Electrolyte Disorders Research Articles

Stress-induced urgent conditions in endocrinology

The literature review deals with the influence of chronic stress on the functioning of the endocrine system. The most significant pathological conditions induced by chronic stress are decompensation of carbohydrate metabolism, disorders of the thyroid gland, reproductive system, depressive disorders, electrolyte disorders. The significance of these pathologies is determined by a pronounced decrease in the quality of life, the occurrence of severe complications, and an increase in mortality. The development of hyperglycemia during the acute period of the disease is an established connection between the stress system and glucose homeostasis, which is confirmed by the development of stress hyperglycemia and increased morbidity. Glucocorticoids have a contrainsular effect, and the significance of their impact on carbohydrate metabolism is due to the pleiotropic action: induction of insulin resistance, stimulation of gluconeogenesis, increase in the blood content of glucagon due to dysregulation of its synthesis and secretion. The effects of stress on the thyroid gland are determined by its duration, characterized by the activation of the pituitary-thyroid system in the acute period and its suppression during long-term and chronic stress. The contribution of the stress component and glucocorticoid deficiency to the development of autoimmune thyroid diseases due to the suppression of cellular and strengthening of humoral immunity is discussed. Under conditions of psychological stress, the development of hypothyroidism was noted in emigrants with anxiety-depressive syndrome and insomnia, as evidenced by a decrease in the concentration of thyroid hormones. A decreased thyroid status in these patients is associated with the severity of chronic stress. Research data show that chronic stress can significantly change a person’s thyroid status, leading to the development of triiodothyronine deficiency syndrome and an increase in the production of inactive reverse triiodothyronine, inducing the development of hypothyroidism. It is possible that the pronounced growth of subclinical forms of hypothyroidism, noted in many countries of the world, is a consequence of chronic stress. The hypothalamic-pituitary-adrenal axis is involved in the formation of stress-induced reactions almost immediately after exposure to the stressor. Stress-induced changes in the endocrine system arise and develop in close connection, forming a vicious circle of pathological changes and emergencies.

Total shoulder arthroplasty in patients with a history of cerebrovascular accident: a matched case–control study

BackgroundWith increasing survivorship following cerebrovascular accidents (CVAs), more patients with a history of CVA are undergoing total shoulder arthroplasty (TSA). The purpose of this study is to determine the impact of prior CVA on the perioperative outcomes following TSA. MethodsThe Nationwide Readmissions Database was queried from 2010 to 2019 to identify all patients with a history of CVA undergoing TSA. Eight hundred seventeen cases were identified and case matched on a 1:2 ratio for age, sex, obesity status, and year of procedure. Patient demographic characteristics were collected and analyzed for differences between the 2 groups. Data on length of stay, 180-day complications, 180-day readmissions, and 180-day mortality were collected and analyzed for differences between the 2 groups. ResultsEight hundred seventeen cases of patients with a history of CVA were matched with 1634 patients without a history of CVA undergoing TSA. The average age was 71. Fifty six percent of patients were female, and 23% of patients were obese. Patients with CVA had higher incidence of tobacco use (P < .001), deficiency anemia (P < .001), electrolyte disorders (P < .001), paralysis (P < .001), coagulopathy (P < .001), heart valve disorders (P < .001), history of myocardial infarction (P < .001), and higher rates of chronic diseases, such as hypertension (P < .001), diabetes (P < .001), liver disease (P < .001), congestive heart failure (P < .001), renal failure (P < .001), and peripheral vascular disease (P < .001). Patients with a history of CVA had higher rates of complications, readmissions, and revisions within 180 days (P < .001). One hundred eighty–day mortality was similar between the 2 groups. The average length of stay was 3.2 days in patients with a history of CVA compared to 1.4 days in those without a history of CVA (P < .001). ConclusionPatients with a history of CVA have a higher rate of medical comorbidities than those without. These patients have higher rates of complications within 180 days of procedure, 180-day readmissions, and 180-day revisions. One hundred eighty–day mortality was similar between the 2 groups. Surgeons should take care to ensure thorough preoperative optimization and risk discussions to try and minimize postoperative adverse outcomes.

Intraoperative Cardiac Arrest During Liposuction: A Case Report.

With the popularity of liposuction surgery, more awareness should be obtained regarding complications. Liposuction has been thought of as a safe procedure with a very low incidence of major complications. However, life-threatening risks of liposuction have rarely been reported. We present a case of a 36-year-old woman who developed cardiac arrest during a liposuction procedure, and we present a literature review. She was previously healthy and had no risk factors for pulmonary embolism. The diagnosis was made based on clinical presentation and the presence of an electrolyte disorder and a positive sign on computed tomography pulmonary angiogram (CTPA). Mild hypothermia treatment, symptomatic treatment, and supportive therapy were applied. As the respiratory and circulation were smooth, she was discharged to a rehabilitation hospital. Seven months after discharge, the patient was still in a coma with eye opening. Spinal anesthesia, pulmonary embolism, and hyperkalemia are the most probable contributors to the cardiac arrest observed during the liposuction procedure in this specific case. There is a heightened imperative to vigilantly monitor for critical incidents during these operations and to meticulously identify associated risk factors during liposuction.

Estimates of 30-day postoperative pulmonary complications after gastrointestinal endoscopic procedures: A retrospective cohort analysis of a health system population.

The incidence of 30-day postoperative pulmonary complications (PPC) of gastrointestinal endoscopic procedures (GIEP) are not well characterized in the literature. The primary aim of this study was to identify the incidence of 30-day PPC after GIEP within a large healthcare system. We conducted a retrospective cohort study of 5377 patients presenting for GIEP between January 2013 and January 2022. Our primary outcome was the Agency for Healthcare Research and Quality PPC composite (AHRQ-PPC). Secondary outcomes were sub-composites derived from the AHRQ-PPC; including pneumonia (AHRQ-PNA), respiratory failure (AHRQ-RF), aspiration pneumonia/ pneumonitis (AHRQ-ASP) and pulmonary emboli (AHRQ-PE). We performed propensity score matching (PSM) followed by multivariable logistic regression to analyze primary and secondary outcomes. Inpatients had higher 30-day AHRQ-PPC (6.0 vs. 1.2%, p<0.001), as well as sub-composite AHRQ-PNA (3.2 vs. 0.7%, p<0.001), AHRQ-RF (2.4 vs. 0.5%, p<0.001), and AHRQ-ASP (1.9 vs. 0.4%, p<0.001). After PSM adjustment, pre-procedural comorbidities of electrolyte disorder [57.9 vs. 31.1%, ORadj: 2.26, 95%CI (1.48, 3.45), p<0.001], alcohol abuse disorder [16.7 vs. 6.8%, ORadj: 2.66 95%CI (1.29, 5.49), p = 0.01], congestive heart failure (CHF) [22.3 vs. 8.7%, ORadj: 2.2 95%CI (1.17, 4.15), p = 0.02] and pulmonary circulatory disorders [21 vs. 16.9%, ORadj: 2.95, 95%CI (1.36, 6.39), p = 0.01] were associated with 30-day AHRQ-PPC. After covariate adjustment, AHRQ-PPC was associated with upper endoscopy more than lower endoscopy [5.9 vs. 1.0%, ORadj: 3.76, 95%CI (1.85, 7.66), p<0.001]. When compared to gastroenterologist-guided conscious sedation, anesthesia care team presence was protective against AHRQ-PPC [3.7 vs. 8.4%, ORadj: 0.032, 95%CI (0.01, 0.22), p<0.001] and AHRQ-ASP [1.0 vs. 3.37%, ORadj: 0.002, 95%CI (0.00, 0.55), p<0.001]. In conclusion, we report estimates of 30-day PPC after GIEP across inpatient and outpatient settings. Upper endoscopic procedures confer a higher risk, while the presence of an anesthesia care team may be protective against 30-day PPC.

Clinical and Laboratory Effects of Foodborne Illness in Children.

The World Health Organization estimates that 31 foodborne pathogen account for 600 million cases of illness annually. This study, conducted in a pediatric emergency department in Turkey, addresses the limited research on pediatric foodborne diseases (FD) in the country, exposing a significant knowledge gap. Analyzing 17,091 pediatric cases, 106 FD cases were identified, predominantly affecting boys (94.3%) with an average age of 7.65 ± 6.51 years. Remarkably, no patients required pediatric intensive care admission, and no mortalities were recorded. Hyponatremia emerged as a prevalent electrolyte disorder in pediatric FD, while hyperkalemia was notably observed in children under 5. The study emphasizes the severity of FD in children under 5, reflected in longer hospital stays, underscoring the urgent need for targeted interventions and improved detection methods in pediatric FD.

Incorporating Acute Conditions into Risk-Adjustment for Provider Profiling: The Case of the US News and World Report Best Hospitals Rankings Methodology.

Several years ago, the US News and World Report changed their risk-adjustment methodology, now relying almost exclusively on chronic conditions for risk adjustment. The impacts of adding selected acute conditions like pneumonia, sepsis, and electrolyte disorders ("augmented") to their current risk models ("base") for 4 specialties-cardiology, neurology, oncology, and pulmonology-on estimates of hospital performance are reported here. In the augmented models, many acute conditions were associated with substantial risks of mortality. Compared to the base models, the discrimination and calibration of the augmented models for all specialties were improved. While estimated hospital performance was highly correlated between the 2 models, the inclusion of acute conditions in risk-adjustment models meaningfully improved the predictive ability of those models and had noticeable effects on hospital performance estimates. Measures or conditions that address disease severity should always be included when risk-adjusting hospitalization outcomes, especially if the goal is provider profiling.

A307 NEUROGASTROENTEROLOGY &amp; MOTILITY CAID (CHRONIC ATRIAL AND INTESTINAL DYSRHYTHMIA) SYNDROME: A SEVERE LATE-ONSET PEDIATRIC INTESTINAL PSEUDO-OBSTRUCTION

Abstract Background Pediatric intestinal pseudo-obstruction (PIPO) is a rare, heterogeneous and severe gut motility disorder. It is associated with a high morbidity and mortality rate. The etiology of PIPO can be either primary (sporadic or familial), secondary or idiopathic. In primary forms, 50 to 75% of patients will present symptoms in the first month of life and 80% by the end of the first year of life. In 2014, Chetaille et al. described the CAID syndrome related to a recessive SGOL1 mutation as a new form of PIPO associated with cardiac dysrhythmia. Aims Our aim is to describe the clinical presentation and the specific digestive and nutritional features of pediatric patients with SGOL1 mutation. Methods Monocentric, retrospective and descriptive study. We enrolled children and adolescents aged less than 18 years. All data were collected from patients’ files. Results 8 patients were included (5 girls), two of them were first-degree related. They all had a typical clinical presentation of PIPO (excessive abdominal distension, abdominal pain and vomiting) but with a later onset than usually seen in primary PIPO (median (range) age: 6.3 years [2-15.6]). The median age (range) at diagnosis was 7.8 years [4-15.7]. In most patients contrast studies showed massively distended small bowel and colon. Antroduodenal manometry was performed in 6 patients and was abnormal with a neuropathic pattern. Others were diagnosed using the ESPGHAN criteria (2018 Jun;66(6):991-1019). All patients needed parenteral nutrition at a median (range) age of 11.8 years [6.5-15.9] due to failure to thrive, intestinal failure and electrolytic disorders. Seven patients needed an ileostomy. One out of 8 patients was off PN at 18 years. Three patients had sinus dysfunction: one at the time of PIPO diagnosis and two sometimes after. All of them required a pacemaker. One patient died in her twenties and it wasn’t related to PIPO or its possible complications. Conclusions Recessive SGOL1 mutation, a new cohesinopathy affecting the gut and heart rhythm, represents a late-onset but severe form of PIPO. It is usually associated with sinus dysfunction and cardiac dysrhythmia. However, digestive symptoms appear first. Long term outcome is still to describe. Funding Agencies None

Need assessment of medical school curriculum for MOOCs: perspectives of instructors and students of Shiraz University of Medical Sciences

IntroductionDesigning, developing, and implementing a course without assessing and prioritizing instructional needs may result in inefficiency due to the disregard for the actual needs of the target population. The present study aimed to determine and prioritize medical students’ instructional needs regarding Massive Open Online Courses (MOOCs) at Shiraz University of Medical Sciences.MethodsThis survey study was carried out in three stages (2020–2021) using the Delphi technique. Purposive and snowball sampling methods were used to select the instructors. The students were selected through simple random sampling. The first round of the Delphi technique involved a questionnaire consisting of one open-ended question, completed by 49 basic/clinical faculty members and 47 senior medical students. In the second round, a 5-point Likert scale-based questionnaire was used to prioritize the instructional needs. The reliability of the questionnaire was verified by Cronbach’s alpha coefficient. In the third round, a focus group was used. A total of six expert faculty members and one senior medical student were invited to the focus group session to prioritize the needs. Data were analyzed using Friedman’s non-parametric ranking test in SPSS version 26.ResultsTen instructional needs priorities were extracted, including common pharmacotherapies (antibiotics and narcotics), prescriptions, physiology, anatomy, physical examination, electrocardiography interpretation, radiography, computed tomography scans, serum electrolyte disorders, and cardiovascular and internal (endocrine and metabolic) diseases. The chi-squared calculated value (715.584) indicated a significant difference in the importance of the questionnaire’s questions (P < 0.001). These questions did not have equal value, and the importance, from the respondent’s point of view and the observed distribution of ranks, was not the output of a random factor.ConclusionsThe findings of this study can be used to design MOOCs, revise instructional programs, and adapt the curriculum to meet the needs of general practitioners, which will, in turn, help meet the medical needs of the general population.

A Systematic Literature Review on Risk Factors for and Timing of Clostridioides difficile Infection in the United States.

Clostridioides difficile infection (CDI) is a major public health threat. Up to 40% of patients with CDI experience recurrent CDI (rCDI), which is associated with increased morbidity. This study aimed to define an at-risk population by obtaining a detailed understanding of the different factors leading to CDI, rCDI, and CDI-related morbidity and of time to CDI. We conducted a systematic literature review (SLR) of MEDLINE (using PubMed) and EMBASE for relevant articles published between January1, 2016, and November11, 2022, covering the US population. Of the 1324 articles identified, 151 met prespecified inclusion criteria. Advanced patient age was a likely risk factor for primary CDI within a general population, with significant risk estimates identified in nine of 10 studies. Older age was less important in specific populations with comorbidities usually diagnosed at earlier age, such as bowel disease and cancer. In terms of comorbidities, the established factors of infection, kidney disease, liver disease, cardiovascular disease, and bowel disease along with several new factors (including anemia, fluid and electrolyte disorders, and coagulation disorders) were likely risk factors for primary CDI. Data on diabetes, cancer, and obesity were mixed. Other primary CDI risk factors were antibiotics, proton pump inhibitors, female sex, prior hospitalization, and the length of stay in hospital. Similar factors were identified for rCDI, but evidence was limited. Older age was a likely risk factor for mortality. Timing of primary CDI varied depending on the population: 2-3weeks in patients receiving stem cell transplants, within 3weeks for patients undergoing surgery, and generally more than 3weeks following solid organ transplant. This SLR uses recent evidence to define the most important factors associated with CDI, confirming those that are well established and highlighting new ones that could help to identify patient populations at high risk.

Hyperkalaemia in Cardiological Patients: New Solutions for an Old Problem.

Hyperkalaemia is one of the most common electrolyte disorders in patients with cardiovascular disease (CVD). The true burden of hyperkalaemia in the real-world setting can be difficult to assess, but in population-based cohort studies up to 4 in 10 patients developed hyperkalaemia. In addition to drugs interfering with potassium metabolism and food intake, several conditions can cause or worsen hyperkalaemia, such as advanced age, diabetes, and chronic kidney disease. Mortality, cardiovascular morbidity, and hospitalisation are higher in patients with hyperkalaemia. Hyperkalaemia represents a major contraindication or a withholding cause for disease-modifying therapies like renin-angiotensin-aldosterone inhibitors (RAASi), mainly mineralocorticoid receptor antagonists. Hyperkalaemia can be also classified as acute and chronic, according to the onset. Acute hyperkalaemia is often a life-threatening emergency requiring immediate treatment to avoid lethal arrhythmias. Therapy goal is cell membrane stabilisation by calcium administration, cellular intake, shift of extracellular potassium to the intracellular space (insulin, beta-adrenergic agents, sodium bicarbonate), and increased elimination with diuretics or dialysis. Chronic hyperkalaemia was often managed with dietary counselling to prevent potassium-rich food intake and tapering of potassium-increasing drugs, mostly RAASi. Sodium polystyrene sulphonate, a potassium binder, was the only therapeutic option. Recently, new drugs such as patiromer and sodium zirconium cyclosilicate give new opportunities for the treatment of hyperkalaemia, as they proved to be safe, well tolerated, and effective. Aim of this review is to describe the burden of hyperkalaemia in cardiovascular patients, its direct and indirect effects, and the therapeutic options now available in the acute and chronic setting.

Outcomes After Pectus Excavatum Repair: Center Volume Matters

PurposePectus excavatum (Pectus) repair may be offered for those with significant cardiopulmonary compromise or severe cosmetic defects. The influence of hospital center volume on postoperative outcomes in children is unknown. This study aimed to investigate the outcomes of children undergoing Pectus repair, stratified by hospital surgical volume. MethodsThe Nationwide Readmission Database was queried (2016–2020) for patients with Pectus (Q67.6). Patients were stratified into those who received repair at high-volume centers (HVCs; ≥20 repairs annually) versus low-volume centers (LVCs; <20 repairs annually). Demographics and outcomes were analyzed using standard statistical tests. ResultsA total of 9414 patients with Pectus underwent repair during the study period, with 69% treated at HVCs and 31% at LVCs. Patients at LVCs experienced higher rates of complications during index admission, including pneumothorax (23% vs. 15%), chest tube placement (5% vs. 2%), and overall perioperative complications (28% vs. 24%) compared to those treated at HVCs, all p < 0.001.Patients treated at LVCs had higher readmission rates within 30 days (3.8% vs. 2.8% HVCs) and overall readmission (6.8% vs. 4.7% HVCs), both p < 0.010. Among readmitted patients (n = 547), the most frequent complications during readmission for those initially treated at LVCs included pneumothorax/hemothorax (21% vs. 8%), bar dislodgment (21% vs. 12%), and electrolyte disorders (15% vs. 9%) compared to those treated at HVCs. ConclusionPediatric Pectus repair performed at high-volume centers was associated with fewer index complications and readmissions compared to lower-volume centers. Patients and surgeons should consider this hospital volume-outcome relationship. Type of StudyRetrospective Comparative. Level of EvidenceIII.

Risk factors for perioperative blood transfusion in patients undergoing total laparoscopic hysterectomy

PurposeThe goal is to identify risk factors associated with receiving a blood transfusion during the perioperative period in patients who undergo total laparoscopic hysterectomy (TLH) using a large-scale national database.MethodsIn this retrospective analysis, data from the Nationwide Inpatient Sample (NIS) was utilized to review the medical records of all patients who underwent TLH from 2010 to 2019. The researchers identified patients who had received a blood transfusion during the perioperative period and compared with those who had not. The subsequent factors associated with blood transfusion were examined: hospital characteristics (type of admission and payer, patient demographics (age and race), bed size, teaching status, location, and region of hospital), length of stay (LOS), total charges during hospitalization, in-hospital mortality, comorbidities, and perioperative complications. The data was analyzed using descriptive statistics. The independent risk factors of perioperative blood transfusion after TLH was identified by performing multivariate logistic regression.ResultsA total of 79,933 TLH were captured from the NIS database, among which 3433 (4.40%) patients received a perioperative blood transfusion. TLH patients affected by blood transfusion were 2 days longer hospital stays (P < 0.001), higher overall costs (P < 0.001), the patients who received a transfusion after a long-term hospitalization had a significantly higher rate of mortality (0.5% vs. 0.1%; P < 0.001). Perioperative blood transfusion after TLH was associated with chronic blood loss anemia, deficiency anemia, coagulopathy, congestive heart failure, fluid and electrolyte disorders, renal failure, metastatic cancer, sepsis, weight loss, deep vein thrombosis, gastrointestinal hemorrhage, shock, acute myocardial infarction, and pneumonia, stroke, hemorrhage, pulmonary embolism, and disease of the genitourinary system.ConclusionStudying the risk factors of perioperative blood transfusion after TLH is advantageous in order to ensure proper management and optimize outcomes.

Risk factors of postoperative delirium following spine surgery: A meta-analysis of 50 cohort studies with 1.1 million participants

ObjectivesPostoperative delirium (POD) is considered to be a common complication of spine surgery. Although many studies have reported the risk factors associated with POD, the results remain unclear. Therefore, we performed a meta-analysis to identify risk factors for POD among patients following spinal surgery. MethodsWe systematically searched the PubMed, Embase and the Cochrane Library for relevant articles published from 2006 to February 1, 2023 that reported risk factors associated with the incidence of POD among patients undergoing spinal surgery. The Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed, and random effects models were used to estimate pooled odds ratio (OR) estimates with 95 % confidence intervals (CIs) for each factor. The evidence from observational studies was classified according to Egger's P value, total sample size, and heterogeneity between studies. ResultsOf 11,329 citations screened, 50 cohort studies involving 1,182,719 participants met the inclusion criteria. High-quality evidence indicated that POD was associated with hypertension, diabetes mellitus, cardiovascular disease, pulmonary disease, older age (>65 years), patients experiencing substance use disorder (take drug ≥1 month), cerebrovascular disease, kidney disease, neurological disorder, parkinsonism, cervical surgery, surgical site infection, postoperative fever, postoperative urinary tract infection, and admission to the intensive care unit (ICU). Moderate-quality evidence indicated that POD was associated with depression, American Society of Anesthesiologists (ASA) fitness grade (>II), blood transfusion, abnormal potassium, electrolyte disorder, length of stay, inability to ambulate and intravenous fluid volume. ConclusionsConspicuous risk factors for POD were mainly patient- and surgery-related. These findings help clinicians identify high-risk patients with POD following spinal surgery and recognize the importance of early intervention.

Point-of-care ultrasound is a useful adjunct tool to a clinician's assessment in the evaluation of severe hyponatraemia.

Hyponatraemia is the most common electrolyte disorder in inpatients resulting mainly from an imbalance in water homeostasis. Intravascular fluid status assessment is pivotal but is often challenging given multimorbidity, polypharmacy and diuretics use. We evaluated the utility of point-of-care ultrasound (POCUS) as an adjunct tool to standard practice for fluid assessment in severe hyponatraemia patients. Patients presenting with severe hyponatremia (Serum Sodium [Na] < 120 mmol/L; Normal range: 135-145 mol/L), managed by standard care were included. Hyponatraemia biochemistry work-up and POCUS examination were undertaken. Both clinician and POCUS independently assigned one of the three fluid status groups of hypovolaemia, hypervolaemia or euvolaemia. The final diagnosis of three fluid status groups at admission was made at the time of discharge by retrospective case review. Clinician's (standard of care) and POCUS fluid assessments were compared to that of the final diagnosis at the time of discharge. n = 19 patients were included. Median Na on admission was 113 mmol/L (109-116), improved to 129 ± 3 mmol/L on discharge. POCUS showed the higher degree of agreement with the final diagnosis (84%; n = 16/19), followed by the clinician (63%; n = 12/19). A trend towards higher accuracy of POCUS compared to clinician assessment of fluid status was noted (84% vs. 63%, p = 0.1611). Biochemistry was unreliable in 58% (n = 11/19) likely due to renal failure, polypharmacy or diuretic use. Inappropriate emergency fluid management was undertaken in 37% (n = 7/19) of cases based on initial clinician assessment. Thirst symptom correlated to hypovolaemia in 80% (4/5) cases. As subjective clinical and biochemistry assessments of fluid status are often unreliable due to co-morbidities and concurrent use of medications, POCUS can be a rapid objective diagnostic tool to assess fluid status in patients with severe hyponatraemia, to guide accurate emergency fluid management.

A retrospective study on the relationship between serum electrolyte disorder and delayed cerebral infarction after aneurysmal subarachnoid hemorrhage

ObjectiveDelayed cerebral ischemia (DCI)-induced cerebral infarction is a major cause of adverse neurological outcomes following aneurysmal subarachnoid hemorrhage (aSAH). This study aimed to investigate the relationship between postoperative serum electrolyte levels and DCI in patients with aSAH. Materials and methodsWe analyzed the data of patients with aSAH between 2015 and 2022. The patients were classified into two groups according to whether they experienced DCI. Electrolyte levels were categorized into three groups based on the normal ranges for electrolytes. Logistic regression models were used to study the relationship between electrolyte levels and DCI. Another logistic regression analysis was conducted to explore the relationship between the different severity levels of statistically significant indicators and DCI. A restrictive cubic spline model was adopted to assess the potential linear relationship between electrolytes and DCI. Subsequently, sensitivity analysis was performed to assess the impact of collinearity among ions. Finally, subgroup analysis was performed. ResultsThis study included 1,099 patients. Patients with hyperchloremia were more prone to DCI than those with normal chloride levels. Subsequently, excluding the population with hypochloremia, both mild and severe hyperchloremia were found to be associated with an increased risk of DCI compared with normal chloride levels. Within the framework of a restrictive cubic spline, our findings revealed an increased incidence of DCI (P for nonlinear = 0.735) as chloride levels increased. Sensitivity analysis revealed that patients with severe hyperchloremia were more susceptible to DCI. ConclusionsThis study found that patients with aSAH and postoperative hyperchloremia are more prone to developing DCI.

Comparative Analysis of Enteral and Parenteral Nutrition Impact on Outcomes in Esophageal Cancer Patients: A Paradigm for Nutritional Optimization in Oncology

Background: Individuals diagnosed with esophageal cancer face a pronounced risk of malnutrition, primarily attributed to the early onset of gastrointestinal obstruction. This risk persists and may even intensify following therapeutic interventions and the subsequent reconstruction of gastrointestinal passages. The current study focuses on elucidating the differential impact of enteral vs. parenteral nutrition on outcomes in patients hospitalized with esophageal cancer. Methods: The study analyzed adult discharges related to esophageal cancer from 2019 and 2020 using data from the National Inpatient Sample. Exclusion criteria included discharges involving minors and mixed nutritional regimens. Enteral nutrition and parenteral nutrition subgroups were identified using International Classification of Diseases, 10th revision codes. Outcome variables were determined through ICD-10 codes in the NIS dataset. Multivariable regression analyses were used to investigate associations between mode of nutrition and specified outcomes. Results: In this study involving 28,015 hospitalizations for esophageal cancer, 756(2.7%) received enteral nutrition, and 1064(3.8%) received parenteral nutrition. After adjusting for confounding variables, parenteral nutrition emerged as an independent predictor of mortality (OR 1.75, P=0.023), while enteral nutrition showed no association with higher mortality (OR 0.56, P=0.162). Both nutrition modes were associated with increased length of stay, with patients on parenteral nutrition having significantly longer stays (+9.07 days, P&lt;0.001 vs 3.07 days, P=0.001). While both nutrition modes were linked to high total hospitalization charges, patients with parenteral nutrition experienced a significantly more significant increase in total treatment cost compared to those on enteral nutrition (112,093 USD, P&lt;0.001 vs 54,953 USD, P=0.01) patients on enteral nutrition had lower odds of pneumonia compared to the parenteral nutrition group. The parenteral nutrition group had higher odds of various complications, including esophageal perforation, constipation, diarrhea, acute kidney injury, ICU admission, and acute respiratory failure, than those on enteral nutrition. Both forms of nutrition were associated with increased odds of malnutrition, fluid and electrolyte disorders, and septic shock. Conclusion: Parenteral nutrition has a higher risk of mortality compared to enteral nutrition. Both types are linked to longer hospital stays, increased treatment costs, and other adverse outcomes, with parenteral nutrition leading to more complications than enteral nutrition.

Chronic Hyponatremia and Brain Structure and Function Before and After Treatment

Rationale & ObjectiveHyponatremia is the most common electrolyte disorder and is associated with significant morbidity and mortality. This study investigated neurocognitive impairment, brain volume, and alterations in MRI-based measures of cerebral function in patients before and after treatment for hyponatremia. Study DesignProspective cohort study. Setting & ParticipantsPatients with presumed chronic hyponatremia without signs of hypo- or hypervolemia treated in the Emergency Department of a German tertiary care hospital. ExposureHyponatremia ([Na+] <125 mmol/L) before and after treatment leading to [Na+] >130 mmol/L. OutcomesStandardized neuropsychological testing (Mini-Mental-State examination [MMSE], DemTect, Trail-Making Test [TMT] A/B, Beck’s Depression Inventory, Timed Up and Go) and resting-state MRI were performed prior to and following treatment of hyponatremia to assess volumes of total brain, white and gray matter, as well as neuronal activity and its synchronization. Analytical ApproachChanges in outcomes after treatment for hyponatremia assessed using bootstrapped confidence intervals and Cohen’s d. Associations between parameters were assessed using correlation analyses. ResultsDuring a 3.7-year period, 26 patients were enrolled. Complete data were available for 21 patients. Mean [Na+] was 118.4 mmol/L before treatment and 135.5 mmol/L following treatment. Most measures of cognition improved significantly. Comparison of MRI studies showed a decrease in brain tissue volumes, neuronal activity, and synchronization across all gray matter after normalization of [Na+]. Volume effects were particularly prominent in the hippocampus. During hyponatremia, synchronization of neuronal activity was negatively correlated with [Na+] (r=-.836, [-.979, -.446]) and cognitive function (MMSE: r=-.523, [-.805, -.069]; DemTect: r=-.744, [-.951, -.385] and TMT-A: r=.692, [.255, .922]). LimitationsSmall sample size, insufficient quality of several MRI scans due to motion artifact. ConclusionsResolution of hyponatremia was associated with improved cognition and reductions in brain volumes and neuronal activity. Impaired cognition during hyponatremia is closely linked to increased neuronal activity rather than to tissue volumes. Furthermore, the hippocampus appears to be particularly susceptible to hyponatremia, exhibiting pronounced changes in tissue volume.

Determinants of Hospital Stay Duration Post-Colorectal Surgery

Introduction: Hospital length of stay (LOS) remains a vital metric for assessing patient outcomes and healthcare resource utilization. Given the substantial financial impact of diagnosing and treating colorectal anomalies, coupled with an increased susceptibility to postoperative complications, it is crucial to understand the factors affecting LOS following colorectal surgery. Our primary objective was to investigate the preoperative, intraoperative, and postoperative risk factors that have substantial influence over LOS following a colorectal procedure.&#x0D; Methods: This study analyzed data from a retrospective study of adults who underwent various colorectal surgeries (colostomy, ileostomy, small bowel resection, etc.) at Cleveland Clinic Foundation (January 2005&#x0D; - December 2014). Predictor variables were categorized into preoperative (patient demographics, medical history, comorbidities, lifestyle factors), intraoperative, and postoperative factors. LOS was grouped into short-term (SLOS) (≤ 7 days), medium-term (MLOS) (8-30 days), and long-term (LLOS) (&gt; 30 days) stays. Multinomial logistic regression models assessed predictor effects on LOS.&#x0D; Results: Among the 7874 patients, 50.7% were females, with a minimum age of 20 years. SLOS were observed in 61.1%, MLOS in 37.6%, and LLOS in 1.3% of patients. Advanced age correlated with prolonged LOS, possibly due to age-related health challenges like weak immune systems. Coagulopathy, and fluid and electrolyte disorders raised MLOS and LLOS risk, likely due to complications like significant bleeding and electrolyte imbalances. Surgery duration predicted longer LOS, elevating LLOS and MLOS by 52% and 42%. Postoperative infections were associated to extended stays, possibly due to subsequent interventions, monitoring and recovery delays.&#x0D; Conclusion: Our study revealed that key preoperative predictors of LOS included Age, coagulopathy, fluid and electrolyte disorders, severe weight loss, and drug abuse. Notably, intraoperative factors such as surgical approach (open vs laparoscopic) and surgery duration, alongside postoperative complications including superficial and serious infections, significantly influenced LOS. By incorporating these insights into the preoperative planning, clinicians could potentially develop tailored interventions to mitigate risk factors and enhance postoperative recovery, thus potentially reducing LOS and improving patient outcomes.

Verification of the Morphofunctional Disorders Level of the Hepatorenal System during the Feline Tripelphosphate Urolithiasis

Introduction. The available information referring to the feline urolithiasis pathogenesis does not fully reflect the nature of changes taking place in the body, because it does not take into account the existing liver-kidney interrelationship. A systemic approach to studying this problem enables development of the targeted diagnostic strategies, increase of the subsequent therapeutic efficacy, as well as reduction of the possible clinical harm of polypragmasia. The aim of this article is to study the interrelationship between the nature of the hepatorenal system morphofunctional disorders and the level of metabolic processes in cats sick with struvite urolithiasis with the signs of cystolithiasis.Materials and Methods. The objects of the research were cats: the 1st experimental group consisted of the outbred female cats with tripelphosphate urolithiasis with signs of cystolithiasis, the 2nd experimental group — outbred castrated male cats with tripelphosphate urolithiasis with signs of cystolithiasis, the control group was mixed of the clinically healthy male and female animals. During the research, the results of the sick animals' clinical study, morphological and biochemical blood serum tests, hepatorenal system transabdominal ultrasonography were used, the urine macroscopic and biochemical examinations as well as urine sediment microscopy were carried out.Results. Against the background of hyperazotemia in sick animals (UREA — 14.70±1.30 mmol/L and 17.05±1.60 mmol/L; CREA — 173.90±6.06 μmol/L and 182.30±7.54 μmol/L; URIC ACID — 69.30±4.50 μmol/L and 73.48±4.83 μmol/L) and water-electrolyte metabolism disorder (Ca+2 — 2.89±0.05 mmol/L and 3.04±0.12 mmol/L; P+3 — 3.12±0.06 mmol/L and 3.20±0.09 mmol/L; iCa+2 — 1.39±0.03 mmol/L and 1.42±0.02 mmol/L; Cl- — 125.58±1.19 mmol/L and 129.90±1.06 mmol/L) there were observed: a disorder in the hepatobiliary system functioning due to elevation of the main hepatic transaminase activity (AST — 41.74±5.35 unit/L and 49.30±6.74 unit/L; ALT — 85.82±6.15 unit/L and 90.05±6.50 unit/L; ALКP — 45.61±3.10 unit/L and 48.16±2.86 unit/L; AAR — 0.49±0.03 and 0.54±0.02), elevation of total bilirubin level (BILT — 5,76±0,15 μmol/L and 6,08±0,24 μmol/L) and bilirubin direct (BILD — 1,40±0,03 μmol/L and 1,62±0,02 μmol/L), as well as elevation of the gamma-glutamyl transpeptidase (GGT — 6,67±1,01 unit/L and 7,90±0,90 unit/L) and lactate dehydrogenase (LDH — 215,47±10,30 unit/L and 219,04±9,27 unit/L) activity level. The acoustic shadowing of the hepatorenal system organs confirmed the signs of acute hepatitis against the background of cystolithiasis due to the existing anatomical relationship between kidneys and liver.Discussion and Conclusion. The results of the sick animals’ blood serum examination indicated the progression of the hematopoietic dysfunction during the tripelphosphate urolithiasis, which contributed to the development of the circulatory tissue hypoxia in the liver-kidney system. The development of the hyperazotemia contributed to the elevation of the main hepatic transaminase activity and building-up of the functional disorders in the hepato-biliary system of sick cats in response to the acute inflammatory process going on in the urogenital tract. The carbohydrate and lipid metabolism disorders indicated the liver metabolic activity disorder and its parenchymal damage on the background of urolithiasis. The electrolyte and water metabolism disorders, the development of the hyperproteinemia in test cats with the tripelphosphate urolithiasis contributed to the damage of the hepatorenal system organs due to development of the compensated metabolic acidosis and hyperchloremia.

Impact of electrolyte abnormalities and adverse outcomes in persons with eating disorders: A systematic review protocol.

Electrolytes (sodium, potassium, calcium, magnesium, chloride, phosphate) are required in specific amounts for proper functioning of the human body. Although the body has different organ systems, such as the kidneys, that regulate electrolyte levels in the blood, electrolyte abnormalities occur frequently in people with eating disorders. The objective of this review will be to examine the association between electrolyte imbalances and adverse outcomes in people with eating disorders. A systematic review of studies on eating and electrolyte disorders shall be conducted. Electronic searches shall be done in the Ovid MEDLINE, EMBASE, and PsycINFO databases. Selected studies shall include randomized control trials (RCTs), non-randomized controlled trials, and cross-sectional studies published in English or French. Quality appraisal of studies and a narrative synthesis of extracted data shall be conducted. This review will synthesize existing evidence on electrolyte abnormalities in people with eating disorders. It will identify the type of electrolyte imbalances, their impact, and outcomes in people with eating disorders. We anticipate that information that will be useful to policy makers and clinicians in designing better policies to prevent eating disorders and or manage people with eating disorders shall be elucidated in this study. The final manuscript will be submitted for publication in a journal. This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO); registration number CRD42023477497.