Notes

Mortality chance through serious aortic dissection amongst healthcare facility admission through week-ends along with winter holiday.
Retention at 12 weeks was 86%, and attendance at exercise sessions averaged 62%±28%. After 12 weeks, 69% of participants experienced a remission of MDD based on the SCID. Mean BDI-II scores decreased from 31.9±9.1 to 13.1±10.1 [Cohen d effect size (ES)=1.96]. Improvements were observed in upper (ES=0.64) and lower (ES=0.32) body muscular endurance. Exercise session attendance was moderately correlated with changes in BDI-II scores (Pearson r=0.49). It appears feasible to attract and engage some youth with MDD in an exercise intervention. The positive impact on depression symptoms justifies further studies employing exercise interventions as an adjunct to routine care for young people with MDD.Neuroplasticity is an area of expanding interest in psychiatry. Plasticity and metaplasticity are processes contributing to the scaling up and down of neuronal connections, and they are involved with changes in learning, memory, mood, and sleep. Effective mood treatments, including repetitive transcranial magnetic stimulation (rTMS), are reputed to work via changes in neuronal circuitry. This article explores the interrelatedness of sleep, plasticity, and rTMS treatment. A PubMed-based literature review was conducted to identify all available studies examining the relationship of rTMS, plasticity, and sleep. Key words used in this search included "TMS," "transcranial magnetic stimulation," "plasticity," "metaplasticity," "sleep," and "insomnia." Depressed mood tends to be associated with impaired neural plasticity, while antidepressant treatments can augment neural plasticity. rTMS impacts plasticity, yielding long-lasting effects, with differing impacts on the waking and sleeping brain. Higher quality sleep promotes plasticity and learning. Reports on the sleep impact of high-frequency and low-frequency rTMS are mixed. The efficacy of rTMS may rely on brain plasticity manipulation, enhanced via the stimulation of neural circuits. Total sleep time and sleep continuity are sleep qualities that are likely necessary but insufficient for the homeostatic plasticity driven by slow-wave sleep. Understanding the relationship between sleep and rTMS treatment is likely critical to enhancing outcomes.Almost half of new diagnoses of human immunodeficiency virus (HIV) infection are made late, leading to increased morbidity and mortality, greater spread of infection, and higher public health care costs. Emergency services care for many patients who share behaviors associated with HIV transmission risk who arrive in clinical situations that are associated with HIV infection. D-Cycloserine A strategy to increase the rates of early diagnosis by promoting serology for HIV when caring for patients with certain clinical profiles might therefore be the key to improvement. This approach is hardly used at present, however, unless the result of serology would change the management of the acute complaint that led to the visit. These recommendations based on evidence from a search and review of recent publications were developed by a group of experts appointed by the Spanish Society of Emergency Medicine (SEMES). The resulting statement aims to support decision-making by emergency physicians and promote HIV screening and referral to appropriate specialists for follow-up in patients with certain conditions (sexually transmitted infections, herpes zoster, community-acquired pneumonia) or reporting certain scenarios (practice of chemsex, need for post-exposure prophylaxis). These 6 settings were selected because they are often seen in emergency departments and are common in patients with HIV-positive tests. The recommendations address when to order serology for HIV and how to manage the referral process. Included are decision-making tools for emergency physicians.
To describe the clinical course of patients discharged from the emergency department (ED) with nonsevere coronavirus disease 2019 (COVID-19) and explore possible risk factors for later hospitalization.

Patients with nonsevere COVID-19 who were discharged from the ED were included prospectively. We explored risk factors for hospitalization after discharge.

Seventy-four patients were included; 17 (23%) were hospitalized after discharge. Three (4%) of the 17 patients died. Age, lymphopenia, a high Charlson Comorbidity Index, and a shorter delay between the onset of symptoms and the first visit to the ED were associated with hospitalization afterwards, although on multivariate analysis only time less than 6 days between symptom onset and the first ED visit was associated with later hospitalization (odds ratio, 4.62; 95% CI, 1.08-19.7).

More than 20% of ED patients with nonsevere COVID-19 require hospitalization later.
More than 20% of ED patients with nonsevere COVID-19 require hospitalization later.
To study nurse staffing at emergency response coordination centers (ERCCs) and determine nurses' functions and activities within the structure and organization of ERCCs.

Observational cross-sectional study in January and April 2019 in the 17 Spanish autonomous communities and the autonomous cities of Ceuta and Melilla. We consulted ERCC institutional reports and webpages, conducted telephone interviews, and maintained email correspondence with key informants (nurse supervisors and staff directly implicated in managing emergency calls).

All the ERCCs except those in Asturias, Rioja, and the 2 autonomous cities have nurses on staff. Their usual functions are prevention and health promotion; supporting primary care physicians; managing health alerts, multiple victim incidents, and secondary patient transport; activating response codes; coordinating transport for transplants; and contacting hospitals so they expect arrivals.

Nurses in Spanish ERCCs have similar functions, but they are developed at different levels in each center.
Nurses in Spanish ERCCs have similar functions, but they are developed at different levels in each center.
To investigate the presence of fundamental concepts in emergency medicine on the entrance examination taken by candidates for medical internships and residency training in Spain, and to identify changes over time.

Longitudinal retrospective study. Three independent researchers reviewed questions on the entrance examinations of the past 10 years (2010-2019) and classified them as directly, indirectly, or not related to emergency medicine. The topics of directly related questions were also classified according to the categories listed in Tintinalli's Emergency Medicine and subject areas in the Citation Index Expanded (SCIE) of the Web of Science. Changes in the number of questions and range of topics were analyzed with simple linear regression models.

A total of 2300 questions were reviewed; 487 (22%) were directly related to emergency medicine, and 313 of them specifically referred to an emergency or urgent care setting. The proportion of directly related questions held steady over the 10-year period (P= the high percentage of questions on the examinations.
To develop a model to predict hospital admission of patients in cases assessed as nonurgent or semiurgent on emergency department triage.

Single-center observational study of a retrospective cohort. We included cases of patients older than 15 years whose emergency was classified as level IV-V according to the Andorran-Spanish triage model (MAT-SET, the Spanish acronym). Fourteen independent variables included demographic and care process items as well as vital signs. The dependent variable was hospital admission. The regression models were based on generalized estimating equations.

A total of 53 860 episodes were included; 3430 patients (6.4%) were admitted. The median (interquartile range) age was 44.5 (31.1-63.9) years, and 54.1% were female. Vital signs were recorded in 19.3% of the episodes. The model that best predicted admission included the following variables age > 84 years (adjusted odds ratio [aOR], 6.72; 95% CI, 5.26-8.60); male sex (aOR, 1.46; 95% CI, 1.28-1.66); referral from a primary cy to be admitted after their cases were initially considered nonurgent or semi-urgent on triage. Patients found to be at risk can then be given greater attention than others in the same triage level.
To analyze emergency department (ED) revisits from patients discharged with possible coronavirus disease 2019 (COVID-19).

Retrospective observational study of consecutive patients who came to the ED over a period of 2 months and were diagnosed with possible COVID-19. We analyzed clinical and epidemiologic variables, treatments given in the ED, discharge destination, need to revisit, and reasons for revisits. Patients who did or did not revisit were compared, and factors associated with revisits were explored.

The 2378 patients included had a mean age of 57 years; 49% were women. Of the 925 patients (39%) discharged, 170 (20.5%) revisited the ED, mainly for persistence or progression of symptoms. Sixty-six (38.8%) were hospitalized. Odds ratios (ORs) for the following factors showed an association with revisits history of rheumatologic disease (OR, 2.97; 95% CI, 1.10-7.99; P = .03), digestive symptoms (OR, 1.73; 95% CI, 1.14-2.63; P = .01), respiratory rate over 20 breaths per minute (OR, 1.03; 95% CI, 1ver and age over 48 years were associated with a need for hospitalization.Introduction The controversial characteristics of neonatal screening influenced by bioethical considerations make its implementation complex. Colombia is not an exception in this sense and local circumstances complicate the panorama. Objective To establish how bioethical controversies on neonatal screening are approached at a local level as a basis for deliberating on the must-be of this activity in Colombia. Materials and methods A survey immersed in an interpretative investigation with descriptive and deliberative components of analysis was applied to approach the values exposed by officials of the Colombian Instituto Nacional de Salud. Results The compulsory offer of screening by the nation, regardless of its opportunity cost and the consent for the use in research of results and residual samples, were not controversial, but, in contrast, the type of information and the consent to authorize screening did arise controversy. The more experienced officials preferred mandatory screening (17.7 vs. 11.79 years on average, p=0.007). Surprisingly, despite the risk of discrimination, keeping the neonate as the purpose, there was agreement on giving all the information to parents and medical records. Another controversial aspect was the follow-up of cases without hiding their identification where officials with more experience in bioethical aspects preferred the use of codes (4.5 vs. 1.26 years on average, p=0.009). In this context, strategies such as informed dissent, specialized advice or public health programs that appreciate diversity would allow to rescue even seemingly opposite values. Conclusion A local approach regarding what ought to be in neonatal screening based on a deliberative bioethical perspective allowed to present an implementation proposal for this activityIntroduction Trypanosoma cruzi, the causative agent of Chagas disease, shows substantial phenotypic and genotypic heterogeneity, which can influence the epidemiological and clinical variations of the disease and the sensitivity to the drugs used in the treatment. Objective To assess the in vitro susceptibility to benznidazole, nifurtimox, and posaconazole of 40 cloned strains of T. cruzi isolated in Paraguay belonging to different genotypes, hosts, and localities. Materials and methods We incubated the parasites in their epimastigote stage in LIT culture medium with different concentrations of each drug in triplicate assays. The degree of susceptibility was estimated by the inhibitory concentrations of 50 and 90% (IC50 and IC90) to obtain the average values and the standard deviation for each strain and drug. We determined the statistical significance between groups by analysis of variances with the Wilcoxon/Kruskal-Wallis non-parametric test and values of p less then 0.05. Results A wide range of drug response was observed.
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