Fluorescence quenching of the N-methylquinolinium cation by pairs of water or alcohol molecules.

N-Methylquinolinium cation (MQ+) in its first-excited singlet state is a strong oxidant commonly used as a photosensitizer, whose fluorescence is therefore quenched by electron donors. Interestingly, the fluorescence of MQ+ is also quenched by hydroxy compounds such as water and alcohols, more difficult to oxidize. We investigated the quenching mechanism of MQ+ fluorescence by small amounts of water and alcohols in acetonitrile solution. The fluorescence intensities and lifetimes exhibited a nonlinear dependence on the quencher concentration. We found evidence that emissive exciplexes MQ+*-ROH are formed between the excited quinolinium and the hydroxy compounds. An accurate quantitative description of the results was obtained with a model in which the exciplex reacts with a second molecule of the hydroxy compound, which quenches the fluorescence. The rate constant of this process increased as the quencher ionization energy decreased. We showed also that a low basicity of the hydroxy compound inhibits the quenching process. These results are consistent with the existence of a concerted photoinduced proton-coupled electron transfer (PCET) involving an intermediate complex of the excited quinolinium with a H-bonded molecular pair of the hydroxy compounds. In these pairs, a water or an alcohol molecule is able to donate an electron to the photoexcited quinolinium cation and a proton to the second H-bonded hydroxy molecule, showing an enhanced reducing power in comparison with the isolated molecule. The structure of the intermediate complex was investigated using high-level quantum mechanical calculations. At high water concentrations in acetonitrile/water mixtures, the quenching process is slowed down, indicating that higher water aggregates are less effective for a PCET process. The results obtained may be relevant to the study of water oxidation and electron transfer in biological systems.

Latin American formal consensus on the indications for the surgical treatment of massive and irreparable rotator cuff tears.

OBJECTIVES: To implement the Formal Consensus Method among a group of experts in shoulder surgery in Latin America, in order to establish appropriate indications for the surgical treatment of massive and irreparable rotator cuff injuries. METHODS: The Formal Consensus Method was used to develop surgical treatment recommendations for massive and irreparable rotator cuff tears (MIRCT). Three independent groups of experts in shoulder surgery were confirmed. The steering group conducted a systematic literature review and constructed a voting matrix consisting of 348 clinical scenarios. The rating group, composed of 15 members, rated each scenario on two occasions: first anonymously and then during an in-person discussion meeting. The median and voting ranges were used to classify each scenario as inappropriate, uncertain, or appropriate for each surgical technique. Finally, the reading group, consisting of 10 surgeons, reviewed, evaluated and rated the recommendations derived from the detailed analysis of the voting grids. RESULTS: The main finding of the study reveals a high percentage (70%) of clinical scenarios in which consensus was achieved regarding the appropriateness or inappropriateness of different surgical alternatives for the treatment of massive and irreparable rotator cuff injuries. Through a detailed analysis of the voting grids, a total of 20 recommendations were elaborated concerning the appropriateness of various surgical techniques in addressing irreparable rotator cuff tears. CONCLUSIONS: The indications for the operative treatment of MIRCT were determined based on expert consensus and the best available evidence, they seek to provide guidance on the appropriateness of various surgical techniques for different clinical scenarios. LEVEL OF EVIDENCE: V.

Latin American formal consensus on the appropriate indications of extra-articular lateral procedures in primary anterior cruciate ligament reconstruction.

OBJECTIVES: To create a practice guideline for the appropriate indications of an extra-articular procedure in primary anterior cruciate ligament reconstruction (ACLR). METHODS: The formal consensus method described by the Haute Autorité de Santé was used. The Latin American Society of Arthroscopy, Articular Replacement, and Sports Injuries (SLARD) recruited three groups of experts on ACLR. Initially, the steering group, consisting of eight surgeons, performed a systematic review of the literature and elaborated on 192 scenarios for primary ACLR. The rating group, composed of 23 surgeons, rated each scenario in two rounds, with an in-between in-person meeting for discussion. Median scores and agreement levels were estimated to classify each scenario as inappropriate, uncertain or appropriate for adding anterolateral reconstruction. Finally, the lecture group, consisting of 10 surgeons, revised each stage of the method, results and interpretation. RESULTS: Of the scenarios, 11.97% were rated as appropriate for adding an extra-articular lateral procedure, 7.81% as inappropriate and 80.21% as uncertain. The key recommendations for the addition of extra-articular lateral techniques were as follows: it is appropriate when the patient is under 25 years of age, has high-grade physical examination findings, practises a pivoting sport and has hyperlaxity; meanwhile, it is inappropriate when the patient has low-grade physical examination findings, has normal laxity and does not practise a pivoting sport. CONCLUSIONS: The appropriate indications of extra-articular lateral procedures in primary ACLR were determined on the basis of the best available evidence and expert opinion following a formal consensus method. LEVEL OF EVIDENCE: V.

Two-staged surgical management for complicated Boerhaave syndrome with esophagectomy and deferred gastroplasty: A case report.

INTRODUCTION AND IMPORTANCE: Boerhaave syndrome is a rare, challenging entity with high morbimortality rates. Therefore, early diagnosis and prompt treatment are needed. However, a standardized technique has not been developed, especially in large esophageal ruptures. PRESENTATION OF CASE: A female patient of 69 years with an acute thoracic syndrome consistent with severe retrosternal pain of sudden onset, radiating to the left hemithorax, vomiting, and dyspnea that began after food intake associated with subcutaneous emphysema, hypotension, and tachycardia. An A-CT was performed, revealing an esophageal perforation, and Boerhaave syndrome was diagnosed. The patient was taken to esophagectomy and gastroplasty. 2,5 years after the procedure, the patient was without long-term complications, and only dysphagia was present. CLINICAL DISCUSSION: The differential diagnoses of acute thoracic syndromes are needed to be ruled out; however, it usually delays the diagnosis of Boerhaave syndrome. Therefore, early diagnosis (<24 h) may impact this patient's outcomes. On the other hand, esophagectomy can be feasible to control the acute condition and permit a digestive tract reconstruction. CONCLUSION: In patients with large esophageal ruptures and concomitant septic shock, an esophagectomy is an option to control the source of infection and to permit early digestive tract reconstruction.

Evaluation of emergency department visits prior to an HIV diagnosis: Missed opportunities.

OBJECTIVE: There is a high rate of occult infection and late diagnosis in HIV. Hospital emergency departments (ED) are an important point of health care. The present work aims to know the number of missed opportunities for HIV diagnosis occurring in the ED. METHOD: Retrospective multicenter cohort study that included all patients diagnosed with HIV infection in 2019 in 27 Spanish hospitals in 7 different autonomous communities. All ED consultation episodes in the 5 years prior to diagnosis were reviewed to find out the reason for consultation and whether this represented a missed opportunity for HIV diagnosis. RESULT: Seven hundred twenty-three patients were included, and 352 (48.7%, 95%CI: 45.1%-52.3%) had at least one ED visit during the 5 years prior to diagnosis (median 2, p25-p75: 1-4). One hundred and eighteen patients (16.3%, 95%CI: 13.8%-19.2%) had a missed diagnostic opportunity. The main consultations were drug use [145 (15%)], sexually transmitted infections [91 (9.4%)] and request for post-exposure HIV prophylaxis [39 (4%)]. One hundred and fifty-five (42.9%) of the 352 had less than 350 CD4/mm3 when the HIV diagnosis was established. In patients with previous ED visits, the mean time to diagnosis from this visit was 580 (SD 647) days. CONCLUSIONS: Sixteen percent of patients diagnosed with HIV missed the opportunity to be diagnosed in the 5 years prior to diagnosis, highlighting the need to implement ED screening measures different from current ones to improve these outcomes.

Prediction of pulmonary embolism in patients with SARS-CoV-2 infection.

OBJECTIVE: To determine the predictive factors of pulmonary thromboembolic (PTE) in patients with SARS-CoV-2 infection (COVID-19) assessed in the emergency department at a tertiary hospital during the first pandemic wave. METHODS: Observational single-center study conducted in a retrospective cohort of patients with confirmed SARS-CoV-2 infection (or high clinical-radiological suspicion) who underwent PTE screening by computed tomography pulmonary angiography (CTPA). Predictive factors of PTE were explored using logistic regression, creating two predictive models (without or with D-dimer values). RESULTS: Out of a total of 274 CTPA performed, 70 procedures presented diagnostic findings of PTE, representing a cumulative incidence of 25.54% (95% confidence interval [CI]: 20.49-31.14). In the non-D-dimer based model, respiratory rate >22 bpm (odds ratio [OR]: 3.162; 95% CI: 1.627-6.148; p = 0.001) and the absence of findings suggestive of COVID-19 in plain chest X-ray (OR: 3.869; 95% CI: 0.869-17.225; p = 0.076) were predictors of PTE. In the D-dimer-based model, tachypnea remained as a predictive factor (OR: 4.967; 95% CI: 2.053-12.018; p < 0.001), as well as D-dimers > 3000 ng/mL (OR: 7.494; 95% CI: 3.038-18.485; p < 0.001). CONCLUSIONS: The presence of tachypnea (>22 bpm) and the absence of radiological findings suggestive of SARS-CoV-2 infection in the chest X-ray, in addition to D-dimer values >3000 ng/mL, were identified as predictive factors of PTE in patients with COVID-19.

OBJETIVO: Pretendemos determinar los factores predictores de enfermedad tromboembólica pulmonar (ETEP) en pacientes con infección por SARS-CoV-2 (COVID-19) atendidos en el servicio de urgencias de un hospital terciario durante la primera ola pandémica. MÉTODOS: Estudio observacional unicéntrico realizado en una cohorte retrospectiva de pacientes con infección confirmada por SARS-CoV-2 (o alta sospecha clínico-radiológica de COVID-19) sometidos a despistaje de ETEP mediante tomografía computarizada de arterias pulmonares (TCAP). Se exploraron los factores predictores de ETEP mediante regresión logística, creándose dos modelos predictivos (sin o con los valores de dímeros-D). RESULTADOS: De un total de 274 TCAP realizados, 70 procedimientos presentaron hallazgos diagnósticos de ETEP, representando una incidencia acumulada de 25,54% (intervalo de confianza [IC] 95%: 20,49­31,14). En el modelo no ajustado por el nivel de dímeros-D, la frecuencia respiratoria >22 rpm (odds ratio [OR]: 3,162; IC 95%: 1,627­6,148; p = 0,001) y la ausencia de hallazgos sugerentes de COVID-19 en la radiología simple de tórax (OR: 3,869; IC 95%: 0,869­17,225; p = 0,076) fueron predictores de ETEP. En el segundo modelo se mantuvo la presencia de taquipnea (OR: 4,967; IC 95%: 2,053­12,018; p < 0,001), identificándose además un nivel de dímeros-D > 3.000 ng/mL (OR: 7,494; IC 95%: 3,038­18,485; p < 0,001). CONCLUSIONES: La presencia de taquipnea (>22 rpm) y la ausencia de hallazgos radiológicos sugestivos de infección por SARS-CoV-2 en la radiografía simple de tórax, además de los valores de dímero-D > 3.000 ng/mL, fueron identificados como factores predictores de ETEP en pacientes con COVID-19.

[Prediction of pulmonary embolism in patients with SARS-CoV-2 infection]. / Predicción del desarrollo de tromboembolia pulmonar en pacientes con infección por SARS-CoV-2.

OBJECTIVE: To determine the predictive factors of pulmonary thromboembolic (PTE) in patients with SARS-CoV-2 infection (COVID-19) assessed in the emergency department at a tertiary hospital during the first pandemic wave. METHODS: Observational single-center study conducted in a retrospective cohort of patients with confirmed SARS-CoV-2 infection (or high clinical-radiological suspicion) who underwent PTE screening by computed tomography pulmonary angiography (CTPA). Predictive factors of PTE were explored using logistic regression, creating two predictive models (without or with D-dimer values). RESULTS: Out of a total of 274 CTPA performed, 70 procedures presented diagnostic findings of PTE, representing a cumulative incidence of 25.54% (95% confidence interval [CI]: 20.49-31.14). In the non-D-dimer based model, respiratory rate>22bpm (odds ratio [OR]: 3.162; 95% CI: 1.627-6.148; p=0.001) and the absence of findings suggestive of COVID-19 in plain chest X-ray (OR: 3.869; 95% CI: 0.869-17.225; p=0.076) were predictors of PTE. In the D-dimer-based model, tachypnea remained as a predictive factor (OR: 4.967; 95% CI: 2.053-12.018; p<0.001), as well as D-dimers>3,000ng/ml (OR: 7.494; 95% CI: 3.038-18.485; p<0.001). CONCLUSIONS: The presence of tachypnea (>22bpm) and the absence of radiological findings suggestive of SARS-CoV-2 infection in the chest X-ray, in addition to D-dimer values>3,000 ng/mL, were identified as predictive factors of PTE in patients with COVID-19.

Return to sport soccer after anterior cruciate ligament reconstruction: ISAKOS consensus.

INTRODUCTION: Many factors can affect the return to pivoting sports, after an Anterior Cruciate Ligament Reconstruction. Prehabilitation, rehabilitation, surgical and psychological aspects play an essential role in the decision to return to sports. The purpose of this study is to reach an international consensus about the best conditions for returning to sports in soccer-one of the most demanding level I pivoting sports after anterior cruciate ligament (ACL) reconstruction. METHODS: 34 International experts in the management of ACL injuries, representing all the Continents were convened and participated in a process based on the Delphi method to achieve a consensus. 37 statements related to ACL reconstruction were reviewed by the experts in three rounds of surveys in complete anonymity. The statements were prepared by the working group based on previous literature or systematic reviews. Rating agreement through a Likert Scale: strongly agree, agree, neither agree or disagree, disagree and strongly disagree was used. To define consensus, it was established that the assertions should achieve a 75% of agreement or disagreement. RESULTS: Of the 37 statements, 10 achieved unanimous consensus, 18 non-unanimous consensus and 9 did not achieve consensus. In the preoperative, the correction of the range of motion deficit, the previous high level of participation in sports and a better knowledge of the injury by the patient and compliance to participate in Rehabilitation were the statements that reached unanimous consensus. During the surgery, the treatment of associated injuries, as well as the use of autografts, and the addition of a lateral extra-articular tenodesis in some particular cases (active young athletes, <25 years old, hyperlaxity, high rotatory laxity and revision cases) obtained also 100% consensus. In the postoperative period, psychological readiness and its validation with scales, adequate physical preparation, as well as not basing the RTSS purely on the time of evolution after surgery, were the factors that reached unanimous Consensus. CONCLUSIONS: The consensus statements derived from this international ISAKOS leaders, may assist clinicians in deciding when to return to sports soccer in patients after an ACL reconstruction. Those statements that reached 100% consensus have to be strongly considered in the final decision to RTS soccer.

Toward the rational design of molecular rotors ion sensors based on α,γ-cyclic peptide dimers.

A dimer-forming self-assembling cyclic hexapeptide with a control register and a large association constant in water is described. The self-assembly process is followed by pyrene-excimer emission and the main diastereomeric dimer present in solution is switched by controlled addition of divalent cations (e.g., Ca, Mg) or oxalic acid.

Fluorescence of methylated derivatives of hydroxyphenylimidazopyridine. Resolution of strongly overlapping spectra and a new ESIPT dye showing very efficient radiationless deactivation.

The ground- and excited-state behaviour of the isomeric species 2-(2'-methoxyphenyl)imidazo[4,5-b]pyridine (1-OMe) and 2-(2'-hydroxyphenyl)-4-methylimidazo[4,5-b]pyridine (1-NMe) in neutral and acid media has been studied by UV-vis absorption spectroscopy, steady-state and time-resolved fluorescence spectroscopy. The new dye 1-NMe is non-fluorescent in neutral media except in trifluoroethanol, where it shows a very weak fluorescence. 1-NMe also exhibits highly solvent-dependent fluorescence intensity in acidic media. We propose that the neutral species experiences a fast excited-state intramolecular proton transfer (ESIPT), relaxing afterwards by intramolecular twisting associated with internal charge transfer (TICT) and subsequent very fast internal conversion of the proton-transferred TICT structure. The behaviour of 1-NMe in acidic media is explained by the existence of a ground-state tautomeric equilibrium between species with intramolecular hydrogen bonds N-HOH and NHO. The first type of tautomers dissociates at the hydroxyl group in water and ethanol, but fluoresces in acetonitrile and trifluoroethanol due to the inability of these solvents to accept the proton. The second type of tautomers is non-emissive due to fast radiationless deactivation through an ESIPT-TICT process. The fluorescence of 1-OMe was investigated in neutral and acidic media, demonstrating the photobasic character of the pyridine nitrogen. A ground-state equilibrium between pyridinium and imidazolium cations was found for this species, showing overlapping absorption and fluorescence spectra. We devised a method to resolve the spectra by applying principal component global analysis to a series of excitation spectra taken at different emission wavelengths, which allowed estimation of the equilibrium constant between the cations.

Controversies in acute multiligamentary knee injuries (MLKI).

Multiligament injuries of the knee (MLKI), remain an infrequent pathology especially in developed countries compared to mono-ligament lesions. In Colombia, MLKI is frequent due to the high accident rate on motorcycles. In the city of Bogota alone, about 160 motorcycle accidents have been estimated daily, being one of the cities that proportionately use this means of transport less compared to small cities. The term MLKI, include all ruptures of two or more major ligaments and therefore it has a broad spectrum of clinical presentation which creates a great challenge for the orthopedists and the surgeons envolved in this topic. The literature is rich in studies level IV but very poor in level I and level II, which generates controversies and little consensus in the diagnosis and treatment of this pathology. However there has been a gradual and better understanding of all factors involved in the treatment of MLKI that has improved the functional results of these knees in our patients, in fact we currently are more precise to achieve accurate diagnosis, evolved from not surgical approach to operate most, applying new anatomical and biomechanical concepts, with specialized and skill surgical techniques with more stable and biocompatible fixation implants, which allow in most cases to initiate an early integral rehabilitation program. Nevertheless due to the complexity and severity of the lesions, in some patients the functional results are poor. The goal of this revision is to identify the most frequent controversies in the diagnosis and treatment of MLKI, defining which of them are agreed according to what is reported in the literature and share some concepts based from the experience of more than 25 years of the senior author (MM) in the management of these injuries. LEVEL OF EVIDENCE: V - Expert Opinion.

Immunoglobulin G4-related gastric pseudotumor - An impostor: Case report.

INTRODUCTION: Gastric pseudotumors are rare entities whose clinical presentation resembles typical gastric neoplasias, often making them unrecognized unless other causes are considered. PRESENTATION OF CASE: We present a case report of a patient that debuts with dysphagia, with an abdominal computed axial tomography (CAT) scan revealing a mass at the gastro-esophageal junction suggestive of malignant origin, with studies revealing it to be Immunoglobulin G4-related (IgG4). DISCUSSION: The diagnosis and identification of IgG4-related gastric pseudotumors is very complicated, often and most commonly an incidental diagnosis upon histologic analysis, as is the situation in this case. CONCLUSION: Understanding its clinical course and early diagnosis can reduce unwarranted surgical intervention in some patients with IgG4-related disease.

Dynamic polar solvation is reported by fluorescing 4-aminophthalimide faithfully despite H-bonding.

Solvation dynamics of 4-aminophthalimide (4AP) in methanol is measured by broadband upconversion of the fluorescence band. The peak emission frequency nu(t) is determined from 100 fs onward with 85 fs time resolution. Polar solvation based on simple continuum theory, including solute polarizability, describes the temporal shape of nu(t) quantitatively. Extrapolation nu(t-->0) points to an initial emission frequency which agrees with the result from stationary spectroscopy in a nonpolar solvent. The extent (4300 cm(-1)) of the dynamic Stokes shift is largely due (50%) to H-bonding, however. The observations imply that H-bonds with 4AP adiabatically follow the dielectric relaxation of the methanol network. The stimulated emission band is also used to measure solvation dynamics. The evolving band is monitored by transient absorption spectroscopy of supercontinuum probe pulses. But the excited-state absorption spectrum, its relative amplitude, and its evolution are needed to extract nu(t) from such measurements. These key data are obtained by comparison with the upconversion results. Thus calibrated photometrically, 4AP transient absorption can be used to monitor solvation dynamics in any solvent. The excited-state absorption spectrum is assigned with the help of time-dependent density-functional calculations. Fluorescence excitation and double-resonance spectroscopy of isolated 4AP, cooled in a supersonic jet, is used to determine optically active modes. An intramolecular reorganization energy is inferred which is consistent with the value in 2-methylbutane (2025 cm(-1)). The crystal structure is also provided.

Solvent-modulated ground-state rotamerism and tautomerism and excited-state proton-transfer processes in o-hydroxynaphthylbenzimidazoles.

The ground-state rotamerism and tautomerism and the excited-state proton-transfer processes of 2-(1'-hydroxy-2'-naphthyl)benzimidazole (1) and 2-(3'-hydroxy-2'-naphthyl)benzimidazole (2) have been investigated in various solvents by means of UV-vis absorption spectroscopy, steady-state and time-resolved fluorescence spectroscopy, and quantum-mechanical ab initio calculations. For both compounds, a solvent-modulated rotameric equilibrium, and also tautomeric for 1, was observed in the ground state. In apolar solvents, both 1 and 2 exist as planar syn normal forms, with the hydroxyl group hydrogen bonded to the benzimidazole N3. In acetonitrile and ethanol, a rotameric equilibrium is established between the syn form and its planar anti rotamer, with the phenyl ring rotated 180 degrees about the C2-C2' bond. In ethylene glycol, glycerol, and aqueous solution with 40% ethanol, a tautomeric equilibrium was detected for 1 between the syn and anti normal forms and the tautomer form, with the hydroxyl proton transferred to the benzimidazole N3. In all of the solvents studied, the syn normal form of 1 and 2 undergoes an ultrafast excited-state intramolecular proton transfer (ESIPT) to yield the excited tautomer. The anti normal forms of 1 and 2, unable to experience ESIPT, give normal form fluorescence. In addition, the anti normal conformer of 2 partly deprotonates at the hydroxyl group in aqueous solution with 40% ethanol, giving the excited anion. The monocations of 1 and 2, protonated at the benzimidazole N3, are strong photoacids that deprotonate completely in aqueous solution with 40% ethanol and to a great extent in ethanol, giving the excited tautomer.

A cutaneous horn on the ear.

A man, 64 years of age, retired and resident on the Spanish Mediterranean coast, without family or personal history of cutaneous tumours, requested primary medical evaluation for a lesion that had been present for a year. The lesion was located on his left ear, and had been growing progressively, without irritation, pain or other significant symptoms. No loss of weight or appetite was present.

Total gastrectomy in systemic scleroderma when anti-reflux surgery is not viable: A case report.

INTRODUCTION: Systemic scleroderma is an autoimmune disease that can affect the respiratory system and the gastrointestinal tract. When diffuse lung disease and pulmonary hypertension develop, a lung transplant is usually considered as treatment. This option, however, is not feasible in the presence of concomitant gastroesophageal reflux disease. In this case, medical therapy is initially warranted. If this fails, surgical approach may be considered in order for the patient to be a lung transplant candidate. CASE PRESENTATION: A 56-year-old female, with previous history of intestinal pneumonitis, mild pulmonary hypertension and gastroesophageal reflux secondary to systemic scleroderma, is considered for lung transplant. Initially, due to persistent gastroesophageal reflux, a transplant was not a viable. This was corrected with an open gastrectomy with roux-en-Y anastomosis. Follow-up one week later revealed normal anatomy, adequate esophageal-jejunal anastomosis, and adequate contrast medium transit via esophagogram. Additionally, there was no evidence of contrast medium reflux indicating a resolved gastroesophageal reflux disease. This led to the patient becoming a candidate for lung transplant. DISCUSSION: We suggest an open gastrectomy with roux-en-Y anastomosis as an alternative to the Nissen fundoplication for patients with connective tissue disease that develop terminal pulmonary consequences and require a lung transplant.

Fever in travellers returning from the tropics.

The increase in international travel, the growing presence of arbovirus vectors in our country, and notifications of haemorrhagic fever such as the current outbreak of Ebola in D.R. Congo and the cases of Crimea-Congo haemorrhagic fever in our country have again cast the spotlight on tropical diseases. Isolating suspected cases of highly contagious and lethal diseases must be a priority (haemorrhagic fever, MERS-CoV). Assessing the patient, taking a careful medical history based on epidemiological aspects of the area of origin, activities they have carried out, their length of stay in the area and the onset of symptoms, will eventually help us, if not to make a definitive diagnosis, at least to exclude diseases that pose a threat to these patients. Malaria should be ruled out because of its frequency, without forgetting other common causes of fever familiar to emergency doctors.

El incremento de los viajes internacionales, la creciente presencia de vectores transmisores de arbovirusen nuestro país, las alertas de fiebres hemorrágicas, como el actual brote de ébola en la R. D. del Congoy los casos autóctonos de fiebre hemorrágica de Crimea-Congo en nuestro país, ponen de nuevo enprimer plano las enfermedades tropicales. El aislamiento de los casos sospechosos de enfermedades dealta transmisibilidad y letalidad ha de ser una prioridad (fiebres hemorrágicas, MERS-CoV). Al valorar alpaciente, una cuidadosa historia clínica basada en los aspectos epidemiológicos de la zona de procedencia,las actividades realizadas, el tiempo de estancia en el mismo y el inicio de los síntomas nos ayudaránfinalmente, si no al diagnóstico definitivo, sí al menos a descartar las enfermedades que signifiquen unaamenaza para él. Por su frecuencia y gravedad la malaria debe ser descartada, sin olvidar las otras causashabituales de fiebre con las que el médico de urgencias debe estar familiarizado también.

Fever in travellers returning from the tropics. / Fiebre en el viajero retornado del trópico.

The increase in international travel, the growing presence of arbovirus vectors in our country, and notifications of haemorrhagic fever such as the current outbreak of Ebola in D.R. Congo and the cases of Crimea-Congo haemorrhagic fever in our country have again cast the spotlight on tropical diseases Isolating suspected cases of highly contagious and lethal diseases must be a priority (Haemorrhagic fever, MERS-CoV). Assessing the patient, taking a careful medical history based on epidemiological aspects of the area of origin, activities they have carried out, their length of stay in the area and the onset of symptoms, will eventually help us, if not to make a definitive diagnosis, at least to exclude diseases that pose a threat to these patients. Malaria should be ruled out because of its frequency, without forgetting other common causes of fever familiar to emergency doctors.