[Experience of a mid-term care facility in the covid-19 with visit protocols.] / Experiencia de un hospital de media estancia en época covid-19 con protocolos de visitas.

OBJECTIVE: The Hospital Virgen de la Poveda, (Villa del Prado, Spain), assists patients in need of Continuous medical care, Rehabilitation or Palliative care; these patients have many risk-factors of COVID-19 morbility and mortality. With both healthcare humanization and contagion-prevention purposes, in July 2020 two patient visit protocols were implemented. The objective of this study is to describe these measures qualitatively and quantitatively. METHODS: A context is provided regarding COVID-19 measures in this institution. The content and follow-up indicators of visit protocols (number of visits, of outbreaks, inpatients, etc.) and of their context were provided. The empirical outbreak probabilities were calculated, and hypothesis contrast was performed against no-visits (0%) and no visit-control (7-day cumulative incidence/habitant). RESULTS: Two protocols were created. Accompanying was applied to Palliative Care cases (no appointments required, no time limits), and a short visits protocol was applied to the other patients (appointments for 1 weekly visit for 1-2 persons were given and visits last up to 45 minutes). In both protocols, visitors with symptoms or fever or particularly susceptible were forbidden entrance. Between July and April 2021, 4,759 short-visit appointments were given and 7,544 total visits took place (short visits, accompanying, exceptions). An outbreak was possibly attributed to short visits (probability=0.021% [CI95%: 0.0005-0.1171%]) and two outbreaks were possibly attributed to visits globally (probability=0.0265% [IC95%: 0.0032-0.0958%]). CONCLUSIONS: Elaborating adapted, applicable and prospectively-evaluated protocols with prevention measures at multiple levels might succeed in minimizing the risk of adverse events (in this case, COVID-19 outbreaks).

OBJETIVO: El Hospital Virgen de la Poveda atiende a pacientes con necesidades de Cuidados Continuos, Rehabilitación o Cuidados Paliativos, que presentan factores de riesgo de morbilidad y mortalidad por COVID-19. Para humanizar la asistencia sanitaria, se implementaron en julio de 2020 protocolos de visitas que minimizasen el riesgo de contagio. El objetivo de este estudio fue realizar una descripción cualitativa y cuantitativa de tales medidas. METODOS: Se contextualizó el problema de las medidas ante el COVID-19 de esta institución. Se recogió el contenido e indicadores de seguimiento de los protocolos de visitas (número de visitas, de brotes, ocupación, etc.) y de contexto. Se calcularon probabilidades empíricas de brote y contraste de hipótesis: vs. no-visitas (0%), y vs. no-control (incidencia acumulada); (distribución de Poisson). RESULTADOS: Se crearon dos protocolos: acompañamiento (para Cuidados Paliativos, sin citas y sin límite a la duración); y visitas cortas con cita previa (para los demás, limitadas a 45 minutos, 1-2 personas por paciente, 1 visita semanal). En ambos casos se controlaron el acceso de personas con síntomas o especialmente susceptibles. Entre julio 2020 y abril de 2021 se dieron 4.759 citas para visitas cortas (con 1 posible brote atribuido, probabilidad de brote=0,021% [IC95%: 0,0005-0,1171%]) y se produjeron en total 7.544 visitas (citadas, acompañamiento y excepcionales; con 2 posibles brotes atribuidos, probabilidad de brote=0,0265% [IC95%: 0,0032-0,0958%]). CONCLUSIONES: La elaboración de protocolos con medidas de prevención a múltiples niveles, adaptados, aplicables y con un adecuado seguimiento, puede conseguir minimizar el riesgo de aparición de eventos negativos (brotes en este caso).

A Mediterranean dietary style influences TNF-alpha and VCAM-1 coronary blood levels in unstable angina patients.

BACKGROUND: A Mediterranean dietary pattern has been associated with a reduced risk of coronary heart disease, as well as a reduction of oxidative stress, but studies indicating possible interactions between food intake and inflammatory mediators production at specific sites are lacking. AIM OF THE STUDY: To assess the relationship between Mediterranean diet consumption and inflammatory related molecules production in coronary vessels. METHODS: A previously reported Mediterranean-diet score was computed summing-up the quintiles of eight dietary components from a validated food frequency questionnaire in 24 patients with unstable angina. Tumor necrosis factor (TNF-alpha) and vascular cell adhesion molecule (VCAM-1) concentrations were measured in coronary sinus blood. RESULTS: Both biomarkers showed an inverse association with the Mediterraneandiet score. The association between VCAM-1 and the Mediterranean-diet score had an adjusted beta coefficient of -35.1 ng/ml (95% coefficient interval, CI: -63.5 to -6.7). The adjusted beta coefficient using TNF-alpha as the dependent variable was -41.6 pg/ml (95 % CI: -76.2 to -7.1). The consumption of olive oil as a single item showed a significant inverse association, and a Mediterranean-diet score excluding olive oil was also inversely associated with TNF-alpha and VCAM-1 serum levels in coronary venous blood. CONCLUSIONS: Adherence to a Mediterranean dietary pattern may protect against coronary artery wall production of inflammatory mediators. This finding could provide a novel mechanistic explanation for the recognized lower coronary risk associated with a Mediterranean diet.

Resección abdóminoperineal por cáncer de recto: presentación de caso y revisión bibliográfica / Abdominoperineal resection for rectum cancer: case report and bibliographic review

Presentamos el caso de un paciente con adenocarcinoma indiferenciado de recto; es tratado agresivamente con una resección abdóminoperineal y excéresis ganglionar evolucionando favorablemente; actualmente recibe tratamiento quimioterapéutico y radioterapia. El tratamiento más importante en este tipo de neoplasias sigue siendo la resección quirúrgica amplia, con esta oportunidad exponemos una revisión bibliográfica sobre el tema.