Recommendations Of Scientific Societies Research Articles

POSTMORTEM HEART DISSECTION FOR SUDDEN DEATH EXAMINATION

The article describes the postmortem heart examination technique during a forensic autopsy of adults. The heart examination technique is based on the recommendations of scientific societies of pathologists, publications on autopsy techniques used in recent decades. The achievements of morphologists of the second half of the 20th century are also taken into account. The postmortem heart examination technique provides an examination of the coronary vessels, as well as myocardium and heart valves. The possibilities for examination of the elements of the conductive system are also represented. The following method ensures preservation of topographic relationships of morphological structures within the heart and possibility of its re-examination. The postmortem heart examination includes the following stages: examination of the coronary arteries, the making of three transverse incisions from the apex to the middle of the ventricles, “blood flow” incisions taking into account the localization of the main nodes of the conducting system, as well as the peculiarities of the examination of the heart valves. Peer Review History: Received: 12 October 2023; Revised: 21 November; Accepted: 27 December, Available online: 15 January 2024 Academic Editor: Dr. Nuray Arı, Ankara University, Turkiye, ari@ankara.edu.tr Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Prof. Hassan A.H. Al-Shamahy, Sana'a University, Yemen, shmahe@yemen.net.ye Dr. Rima Benatoui,Laboratory of Applied Neuroendocrinology, Department of Biology, Faculty of Science, Badji Mokhtar University Annaba, Algeria. benattouiryma@gmail.com Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, ahsndkyc@gmail.com

COVID-19 pandemic experiences, ethical conflict and decision-making process in critical care professionals (Quali-Ethics-COVID-19 research part 1): An international qualitative study.

The aim of this study was to explore the sources of ethical conflict and the decision-making processes of ICU nurses and physicians during the first and subsequent waves of the COVID-19 pandemic. Depside several studies exploring ethical conflicts during COVID-19 pandemic, few studies have explored in depth the perceptions and experiences of critical care professionals regarding these conflicts, the decision-making process or which have analysed the complexity of actually implementing the recommendations of scientific societies and professional/healthcare institutions in interdisciplinary samples. A descriptive phenomenological study. Thirty-eight in-depth interviews were conducted with critical care nurses and physicians from five hospitals in Spain and Italy between December 2020 and May 2021. A thematic content analysis of the interview transcripts was conducted by two researchers. Consolidated criteria for reporting qualitative research (COREQ) were employed to ensure the quality and transparency of this study. Two main themes emerged as sources of ethical conflict: the approach to end of life in exceptional circumstances and the lack of humanisation and care resources. The former comprised two subthemes: end-of-life care and withholding and withdrawal of life-sustaining treatment; the latter comprised three subthemes: the impossibility of guaranteeing the same opportunities to all, fear of contagion as a barrier to taking decisions and the need to humanise care. Professionals sought to take their decisions in line with professional ethics and bioethical principles, but, nevertheless, they experienced moral dilemmas and moral distress when not being able to care for, or to treat, their patients as they believed fit. Further education and training are recommended on the provision of end-of-life and post-mortem care, effective communication techniques via video calls, disclosure of bad news and bioethical models for decision-making in highly demanding situations of uncertainty, such as those experienced during the COVID-19 pandemic.

Management of myocardial infarction complicated by cardiogenic shock: Expert opinion of the Association of Intensive Cardiac Care and Association of Cardiovascular Interventions of the Polish Society of Cardiology.

Despite significant advances in interventional cardiology and mechanical circulatory support (MCS) techniques, outcomes for patients with myocardial infarction (MI) complicated by cardiogenic shock (CS) remain suboptimal. This expert consensus aims to provide information on the current management of patients with MI complicated by CS in Poland and to propose solutions, including systemic ones, for all stages of care. The document uses data from the Polish PL-ACS Registry of Acute Coronary Syndromes, which includes records of more than 820 000 hospital admissions. We describe the role of medical rescue teams, highlighting the necessity to expand their range of competencies at the level of prehospital care. We emphasize the importance of treating the underlying cause of CS and direct patient transfer to centers capable of performing percutaneous coronary interventions. We present current recommendations of scientific societies on MCS use. We underline the role of the Cardiac Shock Team in the management of patients with MI complicated by CS. Such teams should comprise an interventional cardiologist, a cardiothoracic surgeon, and an intensive care physician. Patients should be transferred to highly specialized CS centers, following the example of so-called Cardiac Shock Care Centers described in some other countries. We propose criteria for the operation of such centers Other important aspects discussed in the document include the role of rehabilitation, multidisciplinary care, and long-term follow-up of treatment outcomes. The document was developed in cooperation with experts from different scientific societies in Poland, which illustrates the importance of interdisciplinary care in this patient population.

Evidence-Based Nursing Practices for the Prevention of Newborn Procedural Pain in Neonatal Intensive Therapy-An Exploratory Study.

Background: Due to the progress in neonatology, in particular, in the past three decades, the mortality rate among patients of intensive care units has decreased. However, this is connected not only with newborns needing to stay longer in the unit, but also with the exposure of newborns to many painful procedures and stresses. Lack of or insufficient pain prevention has a negative impact on the sensory or locomotor development of newborns. Despite the presence of guidelines based on scientific evidence, the use of pharmacological and non-pharmacological pain-management methods in newborns is still insufficient. Aim: The aim of the study was to: identify the knowledge nurses/midwives have of recommended non-pharmacological and/or pharmacological methods, in particular, in relation to medical intervention procedures; assess the interventions for pain relief applied by midwives/nurses most often in their clinical practice; examine the role of age, general work experience, education level and years of work of medical professionals on a neonatal ward, as well as the referral level of a unit, versus the application of pharmacological and non-pharmacological methods. Methods: A descriptive and quantitative study conducted in 2019 among Polish nurses/midwives working at neonatal intensive care units. Results: The analysis of the material reflected the deficit of knowledge and the insufficient daily use of recommended pain-relief measures among the respondents. Conclusions: The interpretation of data indicates that despite the clear and easily available recommendations of scientific societies concerning the mode of conduct in particular medical procedures, medical personnel do not apply those recommendations in their everyday practice. It is necessary to plan and implement education strategies for nurses/midwives on standard pain-management interventions during painful medical procedures.

Spanish Society of Thoracic Surgery (SECT) consensus document. Long-term follow-up for operated patients with lung cancer

The most effective treatment for lung cancer is complete lung resection, although recurrences reach up to 10% and the appearance of second neoplasms, up to 6%. Therefore, the follow-up of these patients will be essential for the early detection and treatment of these events; however there is no definition of the form, time and cadence of these follow-ups. In this consensus document, we try to define them based on the available scientific evidence.A critical review of the literature is carried out (meta-analysis, systematic reviews, reviews, consensus recommendations of scientific societies, randomized controlled studies, non-randomized controlled studies, observational studies and case series studies) and communications to the main congresses on oncology and thoracic surgery in Spanish, English and French. The evidences found are classified following the GRADE system.It is defined according to the existing evidence that the patient resected for lung cancer should be followed up, as well as that this follow-up should be close during the first years and with CT (not being necessary to follow up with PET-CT, biomarkers or bronchoscopy). Cessation of smoking is also recommended in this follow-up.

Immune-mediated inflammatory disease patients in the era of COVID-19 — who, how and when to vaccinate against COVID-19

Patients with autoimmune diseases are a particularly vulnerable group, prone to developing infectious complications. At the same time, due to the immunosuppressive treatment of these patients, the use of vaccination may raise some concerns as to its effectiveness and, above all, its safety. This article presents the current recommendations of scientific societies indicating the efficacy, safety and, in particular, the necessity of immunization in all patients with inflammatory rheumatic diseases. Special emphasis in this study is placed on the efficacy and safety of vaccination against COVID-19.

Factors affecting the choice of budesonide in the therapy of croup, asthma and chronic obstructive pulmonary disease.

Budesonide is one of inhaled corticosteroids with an established position in the therapy of croup, bronchial asthma and chronic obstructive pulmonary disease (COPD). To assess factors affecting the choice of budesonide in the therapy of croup, asthma and COPD by specialists and general practitioners in daily clinical practice. This multicentre, open-label, post-marketing survey was performed nation-wide with the participation of 1113 doctors and 100,980 patients treated with budesonide. The study questionnaire included questions about factors affecting the choice of budesonide and assessing the prescription pattern of the drug. The doctors frequently declared use of budesonide in monotherapy in patients with croup, and in polytherapy in asthma and COPD (with salmeterol or formoterol and with formoterol, respectively). The most important factors affecting the choice of budesonide, as declared by doctors, were safety, efficacy, good personal experience with the use of this medication and recommendations of scientific associations. Budesonide in monotherapy was prescribed in 63.7%, 49.7%, and only 13.5% of patients with croup, asthma and COPD, respectively. The most important factors which determined the choice of this drug were safety (from 78.7% to 91.0%), efficacy (from 78.9% to 90.5%) and good personal experience of doctors (from 65.6% to 84.5%). Budesonide is still frequently chosen in the treatment of croup, asthma and COPD by Polish specialists and general practitioners because of its efficacy, safety and considerable experience in the application. Acquired clinical experience of physicians prevails over the issued recommendations of scientific societies regarding the use of budesonide in daily clinical practice.

Prognostic impact of treatment with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in the acute phase and medium-term on COVID-19 infected patients

Abstract Introduction The first case of COVID-19 infection was described in Wuhan, China, in December 20191. Shortly after, cases of limited human-to-human transmission were reported in other countries, which made the WHO declare the outbreak a Public Health Emergency of International Concern (ESPII) on January 30, 20202. Recent studies suggest that treatment with angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARAB) during acute COVID-19 infection has no effect on mortality3, but it is no evidence regarding the medium-term clinical implication of previous treatment with ACEI/ARAB on the prognosis of patients with COVID-19 infection. Purpose The aim of this study is to evaluate the clinical implication of the use of ACEI/ARB in the acute moment and in medium-term follow-up in patients after COVID-19. Methods It is a single-centre, retrospective, analytical observational study of cohorts based on all consecutive patients diagnosed with COVID-19 who were admitted during the first wave (March 10th until May 31st), of the pandemic in our health area. Survival analysis of main outcomes (mortality, heart failure, and major acute cardiovascular events [a composite of cardiovascular mortality, myocardial infarction and stroke]) were adjusted by multivariate logistic regression. Results Of the total population studied, 447,979 inhabitants, 1,030 (0.23%) were diagnosed with COVID-19 infection, of which 196 (19%) were under treatment with ACEI/ARB at the time of diagnosis. The main results showed that ACEI/ARB treatment (combined and individually) had no effect on mortality (Hazard Ratio [HR]: 1.64, 95% Confidence Interval [CI] 0.98 2.76, p=0.062), heart failure (HR: 0.98, 95% CI 0.53 1.79, p=0.942), thrombotic events (HR: 1.02, 95% CI 0.22 4.83, p=0.98) and major acute cardiovascular events (HR: 0.88, 95% CI 0.48 1.60, p=0.665). Conclusions In conclusion, previous treatment with ACEI/ARB in patients with COVID-19 had no effect on the 6-month prognosis, defined as mortality, heart failure, or major acute cardiovascular events. Withdrawal of ACEI/ARB in patients testing positive for COVID-19 would not be justified, in line with current recommendations of scientific societies and government agencies. Funding Acknowledgement Type of funding sources: None.

Which Milk during the Second Year of Life: A Personalized Choice for a Healthy Future?

Nutrition in early life is a crucial element to provide all essential substrates for growth. Although this statement may appear obvious, several studies have shown how the intake of micro and macronutrients in toddlers differs a lot from the recommendations of scientific societies. Protein intake often exceeds the recommended amount, while the intake of iron and zinc is frequently insufficient, as well as Vitamin D. Nutritional errors in the first years of life can negatively impact the health of the child in the long term. To date, no clear evidence on which milk is suggested during the second year of life is yet to be established. In this study, we compare the nutrient profiles of cow’s milk and specific formulas as well as nutritional risks in toddlers linked to growth and childhood obesity development. The purpose of this review is to resume the latest clinical studies on toddlers fed with cow’s milk or young children formula (YCF), and the potential risks or benefits in the short and long term.

Documento de consenso de la Sociedad Española de Cirugía Torácica (SECT). Seguimiento a largo plazo de los pacientes operados de cáncer de pulmón

The most effective treatment for lung cancer is complete lung resection, although recurrences reach up to 10% and the appearance of second neoplasms, up to 6%. Therefore, the follow-up of these patients will be essential for the early detection and treatment of these events; however, there is no definition of the form, time and cadence of these follow-ups. In this consensus document, we try to define them based on the available scientific evidence.A critical review of the literature is carried out (meta-analysis, systematic reviews, reviews, consensus recommendations of scientific societies, randomized controlled studies, non-randomized controlled studies, observational studies and case series studies) and communications to the main congresses on oncology and thoracic surgery in Spanish, English and French. The evidences found are classified following the GRADE system.It is defined according to the existing evidence that the patient resected for lung cancer should be followed up, as well as that this follow-up should be close during the first years and with CT (not being necessary to follow up with PET-CT, biomarkers or bronchoscopy). Cessation of smoking is also recommended in this follow-up.

P–790 Effects of COVID–19 quarantine period on Fertility Treatment and IVF Clinic management

Abstract Study question What are the effects of the initial COVID–19 response on the management of fertility clinics and clinical practice around the world? Summary answer In the COVID–19 outbreak, the large majority of fertility clinics worldwide suspended fertility treatments. In cycles that continued, there was a shift to frozen embryo-transfer. What is known already After the initial months of 2020 showed a rapid spread of the new Coronavirus SARS-CoV–2, the World Health Organisation declared a global pandemic on 11 March 2020. Occupation of health care facilities with acutely sick patients and the need to reduce infection transmission led to a reduction in capacity to perform elective medical procedures. Little was known on the global impact of COVID–19 on fertility care. With the implication of ‘lockdowns’ in different countries around the world to stop the spread of the virus, the question was posed on how fertility clinics and treatments would proceed moving forward. Study design, size, duration We surveyed fertility clinics with an online questionnaire developed through the platform RedCap (HELIX). The questionnaire contained 33 questions focused on the differences of country responses to different body guidelines including American Society for Reproductive Medicine (ASRM) and European Society of Human Reproduction and Embryology (ESHRE). Fertility clinic associates were contacted through the use of a known contact list comprising scientific directors, medical directors and lab managers. Participants/materials, setting, methods Study participants were individuals associated with fertility clinics around the world with at least one representative from each country. The questionnaire was active from 13th October 2020 until 21st January 2021. The time frame was specific to the country’s response to their first lockdown. The survey was approved by Monash Health Human Research Ethics Committee(#65223). All survey answers were anonymous with only the countries’ name as a reference for analysis. Main results and the role of chance There were 34 individual country responses,Asia(11), Europe(10), Africa(3), North America(3), Oceania(2) and South America(5). Of the 34 countries, 7 countries did not experience a complete stop of all procedures. Most countries (18) followed their government body recommendations. One country followed local recommendations, 3 followed local and international recommendations, 3 countries changed by clinic initiative and 7 countries did not specify. ASRM and ESHRE were the two most common guidelines mentioned. IVF/ICSI treatment had delays in 28 countries ranging from 14 (Scotland) to 160 (Egypt) days. FETs were delayed in 29 countries ranging from 15 (Pakistan) to 228 (Scotland) days. Couples undergoing timed intercourse experienced the least delay in treatment (13 countries). AI/OI (artificial insemination/ovulation induction) patients were delayed treatment in 25 countries, fertility consultations were delayed in 20 countries. During the quarantine period, the amount of freeze-all cycles increased in 16 countries with the ratio of IVF-ICSI remaining constant pre and post lockdown. Patients were reported to undergo a SARS-CoV–2 test in 17 countries. 11 countries reported having a procedure in place for patients whom tested positive, 6 countries reported no procedure in place for positive patients. Additional support counselling was offered for patients during the pandemic in 22 countries. Limitations, reasons for caution Our survey does only represent a minute sample of countries. As only one representative from each country was used, the results obtained are specific to the individual’s anonymous clinic. However, the questionnaire includes questions that specifies if the clinic was performing outside the country’s scientific society recommendations. Wider implications of the findings: During the COVID–19 pandemic most fertility services were suspended, providing insight to the implications of a shutdown and whether a protocol for scenarios of this nature could benefit outcomes for future events. A protocol that allows continuation of care,including telehealth and guidelines for prioritizing couples who need care most urgently. Trial registration number N/A

Pharmacological treatment of a depressive episode and recurrent depressive disorder - guidelines of the Polish Psychiatric Association and the National Consultant for Adult Psychiatry.

Under the auspices of the Polish Psychiatric Association and the National Consultant in Psychiatry, on the basis of analysis of international guidelines, the expert group consisting of psychiatrists and an epidemiologist compiled recommendations for the treatment of adepressive episode and recurrent depressive disorder. The recommendations take into account the information that the patient should receive before starting the treatment, the selection criteria for the treatment method and the choice of the antidepressant, the method of assessing the efficacy of treatment, treatment monitoring, and the duration of treatment. Formulating the recommendations, the experts analyzed the source data for their applicability in Poland. The current recommendations of scientific societies and an analysis of the literature on the treatment of depressive episodes and recurrent depressive disorder broken down by the treatment of acute episodes and maintenance treatment, as well as the recommendations on the method of creating guidelines have been taken into account. Furthermore, the guidelines developed in collaboration with the Supreme Medical Council and the Polish Psychiatric Association, entitled: "Diagnostic work-up and treatment of depression in adults - guidelines for family physicians", and recommendations of theNationalConsultantin Adult Psychiatry have been taken into account. The recommendations were discussed among the experts and accepted by the General Board of the Polish Psychiatric Association. Subsequently, the recommendations were modified in line with the Board's commentsand endorsed by the Association for use in the management of patients with depression in Poland.

Hepatitis C reflex testing in Spain in 2019: A story of success

BackgroundReflex testing is necessary to achieve the objectives of hepatitis C elimination. However, in 2017 only 31% of Spanish hospitals performed reflex test. As a consequence of that finding, reflex testing was recommended by scientific societies involved in the diagnosis and treatment of hepatitis C. ObjectiveTo evaluate the degree of implementation of reflex testing in 2019 and to know the implementation of rapid diagnostic and/or dried blood spot testing (RDT and / or DBS) in Spanish hospitals. MethodsCross-sectional study through a survey conducted in October 2019 to Spanish general hospitals with at least 200 beds, public or private with teaching accreditation. Results129 (80%) hospitals responded. Reflex testing is performed by 89% of the centres vs. 31% in 2017 (P<.001). From 2017 to 2019, centres using alerts to improve continuity of care increased from 69% to 86% (P=.002). In 2019, 11% of centres can determine anti-HCV in dried spot, 15% viremia in dried spot, 0.85% anti-HCV in saliva, and 37% of antibodies and/or viremia with point of care test. 43% of hospitals have at least one diagnostic method with RDT and/or DBS. ConclusionThe implementation of reflex testing has increased significantly, reaching 89% of hospitals in 2019. The recommendations of scientific societies could have contributed to the implementation of reflex testing. On the other hand, access to RDT and/or DBS is insufficient and initiatives are needed to improve their implementation.

COVID-19: coagulation disorders and anticoagulant treatment in patients hospitalised in ICU.

Patients hospitalized in the intensive care unit (ICU) due to the COVID-19 experience ahigh incidence (up to 43%) of venous thromboembolic events. While laboratory findings in COVID-19-associated coagulopathy (CAC) show increased D-dimer and fibrinogen levels, the abnormalities in standard coagulation tests and platelet count are minimal. Recent studies suggest contribution of fibrinolysis shutdown to this phenomenon. Endothelial injury and alteration of its antithrombotic activity can lead to micro- and macrovascular thrombosis in the lungs, occurrence of which is associated with poor clinical outcome in critically ill patients with COVID-19. Additionally, the hypercoagulability induced by activation of coagulation pathways during the immune response to SARS-CoV-2 infection contributes to impaired organ perfusion. This, alongside with hypoxemia, leads to multiorgan failure. Various diagnostic regimens, some of which include global assays of haemostasis, are currently being published and discussed. Numerous guidelines and recommendations of scientific societies and groups of specialists have been published. However, there is no single optimal algorithm for anticoagulation treatment and monitoring specific to the ICU patients with COVID-19. The authors have attempted to summarize the data related to CAC and thrombotic disease and develop an algorithm consistent with the latest clinical practice guideline recommendations.

Recommendations for use of the diverse tests for detection of SARS-COV-2 infection

En la actual crisis provocada por el SARS-CoV-2, surge la necesidad global de conocer y combatir el virus. Una de las estrategias es rastrear y diagnosticar los casos con el fin de aislar e interrumpir la cadena epidemiológica. Por ello, el objetivo de este artículo es describir las distintas pruebas diagnósticas más utilizadas y analizar su validez e indicaciones de uso según la evidencia científica y las principales recomendaciones de sociedades científicas y organismos de referencia nacionales e internacionales. Desde el inicio de la pandemia, la disponibilidad de test ha estado supeditada a las condiciones del propio mercado de fabricación y a las directrices marcadas en cada país. Entre los tipos de test más utilizados cabe destacar la PCR, los test de detección de anticuerpos (IgG e IGM) y anticuerpos totales (Ab), también conocidos como test rápidos, y los test de detección de antígenos en exudado nasofaríngeo u otras muestras respiratorias de vías altas/bajas. Para cada uno de estos test es necesario conocer sus recomendaciones de uso y el procedimiento para la toma de muestras, siendo fundamental para minimizar las alteraciones en los resultados debidas a una manipulación deficitaria. Asimismo, es necesario determinar el momento más adecuado para la toma de muestras y la adecuada interpretación de los resultados obtenidos, que siempre ha de ser considerada junto con la sintomatología del paciente para la toma de decisiones clínicas.

Imaging in large-vessel vasculitis

Imaging has recently been acknowledged as at least equivalent to histology for confirming large-vessel vasculitis in the recommendations of scientific societies. Many studies have been recently published on the use of ultrasound, magnetic resonance imaging (MRI), computed tomography (CT) and fluorodeoxyglucose (FDG) positron emission tomography (PET) in giant cell arteritis and Takayasu arteritis. Ultrasound, MRI and CT show concentric, arterial wall thickening in vasculitis. PET demonstrates enhanced FDG uptake of inflamed artery walls due to increased glucose metabolism. Ultrasound is particularly useful for smaller arteries like the temporal arteries due to its high resolution. MRI and PET/CT provide an excellent overview particularly on extracranial arteries. However, ultrasound can also detect extracranial vasculitis while PET/CT may delineate vasculitis in temporal arteries. The diagnosis needs to be confirmed without delay as the sensitivity of imaging decreases with treatment. Ongoing studies are evaluating the role of imaging for follow-up.

Transforming a surgical department during the outbreak of new coronavirus pandemic. Clinical implications.

BackgroundThe 2019 novel coronavirus (2019-nCoV) has caused an outbreak of the disease now officially named coronavirus disease 2019 (COVID-19). Since then, all hospitals have required a complete restructuring of their usual facilities and the treatments provided. Our goal was to detail the remodeling of a tertiary hospital during the COVID-19 outbreak and analyze pitfalls to avoid increasing surgical department burdens.MethodsThis was a retrospective analysis of data affecting patients during their admission in our institution during March 2020. Data from general admission, intensive care units, and elective and emergency surgeries were collected and analyzed. All patients who underwent a surgical procedure were reviewed to elucidate limitations in the deployment of the hospital transformation to a COVID-19 hospital.ResultsA total of 688 patients have been treated in our institution. Of those, 186 required intensive care. More than 120 new intensive care beds have been created during this period, and a decrease in elective surgeries of more than 75% was observed. Inadvertent COVID-19 patients accounted for 70%. Thirty percent of the patients who underwent surgery while infected with COVID-19 died in our institution.ConclusionsThe complete reorganization of surgical departments will be requested during the outbreak and adaptive solutions are needed in order to avoid increased mortality rates and infection among patients and to promote maximal optimization of surgical spaces. Timing, governmental decisions, and scientific society’s recommendations may be limitations in the efficient deployment of hospital transformations to COVID-19 facilities.

Role of wearable rhythm recordings in clinical decision making-The wEHRAbles project.

BackgroundMultiple wearable devices for rhythm analysis have been developed using either photoplethysmography (PPG) or handheld ECG.HypothesisThe aim of this survey was to assess impact of these technologies on physicians' clinical decision‐making regarding initiation of diagnostic steps, drug therapy, and invasive strategies.MethodsThe online survey included 10 questions on types of devices, advantages, and disadvantages of wearable devices as well as case scenarios for patients with supraventricular arrhythmias and atrial fibrillation (AF).ResultsA total of 417 physicians (median age 37 [IQR 32‐43] years) from 42 countries world‐wide completed the survey.When presented a tracing of a regular tachycardia by a symptomatic patient, most participants would trigger further diagnostic steps (90% for single‐lead ECG vs 83% for PPG, P < .001), while a single‐lead ECG would be sufficient to perform an invasive EP study in approximately half of participants (51% vs 22% for PPG, P < .001).When presented with a single‐lead ECG tracing suggesting AF, most participants (90%) would trigger further diagnostic steps. A symptomatic AF patient would trigger anticoagulation treatment to a higher extent as an asymptomatic patient (59% vs 21%, P < .001). PPG tracings would only rarely lead to therapeutic steps regardless of symptoms.Most participants would like scientific society recommendations on the use of wearable devices (62%).ConclusionsTracings from wearable rhythm devices suggestive of arrhythmias are most likely to trigger further diagnostic steps, and in the case of PPG recordings rarely therapeutic interventions. A majority of participants expect these devices to facilitate diagnostics and arrhythmia screening but fear data overload and expect scientific society recommendations on the use of wearables.

Impacto de los inhibidores de la enzima de conversión de la angiotensina y los antagonistas del receptor de la angiotensina II en la COVID-19 en una población occidental. Registro CARDIOVID

Introduction and objectivesCoronavirus disease (COVID-19) has been designated a global pandemic by the World Health Organization. It is unclear whether previous treatment with angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) affects the prognosis of COVID-19 patients. The aim of this study was to evaluate the clinical implications of previous treatment with ACEI/ARB on the prognosis of patients with COVID-19 infection. MethodsSingle-center, retrospective, observational cohort study based on all the inhabitants of our health area. Analyses of main outcomes (mortality, heart failure, hospitalization, intensive care unit [ICU] admission, and major acute cardiovascular events [a composite of mortality and heart failure]) were adjusted by multivariate logistic regression and propensity score matching models. ResultsOf the total population, 447 979 inhabitants, 965 patients (0.22%) were diagnosed with COVID-19 infection, and 210 (21.8%) were under ACEI or ARB treatment at the time of diagnosis. Treatment with ACEI/ARB (combined and individually) had no effect on mortality (OR, 0.62; 95%CI, 0.17-2.26; P=.486), heart failure (OR, 1.37; 95%CI, 0.39-4.77; P=.622), hospitalization rate (OR, 0.85; 95%CI, 0.45-1.64; P=.638), ICU admission (OR, 0.87; 95%CI, 0.30-2.50; P=.798), or major acute cardiovascular events (OR, 1.06; 95%CI, 0.39-2.83; P=.915). This neutral effect remained in a subgroup analysis of patients requiring hospitalization. ConclusionsPrevious treatment with ACEI/ARB in patients with COVID-19 had no effect on mortality, heart failure, requirement for hospitalization, or ICU admission. Withdrawal of ACEI/ARB in patients testing positive for COVID-19 would not be justified, in line with current recommendations of scientific societies and government agencies.

Practical recommendations for gynecologic surgery during the COVID-19 pandemic.

Surgery in suspected/confirmed COVID‐19 patients is a high‐risk venture. In infected patients, COVID‐19 is present in the body cavity. During surgery it could be nebulized in the spray generated by surgical instruments and could theoretically infect members of the surgical team. Nevertheless, some surgical gynecologic pathologies cannot be postponed. We present a list of the most frequent gynecologic diseases and recommendations on their surgical management during the COVID‐19 pandemic, based on expert opinion, current available information, and international scientific society recommendations to support the work of gynecologists worldwide. In brief, any kind of surgical treatment should be scrutinized and postponed if possible. Nonoperative conservative treatment including pharmacological therapies for hormone‐sensitive pathologies should be implemented. Health risk assessment by patient history and COVID‐19 test before elective surgery are pivotal to protect both patients and healthcare providers. In confirmed COVID‐19 patients or highly suspected cases, elective surgery should be postponed until full recovery.