Impact of a delayed presentation to the emergency department for acute renal colic on biochemical and clinical outcomes.

INTRODUCTION AND OBJECTIVE: To verify the impact of delay on biochemical and clinical outcomes for patients presenting to the emergency department (ED) with acute renal colic. MATERIALS AND METHODS: Data were retrospectively collected from three institutions of two European countries between 01 January and 30 April 2020. Patients who presented to the ED with unilateral or bilateral renal colic caused by urolithiasis confirmed by imaging tests during the study period were included. A presentation after 24 h since the onset of symptoms was considered a delay. Patients presenting before 24 h from the symptom onset were included in Group A, while the patients presenting after 24 h in Group B. Clinical and biochemical parameters and management were compared. RESULTS: A total of 397 patients who presented to ED with confirmed urolithiasis were analyzed (Group A, n = 199; Group B, n = 198. The median (IQR) delay in presentation was 2 days (1,5-4). At presentation, no statistically significant differences were found amongst the two groups of patients regarding presenting symptoms such as fever and flank pain, and the median serum levels of creatinine, C reactive protein and white blood cells. No differences were found in terms of conservative or operative management. CONCLUSION: Delay in consultation >24 h is not associated with worsening biochemical parameters and clinical outcomes. Most patients with acute loin pain do not necessarily need urgent attendance to the ED and may be managed in the outpatients.

Evaluación de las tendencias y presentación clínica de pacientes con cólico nefrítico que acuden al servicio de urgencias durante la era pandémica del COVID-19 / Assessment of trends and clinical presentation in the emergency department of patients with renal colic during the COVID-19 pandemic era

INTRODUCCIÓN: Nuestra hipótesis es que la pandemia por COVID-19, y el estado de alarma impuesto por los gobiernos, pueden haber retrasado las visitas a urgencias por cólicos nefríticos, debido al miedo a contagiarse en los centros sanitarios. Este atraso en acudir a los servicios de urgencias puede llevar a un empeoramiento clínico y aumentar las complicaciones relacionadas con la enfermedad o el tratamiento recibido. MATERIAL Y MÉTODOS: Realizamos una revisión retrospectiva de 3 centros hospitalarios en España e Italia. Fueron incluidos pacientes atendidos en el servicio de urgencias por cólico renal (unilateral o bilateral) secundario a litiasis confirmadas en pruebas de imagen durante los 45 días previos y posteriores a la declaración del estado de alarma de cada país. Se recolectaron datos demográficos, síntomas y signos de presentación, análisis de sangre y orina, pruebas de imagen, y manejo terapéutico. El análisis estadístico se realizó entre dos grupos, Grupo A: pacientes que acudieron antes de la declaración del estado de alarma y Grupo B: pacientes que acudieron tras la declaración del estado de alarma. RESULTADOS: Un total de 397 pacientes que acudieron a urgencias por cólicos nefríticos secundarios a litiasis fueron incluidos en el estudio, 285 (71,8%) en el Grupo A y 112 (28,2%) en el Grupo B (p < 0,001). Un total de 135 (47,4%) en el Grupo A y 63 (56,3%) en el Grupo B (p = 0,11) admitieron haber pospuesto su búsqueda de atención médica urgente. En el momento de la valoración inicial, no se encontraron diferencias entre ambos grupos en los niveles de creatinina sérica, leucocitosis, fiebre, oliguria, dolor, o hidronefrosis. Además, no se observaron diferencias en relación con la estancia media, ingreso en el servicio de urología, o necesidad de tratamientos invasivos. CONCLUSIÓN: Nuestros resultados muestran una disminución significativa de atenciones en urgencias por cólicos nefríticos tras la declaración del estado de alarma en España e Italia. A diferencia de otros estudios publicados recientemente, no encontramos diferencias en la estancia media, ingreso al servicio de urología, o necesidad de tratamientos invasivos en pacientes que se presentaron antes y después del estado de alarma

INTRODUCTION: We hypothesized that the recent COVID-19 pandemic may lead to a delay in renal colic patients presenting to the Emergency Department due to the fear of getting infected. This delay may lead to a more severe clinical condition at presentation with possible complications for the patients. MATERIAL AND METHODS: Retrospective review of data collected from three institutions from Spain and Italy. Patients who presented to Emergency Department with unilateral or bilateral renal colic caused by imaging confirmed urolithiasis during the 45 days before and after each national lockdown were included. Data collected included patients’ demographics, biochemical urine and blood tests, radiological tests, signs, symptoms and the therapeutic management. Analysis was performed between two groups, Group A: patients presenting prior to the national lockdown date; and Group B: patients presenting after the national lockdown date. RESULTS: A total of 397 patients presented to Emergency Department with radiology confirmed urolithiasis and were included in the study. The number of patients presenting to Emergency Department with renal/ureteric colic was 285 (71.8%) patients in Group A and 112 (28.2%) patients in Group B (p < 0.001). The number of patients reporting a delay in presentation was 135 (47.4%) in Group A and 63 (56.3%) in Group B (p = 0.11). At presentation, there were no statistical differences between Group A and Group B regarding the serum creatinine level, C reactive protein, white blood cell count, fever, oliguria, flank pain and hydronephrosis. In addition, no significant differences were observed with the length of stay, Urology department admission requirement and type of therapy. CONCLUSION: Data from our study showed a significant reduction in presentations to Emergency Department for renal colic after the lockdown in Spain and Italy. However, we did not find any significant difference with the length of stay, Urology department admission requirement and type of therapy

Assessment of trends and clinical presentation in the emergency department of patients with renal colic during the COVID-19 pandemic era. / Evaluación de las tendencias y presentación clínica de pacientes con cólico nefrítico que acuden al servicio de urgencias durante la era pandémica del COVID-19.

INTRODUCTION: We hypothesized that the recent COVID-19 pandemic may lead to a delay in renal colic patients presenting to the Emergency Department due to the fear of getting infected. This delay may lead to a more severe clinical condition at presentation with possible complications for the patients. MATERIAL AND METHODS: Retrospective review of data collected from three institutions from Spain and Italy. Patients who presented to Emergency Department with unilateral or bilateral renal colic caused by imaging confirmed urolithiasis during the 45 days before and after each national lockdown were included. Data collected included patients' demographics, biochemical urine and blood tests, radiological tests, signs, symptoms and the therapeutic management. Analysis was performed between two groups, Group A: patients presenting prior to the national lockdown date; and Group B: patients presenting after the national lockdown date. RESULTS: A total of 397 patients presented to Emergency Department with radiology confirmed urolithiasis and were included in the study. The number of patients presenting to Emergency Department with renal/ureteric colic was 285 (71.8%) patients in Group A and 112 (28.2%) patients in Group B (p<0.001). The number of patients reporting a delay in presentation was 135 (47.4%) in Group A and 63 (56.3%) in Group B (p=0.11). At presentation, there were no statistical differences between Group A and Group B regarding the serum creatinine level, C reactive protein, white blood cell count, fever, oliguria, flank pain and hydronephrosis. In addition, no significant differences were observed with the length of stay, Urology department admission requirement and type of therapy. CONCLUSION: Data from our study showed a significant reduction in presentations to Emergency Department for renal colic after the lockdown in Spain and Italy. However, we did not find any significant difference with the length of stay, Urology department admission requirement and type of therapy.

A modular micromachined high-density connector system for biomedical applications.

This paper presents a high-density, modular, low-profile, small, and removable connector system developed using micromachining technologies for biomedical applications. This system consists of a silicon or polyimide electrode with one end in contact with the biological tissue and its back-end supported in a titanium base (12.5 mm in diameter and 2.5 mm in height) that is fixed on the test subject. An external glass substrate (6 x 6 x 0.75 mm3), which supports a flexible polyimide diaphragm and CMOS buffers, is attached to the titanium base whenever electrical contact is required. The polyimide flexible diaphragm contains high-density gold electroplated pads (32 pads, each having an area of 100 x 100 micron 2 and separated by 150 microns) which match similar pads on the electrode back-end. When vacuum is applied between the two, the polyimide diaphragm deflects and the corresponding gold pads touch, therefore, establishing electrical connection. In vitro electrical tests in saline solution have been performed on a 32-site connector system demonstrating < 5 omega contact resistance, which remained stable after 70 connections, and -55 dB crosstalk at 1 kHz between adjacent channels. In vivo experiments have also confirmed the establishment of multiple contacts and have produced simultaneous biopotential recordings from the guinea pig occipital cortex.

Pathways of lymph flow through intestinal lymph nodes in the horse.

In the horse, several thousand lymph nodes receive lymph from the intestine, part of which is very large and contains microorganisms that enable the animal to utilize refractory dietary constituents such as cellulose. The aim of this study was to describe the pathways by which lymph is delivered into, traverses, and is drained from these lymph nodes. These pathways were studied with either Microfil or methacrylate casting materials and with light and electron microscopy. The afferent lymphatic vessel delivering lymph into one of the nodes divides over the capsular surface and within trabeculae into terminal branches, and these are continuous with the subcapsular and trabecular sinuses through rounded holes up to 30 microns across. Lymph is conveyed from the subcapsular and trabecular sinuses through the cortex by four types of sinuses: trabecular sinuses, cortical tubular sinuses, tubule-like sinuses with a network of stellate cell processes, and sinuses between cortical cords. It is conveyed through the medulla by sinuses both within and between medullary cords. Lymph is drained from these sinuses by initial efferent lymphatics of three types: those between medullary cords, those within the subcapsular sinus overlying medullary or cortical cords, and those within trabeculae. All three types are continuous with surrounding sinuses through holes 5-30 microns across. These three alternative routes for lymph drainage may ensure adequate lymph flow during different intranodal conditions that may exist when the node is responding to microorganisms or other foreign materials.

Relationships between lymphoid nodules and lymph sinuses in lymph nodes: a study in horses.

Secondary lymphoid nodules in lymph nodes of the horse are surrounded by a network of lymph sinuses, including the subcapsular sinus and its extensions around tabeculae, tubular and tubule-like sinuses deeper in the cortex, and sinuses between cord-like projections of cortical tissue. The precise role of this close association between sinuses and nodules in the transport of immune complexes, cells and cytokines is not known.

Pathways of lymph flow from the intestine of the horse.

The intestine of horses differs from that of most other domestic animals in having a huge ascending colon and cecum, which together act as a large fermentation vat. The lymph drainage from this intestine occurs through a complex network of lymph vessels and lymph nodes, of which there are several thousand. The pathways taken by lymph through these vessels and nodes were studied by tracing injections of dye, by examining Microfil casts, and with light and transmission electron microscopy. Lymph vessels transporting lymph from the intestinal wall generally terminate on a single node within a group of primary nodes. Efferent lymphatics form networks in the immediate vicinity of groups of nodes. In these networks, the vessels branch, anastomose, entwine amongst one another, and sometimes form recirculating loops. Usually 2-9 lymphatic vessels course away from these networks to secondary or higher-order nodes in both local and more central locations. Vessels reaching these nodes generally terminate on more than one node within each group. This pattern of lymph distribution is repeated as lymph passes through a succession of five or more nodes before flowing into the cisterna chyli. The complexity of the lymph pathways, it is suggested, would promote the mixing of lymph from different parts of the intestine and from different nodes, thus collating, integrating, and potentiating the immunological responses of these nodes. The walls of lymphatic vessels are well endowed with smooth muscle cells and elastic fibres, suggesting that intrinsic contractility of these vessels is a major mechanism in the propulsion of lymph from the intestine of the horse.