[When personal protective equipment for health workers during COVID-19 outbreaks is missing: conclusions of the Catalan COVID-19 Workgroup]. / Cuando falta el Equipo de Protección Personal para los trabajadores de la salud durante los brotes de COVID-19: conclusiones del Grupo de trabajo catalán COVID-19.

OBJECTIVES: Frontline healthcare workers (HCWs) are at high risk of SARS-CoV-2 infection. The aim of this study is to ensure risk-based protection when there is a lack of personal protective equipment (PPE). MATERIALS AND METHODS: At the beginning of the pandemic, it was suggested that PPE were necessary to protect HCWs from COVID-19. However, given supply shortage, PPE had to be replaced in some situations. Three levels of protection were established depending on the risk level of exposure to SARS-CoV-2. Best practices were reviewed and analysed, and subsequently implemented in all hospitals in Catalonia. As the first COVID-19 wave progressed, we became more knowledgeable with the behaviour of the virus, so PPE procedure tables and algorithms were modified and adapted to the changing scenarios. After airborne transmission was demonstrated as the main route of the virus transmission, we emphasized new measures to ensure respiratory tract protection. RESULTS: Three general tables were established based on low, medium, and high risk of infection for HCWs. These three scenarios are a subgroup of the very high-risk category, according to OSHA's pyramid of SARS-CoV-2 risk characterization. The most appropriate PPE for each task or job were identified and alternatives were given amid the shortage of PPE. CONCLUSIONS: Specific PPE are required for the healthcare sector. Many studies on PPE are based on the characteristics of industrial jobs, and do not consider the specificities of the healthcare sector, which requires close and prolonged contact with patients.

OBJETIVOS: Los trabajadores sanitarios de primera línea tienen un alto riesgo de infección por SARS-CoV-2. El objetivo de este estudio es garantizar la protección según el nivel riesgo cuando falta el equipo de protección personal (EPI). Métodos: Al comienzo de la pandemia, se sugirió que el EPI era necesario para proteger a los trabajadores de la salud del COVID-19; pero dada la escasez, el EPI tuvo que ser reemplazado en algunos escenarios. Se establecieron tres niveles de protección dependiendo del nivel de riesgo de exposición al SARS-CoV-2. Se analizaron las mejores prácticas para su posterior implantación en todos los hospitales de Cataluña. A medida que avanzaba la primera ola, nos familiarizamos mejor con el comportamiento del virus y los procedimientos en formato de tablas se modificaron y adaptaron a los nuevos escenarios. Se produjo un punto de inflexión después de que se confirmara que la mayoría de las infecciones se debían a la transmisión por vía aérea. Este avance mostró la importancia de identificar nuevas medidas que pudieran garantizar la protección de las vías respiratorias. RESULTADOS: Se han establecido tres tablas generales con según el riesgo bajo, medio y alto de contagio de los trabajadores de la salud. Estos tres escenarios son un subgrupo de la categoría de riesgo muy alto, de acuerdo con la pirámide de caracterización del riesgo de SARS-CoV-2 de OSHA. Se ha identificado el EPI más adecuado para cada tarea o trabajo y se han dado alternativas ante la escasez de EPI. CONCLUSIONES: Se requieren EPI específicos para el sector sanitario. Muchos estudios realizados sobre EPI se basan en las características de los trabajos industriales y no consideran las especificidades del sector sanitario, que requiere un contacto cercano y prolongado con los pacientes.

Hypertrophic cardiomyopathy in a patient with secondary hypoparathyroidism: A case report.

Parathyroid hormone (PTH) has direct and indirect actions on cardiovascular cells. The effects of chronic hypoparathyroidism on cardiac morphology, function, and conduction are still unclear. Low PTH states are associated with multiple manifestations in the heart, acute or chronic. Acute hypocalcemic cardiomyopathy is a transient dilated cardiomyopathy with reduced ejection fraction and diffuse left ventricular hypokinesia. Chronic hypoparathyroidism-associated cardiomyopathy is a rare disease that may cause reduced myocardial tension, cardiac cavity enlargement, arrhythmias, and congestive heart failure. Here, we describe a 73-year-old woman with chronic hypoparathyroidism and hypocalcemia, who developed a hypertrophic cardiomyopathy, and not a dilated hypocalcemia-associated cardiomyopathy, which would be usually the case.

When personal protective equipment for health workers during COVID-19 outbreaks is missing: conclusions from the Catalan COVID-19 Workgroup / Cuando falta el equipo de protección personal para los trabajadores sanitarios durante los brotes de COVID-19: conclusiones del Grupo de trabajo catalán COVID-19

Objectives: Frontline healthcare workers (HCWs) are at high risk of SARS-CoV-2 infection. The aim of this study is to ensure risk-based protection when there is a lack of personal protective equipment (PPE).Materials and methods: At the beginning of the pandemic, it was suggested that PPE were necessary to protect HCWs from COVID-19. However, given supply shortage, PPE had to be replaced in some situations. Three levels of protection were established depending on the risk level of exposure to SARS-CoV-2. Best practices were reviewed and analysed, and sub-sequently implemented in all hospitals in Catalonia. As the first COVID-19 wave progressed, we became more knowledgeable with the behaviour of the virus, so PPE procedure tables and algorithms were modified and adapted to the changing scenarios. After airborne trans-mission was demonstrated as the main route of the virus transmission, we emphasized new measures to ensure respiratory tract protection.Results: Three general tables were established based on low, medium, and high risk of infection for HCWs. These three scenarios are a subgroup of the very high-risk category, ac-cording to OSHA’s pyramid of SARS-CoV-2 risk characterization. The most appropriate PPE for each task or job were identified and alternatives were given amid the shortage of PPE.Conclusions: Specific PPE are required for the healthcare sector. Many studies on PPE are based on the characteristics of industrial jobs, and do not consider the specificities of the healthcare sector, which requires close and prolonged contact with patients (AU)

Objetivos: Los trabajadores sanitarios de primera línea tienen un alto riesgo de infección por SARS-CoV-2. El objetivo de este estudio es garantizar la protección según el nivel riesgo cuando falta el equipo de protección personal (EPI).Métodos: Al comienzo de la pandemia, se sugirió que el EPI era necesario para proteger a los trabajadores de la salud del COVID-19; pero dada la escasez, el EPI tuvo que ser reem-plazado en algunos escenarios. Se establecieron tres niveles de protección dependiendo del nivel de riesgo de exposición al SARS-CoV-2. Se analizaron las mejores prácticas para su posterior implantación en todos los hospitales de Cataluña. A medida que avanzaba la primera ola, nos familiarizamos mejor con el comportamiento del virus y los procedimien-tos en formato de tablas se modificaron y adaptaron a los nuevos escenarios. Se produjo un punto de inflexión después de que se confirmara que la mayoría de las infecciones se debían a la transmisión por vía aérea. Este avance mostró la importancia de identificar nue-vas medidas que pudieran garantizar la protección de las vías respiratorias.Resultados: Se han establecido tres tablas generales con según el riesgo bajo, medio y alto de contagio de los trabajadores de la salud. Estos tres escenarios son un subgrupo de la categoría de riesgo muy alto, de acuerdo con la pirámide de caracterización del riesgo de SARS-CoV-2 de OSHA. Se ha identificado el EPI más adecuado para cada tarea o trabajo y se han dado alternativas ante la escasez de EPI. Conclusiones: Se requieren EPI específicos para el sector sanitario. Muchos estudios reali-zados sobre EPI se basan en las características de los trabajos industriales y no consideran las especificidades del sector sanitario, que requiere un contacto cercano y prolongado con los pacientes (AU)

Coagulation Panel in Patients with SARS-CoV2 Infection (COVID-19).

The 2019 novel coronavirus (SARS-CoV2) is the causal agent of the newly-termed Coronavirus Disease 2019 (COVID-19). In January 2020, the World Health Association (WHO) declared the CO-VID-19 as an epidemic. Abnormal coagulation parameters in COVID-19 patients currently are considered as prognostic factors of severity. Our aim is to summarize the current data available in the literature. MATERIALS AND METHODS: An electronic search was performed in the Database of publications on coronavirus disease (COVID-19) of the World Health Organization. Thrombin Time (TT), Prothrombin Time (PT), Fibrinogen (FIB), Activated Partial Thromboplastin Time (APPT), and D-Dimer have been detected as parameters to study in every COVID-19 patient. CLINICAL APPLICATION: The coagulation function panel has been described to be altered in critical COVID-2019 patients. DIC, which plays an important role in advanced stage, is known to be associated with sepsis. Anticoagulant therapy, mainly with low molecular weight heparin (LMWH), appears to be associated with better prognosis in patients with severe COV-ID-19. DISCUSSION: Coagulation function in patients with SARS-CoV2 infection is significantly deranged compared with normal patients. FIB and D-Dimer/FDP are the most significantly altered values and the early deetection of alteration could be useful to address therapies. D-Dimer/FDP (DD/FDP) alteration correlates with severity. Markedly elevated D-Dimer can be used to guide the introduction of anticoagulation therapy and evaluate prognosis of COVID-19. In every patient admitted with SARS-CoV2 infection PT, FIB, D-Dimer/FDP, and platelets must be ordered. We suggest daily extraction for every patient admitted and tested positive for COVID-19.

Cryopreserved Allografts for Treatment of Chronic Limb-Threatening Ischemia in Patients Without Autologous Saphenous Veins.

BACKGROUND: Revascularization is the best alternative to reduce symptoms and to improve the limb salvage rate in patients with chronic limb-threatening ischemia (CLI). Alternative grafts as synthetic prostheses and allografts must be considered for patients without a suitable autologous graft. Our aim was to evaluate outcomes of cryopreserved allografts used as a vascular conduit for bypass surgery in the infrainguinal territory. METHODS: A retrospective analysis (January 1995 to January 2014) of the Registry of vascular and valvular allografts transplant in the autonomous community of Catalonia, Spain was performed for identifying patients with CLI who required infrainguinal bypass with cryopreserved arterial allografts. Statistical analysis was performed using SPSS, ver. 20, for Mac (Chicago). RESULTS: A total of 149 patients with CLI (mean age of 70.1 years) were analyzed. One hundred two patients (68.5%) had a grade IV lesion (Fontaine classification). In the overall follow-up, 24.8% of patients required a reintervention. Overall graft occlusion, infection, and dilation rate were 52.3%, 6%, and 5.4% respectively. Overall 30-day mortality was 0.7%. Five-year primary patency rate and limb salvage rate were 38.6% and 50.2%, respectively. Survival rate at 5 years was 54.2%. Major adverse limb event (MALE)-free rate was 21.5% at 5 years. Revascularization to a distal target vessel was an independent positive predictive risk factor for a lower limb salvage rate and lower primary patency rate. Dyslipidemia was related to a lower limb salvage rate and represents a risk factor involved in MALEs. CONCLUSIONS: Although arterial allografts seem to represent a suboptimal alternative, some selected patients could beneficiate from them. Five-year results are disappointing, and more studies are required to know other predictive factors for better selection of patients.