Base Excess Research Articles

Severe Traumatic Brain Injury Induced Coagulopathy in Pediatric: An Important Lesson with Literature Review

Children with coagulopathy had a greater mortality rate after moderate to severe traumatic brain injury (TBI). The purpose of the current study was to examine the most recent relevant literature in relation to the therapy of TIC in pediatric isolated severe TBI patients. A 5 years old boy presented to emergency department with decrease of consciousness after hit by a motorcycle. He was referred from the district hospital without proper stabilization within 3 hours after the injury. From the blood examination, hemoglobin level was 8.1 g/dl, base deficit -9.9mEq/L with PTT and aPTT no coagulation suggesting coagulopathy. Emergency non-contrast head computed tomography was performed and showed anterior skull base fracture with discontinuity in left squamous suture suggesting a diastases fracture with an air hypodensity lesion in left frontal area suggesting a pneumocephalus. There was also a hyperdense lesion with crescent shape in frontal and interhemispheric region suggesting subdural hematoma. Delayed operation for almost 6 hours was advocated due to transfusion of whole blood and fresh frozen plasma to correct coagulopathy. The operation was successful, the patient was survived but upon 2 years follow up, the patient still wasn’t able to perform normal daily activity. Localized injury at the brain manifesting in systemic coagulopathy requires special care. Several steps need to be evaluated before surgery but it should not delay the attempt of controlling the source of coagulopathy by it means lesion in the brain. Our case demonstrates the important of recognizing and managing coagulopathy in severe traumatic brain injury.

Association between peri-transplant acid-base parameters and graft dysfunction types in kidney transplantation.

Perioperative acid-base disturbance could be informative regarding the possible slow graft function (SGF) or delayed graft function (DGF) development. There is a lack of data regarding the relationship between perioperative acid-base parameters and graft dysfunction in kidney transplant (KT) recipients. We aim to determine the incidence of graft dysfunction types and the association between them and acid-base parameters. We performed a prospective, cohort study on 54 adults, KT recipients, between 1st of January 2019 and 31st of December 2019. Graft function was defined and classified in three categories: immediate graft function (IGF) (serum creatinine < 3 mg/dL at day 5 after KT), SGF (serum creatinine ≥ 3mg/dL at day 5 or ≥ 2.5mg dL at day 7 after KT) and DGF (the need for at least one dialysis treatment in the first week after kidney transplantation). Among the 54 KT recipients, the incidence of SGF and DGF was 13% and 11.1%, respectively. SGF was significantly associated with lower intraoperative pH (7.26± 0.05 vs 7.35± 0.06, p= 0.004), preoperative and intraoperative base excess (BE) [-7.0 (-10.0 ߝ -6.0) vs -3.4 (-7.8 ߝ - 2.1) mmol/L, p= 0.04 and -10.3 (-11.0 ߝ -9.1) vs -4.0 (-6.3 ߝ - 3.0) mmol/L, p= 0.002, respectively] and serum bicarbonate (HCO3-) (16.0± 2.7 vs 19.3± 3.4 mmol/L, p= 0.01 and 14.1± 1.9 vs 18.8± 3.2 mmol/L, p= 0.002 respectively), compared to IGF. DGF was significantly associated with lower intraoperative values of pH (7.27± 0.05 vs 7.35± 0.06, p= 0.003), BE [-7.1 (-10.9 ߝ -6.1) vs -4.0 (-6.3 ߝ - 3.0) mmol/L, p= 0.02] and HCO3- (15.9± 2.4 vs 18.8± 3.2 mmol/L, p=0.02) compared to IGF. No differences were observed between SGF and DGF patients in any of the perioperative acid-base parameters. In conclusion we found that kidney graft dysfunction types are associated with perioperative acid-base parameters and perioperative metabolic acidosis could provide important information to predict SGF or DGF occurrence.

Bicarbonate ringer’s solution could improve the intraoperative acid-base equilibrium and reduce hepatocellular enzyme levels after deceased donor liver transplantation: a randomized controlled study

BackgroundBicarbonate Ringer’s (BR) solution is a direct liver and kidney metabolism-independent HCO3− buffering system. We hypothesized that BR solution would be more effective in improving acid-base equilibrium and more conducive to better liver function than Acetate Ringer’s (AR) solution in conventional orthotopic liver transplantation (OLT) patients.MethodsSixty-nine adult patients underwent OLT. Patients in the bicarbonate and acetate groups received BR solution or AR solution as infused crystalloids and graft washing solution, respectively. The primary outcome was the effect on pH and base excess (BE) levels. The secondary outcome measures were the incidence and volume of intraoperative 5% sodium bicarbonate infusion and laboratory indicates of liver and kidney function.ResultsThe pH and absolute BE values changed significantly during the anhepatic phase and immediately after transplanted liver reperfusion in the bicarbonate group compared with the acetate group (all P < 0.05). The incidence and volume of 5% sodium bicarbonate infusion were lower in the bicarbonate group than in the acetate group (all P < 0.05). The aspartate transaminase (AST) level at 7 postoperative days and the creatine level at 30 postoperative days were significantly higher in the acetate group than in the bicarbonate group (all P < 0.05).ConclusionCompared with AR solution, BR solution was associated with improved intraoperative acid-base balance and potentially protected early postoperative liver graft function and reduced late-postoperative renal injury.

Gastroschisis ultrasound bowel characteristics demonstrate minimal impact on perinatal outcomes.

Bowel dilation and bowel wall thickness are common prenatal ultrasound measurements for fetuses with gastroschisis. Data regarding antenatal sonographic bowel findings and postnatal outcomes are conflicting. Our objective was to evaluate the impact of in utero bowel measurements on perinatal outcomes in gastroschisis pregnancies. Retrospective cohort study of 116 pregnancies complicated by gastroschisis between 2011 and 2020. We reviewed ultrasounds documenting fetal bowel measurements. To evaluate the association of these measurements with antepartum and delivery outcomes, we ran logistic and linear models using generalized estimating equations. Eleven perinatal outcomes reached statistical significance, although with minimal clinical impact given small magnitude of effect. Intra-abdominal bowel dilation was associated with a 0.5 week decrease in delivery gestational age (GA) (95% CI -0.07, -0.03) and a 6.93 g increase in birth weight (95% CI 1.54, 28.73). Intra-abdominal bowel wall thickness was associated with later GA of non-stress test (NST) start of 0.22 weeks (95% CI 0.07, 0.37), increased delivery GA of 0.08 weeks (95% CI 0.02, 0.15), 0.006 decrease in umbilical artery (UA) pH (95% CI -0.009, -0.003), 0.26 increase in UA base deficit (95% CI 0.09, 0.43), and decreased odds of cesarean delivery (OR = 0.83, 95% CI 0.70, 0.99). Extra-abdominal bowel wall thickness was associated with a 0.1 increase in UA base deficit (95% CI 0.02, 0.19) and a 0.05 increase in 5-min APGAR score (95% CI 0.01, 0.09). Stomach cross-section was associated with a 0.01 week decrease in delivery GA (95% CI -0.02, -0.001) and increased odds of receiving betamethasone (OR = 1.02, 95% CI 1.01, 1.04). In utero bowel characteristics reached statistical significance for several outcomes, but with minimal meaningful clinical differences in outcomes.

Susceptible-Infected-Susceptible type COVID-19 spread with collective effects

Many models developed to forecast and attempt to understand the COVID-19 pandemic are highly complex, and few take collective behavior into account. As the pandemic progressed individual recurrent infection was observed and simpler susceptible-infected type models were introduced. However, these do not include mechanisms to model collective behavior. Here, we introduce an extension of the SIS model that accounts for collective behavior and show that it has four equilibria. Two of the equilibria are the standard SIS model equilibria, a third is always unstable, and a fourth where collective behavior and infection prevalence interact to produce either node-like or oscillatory dynamics. We then parameterized the model using estimates of the transmission and recovery rates for COVID-19 and present phase diagrams for fixed recovery rate and free transmission rate, and both rates fixed. We observe that regions of oscillatory dynamics exist in both cases and that the collective behavior parameter regulates their extent. Finally, we show that the system exhibits hysteresis when the collective behavior parameter varies over time. This model provides a minimal framework for explaining oscillatory phenomena such as recurring waves of infection and hysteresis effects observed in COVID-19, and other SIS-type epidemics, in terms of collective behavior.

Factors affecting the mortality of February earthquakes victims in Türkiye

Objective>50,000 people died in the February 2023 earthquakes in Türkiye. The aim of this study was to identify the factors affecting mortality rates of the trauma patients who were presented to the emergency department (ED) after the earthquake and provide suggestions for better preparedness strategies for future natural disasters. MethodsThis retrospective, cross-sectional study encompassed data from 955 trauma patients out of 3072 patients aged 18 years and above who sought assistance in the ED. Patients were divided into two groups: the survivor group and the exitus group. Age, gender, the city where patients came from, type of presentation, injured organ systems and mechanisms of injury, laboratory findings, the diagnoses in the ED, time spent in the ED, surgical intervention, and hemodialysis sessions were analyzed. The characteristics of those who could not be identified at the presentation to the ED were subjected to additional analysis. ResultsOut of 955 patients, 75.9% had extremity injuries, with crushing injuries (23.6%) being predominant. There were no significant differences in age or gender between the survivor and exitus groups (p = 0.776, p = 0.522), nor in the province of admission (p = 0.249). Clinical factors indicated that the exitus group were more likely to lack identification documents (29.6%), have spent longer trapped under debris, and have a higher frequency of ambulance transportation. Injuries such as chest and abdominal trauma, specific injury types, and amputation or open wounds were notably more frequent in the exitus group. Diagnoses revealed that metabolic causes were more common in exitus group (p < 0.001). While no significant difference existed in the need for emergency surgical intervention (p = 0.939), a higher frequency of emergency hemodialysis was observed among exitus group (p = 0.001). Laboratory findings indicated higher levels of various markers and lower calcium, base excess, and pH levels among those in the exitus group. ConclusionIn the aftermath of a devastating earthquake, this study underscores the formidable challenges faced by healthcare systems during natural disasters. To prepare for future disasters, healthcare systems must enhance resilience, develop rapid identification techniques, and adopt a holistic patient care approach.

Predicting the effectiveness of drugs used for treating cardiovascular conditions in newborn infants.

Cardiovascular support (CVS) treatment failure (TF) is associated with a poor prognosis in preterm infants. Medical charts of infants with a birth weight <1500 g who received either dopamine (Dp) or dobutamine (Db), were reviewed. Treatment response (TR) occurred if blood pressure increased >3rd centile for gestational age or superior vena cava flow was maintained >55 ml/kg/min, with decreased lactate or less negative base excess, without additional CVS. A predictive model of Dp and Db on TR was designed and the impact of TR on survival was analyzed. Sixty-six infants (median gestational age 27.3 weeks, median birth weight 864 g) received Dp (n = 44) or Db (n = 22). TR occurred in 59% of the cases treated with Dp and 31% with Db, p = 0.04. Machine learning identified a model that correctly labeled Db response in 90% of the cases and Dp response in 61.4%. Sixteen infants died (9% of the TR group, 39% of the TF group; p = 0.004). Brain or gut morbidity-free survival was observed in 52% vs 30% in the TR and TF groups, respectively (p = 0.08). New predictive models can anticipate Db but not Dp effectiveness in preterm infants. These algorithms may help the clinicians in the decision-making process. Failure of cardiovascular support treatment increases the risk of mortality in very low birth weight infants. A predictive model built with machine learning techniques can help anticipate treatment response to dobutamine with high accuracy. Predictive models based on artificial intelligence may guide the clinicians in the decision-making process.

Endothelial Cell Calcium Influx Mediates Trauma-induced Endothelial Permeability.

We aimed to investigate if ex vivo plasma from injured patients causes endothelial calcium (Ca2+) influx as a mechanism of trauma-induced endothelial permeability. Endothelial permeability after trauma contributes to post-injury organ dysfunction. While the mechanisms remain unclear, emerging evidence suggests intracellular Ca2+ signaling may play a role. Ex vivo plasma from injured patients with "Low Injury/Low Shock" (injury severity score [ISS]<15, base excess [BE])≥-6mEq/L) and "High Injury/High Shock" (ISS≥15, BE<-6mEq/L) were used to treat endothelial cells. Experimental conditions included Ca2+ removal from the extracellular buffer, cyclopiazonic acid pre-treatment to deplete intracellular Ca2+ stores, and GSK2193874 pre-treatment to block the TRPV4 Ca2+ channel. Live cell fluorescence microscopy and ECIS were used to assess cytosolic Ca2+ increases and permeability, respectively. Western blot and live cell actin staining were used to assess myosin light chain (MLC) phosphorylation and actomyosin contraction. Compared to Low Injury/Low Shock plasma, High Injury/High Shock induced greater cytosolic Ca2+ increase. Cytosolic Ca2+ increase, MLC phosphorylation, and actin cytoskeletal contraction were lower without extracellular Ca2+ present. High Injury/High Shock plasma did not induce endothelial permeability without extracellular Ca2+ present. TRPV4 inhibition lowered trauma plasma-induced endothelial Ca2+ influx and permeability. This study illuminates a novel mechanism of post-injury endotheliopathy involving Ca2+ influx via the TRPV4 channel. TRPV4 inhibition mitigates trauma-induced endothelial permeability. Moreover, widespread endothelial Ca2+ influx may contribute to trauma-induced hypocalcemia. This study provides the mechanistic basis for the development of Ca2+-targeted therapies and interventions in the care of severely injured patients.

Relationship between External Domestic Debt and Economic Growth

Purpose: Pakistan is surrounded by serious socio-economic problems. Due to the low tax base and double deficit, Pakistan has to rely on internal and external capital flows. Foreign capital flows are not easily accessible, but domestic capital flows are always accessible Methodology: The study investigates the effects of domestic debt on economic growth in Pakistan by applying the OLS technique Findings: The study indicates that the stock of domestic debt positively affects economic growth in Pakistan. This clearly means that the resources generated through internal debt have been partially used to finance public spending which contributes to economic growth. The study also notes that there is an inverse relationship between domestic debt service and economic growth. This result is due to the fact that the enormous burden of non-development spending hinders economic growth. The study results reveal that the negative effects of domestic debt service on economic growth is stronger than the positive effects of domestic debt on economic growth. Unique Contribution to Theory, Policy and Practice: The study also suggests some policies to repay existing internal debt.

Endotheliopathy of trauma in children: The association of syndecan-1 with injury and poor outcomes.

The contribution of the endothelium to trauma-induced coagulopathy has not been thoroughly investigated in injured children. This is a prospective cohort study of children (younger than 18 years) who presented with a potentially severe injury to an academic pediatric trauma center. Syndecan-1 level was collected on arrival and 24 hours following hospital arrival. Children were categorized as injured versus uninjured based on results of trauma evaluation. Demographics, injury characteristics, vital signs, and clinical laboratories were recorded. A composite clinical outcome was defined as death or blood product transfusion within 24 hours of hospital arrival. Statistical tests determined the impact of injury characteristics and therapeutics on syndecan-1 levels and assessed for associations between syndecan-1 level and outcomes. A total of 121 subjects were included in the analysis: 96 injured (79%) and 25 uninjured (21%). There were no differences between groups in age (median [interquartile range (IQR)], 11 [4-14] years), sex, or race. The injured cohort had a median (IQR) Injury Severity Score of 16 (9-21), 75% had blunt mechanism, 26% were transfused within 6 hours, 3% had 24-hour mortality, and 6% had in-hospital mortality. Median (IQR) syndecan-1 level on admission was significantly higher in injured versus uninjured cohort (44 [21-75] vs. 25 [17-42]; p = 0.04). Admission base deficit was significantly correlated with syndecan-1 level ( r = 0.8, p < 0.001); no association with traumatic brain injury or injury mechanism was seen. Children with elevated syndecan-1 on admission had significantly increased odds of poor outcome; every 10 ng/mL increase in syndecan-1 was associated with 10% increased odds of death or transfusion ( p < 0.001). Transfusion with any blood product was associated with a significant decrease in syndecan-1 from arrival to 24 hours (Δ syndecan-1, -17 [-64 to -5] vs. -8 [-19 to +2]; p < 0001). Elevated admission syndecan-1 level, suggestive of endotheliopathy, was associated with shock and poor outcomes in pediatric trauma. Larger cohort studies are required to fully describe the complexities of trauma-induced coagulopathy and investigate the benefit of therapies targeting endotheliopathy in children. Prognostic and Epidemiological; Level III.

Does base excess predict kidney injury in neonates with hypoxic-ischemic encephalopathy?

In neonates with hypoxic-ischemic encephalopathy (HIE), we studied the correlation between cord blood base excess (BE) and kidney function. Among 225 infants, 29 % had oliguria. BE levels differed significantly between oliguric and non-oliguric infants (p < 0.01), with a negative correlation to kidney injury (r = −0.544, p < 0.01). BE < −18 had 85 % specificity and 76 % sensitivity in predicting kidney injury (AUC = 0.88). These findings suggest BE as a valuable indicator of impending kidney injury in HIE infants, though underlying mechanisms may vary.

Effects of Training Sets Sequence on Swimming Performance, Training Load and Physiological Responses.

The study examined the effect of set sequence on performance and physiological responses in a training session and in each set separately. Twelve male swimmers performed four sessions in a randomized order, including a combination of two training sets: (i) set A-set C, (ii) set C-set A, (iii) set B-set C, (iv) set C-set B. Set A consisted of 8 × 200 m at a speed corresponding to lactate threshold (30 s recovery), set B included 8 × 100 m at the maximal aerobic speed (30 s recovery), set C included 8 × 50 m sprints at 95% of the maximum 50 m speed (30 s recovery). Speed, blood lactate, pH, base excess, bicarbonate and heart rate variability (HRV) were measured. Speed in each set was similar between sessions irrespective of set sequence (p > 0.05). Physiological responses during sets A and C were similar in all sessions (p > 0.05). In set B, when applied after set C, the metabolic response increased, and HRV decreased (p < 0.05). Overall, session biochemical disturbance was higher when set C was applied before sets A and B (p < 0.05). The magnitude of metabolic and HRV responses in a set conducted at maximal aerobic speed, but not at lactate threshold intensity, is increased when applied after sprint intervals.

An audit of electronic discharge summaries of neonates admitted with hypoxic ischaemic encephalopathy to tertiary hospitals in [City], 2018–2019.

Background. A discharge summary may be the only available health record for a patient, especially in resource-limited settings with suboptimal record-keeping. Considering the risk of adverse neurodevelopmental outcomes secondary to hypoxic ischaemic encephalopathy (HIE) and litigation, the quality of summaries for neonates with HIE is particularly important. &#x0D; Objectives. To audit electronic discharge summaries of neonates admitted with HIE to two tertiary hospitals in [City], South Africa. &#x0D; Methods. A retrospective, quantitative study was conducted. Electronic discharge summaries of late preterm and term neonates with HIE, admitted in 2018 and 2019 were audited for relevant information: final diagnosis, birth history, clinical evaluation, management, investigations, plan at discharge, and counselling of parents. &#x0D; Results. Of the 165 identified cases, 34 (20.6%) were excluded. Ten patients did not have electronic discharge summaries. Details of the other 24 cases in admission registers were incomplete. The final diagnosis of HIE appeared in 87 (66.4%) of 131 audited summaries. More than half (52.7%) lacked correct ICD-10 coding for HIE. Information on foetal distress and sentinel events was absent in 61.1% and 42.0%. Requirement for resuscitation was recorded in 90.8% of summaries. Performance of cardiac compressions and adrenaline administration were not specified in 46.6% and 54.2%. Admission blood gas results, particularly base deficit, lactate and glucose, were absent in 42.7%, 63.4% and 90.8% of summaries. Eligibility for therapeutic hypothermia was not captured in 41.2%. Cranial ultrasound, neuro-imaging, exclusion of meningitis, or multisystem involvement was not mentioned in 80.9%, 99.2%, 80.2% and 96.2%, respectively. Notes on counselling of parents were lacking (83.2%). Final cause of death was unspecified in 12 of 14 (85.7%) patients who died. &#x0D; Conclusion. Discharge summaries of neonates at risk of adverse neurodevelopmental outcomes secondary to HIE lacked essential information. Quality improvement and regular auditing of patient records must be prioritised.

Base excess as a predictor of neonatal mortality in neonatal sepsis

Background: Neonatal sepsis is responsible for approximately 15% of all neonatal deaths in the world. Despite of availability in advanced medical healthcare facilities for mother and neonates, incidence of mortality secondary to sepsis especially in developing countries like India is more common. Metabolic acidosis is the most common form of acid base imbalance in neonatal sepsis which can be analyzed with increased levels of base excess. Hence early diagnosis of neonatal sepsis can be done by determining base excess. Methods: This is a prospective observational study conducted in NICU at Cheluvamba Hospital, Mysore. 73 term neonates with suspected sepsis were enrolled in the study who were on regular follow-up and treatment till death/discharged from NICU. Base excess value is obtained from the arterial blood gas analysis from each subject and it was compared with survivor and non-survivor group along with other study parameter Results: Out of 73 subjects, incidence of non survivors group with severe increase in base excess is 75%. To predict the mortality, we compared it with standard base excess which showed the prediction of more than 60%, with significant AOC (0.827) of very near to one in ROC curve, with statistically significant (p&lt;0.001) sensitivity of 92.59%, specificity of 63.04%, positive predictive value of 59.5%, negative predictive value of 93.5%. Conclusions: In present study we have proved that base excess is an important parameter for the early diagnosis and for early intervention in neonatal sepsis.

Effect of cord blood double collection method on cord blood hematopoietic stem cell transplantation-related indices and blood gas analysis.

Umbilical cord blood has been widely used in clinical transplantation. Blood gas analysis of umbilical cord blood is routinely used to evaluate neonatal asphyxia. This study aimed to evaluate an improved umbilical cord blood collection method that does not affect the results of umbilical cord blood gas analysis and hematopoietic stem cell transplantation-related indices. Three hundred pregnant women were recruited between December 2019 and August 2022. In total, 270 umbilical cord blood samples were included and randomly divided into 3 groups. Group A was defined as the group in which both umbilical cord blood samples for hematopoietic stem cell transplantation and blood gas analysis were collected. Group B was defined as the group from which umbilical cord blood was collected for hematopoietic stem cell transplantation. Group C was defined as that wherein umbilical cord blood was collected only for blood gas analysis. Hematopoietic stem cell transplantation-related indices were detected in groups A and B, and blood gas analysis was performed in groups A and C. Hematopoietic stem cell transplantation-related indices were not significantly different between groups A and B. The pH, base excess, and lactic acid values were not significantly different between groups A and C. The cord blood double collection method would not affect the results of umbilical cord blood gas analysis and hematopoietic stem cell transplantation-related indices. It is suitable for cord blood collection when preparing for hematopoietic stem cell transplantation and blood gas analysis.

Spinal Hypotension and Time from Spinal-to-Delivery in Scheduled Cesarean Deliveries: Association with Neonatal Acidosis.

This work aimed to study the effect of sustained hypotension after spinal on neonatal acidosis and adverse outcomes in those undergoing scheduled cesarean delivery (CD) with universal prophylactic vasopressor exposure and to examine differences in spinal-to-delivery time by neonatal acidosis status. This retrospective cohort study conducted at a quaternary care center from January 2019 to December 2021 included singleton, term, nonanomalous pregnancies, with scheduled CD under spinal anesthesia. Hypotension was defined as a systolic blood pressure (SYS-BP) < 100 mm Hg (SYS-BP100) or a >20% drop from baseline blood pressure (SYS-BP20). Both the occurrence of hypotension and its magnitude and duration were studied; the latter through the development of a hypotension index. The 90th and 95th percentiles of the hypotension index for SYS-BP20 and SYS-BP100, respectively, were used to define sustained hypotension. The primary outcome was neonatal acidosis (umbilical artery pH ≤ 7.1 or base excess ≤ -12 mmol). Secondary outcomes were composites of neonatal (CNAO) and maternal (CMAO) adverse outcomes. Multivariable Poisson regression models with robust error variance analysis was used to estimate adjusted relative risks (aRRs) and 95% confidence intervals (CIs). Our study included 332 individuals who underwent scheduled CD; among them 330 (99.4%) received prophylactic vasopressors. The rate of neonatal acidosis was 4.2%. Sustained hypotension after spinal anesthesia, which occurred in 12.3% of the cohort, was associated with increased risk for neonatal acidosis (aRR 3.96, 95% CI 1.21-12.98), but was not associated with CNAO or CMAO. Time from spinal-to-delivery was not different in those with and without neonatal acidosis. Despite universal exposure to prophylactic vasopressors, sustained hypotension after spinal anesthesia was still associated with neonatal acidosis, but no other adverse perinatal outcomes. Our findings may provide additional support for the adoption of prophylactic vasopressors to reduce spinal hypotension and downstream effects on the neonate from intraoperative hemodynamic instability. · Despite prophylactic vasopressors during scheduled CD, neonatal acidosis occurred in 4% of subjects.. · Sustained hypotension after spinal anesthesia was associated with neonatal acidosis, but not adverse neonatal outcomes.. · Spinal-to-delivery time was not associated with neonatal acidosis in scheduled CD..

Predicting high-intensity resuscitation needs in injured patients in the post-hemostasis phase of care following intervention.

Best resuscitation practices in the posthemostasis phase of care are poorly defined; this phase of care is characterized by a range of physiologic derangements and multiple therapeutic modalities used to address them. Using a cohort of injured patients who required an immediate intervention in the operating room or angiography suite following arrival to the emergency department, we sought to define high-intensity resuscitation (HIR) in this posthemostasis phase of care; we hypothesized that those who would require HIR could be identified, using only data available at intensive care unit (ICU) admission. Clinical data were extracted for consecutive injured patients (2016-2019) admitted to the ICU following an immediate procedure in the operating room or angiography suite. High-intensity resuscitation thresholds were defined as the top decile of blood product (≥3 units) and/or crystalloid (≥4 L) use in the initial 12 hours of ICU care and/or vasoactive medication use between ICU hours 2 and 12. The primary outcome, HIR, was a composite of any of these modalities. Predictive modeling of HIR was performed using logistic regression with predictor variables selected using Least Absolute Shrinkage and Selection Operator (LASSO) estimation. Model was trained using 70% of the cohort and tested on the remaining 30%; model predictive ability was evaluated using area under receiver operator curves. Six hundred five patients were included. Patients were 79% male, young (median age, 39 years), severely injured (median Injury Severity Score, 26), and an approximately 3:2 ratio of blunt to penetrating mechanisms of injury. A total of 215 (36%) required HIR. Predictors selected by LASSO included: shock index, lactate, base deficit, hematocrit, and INR. The area under receiver operator curve for the LASSO-derived HIR prediction model was 0.82. Intensive care unit admission data can identify subsequent HIR in the posthemostasis phase of care. Use of this model may facilitate triage, nursing ratio determination, and resource allocation. Therapeutic/Care Management; Level IV.

Retrospective evaluation of admission total plasma protein as a predictor of red blood cell transfusion requirement in dogs diagnosed with traumatic and nontraumatic hemoabdomen: 90 dogs (2009-2019).

To evaluate the association of admission total plasma protein (TPP) and the administration of red blood cell transfusions in dogs with diagnosed hemoabdomen. To secondarily evaluate additional point-of-care parameters associated with red blood cell transfusion administration. Retrospective study between 2009 and 2019. University veterinary teaching hospital. Ninety dogs admitted to a university veterinary teaching hospital after a diagnosis of traumatic or nontraumatic hemoabdomen (NTH). Medical records were retrospectively reviewed; signalment, point-of-care diagnostics, and transfusion administration information was recorded.A total of 47 dogs (traumatic hemoabdomen 11/26; NTH 36/64) received packed red blood cell transfusions. For each 1g/dL unit decrease in TPP, dogs had an increased odds ratio (OR) of 2.14 (95% confidence interval [CI]: 1.44-3.40, P<0.001) of receiving a red blood cell transfusion. Dogs diagnosed with NTH were more likely to receive a red blood cell transfusion than dogs with a traumatic hemoabdomen (OR: 2.78, 95% CI: 1.11-7.141, P=0.03). Lower PCV values (OR: 1.08, 95% CI: 1.04-1.12, P<0.001), bicarbonate values (OR: 1.3, 95% CI: 1.09-1.56, P=0.003), and base excess (OR: 1.27, 95% CI: 1.1-1.49, P=0.003) were associated with a higher likelihood of red blood cell transfusion. Additionally, higher lactate (OR: 1.35, 95% CI: 1.16-1.63, P<0.001) and Acute Patient Physiologic and Laboratory Evaluation (APPLE)fast scores (OR: 1.10, 95% CI: 1.04-1.17, P<0.001) were associated with increased red blood cell transfusion administration. Low admission TPP, independent of low PCV, was associated with red blood cell transfusions regardless of underlying cause. For each 1g/dL unit decrease in TPP on presentation, dogs were approximately 2 times more likely to receive a red blood cell transfusion during hospitalization. Other factors that were associated with increased transfusion administration included presenting PCV, PCV/TPP ratio, bicarbonate, base excess, lactate, and APPLEfast scores.

Evaluate the use of flower waste biosorbents for treatment of contaminated water

Human and industrial activities have contaminated the groundwater and surface water. This is a significant issue today. Therefore, the analysis of water quality is crucial. The purpose of this study is to evaluate the water quality index (WQI) of groundwater at various locations for physiochemical analysis. For calculating the current water quality status using statistical analysis and in the water quality index, the following parameters were considered: pH, total dissolved solids, total alkalinity, chlorides, hardness, dissolved oxygen, Biochemical oxygen demand, and chemical oxygen demand. The acquired results are compared to the Indian drinking water standard IS: 10500–2012. The investigation of the physicochemical and biological characteristics of this ground water sample indicates that the evaluation of water quality parameters and resources is necessary. In the water quality index of six different places Gudlavalleru, Ainampudi, Penjendra, Gudlavalleru Gudem, Angaluru and Kondiparru. In the six locations the pH value vary from (6.72–8.3), temperature vary from (34 °C-36.5 °C), acidity vary from (15–40), alkanity vary from (10–25), turbidity vary from (0.8–60.4), DO vary from (3.7–6.2), COD vary from (209–477), Iron vary from (3–5), fluorides is zero, phosphorous vary from (0–0.5), ammonium vary from (0–1), nitrates vary from (0–5), chlorides vary from (375–575), hardness vary from (200–505), nitrites vary from (0–1), total solids vary from (729–1573), suspended solids vary from (468–971) and dissolved solids vary from (301–602). Using dry flowers biosorbents for biosorptions of heavy metals from polluted water or treat contaminated groundwater. Biological reactions occur to control the concentration of contaminated water when fine, dried powder of flower waste biosorbents is added to contaminated water. In this study, we employ four different flower waste biosorbents, including Targets or marigold flower waste, Ixora-coccinea flower waste, Hibiscus flower waste, and Allamanda flower waste. The Targets or marigold flower waste biosorbents have the highest performance for removing toxic metals from contaminated water among the four flower waste biosorbents. Further optimization of the various parameters, i.e. biosorbents dosage, contact time, pH, temperature, and agitation speed, was performed on Targets or marigold flowers waste biosorbents in order to increase pollutant biosorption. Further research is required into the mechanisms of biosorbents, the kinetics and reusability of metal uptake, the recovery and regeneration of biosorbents, process design, and the commercial application of Targets or marigold flower refuse biosorbents.

Experimental hemodialysis in diet-induced ketosis and the potential use of dialysis as an adjuvant cancer treatment

Numerous in vivo studies on the ketogenic diet, a diet that can induce metabolic conditions resembling those following extended starvation, demonstrate strong outcomes on cancer survival, particularly when combined with chemo-, radio- or immunological treatments. However, the therapeutic application of ketogenic diets requires strict dietary adherence from well-informed and motivated patients, and it has recently been proposed that hemodialysis might be utilized to boost ketosis and further destabilize the environment for cancer cells. Yet, plasma ketones may be lost in the dialysate—lowering blood ketone levels. Here we performed a single 180-min experimental hemodialysis (HD) session in six anesthetized Sprague–Dawley rats given ketogenic diet for five days. Median blood ketone levels pre-dialysis were 3.5 mmol/L (IQR 2.2 to 5.6) and 3.8 mmol/L (IQR 2.2 to 5.1) after 180 min HD, p = 0.54 (95% CI − 0.6 to 1.2). Plasma glucose levels were reduced by 36% (− 4.5 mmol/L), p < 0.05 (95% CI − 6.7 to − 2.5). Standard base excess was increased from − 3.5 mmol/L (IQR − 4 to − 2) to 0.5 mmol/L (IQR − 1 to 3), p < 0.01 (95% CI 2.0 to 5.0). A theoretical model was applied confirming that intra-dialytic glucose levels decrease, and ketone levels slightly increase since hepatic ketone production far exceeds dialytic removal. Our experimental data and in-silico modeling indicate that elevated blood ketone levels during ketosis are maintained during hemodialysis despite dialytic removal.