Toenail zinc and risk of prostate cancer in the MCC-Spain case-control study.

BACKGROUND: Some researchers have suggested that zinc (Zn) could reduce the risk of prostate cancer (PC). However, research from observational studies on the relationship between PC risk and biomarkers of Zn exposure shows conflicting results. OBJECTIVES: To evaluate the association between toenail Zn and PC, considering tumour extension and aggressiveness, along with a gene-environment approach, exploring the interaction of individual genetic susceptibility to PC in the relationship between toenail Zn and PC. METHODS: In MCC-Spain study we invited all incident PC cases diagnosed in the study period (2008-2013) and recruited randomly selected general population controls. In this report we included 913 cases and 1198 controls with toenail Zn determined by inductively coupled plasma mass spectrometry. To measure individual genetic susceptibility, we constructed a polygenic risk score based on known PC-related single nucleotide polymorphisms. The association between toenail Zn and PC was explored with mixed logistic and multinomial regression models. RESULTS: Men with higher toenail Zn had higher risk of PC (OR quartile 4 vs.1: 1.41; 95% CI: 1.07-1.85). This association was slightly higher in high-grade PC [(ISUP≤2 Relative risk ratio (RRR) quartile 4 vs.1: 1.36; 1.01-1.83) vs. (ISUP3-5 RRR quartile 4 vs.1: 1.64; 1.06-2.54)] and in advanced tumours [(cT1-cT2a RRR quartile 4 vs.1: 1.40; 95% CI: 1.05-1.89) vs. (cT2b-cT4 RRR quartile 4 vs.1: 1.59; 1.00-2.53)]. Men with lower genetic susceptibility to PC were those at higher risk of PC associated with high toenail Zn (OR quartile 4 vs.1: 2.18; 95% CI: 1.08-4.40). DISCUSSION: High toenail Zn levels were related to a higher risk for PC, especially for more aggressive or advanced tumours. This effect was stronger among men with a lower genetic susceptibility to PC.

Genotoxic action of bifenthrin nanoparticles and its effect on the development, productivity, and behavior of Drosophila melanogaster.

Rapid development of nanotechnology, particularly nanoparticles of pesticides, has facilitated the transformation of traditional agriculture. However, testing their effectiveness is essential for avoiding any environmental or adverse human health risk attributed to nanoparticle-based formulations, especially insecticides. Recently, organic nanoparticles of bifenthrin, a pyrethroid insecticide, were successfully synthesized by laser ablation of solids in liquid technique, with the most probable size of 5 nm. The aim of the present study was to examine the effects of acute exposure to bifenthrin (BIF) or bifenthrin nanoparticles (BIFNP) on larval-adult viability, developmental time, olfactory capacity, longevity, productivity defined as the number of eggs per couple, and genotoxicity in Drosophila melanogaster. Data demonstrated that BIFNP produced a marked delay in developmental time, significant reduction in viability and olfactory ability compared to BIF. No marked differences were detected between BIF and BIFNP on longevity and productivity. Genotoxicity findings indicated that only BIF, at longer exposure duration increased genetic damage.

Comparative Analysis of Power Consumption between MQTT and HTTP Protocols in an IoT Platform Designed and Implemented for Remote Real-Time Monitoring of Long-Term Cold Chain Transport Operations.

IoT platforms for the transportation industry are portable with limited battery life and need real-time and long-term monitoring operations. Since MQTT and HTTP are widely used as the main communication protocols in the IoT, it is imperative to analyze their power consumption to provide quantitative results that help maximize battery life in IoT transportation systems. Although is well known that MQTT consumes less power than HTTP, a comparative analysis of their power consumption with long-time tests and different conditions has not yet been conducted. In this sense, a design and validation of an electronic cost-efficient platform system for remote real-time monitoring is proposed using a NodeMCU module, in which experimentation is carried out for HTTP and MQTT with different QoS levels to make a comparison and demonstrate the differences in power consumption. Furthermore, we characterize the behavior of the batteries in the systems and compare the theoretical analysis with real long-time test results. The experimentation using the MQTT protocol with QoS 0 and 1 was successful, resulting in power savings of 6.03% and 8.33%, respectively, compared with HTTP, demonstrating many more hours in the duration of the batteries, which could be very useful in technological solutions for the transport industry.

Smartvessel: A New Extinguisher Prototype Based on New Materials and IoT Sensors.

Smartvessel is an innovative fire extinguisher prototype supported by new materials and IoT technology that seeks to improve the functionality and efficiency of conventional fire extinguishers. Storage containers for gases and liquids are essential for industrial activity as they enable higher energy density. The main contributions of this new prototype are (i) innovation in the use of new materials that provide lighter and more resistant extinguishers, both mechanically and against corrosion in aggressive environments. For this purpose, these characteristics are directly compared in vessels made of steel, aramid fiber and carbon fiber with the filament winding technique. (ii) The integration of sensors that allow its monitoring and provide the possibility of predictive maintenance. The prototype is tested and validated on a ship, where accessibility is complicated and critical. For this purpose, different data transmission parameters are defined, verifying that no data are lost. Finally, a noise study of these measurements is carried out to verify the quality of each data. Acceptable coverage values are achieved with very low read noise, on average less than 1%, and a weight reduction of 30% is obtained.

Amoebiasis: Advances in Diagnosis, Treatment, Immunology Features and the Interaction with the Intestinal Ecosystem.

This review of human amoebiasis is based on the most current knowledge of pathogenesis, diagnosis, treatment, and Entamoeba/microbiota interactions. The most relevant findings during this last decade about the Entamoeba parasite and the disease are related to the possibility of culturing trophozoites of different isolates from infected individuals that allowed the characterization of the multiple pathogenic mechanisms of the parasite and the understanding of the host-parasite relationship in the human. Second, the considerable advances in molecular biology and genetics help us to analyze the genome of Entamoeba, their genetic diversity, and the association of specific genotypes with the different amoebic forms of human amoebiasis. Based on this knowledge, culture and/or molecular diagnostic strategies are now available to determine the Entamoeba species and genotype responsible for invasive intestinal or extraintestinal amoebiasis cases. Likewise, the extensive knowledge of the immune response in amoebiasis with the appearance of new technologies made it possible to design diagnostic tools now available worldwide. Finally, the understanding of the interaction between the Entamoeba species and the intestinal microbiota aids the understanding of the ecology of this parasite in the human environment. These relevant findings will be discussed in this review.

Calpain Regulates Reactive Oxygen Species Production during Capacitation through the Activation of NOX2 and NOX4.

Capacitation is a series of physiological, biochemical, and metabolic changes experienced by mammalian spermatozoa. These changes enable them to fertilize eggs. The capacitation prepares the spermatozoa to undergo the acrosomal reaction and hyperactivated motility. Several mechanisms that regulate capacitation are known, although they have not been fully disclosed; among them, reactive oxygen species (ROS) play an essential role in the normal development of capacitation. NADPH oxidases (NOXs) are a family of enzymes responsible for ROS production. Although their presence in mammalian sperm is known, little is known about their participation in sperm physiology. This work aimed to identify the NOXs related to the production of ROS in guinea pig and mouse spermatozoa and define their participation in capacitation, acrosomal reaction, and motility. Additionally, a mechanism for NOXs' activation during capacitation was established. The results show that guinea pig and mouse spermatozoa express NOX2 and NOX4, which initiate ROS production during capacitation. NOXs inhibition by VAS2870 led to an early increase in the capacitation and intracellular concentration of Ca2+ in such a way that the spermatozoa also presented an early acrosome reaction. In addition, the inhibition of NOX2 and NOX4 reduced progressive motility and hyperactive motility. NOX2 and NOX4 were found to interact with each other prior to capacitation. This interaction was interrupted during capacitation and correlated with the increase in ROS. Interestingly, the association between NOX2-NOX4 and their activation depends on calpain activation, since the inhibition of this Ca2+-dependent protease prevents NOX2-NOX4 from dissociating and ROS production. The results indicate that NOX2 and NOX4 could be the most important ROS producers during guinea pig and mouse sperm capacitation and that their activation depends on calpain.

A bibliometric analysis of published literature on membrane photobioreactors for wastewater treatment from 2000 to 2022.

With the focus on limiting greenhouse gas emissions, microalgae-based technology is a promising approach for wastewater treatment, combining cost-effective operation, nutrient recovery, and assimilation of CO2. In addition, membrane technology supports process intensification and wastewater reclamation. Based on a bibliometric analysis, this paper evaluated the literature on membrane photobioreactors to highlight promising areas for future research. Specifically, efforts should be made on advancing knowledge of interactions between algae and bacteria, analysing different strategies for membrane fouling control and determining the conditions for the most cost-effective operation. The Scopus® database was used to select documents from 2000 to 2022. A set of 126 documents were found. China is the country with the highest number of publications, whereas the most productive researchers belong to the Universitat Politècnica de València (Spain). The analysis of 50 selected articles provides a summary of the main parameters investigated, that focus in increasing the biomass productivity and nutrient removal. In addition, microalgal-bacterial membrane photobioreactor seems to have the greatest commercialisation potential. S-curve fitting confirms that this technology is still in its growth stage.

Outcomes of an automated alert system from Microbiology to link diagnosis to treatment in patients with hepatitis C virus.

INTRODUCTION: simplification strategies for the care circuit of patients with hepatitis C virus (HCV) are key to achieve eradication. An electronic identification system was set up for HCV serology to link diagnosis to specialist management, aimed to reduce patient loss. MATERIAL AND METHODS: a retrospective, single-center study was performed in patients with HCV identified from 15/3/2020 to 15/12/2021, using an alert system from Microbiology that notified specialists of positive cases. The patient was contacted and appointed a Fibroscan® and viral load measurement, with antiviral therapy prescribed on the same day. Origin, public health data, patient location rate and antiviral therapy prescription were recorded. RESULTS: of 174 patients identified, 171 had positive viremia, with a mean age of 59.6 ± 15.9 years, 61.5 % were males and 81.2 % were Spanish nationals. Origin in the outpatient setting predominated (57.9 %, 99/171), particularly Primary Care (51/171), penitentiaries (21/171) and addiction units (14/171). Overall, 43.3 % (74/171) were aware of their diagnosis; 19.4 % (20/103) of patients had F3 fibrosis and 25.2 % (26/103) had F4 fibrosis. Also, 78.4 % (134/171) were deemed candidates for treatment. Of these, 74.6 % (100/134) were located and treatment was initiated, and all those who completed their treatment achieved a sustained viral response (96/96). This system managed 58.5 % (100/171) of the patients identified. The only association found between antiviral therapy and patient variables was comorbidities with being untreated (OR, 7.14; p ˂ 0.001). CONCLUSIONS: this alert system allows to minimize patient loss in the care circuit and provides high rates of treated patients.

Air pollution relevance analysis in the bay of Algeciras (Spain).

The aim of this work is to accomplish an in-depth analysis of the air pollution in the two main cities of the Bay of Algeciras (Spain). A large database of air pollutant concentrations and weather measurements were collected using a monitoring network installed throughout the region from the period of 2010-2015. The concentration parameters contain nitrogen dioxide (NO2), sulphur dioxide (SO2) and particulate matter (PM10). The analysis was developed in two monitoring stations (Algeciras and La Línea). The higher average concentration values were obtained in Algeciras for NO2 (28.850 µg/m3) and SO2 (11.966 µg/m3), and in La Línea for PM10 (30.745 µg/m3). The analysis shows patterns that coincide with human activity. One of the goals of this work is to develop a useful virtual sensor capable of achieving a more robust monitoring network, which can be used, for instance, in the case of missing data. By means of trends analysis, groups of equivalent stations were determined, implying that the values of one station could be substituted for those in the equivalent station in case of failure (e.g., SO2 weekly trends in Algeciras and Los Barrios show equivalence). On the other hand, a calculation of relative risks was developed showing that relative humidity, wind speed and wind direction produce an increase in the risk of higher pollutant concentrations. Besides, obtained results showed that wind speed and wind direction are the most important variables in the distribution of particles. The results obtained may allow administrations or citizens to support decisions.

FAK regulates actin polymerization during sperm capacitation via the ERK2/GEF-H1/RhoA signaling pathway.

Actin polymerization is a crucial process during sperm capacitation. We have recently described the participation of FAK during actin polymerization in guinea pig spermatozoa. However, the mechanism by which FAK mediates these processes is unknown. Our previous data have shown that MAPK1 (hereafter referred to as ERK2) is activated during the first minutes of capacitation, and inhibition of ERK2 blocked actin polymerization and the acrosome reaction. In this current study, we found that FAK is involved in ERK2 activation - as FAK was phosphorylated at tyrosine residue 925 and bound to Grb2 - and that inhibition of FAK results in a significant decrease of ERK2 activation. We also confirmed the presence of Rho guanine nucleotide exchange factor 2 (ARHGEF2, hereafter referred to as GEF-H1), which is able to associate with RhoA during capacitation. RhoA activation and its participation in actin polymerization were also analyzed. Inhibition of FAK or ERK1/2 impeded GEF-H1 phosphorylation, RhoA activation, and the association between GEF-H1 and RhoA. Finally, we observed the presence of fibronectin on the sperm surface, its role in sperm-sperm interaction as well as participation of ß-integrin in the activation of ERK2. Our results show that the signaling pathway downstream of fibronectin, via integrin, FAK, Grb2, MEK1/2, ERK2, GEF-H1 and RhoA regulates the actin polymerization associated with spermatozoa capacitation.

Extended vertical rectus abdominis myocutaneous flap for reconstruction of large pelviperineal defects following oncologic resection.

BACKGROUND AND OBJECTIVES: Extended vertical rectus abdominis myocutaneous (eVRAM) flap has been proposed for reconstruction of large pelviperineal defects where traditional VRAM flap is insufficient. We present our experience with eVRAM flap for pelviperineal reconstruction following oncologic resection. METHODS: A retrospective study was conducted, including all the patients who underwent reconstruction with eVRAM flap after complex pelvic resection, between 2012 and 2020. EVRAM flap was indicated when traditional VRAM was considered deficient to cover or reach the skin defect or to fill the dead space. RESULTS: Forty-four patients were included in the study. Successful reconstruction with eVRAM flap was achieved in 40 patients. There were three flap failures, and one patient died in the second postoperative day because of multiple organ failure. Perineal wound complications occurred in 17 patients (38.6%), eight of them requiring surgical reoperation. Donor site problems were present in five patients (11.4%), and only one patient required surgical closure because of a major dehiscence. CONCLUSIONS: The authors found the eVRAM flap to be a useful and reliable flap for reconstruction of complex pelviperineal wounds, with a low rate of donor site morbidity.

One-step diagnosis strategy together with multidisciplinary telematics referral perform an effective approach for identifying and treating patients with active Hepatitis C infection.

INTRODUCTION AND OBJECTIVES: Implementation of a one-step strategy for diagnosis of active Hepatitis C virus (HCV) infection would encourage the early diagnosis and reduce the time to access antiviral treatments. The aim of this study was to evaluate the impact of a HCV one-step diagnosis compared to the traditional two-step protocol in terms of the time required for patients to be seen by specialists and the time taken to start antiviral treatment. MATERIAL AND METHODS: A comparative study was carried out to assess two diagnostic algorithms (one-step and two-step) for active HCV infection. Serological markers were quantified using the same serum sample to determine both anti-HCV antibodies (HCV-Ab) and HCV core antigen (HCV-cAg) by Architect i2000 SR kit. In this period, a multidisciplinary procedure was started for telematics referral of viremic patients. RESULTS: One-step approach reduced the time required for patient HCV diagnosis, referral to a specialist, access to treatment, and eliminated the loss of patients to follow-up. Significant differences were observed between one-step and two-step diagnosis methods in the time required for patients to be seen by a specialist (18 days [Interquartile range (IQR) = 14-42] versus 107 days [IQR = 62-148]) and for the initiation of treatment (54 days [IQR = 43-75] versus 200 days [IQR = 116-388]), mainly for patients with advanced fibrosis (35 days [IQR = 116-388] versus 126 days [IQR = 152-366]). CONCLUSIONS: Use of HCV-cAg has proven to be a useful tool for screening patients with active hepatitis C. The development of a multidisciplinary protocol for the communication of results improved the efficiency of the care process.

Polarization Calibration of a Microwave Polarimeter with Near-Infrared Up-Conversion for Optical Correlation and Detection.

This paper presents a polarization calibration method applied to a microwave polarimeter demonstrator based on a near-infrared (NIR) frequency up-conversion stage that allows both optical correlation and signal detection at a wavelength of 1550 nm. The instrument was designed to measure the polarization of cosmic microwave background (CMB) radiation from the sky, obtaining the Stokes parameters of the incoming signal simultaneously, in a frequency range from 10 to 20 GHz. A linearly polarized input signal with a variable polarization angle is used as excitation in the polarimeter calibration setup mounted in the laboratory. The polarimeter systematic errors can be corrected with the proposed calibration procedure, achieving high levels of polarization efficiency (low polarization percentage errors) and low polarization angle errors. The calibration method is based on the fitting of polarization errors by means of sinusoidal functions composed of additive or multiplicative terms. The accuracy of the fitting increases with the number of terms in such a way that the typical error levels required in low-frequency CMB experiments can be achieved with only a few terms in the fitting functions. On the other hand, assuming that the calibration signal is known with the required accuracy, additional terms can be calculated to reach the error levels needed in ultrasensitive B-mode polarization CMB experiments.

Toxic metals in toenails as biomarkers of exposure: A review.

Toenails have been used as biomarkers of exposure to toxic metals, but their validity for this purpose is not yet clear and might differ depending on the specific agent. To evaluate this issue, we reviewed the literature on: a) the time-window of exposure reflected by toenails; b) the reproducibility of toenail toxic-metal levels in repeated measures over time; c) their relationship with other biomarkers of exposure, and; d) their association with potential determinants (i.e. sociodemographic, anthropometric, or lifestyle characteristics) or with sources of exposure like diet or environmental pollution. Thus, we performed a systematic review, searching for articles that provided original data for levels of any of the following toxic metals in toenails: aluminum, beryllium, cadmium, chromium, mercury, nickel, lead, thallium and uranium. We identified 88 articles, reporting data from 67 different research projects, which were quite heterogeneous with regard to population profile, sample size and analytical technique. The most commonly studied metal was mercury. Concerning the time-window of exposure explored by toenails, some reports indicate that toenail cadmium, nickel and lead may reflect exposures that occurred 7-12 months before sampling. For repeated samples obtained 1-6 years apart, the range of intraindividual correlation coefficients of aluminum, chromium and mercury was 0.33-0.56. The correlation of toxic metal concentrations between toenails and other matrices was higher for hair and fingernails than for urine or blood. Mercury levels were consistently associated with fish intake, while other toxic metals were occasionally associated with specific sources (e.g. drinking water, place of residence, environmental pollution, and occupation). The most frequently evaluated health endpoints were cardiovascular diseases, cancer, and central nervous system diseases. Available data suggest that toenail mercury levels reflected long-term exposures and showed positive associations with fish intake. The lack of standardization in sample collection, quality control, analytical techniques and procedures - along with the heterogeneity and conflicting results among studies - mean it is still difficult to conclude that toenails are a good biomarker of exposure to toxic metals. Further studies are needed to draw solid conclusions about the suitability of toenails as biomarkers of exposure to toxic metals.

Toenails as a biomarker of exposure to arsenic: A review.

This systematic review summarizes the current evidence related to the reliability of toenail total arsenic concentrations (thereafter "arsenic") as a biomarker of long-term exposure. Specifically, we reviewed literature on consistency of repeated measures over time, association with other biomarkers and metal concentrations, factors influencing concentrations, and associations with health effects. We identified 129 papers containing quantitative original data on arsenic in toenail samples covering populations from 29 different countries. We observed geographic differences in toenail arsenic concentrations, with highest median or mean concentrations in Asian countries. Arsenic-contaminated drinking water, occupational exposure or living in specific industrial areas were associated with an increased toenail arsenic content. The effects of other potential determinants and sources of arsenic exposure including diet, gender and age on the concentrations in toenails need further investigations. Toenail arsenic was correlated with the concentrations in hair and fingernails, and with urine arsenic mainly among highly exposed populations with a toenail mean or median ≥1 µg/g. Overall, there is a growing body of evidence suggesting that arsenic content from a single toenail sample may reflect long-term internal dose-exposure. Toenail arsenic can serve as a reliable measure of toxic inorganic arsenic exposure in chronic disease research, particularly promising for cancer and cardiovascular conditions.

Artificial Neural Networks, Sequence-to-Sequence LSTMs, and Exogenous Variables as Analytical Tools for NO2 (Air Pollution) Forecasting: A Case Study in the Bay of Algeciras (Spain).

This study aims to produce accurate predictions of the NO2 concentrations at a specific station of a monitoring network located in the Bay of Algeciras (Spain). Artificial neural networks (ANNs) and sequence-to-sequence long short-term memory networks (LSTMs) were used to create the forecasting models. Additionally, a new prediction method was proposed combining LSTMs using a rolling window scheme with a cross-validation procedure for time series (LSTM-CVT). Two different strategies were followed regarding the input variables: using NO2 from the station or employing NO2 and other pollutants data from any station of the network plus meteorological variables. The ANN and LSTM-CVT exogenous models used lagged datasets of different window sizes. Several feature ranking methods were used to select the top lagged variables and include them in the final exogenous datasets. Prediction horizons of t + 1, t + 4 and t + 8 were employed. The exogenous variables inclusion enhanced the model's performance, especially for t + 4 (ρ ≈ 0.68 to ρ ≈ 0.74) and t + 8 (ρ ≈ 0.59 to ρ ≈ 0.66). The proposed LSTM-CVT method delivered promising results as the best performing models per prediction horizon employed this new methodology. Additionally, per each parameter combination, it obtained lower error values than ANNs in 85% of the cases.

L2-CalSat: A Calibration Satellite for Ultra-Sensitive CMB Polarization Space Missions.

In this work, the use of a calibration satellite (L2-CalSat) flying in formation with a Cosmic Microwave Background (CMB) polarization mission in an orbit located at the second Lagrange point, is proposed. The new generation of CMB telescopes are expected to reach unprecedented levels of sensitivity to allow a very precise measurement of the B-mode of polarization, the curl-like polarization component expected from gravitational waves coming from Starobinski inflationary models. Due to the CMB polarized signal weakness, the instruments must be subjected to very precise calibration processes before and after launching. Celestial sources are often used as external references for calibration after launch, but these sources are not perfectly characterized. As a baseline option, L2-CalSat is based on the CubeSat standard and serves as a perfectly known source of a reference signal to reduce polarization measurements uncertainty. A preliminary design of L2-CalSat is described and, according to the scanning strategy followed by the telescope, the influence of the relative position between the spacecrafts in the calibration process is studied. This new calibration element will have a huge impact on the performance of CMB space missions, providing a significant improvement in the measurements accuracy without requiring new and costly technological developments.

A Randomized Controlled Trial of Three Noninvasive Analgesic Techniques for the Prevention of Pain During Facial Injections.

BACKGROUND: Injections are associated with a certain amount of pain, the tolerance of which can vary between individuals. With regard to noninvasive pain control techniques in subcutaneous injections, few studies with adequate levels of evidence and design quality exist to support any specific analgesic method. OBJECTIVES: In this study, we evaluated the efficacy of 3 noninvasive analgesic techniques (cold, anesthetic cream, and vibration) during subcutaneous forehead injections in 100 healthy volunteers. METHODS: This randomized, single-blind, controlled trial comprised 100 healthy volunteers. Every patient received 4 forehead injections of 0.1 mL physiological saline through 29G needles after 1 of 3 noninvasive analgesic techniques (cold, vibration, or anesthetic cream) or control treatment was applied to each injection site. The results were evaluated through a survey that included a visual analog scale for pain measurements. RESULTS: All analgesic methods demonstrated better pain control than the no-treatment arm (P < 0.001), of which vibration performed better than the other analgesic techniques (P < 0.015 vs cold and P < 0.015 vs anesthetic cream). No differences were observed between cold and anesthetic cream. The average amount of pain per injection in males was higher than in females (P < 0.014). CONCLUSIONS: Vibration analgesia effected significantly better pain control than cold and anesthetic cream. Nevertheless, the choice of anesthetic method should be adapted to the preferences and experiences of each patient to optimize pain control in procedures that involve subcutaneous injections.

Using Free Arterialized Venous Flaps for Reconstructing Hand Defects.

Hand and digit soft tissue defects are quite common and frequently require specialized reconstruction. When local flaps cannot be used to reconstruct a soft tissue defect, free flaps must be utilized. To overcome tissue volume and discrepancies in vessel diameter, arterialized venous free flaps from the forearm may provide an acceptable alternative. When using arterialized venous free flaps, surgeons should implement shunt restriction procedures to enhance flap viability.

A Protocol for Performing Reconstructive Microsurgery on Patients With COVID-19.

On March 11, 2020, the World Health Organization declared COVID-19 to be a pandemic, challenging health care systems all over the world. National health care systems have reorganized to cope with the disease. Surgical services departments around the world have been affected and elective surgical procedures have been postponed to conserve medical resources. When a patient with COVID-19 requires an urgent microsurgical free flap due to trauma or a tumor, personnel from the health care facility must have a protocol in place to follow for the patient's care and follow-up. In this article, we present our protocol for patients with COVID-19 requiring reconstructive microsurgery.