Bioethical Concerns During the COVID-19 Pandemic: What Did Healthcare Ethics Committees and Institutions State in Spain?

Objectives: Each new wave of the COVID-19 pandemic invites the possible obligation to prioritize individuals' access to vital resources, and thereby leads to unresolved and important bioethical concerns. Governments have to make decisions to protect access to the health system with equity. The prioritization criteria during a pandemic are both a clinical and legal-administrative decision with ethical repercussion. We aim to analyse the prioritization protocols used in Spain during the pandemic which, in many cases, have not been updated. Method: We carried out a narrative review of 27 protocols of prioritization proposed by healthcare ethics committees, scientific societies and institutions in Spain for this study. The review evaluated shared aspects and unique differences and proffered a bioethical reflection. Results: The research questions explored patient prioritization, the criteria applied and the relative weight assigned to each criterion. There was a need to use several indicators, being morbidity and mortality scales the most commonly used, followed by facets pertaining to disease severity and functional status. Although age was initially considered in some protocols, it cannot be the sole criterion used when assigning care resources. Conclusions: In COVID-19 pandemic there is a need for a unified set of criteria that guarantees equity and transparency in decision-making processes. Establishing treatment indications is not the aim of such criteria, but instead prioritizing access to care resources. In protocols of prioritization, the principle of efficiency must vary according to the principle of equity and the criteria used to guarantee such equity.

Retroperitoneal paraganglioma-Is pre operative embolization useful?

INTRODUCTION: Paragangliomas (PG) are rare tumors derived from chromaffin cells that are located outside the adrenal gland and are capable of producing catecholamines. The treatment is based on a surgical resection, and there is controversy regarding the usefulness of previously carrying out an embolization and what is the most adequate surgical approach. CLINICAL CASE: We will present a 17-year-old woman with a retroperitoneal tumour in contact with the aorta and the inferior vena cava, treated with embolization prior to the surgical resection via laparotomy. DISCUSSION: The PG tumors are very infrequent and originate in the extra-adrenal chromaffin cells that exist in the vicinity of the components of the autonomic nervous system. Most of them (86%) produce catecholamines, are unique, sporadic, benign and more frequent in middle-aged women. Since they are radioresistant tumors, the only possibility for a cure is by a complete surgical excision. The preoperative embolization has been described mainly as the treatment of cervical PG, although its use in abdominal PG is more controversial and is not done in a systematic manner. CONCLUSION: We can conclude that the embolization of abdominal PG is not free of risks and that it has not been demonstrated that it significantly reduces the peri-operative bleeding or the surgical time. Probably, the embolization should be reserved for intensively hypervascularized and larger PGs.

[Current status of the prognostic value of molecular markers in patients with colorectal cancer and the prediction of response to adjuvant therapy]. / Estado actual del valor pronóstico de los marcadores moleculares en pacientes con cáncer colorrectal y la predicción de respuesta al tratamiento adyuvante.

Colorectal cancer is one of the best studied of all malignant diseases in terms of genetics and/or molecular prognostic factors. These factors, and relationships with prognosis, may have important implications especially in the design of surgical and adjuvant chemo-radiotherapy options. However, the true prognostic significance of all known factors has yet to be realised. We have reviewed the literature with specific focus on the role of molecular markers involved in prognosis and the prediction of response to adjuvant treatment.

Estado actual del valor pronóstico de los marcadores moleculares en pacientes con cáncer colorrectal y la predicción de respuesta al tratamiento adyuvante / Current status of the prognostic value of molecular markers in patients with colorectal cancer and the prediction of response to adjuvant therapy

El cáncer colorrectal es uno de los tumores mejor conocidos de todas las enfermedades malignas en términos genéticos y/o moleculares. Su conocimiento y su relación con el pronóstico puede tener importantes implicaciones, fundamentalmente en el diseño de estrategias quirúrgicas y de quimiorradioterapia adyuvante. Sin embargo, aún desconocemos el verdadero significado pronóstico de todos los factores hasta ahora estudiados. En este trabajo hemos revisado la literatura acerca del papel específico de los marcadores moleculares en cáncer colorrectal y su probable respuesta al tratamiento

Colorectal cancer is one of the best studied of all malignant diseases in terms of genetics and/or molecular prognostic factors. These factors, and relationships with prognosis, may have important implications especially in the design of surgical and adjuvant chemo-radiotherapy options. However, the true prognostic significance of all known factors has yet to be realised. We have reviewed the literature with specific focus on the role of molecular markers involved in prognosis and the prediction of response to adjuvant treatment

Hemorroidectomía con bisturí armónico (Ultracision®) frente a electrocauterio: ¿disminuye el dolor postoperatorio? / Harmonic scalpel (Ultracision®) versus electrocautery hemorrhoidectomy: does it reduce postoperative pain?

Objetivo. Evaluar el efecto sobre el dolor postoperatorio, las complicaciones derivadas de su manejo y los efectos sobre la cicatrización de las heridas en hemorroidectomías con bisturí armónico en comparación con el electrocauterio. Diseño. Estudio prospectivo, aleatorizado. Pacientes y método. Se aleatorizó a 72 pacientes consecutivos con hemorroides de grado 3-4 sintomáticas en 2 grupos: grupo 1 (bisturí armónico) y grupo 2 (electrocauterio). Se evaluaron las diferencias en ambos grupos en cuanto al dolor postoperatorio, el tiempo de cicatrización de la herida y la incontinencia. Resultados. El dolor postoperatorio fue significativamente menor en el grupo 1 en los días 1, 2 y 30 y similar al grupo 2 en los días 7 y 15. El número de analgésicos requeridos en 24 h fue también menor en el grupo 1 en los días 1, 2 y 7 (p = 0,037; p = 0,042; p = 0,049). No hubo diferencias significativas entre ambos grupos en los días 15 y 30. Solamente 2 pacientes del grupo 1 necesitaron analgesia de rescate con petidina, frente a 8 pacientes del grupo 2. El tiempo de cicatrización de la herida fue menor en el grupo 1 (26,3 ñ 3,2 días) que en el grupo 2 (35,2 ñ 2,4 días) (p = 0,049). Las complicaciones postoperatorias fueron similares en ambos grupos. Cuatro pacientes del grupo 1 presentaron retención urinaria y 1, una fisura anal. En el grupo 2, 4 pacientes presentaron retención urinaria y 2, impactación fecal. El grado de incontinencia posquirúrgica medida a los 7 días fue similar en ambos grupos, un 15,23 por ciento de los pacientes del grupo 1 y un 17,26 por ciento del grupo 2, presentaron escape ocasional de gas o moco menos de una vez a la semana (grado A1 de Pescatori). A las 4 semanas poscirugía todos los pacientes de ambos grupos estaban continentes. Conclusión. El estudio muestra que la hemorroidectomía realizada con bisturí armónico produjo menos dolor postoperatorio que la realizada con electrocauterio, sobre todo durante las primeras 48 h postoperatorias, sin afección significativa de la continencia anal y una rápida cicatrización de las heridas (AU)