Isotonic Solution Research Articles

Use of isotonic seawater solutions in patients with ENT symptoms: Real world efficacy, safety and performance evaluation

Limited real-world data exist on the efficacy, user satisfaction, and usage patterns of medical devices used for nasal rinsing in patients with ENT conditions. This study aimed to evaluate a natural Isotonic Seawater nasal Spray (ISS). Over a 1-2 week period

HSPiP, Computational, and Thermodynamic Model-Based Optimized Solvents for Subcutaneous Delivery of Tolterodine Tartrate and GastroPlus-Based In Vivo Prediction in Humans: Part I.

Tolterodine tartrate (TOTA) is associated with adverse effect, high hepatic access, varied bioavailability, slight aqueous solubility, and short half-life after oral delivery. Hansen solubility parameters (HSP, HSPiP program), experimental solubility (T = 298.2 to 318.2K and p = 0.1MPa), computational (van't Hoff and Apelblat models), and thermodynamic models were used to the select solvent(s). HSPiP predicted PEG400 as the most suitable co-solvent based on HSP values (δd = 17.88, δp = 4.0, and δh = 8.8 of PEG400) and comparable to the drug (δd = 17.6, δp = 2.4, and δh = 4.6 of TOTA). The experimental mole fraction solubility of TOTA was maximum (xe = 0.0852) in PEG400 confirming the best fit of the prediction. The observed highest solubility was attributed to the δp and δh interacting forces. The activity coefficient (ϒi) was found to be increased with temperature. The higher values of r2 (linear regression coefficient) and low RMSD (root mean square deviation) indicated a good correlation between the generated "xe" data for crystalline TOTA and the explored models (modified Apelblat and van't Hoff models). TOTA solubility in "PEG400 + water mixture" was endothermic and entropy-driven. IR (immediate release product) formulation can be tailored using 60% PEG400 in buffer solution for 2mg of TOTA in 0.25mL (dosing volume). The isotonic binary solution was associated with a pH of 7.2 suitable for sub-Q delivery. The approach would be a promising alternative with ease of delivery to children and aged patients.

Evaluation of Fluid Loading Protocols for Use Before Returning from Spaceflight

Reductions in plasma volume (PV) during spaceflight contribute to post-spaceflight orthostatic intolerance (OI) during re-exposure to a gravitational environment. Both the National Aeronautics and Space Administration (NASA) and the Russian Space Agency (RSA) utilize fluid loading prior to re-entry to expand PV and mitigate the risk of post flight OI, but the timing of ingestion differs. Before landing NASA crewmembers consume 1-1.5 L of water with salt tablets to produce an isotonic solution in ~1 hour, whereas RSA cosmonauts consume the same, over ~4 hours. Anecdotal reports suggest low palatability and gastrointestinal (GI) distress with salt tablet and water fluid loading. To address this concern, the NASA Space Food Systems Laboratory developed an electrolyte solution. The purpose of this study is to test the effcacy and palatability of the two fluid loading compositions ingested in 1 hour versus 4 hours. Seven participants (2 Female, 39±9 years, 178.2±9.9 cm, 74.9±8.6 kg) completed four randomized visits separated ≥ 48 hours. The four visits were (1) no fluid loading (control), (2) 4 hour ingestion of the electrolyte solution (4hr-Electro), (3) 1 hour ingestion of the electrolyte solution (1hr-Electro), and (4) 4 hour ingestion of salt tablets and water (4hr-Salt). Participants reported to the lab at ~7:00 a.m. fasted, and PV was measured using a carbon monoxide re-breathing technique. During each visit subjects consumed 500 mL of water representing normal daily water intake through the first five hours of the session along with breakfast and lunch meals identical to those provided to astronauts. During the control visit, no other fluid consumption was allowed. During the three fluid loading visits, participants also consumed up to 1.2 L of additional fluid, either water with salt tablets or the electrolyte solution. After completion of the fluid loading protocol no additional fluid was consumed during the final 3.5 hours of the test. Participants remained seated for all portions of the study. Hemoglobin and hematocrit were measured at 0, 1, 2, 3, and 3.5 hours after cessation of food and fluid intake to assess changes in PV. In these preliminary data, PV was not significantly different from baseline at any timepoint during the control and 4hr-Electro sessions ( P>0.20). PV increased from baseline at all timepoints for the 1hr-Electro session ( P<0.003) and at all timepoints, other than 0 ( P=0.17 ), for the 4hr-Salt condition ( P<0.01 ). GI distress was reported by participant during the 4hr-Electro (n=2), 1hr-Electro (n=1), and 4hr-Salt protocols (n=4). No GI distress was reported during the control visit. The most severe GI symptom (18/20) was nausea reported with the 4hr-Salt protocol. These data suggest that both the 4hr-Salt and 1hr-Electro fluid loading protocols successfully expands PV, however the 1hr-Electro results in fewer participants reporting GI symptoms. Supported by Mars Campaign Development - Exploration Capabilities. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Protective action of water-soluble fullerene adducts on the example of an adduct with l-arginine

We present radioprotective, antiglycating, and photoprotective properties of a water-soluble C60 fullerene derivative with l-arginine (C60-Arg) and composite films based on collagen containing C60-Arg. The synthesis of these materials is described. The identification of the synthesised materials was carried out using modern physicochemical methods of analysis. The physicochemical properties of aqueous solutions of C60-Arg, such as, particle size distribution, zeta potentials, distribution coefficient in the octan-1-ol–water system were measured. The computer simulation of the process of C60-Arg association in aqueous and isotonic solutions was carried out using Molecular Dynamics. Composite films based on collagen containing C60-Arg demonstrate significant improvement in mechanical properties, cell adhesion, and cell proliferation when the nano-modifier is added. This shows high potential for the use of the C60-Arg adduct in biomedicine.

An isotonic protein solution favorably modulated the porcine intestinal immune response and cellular adhesion markers and reduced PEDV shedding in vivo

Porcine epidemic diarrhea virus (PEDV) causes immensely large economic losses worldwide in the swine industry. PEDV attacks the intestine, disrupts intestinal epithelium morphology and barrier integrity, and results in profound diarrhea and high mortality. A commercially available isotonic protein solution (IPS) (Tonisity Px) has anecdotally been reported to be effective in supportive treatment of piglets with active PEDV infections. This study evaluated the effects of supplementing (or not) the drinking water of 14 day old PEDV-infected piglets with the IPS on the content of E-cadherin, fibronectin, interferon-alpha (IFN-α), and matrix metalloproteinase 9 (MMP-9) in duodenal tissue. The content of PEDV DNA in feces was also measured. Though both groups had similar PEDV shedding at day 1, IPS piglets had significantly lower PEDV shedding at day 5, 14 and 21. The IPS group also had a shorter duration of PEDV virus shedding.Levels of E-cadherin and fibronectin, both of which are structural proteins in the intestine, remained unchanged from baseline in the IPS group, whereas the same molecules decreased significantly in the control group. IFN-α, an antiviral cytokine, and MMP-9, an enzyme that aids in tissue remodeling, were increased at days 5 and 14 post infection, and then decreased at day 21 post-infection in the IPS group compared to control.Overall, the IPS used in this study enhanced epithelial intercellular adhesion (E-cadherin) and extracellular matrix structure (fibronectin), resulted in significantand favorable changes in MMP-9 activity, and favorably modulated IFN-α production.This is the first report of this panel of biomarkers, especially MMP-9 and IFN-α, in the face of in vivo PEDV infection. This is also the first report to investigate a commercially available swine product that does not need to be administered in solid feed, and that is already registered for use throughout Asia, Europe, South America, and North America.Overall, the results of this study serve to clarify the behavior of 4 key biomarkers in the presence of in vivo PEDV infection. The results also indicate that IPS (Tonisity Px) supplementation is a viable intervention to modulate the porcine intestinal immune response with favorable effects on the intestine.

New drugs for horses and production animals in 2023

In 2023, no new active pharmaceutical ingredients were released on the German market for horses and food-producing animals. Two established veterinary active pharmaceutical ingredients became available for additional species: The phosphorus compound butafosfan was also approved for horses, dogs, and cats and the mineral sodium chloride as an isotonic sodium chloride solution was also approved for rabbits and guinea pigs. In addition, for small animals, there were new releases of an agent (pergolidmesilate) in a novel pharmaceutical formulation and a lower content of the active ingredient, one drug (fluralaner) in a smaller package size as well as one drug (oxalic acid dehydrate) with a new route of administration. Furthermore, one combination of active ingredients (diprophylline+heptaminol) is available on the market for horses and food producing animals again.

New drugs for small animals in 2023

In 2023, 2 novel pharmaceutical agents for small animals were released on the German market: the structural but non-functional analog of the inhibitory neurotransmitter gamma-aminobutyric acid pregabalin with an anxiolytic active component and the dopamine agonist ropinirole in form of eye drops to induce vomiting. Two established active veterinary pharmaceutical ingredients became available for additional species: The phosphorus compound butafosfan was additionally approved for horses, dogs and cats and the mineral sodium chloride as an isotonic sodium chloride solution was also approved for rabbits and guinea pigs. In addition, for small animals, there were new releases of an agent (dexamethasone) in a novel pharmaceutical formulation, one drug with a new route of administration (hydrocortisone aceponate), one drug with a new content of the active ingredient (firocoxib) as well as one veterinary drug with a new combination of active ingredients in a novel pharmaceutical formulation (gentamicin+mometasone+posaconazole). Furthermore, one combination of active ingredients (diprophylline+heptaminol) is available on the market for small animals again.

Death from caustic ingestion: A case report

Rationale: Acute caustic ingestion from suicidal intent is not usual in emergency departments in developed countries. One of the substances commonly ingested by suicidal patients, phosphoric acid, tends to cause multi-system derangements. Patient’s Concern: A 41-year-old male patient presented with complaints of throat discomfort, severe generalized abdominal pain, and multiple episodes of hematemesis after ingesting a restroom cleaning solution. Diagnosis: Poisoning by acute caustic ingestion (containing <30% phosphoric acid and <4% ethylene glycol). Interventions: The patient was administered 50 mL of 8.4% sodium bicarbonate solution followed by an isotonic sodium bicarbonate solution running at 500 mL/h, a hyperkalemia kit, ceftriaxone, metronidazole, omeprazole, and atropine. The patient then underwent urgent hemodialysis. Outcomes: The patient suffered gastrointestinal bleeding as a result of local caustic injury. In addition, his course of illness was complicated by severe acidemia from high anion gap metabolic acidosis and deranged electrolytes (hyperphosphatemia, hyperkalemia, and hypocalcemia). He developed multi-organ failure and eventually demised. Lessons: The clinician needs to be mindful of the multi-system complications arising from such a caustic ingestion. These patients need to be monitored closely for deterioration, and have prompt management of the various arising complications, to reduce the high morbidity and mortality associated with this condition.

АНАЛИЗ АССОРТИМЕНТА РАСТВОРИТЕЛЕЙ И РАЗБАВИТЕЛЕЙ ИНЪЕКЦИОННЫХ РАСТВОРОВ ДЛЯ ПЕДИАТРИЧЕСКОЙ ПРАКТИКИ

Introduction. Solvents and diluents for parenteral medicines are widely used in pediatric hospitals and occupy leading positions in terms of the number of packages in purchases. Injectables are prescribed to children in reduced volumes, as compared to adults. In this regard, it is relevant to study the solvents and diluents available for parenteral administration of drugs in terms of packaging types and reduced volumes for use in pediatrics in the domestic pharmaceutical market. Aim of the study is to analyze the available solvents and diluents for parenteral medicines, such as water for injection, isotonic solutions of sodium chloride, Ringer, and Ringer lactate, on the Russian pharmaceutical market and in a multidisciplinary children’s hospital. Material and Methods. Objects of the study were data from the State Register of Medicines of Russia, the requisition slips of Medical Devices and Pharmacy of Tatarstan for medicines shipped from a warehouse to the Republic Clinical Children’s Hospital of the Ministry of Health of the Republic of Tatarstan in 2022, the price lists for medicines of pharmaceutical wholesalers (September 2023), and the data from scientific publications. Results and Discussion. The data obtained indicate that the regional pharmaceutical market has about twice as many options for the supply of medicinal solvents and diluents than in a children’s multidisciplinary hospital, and this allows expanding the range of this group of medicines. It can be assumed that pharmaceutical industrial enterprises do not produce a full range of options for the volume of primary packaging of solvents and diluents registered in the State Register of Medicines. Conclusions. In Russia, reduced volumes (20-30 ml) of 0.9% sodium chloride, 5% glucose, Ringer, and Ringer lactate solutions in vials for intravenous drip administration in pediatric practice are neither registered nor produced. The depth coefficient of the assortment of the studied solvents and diluents for parenteral medicines in relation to the volume of primary packaging in a children’s multidisciplinary hospital is 0.102. This indicates the need for medical organizations to consider the possibilities of the pharmaceutical market when drawing up applications for the supply of medicines.

Гострий риноcинусит у дитячому віці - нове вирішення старої проблеми

Acute inflammation of the mucous membrane of the nose and paranasal sinuses (acute rhinosinusitis (ARS)) is a fairly common pathology in pediatrics and otorhinolaryngology. The aim of the research was to improve the effectiveness of treatment children with ARS by introducing a combination complex of natural plant extracts "Sinudafen" and effervescent isotonic seawater solution "Sparklin" and to investigate the effect of the proposed complex treatment on the frequency of repeated ARS. Materials and methods. The study was conducted between February and December 2023 in two independent centers. The study included 98 patients with signs of ARS. The Main group - 67 patients who received "Sinudafen" and "Sparklin" for 10-14 days, symptomatic and/or etiotropic therapy if necessary. The Control group - 31 patients who received standard therapy. The results. The examination carried out on the 14th day showed that, compared to standard treatment, the patients of the Main group had a statistically significantly lower risk of maintaining such local symptoms of ARS (edema of the mucous membrane and mucous secretions from the nose). With the faster rates of recovery of children in the Main group, the pharmacological load on patients decreased significantly. The use of "Sinudafen" and "Sparklin" in comparison reduced the need to prescribe antibacterial and antiseptic drugs in the acute period. Better clinical dynamics was accompanied by a reduction in the length of hospitalization, the use of "Sinudafen" + "Sparklin" increased the chances of reducing the duration of the acute period within ≤4 days. Conclusions. The use of "Sinudafen" and "Sparklin" complex in the treatment of children with ARS allows for a 3.8-fold increase in the chances of recovery within ≤4 days. The proposed complex treatment reduces the need for antibiotics/anesthetics by 15.8 times and reduces the risk of repeated episodes of ARS by 18.2 times during the 6-month follow-up period. The use of "Sinudafen" with "Sparklin" is characterized by good tolerability, absence of side effects, high adherence, and also reduces the cost of treatment of one episode of ARS by 50%. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Submicroscopic changes of type II alveolocytes in the late development of experimental acute pancreatitis

Background. Today, acute pancreatitis is one of the most common and severe visceral disorders in patients worldwide. The aim of the work was to study the dynamics of ultrastructural changes of type II alveolocytes in the long-term periods of development of experimental acute pancreatitis. Material and methods. The experiments were carried out on 54 white Wistar male rats weighing 180–220 g. The animals were divided into three groups: first — intact, second — control, third — experimental with a model of acute pancreatitis, which was reproduced by intraperitoneal administration of a 20% solution of L-arginine at a total dose of 5 g/kg at one-hour interval. The control group of animals was intraperitoneally injected with an equivalent dose of isotonic sodium chloride solution. All research were performed under sodium thiopental anesthesia at the rate of 60 mg/kg body weight. Lung tissue for electron microscopic examination was collected from the lower lobe of the left lung at 3–5 and 7 days. Pieces of lung tissue measuring 1×1×1 mm were fixed in a 2.5% glutaraldehyde solution, followed by additional fixation in a 1% osmium tetroxide solution. After dehydration, the material was poured into Epon-Araldite. Sections with a thickness of 20–50 nm obtained on “Tesla BS-490” ultramicrotome were studied in a PEM-125K electron microscope. Results. It was found that three days after the start of the study, along with dystrophic-destructive changes, type II alveolocytes in a state of increased functional activity were observed. Continuation of the experiment (5 days) leads to the progression of ultrastructural changes in type II alveolocytes are determined, which are most pronounced on the 7 day of the study. Conclusion. Acute experimental pancreatitis is accompanied by marked changes in the ultrastructural structure of type II alveolocytes. The nature and severity of structural changes of type II alveolocytes depends on the duration of the course of arginine-induced acute pancreatitis.

How to follow the guidelines, when the appropriate fluid is missing?

Intravenous maintenance fluid therapy (IV-MFT) is probably the most prescribed drug in paediatric hospital care. Recently paediatric societies have produced evidence-based practice guidelines that recommend the use of balanced isotonic fluid when prescribing IV-MFT in both acute and critical paediatric care. Unfortunately, the applicability of these guidelines could be called into question when a ready-to-use glucose-containing balanced isotonic fluid is not available. The main objective of this study was to describe the availability of glucose-containing balanced isotonic fluids in European and Middle Eastern paediatric acute and critical care settings. This work is an ancillary study of the survey dedicated to IV-MFT practices in the paediatric acute and critical care settings in Europe and Middle East, a cross-sectional electronic 27-item survey, emailed in April-May 2021 to paediatric critical care physicians across 34 European and Middle East countries. The survey was developed by an expert multi-professional panel within the European Society of Peadiatric and Neonatal Intensive Care (ESPNIC). Balanced isotonic fluid with glucose 5% was available for only 32/153 (21%) responders. Balanced isotonic fluid with glucose 5% was consistently available in the UK (90%) but not available in France, Greece, The Netherlands and Turkey. Conclusion: Ready-to-use isotonic balanced IV solutions containing glucose in sufficient amount exist but are inconsistently available throughout Europe. National and European Medication Safety Incentives should guarantee the availability of the most appropriate and safest IV-MFT solution for all children. What is Known: • Intravenous maintenance fluid therapy (IV-MFT) is probably the most prescribed drug in paediatric hospital care. • Balanced isotonic fluid is recommended when prescribing IV-MFT in both acute and critical paediatric care. What is New: • Balanced isotonic fluid with glucose 5% is available for less than 25% of the prescribers in Europe and the Middle East.Availability of balanced isotonic fluid with glucose 5% varies from one country to another but can also be inconsistent within the same country. • Clinicians who have access to a ready-to-use balanced isotonic fluid with glucose 5% are more likely to consider its use than clinicians who do not have access to such an IV solution.

The effects of CDP-choline treatment in Amanita phalloides mushroom toxicosis

Amanita phalloides poisoning is known to be the most fatal case among mushroom poisoning cases. Its main mechanism of toxicity is that it leads to cell death by the irreversible binding of its toxins to the DNA-dependent RNA polymerase II enzyme. This study was planned to analyze the effects of the CDP-choline molecule on Amanita phalloides mushroom poisoning cases.The extract of the Amanita phalloides mushroom was taken and intraperitoneally administered to male Wistar Albino rats at a dose of 0.3 g/kg. In the experiment phase, the rats were divided into three groups of CDP-choline treatment according to the doses of 100 mg/kg, 250 mg/kg, and 500 mg/kg, and one control group was administered a 1 ml/kg dose of 0.9% isotonic NaCl solution. The treatments were then administered intraperitoneally at the 2nd hour, and at the 6th hour, the rats were sacrificed. The degree of damage in the liver and kidney tissues of the rats was evaluated histopathologically.It was concluded that CDP-choline reduced or prevented the damage that occurred in the liver significantly and dose-dependently in the toxicosis picture caused by Amanita phalloides, and it showed a tendency to lower or prevent the damage in the kidney, albeit not significantly.

Isotonic hydroxyethyl starch is ineffective in restoring blood pressure during experimental septic shock: Implications for fluid resuscitation strategies

Objectives: The objectives of the study were to evaluate the effect of isotonic or hypertonic hydroxyethyl starch (HES) solutions on blood pressure and to assess the influence of the neurohypophyseal system on this response during experimental septic shock. Male Wistar rats were randomly allocated to undergo either cecal and ligation puncture (CLP) or a simulated surgical procedure (sham). Materials and Methods: Of 6 h post-surgery, either isotonic saline (0.9% sodium chloride, 4 mL/kg), isotonic (HES; at doses of 4, 8 or 16 mL/kg), or hypertonic saline-HES (HS-HES; 4 mL/kg) was administered through the endovenous route, followed by the recording of blood pressure and heart rate. In addition, the levels of sodium, vasopressin, and oxytocin were evaluated after the fluid infusion. Results: The administration of HES did not have a significant effect on blood pressure in our study. However, the HS-HES solution increased plasma osmolality, sodium, vasopressin, and oxytocin levels. Furthermore, the HS-HES induced a transient elevation in blood pressure immediately after infusion, which could be completely blunted by the pre-administration of a V1-vasopressin antagonist. Conclusion: Our results demonstrate that the infusion of an isotonic blood volume expander during experimental septic shock is ineffective in restoring blood pressure due to blood vessel compliance. In contrast, the infusion of a hypertonic solution stimulates vasopressin secretion and can transiently restore blood pressure.

A comparative study of postoperative acidemia after intraoperative administration of balanced crystalloid (Plasma-lyte A@) versus 0.9% sodium chloride in gastrointestinal surgery

Background: The administration of intravenous fluids is one of the most common and universal interventions in medicine. Fluid therapy is the most challenging and debated aspect of perioperative care. Plasma-lyte A® Injection (multiple electrolytes injection, type 1, USP) is indicated as a source of water and electrolytes or as an alkalinizing agent. 0.9% sodium chloride is an isotonic crystalloid solution having a sodium concentration higher is useful in replacing fluid and electrolyte loss. Aims and Objectives: The study was designed to compare the effects of intraoperative administration of balanced crystalloid solution (Plasma-Lyte A®) and 0.9% NaCl on acid-base balance in the post-operative period in patients undergoing gastrointestinal surgery. Materials and Methods: Eighty consenting patients of ASA-l and ASA-II who underwent Gastrointestinal surgery were at first randomly allocated to 2 groups. One group received Plasma-Lyte A® as the sole crystalloid and the other group received 0.9% sodium chloride. Results: Serum Na+ conc. of the groups were comparable and no difference was shown at the time of induction, but postoperatively at 12 h, there was a significant increase in group 2. There was no significant difference in serum K+ concentration in both the groups except at 6 h postoperatively when there was an increase in K+ concentration in group 1. Serum Cl− concentration was having no significant difference at the time of induction and 1 h intraoperative, but postoperatively at 1, 6, and 12 h the Cl− concentration significantly increased in group 2. HCO3− concentration of the two groups had no difference between them throughout the study period. The pH of patients in both the groups showed no statistically significant difference during the entire procedure (P>0.05). A significant decrease in pH observed in 0.9% sodium chloride group in comparison to Plasma-Lyte® group when the duration of surgery increased to more than 120 min. Conclusion: Both plasma-lyte A and 0.9% sodium chloride can be used safely as intravenous infusion fluid without altering pH status and blood electrolyte concentration in patients undergoing gastrointestinal surgery.

Influence of Blood Components on Neuroinflammation, Blood-Brain Barrier Breakdown, and Functional Damage After Acute Subdural Hematoma in Rats.

A central component of injury development after acute subdural hematoma (ASDH) is the increased intracranial pressure and consecutive mechanical reduction of cerebral blood flow (CBF). However, the role of different blood constituents in ASDH as additional lesioning factors remains unclear. This study examines the influence of blood components on neuroinflammation, blood-brain barrier (BBB) breakdown, and functional deficits in a rat model of ASDH. We infused corpuscular (whole blood, whole blood lysate, and red cell blood) and plasmatic (blood plasma, anticoagulated blood plasma, and aqueous isotonic solution) blood components into the subdural space while CBF was monitored. Rats then underwent behavioral testing. Lesion analysis and immunohistochemistry were performed 2 days after ASDH. Inflammatory reaction was assessed using staining for ionized calcium-binding adaptor molecule 1 and glial fibrillary acidic protein, interleukin-1ß, tumor necrosis factor-alpha, and membrane attack complex. Integrity of the BBB was evaluated with albumin and matrix metalloproteinase 9 (MMP9) staining. We observed a significant drop in CBF in the corpuscular group (75% ± 7.5% of baseline) with distinct post-operative deficits and larger lesion volume compared to the plasmatic group (13.6 ± 5.4 vs. 1.3 ± 0.4 mm3). Further, inflammation was significantly increased in the corpuscular group with stronger immunoreaction. After whole blood infusion, albumin and MMP9 immunoreaction were significantly increased, pointing toward a disrupted BBB. The interaction between corpuscular and plasmatic blood components seems to be a key factor in the detrimental impact of ASDH. This interaction results in neuroinflammation and BBB leakage. These findings underscore the importance of performing surgery as early as possible and also provide indications for potential pharmacological targets.

Клінічне значення деблокади носового дихання в дітей грудного і раннього віку на тлі гострих респіраторних вірусних інфекцій: переваги ізотонічного розчину морської води

Acute respiratory viral infections (ARVI) are an urgent problem in young children, which is due to their significant prevalence, they have a constant tendency to increase and occupy the first places in the structure of infectious diseases. Damage to the mucous membranes of the upper respiratory tract in children with ARVI lead to numerous problems that require adequate replacement of the main functions of the child’s body, which determined the relevance of our study. Purpose - to analyze the effectiveness of the use of isotonic dilution of sea water (Pshyk Mini medicine) for irrigation therapy in nasal congestion in infants and young children caused by acute respiratory infections. Materials and methods. A comprehensive examination of 100 infants and young children with influenza and other ARVI was conducted in the infectious diseases department of the Chernivtsi Regional Children’s Clinical Hospital. The children were randomly divided into 2 clinical groups: the Group I included 55 children (average age - 1.09±0.3 years, the proportion of boys - 58.1%), who, as part of complex standard therapy, received nasal irrigation using 2-3 drops of Pshyk mini medicine in each nostril 3 times/day. The Group II included 45 patients (average age - 1.15±0.2 years (p>0.05), the proportion of boys - 59.1% (p>0.05)), in whom isotonic sodium chloride solution was used for the purpose of the nasal sanitation. Results. The conducted studies showed that starting from the 3-4th day of hospitalization, a statistically significant decrease in catarrhal manifestations and the severity of nasal obstruction was noted in patients of the Group I who received Pshyk Mini in complex treatment. In particular, in relation to the results of the Group II, in the children of the Group I, on the 4th day of inpatient treatment, the chances of reducing the severity of catarrhal manifestations (estimated ≤2 points) increased: the absolute risk increase - 53.0%, the relative risk increase - 67.9% (95% CI: 57.8-76.9) with the minimum number of patients who need to be treated to obtain a positive result - 1.5. We also established that compared to the representatives of the Group II, children of the Group I had almost a 4-fold increase in the chances of restoring tolerance to feeding (estimation of feeding difficulties ≤2 points): attributive risk - 30.5%, relative risk - 1.6 (95% CI: 0.6-4.8), odds ratio - 3.9 (95% CI: 1.2-12.3). Conclusions. For the purpose of unblocking of nasal breathing in infants and children of early age at the background of acute respiratory viral infections, the use of an isotonic solution of sea water (Pshyk Mini medicine) has a number of significant advantages compared to the use of an isotonic solution of sodium chloride for this purpose. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Fluids and body composition during anesthesia in children and adolescents: A pilot study

The purpose of this study is to evaluate the intracellular and extracellular volume before and after anesthesia in order to ascertain their variations and determine the potential utility of this information in optimizing intraoperative fluid administration practices. A bioimpedance spectroscopy device (body composition monitor, BCM) was used to measure total body fluid volume, extracellular volume, and intracellular volume. BCM measurements were performed before and after general anesthesia in unselected healthy children and adolescents visiting the Pediatric Institute of Southern Switzerland for low-risk surgical procedures hydrated with an isotonic solution. In 100 children and adolescents aged 7.0 (4.8–11) years (median and interquartile range), the average total body water increased perioperatively with a delta value of 182 (0–383) mL/m2 from pre- to postoperatively, as well as the extracellular water content, which had a similar increase with a delta value of 169 (19–307) mL/m2. The changes in total body water and extracellular water content significantly correlated with the amount of fluids administered. The intracellular water content did not significantly change. Conclusion: Intraoperative administration of isotonic solutions results in a significant fluid accumulation in low-risk schoolchildren during general anesthesia. The results suggest that children without major health problems undergoing short procedures do not need any perioperative intravenous fluid therapy, because they are allowed to take clear fluids up to 1 h prior anesthesia. In future studies, the use of BCM measurements has the potential to be valuable in guiding intraoperative fluid therapy.What is Known:• Most children who undergo common surgical interventions or investigations requiring anesthesia are nowadays hydrated at a rate of 1700 mL/m2/day with an isotonic solution.• The use bioimpedance spectroscopy for the assessment of fluid status in healthy children has already been successfully validated.• The bioimpedance spectroscopy is already currently widely used in various nephrological settings to calculate fluid overload and determine patient’s optimal fluid status.What is New:• Routine intraoperative fluid administration results in a significant fluid accumulation during general anesthesia in low-risk surgical procedures.• This observation might be relevant for children and adolescents with conditions predisposing to fluid retention.• In future studies, the use of BCM measurements has the potential to be valuable in guiding intraoperative fluid therapy.

A Novel Bionebulizer Approach to Study the Effects of Natural Mineral Water on a 3D In Vitro Nasal Model from Allergic Rhinitis Patients.

Sulfurous thermal waters (STWs) are used as a complementary treatment for allergic rhinitis. However, there is scant data on the effects of STW on nasal epithelial cells, and in vitro models are warranted. The main aim of this study was to evaluate the dose and time effects of exposure to 3D nasal inserts (MucilAirTM-HF allergic rhinitis model) with STW or isotonic sodium chloride solution (ISCS) aerosols. Transepithelial electrical resistance (TEER) and histology were assessed before and after nebulizations. Chemokine/cytokine levels in the basal supernatants were assessed by enzyme-linked immunosorbent assay. The results showed that more than four daily nebulizations of four or more minutes compromised the normal epithelial integrity. In contrast, 1 or 2 min of STW or ISCS nebulizations had no toxic effect up to 3 days. No statistically significant changes in release of inflammatory chemokines MCP-1/CCL2 > IL-8/CXCL8 > MIP-1α/CCL3, no meaningful release of "alarmins" (IL-1α, IL-33), nor of anti-inflammatory IL-10 cytokine were observed. We have characterized safe time and dose conditions for aerosol nebulizations using a novel in vitro 3D nasal epithelium model of allergic rhinitis patients. This may be a suitable in vitro setup to mimic in vivo treatments of chronic rhinitis with STW upon triggering an inflammatory stimulus in the future.

Ultrastructural organization of alveolar macrophages during late development of experimental acute pancreatitis

Background. Nowadays, acute pancreatitis continues to remain an actual problem both in surgery and in intensive care medicine. The aim of the work was to study the dynamics of ultrastructural changes of alveolar macrophages in the long-term development of experimental acute pancreatitis. Material and methods. The experiments were carried out on 62 white Wistar male rats weighing 180–220 g. The animals were divided into three groups: first — intact, second — control, third — experimental with a model of acute pancreatitis, which was reproduced by intraperitoneal administration of a 20% solution of L-arginine in a total dose of 5 g/kg at one-hour interval. The control group of animals was intraperitoneally injected with an equivalent dose of isotonic sodium chloride solution. All research were performed under sodium thiopental anesthesia at the rate of 60 mg/kg body weight. Lung tissue for electron microscopic examination was collected from the lower lobe of the left lung at 3–5 and 7 days. Pieces of lung tissue measuring 1×1×1 mm were fixed in a 2.5% glutaraldehyde solution, followed by additional fixation in a 1% osmium tetroxide solution. After dehydration, the material was poured into Epon-Araldite. Sections with a thickness of 20–50 nm obtained on “Tesla BS-490” ultramicrotome were studied in a PEM-125K electron microscope. Results. It was found that three days after the start of the study, significant heterogeneity of alveolar macrophages was observed in the alveolar lumen. Next to active phagocytic macrophage elements with dystrophic-destructive changes are determined. Continuation of the experiment (5 days) leads to the progression of submicroscopic changes in alveolar macrophages, which are most pronounced on the7 day of the study. Conclusion. Acute experimental pancreatitis is accompanied by pronounced changes in the ultrastructural structure of alveolar macrophages. The features and severity of structural changes in alveolar macrophages depends on the duration of arginine-induced acute pancreatitis.