Infusion Of Solution Research Articles

The experience of L-arginine using in placental insufficiency

Objective. To evaluate the effectiveness of the use of L-arginine in the treatment of placental insufficiency (PI) in pregnant women.
 Materials and methods. We examined 49 pregnant women with PI at 22-34 weeks of gestation. The women were divided into two groups. The 1st group included 27 patients who, as part of the standard complex treatment, were injected intravenously with L-arginine (Tivortin®, “Yuria-Pharm”, Ukraine) 4.2 % solution for infusion at a dose of 100 ml a day for 5 days. The 2nd group included 22 women in which standard basic therapy was used for PI treatment. To study the state of the fetoplacental complex in the blood serum of pregnant women, the level of human placental lactogen (hPL) and free estriol (E3) was determined by direct competitive enzyme immunoassay (ELISA).
 Results and discussion. All patients included in the study were comparable in somatic and obstetric status. The age of pregnant women in both groups ranged from 22 to 39 years, averaging 26±3.2 years in the 1st and 31±2.4 years in the 2nd group. The level of hPL before therapy was reduced in 10 (37.03 %) patients in the 1st group and in 8 (29.62 %) patients in the 2nd group. The concentration of free E3 was reduced in 12 (44.44 %) patients of the 1st group and in 9 (40.9 %) patients of the 2nd group. In the main group, the average concentration of free E3 was 18.8±13.3 ng/ml, and the hPL was 7.1±2.6 mg/L. In the comparison group, the level of free E3 averaged 19.1±10.2 ng/ml and hPL was 6.9±3.9 mg/L. After adjustment of PI in all patients of the 1st group, and in 19 (86.36 %) of the 2nd group, the concentration of hPL and free E3 corresponded to the norm. Thus, in the main group, the average concentration of free E3 was 22.7±14.1 ng/ml, and the hPL was 8.1±2.9 mg/L. In the comparison group, the level of free E3 averaged 22.1±14.6 ng/ml and hPL – 8.3±3.9 mg/L. Only in 3 (13.63 %) patients of the comparison group, the level of hormones was still reduced.
 Conclusions. The inclusion of L-arginine (Tivortin) in therapeutic regimens in order to correct placental dysfunction leads to a regression of fetoplacental circulatory disorders and reduces the risk of unfavorable perinatal outcomes.

Features of the composition of certain complex hyperosmolar infusion solutions

Objective. To justify the use of complex hyperosmolar solutions.
 Results and discussion. Today, the question of the qualitative composition and quantitative relationship between the various components of infusion-transfusion therapy remains controversial. Hypertonic solutions in various concentrations of NaCl were first used for “low-volume resuscitation” in patients with hemorrhagic shock. Administration of these solutions results in a temporary osmotic pressure gradient between the blood plasma and the interstitial space, causing fluid to move into the intravascular space, increasing cardiac output, blood pressure, and improving microcirculation. Recently, combinations of hypertonic NaCl with colloids, as well as multicomponent infusion drugs are increasingly used. These are, in particular, the drugs Rheosorbilact, Xylate, Lactoxyl, Sorbilact, Lactoprotein with sorbitol, Gecoton developed at the Institute of Blood Pathology and Transfusion Medicine of the National Academy of Medical Sciences of Ukraine. Preparations based on polyhydric alcohols of sorbitol or xylitol, alkalizing agents of sodium lactate or sodium acetate and electrolytes. Rheosorbilact, Xylate, Lactoxyl are basic solutions for detoxification therapy, including in patients with diabetes. Sorbilact used as an osmodiuretic and for the treatment of patients in the postoperative period. Protein-salt solution based on donor albumin Lactoprotein with sorbitol is a mean for intensive care in emergencies. Colloid-hyperosmolar infusion solution Gecoton based on hydroxyethyl starch is used as a mean for low-volume resuscitation in the prehospital stage, including combat victims. Specially selected substances comprising the combined drugs affect different parts of the pathological process and have several advantages compared to mono-drugs. The pharmacological action of such solutions is due to the mutual potentiation of the action of its components. This provides hemodynamic effect and can reduce the dosage of each component separately, reducing the likelihood of side effects. The use of multicomponent hyperosmolar solutions can significantly reduce the total volume of fluid administered to patients.
 Conclusions. Complete hyperosmolar drugs can be recommended for routine and auxiliary fluid therapy and treatment for emergency conditions.

Tactics of infusion therapy in patients with acute cerebral circulatory disorders in the prehospital stage

Objective. To streamline the tactics of infusion therapy in patients with acute cerebrovascular accident (ACVA) in the prehospital stage.
 Materials and methods. A retrospective, non-randomized study of 49 patients with ACVA who received emergency medical care in the prehospital phase.
 Results and discussion. Ensuring adequate brain perfusion in the area of ischemia is the main task of emergency medical care ACVA in the prehospital stage (Zozulya I.S., Volosovets A.O., Zozulya A.I. et al., 2019). Among the drugs that effectively improve blood circulation to the brain in the area of ischemia, an important place is occupied by infusion solutions (Semenenko A.I., Kobeliatskyi Yu.Yu., Kondratskyi B.O. et al., 2016). The choice of the optimal qualitative and quantitative composition of infusion solutions in patients with ACVA is one of the most difficult issues of treatment (Halushko O.A., 2017). Infusion therapy for patients with ACVA in the prehospital stage was used according to the Unified Clinical Protocol of Medical Care “Ischemic stroke (emergency, primary, secondary (specialized) medical care, medical rehabilitation)” (Order of the Ministry of Health of Ukraine from 03.08.2012 № 602) according to the following algorithm: 1) providing venous access by standard venous catheterization procedure with asepsis/antiseptics by intravenous catheter № 18; 2) carrying out infusion therapy by introducing 0,9 % sodium chloride solution at a rate of 100 ml×h-1; 3) the introduction of colloidal solutions in patients with ACVA in the prehospital stage was not carried out.
 Conclusions. The choice of the optimal qualitative and quantitative composition of infusion solutions in patients with ACVA in the prehospital stage is one of the most difficult issues of emergency care. After providing venous access by catheterization of the peripheral vein with a catheter № 18 infusion therapy is carried out by administering 0,9 % sodium chloride solution at a rate of 100 ml×h-1. The introduction of colloidal solutions in patients with acute cerebral circulatory disorders in the prehospital stage is contraindicated.

Morphological features of animal organs after introduction of new ALX-5 % protein-salt solution

Objective. To investigate the morphological features of the internal organs of experimental animals and identify potential target organs with the introduction of ultra-high doses of the drug ALX-5 % and the drug with double the concentration of components ALX-2N.
 Materials and methods. The experiments were performed on outbred white male mice and outbred white male rats. Animals were administered ALX-5 % and ALX-2N solution. ALX-5 % protein-saline solution contains: donor albumin (5 %) pentatomic alcohol xylitol (5 %), alkalizing components – sodium lactate (1.9 %) and sodium bicarbonate (0.01 %), as well as sodium chloride (0.8 %), potassium chloride (0.03 %), calcium chloride (0.01 %). Theoretical osmolarity – 990 mOsm/l, pH – 6.2-7.4. The drug with double the concentration of ALX-2N contains all these components in double the concentration (osmolarity of the solution – 1980 mOsm/l). ALX-5 % was administered intraperitoneally multiple times at a dose of 174 ml/kg for mice and 90 ml/kg for rats. These doses are conditionally toxic, as these doses are the maximum that animals have been able to administer. Further increase in the volume of infusion solution was not allowed due to possible excessive hypervolemic effect. The ALX-2N solution was administered at a dose of 50 ml/kg. At the end of the experiment, histological preparations were prepared from the internal organs of animals, which were stained with hematoxylin and eosin and toluidine blue and studied under a light microscope.
 Results and discussion. It was found that when white mice and white rats were injected with the native protein-salt preparation ALX-5 % (osmolarity of the solution – 990 mOsm/l) in ultra-high doses (174 ml/kg for mice and 90 ml/kg for rats) the main target organs were the brain and lungs. Changes in other organs (kidneys, liver, pancreas, spleen, heart) are uncritical. With the introduction of concentrated drug ALX-2N (osmolarity of the solution – 1980 mOsm/l) at a dose of 50 ml/kg in addition to pronounced changes in the lungs and brain, dystrophic changes of heart and liver cells are observed. In all the study groups of animals accumulation of glycogen was observed, which is obviously due to administration of the high dose polyhydric alcohols xylitol and sodium lactate, a significant part of which is metabolized in the liver.
 Conclusions. According to the results of a comprehensive study of pharmaco-toxicological properties, it was found that the multicomponent protein-salt solution ALX-5 % may be suitable for further clinical study.

Application of colloidal-hyperosmolar solution in the early postoperative period in patients after cardiosurgery

Objective. To substantiate the safety of the infusion drug Hecoton in the early postoperative period in patients after cardiac surgery.
 Materials and methods. The study involved 60 patients receiving infusions of 200 ml colloid-hyperosmolar solution Gecotone. The solution contains: hydroxyethyl starch 130/0.42 – 5 %, polyatomic alcohol xylitol – 5 %, sodium lactate – 1.5 % and electrolytes Na+, K+, Ca++, Mg++, Cl-. The total amount of sodium in the solution is 270 mmol/l, which is 2 times higher than its concentration in blood plasma. The amount of lactate is 133 mmol/l, which is 4 times higher than in isotonic polyelectrolyte solutions. The total osmolarity of the drug is 890 mOsm/l. Vital signs, hemodynamics, glucose, arterial blood gas and acid-base status was evaluated before, during and infusion of medication.
 Results and discussion. Gecoton infusions had no adverse effect on hemodynamic parameters. All changes were not statistically significant. The mean values of the patient’s body temperature were within the normal range. There was no case of temperature increase above 36.9 °C in all patients after administration of the drug. There was a slight, statistically unreliable increase in the mean glucose level (from 8.57±0.42 to 9.53±0.48 mmol/l), which was most likely due to response to the surgical stress. Dynamics of arterial blood gas and acid-base state shows that pH and PaCO2 practically did not change, decrease of PaO2 from 115.69±5.52 mm Hg to 110,79±4,83 mm Hg after the infusion of Gecotone, was statistically unreliable, the base excess showed little dynamics to increase (from -1.84±0.35 to -1.29±0.23 mmol/l) after administration of Gecotone.
 Conclusions. The use of the complex colloid-hyperosmolar infusion solution Gecotone in patients after cardiac surgery in the early postoperative period is safe.

Obstetric blood loss: priorities in the infusion solutions choice

Objective. To study the effect of Rheosorbilact on the main life support systems in patients with massive blood loss in obstetrics.
 Materials and methods. The study was carried out in 56 puerperas with massive blood loss during obstetric operations for placenta previa. Surgical intervention was performed under general multicomponent anesthesia with mechanical ventilation. After the end of the operation, the patients were on prolonged mechanical ventilation for 4-6 h until the main life support systems were stabilized. With the purpose of infusion therapy were used Rheosorbilact (13-15 ml/kg), 0.9 % sodium chloride solution (25-30 ml/kg) and blood components. The main life support systems were assessed by non-invasive monitoring of central and peripheral hemodynamics and autonomic nervous system.
 Results and discussion. Blood loss was 1500-2000 ml, which developed within 20 min from the moment of the start of the operation. Taking into account the pharmacological properties of the drugs used, infusion therapy began with a jet intravenous injection of Rheosorbilact followed by the introduction of 0.9 % sodium chloride. After 30 min from the onset of bleeding and the administration of infusion-transfusion therapy, a significant increase in cardiac output over the initial parameters was noted. At the same time, the epicardial fat volume (EFV) significantly decreased by 4.4 %. 30 min after the end of the infusion-transfusion therapy, a stable hemodynamic profile was noted. 4 h after the end of the infusion therapy, there was an increase in cardiac output and MDP relative to the original value, a decrease in post-load and heart rate, an increase in EFV by 8.1 % (p<0.05). SI decreased by 54.6 % (p<0.05). Diuresis significantly increased to 1.75 ml/kg/h. The initial intravenous infusion was with Rheosorbilact. Considering that the transition of extracellular fluid into the vascular bed is a rather slow process, the transfusion of a hyperosmolar solution exceeding the plasma pressure is more justified. Within 30 min from the start of infusion therapy, the hemodynamic profile stabilized.
 Conclusions. In acute massive blood loss, the use of Rheosorbilact allows you to quickly, effectively and safely correct the deficit in circulating blood volume. Primary targeted hemodynamic support with the use of a low-volume hyperosmolar infusion of Rheosorbilact makes it possible to achieve hemodynamic stabilization with a smaller infusion volume due to interstitial redistribution of fluid into the vascular bed.

Dissolution of Polysorbate 20 Degradation Related Free Fatty Acid Particles in Intravenous Bag Solutions.

Degradation of Polysorbate 20 (PS20), a commonly used surfactant in drug product (DP) formulations, is a phenomenon of increasing concern to the biopharmaceutical industry. One of the most prevalent modes of PS20 degradation is enzymatic hydrolysis resulting from co-purified hydrolases that make their way into biologic DP formulations at trace levels. Enzymatic PS20 degradation results in generation of free fatty acids (FFAs) that have limited solubility in aqueous formulations and can form visible and/or sub-visible particles which is undesirable for parenteral DP stability and administration. Many therapeutic monoclonal antibodies are administered intravenously after first diluting the DP into an infusion solution (e.g., 0.9% normal saline, 0.45% half normal saline or 5% dextrose). The purpose of this work is to understand if FFA particles in the DP dissolve in intravenous solutions prior to administration. Our assessment indicates that visible and/or sub-visible particles that contain high levels of lauric, myristic and palmitic acids dissolve immediately upon dilution (at or exceeding two fold) regardless of the intravenous bag or solution type. Therefore, the risk is low of visible and/or sub-visible particles, comprised of FFAs in biopharmaceutical DPs, being intravenously administered to a patient.

Development and Validation of UV-Spectrophotometric Method for Quantitative Assessment of Metronidazole in the «Metromed® Neo» Solution for Infusion

Introduction: Metronidazole is widely used in medicine and issues of quality control of its dosage formsare relevant. Objective - development and validation of a UV spectrophotometric method for monitoring thequality of metronidazole in the «Metromed® Neo» solution for infusion.Materials and Method: The object of the study was a solution for infusion containing metronidazole. Themethod used is UV spectrophotometry.Results: The relative error of the developed UV spectrophotometric method for the quantitative assessmentof metronidazole in the solution for infusion was 1.9%. Validation characteristics of the method are withinacceptable limits.Conclusion: A UV spectrophotometric technique was developed and validated to assess the quality ofthe solution for infusion containing metronidazole. The results of the studies make it possible to use thedeveloped and validated methodology in assessing the quality of metronidazole.

Novel risk factors and management of brain sag after brain tumor surgery

ObjectiveLumbar drains (LD) have been identified to cause brain sag (BS), which is a serious intracranial hypotension that causes coma; however, other contributing risk factors should also be considered. Therefore, this study aims to identify the BS risk factors and determine the proper treatment plan after brain tumor surgery for patients with BS. MethodsThis retrospective study included patients who underwent brain tumor surgery between 2011 and 2015. BS was diagnosed based on the clinical signs of cerebrospinal fluid hypovolemia along with the radiological findings of the basal cistern effacement. Based on the data on the clinical features, the symptoms were used to determine the BS risk factors using logistic regression. ResultsOverall, among the 412 patients included in this study, 12 (2.91%) were found to develop BS, 10 experienced altered consciousness, and 2 experienced orthostatic headaches. In all cases, radiological images at onset showed epidural/subdural fluid collection, along with basal cistern effacement. LD was inserted just before surgery in 11 cases, while a ventriculoperitoneal shunt was placed in one patient. The treatment strategies used are as follows: Ringer’s solution infusion (n = 4), Trendelenburg position (n = 2), intrathecal injection of saline (n = 1), or no care due to misdiagnosis (n = 5). Moreover, the significant BS risk factors were determined to be the LD (odds ratio [OR] 30.70, CI 2.77–339.86), supratentorial skull base approach (SBA) (OR 35.71, CI 9.1922–138.7250), surgical time (1693.07, CI 69.5621–41207.448), and postoperative hyperosmotic diuretic use (OR 8.092, CI 2.485–26.345) after surgery. ConclusionsIn the brain tumor surgery, aside from the LD, the application of supratentorial SBA, use of HD, and lengthy surgery are also found to be contributing risk factors for BS. Therefore, BS should be considered in the differential diagnosis of high-risk patients with postoperative altered consciousness.

In-use stability of diluted thiamazole (methimazole) infusion solutions in prefilled 0.9% sodium chloride infusion bags for continuous infusion

ObjectiveIn patients with severe hyperthyroidism unable to tolerate oral antithyroid therapy, diluted thiamazole infusion solutions (dose 120–240 mg) are administered by continuous infusion over 24 hours. Information about the type...

Solid State Device from Plant Extracts

The infusion of green solution into solid-state technology is timely at a time where land, air, and water pollution (from electronic waste) is high in most parts of the globe. At the moment, several research works have proven that plant extract doped with metallic compound exhibits high electrical, optical and chemical properties. In this research we examine two different plant extracts with different dopant. The special opto-transport property of the synthesized compounds was examined using an unconventional characterization technique. It was observed that both compounds can be identified as solid-state device with remarkable optical properties.

Comparative Study of the Dose-Dependent Effects of the Osmoregulators Sorbitol and Mannitol in Asaparkam-L on Diuresis and Saluresis in Rats

The effects of the osmoregulators D-sorbitol and D-mannitol in Asparkam-L solution for infusion on diuresis and urinary K+ and Mg2+ excretion were studied in white mongrel rats. Animals received single i.v. doses of samples of the formulation Asparkam-L: 1) with osmoregulator D-sorbitol; 2) with osmoregulator D-mannitol, 3) without osmoregulator, at the recommended one-time dose (1ROTD, calculated from the dose of 10 ml for a human with the average body weight of 70 kg) and at doses 2, 4, and 6 times greater than 1ROTD. Use of all study doses produced a background of minor oscillations in diuresis, with the smallest levels of urinary K+ and Mg2+ excretion with sample 1 and the largest with sample 2. Levels of K+ and Mg2+ excretion in rats given sample 2 were statistically significantly greater than those in control animals given 0.89% NaCl at a volume equivalent to that of 6 ROTD. Increased K+ and Mg2+ excretion after use of sample 2 probably indicated lower efficacy and the inadvisability of using mannitol as osmoregulator in the formulation intended to make up for deficit of these cations.

Long-Term Outcomes from an Intraoperative Bleb Needling Procedure Augmented with Continuous Infusion

To investigate long-term outcomes of a modified bleb needling technique performed in the operating room in controlling intraocular pressure (IOP) and to report risk factors for procedure failure. Retrospective, observational cohort study. One hundred six eyes of 98 consecutive patients undergoing intraoperative bleb needling with a continuous infusion of balanced salt solution at the Wilmer Eye Institute, Johns Hopkins Hospital, in the setting of a failed trabeculectomy or express shunt, between May 2011 and December2015. Postoperative data were collected between May 2011 and August 2019. Success was defined as achieving a previously determined target IOP regardless of (qualified success) or without (complete success) glaucoma medications. Patients who underwent additional glaucoma surgery were censored in the survival analysis. Primary outcome measures included IOP, attainment of target IOP, and number of glaucoma medications used at different time points pre- and post-operatively. Needling was performed in 106 eyes at an average of 4.3 years from the time of trabeculectomy (standard deviation [SD], 6.5 years) and an average baseline IOP of 20.7 mmHg (SD, 7.2 mmHg). Further glaucoma surgery was required for 33 eyes. We observed a 70% qualified success rate with a mean IOP lowering of 25% (95% confidence interval [CI], 13.8%-36.4%) at 1 year after surgery and a 52% qualified success rate and 44.3% reduction in IOP (95% CI, 34.9%-53.6%) at 5 years after surgery. Nearly half and a third of the eyes did not require medications after 1 and 5 years, respectively. The average medication reduction was 0.8 at year 1 (95% CI, 0.5-1.1) and 0.4 at year 5 (95% CI, -0.2 to 1.0). Postoperative complications were uncommon. Poorer outcomes were not associated with the age of the bleb but were more likely in Black patients. Reductions in IOP were maintained in most patients over the long term using a modified bleb needling technique, despite an average time from trabeculectomy of over 4 years. No significant adverse events were observed. Bleb needling may defer or avoid more invasive procedures such as tube-shunts or repeat trabeculectomy.

Effects and mechanisms of glucose-insulin-potassium on post-procedural myocardial injury after percutaneous coronary intervention.

ObjectiveTo evaluate the effects and mechanisms of glucose-insulin-potassium (GIK) on post-procedural myocardial injury (PMI) after percutaneous coronary intervention (PCI).MethodsA total of 200 non-diabetic patients with documented coronary heart disease (CHD) were divided into the Group GIK and Group G, with 100 patients in each group. Patients in Group G were given intravenous infusion of glucose solution 2 hours before PCI. As compared, patients in Group GIK were given GIK.ResultsBoth post-procedural creatine phosphokinase isoenzyme MB (CK-MB; 62.1 ± 47.8 vs. 48.8 ± 52.6 U/L, P = 0.007) and cTnI (0.68 ± 0.83 vs. 0.19 ± 0.24 ng/mL, P < 0.001) in Group GIK were significantly higher than those in Group G. In Group G, 9.0% and 4.0% of patients had post-procedural increases in CK-MB 1-3 times and > 3 times, which were significantly lower than those in Group GIK (14.0% and 7.0%, respectively; all P values < 0.01); 13.0% and 7.0% of patients had post-procedural increases in cTnI 1-3 times and > 3 times, which were also significantly lower than those in Group GIK (21.0% and 13.0%, respectively; all P < 0.001). Pre-procedural (10.2 ± 4.5 vs. 5.1 ± 6.3, P < 0.001) and post-procedural rapid blood glucose (RBG) levels (8.9 ± 3.9 vs. 5.3 ± 5.6, P < 0.001) in Group G were higher than those in Group GIK. In adjusted logistic models, usage of GIK (compared with glucose solution) remained significantly and independently associated with higher risk of post-procedural increases in both CK-MB and cTnI levels > 3 times. Furthermore, pre-procedural RBG levels < 5.0mmol/L were significantly associated with higher risk of post-procedural increases in both CK-MB and cTnI levels.ConclusionsIn non-diabetic patients with CHD, the administration of GIK may increase the risk of PMI due to hypoglycemia induced by GIK.

Assessment of the stability of citrate-buffered piperacillin/tazobactam for continuous infusion when stored in two commercially available elastomeric devices for outpatient parenteral antimicrobial chemotherapy: a study compliant with the NHS Yellow Cover Document requirements

ObjectivesTo investigate the effect of pH control through the use of a citrate-buffered saline diluent pH 7 on the degradation rate of piperacillin/tazobactam solutions for infusion and to determine if...

Hypertonic Sodium Lactate to Alleviate Functional Deficits Following Diffuse Traumatic Brain Injury: An Osmotic or a Lactate-Related Effect?

There has been growing interest in the use of hypertonic sodium lactate (HSL) solution following traumatic brain injury (TBI) in humans. However, little is known about the effects of HSL on functional deficits with respect to the hyperosmotic nature of HSL. We have compared the effects of HSL solution and isotonic saline solution using sensorimotor and cognitive tests for 14days post-trauma in animals. Thirty minutes after trauma (impact-acceleration model), anesthetized rats were randomly allocated to receive a 2-h infusion of isotonic saline solution (TBI-saline group) or HSL (TBI-HSL group) (n = 10 rats per group). In another series of experiments using a similar protocol, the effects of equiosmolar doses of HSL and hypertonic saline solution (HSS) were compared in TBI rats (n = 10 rats per group). Blood lactate and ion concentrations were measured during the 2-h infusions. Compared to the TBI-saline group, the TBI-HSL group had a reduced latency to complete the adhesive removal test: 6s (5-9) (median [25-75th centiles]) versus 13s (8-17) on day 7, and 5s (5-9) versus 11s (8-26) on day 14 (P < 0.05), respectively, and a shorter delay to complete the radial arm maze test on day 7: 99s (73-134) versus 176s (127-300), respectively (P < 0.05). However, no differences were found between the TBI-HSL and TBI-HSS groups in neurocognitive tests performance. Compared to the TBI-saline group, the HSL and HSS groups had higher serum osmolality: 318mOsm/Kg (315-321) and 315mOsm/Kg (313-316) versus 307mOsm/Kg (305-309), respectively (P < 0.05), and the HSL group had a higher serum lactate concentration: 6.4mmol/L (5.3-7.2) versus 1.5mmol/L (1.1-1.9) and 1.6mmol/L (1.5-1.7), respectively (P < 0.05). These results indicate that improvements in cognitive and sensorimotor tests with HSL infusion post-TBI could be related to elevation of serum osmolality, not to exogenous administration of lactate.

Large volume sample stacking of antiepileptic drugs in counter current electrophoresis performed in PAMAPTAC coated capillary

Electrophoretic stacking is developed for sensitive determination of three zwitterionic antiepileptics, namely vigabatrin, pregabalin and gabapentin, in human serum. CE separation is performed in a 25 μm fused silica capillary covalently coated with the copolymer of acrylamide with 5% content of permanently charged 3-acrylamidopropyl trimethylammonium chloride (PAMAPTAC). In background electrolyte of 500 mM acetic acid, the 5% PAMAPTAC generates an anodic electro-osmotic flow with a magnitude of (−18.6 ± 0.5) · 10−9 m2V−1s−1, which acts against the direction of the electrophoretic migration of the analytes. A sample of the antiepileptic prepared in a 25% v/v infusion solution and 75% v/v acetonitrile is injected into the capillary in a large volume attaining a zone length of up to 270 mm. After turning on the separation voltage, the antiepileptics are isotachophoretically focussed behind the zone of Na+ ions with a sensitivity enhancement factor of 78. For the clinical determination of antiepileptics, the human serum is diluted with acetonitrile in a ratio of 1:3 v/v and a zone with a length of 90 mm is injected into the capillary. The method is linear in the 0.025–2.5 μg/mL concentration range; the attained limit of quantification is in the range 18.3–22.8 nmol/L; the within-day precision for the migration time is 0.8–1.2% and for the peak area 1.5–2.4%.

Do Near-Infrared Intra-Operative Findings Obtained Using Indocyanine Green Correlate with Post-Thyroidectomy Parathyroid Function? the Icgpredict Study

Postoperative hypoparathyroidism (hypoPT) still remains a significant complication after thyroidectomy. Intra-operative imaging modalities, such as near-infrared fluorescence using indocyanine green (ICG), may assist in identifying and preserving the parathyroid glands (PGs). The purpose of this study was to test the association between the intra-operative ICG staining scoring system and 24-hour postoperative parathyroid hormone (PTH) levels, as well as its capability for intra-operative PG identification. This was a prospective study, recruiting patients scheduled for total thyroidectomy by the same surgical team, from December 2018 to April 2019. Intra-operative angiography was performed after infusion of ICG solution (5 mg). Two minutes later, images were acquired using the near-infrared system. Sixty patients fulfilled the eligibility criteria. The percentage of temporary postoperative hypoPT (defined as PTH <14 pg/mL) was 11.66%. No association between intra-operative ICG staining score (expressed as the number of PGs scoring <2 per patient) and 24-hour postoperative PTH (r = 0.011; P = .933) or serum calcium concentrations (r = 0.127; P = .335) was observed. There was also no correlation between the location of PGs scoring ≤2 and postoperative PTH (P = .257) or serum calcium levels (P = .950). Moreover, with regard to secondary endpoint, ICG correctly identified PGs in 98.3% of cases. ICG score was not affected by age, gender, duration of operation, or thyroid gland pathology. No allergic reactions attributed to ICG administration were observed. The intra-operative ICG staining scoring system did not predict 24-hour postoperative PTH and serum calcium levels. However, this modality may assist in intra-operative PG identification during a total thyroidectomy.

LONG-TERM OUTCOMES OF RENAL TRANSPLANTATION FROM UNCONTROLLED AND CONTROLLED DONATIONS AFTER CIRCULATORY ARREST AT A TERTIARY CARE HOSPITAL IN INDIA

Introduction: Donation after circulatory death (DCD) has never been attempted in India because of legal constraints and lack of guidelines for the withdrawal of life support in end-of-life situations. Renal transplantation from DCD donors was started in 2011 at our centre. The present report describes the outcomes of these transplants from Maastricht category IV and V donors at a tertiary care hospital in India. Methods: Between 2011 and 2019, 394 deceased donor transplants were performed at our centre. During this period, 14 donors had kidneys retrieved after circulatory arrest. These patients were declared dead after waiting for 5 min with no electrocardiographic signal on monitor following failed cardiopulmonary resuscitation (CPR), which was restarted in eight patients till organ retrieval. All donors received heparin and underwent rapid cannulation of aorta, infusion of preservative cold solution, and immediate surface cooling of organs during retrieval surgery. 25/28(89.2%) kidneys were utilized. Two kidneys were explanted due to refractory hypotension in a patient undergoing dual kidney transplant. Mean follow up duration was 40.2 + 20 months (Range 5.3 - 74 months) Results: Mean donor age was 32.8 ± 13.6 years, M:F 9:5 and mean age of recipients was 42.5 ± 11.3 years, M:F 14:10. 21/25 patients had delayed graft function and required dialysis in the postoperative period. Mean serum creatinine of 1.49 ± 0.38 mg/dl was achieved at the time of discharge at a mean duration of 32.2 ± 19.9 days. Kidneys from donors where CPR was continued after the declaration of death had earlier recovery of renal function (time to reach baseline creatinine 21.2 ± 7.2 vs. 34.3 ± 23.7 days). One kidney from the first uncontrolled DCD donor never functioned. For the remaining cohort of 23 patients, the mean creatinine at the last follow up was 1.26 ± 0.57 mg/dl. Patient survival was 100% and graft survival 95.8% at 1 year and 91.6% at the last follow up. Conclusion: Kidneys from DCD donors can provide good outcomes in the long term and serve as a useful adjunct in deceased donor program. Continuing CPR after the declaration of death hastens recovery of kidney function.

The Corrected Serum Sodium Concentration in Hyperglycemic Crises: Computation and Clinical Applications.

In hyperglycemia, hypertonicity results from solute (glucose) gain and loss of water in excess of sodium plus potassium through osmotic diuresis. Patients with stage 5 chronic kidney disease (CKD) and hyperglycemia have minimal or no osmotic diuresis; patients with preserved renal function and diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS) have often large osmotic diuresis. Hypertonicity from glucose gain is reversed with normalization of serum glucose ([Glu]); hypertonicity due to osmotic diuresis requires infusion of hypotonic solutions. Prediction of the serum sodium after [Glu] normalization (the corrected [Na]) estimates the part of hypertonicity caused by osmotic diuresis. Theoretical methods calculating the corrected [Na] and clinical reports allowing its calculation were reviewed. Corrected [Na] was computed separately in reports of DKA, HHS and hyperglycemia in CKD stage 5. The theoretical prediction of [Na] increase by 1.6 mmol/L per 5.6 mmol/L decrease in [Glu] in most clinical settings, except in extreme hyperglycemia or profound hypervolemia, was supported by studies of hyperglycemia in CKD stage 5 treated only with insulin. Mean corrected [Na] was 139.0 mmol/L in 772 hyperglycemic episodes in CKD stage 5 patients. In patients with preserved renal function, mean corrected [Na] was within the eunatremic range (141.1 mmol/L) in 7,812 DKA cases, and in the range of severe hypernatremia (160.8 mmol/L) in 755 cases of HHS. However, in DKA corrected [Na] was in the hypernatremic range in several reports and rose during treatment with adverse neurological consequences in other reports. The corrected [Na], computed as [Na] increase by 1.6 mmol/L per 5.6 mmol/L decrease in [Glu], provides a reasonable estimate of the degree of hypertonicity due to losses of hypotonic fluids through osmotic diuresis at presentation of DKH or HHS and should guide the tonicity of replacement solutions. However, the corrected [Na] may change during treatment because of ongoing fluid losses and should be monitored during treatment.