Intravenous Rehydration Research Articles

Proton pencil beam scanning radiotherapy in the postoperative treatment of p16 positive squamous cell tonsillar cancer – evaluation of toxicity and effectivity

PurposePatients with p16 positive tonsillar cancer (p16 + TC) have an excellent prognosis and long-life expectancy. Deintensification of therapy is a prevalent topic of discussion. Proton radiotherapy is one way to reduce radiation exposure and thus reduce acute and late toxicity. The aim is to evaluate treatment outcomes and toxicity of postoperative treatment with intensity-modulated proton therapy (IMPT).MethodsBetween September 2013 and November 2021, 47 patients with p16 + TC were treated postoperatively with IMPT. Median age was 54.9 (38.2–74.9) years, 31 were males and 16 were females. All patients had squamous cell carcinoma and underwent surgery as a primary treatment. Median dose of radiotherapy was 66 GyE in 33 fractions. Bilateral neck irradiation was used in 39 patients and unilateral in 8. Concomitant chemotherapy was applied in 24 patients.ResultsMedian follow-up time was 4.2 (0.15–9.64) years. Five-year overall survival, relapse free survival and local control were 95.7%, 97.8% and 100%. The most common acute toxicities were dermatitis and mucositis, with grade 2 + in 61.7% and 70.2% of patients. No acute percutaneous gastrostomy insertion was necessary and intravenous rehydration was used in 12.8% of patients. The most common late toxicity was grade 1 xerostomia in 70.2% of patients and grade 2 in 10.6% of patients. Subcutaneous fibrosis of grades 2 and 3 occurred in 17.0% and 2.1% of patients, respectively. One patient developed late severe dysphagia and became PEG-dependent.ConclusionIMPT for the postoperative treatment of p16 + TC is feasible with excellent efficiency and acceptable acute and late toxicity.

Comparing the Efficacy of Ondansetron, Domperidone, and Metoclopramide in Treating Vomiting in Pediatric Patients With Acute Gastroenteritis: A Network Meta-Analysis.

This network meta-analysis compared the efficacy of ondansetron, domperidone, and metoclopramide in managing vomiting in pediatric acute gastroenteritis. A comprehensive literature search was conducted across multiple databases, including PubMed, Cochrane Library, Web of Science, and Embase, from their inception to July 25, 2024. Additionally, Google Scholar was searched to identify further relevant studies. In total, 19 randomized controlled trials (RCTs) were included. The primary outcome was cessation of vomiting. The results indicated that ondansetron was significantly more effective than placebo in achieving cessation of vomiting. While domperidone and metoclopramide also showed improved efficacy compared to placebo, these differences were not statistically significant. Ondansetron emerged as the most effective intervention, followed by domperidone and metoclopramide. These findings have significant clinical implications, suggesting that ondansetron should be the preferred antiemetic for pediatric acute gastroenteritis. Its use may reduce the need for intravenous rehydration and hospitalization, potentially improving patient outcomes and reducing healthcare costs. However, the study has limitations, including a lack of data on secondary outcomes and safety profiles of the interventions. Future prospective, multicenter studies are needed to assess both the efficacy and safety of these antiemetics comprehensively in pediatric acute gastroenteritis.

Нудота та блювання під час вагітності: огляд сучасних можливостей

Nausea and vomiting of pregnancy (NVP) are the most frequent and characteristic symptoms of pregnancy for the first trimester that potentially may cause substantial negative consequences for the physical and emotional health of a woman. According to various studies, from 50 to 90% of women suffer from NVP. Usually, the symptoms of NVP begin at 5-6 weeks after the last menstrual period and disappear in most cases by the 16th-20th week of pregnancy, but sometimes they persist and may be observed until the third trimester, and in rare cases - even until childbirth. The doctor's main task in providing assistance to a pregnant woman with NVP is the timely application of an adequate treatment strategy, both effective and safe for a mother and a fetus, as well as ensuring the highest achievable life quality for a woman. The aim of this article is to analyze modern management opportunities for pregnant women with NVP, including an assessment of the advantages and disadvantages of different treatment strategies, for a comprehensive understanding of the NVP problem and the main principles and ways for solving it. This review is based on national guidelines (updated Royal College of Obstetricians and Gynecologists (RCOG) Green-top clinical guideline 2024, Society of Obstetricians and Gynecologists of Canada (SOGC) Guideline 2016), the results of various studies, and review articles (database of the Cochrane Library, UpToDate, EMBASE, MEDLINE). Conclusion: a combination of pyridoxine and doxylamine can be prescribed for the prevention of NVP since the diagnosis of pregnancy in a high-risk group of women. In case of already existing symptoms of NVP, the objective assessment of complaints, as well as a response to the prescribed therapy, are facilitated by the unified scales. In most cases, lifestyle modification and first-line drug therapy effectively reduce the severity of NVP symptoms and improve a woman's quality of life. In case of insufficient response, other drugs are added to the treatment regimen, including second and third-line drugs, with a consideration of possible drug interactions. Some patients might need admission, and in addition to antiemetic therapy, they might need intravenous rehydration, electrolyte balance restoration, and thromboprophylaxis. The authors declare that there is no conflict of interest.

Medication reconciliation to minimise medication errors: Iatrogenic hypercalcaemia as a case report

Hypercalcaemia is a relatively less common yet life-threatening electrolyte disorder and is caused by parathyroid-dependent and independent factors. This case report describes an elderly lady, a known patient of stable hypothyroidism, hypertension, type 2 diabetes mellitus and non-oliguric chronic kidney disease-IV who presented with complaints of gradually worsening drowsiness. Investigations revealed a hypercalcemic crisis; all other contributory investigations were unremarkable. She was put on intravenous saline rehydration, furosemide, pamidronate, and calcitonin. However, due to new-onset haemodynamic instability, cardiomyopathy, and worsening renal parameters, haemodialysis was initiated to reduce the serum calcium levels rapidly. The patient remained asymptomatic after that, and her renal parameters improved to near baseline levels, though cardiac function improvement was not obtained at the end of one month. History elicited from the patient after her neurological improvement revealed that failing to interpret the prescription of three orthopaedics she had visited lately, she followed all simultaneously and had thus consumed toxic levels of calcium and Vitamin D. Medication reconciliatory measures such as e-prescribing, computerised drug dispensing system, automated patient drug dispensing boxes and ‘brown-bagging’ all ongoing medications during the physician visits would ensure reduction in medication errors, thus avoiding adverse events, reducing uncalled for mortalities and morbidities and healthcare cost.

Crisi celiaca: una complicanza rara e insidiosa della celiachia

Coeliac Crisis is an urgent and potentially fatal complication of Coeliac Disease (CeD), which is most frequent in early childhood. The crisis may occur at onset or develop in CeD patients with poor compliance to the gluten-free diet (GFD). Stress, surgery and infections can act as triggers. The diagnosis is based on the acute onset of rapidly progressive diarrhoea associated with at least two conditions among severe dehydration, metabolic acidosis, dyselectrolytemia, renal dysfunction, neurological alterations, hypoproteinemia and weight loss. Haematological manifestations, such as thrombocytopenia, increased INR, aplastic anaemia and leukopenia, are rare. The cornerstones of therapy are intravenous rehydration, correction of hypoalbuminemia, acidosis and dyshionemia along with a strict GFD. Steroids may be also used in refractory cases. The paper describes a recent case of a patient presenting with a severe life-threatening coeliac crisis characterized by inability to walk due to lower limb weakness, severe abdominal distension, diarrhoea and peripheral oedema.

Oral rehydration therapy versus intravenous rehydration therapy in the first 12 h following hospitalization for hyperemesis gravidarum: A randomized controlled trial.

To evaluate oral rehydration therapy (ORT) compared with intravenous rehydration therapy (IVT) in the early inpatient management of hyperemesis gravidarum (HG). A total of 124 women hospitalized for HG from February 10, 2021 till January 6, 2023 were randomized to ORT (n = 61) or IVT (n = 63) for an initial 12 h. Inclusion criteria includes women older than 18 years, with a viable intrauterine pregnancy less than 14 weeks at their first hospitalization for HG with ketonuria of at least 2+. Primary outcomes were (1) satisfaction score with allocated intervention, (2) weight change, and (3) ketonuria change at 12 h. Secondary outcomes included vomiting frequency, nausea score, serial vital signs, hematocrit and electrolyte levels at 12 h, deviation from treatment protocol (cross-over therapy), participant recommendation of allocated treatment to a friend, and length of hospital stay. Primary outcomes of (1) participant satisfaction score (on a 0-10 visual numerical rating scale) was 7 (interquartile range [IQR] 5-8) versus 9 (IQR 8-10), P < 0.001; (2) weight gain was 293 ± 780 g versus 948 ± 758 g, P < 0.001; and (3) ketonuria improvement was 50/61 (82.0%) versus 49/63 (77.8%) (relative risk [RR] 1.05, 95% confidence interval [CI] 0.88-1.26, P = 0.561) for ORT versus IVT, respectively. For secondary outcomes, vomiting frequency was 2.6 ± 2.7 versus 1.1 ± 1.4 episodes (P < 0.001), participant cross-over rate to opposing treatment 20/61 (32.8%) versus 0/63 (0%) (P < 0.001) (in the 12-h study period) and participant recommendation of allocated treatment to a friend rate 24/61 (39.3%) versus 61/63 (96.8%) (RR 0.41, 95% CI 0.30-0.56, P < 0.001) for ORT versus IVT, respectively. By hospital discharge, 31/61 (50.8%) of women allocated to ORT had required IVT. Other secondary outcomes of serial assessments of nausea score and vital signs, hematocrit and electrolyte levels, and length of hospital stay were not different. ORT was inferior to IVT in two primary outcomes and three secondary outcomes. Cross-over rate to intravenous therapy from oral therapy was 50.8% by hospital discharge. Intravenous rehydration therapy should remain as first-line rehydration therapy in the early inpatient treatment of HG. The present study was registered in ISRCTN registry on December 6, 2020 with trial identification number: ISRCTN 40152556 (https://doi.org/10.1186/ISRCTN40152556). The first participant was recruited on February 10, 2021.

Hypercalcemia: a practical review

Hypercalcemia, defined as an abnormal elevation of serum calcium, is a common electrolyte anomaly in primary care, affecting almost 1% of the worldwide population. Clinical manifestations concern the neuromuscular, cardiovascular, gastrointestinal, renal and skeletal systems. Among the causes, the main ones are primary hyperparathyroidism, and malignancies. Le initial workup should include the measurement of parathyroid hormone (PTH), and the discontinuation of any medication likely to be involved in iatrogenic hypercalcemia. The chosen treatments and their speed of introduction depend mainly on the severity of hypercalcemia. They include intravenous rehydration, and antiresorptive agents such as bisphosphonates, denosumab or calcitonin.

Tachycardia Unresponsive to Crystalloid Bolus

Dehydration is a common complaint in the pediatric emergency department. The treatment is typically focused on oral or intravenous rehydration with the goal of normalization of vital signs, primarily the heart rate but potentially also the blood pressure. The failure of routine therapy may lead to the consideration of other etiologies, including potential chronic conditions. We present a unique case of a twenty-three-month-old female who initially presented to the pediatric emergency department with signs of dehydration secondary to vomiting and diarrhea as well as tachycardia that did not improve with fluid resuscitation. Although physical examination findings were subtle, laboratory testing later confirmed the diagnosis of thyrotoxicosis. She was started on treatment with atenolol and methimazole. This case describes thyroid disease in a young child without a history of maternal autoimmune illness, which is rarely diagnosed in the emergent department. Healthcare providers should be cognizant of the spectrum of clinical findings in pediatric hyperthyroidism, since the early recognition and treatment is crucial for improved outcomes with this life-threatening pediatric condition. We discuss the consequences of undiagnosed Grave’s disease and review common findings that can assist with early diagnosis in the emergency department.

Gastroenteritis Rehydration Of children with Severe Acute Malnutrition (GASTROSAM): A Phase II Randomised Controlled trial: Trial Protocol.

Children hospitalised with severe acute malnutrition (SAM) are frequently complicated (>50%) by diarrhoea ( ≥3 watery stools/day) which is accompanied by poor outcomes. Rehydration guidelines for SAM are exceptionally conservative and controversial, based upon expert opinion. The guidelines only permit use of intravenous fluids for cases with advanced shock and exclusive use of low sodium intravenous and oral rehydration solutions (ORS) for fear of fluid and/or sodium overload. Children managed in accordance to these guidelines have a very high mortality. The proposed GASTROSAM trial will reappraise current recommendations with mortality as the primary outcome. We hypothesize that liberal rehydration strategies for both intravenous and oral rehydration in SAM children with diarrhoea may reduce adverse outcomes. An open Phase II trial, with a partial factorial design, enrolling children in Uganda, Kenya, Nigeria and Niger aged 6 months to 12 years with SAM hospitalised with gastroenteritis (>3 loose stools/day) and signs of moderate and severe dehydration. In Stratum A (severe dehydration) children will be randomised (1:1:2) to WHO plan C (100mls/kg Ringers Lactate (RL) with intravenous rehydration (IV) given over 3-6 hours according to age including boluses for shock), slow rehydration (100 mls/kg RL over 8 hours (no boluses)) or WHO SAM rehydration regime (ORS only (boluses for shock (standard of care)). Stratum B incorporates all children with moderate dehydration and severe dehydration post-intravenous rehydration and compares (1:1 ratio) standard WHO ORS given for non-SAM (experimental) versus WHO SAM-recommended low-sodium ReSoMal. The primary outcome for intravenous rehydration is mortality to 96 hours and for oral rehydration a change in sodium levels at 24 hours post-randomisation. Secondary outcomes include measures assessing safety (evidence of pulmonary oedema or heart failure); change in sodium from post-iv levels for those in Stratum A; perturbations of electrolyte abnormalities (severe hyponatraemia <125 mmols/L or hypokalaemia. If the trial shows that rehydration strategies for non-malnourished children are safe and improve mortality in SAM this could prompt revisions to the current treatment recommendations or may prompt future Phase III trials.

When hemorrhagic enterititis can cause anemia and thrombocytopenia without significant kidney damage.

A healthy 9-years-old boy was brought to the Emergency Department for widespread abdominal pain associated with bloody diarrhoea and significant tenesmus, in the absence of fever. Blood tests were compatible with an acute gastroenteritis, even though microbiological tests on stools resulted negative. Given the haemorrhagic dysentery, the boy was hospitalized to start empiric antibiotic therapy and intravenous rehydration. Abdominal ultrasound showed a thickening of colonic walls, mimicking an inflammatory intestinal disease at the onset (subsequently denied by gastro-colonoscopy). Seven days after the onset of symptoms, blood tests revealed microangiopathic anaemia with negative Coombs test, associated with thrombocytopenia. Urine dipstick revealed haematuria and proteinuria in nephritic range. No contraction of diuresis or alteration of renal function were observed (being creatinine values always within the normal range). Laboratory tests were consistent with the diagnosis of Haemolytic Uremic Syndrome (Hus) at the onset. Approximately 1% of paediatric patients with bloody diarrhoea can develop Hus. Positivity for Escherichia coli is not always evident in the stools. Thus, the triad of haemolytic anaemia, thrombocytopenia and renal failure could be present in only 60% of Hus at the onset. The finding of haematuria and/or proteinuria on the urine dipstick may be indicative of early kidney damage, allowing for careful monitoring and a rehydration program that can prevent progression of kidney damage and extrarenal complications.

Pharmacological Management of Cholera: A Century of Expert Opinions in Cecil Textbook of Medicine.

Cholera is a potentially lethal diarrheal disease produced by Vibrio cholerae serotypes O1 El Tor and O139. Known since antiquity, the condition causes epidemics in many areas, particularly in Asia, Africa, and South America. Left untreated, the mortality may reach 50%. The crucial therapeutic intervention is intravenous or oral rehydration and correction of acidosis, dyselectrolytemia, and renal impairment. Antibiotic use represents the main pharmacological intervention. What are the milestones of the antibiotics use recommended by experts for the pharmacological management of cholera in the past century? To determine the changes in the experts' approach to the management of cholera and particularly the use of antibiotics as presented in a widely used textbook in the United States. The chapters describing the management of cholera in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020. Sulfonamides were recommended in 1947, followed by the introduction of tetracyclines, chloramphenicol, and furazolidone in 1955. The options were restricted in 2000 to doxycycline. In the past decade, patients infected with strains known to have a degree a resistance to tetracyclines were treated with azithromycin or ciprofloxacin. Antibiotic use decreases the volume of stool and the duration of diarrhea but has not been considered lifesaving. Drugs with antimotility, antiemetic, or antisecretory properties are not useful. The utility of antibiotic use in cholera has been endorsed by experts, but only as an adjunct to rapid and complete fluid and electrolyte replacement.

Ukrainian War Refugee Children With Particularly Severe Viral Infections: A Case Series Report.

The humanitarian crisis in Ukraine in 2022 led to a massive migration of refugees to Poland. Immigrant children, living in overcrowded humanitarian hubs, were exposed to multiple stressful factors likely affecting their immune systems. This case series study aimed to describe a particularly severe course of common viral infections, in Ukrainian refugee children. We present 2 case series of Ukrainian refugee children: 5 hospitalized due to either adenovirus (AdV) and 8 with rotavirus (RV) infection, admitted within 3 months in each case series, recruited retrospectively. Most patients lived in humanitarian hubs and were neglected on admission (dehydrated, with poor hygiene and anxious). All RV infection cases had symptoms of severe gastroenteritis requiring intravenous rehydration. Metabolic acidosis was present in 6 children, and hypoglycemia in 4 participants. None of them were vaccinated against RV. All children with AdV infection had prolonged fever, dyspnea requiring oxygen therapy and hyperinflammation. In 2 AdV infection cases with no clinical improvement and increasing inflammatory markers, intravenous immunoglobulins and glucocorticosteroids were used. The combination of stressful factors and living in overcrowded hubs during the high prevalence of viral infections led to a particularly severe course of viral infections in Ukrainian refugee children.

Randomized trial to assess the efficacy and safety of xyloglucan for the treatment of acute gastroenteritis in children.

Acute gastroenteritis is one of the most common diseases in children and an important cause of morbidity and mortality worldwide. No specific treatment is available; therefore, management is exclusively symptomatic. Xyloglucan has been approved in Europe as a class IIa medical device for restoration of the physiological functions of the intestinal wall. Our objective was to assess efficacy and safety of xyloglucan for the treatment of acute gastroenteritis in children. We performed a triple-blind, randomized placebo-controlled clinical trial in four primary care centers and one continued care hospital center. The study population comprised children with acute gastroenteritis aged >3 months and <5 years. Our primary endpoint was time (in hours) of resolution of diarrhea, defined as the time to resolution of stool consistency (Bristol Stool Form Scale ≤5 or Amsterdam Stool Form Scale B or C) or time until deposition frequency resumes to normality, whichever occurred first. We also recorded intravenous rehydration, hospitalization, stools per day, Vesikari scale, vomiting, relapse, weight loss, drugs prescribed, and adverse events. Eighty children were included in the intention-to-treat population (43 xyloglucan and 37 placebo) and 74 (93%) in the per-protocol population. Time to resolution of diarrhea was similar in both groups with (median, 95% CI) 24, 17-24 h in the xyloglucan group versus 24, 19-24 h in the placebo group, p = .680. Significant differences were observed for patients with moderate-to-severe diarrhea (Vesikari scale ≥9): xyloglucan group (20 [15-24] h) versus placebo group (85 [51-120] h) (p = .04). No other significant differences were found. Xyloglucan can be considered safe and other studies should be performed to confirm the usefulness in patients with moderate-to-severe diarrhea.

#6665 NON TRAUMATIC RHABDOMYOLYSIS AND ACUTE RENAL FAILURE: WHICH INDICATIONS OF RENAL REPLACEMENT THERAPY?

Abstract Background and Aims The aim of our study is to identify the causes of non-traumatic rhabdomyolysis in our context, to study the clinical and biological presentation of patients and the indications of renal replacement therapy in the management of this entity. Method Our study is a monocentric retrospective study conducted at the universitary hospital Mohamed VI of Marrakech including 14 patients who presented rhabdomyolysis complicated by acute kidney inury (AKI) with no traumatic context. Those patients were followed up at intensive care unit and nephrology department over a period of 10 months from March to December 2022. Results The age of our patients varied between 24 and 64 years for an average of 42 years. The male sex was predominant (78.57%) 11 men versus 3 women with no history of previous kidney disease. The average hospital stay was 20 days [12-42 days]. The most common clinical signs were oligo-anuria (85.7%), abdominal pain (57.1%), nausea and vomiting (42.8%), flank pain (42.8%) and muscle pain (14.2%), hypertension in 5 patients (35.7%), while 4 were hypotensive. The average creatinine on admission was 22mg/l [14-42.3], the average CPK level was 6240UI/L [2225-12570], the myoglobin was assayed in a single patient which returned positive at 6230 mg/l. The mean serum potassium was 5.6mmol/l [4.2-8.1], serum phosphorus was 45mg/l [32-72mg/l], serum calcium 81.2mg/l [68- 91] and bicarbonate 12 mmol/l [4-22]. The etiologies of rhabdmyolysis in our series were as follows: In 3 cases rhabdomyolysis was related to prolonged immobilization, in 3 cases it occurred in a postoperative context (post-vascular surgery of femoro-popliteal bypass and ilio-popliteal bypass in 2 cases and orthopedic surgery for a bone tumor of the tibia in one case), in 3 patients rhabdomyolysis was related to severe sepsis. In 2 cases, it was a status epilepticus, in 2 cases a neuroleptic malignant syndrome and in one case it occurred post-IdM. Management was based on hemodynamic and respiratory support through the restoration of blood volume by intravenous (100% of patients) and oral (83.3%) rehydration, the use of vasoactive drugs (35.7%), the correction of metabolic disorders essentially hyperkalaemia and acidosis and the etiological treatment of the causal condition. RRT (Renal replacement therapy) was indicated in a total of 5 patients: In 3 patients with anuria &amp;gt; 24 hours and in 2 with threatening hyperkalaemia. The modalities were as follows: The technique used was daily IHD (intermittent hemodialysis) lasting from 1h30 to 4h. The average number of hemodialysis sessions was 3.6 (minimum of 3 sessions maximum of 5). The evolution of the patients was as follows: Among the 9 patients not on dialysis, 6 recovered normal renal function, 2 maintained an IR at discharge (creatinine at 13 and 19 mg/l respectively) and one patient died of septic shock. Among the 5 patients on dialysis, two recovered good renal function with recovery of diuresis, 2 remained on kidney failure, and one patient died due to multiple organ failure. Conclusion The management of non traumatic rhabdomyolysis is based above all on rehydration in order to establish blood volume and eliminate the myoglobin pigment. The use of RRT is necesseray in some cases such as sever acute renal failure, threatening hyperkalaemia, acidosis or persistent anuria. Several studies suggest the benefit of its early initiation, which still remains to be demonstrated.

Abandonment of intravenous volume expansion after preoperative receipt of α-blockers in patients with adrenal pheochromocytoma was not an independent risk factor for intraoperative hemodynamic instability.

There is no consensus on whether intravenous rehydration must be added after preoperative phenoxybenzamine (PXB) administration for pheochromocytoma. The aim of this study is to investigate whether abandonment of intravenous volume expansion after PXB administration is associated with intraoperative hemodynamic instability. 83 Patients with pheochromocytoma received surgical treatment in the Department of Urology, Handan First Hospital, between October 2014 and July 2022. All patients were subclassified into either the hemodynamic stability group (HS group) or the hemodynamic instability group (HU group) according to whether intraoperative hemodynamic instability occurred, with 51 cases in HS group and 32 cases in HU group. Differences in data between the two groups were examined, and the risk factors for intraoperative hemodynamic instability were analyzed using logistic regression. The results of the analysis showed no statistically significant differences in age, sex, location of the tumor, surgical method, body mass index (BMI) ≥ 24 kg/m2, blood and urine catecholamine test results, preoperative oral PXB followed by combined intravenous volume expansion, proportion of patients with hypertension or diabetes mellitus or coronary heart disease between the two groups (P>0.05). The size of the tumor in the HS group was smaller than that in the HU group (5.3 ± 1.9cm vs 6.2 ± 2.4cm P=0.010). Multivariate analyses demonstrated that abandonment of intravenous volume expansion after preoperative receipt of α-blockers in patients with adrenal pheochromocytoma was not an independent risk factor for intraoperative hemodynamic instability. Only the tumor size (P=0.025) was an independent risk factor for intraoperative hemodynamic instability. The purpose of general preoperative intravenous fluid expansion is to prevent hypotension after the tumor has been resected. In the current study, we indicated that preoperative management of pheochromocytomas using the α-blocker PXB in combination with intravenous volume expansion does not further reduce the risk of intraoperative hemodynamic instability or postoperative complications compared with oral PXB alone. Therefore, our study supports preoperative management of pheochromocytoma with a single α-blocker, PXB, as sufficient.

Moderate-to-Severe Diarrhea and Stunting Among Children Younger Than 5 Years: Findings From the Vaccine Impact on Diarrhea in Africa (VIDA) Study

Stunting affects >20% of children <5 years old worldwide and disproportionately impacts underserved communities. The Vaccine Impact on Diarrhea in Africa (VIDA) Study examined the association between an episode of moderate-to-severe diarrhea (MSD) and the risk of subsequent stunting in children <5 years living in 3 sub-Saharan African countries. In this prospective, matched, case-control study among children <5 years, data were collected over 36 months from 2 groups. "Children with MSD" visited a health center within 7 days of illness onset experiencing ≥3 loose stools/day plus sunken eyes, poor skin turgor, dysentery, intravenous rehydration, or hospitalization. "Children without MSD" were enrolled from the community within 14 days of the index MSD child; they were diarrhea-free during the previous 7 days and were matched to the index case by age, sex, and residence. Using generalized linear mixed-effects models, we estimated the effect of an MSD episode on odds of being stunted, defined as height-for-age z-scores <-2, at a follow-up visit 2-3 months post-enrollment. The proportion of stunting at enrollment was similar when 4603 children with MSD and 5976 children without MSD were compared (21.8% vs 21.3%; P = .504). Among children not stunted at enrollment, those with MSD had 30% higher odds of being stunted at follow-up than children without MSD after controlling for age, sex, study site, and socioeconomic status (adjusted OR: 1.30; 95% CI: 1.05-1.62: P = .018). Children <5 years in sub-Saharan Africa without stunting experienced an increased likelihood of stunting during 2-3 months following an episode of MSD. Strategies for control of early childhood diarrhea should be integrated into programs intended to reduce childhood stunting.

Norovirus Disease Among Children &amp;lt;5 Years in 3 Sub-Saharan African Countries: Findings From the Vaccine Impact on Diarrhea in Africa (VIDA) Study, 2015–2018

To address a paucity of data from sub-Saharan Africa, we examined the prevalence, severity, and seasonality of norovirus genogroup II (NVII) among children <5 years old in The Gambia, Kenya, and Mali following rotavirus vaccine introduction. Population-based surveillance was conducted to capture medically-attended moderate-to-severe diarrhea (MSD) cases, defined as a child 0-59 months old passing ≥3 loose stools in a 24-hour period with ≥1 of the following: sunken eyes, poor skin turgor, dysentery, intravenous rehydration, or hospitalization within 7 days of diarrhea onset. Diarrhea-free matched controls randomly selected from a censused population were enrolled at home. Stools from cases and controls were tested for enteropathogens, including norovirus and rotavirus, by TaqMan quantitative polymerase chain reaction (PCR) and conventional reverse transcription PCR. We used multiple logistic regression to derive adjusted attributable fractions (AFe) for each pathogen causing MSD, which takes into consideration the prevalence in both cases and controls, for each site and age. A pathogen was considered etiologic if AFe was ≥0.5. In further analyses focusing on the predominant NVII strains, we compared rotavirus and NVII severity using a 20-point modified Vesikari score and examined seasonal fluctuations. From May 2015 to July 2018, we enrolled 4840 MSD cases and 6213 controls. NVI was attributed to only 1 MSD episode. NVII was attributed to 185 (3.8%) of all MSD episodes and was the sole attributable pathogen in 139 (2.9%); peaking (36.0%) at age 6-8 months with majority (61.2%) aged 6-11 months. MSD cases whose episodes were attributed to NVII alone compared with rotavirus alone were younger (median age, 8 vs 12 months, P < .0001) and had less severe illness (median Vesikari severity score, 9 vs 11, P = .0003) but equally likely to be dehydrated. NVII occurred year-round at all study sites. Infants aged 6-11 months bear the greatest burden of norovirus disease, with NVII predominating. An early infant vaccine schedule and rigorous adherence to guidelines recommended for management of dehydrating diarrhea may offer substantial benefit in these African settings.

Intractable hyponatremia secondary to syndrome of inappropriate antidiuresis complicated with empty sella: A case report

Hyponatremia is a common electrolyte disorder in elderly critically ill patients, and it may be associated with poor outcomes, higher morbidity, and mortality. Syndrome of inappropriate antidiuresis (SIAD) is one of the main causes of hyponatremia, with an insidious onset that is highly misdiagnosed. Primary empty sella lesions are specific, mostly asymptomatic, and easily overlooked. SIAD combined with empty sella is much rarer in clinic, this article focuses on the diagnosis and management of an elderly patient with intractable hyponatremia secondary to syndrome of inappropriate antidiuresis complicated with empty sella. An 85-year-old male patient with severe pneumonia presented with progressive and intractable hyponatremia. The patient had clinical signs of persistent hyponatremia, low plasma osmolality, elevated urinary sodium excretion, and hyponatremia that worsened with increased intravenous rehydration and was effective with appropriate fluid restriction. The diagnosis of SIAD combined with empty sella was made in combination with the findings of the pituitary and its target gland function. Numerous screenings were performed to clarify the cause of hyponatremia. His overall condition was poor due to recurrent episodes of hospital-acquired pneumonia. We treated with ventilation support, circulatory support, nutritional support, anti-infection, and continuous correction of electrolyte imbalance. His hyponatremia gradually improved through aggressive infection control, appropriate fluid restriction (intake controlled at 1500-2000mL/d), continuous electrolyte correction, supplementation with hypertonic salt solution, and potassium replacement therapy. Electrolyte disorders, especially hyponatremia, are very common in critically ill patients, but the etiology of hyponatremia is challenging to diagnose and treat, and timely attention and proper diagnosis of SIAD and individualized treatment are the significance of this article.

Neurologic Complications of Rotavirus Infections in Children.

Rotavirus is the leading cause of complicated gastroenteritis in children younger than 5 years in countries where rotavirus vaccination is not implemented as a routine vaccination. Besides the intestinal symptoms that are associated with ordinary gastroenteritis, rotavirus can cause neurological complications. The aim of this study is to describe the clinical characteristics of complicated rotavirus infections. From January 1, 2016 to January 31, 2022, all children (below the age of 18 years) with a positive rotavirus test in feces that were either hospitalized or presented at the outpatient clinic or emergency department of a large pediatric hospital in the Netherlands were included. Rotavirus was only tested in case of a severe or abnormal disease course. We described the clinical characteristics and outcomes with a particular focus on neurological manifestations. In total, 59 patients with rotavirus were included of whom 50 (84.7%) were hospitalized and 18 (30.5%) needed intravenous rehydration. Ten patients (16.9%) had neurologic complications, of whom 6 patients (60.0%) presented encephalopathy. Two patients (20.0%) with neurological symptoms showed abnormalities on diagnostic imaging. Rotavirus can cause gastroenteritis with severe, but apparently self-limiting, neurological manifestations. Considering rotavirus in pediatric patients with neurological symptoms such as encephalopathy and encephalitis is therefore important. Early detection of rotavirus infection may predict a favorable course of the disease and may thereby prevent unnecessary treatment and should be further investigated.

Cosa fare nella diarrea ematica? Tutto e niente?

We present the case of a 7-year-old boy with 2 days’ fever and diarrhea, who starts to present hemorrhagic diarrhea. He was evaluated in the Emergency Department and hospitalized. Campylobacter and Norovirus have been isolated on stool. During hospitalization, the patient was treated with intravenous rehydration and antipyretics, with rapid clinical improvement and discharge on the third day of hospitalization. A review of the literature shows that hemorrhagic enteritis is a frequent condition in children, with different etiologies depending on age. In children older than one year of age, the first cause is infective, of viral or bacterial origin. Generally, supportive care is sufficient in consideration of good prognosis of the infections. The use of antibiotics generally does not change outcomes; in some cases, it can even be harmful. The regional protocol for the management of hemorrhagic diarrhea in the Puglia region will be presented, with the aim of early identification of STEC infections, given their clinical relevance in the evolutionary risk of haemolytic uremic syndrome.