Cold stress induces rapid gene-specific changes in the levels of H3K4me3 and H3K27me3 in Arabidopsis thaliana.

When exposed to low temperatures, plants undergo a drastic reprogramming of their transcriptome in order to adapt to their new environmental conditions, which primes them for potential freezing temperatures. While the involvement of transcription factors in this process, termed cold acclimation, has been deeply investigated, the potential contribution of chromatin regulation remains largely unclear. A large proportion of cold-inducible genes carries the repressive mark histone 3 lysine 27 trimethylation (H3K27me3), which has been hypothesized as maintaining them in a silenced state in the absence of stress, but which would need to be removed or counteracted upon stress perception. However, the fate of H3K27me3 during cold exposure has not been studied genome-wide. In this study, we offer an epigenome profiling of H3K27me3 and its antagonistic active mark H3K4me3 during short-term cold exposure. Both chromatin marks undergo rapid redistribution upon cold exposure, however, the gene sets undergoing H3K4me3 or H3K27me3 differential methylation are distinct, refuting the simplistic idea that gene activation relies on a switch from an H3K27me3 repressed chromatin to an active form enriched in H3K4me3. Coupling the ChIP-seq experiments with transcriptome profiling reveals that differential histone methylation only weakly correlates with changes in expression. Interestingly, only a subset of cold-regulated genes lose H3K27me3 during their induction, indicating that H3K27me3 is not an obstacle to transcriptional activation. In the H3K27me3 methyltransferase curly leaf (clf) mutant, many cold regulated genes display reduced H3K27me3 levels but their transcriptional activity is not altered prior or during a cold exposure, suggesting that H3K27me3 may serve a more intricate role in the cold response than simply repressing the cold-inducible genes in naïve conditions.

All You Need is Music: Supporting Medical Students' Emotional Development with a Music-Based Pedagogy.

PROBLEM: Although the practice of medicine is often emotionally challenging, medical curricula seldom systematically address the emotional development of medical students. To fill this gap, the authors developed and evaluated an innovative pedagogical activity based on music to nurture medical students' emotional development. The authors believe that the metaphoric nature of music offers an efficient venue for exploring emotion perception, expression, and regulation. APPROACH: The pedagogical activity Emotions in Medicine was carried out throughout 2020 and 2021 and consisted of 4 encounters to explore: (1) emotion perception, (2) emotion expression, (3) emotion regulation, and (4) the role of emotions in medical practice. During all encounters, the authors used music to evoke students' emotions and focused the discussions on the relevance of emotions for meaningful medical practice. Emotional intelligence before and after the workshop was tested using the Schutte Self-Report Emotional Intelligence Test (SSEIT), a validated psychometric scale. OUTCOMES: The workshop facilitated emotional connection among students and created a safe space to explore the role of emotions in medical practice. The mean total pretest SSEIT score was 110 (SD = 14.2); it increased to 116.8 (SD = 16.1) in the posttest (P < .001). This increase was true across its 4 dimensions: (1) perception of emotions, (2) management of own emotions (3) management of others' emotions, and (4) use of emotions. NEXT STEPS: Music can be an active tool to explore the role of emotions in medical practice. It fosters students' capacity to identify and reflect on emotions while exploring their role in patient care. Further (qualitative) research is needed to explore the mechanisms by which music facilitates learning emotion perception, expression, and regulation.

Nonpathogenic leaf-colonizing bacteria elicit pathogen-like responses in a colonization density-dependent manner.

Leaves are colonized by a complex mix of microbes, termed the leaf microbiota. Even though the leaf microbiota is increasingly recognized as an integral part of plant life and health, our understanding of its interactions with the plant host is still limited. Here, mature, axenically grown Arabidopsis thaliana plants were spray inoculated with six diverse leaf-colonizing bacteria. The transcriptomic changes in leaves were tracked over time and significant changes in ethylene marker (ARL2) expression were observed only 2-4 days after spray inoculation. Whole-transcriptome sequencing revealed that 4 days after inoculation, leaf transcriptional changes to colonization by nonpathogenic and pathogenic bacteria differed in strength but not in the type of response. Inoculation of plants with different densities of the nonpathogenic bacterium Williamsia sp. Leaf354 showed that high bacterial titers resulted in disease phenotypes and led to severe transcriptional reprogramming with a strong focus on plant defense. An in silico epigenetic analysis of the data was congruent with the transcriptomic analysis. These findings suggest (1) that plant responses are not rapid after spray inoculation, (2) that plant responses only differ in strength, and (3) that plants respond to high titers of nonpathogenic bacteria with pathogen-like responses.

Heart rate variability and perception of mental stress among medical students and residents at an emergency department.

BACKGROUND: When Medical Residents (MR) and Medical Students (MS) are assigned to the demanding environment of an Emergency they inevitably encounter stress. The aims of this study are to measure short-term heart rate variability (HRV) before and after shifts, estimate perceived stress levels, and assess the recovery patterns after their shifts. METHODS: We assessed HRV parameters in MS and MR using the wristband physiological monitor Polar® Verify Sense before and after day (DS) and night shifts (NS). Perceived stress levels were evaluated using the simplified State Trait Anxiety Inventory (STAI-S6) and the Subjective Units of Distress Scale. RESULTS: This study included 60 participants of which 55% were female with a mean age of 26 years. MS presented significant reduction in sympathetic nervous system index after DS [0.68 (0.01-2.42) vs -0.22 (-0.75-1.13), p < 0.01] and NS [0.87 (-0.28-1.45) vs 0.06 (-0.70-1.04), p < 0.01], while MR maintained the same levels of sympathetic activity [DS: 1.17 (0.04 -2.88) vs 0.93 (0.50-1.41), p = 0.14; NS: 1.37 (0.76-2.21) vs 1.29 (0.35-2.18), p = 0.40]. Psychological data from STAI-S6 showed statistically significant differences when comparing before and after DS in both groups, with more perceived stress after than before DS (MS: 12 ± 4 vs 14 ± 4, p = 0.04; MR: 14 ± 4 vs 16 ± 4, p = 0.04), which was not observed at NS (MS: 12 ± 3 vs 12 ± 3, p = 0.84; MR: 15 ± 3 vs 15 ± 4, p = 0.40). CONCLUSIONS: Short-term HRV recordings before and after day or night shifts among MR and MS revealed heightened sympathetic activity preceding each shift, with a more sustained increase observed in the MR population and more perceived stress after day shifts in both groups.

The UBP5 histone H2A deubiquitinase counteracts PRCs-mediated repression to regulate Arabidopsis development.

Polycomb Repressive Complexes (PRCs) control gene expression through the incorporation of H2Aub and H3K27me3. In recent years, there is increasing evidence of the complexity of PRCs' interaction networks and the interplay of these interactors with PRCs in epigenome reshaping, which is fundamental to understand gene regulatory mechanisms. Here, we identified UBIQUITIN SPECIFIC PROTEASE 5 (UBP5) as a chromatin player able to counteract the deposition of the two PRCs' epigenetic hallmarks in Arabidopsis thaliana. We demonstrated that UBP5 is a plant developmental regulator based on functional analyses of ubp5-CRISPR Cas9 mutant plants. UBP5 promotes H2A monoubiquitination erasure, leading to transcriptional de-repression. Furthermore, preferential association of UBP5 at PRC2 recruiting motifs and local H3K27me3 gaining in ubp5 mutant plants suggest the existence of functional interplays between UBP5 and PRC2 in regulating epigenome dynamics. In summary, acting as an antagonist of the pivotal epigenetic repressive marks H2Aub and H3K27me3, UBP5 provides novel insights to disentangle the complex regulation of PRCs' activities.

Conserved functions of chromatin regulators in basal Archaeplastida.

Chromatin is a dynamic network that regulates genome organization and gene expression. Different types of chromatin regulators are highly conserved among Archaeplastida, including unicellular algae, while some chromatin genes are only present in land plant genomes. Here, we review recent advances in understanding the function of conserved chromatin factors in basal land plants and algae. We focus on the role of Polycomb-group genes which mediate H3K27me3-based silencing and play a role in balancing gene dosage and regulating haploid-to-diploid transitions by tissue-specific repression of the transcription factors KNOX and BELL in many representatives of the green lineage. Moreover, H3K27me3 predominantly occupies repetitive elements which can lead to their silencing in a unicellular alga and basal land plants, while it covers mostly protein-coding genes in higher land plants. In addition, we discuss the role of nuclear matrix constituent proteins as putative functional lamin analogs that are highly conserved among land plants and might have an ancestral function in stress response regulation. In summary, our review highlights the importance of studying chromatin regulation in a wide range of organisms in the Archaeplastida.

The Polycomb repressive complex 2 deposits H3K27me3 and represses transposable elements in a broad range of eukaryotes.

The mobility of transposable elements (TEs) contributes to evolution of genomes. Their uncontrolled activity causes genomic instability; therefore, expression of TEs is silenced by host genomes. TEs are marked with DNA and H3K9 methylation, which are associated with silencing in flowering plants, animals, and fungi. However, in distantly related groups of eukaryotes, TEs are marked by H3K27me3 deposited by the Polycomb repressive complex 2 (PRC2), an epigenetic mark associated with gene silencing in flowering plants and animals. The direct silencing of TEs by PRC2 has so far only been shown in one species of ciliates. To test if PRC2 silences TEs in a broader range of eukaryotes, we generated mutants with reduced PRC2 activity and analyzed the role of PRC2 in extant species along the lineage of Archaeplastida and in the diatom P. tricornutum. In this diatom and the red alga C. merolae, a greater proportion of TEs than genes were repressed by PRC2, whereas a greater proportion of genes than TEs were repressed by PRC2 in bryophytes. In flowering plants, TEs contained potential cis-elements recognized by transcription factors and associated with neighbor genes as transcriptional units repressed by PRC2. Thus, silencing of TEs by PRC2 is observed not only in Archaeplastida but also in diatoms and ciliates, suggesting that PRC2 deposited H3K27me3 to silence TEs in the last common ancestor of eukaryotes. We hypothesize that during the evolution of Archaeplastida, TE fragments marked with H3K27me3 were selected to shape transcriptional regulation, controlling networks of genes regulated by PRC2.

Completing the TRB family: newly characterized members show ancient evolutionary origins and distinct localization, yet similar interactions.

Telomere repeat binding proteins (TRBs) belong to a family of proteins possessing a Myb-like domain which binds to telomeric repeats. Three members of this family (TRB1, TRB2, TRB3) from Arabidopsis thaliana have already been described as associated with terminal telomeric repeats (telomeres) or short interstitial telomeric repeats in gene promoters (telo-boxes). They are also known to interact with several protein complexes: telomerase, Polycomb repressive complex 2 (PRC2) E(z) subunits and the PEAT complex (PWOs-EPCRs-ARIDs-TRBs). Here we characterize two novel members of the TRB family (TRB4 and TRB5). Our wide phylogenetic analyses have shown that TRB proteins evolved in the plant kingdom after the transition to a terrestrial habitat in Streptophyta, and consequently TRBs diversified in seed plants. TRB4-5 share common TRB motifs while differing in several others and seem to have an earlier phylogenetic origin than TRB1-3. Their common Myb-like domains bind long arrays of telomeric repeats in vitro, and we have determined the minimal recognition motif of all TRBs as one telo-box. Our data indicate that despite the distinct localization patterns of TRB1-3 and TRB4-5 in situ, all members of TRB family mutually interact and also bind to telomerase/PRC2/PEAT complexes. Additionally, we have detected novel interactions between TRB4-5 and EMF2 and VRN2, which are Su(z)12 subunits of PRC2.

Facilitating transcriptional transitions: an overview of chromatin bivalency in plants.

Chromatin is an essential contributor to the regulation of transcription. The two histone post-translational modifications H3K4me3 and H3K27me3 act as an activator and repressor of gene expression, respectively, and are usually described as being mutually exclusive. However, recent work revealed that both marks might co-exist at several loci, forming a distinctive chromatin state called bivalency. While this state has been detected on a handful of genes involved in plant development and stress responses, its role in the regulation of transcription remains unclear. In an effort to shed more light on the putative function(s) of bivalency in plants, this review details the potential players involved in its setting and reading, and explores how this chromatin state might contribute to the control of gene expression. We propose that bivalency maintains transcriptional plasticity by facilitating transitions between a repressed and an active state and/or by preventing irreversible silencing of its targets. We also highlight recently developed techniques that could be used for further investigating bivalency.

Image analysis workflows to reveal the spatial organization of cell nuclei and chromosomes.

Nucleus, chromatin, and chromosome organization studies heavily rely on fluorescence microscopy imaging to elucidate the distribution and abundance of structural and regulatory components. Three-dimensional (3D) image stacks are a source of quantitative data on signal intensity level and distribution and on the type and shape of distribution patterns in space. Their analysis can lead to novel insights that are otherwise missed in qualitative-only analyses. Quantitative image analysis requires specific software and workflows for image rendering, processing, segmentation, setting measurement points and reference frames and exporting target data before further numerical processing and plotting. These tasks often call for the development of customized computational scripts and require an expertise that is not broadly available to the community of experimental biologists. Yet, the increasing accessibility of high- and super-resolution imaging methods fuels the demand for user-friendly image analysis workflows. Here, we provide a compendium of strategies developed by participants of a training school from the COST action INDEPTH to analyze the spatial distribution of nuclear and chromosomal signals from 3D image stacks, acquired by diffraction-limited confocal microscopy and super-resolution microscopy methods (SIM and STED). While the examples make use of one specific commercial software package, the workflows can easily be adapted to concurrent commercial and open-source software. The aim is to encourage biologists lacking custom-script-based expertise to venture into quantitative image analysis and to better exploit the discovery potential of their images.Abbreviations: 3D FISH: three-dimensional fluorescence in situ hybridization; 3D: three-dimensional; ASY1: ASYNAPTIC 1; CC: chromocenters; CO: Crossover; DAPI: 4',6-diamidino-2-phenylindole; DMC1: DNA MEIOTIC RECOMBINASE 1; DSB: Double-Strand Break; FISH: fluorescence in situ hybridization; GFP: GREEN FLUORESCENT PROTEIN; HEI10: HUMAN ENHANCER OF INVASION 10; NCO: Non-Crossover; NE: Nuclear Envelope; Oligo-FISH: oligonucleotide fluorescence in situ hybridization; RNPII: RNA Polymerase II; SC: Synaptonemal Complex; SIM: structured illumination microscopy; ZMM (ZIP: MSH4: MSH5 and MER3 proteins); ZYP1: ZIPPER-LIKE PROTEIN 1.

BLISTER promotes seed maturation and fatty acid biosynthesis by interacting with WRINKLED1 to regulate chromatin dynamics in Arabidopsis.

WRINKLED1 (WRI1) is an important transcription factor that regulates seed oil biosynthesis. However, how WRI1 regulates gene expression during this process remains poorly understood. Here, we found that BLISTER (BLI) is expressed in maturing Arabidopsis thaliana seeds and acts as an interacting partner of WRI1. bli mutant seeds showed delayed maturation, a wrinkled seed phenotype, and reduced oil content, similar to the phenotypes of wri1. In contrast, BLI overexpression resulted in enlarged seeds and increased oil content. Gene expression and genetic analyses revealed that BLI plays a role in promoting the expression of WRI1 targets involved in fatty acid biosynthesis and regulates seed maturation together with WRI1. BLI is recruited by WRI1 to the AW boxes in the promoters of fatty acid biosynthesis genes. BLI shows a mutually exclusive interaction with the Polycomb-group protein CURLY LEAF (CLF) or the chromatin remodeling factor SWITCH/SUCROSE NONFERMENTING 3B (SWI3B), which facilitates gene expression by modifying nucleosomal occupancy and histone modifications. Together, these data suggest that BLI promotes the expression of fatty acid biosynthesis genes by interacting with WRI1 to regulate chromatin dynamics, leading to increased fatty acid production. These findings provide insights into the roles of the WRI1-BLI-CLF-SWI3B module in mediating seed maturation and gene expression.

Polycomb proteins control floral determinacy by H3K27me3-mediated repression of pluripotency genes in Arabidopsis thaliana.

Polycomb group (PcG) protein-mediated histone methylation (H3K27me3) controls the correct spatiotemporal expression of numerous developmental regulators in Arabidopsis. Epigenetic silencing of the stem cell factor gene WUSCHEL (WUS) in floral meristems (FMs) depends on H3K27me3 deposition by PcG proteins. However, the role of H3K27me3 in silencing of other meristematic regulator and pluripotency genes during FM determinacy has not yet been studied. To this end, we report the genome-wide dynamics of H3K27me3 levels during FM arrest and the consequences of strongly depleted PcG activity on early flower morphogenesis including enlarged and indeterminate FMs. Strong depletion of H3K27me3 levels results in misexpression of the FM identity gene AGL24, which partially causes floral reversion leading to ap1-like flowers and indeterminate FMs ectopically expressing WUS and SHOOT MERISTEMLESS (STM). Loss of STM can rescue supernumerary floral organs and FM indeterminacy in H3K27me3-deficient flowers, indicating that the hyperactivity of the FMs is at least partially a result of ectopic STM expression. Nonetheless, WUS remained essential for the FM activity. Our results demonstrate that PcG proteins promote FM determinacy at multiple levels of the floral gene regulatory network, silencing initially floral regulators such as AGL24 that promotes FM indeterminacy and, subsequently, meristematic pluripotency genes such as WUS and STM during FM arrest.

[Illustration Techniques in Ophthalmic Textbooks 200 Years Ago - a Platform for the Rostock Glass Eye Collection of Anterior Segment Pathologies from 1860]. / Ophthalmologische Abbildungstechnik vor 200 Jahren ­ der Atlas von Antoine Pierre Demours als Grundlage der Rostocker Kunstaugensammlung.

Very recent research results have demonstrated that the "Rostock Artificial Eye Collection" - assembled 150 years ago with 132 glass modelled exhibits of anterior segment pathologies - is mainly based on the figures of the Atlas of Ophthalmology published by Antoine Pierre Demours in 1818. This article focusses on the analyses of the imaging techniques of this atlas. Present knowledge implies that the author used different colour etching concepts which were partially re-coloured individually. In the opinion of contemporaries, the figures of Demours' atlas represent the climax of scientific imaging techniques. In the academic literature, it is still described as a "recent remarkable masterpiece", even 100 years later.

Emergency medicine in Brazil: historical perspective, current status, and future challenges.

BACKGROUND: Emergency medicine (EM) in Brazil has achieved critical steps toward its development in the last decades including its official recognition as a specialty in 2016. In this article, we worked in collaboration with the Brazilian Association of Emergency Medicine (ABRAMEDE) to describe three main aspects of EM in Brazil: (1) brief historical perspective; (2) current status; and (3) future challenges. MAIN TEXT: In Brazil, the first EM residency program was created in 1996. Only 20 years later, the specialty was officially recognized by national regulatory bodies. Prior to recognition, there were only 2 residency programs. Since then, 52 new programs were initiated. Brazil has now 54 residency programs in 16 of the 27 federative units. As of December 2020, 192 physicians have been board certified as emergency physicians in Brazil. The shortage of formal EM-trained physicians is still significant and at this point it is not feasible to have all Brazilian emergency care units and EDs staffed only with formally trained emergency physicians. Three future challenges were identified including the recognition of EM specialists in the house of Medicine, the need of creating a reliable training curriculum despite highly heterogeneous emergency care practice across the country, and the importance of fostering the development of academic EM as a way to build a strong research agenda and therefore increase the knowledge about the epidemiology and organization of emergency care. CONCLUSION: Although EM in Brazil has accomplished key steps toward its development, there are several obstacles before it becomes a solid medical specialty. Its continuous development will depend on special attention to key challenges involving recognition, reliability, and research.

Crew time in a space greenhouse using data from analog missions and Veggie.

Crew time requirements for human space exploration missions is as critical as mass, energy, and volume requirements. However, it has only been sporadically recorded in past analog and space missions for plant cultivation. In this retrospective study on crew time data collected in various analog facilities and on the Veggie hardware on ISS, we propose a methodology for efficient categorizing and reporting of crew time in space plant growth systems. Crew time is difficult to capture in operational environments, and this study intends to harmonize these efforts among different locations. This article also provides a current database for required crew time in several plant growth hardware and facilities, on the ISS, and on Earth. These data could serve mission planners as a baseline to establish standardized activities and extrapolate crew time needed to operate future plant growth units. Finally, we discuss how crew time needed for plant cultivation will change in future exploration missions, based on choices made for plant species, watering systems, level of automation, and use of virtual assistants, among others. Crew time will need to be accounted for as a decisive factor to design future space greenhouse modules.

Crew time and workload in the EDEN ISS greenhouse in Antarctica.

The goal of the EDEN ISS project is to research technologies for future greenhouses as a substantial part of planetary surface habitats. In this paper, we investigate crew time and workload needed to operate the space analogue EDEN ISS greenhouse on-site and remotely from the Mission Control Center. Within the almost three years of operation in Antarctica, different vegetable crops were cultivated, which yielded an edible biomass of 646 kg during the experiment phase 2018 and 2019. Operating in such a remote environment, analogue to future planetary missions, both greenhouse systems and remote support capabilities must be carefully developed and assessed to guarantee a reliable and efficient workflow. The investigation of crew time and workload is crucial to optimize processes within the operation of the greenhouse. For the Antarctic winter seasons, 2019 and 2020, as well as the summer season 2019/2020, the workload of the EDEN ISS greenhouse operators was assessed using the NASA Task Load Index. In addition, crew time was measured for the winter season 2019. The participants consisted of on-site operators, who worked inside the EDEN ISS greenhouse in Antarctica and the DLR remote support team, who worked in the Mission Control Center at the DLR Institute of Space Systems in Bremen (Germany). The crew time results show that crew time for the whole experiment phase 2019 required by the on-site operator team 2019 is approximately four times higher than the crew time of the corresponding remote support team without considering planning activities for the next mission. The total crew time for the experiment phase 2019 amounts to 694.5 CM-h or 6.31 CM-h/kg. With the measurements of the experiment phase 2019 it was possible to develop a methodology for crew time categorization for the remote support activities, which facilitates the analysis and increases the comparability of crew time values. In addition, the development of weekly and monthly crew time demand over the experiment phase is presented. The workload investigations indicate that the highest workload is perceived by the remote support team 2019 + 2020, followed by the summer maintenance team 2019/2020. The on-site operator team 2019 and on-site operator team 2020 showed the lowest values. The values presented in this paper indicate the need to minimize crew time as well as workload demands of the operators involved in the operation of future planetary surface greenhouses.

(S)-3-Hydroxybutyryl-CoA Dehydrogenase From the Autotrophic 3-Hydroxypropionate/4-Hydroxybutyrate Cycle in Nitrosopumilus maritimus.

Ammonia-oxidizing archaea of the phylum Thaumarchaeota are among the most abundant organisms that exert primary control of oceanic and soil nitrification and are responsible for a large part of dark ocean primary production. They assimilate inorganic carbon via an energetically efficient version of the 3-hydroxypropionate/4-hydroxybutyrate cycle. In this cycle, acetyl-CoA is carboxylated to succinyl-CoA, which is then converted to two acetyl-CoA molecules with 4-hydroxybutyrate as the key intermediate. This conversion includes the (S)-3-hydroxybutyryl-CoA dehydrogenase reaction. Here, we heterologously produced the protein Nmar_1028 catalyzing this reaction in thaumarchaeon Nitrosopumilus maritimus, characterized it biochemically and performed its phylogenetic analysis. This NAD-dependent dehydrogenase is highly active with its substrate, (S)-3-hydroxybutyryl-CoA, and its low K m value suggests that the protein is adapted to the functioning in the 3-hydroxypropionate/4-hydroxybutyrate cycle. Nmar_1028 is homologous to the dehydrogenase domain of crotonyl-CoA hydratase/(S)-3-hydroxybutyryl-CoA dehydrogenase that is present in many Archaea. Apparently, the loss of the dehydratase domain of the fusion protein in the course of evolution was accompanied by lateral gene transfer of 3-hydroxypropionyl-CoA dehydratase/crotonyl-CoA hydratase from Bacteria. Although (S)-3-hydroxybutyryl-CoA dehydrogenase studied here is neither unique nor characteristic for the HP/HB cycle, Nmar_1028 appears to be the only (S)-3-hydroxybutyryl-CoA dehydrogenase in N. maritimus and is thus essential for the functioning of the 3-hydroxypropionate/4-hydroxybutyrate cycle and for the biology of this important marine archaeon.

Puntos clave sobre la COVID-19 en los servicios de urgencias: propuestas de mejora para su atención en Latinoamérica / Key issues in emergency department management of COVID-19: proposals for improving care for patients in Latin America

La incidencia y el impacto de la COVID-19 (Coronavirus Disease 2019) en Latinoamérica y España, en particular en sus servicios de urgencias hospitalarios (SUH), independientemente de la diversidad de los conceptos y definiciones de casos confirmados o sospechosos empleados ha sido, es, y, desgraciadamente a medio plazo, va a seguir siendo enorme, sostenida e imprevisible. En este escenario global, un grupo multinacional de expertos y representantes del Grupo de Trabajo Latinoamericano para la mejora de la atención del paciente con Infección en Urgencias (GT-LATINFURG), compuesto por 13 Sociedades y Asociaciones Científicas que integran la Federación Latinoamericana de Medicina de Emergencias (FLAME), junto con la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES),ha elaborado diversos documentos técnicos y de opinión destinados a los profesionales de los Sistemas de Urgencias y Emergencias de nuestros países. El objetivo de este artículo es ofrecer unas pautas o recomendaciones consensuadas para facilitar la actuación de los SUH en relación los puntos que los miembros del grupo han considerado más interesantes o clave en relación a: la necesidad de reorganizar los SUH, triaje, disponibilidad de pruebas complementarias habituales y otras como biomarcadores, la identificación del paciente con COVID-19 a través de criterios clínicos, analíticos, radiológicos y microbiológicos, así como factores de riesgo, pronóstico y de mortalidad que puedan ayudara detectar rápidamente a los pacientes graves a su llegada a los dispositivos de Urgencias y Emergencias de los hospitales en nuestro entorno

The incidence of the coronavirus disease 2019 (COVID-19) in Latin America and Spain and its impact particularly on hospital emergency departments have been great, sustained, and unpredictable. Unfortunately, this situation will continue in the medium term, regardless of the diverse concepts and definitions used to identify cases or hypotheses about the role of staff. In the context of the worldwide pandemic, a multinational group of experts from the Latin American Working Group to Improve Care for Patients With Infection (GT-LATINFURG) has drafted various opinion papers for use by emergency care systems in the member countries. The GT-LATINFURG is comprised of representatives from the 13 scientific associations affiliated with the Latin American Federation for Emergency Medicine (FLAME). Experts from the Spanish Society of Emergency Medicine (SEMES) also participated. The present consensus statement offers protocols and recommendations to facilitate the work of hospital emergency departments with regard to key issues the group identified, namely, the need for reorganization, triage, and routine test availability. Additional issues discussed include biomarkers; clinical, laboratory, radiologic, and microbiologic criteria for identifying patients with COVID-19; and risk and prognostic factors for mortality that emergency staff can use to quickly detect severe cases in our settings