Clinical Consensus Recommendations Regarding Non-Invasive Respiratory Support in the Adult Patient with Acute Respiratory Failure Secondary to SARS-CoV-2 infection

Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four Spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials.

[Lung hypoplasia in the adult: description, pathogenesis and review]

The lung hypoplasia is a very few frequent entity characterized by a detention in the lung development that leads to a poor development of this organ. Habitually this disease is diagnosed in the childhood and there are very few cases that pass unknown, being detected in the mature age (> 18 years). We present four cases of diagnoses adult patients of lung hypoplasia for diverse test (imaging or invasive) that consulted for not specific symptoms, mostly related with infections of the lung and their later evolution over the years. We also review the pathogenesis, etiology and malformations associated of this disease as well as a review of the published articles in this age group.

[The clinical applications of serum tumor markers in gastroenterology]

Serum tumors markers tests have five potential uses; the value of a given tests depends on its sensitivity and specificity. As a rule tumor markers have no use as screening tests except for alpha-fetoprotein in hepatocarcinoma which value has been established, for monitoring treatment and for detecting relapse. On the other hand the highest value for carcino-embryonic antigen tests lies on the early detection of colonic cancer relapse. Ca 19-9 assay has a high sensitivity and specificity in diagnosis of pancreatic cancer and a high predictive value in unresectable disease. Low serum Testosterone/dihydrotestosterone ratio is useful in diagnosis pancreatic carcinoma. There is no useful marker for diagnosis of gastric cancer.