Have acute appendicitis complications increased in children as a result of SARS-CoV-2? / ¿Han aumentado las complicaciones de las apendicitis agudas en niños por el impacto del SARS-CoV-2?

INTRODUCTION: The impact of the SARS-CoV-2 pandemic on healthcare has already been described, since it has caused an increase in diagnostic delay and morbidity. Our objective was to assess its influence on the development of complications in children with acute appendicitis. MATERIALS AND METHODS: A retrospective cohort study was carried out. It included acute appendicitis patients under 15 years of age treated from January 1, 2019 to December 31, 2020. They were classified according to diagnosis date as before the pandemic (B) (January 2019-February 2020) and during the pandemic (D) (March 2020-December 2020). According to operative findings, they were classified as complicated appendicitis (perforated/abscess/plastron/peritonitis) and non-complicated appendicitis (catarrhal/phlegmonous/gangrenous). Demographic data, progression time, and postoperative complications were analyzed. RESULTS: A total of 309 patients were included, 193 (62.5%) in Group B, and 116 (37.5%) in Group D, with an age of 9.2 ± 0.4 and 9.4 ± 0.6 years, respectively (CI = 95%). Diagnostic time was 1.35 and 1.43 days (p>0.05) in Groups B and D, respectively, with ≥ 3 days representing 15.5% of cases in Group B, and 16.4% of cases in Group D (p = 0.84). The proportion of complicated appendicitis was 23.3% in Group B vs. 21.6% in Group D (p>0.05). Postoperative complications were observed in 11.4% of patients in Group B, and in 13.8% of patients in Group D (p>0.05), with intra-abdominal abscess being the most frequent complication in both groups (54.5% of the total complications in Group B vs. 65.5% in Group D; p>0.05). CONCLUSIONS: The management of acute appendicitis and its complications in pediatric patients has not been impacted by the SARS-CoV-2 pandemic or the safety measures enforced.

INTRODUCCION: Se ha descrito el impacto de la pandemia del SARS-CoV-2 en la atención sanitaria, al suponer un aumento del retraso diagnóstico y morbilidad. Nuestro objetivo es evaluar su influencia en el desarrollo de complicaciones en las apendicitis agudas en niños. METODOLOGIA: Estudio retrospectivo de cohortes, incluyendo los pacientes menores de 15 años tratados por apendicitis aguda desde 01/01/2019 hasta 31/12/2020. Se distribuyeron según su fecha de diagnóstico en: antes de la pandemia (A) (enero/2019-febrero/2020) y durante la pandemia (P) (marzo-diciembre/2020). Según los hallazgos quirúrgicos se clasificaron en: apendicitis complicadas (perforadas/abscesos/plastrones/peritonitis) y no complicadas (catarrales/flemonosas/gangrenosas). Se analizaron datos demográficos, tiempo de evolución y complicaciones postoperatorias. RESULTADOS: Se incluyeron un total de 309 pacientes, 193 pacientes (62,5%) en el grupo A y 116 (37,5%) en el P, con edades de 9,2 ± 0,4 y 9,4 ± 0,6 años respectivamente (IC = 95%). Los días al diagnóstico fueron 1,35 y 1,43 (p>0,05) en A y P respectivamente, siendo ≥ 3 días en 15,5% de A y 16,4% en P (p = 0,84). La proporción de apendicitis complicada fue un 23,3% en A vs. 21,6% en P; con p>0,05. Se observaron complicaciones postoperatorias en 11,4% de A y 13,8% de P (p>0,05), siendo la más frecuente el absceso intraabdominal en ambos grupos (54,5% del total de complicaciones vs 65,5%; en A y P respectivamente; p>0,05). CONCLUSIONES: La atención sanitaria de la apendicitis aguda y sus complicaciones en pacientes pediátricos no se ha visto modificada por la pandemia del SARS-CoV-2 o las medidas de seguridad adoptadas durante la misma.

Pandemic's impact on inguinal hernia management in infants. / Impacto de la pandemia en el manejo de la hernia inguinal en lactantes.

INTRODUCTION: The SARS-CoV-2 pandemic brought about a reduction in surgical activity. The objective of this work was to analyze its impact on inguinal hernia morbidity. MATERIAL AND METHODS: A retrospective study of cases and controls was carried out. Patients under 18 months of age undergoing inguinal hernia surgery from January 1, 2019 to August 31, 2020 were included. They were divided into two groups: patients undergoing surgery before (group A) or after (group D) the state of alarm was declared in Spain. Primary variables: episodes of incarceration and postoperative complications. Secondary variable: urgent or scheduled surgery. Demographic variables: sex, gestational age (GA), previous pathologies, age at diagnosis (AD), and age at surgery (AS) (months). RESULTS: 64 patients were included - 43 in group A and 21 in group D. In group A, median GA was 37+3, 90.5% of patients were male, median AD was 2.33, and median AS was 3.27. In group D, median GA was 31+2, 72.1% of patients were male, median AD was 3, and median AS was 3.63. There were no statistically significant differences. However, differences in terms of previous pathologies were significant (16.3% for Group A vs. 38.1% for group D) (p = 0.05). Regarding the primary variable, 25.6% of patients in group A had incarcerations vs. 33.3% of patients in group D (p = 0.51), whereas 9.3% of patients in group A had postoperative morbidity vs. 14.3% of patients in group D (p = 0.41). Regarding the secondary variable, 88.4% of surgeries in group A were scheduled vs. 90.5% of surgeries in group D (p = 0.583). CONCLUSION: In spite of reduced surgical activity, inguinal hernia morbidity did not surge in our environment. An increase in patients with previous pathologies was noted, which means severe patients should be prioritized.

INTRODUCCION: La pandemia del SARS-CoV-2 supuso una reducción de las jornadas quirúrgicas. Analizamos el efecto en la morbilidad de la hernia inguinal. MATERIAL Y METODOS: Estudio retrospectivo de casos y controles. Incluimos menores de 18 meses intervenidos de hernia inguinal desde 01/01/2019 hasta 31/08/2020, divididos en 2 grupos: intervenidos antes (grupo A) o después (grupo D) de la declaración del estado de alarma. Variables principales: episodios de incarceraciones y complicaciones postoperatorias. Variable secundaria: intervención urgente o programada. Variables poblacionales: sexo, edad gestacional (EG), patología previa, edad al diagnóstico(ED) y a la intervención (EI) (meses). RESULTADOS: Incluimos 64 pacientes, 43 grupo A y 21 grupo D. En el grupo A la mediana de EG fue 37+3, el 90,5% fueron varones, la mediana ED fue 2,33 y EI 3,27. En el grupo B la mediana de EG fue 31+2, el 72,1% fueron varones, la mediana ED fue 3 y EI 3,63. No hubo diferencias estadísticamente significativas. Si fueron significativas las diferencias en patología previa 16,3% A y 38,1% D (p = 0,05). Sobre la variable principal: 25,6% del A sufrieron incarceraciones frente a 33,3% del D (p = 0,51) y un 9,3% tuvieron morbilidad postoperatoria en A frente a 14,3% en D (p = 0,41). Respecto a la variable secundaria un 88,4% se realizaron de forma programada en el grupo A y un 90,5% en el grupo D (p = 0,583). CONCLUSION: Pese a la reducción de jornadas quirúrgicas no ha aumentado la morbilidad de la hernia inguinal en nuestro medio. Hemos observado un aumento de pacientes con patología previa, implicando la priorización de los pacientes más graves.

Presence of SARS-CoV-2 on food surfaces and public space surfaces in three districts of Lima, Peru

The aim of this study was to determine the presence of SARS-CoV-2 on food surfaces and surfaces in public spaces in 3 districts of Lima, Peru. A cross-sectional descriptive study was carried out in three districts of the Lima metropolitan area. Surfaces that were most exposed to users were selected. Samples were swabbed for 4 weeks and transported to the laboratory to determine the presence of the virus. One thousand ninety-five inert surface samples and 960 food surface samples were evaluated for the identification of SARS-CoV-2 by the real time-PCR molecular test, whereby only one sample from an automated teller machine was positive. Most of the inert and food surfaces evaluated did not show the presence of SARS-CoV-2 during the time of sample collection. Despite the negative results, the frequency of disinfection and hygiene measures on high-contact surfaces should be maintained and increased to prevent other highly contagious infectious diseases.

Amebic liver abscess in rat: morphological evidence of innate immune modulation by the sympathetic nervous system / Absceso hepático amebiano en rata: evidencia morfológica de la modulación de la respuesta inmune innata por el sistema nervioso simpático

All organs of the immune system are innervated and almost all neurotransmitter receptors are present on immune cells. We studied the effects of sympathetic innervation in the development of amebic liver abscess (ALA) in rats. Our results showed that lack of sympathetic innervation promote a decrease in size of ALA. We found scarce amoebas, increased the number of neutrophils and a few collagen fibers surrounding the abscess, meanwhile in control group, we observed abscesses areas with typical necrosis including trophozoites and neutrophils. Macrophages were differentially distributed surrounding abscess area in control and vehicle groups, but equally located in and outside of the abscesses in sympathectomized rat. No significant differences were observed on NK cells in analysed groups. In cytokines quantification studies, we observed down-expression of IFN-g and TNF-a, moreover, we found overexpression of IL-10 in sympathectomized and ALA group. In conclusion, our results suggest that elimination of sympathetic nerve fibers in a model rat of amebic liver abscess induces reduction of the innate immune response and presence of amebas through the liver at seven days post-inoculation.

Todos los órganos del sistema inmune están inervados y casi todos los receptores para neurotransmisores están presentes en las células de la respuesta inmune. Nosotros estudiamos el efecto de la inervación simpática en el desarrollo del Absceso Hepático Amebiano (AHA) en ratas. Nuestros resultados muestran que la inervación simpática promueve una disminución en el tamaño del AHA. Nosotros encontramos áreas fibróticas bien definidas con algunas amibas, mayor número de neutrófilos y pocas fibras de colágena rodeando el área de daño, mientras que en el grupo control, nosotros observamos áreas con necrosis, trofozoítos y pocos neutrófilos en el área fibrótica. Los macrófagos se observaron distribuidos en el área fibrótica en los animales simpatectomizados, mientras que en los controles encontramos a los macrófagos distribuidos en la periferia del absceso. No se encontró diferencia significativa en la distribución y cantidad de células NK. En el estudio de citocinas nosotros observamos una disminución de IFN-g y TNF-a y un incremento de IL-10 en animales simpatectomizados. En conclusión, nuestros resultados sugieren que la eliminación de las fibras del sistema nervioso simpático en el modelo de AHA en rata, reduce la respuesta inmune innata y persisten amebas en el tejido dañados a los 7 días post-inoculación.

Modulation of amoebic hepatic abscess by the parasympathetic system.

The neuro-immune network, in which the vagus nerve is involved, provides feedback between its afferent branches for signalling central nervous system from sites of injury through cytokines and its efferent branches, which release acetylcholine, an anti-inflammatory neurotransmitter. For gain insight into the parasympathetic mechanisms participating in the inflammatory response in the liver, we studied the effects of a vagotomy on the innate immune response in hamsters with amoebic liver abscess. At 7 days post-infection, compared to the control, liver parasympathectomy resulted in a larger abscess size, a greater production of collagen fibres, fewer trophozoites, increased serum levels of IL-10 and IFN-γ and increased numbers of IL-10 and IFN-γ-positive cells in situ, with no change in the number of macrophages and NK cells. Data indicate that the vagotomy disrupted the inflammatory response, causing an increase in the response against infection, then could favour the innervation of the liver by the sympathetic nervous system and would then take the control of the immune response by stimulating the conversion of macrophages to epithelioid cells; and through increased IL-10 production would induce the hepatic stellar cells to become myofibroblast collagen producer cells, thus forming a barrier of collagen and blocking trophozoite migration.

Cleaner production and methodological proposal of eco-efficiency measurement in a Mexican petrochemical complex.

Abstract In the frame of the Petróleos Mexicanos Institutional Program for Sustainable Development, processes were evaluated in the manufacture operation of the petrochemical industry, with the purpose of reducing their ecological fingerprint. Thirteen cleaner production opportunities were registered in six process plants: ethylene oxide and glycols, acetaldehyde, ethylene, high density polyethylene, polypropylene switch and acrylonitrile, and 45 recommendations in the waste water treatment plant. Morelos is the second most important petrochemical complex in the Mexican and Latin American petrochemical industry. A tool was developed to obtain eco-efficiency indicators in operation processes, and as a result, potential savings were obtained based on best performance, as well as the integrated distribution of Sankey diagrams. Likewise, a mechanism of calculation to obtain economic savings based on the reduction of residues during the whole productive process is proposed. These improvement opportunities and recommendations will result in economic and environmental benefits minimising the use of water, efficient use of energy, raw materials and reducing residues from source, generating less environmental impacts during the process.

Removal of chromium hexavalent from rinsing chromating waters electrochemical reduction in a laboratory pilot plant.

In this work, experiments in a 16 L operating volume laboratory pilot plant with ring iron rotary electrodes were performed, obtaining an overall kinetic equation rate of hexavalent chromium reduction concentration and current density-dependent. Other scale-up criteria such as Reynolds' number were also evaluated to ensure a completely stirred reactor at low energy expenditure. A dimensionless N(E) is a relationship between liquid properties and the electric charge supplied to the system. The number, which depends on the rotation iron ring electrode speed number and the current density, is proposed to be used as scale-up criterion. It was found that at N(Re) = 42,179 (130 rpm rotation electrodes rate) and at N(E) = 9.8 x 10(5) (current density of 113 A/m2), complete mixing was reached at minimum energy spent and the process becomes more efficient. In addition, it was found that the higher the current density, the less treatment time and less energy spent on agitation. After the electrochemical treatment the Cr(VI) concentration in the rinsing wastewater was less than 0.5 mg/L.

Recurrence of desmoid tumor in a multivisceral transplant patient with Gardner's syndrome.

BACKGROUND: Desmoid tumors are locally invasive fibromatous tumors, which, in patients with Gardner's syndrome, usually occur in the abdominal wall or intra-abdominally. After excision, they tend to recur, often leading to multiple bowel resections. METHODS: This is a report of the clinical course of a patient with Gardner's syndrome and desmoid tumor who had multiple enterectomies and gradually developed short-gut syndrome. He required prolonged parenteral nutrition, which damaged the liver. The patient underwent a multivisceral transplantation as a life-saving procedure. RESULTS: After the transplant, the desmoid tumor recurred in the thoracic wall twice and was successfully resected. It also recurred in the abdominal cavity, compressing the intestinal loops; the tumor was excised uneventfully, leaving the graft intact. The recurrent tumors were all of recipient origin. CONCLUSIONS: Intestinal and multivisceral transplantation could be considered in patients with short-gut syndrome caused by recurrent desmoid tumor. In the case of posttransplant tumor recurrence, resection is the only option recommended.

Induction of alkalinization in cultured renal cells (MDCK line) by prostaglandin E2.

The effect of prostaglandin E2 (PGE2), on the intracellular pH (pHi) in BCECF-loaded Madin Darby Canine Kidney (MDCK) cells was investigated. PGE2 elevated the pHi. Under resting conditions, pHi of MDCK cells suspended in PBS at pH 7.4 was 7.11 +/- 0.08; PGE2 increased pHi with an EC50 of 0.16 microM. PGF2 alpha elicited a similar response to PGE2, with an EC50 of 0.24 microM. Amiloride (0.4 mM) reversed the response to PGE2 (control 7.18 +/- 0.05; PGE2 7.26 +/- 0.05; after amiloride 7.18 +/- 0.05). In MDCK cells exposed to a Na(+)-free solution, alkalinization induced by this eicosanoid was blocked (Ringer-choline 7.16 +/- 0.03; PGE2 7.16 +/- 0.02). PGE2 increased by 100% the rate of recovery after an acidification pulse with ammonium chloride. In the presence of Ringer-HCO3- (pH 7.4), there was a delay in the maximal response to this prostaglandin (PBS 2.2 +/- 0.27, Ringer-bicarbonate 3.4 +/- 0.55 min) and the pHi increment was less marked than in PBS (0.09 pH units in HCO3- versus 0.16 pH units in PBS; P < 0.001). This effect of PGE2 was not blocked by 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid (1.0 mM). PMA (100 nM), activator of protein kinase C, mimicked the response to PGE2, suggesting the participation of this kinase on the effect of the prostanoid. As expected, two inhibitors of protein kinase C, staurosporine and sphingosine, abolished the response to PGE2. Staurosporine (0.10 microM), an inhibitor of protein kinase C, blocked the response to PGE2 (control 7.02 +/- 0.04; PGE2 and staurosporine 7.03 +/- 0.04, n = 9, not significant). Sphingosine, another inhibitor of protein kinase C, also blocked the response to PGE2. Two analogues of cAMP did not modify the pHi. In summary, PGE2 induced an intracellular alkalinization via stimulation of a Na+/H+ exchanger, with the participation of protein kinase C, in MDCK cells.

[Cutaneous leukocytoclastic vasculitis as a marker of systemic diseases]. / Vasculitis leucocitoclástica cutánea como marcador de enfermedades sistémicas.

Fifty-eight patients with cutaneous leukocytoclastic vasculitis were evaluated. The most frequent cutaneous manifestation was purpura, followed by palpable purpura. Vascular inflammation was confirmed by skin biopsy: two distinct patterns of cellular infiltrate were found, a neutrophilic-predominant and a mononuclear-predominant type, as a manifestation of the dynamic evolution of the process. On the basis of the associated disease we grouped our cases as follows: autoimmune disease, reaction, malignancy, infection and idiopathic.