Real-Life Impact of Glucocorticoid Treatment in COVID-19 Mortality: A Multicenter Retrospective Study.

We aimed to determine the impact of steroid use in COVID-19 in-hospital mortality, in a retrospective cohort study of the SEMICOVID19 database of admitted patients with SARS-CoV-2 laboratory-confirmed pneumonia from 131 Spanish hospitals. Patients treated with corticosteroids were compared to patients not treated with corticosteroids; and adjusted using a propensity-score for steroid treatment. From March-July 2020, 5.262 (35.26%) were treated with corticosteroids and 9.659 (64.73%) were not. In-hospital mortality overall was 20.50%; it was higher in patients treated with corticosteroids than in controls (28.5% versus 16.2%, OR 2.068 [95% confidence interval; 1.908 to 2.242]; p = 0.0001); however, when adjusting by occurrence of ARDS, mortality was significantly lower in the steroid group (43.4% versus 57.6%; OR 0.564 [95% confidence interval; 0.503 to 0.633]; p = 0.0001). Moreover, the greater the respiratory failure, the greater the impact on mortality of the steroid treatment. When adjusting these results including the propensity score as a covariate, in-hospital mortality remained significantly lower in the steroid group (OR 0.774 [0.660 to 0.907], p = 0.002). Steroid treatment reduced mortality by 24% relative to no steroid treatment (RRR 0.24). These results support the use of glucocorticoids in COVID-19 in this subgroup of patients.

Healthcare Professionals and Students' Awareness of Chagas Disease: Design and Validation of Chagas Level of Knowledge Scale (ChaLKS).

There are few studies evaluating awareness of Chagas disease among healthcare professionals attending migrants from Latin America or working in Chagas-endemic areas. The objective of this study was to design and validate instruments for assessing knowledge about Chagas disease among healthcare students and residents as well as students and professionals of social and other health science disciplines. Two validated scales have been developed: the 10-item Chagas Level of Knowledge Scale for healthcare professionals (ChaLKS-Medical) and the 8-item ChaLKS-Social&Health for potential aid workers from those fields. Both scales were considered adequate in terms of readability, internal consistency, construct validity, and discriminant validity. The mean number of correct answers on the ChaLKS-Medical among respondents from non-healthcare versus healthcare sectors was 1.80 versus 7.00 (P < 0.001). The scores on the ChaLKS-Social&Health also discriminated between the knowledge levels in these two groups (1.76 versus 6.78, P < 0.001). Knowledge among medical/pharmacy students and residents on the ChaLKS-Medical was acceptable and different (mean: 5.8 and 7.4, respectively; P < 0.001). Respondents' knowledge of Chagas disease was greater in those who had previously received information on the disease; this was true in both respondents from the healthcare sector (mean correct answers, ChaLKS-Medical: 7.2 versus 4.3, P < 0.001) and in potential aid workers (mean correct answers, ChaLKS-Social&Health: 5.1 versus 1.1, P = 0.001). The metric properties of both scales are adequate for their use in supporting aid operations in Chagas-endemic countries or in providing health and social care to migrant populations in non-endemic countries.

Syphilis and HIV infection in indigenous Mbya Guarani communities of Puerto Iguazu (Argentina): diagnosis, contact tracking, and follow-up.

The aim of study was to assess the prevalence of Treponema pallidum and HIV infection in Amerindian people (Mbya Guarani) over the age of 11 in Puerto Iguazu (Argentina) and to describe the contact tracking of cases. The method was a cross-sectional study in the Mbya Guarani people living in three villages of Puerto Iguazu (community A, pop. 1,146; community B, pop. 369; and community C, pop. 149). Participants were randomly invited to participate in the survey and in blood testing. Of the 551 participants, 48 were infected by T. pallidum (8.71%; 95% confidence interval [CI] 7.38-10.04). The infection prevalence decreased with age, standing at 9.66% in the 11-19 age group, 8.42% in 20-39 age group and 4.54% in people aged 40 and older. We tracked 130 contacts for the 48 T. pallidum cases; 39/40 (97.5%) sexual contacts tested positive for syphilis. Among the 90 children born to infected mothers, 76 aged 18 months or older tested negative, while 8/14 younger children were still at risk for congenital syphilis. There were four cases of HIV infection (0.72%, 95% CI 0.31-1.13). Prevalence of T. pallidum infection and HIV infection are relevant in this indigenous community of Argentina, representing a public health concern.

Experiencia Pecha Kucha en la facultad de medicina / Pecha Kucha experience in the school of medicine

INTRODUCCIÓN: Pecha Kucha (P-K) es una nueva técnica de presentación innovadora que enfatiza la entrega rápida de imágenes visuales. Fue utilizada por primera vez en el diseño de arquitectura, y desde hace poco tiempo también se está empleando en la educación superior. Con el fin de conocer más esta última aplicación nos planteamos estudiar la experiencia de la presentación P-K en la docencia de estudiantes del grado en medicina. MÉTODOS: Se realizaron 2 eventos P-K de 15 presentaciones. Cada presentación fue preparada por 4 alumnos y versaban sobre «pruebas y exploraciones complementarias y técnicas especiales en medicina clínica». El evento estaba integrado en la asignatura «Talleres integrados II» del grado en medicina de la Universidad Miguel Hernández de Elche. RESULTADOS: Las presentaciones en formato P-K fueron grabadas, editadas y cargadas en el canal Universidad Miguel Hernández de YouTube. Con respecto a la fidelidad al formato P-K, solo 2 presentaciones (6,7%) usaron imágenes en más del 75% del espacio de las diapositivas, 6 presentaciones usaron imágenes en el 50-75% de las diapositivas y 8 presentaciones (26,7%) tenían menos del 25% de la diapositiva con imágenes. En una encuesta de satisfacción el 62,3% encontraron que la organización del seminario de P-K merecía una puntuación de 6 o 7 en una escala de Likert de 7 puntos (donde 0 es «perjudicial» y 7 es «sobresaliente»); el 42,7% de los estudiantes calificó su satisfacción general como «muy buena» o «sobresaliente». CONCLUSIÓN: Esta experiencia P-K podría aplicarse a otros grados en ciencias de la salud, pudiendo ser presentadas por los alumnos

INTRODUCTION: Pecha Kucha is an innovative presentation technique emphasising the rapid delivery of visual images. First used in architecture design, today it is making new inroads in higher education. The aim of this article is to determine the acceptability of this approach among medical students. METHODS: Two events were held with 15 Pecha Kucha presentations each, for a total of 30 total topics related to complementary tests, examinations, and special techniques in clinical medicine. Four students contributed to preparing each presentation. The event was part of the third-year module, "Integrated Workshops", at the Miguel Hernández University (UMH) Medical School (Elche, Spain). RESULTS: Pecha Kucha presentations were recorded, edited, and uploaded onto the UMH YouTube channel. As regards the fidelity of the Pecha Kucha format, only 2 presentations (6.7%) used images for more than 75% of the space on the slides, 6 presentations used images in 50% to 75% of the slides, and 8 presentations (26.7%) had less than 25% of the slides with images. In a student satisfaction survey, 62.3% of respondents considered the organisation of the Pecha Kucha seminar to merit a score of 6 or 7 on a 7-point Likert scale (where 0 is 'detrimental' and 7 is "outstanding"), and 42.7% of the students scored their overall satisfaction as a "very good" or "outstanding". Conclusion: It is believed that this experience is valuable and can be applied in other disciplines of medical education, as well as other science degree programs

Adverse Events Leading to Discontinuation of Phototherapy: An Observational Study.

The aim of this prospective study in a phototherapy unit was to describe adverse events (AEs) associated with discontinuation of phototherapy in a clinical setting. A total of 872 included patients received 1,256 courses of phototherapy treatment: 76.9% narrow-band UVB (NBUVB); 9.6% systemic psoralen plus UVA (PUVA); 11.4% topical PUVA; and 2.1% UVA. Approximately a fifth of the treatments (n = 240, 19.1%) were associated with AEs, the most frequent of which was erythema (8.8%). Systemic PUVA had the highest rate of AEs (32.5%). Mycosis fungoides was the dermatosis with the highest rate of AE (36.9%). A total of 216 (17.2%) patients stopped treatment: 23.6% because of AEs (4.1% of all treatments). Treatment suspension due to AEs was associated with PUVA, both topical and systemic (p < 0.001), and diagnoses of mycosis fungoides (p <0.001), palmoplantar psoriasis (p = 0.002), hand eczema (p = 0.002) and pityriasis lichenoides (p = 0.01). In conclusion, one in every 5 patients receiving phototherapy had an AE, but few stopped treatment for this reason.

Infective endocarditis in elderly and very elderly patients.

AIMS: To compare the clinical and epidemiological characteristics and the evolution of infective endocarditis in adults aged under 65 years, 65-79 years, and 80 years or older. METHODS: An observational retrospective cohort study in patients with infective endocarditis was performed in a public hospital in Spain from January 2013 to December 2017. RESULTS: Seventy-two patients were treated: 26 (36.1%) were under 65 years old, 28 (38.9%) were 65-79 years old, and 18 (25%) were aged 80 or older. Prosthetic valve endocarditis was less common in patients aged 65-79 years (3.6%) than in younger (23.1%; p = 0.047) or older (38.9%; p = 0.004) patients. In contrast, degenerative heart disease was more prevalent in the 65-79 year age group [64.3% compared to 15.4% (p < 0.001) in the youngest group, and 33.3% (p = 0.04) in the oldest]. Surgical interventions were similar in patients aged 65-79 (50%) and under 65 years (42.3%), but less common in people over 80 years (16.7%; p = 0.022). CONCLUSIONS: The characteristics of infective endocarditis are different in patients aged 65-79 years and in those over 80 years.

Molecular Survey of Rickettsia spp., Anaplasma spp., Ehrlichia spp., Bartonella spp., and Borrelia spp. in Fleas and Lice in Ethiopia.

Bacterial arthropod-borne pathogens can often cause fever in Africa, but rural laboratories in these settings are usually too basic to provide a precise picture of their epidemiological impact. Our aim was to determine the prevalence of bacterial pathogens in fleas and lice in a rural area of southeast Ethiopia. Between July and November 2013, we extracted DNA from 91 fleas (Ctenocephalides felis [n = 50; 54.9%], Pulex irritans [n = 37; 40.1%], and C. canis [n = 4; 4.4%] and 30 lice (Pediculus humanus capitis [n = 16; 53.3%] and Pediculus humanus humanus [n = 14; 46.7%]), using two quantitative PCR (qPCR) analyses to look for bacteria from the genera: Anaplasma, Bartonella, Borrelia, Coxiella, Ehrlichia, Francisella, and Rickettsia. Of the 91 fleas analyzed, pathogens were present in 79 (86.8%), including Rickettsia felis (n = 41; 45%), Anaplasma platys (n = 40; 44.0%), Rickettsia monacensis (n = 2; 2.2%), Ehrlichia muris-like agent (n = 1; 1.1%), and Bartonella clarridgeiae (n = 1; 1.1%). P. irritans was the flea species most frequently infected with A. platys (67.7%), followed by C. felis (30.7%) (p < 0.001). Of the 30 lice identified, pathogens were present in 7 (23.3%): Bartonella quintana (n = 4; 16.7%), E. muris (n = 2, 6.7%), and Borrelia recurrentis (n = 1, 3.3%). Thus, in this rural area of Africa, fleas and lice can transmit parasitic pathogens to humans, causing febrile symptoms.

Cytokine levels predict 30-day mortality in octogenarians and nonagenarians with community-acquired pneumonia: a retrospective observational study.

To analyze the value of cytokines (tumor necrosis factor [TNF]-α, interleukin [IL]-1ß, IL-6, IL-8, IL-10) as predictors of mortality at 30 days in octogenarians and nonagenarians hospitalized in an internal medicine unit for community-acquired pneumonia (CAP). An observational, analytical, retrospective cohort study was conducted in the Department of Internal Medicine at Alicante General University Hospital between January 2014 and December 2015. Blood samples were frozen at - 80 °C, and cytokines were measured by ELISA. We included 115 patients, of whom 54% were men, with a mean age of 86.4 (standard deviation 4.5) years. There is a moderate correlation between IL-10 levels and CURB-65 score (p < 0.001) and a weak correlation with creatinine levels (p = 0.012) and urea levels (p = 0.032). Forty-five (39.1%) patients died within 30 days. In a multivariate analysis, the variables associated with mortality at 30 days were the following: age (adjusted odds ratio [ORa] 1.134, 95% confidence interval [CI] 1.02, 1.26), male sex (ORa 2.85, 95% CI 1.14, 7.14), IL-8 of 19 pg/mL or more (ORa 4.09, 95% CI 1.67, 10.01), and IL-10 of 11.29 pg/mL or more (ORa 4.00, 95% CI 1.58, 10.12). High IL-8 and IL-10 levels were shown to predict 30-day mortality in elderly patients with CAP. The inflammatory response in these patients seems to condition their prognosis. Further research in this line would provide more understanding about the physiopathological mechanisms and potential therapeutic targets for improving survival.

The quick Sepsis-related Organ Failure Assessment (qSOFA) is a good predictor of in-hospital mortality in very elderly patients with bloodstream infections: A retrospective observational study.

People over 80 years old are now the fastest-growing age group. Bloodstream infections (BSI) in these patients may present with specific characteristics. The objective of this study was to analyze independent factors affecting in-hospital mortality (IHM) due to BSI in very elderly patients (≥80 years of age) and to compare the clinical presentation of BSI in patients aged 80-89 years versus those aged 90 or more. Retrospective, cross-sectional and observational study of BSI in patients aged 80 years or older. The study used IHM as the primary outcome. Stepwise multiple logistic regression models were used to identify associations between potential predictors and IHM. Of the 336 included patients, 76.8% (n = 258) were in the 80-89-year age group and 23.2% (n = 78) in the 90+ age group; 17.3% (n = 58) of patients died during admission. This outcome was independently associated with quick Sepsis Related Organ Failure Assessment (qSOFA) of 2 or more (adjusted odds ratio [aOR] 4.7, 95% confidence interval [CI] 2.3-9.4; p < 0.001). Other predictors included an origin of BSI outside the urinary tract (aOR 5.5, 95% CI 2.4-12.6; p < 0.001), thrombocytopenia (aOR 4.9, 95% CI 1.8-13.4; p = 0.002), hospital-acquired infection (aOR 3.0, 95% CI 1.2-7.5; p = 0.015), and inappropriate empiric antibiotics (aOR 2.0, 95% CI 1.1-3.9; p = 0.04). IHM was 23.1% in the 90+ age group and 15.5% in patients aged 80 to 89 (p = 0.012). However, the 90+ age group was more likely to have a score of at least 2 on the qSOFA (29.9% vs. 19.1%, p = 0.043) and Pitt bacteremia scales (44.9% vs. 30.2%; p = 0.02), as well as chronic kidney disease (56.4% vs. 36.0%; p = 0.001) and altered mental state (40.3% vs. 25.7%; p = 0.013). In conclusion: A qSOFA score of 2 or more and a BSI originating outside the urinary tract were independent predictors of IHM. The 90+ age group was at higher risk than the 80-89-year age group of having a qSOFA score and Pitt bacteremia score of 2 or more as well as an altered mental state.

A snapshot of pneumonia research activity and collaboration patterns (2001-2015): a global bibliometric analysis.

BACKGROUND: This article describes a bibliometric review of the scientific production, geographical distribution, collaboration, impact, and subject area focus of pneumonia research indexed on the Web of Science over a 15-year period. METHODS: We searched the Web of Science database using the Medical Subject Heading (MeSH) of "Pneumonia" from January 1, 2001 to December 31, 2015. The only document types we studied were original articles and reviews, analyzing descriptive indicators by five-year periods and the scientific production by country, adjusting for population, economic, and research-related parameters. RESULTS: A total of 22,694 references were retrieved. The number of publications increased steadily over time, from 981 publications in 2001 to 1977 in 2015 (R2 = 0.956). The most productive country was the USA (38.49%), followed by the UK (7.18%) and Japan (5.46%). Research production from China increased by more than 1000%. By geographical area, North America (42.08%) and Europe (40.79%) were most dominant. Scientific production in low- and middle-income countries more than tripled, although their overall contribution to the field remained limited (< 15%). Overall, 18.8% of papers were the result of an international collaboration, although this proportion was much higher in sub-Saharan Africa (46.08%) and South Asia (23.43%). According to the specific MeSH terms used, articles focused mainly on "Pneumonia, Bacterial" (19.99%), followed by "Pneumonia, Pneumococcal" (7.02%) and "Pneumonia, Ventilator-Associated" (6.79%). CONCLUSIONS: Pneumonia research increased steadily over the 15-year study period, with Europe and North America leading scientific production. About a fifth of all papers reflected international collaborations, and these were most evident in papers from sub-Saharan Africa and South Asia.

Docencia en grado y posgrado en Medicina de Urgencias y Emergencias en las facultades de medicina españolas / Undergraduate and post-graduate teaching of Emergency Medicine and Emergencies in Spanish medical schools

INTRODUCCIÓN: Analizar la situación actual y las características de la docencia en Medicina de Urgencias y Emergencias (MUE) en el grado y posgrado en las facultades de medicina españolas. MÉTODO: Análisis descriptivo de los planes de estudio de grado y posgrado de las 42 facultades de medicina españolas, identificando en los planes de estudio de sus páginas web las asignaturas con la denominación «Medicina de Urgencias-Emergencias» o «Medicina de Urgencias». RESULTADOS: De las 42 facultades de medicina, 38 (90,4%) presentan en sus planes de estudio asignaturas con denominación MUE. De las 38 facultades, 3 (2,4%) tienen MUE como materia obligatoria única no prácticas, 21 (50%) facultades tienen MUE como materia obligatoria no prácticas compartida con otras materias, 26 (61,9%) facultades tiene MUE como materia obligatoria en el rotario clínico o de práctica clínicas y 13 (31%) facultades tienen MUE como materia optativa. En 11 (26,2%) imparten un título de posgrado como máster o experto relacionado con la MUE. De las 11 facultades, 2 imparten dos o más títulos y las 9 restantes solo uno. Solo en 2 facultades el título del máster es oficial; las 9 restantes ofertan su formación con título propio. CONCLUSIONES: La enseñanza-aprendizaje de la MUE es incluida en los planes de estudio de las facultades de medicina españolas, de carácter obligatorio, optativo o de práctica clínica

INTRODUCTION: To analyse the situation and characteristics of medical education in Emergency Medicine (EM) in undergraduates and post-graduates in Spanish medical schools. METHODS: Data were collected and analysed from 42 Spanish schools of medicine. A search was conducted on each school of medicine's website curricula, identifying subjects under the name "emergency medicine" or "urgent medicine". RESULTS: Of the 42 schools of medicine, 38 (90.4%) present EM in their plans of study subjects. Of these 38 schools, 3 (2.4%) have EM as a single non-practical, compulsory subject, 21 (50%) schools have EM as a non-practical compulsory subject shared with other subjects, 26 (61.9%) schools have EM as a compulsory subject in the clinical practice, and 13 (31%) schools have EM as optional subject. Eleven schools (26.2%) had a postgraduate certificates related to emergency medicine, with two of them having 2 or more certificates, and 9 with only one. Only 2 had official certificates and the others were non-official certificates. CONCLUSIONS: This study clearly shows that teaching in emergency medicine is included in the undergraduate curricula in most Spanish medical schools as mandatory, optional, or in clinical rotation, however in postgraduate education, its implantation is low

Organización y métodos didácticos de una asignatura que integra asignaturas y competencias transversales en el Grado en Medicina. Experiencia con «Talleres integrados II» de la Universidad Miguel Hernández de Elche / Organisation and didactic methods of a subject that integrates subjects and transversal skills into the Medical Degree. Experience with the Integrated Workshops of the Miguel Hernández University of Elche, Spain

Los estudiantes de medicina necesitan adquirir una serie de conocimientos, habilidades y actitudes que les capaciten para el desempeño de la medicina. La facultad de Medicina de la Universidad Miguel Hernández de Elche incluyó en su plan de estudios del Grado en Medicina 4 asignaturas denominadas «talleres integrados» en las que se desarrollan diversas actividades docentes para integrar conocimientos y habilidades clínicas de varias disciplinas y fomentar la adquisición de competencias transversales. En este artículo describimos la organización y métodos didácticos empleados en la asignatura «Talleres integrados II» como un elemento de reflexión para compartir la experiencia con la comunidad educativa en medicina. Esta asignatura integra las siguientes materias: bases generales de la cirugía, farmacología clínica, patología general, inmunología y alergia, dermatología, epidemiología y demografía sanitaria, microbiología, obstetricia y oftalmología. Es una asignatura con 4,5 créditos prácticos y utiliza elementos docentes como práctica hospitalaria guiada por objetivos, participación de alumnos y talleres prácticos, simulación, prueba evaluación de competencias objetiva estructurada, y presentación clínica en formato Pecha Kucha, lo que potencia la integración de conocimientos y el aprendizaje activo con adquisición de competencias y habilidades prácticas muy pertinentes para el futuro médico

Medical students need to acquire a range of knowledge, skills, and attitudes that will prepare them for medical clinical practice. The School of Medicine of Miguel Hernández University (Elche, Spain) includes, in its Medical Degree curriculum, 4 subjects called "Talleres integrados" (Integrated Workshops-II). Diverse teaching activities are developed to integrate knowledge and clinical skills of several disciplines, and to promote the acquisition of transversal skills. A description is presented of the organisation and didactic methods used in the Integrated Workshops-II subject as an element for reflection and to share the experience with the educational community in medicine. This subject integrates the following: general bases of surgery, clinical pharmacology, general pathology, immunology and allergy, dermatology, epidemiology and health demography, microbiology, obstetrics and ophthalmology. It is a subject with 4.5 practical credits and uses teaching elements such as hospital practice guided by objectives, student participation and practical workshops, simulation, objective structured clinical examination (OSCE), and presentation of cases in Pecha Kucha format, all of which enhances the integration of knowledge and active learning with acquisition of skills and practical skills very pertinent for the future doctor

Diferencias en pacientes oncológicos y no oncológicos ingresados en una unidad de cuidados paliativos de reciente creación en un hospital de tercer nivel en la Comunidad Valenciana (España) / Differences in cancer patients and non-cancer patients admitted to a new palliative care unit of the general university hospital of the Valencian Community (Spain)

OBJETIVO: Evaluar las diferencias entre pacientes paliativos oncológicos y no oncológicos ingresados en la Unidad de Cuidados Paliativos. MATERIAL Y MÉTODOS: Estudio retrospectivo y analítico de los paciente paliativos atendidos en la Unidad de Cuidados Paliativos perteneciente al Servicio de Medicina Interna del Hospital General Universitario de Alicante entre el 1 junio de 2013 y el 31 de junio del 2014. De cada paciente se recogieron variables epidemiológicas (edad, sexo), clínicas (fiebre, caquexia/anorexia, astenia, náuseas/vómitos, somnolencia, síntomas psicológicos, dolor y disnea), evolutivas y necesidad de sedación paliativa. RESULTADOS: Fueron estudiados en la Unidad de Cuidados Paliativos 143 de los 1.599 (8,9%) ingresados en la sección de medicina interna. La mediana de edad de los paciente fue de 83 años (recorrido intercuartílico: 75-89) y la relación hombre/mujeres fue de 1,4. Sesenta y cuatro (44,7%) ingresos fueron pacientes paliativos oncológicos y 79 (65,3%) no oncológicos. Y dentro de los pacientes no oncológicos estos fueron: 38 (48,1%) pacientes pluripatológicos con progresión irreversible de comorbilidades, 33 (41,8%) (pacientes por enfermedad crónica en estadio final y 8 (10,1%) pacientes de edad avanzada en estadio final de la vida. Respecto a los síntomas hubo una mayor probabilidad de disnea en los pacientes paliativos no oncológicos (odds ratio [OR]: 4,65, intervalo de confianza [IC] 95%: 2,17-10,7) y una menor probabilidad de dolor (OR: 0,23; IC 95%: 0,09-0,54) y náuseas/vómitos (p = 0,025) en ellos. Así como un mayor control de síntomas fue mayor en los pacientes paliativos no oncológicos (OR: 2,03; IC95%: 1,0-4,10). La sedación paliativa fue administrada en el 23% de los casos, similar en los dos grupos de pacientes. CONCLUSIÓN: La sintomatología de los cuidados paliativos es diferente en pacientes no oncológicos y oncológicos

OBJECTIVE: To evaluate patient differences between palliative cancer and non-cancer patients admitted to the Unit of Palliative Care. MATERIAL AND METHODS: A retrospective and analytical study of the palliative patients treated in the Unit of Palliative Care under the Department of Internal Medicine, Hospital General Universitario of Alicante between 1 June 2013 and 31 June 2014. Variables included were epidemiological (age, sex), clinical symptoms (fever, cachexia / anorexia, asthenia, nausea / vomiting, drowsiness, psychological symptoms, pain and dyspnoea), outcome and need for palliative sedation. RESULTS: One hundred and forty-three patients out of the 1,599 (8.9%) admitted to the Section of Internal Medicine were studied in the Unit of Palliative Care. The median age of the patients was 83 years (interquartile range: 75-89) and the male: female ratio was 1.4. Sixty-four (44.7%) were palliative cancer patients and 79 (65.3%) were non-cancer palliative. Out of 79 non-cancer palliative PATIENTS: 38 (48.1%) were patients with irreversible progression of comorbidities, 33 (41.8%) patients with end-stage chronic disease and 8 (10.1%) elderly patients in the final stage of life. With regard to symptoms, the non-cancer palliative patients were more likely to experience dyspnoea (odds ratio [OR]: 4.65, 95% confidence interval [CI]:, 1.7-10 7) and less likely to experience pain (OR: 0.23; 95% CI: 0.09 to 0.54) and nausea /vomiting (p =.025). Symptoms were better controlled in the non- non- cancer palliative patients (OR: 2.03; 95% CI 1.0 to 4.10). Palliative sedation was administered to 23% of the patients, similar in both types of PATIENTS: CONCLUSIONS: The symptoms of palliative care were different in the non-cancer and cancer patients

Panorama actual de la enseñanza de la Medicina Tropical, Salud Internacional y Salud Global en la universidad española / A current overview of the teaching of Tropical Medicine, International Health and Global Health in the Spanish university

Introducción. La enseñanza de la medicina tropical, salud internacional o salud global en las Facultades de Medicina y Farmacia españolas se desconoce. El objetivo de este estudio es mostrar el panorama actual de la docencia en grado y post-grado. Material y métodos. Se revisan los planes de estudio, identificando aquellas asignaturas y postgrados con la denominación "Medicina Tropical", "Salud Internacional", "Salud Global" o "Enfermedades Importadas". Resultados. En 15 de las 40 (37,5 %) facultades de Medicina se imparte durante el grado la materia de Medicina Tropical, Salud Internacional o Salud Global. En 14 de ellas (93,3%) con carácter optativo y en 1 (6,7%) con carácter obligatorio. En 4 de las 22 (18,1%) facultades de Farmacia se imparte en el grado la materia de medicina tropical, salud internacional o salud global. Conclusión. La docencia en Medicina Tropical, Salud Internacional y Salud Global en las facultades de Medicina y Farmacia tienen una presencia limitada actualmente

Background. The teaching of tropical medicine, international health or global health in the Spanish Schools of Medicine and Pharmacy is unknown. The objective of this study is to show a current overview of teaching in degree and post-graduate. Material and methods. The curricula are reviewed, identifying those subjects and postgraduate courses with the denomination "Tropical Medicine", "International Health", "Global Health" or "Imported Diseases" Results. In 15 of the 40 (37.5%) schools of Medicine the subject of Tropical Medicine, International Health or Global Health is taught during the degree. In 14 of them (93.3%) with an optional character and in one (6.7%) with obligatory character. In 4 out of 22 (18.1%) Pharmacy schools are taught in the degree of Tropical Medicine, International Health or Global Health. Conclusions. The teaching in Tropical Medicine, International Health and Global Health in the Schools of Medicine and Pharmacy in Spain has, currently, a limited presence

The reach of Spanish-language YouTube videos on physical examinations made by undergraduate medical students.

This study was conducted to evaluate the performance and reach of YouTube videos on physical examinations made by Spanish university students. We analyzed performance metrics for 4 videos on physical examinations in Spanish that were created by medical students at Miguel Hernández University (Elche, Spain) and are available on YouTube, on the following topics: the head and neck (7:30), the cardiovascular system (7:38), the respiratory system (13:54), and the abdomen (11:10). We used the Analytics application offered by the YouTube platform to analyze the reach of the videos from the upload date (February 17, 2015) to July 28, 2017 (2 years, 5 months, and 11 days). The total number of views, length of watch-time, and the mean view duration for the 4 videos were, respectively: 164,403 views (mean, 41,101 views; range, 12,389 to 94,573 views), 425,888 minutes (mean, 106,472 minutes; range, 37,889 to 172,840 minutes), and 2:56 minutes (range, 1:49 to 4:03 minutes). Mexico was the most frequent playback location, followed by Spain, Colombia, and Venezuela. Uruguay, Ecuador, Mexico, and Puerto Rico had the most views per 100,000 population. Spanish-language tutorials are an alternative tool for teaching physical examination skills to students whose first language is not English. The videos were especially popular in Uruguay, Ecuador, and Mexico.

Características asistenciales de la población extranjera en el servicio de urgencias del Hospital Universitario de Torrevieja: diferencias con la población nacional / Care characteristics of the foreigner population in the emergency department at the University Hospital of Torrevieja, Alicante (Spain): differences with the native population

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Características epidemiológicas en pacientes ingresados por lepra en un hospital rural de referencia en Etiopía durante 14 años / No disponible

Introducción: El objetivo del estudio fue analizar las características clínico epidemiológicas y evolutivas de los de los pacientes ingresados en una sala de hospitalización específica de la lepra. Métodos: Recogida retrospectiva de datos de pacientes ingresados por lepra usando los libros de registro de admisión desde septiembre 2002 hasta septiembre 2016 en el Hospital General Rural de Gambo. Resultados: Durante el período de estudio hubo 2.134 ingresos en la sala de lepra; de ellos 1.386 (64,9%) fueron hombres, el ratio de admisiones hombres /mujeres fue 1,9. Ciento ochenta pacientes (8,4%) pacientes tenían 18 años o menos. El número de casos nuevos fue 287 (13,4%) frente a los antiguos casos 1.847 (86,6%). Mil setecientos ochenta y cuatro pacientes presentaban lepra multibacilar (83,6%). El principal diagnóstico durante el ingreso fueron úlceras de piel neuropáticas (n=1280; 60%). Otros diagnósticos por orden de frecuencia fueron leprorreacción (n=305; 14,3%) y neuropatía (n=132; 6,2%). La mediana de estancia en el hospital fue 58 días (recorrido intercuartílico: 31-96,5). La mayoría de los pacientes se recuperaron satisfactoriamente al alta 1.822 (84,9%). La mortalidad fue baja 1,7%. Conclusiones: La mayoría de los pacientes eran varones, que ingresaron en el curso de la enfermedad (en tratamiento o antiguos leprosos), la mayoría adultos y principalmente por ulceraciones

Introduction: The objective of the study was to analyze the clinical and evolutionary characteristics of the patients admitted to a specific hospitalization room for leprosy at the Hospital Rural of Gambo .Methods: Retrospective data collection of patients admitted for leprosy using the admission logbooks from September 2002 to September 2016 at the General Rural Hospital of Gambo. Results: During the study period, there were 2,134 admissions in the leprosy ward; there were 1,386 (64.9%) men, the ratio of admissions for men / women was 1.9. One hundred and eighty patients (8.4%) were 18 years or younger. The number of new cases was 287 (13.4%) compared to the old cases, 1,847 (86.6%). One thousand seven hundred and eighty four patients presented multibacillary leprosy (83.6%). The main diagnosis during admission was neuropathic skin ulcers (n = 1280; 60%). Other diagnoses in order of frequency were leprosy reactions (n = 305, 14.3%) and neuropathy (n = 132, 6.2%). The median hospital stay was 58 days (interquartile range: 31-96.5). The majority of the patients recovered satisfactorily at the 1822 discharge (84.9%). Mortality was low 1.7%. Conclusions: The majority of the patients were men, who entered the course of the disease (in treatment or old lepers), most of them adults and mainly ulcerations