentations and efficiency of the workshops in the face-to-face phase.

Characterization of Dengue Virus 4 Cases in Paraguay, 2019-2020.

In 2019-2020, dengue virus (DENV) type 4 emerged to cause the largest DENV outbreak in Paraguay's history. This study sought to characterize dengue relative to other acute illness cases and use phylogenetic analysis to understand the outbreak's origin. Individuals with an acute illness (≤7 days) were enrolled and tested for DENV nonstructural protein 1 (NS1) and viral RNA by real-time RT-PCR. Near-complete genome sequences were obtained from 62 DENV-4 positive samples. From January 2019 to March 2020, 799 participants were enrolled: 253 dengue (14 severe dengue, 5.5%) and 546 other acute illness cases. DENV-4 was detected in 238 dengue cases (94.1%). NS1 detection by rapid test was 52.5% sensitive (53/101) and 96.5% specific (387/401) for dengue compared to rRT-PCR. DENV-4 sequences were grouped into two clades within genotype II. No clustering was observed based on dengue severity, location, or date. Sequences obtained here were most closely related to 2018 DENV-4 sequences from Paraguay, followed by a 2013 sequence from southern Brazil. DENV-4 can result in large outbreaks, including severe cases, and is poorly detected with available rapid diagnostics. Outbreak strains seem to have been circulating in Paraguay and Brazil prior to 2018, highlighting the importance of sustained DENV genomic surveillance.

Serum biomarkers and anti-flavivirus antibodies at presentation as indicators of severe dengue.

BACKGROUND: Dengue is the most common vector-borne viral disease worldwide. Most cases are mild, but some evolve into severe dengue (SD), with high lethality. Therefore, it is important to identify biomarkers of severe disease to improve outcomes and judiciously utilize resources. METHODS/PRINCIPAL FINDINGS: One hundred forty-five confirmed dengue cases (median age, 42; range <1-91 years), enrolled from February 2018 to March 2020, were selected from an ongoing study of suspected arboviral infections in metropolitan Asunción, Paraguay. Cases included dengue virus types 1, 2, and 4, and severity was categorized according to the 2009 World Health Organization guidelines. Testing for anti-dengue virus IgM and IgG and serum biomarkers (lipopolysaccharide binding protein and chymase) was performed on acute-phase sera in plate-based ELISAs; in addition, a multiplex ELISA platform was used to measure anti-dengue virus and anti-Zika virus IgM and IgG. Complete blood counts and chemistries were performed at the discretion of the care team. Age, gender, and pre-existing comorbidities were associated with SD vs. dengue with/without warning signs in logistic regression with odds ratios (ORs) of 1.07 (per year; 95% confidence interval, 1.03, 1.11), 0.20 (female; 0.05,0.77), and 2.09 (presence; 1.26, 3.48) respectively. In binary logistic regression, for every unit increase in anti-DENV IgG in the multiplex platform, odds of SD increased by 2.54 (1.19-5.42). Platelet count, lymphocyte percent, and elevated chymase were associated with SD in a combined logistic regression model with ORs of 0.99 (1,000/µL; 0.98,0.999), 0.92 (%; 0.86,0.98), and 1.17 (mg/mL; 1.03,1.33) respectively. CONCLUSIONS: Multiple, readily available factors were associated with SD in this population. These findings will aid in the early detection of potentially severe dengue cases and inform the development of new prognostics for use in acute-phase and serial samples from dengue cases.

Creating a Learning Scenario for Cardiopulmonary Resuscitation Training During the COVID-19 Pandemic.

INTRODUCTION: Different organizations have recommended changes in life support in the COVID-19 pandemic, just when maintaining the competence in cardiopulmonary resuscitation is compromised because on-site training must be avoided. We developed a pilot teaching-learning experience to promote cardiopulmonary resuscitation skills acquisition in this situation. The aim of this study was to describe that tool and to analyze its usefulness. METHODS: The experience consisted of three phases: first, reviewing the scientific literature; second, defining written local recommendations and recording a short video simulating the initial attention to a cardiac arrest in this COVID-19 context; third, creating a test to be answered by hospital health professionals. RESULTS: The final sample was 121 subjects; 66.1% were women; the mean age was 45.8 years (SD = 10.24). Among them, 43% were doctors, 43% nurses, 4.1% nursing assistants, and 9.9% others. 89.3% participants had received prior training in life support. In the test, questions 1, 2, 5, 6, 7, and 8 were answered correctly by more than 80%; questions 3 and 4 were answered correctly by 57.9% and 41.3%, respectively. All participants expressed that the video helped them to refresh their knowledge and skills in life support. DISCUSSION: When on-site training is not possible, distance learning-as in our teaching-learning innovation because of the COVID-19 pandemic-may be a valid option to acquire/refresh cardiopulmonary resuscitation skills.

[Pancoast syndrome caused by lung tuberculosis]. / Síndrome de Pancoast producido por tuberculosis pulmonar.

Pancoast's syndrome arises from neoplasms in 95% of cases but infection is a rare cause. We describe a patient with Pancoast's tumor secondary to tuberculosis. Pain caused by plexopathy and lack of diagnosis by noninvasive means led to the need for open biopsy.

[Transmembrane Na+ transport kinetics in arterial hypertension: relations with vascular risk parameters]. / Cinética del transporte transmembranoso de Na+ en la hipertensión arterial: relación con los parámetros de riesgo vascular.

BACKGROUND: To characterize the possible existence of kinetic anomalies of four erythrocyte membrane sodium transport systems in a group of essential hypertensive patients, and to study the clinical and biochemical profile of those with anomalies. METHODS: We studied 33 essential hypertensive patients and 33 normotensive controls. The kinetics (maximal rate and apparent dissociation constant for internal sodium) of Na(+)-K+ pump, Na(+)-K(+)-Cl- cotransport and Na(+)-Li+ countertransport was calculated after a sodium loading procedure, according to the methods of Garay; the passive Na+ permeability was also determined. RESULTS: The studied kinetic parameters were not significantly different in both groups. Nevertheless, we found a group of hypertensive patients with some transport abnormalities: increased intracellular sodium (9.1%), accelerated Na+ passive permeability (9.1%), lower activity of the Na(+)-K+ pump (7.1%) and the Na(+)-K(+)-Cl- cotransport (4%) and an increased maximal rate of the Na(+)-Li+ countertransport (11.8%). Na+Li+ countertransport activity was statistically related to plasma levels of urea, creatinine, glucose and LDL-cholesterol, and the activity of the Na(+)-K(+)-Cl- cotransport was related to plasma uric acid. The hypertensive patients with sodium transport anomalies showed higher body mass index, uric acid plasma levels and atherogenic index than those without these kind of anomalies, and they also showed lowered HDL-cholesterol plasma levels. CONCLUSIONS: A small group of essential hypertensive patients (around 31%) show kinetic alterations of sodium transport systems. There is a relation between Na(+)-Li+ countertransport activity and some cardiovascular risk parameters. Hypertensive patients with transport anomalies are a group with an increased cardiovascular risk.

[Mesenteric panniculitis: a case of acute and fatal presentation]. / Paniculitis mesentérica: un caso de presentación aguda y fatal?

Mesenteric panniculitis is a rare process in which there is an inflammation of the mesenteric adipose tissue due to unknown causes and mechanisms. It evolves with abdominal pain and/or mass, among other symptoms, generally with a chronic and bening course. The concomitant tests are generally non-specific, the diagnosis being anatompathological. We present the case of an old woman who died hours after starting an episode of abdominal pain. The autopsy showed the presence of mesenteric panniculitis. The sudden onset of the clinical signs, without other justifying cause than the panniculitis itself, suggests that this must be considered in the differential diagnosis of acute abdominal pain. In addition, the absence of other morphological findings which could suggest a fatal cause make us to consider the relationship between this and the panniculitis.

Conocimientos en resucitación cardiopulmonar en distintos servicios hospitalarios / Knowledge of cardiopulmonary resuscitation in different hospital departments

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La plataforma Moodle: Una herramienta útil para la formación en soporte vital. Análisis de las encuestas de satisfacción a los alumnos e instructores de los cursos de soporte vital avanzado del programa ESVAP de la semFYC / The Moodle platform: A useful tool for training in life support. Analysis of satisfaction questionnaires from students and instructors of the semFYC advanced life support courses

OBJETIVO: Medir la utilidad del método semipresencial en la formación en soporte vital. El uso de Moodle para implementar una fase no presencial previa a la fase presencial «clásica» en la metodología docente es su principal novedad. DISEÑO: Analizamos encuestas de satisfacción a alumnos e instructores de cursos semipresenciales de soporte vital avanzado del programa de Enseñanza de Soporte Vital en Atención Primaria (ESVAP). Emplazamiento: plataforma Moodle. Aula Virtual de semFYC. Participantes y/o contextos: Alumnos e instructores del curso de soporte vital avanzado del programa ESVAP de semFYC. MÉTODO: Análisis cualitativo. RESULTADOS: A la mayoría de los alumnos les parece muy útil (50%) o útil (45,37%) el hecho de que haya una fase no presencial previa y considera que esta fase les ha ayudado mucho (42,20%) o bastante (48,62%) a aprovechar la fase presencial. Los instructores consideraron que la fase no presencial había resultadomuy útil (89%) o útil (11%) para el desarrollo de la fase presencial. DISCUSIÓN: De los resultados se concluye que: 1) para los alumnos resulta muy útil una fase no presencial previa y consideran que ayuda bastante/mucho a aprovechar la fase presencial, y 2) los instructores consideran que la fase no presencial ha ayudado bastante en el aprovechamiento y eficiencia de los talleres en la fase presencial

OBJECTIVE: The aim of this study is to assess the validity and use of a mixed method of training in life support. The use of Moodle to implement an online pre-sessional phase prior to a 'classic' classroom phase of teaching in this type of course is the main novelty. DESIGN: Analysis of satisfaction questionnaires of students and instructors of a mixed course in the advanced life support program of SemFYC (ESVAP). SETTING: Moodle platform. semFYC Virtual Classroom. Participants and/or contexts: Students and instructors participating in the semFYC advanced life support program, ESVAP. Method: Qualitative analysis. RESULTS: The majority of students rate as very useful (50%) or useful (45.37%) the existence of an online pre-sessional phase, and consider that it has helped them very much (42.20%) or quite a lot (48.62%) to make the most of the face-to-face sessions. For instructors, they considered that the existence of an online pre-sessional phase was very useful (89%) or useful (11%) for the development of the face-to-face sessions. DISCUSSION: The analysis of the results concluded that: 1) the students considered a prior non-face to face phase as very useful, and it helped them much/very much in the face to face phase, and 2) the instructors believe that the non-face to face phase had helped them a lot in the presentations and efficiency of the workshops in the face-to-face phase

Día europeo del paro cardiaco / European Day of cardiac arrest

No disponible

[Communication between primary care and specialists]. / Comunicación entre atención primaria y atención especializada: análisis de los contenidos de los documentos de derivación y retorno de enfermos reumatológicos.

OBJECTIVE: To assess how well referral and referral-back documents for rheumatology patients going back and forth between a health area's Primary Care and the specialist clinics are filled in. DESIGN: A descriptive retrospective study. Sevilla Central Health area. PATIENTS: These were the 233 patients with a referral document in their Clinical Notes, who were sent from Primary Care (both Health Centres (HC) and out-patient clinics (OC)) to the Rheumatology Service during 1991 (233 cases). MEASUREMENTS AND MAIN RESULTS: Out of the total, 69.96% (163) came from General Practitioners in out-patient clinics and 30.04% (70) from HC Family or General doctors. In HC the referral document was completed better than in OC, in the areas of clinical history, physical investigation and laboratory data. How well the referral-back document was filled in was independent of where the patient was referred from. 30.67% of the OC referrals and 15.71% of the HC ones were suggested by Area Specialists, without any significant differences existing. CONCLUSIONS: Patients coming from HC have their referral document better completed than those referred from out-patient clinics. The return document the HC patients take back is no better filled in by the rheumatologists. A high percentage of rheumatology referrals are suggested by Area Specialists but processed through Primary Care.

[Analysis of mortality trends of ischemic heart disease in Andalucia (1975-1992)]. / Análisis temporal de la mortalidad por enfermedades isquémicas del corazón en Andalucía (1975-1992).

OBJECTIVE: To describe the evolution of mortality due to ischaemic heart diseases in Andalucia between 1975 and 1992 and predict rates up to the year 2000. DESIGN: Descriptive study. SETTING: The Autonomous Community of Andalucia. Patients and other participants. Deaths because of ischaemic heart diseases between 1975 and 1992 were obtained. MEASUREMENTS AND MAIN RESULTS: The direct method was used for the standardisation of mortality rates for age and sex, with the European population as the standard. Logarithmic transformations of the standardised rates for mortality due to ischaemic heart diseases for both sexes were performed and the regression lines were adjusted. Between 1975 and 1992 the theoretical rates went down both in men and women. If the same tendency were maintained, we would expect to see a moderate reduction between 1992 and 2000 in men and in women. CONCLUSIONS: The tendency of mortality due to ischaemic heart diseases in Andalucia is downwards in both men and women.

[Comparison of the place of origin of the referral of patients to hospital emergency service]. / Comparación de la derivación de pacientes a un servicio de urgencias hospitalario según medio de procedencia.

OBJECTIVES: To find the clinical and epidemiological differences in the place of origin (rural or urban) of patients attending a hospital Casualty Department (HCD) referred by a doctor. To detect problems in urgent non-hospital medical care, especially in rural areas. DESIGN: A descriptive crossover study. SETTING: "Centro" Health District, Sevilla. PARTICIPANTS: Patients referred to HCDs during 1995: Rural (R) = 3,521; Urban (U) = 13,203. MEASUREMENTS: The variables recorded for both groups were: age, sex, frequency of attendance, referral, diagnosis and destination of the patient. RESULTS: The urban population had a higher rate of attendance (131.8 visits per 1,000 inhabitants) than the rural (67.5). The percentage of referrals was greater from R (p < 0.001), although the proportion of population covered was similar. Age was similar, with more males from R. Abdominal and precordial pain and foreign bodies were the symptoms with most referrals from R; ear-ache, dizzy spells, minor surgery and fainting were from U. CONCLUSIONS: HCD is used to the same extent by R and U. More and better selected referred patients came from R. The rural doctor is the first to attend both serious and trivial pathology, whereas in the urban milieu the seriously ill patient goes straight to hospital.