ABSTRACT
Latin America was during November 2020 one of the most affected regions by the COVID-19 pandemic in terms of prevalence and deaths attributed to the virus. Therefore, the start of vaccine testing in citizens of the region was received with high expectations about its effectiveness. Therefore, it is essential to take into account certain fundamental principles that should guide this process ensuring its correct implementation. The objective of this article is to provide considerations on the process of implementing clinical trials and post-trial access to COVID-19 vaccines in Latin America, in particular those related to respect for the dignity of participants, the historical global and regional tensions regarding the political economy of clinical trials, some aspects of global governance and the role of the World Health Organization in the pandemic, and the need to ensure post-trial access to the vaccine. It is concluded that the pandemic is an opportunity to strengthen bonds of cooperation and solidarity between Latin American countries. Clinical trials are a key instance to strengthen local and regional governance with a view to consolidate transparency and monitoring of the correct implementation of public-private partnerships in the development of therapies, in which the World Health Organization and the Pan American Health Organization have an important role for the implementation of integration strategies and access to vaccines.
ABSTRACT
Introduction: Regional techniques are valuable tools in this specific pandemic context, inclusive in terms of patient and team safety. The authors report the ultrasound-guided selective trunk block (STB) of the brachial plexus with superficial cervical plexus (SCP) for proximal humeral fracture surgery. Case reports: Case 1: 52-year-old male proposed for open reduction and fixation (ORF) of the humerus. Case 2: 53-year-old male proposed for ORF of oblique fracture of the humeral shaft. Both patients were obese, had a hypertensive disease, and a positive test for SARS-COV2. The procedures were performed under ultrasound-guided STB and SCPB using 15 + 3 mL of 0.5% ropivacaine and 10 + 3 mL of lidocaine 1,5%. Intraoperatively, dexamethasone 4 mg, propofol IV perfusion titrated for BIS 60-70, and paracetamol 1g were administered. None of the patients experienced pain, desaturation, or any other complications. Postoperatively, there was no need for rescue analgesia. They had no complications on discharge and globally were satisfied with the technique. Discussion: When a patient with a positive test for SARS-COV2 needs surgery, regional anesthesia allows minimal aerosolization without airway manipulation, but also adds advantages in terms of hemodynamic stability, postoperative analgesia with decreased opioid consumption, and patient's recovery time. In these case reports, SCPB with Selective Trunk Block (upper trunk - C5 and C6, middle trunk - C7, and inferior trunk - C8-T1) allow the ideal target for a safe and effective block, avoiding unwanted side effects.
ABSTRACT
Resumen La pandemia por el virus SARS-CoV-2 ha afectado fuertemente los programas de educación quirúrgica. El Capítulo Chileno del American College of Surgeons realizó un webinar para evaluar y discutir los efectos de la pandemia en la educación quirúrgica. Este evento contó con la asistencia de 450 personas de 17 países, incluyendo la participación de destacados docentes del área quirúrgica. Las principales conclusiones de este webinar fueron que la pandemia alteró considerablemente los programas de educación quirúrgica. Un 26% de los residentes se contagiaron, pero la mayoría no precisó cuidados especiales. Las intervenciones quirúrgicas disminuyeron hasta en un 90% en algunos programas. Los residentes debieron asumir el cuidado de pacientes COVID-19. Se han implementado sistemas de enseñanza virtual, como seminarios en línea o webinars, discusión de casos clínicos, videos y simulación. Dichas actividades teóricas, al igual que la simulación quirúrgica fueron evaluadas, mayoritariamente, vía web. Las sociedades científicas han tenido un importante rol en estas actividades. En el futuro, los programas universitarios enfrentarán escenarios con menos pacientes y una reducción de las oportunidades de enseñanza para residentes. Las actividades en línea y simulación adquirirán mayor relevancia. Es posible superar esta crisis como lo han hecho los países desarrollados, comparados con ellos, carecemos de un plan nacional de emergencia en salud, en el que los estudiantes y personal sanitario tengan un rol definido en áreas específicas, con metas concretas. El retorno a la "nueva normalidad" estará lleno de desafíos.
The SARS-CoV-2 pandemic has had an impact in surgical residency programs. The Chilean chapter of the American College of Surgeons organized a webinar to discuss and address the effects of this pandemic on surgical education. This meeting had a virtual attendance of 450 people from 17 countries, including the participation of surgical educators. Conclusions of this webinar were that COVID-19 has strongly affected surgical education programs. Twenty six per cent of residents were infected. Most of them did not need special care. Surgical opportunities have decreased up to 90% in some programs. Residents have had to be involved in managing COVID-19 patients. Changes in surgical education, led to a virtual instruction which includes seminars, webinars, case discussion, videos and simulation. Assessment has been performed of theoretical activities, via web. Simulation tasks also have been evaluated. Scientific societies had a very important role in these activities. In the near future, university programs will face different scenarios in hospitals and clinical centers, with fewer patients and reduced clinical instruction for residents. Online activities and simulation will increase in relevance in years to come. It is possible to overcome this crisis, as some developed countries have already done, compared to them, we lack a national emergency health plan in which medical students, residents, doctors, and all health care providers have a designated role in specific areas with clear goals. The return to "the new normal" will be filled with challenges.