Impact of SARS-CoV-2 pandemic on emergency department activity at the pediatric surgery unit of a third-level hospital. / Impacto en la actividad de Urgencias en el Servicio de Cirugía Pediátrica de un Hospital de tercer nivel durante la pandemia de SARS-CoV-2.

INTRODUCTION: As a result of the emergence of the SARS-CoV-2 respiratory virus in Wuhan in December 2019, the Spanish Government declared the state of emergency with restrictions such as stay-at-home lockdown. The objective of this study was to analyze emergency activity at a referral pediatric surgery unit in its territory and determine whether surgical pathologies had decreased or not. METHODS: A retrospective study of pediatric patients presenting at the emergency department and referred to the pediatric surgery unit from March 14, 2020 to April 20, 2020 was carried out. The results were compared with those from the same dates of the previous year. Demographic variables, pathologies, and management strategies were studied for each case. The number of patients with abdominal pain requiring surgical assessment was also analyzed. RESULTS: 161 patients were included - 91 from 2019 and 70 from 2020. Of the 2020 patients, 62 (88.6%) underwent surgery and 8 (11.4%) were admitted, whereas in 2019, patient distribution was 67 (73.6%) and 24 (26.4%), which means there were fewer admissions in 2020 (p= 0.018). There were no differences in terms of hours to emergency department consultation - just an increase in the case of appendicular pathologies in the 2020 period, with 24 [23-48] hours vs. 24 [12-30] hours (p =  0.045). CONCLUSION: The current pandemic has not caused emergency surgeries to decrease. It has only increased time to consultation in patients with appendicular pathologies.

INTRODUCCION: A raíz de la aparición del virus respiratorio SARS-CoV-2 en Wuhan en diciembre de 2019, el Gobierno de España decretó el estado de alarma con medidas que han incluido el confinamiento domiciliario. El objetivo de este trabajo es analizar la actividad urgente de un Servicio de Cirugía Pediátrica referente en su Comunidad Autónoma y comprobar si ha existido disminución o no en la patología quirúrgica. METODOS: Estudio retrospectivo de los pacientes pediátricos que acudieron a Urgencias y fueron derivados a Cirugía Pediátrica entre los periodos del 14 de marzo hasta el 20 de abril de 2020, comparándolos con aquellos que acudieron en las mismas fechas del año previo. Se analizaron variables demográficas, la patología y el tipo de manejo en cada caso. Se analizó también el número de pacientes con dolor abdominal que precisaron valoración quirúrgica. RESULTADOS: Se incluyeron 161 pacientes, de los que 91 acudieron en 2019 y 70 acudieron en 2020. De estos últimos, 62 (88,6%) fueron intervenidos y 8 (11,4%) fueron hospitalizados, mientras que en 2019 fueron 67 (73,6%) y 24 (26,4%), respectivamente, observando un menor número de ingresos en 2020 (p=  0,018). El número de horas de evolución hasta la consulta en Urgencias del total de pacientes no demostró diferencias, únicamente existió un aumento en los pacientes con patología apendicular en el periodo de 2020, 24 [23-48] respecto al periodo del año previo 24 [12-30] (p=  0,045). CONCLUSION: La situación actual de pandemia no ha provocado una disminución del número de intervenciones quirúrgicas urgentes. Únicamente aumentó el tiempo hasta la consulta en los pacientes con patología apendicular.

[Thyroid C cells are decreased in experimental CDH]. / Las células C tiroideas están disminuidas en la hernia diafragmática experimental.

BACKGROUND/AIM: Experimental CDH is often associated with malformations of neural crest origin. Several of these features are present in human CDH and therefore likely similar pathogenic mechanisms should be explored. The aim of the present study is to examine whether thyroid C-cells, another neural crest derivative, are abnormal in this rat model. METHODS: Pregnant rats were exposed either to 100 mg of 2-4-dichlorophenyl-p-nitrophenyl ether (nitrofén) or vehicle (controls) on 9.5 day of gestation. Fetuses were recovered on day 21st and the thyroids of those with CDH (68%) were immuno-histochemically stained with anti-calcitonin antibody. The number of positively stained cells per high power field were counted using a computer-assisted image analysis method in at least 5 sections per thyroid. The distribution of the cells within the gland was assessed as well. Comparisons between CDH and control rats were made by non-parametric tests with a significance threshold of p<0.05. RESULTS: The number of c-cells was dramatically reduced in CDH animals in comparison with controls (101.2 +/- 61.3 vs 23.1 +/- 37, p<0.0001). Histology of the thyroid was similar in both groups, but the distribution of positive C-cells within the gland followed an abnormal pattern in CDH rats with the cells tending to be located at the periphery rather than at the core of the lobes. CONCLUSIONS: Nitrofén induces a severe decrease in thyroid C cells accompanied by abnormal distribution patterns. These results add further evidence of the involvement of a neural crest dysregulation as a component of the pathogenesis of experimental CDH. Whether there is or not a clinical counterpart to these findings is still unknown, but the nature of the cardiovascular and craneo-facial malformations in some babies with CDH strongly support further research in this field.

[Hereditary amyotrophic neuralgia: two new cases]. / Neuralgia amiotrófica hereditaria: dos nuevos casos.

We report clinical and electrophysiologic findings for two members of a family with a history of hereditary amyotrophic neuralgia, emphasizing the early onset in both patients, the great variation in symptoms within the same family and the poor functional evolution of one patient, who suffered significant functional sequelae at the age of 17 years in spite of not having suffered recurrences since age 5, and without having experienced either clinical or neurophysiological improvement during the intervening years.