Hyperkalemia Research Articles

Evaluation of Vermicompost, Seaweed, and Algal Fertilizers on Soil Fertility and Plant Production of Sunn Hemp

Regenerative agriculture increasingly relies on organic soil amendments to improve soil fertility and crop productivity. This study evaluates the effects of dried algae (DA), vermicompost (VC), liquid hydrolyzed fish and seaweed fertilizer (LA), and a control (S0, untreated soil without amendments) on the soil fertility, growth, nutrient uptake, and physiology of sunn hemp (Crotalaria juncea L.), a key cover crop for soil improvement. Treatments were applied at 1 ton/ha (DA), 3 ton/ha (VC), and 8 mL/L (LA). Plants were grown for 10 weeks, during which plant growth, chlorophyll content, and biomass were measured. Soil and plant samples were analyzed for macro- and micronutrients. S0 and DA treatments produced the highest biomass, with S0 showing the highest total carbon and organic matter content. LA-treated soils exhibited elevated phosphorus, potassium, and sodium levels, while DA and S0 shoots had significantly higher sulfur and zinc concentrations. LA treatment notably increased chlorophyll content by the study’s end. Overall, DA demonstrated strong potential as a nutrient-rich organic amendment, while S0 provided a robust baseline for biomass production. VC enriched phosphorus and potassium but resulted in the lowest total biomass. LA promoted shoot growth and chlorophyll content but required root development and sodium management optimization. These findings highlight the need to align the amendment choice with soil characteristics and environmental conditions to optimize crop productivity and soil health in sustainable farming systems.

Adipokines Identify Crucial Biomarkers for Hypertension in Iraq

Adipokines, which are generated by adipose tissue, are biologically active compounds that function similarly to traditional hormones. These proteins are involved in cellular signaling and control or modify several biological processes in target organs such as the brain, liver, muscles, heart, blood vessels, pancreas, and immune system. Adipokines can be incorporated into new diagnostic approaches as biological indicators of different metabolic, inflammatory, and cardiovascular conditions. The study was conducted at Al-Basrah Teaching Hospital on hypertensive patients between December 2022 and March 2023. This study included a sample of fifty-three patients with hypertension, whose ages ranged from 30 to 60 years. The features of these patients were compared to the same variables in a group of fifty-three healthy volunteers aged 30 to 40 years. This study aimed to identify the most significant alterations in serum apelin, spexin, and serum electrolyte levels (sodium, potassium, calcium, magnesium, and chloride) in patients solely diagnosed with hypertension. The analysis involved a statistical examination of the variables. The hypertension group had lower apelin and higher spexin levels than the control group. Additionally, each group had normal electrolyte levels (sodium, potassium, calcium, magnesium, chloride). The control group had somewhat higher potassium, calcium, and chloride levels than the hypertension group. The concentration of apelin does not influence sodium, calcium, magnesium, or chloride. Negative potassium correlation for apelin. However, spexin concentration does not impact sodium, potassium, calcium, or magnesium. Spexin concentrations are negatively correlated with apelin and chloride concentrations. Highlight: Adipokines Role: Adipokines are key in cellular signaling affecting multiple organs. Study Findings: Hypertensive patients showed lower apelin and higher spexin levels. Serum Electrolyte Levels: normal in both groups, with minor differences in potassium, calcium, and chloride. Keywoard: Adipokines, Hypertension, Apelin, Spexin, Electrolytes

Chronic administration of Musa acuminata Colla (BANANA) to Wistar albino rats induces hyperkalemia

ABSTRACT Background Hyperkalemia is a medical condition characterized by excess potassium in the blood. Overindulgence in foods high in potassium can also result in hyperkalemia, particularly in individuals with severe kidney disease.. Aim of the study In this study, hyperkalemia was assessed in Wistar albino rats administered with M. acuminata. Material and Methods Thirty-six rats underwent various treatments over three months after being randomly divided into groups of six. Standard medications administered included Lisinopril and keyaxalate. The proximate and mineral content of raw banana (RB) and normal rat pellets (NRP) were compared and evaluated with that of cooked banana (CB). The rats’ serum and urine calcium and potassium levels were measured using established protocols. Results In comparison to RB, CB was found to have significantly higher levels of nutrients (proteins and fats) and minerals (calcium, sodium, and potassium). Administration of CB markedly significantly increased serum potassium levels however, keyaxalate decreased urine potassium levels; the treatment of kayexalate plus lisinopril markedly decreased urine Ca concentration (p<0.05). Conclusions Cooked banana has a higher mineral and nutritional content than raw banana. Continuous and daily consumption of cooked bananas led to hyperkalemia in Wistar rats as evidenced by elevated serum potassium levels.

Flower-like graphitic carbon derived from biomass for anode of potassium ion battery

The conventional graphite anode for potassium ion batteries (PIBs) can be structurally disrupted by intercalation of potassium ion with a large radius, resulting in the poor cycling stability and rate capability. Here an architecture of flower-like graphitic carbon (FLGC) derived from biomass is designed. As the anode for PIBs, FLGC achieves the stable performance and high-rate capability because of numerous mesopores, intrinsic defects, and a large interlayer spacing. FLGC presents a stable cycling performance (171mAh g−1 after 1700 cycles at 500 mA g−1 with a capacity retention of 79.2 %) and a high potassium storage capacity (301mAh g−1 at 100 mA g−1), in addition to low charge/discharge plateaus (0.35 V for charge and 0.12 V for discharge). More importantly, the mechanism for potassium storage and influence of intrinsic defects on the electrochemical performance are investigated. This study offers a novel design for graphitic structures, which is important for PIBs.

Toxicological Effects of Sewage Sludge on Biochemical Biomarkers of Earthworms (Eisenia andrei)

ABSTRACTSewage sludge, or biosolids, produced in wastewater treatment plants (WWTP) can be used as an alternative to organic fertilizer in the agricultural field. However, it holds a large amount of anthropogenic chemicals, such as drugs and metals. The aim of the present study is to evaluate biochemical biomarker responses in earthworms (Eisenia andrei) exposed to soil presenting different sludge concentrations deriving from the largest WWTP in Southern Brazil. Treatments comprised 3%, 6%, 12%, 24%, 50%, and 75% of sludge incorporated to native forest soil, 100% of sludge and the control group (0%). Concentrations of different drugs, mainly of antibiotics, as well as high sulfur, magnesium, potassium, zinc, and phosphorus were identified in analyzed sewage sludge. Exposed earthworms were collected on the 7th, 14th, and 28th day of the experiment and subjected to analysis of lipid peroxidation levels (TBARS), acetylcholinesterase (AChE), catalase (CAT), and glutathione S‐transferase (GST) activity. Treatments with 50%, 75%, and 100% of sludge were lethal to earthworms after 7 days. Based on biochemical tests performed in treatments with 3%, 6%, 12%, and 24% of sludge, the highest sludge concentrations (12% and 24%) and the longest exposure time (28 days) led to significant changes in biomarkers. Therefore, sewage sludge must be incorporated into the soil at concentrations lower than 3%, mainly due to changes in CAT, AChE, GST, and the resulting lipid damage observed at concentrations of 6%, 12%, and 24%.

Hyperkalemia or Not? A Diagnostic Pitfall in the Emergency Department

Introduction: Hyperkalemia, a potentially life-threatening electrolyte disturbance, is commonly encountered in the Emergency Department (ED). However, the frequency of factitious hyperkalemia, an artificially elevated potassium level in hyperkalemic ED patients, is unknown. This study aims to detect the rate of factitious hyperkalemia among patients with a potassium concentration of ≥5.0 mmol/l in an all-comer ED population. Methods: This retrospective, monocentric chart review analyzed data of 2,440 ED patients who presented with a potassium concentration of ≥5.0 mmol/L in their initial whole blood or plasma sample, who also underwent a repeat potassium measurement on the same day. Two groups were established based on potassium levels in the initial and repeat blood tests: 1) True hyperkalemia, characterized by consistently elevated potassium levels in both the initial and repeat samples; and 2) Factitious hyperkalemia, defined by an elevated initial potassium level while the repeat blood test showed a normal potassium level. A subset of factitious hyperkalemia was spurious hyperkalemia. In spurious hyperkalemia, the initial blood sample showed an elevated potassium level with evidence of hemolysis, but a repeat test revealed a normal potassium level without evidence of hemolysis. Results: Of the 2,440 patients, 1,576 (65%) had true hyperkalemia and 864 (35%) factitious hyperkalemia. Among the 864 patients with factitious hyperkalemia, 597 (69%) displayed hemolysis in their initial blood sample, indicating spurious hyperkalemia due to in-vitro hemolysis. Conclusion: These data show that about one third of all hyperkalemic blood samples drawn in the ED were due to factitious hyperkalemia. The leading cause of factitious hyperkalemia was spurious hyperkalemia due to in-vitro hemolysis.

EGFR slope as predictor of mortality in heart failure patients.

Heart failure (HF) leads to an imbalance between heart and kidney function, resulting in poor outcomes. However, the prognostic significance of the estimated glomerular filtration rate (eGFR) trajectory in HF patients remains unclear. We analysed electronic health records (EHRs) of real-world HF patients, assessing eGFR trajectories and their impact on mortality. Retrospective clinical data of HF patients were processed using natural language processing. Chronic kidney disease (CKD) was evaluated, and eGFR trajectories were analysed using linear mixed-effects models. Cox proportional hazard models were used to evaluate the relationship between baseline variables and mortality, while joint modelling combined eGFR trends and mortality. The dataset comprised 1986 patients, with a mean age of 74.8years (SD±11.7) and 58% male. At the time of HF diagnosis, 58% of patients were diagnosed with CKD, and 39% presented with heart failure with preserved ejection fraction (HFpEF). The median follow-up duration was 3.16years, during which 399 patients (20%) died. Patients with CKD were significantly older and exhibited a higher prevalence of myocardial infarction (P=0.048), coronary revascularization (P=0.004), stroke (P<0.001), atrial fibrillation (P<0.001) and type 2 diabetes (P<0.001). Mortality rates at 1 and 2years were nearly twice as high in CKD patients compared with those without (P<0.001). Notably, CKD was significantly less prevalent among survivors (55% vs. 71%, P<0.001). Key predictors of mortality included older age, beta-blocker use, prior stroke, lower serum haemoglobin levels, and elevated potassium and NT-proBNP levels. Each 10mL/min/1.73m2 decrease in eGFR was associated with a 1.22 (95% CI: 1.10-1.35, P<0.001) increase in mortality hazard. Additionally, a 1-year decline of 10mL/min/1.73m2 in eGFR resulted in a mortality hazard of 1.97 (95% CI: 1.45-2.69, P<0.001). CKD is prevalent in a real-world HF population and is an independent predictor of mortality. The current eGFR value and the eGFR slope from the previous year have the potential to be used for assessing individual mortality risk in the clinical follow-up of HF patients.

Effect of Fertilizers and Humic Acids on Soil Micro Nutrients of Foxtail Millet Crop

Humic acids is an important soil component that can improve nutrient availability and impact on other important chemical, biological, and physical properties of soils. The ecological benefits of Humic acids are diverse and represent profitable and effective solutions for environmental problems and preservation of the environment. It can be integrated into the soils in the form of manure; it improves the physico chemical and biological properties of the soil. A field experiment was conducted at the College Farm, Agricultural College, Mahanandi, ANGRAU during kharif &amp; rabi seasons of 2020-21 and 2021-22. The experimental soil was sandy loam in texture with a pH of 7.52, an Electrical Conductivity (EC) of 0.42 dS/m, 0.32% Organic Carbon (OC), low available nitrogen (175 kg ha-1), medium phosphorus (P) at 18.48 kg ha-1, high potassium (K) at 580 kg ha-1, and sufficient zinc (Zn) status at 0.85 ppm. The experiment was laid out in split plot design with three replications with four main plots and six sub plots total twenty four treatments. After critical observation of the study, available iron, Zinc, Copper and Manganese contents in soil revealed that there was significant difference between the subplots that received different levels of Humic acids but main plots that received different levels of inorganic fertilizers and their interaction was found to be non significant at panicle initiation and harvest stages of foxtail millet crop in two kharif seasons of 2020 and 2021. Similar results were recorded in soil Copper and Manganese contents during two kharif seasons of Foxtail millet crop. However, the similar trend was followed in succeeding bengalgram crop.

Study of temperature dynamics and influencing factors during composting process

Abstract This study investigated the most influential composting parameters (temperature, pH, humidity, C/N ratio, and CO2 emissions) on final compost quality. Composting bags (turned daily) containing prunings, lignocellulose material, cattle manure, and household organic waste were monitored for eight weeks across three batches. All the temperature data registered daily were statistically analyzed with one-way ANOVA to verify the consistency between batches. This study employs a first-order kinetic model to quantify the decomposition of organic matter in composting, revealing the influence of temperature on the decomposition rate. Principal component analysis was conducted for these factors and their interactions with respect to the final compost quality. Finished compost showed a significantly high nitrogen, phosphorus, and potassium content compared with that in the feedstock of the initial compost mixture, while there was constant organic carbon content. In addition to the control of key parameters, a linear regression analysis allowed us to identify the factors that most influenced temperature. We identified two key models: one including pH, humidity, C/N ratio, and CO2 emissions, and another focusing only on CO2. This study emphasized the importance of monitoring and controlling the crucial parameters of the composting process in order to obtain quality compost suitable for application in soil use. Moreover, high temperatures possibly attained in the process of aerobic decomposition destroy the pathogens, making the end products safer for uses in agriculture.

Diversity of Rhizospheric Bacterial Community from Kaolin Mining Site and Their Potential as Plant Growth Promoting Bacteria

Tailing from mining activities affects soil fertility resulting in poor soil conditions that are challenging for plants to grow. Plants can interact with rhizosphere bacteria to enhance their growth in harsh environments. Rhizospheric bacteria possess numerous mechanisms that promote plant growth and induced resistance to various abiotic stress. This study aims to determine the diversity of rhizobacteria and their potential as plant growth-promoting rhizobacteria (PGPR) agents. Bacterial communities from rhizosphere soil samples from kaolin mining sites in Perawas, Tanjung Pandan district, Belitung Regency, Bangka Belitung Island, Indonesia were analyzed using Next Generation Sequencing based on the V3-V4 region of the 16S rRNA gene, while culturable bacteria were isolated from samples and screened for PGP activity. The results showed that the rhizosphere bacterial community was mostly dominated by Pseudomonadota, Acidobacteria, and Verrumicrobiota. There were 15 bacteria isolated from the sample and RKB-5 bacterial isolate had the potential to be PGP agent. The RKB-5 bacterial isolate was identified as Burkholderia cenocepacia based on its 16S rRNA sequence. The bacterial isolate produced IAA, utilized ACC, dissolved phosphate up to 209,5 mg/L, and formed a high potassium solubilizer index value of 5.00. Therefore, the B. cenocepacia RKB-5 has potential application as the PGPR to support plants growth by obtaining nutrients in ex-mining lands with poor soil conditions.

Pemanfaatan kulit buah kakao pada proses alkalisasi biji kakao serta pengaruhnya terhadap mutu kakao bubuk

The problem facing the industry of cocoa powder in Indonesia is that cocoa powder on the market has a high fat content, high acidity, a color quality that is not comparable with imported cocoa products, and a variety of flavors and aromas. Alkalization is a method that can handle these problems. Alkalization is a process to improve the quality and appearance of cocoa powder. Alkalization is carried out by adding potassium, magnesium, and others to cocoa. High potassium content can be found in cocoa pod husks. Cocoa pod husks are the main by-product from the cocoa industry, constituting 67 – 76% of the cocoa fruit weight. Cocoa pod husk contains potassium, fiber, and antioxidants that function as biomaterials for food and non-food products. The aims of the study were to determine and evaluate the quality of cocoa powder with the effect of alkalization treatments using cocoa pod husks. The study was carried out at The Indonesian Industrial and Beverage Crops Research Institute, Sukabumi, West Java, from January to June 2022. This study was designed in a factorial completely randomized design. The first factor was the alkaline material, which consisted of two levels (cocoa pod husk and baking soda). The second factor was the concentration, which consisted of 3 levels (1%, 2%, and 3%). The variables observed were the L*, a*, b*, moisture content, ash content, fineness, pH, fat content, protein, antioxidant activity, and organoleptic properties. The results showed that the alkalization process with alkaline material from cocoa pod husk and a concentration of 2% is the best quality characteristic of cocoa powder in accordance with SNI 01-3747-2013.

Finerenone, Serum Potassium, and Clinical Outcomes in Heart Failure With Mildly Reduced or Preserved Ejection Fraction

Treatment with finerenone, a nonsteroidal mineralocorticoid receptor antagonist (MRA), improved outcomes in patients with heart failure with mildly reduced or preserved ejection fraction in FINEARTS-HF, but was associated with increased levels of serum potassium in follow-up. To investigate the frequency and predictors of serum potassium level greater than 5.5 mmol/L and less than 3.5 mmol/L and examine the treatment effect associated with finerenone, relative to placebo, on clinical outcomes based on postrandomization potassium levels. Secondary analysis of the FINEARTS-HF multicenter, randomized clinical trial, performed between September 14, 2020, and January 10, 2023, with a median follow-up of 32 months (final date of follow-up: June 14, 2024). Patients with heart failure and left ventricular ejection fraction greater than or equal to 40%, New York Heart Association class II to IV symptoms, and elevated natriuretic peptides were included. Participants received finerenone or placebo. The primary outcome was a composite of total worsening heart failure events or cardiovascular death. A total of 6001 participants were included (3003 randomized to receive finerenone and 2998 randomized to receive placebo). The increase in serum potassium was greater in the finerenone group than the placebo group at 1 month (median [IQR] difference, 0.19 [0.17-0.21] mmol/L) and 3 months (median [IQR] difference, 0.23 [0.21-0.25] mmol/L), which persisted for the remainder of trial follow-up. Finerenone increased the risks of potassium level increasing to greater than 5.5 mmol/L (hazard ratio [HR], 2.16 [95% CI, 1.83-2.56]; P < .001) and decreased the risks for potassium level decreasing to less than 3.5 mmol/L (HR, 0.46 [95% CI, 0.38-0.56]; P < .001). Both low (< 3.5 mmol/L; HR, 2.49 [95% CI, 1.8-3.43]) and high (>5.5 mmol/L; HR, 1.64 [95% CI, 1.04-2.58]) potassium levels were associated with higher subsequent risks of the primary outcome in both treatment groups. Nevertheless, the risk of the primary outcome was generally lower in patients treated with finerenone compared with placebo, even in those whose potassium level increased to greater than 5.5 mmol/L. In patients with heart failure with mildly reduced or preserved ejection fraction, finerenone resulted in more frequent hyperkalemia and less frequent hypokalemia. However, with protocol-directed surveillance and dose adjustment, clinical benefit associated with finerenone relative to placebo was maintained even in those whose potassium level increased to greater than 5.5 mmol/L. ClinicalTrials.gov Identifier: NCT04435626.

Abstract 4117180: Hyperkalemia-Related Hospitalization Associated with Short-Term vs. Long-Term Outpatient SZC Therapy Among RAASi Users: The GALVANIZE Outcome study

Introduction: Patients receiving renin-angiotensin-aldosterone system inhibitors (RAASi) are at increased risk of developing hyperkalemia (HK). Sodium zirconium cyclosilicate (SZC) is used to treat HK, but the impact of duration of SZC on healthcare resource utilization (HRU) in RAASi users is unknown. The GALVANIZE Outcome study compared HK-related HRU among RAASi users between long-term and short-term SZC users. Methods: Adults with ≥1 outpatient prescription for SZC (index date) and ≥1 RAASi prescription spanning the index date were identified from a large US insurance claims database (7/2018-12/2022) and were stratified based on duration of SZC use. Long-term SZC users (&gt;90 days) and short-term SZC users (≤30 days) were exactly and propensity score matched on key baseline characteristics. Rates of HK-related hospitalizations or emergency department (ED) visits, HK-related ED visits, and HK-related hospitalizations were compared during follow-up from index to the earliest of 6 months post-index, end of data availability, other potassium binder use, or re-initiation of SZC post-discontinuation. Results: Among 1,586 matched pairs, the mean age was 65.5 years, 41.0% of patients were female, and most patients had any stage chronic kidney disease (91.9%), hypertension (90.8%), and diabetes (73.4%). Also, 30.0% of patients had heart failure. The most used RAASi therapies at index were angiotensin-converting enzyme inhibitors (57.3%) and angiotensin-receptor blockers (56.3%). Patients with long-term SZC use had a 44% lower rate of HK-related hospitalizations or ED visits, a 41% lower rate of HK-related hospitalizations and a 52% lower rate of HK-related ED visits than patients with short-term SZC use during follow-up (all p&lt;0.01; Figure 1). Conclusions: Among patients with RAASi and SZC therapy use, long-term SZC use was associated with significantly lower rates of HK-related HRU compared to matched patients with short-term SZC use. Funding: AstraZeneca

Abstract 4130314: High sodium, low potassium diet is associated with incident cardiovascular disease among US Hispanic/Latino adults: results from the Hispanic Community Health Study/Study of Latinos.

Background: Diets high in sodium and low in potassium are associated with increased blood pressure level but associations with cardiovascular disease (CVD) remain controversial. Few studies have evaluated this relationship among Hispanic/Latino adults. Objective: To assess whether dietary sodium and potassium are associated with incident CVD among diverse US Hispanics/Latino adults. Methods: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a cohort of 16,415 self-identifying Hispanic/Latino adults aged 18-74 four US urban communities in 2008-2011 (visit 1; V1). V1 included a comprehensive examination with in-person measurement of health information and interviewer administered questionnaires. Dietary sodium (mg/day) and potassium (mg/day) intakes were assessed from the average of two 24-hour dietary recall surveys administered by bilingual registered dietitians. CVD events occurring from V1 through 2019 were adjudicated by an expert panel of clinicians. We used Poisson regression to determine the association (incidence rate ratio, IRR) between sodium, potassium, and the sodium-to-potassium ratio, with CVD, using time to CVD as an offset. Models accounted for HCHS/SOL complex survey design and were adjusted for demographic, including Hispanic/Latino background, socioeconomic, and behavioral factors along with energy consumption, body mass index, cholesterol, and family history of CVD. Results: Among 15,291 participants without self-reported CVD at V1, mean age was 40 years, with 53% female. Mean daily intakes of sodium and potassium were 3,040 mg/day and 2,422 mg/day, respectively. Molar ratio of sodium to potassium was 1.33. Over 9.7 years of follow-up, there were 311 CVD events (2.0 events per 1,000 person years, 95% CI: 1.6, 2.5). In adjusted models, nutrients were associated with increased risk of CVD: by 17% for each 1g/day increment of sodium (IRR: 1.17, 95% CI: 1.03, 1.33); by 29% for each 1g/day decrement of potassium (IRR: 1.29, 95% CI: 1.01, 1.64); and by 112% for each 0.5 molar increment of sodium to potassium ratio (IRR: 2.12, 95% CI: 1.13, 4.11). Conclusions: In a large diverse sample of Hispanic/Latino adults, high dietary sodium and low dietary potassium were independently associated with an increased risk of CVD. Results underscore the importance of intensifying public health interventions to improve nutrient quality, by reducing dietary sodium and increasing dietary potassium consumption as a means of preventing CVD.

Sustainable Cropping Sequences to Improve Soil Fertility and Microbiological Properties

Different cropping systems and nutrient management techniques impact the microbiological characteristics of soil and nutrient availability for plants. This study assessed four cropping systems—rice–wheat, cotton–wheat, pearl millet–wheat, and pearl millet–mustard in Hisar district, Haryana, using 80 soil samples (20 from each system) collected in April 2022 after the Rabi crop harvest. The cotton–wheat system had the highest accessible nitrogen (N) at 155.9 kg ha−1, while both the cotton–wheat (59.3 kg ha−1) and rice–wheat (54.0 kg ha−1) systems had higher available sulfur (S) levels compared to pearl millet–wheat (41.2 kg ha−1). Pearl millet–wheat also showed 12.4% higher potassium (K) levels than rice–wheat. The rice–wheat system exhibited the highest phosphorus (P) concentration at 54.3 kg ha−1 and greater DTPA-extractable micronutrients. Soils from the rice–wheat system had higher DTPA-extractable micronutrients (Zn, Fe, Mn, Cu) and superior microbial biomass nitrogen (MBN, 54.7 mg kg−1), urease (37.9 µg NH4+-N g−1 h−1), and alkaline phosphatase activity (APA, 269.7 µg PNP g−1 h−1) compared to other systems. Canonical discriminant functions explained 88.1% of the variability among cropping systems, while principal component analysis identified available P, DTPA-extractable Zn, and Cu as key soil quality indicators, accounting for 66.9% of the variance. These insights can inform policymakers on promoting effective cropping systems and sustainable soil health in northwestern India.

Patients with crush syndrome and kidney disease: lessons learned from the earthquake in Kahramanmaraş, Türkiye

This study investigated in-hospital outcomes and related factors in patients diagnosed with postearthquake crush syndrome after the earthquakes in Kahramanmaraş, Türkiye. One thousand twenty-four adult patients diagnosed with crush syndrome were analyzed. Data on demographic characteristics, clinical presentation, laboratory values, treatments, and outcomes were collected. A total of 9.8% of patients died during their hospital stay. Nonsurvivors were generally older, more likely to have preexisting chronic kidney disease, and faced more severe injuries and complications, including hypotension-shock, arrhythmias, elevated markers of renal dysfunction, and higher rates of acute kidney injury (AKI) and compartment syndrome. In addition, intensive care unit needs were higher. Multivariate analysis confirmed that age, injury severity, shock, high potassium, uric acid, and lactate levels on admission, development of AKI, compartment syndrome, and intensive care unit admission were significant predictors of mortality. Better disaster preparedness and improved health care infrastructure could be potential explanations for improved in-hospital mortality in the current era, as compared to previous earthquakes.

Bimetallic Sulfide Hollow Nanocubes Heterostructure Promotes Dual Coupling of Conversion and Alloying/Dealloying Reactions to Achieve Durable Potassium-Ion Battery Anode.

Conversion and alloying-type transitional metal sulfides have attracted significant interests as anodes for Potassium-ion batteries (PIBs) and Sodium-ion batteries (SIBs) due to their high theoretical capacities and low cost. However, the poor conductivity, structural pulverization, and high-volume expansions greatly limit the performance. Herein, Co1-xS/ZnS hollow nanocube-like heterostructure decorated on reduced graphene oxide (Co1-xS/ZnS@rGO) composite is fabricated through convenient hydrothermal and post-heat vulcanization techniques. This unique composite can provide a more stable conductive network and shorten the diffusion length of ions, which exhibits a remarkable initial charge capacity of 638.5mA h g-1 at 0.1 A g-1 for SIBs and 606mA h g-1 at 0.1 A g-1 for PIBs, respectively; It is worth noting that the composite presents remarkable long stable cycle performance in PIBs, which initially delivered 274mA h g-1 and sustained the charge capacity up to 245mA h g-1 at high current density of 1 A g-1 after 2000 cycles. A series of in situ/ex situ detections and first principle calculations further validate the high potassium ions adsorption ability of Co1-xS/ZnS anode materials with high diffusion kinetics. This work will accelerate the fundamental construction of bimetallic sulfide hollow nanocubes heterostructure electrodes for energy storage applications.

Effect of sulfur and potassium foliar applications on wheat grain protein quality

ContextThe effects of sulfur and potassium fertilizers on wheat yield and quality have been well studied, but most of them are used as basal fertilizers. However, the root system is senescent at the later stages of wheat growth and cannot absorb sufficient sulfur and potassium fertilizers plant needed. It is still unclear whether sulfur and potassium foliar applications at the later stages can affect wheat yield and quality. ObjectiveThis experiment was conducted to investigate the changes of sulfur and potassium accumulation and transport, protein synthesis and flour processing quality after foliar application of sulfur and potassium fertilizers, transport and the relating physiological mechanisms. MethodsIn 2020–2021 and 2021–2022, a three-factor split plot experiment was carried out in the middle and lower reaches of Yangtze River, with wheat variety, concentration of sulfur fertilizer and potassium fertilizer served as main factor, subfactor and sub-subfactor respectively. ResultsIn the study from 2020 to 2022, the albumin protein content of both varieties decreased in the nutrient spraying treatment, particularly in the high potassium level. However, there was no significant effect on the globulin content. Moreover, the gliadin protein content decreased in the sulfur spraying treatment alone, but significantly increased the wheat gluten content, and thereby the total protein content. We also found significant genotypic differences in the composition and content of high molecular weight wheat glutenin subunits (HMW-GS) between the two varieties. The foliar spraying of sulfur and potassium fertilizers significantly increased the content of subunits 1 and 8 in Yangmai (YM15) and subunits 7 and 12 in Yangmai (YM16), and the effect of mixed spraying was better than single-nutrient spraying, especially the amount of 0.2 % sulfur and 0.3 % potassium fertilizer treatment. ConclusionsThe superimposed effect of sulfur and potassium effectively increased the total protein content by promoting the accumulation of sulfur in transit to the seeds, increasing the substrate supply level, and enhancing enzyme activity. Although sulfur and potassium combination can improve the grain protein quality and flour processing quality, too high spraying concentrations can decrease the flour processing quality. ImplicationsSpraying the appropriate amount of 0.2 % sulfur and 0.3 % potassium fertilizer can serve as an optimization measure for high-quality and efficient production of different types of wheat varieties.

High Potassium Diet Rich in Spices and Herbs-Salt Substitution (HPSH-SS) for Blood Pressure Reduction in Older Adults: Protocol for Diet Concept and Randomized Controlled Trial.

Hypertension increases with age, often due to high sodium (Na) and low potassium (K) intake. Reducing salt and increasing K intake is challenging, especially for older adults due to taste preferences. Culinary herbs and spices, rich in K, offer a potential solution. The High Potassium Diet Rich in Spices and Herbs-Salt Substitution (HPSH-SS) diet has not yet been studied for its effectiveness in lowering blood pressure. This study aims to create an HPSH-SS diet, analyze its effects on blood pressure in older adults, and study the molecular mechanism occurring in the kidneys and blood vessels influenced by this diet. This study consists of 2 phases. The first phase involved formulating and assessing the HPSH-SS diet tailored for older adults. The intervention group (IG) received a diet of 1800 kcal/day, with 3500 mg K and 1500 mg Na, while the control group (CG) received 1500 mg K and 2000 mg Na. The diet was administered for 14 days and standardized using the NutriSurvey program and biochemistry analysis by atomic absorbance spectrophotometry (AAS). The second phase was a 14-day parallel randomized controlled trial (RCT) with the older adult participants divided into IG and CG. Primary outcomes included blood pressure; serum potassium; aldosterone; F2 isoprostane; nitric oxide plasma levels; and urine analysis of Na, K, and the Na/K ratio. Confounding variables were controlled through randomization and stratified analysis. The menu formulation and organoleptic assessment of the HPSH-SS diet began in mid-2022 and was approved by the Ethics Committee of the Faculty of Public Health at Universitas Airlangga (78/EA/KEPK/2022) on May 11, 2022. The diet was standardized to achieve daily nutritional values of 1800 kcal energy, 3500 mg K, and 1500 mg Na. K and Na contents were analyzed using AAS from several participants' spice diet menus. Recruitment for the RCT started in March 2023, with approval from the Health Research Ethics Committee Universitas Airlangga School of Medicine, Surabaya (35/EC/KEPK/FKUA/2023). The study was registered from February 9, 2023, to February 9, 2024. Between March and June 2023, 64 participants were recruited, with 32 participants in the IG and CG. The intervention and data collection will take place over 1 year. Data management is in progress, and data analysis is yet to be performed. This RCT protocol hypothesizes that the diet will increase serum K, plasma aldosterone, and nitric oxide levels; decrease plasma F2 isoprostane; increase urinary Na and K levels; lower the urinary Na/K ratio; and reduce systolic and diastolic blood pressure. If effective, it will offer valuable insights into dietary strategies for blood pressure regulation in older adults. DERR1-10.2196/56869.

The safety of in-hospital initiation of SGLT2 inhibitor with MRA therapy in patients hospitalized for heart failure with a reduced left ventricular ejection fraction and chronic kidney disease

Abstract Deferring in-hospital initiation of guideline-recommended medications in HFrEF has a few chances they will be initiated ambulatory, especially in the case of coexisting HFrEF and chronic kidney disease (CKD). The aim was to investigate the safety of in-hospital initiation of SGLT2i with MRA therapy for patients hospitalized for HFrEF and CKD 3. Methods 88 patients with HFrEF (on top of standard therapy ACE-I/ARB, B-blockers) and CKD (baseline eGFR between 30 and 60 ml/min) were included in the study. The potassium (K), creatinine (C), uric acid (UA) levels were estimated at baseline and week 12. After biochemical evaluation, patients started on spironolactone (SP) treatment with a median dose of 20 mg daily (titrated) and dapagliflozin (D) with a dose of 10 mg daily (D+SP). Blood pressure (BP), K, and renal function (RF) were checked at weeks 1 (in-hospital), 2, 4, 6, 8, 12 (ambulatory), and more frequently as necessary. Results After the start of therapy D+SP mean eGFR decreased significantly at week 1 from 51.14±9.18 to 46.26±7.91 ml/min/1.73m2 (P&amp;lt;.0001) and at week 2 to 44.18±6.51 ml/min/1.73m2 (-2.08±1.2; P&amp;lt;.001). At week 4 mean eGFR decreased to 42.73±6.86 ml/min/1.73m2 (-1.45±1.1; P&amp;lt;.05). So, a significant decrease in eGFR was observed only during the first month with no significant decrease at 6 and 12 weeks after the start of therapy. Six patients (8%) experienced a significant decline in RF resulting in temporary withdrawal of SP. At week 2 mean K level increased significantly from 4.56±0.63 to 5.07±0.57 mmol/L (P&amp;lt;.001). At weeks 4, 6, 8 K levels remain stable. At week 12 mean K level decreased significantly compared with week 2 (to 4.92±0.57 mmol/L, P&amp;lt;.05). The incidences of severe hyperkalemia (HK) (K+≥6.0mmol/L) were in three patients &amp;lt; 2 %, and moderate HK (K 5.5–5.9 mmol/L) occurred in ten patients (11 %). Patients who experienced inpatient hyperkalemia had a significantly lower eGFR than patients without episodes of HK (38.70 vs. 55.21 mL/min/1.73 m2; P&amp;lt;.0001). Episodes of HK were predicted by baseline K≥5.0 mmol/L and eGFR≤40 ml/min/1.73m2. Additionally, there was a significant improvement in blood UA (-1,53±0.49 mg/dL, P&amp;lt;.01). By multivariate analysis older age, diabetes, low diastolic BP (&amp;lt;60 mm Hg), eGFR≤40 ml/min/1.73m2 at baseline were associated with decreased RF (0.378, P&amp;lt;.01; 0.632, P&amp;lt;.001; 0.771, P&amp;lt;.0001; 0.397, P&amp;lt;.01; respectively), whereas episodes of HK were predicted by baseline K≥5.0 mmol/L and eGFR≤40 ml/min/1.73m2 (0.785, P&amp;lt;.0001; 0.542, P&amp;lt;.001; respectively). Conclusion Initiation of SGLT2i with MRA in patients hospitalized for HFrEF and CKD 3 was mainly safe although it caused an early drop in eGFR. Importantly, a fall in eGFR was observed during the first month. Concern about the reduction in eGFR should be in older diabetic patients with eGFR≤40 and low diastolic blood pressure. Although hyperkalemia was common, the occurrence of it was predicted by baseline potassium level and eGFR.