Percutaneous Thrombectomy With Flowtriever System in Pregnant Women With High-Risk Pulmonary Embolism and Contraindications to Systemic Thrombolysis.

CLINICAL IMPACT: Through these clinical cases, we present a new protocol of action, updated with the latest evidence on percutaneous pulmonary thrombectomy using dedicated catheters, for high-risk PE in pregnant women or during the early postpartum period.

Has Coranavirus Disease 2019 Changed the Incidence and Outcome of Bell's Palsy?

BACKGROUND: Objectives: (1) To determine whether the incidence of Bell's Palsy (BP) increased during the pandemic. (2) To investigate whether the outcomes of patients with BP and COVID-19 infection or vaccination differ from those in the pre-pandemic era. METHODS: Patients with BP were studied in 2 periods retrospectively (March 2021-March 2022 and August 2018-August 2019). A prospective study from March 2021 to March 2022 was also performed. Primary outcome was grade ≤Ⅱ in the House-Brackmann (HB) and/or >70 in the Sunnybrook facial grading system (SFGS) scales at the 12-week visit. Reverse transcriptase polymerase chain reaction (PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and enzyme-linked immunosorbent assay-based SARS-CoV-2 immuonoglobulin G (IgG) test (blood) were measured. RESULTS: About 162 and 196 patients with BP were identified between March 2021 and March 2022 and August 2018 and August 2019, respectively. Forty-seven patients (29%) entered the prospective study; 85% had HB grades I or II, while 92% had an SFGS score of 71-100 at the last visit. Only 3 patients (6.5%) had a positive PCR during the initial episode, whereas 35 patients (77%) had positive IgG SARS-CoV-2. There was no association between positive PCR and facial function outcomes. Of the 162 patients, 105 (67%) had received COVID-19 vaccine. In 23 of them (22%), the paralysis appeared within the first 30 days after a vaccine dose. CONCLUSION: Coronavirus disease 2019 did not increase the incidence of BP. A direct association between the coronavirus and BP outcome cannot be established. The considerable number of patients developing BP within the first month suggests a possible association between COVID-19 vaccines and BP.

Effectiveness of Treatment Approaches in COVID-19 Pneumonia: A Comparative Evaluation between a Specialized Center and Conventional Hospitals.

BACKGROUND: The early stages of the COVID-19 pandemic overwhelmed general hospitals in Spain. In response, a dedicated hospital for COVID-19 care, the Hospital de Emergencias Enfermera Isabel Zendal (HEEIZ), was established. This study aimed to compare clinical outcomes of COVID-19 patients treated at the specialized HEEIZ with those at conventional general hospitals (CGHs) in Madrid, Spain. METHODS: The study was a prospective, observational cohort study including COVID-19 patients admitted to the HEEIZ and 14 CGHs (December 2020 to August 2021). Patients were assigned based on hospital preference. Clinical data were collected and analyzed using multivariate regression to assess primary and secondary outcomes, including hospital mortality, need of invasive mechanical ventilation (IMV), and pharmacological treatments. RESULTS: The HEEIZ cohort (n = 2997) was younger and had lower Charlson comorbidity scores than the CGH cohort (n = 1526). Adjusted HEEIZ hospital mortality was not significantly higher compared with CGHs (OR: 1.274; 95% CI: 0.781-2.079; p = 0.332). CONCLUSIONS: During the study period, patients admitted to the HEEIZ showed no significant differences in clinical outcomes, compared with patients admitted at CGHs. These results might support the use of specialized centers in managing pandemic surges, allowing CGHs to handle other needs.

Hospital pharmacist experience in a multidisciplinary team in special care settings.

The COVID-19 pandemic is placing huge strain on health systems and professionals. Emergency departments and their pharmacy services have been the first to face this challenge before any other pharmacy units. This article provides a description of the experience of two public hospitals  located in the Autonomous Community of Madrid, Spain. Team working and  reciprocal trust have made it possible to meet the unprecedented demand for  health services and has facilitated rapid decision making. Strategies have been  developed to guarantee the availability, distribution and safe use of medications. Other strategies have included favoring communication within Emergency  Departments pharmacy services, and between these services and Emergency  Departments during the pandemic. Multidisciplinary cooperation and information  sharing have traditionally formed the base for efficient and quality work, along  with solid technologies that guarantee a safe use of medications. The crucial role of information and communication technologies during the pandemic may give  rise to a new model of pharmaceutical care, which should not replace face-to- face Emergency Department pharmacist support and advice. Promoting the re- humanization of healthcare and pharmacy services is essential. An adequate  technical training and the development of abilities such as flexibility, planning  and coordination skills, and an assertive communication and management of  emotions will be key to the successful management of unimaginable settings in  the future.

La actual pandemia ha puesto al límite la capacidad de respuesta del sistema  sanitario y a sus profesionales. Los primeros en enfrentarse a este reto han sido  los servicios de urgencias y, con ellos, los farmacéuticos ligados a estas  unidades, que han precedido a los del resto de áreas del servicio de farmacia. En este artículo se narra la experiencia en dos hospitales públicos de la Comunidad  de Madrid. El trabajo en equipo y la confianza mutua han permitido abordar una demanda asistencial desorbitada y una rápida toma de decisiones. Se han  desarrollado estrategias para garantizar la disponibilidad y la dispensación de  medicamentos, y favorecer la mejora en la seguridad de su utilización. Fomentar la comunicación dentro del propio servicio y con urgencias ha sido otra de las  estrategias imprescindibles potenciadas durante la pandemia. La cooperación  multidisciplinar y la coordinación de la información siempre serán la base de un  trabajo eficiente y de calidad, junto con sistemas informáticos bien desarrollados como pieza clave en la seguridad del proceso de utilización de medicamentos. El  impulso de las tecnologías para la información y la comunicación durante la  pandemia quizá permita un nuevo modelo de atención farmacéutica que no  debería sustituir la actividad presencial del farmacéutico en urgencias; es  imprescindible retomar e impulsar la humanización desde los diferentes  estamentos. Una buena formación técnica y el desarrollo de habilidades como  flexibilidad, capacidad de organización y coordinación, comunicación y gestión de las emociones serán imprescindibles para afrontar futuras e inimaginables situaciones.

[Preparation of a questionnaire to detect cases of hate violence in emergency rooms]. / Elaboración de un cuestionario de detección de casos de violencia de odio en urgencias hospitalarias.

OBJECTIVE: In the context of the SIVIVO project, the development of a tool to facilitate the detection, recording and description of cases of hate violence and its consequences on health was proposed. METHOD: A two-round Delphi method was used with experts from clinical-care, public health, epidemiological, academic, administration and non-governmental organizations to assess the relevance of different items using a Likert scale, presenting the results with medians and coefficients of variation. RESULTS: The best evaluated questions, with scores equal to or greater than 4, and which make up the final version of the questionnaire are the relative socio-demographic characteristics of the victim, the injuries, description of the incident, the motivations perceived by the aggrieved person, possible evidence of hatred, the intention to denounce and the perception of the health personnel of the motive for the aggression. The piloting showed the adequacy of the questions that were finally selected. CONCLUSIONS: The systematic incorporation of this tool can help us to learn the magnitude and characteristics of hate violence and its impact on health. This information would allow the elaboration of prevention and intervention strategies aimed, specifically, at the sectors of the population most exposed to this type of violence.

A Cohort of Patients with COVID-19 in a Major Teaching Hospital in Europe.

BACKGROUND: Since the confirmation of the first patient infected with SARS-CoV-2 in Spain in January 2020, the epidemic has grown rapidly, with the greatest impact on the region of Madrid. This article describes the first 2226 adult patients with COVID-19, consecutively admitted to La Paz University Hospital in Madrid. METHODS: Our cohort included all patients consecutively hospitalized who had a final outcome (death or discharge) in a 1286-bed hospital of Madrid (Spain) from 25 February (first case admitted) to 19 April 2020. The data were manually entered into an electronic case report form, which was monitored prior to the analysis. RESULTS: We consecutively included 2226 adult patients admitted to the hospital who either died (460) or were discharged (1766). The patients' median age was 61 years, and 51.8% were women. The most common comorbidity was arterial hypertension (41.3%), and the most common symptom on admission was fever (71.2%). The median time from disease onset to hospital admission was 6 days. The overall mortality was 20.7% and was higher in men (26.6% vs. 15.1%). Seventy-five patients with a final outcome were transferred to the intensive care unit (ICU) (3.4%). Most patients admitted to the ICU were men, and the median age was 64 years. Baseline laboratory values on admission were consistent with an impaired immune-inflammatory profile. CONCLUSIONS: We provide a description of the first large cohort of hospitalized patients with COVID-19 in Europe. Advanced age, male sex, the presence of comorbidities and abnormal laboratory values were more common among the patients with fatal outcomes.