Decreased Serum Sodium Research Articles

Joint association of serum sodium and frailty with mild cognitive impairment among hospitalized older adults with chronic diseases: a cross-sectional study

BackgroundTo examine the associations of serum sodium and frailty with the risk of mild cognitive impairment (MCI) among hospitalized older adults with chronic diseases.MethodsA cross-sectional study was conducted in 403 hospitalized older adults with chronic diseases. Serum sodium concentration was assessed by the ion-selective electrode method, frailty status was evaluated by the FRAIL scale, and MCI was determined by the Montreal Cognitive Assessment (MoCA). Multiple logistic regression models were used to estimate the associations of serum sodium and frailty with MCI.ResultsParticipants with the lowest tertile of serum sodium had a higher risk of MCI than those in the middle tertile group (OR = 1.75, 95% CI: 1.01–3.04). Below 143 mmol/L, the risk of MCI was 1.38 (95% CI: 1.03–1.84) for per 1 SD decrease in serum sodium. Compared with the robust group, frailty was significantly associated with an increased risk of MCI (OR = 3.94, 95% CI: 1.92–8.10). Moreover, in comparison with participants with the middle tertile of serum sodium and who were robust/prefrail, those with frailty and either the lowest (OR = 5.53, 95% CI: 2.08–14.67) or the highest tertile of serum sodium (OR = 3.48, 95% CI: 1.20–10.05) had higher risks of MCI.ConclusionBoth lower and higher serum sodium impose a significantly higher risk for MCI in older adults with frailty. This could inform the design of clinical trials and the development of guidelines and recommendations for correcting serum sodium and frailty in hospitalized older adults with chronic diseases.

Pre-treatment of hyponatremia as a biomarker for poor immune prognosis in advanced or metastatic gastric cancer: A retrospective case analysis

ABSTRACT Hyponatremia, a prevalent electrolyte imbalance among tumor patients, has often been overlooked regarding its prognostic significance for immunotherapy. In this study, we delved into the prognostic ramifications of hyponatremia in advanced gastric cancer (AGC) patients undergoing immunotherapy. Enrolling AGC patients diagnosed between December 2014 and May 2021, we extracted pertinent data from electronic medical records, with a median follow-up of 35.8 months. Kaplan–Meier curves illuminated patients’ progression-free survival (PFS) and overall survival (OS), while survival disparities were tested using the Mantel–Haenszel log rank test. COX and logistic regressions were employed to scrutinize the correlation between serum sodium levels and prognosis in 268 AGC patients, both at baseline and during treatment. Notably, patients with hyponatremia exhibited shorter PFS (4.7 vs 2.1 months, p = .001*) and OS (12.5 vs 3.9 months, p < .001*). Serum sodium emerged as an independent prognostic factor for both PFS (HR = 1.773; 95% CI 1.067–2.945; p = .001*) and OS (HR = 1.773; 95% CI 1.067–2.945; p = .003*). Subgroup analysis revealed that AGC patients with hyponatremia derived no benefit from immunotherapy in terms of PFS and OS. Strikingly, a decrease in serum sodium during immunotherapy was associated with early relapse and mortality. Based on these findings, we hypothesize that hyponatremia portends poor prognostic outcomes in AGC patients treated with immunotherapy and may serve as a valuable prognostic biomarker. However, further large-scale prospective studies are warranted to validate these observations.

Effect of diabetes on mortality and liver transplantation in alcoholic liver cirrhotic patients with acute decompensation.

Previous studies have investigated the influence of diabetes on alcoholic liver cirrhosis patients, leaving its impact unclear. Thus, we conducted a study to reveal the association of diabetes and clinical outcomes of such patients. We prospectively collected data from multicenter pertaining to 965 patients diagnosed with alcoholic liver cirrhosis, all of whom were admitted due to acute decompensation between 2015 and 2019. Risk of major precipitating factors and incidences of death or liver transplantation in patients with and without diabetes was comparatively assessed. Propensity score (PS) matching was performed at a 1:2 ratio for accurate comparisons. The mean age was 53.4years, and 81.0% of the patients were male. Diabetes was prevalent in 23.6% of the cohort and was positively correlated with hepatic encephalopathy and upper gastrointestinal bleeding, although not statistically significant. During a median follow-up of 903.5 person-years (PYs), 64 patients with and 171 without diabetes died or underwent liver transplantation, with annual incidence of 33.6/100 PYs and 24.0/100 PYs, respectively. In the PS-matched cohort, the incidence of death or liver transplantation was 36.8/100 PYs and 18.6/100 PYs in the diabetes and matched control group, respectively. After adjusting for various factors, coexisting diabetes significantly heightened the risk of death or liver transplantation in the short and long term, in addition to prolonged prothrombin time, low serum albumin, elevated total bilirubin and creatinine, and decreased serum sodium levels. Diabetes increases the risk of death or liver transplantation in patients with alcoholic liver cirrhosis.

Does Desmopressin Reduce Intraoperative Bleeding in Patients Who Undergo Nasal Surgery? A Systematic Review and Meta-Analysis

Background and Objectives: This study aimed to determine the efficacy of prophylactic desmopressin administered via the intranasal or intravenous route in reducing intraoperative bleeding during nasal surgery. We conducted a meta-analysis of the relevant literature to investigate the role of preoperative desmopressin in minimizing bleeding complications associated with nasal surgery.Methods: We screened the relevant literature published before February 2023. Nine articles that compared the perioperative use of desmopressin (treatment) with a placebo or no treatment (control) were included. The analyzed outcomes were intraoperative bleeding during nasal surgery and postoperative morbidity.Results: The treatment group showed significant improvements in intraoperative bleeding, the surgical field, and surgeon satisfaction compared to the control group. However, the prophylactic use of desmopressin was associated with elevated blood pressure and decreased serum sodium levels compared to the control group. Nonetheless, no significant adverse effects were reported in the included studies. Subgroup analyses comparing the route of administration (intravenous vs. intranasal) and type of surgery (rhinoplasty vs. endoscopic sinus surgery) showed that desmopressin had a beneficial effect on intraoperative bleeding and the surgical field, regardless of the route of administration or type of surgery.Conclusion: The prophylactic use of desmopressin for nasal surgery effectively reduced intraoperative bleeding, improved the surgical field, and increased surgeon satisfaction, with no significant adverse effects. However, caution should be exercised when administering desmopressin as it may cause an elevation in postoperative blood pressure in patients with cardiopulmonary problems.

Efficacy and safety of terlipressin and albumin vs. noradrenaline and albumin in adult patients with hepatorenal syndrome: A systematic review and meta-analysis

Introduction and ObjectivesHepatorenal syndrome (HRS) is a serious complication of cirrhosis treated with various medications. We aim to evaluate terlipressin and albumin's effectiveness and safety compared to albumin and noradrenaline in adult hepatorenal disease patients. Materials and MethodsClinical trials from four databases were included. Cochrane's approach for calculating bias risk was utilized. We rated the quality evaluation by Grading of Recommendations Assessment, Development, and Evaluation (GRADE). We included the following outcomes: serum creatinine (mg/dl), urine output (ml/24 h), mean arterial pressure (mmHg), reversal rate of HRS, mortality rate, blood plasma renin activity (ng/ml/h), plasma aldosterone concentration (pg/ml), urine sodium (mEq/l), and creatinine clearance (ml/min). ResultsOur analysis of nine clinical studies revealed that the noradrenaline group was associated with higher creatinine clearance (MD = 4.22 [0.40, 8.05]), (P = 0.03). There were no significant differences in serum creatinine levels (MD = 0.03 [-0.07, 0.13]), urinary sodium (MD = -1.02 [-5.15, 3.11]), urine output (MD = 32.75 [-93.94, 159.44]), mean arterial pressure (MD = 1.40 [-1.17, 3.96]), plasma renin activity (MD = 1.35 [-0.17, 2.87]), plasma aldosterone concentration (MD = 55.35 [-24.59, 135.29]), reversal rate of HRS (RR = 1.15 [0.96, 1.37]), or mortality rate (RR = 0.87 [0.74, 1.01]) between the two groups (p-values > 0.05). ConclusionsNoradrenaline is a safe alternative medical therapy for HRS.

Feeds Alone versus Intravenous Fluids and Feeds for Treatment of Mild Hypernatremia in Otherwise Healthy Neonates – An Open-labeled Randomized Controlled Noninferiority Trial

Background: The treatment of hypernatremia in newborns is usually done by giving intravenous (IV) fluids. Methodology: This study aimed to determine whether treating neonates with hypernatremia using oral feeds was not inferior by a margin of 10% to treatment with IV fluids and feeds in achieving a safe decline in serum sodium. A decrease in serum sodium ≤0.5 mEq/L/h over 24 h of treatment was considered a safe decline. Neonates with serum sodium 150–155 mEq/L were randomized to receive oral feeds ad libitum (Group A) or 5% dextrose +0.45% normal saline (D5 ½ NS) and oral feeds (group B). Results: There were 43 neonates in Group A and 42 neonates in Group B. It was found that a safe decline in serum sodium was seen in 60.5% of Group A neonates and 47.6% of Group B neonates (P = 0.246). There was no significant difference in the duration of treatment or duration of hospital stay. Group B babies had more weight gain compared to Group A. No complications were observed in the groups. Conclusion: Treating mildly hypernatremic neonates with serum sodium 150–155 mEq/L using oral feeds alone may not be inferior to IV fluids with oral feeds in achieving a safe decline in serum sodium.

The use of prednisolone during Ramadan fasting in patients with adrenal insufficiency.

Once daily prednisolone taken at predawn has been proposed to be the glucocorticoid replacement of choice in patients with adrenal insufficiency (AI) who intend to fast for the month of Ramadan. However, the effects of prednisolone on metabolic parameters and quality of life during fasting for Ramadan are unknown. Patients with AI on twice-daily hydrocortisone, who had low or moderate risk and intended to fast, were recruited. Patients were converted to prednisolone 5 mg once daily taken at sahur (predawn) and Ramadan education given. Weight, sleep duration, biochemical parametersand quality of life measures (SF-36 questionnaire) were analysed at the end of Ramadan and compared against baseline. Twenty patients (13 men) were recruited, with a mean age of 59.9 ± 15.0 years. All patients were on hydrocortisone 15 mg daily (in divided doses) as pre-Ramadan glucocorticoid replacement. Half had type 2 diabetes with low IDF-DAR risk. Eighty-five percentof patients completed the full 29 days of fasting with no complications. There was a significant reduction in weight (-1.1 ± 1.6 kg, p = .005), with no significant change in blood pressure or sleep duration. There was a significant increase in urea (0.80 ± 1.1 mmol/L, p = .005) and haematocrit, (0.011 ± 0.019 L/L, p = .019) and decrease in serum sodium (-1.6 ± 3.0 mmol/L, p = .028), with no change in serum creatinine or liver function. Quality of life measures were preserved in all domains with significant improvement in role limitation due to physical health (15.3 ± 21.6, p = .005) and bodily pain (8.8 ± 16.3, p = .031). This study has demonstrated that converting patients with AI who are fasting for Ramadan from twice-daily hydrocortisone to prednisolone 5 mg daily at sahur was safe, with no major short-term adverse effects. Despite the higher equivalent glucocorticoid doses, patients experienced weight loss and no clinically significant change in blood pressure, sleep, biochemical parameters or quality of life. This study paves the way to trial even lower doses of prednisolone once daily in patients fasting for Ramadan with AI.

Regulation of renal nitric oxide and eNOS/iNOS expression by tadalafil participates in the mitigation of amphotericin B–induced renal injury: Down-regulation of NF-κB/iNOS/caspase-3 signaling

Amphotericin B (AmB)–induced acute kidney injury (AKI) is a common health problem having an undesirable impact on its urgent therapeutic utility for fatal systemic fungal infections. Tadalafil (TAD), a phosphodiesterase-5 (PDE-5) inhibitor, has been observed to have a wide range of pharmacological actions, including nephroprotection. The study’s objective was to examine the possible underlying protective mechanism of TAD against AmB-induced nephrotoxicity. Experimentally, animals were divided randomly into four groups: control, TAD (5 mg/kg/day; p.o.), AmB (18.5 mg/kg/day; i.p.), and TAD+AmB groups. Sera and tissue samples were processed for biochemical, molecular, and histological analyses. The biochemical investigations showed that TAD significantly ameliorated the increase of kidney function biomarkers (creatinine, urea, CysC, KIM-1) in serum, renal nitric oxide (NO), lipid peroxidation (MDA), and inflammatory cytokines (TNF-α, IL-6) in AmB-treated rats. Meanwhile, TAD significantly retarded AmB-induced decrease in serum magnesium, sodium, potassium, and renal glutathione content. Molecular analysis revealed that TAD reduced AmB-induced imbalance in the protein expression of eNOS/iNOS, which explains its regulatory effect on renal NO content. These results were also supported by the down-regulation of nuclear NF-κB p65 and cleaved caspase-3 protein expressions, as well as the improvement of histological features by TAD in AmB-treated rats. Therefore, it can be suggested that TAD could be a promising candidate for renoprotection against AmB-induced AKI. That could be partly attributed to its regulatory effect on renal eNOS/iNOS balance and NO, the inhibition of NF-κB p65 nuclear translocation, its downstream inflammatory cytokines and iNOS, and ultimately the inhibition of caspase-3-induced renal apoptosis.

Rosuvastatin, but not atorvastatin, enhances the antihypertensive effect of cilostazol in an acute model of hypertension

PurposeHypertensive emergency, a sudden and severe increase in blood pressure, necessitates immediate intervention to avoid end-organ damage. Cilostazol, a selective phosphodiesterase-III inhibitor, has vasodilator effect. Here, we investigated the effect of two commonly used statins, atorvastatin or rosuvastatin, on cilostazol antihypertensive activity in acute model of hypertension.MethodsHypertensive emergency was induced via angiotensin II intravenous infusion (120 ng.kg−1.min−1). Rats were subjected to real-time arterial hemodynamics and electrocardiogram recording while investigated drugs were injected slowly at cumulative doses 0.5, 1, and 2 mg.kg−1, individually or in combination, followed by baroreflex sensitivity (BRS) analysis and serum electrolytes (Na+ and K+) and vasomodulators (norepinephrine (NE), and nitric oxide (NO)) assessment.ResultsCilostazol reduced systolic blood pressure (SBP), while co-injection with rosuvastatin augmented cilostazol SBP-reduction up to 30 mmHg. Compared to atorvastatin, rosuvastatin boosted the cilostazol-associated reduction in peripheral resistance, as evidenced by further decrease in diastolic, pulse, and dicrotic-notch pressures. Rosuvastatin co-injection prevented cilostazol-induced changes of ejection and non-ejection durations. Additionally, rosuvastatin coadministration produced better restoration of BRS, with an observed augmented increase in BRS indexes from spectral analysis. Greater reduction in sympathetic/parasympathetic ratio and serum NE upon rosuvastatin coadministration indicates further shift in sympathovagal balance towards parasympathetic dominance. Additionally, rosuvastatin coinjection caused a greater decrease in serum sodium, while more increase in NO indicating augmented reduction of extracellular volume and endothelial dysfunction.ConclusionRosuvastatin boosted cilostazol’s antihypertensive actions through effects on peripheral resistance, BRS, sympathovagal balance, endothelial dysfunction, and electrolytes balance, while atorvastatin did not demonstrate a comparable impact.

Effect of Coffee-Corn Mix on Hypertensive Mice on Biomarkers of Nitric Oxide, eNOS, Sodium, and ACE Serum Levels

Hypertension is a major determinant of morbidity and mortality worldwide. Hypertension is the most common cause of death in Southeast Asia. The pathophysiology of hypertension is complex and not fully understood. Increased oxidative stress is considered one of the main mechanisms involved in the pathogenesis of endothelial dysfunction leading to hypertension. Therefore, antioxidant therapy can be an alternative option to prevent endothelial damage and hypertension. Robusta coffee and corn are high sources of antioxidants. This study aimed to analyze the effect of the coffee-corn mixture on NO, eNOS, sodium, and ACE serum levels in hypertensive rats. This research is an experimental laboratory study with a post-test only control group design. Robusta coffee and yellow corn samples were roasted at 180°C for 10 minutes. Rats were induced by DOCA salt and given a mixture of coffee-corn in a ratio of 75%: 25% and 50%: 50% for two weeks. After treatment, the levels of NO, eNOS, ACE, and F2-isoprostane from blood serum were measured. The results showed that there was no significant difference in serum Nitric Oxide levels in the negative, positive control group and the treatment group after treatment. There was a significant increase in eNOS levels and a significant decrease in serum sodium, ACE, and F2-isoprostane levels in the negative, positive, and treatment groups. In the path analysis, it was found that the administration of the coffee-corn mixture (50%:50%) can reduce blood pressure through two pathways, namely a decrease in the level of F2-isoprostane, which causes a decrease in sodium levels and a direct decrease in sodium levels.

Chlamydia psittaci pneumonia in Wuxi, China: retrospective analysis of 55 cases and predictors of severe disease.

More and more patients with community-acquired pneumonia have been detected with Chlamydia psittaci (C. psittaci) infected using metagenomic next-generation sequencing (mNGS). Previously, this was unheard of, and several patients presented with severe pneumonia and even required ECMO. We aimed to clarify the clinical characteristics of C. psittaci pneumonia and find out if there are any possible predictors of severe C. psittaci pneumonia. In this retrospective study, we included all confirmed cases of C. psittaci pneumonia in Wuxi. Epidemiological, clinical, and radiological features, as well as laboratory data, were collected and analyzed. We enrolled 55 patients with C. psittaci pneumonia, with 30 (54.5%) having a history of exposure to birds or their internal organs. 50 (90.9%) patients were diagnosed by mNGS. Patients with C. psittaci pneumonia had many complications, among which, that deserve sufficient attention from clinicians were vascular embolic events (3, 5.5%). High fever was the most common clinical manifestation (41, 74.5%). The majority of patients had a significant increase in neutrophils ratio, neutrophils to lymphocytes ratio (NLR), rapid c-reactive protein, creatine kinase (CK), and lactate dehydrogenase (LDH), as well as a decrease in lymphocytes ratio, albumin, serum sodium, serum potassium, and serum phosphorus. Chest computed tomography scans revealed unilateral pneumonia (70.9%), consolidation (87.3%), air bronchogram (76.4%), and ground-glass opacity (69.1%). The neutrophil ratio, NLR, LDH, and CK were all factors that could identify severe pneumonia. Both AUCs exceeded 0.8; the respective 95% CIs were 0.715-0.944, 0.710-0.963, 0.677-0.937, and 0.718-0.950; all p < 0.05 (0.01, 0.001, 0.007, 0.007 respectively). The ORs were 10.057, 9.750, 10.057, and 9.667, respectively; the 95% CIs were 2.643-38.276, 2.339-40.649, and 2.643-38.276, respectively; all p-values were less than 0.05 (0.001, 0.002, 0.001, 0.001 respectively). C. psittaci pneumonia is a very complex disease that changes all the time. Some patients showed severe pneumonia. Patients will have a poor prognosis if they are not treated promptly and effectively. We discovered that many clinical indicators were typical. Meanwhile, significant increases in neutrophil ratio, NLR, LDH, and CK predicted severe pneumonia. Timely detection of mNGS provided substantial help for clinical diagnosis and early treatment.

Assessment of the Pro-oxidant Antioxidant Balance (PAB) in COVID-19 Patients Compared to Healthy Subjects Referred to Masih Hospital

Background: Recent studies have reported that the increase in the pro-oxidant-antioxidant balance (PAB) in patients with COVID-19 is associated with the exacerbation of clinical manifestations of the disease. The underlying risk factors of these patients, including a history of chronic systemic diseases, also may be associated with PAB disorder. It seems that there should be a significant relationship between clinical disorders and laboratory factors with PAB disorder. This issue was evaluated in this study. Methods: In this cross-sectional study, 105 patients referred to Masih Hospital in Tehran in 2021, including 58 subjects with COVID-19 infection and 47 as a control group, were studied. The subjects in this study were evaluated for PAB by the ELISA method. Results: The mean value of PAB in individuals with and without COVID-19 was 72.77±17.66 and 66.53±14.30, respectively, which was significantly higher in COVID-19 patients (P=0.049). In patients with COVID-19, there was a significant correlation between PAB and plasma triglyceride level (P=0.011) and an inverse relationship between PAB level and blood sodium level (P=0.047). In the COVID-19 group, there was no significant relationship between PAB level and histories of hypertension, hyperlipidemia, diabetes, and ischemic heart disease. Conclusion: The increase in PAB is quite evident in patients with COVID-19 compared to healthy individuals. There is a significant relationship between PAB and some laboratory markers in these patients such as blood triglyceride levels as well as decreased serum sodium. Therefore, it still seems that the activity of oxidative stress processes plays a role in the pathogenesis and exacerbation of COVID-19 disease and can be considered one of the therapeutic goals in these patients.

Vasospasm following brain tumor resection in children: institutional experience and systematic review.

Delayed cerebral ischemia (DCI) associated with vasospasm is well described in the setting of aneurysmal subarachnoid hemorrhage (SAH). In addition, DCI is very infrequently encountered in patients who have undergone resection of a brain tumor with unclear pathophysiology. The occurrence of DCI in the pediatric population is exceedingly rare, and outcomes in this population have, to the authors' knowledge, never been systematically reviewed. Therefore, the authors present what is to their knowledge the largest series of pediatric patients with this complication and systematically reviewed the literature for individual participant data. The authors conducted a retrospective review of 172 sellar and suprasellar tumors in pediatric patients who underwent surgery at the Montreal Children's Hospital between 1999 and 2017 to identify cases of vasospasm occurring after tumor resection. Descriptive statistics, including patient characteristics, intraoperative and postoperative findings, and outcome status, were collected. A systematic review was also conducted using three databases (PubMed, Web of Science, Embase) to identify reported cases available in the literature of vasospasm after tumor resection in children and collect individual participant data on these patients for further analysis. Six patients treated at Montreal Children's Hospital were identified, with an average age of 9.5 years (range 6-15 years). The prevalence of vasospasm after tumor resection was 3.5% (6/172). Vasospasm in all 6 patients occurred after craniotomy was performed to treat a suprasellar tumor. The average interval from surgery to symptoms was 3.25 days (range 12 hours-10 days). The most common tumor etiology was craniopharyngioma, seen in 4 cases. Extensive tumor encasement of blood vessels requiring significant operative manipulation was described in all 6 patients. A rapid decrease in serum sodium (exceeding 12 mEq/L/24 hrs or below 135 mEq/L) was seen in 4 patients. On final follow-up, 3 patients were left with significant disability, and all patients had persistent deficits. A systematic review of the literature revealed a total of 10 other patients whose characteristics and treatment were compared with those of the 6 patients treated at Montreal Children's Hospital. Vasospasm after tumor resection in children and youth is likely a rare entity, with a prevalence of 3.5% in this case series. Suprasellar tumor location (particularly craniopharyngioma tumor etiology), significant encasement of blood vessels by the tumor, and postoperative hyponatremia may be predictive factors. Outcome is poor, with most patients having significant persistent neurological deficits.

Haemato-biochemical Alterations in Canine Rotaviral Enteritis of Dogs and its Management

Background: Rotaviruses cause acute diarrhoea, mostly in young puppies. Rotavirus associated gastroenteritis in dog is of great concern not only because of their high morbidity and mortality, but became of the reason that, they act as potential source of zoonotic infection and inter-species transmission. There is no report on rotavirus infection in dog from Assam. Therefore, there is a need to study the haemato-biochemical alterations in rotavirus infected dogs while treating such type of clinical cases. Methods: A total of 157 faecal and blood samples were collected from the dogs affected with gastroenteritis, registered at Veterinary Clinical Complex, Khanapara, Assam during November, 2020 to April, 2021. Diagnosis of rotavirus was done by RNA-PAGE and RT-PCR. Haematological study of the canine rotavirus (CRV) infected dogs were carried out with automated haematological cell counter and biochemical analysis was done with semi-automated biochemistry analyser using commercial kit. Result: Out of 157 samples, 8 samples were found positive for canine rotavirus by RNA-PAGE and 17 samples by RT-PCR. Haemato-biochemical alterations in canine rotavirus infected dogs revealed significant increase in Hb, PCV, TEC, monocyte, lymphocyte, AST, ALT, BUN and creatinine while significant decrease in TLC, neutrophil, total protein, serum sodium, potassium and chloride.

Clinical and CT diagnosis of 50 cases of Chlamydia psittaci pneumonia.

This is a retrospective cross-sectional study aiming to explore the clinical and imaging manifestations of Chlamydia psittaci pneumonia (CPP), thus improving its diagnosis, guiding its early clinical treatment, and reducing its mortality rate. Fifty cases of CPP diagnosed by hospitals across the country with metagenomics next-generation sequencing (mNGS) from January 2019 to March 2021 were collected. Its clinical symptoms, laboratory test results, and computed tomography (CT) features were discussed. Forty patients had a history of poultry exposure; 37 experienced respiratory symptoms, 48 had a fever, 14 experienced gastrointestinal symptoms, and 12 experienced neurological symptoms; 34 patients had normal blood cell counts, 49 patients had elevated C-reactive protein, and 24 showed decreased serum sodium. Imaging manifestations: (I) Distribution: lesions were limited to a single lung in 31 patients, lesions were distributed in bilateral lungs in 19 patients; (II) Signs: 37 patients developed the "fine mesh sign". Necrosis, cavity and "tree-in-bud" were not observed. Pleural effusion occurred in 33 patients, mediastinal lymphadenopathy in 18, and splenomegaly in 15 patients. Patients with CPP often have a history of poultry exposure and present with fever and increased C-reactive protein. White blood cells may be slightly increased or completely normal. Hyponatremia may occur in some patients, and multiple systems may be clinically involved. The imaging can show lesions with unilateral or bilateral lung distribution and a rapid progression. Both the lung parenchyma and the interstitium are involved. Fine mesh sign is the most common sign. Necrosis, cavitation, and tree-in-bud signs are not observed. In conclusion, imaging examinations are helpful for the early diagnosis of this disease and the evaluation of the treatment effect.

Serum copeptin as a predictor of risk of hyponatremia after transurethral prostatectomy.

Transurethral resection of the prostate gland (TURP) frequently leads to the development of dilutional hyponatremia. Copeptin has been established as a surrogate marker of vasopressin and is measured for clinical assessment of various sodium and water disturbances. This study aims to assess the utility of serum concentration of copeptin and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) for prediction of post-TURP alterations of serum sodium concentration. Forty-three patients with benign prostatic hyperplasia undergoing TURP were enrolled. Serum sodium and copeptin were measured before the procedure, then 12 hours after its completion. NT-proBNP was assessed at baseline. The total amount of fluids and sodium administered intravenously and used to flush the bladder during TURP was calculated in each patient. Receiver operator characteristic (ROC) curve analysis was used to determine value of copeptin and NT-proBNP for prediction of hyponatremia after TURP. In forward stepwise multiple regression analysis of serum copeptin before surgery and the duration of TURP explained the significant portion of the sodium concentration variation 12 hours from the start of the surgery. ROC curve analysis showed that serum copeptin before surgery predicted development of hyponatremia 12 hours after TURP (area under the curve, 0.775; 95% confidence interval, 0.62-0.89; p &lt; 0.001) with a cut-off point of &gt;78.6 pg/mL with 77% sensitivity and 64.7% specificity. Serum NT-proBNP before surgery did not predict hyponatremia 12 hours after TURP. Serum copeptin before TURP surgery, but not NT-proBNP, may be a clinically useful marker of the risk of serum sodium decrease after TURP.

BIOCHEMICAL CHANGES IN THE STORED WHOLE BLOOD ASSESSED AT PERIODIC INTERVALS IN CPDA-1 ANTICOAGULANT CONTAINING BLOOD BAGS: A STUDY AT THE BLOOD BANK OF TERTIARY CARE HOSPITAL OF SOUTHERN RAJASTHAN

Objectives: The objectives of this study were to study the various biochemical changes occurring in a stored whole blood unit at day 0, day 17th, and the 35th day in full blood bag containing citrate phosphate dextrose adenine-1 anticoagulant. Methods: A cross-sectional descriptive study had been carried out among 110 healthy volunteer donors in the Department of Transfusion Medicine, RNT Medical College, Udaipur, between August 2019 and July 2020. A 10 mL blood sample from each bag containing anti-coagulated blood being collected, and the level of sodium, potassium, chloride, total protein, and albumin were measured on days 0, 17th, and the 35th. Mean and standard deviation had been calculated for the parameters, a one-way analysis of variance test was applied to compare the differences, and a p&lt;0.05 was considered statistically significant. Results: A higher proportion of males in the age group 18–27 years, and a generally steady increase in serum potassium level with a steady decrease in serum sodium, chloride, total protein, and albumin levels over the 35-day storage period. Conclusions: In this study, stored whole blood undergoing changes in its biochemical parameters had been studied and found to be significant. The study also recommends transfusion of fresh blood for high-risk patients.

Effect of fetuin-A on adenine-induced chronic kidney disease model in male rats.

This study aimed to investigate the possible effects of fetuin-A on an adenine-induced chronic kidney disease (CKD) model in male rats. Rats were divided into three groups: group A included rats fed a normal diet; group B included rats fed a normal diet with 220 mg/kg adenine daily for 21 days; group C included rats fed a normal diet with 220 mg/kg adenine daily for 21 days and intraperitoneally administered with 5 mg\kg fetuin-A every other day for 2 weeks. Serum samples were assayed for serum creatinine, urea, sodium, potassium, calcium, phosphorus, tumor necrosis factor (TNF), interleukin-6 (IL-6), and estimated glomerular filtration rate (eGFR), and immunohistochemical staining was performed. Group B showed a significant increase in serum creatinine, urea, phosphorus, potassium, TNF, and IL-6 and a significant decrease in serum sodium, calcium, and eGFR compared with group A. Regarding immunohistochemistry, group B showed increased apoptosis. In group C, fetuin-A reduced the urea, creatinine, and phosphorus levels, and in group C, fetuin-A decreased inflammation and apoptosis by reduction of caspase-3 staining. Fetuin-A improved kidney function in CKD due to its anti-inflammatory and anti-fibrotic role.

Serum Electrolyte and Metabolic Changes During Conditioning of Autologous Hematopoietic Stem Cell Transplantation in Patients with Autoimmune Diseases: A Prospective Study in a Single Institution.

A hematopoietic stem cell transplant (HSCT) includes a conditioning regimen which may cause unwanted metabolic changes. We analyzed the changes in electrolytes, glucose, urea, and glomerular filtration rate in patients with multiple sclerosis (MS) who underwent an autologous HSCT employing the "Mexican method." Serum and urinary electrolytes, blood glucose, creatinine, uric acid, and estimated glomerular filtration rate (eGFR) were prospectively assessed on days -11, -9, and 0 in a group of 75 patients with MS receiving an autologous HSCT employing the "Mexican method," which includes high doses of both cyclophosphamide (Cy, 200 mg/kg) and rituximab (1000 mg). The median age of the patients was 46 years, with a range of 20-65. Baseline data were defined at day -11 of the HSCT. There were significant changes in serum and urinary electrolytes, which diminished substantially after the delivery of high-dose Cy; 12 patients (16%) developed hyponatremia and 2 had hyponatremia-induced seizures, which resulted in hospital admissions. A comparison of baseline blood metabolites with those obtained after the full Cy dosage (day 0) revealed a significant increase in blood glucose and uric acid levels with an associated decrease in serum calcium, sodium, and potassium levels. The salient findings were drug-induced hyponatremia and hyperglycemia. Significant changes in serum electrolytes, blood glucose, creatinine, uric acid, and estimated glomerular filtration rate (eGFR) were observed in patients given autologous HSCT for MS employing high-dose Cy. Some of these changes may have clinical consequences, mainly those derived from iatrogenic hyponatremia. No evidence of damage to renal function was observed at day 0.

Evaluation of Ultrasonography as an Adjunct for Diagnosis of Dengue Fever Among Children

Introduction: This study aims to evaluate the role of ultrasonography (USG) for early diagnosis of clinically suspected dengue fever before it becomes serologically positive and usefulness of USG in predicting severity of the disease. Methods: Prospective observational study conducted at a tertiary care hospital from April 2020 to March 2021, 70 cases of clinically suspected dengue within the age group of 6 months to 15 years presenting with fever for less than 5days underwent whole abdomen and chest ultrasonography. For seropositive cases, ultrasonography findings and their utility in early diagnosis and prediction of disease severity was analyzed along with their correlation to the clinical and laboratory profiles.Results:75.8% had primary dengue and 24.2% had secondary dengue. 94% cases demonstrated ultrasonography features suggestive of dengue like hepatomegaly (81%), ascites (63.8%), splenomegaly (56.9%), gall bladder wall thickness (46.6%), Cholecystitis (44.8%) and Pleural effusion (41.4%). Ascites and pleural effusion correlated well with clinical severity (p&lt;0.05). Ascites also had significant correlation with increased hematocrit (p=0.040) and thrombocytopenia (p=0). Significant correlation was observed between pleural effusion with decreased platelet count ((p=0.004) and decreased serum sodium levels (p=0.044). Gall bladder wall thickening &gt;5mm correlated well with disease severity. USG showed 94.3% sensitivity, 16.67% specificity and 81.43% of diagnostic accuracy in the seropositive cases of this study. Conclusion: Ultrasonography is useful not only as an adjuvant for early diagnosis of Dengue fever but also as a marker of disease severity.