Increased Fluid Intake Research Articles

FACTORES DE RIESGO NUTRICIONALES ASOCIADOS A INCONTINENCIA URINARIA Y SU IMPACTO SOBRE LA CALIDAD DE VIDA EN MUJERES ADULTAS

Introduction: There is evidence in the literature studies about nutritional factors that could increase the risk of developing urinary incontinence (UI), which significantly impairs the quality of life of patients. Objectives: To identify nutritional risk factors associated with UI in adult women and its impact on quality of life. Materials and methods: Cross-sectional, observational and analytical study of cases and controls, on a non-probabilistic, intentional and voluntary sample of adult women (35 to 75 years old), who attended Centro de Kinesiología y Estética (Esteban Echeverría, Province of Buenos Aires). Thirty women with UI (cases) were identified by ICIQ-SF (International Consultation on Incontinence Questionnaire), and controls without UI, obtained from the same population base (n=30), were matched one by one. Variables under study: age, nutritional risk factors for UTI: nutritional status by Body Mass Index (BMI) and waist circumference (WC); hygienic-dietary habits: sedentary lifestyle (exercise <150 minutes/week), functional constipation according to ROME IV criteria and increased fluid intake (≥ recommendation); UTI impact on quality of life by Potenziani- 14-CI- IO- QOL- 2000 questionnaire. Statistical analysis using SPSS 19.00 calculating measures of central tendency, Chi-square and Odds Ratio (OR) with 95% confidence intervals and significance p<0.05. Results: Most women with UTI were sedentary (86.7%) with overweight or obesity (66.7%) and increased CC (73.7%). UI was associated with age (OR=0.32; 95%CI: 0.11-0.94; p=0.03), overweight/obesity (OR=0.15; 95%CI: 0.04-0.47; p=0.001), increased QoL (OR=0.11; 95%CI: 0.03-0.42; p=0.0001) and sedentary (OR=0.20; 95%CI: 0.059-0.695; p=0.02). The impact on quality of life was mild-moderate for most women with UI (93.3%). Conclusion: Age, overweight or obesity, increased waist circumference and sedentary lifestyle were risk factors associated with UI. An adequate nutritional intervention would improve the quality of life of adult women with this condition. Keywords: Urinary incontinence; adult women; risk factors; life quality.

Increasing Overnight Fluid Intake and Kidney Function During Ramadan Fasting: A Randomized Controlled Trial

All healthy Arab individuals are obligated to abstain from eating, drinking, and sexual relations from dawn to sunset during Ramadan, which is one of the 5 pillars of Islam. Fasting effects various body systems, apart from the renal system. Fasting can also increase serum creatinine levels because of dehydration. Our aim was to examine the effects of increased fluid intake during the night on serum creatinine and urea levels. This randomized controlled trial included 58 healthy subjects who were randomly divided into 2 groups of 29. The hydrated group drank 2 to 3 L of fluid from sunset to the dawn of the next day. Kidney function was measured before, during, and 1 month after Ramadan. After adjustment for sociodemographic variables, the control group exhibited higher means of serum concentrations of creatinine and urea and lower estimated glomerular filtration rate than the hydrated group. The Ramadan group exhibited highest means of serum levels of creatinine and urea and the lowest estimated glomerular filtration rate compared with the pre- and post-Ramadan periods. All results were statistically significant at P <.05. We found that Ramadan fasting was not associated with a permanent increase in serum creatinine or urea. For those groups with a high fluid intake, serum creatinine and urea were significantly lower than the controls suggesting a favorable effect of hydration during the nonfasting hours. This compensated with the dehydration occurring during daylight, as dehydration is responsible for increased concentrations of urea and creatinine. This study adds further evidence that Ramadan fasting does not affect the renal system of healthy subjects; however, fluids should be increased at night, during nonfasting hours.

Effect of high-energy and/or high-protein feeding in children with congenital heart disease after cardiac surgery: a systematic review and meta-analysis.

The certainty of the evidence was graded as moderate to high, which suggests that high-energy and/or high-protein feeding may be safe in children after congenital heart surgery. Furthermore, this intervention improves nutrition and reduces the duration of mechanical ventilation, length of ICU stay, and length of hospital stay. However, the overall conclusion of this meta-analysis will need to be confirmed in a cohort of patients with different cardiac physiologies. •Malnutrition is highly prevalent in children with congenital heart disease (CHD) and can negatively affect the prognosis of these children. • High-energy and/or high-protein feeding can improve nutrition status and facilitate recovery; however, evidence on its safety and efficacy is lacking. •Pooled data suggest that high-energy and/or high-protein feeding does not increase fluid intake or feeding intolerance in children with CHD. • High-energy and/or high-protein feeding may reduce the duration of mechanical ventilation, length of intensive care unit stay, and length of hospital stay.

Clinical Effectiveness of Calcium Oxalate Stone Treatments

Introduction: Lowering kidney stone risk and urine calcium oxalate supersaturation is a primary clinical focus for kidney stone prevention and can be achieved with multiple strategies. Common strategies include advice to increase fluid intake, restrict dietary sodium, or prescribing a thiazide-type diuretic. We investigated how physicians make these decisions in real-world practice and evaluate their efficacy based on 24-h urine collections. Methods: We reviewed medical charts for 203 kidney stone formers with idiopathic calcium stones from University of Chicago Kidney Stone Clinic between 2005 and 2020. Patients had three 24-h urines before an initial pre-treatment clinic visit and one follow-up 24-h urine. We analyzed changes in urine composition based on treatment advice using t tests and ANOVA. Results: Patients who received advice to increase fluid intake had lower urine volume at baseline (1.5 vs. 2.5 L/day, p < 0.001) and larger increase in urine volume at follow-up (0.6 vs. 0.1 L/day, p < 0.001) compared to those who did not receive the advice. Patients who were advised to restrict dietary sodium had a higher urine sodium at baseline (208 vs. 139 mEq/day, p < 0.001), a larger reduction in urine sodium (−28 vs. 13 mEq/day, p = 0.002), and larger reduction in urine calcium (−74 vs. −28 mg/day, p = 0.005) compared with those not advised to restrict dietary sodium. Patients started on a thiazide had a higher baseline urine calcium (281 vs. 213 mg/day) and larger reduction in urine calcium (−83 vs. −9 mg/day, p < 0.001) compared with patients not started on a thiazide. In combination, thiazide prescriptions with dietary sodium restriction reduced urine calcium by 99 mg/day and reduced calcium oxalate supersaturation from 8.0 to 5.5 and calcium phosphate supersaturation from 1.4 to 1.0. Conclusion: Providers use 24-h urine data to guide treatment strategy decisions. These strategies achieved the intended effects on urine composition and lowered kidney stone risk.

ODP026 An Incidental Giant Normotensive Pheochromcytoma with Elevated Metanephrines demonstrated no evidence of hypertensive crisis during a major surgery

Abstract A 48-year-old Caucasian male with no known past medical history admitted to our hospital following MVA resulting in acute severely comminuted displaced fracture of the left femur and tibia. On admission, the patient was in severe pain. His vitals were significant for elevated blood pressure (BP) of 137/100 and pulse rate of 161 per minute, which resolved soon after pain medications and splint placement. On review of systems, he denied episodic spells of headaches, palpitations, pallor, tremors, anxiety, abdominal pain, or diaphoresis. He denied any family history of endocrine disorders. Physical exam was unremarkable, except for the left femur traction splint. He had multiple CT imaging performed for evaluation of his injuries. On CT scan of the abdomen, he was found to have a 7.2cm adrenal incidentaloma with imaging characteristics consistent with pheochromocytoma. He was admitted to the intensive care unit for one day for closer monitoring where he remained hemodynamically stable without any BP lowering medications. Laboratory work up for a pheochromocytoma was pending. However, due to concern of compartment syndrome of left lower extremity, patient underwent two emergent procedures of open reduction and internal fixation of left femur and tibial fracture repair. Robust monitoring of hemodynamics was performed during both surgeries but patient did not require any antihypertensive medications during the procedures. Eventually, serum total metanephrines drawn on admission day two, resulted as 7848 pg/ml (normal &amp;lt;205pg/ml), normetanephrines 3626 pg/ml (normal &amp;lt;148pg/ml), and metanephrines 4224 pg/ml (normal&amp;lt;57pg/ml). Serum cortisol, aldosterone, renin, dehydroepiandrosterone sulfate, and glucose were within normal limits. On day 3 of admission, repeated serum metanephrines were persistently elevated in 4000s. 24-hour (hr) urine studies showed total metanephrines 7353 mg/24hr (normal &amp;lt;832 mg/24hr), metanephrines 4934 mg/24hr (normal &amp;lt;315 mg/24hr), normetanephrines 2419 mg/24hr (normal &amp;lt;676 mg/24hr) and creatinine2.3g/24 hr (normal &amp;lt;2. 0g/24hr) . MRI abdomen confirmed pheochromocytoma abutting the pancreas and left upper pole of kidney. Interestingly, patient remained hemodynamically stable with highest BP measurement of 120/90 throughout the hospital course. He was eventually discharged on Prazosin 1 mg twice daily which was gradually increased to 5 mg daily in divided doses; increase fluid intake and high salt diet. Beta-blocker was not added due to borderline blood pressure. The patient underwent robotic left radical adrenalectomy without any intraoperative hemodynamic instability. Pathology was consistent with pheochromocytoma, confined to the adrenal gland without no capsular invasion. The patient refused genetic testing. Presentation: No date and time listed

Recurrent Vertigo of Childhood: Clinical features and prognosis.

Introduction“Recurrent Vertigo of Childhood” (RVC) has recently replaced the term “Benign Paroxysmal Vertigo of Childhood” and was defined as recurrent spells of vertigo without evidence of a vestibular migraine of childhood (VMC). RVC and VMC are considered the most frequent causes of vertigo and dizziness in children below 18 years of age. Diagnosis might be challenging since clinical features of RVC and VMC may overlap.ObjectiveThis study aims to characterize clinical and instrument-based findings in patients with RVC and to evaluate the course of the disorder.MethodsWe prospectively collected clinical and instrument-based data of children/adolescents younger than 18 years, who presented at the German Center for Vertigo and Balance Disorders (DSGZ) at the LMU University Hospital in Munich. All patients underwent a comprehensive neurological, ocular motor, vestibular and cochlear examination. Furthermore, findings from follow-up examinations were analyzed.ResultsOverall 42 children (24 male and 18 female) with RVC were included in the study. The mean age at diagnosis was 7 ± 3.6 years with a mean onset of symptoms at the age of 5.6 ± 3.4 years. Attack duration ranged between 1 min and 4 h. The most common accompanying symptoms included nausea, vomiting, expression of fear, and falls. Non-migrainous headaches were reported by 11 patients during initial presentation, 7 of whom were later diagnosed with migraine. Female patients showed a higher age at symptom onset, a higher attack frequency, and attack duration. Eleven of the 24 patients seen at a 3.5 year follow-up reported a complete cessation of attacks. Patients still experiencing vertigo attacks had a significantly reduced attack frequency, especially those who implemented at least one prophylactic measure.ConclusionA precise characterization of symptoms is essential for diagnosing children with RVC. Age at symptom onset does not exceed the age of 12. Gender-specific differences should be considered and may further support the evidence of an association with migraine. The disease course of RVC is benign, nevertheless implementing prophylactic measures such as regular exercise, increased fluid intake, sleep hygiene, and relaxation exercises, can improve attack frequency.

What treatments reduce kidney stone risk in patients with bowel disease?

We examined how physicians made therapeutic choices to decrease stone risk in patients with bowel disease without colon resection, many of whom have enteric hyperoxaluria (EH), at a single clinic. We analyzed clinic records and 24-h urine collections before and after the first clinic visit, among 100 stone formers with bowel disease. We used multivariate linear regression and t tests to compare effects of fluid intake, alkali supplementation, and oxalate-focused interventions on urine characteristics. Patients advised to increase fluid intake had lower initial urine volumes (L/day; 1.3 ± 0.5 vs. 1.7 ± 0.7) and increased volume more than those not so advised (0.7 ± 0.6 vs. 0.3 ± 0.6 p = 0.03; intervention vs. non-intervention). Calcium oxalate supersaturation (CaOx SS) fell (95% CI -4.3 to -0.8). Alkali supplementation increased urine pH (0.34 ± 0.53 vs. 0.22 ± 0.55, p = 0.26) and urine citrate (mg/d; 83 ± 256 vs. 98 ± 166, p = 0.74). Patients advised to reduce oxalate (mg/day) absorption had higher urine oxalate at baseline (88 ± 44 vs. 50 ± 26) which was unchanged on follow-up (88 (baseline) vs. 91 (follow-up), p = 0.90). Neither alkali (95% CI -1.4 to 2.1) nor oxalate-focused advice (95% CI -1.2 to 2.3) lowered CaOx SS. Physicians chose treatments based on baseline urine characteristics. Advice to increase fluid intake increased urine volume and decreased CaOx SS. Alkali and oxalate interventions were ineffective.

EVALUATION OF THE IMPACT OF NUTRITIONAL EDUCATION ON THE EVOLUTION OF GOUT: THE CASE OF THE LA PROVIDENCE CLINIC IN NDJAMENA

Gout is a fairly common problem in middle-aged men. Despite the high prevalence of the condition, there are few clinical studies of gout patients in Chad. The management of gout is based on the treatment and prevention of very painful gout attacks. In general, treatments for gout attacks are not based on rigorous scientific data. The present study aims to contribute to the nutritional management of gout. We used socio-demographic and cultural characteristics of gout patients, patients knowledge of the aetiology and management of their disease before assessing the effect of nutrition education on disease progression. A total of 50 patients suffering from gout and attending the clinic La providence in NDjamena were included in the study from 20 June to 26 July 2016. Our study shows that environmental factors play a significant role in the occurrence of gout: overweight, regular alcohol consumption, diet rich in purines (red meat and offal in particular). The effectiveness of dietary advice such as avoiding purine-rich foods and increasing fluid intake (2 to 3 litres of water per day) has been demonstrated, but these measures are recommended. It is advisable to limit alcohol consumption and to reduce body weight.

Granulomatosis with polyangiitis in a patient with polydipsia, facial nerve paralysis, and severe otologic complaints: a case report and review of the literature

BackgroundGranulomatosis with polyangiitis, formerly known as Wegener granulomatosis, is a necrotizing vasculitis with granulomatous inflammation that belongs to the class of antineutrophil cytoplasmic antibodies-positive diseases. It occurs in a localized and a systemic form and may present with a variety of symptoms. Involvement of the upper respiratory tract is very common, while neurologic, endocrinological, and nephrological dysfunction may occur.Case presentationWe describe the case of a 29-year-old Central European male patient presenting with severe bilateral sensorineural hearing loss, otorrhea, and one-sided facial nerve paralysis. The patient was unsuccessfully treated with i.v. antibiotics at another hospital in Berlin, and tympanic tubes were inserted. After presentation to our emergency room, he was hospitalized and further diagnostics started. Increased fluid intake and 12 kg weight gain over the last months were reported. The patient was diagnosed with granulomatosis with polyangiitis and diabetes insipidus. The patient’s condition improved after treatment with rituximab.DiscussionA comprehensive PubMed search of all articles with granulomatosis with polyangiitis and diabetes insipidus was conducted to assess which combination of symptoms occurs simultaneously and whether other parts of the pituitary are commonly involved. The 39 selected articles, describing 61 patients, showed that ear–nose–throat involvement occurred most commonly, in 71% of cases. Of patients, 59% had involvement of the anterior pituitary gland, while true panhypopituitarism occurred in 13% of cases. Only one case report featured the same set of symptoms as described herein.ConclusionGranulomatosis with polyangiitis is a highly variable disease, commonly involving the upper airways, but that may present with symptoms solely related to the pituitary gland. Clinicians should have a low threshold to investigate for granulomatosis with polyangiitis in patients with therapy-resistant otorrhea. Patients may present with a complex set of symptoms, and integrating different specialists when additional symptoms occur may lead to faster diagnosis.

Role of β‐Arrestin2 as a Regulator of Fluid Homeostasis and Blood Pressure

Low‐renin hypertension is a common subset of hypertensive patients, which is associated with salt sensitivity. Deoxycorticosterone (DOCA)‐salt hypertension, a prototypical model of low‐renin hypertension, requires activation of the angiotensin type‐1 receptor (AT1R) in specific brain areas. The canonical G‐protein‐mediated signaling of the AT1R is known to induce pressor responses while the non‐canonical β‐Arrestin mediated signaling is thought to counterbalance the detrimental effects of canonical signaling. We hypothesized that β‐Arrestin activation contributes to fluid homeostasis and blood pressure (BP) regulation in DOCA‐salt hypertension. Global β‐Arrestin1 (Arrb1) and β‐Arrestin2 (Arrb2) knockout (KO) mice were employed to evaluate drinking behavior and BP. Age‐ and sex‐matched C57BL/6J mice served as controls. Mice were subjected to the two‐bottle choice paradigm, in which the animals were presented with two bottles, one containing water and one containing varying concentrations of NaCl (0.15, 0.30, and 0.45 mol/L). At baseline, Arrb2‐KO mice exhibited a significant increase in saline intake when presented with 0.15M and 0.30M but not 0.45M (WT0.15M=2.4±0.8 and WT0.30M 1.2±0.4 vs Arrb2‐KO0.15M=4±1.7 and Arrb2‐KO0.30M=2.3±1.1 mL/day; p0.15M=0.23 and p0.30M&lt;0.05; n=19 and 24, respectively). This resulted in a saline preference, which means mice preferred saline over water by more than 50% by volume. Under DOCA, Arrb2‐KO, but not Arrb1‐KO, exhibited a significant increase in saline intake when presented with 0.15M and 0.30M, but not 0.45M saline (WT0.15M=10.9±3.6 and WT0.30M 3.8±2 vs Arrb2‐KO0.15M=15.2±6.3 and Arrb2‐KO0.30M=6±2 mL/day; p&lt;0.05; n=19 and 24, respectively) when compared with wildtype. In addition, Arrb2‐KO mice showed a significant increase in fluid intake when presented to 0.15M, 0.30M, and 0.45M saline. Telemetric BP was measured under three conditions: 1) baseline without saline in drinking water 2) baseline with a choice of saline and water, and 3) administration with DOCA with a choice of saline and water. Arrb2‐KO did not exhibit significant differences in BP in absence of DOCA infusion when given water alone or a choice for saline. However, Arrb2‐KO exhibited an increase in the pressor response to DOCA‐salt (WT=152.2±11.9 vs Arrb2‐KO=163.7±4.2 mmHg; p=0.18; n=6). Surprisingly, no alterations in water intake, saline intake, total fluid intake, saline preference, or BP was observed in Arrb1 KO at any given saline concentration under either baseline or DOCA condition. These findings suggest that in low renin hypertension, Arrb2, but not Arrb1, might counterbalance the detrimental canonical signaling of pathological G protein‐coupled receptors including AT1R.

PD05-11 USE OF MINI SIP IT BEHAVIORAL INTERVENTION INCREASES FLUID INTAKE IN PATIENTS WITH KIDNEY STONES

You have accessJournal of UrologyCME1 May 2022PD05-11 USE OF MINI SIPIT BEHAVIORAL INTERVENTION INCREASES FLUID INTAKE IN PATIENTS WITH KIDNEY STONES Necole Streeper, James Marks, Jason Fairbourn, Emily Frith, Edison Thomaz, Nilam Ram, and David Conroy Necole StreeperNecole Streeper More articles by this author , James MarksJames Marks More articles by this author , Jason FairbournJason Fairbourn More articles by this author , Emily FrithEmily Frith More articles by this author , Edison ThomazEdison Thomaz More articles by this author , Nilam RamNilam Ram More articles by this author , and David ConroyDavid Conroy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002524.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Wearable technology is both increasingly prevalent and successfully improving a variety of health behaviors. We previously showed that digital tools are capable of identifying lapses in drinking behavior and delivering just-in-time messages to promote fluid consumption. The purpose of this study was to determine the feasibility, acceptability and impact of mini sipIT, a context-sensitive reminder system that incorporates a connected water bottle and mobile app with text messaging, for kidney stone patients – a population that often has poor adherence to increasing fluid intake for prevention. METHODS: Patients with a history of kidney stones and urine volume less than 2 liters/day were recruited to participate in a 1-month feasibility trial. Patients were given an H2OPal connected water bottle and received hourly text message reminders when they were not meeting fluid intake goals. Perceptions of drinking behavior, intervention acceptability and 24-hour urine volumes were obtained at baseline and after the 1-month mini sipIT behavioral intervention. RESULTS: Patients with a history of kidney stones were enrolled (n = 26, 77% female, age = 50.4 ± 14.2 years). There was a significant increase in 24-hour urine volume at the end of the 1-month mini sipIT behavioral intervention compared to baseline (2006.5 ± 980.8 mL vs. 1352.7 ± 449.9 mL, t (25) = 3.66, p = .001, d = 0.84). 24-hour urine volumes increased at the end of the 1-month trial for 73% of participants. Most participants perceived that mini sipIT intervention helped them to increase their fluid intake (85%) and reach their fluid intake goals (65%). The majority used the connected water bottle and mobile app every day of the intervention (92%). However, 35% of participants reported that carrying the water bottle was cumbersome. CONCLUSIONS: Mini sipIT behavioral intervention is feasible and provides automated lapse-detection that improves fluid intake with a significant increase in 24-hour urine volume. Although patients found the intervention acceptable, reports that carrying the water bottle was cumbersome suggest use of a different water bottle design or multimodal intake monitoring systems may be necessary to reduce patient burden. Digital tools in combination with behavioral science may help to improve adherence to fluid intake recommendations for kidney stone prevention. Source of Funding: Keith and Lynda Harring Fund for Kidney Research at Penn State Health and National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK124469) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e90 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Necole Streeper More articles by this author James Marks More articles by this author Jason Fairbourn More articles by this author Emily Frith More articles by this author Edison Thomaz More articles by this author Nilam Ram More articles by this author David Conroy More articles by this author Expand All Advertisement PDF DownloadLoading ...

Orthostatic hypotonia as a probably late sequela of SARS-CoV-2 infection in a patient provided with palliative home care: a case report

BackgroundThe SARS-CoV-2 pandemic has become a challenge for the entire healthcare system. Treatment for COVID-19 includes casual and symptomatic management in the acute phase of the disease and focuses on the treating early complications of the disease. Long-term health consequences of the infection have not yet been fully identified. A special group of patients with comorbidities, including neoplastic disease for whom the interpretation and management of symptoms is a major challenge.Case presentationIn this case report, we present a 73-year-old woman with recently diagnosed gastric adenocarcinoma in whom we diagnosed orthostatic hypotonia in the aftermath of SARS-CoV-2 infection. We administered thiethylperazine maleate 6.5 mg daily. Additionally, we advised the patient to slowly lift from the recumbent position, raise the headboard, take meals in small portions, and increase fluid intake. These pharmacological and nonpharmacological measures resulted in sustained relief of dizziness and nausea.ConclusionsThe occurrence of orthostatic hypotonia seems a possible late sequela of SARS-CoV-2 infection, and simple measures appeared sufficient to achieve sustained symptom control.

A Randomized Trial Evaluating the Use of a Smart Water Bottle to Increase Fluid Intake in Stone Formers

The aim of this study is to evaluate if the use of a smart water bottle improves urine volume in stone forming patients. Adults with nephrolithiasis and low urine volume (<1.5L) documented on a 24-hour urinalysis (24hr U) were randomized to receive either standard dietary recommendations to increase fluid intake (DR arm), or DR and a smart water bottle (HidrateSpark®; Hydrate Inc., Minneapolis, MN) that recorded fluid intake, synced to the user's smartphone, and provided reminders to drink (SBarm). Participants completed baseline surveys assessing barriers to hydration. They then repeated a 24hr U and survey at 6 and 12weeks, respectively. Eighty-five subjects (44 DR, 41 SB) were enrolled. The main baseline factor limiting fluid intake was not remembering to drink (60%). Follow-up 24hr Us were available for 51 patients. The mean increase in volume was greater in the SB arm (1.37L, 95% confidence interval -0.51 to 3.25) than the DR arm (0.79L, 95% confidence interval -1.15 to 2.73) (P=.04). A smaller percentage of subjects in the SB arm reported not remembering to drink as the main factor limiting fluid intake in the follow-up questionnaire compared to baseline (45.4% vs. 68.4%, P<.05). This was not true for the DR arm (40.0% vs. 51.2%, P=.13). Difficulty remembering to drink is a barrier to achieving sufficient fluid intake in stone formers. The use of a smart bottle was associated with greater increases in 24hr U volumes and less difficulty remembering to drink.

Numerical characterization of astronaut CaOx renal stone incidence rates to quantify in-flight and post-flight relative risk

Changes in urine chemistry potentially alter the risk of renal stone formation in astronauts. Quantifying spaceflight renal stone incidence risk compared to pre-flight levels remains a significant challenge for assessing the appropriate vehicle, mission, and countermeasure design. A computational biochemistry model representing CaOx crystal precipitation, growth, and agglomeration is combined with a probabilistic analysis to predict the in- and post-flight CaOx renal stone incidence risk ratio (IRR) relative to pre-flight values using 1517 astronaut 24-h urine chemistries. Our simulations predict that in-flight fluid intake alone would need to increase from current prescriptions of 2.0–2.5 L/day to ~3.2 L/day to approach the CaOx IRR of the pre-flight population. Bone protective interventions would reduce CaOx risk to pre-flight levels if Ca excretion alone is reduced to <150 mg/day or if current levels are diminished to 190 mg/day in combination with increasing fluid intake to 2.5–2.7 L/day. This analysis provides a quantitative risk assessment that can influence the critical balance between engineering and astronaut health requirements.

Exercício físico aeróbio contínuo ou intervalado reduz ingestão de frutose em ratas Wistar

ABSTRACT: Objctive: Fructose consumption has increased worldwide. Excessive fructose intake has been a risk factor for the increased metabolic syndrome disorder incidence. This study aimed to investigate the possible influence of two different exercise training methods, continuous and interval, on fructose intake. Methods: Thirty two-months-old female Wistar rats were divided into six groups: sedentary + water ; sedentary + fructose ; continuous training + water ; interval training + water ; continuous training + fructose ; interval training + fructose . Fructose was given in drinking water (10%). Continuous (40 minutes at 40% maximal speed) or interval training (28 minutes, 1 minute at 70%; 3 minutes at 35% maximal speed) sessions were carried out 3 days/week for 8 weeks. Results: Fructose consumption decreased food intake with a concomitant increase in fluid intake. Continuous and interval training did not modify food intake but progressively reduced fructose ingestion. In the 8th week, interval training + fructose and continuous training + fructose groups drank less fructose solution, 35% and 23%, respectively, than sedentary + fructose group. Conclusion: The findings indicate that both continuous and interval aerobic exercise training seem to modulate food behavior, possibly by mitigating the craving for sweetness, with interval training being more effective in reducing fructose intake than continuous exercise.

Naturopathic Management of Urinary Tract Infections: A Retrospective Chart Review.

Introduction: Antibiotic overuse is a significant driver of bacterial resistance. Urinary tract infections (UTIs, cystitis) are the most common condition for which antibiotics are prescribed in the ambulatory setting. Many complementary and integrative approaches to cystitis have been proposed, including probiotics, D-mannose, and several herbal therapies. Trials comparing such therapies with placebo or antibiotics showed mixed, but promising, results. Naturopathy is a system of medicine that has potential to avoid antibiotic use for UTI because of its affinity for nonpharmacologic therapies and its theory that infection is a result of both the immune system's vulnerability and the pathogen's virulence. Methods: The authors conducted a retrospective chart review of cases treated at four naturopathic clinics in the Portland, OR, metro area, where naturopathic doctors (NDs) have a scope of practice consistent with their license as primary care providers. The primary aim was to characterize how NDs treat UTIs in a real-world setting. Secondary aims were to gather preliminary evidence on the types of patient cases receiving such treatments, outcomes of treatments, and associations between presentation and treatment prescriptions. Results: The authors found 82 distinct treatment regimens among 103 individual patients diagnosed with UTI. Most patients received a combination of herbal medicine and behavioral modification (e.g., increase fluid intake), whereas the most common monotherapeutic regimen was antibiotics. Of the 43 patients who were followed up, 15 had no success with nonpharmacologic therapies and required antibiotics. The sample was comparable with national data regarding composition of public versus private insurance, acute versus recurrent/chronic UTI, and percent of cases related to uropathogenic Escherichia coli. Conclusions: NDs practicing in a primary care context frequently prescribe antibiotic and nonantibiotic multimodal therapy for uncomplicated UTI. These results may guide future studies testing complementary and integrative therapies for uncomplicated UTI.

Effects of fluid and drinking on pneumonia mortality in older adults: A systematic review and meta-analysis.

Background and aimsAdvice to drink plenty of fluid is common in respiratory infections. We assessed whether low fluid intake (dehydration) altered outcomes in adults with pneumonia.MethodsWe systematically reviewed trials increasing fluid intake and well-adjusted, well-powered observational studies assessing associations between markers of low-intake dehydration (fluid intake, serum osmolality, urea or blood urea nitrogen, urinary output, signs of dehydration) and mortality in adult pneumonia patients (with any type of pneumonia, including community acquired, health-care acquired, aspiration, COVID-19 and mixed types). Medline, Embase, CENTRAL, references of reviews and included studies were searched to 30/10/2020. Studies were assessed for inclusion, risk of bias and data extracted independently in duplicate. We employed random-effects meta-analysis, sensitivity analyses, subgrouping and GRADE assessment. Prospero registration: CRD42020182599.ResultsWe identified one trial, 20 well-adjusted cohort studies and one case–control study. None suggested that more fluid (hydration) was associated with harm. Ten of 13 well-powered observational studies found statistically significant positive associations in adjusted analyses between dehydration and medium-term mortality. The other three studies found no significant effect. Meta-analysis suggested doubled odds of medium-term mortality in dehydrated (compared to hydrated) pneumonia patients (GRADE moderate-quality evidence, OR 2.3, 95% CI 1.8 to 2.8, 8619 deaths in 128,319 participants). Heterogeneity was explained by a dose effect (greater dehydration increased risk of mortality further), and the effect was consistent across types of pneumonia (including community-acquired, hospital-acquired, aspiration, nursing and health-care associated, and mixed pneumonia), age and setting (community or hospital). The single trial found that educating pneumonia patients to drink ≥1.5 L fluid/d alongside lifestyle advice increased fluid intake and reduced subsequent healthcare use.No studies in COVID-19 pneumonia met the inclusion criteria, but 70% of those hospitalised with COVID-19 have pneumonia. Smaller COVID-19 studies suggested that hydration is as important in COVID-19 pneumonia mortality as in other pneumonias.ConclusionsWe found consistent moderate-quality evidence mainly from observational studies that improving hydration reduces the risk of medium-term mortality in all types of pneumonia. It is remarkable that while many studies included dehydration as a potential confounder, and major pneumonia risk scores include measures of hydration, optimal fluid volume and the effect of supporting hydration have not been assessed in randomised controlled trials of people with pneumonia. Such trials, are needed as potential benefits may be large, rapid and implemented at low cost. Supporting hydration and reversing dehydration has the potential to have rapid positive impacts on pneumonia outcomes, and perhaps also COVID-19 pneumonia outcomes, in older adults.

Evaluation of demographic and clinical risk factors for high interdialytic weight gain.

Xerostomia and hyposalivation are highly prevalent in hemodialysis (HD) patients and this is effective in increased fluid intake. The aim of this study is to determine the demographic and clinical risk factors associated with high interdialytic weight gain (IDWG) in nondiabetic HD patients. In total, 52 eligible HD patients were recruited in this cross-sectional study. Patients were divided into two groups according to % IDWG: Group 1: High IDWG (≥3%) and Group 2: normal IDWG (<3%). Plasma osmolarity (POsm), unstimulated salivary flow rate (USFR), xerostomia inventory (XI), and dialysis thirst inventory (DTI) were evaluated. The mean age of the patients was 53.7 ± 15.7 years. The prevalence of xerostomia was 53.8%, and hyposalivation was in 40.3% in the patients. High IDWG was positively correlated with XI and DTI while it was negatively correlated with POsm and USFR. The area under the receiver-operating characteristics curve for POsm for high IDWG was 0.661, with sensitivity of 63.8% and specificity of 72.7% for a cut-off point of 297.4mOsm/L. Logistic regression analysis showed that advanced age odds ratio (OR: 1.215, p= 0.019), pill burden (OR: 1.162, p= 0.031), C-reactive protein (CRP; OR: 1.308, p= 0.042), and low POsm (OR: 0.768, p= 0.046) were independently related to high IDWG. The prevalence of xerostomia and thirst was higher in HD patients with high IDWG compared to the normal IDWG group. Age, CRP, low POsm, and pill burden were independently associated with high IDWG.

Vaptans or voluntary increased hydration to protect the kidney: how do they compare?

The adverse effects of vasopressin (AVP) in diverse forms of chronic kidney disease have been well described. They depend on the antidiuretic action of AVP mediated by V2 receptors (V2R). Tolvaptan, a selective V2R antagonist, is now largely used for the treatment of patients with autosomal dominant polycystic kidney disease. Another way to reduce the adverse effects of AVP is to reduce endogenous AVP secretion by a voluntary increase in fluid intake. These two approaches differ in several ways, including the level of thirst and AVP. With voluntary increased drinking, plasma osmolality will decline and so will AVP secretion. Thus, not only will V2R-mediated effects be reduced, but also those mediated by V1a and V1b receptors (V1aR and V1bR). In contrast, selective V2R antagonism will induce a loss of fluid that will stimulate AVP secretion and thus increase AVP's influence on V1a and V1b receptors. V1aR is expressed in the luminal side of the collecting duct (CD) and in inner medullary interstitial cells, and their activation induces the production of prostaglandins, mostly prostaglandin E2 (PGE2). Intrarenal PGE2 has been shown to reduce sodium and water reabsorption in the CD and increase blood flow in the renal medulla, both effects contributing to increase sodium and water excretion and reduce urine-concentrating activity. Conversely, non-steroidal anti-inflammatory drugs have been shown to induce significant water and sodium retention and potentiate the antidiuretic effects of AVP. Thus, during V2R antagonism, V1aR-mediated actions may be responsible for part of the diuresis observed with this drug. These V1aR-dependent effects do not take place with a voluntary increase in fluid intake. In summary, while both strategies may have beneficial effects, the information reviewed here leads us to assume that pharmacological V2R antagonism, with resulting stimulation of V1aR and increased PGE2 production, may provide greater benefit than voluntary high water intake. The influence of tolvaptan on the PGE2 excretion rate and the possibility to use somewhat lower tolvaptan doses than presently prescribed remain to be evaluated.

Fluid intake and blood pressure in children: the Salus per Aquam project.

Sodium intake is known to contribute to the development of hypertension, thus intake reduction is a cornerstone in the prevention and management of hypertension. The increase in renal sodium excretion might represent a further potential preventive and/or therapeutic opportunity. To explore the working hypothesis that an increased fluid intake can improve renal sodium handling towards a decrease in blood pressure. The SPA Project is a multicenter, observational, cross-sectional, cohort study investigating healthy children, aged 5-8 years as to sodium and fluid intake by means of urinary sodium and creatinine from multiple samples taken in different days in order to characterize them in lower/higher sodium and lower/higher fluid intake. Both SBP and DBP (by multiple office blood pressure measurements) were used as outcome measures. Three hundred and thirty-nine healthy, nonoverweight children (51.6% boys) with a median age of 5.7 years old (IQR: 5.3-6.2) participated in the study but only 223 could be analyzed. Among children with higher sodium intake, those introducing more fluids, showed a significantly lower blood pressure (both systolic and diastolic) compared with those with lower fluid intake: systolic 86.0 ± 8.5 vs. 90.0 ± 8.1 mmHg; P = 0.014 and diastolic: 53.8 ± 4.9 vs. 58.6 ± 6.6 mmHg; P < 0.0001. An increased fluid intake is associated with a reduced blood pressure possibly by increasing renal sodium excretion. We speculate that this simple, highly acceptable, inexpensive, and harmless measure might have a role in preventing and/or minimizing the epidemics of hypertension and of its related morbidities both in children and in adults.