Abstract INTRODUCTIONSARS-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. OBJECTIVEEstimate baseline cerebral hemodynamic patterns, cerebral hemodynamic reserve, and breath-holding index in recovered COVID-19 patients. METHODWe 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). RESULTSThere 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). CONCLUSIONSPatients 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.

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.

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.

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.

Introducción: El personal no sanitario de centros hospitalarios tiene una importante credibilidad a nivel poblacional, siendo un grupo generador de opinión sin formación sanitaria adecuada. Objetivo: Analizar la actitud hacia la donación de los órganos de los profesionales no sanitarios de hospitales españoles y latinoamericanos, y determinar los factores que condicionan dicha actitud. Material y métodos: Del Proyecto Colaborativo Internacional Donante se selecciona una muestra aleatoria y estratificada entre los servicios no sanitarios de once hospitales: 3 españoles (n = 277), 5 mexicanos (n = 632), 2 cubanos (n = 42) y 1 costarricense (n = 101). Resultados: De los 1052 profesionales encuestados, el 72 % (n = 754) está a favor de la donación de órganos tras fallecer. Por país, el 98 % de los cubanos están a favor, el 80 % de los mexicanos, el 66 % de los costarricenses y el 52 % de los españoles (p < 0,001). Las variables con más peso son: 1) país, siendo más favorable en México (odds ratio [OR] = 2,197); 2) creer en la posibilidad de necesitar un trasplante (OR = 2,202); 3) haber comentado el tema con la familia (OR = 3,23); 4) actitud favorable de la pareja hacia la donación (OR = 3,322); 5) no estar preocupado por la posible mutilación del cuerpo tras la donación (OR = 3,378); 6) preferir otras opciones distintas de la inhumación (OR = 2,525); 7) aceptar la realización de una autopsia (OR = 2,958). Conclusiones: La actitud hacia la donación de órganos propios entre el personal no sanitario de centros hospitalarios presenta variaciones importantes según el país del encuestado. Los factores psicosociales que condicionan dicha actitud son similares a los descritos a nivel poblacional.

This is the male case aged 59 diagnosed with left hypernephroma and thrombosis of the inferior vena cava with extension to right atrium. A multidisciplinary staff performed a left radical nephrectomy, exposition of inferior vena cava using the piggyback technique, right atriotomy and inferior cavotomy for extension of thrombus and previous clamping of right renal vein and hepatic hilus. The total surgical time was of 7 hours and 30 minutes. The procedure was performed under general anesthesia and a minimal period of cardiopulmonary shunt. Standardized transoperative monitoring of vital parameters was used and also transesophageal echocardiography to detect the total removal of thrombus and its extraction, as well as the potential detached emboli. The transoperative and postoperative course was satisfactory. A review of the international medical literature on this subject was made offering conclusions.

Se presenta el caso de un hombre de 59 años con diagnóstico de hipernefroma izquierdo y trombosis de la vena cava inferior con extensión hacia la aurícula derecha. Un equipo multidisciplinario realizó una nefrectomía radical izquierda, exposición de la vena cava inferior con técnica de piggyback, atriotomía derecha y cavotomía inferior para extracción del trombo, previo pinzamiento de la vena renal derecha y el hilio hepático. El tiempo quirúrgico total fue de 7 h 30 min. El procedimiento se realizó con anestesia general y un período mínimo de derivación cardiopulmonar. Se utilizó monitorización transoperatoria estandarizada de los parámetros vitales y además ecocardiografía transesofágica para la detección de la remoción completa del trombo y su extracción, así como posibles émbolos desprendidos. La evolución transoperatoria y posoperatoria fue satisfactoria. Se realiza una revisión de la literatura médica internacional sobre el tema y se ofrecen conclusiones.