Volume Status Research Articles

"It's really hard to strike a balance": The role of digital influencers in shaping youth mental health.

Social media influencers have enormous sway with youth; however, little is known about how they communicate about mental health and how young people respond to this content. This study used semi-structured, remote interviews with 31 participants aged 16 to 24 years to explore how young people feel about the way social media influencers discuss mental health online. Thematic analysis and member-checking processes were used to identify five themes, each reflecting a tension in how participants viewed a specific aspect of influencer content. Themes included the style (casual or serious), volume (inadequate or excessive), focus (distress or solutions), source (lived experience or professional advice), and sponsorship status (persuading or exploitative) of influencer content. Young people appear to hold widely varying, nuanced preferences regarding influencer mental health content. Notwithstanding some risks and limitations, influencers can generate engaging mental health content-their potential role in shaping youth mental health and other health communication efforts warrants further exploration.

A randomised controlled crossover trial comparing a polymeric with a semi-elemental oral nutritional supplement on fluid and sodium status in patients with a jejunostomy

BackgroundPatients with a short bowel need to restrict oral fluid to reduce stoma/fistula output. Some patients require oral nutritional supplements (ONS) to meet nutritional requirements. There is limited research on ONS for patients with a short bowel. This study aimed to compare polymeric verses semi-elemental ONS on jejunal wet weight and sodium output. Materials and methodsPatients were included if they had < 200 cm of small bowel to a jejunostomy or an enterocutaneous fistula. Patients fasted from midnight then were randomly allocated to consume 200 ml of either Vital 1.5® or Ensure Plus® over 30 min. Jejunal output and urine were collected for 6 h during which patients remained nil by mouth. Jejunal and urine outputs were weighed, and samples sent for analysis. After a day washout, patients were swapped to the other ONS. Differences between the two study periods were assessed using multilevel regression. ResultsTen patients completed, 4 females: 6 males, mean age 59.2 years, mean small bowel length 95 cm. Jejunal wet weight (P < 0.001) and jejunal sodium (P = 0.003) were significantly higher on Vital 1.5® compared to Ensure Plus® with a mean difference of 0.1 kg and13mmol respectively. There was no difference in faecal sodium balance (P = 0.16), urine sodium (P = 0.38) or urine volume (P = 0.56). ConclusionA semi-elemental ONS results in a greater jejunal wet weight loss compared to a polymeric one. The amount is small but the daily cumulative loss will be greater.

Ratio of Estimated Right Atrial Pressure with Pulmonary Capillary Wedge Pressure and Estimated Plasma Volume Status as Predictor of Major Adverse Cardiovascular Event During Hospitalization in Patients with Acute Heart Failure

Ratio of Estimated Right Atrial Pressure with Pulmonary Capillary Wedge Pressure and Estimated Plasma Volume Status as Predictor of Major Adverse Cardiovascular Event During Hospitalization in Patients with Acute Heart Failure

672 Outcomes of operative vaginal deliveries by hospital volume status

672 Outcomes of operative vaginal deliveries by hospital volume status

A prospective observational study to compare and evaluate delta down, aortic velocity time integral variability, and superior vena cava collapsibility index as predictors of fluid responsiveness in patients with supratentorial brain tumors undergoing elective neurosurgery.

Patients undergoing surgical resection of brain tumors frequently exhibit a spectrum of hemodynamic fluctuations necessitating careful fluid management. This study aimed to evaluate the feasibility of dynamic predictors of fluid responsiveness, such as delta down (DD), aortic velocity time integral variability (VTIAoV), and superior vena cava collapsibility index (SVCCI), in patients undergoing neurosurgery for brain tumors. In this prospective study, 30 patients scheduled to undergo elective neurosurgery for brain tumor resection were enrolled. Baseline measurements of vitals, anesthetic parameters, and study variables were recorded post-induction. Subsequently, patients received a fluid bolus of 10 mL/kg of colloid over 20 min, and measurements were repeated post-loading. Data were presented as mean ± standard deviation. The normally distributed continuous variables were compared using Student's t-test, with P < 0.05 considered statistically significant. The predictive capability of variables for fluid responsiveness was assessed using Pearson's coefficient analysis (r). Of the 30 patients, 22 were identified as volume responders (R), while eight were non-responders (NR). DD >5 mmHg effectively distinguished between R and NR (P < 0.001), with a good predictive ability (r = 0.759). SVCCI >38% differentiated R from NR (P < 0.001), with excellent predictability (r = 0.994). Similarly, VTIAoV >20% was also a good predictor (P < 0.05; r = 0.746). Our study revealed that most patients undergoing surgical resection of brain tumors exhibited fluid responsiveness. Among the variables assessed, SVCCI >38% emerged as an excellent predictor, followed by VTIAoV >20% and DD >5 mm Hg, for evaluating fluid status in this population.

Partograph Utilization and Associated Factors among Obstetric Care Providers in Public Hospitals, Addis Ababa, Ethiopia, 2021

Background Worldwide, 13% of maternal deaths were caused by protracted and difficult labour, which can be decreased by wise use of the partograph while giving birth. It is crucial to spot any irregularity during labour by employing a partograph during professional aided delivery. Partograph use is influenced by a variety of circumstances according to the literature however, the extent of partograph use and the associated factors are not well understood in the research area. The purpose of this study was to assess the magnitude of partographs utilization and associated factors among obstetric care providers in public hospitals in Addis Ababa, Ethiopia, 2021. Methods A cross-sectional study was carried out at 296 obstetric care providers in selected public hospitals in Addis Ababa, Ethiopia. Systematic random sampling techniques were used to select study participants. A structured self-administered questionnaire and direct observation was used to collect data. Epi-data version 4.6 was used to enter the collected data, which was then exported to statistical package for the social sciences (SPSS) version 26 for analysis. Variables with p-value≤0.25 were included in the multivariable model to control for confounders. The statistical significance level was declared at p-value≤0.05. Results The study included 296 (100%) obstetric care providers. 184 (62.0%) of those who used partographs did so on a regular basis for all laboring mothers. Service year ≤5-years (AOR=10.66, 95% CI: 3.11, 36.51) and 5-10-years (AOR=4.74, 95% CI: 1.27, 17.73), on-the-job training (AOR=2.72, 95% CI (1.53, 4.83), knowledge (AOR=2.78, 95% CI (1.29, 5.99) and attitude (AOR=4.11, 95% CI (2.31, 7.32). Conclusion The overall utilization of partographs was low. Partograph utilization was significantly associated with service year (year of work experience), on-the-job training, partograph knowledge, and obstetric care providers’ attitudes toward partograph. To follow the progress of labour, these observation findings indicated that molding of fetal head, status of amniotic fluid, continuous monitoring of maternal and fetal condition was lacking.

Comparing preoperative fasting and ultrasound-measured intravascular volume status in elective surgery, enhanced recovery patients versus inpatient, urgent surgery patients and the ability of IVC collapsibility to predict post-induction hypotension.

Hypotension following induction of general anaesthesia has been shown to result in increased complications and mortality postoperatively. Patients admitted to the hospital undergoing urgent surgery are often fasted from fluids for significant periods compared to elective patients subject to Enhanced Recovery After Surgery protocols despite guidelines stating that a two-hour fast is sufficient. The aim of this prospective, observational study was to compare fasting times and intravascular volume status between elective surgery patients subject to enhanced recovery protocols and inpatient, urgent surgery patients and to assess differences in the incidence of post-induction hypotension. Fasting data was obtained by questionnaire in the preoperative area in addition to inferior vena cava collapsibility index, a non-invasive measure of intravascular volume. Blood pressure readings and drug administration for the ten minutes following induction were obtained from patients' charts. Inpatients undergoing urgent surgery were fasted significantly longer than enhanced recovery patients and had lower intravascular volume. However, no difference was found in the incidence of post-induction hypotension.

Analysis of functional activity of granulosa cells of porcine ovarian follicles

Functioning of the granulosa cells of animal ovarian follicles (OF) determines the growth and development of the OF and the oocyte formed in it, which determines their use in modeling the composition of media for oocyte maturation in vitro in cell reproductive technologies. The purpose of the study is to determine the peculiarities of functional activity of granulosa cells in follicles of different diameters (&lt; 3, 3–5, 5–8 mm) using complex testing of granulosa cell viability parameters (apoptosis level, production of reactive oxygen species, functional activity of mitochondria and lipidome) and hormonal status of follicle fluid (estradiol, testosterone, anti-Müllerian hormone level) in order to optimize the composition of the culture media for in vitro maturation of pig oocytes. The experiments found that the proportion of apoptotic cells in the OF increased as the diameter of the OF increased (by 11% in OFs 5–8 mm in diameter, by 4% in OFs &lt; 3 mm in diameter). There was an increase in the number of high reactive oxygen species cells (by 10% in 5–8 mm diameter OF compared with &lt; 3 mm diameter OF) and high mitochondrial activity (by 12% in 5–8 mm diameter OF compared with &lt; 3 mm diameter OF). Correlations were found between the group of cells with high generation of reactive oxygen species and the level of apoptosis (0.500, p &lt; 0.05), as well as with high levels of mitochondrial activity (0.500, p &lt; 0.05). Estradiol concentration in follicular fluid increased as the OF grew (1.50 ng/ml in OF &lt; 3 mm diameter and 2.09 ng/ml in OF 3–5 mm diameter, p &lt; 0.01), being almost unchanged in OF 5–8 mm diameter (2.11 ng/ml), as was the testosterone concentration. Correlations were found between the proportion of the cells with high NileRed/LD FI (a marker of lipid droplet functional activity) and the levels of estradiol (0.998, p &lt; 0.05), testosterone (0.500, p &lt; 0.05), and anti-Müllerian hormone (–0.500, p &lt; 0.05) in the dynamics of folliculogenesis, as well as between estradiol concentration and the proportion of cells with high mitochondrial activity (0.746, p &lt; 0.05). Correlations were detected between the concentrations of estradiol and anti-Müllerian hormone, testosterone and anti-Müllerian hormone (–1.000, p &lt; 0.05), between the level of apoptotic cells and the concentration of anti-Müllerian hormone in follicular fluid (–1.000, p &lt; 0.05). The results of the monitoring of the viability and functional activity of porcine OF granulosa cells supplement the available data on the peculiarities of their functioning in the dynamics of folliculogenesis and can be used in modeling the systems of in vitro maturation of donor oocytes of Sus Scrofa Domesticus.

Low-Volume Elective Surgery and Outcomes in Medicare Beneficiaries Treated at Hospital Networks

Minimum volume standards have been advocated as a strategy to improve outcomes for certain surgical procedures. Hospital networks could avoid low-volume surgery by consolidating cases within network hospitals that meet volume standards, thus optimizing outcomes while retaining cases and revenue. The rates of compliance with volume standards among hospital networks and the association of volume standards with outcomes at these hospitals remain unknown. To quantify low-volume surgery and associated outcomes within hospital networks. This cross-sectional study used Medicare Provider Analysis and Review data to examine fee-for-service beneficiaries aged 66 to 99 years who underwent 1 of 10 elective surgical procedures (abdominal aortic aneurysm repair, carotid endarterectomy, mitral valve repair, hip or knee replacement, bariatric surgery, or resection for lung, esophageal, pancreatic, or rectal cancers) in a network hospital from 2016 to 2018. Hospital volume for each procedure (calculated with the use of the National Inpatient Sample) was compared with yearly hospital volume standards for that procedure recommended by The Leapfrog Group. Networks were then categorized into 4 groups according to whether or not that hospital or another hospital in the network met low-volume standards for that procedure. Data were analyzed from February to June 2023. Receipt of surgery in a low-volume hospital within a network. Primary outcomes were postoperative complications, 30-day readmission, and 30-day mortality, stratified by the volume status of the hospital and network type. The secondary outcome was the availability of a different high-volume hospital within the same network or outside the network and its proximity to the patient (based on hospital referral region and zip code). In all, data were analyzed for 950 079 Medicare fee-for-service beneficiaries (mean [SD] age, 74.4 [6.5] years; 621 138 females [59.2%] and 427 931 males [40.8%]) who underwent 1 049 069 procedures at 2469 hospitals within 382 networks. Of these networks, 380 (99.5%) had at least 1 low-volume hospital performing the elective procedure of interest. In 35 137 of 44 011 procedures (79.8%) that were performed at low-volume hospitals, there was a hospital that met volume standards within the same network and hospital referral region located a median (IQR) distance of 29 (12-60) miles from the patient's home. Across hospital networks, there was 43-fold variation in rates of low-volume surgery among the procedures studied (from 1.5% of carotid endarterectomies to 65.0% of esophagectomies). In adjusted analyses, postoperative outcomes were inferior at low-volume hospitals compared with hospitals meeting volume standards, with a 30-day mortality of 8.1% at low-volume hospitals vs 5.5% at hospitals that met volume standards (adjusted odds ratio, 0.67 [95% CI, 0.61-0.73]; P < .001). Findings of this study suggest that most US hospital networks had hospitals performing low-volume surgery that is associated with inferior surgical outcomes despite availability of a different in-network hospital that met volume standards within a median of 29 miles for the vast majority of patients. Strategies are needed to help patients access high-quality care within their networks, including avoidance of elective surgery at low-volume hospitals. Avoidance of low-volume surgery could be considered a process measure that reflects attention to quality within hospital networks.

Gynecologic Surgical Subspecialty Training Decreases Surgical Complications in Benign Minimally Invasive Hysterectomy

Study ObjectiveTo evaluate the impact of gynecologic subspecialty training on surgical outcomes in benign minimally invasive hysterectomies (MIH) while accounting for surgeon volume. DesignRetrospective cohort study of patients who underwent a MIH between 2014 and 2017. SettingSingle community hospital system. PatientsPatients were identified via CPT (Current Procedural Terminology) codes for MIH: vaginal, laparoscopic or robotic. Exclusion criteria included a gynecologic cancer diagnosis or concomitant major procedure at the time of hysterectomy. One thousand six hundred and thirty-one patients underwent a benign MIH performed by a gynecologic generalist or a subspecialist in Minimally-Invasive Gynecologic Surgery (MIGS), Urogynecology and Pelvic Reconstructive Surgery (URPS), or Gynecologic Oncology. 125 hysterectomies were vaginal, 539 were conventional laparoscopic, and 967 were robotic. InterventionsN/A Measurements and Main ResultsSurgical outcomes including intraoperative complications, operative outcomes, and postoperative readmissions and reoperations, were compared between generalists and subspecialists and stratified by surgeon volume status, with “high-volume” defined as performing 12 or more hysterectomies annually. Odds ratios for the primary outcome, Clavien-Dindo Grade III complications (which included visceral injuries, conversions, and reoperations within 90 days), were calculated to evaluate the impact of subspecialty training while accounting for surgeon volume status. 855/1631 (52.4%) MIH were performed by generalists and 776/1631 (47.6%) by subspecialists. High-volume generalists performed 618/1631 (37.9%) of MIH, 14.5% (237/1631) were performed by low-volume generalists. All subspecialists were high-volume surgeons; 38.1% of generalists were high-volume.The odds of a Clavien-Dindo Grade III complication was 0.39 (0.25-0.62) for hysterectomies performed by subspecialists compared to high-volume generalists after adjusting for potential confounding variables (p < .001). Subspecialists and high-volume surgeons had significantly lower incidence of visceral injuries, transfusions, blood loss over 500 mL, and conversions compared to generalists and low-volume surgeons, respectively. ConclusionBoth subspecialty training and high surgeon volume status are associated with a lower risk of surgical complications in benign MIH. Subspecialty training is associated with a reduction in surgical complications even after accounting for surgeon volume.

Use of POCUS for the assessment of dehydration in pediatric patients-a narrative review.

In pediatric practice, POCUS (point-of-care ultrasound) has been mostly implemented to recognize lung conditions and pleural and pericardial effusions, but less to evaluate fluid depletion. The main aim of this review is to analyze the current literature on the assessment of dehydration in pediatric patients by using POCUS. The size of the inferior vena cava (IVC) and its change in diameter in response to respiration have been investigated as a tool to screen for hypovolemia. A dilated IVC with decreased collapsibility (< 50%) is a sign of increased right atrial pressure. On the contrary, a collapsed IVC may be indicative of hypovolemia. The IVC collapsibility index (cIVC) reflects the decrease in the diameter upon inspiration. Altogether the IVC diameter and collapsibility index can be easily determined, but their role in children has not been fully demonstrated, and an estimation of volume status solely by assessing the IVC should thus be interpreted with caution. The inferior vena cava/abdominal aorta (IVC/AO) ratio may be a suitable parameter to assess the volume status in pediatric patients even though there is a need to define age-based thresholds. A combination of vascular, lung, and cardiac POCUS could be a valuable supplementary tool in the assessment of dehydration in several clinical scenarios, enabling rapid identification of life-threatening primary etiologies and helping physicians avoid inappropriate therapeutic interventions. Conclusion: POCUS can provide important information in the assessment of intravascular fluid status in emergency scenarios, but measurements may be confounded by a number of other clinical variables. The inclusion of lung and cardiac views may assist in better understanding the patient's physiology and etiology regarding volume status. What is Known: • In pediatric practice, POCUS (point-of-care ultrasound) has been mostly implemented to recognize lung conditions (like pneumonia and bronchiolitis) and pleural and pericardial effusions, but less to evaluate fluid depletion. • The size of the IVC (inferior vena cava) and its change in diameter in response to respiration have been studied as a possible screening tool to assess the volume status, predict fluid responsiveness, and assess potential intolerance to fluid loading. What is New: • The IVC diameter and collapsibility index can be easily assessed, but their role in predicting dehydration in pediatric age has not been fully demonstrated, and an estimation of volume status only by assessing the IVC should be interpreted carefully. • The IVC /AO(inferior vena cava/abdominal aorta) ratio may be a suitable parameter to assess the volume status in pediatric patients even though there is a need to define age-based thresholds.A combination of vascular, lung, and cardiac POCUS can be a valuable supplementary tool in the assessment of intravascular volume in several clinical scenarios.

Real-world experience of brolucizumab in nAMD.

To evaluate real-world outcomes with neovascular age-related macular degeneration (nAMD) in relation to anatomical success, visual outcomes, and safety of intravitreal brolucizumab (IVBr) injection at 1.5 years. Prospective, randomized, single-center study between December 2020 and December 2022 that included 71 eyes of 62 patients with nAMD, who received IVBr. Patients were divided into three groups, i.e., naïve choroidal neovascular membrane (CNVM), switched therapy (st) CNVM, and st polypoidal choroidal vasculopathy (stPCV). They were subdivided into dry, minimal fluid (fluid <50 microns)/pigment epithelial detachment (PED) and persistent fluid (fluid >100 microns)/PED subgroups depending upon the fluid level at the end of 1.5 years. Best-corrected visual acuity (BCVA), central macular thickness (CMT), status of fluid, and number of injections at 1.5 years were evaluated. From the beginning, patients were treated on pro re nata (PRN) basis. Of the 71 eyes, 27 eyes (38%) were naïve CNVM, 35 eyes (49.3%) were stCNVM, and 9 (12.7%) were stPCV cases. Significant vision improvement after 1.5 years was seen in the stCNVM category (P = 0.001), while CMT reduction was significant in all three groups (P < 0.05). The mean number of injections required in naïve CNVM and stCNVM groups was significantly less as compared to the stPCV group (P = 0.017). Further, vision improvement was significant in the "Minimal fluid" subgroup (P = 0.002), while the CMT improvement was significant in the "Minimal fluid" and "Dry" subgroups each with P < 0.0001. No ocular/systemic adverse events including intraocular inflammation (IOI) were noted. In a real-world scenario, with 203 procedures and 1.5-year follow-up, brolucizumab is found to be efficacious and safe with the need for a lesser number of injections and more interval-free period in the management of naïve CNVM, stCNVM, and stPCV patients.

Ultrasound Assessment of Volume Status in Participants of High-Altitude Mountaineering Expeditions

Ultrasound Assessment of Volume Status in Participants of High-Altitude Mountaineering Expeditions

A systematic review on oral rehydration beverages for treating exerciseassociated dehydrationPart II. The effectiveness of alternatives to carbohydrate-electrolyte drinks.

Dehydration associated with exertion is a commonly encountered condition in the first aid setting, particularly at outdoor sporting events. Part I of this back-to-back review demonstrated that commercial sports drinks can be suggested for effective restoration of fluid balance in dehydrated persons. This systematic review was undertaken to compare alternative liquids, such as milk, beer, and coconut water, with water for effective oral rehydration after prolonged exercise. Cochrane Library, PubMed, and Embase were searched for relevant literature in June 2022. Controlled experimental and observational studies involving adults and children were included when dehydration was induced by physical exercise and oral rehydration fluids were administered and compared with regular water. No additional food intake accompanied the rehydration drinks or water. Articles in all languages were included if an English abstract was available. The study design, study population, intervention, outcome measures, and study limitations were extracted from each included article. Out of 3485 records, 11 studies were included comparing skim or low-fat milk, coconut water, and beer (0-5% alcohol) with water. Four studies showed that drinking skim or low-fat milk, without additional food intake, led to a statistically significant improved volume/hydration status when compared with drinking water. In three trials, no significant differences were shown at multiple timepoints for outcomes related to volume and hydration status following rehydration with fresh coconut water compared with water. Lastly, there is insufficient evidence to recommend beer for rehydration (0-5% alcohol). Consuming skim or low-fat cow's milk without additional food as compared with water appears to improve volume/hydration status in persons with exercise-induced dehydration. However, evidence is of very low certainty and should be interpreted with caution.

An observational study on salivary conductivity for fluid status assessment and clinical relevance in acute ischemic stroke during intravenous fluid hydration

The body fluid status in acute stroke is a crucial determinant in early stroke recovery but a real-time method to monitor body fluid status is not available. This study aims to evaluate the relationship between salivary conductivity and body fluid status during the period of intravenous fluid hydration. Between June 2020 to August 2022, patients presenting with clinical signs of stroke at the emergency department were enrolled. Salivary conductivities were measured before and 3 h after intravenous hydration. Patients were considered responsive if their salivary conductivities at 3 h decreased by more than 20% compared to their baseline values. Stroke severity was assessed using the National Institutes of Health Stroke Scale, and early neurological improvement was defined as a decrease of ≥ 2 points within 72 h of admission. Among 108 recruited patients, there were 35 of stroke mimics, 6 of transient ischemic attack and 67 of acute ischemic stroke. Salivary conductivity was significantly decreased after hydration in all patients (9008 versus 8118 µs/cm, p = 0.030). Among patients with acute ischemic stroke, the responsive group, showed a higher rate of early neurological improvement within 3 days compared to the non-responsive group (37% versus 10%, p = 0.009). In a multivariate logistic regression model, a decrease in salivary conductivity of 20% or more was found to be an independent factor associated with early neurological improvement (odds ratio 5.42, 95% confidence interval 1.31–22.5, p = 0.020). Real-time salivary conductivity might be a potential indicator of hydration status of the patient with acute ischemic stroke.

Incidence of major cardiovascular events at 1, 2, and 5years and mortality in incident patients on peritoneal dialysis regarding their nutritional status by bioimpedanciometry: A multicenter study in Colombia.

The nutritional status of incident patients on peritoneal dialysis (PD) has been associated with survival outcomes. Bioimpedanciometry (BCM) enables to establish a nutritional diagnosis, the volume status, and correlates these findings with survival. This study used a retrospective multicenter historical cohort. In this study, which included 420 incident patients on peritoneal dialysis with a 5-year follow-up, a cumulative incidence of major adverse cardiovascular events (MACE) of 28.8% was found, being higher in the diabetic population at 36.8%. In regard to the nutritional status in this population, it was found that approximately 44% had altered nutritional status; 34% were found to be in sarcopenia; 6.7% sarcopenic obesity; and 2.8% in obesity (p< 0.001). In the survival analysis, a lower probability of survival was found in patients with overhydration (OH) greater than 3L (p< 0.001) and in patients with altered nutritional status due to sarcopenia, sarcopenic obesity, and obesity (p 0.016). According to survival in the subgroup of the diabetic population, a lower probability of survival was found in this group of patients (p: 0.011). The overall mortality of the study population was 18%, being higher in the first 2years, with the most important causes of mortality being cardiovascular. Of the deceased population, 51% were diabetic patients (p: 0.012). In incident patients on peritoneal dialysis, sarcopenic obesity, sarcopenia, overhydration status determined by BCM, and having a diagnosis of diabetes are related to a lower probability of survival; MACE outcomes are more frequent in the diabetic population.

Fluid homeostatic action of dapagliflozin in patients with chronic kidney disease: the DAPA-BODY Trial.

Sodium glucose cotransporter 2 (SGLT2) inhibitors have both glucose-lowering and diuretic effects. We recently reported that the SGLT2 inhibitor dapagliflozin exerts short-term fluid homeostatic action in patients with chronic kidney disease (CKD). However, the long-term effects of SGLT2 inhibitors on body fluid status in patients with CKD remain unclear. This was a prospective, non-randomized, open-label study that included a dapagliflozin treatment group (n = 73) and a control group (n = 24) who were followed for 6 months. Body fluid volume was measured using a bioimpedance analysis device. The extracellular water-to-total body water ratio (ECW/TBW), a predictor of renal outcomes, was used as a parameter for body fluid status (fluid retention, 0.400 ≤ ECW/TBW). Six-month treatment with dapagliflozin significantly decreased ECW/TBW compared with the control group (-0.65% ± 2.03% vs. 0.97% ± 2.49%, p = 0.0018). Furthermore, dapagliflozin decreased the ECW/TBW in patients with baseline fluid retention, but not in patients without baseline fluid retention (-1.47% ± 1.93% vs. -0.01% ± 1.88%, p = 0.0017). Vasopressin surrogate marker copeptin levels were similar between the control and dapagliflozin groups at 6 months (32.3 ± 33.4 vs. 30.6 ± 30.1 pmol/L, p = 0.8227). However, dapagliflozin significantly increased the change in copeptin levels at 1 week (39.0% ± 41.6%, p = 0.0010), suggesting a compensatory increase in vasopressin secretion to prevent hypovolemia. Renin and aldosterone levels were similar between the control and dapagliflozin groups at 6 months, while epinephrine and norepinephrine (markers of sympathetic nervous system activity) were significantly lower in the dapagliflozin group than in the control group. In conclusion, the SGLT2 inhibitor dapagliflozin ameliorated fluid retention and maintained euvolemic fluid status in patients with CKD, suggesting that SGLT2 inhibitors exert sustained fluid homeostatic actions in patients with various fluid backgrounds. Clinical trial registration: https://www.umin.ac.jp/ctr/, identifier [UMIN000048568].

The Impact of Follicular Fluid Oxidative Stress Levels on the Outcomes of Assisted Reproductive Therapy.

Oocyte quality is a pivotal determinant of assisted reproductive outcomes. The quality of oocytes is intricately linked to their developmental microenvironment, particularly the levels of oxidative stress within the follicular fluid. Oxidative stress levels in follicular fluid may have a substantial influence on oocyte health, thereby impacting the outcomes of ART procedures. This review meticulously explores the intricate relationship between oxidative stress in follicular fluid and ART outcomes. Furthermore, it delves into strategies aimed at ameliorating the oxidative stress status of follicular fluid, with the overarching goal of enhancing the overall efficacy of ART. This research endeavors to establish a robust foundation and provide valuable guidance for clinical treatment approaches, particularly in the context of infertile women, including those of advanced maternal age.

Management of Low Sodium in AMU

Hyponatremia is a common finding in acutely ill patients and is defined as serum sodium (Na) level less than 135 mEq/L which is due to a relative excess of water in relation to serum sodium. Reasons for hyponatremia are increase in water intake (hypotonic intravenous fluid therapy or primary polydipsia) or impaired water excretion due to renal failure or increase release of antidiuretic hormone. Optimum management depends on the duration and severity of hyponatremia and involves close monitoring and accurate fluid balance assessment. We will discuss in this article the basics of management, pitfalls to avoid in Hyponatremia and recommended approach based on literature review when reviewing a patient with Hyponatremia, firstly to enquire about the duration of Hyponatremia to differentiate acute from chronic as the threshold for treatment is different, following duration is assessment of severity (clinically by symptoms and signs as well as biochemistry) as severity will affect the management. Following duration and severity the acute physician should assess the volume status of the patient to hypovolemic, euvolemic or hypervolemic Hyponatremia which aids in reaching the possible cause of Hyponatremia and the right treatment.

Delphi Process for Validation of Fluid Treatment Algorithm for Critically Ill Pediatric Trauma Patients

IntroductionWhile intravenous fluid therapy is essential to re-establishing volume status in children who have experienced trauma, aggressive resuscitation can lead to various complications. There remains a lack of consensus on whether pediatric trauma patients will benefit from a liberal or restrictive crystalloid resuscitation approach and how to optimally identify and transition between fluid phases. MethodsA panel was comprised of physicians with expertise in pediatric trauma, critical care, and emergency medicine. A three-round Delphi process was conducted via an online survey, with each round being followed by a live video conference. Experts agreed or disagreed with each aspect of the proposed fluid management algorithm on a five-level Likert scale. The group opinion level defined an algorithm parameter's acceptance or rejection with greater than 75% agreement resulting in acceptance and greater than 50% disagreement resulting in rejection. The remaining were discussed and re-presented in the next round. ResultsFourteen experts from five Level 1 pediatric trauma centers representing three subspecialties were included. Responses were received from 13/14 participants (93%). In round 1, 64% of the parameters were accepted, while the remaining 36% were discussed and re-presented. In round 2, 90% of the parameters were accepted. Following round 3, there was 100% acceptance by all the experts on the revised and final version of the algorithm. ConclusionsWe present a validated algorithm for intavenous fluid management in pediatric trauma patients that focuses on the de-escalation of fluids. Focusing on this time point of fluid therapy will help minimize iatrogenic complications of crystalloid fluids within this patient population.