Resucitación cardiopulmonar durante la pandemia por COVID-19 en España

ObjectivesThe disease COVID-19 produces serious complications that can lead to cardiorespiratory arrest. Quality cardiopulmonary resuscitation (CPR) can improve patient prognosis. The objective of this study was to evaluate the performance of the specialty of Anaesthesiology in the management of CPR during the pandemic.MethodsA survey was carried out with Google Forms consisting of 19 questions. The access link to the questionnaire was sent by email by the Spanish Society of Anesthesia (SEDAR) to all its members.Results225 responses were obtained. The regions with the highest participation were: Madrid, Catalonia, Valencia and Andalusia. 68.6%% of the participants work in public hospitals. 32% of the participants habitually work in intensive care units (ICU), however, 62.1% have attended critical COVID-19 in the ICU and 72.6% have anesthetized them in the operating room. 26.3% have attended some cardiac arrest, 16.8% of the participants admitted to lead the manoeuvres, 16.8% didn’t participate in the CPR, and 66.2% was part of the team, but did not lead the assistance. Most of the CPR was performed in supine, only 5% was done in prone position. 54.6% of participants had not taken any course of Advance Life Support (ALS) in the last 2 years. 97.7% of respondents think that Anaesthesia should lead the in-hospital CPR.ConclusionThe specialty of Anesthesiology has actively participated in the care of the critically ill patient and in the management of CPR during the COVID-19 pandemic. However, training and/or updating in ALS is required.     

Recomendaciones de actuación en cirugía oncológica hepatobiliopancreática durante la pandemia COVID-19

The SARS-CoV-2 (COVID-19) pandemic requires an analysis in the field of oncological surgery, both on the risk of infection, with very relevant clinical consequences, and on the need to generate plans to minimize the impact on possible restrictions on health resources.The AEC is making a proposal for the management of patients with hepatopancreatobiliary (HPB) malignancies in the different pandemic scenarios in order to offer the maximum benefit to patients, minimising the risks of COVID-19 infection, and optimising the healthcare resources available at any time. This requires the coordination of the different treatment options between the departments involved in the management of these patients: medical oncology, radiotherapy oncology, surgery, anaesthesia, radiology, endoscopy department and intensive care.The goal is offer effective treatments, adapted to the available resources, without compromising patients and healthcare professionals safety.     

Atención de la urgencia quirúrgica durante la pandemia COVID-19. Recomendaciones de la Asociación Española de Cirujanos

New coronavirus SARS-CoV-2 infection (coronavirus disease 2019 [COVID-19]) has determined the necessity of reorganization in many centers all over the world. Spain, as an epicenter of the disease, has been forced to assume health policy changes in all the territory. However, and from the beginning of the pandemic, every center attending surgical urgencies had to guarantee the continuous coverage adopting correct measures to maintain the excellence of quality of care. This document resumes general guidelines for emergency surgery and trauma care, obtained from the available bibliography and evaluated by a subgroup of professionals designated from the general group of investigators Cirugía-AEC-COVID-19 from the Spanish Association of Surgeons, directed to minimize professional exposure, to contemplate pandemic implications over different urgent perioperative scenarios and to adjust decision making to the occupational pressure caused by COVID-19 patients.     

Monitorización de la presión arterial en el paciente hipertensivo perioperatorio

The choice of the type of blood pressure monitoring in patients with uncontrolled hypertension varies depending on the patient's risk due to his previous pathology and cardiovascular risk, as well as the risk of the type of surgical intervention. We must assess the possibility of using new non-invasive monitors that allow optimal control of blood pressure continuously and evaluate the usefulness of new hemodynamic indexes that are still under study.     

Descripción de un modelo ovino para la prueba de ventiladores de urgencia en la pandemia de COVID-19

The COVID-19 pandemic has revealed a ventilator deficit in the global health system for this scenario. For this reason, several national and international projects have been developed to get done prototypes of ventilators which could be easy and fast to manufacture. One of the requirements of the AEMPS for conducting clinical studies with new prototypes is through the validation of these new prototypes in an animal model. Therefore, it is important to achieve an animal model which allows us to easily reproduce different clinical scenarios. In this article, we describe the use of a sheep as a research model to assess a prototype ventilator. The animal was anesthetized for 10 hours in which the prototype was tested in up to 6 different scenarios. This model is effective and easy to reproduce, making it an excellent choice for this kind of research.     

El estudio de la metilación del ADN en el cáncer urológico: presente y futuro

ObjectivesWe have synthesized the principal advances in the field of the study of epigenetics and specifically DNA methylation regarding the diagnosis of urological neoplasms.Acquisition of evidenceReview of the literature (PubMed, MEDLINE y COCHRANE) on the study of DNA methylation in urological neoplasms (prostate cancer, bladder cancer, renal cancer and testicular cancer), considering all the studies published up to January 2013.Synthesis of evidenceIt was possible to determine the state of methylation of many genes in our tumor samples. When these were compared with healthy tissue samples, it was possible to define the specific aberrant methylation patterns for each type of tumor. The study and definition of specific abnormal methylation patterns of each type of tumor is a tool having potential utility for diagnosis, evaluation, prediction of prognosis and treatment of the different forms of genitourinary cancer. The analysis of gene methylation in urine after micturition or post-prostatic massage urine, semen, in the wash plasma or fluid from prostatic biopsies may allow early detection of bladder, prostate, renal and testicular cancer. In each one of the neoplasms, an epigenetic signature that may be detected in the DNA has been identified, obtained from very scarce or not at all invasive specimens, with potential in the diagnosis and evaluation of prognosis. Validation of these studies will confirm the accuracy, effectiveness and reproducibility of the results available up to now. Criteria have still not been developed that determine if a gene panel provides sufficient information in the health care practice to guide an unequivocal diagnosis or therapeutic conduct. More studies are needed to compare sensitivity, specificity, positive and negative predictive value of the test in each case. Multicenter studies analyzing the real reproducibility of these results in a clinical setting also do not exist.ConclusionsThe study of aberrant DNA methylation in biological specimens of patients has an enormous potential for the early diagnosis and screening of genitourinary neoplasms. A larger number of studies is needed to be able to define the series of genes that would mean unequivocal signatures of malignancy. This methodology also has potential when defining prognostic groups and potential of response to different therapies.     

Análisis de la difusión y utilidad percibida a través de la implementación de una plataforma de formación virtual durante la pandemia por COVID-19

IntroductionThe SARS-CoV-2 pandemic has affected training opportunities for healthcare professionals partly because face to face courses were cancelled. This study analyzes the results of participation and satisfaction of the AEC Virtual Classroom sessions during the first year.MethodsThe AEC Virtual Classroom includes a combined format of weekly Webinar broadcast live that can be viewed on a delayed basis in a virtual platform. In this study, the results in its first year are evaluated considering the number of live participants, the delayed views and the global reach; as well as the results of the satisfaction survey in each of the sessions (0–10).ResultsFrom 16/04/2020 to 15/04/2021, 50 sessions of the Virtual Classroom AEC were held. The average scope of the sessions was 509 ± 288 views with a range between 196 and 149. At the times of highest incidence of cases during the pandemic, a decrease in live participants was observed 275 ± 135 vs. 391 ± 233 (p = 0.032). The mean score on the format was 8.46 ± 0.31/10. The best-scored sessions were those of the subject related to coloproctology with a statistically significant difference in the mean score 8.79 ± 0.42 vs. 8.39 ± 0.27 (p = 0.035). 90% of users considered the sessions useful. 97.2% of respondents believe that the sessions should be maintained after the pandemic.ConclusionsThe AEC Virtual Classroom has a very good results in the first year, proving to be a useful surgical teaching tool that will foreseeably survive once the pandemic is over.     

Impacto de la pandemia en la actividad de las unidades de cirugía reconstructiva urológica y de andrología en España durante el estado de alarma (COVID-19) en 2020: resultados de una encuesta nacional

IntroductionIn Spain the state of alarm secondary to COVID-19 dramatically changed the medical and surgical assistance activity of other pathologies. Regarding urological pathologies, those considered as «non-urgent» (andrology and reconstructive surgery) were postponed or even unattended.Material and methodsIn May 2020, once the first COVID-19 wave was almost over and still in the state of alarm, a 24-item survey was sent to 120 urologists from the Andrology Group and the Urologic Reconstructive Surgery Group of the Spanish Urological Association (AEU). Its aim was to determine the impact on clinical and surgical practice in both subspecialties.ResultsWe observed a response rate of 75.8% with 91 answered surveys. Before the state of alarm, 49.5% of urologists had 1-2 weekly surgical sessions available, surgical waiting list was 3-12 months for the 71.4%, and 39.6% attended between 20-40 patients weekly in office. During the state of alarm, 95.6% were given any kind of surgical guidelines, prioritizing emergency and oncologic pathologies. In the 85.7% of the hospitals neither andrology nor reconstructive surgeries were performed. In office, around 50% of patients were attended not on-site, most of them through telemedicine (phone calls and e-mails).ConclusionsThe negative pandemic implications in relation to the andrology and reconstructive surgery pathologies were truly important. After almost 2 years from the start of the pandemic, the true final impact on our health system has yet to be determined.