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Resumen Introducción El prono en ventilación espontánea no es una estrategia reciente, y pese a los muchos años que lleva intentando consolidarse, no ha podido demostrar ser de real utilidad. Durante la reciente pandemia, el prono en ventilación espontánea resurgió como una alternativa práctica y simple, aunque muy cuestionada por su débil nivel de evidencia. Con el tiempo y la experiencia generada, de a poco fue relegada a convertirse únicamente en una atractiva hipótesis. Objetivo Este estudio busca analizar los potenciales beneficios del prono en ventilación espontánea en pacientes con hipoxemia producida por SARS-CoV-2. Método Se realizó una revisión panorámica de los estudios más relevantes publicados en las bases de datos MEDLINE, Embase y Scopus hasta el 20 de diciembre de 2021. Resultados Tras el escrutinio se eligieron para el análisis: 4 estudios observacionales, un ensayo clínico aleatorizado y 3 revisiones sistemáticas. Conclusiones Mediante análisis estadísticos concluimos que el prono en ventilación espontánea, si bien podría retrasar la intubación, no mejoraba la sobrevida de los sujetos hipoxémicos por neumonía viral causada por coronavirus tipo 2. Intoduction Prone position in spontaneous ventilation is not a recent strategy, and despite the many years it has been trying to consolidate, it has not been able to prove to be of real utility. During the recent pandemic, prone spontaneous ventilation re-emerged as a practical and simple alternative, although it was highly questioned due to its weak level of evidence. With time and experience, it was gradually relegated to become only an attractive hypothesis. Objective This study aims to analyze the potential benefits of prone position in spontaneous ventilation in patients with hypoxemia caused by SARS-CoV-2. Methods A panoramic review of the most relevant studies published in the MEDLINE, Embase and Scopus databases up to December 20, 2021 was performed. Results After screening, 4 observational studies, 1 randomized clinical trial, and 3 systematic reviews were selected for analysis. Conclusions By statistical analysis we concluded that prone position in spontaneous ventilation, although it could delay intubation, did not improve survival in hypoxemic subjects with viral pneumonia caused by coronavirus type 2.
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BACKGROUND: The aim was to determine the impact of COVID-19 pandemic on urolithiasis presentation and management. METHODS: In this retrospective study we comparatively evaluated urgent and elective procedures due to urolithiasis during the early eight months of the COVID-19 pandemic (March 1, 2020 to October 31, 2020) compared to the same period a year before, and between waves. The student's t-test, chi-square test, Mann-Whitney U test and Fisher's exact test were used to compare the patients' characteristics and outcomes between the two periods and waves. RESULTS: 530 procedures were included. The overall number of surgical procedures due to urolithiasis were similar between pre-pandemic and pandemic periods. Regarding elective surgery, our data draw attention to the increased complication rate in the pandemic times, but no statistically significant differences in terms of types of procedures and need for complementary treatments were observed. We noted that patterns of presentation of complicated renal colic were different during COVID-19 pandemic, with a higher number of days after the onset of symptoms and a higher proportion of patients presenting acute kidney injury. Furthermore, a significant increase of creatinine levels at presentation in 1st wave was detected. A growth in the number of urgent procedures after the 1st wave was noted, owing to the delay in urolithiasis treatment and diagnosis. CONCLUSION: The COVID-19 pandemic has negatively affected both urgent and elective management of urolithiasis. Lessons about the management of urolithiasis in this context should be learned to avoid fatal complications and improve standards of care.
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Introducción: El objetivo del estudio fue analizar el impacto de la pandemia COVID-19 en la presentación y el manejo de la patología litiásica. Métodos: Estudio retrospectivo comparativo de los procedimientos (urgentes y electivos) por litiasis durante los primeros ocho meses de la pandemia (01/03/2020 al 31/10/2020), comparándose con el mismo período de 2019, y entre olas. Los tests utilizados fueron la prueba exacta de Fisher, t de Student, chi-cuadrado y U de Mann-Whitney. Resultados: Se analizaron 530 procedimientos. El número total de procedimientos quirúrgicos por patología litiásica fue similar entre los dos períodos. En cuanto a la cirugía electiva, se identificó un aumento en la tasa de complicaciones en el período de pandemia, pero no se observaron diferencias estadísticamente significativas en cuanto a tipos de procedimientos realizados y necesidad de tratamientos complementarios. El patrón de presentación del cólico renoureteral complicado fue diferente durante la pandemia, con mayor número de días desde del inicio de los síntomas hasta la consulta y mayor proporción de pacientes con fracaso renal agudo. Asimismo, se detectó un aumento significativo de los niveles de creatinina en la 1ª ola. Se observó un incremento en el número de procedimientos urgentes tras la 1ª ola, debido al retraso en el tratamiento y diagnóstico de la patología litiásica. Conclusiones: La pandemia COVID-19 ha impactado negativamente en el tratamiento urgente y electivo de la litiasis. Se deben aprender lecciones sobre el manejo de la litiasis en este contexto para evitar complicaciones graves y mejorar los estándares de atención.
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Medical progress has historically depended on scientific discoveries. Until recently, science was driven by technological advancements that, once translated to the clinic, fostered new treatments and interventions. More recently, technology-driven medical progress has often outpaced laboratory research. For example, intravascular devices, pacemakers for the heart and brain, spinal cord stimulators, and surgical robots are used routinely to treat a variety of diseases. The rapid expansion of science into ever more advanced molecular and genetic mechanisms of disease has often distanced laboratory-based research from day-to-day clinical realities that remain based on evidence and outcomes. A recognized reason for this hiatus is the lack of laboratory tools that recapitulate the clinical reality faced by physicians and surgeons. To overcome this, the NIH and FDA have in the recent past joined forces to support the development of a "human-on-a-chip" that will allow research scientists to perform experiments on a realistic replica when testing the effectiveness of novel experimental therapies. The development of a "human-on-a-chip" rests on the capacity to grow in vitro various organs-on-a-chip, connected with appropriate vascular supplies and nerves, and our ability to measure and perform experiments on these virtually invisible organs. One of the tissue structures to be scaled down on a chip is the human blood-brain barrier. This review gives a historical perspective on in vitro models of the BBB and summarizes the most recent 3D models that attempt to fill the gap between research modeling and patient care. We also present a summary of how these in vitro models of the BBB can be applied to study human brain diseases and their treatments. We have chosen NeuroAIDS, COVID-19, multiple sclerosis, and Alzheimer's disease as examples of in vitro model application to neurological disorders. Major insight pertaining to these illnesses as a consequence of more profound understanding of the BBB can reveal new avenues for the development of diagnostics, more efficient therapies, and definitive clarity of disease etiology and pathological progression.
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PURPOSE OF REVIEW: The alarming number of confirmed COVID-19 cases put a strain on the healthcare systems, which had to reallocate human and technical resources to respond to the emergency. Many urologists became integrated into multidisciplinary teams, dealing with this respiratory illness and its unknown management. It aims to summarize the epidemiological, clinical, diagnostical, and therapeutical characteristics of COVID-19, from a practical perspective, to ease COVID-19 management to non-physician staff. RECENT FINDINGS: We performed a narrative review of the literature regarding COVID-19, updated to May 8th, 2020, at PubMed and COVID resource platforms of the main scientific editorials. COVID-19, characterized by fever, myalgias, dyspnea, and dry cough, varies widely from asymptomatic infection to death. Arrhythmias and thrombotic events are prevalent. Lymphopenia and inflammatory reactant elevation on laboratory, as well as bilateral and peripheral ground-glass opacities or consolidations on X-Ray, are usually found in its assessment. Little is known about SARS-CoV-2 immunology. To date, no therapy has demonstrated efficacy in COVID-19. Of-level or compassionate-use therapies are prescribed in the context of clinical trials. We should become familiar with specific adverse events and pharmacological interactions. The COVID-19 pandemic has paralyzed the urological activity, and its long-term consequences are unpredictable. Despite not being used to deal with respiratory diseases, the urologists become easily qualified to manage COVID-19 by following protocols and being integrated into multidisciplinary teams, helping to overcome the pandemic.