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      Experiencia del Servicio de Medicina Hiperbárica en el tratamiento con oxigenoterapia hiperbárica de pacientes COVID-19 Translated title: Lessons identified by the Hyperbaric Departament about the treatment for COVID-19 patients with hyperbaric oxygentherapy

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          Abstract

          RESUMEN Durante el periodo inicial de la pandemia de COVID-19, y debido a la saturación del sistema asistencial se planteó administrar tratamiento con oxigenoterapia hiperbárica (OHB) a pacientes con PCR + para COVID-19 o con alta sospecha clínica, radiológica y analítica en el Servicio de Medicina Hiperbárica (SMHB) del Hospital Central de la Defensa «Gómez Ulla» (HCD). Objetivos: asistir a pacientes que no respondían a tratamiento, así como comprobar la eficacia de la OHB como una herramienta útil para el tratamiento del COVID-19. Material y métodos: Se valoraron 11 peticiones de tratamiento con OHB, de pacientes procedentes de plantas COVID-19 y UCI, de los cuales finalmente se trataron únicamente a 6 pacientes. Se procedió al tratamiento en cámara multiplaza, entre 1,6 y 2 atmósferas de presión absoluta (ATA) y tiempo de exposición entre 90 y 105 minutos, con la presencia en todo momento de acompañante. Se diseñaron protocolos de protección biológica respiratoria y de contacto frente al coronavirus. Se realizaron controles analíticos y pruebas de imagen. Resultado y conclusiones: Se completaron 35 sesiones de tratamiento. Los pacientes recibieron entre 1 y 14 sesiones. No se produjo ningún caso de infección entre los sanitarios del servicio. Los pacientes que por su estado pudieron recibir más de 5 sesiones de OHB tuvieron una mejor evolución clínica. Se observaron reflejos de desaturación postratamiento con OHB.

          Translated abstract

          SUMMARY During the first period of the COVID-19 pandemic and due to saturation of the health care system, it was necessary to treat with hyperbaric oxygen therapy (HBO) (in the Hyperbaric Medicine Service at the Defence Central Hospital «Gómez Ulla» (HCD)), some patients with PCR (+) for COVID -19, or with clinical, radiological or analytical high indicative data. Objectives: to treat patients without positive answer to regular treatment and to check the effectiveness of HBO as useful therapy for COVID-19. Material and method: There were valued 11 requests for treatment from COVID-9 wards and the Intensive Care Department. Eventually 6 of those patients were treated. These patients were treated in a multiplace hyperbaric chamber between 1.6 and 2 ATAs and for 90 to 105 minutes of time, with ancillary personnel inside the chamber the whole sessions. There were also developed security protocols to prevent COVID-19 infection. Image and analytics controls were followed. Results and conclusions: 35 sessions of treatment were completed. The patients received from 1 to 14 sessions. It did not happen any case of infection on the medical personnel of the HBO Department. The patients which (due to their physical status) could receive 5 or more sessions had a better clinical evolution. Some desaturation reflexes were observed.

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          COVID-19 pandemic, coronaviruses, and diabetes mellitus

          The pandemic of coronavirus disease (COVID-19), a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is causing substantial morbidity and mortality. Older age and presence of diabetes mellitus, hypertension, and obesity significantly increases the risk for hospitalization and death in COVID-19 patients. In this Perspective, informed by the studies on SARS-CoV-2, Middle East respiratory syndrome (MERS-CoV), and the current literature on SARS-CoV-2, we discuss potential mechanisms by which diabetes modulates the host-viral interactions and host-immune responses. We hope to highlight gaps in knowledge that require further studies pertinent to COVID-19 in patients with diabetes.
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            Sex and Gender Disparities in the COVID-19 Pandemic

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              Hyperbaric Oxygen Therapy: Side Effects Defined and Quantified.

              Significance: Hyperbaric oxygen therapy (HBOT) is an important advanced therapy in the treatment of problem wounds, including diabetic foot ulcers and late effect radiation injury. HBOT remains among the safest therapies used today. Nonetheless, there are side effects associated with HBOT. It is important for providers to be able to identify, understand, and quantify these side effects for prevention, management, and informed consent. Recent Advances: The past two decades have seen significant advancements in our understanding of the underlying mechanisms of HBOT. This has led to a better understanding of the underlying reason for clinical benefit. It has also led to a better understanding of its side effects. Moreover, more recent literature allows for better quantification of these side effects. This review will highlight these side effects. Critical Issues: Wound healing in the case of problem nonhealing wounds requires the use of various advanced treatment modalities, including HBOT. HBOT has been shown to significantly improve healing rates in certain problem wounds, including advanced diabetic foot ulcers and late effect radiation injury. It is provided in a variety of clinical settings by providers with varying levels of expertise. It is important for those providing this therapy to understand the potential side effects. Future Directions: Research in HBOT has led to significant advancements in the area of wound healing. At the same time, there remains a variety of treatment protocols used at different institutions. It is important to quantify risk and benefit at different treatment pressures and times to better standardize treatment and improve patient care.
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                Author and article information

                Journal
                sm
                Sanidad Militar
                Sanid. Mil.
                Ministerio de Defensa (Madrid, Madrid, Spain )
                1887-8571
                June 2020
                : 76
                : 2
                : 57-63
                Affiliations
                [5] orgnameCentro de Buceo de la Armada
                [1] orgnameHospital Central de la Defensa Gómez-Ulla
                [3] orgnameHospital Central de la Defensa Gómez-Ulla
                [2] orgnameHospital Central de la Defensa Gómez-Ulla
                Article
                S1887-85712020000200002 S1887-8571(20)07600200002
                10.4321/s1887-85712020000200002
                1914f599-209b-4c32-b240-929f553292e9

                http://creativecommons.org/licenses/by/4.0/

                History
                : 19 August 2020
                : 01 June 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 18, Pages: 7
                Product

                SciELO Spain

                Categories
                Artículo Original

                HCD,hyperbaric oxygen therapy (OHB) and hyperbaric chamber,COVID-19,cámara hiperbárica,terapia oxigenación hiperbárica

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