Cerebral Hemodynamic Reserve Abnormalities Detected Via Transcranial Doppler Ultrasound in Recovered COVID-19 Patients.

INTRODUCTION: SARS-CoV-2 infection can produce endothelial injury and microvascular damage, one cause of the multiorgan failure associated with COVID-19. Cerebrovascular endothelial damage increases the risk of stroke in COVID-19 patients, which makes prompt diagnosis important. Endothelial dysfunction can be evaluated by using transcranial Doppler ultrasound to study cerebral hemodynamic reserve, but there are few of these studies in patients with COVID-19, and the technique is not included in COVID-19 action and follow-up guidelines nationally or internationally. OBJECTIVE: Estimate baseline cerebral hemodynamic patterns, cerebral hemodynamic reserve, and breath-holding index in recovered COVID-19 patients. METHOD: We conducted an exploratory study in 51 people; 27 men and 24 women 20-78 years of age, divided into two groups. One group comprised 25 recovered COVID-19 patients, following clinical and epidemiological discharge, who suffered differing degrees of disease severity, and who had no neurological symptoms or disease at the time they were incorporated into the study. The second group comprised 26 people who had not been diagnosed with COVID-19 and who tested negative by RT-PCR at the time of study enrollment. Recovered patients were further divided into two groups: those who had been asymptomatic or had mild disease, and those who had severe or critical disease. We performed transcranial Doppler ultrasounds to obtain baseline and post-apnea tests of cerebral hemodynamic patterns to evaluate cerebral hemodynamic reserve and breath-holding indices. We characterized the recovered patient group and the control group through simple descriptive statistics (means and standard deviations). RESULTS: There were no measurable differences in baseline cerebral hemodynamics between the groups. However, cerebral hemodynamic reserve and breath-holding index were lower in those who had COVID-19 than among control participants (19.9% vs. 36.8% and 0.7 vs. 1.2 respectively). These variables were similar for patients who had asymptomatic or mild disease (19.9% vs.19.8%) and for those who had severe or critical disease (0.7 vs. 0.7). CONCLUSIONS: Patients recovered from SARS-CoV-2 infection showed decreased cerebral hemodynamic reserve and breath-holding index regardless of the disease's clinical severity or presence of neurological symptoms. These abnormalities may be associated with endothelial damage caused by COVID-19. It would be useful to include transcranial Doppler ultrasound in evaluation and follow-up protocols for patients with COVID-19.

Health Care-Associated Infection in Solid Organ Transplant Recipients.

BACKGROUND: Health care-associated infection (HAI) represent a global health problem with an increase in hospital stays, deaths, and monetary costs. Recipients of solid organ transplants are a population at risk. The objectives of the study were to characterize the incidence of HAI in renal and hepatic transplant recipients as well as to compare them with the population without transplants in intensive care units (ICU). METHODS: The data on the incidence of HAI, localization, microorganisms, and demographics were taken from the patients admitted between the years 2013 to 2018 (n = 4307) from the registration of the Project for the Reduction of Nosocomial Infection in Intensive Care Units. The variables were compared with those of renal transplant (n = 96) and liver transplants (n = 68) recipients. RESULTS: Renal transplant recipients showed 26% incidence of HAI. The most frequent were surgical site infection (SSI), urinary tract infection, and primary bacteremia; the most frequent microorganism was Staphylococcus spp, mortality 3.8%. Liver transplant recipients showed 41% incidence of HAI. The most frequent were tracheobronchitis associated with mechanical ventilation, SSI, and primary bacteremia; the most frequent microorganism was Staphylococcus spp, mortality 37%. The population without transplants in the ICU showed 17% incidence of HAI. The most frequent were respiratory infections associated with mechanical ventilation, primary bacteremia, and SSI; the most frequent microorganism was Acinetobacter spp, mortality 21%. CONCLUSIONS: HAI in recipients of solid organ transplants (renal and hepatic) have a higher incidence than in a population without transplants. The location and causal microorganisms have particularities that must be taken into account for the development of prevention protocols.

Protección renal y hepática por condicionamiento isquémico a distancia en la revascularización miocárdica quirúrgica / Renal and hepatic protection due to remote ischemic conditioning in coronary artery bypass grafting

RESUMEN Introducción: Breves períodos de isquemia a distancia pueden limitar el daño miocárdico producido por la isquemia/reperfusión. Objetivos: Identificar el efecto del condicionamiento isquémico a distancia con fines de protección renal y hepática, relacionado al comportamiento postoperatorio de los niveles de creatinina y transaminasas glutámico-purúvica y glutámico-oxalacética en la revascularización miocárdica quirúrgica. Método: Se realizó un estudio cuasiexperimental, explicativo, comparativo con control histórico, en dos grupos de 247 pacientes cada uno, propuestos para revascularización miocárdica quirúrgica. Se colocó un torniquete en el brazo derecho, en el grupo estudio, alternando 3 insuflaciones (con una presión de 200 mmHg) con 3 desinsuflaciones, durante cinco minutos cada una. Este procedimiento se realizó previo, durante y después de la mayor isquemia inducida, provocada por el pinzamiento de la arteria coronaria. Resultados: Se logró una disminución significativa en los valores de creatinina (p<0,001), transaminasa glutámico-purúvica (p<0,001) y transaminasa glutámico-oxalacética (p<0,05). Conclusiones: El condicionamiento isquémico a distancia es una importante herramienta a tener en cuenta para la protección renal y hepática en la revascularización miocárdica quirúrgica.

ABSTRACT Introduction: Short periods of distant ischemia can limit myocardial damage caused by ischemia/reperfusion. Objective: To identify the effect of remote ischemic preconditioning in relation to the postoperative behavior of creatinine, glutamic transaminase, puruvic and oxalacetic levels. Method: A quasi-experimental, explanatory, comparative study with historical control was carried out in two groups of 247 patients each; all candidates for coronary artery bypass grafting. A blood-pressure cuff was placed on the right arm in the study group alternating three inflations with three deflations of five minutes at 200 mmHg. This procedure was performed prior to during and after the major ischemic episode caused by the coronary artery impingement. Results: A significant decrease in the values ​​of creatinine, puruvic glutamic transaminase and glutamic oxalacetic transaminase was achieved. Conclusions: Remote ischemic conditioning is an important tool to take into account for renal and hepatic protection in coronary artery bypass grafting.

Factores de riesgo asociados a síndrome QT largo en anestesia cardiovascular / Risk factors associated with long QT syndrome in cardiovascular anesthesia

Introducción: el síndrome de QT largo es una canalopatía caracterizada por una grave alteración en la repolarización ventricular. Objetivo: determinar los factores de riesgo asociados a intervalo QT prolongado en anestesia cardiovascular. Métodos: estudio descriptivo, de corte transversal desde mayo de 2014 a mayo de 2016, en pacientes programados para cirugía cardíaca bajo circulación extracorpórea. Se evaluó el riesgo atribuible y el intervalo de confianza para un 95 por ciento en variables con p< 0,05. Resultados: se incluyeron 483 pacientes, con una edad media de 62 años, de ellos 57 (12 por ciento) registraron un QTc prolongado. La edad avanzada (RA: 1,8; IC 95 por ciento: 0,86-2,67), insuficiencia renal crónica (RA: 2,7; IC 95 por ciento: 0,82-4,96), diabetes mellitus tipo 2 (RA: 1,7; IC 95 por ciento: 1,01-2,15), cardiopatía isquémica (RA: 3,5; IC 95 por ciento: 1,60-4,02), hipertrofia ventricular izquierda (RA: 2,2; IC 95 por ciento: 2,53-3,15), anticálcicos (RA: 1,5; IC 95 por ciento: 0,92-2,98), anestesia general orotraqueal balanceada (RA: 2,1; IC 95 por ciento: 2,92-2,35), ondansetrón (RA: 1,7; IC 95 por ciento: 0,98-2,74), droperidol (RA: 1,8; IC 95 por ciento: 2,18-3,94), tiempo de circulación extracorpórea (RA: 2,5; IC 95 por ciento: 1,02-3,62), hipopotasemia (RA: 1,4; IC 95 por ciento: 1,03-2,91) y la bradicardia severa (RA: 1,8; IC 95 por ciento: 1,12-3,86) fueron asociados con alto riesgo de prolongación del intervalo QT. Las complicaciones fueron mayores en este grupo, con una mortalidad de 23 por ciento. Conclusiones: la edad avanzada, la insuficiencia renal crónica, diabetes mellitus tipo 2, hipertrofia ventricular y la cardiopatía isquémica facilitan la prolongación del QT inducida por los bloqueadores del calcio. El mayor tiempo de circulación extracorpórea, la anestesia balanceada con isoflurano, el uso de droperidol y ondansetrón, la bradicardia e hipopotasemia posoperatoria son variables asociadas con la extensión del intervalo QT, con un incremento en las complicaciones. Las taquiarritmias ventriculares y la mortalidad fueron mayores en este subgrupo de pacientes(AU)

Introduction: The long QT syndrome is a channelopathy characterized by a serious alteration in ventricular repolarization. Objective: To determine the risk factors associated with prolonged QT interval in cardiovascular anesthesia. Methods: Descriptive, cross-sectional study from May 2014 to May 2016, in patients scheduled for cardiac surgery under extracorporeal circulation. The attributable risk and the confidence interval were evaluated for 95 percent and in variables with p value under 0.05. Results: 483 patients were included, with a mean age of 62 years, of whom 57 (12 percent) had prolonged QTc. Advanced age (RA: 1.8, 95 percent CI: 0.86-2.67), chronic renal failure (RA: 2.7, 95 percent CI: 0.82-4.96), type 2 diabetes mellitus (RA: 1.7, 95 percent CI: 1.01-2.15), ischemic heart disease (RA: 3.5, 95 percent CI: 1.60-4.02), left ventricular hypertrophy (RA: 2.2, 95 percent CI: 2.53-3.15), calcium-lactam antibiotics (RA: 1.5, 95 percent CI: 0.92-2.98), balanced orotracheal general anesthesia (RA: 2.1, 95 percent CI: 2.92-2.35), ondansetron (RA: 1.7, 95 percent CI: 0.98-2.74), droperidol (RA: 1.8, 95 percent CI: 2.18-3.94) ), extracorporeal circulation time (RA: 2.5, 95 percent CI: 1.02-3.62), hypokalemia (RA: 1.4, 95 percent CI: 1.03-2.91) and severe bradycardia (RA: 1.8, 95 percent CI: 1.12-3.86) were associated with a high risk of QT prolongation. The complications were more significant in this group, with a mortality of 23 percent. Conclusions: Advanced age, chronic renal failure, type 2 diabetes mellitus, ventricular hypertrophy, and ischemic heart disease facilitate the prolongation of QT induced by calcium blockers. The longer time of extracorporeal circulation, the balanced anesthesia with isoflurane, the use of droperidol and ondansetron, bradycardia and postoperative hypokalemia are variables associated with the extension of the QT interval, with an increase in complications. Ventricular tachyarrhythmias and mortality were higher in this subgroup of patients(AU)

Precondicionamiento isquémico a distancia en la revascularización miocárdica de los pacientes diabéticos. ¿Es realmente beneficioso? / Remote ischemic preconditioning in myocardial revascularization of diabetic patients. Is it really beneficial?

Introducción: una serie de breves períodos de isquemias a distancia, previo al evento isquémico mayor, pueden limitar el daño miocárdico producido por la isquemia crítica y el que se produce posreperfusión.Objetivo: demostrar la efectividad del precondicionamiento isquémico a distancia en pacientes diabéticos a los cuales se les realizó revascularización coronaria. Métodos: se realizó un estudio longitudinal prospectivo experimental en dos grupos de 103 pacientes, a los que se les realizó revascularización con injerto de la arteria coronaria. En el grupo de prueba incluido en este estudio, se le colocó al paciente un torniquete el cual se insufló tres veces durante cinco minutos en el brazo no dominante, a una presión de 200 mmHg, previo, durante y después del evento isquémico mayor, el que se correspondió con el pinzamiento de la arteria coronaria.Resultados: no se logró una disminución significativa de la creatinina sérica, glicemia, transaminasas glutámico pirúvica, de la creatinfosfoquinasa-MB, ni del consumo de drogas inotrópicas y vasoactivas. Tampoco en la incidencia de arritmias ventriculares letales, bajo gasto cardiaco fatal y muerte postoperatoria.Conclusiones: el precondicionamiento isquémico a distancia puede ser una importante herramienta a tener en cuenta en la protección anti-isquémica de la revascularización miocárdica, pero no parece ser útil en los pacientes diabéticos acorde a esta investigación(AU)

Introduction: A series of short periods of ischemia at a distance, prior to the greater ischemic event, may limit myocardial damage caused by severe ischemia and that occurs after reperfusion. Objective: To show the effectiveness of ischemic preconditioning at a distance in diabetic patients who were performed coronary revascularization. Methods: An experimental prospective longitudinal study was carried out in two groups of 103 patients, who were performed revascularization with coronary artery bypass graft. In the test group included in this study, the patient was placed a tourniquet insufflated three times for five minutes in the non-dominant arm, at a pressure of 200 mmHg, prior, during and after the greater ischemic event, which corresponded to the coronary artery clamping. Results: A significant decrease was not achieved in serum creatinine, glucose, glutamic pyruvic transaminase, creatine kinase-MB or in inotropic and vasoactive drugs consumption. Neither did it so in the incidence of lethal ventricular arrhythmias, low cardiac fatal output and postoperative death. Conclusions: Remote ischemic preconditioning can be an important tool for protection of antiischemic myocardial revascularization, but according to this research it may not be useful in diabetic patients(AU)

Precondicionamiento isquémico a distancia en la revascularización miocárdica de los pacientes diabéticos. ¿Es realmente beneficioso? / Remote ischemic preconditioning in myocardial revascularization of diabetic patients. Is it really beneficial?

Introducción: una serie de breves períodos de isquemias a distancia, previo al evento isquémico mayor, pueden limitar el daño miocárdico producido por la isquemia crítica y el que se produce posreperfusión. Objetivo: demostrar la efectividad del precondicionamiento isquémico a distancia en pacientes diabéticos a los cuales se les realizó revascularización coronaria. Métodos: se realizó un estudio longitudinal prospectivo experimental en dos grupos de 103 pacientes, a los que se les realizó revascularización con injerto de la arteria coronaria. En el grupo de prueba incluido en este estudio, se le colocó al paciente un torniquete el cual se insufló tres veces durante cinco minutos en el brazo no dominante, a una presión de 200 mmHg, previo, durante y después del evento isquémico mayor, el que se correspondió con el pinzamiento de la arteria coronaria. Resultados: no se logró una disminución significativa de la creatinina sérica, glicemia, transaminasas glutámico pirúvica, de la creatinfosfoquinasa-MB, ni del consumo de drogas inotrópicas y vasoactivas. Tampoco en la incidencia de arritmias ventriculares letales, bajo gasto cardiaco fatal y muerte postoperatoria. Conclusiones: el precondicionamiento isquémico a distancia puede ser una importante herramienta a tener en cuenta en la protección anti-isquémica de la revascularización miocárdica, pero no parece ser útil en los pacientes diabéticos acorde a esta investigación(AU)

Introduction: A series of short periods of ischemia at a distance, prior to the greater ischemic event, may limit myocardial damage caused by severe ischemia and that occurs after reperfusion. Objective: To show the effectiveness of ischemic preconditioning at a distance in diabetic patients who were performed coronary revascularization. Methods: An experimental prospective longitudinal study was carried out in two groups of 103 patients, who were performed revascularization with coronary artery bypass graft. In the test group included in this study, the patient was placed a tourniquet insufflated three times for five minutes in the non-dominant arm, at a pressure of 200 mmHg, prior, during and after the greater ischemic event, which corresponded to the coronary artery clamping. Results: A significant decrease was not achieved in serum creatinine, glucose, glutamic pyruvic transaminase, creatine kinase-MB or in inotropic and vasoactive drugs consumption. Neither did it so in the incidence of lethal ventricular arrhythmias, low cardiac fatal output and postoperative death. Conclusions: Remote ischemic preconditioning can be an important tool for protection of antiischemic myocardial revascularization, but according to this research it may not be useful in diabetic patients(AU)

Factores de riesgo asociados a infarto miocárdico agudo perioperatorio en cirugía coronaria sin circulación extracorpórea / Risk factors associated with acute perioperative myocardial infarction in coronary artery bypass

Introducción: el infarto miocárdico perioperatorio es una complicación con gran impacto en la morbilidad y mortalidad en anestesia cardiovascular.Objetivos: determinar posibles factores de riesgo asociados a infarto miocárdico perioperatorio en cirugía coronaria sin circulación extracorpórea.Métodos: estudio descriptivo, de corte transversal desde septiembre de 2011 a noviembre de 2012, en pacientes intervenidos a corazón latiendo. Se evaluó odds ratio, intervalo de confianza para un 95 por ciento, en variables con p ≤ 0.05. Resultados: se incluyeron 210 pacientes, 75,2 por ciento hombres, con edad media 62,3 ± 8,7 años, de ellos 30 con infarto miocárdico. La edad avanzada (OR 14,5; IC 95 por ciento: 5,9-35,1), clase IV-NYHA (OR 3,2; IC 95 por ciento: 1,2-9,3), insuficiencia renal crónica (OR 6,8; IC 95 por ciento:1,6-28,7), EPOC (OR 4,5; IC 95 por ciento:1,9-10,4), diabetes mellitus tipo 1 (OR 7,1; IC 95 por ciento: 3,1-16,3), tabaquismo (OR 6,3; IC 95 por ciento: 2,7-14,2), infarto reciente (OR 6,6; IC 95 por ciento:1,3-34,2), FeVI ≤ 40 por ciento (OR 2,5; IC 95 por ciento: 1,1-5,7), angina inestable (OR 2,5; IC 95 por ciento: 1,1-6,2), insuficiencia cardiaca (OR 27,5; IC 95 por ciento:2,9-256,1) y la enfermedad coronaria compleja (OR12,6; IC 95 por ciento: 5,2-30,7) fueron asociados con alto riesgo de infarto miocárdico perioperatorio. Pacientes no tratados con bloqueadores β en el preoperatorio tuvieron 3,3 veces más riesgo de sufrir un infarto miocárdico perioperatorio. Las complicaciones fueron significativamente mayores en este grupo, con una mortalidad de 23,3 por ciento. Conclusiones: las enfermedades coexistentes que mostraron significación se asociaron con alto riesgo de infarto miocárdico perioperatorio, con incremento en las complicaciones y la mortalidad(AU)

Introduction: perioperative myocardial infarction is a complication with great impact in morbidity and mortality in cardiovascular anesthesia. Objetive: Determine the posible risk factors associated to perioperative myocardial infarction in off-pump coronary artery bypass. Methods: descriptive and cross-sectional study between September 2011 - November 2012, in patients to whom myocardial revascularization without pump. The Odds Ratio value and confidence intervals of 95 percent in patients with values of p < 0.05 were considered to have a significant stadistical correlation. Results: this study included 210 patients (75.2 percent men), mean age 62.3 ± 8.7 years, from these 30 with perioperative myocardial infartion. Patients with advanced age (OR, 14.5; IC 95 percent: 5.9-35.1), functional class IV of NYHA (OR, 3.2; IC 95 percent: 1.2-9.3), chronic renal failure (OR, 6.8; IC 95 percent: 1.6-28.7), pulmonary obstructive chronic disease (OR,4.5; IC 95 percent:1.9-10.4), diabetes mellitus tipe 1 (OR, 7.1; IC 95 percent: 3.1-16.3), tobacco addiction (OR, 6.3; IC 95 percent: 2.7-14.2), recent myocardial infarction (OR, 6.6; IC 95 percent:1.3-34.2), FeVI ≤ 40 percent (OR, 2.5; IC 95 percent: 1.1-5.7), unstable angina (OR, 2.5; IC 95 percent: 1.1-6.2), heart failure (OR, 27.5; IC 95 percent:2.9-256.1) and coronary complex disease (OR,12.6; IC 95 percent: 5.2-30.7) showed a significant association with the presence of perioperative myocardial infarction. Patients without β blocker have 3 times as much of suffer myocardial infarction. Complications were significantly greater in these group, with a mortality of 23 percent.Conclusions: the coexistents diseases that showed association with the presence of perioperative myocardial infarction, with a significant increase in them complications and mortality(AU)

Estudio multicéntrico hospitalario en España, México y Cuba de actitud hacia la donación de vivo hepática / Hospital-based multicenter study in Spain, Mexico and Cuba on attitudes to living liver donation

INTRODUCCIÓN: Dado el déficit de hígados para trasplante se está potenciando la donación de vivo hepática (DVH) en el ámbito de habla hispana. Para ello es fundamental que los profesionales de centros hospitalarios estén a favor de dicha donación, dado que son una pieza clave en este tratamiento y son un grupo generador de opinión ante la población. Objetivo Analizar la actitud hacia la donación de vivo hepática (DVH) entre el personal hospitalario de centros sanitarios de España y Latinoamérica MATERIAL Y MÉTODO: Del «Proyecto Colaborativo Internacional Donante» se seleccionaron 10 centros hospitalarios, 3 de España, 5 de México y 2 de Cuba. Muestra aleatoria y estratificada por tipo de servicio y categoría laboral. Se valora la actitud hacia la DVH a través de un cuestionario validado de aspectos psicosociales. El cuestionario fue anónimo y autoadministrado. Estadística: test de la t de Student, de la χ2 y análisis de regresión logística. RESULTADOS: De los 2.618 profesionales encuestados, el 85% (n = 2.231) está a favor de la DVH relacionada, y de ellos el 31% (n = 804) a favor de la DVH no relacionada. No se asocian con dicha actitud ni el país del encuestado, ni las variables sociopersonales ni las laborales. Los factores que se asocian a la actitud favorable hacia la DVH relacionada son haber tenido experiencia personal con la donación y el trasplante (p < 0,001), estar a favor de la donación de cadáver (p < 0,001), creer en la posibilidad de necesitar un trasplante para sí mismo (p < 0,001), estar a favor de la donación de vivo renal (p < 0,001), aceptar un hígado procedente de donante vivo si fuera necesario (p < 0,001), haber comentado con la familia sobre la donación y el trasplante (p < 0,001), la actitud favorable de la pareja hacia la donación y el trasplante (p < 0,001), realizar actividades de tipo prosocial (p < 0,001), ser católico (p = 0,040), creer el encuestado que su religión está a favor de la donación y el trasplante (p < 0,001), y no preocuparle la posible mutilación del cuerpo tras la donación (p < 0,001). CONCLUSIONES: La actitud hacia la DVH referida entre el personal hospitalario de España y Latinoamérica es favorable, y está asociada con factores relacionados directa e indirectamente con la donación y el trasplante, factores familiares, religiosos y de actitud hacia el cuerpo

INTRODUCTION: Given the lack of a sufficient number of livers available for transplantation, living liver donation (LLD) is being developed in the Spanish-speaking world. To do this, it is essential that health workers in hospitals are in favor of such donation, given that they are a key component in this treatment and that their attitudes influence public opinion. OBJECTIVE: To analyze attitude toward LLD among hospital personnel from healthcare centers in Spain and Latin America. MATERIAL AND METHOD: Ten hospitals were selected from the «International Donor Collaborative Project»: 3 from Spain, 5 from Mexico and 2 from Cuba. Random sampling stratified by type of service and job category was used. Attitudes to LLD were evaluated through a validated questionnaire on psychosocial aspects. The questionnaire was anonymous and self-administered. Statistical tests consisted of Student's T test, the chi-square test and logistic regression analysis. RESULTS: Of the 2,618 employees surveyed, 85% (n = 2,231) were in favor of related LLD; of these, 31% (n = 804) were in favor of unrelated LLD. No association was found between the country of the interviewed, personal-social variables or work-related variables. The following factors were associated with a favorable attitude toward related LLD donation: having had personal experience of donation and transplantation (P < .001); being in favor of deceased donation (P < .001); believing that one might need a possible transplant (P < .001); being in favor of living kidney donation (P < .001); being willing to accept a liver from a living donor (P < .001); having discussed the matter of donation and transplantation within the family (P < .001) and with one's partner (P < .001); carrying out pro-social type activities (P < .001); being Catholic (P = .040); believing that one's religion is in favor of donation and transplantation (P < .001); and not being concerned about the possible mutilation of the body after donation (P < .001). CONCLUSIONS: Hospital personnel from Spain and Latin America had a favorable attitude toward LLD, which was associated with factors directly and indirectly related to donation and transplantation, family and religious factors, and attitudes toward the body

[Hospital-based multicenter study in Spain, Mexico and Cuba on attitudes to living liver donation]. / Estudio multicéntrico hospitalario en España, México y Cuba de actitud hacia la donación de vivo hepática.

INTRODUCTION: Given the lack of a sufficient number of livers available for transplantation, living liver donation (LLD) is being developed in the Spanish-speaking world. To do this, it is essential that health workers in hospitals are in favor of such donation, given that they are a key component in this treatment and that their attitudes influence public opinion. OBJECTIVE: To analyze attitude toward LLD among hospital personnel from healthcare centers in Spain and Latin America. MATERIAL AND METHOD: Ten hospitals were selected from the «International Donor Collaborative Project¼: 3 from Spain, 5 from Mexico and 2 from Cuba. Random sampling stratified by type of service and job category was used. Attitudes to LLD were evaluated through a validated questionnaire on psychosocial aspects. The questionnaire was anonymous and self-administered. Statistical tests consisted of Student's T test, the chi-square test and logistic regression analysis. RESULTS: Of the 2,618 employees surveyed, 85% (n=2,231) were in favor of related LLD; of these, 31% (n=804) were in favor of unrelated LLD. No association was found between the country of the interviewed, personal-social variables or work-related variables. The following factors were associated with a favorable attitude toward related LLD donation: having had personal experience of donation and transplantation (P<.001); being in favor of deceased donation (P<.001); believing that one might need a possible transplant (P<.001); being in favor of living kidney donation (P<.001); being willing to accept a liver from a living donor (P<.001); having discussed the matter of donation and transplantation within the family (P<.001) and with one's partner (P<.001); carrying out pro-social type activities (P<.001); being Catholic (P=.040); believing that one's religion is in favor of donation and transplantation (P<.001); and not being concerned about the possible mutilation of the body after donation (P<.001). CONCLUSIONS: Hospital personnel from Spain and Latin America had a favorable attitude toward LLD, which was associated with factors directly and indirectly related to donation and transplantation, family and religious factors, and attitudes toward the body.

Estudio multicéntrico hispano-latinoamericano de actitud hacia la donación de órganos entre profesionales de centros sanitarios hospitalarios / Spanish-Latin American multicenter study of attitudes toward organ donation among personnel from hospital healthcare centers

INTRODUCCIÓN: Los profesionales hospitalarios son un colectivo generador de opinión para el resto de la población en temas sanitarios. La actitud no favorable de dicho grupo es un obstáculo hacia el incremento de las tasas de donación de órganos propios de cadáver. OBJETIVO: Analizar la actitud de los profesionales hospitalarios hacia la donación de los órganos propios en centros sanitarios españoles y latinoamericanos y determinar los factores que condicionan dicha actitud. MATERIAL Y MÉTODO: Del «Proyecto Colaborativo Internacional Donante» se seleccionaron 11 centros hospitalarios, 3 de España, 5 de México, 2 de Cuba y uno de Costa Rica. Muestra aleatorizada y estratificada por tipo de servicio y categoría laboral. La actitud hacia la donación y el trasplante se valoró mediante una encuesta validada. El cuestionario fue anónimo y autoadministrado. Estadística: tests de la t de Student, de la χ2 y análisis de regresión logística. RESULTADOS: De los 2.785 profesionales encuestados, 822 son de España, 1.595 de México, 202 de Cuba y 166 de Costa Rica. El 79% (n = 2.191) está a favor de la donación de órganos de cadáver. Por país, están a favor el 94% (n = 189) de los cubanos, el 82% (n = 1.313) de los mexicanos, el 73% (n = 121) de los costarricenses y el 69% (n = 568) de los españoles (p < 0,001). En el análisis multivariante, las variables con más peso específico son: 1) país, siendo más favorable en Cuba (odds ratio= 8,196; p < 0,001); 2) ser médico (OR = 2,544; p < 0,001); 3) realizar una actividad laboral relacionada con el trasplante (OR = 1,610; p = 0,005); 4) haber comentado a nivel familiar el tema de la donación y el trasplante (OR = 3,690; p < 0,001); 5) la actitud a favor hacia la donación y el trasplante de la pareja (OR = 3,289; p < 0,001); 6) considerar el encuestado que su religión está a favor de la donación y el trasplante (OR= 3,021; p = 0,001); 7) no estar preocupado por la posible mutilación del cuerpo tras la donación (OR = 2,994; p < 0,001); 8) la preferencia de otras opciones distintas de la inhumación en el tratamiento del cuerpo tras el éxitus (OR = 2,770; p < 0,001) y 9) la aceptación de la realización de una autopsia si fuese necesaria (OR = 2,808; p < 0,001). CONCLUSIONES: La actitud hacia la donación entre el personal hospitalario de centros sanitarios españoles y latinoamericanos es favorable, aunque un 21% no está a favor de donar. Dicha actitud es más favorable entre los profesionales latinoamericanos, y está muy condicionada por factores laborales y psicosociales

INTRODUCTION: Hospital personnel are a group which has an influence on the opinion of the rest of the population about healthcare matters. Any unfavorable attitude of this group would be an obstacle to an increase in organ donation. OBJECTIVE: To analyze the attitude of hospital workers toward the donation of one's own organs in Spanish and Latin American hospitals and to determine the factors affecting this attitude. MATERIAL AND METHOD: Eleven hospitals from the "International Collaborative Donor Project" were selected, 3 in Spain, 5 in Mexico, 2 in Cuba and one in Costa Rica. A random sample was stratified by the type of service and job category. Attitude toward donation and transplantation was assessed using a validated survey. The questionnaire was completed anonymously and was self-administered. Statistical analysis: Student's t-test, the χ2 test and logistic regression analysis. RESULTS: Of the 2,785 workers surveyed, 822 were from Spain, 1,595 from Mexico, 202 from Cuba and 166 from Costa Rica and 79% (n = 2,191) were in favor of deceased organ donation. According to country, 94% (n = 189) of Cubans were in favor, compared to 82% (n = 1,313) of the Mexicans, 73% (n = 121) of the Costa Ricans and 69% (n = 568) of the Spanish (P < .001). In the multivariate analysis, the following variables had the most specific weight: 1) originating from Cuba (odds ratio=8.196; P < .001); 2) being a physician (OR = 2.544; P < .001); 3) performing a job related to transplantation (OR = 1.610; P = .005); 4) having discussed the subject of donation and transplantation within the family (OR = 3.690; P < .001); 5) having a partner with a favorable attitude toward donation and transplantation (OR = 3.289; P < .001); 6) a respondent's belief that his or her religion is in favor of donation and transplantation (OR = 3.021; P = .001); 7) not being concerned about the possible mutilation of the body after donation (OR = 2.994; P < .001); 8) the preference for other options apart from burial for treating the body after death (OR = 2.770; P < .001); and 9) acceptance of carrying out an autopsy if one were needed (OR = 2.808; P < .001). CONCLUSIONS: Hospital personnel in Spanish and Latin American healthcare centers had a favorable attitude toward donation, although 21% of respondents were not in favor of donating. This attitude was more favorable among Latin American workers and was very much conditioned by job-related and psychosocial factors

Knowledge of the brain death concept by personnel in Spanish and Latin-American healthcare centers.

BACKGROUND: The knowledge and acceptance of the concept of brain death (BD) among health care personnel is fundamental. OBJECTIVE: To analyze the level of understanding of the BD concept among personnel in Spanish and Latin American healthcare centers and to determine the factors affecting this attitude. MATERIAL AND METHODS: Data from 12 hospitals and 32 primary care centers in 4 countries within the International Collaborative Donor Project were selected (Spain, Mexico, Cuba and Costa Rica (n=4378)). RESULTS: 62% of the personnel (n=2714) understood BD and believed that this was the death of an individual. Of the rest, 30% (n=1333) did not understand it and the remaining 8% (n=331) believed it did not mean the death of a patient. 83% (n=931) of physicians understood BD, compared to 75% (n=895) of nurses, 55% (n=299) of healthcare assistants, 53% (n=108) of non-healthcare university-educated personnel and 36% (n=481) of those without a university education (p<0.001). 68% (n=1084) of Mexicans understood BD compared to 66% (n=134) of Cubans, 58% (n=1411) of Spaniards, and 52% (n=85) (p<0.001) of Costa Ricans. There were significant relationships between knowledge of the concept and the following: type of healthcare center (p<0.001), clinical service (p<0.001), having spoken about organ donation within the family (p<0.001) and one's partner's attitude to the subject (p<0.001). A direct relationship has been found between understanding the concept and attitude toward deceased donation (p<0.001). CONCLUSIONS: The understanding of BD by personnel from healthcare centers was not as good as expected. There were marked differences depending on job category.

Spanish-Latin American multicenter study of attitudes toward organ donation among personnel from hospital healthcare centers.

INTRODUCTION: Hospital personnel are a group which has an influence on the opinion of the rest of the population about healthcare matters. Any unfavorable attitude of this group would be an obstacle to an increase in organ donation. OBJECTIVE: To analyze the attitude of hospital workers toward the donation of one's own organs in Spanish and Latin American hospitals and to determine the factors affecting this attitude. MATERIAL AND METHOD: Eleven hospitals from the "International Collaborative Donor Project" were selected, 3 in Spain, 5 in Mexico, 2 in Cuba and one in Costa Rica. A random sample was stratified by the type of service and job category. Attitude toward donation and transplantation was assessed using a validated survey. The questionnaire was completed anonymously and was self-administered. STATISTICAL ANALYSIS: Student's t-test, the χ2 test and logistic regression analysis. RESULTS: Of the 2,785 workers surveyed, 822 were from Spain, 1,595 from Mexico, 202 from Cuba and 166 from Costa Rica and 79% (n=2,191) were in favor of deceased organ donation. According to country, 94% (n=189) of Cubans were in favor, compared to 82% (n=1,313) of the Mexicans, 73% (n=121) of the Costa Ricans and 69% (n=568) of the Spanish (P<.001). In the multivariate analysis, the following variables had the most specific weight: 1) originating from Cuba (odds ratio=8.196; P<.001); 2) being a physician (OR= 2.544; P<.001); 3) performing a job related to transplantation (OR = 1.610; P=.005); 4) having discussed the subject of donation and transplantation within the family (OR= 3.690; P<.001); 5) having a partner with a favorable attitude toward donation and transplantation (OR= 3.289; P<.001); 6) a respondent's belief that his or her religion is in favor of donation and transplantation (OR= 3.021; P=.001); 7) not being concerned about the possible mutilation of the body after donation (OR= 2.994; P<.001); 8) the preference for other options apart from burial for treating the body after death (OR= 2.770; P<.001); and 9) acceptance of carrying out an autopsy if one were needed (OR= 2.808; P<.001). CONCLUSIONS: Hospital personnel in Spanish and Latin American healthcare centers had a favorable attitude toward donation, although 21% of respondents were not in favor of donating. This attitude was more favorable among Latin American workers and was very much conditioned by job-related and psychosocial factors.

The attitude toward living kidney donation among personnel from units related to donation and transplantation in Spain, Mexico and Cuba.

BACKGROUND: Living kidney donation (LKD) is becoming increasingly necessary as a treatment option for reducing the deficit in transplant organs. Hospital personnel in services related to donation and transplantation play a key role in promoting this kind of donation. OBJECTIVE: To analyze the attitude toward LKD among hospital workers in services related to donation and transplantation in Spain and Latin America. METHODS: Eight hospitals in the "International Collaborative Donor Project" were selected (Spain-Mexico-Cuba). A random sample was taken which was stratified according to the type of service and job category, in transplant-related services. RESULTS: Of the 878 respondents, 90% were in favor of related LKD, and 28% were in favor if the LKD was not related. Attitude was more favorable among Latin Americans workers compared to the Spanish (p=0.014). Other factors associated to attitude included: age (p=0.004); an attitude in favor of deceased donation and living liver donation (p<0.001); and acceptance of a kidney from a donor (p<0.001). CONCLUSIONS: The attitude toward related LKD was very favorable among hospital personnel in units related to the donation and transplantation process in Spain and Latin America, which means that they could contribute to its promotion particularly at the current time when living kidney donation needs to be expanded.

Level of acceptance of solid organ xenotransplantation among personnel in Spanish, Mexican, and Cuban hospitals.

BACKGROUND: Xenotransplantation is still a long way from becoming a clinical reality. However, in an emergency situation, it could be used as a bridge for replacing vital organs until the arrival of a human organ. To analyze the attitude toward xenotransplantation among hospital personnel from several hospitals in Spain and Latin America. METHODS: A random sample stratified according to the type of hospital and job category (n = 2618) in 10 hospitals in three different countries: Spain (n = 821), Mexico (n = 1595), and Cuba (n = 202). A validated questionnaire (PCID-XenoTx Rios) was self-administered and completed anonymously by the respondents. RESULTS: If the results of xenotransplantation were similar to those achieved using human donor organs, 61% (n = 1591) of the respondents would be in favor, while 9% (n = 234) would be against and 30% (n = 793) would be unsure. The analysis of the variables affecting attitude toward xenotransplantation revealed that attitude varied according to the country of reference and was more favorable among personnel in Cuban hospitals (70% a favor) than in Spanish (57%) and Mexican ones (62%; P = 0.000). However, these differences are mainly determined by job category with the physicians having the most favorable attitude. The ancillary staff, in contrast, had the least favorable attitude (76 vs. 51% respectively; P = 0.000). Of the remaining variables, attitude is significantly related to variables connected to human donation: attitude toward the different kinds of human organ donation (deceased [P < 0.001] and living [P < 0.001]), the possibility of needing a transplant oneself in the future (P < 0.001), and attitude toward donating the organs of a deceased family member (P = 0.004). CONCLUSIONS: A third of healthcare personnel from several hospitals are not in favor of xenotransplantation. It is necessary to provide more information about the matter, especially in hospitals where there is a preclinical xenotransplantation program or where there is access to one, such as in the hospitals in this study.

Opinion toward living liver donation of hospital personnel from units related to organ donation and transplantation: a multicenter study from Spain and latin-america.

BACKGROUND: Hospital personnel of services related to donation and transplantation process play a fundamental role in the development of transplantation. OBJECTIVES: The aim of this study was to investigate the attitude toward living liver donation (LLD) among hospital personnel from services related to donation and transplantation in hospital centers in Spain and Latin America. MATERIALS AND METHODS: Eight hospitals within the "International Donor Collaborative Project" were selected, three in Spain, three in Mexico and two in Cuba. The study was performed in transplant-related services, using a randomized sample, which was stratified by the type of service and job category. RESULTS: In total, 878 workers were surveyed of which 82% (n = 720) were in favor of related LLD, 10% (n = 90) were against and 8% (n = 68) undecided. Attitudes toward related LLD were more favorable in the following groups: the Latin Americans (86% in favor vs. 77% among the Spanish; P = 0.007); younger people (37 vs. 40 years, P = 0.002); those in favor of either deceased donation (P < 0.001) or living kidney donation (P < 0.001); those who believed that they might need a transplant in the future (P < 0.001); those who would accept a liver from a living donor (P < 0.001); those who discussed the subject of donation and transplantation with their families (P = 0.040); and those whose partner was in favor of donation and transplantation (P = 0.044). CONCLUSIONS: Personnel from donation and transplantation-related units had a favorable attitude toward LLD. This attitude was not affected by psychosocial factors, although it was influenced by factors directly and indirectly related to the donation and transplantation process.

Attitudes of non-medical staff in hospitals in Spain, Mexico, Cuba and Costa Rica towards organ donation.

INTRODUCTION: Non-medical staff members in hospitals are highly credible at population level, and are a source of opinion even though they do not have sufficient medical training. OBJECTIVES: To analyse the attitudes of non-medical professionals of Spanish and Latin American hospitals towards organ donation and identify the factors that influence these attitudes. MATERIAL AND METHOD: Through the "Proyecto Colaborativo Internacional Donante" (International Collaborative Donor Project), a stratified random sample was selected from non-medical services of eleven hospitals: 3 Spanish (n=277), 5 Mexican (n=632), 2 Cuban (n=42) and 1 Costa Rican (n=101). RESULTS: Of the 1052 professionals surveyed, 72% (n=754) were in favour of donating an organ after death. By country, 98% of Cubans, 80% of Mexicans, 66% of Costa Ricans and 52% of Spanish were in favour (P<.001). The most influential variables were: 1) country, with results being more positive in Mexico (odds ratio [OR]=2.197), 2) believing in the possibility that they will require a transplant (OR=2.202), 3) having discussed the issue with their family (OR=3.23), 4) the positive attitude of their partner towards donation (OR=3.322), 5) not being concerned about possible mutilation of their body after donation (OR=3.378), 6) preferring options other than burial (OR=2.525), 7) accepting an autopsy (OR=2.958). CONCLUSIONS: The attitude of non-medical staff members of hospitals towards the donation of their own organs varies greatly depending on the country of the respondent. Psychosocial factors that influence these attitudes are similar to those described at the population level.