Higher Risk Of Dehydration Research Articles

All-in-One, Wireless, Multi-Sensor Integrated Athlete Health Monitor for Real-Time Continuous Detection of Dehydration and Physiological Stress.

Athletes are at high risk of dehydration, fatigue, and cardiac disorders due to extreme performance in often harsh environments. Despite advancements in sports training protocols, there is an urgent need for a non-invasive system capable of comprehensive health monitoring. Although a few existing wearables measure athlete's performance, they are limited by a single function, rigidity, bulkiness, and required straps and adhesives. Here, an all-in-one, multi-sensor integrated wearable system utilizing a set of nanomembrane soft sensors and electronics, enabling wireless, real-time, continuous monitoring of saliva osmolality, skin temperature, and heart functions is introduced. This system, using a soft patch and a sensor-integrated mouthguard, provides comprehensive monitoring of an athlete's hydration and physiological stress levels. A validation study in detecting real-time physiological levels shows the device's performance in capturing moments (400-500s) of synchronized acute elevation in dehydration (350%) and physiological strain (175%) during field training sessions. Demonstration with a few human subjects highlights the system's capability to detect early signs of health abnormality, thus improving the healthcare of sports athletes.

2042 Implementing the principles of Shared Decision Making into a Hospital at Home service, as part of a wider organisation adoption

Abstract Background NICE (2023) Shared Decisions Making (SDM) Guidelines ensure Health Care professionals work together with a person to reach a decision about care based on their individual preferences, beliefs, and values. Local Problem. We conducted an Audit across our community services to assess NICE SDM, achieving 71% compliance. Results informed the project problem statement “Clinical Teams are not fully compliant to NICE SDM guidelines therefore a shared decision-making approach is not guaranteed”. Methods A fishbone diagram was applied to understand why SDM wasn’t routinely occurring in clinical practice. Our aim is to achieve organisation wide adherence to SDM. We propose a multi modal approach to increasing awareness of SDM across the organisation. We used a driver diagram working backwards from the goal, identifying the drivers and determining the project activities. Interventions Due to the enormity of rolling out a pan-organisational programme we decided to use the Frailty NHS@Home virtual ward to test and learn before greater adoption. We firstly processed mapped how the “What Matters to you?” question is embedded into our Comprehensive Geriatric Assessments. A decision support grid for treatment option decision making was created for dehydration or high risk of dehydration within the NHS@Home service, adapted from Marrin et al (2014). Three options are described underpinned by five questions. Feedback from Patient and public involvement ensured the language was appropriate. After the first PDSA cycle, the tool was reviewed by the project team and two further questions were added, “Did you understand the options which were explained to you?” and “What matters most to you as we decide together how best to treat your dehydration?” Conclusion A re audit and colleague survey will reveal increased knowledge and understanding of the SDM concept. We continually seek Feedback from individuals who use our services for their experience of SDM processes.

Thermoregulatory strategies of songbird nestlings reveal limited capacity for cooling and high risk of dehydration

How the accelerating pace of global warming will affect animal populations depends on the effects of increasing temperature across the life cycle. Developing young are sensitive to environmental challenges, often with life-long consequences, but the risks of climate warming during this period are insufficiently understood. This may be due to limited insight into physiological sensitivity and the temperatures that represent a thermal challenge for young. Here we examined the physiological and behavioural effects of increasing temperatures by measuring metabolic rate, water loss, and heat dissipation behaviours between 25–45 °C in nestlings of a small free-living songbird of temperate SE-Australia, the superb fairy-wren. We found a high and relatively narrow thermoneutral zone from 33.1 to 42.3 °C, with metabolic rate increasing and all nestlings panting above this range. Evaporative water loss sharply increased above 33.5 °C; at the same temperature, nestlings changed their posture (extended their wings) to facilitate passive heat loss. However, at all temperatures measured, water loss was insufficient to dissipate metabolically produced heat, indicating poor cooling capabilities, which persisted even when individuals were panting. While nestlings are relatively tolerant to higher temperatures, with no evidence for hyperthermia at temperatures below 42 °C, they are at a high risk of dehydration even at lower temperatures, with limited ability to mitigate this. Thus, climate warming is likely to elevate the risk dehydration, which is concerning, since it is accompanied by drier conditions.

Determinants of Hydration Status in Martial Athletes at The Student Sports Training Center Jakarta

Adolescent athletes are a group that’s vulnerable to decreased water content and has a higher risk of dehydration. Results showed, 22% of adolescent athletes were highly dehydrated. This study aims to knowing the determinants factor of hydration status for martial arts athletes in Pusat Pelatihan Olahraga Pelajar DKI Jakarta. The research uses a quantitive method with a cross sectional design and sample of 50 martial arts athletes (13-18 years). Data obtained through food recall 1x24 hours for fluid consumption, nutritional status with BMI/U, percent body fat with Ultrasonic Body Fat Analyzer SR-HW 05 Serenity instrument, physical activity with PAL sheets, and hydration status with Specific Gravity values. Data analysis using Pearson correlation test. The results showed a significant correlation between female nutritional status (p<0.05), male and female fluid consumption (p<0.05) with hydration status of martial arts athletes. However, there was no significant correlation between male nutritional status, male and female percent body fat, male and female physical activity with hydration status of martial arts athletes (p>0.05). Fluid consumption is factor that affects the hydration status of male and female martial arts athletes. It’s important for athletes to maintain their hydration status in order to carry out training and competitions optimally.

Neuromuscular Electrical Stimulation in Conjunction with Conventional Swallowing Therapy in the Treatment of Dysphagia Caused by Multiple Sclerosis: A Single-Case Experimental Design

Introduction: Dysphagia as a consequence of multiple sclerosis (MS) puts individuals at higher risk of dehydration, malnutrition, and aspiration pneumonia. This study intended to investigate the effects of a combined program of neuromuscular electrical stimulation (NMES) and conventional swallowing therapy to improve swallow safety and efficiency, oral intake, and physical, emotional, and functional impacts of dysphagia in people with dysphagia and MS. Methods: In this single-case experimental study with ABA design, two participants with dysphagia caused by MS underwent 12 sessions therapy during 6 weeks following a baseline of 4 evaluation sessions. They were evaluated 4 more times in the follow-up phase after therapy sessions. Scores of Mann Assessment of Swallowing Ability (MASA), DYsphagia in MUltiple Sclerosis (DYMUS), and timed test of swallowing capacity were obtained at baseline, during treatment, and in the follow-up phases. The Dysphagia Outcome and Severity Scale (DOSS) based on videofluoroscopic swallow studies, Persian-Dysphagia Handicap Index (Persian-DHI), and Functional Oral Intake Scale (FOIS) were also completed before and after treatment. Visual analysis and percentage of nonoverlapping data were calculated. Results: MASA, DYMUS, FOIS, and DHI scores indicated significant improvement in both participants. Although the scores of the timed test of swallowing capacity in participant 1 (B.N.) and DOSS in participant 2 (M.A.) showed no changes, considerable improvements including reducing the amount of residue and the number of swallows required to clear bolus were seen in the posttreatment videofluoroscopic records of both participants. Conclusion: NMES in conjunction with conventional dysphagia therapy based on motor learning principles could improve the swallowing function and decrease disabling effects of dysphagia on different aspects of life in participants with dysphagia caused by MS.

Present and future heat stress of preschoolers in five Swedish cities

Heat stress can have negative effects on human wellbeing with morbidity and mortality as harmful consequences, especially in vulnerable groups, e.g. children, elderly and chronically ill. Children is for example at higher risk of dehydration and heat stroke compared to healthy adults. Furthermore, children attending preschools are endorsed to spend time outdoors and engaging in physical activities. Therefore, thermally comfortable preschool yards are detrimental to sustain safe environments where the children can continue their physically active play. Here we show that preschoolers in five Swedish cities, Malmö, Gothenburg, Stockholm, Östersund and Luleå, are exposed to heat stress on warm and clear days between May-August in preschool yards with insufficient shading, using three different thermal indices (COMFA, PET and UTCI). Furthermore, future number of heat stress days are evaluated using the SMHI RCA4 regional climate model from the EURO-CORDEX project, forced with six different global climate models. Results show that heat stress will increase under the RCP2.6, 4.5 and 8.5 climate change scenarios. In Malmö, Gothenburg and Stockholm number of days with heat stress all hours 09:00–15:00 while playing in a sunlit sandbox have doubled from approximately 10 to 20 days for 2071–2100 (RCP8.5) compared to 2008–2020. These numbers are even higher if active play, e.g. running, is performed, estimating to around two weeks in July alone by the end of the century. Without adaptation this is likely to have adverse effects on the health and learning of children. If the preschool yard, on the other hand, is shaded by trees, days with heat stress are almost entirely diminished, indicating the importance of trees in preschool yard design as a tool to mitigate heat stress.

FAKTOR DETERMINAN STATUS HIDRASI ATLET BELA DIRI DI PUSAT LATIHAN OLAHRAGA PELAJARajar

Adolescent athletes are a group that’s vulnerable to decreased water content and has a higher risk of dehydration. Results showed, 22% of adolescent athletes were highly dehydrated. This study aims to knowing the determinants factor of hydration status for martial arts athletes in Pusat Pelatihan Olahraga Pelajar DKI Jakarta. The research uses a quantitive method with a cross sectional design and sample of 50 martial arts athletes (13-18 years). Data obtained through food recall 1x24 hours for fluid consumption, nutritional status with BMI/U, percent body fat with Ultrasonic Body Fat Analyzer SR-HW 05 Serenity instrument, physical activity with PAL sheets, and hydration status with Specific Gravity values. Data analysis using Pearson correlation test. The results showed a significant correlation between female nutritional status (p<0.05), male and female fluid consumption (p<0.05) with hydration status of martial arts athletes. However, there was no significant correlation between male nutritional status, male and female percent body fat, male and female physical activity with hydration status of martial arts athletes (p>0.05). Fluid consumption is factor that affects the hydration status of male and female martial arts athletes. It’s important for athletes to maintain their hydration status in order to carry out training and competitions optimally.

Freezing and desiccation tolerance in the Antarctic bangiophyte Pyropia endiviifolia (Rhodophyta): a chicken and egg problem?

ABSTRACT Antarctic macroalgal communities of the upper intertidal zone are particularly poor compared with other coastal regions. Exposure to desiccation and freezing combined with the abrasive effect of ice threatens the life of sessile organisms. One of the few species able to colonize this environment is the rhodophyte Pyropia endiviifolia. It belongs to the Bangiales, one of the oldest extant clades of photosynthetic eukaryotes, which has occurred for more than one billion years with basically the same morphological structure. Considering that the extent of Antarctic glaciation is a geologically recent event, we hypothesized that pre-adaptations to desiccation in bangiophytes may have contributed to the success of P. endiviifolia in Antarctica. To test this, we compared its photosynthetic performance and tolerance to desiccation and freezing with those from a related intertidal species, the temperate Atlantic species Porphyra linearis. As evidenced by gas exchange and chlorophyll fluorescence, P. endiviifolia is more adapted to high irradiances than P. linearis. The former species was also more desiccation-tolerant, and showed a higher glass transition temperature. Both species did not differ in chlorophyll content per dry weight, and tolerance to −20°C, even though the ice-nucleation temperature was much higher in P. endiviifolia. Membrane integrity may depend on fatty acid composition in P. endiviifolia, while on enhanced tocopherol in P. linearis. Overall, both species show different strategies to deal with freezing temperatures: supercooling in P. linearis vs. freezing-tolerance in P. endiviifolia. This matches with the probability of being subjected to sub-zero temperatures in their natural environments (lower in the case of P. linearis). Surprisingly, the higher risk of dehydration in the natural habitat of P. linearis is not matched by a higher desiccation tolerance. This observation does not support the initial hypothesis of the study but suggests the opposite: the acclimation to a cold environment results in higher desiccation tolerance. HIGHLIGHTS ● Porphyra linearis and Pyropia endiviifolia are remarkably tolerant to desiccation and freezing.● Antarctic P. endiviifolia is remarkably tolerant to desiccation and freezing.● Mechanisms of freezing tolerance could induce a higher tolerance to desiccation.

Dehydration and other strategies of rapid weight loss in young powerlifters

Background: Prevalence of dehydration as a method of rapid weight loss (RWL) and related risks point to the necessity of knowledge assessment in young powerlifters in this regard. The aim of this study was to assess practices and knowledge about RWL methods and their potential detrimental effects on health in young powerlifters. Materials and methods: A diagnostic poll was carried out among the participants (n=98) of sub-junior Polish championships (14 – 18 years), in two subgroups: G1 – weight classes up to 75 kg (n=50) and G2 – weight classes above 75 kg (n=48). Results: Dehydration was most frequently indicated by young powerlifters as a method of body weight reduction in young powerlifters whereas diuretics, potentially hazardous to health, were the most popular supplement. Conclusions: Despite popular belief that extreme RWL methods are most prevalent in lighter weight classes, athletes of higher weight classes more frequently indicated the methods with high risk of dehydration. Among young powerlifters, knowledge of the consequences of RWL is inadequate.

Effect of Thickening Powder on Gastrointestinal Losses in Patients With High-output End Jejunostomy Syndrome - Preliminary Results.

End jejunostomy syndrome is a type of short bowel syndrome (SBS) in which the jejunum forms the end of the bowel, as a result of resection or exclusion of the ileum and colon. It is associated with a high risk of dehydration, electrolyte imbalance, and malnutrition due to excessive stomal losses. In this retrospective study, we analyzed the medical records of sixteen adult patients with SBS and high-output end jejunostomy syndrome who received thickened fluids during their hospitalization in the home parenteral nutrition unit. The main parameter considered was daily stoma excretion volume, measured by 24-h collection. Values were compared between days when patients drank the daily amount of 600 ml of water, and days when patients ingested the same amount of water but mixed with thickening powder to achieve a mildly thick consistency. Median volumes of end jejunostomy output were significantly lower when patients consumed the mixture of water and thickening powder, compared with drinking water without additives (550.0 ml/d vs. 811.9 ml/d, p=0.002). These preliminary results demonstrate a potential benefit of thickening powder for the nutritional management of patients with SBS type I, and point to the need for further randomized clinical studies with larger patient groups.

Nutritional and Functional Properties of Colostrum in Puppies and Kittens.

Simple SummaryThe post-natal period is a crucial time for all animal species. During the course of their first two weeks of life, puppies and kittens face several risks to their health due to their scarce energy storage and weak immune system. Colostrum is the first production of the mammary glands that plays a pivotal role for puppies and kittens. Colostrum is an important source of immunoglobulins and key nutrients such as lipids and carbohydrates, which are fundamental for the health of newborns. Puppies and kittens must ingest a sufficient amount of colostrum within a few hours of birth to ensure their survival. On the other hand, there are some particular compounds that are not strictly essential, but their presence may play an important role in nutrition and health. As there are no recent studies on companion animals, we have reported published articles describing animal studies in different species to review the nutrition of newborn mammals, with particular emphasis on companion animals.The present review aims toward a better understanding of the nutrition of newborn puppies and kittens. The post-natal period is very sensitive in dogs and cats, as in other animal species. During the first two weeks of life, puppies and kittens are at high risk of dehydration, hypothermia, and hypoglycemia, as well as infectious diseases as they start to acquire the physiological functions of the adult. Neonatal hepatic glycogen storage is low, and newborns depend on colostrum intake to survive. Colostrum provides immunoglobulins and other important substances such as lipids and carbohydrates. Immunoglobulins are central to the immunological link that occurs when the mother transfers passive immunity. The mechanism of transfer varies among mammalian species, but in this review, we focused our attention on dogs and cats. Furthermore, there are components of colostrum which, although their presence is not absolutely necessary, play an important role in nutrition. These components have received considerable interest because of their presumed safety and potential nutritional and therapeutic effects both in humans and animals; however, unfortunately, there are few recent studies in companion animals. Here, we have gathered the published articles that describe studies involving different species of animals, emphasizing companion animals. In particular, the purpose of this narrative of the nutritional and functional proprieties of queens’ and bitches’ colostrum.

Zdravstvena nega pacijenta sa celijakijom tokom bolničkog lečenja

Celiac disease is a chronic autoimmune disease of the small intestine that occurs after ingesting foods that contain gluten. In hypersensitive people, gluten from food triggers immune reactions and leads to irritation, inflammation and atrophy of the small intestinal mucosa with consequent malabsorption of nutrients. The only proven treatment for celiac disease is a strict, lifelong gluten-free diet. By following a diet, it is possible to effectively control the disease and preserve the quality of life. However, if the condition worsens, health professionals must ensure adequate nutrition during their stay in the hospital, and treatment in accordance with the identified needs. This paper presents the specifics of determining the need for care in patients with celiac disease (nursing history, determination of nutritional status and elimination data). Then, we considered the most common problems in the field of nursing care such as: knowledge deficit, diarrhea and vomiting, high risk of dehydration, malnutrition, risk of inadequate thermoregulation and inefficient health maintenance. Nursing interventions are also presented in order to solve these problems, during the hospital treatment of patients with celiac disease.

MANAGEMENT OF PATENT DUCTUS ARTERIOSUS IN VERY PRETERM NEWBORNS: CURRENT CONTROVERSIES AND RECOMMENDATIONS

According to numerous studies, the persistence of patent ductus arteriosus (PDA) in very preterm infants is associated with increased morbidity and mortality. The prophylactic use of drugs that prevent or reduce the hemodynamic significance of PDA in preterm infants has several short-term benefits, including reduction in the incidence of symptomatic PDA, severe intraventricular hemorrhages (IVH) and the need for additional medical or surgical treatment. At the same time, this approach does not affect the long-term outcomes of such patients. Pre-symptomatic treatment with cyclooxygenase inhibitors before the time of appearance of symptoms caused by PDA generally does not affect mortality, but significantly reduces the incidence of symptomatic PDA and the need for pharmacological and surgical treatment. Pre-symptomatic treatment of PDA may be of value in extremely preterm infants born within 23-25 wk of gestation taking into account the high incidence of hemodynamically significant PDA (hsPDA) requiring further treatment in such newborns. Treatment of clinically obvious PDA may minimize the risk of exposing preterm infants to the treatment with undesirable side effects. At the same time, the disadvantages of late intervention are lower success rate and an increased risk of complications associated with hsPDA. Expectant management of PDA in preterm newborns is gaining increasing interest because in a substantial proportion of preterm infants, the PDA will close spontaneously and there is a lack of proven benefit of medical treatment. This approach is not associated with a higher risk of death, necrotizing enterocolitis (NEC), or IVH than any other treatment approaches. A conservative approach aimed to close PDA (fluid restriction, diuretics, etc.) can contribute to avoidance of medical and surgical intervention and their potential side effects only in some preterm infants with gestation > 26 wk, without affecting mortality and quality of survival. However, such a therapy is associated with a high risk of dehydration, development of hyponatremia, and an increase in serum creatinine, that is why it isn’t routinely recommend.

SADAR PURI UNTUK MENCEGAH DEHIDRASI PADA REMAJA DI SMA NEGERI 5 KOTA JAMBI

The reaction in the human body almost requires water. If the body lacks water, it will be associated with dehydration. Therefore, the purpose of this service is to carry out the Self-Urine Check (PURI) counseling in adolescents. This activity was held from May to June 2017, in the SMA 5 Kota Jambi. The target is students of class XI SMA 5 Kota Jambi. This activity consists of giving counseling with power point media, leaflets, posters, and pre-post test questions; practice measuring the scale of hydration using PURI cards and; establishment of a Self-Urine Check. The output of this service activity are: (1) Effective and innovative media / tools / leaflets and modules; (2) Application of conscious PURI and; (3) The formation of a group of mobilizing students aware of PURI. Based on the results of the pre-test it was known that most students did not know that people with more nutritional status were at risk of dehydration (90.9%), and did not know that men were at higher risk of dehydration than women (81.3%). However, after being given counseling all targets can answer post-test questions correctly (100%). Therefore, it is necessary to collaborate with the school with local health agencies in providing health information media and facilities in the school.

Use of sodium-glucose co-transporter 2 inhibitors during the fasting of ramadan: Is there cause for concern?

Background: There is some anxiety among physicians about the safety of using sodium-glucose co-transporter 2 (SGLT2) inhibitors in Muslim type 2 diabetes mellitus (T2DM) patients who wish to observe the fast during Ramadan particularly during the summer in hot regions. There is a dearth of research data to help guide physicians and reassure patients. Objectives: To try and extrapolate to the “Ramadan” scenario, we reviewed the pharmacology of SGLT2 inhibitors and those side effects that may be relevant to Ramadan fasting such as osmotic diuresis, dehydration, use in the elderly and concomitant use with diuretics as well as the potential risk of ketoacidosis. We also reviewed the perceptions among physicians along with the currently available expert opinions and recommendations. Approach: The following aspects are addressed 1. Characteristics and pharmacology of SGLT2 inhibition 2. Side effects having a potential relevance to Ramadan fasting 3. Studies of patient outcomes and physician perceptions and 4. Expert opinions and management recommendations. Emerging concepts: 1. SGLT2 inhibitors are a new glucoselowering therapy for T2DM with documented benefits on blood glucose, hypertension, weight reduction and long term cardiovascular benefit. They have an inherent osmotic diuretic effect and lead to some volume loss and possible dehydration. 2. One study confirmed better glycemic control with less risk of hypoglycemia and no marked volume depletion when compared with sulphonylureas. The experiences with their use in the elderly and in combination with diuretics are reassuring for the safety of their use in Ramadan. 3. SGLT2 inhibitor-related diabetic ketoacidosis has not been reported during Ramadan fasting to date. 4. A survey of physicians' opinions revealed that the majority felt that SGLT2 inhibitors are generally safe in T2DM patients during Ramadan fasting but should be discontinued in certain high risk patients. Most respondents also indicated that they would advise taking the SGLT2 inhibitors with the sunset meal (Iftar) and recommend consuming extra clear fluids in the evening. 5. So far, only a few professional groups with interest in Ramadan fasting updated their guidelines and recommendations on management of diabetes to include the SGLT2 inhibitors. These opinions acknowledged the lack of trial data, recommended caution in high risk groups, advised regular monitoring and emphasized pre-Ramadan patients' education and awareness about possible complications. Conclusions: The current knowledge of SGLT2 inhibitors in clinical practice is reviewed with a focus on their use during Ramadan fasting. There are limited data however, extrapolating from their current use, it is likely that stable patients with no high risk of dehydration and with normal kidney functions may safely continue using the SGLT2 inhibitors therapy. It may be prudent that higher risk patients be observed carefully and any decision concerning SGLT2 inhibitors is taken on individual basis. Planned clinical trials, objective observational studies, clinical audits and patients' reports of their own clinical experience should provide ample opportunity to help answer many of the as yet unanswered questions. Results from studies conducted during the current Ramadan period are eagerly awaited.

Dehydration in the elderly treated in the emergency room of the regional hospital.

Introduction: At this time, there is no absolute definition of dehydration that can be useful in clinical practice. The term dehydration refers to several conditions associated with loss of total body fluids. The terms commonly known in clinical practice to describe this situation are fluid deficit, volume depletion, and dehydration. The actual incidence of dehydration is unknown and probably underestimated. There is an important limitation of its diagnosis due to the lack of standardized methods to measure the quantity of liquids in the body. The variation in weight is the process most commonly used to measure the total loss of liquids in the body to determinate dehydration. This is not feasible in patients seen in the emergency department, a fact that has favored the use of other indicators in daily clinical practice. Dehydration underlies many clinical symptoms. Therefore, dehydration diagnosis should be present as a probable cause in the presence the above mentioned risk factors. Among these risk factors are extreme ages of life. The elderly have a higher risk of dehydration compared to the general population. Objective: This study aims to determine the prevalence of dehydration in elderly patients received at the emergency department of EH, and its correlated risk factors associated with their age. Method: An observational and retrospective study from 01/08/2015–31/08/2015 at the EH Emergency Department. The records of every person older than 65 that received medical services will be analyzed. A multivariate analysis of the factors that could influence in the outcome was conducted.

Sauna-induced body mass loss in young sedentary women and men.

The aim of the study was to evaluate the relationship between body mass index (BMI) and body mass loss (BML) induced by thermal stress in a dry sauna. The study was conducted on a group of 674 sedentary students, 326 women and 348 men aged 19-20. The correlations between BMI scores and BML were determined. The subjects were placed in supine position in a dry sauna for two sessions of 10 minutes each with a 5-minute break. The influence of BMI on the amount of BML in the sauna was determined by nonlinear stepwise regression. The smallest BML was noted in underweight subjects; students with normal weight lost more weight, whereas the greatest BML was reported in overweight and obese subjects. Persons with a high BMI are at higher risk of dehydration, and they should pay particular attention to replenishing fluids during a visit to the sauna. The proposed equations for calculating BML based on a person's BMI can be useful in estimating the amount of fluids that should be replenished by both men and women during a visit to a dry sauna.

Nutrition and Fluid Optimization for Patients With Short Bowel Syndrome

Short bowel syndrome (SBS) is characterized by nutrient malabsorption and occurs following surgical resection, congenital defect, or disease of the bowel. The severity of SBS depends on the length and anatomy of the bowel resected and the health of the remaining tissue. During the 2 years following resection, the remnant bowel undergoes an adaptation process that increases its absorptive capacity. Oral diet and enteral nutrition (EN) enhance intestinal adaptation; although patients require parenteral nutrition (PN) and/or intravenous (IV) fluids in the immediate postresection period, diet and EN should be reintroduced as soon as possible. The SBS diet should include complex carbohydrates; simple sugars should be avoided. Optimal fat intake varies based on patient anatomy; patients with end-jejunostomies can tolerate a higher proportion of calories from dietary fat than patients with a remnant colon. Patients with SBS are prone to deficiencies in vitamins, minerals, and essential fatty acids; serum levels should be periodically monitored and supplements provided as needed. Prebiotic or probiotic therapy may be beneficial for patients with SBS, although further research is needed to determine optimal protocols. Patients with SBS, particularly those without a colon, are at high risk of dehydration; oral rehydration solutions sipped throughout the day can help maintain hydration. One of the primary goals of SBS therapy is to reduce or eliminate dependence on PN/IV; optimization of EN and hydration substantially increases the probability of successful PN/IV weaning.

Rotavirus Infection in India: A Major Cause of Childhood Gastroenteritis

Rotaviruses are genetically highly variable, non-enveloped viruses with a double-stranded, segmented ribonucleic acid genome. It is the single most important cause of severe, dehydrating gastroenteritis in infants and young children worldwide. Rotavirus gastroenteritis is associated with high morbidity in developed countries and significant mortality in developing countries. In children aged less than 5 years, they are the most frequent agent of severe acute diarrheal illnesses. Typically, symptomatic rotavirus diseases in infants ( 70 years) arise with sudden onset of watery diarrhoea with high risk of dehydration, accompanied by vomiting. Fecal-oral transmission is the most likely route of virus spread. Group A serotype strains G1 through G4 account for more than 90% of rotavirus gastroenteritis in humans, with G1 being the predominant serotype. The virus preferentially infects the mature small-intestinal enterocytes. Treatment of rotavirus diarrhoea is usually symptomatic and comprises a sufficient fluid and electrolyte substitution. Although nitazoxanide and some other drugs show high efficacy against rotavirus in vitro and in vivo, there is currently no recommended specific antiviral therapy. In India, two efficient and secure live vaccines against rotaviruses have been approved. Rotarix (GSK) vaccine is derived from single attenuated human rotavirus G1P[8], whereas RotaTeq (Merck) is a pentavalent mixture of naturally attenuated bovine/human rotavirus reassortants. Though these vaccines have already dramatically decreased the morbidity associated with rotavirus in countries where they are widely used, the third generation of vaccines, based on inactivated viruses or recombinant virus like particles are already in pipeline. For prophylaxis, special attention should be paid to adequate hygienic rules. Because of the high stability of rotaviruses to changing environmental conditions, disinfection should be performed applying disinfectants with proven activity against rotaviruses.

Dehydration Influences Mood and Cognition: A Plausible Hypothesis?

The hypothesis was considered that a low fluid intake disrupts cognition and mood. Most research has been carried out on young fit adults, who typically have exercised, often in heat. The results of these studies are inconsistent, preventing any conclusion. Even if the findings had been consistent, confounding variables such as fatigue and increased temperature make it unwise to extrapolate these findings. Thus in young adults there is little evidence that under normal living conditions dehydration disrupts cognition, although this may simply reflect a lack of relevant evidence. There remains the possibility that particular populations are at high risk of dehydration. It is known that renal function declines in many older individuals and thirst mechanisms become less effective. Although there are a few reports that more dehydrated older adults perform cognitive tasks less well, the body of information is limited and there have been little attempt to improve functioning by increasing hydration status. Although children are another potentially vulnerable group that have also been subject to little study, they are the group that has produced the only consistent findings in this area. Four intervention studies have found improved performance in children aged 7 to 9 years. In these studies children, eating and drinking as normal, have been tested on occasions when they have and not have consumed a drink. After a drink both memory and attention have been found to be improved.