Diploma on Ultrasound training and competency for Intensive Care and Emergency Medicine: Consensus document of the Spanish Society of Anesthesia (SEDAR), Spanish Society of Internal Medicine (SEMI) and Spanish Society of Emergency Medicine (SEMES). / Documento de consenso de la Sociedad Española de Anestesiología y Reanimación (SEDAR), Sociedad Española de Medicina Interna (SEMI) y Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) para la definición de competencias mínimas de ecografía en Cuidados Intensivos y Urgencias y la obtención del Diploma acreditativo.

The use of ultrasound as a clinical diagnostic tool and guide of bedside procedures has become an indispensable examination in the acute critically ill patient. The training of professionals in minimum skills of knowledge, management and indications of use of ultrasound required to be defined by the Scientific Societies. The Intensive Care Ultrasound Working Group of the Spanish Society of Anesthesiology and Resuscitation (SEDAR), of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Emergency Medicine (SEMES) has developed this consensus document in which the recommended training program and the minimum competencies to be achieved with regard to the use of Ultrasound in Intensive Care, Anesthesia and Emergency medicine are defined. This document defines the training program and the skills to acquire in order to achieve the diploma in lung, abdominal and vascular ultrasound. This document can serve as a guide to define the skills to be acquired in the training programs of residents (MIRs) of specialists working in intensive care, anesthesia, and emergency medicine.

Utility of lateral flow tests in SARS-CoV-2 infection monitorization.

OBJECTIVE: The diagnosis of SARS-CoV-2 infection is crucial for medical and public health reasons, to allow the best treatment of cases and the best control of the pandemic. Serology testing allows for the detection of asymptomatic infections and 19-COVID cases once the virus has been cleared. We analyzed the usefulness of the SARS-CoV-2 rapid test of Autobio and tried to correlate its pattern with the severity of COVID19 infection. METHODS: We analyzed the accuracy and clinical usefulness of a point-of-care IgM and/or IgG test for SARS-CoV-2 in 35 COVID-19 patients [12 (34.3%) mild-moderate and 23 (65.7%) severe-critical] admitted to a field hospital in Madrid, as well as in 5 controls. RESULTS: The mean time from the first day of symptoms to the antibody test was 28 days (SD: 8.7), similar according to the severity of the disease. All patients with SARS-CoV-2 PCR+ showed the corresponding IgG positivity, while these results were negative in all control individuals. A total of 26 (74%) cases also presented with positive IgM, 19 (83%) were severe-critical cases and 7 (58%) were mild-moderate cases. The IgM response lasted longer in the severe critical cases (mean: 29.7 days; SD: 8.4) compared to the moderate cases (mean: 21.2 days; SD: 2.0).. CONCLUSIONS: Rapid serology tests are useful for the diagnosis of patients with COVID-19 (mainly IgG detection) and may also be correlated with the severity of the infection (based on IgM detection).

Ecografía clínica en la enfermedad pulmonar obstructiva crónica / Clinical ultrasonography in chronic obstructive pulmonary disease

La EPOC es una enfermedad con una elevada prevalencia y representa uno de los motivos más frecuentes de ingreso en los servicios de Medicina Interna. Además, presenta una importante morbimortalidad asociada. En los últimos años la ecografía clínica multiórgano (pulmonar, cardiaca y vascular) ha surgido como una herramienta de gran utilidad en el manejo de estos pacientes en múltiples situaciones. Entre ellas podemos destacar el diagnóstico diferencial de la disnea de origen incierto, la evaluación de la etiología en los episodios de exacerbación, la detección de insuficiencia cardiaca concomitante o de hipertensión pulmonar asociada y como apoyo en el manejo de algunos factores de riesgo cardiovascular, como la ateroesclerosis subclínica. En este trabajo se resumen las evidencias más importantes al respecto y se plantean escenarios futuros en el uso de los ultrasonidos que permitan mejorar el diagnóstico, la estimación pronóstica y la selección del tratamiento óptimo en este tipo de pacientes

COPD is a highly prevalent disease and one of the most common reasons for hospitalization in Internal Medicine departments. COPD also has significant associated morbidity and mortality. In recent years, multiorgan clinical ultrasonography (pulmonary, cardiac and vascular) has emerged as a tool of considerable usefulness in managing patients with COPD in numerous situations, including the differential diagnosis of dyspnoea of uncertain origin, the assessment of the aetiology in episodes of exacerbation, detecting concomitant heart failure or associated pulmonary hypertension and as support in managing cardiovascular risk factors such as subclinical atherosclerosis. This study summarises the most important evidence regarding this approach and proposes future scenarios for the use of ultrasonography that will help improve the diagnosis, prognostic estimations and the selection of the optimal treatment for this type of patient

Ecografía clínica en el proceso de toma de decisiones en medicina / Clinical ultrasonography in the decision-making process in medicine point-of-care ultrasound in clinical decision making

La ecografía clínica ha experimentado un importante desarrollo en los últimos años debido a su gran utilidad y a la miniaturización de los equipos que han permitido llegar a la cabecera del enfermo. Se trata de una herramienta que complementa la anamnesis y la exploración física tradicional aumentando la potencia diagnóstica del profesional que la emplea en numerosos escenarios clínicos y que puede ser aplicada en todos los pasos de la toma de decisiones sobre el paciente. En manos de los generalistas, la aplicación de los ultrasonidos en diferentes áreas del cuerpo (ecografía multiórgano) permite optimizar no solo la capacidad diagnóstica, sino la estratificación pronóstica y el seguimiento evolutivo tras la aplicación de un tratamiento. De la misma forma que existe una sistemática de exploración física convencional, se debe plantear el establecimiento de un protocolo de exploración ecográfica que complemente a la primera y de esta forma poder redefinir y potenciar la exploración clásica

Clinical ultrasonography has undergone significant development in recent years due to its considerable usefulness and equipment miniaturisation, which have enabled its use at the point of care. Clinical ultrasonography is a tool that supplements the classical anamnesis and physical examination, thereby increasing the practitioner's diagnostic power. This tool can be employed in numerous clinical scenarios and can be applied at all steps when making decisions about the patient. In the hands of the general practitioner, ultrasonography of the various areas of the body (multiorgan ultrasonography) optimises not only the diagnostic capacity but also the prognostic stratification and monitoring of progress after treatment has been applied. As with the systematic nature of conventional physical examinations, we need to establish an ultrasound examination protocol that supplements the physical examination, thereby redefining and boosting the classic examination

Clinical ultrasonography in the decision-making process in medicine point-of-care ultrasound in clinical decision making. / Ecografía clínica en el proceso de toma de decisiones en medicina.

Clinical ultrasonography has undergone significant development in recent years due to its considerable usefulness and equipment miniaturisation, which have enabled its use at the point of care. Clinical ultrasonography is a tool that supplements the classical anamnesis and physical examination, thereby increasing the practitioner's diagnostic power. This tool can be employed in numerous clinical scenarios and can be applied at all steps when making decisions about the patient. In the hands of the general practitioner, ultrasonography of the various areas of the body (multiorgan ultrasonography) optimises not only the diagnostic capacity but also the prognostic stratification and monitoring of progress after treatment has been applied. As with the systematic nature of conventional physical examinations, we need to establish an ultrasound examination protocol that supplements the physical examination, thereby redefining and boosting the classic examination.

Clinical ultrasonography in chronic obstructive pulmonary disease. / Ecografía clínica en la enfermedad pulmonar obstructiva crónica.

COPD is a highly prevalent disease and one of the most common reasons for hospitalization in Internal Medicine departments. COPD also has significant associated morbidity and mortality. In recent years, multiorgan clinical ultrasonography (pulmonary, cardiac and vascular) has emerged as a tool of considerable usefulness in managing patients with COPD in numerous situations, including the differential diagnosis of dyspnoea of uncertain origin, the assessment of the aetiology in episodes of exacerbation, detecting concomitant heart failure or associated pulmonary hypertension and as support in managing cardiovascular risk factors such as subclinical atherosclerosis. This study summarises the most important evidence regarding this approach and proposes future scenarios for the use of ultrasonography that will help improve the diagnosis, prognostic estimations and the selection of the optimal treatment for this type of patient.

Consenso sobre ecocardioscopia: el comienzo de una prometedora amistad / Consensus on focused cardiac ultrasound: the beginning of a promising friendship

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Documento de posicionamiento sobre la incorporación de la ecografía clínica en los servicios de Medicina Interna / Positioning document on incorporating point-of-care ultrasound in Internal Medicine departments

Este documento de posicionamiento describe los aspectos más importantes de la ecografía clínica en el ámbito de la Medicina Interna, desde sus indicaciones fundamentales hasta el período de formación recomendado. Actualmente ya no quedan dudas sobre la gran utilidad de esta herramienta para la práctica clínica habitual del internista en múltiples escenarios clínicos y ámbitos de actuación (urgencias, planta de hospitalización, consulta general y específica y atención domiciliaria). Su uso tiene un impacto relevante en la capacidad de resolución del profesional, al aumentar su fiabilidad y seguridad diagnóstica, además de proporcionar información pronóstica y evolutiva importante. Además, en los últimos años se ha incorporado como una herramienta en la enseñanza pregrado con excelentes resultados. Por tanto, es necesario generalizar su uso y para ello se debe fomentar la formación estructurada y la adquisición de equipos. El documento ha sido elaborado por el Grupo de Trabajo de Ecografía Clínica y avalado por la Sociedad Española de Medicina Interna

This positioning document describes the most important aspects of clinical ultrasonography in the internal medicine setting, from its fundamental indications to the recommended training period. There is no question as to the considerable usefulness of this tool in the standard clinical practice of internists in numerous clinical scenarios and settings (emergencies, hospital ward, general and specific consultations and home care). Ultrasonography has a relevant impact on the practitioner's ability to resolve issues, increasing diagnostic reliability and safety and providing important information on the prognosis and progression. In recent years, ultrasonography has been incorporated as a tool in undergraduate teaching, with excellent results. The use of ultrasonography needs to be widespread. To accomplish this, we must encourage structured training and the acquisition of equipment. This document was developed by the Clinical Ultrasonography Workgroup and endorsed by the Spanish Society of Internal Medicine

Positioning document on incorporating point-of-care ultrasound in Internal Medicine departments. / Documento de posicionamiento sobre la incorporación de la ecografía clínica en los servicios de Medicina Interna.

This positioning document describes the most important aspects of clinical ultrasonography in the internal medicine setting, from its fundamental indications to the recommended training period. There is no question as to the considerable usefulness of this tool in the standard clinical practice of internists in numerous clinical scenarios and settings (emergencies, hospital ward, general and specific consultations and home care). Ultrasonography has a relevant impact on the practitioner's ability to resolve issues, increasing diagnostic reliability and safety and providing important information on the prognosis and progression. In recent years, ultrasonography has been incorporated as a tool in undergraduate teaching, with excellent results. The use of ultrasonography needs to be widespread. To accomplish this, we must encourage structured training and the acquisition of equipment. This document was developed by the Clinical Ultrasonography Workgroup and endorsed by the Spanish Society of Internal Medicine.

Presente y futuro de la ecografía clínica en medicina interna: una expansión inevitable / The future of point-of-care ultrasound in internal medicine

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Novedades cardiovasculares 2013/2014 / Cardiovascular news 2013/2014

Durante el año 2013 y los primeros meses de 2014 se han publicado numerosos estudios relevantes en el campo cardiovascular. Han aparecido nuevas guías para el manejo de la hipertensión arterial y para reducir el riesgo cardiovascular descendiendo el colesterol. También han aparecido nuevos datos sobre la gran eficacia hipolipidemiante de los anticuerpos monoclonales frente a PCSK-9, decepcionando, sin embargo, los ensayos clínicos dirigidos a elevar el colesterol-HDL con ácido nicotínico, los cuales no han demostrado una reducción de la tasa de complicaciones cardiovasculares. Tampoco en el campo de la hipertensión, la colocación de un stent en pacientes con hipertensión renovascular, o la denervación simpática en pacientes con hipertensión resistente, han demostrado ser eficaces para reducir la presión arterial. Con relación al tratamiento antitrombótico, los test farmacogenéticos no parecen útiles para mantener más tiempo en rango terapéutico a los pacientes anticoagulados con warfarina. A su vez, cada vez existen más evidencias de que en pacientes con enfermedad coronaria y fibrilación auricular, la antiagregación no añade beneficio a la anticoagulación y se asocia con un mayor riesgo de sangrado. Por último, una dieta de tipo mediterráneo podría prevenir la aparición de diabetes, mientras que la cirugía bariátrica podría ser una opción razonable para mejorar la enfermedad en pacientes obesos. Muchos de estos estudios tienen una aplicación práctica inmediata en el trabajo clínico diario (AU)

During 2013 and the first months of 2014, numerous studies have been published in the cardiovascular field. New guidelines have appeared for managing arterial hypertension and reducing cardiovascular risk by lowering cholesterol levels. New data have emerged on the considerable lipid-lowering efficacy of monoclonal antibodies against PCSK-9, in contrast, however, to the clinical trials directed towards raising HDL-cholesterol with nicotinic acid, which have not shown a reduction in the rate of cardiovascular complications. In the field of hypertension, neither stent placement in patients with renovascular hypertension nor sympathetic denervation in patients with resistant hypertension has been shown to be effective in reducing blood pressure. In terms of antithrombotic treatment, the pharmacogenetic tests do not seem useful for maintaining patients anticoagulated with warfarin within the therapeutic range for longer periods. Moreover, there is increasing evidence that, for patients with coronary artery disease and atrial fibrillation, antiplatelet therapy adds no benefit to anticoagulation therapy and is associated with a greater risk of bleeding. Lastly, a Mediterranean diet could prevent the onset of diabetes, while bariatric surgery could be a reasonable option for improving the disease in patients with obesity. Many of these studies have immediate practice applications in daily clinical practice (AU)

Cardiovascular news 2013/2014. / Novedades cardiovasculares 2013/2014.

During 2013 and the first months of 2014, numerous studies have been published in the cardiovascular field. New guidelines have appeared for managing arterial hypertension and reducing cardiovascular risk by lowering cholesterol levels. New data have emerged on the considerable lipid-lowering efficacy of monoclonal antibodies against PCSK-9, in contrast, however, to the clinical trials directed towards raising HDL-cholesterol with nicotinic acid, which have not shown a reduction in the rate of cardiovascular complications. In the field of hypertension, neither stent placement in patients with renovascular hypertension nor sympathetic denervation in patients with resistant hypertension has been shown to be effective in reducing blood pressure. In terms of antithrombotic treatment, the pharmacogenetic tests do not seem useful for maintaining patients anticoagulated with warfarin within the therapeutic range for longer periods. Moreover, there is increasing evidence that, for patients with coronary artery disease and atrial fibrillation, antiplatelet therapy adds no benefit to anticoagulation therapy and is associated with a greater risk of bleeding. Lastly, a Mediterranean diet could prevent the onset of diabetes, while bariatric surgery could be a reasonable option for improving the disease in patients with obesity. Many of these studies have immediate practice applications in daily clinical practice.

Ecocardiografía clínica básica en Medicina Interna / Focused cardiac ultrasound in Internal Medicine

La ecocardiografía clínica básica es una técnica no invasiva, que puede dominar y ser muy útil para el internista. La ecocardiografía ofrece una información útil, rápida y precisa acerca de la estructura y función cardiaca que complementa a la anamnesis y a la exploración física a la cabecera del paciente. Tras un período de formación teórica y práctica breve, el internista puede determinar la dimensión y función de ambos ventrículos, detectar la presencia de derrame pericárdico significativo, orientar el diagnóstico de valvulopatías severas y estimar la presión venosa central mediante el diámetro y colapsabilidad de la vena cava inferior con una elevada fiabilidad. El objetivo de la ecocardiografía clínica básica no es la realización de un ecocardiograma reglado sino agilizar el diagnóstico y optimizar el manejo de gran parte de los enfermos con afección cardiovascular(AU)

Focused cardiac ultrasound is a noninvasive technique which can be performed by the internist. It is capable of providing useful, rapid and accurate information about the structure and function of the heart. It can be used to complement anamnesis and physical examination at the bedside. Clinicians may be able to determine left and right ventricular diameter and function, detect the presence of significant pericardial effusion, identify important valvular defects and estimate the central venous pressure by measuring the diameter and collapsibility of inferior vena cava with good accuracy after a short training period. The aim of focused cardiac ultrasound is not to perform a complete echocardiogram but using previous mentioned data, it is possible to expedite diagnosis and optimize the management of patients with cardiovascular diseases(AU)

[Focused cardiac ultrasound in internal medicine]. / Ecocardiografía clínica básica en medicina interna.

Focused cardiac ultrasound is a noninvasive technique which can be performed by the internist. It is capable of providing useful, rapid and accurate information about the structure and function of the heart. It can be used to complement anamnesis and physical examination at the bedside. Clinicians may be able to determine left and right ventricular diameter and function, detect the presence of significant pericardial effusion, identify important valvular defects and estimate the central venous pressure by measuring the diameter and collapsibility of inferior vena cava with good accuracy after a short training period. The aim of focused cardiac ultrasound is not to perform a complete echocardiogram but using previous mentioned data, it is possible to expedite diagnosis and optimize the management of patients with cardiovascular diseases.

Si fiebre, ¿hemocultivos? / Blood cultures when fever?

Varón de 78 años, con antecedentes de hipertensión arterial y diabetes mellitus, remitido a urgencias desde su residencia por deterioro del estado general y caídas frecuentes en la última semana. Dos semanas antes precisó sondaje vesical, que fue traumático y de forma profiláctica se prescribió ciprofloxacino. En la exploración física destaca desorientación, TA90/40mmHg, frecuencia cardíaca 120lpm, T.a 37,3 1C, 24 respiraciones por minuto y dolor a la palpación en hipocondrio izquierdo. En el electrocardiograma se objetiva taquicardia sinusal. Al canalizar la vía periférica se nos pregunta: ¿le saco hemocultivos?(AU)

A 78-year-old man was refrerred from his residency where he lives to the emergency division due to general deterioration and frequent falls in the last week. His personal history is remarkable for arterial hypertension and diabetes. Two weeks before he needed a vesical catheterism that was traumatic and profilactic ciprofloxacin was prescriped. On phisical exploration he appears desoriented, blodd pressure is 9/40mmHg, cardiac rythm 120 beats per minute, temperature 37,3°C and 24 respirations per minute. He appears to have pain on his upper left abdomen cuadrant. When the nurse gets a peripheral vein she asks, ¿should I obtain hemocultures?(AU)

Pegylated interferon induced interstitial pneumonitis in a patient with hepatitis C infection.

Pegylated interferon and ribavirin is the treatment of choice in patients with chronic hepatitis C infection. The most common side effects of interferon therapy are flu-like symptoms and psychiatric disorders. Pneumonitis is a less frequent complication associated with non-negligible mortality. We herein report a case of interferon associated pneumonitis in a patient with non-severe clinical symptoms and a normal chest radiography. Physicians should be aware of this entity during the differential diagnosis of respiratory symptoms in patients receiving treatment with interferon due to its high morbimortality and good resolution and outcome after drug withdrawal.

[Blood cultures when fever?]. / Si fiebre, ¿hemocultivos?

A 78-year-old man was referred from his residency where he lives to the emergency division due to general deterioration and frequent falls in the last week. His personal history is remarkable for arterial hypertension and diabetes. Two weeks before he needed a vesical catheterism that was traumatic and profilactic ciprofloxacin was prescribed. On physical exploration he appears disoriented, blood pressure is 9/40 mm Hg, cardiac rythm 120 beats per minute, temperature 37,3 °C and 24 respirations per minute. He appears to have pain on his upper left abdomen cuadrant. When the nurse gets a peripheral vein she asks, ¿should I obtain hemocultures?

Neumonitis intersticial secundaria a tratamiento con interferón pegilado / Pegylated interferon induced interstitial pneumonitis in a patient with hepatitis C infection

El interferón pegilado asociado a ribavirina es el tratamiento de elección en los pacientes con infección por hepatitis C crónica. Los efectos secundarios más comunes son los síntomas gripales y las alteraciones psiquiátricas. La neumonitis es una complicación poco frecuente, pero se asocia con una mortalidad no despreciable. Presentamos el caso clínico de un paciente con neumonitis intersticial asociada a interferón que presentaba signos y síntomas clínicos sutiles y una radiografía de tórax sin alteraciones. Se debe de tener presente esta entidad en el diagnóstico diferencial de los síntomas respiratorios en pacientes que reciben tratamiento con interferón debido a su elevada morbi-mortalidad y a su evolución favorable tras la retirada del fármaco(AU)

Pegylated interferon and ribavirin is the treatment of choice in patients with chronic hepatitis C infection. The most common side effects of interferon therapy are flu-like symptoms and psychiatric disorders. Pneumonitis is a less frequent complication associated with non-negligible mortality. We herein report a case of interferon associated pneumonitis in a patient with non-severe clinical symptoms and a normal chest radiography. Physicians should be aware of this entity during the differential diagnosis of respiratory symptoms in patients receiving treatment with interferon due to its high morbimortality and good resolution and outcome after drug withdrawal(AU)