Electrolyte Disorders Research Articles

Individualized nutritional intervention improves the nutritional status of liver cancer patients after transcatheter arterial chemoembolization.

Introduction: to explore the effect of individualized nutritional intervention on the nutritional status of patients with liver cancer after transcatheter arterial chemoembolization (TACE). Methods: 56 patients who underwent TACE in our hospital from March 2022 to March 2023 were selected as the study subjects. The patients were randomly divided into a control group (28 cases) and an intervention group (28 cases). The control group received routine dietary intervention, while the intervention group received individualized nutritional intervention. We analyzed the body mass index (BMI), nutritional risk screening 2002 (NRS 2002), nutritional status, liver function status, and incidence of complications in two groups of patients before TACE, 3 days after TACE, and 1 month after TACE. Results: on the third day after TACE, the nutritional related indicators of both groups of patients showed a significantly decrease compared to those before TACE (p < 0.05), while the majority of liver function indicators significantly increased (p < 0.05). Compared with those at 3 days after TACE, the nutritional status of the intervention group patients significantly improved (p < 0.05) and liver function indicators significantly decreased (p < 0.05) 1 month after TACE. One month after TACE, all nutritional indicators in the intervention group were significantly higher than those in the control group (p < 0.05), and AST was significantly lower than that in the control group (p < 0.05). The incidence of gastrointestinal complications and electrolyte disorders in the intervention group were significantly lower than that in the control group (p < 0.05). Conclusion Individualized nutritional intervention can effectively improve nutritional status, improve liver function, and reduce the incidence of postoperative complications in liver cancer patients after TACE. It was worth promoting.

Electrolytes Disorders in Post Kidney Transplanted Recipients

Electrolytes Disorders in Post Kidney Transplanted Recipients

Identification and prevention of refeeding syndrome in pediatric intensive care

?Refeeding syndrome? is described in the literature as a range of metabolic and electrolyte disorders that result from starting nutritional rehabilitation in malnourished patients. Without a universally accepted definition, data on ?refeeding syndrome? incidence are heterogeneous. In most cases, a clinician will subjectively identify ?refeeding syndrome,? many authors have developed their purposes and criteria for it in their studies. Using the PubMed database and the appropriate filters (?refeeding syndrome?-related terms: refeeding syndrome, pediatrics, child, nutrition support, nutrition assessment, malnutrition), a search of the published literature was conducted. The American Society for Parenteral and Enteral Nutrition?s 2020 recommendations are the only guidelines for identifying children with or at risk for ?refeeding syndrome?. High-quality scientific evidence regarding the clinical syndrome is absent, so we need further research in all ?refeeding syndrome?-related areas, from validation to better identification of risk factors, definitions of ?refeeding syndrome,? and standardization of treatment protocols. For now, clinicians must remain vigilant to protect patients from the potentially devastating consequences of the ?refeeding syndrome.?

Comprehensive understanding of the adverse effects associated with temozolomide: a disproportionate analysis based on the FAERS database.

Temozolomide, which is the standard drug for glioma treatment, has several Adverse events (AEs) in the treatment of gliomas and other tumors that are not yet fully understood. This is due to the pharmacological nature of the alkylating agent. A significant proportion of these effects have not been systematically documented or reported. We selected data from the United States FDA Adverse Event Reporting System (FAERS) database from the first quarter of 2004 to the fourth quarter of 2023. Four algorithms were used for disproportionate analysis, with the objective of assessing the association between temozolomide and related adverse events. In this study, 20,079,906 case reports were collected from the FAERS database, of which 15,152 adverse events related to temozolomide were reported. A total of 352 preferred terms (PTs) and 24 system organ classes (SOCs) that were significantly disproportionally related to the four algorithms were included. The SOCs included blood and lymphatic system disorders (χ2 = 18,220.09, n = 4,325); skin and subcutaneous tissue disorders (χ2 = 408.06, n = 1,347); investigations (χ2 = 639.44, n = 3,925); musculoskeletal and connective tissue disorders (χ2 = 1,317.29, n = 588); and psychiatric disorders (χ2 = 1,098.47, n = 877). PT levels were screened for adverse drug reaction signals consistent with drug inserts, such as anemia, thrombocytopenia, liver function abnormalities, nausea and vomiting, as well as rarely reported adverse drug reactions, such as aplastic anemia, myelodysplastic syndromes, electrolyte disorders, cerebral edema, and high-frequency mutations. The results of our investigation demonstrated both adverse effects that had been reported and a multitude of unreported adverse effects that were serious in nature and lacked a clear cause. These novel findings suggest that more attention should be given to the clinical conditions of patients after treatment to provide a more comprehensive perspective and understanding for further clarifying the safety of temozolomide.

Prevalence and prognostic role of hypochloremia in patients with acute heart failure in Ethiopia: A single-center retrospective analysis.

In patients with heart failure (HF), multiple electrolyte disorders are common, and recent studies have shown that chloride disorders play a significant role in the prognosis of HF. Data about the prevalence and prognostic role of hypochloremia in patients with acute HF (AHF) are scarce in African nations, including Ethiopia. Hence, this study aimed to assess the prevalence, associated factors, and prognostic role of hypochloremia in patients with AHF in Ethiopia. This was a single-center retrospective analysis of AHF patients, aged ≥15 years, with chloride determination upon admission to the medical wards and medical ICU of Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia, from July 1, 2022, to July 1, 2023. Statistical Package for Social Sciences, version 26, was used to enter and analyze the data. Descriptive analysis was used to summarize clinical profiles, laboratory data, and outcomes of AHF patients stratified by the presence and absence of hypochloremia. Logistic regression analysis was used to determine the factors associated with hypochloremia and to assess the association of hypochloremia and other factors with in-hospital mortality in patients with AHF. A two-tailed P value <0.05 was regarded as statistically significant. A total of 267 AHF patients who had chloride determination on admission were included in this study; the mean age was 56.7 years (standard deviation: 18.6), and the gender-based distribution of the patients was nearly equal. The prevalence of hypochloremia was 36.7%. Diastolic blood pressure <60 mm Hg [adjusted odds ratio (AOR) = 3.63, 95% confidence interval (CI), 1.04, 12.72] and hyponatremia (AOR = 29.20, 95% CI, 13.21, 64.56) were significantly associated with hypochloremia. The in-hospital mortality rate was higher in AHF patients with hypochloremia (16.3%) compared to those without hypochloremia (4.7%). The odds of in-hospital mortality among AHF patients with hypochloremia were 2.8 times higher compared to patients without hypochloremia (AOR = 2.82, 95% CI: 1.08, 7.04) after adjusting for ICU admission, systolic blood pressure < 120 mm Hg and diastolic blood pressure < 60 mm Hg. This study revealed a high prevalence of hypochloremia among patients with AHF. Low diastolic blood pressure and hyponatremia were significantly associated with the development of hypochloremia. Most importantly, AHF patients with hypochloremia had a higher in-hospital mortality rate compared to those without hypochloremia. Hence, hypochloremia on admission should be considered a potential prognostic factor in patients with AHF, and further research with a larger sample size is needed to support the findings of this study.

Hypomagnesaemia leading to parathyroid dysfunction, hypocalcaemia, and hypokalaemia as a complication of long-term treatment with a proton pump inhibitor - a literature review.

Proton pump inhibitors (PPIs) are one of the most frequently used medications worldwide. The side effects of this class of drugs have been widely studied. However, their impact on the electrolyte balance is frequently forgotten. Long-term PPI administration can lead to profound electrolyte disturbances, namely hypomagnesaemia as well as, secondary to very low magnesium levels, hypocalcaemia and hypokalaemia. In this paper we comprehensively review the complexity of the mechanisms contributing to electrolyte imbalance following PPI (proton pump inhibitors) by changing the pH in the intestinal lumen, interfering with the active cellular transport of magnesium regulated by the transient receptor potential melastatin cation channels TRPM6 and TRPM7. The accompanying hypomagnesaemia causes unblocking of the renal outer medullary potassium channel (ROMK), which results in increased potassium loss in the ascending limb of the loop of Henle. Hypokalaemia caused by hypomagnesaemia is resistant to potassium supplementation because the loss of this element in urine increases with the supply of potassium. Additionally, within the calcium-sensitive receptor (CASR), dissociation of magnesium from the alpha subunit of G protein caused by hypomagnesaemia increases its activity, leading to inhibition of PTH secretion and hypocalcaemia resistant to calcium supplementation. All this means that in some patients, chronic use of proton pump inhibitors by affecting the absorption of magnesium, may lead to life-threatening electrolyte disorders.

Mean-Variance Serum Sodium Associations with Diabetes Patients

Serum sodium (SNa) is a critically significant component of hyponatremia and bones, has firmly been established as a risk factor correlated with many diseases such as diabetes, heart, anaemia, etc and the incidence of fragility fractures. Note that the fragility fractures are a general complication in type 2 diabetes (T2D) patients, contributing to high rates of mortality and morbidity together with mounting public health costs. SNa is a fundamental component for normal physiological processes, and T2D patients may experience osmotic diuresis as a consequence of disease-related hyperglycemia, contributing to the excess excretion of sodium in the urine and resulting in hyponatremia. Dysnatremias [hyponatremia (&lt;136 mmol/L) and hypernatremia (&gt;145mmol/L)] can severely affect several physiologic organ systems and functions. Diabetes is correlated with many important electrolyte disorders, predominantly affecting magnesium, SNa, and potassium. However, the correlation/ association of SNa with diabetes patients is not clear. This can be confirmed based on the proper probabilistic model of SNa with diabetes status along with the other explanatory factors of the disease. On the other hand, this type of association can be obtained based on the models of fasting glucose/post glucose/random glucose/HbA1c level with SNa and other explanatory factors of the diabetes disease.

ASSESSMENT OF ELECTROLYTE ABNORMALITIES IN OLDER ADULTS WITH COVID-19 DELIRIUM

Abstract This retrospective study explored the impact of COVID-19 on altered sodium and potassium in older adults with delirium. EMRs from the University of Arkansas for Medical Sciences (UAMS) database were reviewed from January 7, 2018 to January 5, 2021 for electrolyte abnormalities and delirium. Inclusion criteria were age 65 or older, all races, genders, and ethnicities with COVID or non-COVID infections. We identified 319 patients with COVID-19 out of which 108 (33.8%) had delirium during COVID. In COVID-delirious patients, hypokalemia was present in 8, hyperkalemia in 10, hyponatremia in 9, and hypernatremia in 20.127/319 (39.8%) COVID patients had an electrolyte disorder at some point with hypokalemia being most represented at 58/127 (45.7%). Out of the patients who experienced hypokalemia at some point, 34/319 (10.6%) had delirium. In another cohort of 306 older adults with non-COVID pneumonias we identified 173 patients with electrolyte disorders and 106 (34.6%) with delirium during pneumonia. Electrolyte disturbances were more present in non-COVID pneumonias vs. those with COVID (p&amp;lt; 0.001). Hypokalemia was more identified in non-COVID, 56/306 (18.3%), vs. COVID patients, 34/319 (10.6%) (p&amp;lt; 0.006). Interestingly, hypernatremia was greater in COVID groups (p&amp;lt; 0.0321). There was no difference in delirium between COVID vs non-COVID patients, but electrolytes disorders and hypokalemia were observed with greater frequency in non-COVID pneumonias. Notably, hypernatremia developed more in patients suffering from COVID and since it can be associated with seizures and cerebral hemorrhage, particular attention should be paid to prevent hypernatremia from developing in order to reduce COVID-related morbidity and mortality.

Association between hyponatremia, inflammation, and mortality in patients undergoing peritoneal dialysis: A nationwide observations.

Hyponatremia is the most common electrolyte disorder often present in peritoneal dialysis (PD) patients. The aim of this retrospective study was to investigate the effect of hyponatremia on mortality in patients undergoing PD. The health records of adult individuals with an inserted PD catheter identified via the centralized national e-health database were used. The mean age of the 846 patients included in the study was 52.48 years (±14.6). The mean sodium level was 136.51 mEq/L. Sodium levels <137 mEq/L were associated with higher death risk independent of comorbidities. There was a 0.821 times less reduction in mortality for each mEq /L increase in serum sodium. Our study provides evidence that monitoring and adjusting serum sodium levels is crucial in managing PD patients with hyponatremia, as low serum sodium level was found to be a significant and independent predictor of mortality.

Puncture biliodigestive bypass in obstructive jaundice of tumor genesis

The experience of successful surgical treatment of two patients with malignant non-resectable tumor of hepatopancreaticoduodenal organs complicated with obstructive jaundice using minimally invasive surgery is described in clinical observations for the first time. The patients underwent fluoroscopy-guided biliodigestive bypass. The study presents a detailed description of the technique and stages of surgery using Ivshin® surgical kit. The proposed method prevents from such negative consequences of palliative surgeries as formation of biliodigestive anastomosis by conventional access or external cholecystostomy, the main disadvantages of which include surgery injury, hypocholia, acholia, as well as water and electrolyte disorders.

Central diabetes insipidus after transnasal adenomectomy:trends in development and recovery, clinical and laboratory characteristics

Background: Currently, there is an increase in the incidence of chiasmosellar neoplasms and respective neurosurgical interventions. The postoperative period may be complicated by vasopressin synthesis and secretion disorders. Both the development and abortion of the fluid and electrolyte disorders can be delayed. Due to a tendency for an earlier discharge of the patients, a proportion of the disorders remain unaddressed. There is no data on the evolution and time to regress of transient abnormalities in the published studies with a long-term postoperative follow-up.&#x0D; Aim: To assess the incidence, evolution and regression trends, clinical and laboratory characteristic of postoperative central diabetes insipidus (CDI).&#x0D; Materials and methods: The single center retrospective comparative study included 150 patients who had undergone transnasal adenomectomy for Cushings disease, acromegaly, prolactinomas, and hormonally inactive pituitary adenomas. Clinical and laboratory assessments were performed pre- and postoperatively. In the event of CDI, treatment with desmopressin was administered. Ninety six (96) patients aged 20 to 65 years (median age 43 [35; 54] years) were followed for at least 60 months after the procedure.&#x0D; Results: Median time to the onset of permanent CDI (pCDI) was Day 5 [1; 9.5] after surgery, that of transient CDI (tCDI) Day 1 [1; 4.5] with its remission by Day 30 [1.5; 199]. The maximally delayed onset was on Day 86 for the pCDI and Day 61 for tCDI; that to the remission of tCDI, 738 days. At discharge from the hospital, postoperative CDI was present in 34/150 patients (23%; 95% CI 1730), and in 25/150 of the patients (16%; 95% CI 1224) the disorder resolved. At 5 to 7 years after surgery, the prevalence of pCDI was 16% (95% CI 1024), that of tCDI 35% (95% CI 2745), 49% (95% CI 3959) of the patients had no abnormalities (respective absolute patient numbers being 15, 34, and 47 of 96 followed for at least 60 months). At Days 1 to 7 after surgery, the patients with pCDI and tCDI had more frequent complaints of dry mouth and thirst than those without the disorder. These complaints were verified by higher 24-hour fluid intake and diuresis at the day of surgery and Days 5 to 7 thereafter, compared to those in the patients without the disorders. At Days 57 after surgery, urine sodium and urine specific gravity were significantly lower, as was urine osmolality at all postoperative stages, compared to those in the patients without the disorders.&#x0D; Conclusion: Within 2 years after transnasal adenomectomy, the incidence of postoperative CDI is gradually decreasing (from 23% to 16%). Due to potentially delayed manifestation of water and electrolyte imbalance, it is recommended that these parameters should be monitored at least for 2,5 months after the discharge from hospital. Due to potentially delayed remission (12 months and more), follow-up and monitoring for 1.5 years is reasonable, with periodic assessment of sodium levels, fluid intake and excretion, and attempts to withdraw desmopressin.

The Laboratory and Clinical Perspectives of Magnesium Imbalance.

Magnesium (Mg2+) is a predominantly intracellular cation that plays significant roles in various enzymatic, membrane, and structural body functions. As a calcium (Ca2+) antagonist, it is imperative for numerous neuromuscular activities. The imbalance of body Mg2+ concentration leads to clinical manifestations ranging from asymptomatic to severe life-threatening complications. Therefore, the contribution of Mg2+ measurementregarding various laboratory and clinical aspects cannot be ignored. Mg2+ is often described as the forgotten analyte. However, its close relationship with body potassium (K+), Ca2+, and phosphate homeostasis proves that Mg2+ imbalance could co-exist as the root cause or the consequence of other electrolyte disorders. Meanwhile, several preanalytical, analytical, and postanalytical aspects could influence Mg2+ measurement. This review highlights Mg2+ measurement's laboratory and clinical issues and some analyte disturbances associated with its imbalance. Understanding this basis could aid clinicians and laboratory professionals in Mg2+result interpretation and patient management.

Substance used in the ripening of fruits can cause kidney damage and water and electrolytic disorders

Substance used in the ripening of fruits can cause kidney damage and water and electrolytic disorders

Substance used in the ripening of fruits can cause kidney damage and water and electrolytic disorders.

Substance used in the ripening of fruits can cause kidney damage and water and electrolytic disorders.

Association of hypertension in pregnancy with serum electrolyte disorders in late pregnancy among Cameroonian women

Multiple electrolyte disorders, including sodium, potassium and calcium disorders, have been associated with hypertension in pregnancy. Most of these studies failed to evaluate the combined effect of low and high sodium, potassium, calcium and chloride ion concentrations on hypertension in pregnancy. This study evaluates the combined effect of these ion categories (low, normal, high) on hypertension in pregnancy. Biochemical ion assays and blood pressure measurements were carried out on 1074 apparently healthy pregnant women in late third trimester. Serum potassium, sodium, chloride, and ionised calcium were measured by ion-selective electrode potentiometry, while total plasma calcium was measured by absorption spectrophotometry. Hypertension in pregnancy was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. The prevalence of hyponatraemia, hypokalaemia, hypochloraemia, ionised hypocalcaemia and total hypocalcaemia in late pregnancy was 1.30 [0.78–2.18]%, 3.55 [2.60–4.84]%, 1.96 [1.28–2.97]%, 1.49 [0.92–2.21]% and 43.58 [40.64–46.56]%, respectively. Hypernatraemia, hyperkalaemia, hyperchloraemia, ionised hypercalcaemia and total hypercalcaemia were found in 1.49 [0.92–2.41]%, 2.34 [1.59–3.43]%, 4.38 [3.31–5.77]%, 39.94 [37.06–42.90]%, 2.79 [1.96–3.96]% of the participants, respectively. The prevalence of hypertension in pregnancy was 7.17 [5.77–8.87]%. When ion categories were considered in multiple logistic regression, only ionised and total calcium had significant associations with hypertension in pregnancy. Women with ionised hypercalcaemia had lower odds of hypertension in pregnancy (AOR = 0.50 [0.29–0.87], p-value = 0.015), and women with total hypocalcaemia had higher odds of hypertension in pregnancy (AOR = 1.99 [1.21–3.29], p-value = 0.007), compared to women with ionised and total normocalcaemia, respectively. Increasing kalaemia was associated significantly with higher odds of hypertension in pregnancy; however, kalaemia below and above the normal concentrations had no significant association with hypertension. Nonetheless, participants with kalaemia ≤ 3.98 mmol/L, had lower odds of hypertension in pregnancy compared with those with higher kalaemia (OR = 0.40 [0.24–0.66], p-value = 0.0003). Calcium disorders remain the most frequent electrolyte disorders in pregnancy. When normal cut-offs are considered for calcium and other ions, only ionised and total calcium influence the occurrence of hypertension in pregnancy. Kalaemia seems to affect hypertension in pregnancy but primarily within its normal concentrations. Serum electrolyte follow-up is indispensable for a proper pregnancy follow-up.

Endovascular repair for abdominal aortic aneurysms involving visceral arteries: Effectiveness and contributing factors

ObjectiveAbdominal aortic aneurysms (AAA) involving branches of the visceral arteries mainly refer to AAA with flat renal artery (neck length ≤5 mm) or beyond the renal artery, and the branch of the visceral arteries needs to be reconstructed during treatment. Endoluminal repair (EVR) surgery refers to the isolation of AAA with less surgical trauma through vascular puncture, guidewire, catheter, stent and double suturer technology. However, postoperative endoleak is a complication specific to open surgery. This study aimed to analyze the efficacy of EVR for AAA involving visceral vessels (AAA-Vs) and the factors influencing the occurrence of postoperative endoleak. MethodsA total of 106 patients with AAA-Vs in our hospital during the period of January 2018 to January 2022 were distinguished as the observation group (received EVR, n = 48) and the control group (received laparotomy, n = 58). The operation time, intraoperative bleeding, intraoperative blood transfusion, postoperative intensive care unit (ICU) observation time, postoperative food-taking time, first time out of bed, hospital stay, complications and the one-year mortality of two groups were compared. According to the occurrence of postoperative endoleak, the patients underwent endoluminal repair surgery were graded as non-endoleak group (n = 39) and endoleak group (n = 9). The clinical data, including aneurysm anatomical conditions (proximal neck length, neck diameter, proximal neck angle), tumor shape (normal, calcification, mural thrombus), and internal iliac artery embolism of two groups were compared. Logistic regression analysis was employed to analyze the risk factors of endoleak after EVR of AAA. ResultsThe operation time, intraoperative blood loss, intraoperative blood transfusion, postoperative ICU observation time, postoperative food-taking time, first time out of bed and hospitalization days were sharply lower in the observation group than the control group (P < 0.001). There existed no significant difference in the proportion of pulmonary complications, cardiac complications and electrolyte disorders between two groups (P > 0.05). The observation group had much lower incidence of incision infection complications than the control group (P < 0.05). The one-year mortality rate in the observation group was 10.42 %, markedly lower than 25.86 % in the control group (P < 0.05). The incidence of endoleak in the observation group was 18.75 %, while no internal endoleak occurred in the control group (P < 0.05). The proportion of male patients, smoking history, internal iliac artery embolism, and the level of tumor neck length and proximal tumor neck angle in the endoleak group were memorably higher in comparison with the non-endoleak group (P < 0.05). Logistic regression analysis revealed that the length of the neck and the angle of the proximal neck were independent risk factors for postoperative endoleak of AAA (P < 0.05). In conclusionEVR was effective for AAA-Vs with the advantages of small trauma, rapid recovery, low complication rate and high safety. The diameter of the aneurysm neck and the angle of the proximal aneurysm neck were the risk factors for the occurrence of endoleak after EVR. It was necessary to fully evaluate the aneurysm before operation to help reduce the incidence of endoleak.

Hyponatremia in Acute ST-elevation Myocardial Infarction – A Retrospective Observational Study

Introduction: Hyponatremia is a common electrolyte disorder in hospitalized patients and has been linked to increased morbidity and mortality in various clinical settings. Patients with ST-elevation myocardial infarction (STEMI) are at risk of developing hyponatremia due to complex interplay of pathophysiological mechanisms. This study aimed to investigate the prevalence, risk factors, and prognostic value of hyponatremia in patients with STEMI. Materials and Methods: This was a retrospective study of 192 patients with STEMI who were admitted to a tertiary care hospital between July 2021 and December 2021. Patients were divided into two groups based on their serum sodium levels during hospitalization: Hyponatremia group (serum sodium &lt;135 mEq/L) and normonatremia group (serum sodium ≥135 mEq/L). The prevalence of hyponatremia, demographic variables, ejection fraction, Killip classification, type of STEMI, and in-hospital mortality were compared between the two groups. Results: 20.8% of patients with STEMI had hyponatremia during their hospital stay. Patients with heart failure, lower ejection fraction, and higher Killip classification at admission were more likely to have hyponatremia ([odds ratio (OR): 2.71, 95% confidence interval (CI): 1.23–5.97, P = 0.014], [P = 0.023] and P = 0.002). Patients with lateral STEMI were more likely to have hyponatremia compared to those with other types of STEMI (OR: 2.68, 95% CI: 1.06–6.81, P = 0.037). Patients with hyponatremia had higher in-hospital mortality rate (8 [22.9%], [OR: 4.27, 95% CI: 1.54–11.85, P = 0.005]) and longer hospital stays (P = 0.019) compared to normonatremia group. Conclusion: Hyponatremic patients with STEMI are associated with increased morbidity and mortality. Patients with heart failure, lower ejection fraction, and higher Killip classification at admission should be closely monitored for dyselectrolytemia.

Surgical management of giant pituitary adenomas: institutional experience and clinical outcomes of 94 patients

BackgroundGiant (with a diameter of at least 40 mm and a volume of at least 10 cm3) pituitary adenomas (GPAs) are intricate tumors that pose considerable difficulty for surgical removal. While endoscopic transsphenoidal surgery (ETS) is a commonly employed technique for these destructive tumors, its effectiveness may be restricted in cases where invasion into multiple compartments is present, leading to limited resection.MethodsA retrospective review was conducted on the clinical records of 94 patients diagnosed with GPAs who had undergone surgical resection from 2014 to 2022. An analysis was conducted on the outcomes of the surgical and clinical procedures.ResultsIn this group, the average size of the tumor before surgery was 44.6 ± 5.6 mm (range, 40–73 mm), and the volume was 25. 5± 16.6 cm3 (range, 10–20.67 cm3). Of the total number of patients, 72 (76.6%) underwent a single ETS, 12 (12.8%) opted for transcranial surgery (TCS), and 10 (10.6%) chose a combined method. Gross total resection (GTR) was successfully performed in 49 (68.1%), 3 (25.0%), and 8 (80.0%) patients who underwent each surgical approach. Seventy-four (78.7%) patients had improved vision, 20 (21.3%) were unchanged, and none had deterioration. Twenty-two patients (23.4%) experienced a total of 43 complications, which comprised hormonal insufficiency (11/94, 11.7%), diabetic insipidus (6/88, 6.8%), electrolyte disorders (7/94, 7.4%), cerebrospinal fluid leakage (5/94, 5.3%), meningitis (8/94, 8.5%), and hydrocephalus (6/94, 6.4%). The GTR, subtotal resection (STR), and partial resection (PTR) rates were 63.8% (60/94), 21.3% (20/94), and 14.9% (14/94), respectively. Throughout the follow-up duration, 18.1% (17/94) of patients required reoperation and/or adjuvant radiation treatment as a result of tumor regrowth or inadequate biochemical remission of functioning GPAs.ConclusionETS remains the optimal surgical option for most GPAs and generally offers safe and efficient tumor resection. However, a combined approach with TCS remains a requirement in cases that are not suitable for treatment with a single ETS. To achieve optimal tumor removal and minimize the occurrence of surgical complications, a flexible combination of ETS and TCS is recommended based on the characteristics of the tumor.

Machine learning prediction of hospital discharge disposition for inpatients with acute ischemic stroke following mechanical thrombectomy in the United States

Background and purposePredicting patient recovery and discharge disposition following mechanical thrombectomy remains a challenge in patients with ischemic stroke. Machine learning offers a promising prognostication approach assisting in personalized post-thrombectomy care plans and resource allocation. As a large national database, National Inpatient Sample (NIS), contain valuable insights amenable to data-mining. The study aimed to develop and evaluate ML models predicting hospital discharge disposition with a focus on demographic, socioeconomic and hospital characteristics. Materials and methodsThe NIS dataset (2006–2019) was used, including 4956 patients diagnosed with ischemic stroke who underwent thrombectomy. Demographics, hospital characteristics, and Elixhauser comorbidity indices were recorded. Feature extraction, processing, and selection were performed using Python, with Maximum Relevance - Minimum Redundancy (MRMR) applied for dimensionality reduction. ML models were developed and benchmarked prior to interpretation of the best model using Shapley Additive exPlanations (SHAP). ResultsThe multilayer perceptron model outperformed others and achieved an AUROC of 0.81, accuracy of 77 %, F1-score of 0.48, precision of 0.64, and recall of 0.54. SHAP analysis identified the most important features for predicting discharge disposition as dysphagia and dysarthria, NIHSS, age, primary payer (Medicare), cerebral edema, fluid and electrolyte disorders, complicated hypertension, primary payer (private insurance), intracranial hemorrhage, and thrombectomy alone. ConclusionMachine learning modeling of NIS database shows potential in predicting hospital discharge disposition for inpatients with acute ischemic stroke following mechanical thrombectomy in the NIS database. Insights gained from SHAP interpretation can inform targeted interventions and care plans, ultimately enhancing patient outcomes and resource allocation.

Approach to Hyponatremia in the Elderly Population

Hyponatremia is the most common electrolyte disorder in both hospitalized patients and the normal population. The prevalence of hyponatremia is approximately 8% in the population and increases significantly with age. In older patients, more than one factor often plays a role in the development of hyponatremia. The tendency of the elderly to develop hyponatremia is mainly attributed to impaired water excretion capacity associated with aging and frequent exposure to drugs and diseases associated with hyponatremia. In acute symptomatic hyponatremia, hypertonic saline solution is commonly used to acutely increase serum sodium levels and prevent severe neurological symptoms. In chronic hyponatremia, the rate of correction of serum sodium concentration should be limited to 10 mEq/L/24 h and more safely to 6–8 mEq/L/24 h. Since both the evaluation and treatment of hyponatremia are difficult in the older population, very careful evaluation is required.