Hypertonic Solution Research Articles

Comparative study between the uses of hypertonic saline versus isotonic saline nasal Irrigation following endoscopic sinus surgery

<b>Introduction:</b> Various nasal saline solutions have been widely used following endoscopic sinus surgery. Irrigation solutions minimize synechia formation, improve mucosal healing and enhance the removal of infective debris and crusts. </br></br> <b>Aim:</b> This study aims to compare the efficacy of hypertonic and isotonic saline solutions in nasal irrigation following, endoscopic sinus surgery. </br></br> <b>Material and methods:</b> Forty patients who underwent endoscopic sinus surgery were randomly and evenly sorted into: group “A”, which received hypertonic saline nasal irrigation, and group “B”, which received isotonic nasal irrigation The outcomes were assessed for mucociliary clearance (MCT), Lund-Kennedy endoscopic score for crusts and mucosal edema, while nasal obstruction, nasal discharge and facial pain were analyzed by SNOT22, whereby their severity was assessed by means of visual analog score. The patients were followed up for 3 weeks.</br></br> <b>Results:</b> There was a significant difference in improvement in both groups. Group “A” MCT value on day 7 was P = 0.023, day 14 P = 0.002, and day 21 P = 0.009: for mucosal edema P = 0.009, P = 0.001, P = 0.025; and, for crusts P = 0.015, P = 0.010, P = 0.011: and, for nasal obstruction P = 0.006, P = 0.0001, P = 0.0001 respectively; and for nasal discharge and facial pain P = 0.010, P = 0.047, and P = 0.0062, P = 0.028 for days 14, and 21, respectively. </br></br> <b>Conclusion:</b> Better results in MCT, nasal mucosal edema, crusts, nasal obstruction, discharge, and facial pain/pressure were achieved with the usage of hypertonic saline nasal irrigation.

A teaspoon of sugar and a pinch of salt: Reviewing hyperosmolar therapy.

The traditional hyperosmolar agents used to treat patients with elevated intracranial pressure are mannitol and hypertonic sodium chloride solution. This article focuses on some of the pros and cons of these treatments for managing cerebral edema.

Calculations of the magnitude of responsivities in pH-, temperature- and ion- responsive hydrogels

Stimuli-responsive hydrogels (SRHs) were prepared by thermal free radical redox polymerization in the aqueous solution of N-isopropyl acrylamide (NIPAAm), acrylamide (AAm) with any weak organic acid (such as propenoic acid, cis-butenedioic acid, crotonic acid, methacrylic acid, methylfumaric acid, itaconic acid, aconitic acid in the presence of N,N′-methylene bisacrylamide. DSC thermograms were taken to find the transition zone parameters of SRHs. Swelling studies were carried out to determine the effects of stimuli such as temperature, pH, and ionic strength on the swelling-shrinkage behavior of SRHs and to calculate the magnitude of the stimuli. A sigmoidal equation was used to calculate the parameters such as transition point, the magnitude of the stimulus, minimum and maximum swelling, the amplitude of the transition zone, etc. of the temperature or pH transition zones of SRHs, while the exponential decay equation was used to calculate the parameters of the swelling-ionic strength relationship of the same gels. With the idea that SRHs can be used as a biomaterial, swelling values of SRHs at the pH values of the body fluids at 37 °C were calculated with the help of these sigmoidal equation parameters. Similarly, swelling values of SRHs in hypertonic, isotonic, and hypotonic saline solutions were determined with the help of these exponential decay equation parameters.In conclusion, calculating the responsivity magnitude with the sigmoidal equation or exponential decay equation approach can be a useful tool for chemists, chemical engineers, bioengineers, biomedicine, biomaterials, polymer, and plastic scientists to find the transition zone parameters of stimuli-responsive hydrogels.

POS-679 SWEET HYDROTHORAX: A PERITONEAL DIALYSIS DILEMMA

Hydrothorax is a rare and serious complication in the patient treated with peritoneal dialysis (PD). It consists of pleuro peritoneal communication through the porous diaphragmatic leak. Its diagnosis is challenging as it may be wrongly considered as fluid overload. It may lead to vicious circle because hypertonic glucose peritoneal solutions may be used thus aggravating surcharge. case report A 45-year-old male with end stage chronic kidney disease secondary to IgA nephropathy, 4 years after starting automated peritoneal dialysis (APD) contacted our institution’s PD unit with complaints of cough and dyspnoea. He has past medical history of hypertension, 2 episodes of peritonitis successfully treated.Clinical examination revealed oedema of the lower extremities and reduced auscultation sounds in the right lower lung. Residual diuresis was absent. Chest radiography confirmed right pleural effusion.Thorax computed tomography showed a massive pleural effusion with right lower-lobe atelectasis and evidence of multiple defects in the diaphragmatic dome with a diaphragm that is shriveled at the right cardiophrenic angle. The thoracentesis drained 1.7L of pleural fluid during the following days.Laboratory findings demonstrated a transudative effusion with the chemical component of pleural fluid similar to PD fluid.We did not find any sign of peritonitis, hypoalbuminaemia, infectious or neoplastic diseases. However, echocardiography revealed cardiac failure. Patient was switched to hemodialysis and intensive ultrafiltration was performed. This case describes an unusual presentation of hydrothorax in the context of peritoneal dialysis. Switchto hemodialysis is frequently necessary temporarily or definitively. All clinicians prescribing peritoneal dialysis should be aware of this complication to avoid delayed diagnosis.

Systems Thinking

Systems Thinking

POS-525 INTEREST OF MANNITOL IN INTRACRANIAL HYPERTENSION DURING HEMODIALYSIS IN A PATIENT WITH ACUTE BRAIN INJURY: A CASE REPORT

Hemodialysis (HD) Patients with acute brain injury are at increased risk of dialysis disequilibrium syndrome (DDS). This is due to the added risk of increased intracranial pressure (ICP) during or following dialysis. We present here a case of severe intracranial hypertension due to post traumatic subdural hematoma in a long-term HD patient, improved by continuous mannitol infusions during HD sessions. A 37-year-old Caucasian woman, in HD during five years, had a car accident in january 2021 with initial loss of consciousness, vomiting, severe headache and a Glasgow score of 14/15. Cerebral CT showed frontal hemorrhagic contusions, a right temporal subdural hematoma, subarachnoid hemorrhage, a non-displaced fracture of the sagittal/frontal bones and severe cerebral edema (figure 1). The patient was transferred to the neurosurgical department for medical management and monitoring. No emergency surgery was needed. On day 4, during her first hemodialysis session post brain injury, the patient presented neurological deterioration, severe headache and vomiting. Her blood pressure was of 143/63, heart rate recorded at 76 and oxygen saturation was stable at 100%. On suspicion of cerebral edema, the session was stopped. CT revealed exacerbation of cerebral edema, with no change in lesions or hemorrhage. Similar problems were encountered on the following session. We tried a test dose of Mannitol 20%: 50ml over 5minutes after start of hemodialysis. Neurologic signs disappeared and the patient was stable. Slow Continous mannitol infusion at a dose of 0,2g/kg body weight was undergone during 3-hours HD session with blood pressure and heart rate monitoring. No complications and no clinical significant changes were observed, except a mild elevation of blood pressure(174/95) controlled by mannitol infusion rate reduction. On day 8, the patient received slower dose of Mannitol 20% : 0,2g/kg body weight over 3.5hours of hemodialysis with 50ml infused over 20min and the remaining 60ml over 3 hours. Repeated blood tests showed no hypernatremia. From day 10 and onwards, the patient was able to tolerate hemodialysis with similar settings. On day 20, a further CT scan showed improvement in cerebral edema and temporal hematoma. we began administrating smaller doses of Mannitol ( 0,1g/kg body weight). On day 28, Mannitol was discontinued, as neurological functions were stable and control cerebral CT showed almost total resorption of the hemmorage and a marked edema reduction (figure 2). This case highlights the inherent risks associated with hemodialysis in patients with acute brain injury. The patient in question was likely predisposed to DDS due to cerebral edema after traumatic subdural hemmorage. In high-risk patients, we suggest the infusion of hypertonic solutions such as mannitol during dialysis. It seems to be well tolerated and may allow correction of ICP and optimisation of hemodialysis sessions. However, the risk of hypertensive crisis and hypernatremia should be considered.

Моніторинг вмісту в крові карбоксигемоглобіну для оцінки тяжкості травматичного шоку та реперфузійних ушкоджень (аналітичний огляд з результатами власних спостережень)

Монооксид вуглецю — природний метаболіт організму. В організмі СО утворюється в процесі роботи ферменту гемоксигенази 1 та 2 із зруйнованого гемоглобіну. Цей процес зумовлює утворення деякої кількості карбоксигемоглобіну у здорових осіб, навіть якщо СО не надходить до організму ззовні в процесі дихання. СО виконує функції сигнальної молекули, модулюючи стан тонусу серцево-судинної системи, пригнічує та сприяє зворотному розвитку порушень, що викликані запальною відповіддю, та може відігравати важливу роль як потенційний терапевтичний агент. З іншого боку, СО при взаємодії з гемоглобіном утворює карбоксигемоглобін та витісняє кисень із зв’язки з гемоглобіном, що веде до неспроможності доставки кисню тканинам. Окрім цього, СО також зв’язується із міоглобіном та мітохондріальною цитохромоксидазою. Тривала присутність у крові значної кількості СО викликає серйозні ушкодження міокарда та центральної нервової системи. Отже, надмірна ендогенна продукція СО та надмірне утворення карбоксигемоглобіну можуть відігравати значну роль у тканинному пошкодженні та формуванні поліорганної дисфункції. Окрім гему, що звільнюється при руйнуванні гемоглобіну, джерелом продукції ендогенного СО та, у свою чергу, карбоксигемоглобіну можуть бути компоненти зруйнованих клітинних мембран та мітохондріальні ферменти, що містять гем. Клітинні ушкодження, що мають місце в умовах травматичного шоку, наслідки ішемії/реперфузії, геморагічне просочення тканин, гемотрансфузії та інтенсивне утворення агресивних вільних радикалів ведуть до зазначених подій. На сьогодні більшість дослідників розглядає продукцію СО та карбоксигемоглобіну при критичних станах як компенсаторний механізм, що забезпечує цитопротекцію та зростання виживаності хворих. Ми вивчили результати досліджень, що стосуються оцінки інтенсивності продукції СО, вмісту в крові карбоксигемоглобіну та вмісту СО в повітрі, що видихається, у пацієнтів в критичних станах та порівняли ці результати із даними власних спостережень. В іноземних джерелах наведено концентрації карбоксигемоглобіну в крові, що в більшості випадків не перевищували 4 %. У нашому дослідженні вивчались пацієнти із політравмою та крововтратою на ранньому госпітальному етапі. Оцінювалися показники центральної гемодинаміки, а також сатурація капілярної крові киснем, перфузійний індекс та вміст у крові карбоксигемоглобіну за допомогою технології компанії «Masimo». Усі постраждалі надходили до клініки з нормальним вмістом карбоксигемоглобіну в крові. Патологічне зростання концентрації карбоксигемоглобіну спостерігалося в процесі реперфузії. Швидка рідинна ресусцитація, застосування гіпертонічних розчинів та адреналіну сприяли зростанню артеріального тиску, перфузійного індексу та концентрації карбоксигемоглобіну. Наступне за реперфузією зростання концентрації в крові карбоксигемоглобіну було тим більшим, чим більш тяжким був перебіг шоку. Реінфузія крові також сприяла збільшенню концентрації карбоксигемоглобіну в крові. Високі показники концентрації карбоксигемоглобіну в крові постраждалих із травматичним шоком у період реперфузії закономірно викликають питання про його роль у формуванні мітохондріальної дисфункції при травматичній хворобі.

Teknik Dehidrasi Osmosis Pada Pembuatan Manisan Kulit Jeruk

High consumption of oranges (Citrus sinensis) leads to the increase of orange peel waste, that’s why those orange peel waste needs to be utilized as a value-added product, such as fruit candy. Fruit candy can be produced by a process called osmotic dehydration, which is the process of immersing food material in a hypertonic solution. This research was done with Randomized Block Design to understand the effect of immersion time (2, 4, and 6 hours) and blanching time as the pretreatment (2,5, 5, and 7,5 minutes). This research was done in triplicate. The parameters that were observed are solid gain (SG), water loss (WL), weight reduction (WR), water content, and colors (L*, a*, and b*). The results indicated that the increase in immersion and blanching time causes the value of solid gain (SG) and water loss (WL) to increase, weight reduction to decrease then increase, and water content to decrease. Analysis of Variance test suggests that immersion time has a significant effect on SG, WL, WR, water content, L*, and a*. On the other hand, blanching time only significantly affects SG, WL, WR, and water content. According to Multiple Attribute Utility Theory, the best treatment in this research, regarding the results of SG, WL, WR, and water content, is the treatment with 6 hours immersion time and 7,5 minutes blanching time.

The Potential Therapeutic Effect of Hypertonic Saline Solution (HSS) for the Management of Refractory Acute Decompensated Heart Failure (ADHF)

Patients with acute decompensated heart failure (ADHF) have high rates of mortality and morbidity despite recent improvements in diagnosis and treatment. Still patients with significant heart failure and especially with NYHA class III -IV HF and low blood pressure with or without hyponatremia and renal failure are considered severe patients with reduced response to standard treatment with high mortality rates and high re-hospitalizations as they are associated with worse prognosis. Several works and meta -analysis have shown the importance and benefit of treatment with the infusion of hypertonic saline solution (HSS) in these patients and in different conditions of cardiovascular collapse. Current evidence indicates that the infusion of hypertonic solution in heart failure patients can provide clinical and hemodynamic improvement. The investigators are testing the hypothesis that the infusion of hypertonic solution in association with diuretics may prevent the occurrence of renal dysfunction in patients with ADHF and can reduced the re-hospitalizations rate. Our experience in treating several patients has been successful and has shown significant improvement in symptoms and weight loss and improvement in renal function, due to the small size of the sample we were unable to perform a controlled study. We hypothesize that HSS, treatment should be adopted practically and a treatment protocol should be built in patients with intractable ADHF, especially with hypotension, hyponatremia with/without renal failure and overloaded.

Primary muscular hydatidosis in an endemic area of Peru: report of two cases.

Primary muscular hydatidosis is an infrequent parasitic infection, caused by Echinococcus granulosus. We report 2 cases of female patients with diagnosis of primary muscular hydatidosis of the thigh. Both hail from an endemic area for hydatidosis, and had no pulmonary, hepatic, or systemic involvement. Cyst extraction was performed after the patients were given hypertonic solution, and antiparasitic treatment.

Uticaj biopolimernih premaza na stabilnost skladištenja osmotski dehidriranih pečuraka

The main aim of this research was to apply biopolymer coatings on osmotically dehydrated mushrooms and monitor their quality during storage. Mushrooms were osmotically dehydrated in sugar beet molasses (80% dry matter) under optimized conditions (45 °C for 5 hours), as previously reported elsewhere. Two different biopolymers were chosen: chitosan, a polysaccharide polymer, and zein, a protein polymer. A non-treated mushroom sample was chosen as a control sample. The mushroom samples were analysed for sugar and protein content, as well as water loss and microbiological profile. An increase in sugar content was the most noticeable in the osmotically dehydrated mushrooms compared to the control sample due to the use of molasses as a hypertonic solution. The contribution of used biopolymer coatings to the sugar and protein content of the coated and osmotically treated mushrooms was negligible. Chitosan coating contributed to better storage stability of treated mushrooms by lowering the moisture loss and microbial count. For this reason, chitosan treated sample was chosen for further examination related to the evaluation of its baking potential as a filling in a traditional stuffed pie-like layered bakery product-burek. Burek was stuffed with fresh mushrooms, osmotically treated mushrooms or osmotically treated mushrooms coated with chitosan. The sensorial assessment proved that control burek and burek samples with osmotically dehydrated mushrooms coated with chitosan were the most preferred groups based on odour and overall impression.

Uticaj biopolimernih premaza na stabilnost skladištenja osmotski dehidriranih pečuraka

The main aim of this research was to apply biopolymer coatings on osmotically dehydrated mushrooms and monitor their quality during storage. Mushrooms were osmotically dehydrated in sugar beet molasses (80% dry matter) under optimized conditions (45 °C for 5 hours), as previously reported elsewhere. Two different biopolymers were chosen: chitosan, a polysaccharide polymer, and zein, a protein polymer. A non-treated mushroom sample was chosen as a control sample. The mushroom samples were analysed for sugar and protein content, as well as water loss and microbiological profile. An increase in sugar content was the most noticeable in the osmotically dehydrated mushrooms compared to the control sample due to the use of molasses as a hypertonic solution. The contribution of used biopolymer coatings to the sugar and protein content of the coated and osmotically treated mushrooms was negligible. Chitosan coating contributed to better storage stability of treated mushrooms by lowering the moisture loss and microbial count. For this reason, chitosan treated sample was chosen for further examination related to the evaluation of its baking potential as a filling in a traditional stuffed pie-like layered bakery product - burek. Burek was stuffed with fresh mushrooms, osmotically treated mushrooms or osmotically treated mushrooms coated with chitosan. The sensorial assessment proved that control burek and burek samples with osmotically dehydrated mushrooms coated with chitosan were the most preferred groups based on odour and overall impression.

A modern view on the treatment of acute bronchiolitis in pediatric intensive care units: a review

INTRODUCTION. The literature has accumulated enough data on the treatment of children with acute bronchiolitis (OB). However, this information is formed mainly on the general population of patients with OB and is often not applicable to patients with a severe course of the disease. From the standpoint of evidence-based medicine, routine use of medications is not recommended in modern consent documents, and there are also no clear recommendations on respiratory support and certain aspects of intensive care in children with OB. OBJECTIVES. To analyze approaches to therapy in children with severe acute course in need of intensive care, and to assess the validity, effectiveness and safety of the use of the analyzed groups of drugs and respiratory strategies. MATERIALS AND METHODS. The analysis of publications in the electronic databases PubMed and the Russian Scientific Citation Index on the keywords “bronchiolitis”, “intensive care units”, “critical care”, “fluid therapy”, “respiratory therapy”, “ventilation”, “co-morbidity”; “respiratory syncytial virus”; “hypertonic saline” was carried out, “corticosteroids”; “epinephrine”; “high-flow oxygen therapy”, “inhalation”, “infant”, “bronchiolitis in children”. The date of the last search is January 15, 2022. RESULTS. This systematic review provides information on the etiology and risk factors of severe acute respiratory syndrome in children, from the standpoint of evidence-based medicine, studies on the treatment of severe acute respiratory syndrome are characterized, including in the intensive care unit with glucocorticosteroids, inhalations of bronchodilators, epinephrine, 3 % hypertonic sodium chloride solution, respiratory support, high-flow oxygenation, noninvasive ventilation, artificial ventilation, antibiotics, air-helium mixture. CONCLUSIONS. Currently, there is more information that infants with OB show a high degree of heterogeneity, while the main uncertainty lies in a misunderstanding of the processes, which patients will benefit most from a particular treatment method. Further research is needed to fill the research deficit in children with a severe course of OB.

Monitoring non-small cell lung cancer progression and treatment response through hyaluronic acid in sputum.

We evaluated whether hyaluronan (HA) levels in the sputum could be used as a noninvasive tool to predict progressive disease and treatment response, as detected in a computed tomography scan in non-small cell lung cancer (NSCLC) patients. Sputum samples were collected from 84 patients with histological confirmation of NSCLC, 33 of which were in early-stage and 51 in advanced-stage disease. Patients received systemic chemotherapy (CT) after surgery (n=36), combined CT and immunotherapy (IO) (n=15), or targeted therapy for driver mutation and disease relapse (N=4). The primary end-point was to compare sputum HA levels in two different concentrations of hypertonic saline solution with overall survival (OS) and the secondary and exploratory end-points were radiologic responses to treatment and patient outcome. Higher concentrations of HA in the sputum were significantly associated to factors related to tumor stage, phenotype, response to treatment, and outcome. In the early stage, patients with lower sputum HA levels before treatment achieved a complete tumor response after systemic CT with better progression-free survival (PFS) than those with high HA levels. We also examined the importance of the sputum HA concentration and tumor response in the 51 patients who developed metastatic disease and received CT+IO. Patients with low levels of sputum HA showed a complete tumor response in the computed tomography scan and stable disease after CT+IO treatment, as well as a better PFS than those receiving CT alone. HA levels in sputum of NSCLC patients may serve as a candidate biomarker to detect progressive disease and monitor treatment response in computed tomography scans.

Опыт применения ирригационной терапии при острой респираторной вирусной инфекции у детей

Objective of the Paper: To draw the attention of pediatricians, otorhinolaryngologists, general practitioners to the possibilities of irrigation therapy in the treatment of acute respiratory viral infections in children. Key points. Irrigation therapy is widely used for the prevention and treatment of acute infections of the upper respiratory tract in children, and is an effective and safe method. However, there are no indications in the clinical guidelines about the exact concentrations of saline solutions, the method of irrigation therapy, and its duration. For use in acute respiratory viral infections in children at different periods of the disease, it is preferable to use a slightly hypertonic solution of sea water in the form of a fine spray. In the acute period, irrigation therapy reduces the need for the use of decongestants and antibiotics. In the subacute and post-viral periods, it promotes the regeneration of the ciliary epithelium. Conclusion. The addition of Ascophyllum nodosum brown algae extract to solutions for irrigation therapy can increase the effectiveness of treatment, promote faster relief of inflammation in the nasal cavity, and restore the mucosa due to the anti-inflammatory, antimicrobial, and immunomodulatory properties of fucoidans. Keywords: acute respiratory viral infections, irrigation therapy, children, sea water, brown algae.

Comparative effects of hypertonic solutions and pentoxifylline in sepsis

Comparative effects of hypertonic solutions and pentoxifylline in sepsis

Hypertonic saline solution and high dose of diuretic, ¿what do we know and how can we use them in persistent congestion?

The presence of decompensated heart failure continues to be a condition with high rates of hospitalization, impact on the health system, and quality of life for those who suffer it. The mainstay of treatment in these cases are diuretics. However, the resistance to this pharmacological group may occasionally occur, generating an inadequate negative fluid balance and persistence of congestion with negative clinical outcomes. Hypertonic saline solution with high doses of diuretic emerges as a therapeutic option for this group of patients with probable physiological, and clinical benefits on hospitalization and re-admission rates due to heart failure decompensation. A review of the most relevant aspects and benefits of this combination is discussed in this article.

Evaluation of water loss and solute uptake during osmotic treatment of white radishes (Raphanus sativus L.) in salt-sucrose solution

White radish, scientifically known as Raphanus sativus L., is a yearly vegetable. Currently, it was being grown and widely used in the world, including Vietnam. These plants have been used as food or food processing. The osmotic treatment of vegetables involves the removal of water from plants in which the solids from the osmotic solution are transported to the plant material by osmosis. By this procedure, sucrose and saline solution are usually performed. White radishes were dehydrated in different hypertonic solutions by combined sucrose and NaCl at three different concentrations, including 9 runs. Mass transfer behaviour was applied according to three common models such as Fick’s second law, Weibull and Peleg’s equations based on the change of moisture and solid content of white radish during osmotic dehydration. The obtained results showed that the mass transfer was fast at initial stage and became slowly at the later stage. The effective moisture (Dm) and solid diffusivities (Ds) were ranged from 1.0186 to 1.2826x10-8 and from 1.0692 to 2.3322x10-8 (m2/s) respectively. The Peleg’s equation was found to be the best fitting for water loss and solid uptake thanks to the high determination coefficient (>97.64%) and the low average relative error (<3.174%). Raised up solution concentration resulted in higher water loss and mass gain.

Association of Prescription With Body Composition and Patient Outcomes in Incident Peritoneal Dialysis Patients.

Objective: The nutritional status of patients on peritoneal dialysis (PD) is influenced by patient- and disease-related factors and lifestyle. This analysis evaluated the association of PD prescription with body composition and patient outcomes in the prospective incident Initiative for Patient Outcomes in Dialysis–Peritoneal Dialysis (IPOD-PD) patient cohort.Design and Methods: In this observational, international cohort study with longitudinal follow-up of 1,054 incident PD patients, the association of PD prescription with body composition was analyzed by using the linear mixed models, and the association of body composition with death and change to hemodialysis (HD) by means of a competing risk analysis combined with a spline analysis. Body composition was regularly assessed with the body composition monitor, a device applying bioimpedance spectroscopy.Results: Age, time on PD, and the use of hypertonic and polyglucose solutions were significantly associated with a decrease in lean tissue index (LTI) and an increase in fat tissue index (FTI) over time. Competing risk analysis revealed a U-shaped association of body mass index (BMI) with the subdistributional hazard ratio (HR) for risk of death. High LTI was associated with a lower subdistributional HR, whereas low LTI was associated with an increased subdistributional HR when compared with the median LTI as a reference. High FTI was associated with a higher subdistributional HR when compared with the median as a reference. Subdistributional HR for risk of change to HD was not associated with any of the body composition parameters. The use of polyglucose or hypertonic PD solutions was predictive of an increased probability of change to HD, and the use of biocompatible solutions was predictive of a decreased probability of change to HD.Conclusion: Body composition is associated with non-modifiable patient-specific and modifiable treatment-related factors. The association between lean tissue and fat tissue mass and death and change to HD in patients on PD suggests developing interventions and patient counseling to improve nutritional markers and, ultimately, patient outcomes.Study Registration: The study has been registered at Clinicaltrials.gov (NCT01285726).

Comparative Evaluation of Efficacy of Mannitol and Hypertonic Saline (3%) for Treatment of Moderate to Severe Traumatic Brain Injury (TBI)

Background: Intracranial Pressure of higher than 20 mm of Hg is considered Intracranial Hypertension. For years, Mannitol has been the go-to drug for its cure. However, it has many adverse effects. Therefore, other drugs are being considered for reducing Intracranial Pressure (ICP), and hypertonic saline (HTS) appears to be a good alternative.
 Methods: The reason for this study is to report any differences in results after using of mannitol or hypertonic saline for treating Intracranial Hypertension (IH) in patients who were in the tertiary care hospital to be treated of moderate or severe Traumatic Brain Injury (TBI).
 Methodology: All patients who had moderate or severe Traumatic Brain Injury (TBI) i.e, were reported at the hospital and had Glasgow Coma Score lesser than 13, were admitted in the hospital over the course of 2 months of the study will be included. Patients will be randomized into 2 statistically comparable groups. Group A and Group B will be given the standard amount of mannitol and hypertonic saline (3%) and clinical result will be noted for both cases.
 Results: The results will be calculated by rate of improvement in Glasgow Coma Score (GCS) of both groups and then compared. Primary endpoint will be clinical improvement after 7 days.
 Conclusion: The rationale behind which drug of the two - mannitol or hypertonic saline solution (HS) - for treatment of people suffering Traumatic Brain Injury (TBI) to be primary varies considerably and there seems to be no protocol to determine which of these should be preferred. Most of the studies that have been done on the topic conclude that Hypertonic saline (HTS) seems to better suited for lowering Intracranial Pressure (ICP), regardless of its concentration. However, other than its apparent superiority in ICP reduction, it doesn’t seem to have any additional benefits, in relation to mortality.