Low Sodium Levels Research Articles

Independent predictors of in-hospital mortality and the need for intensive care in hospitalized non-critical COVID-19 patients: a prospective cohort study

One of the most helpful strategies to deal with ongoing coronavirus pandemics is to use some prudence when treating patients infected with SARS-CoV-2. We aimed to evaluate the clinical, demographic, and laboratory parameters that might have predictive value for in-hospital mortality and the need for intensive care and build a model based on them. This study was a prospective, observational, single-center study including non-critical patients admitted to COVID-19 wards. Besides classical clinic-demographic features, basic laboratory parameters obtained on admission were tested, and then new models for each outcome were developed built on the most significant variables. Receiver operating characteristics (ROC) analyses were performed by calculating each model’s probability. A total of 368 non-critical hospitalized patients were recruited, the need for ICU care was observed in 70 patients (19%). The total number of patients who died in either ICU or wards was 39 (10.6%). The first two models (based on clinical features and demographics) were developed to predict ICU and death, respectively; older age, male sex, active cancer, and low baseline saturation were noted to be independent predictors. The area under the curve values of the first two models were noted 0.878 and 0.882 (p < .001; confidence interval [CI] 95% [0.837–0.919], p < .001; CI 95% [0.844–0.922]). Following two models, the third and fourth were based on laboratory parameters with clinic-demographic features. Initial lower sodium and lower albumin levels were determined as independent factors in predicting the need for ICU care; higher blood urea nitrogen and lower albumin were independent factors in predicting in-hospital mortality. The area under the curve values of the third and fourth model was noted 0.938 and 0.929, respectively (p < .001; CI 95% [0.912–0.965], p < .001; CI 95% [0.895–962]). By integrating the widely available blood tests results with simple clinic demographic data, non-critical patients can be stratified according to their risk level. Such stratification is essential to filter the patients’ non-critical underlying diseases and conditions that can obfuscate the physician’s predictive capacity.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11739-022-02962-6.

Association between duration of fever before treatment and intravenous immunoglobulin resistance in Kawasaki disease

To examine the association between duration of fever before intravenous immunoglobulin (IVIG) treatment and IVIG resistance in children with Kawasaki disease (KD). A retrospective analysis was performed on the medical data of 317 children with KD who were admitted from January 2018 to December 2020. According to the duration of fever before IVIG treatment, they were divided into two groups: short fever duration group (≤4 days) with 92 children and long fever duration group (>4 days) with 225 children. According to the presence or absence of IVIG resistance, each group was further divided into a drug-resistance group and a non-drug-resistance group. Baseline data and laboratory results were compared between groups. A multivariate logistic regression analysis was used to identify the influencing factors for IVIG resistance. In the short fever duration group, 19 children (20.7%) had IVIG resistance and 5 children (5.4%) had coronary artery aneurysm, and in the long fever duration group, 22 children (9.8%) had IVIG resistance and 19 children (8.4%) had coronary artery aneurysm, suggesting that the short fever duration group had a significantly higher rate of IVIG resistance than the long fever duration group (P<0.05), while there was no significant difference in the incidence rate of coronary artery aneurysm between the two groups (P>0.05). In the short fever duration group, compared with the children without drug resistance, the children with drug resistance had a significantly lower level of blood sodium and significantly higher levels of procalcitonin, C-reactive protein, and N-terminal B-type natriuretic peptide before treatment (P<0.05). In the long fever duration group, the children with drug resistance had significantly lower levels of blood sodium and creatine kinase before treatment than those without drug resistance (P<0.05). The multivariate logistic regression analysis showed that a reduction in blood sodium level was associated with IVIG resistance in the long fever duration group (P<0.05). IVIG resistance in children with KD varies with the duration of fever before treatment. A reduction in blood sodium is associated with IVIG resistance in KD children with a duration of fever of >4 days before treatment.

Drug-Induced Hyperprolactinemia and Hyponatremia - Biological Markers of Unfavorable Evolution in Schizophrenia

Adverse reactions to psychotropic medication can be considered as risk indicators for an unfavorable evolution of patients with schizophrenia, based on particular pathogenic mechanisms that can be used in the personalized therapeutic approach. The combination of antidepressants with antipsychotic drugs in schizophrenia has a risk of synergistic action of excessive blockade of dopamine receptors, which causes hyperprolactinemia. Primary hyponatremia occurs during pregnancy and can be an important marker for signaling neurodevelopmental abnormalities, while secondary hyponatremia has a major clinical dimension and is induced by psychotropic drugs. The pathogenic mechanisms presented can be objectified by neuroimaging examinations that bring benefits in the diagnostic accuracy and re-evaluation of the therapeutic approach, especially in correlation with the severity of biological markers such as prolactin and sodium. The persistence of high prolactin and low sodium levels is an alarm signal that announces a negative evolution of the patient or a major risk of severe cardiac, metabolic, vascular or renal comorbidities. Recognition of pathogenic mechanisms of neurodevelopment, including ventriculomegaly, hyponatremia, focal cortical dysplasia, hippocampal or temporal lobe lesions, in association with a positive history of neonatal or febrile seizures, requires prophylaxis due to high risk of onset of schizophrenia in childhood. Fetal cortical dysplasia is associated with the risk of neonatal seizures. This vulnerability favors the appearance of febrile convulsions or enuresis with changes in brain structure. Enuresis may be an important marker of neurodevelopmental potential for schizophrenia. Neonatal seizures are correlated with hyponatremia and severe hypertension, which appeared in the third trimester of pregnancy, can trigger eclampsia. Neuroimaging monitoring in patients with neurodevelopmental abnormalities, hyperprolactinemia and primary or secondary hyponatremia, acquires a major importance, being able to delimit the boundary between a functional lesion, potentially reversible, with an irreversible lesion.

Severe headache trajectory following aneurysmal subarachnoid hemorrhage: the association with lower sodium levels

ABSTRACT Background A clinical hallmark of aneurysmal SAH (aSAH) is headache. Little is known about post-aSAH headache factors which may point to underlying mechanisms. In this study, we aimed to characterize the severity and trajectory of headaches in relation to clinical features of patients with aSAH. Methods This is a retrospective longitudinal study of adult patients admitted to an academic tertiary care center between 2012 and 2019 with aSAH who could verbalize pain scores. Factors recorded included demographics, aneurysm characteristics, analgesia, daily morning serum sodium concentration, and occurrence of vasospasm. Group-based trajectory modeling was used to identify headache pain trajectories, and clinical factors were compared between trajectories. Results Of 91 patients included in the analysis, mean age was 57 years and 20 (22%) were male. Headache score trajectories clustered into two groups: patients with mild-moderate and moderate-severe pain. Patients in the moderate-severe pain group were younger (P<0.05), received more opioid analgesia (P<0.001), and had lower sodium concentrations (P<0.001) than patients in the mild-moderate pain group. Conclusion We identified two distinct post-aSAH headache pain trajectory cohorts and identified an association with age, analgesia, and sodium levels. Future prospective studies considering sodium homeostasis and volume status under standardized analgesic regimens are warranted.

Admission electrolyte and osmotic pressure levels are associated with the incidence of contrast-associated acute kidney injury

This retrospective study aimed to explore the relationships between electrolytes and osmotic pressure homeostasis with contrast-associated acute kidney injury (CA-AKI) risk in patients with percutaneous coronary intervention or coronary angiography. We totally enrolled 4386 hospitalized patients, who were categorized into five groups based on the predetermined cutoff values of electrolytes and osmotic pressure. CA-AKI was defined as an increase in serum creatine by 0.5 mg/dL (44.2 mol/L) or a 25% increase of the highest level post-operation compared to baseline. Multivariable logistic analysis was used to examine the association of CA-AKI incidence with electrolytes and osmotic pressure levels. Piecewise linear regression models and restricted cubic spline analysis were further utilized to determine the nonlinear relationship. The results showed U-shaped relationships between sodium, chloride, magnesium, and osmotic pressure levels and CA-AKI incidence. The lowest incidence was observed in the categories of 139–141.9 mmol/L, 107.0–109.9 mmol/L, 0.91–1.07 mmol/L, and 290.0–299.9 mOsm/kg, respectively. J-shaped associations were observed for potassium and phosphate levels and CA-AKI incidence, with the lowest incidence in the categories of 3.50–4.09 mmol/L and 0.96–1.28 mmol/L, respectively. A negative correlation was observed between calcium level and CA-AKI incidence, with the lowest CA-AKI risk in the category of ≥ 2.58 mmol/L. In conclusion, abnormally higher or lower sodium, chloride, magnesium, phosphate, and osmotic pressure levels on admission were associated with increased risks of CA-AKI. While for potassium and calcium, the status of hyperkalemia and hypocalcemia on admission showed more susceptibility for CA-AKI.

Nutritional Profiles of Non-Dairy Plant-Based Cheese Alternatives

With the growing interest in non-dairy products, there has been a surge of interest in consumers seeking plant-based cheese alternatives spurred by a desire to improve individual health and achieve a more sustainable food supply. The aim of this study was to conduct a cross-sectional survey of non-dairy cheese alternatives available in the United States and to evaluate their nutritional content. A total of 245 non-dairy plant-based cheese alternatives were analyzed using their nutritional facts labels. The various cheese alternatives were based upon coconut oil (n = 106), cashews and coconut (n = 61), cashews (n = 35), oats (n = 16), almonds (n = 7), soy (n = 6), palm fruit oil (n = 5), and other blends (n = 9). Only 3% of these cheese alternatives had 5 g or more of protein, while 19%, 14%, and 1% were fortified with calcium, vitamin B12, and vitamin D, respectively. Almost 60% had high levels of saturated fat, while 15% had low sodium levels. The products based on cashews alone more commonly had the highest protein levels and the lowest sodium and saturated fat levels. Those containing coconut oil more commonly had higher saturated fat and sodium levels and were most frequently fortified with vitamin B12. Few of these products could be considered good dietary sources of either protein or calcium.

How electrolyte values affect COVID-19 patients at the time of application to the hospital?

Aim: COVID-19 disease is life threatening. we aimed to evaluated the effect of electrolyte disturbances on the course of COVID-19 disease. Material and methods: Patients hospitalized with the diagnosis of COVID-19 were included in the study. Demographic characteristics, comorbidities, symptoms, clinical course, and laboratory parameters were recorded. Results: Totally 130 COVID-19 patients, 70 (54%) of whom were female, were included in the study. The mean age was 56.6 ± 16.4 years. The most common symptom was cough (57%) and the accompanying disease hypertension (45%). 68% of the patients had hyponatremia and 29%&#x0D; had hypocalcemia. 95% of the patients were discharged. 5% died. There was a relationship between the need for oxygen and advanced age, male gender, presence of diabetes mellitus, cardiovascular disease, bilateral involvement in chest CT, lymphopenia, CRP, low calcium level, hypocalcemia, and secondary infection (p = 0.024., p= 0.001, p = 0.030, p = 0.045, p = 0.002, p =0.010, p = 0.000, p = 0.022, p = 0.048, p = 0.001, respectively). There was a relationship between the need for intensive care, male gender, low calcium level, hyponatremia conclusion the presence of secondary infection. (respectively, p = 0.045, p = 0.023, p = 0.011, p = 0.001). There was a correlation between the duration of hospitalization and low calcium level and low sodium level (p = 0.026, p = 0.022). Conclusion: The severity of COVID-19 appears to be associated with&#x0D; low serum sodium and calcium concentrations, and regular electrolyte monitoring can be useful in follow-up.

The effect of winter fodder beet or kale allocation on behaviour and blood metabolite status of non-lactating dairy cows

Fodder beet (FB) was at first rapidly adopted by farmers, however, there is uncertainty around the impact of feeding high rates of FB on metabolic diseases and cow behaviour. This study aimed to establish if there was an effect of crop type and feed allocation on blood metabolites and behaviour of dairy cows.&#x0D; In winter 2017, 328 mixed-aged pregnant non-lactating Friesian x Jersey cows were allocated to feeding treatments of either FB or kale, offered at two allocation rates: “target” (to achieve 0.5 BCS gain) or “high” (ad libitum allocation), supplemented with pasture baleage. Blood metabolites were monitored for 20 animals per treatment, 15 of those animals per treatment had an activity sensor fitted for 8 days in late July.&#x0D; Cows fed FB had higher plasma magnesium and lower sodium, phosphate, total protein and urea levels than cows fed kale. The FB cows spent less time lying (9.4 vs 11.1 h/d), walked more (2113 vs 1737 steps/day), had fewer lying bouts per day (6.1 vs 9.3 bouts/day), but had longer bout duration (102 vs 81 min) than kale cows. These results indicate differences between winter crops in susceptibility to metabolic diseases and grazing activity which require further investigation.

Frequency of Complications by Serum Sodium Level among Patients with Liver Cirrhosis

Background: Cirrhosis is a life-threatening and incurable condition. It is a leading cause of death and disease all over the globe. Fluctuations in blood sodium levels are a common consequence of advanced cirrhosis Objective: To determine frequency of complications by serum sodium level among patients with liver cirrhosis. Methodology: This descriptive Cross sectional study was carried out at the Department of Medicine, Khyber Teaching Hospital, Peshawar from Mar 1, 2021 to Aug 31, 2021. The severity of cirrhosis was measured using Child-Pugh Scores for all patients after a thorough history and examination. Blood samples from all patients were obtained under stringent aseptic conditions and sent to the hospital laboratory. The level of sodium in the serum was tested under the observation of a pathologist having more than 10 years of pathology experience. Results: In our study, amongst 210 subjects, 125 (59.52%) were males whereas 85(40.48%) were females. The spontaneous bacterial peritonitis among liver cirrhosis was observed in 42(20%) patients and Encephalopathy was observed in 48(22.9%) cases. Conclusion: Low levels of sodium in serum are a prevalent trait in individuals with cirrhosis, according to the findings of this research. Serum sodium concentrations ˂130 meq/l is associated with an increased risk of Spontaneous Bacterial Peritonitis and hepatic encephalopathy in cirrhotic patients. Keywords: Serum sodium, Hepatic Encephalopathy, Spontaneous Bacterial Peritonitis

Nutritional Status Associated to Red Cell Distribution Width, Length of Stay, and Clinical Outcome patient with Chronic Kidney Diseases

INTRODUCTION: Red cell distribution width (RDW) shows the heterogeneity of erythrocyte size associated with inflammation and various clinical conditions including in patients with chronic kidney disease (CKD). Systemic inflammation and oxidative stress were commonly found in CKD patients. AIM: This study aimed to examine the relationship of nutritional status, length of hospital stay (LOS), and clinical outcome to RDW in CKD patients. METHODS: We conducted a retrospective cohort study of 1736 patients CKD patients who admitted from January 2017 to August 2020, aged between 18 and 60 years and were hospitalized at Wahidin General Hospital. From those, 239 were consulted with clinical nutrition specialist, of which 59 patients eligible with the criteria inclusion. Data were collected through medical records and through electronic data (biochemical data). RDW was categorized into normal and high RDW group, nutritional status based on subjective global assessment (SGA), LOS &lt;10 days and clinical outcome based on conditions at the time of hospital discharged. Data were analyzed using SPSS version 25.0. RESULTS: The data of 59 patients were analyzed, the mean age was 50.42 years (normal RDW) and 47.24 years (high RDW), most of them are women (57.7% vs. 60.6%). There were 42 patients with moderate malnutrition (23 normal RDW and 19 high RDW) and 17 patients with severe malnutrition (3 normal RDW and 14 with high RDW). The study found a significant differences between normal RDW and high RDW (p 0.021), but not significant differences in LOS (p 0.890) and clinical outcome (p 0.968). There were a significant differences in the levels of hemoglobin (p = 0.001), RBG (p = 0.030), and serum sodium level (p = 0.010). Patient with LOS &lt; 10 days had lower sodium levels and more severe anemia when compared with LOS &gt; 10 days and the poor clinical outcome had a heavier degree of anemia compared to the good clinical outcomes. CONCLUSION: Poor nutritional status was associated with an increase in RDW, degree of anemia, and sodium level.

Abstract- Poster

Background:In spite of prevalent use of lithium therapy in clinical settings, there is not much published literature on lithium levels in Indian patient samplesAim:The study aimed to describe the pattern and trend of serum lithium level in consecutive serum lithium estimations between January 2015 and December 2019. It did not include 2020-2021 due to frequent COVID-19 related service disruptions in this period.Methods:This was a retrospective review of lithium laboratory records for consecutive samples received over a five year period at Department of Psychiatry, AIIMS, New Delhi.Results:A total of 4,376 samples were received over five year period (mean age: 34.98±13.06 years; 62% males; out-patient: 87.4%). One-third (36.3%) samples had serum lithium levels <0.60 mEq/L and a small percentage (3.6%) were in toxic range. Further analysis was restricted to out-patient samples within therapeutic range (0.6-1.2 mEq/L) (N=2,278). One-way between-groups ANOVA (Feb-April, May-July, Aug-Oct, Nov-Jan) was significant (F=3.021; df=3; p=0.029), with LSD post-hoc showing a small but statistically significant difference in mean lithium levels of Aug-Oct compared to Nov-Jan (p=0.007) and Feb-April (p=0.015). Further, serum lithium level was positively correlated to age (p=0.019), serum potassium (p=0.002), and inversely correlated to serum sodium (p<0.001).Conclusion:Those with older age and lower sodium levels appear to have higher lithium levels, concordant with existing literature. Serum lithium levels showed a slight but significant elevation in Aug-Oct compared to Nov-Jan and Feb-April. This finding can be explored further with respect to weather variables including temperature and humidity for same period.

484. Identification of Early Features to Differentiate Hospitalized Children Admitted for Suspected MIS-C from Alternative Diagnoses

BackgroundMulti-system inflammatory syndrome in children (MIS-C) is a rare consequence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). MIS-C shares features with common infectious and inflammatory syndromes and differentiation early in the course is difficult. Identification of early features specific to MIS-C may lead to faster diagnosis and treatment. We aimed to determine clinical, laboratory, and cardiac features distinguishing MIS-C patients within the first 24 hours of admission to the hospital from those who present with similar features but ultimately diagnosed with an alternative etiology.MethodsWe performed retrospective chart reviews of children (0-20 years) who were admitted to Vanderbilt Children’s Hospital and evaluated under our institutional MIS-C algorithm between June 10, 2020-April 8, 2021. Subjects were identified by review of infectious disease (ID) consults during the study period as all children with possible MIS-C require an ID consult per our institutional algorithm. Clinical, lab, and cardiac characteristics were compared between children with and without MIS-C. The diagnosis of MIS-C was determined by the treating team and available consultants. P-values were calculated using two-sample t-tests allowing unequal variances for continuous and Pearson’s chi-squared test for categorical variables, alpha set at < 0.05.ResultsThere were 128 children admitted with concern for MIS-C. Of these, 45 (35.2%) were diagnosed with MIS-C and 83 (64.8%) were not. Patients with MIS-C had significantly higher rates of SARS-CoV-2 exposure, hypotension, conjunctival injection, abdominal pain, and abnormal cardiac exam (Table 1). Laboratory evaluation showed that patients with MIS-C had lower platelet count, lymphocyte count and sodium level, with higher c-reactive protein, fibrinogen, B-type natriuretic peptide, and neutrophil percentage (Table 2). Patients with MIS-C also had lower ejection fraction and were more likely to have abnormal electrocardiogram. ConclusionWe identified early features that differed between patients with MIS-C from those without. Development of a diagnostic prediction model based on these early distinguishing features is currently in progress. Disclosures Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Quidel (Grant/Research Support, Other Financial or Material Support, Donation of supplies/kits)Sanofi (Grant/Research Support, Other Financial or Material Support, HAI/NAI testing) Natasha B. Halasa, MD, MPH, Genentech (Individual(s) Involved: Self): I receive an honorarium for lectures - it’s a education grant, supported by genetech, Other Financial or Material Support, Other Financial or Material Support; Sanofi (Individual(s) Involved: Self): Grant/Research Support, Research Grant or Support James A. Connelly, MD, Horizon Therapeutics (Advisor or Review Panel member)X4 Pharmaceuticals (Advisor or Review Panel member)

Frequency of Diabetic Ketoacidosis and Its Determinants Among Pediatric Diabetes Mellitus Patients in Northwest Ethiopia.

BackgroundDiabetic ketoacidosis (DKA) is one of the most common public health problems and is still a major child killer in sub-Saharan African countries, particularly Ethiopia. There are limited and inconclusive data in Amhara regional state; moreover, predictors for the incidence of DKA were not investigated before. Therefore, this study aimed to assess the frequency of DKA and its determinants among pediatric diabetes mellitus patients in public hospitals in northwest Ethiopia.MethodsAn institutional-based retrospective follow-up study was conducted from September 2015 to February 2018 at selected public hospitals in northwest Ethiopia. A simple random sampling method was used to select 389 study subjects. Statistical analysis was done by R-studio version 1.1.4. Akakia’s information criteria was used for model comparison and the negative binomial regression model was fitted to identify determinants for the frequency of DKA. An adjusted incidence rate ratio with 95% confidence interval was used to declare statistical significance.ResultsThe average frequency of DKA was 1.01 per individual. The incidence rate of DKA was increased among diabetes mellitus patients with an infection (adjusted incidence rate ratio (AIRR) = 1.41, 95% CI = 1.05–2.14), heart diseases (AIRR = 4.1, 95% CI = 1.17–14.68), treatment discontinuation (AIRR = 2.91, 95% CI = 2.02–4.22), low level of sodium (AIRR = 1.88, 95% CI = 1.22–2.89) and low dose of treatment at baseline (AIRR = 0.96, 95% CI = 0.94–0.97).ConclusionHaving an infection, heart diseases, taking a low dose of treatment, a low sodium level, and treatment discontinuation were the factors that increase the frequency of DKA.

Abstract 11852: Prognostic Value of B-type Natriuretic Peptide Reduction and Uric Acid Levels as Predictors of 30-day Re-Admission in Patients With Acute Decompensated Heart Failure With Preserved Ejection Fraction

Introduction: There is limited data comparing re-admission outcomes in patients with heart failure with preserved ejection fraction (HFpEF). This study aimed to determine the prognostic value of B-natriuretic peptide (BNP) level reduction and uric acid levels in hospitalized HFpEF patients. Hypothesis: Higher BNP level reduction and uric acid levels are associated with higher 30-day re-admission rates. Methods: This was a multi-center retrospective analysis of 3,398 patients admitted with acute decompensated HFpEF from January 2017 to December 2019. HFpEF was defined as a left ventricular function ≥ 50% and at least stage I diastolic dysfunction. Outcomes were defined by 30-day re-hospitalization rates for the two groups in the inpatient setting. Baseline characteristics, cardiovascular risk factors, admission laboratory data (troponin, sodium, hemoglobin A1c, uric acid), vital signs, length of stay and time to readmission due to heart failure exacerbation were gathered and compared. Results: The median age was 75.5 years and the mean length of stay was 11.1 days. The mean BNP at admission was 910 and the second BNP following standard therapy was 786. The median percent change in BNP was found to be 16.95%. Of the hypothesized clinical predictors of re-admission, we found that none of them; including change in BNP reduction and uric acid, were predictive of re-admission. Those who were re-admitted had lower sodium levels (136.6±5.86 vs 137.0±6.07, p=0.06), while improved creatinine levels (1.94±1.31 vs 2.06±1.66, p=0.02) was associated with re-admission for unclear reasons. For those patients who are white, the odds of experiencing re-admission is 1.54 times more likely compares to those who are of other race. Conclusions: Lower sodium levels and lower creatinine levels were found to be important risk factors for readmission. None of the hypothesized clinical variables including BNP reduction and uric acid predicted re-admission except for white race, which we feel is a surrogate for socioeconomic status. These findings underline the need for further studies and complexity in planning re-admission prevention algorithms in HFpEF patients.

Machine Learning Model for Outcome Prediction of Patients Suffering from Acute Diverticulitis Arriving at the Emergency Department-A Proof of Concept Study.

Background & Aims: We aimed at identifying specific emergency department (ED) risk factors for developing complicated acute diverticulitis (AD) and evaluate a machine learning model (ML) for predicting complicated AD. Methods: We analyzed data retrieved from unselected consecutive large bowel AD patients from five hospitals from the Mount Sinai health system, NY. The study time frame was from January 2011 through March 2021. Data were used to train and evaluate a gradient-boosting machine learning model to identify patients with complicated diverticulitis, defined as a need for invasive intervention or in-hospital mortality. The model was trained and evaluated on data from four hospitals and externally validated on held-out data from the fifth hospital. Results: The final cohort included 4997 AD visits. Of them, 129 (2.9%) visits had complicated diverticulitis. Patients with complicated diverticulitis were more likely to be men, black, and arrive by ambulance. Regarding laboratory values, patients with complicated diverticulitis had higher levels of absolute neutrophils (AUC 0.73), higher white blood cells (AUC 0.70), platelet count (AUC 0.68) and lactate (AUC 0.61), and lower levels of albumin (AUC 0.69), chloride (AUC 0.64), and sodium (AUC 0.61). In the external validation cohort, the ML model showed AUC 0.85 (95% CI 0.78–0.91) for predicting complicated diverticulitis. For Youden’s index, the model showed a sensitivity of 88% with a false positive rate of 1:3.6. Conclusions: A ML model trained on clinical measures provides a proof of concept performance in predicting complications in patients presenting to the ED with AD. Clinically, it implies that a ML model may classify low-risk patients to be discharged from the ED for further treatment under an ambulatory setting.

Antiurolithiatic activity of Didymocarpous pedicellata R. Br.

Didymocarpous pedicellata R.Br. (Gesneriaceae), also known as stone flower, is a valuable medicinal plant growing in the subtropical Himalayas (India). It is traditionally used for treating kidney and bladder stones and is the main ingredient of herbal formulations used to treat kidney stones, such as Cystone and Safoof-e-Pathr Phori (SPP). The present study explored the antiurolithiatic effect of Didymocarpous pedicellata leaves (DPL) in urolithiasis caused by ethylene glycol in Wistar male rats. The EG-induced urolithiasis group exhibited significantly higher (P < 0.001) serum creatinine, blood urea nitrogen, tissue lipid peroxidation, and urinary calcium levels, and significantly lower (P < 0.001) urinary potassium and sodium levels than the standard control group. DPL treatment (200 and 300 mg/kg) exhibited significantly (P < 0.001) lower urine and serum markers than toxicant rats. The histological investigation demonstrated refractile crystals and extensive damage to proximal tubules causing dilation in EG-induced urolithiasis rats. However, Didymocarpous pedicellata treatment of 300 mg/kg exhibited the absence of crystals and reduced kidney tissue damage, thus protecting against urolithiasis and nephrotoxicity. Therefore, DPL (300 mg/kg) is useful in the management of urolithiasis.

Proline accumulation, ion homeostasis and antioxidant defence system alleviate salt stress and protect carbon assimilation in bread wheat genotypes of Omani origin

In this study, the responses of bread wheat genotypes of Omani origin to salt stress (40, 80, and 120 mM NaCl) were evaluated to elucidate the salt tolerance mechanism. The tested bread wheat genotypes varied significantly for their responses to different levels of salt stress. A significant decrease in plant growth and carbon assimilation was noted under salt stress and this reduction increased with an increase in salinity levels. However, salinity caused a significant increase in the tissue sodium and chloride, malondialdehyde contents, leaf proline, and activities of antioxidant enzymes. The genotype SIS-12 was least affected for growth and carbon assimilation under all levels of salt stress. This genotype also had the lowest tissue sodium and leaf malondialdehyde contents, and the highest proline and catalase activity under all levels of salt stress. This was followed by genotypes Sayreea and Messani Black whereas the genotypes Bahree, Messani White, Waleedi and Cooley were sensitive to salt stress. The microsatellite loci showed a high value of polymorphism information content (PIC) ranging from 0.73 to 0.87, with an average of 0.81 PIC. The genotypes with higher proline, activities of catalase and superoxide dismutase, and lower tissue sodium and chloride levels were better able to sustain growth under salt stress. These traits and a moderate level of genetic diversity in Omani wheat genotypes can be used in future breeding programs to develop salt-tolerant wheat genotypes.

Fetuin-A and sodium concentrations are independently associated with all-cause mortality in patients awaiting heart transplantation.

End‑stage heart failure (HF) is a clinical condition with complex pathophysiology and poor prognosis. This study aimed to identify factors associated with mortality during a 1.5‑year follow‑up in patients with end‑stage HF. We prospectively analyzed 72 patients hospitalized with end‑stage HF. During right heart catheterization, 10 ml of coronary sinus (CS) blood was collected. The endpoint was all‑cause mortality during a 1.5‑yearfollow‑up. We used a multivariable logistic regression model to find factors associated with all‑cause mortality. We created 2 separate models for CS fetuin and peripheral blood (PB) fetuin. The median (interquartile range) age of the patients was 58 (50-61.50) years. During the follow‑up, 43.1% of the patients died. Lower levels of fetuin‑A in the CS (OR, 1.103; 95% CI, 1.045-1.164; P <0.001, per 10-unit decrease in fetuin concentration) and PB samples (OR, 1.098; 95% CI, 1.046-1.153; P <0.001, per 10-unit decrease in fetuin concentration), along with lower plasma sodium levels (OR, 1.563; 95% CI, 1.134-2.156; P = 0.006 in the first model and OR, 1.639; 95% CI, 1.209-2.227; P = 0.002 in the second model; per 1-unit decrease in sodium concentration) were independently associated with death during the follow‑up period. The area under the receiver operating characteristics curve (AUC) indicated a good prognostic power of CS and PB fetuin‑A levels (AUC, 0.917 and AUC, 0.850, respectively) and an acceptable prognostic power of sodium concentration (AUC, 0.788). Lower levels of CS and PB fetuin‑A, as well as lower sodium levels, are associated with an increased risk of death in patients with end‑stage HF.

Drugs associated with drug-induced hyponatremia

Hyponatremia (HN) is a significant disturbance of the water-electrolyte balance in clinical practice. Drugs are one of the leading causes of low sodium level. Antidepressants, antiepileptic, antipsychotic, antineoplastic drugs and opioid analgesics are the most common medications that induce hyponatremia. Special attention should be paid to people with cancer, who often receive several drugs that induce HN. Risk factors for the development of drug-induced (DI) HN when taking most medications are female sex, weight loss, and old age. In persons receiving therapy with the listed drugs, it is necessary to assess the risk factors for a decrease in the sodium level, clinical manifestations from the nervous system, and to determine the sodium level in dynamics. Special care must be taken when treating elderly patients, since they have several risk factors for the development of DI HN. These measures will help prevent the development of HN and its severe and sometimes fatal complications.

Laboratory parameters between multisystem inflammatory syndrome in children and Kawasaki disease.

Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) has been described to partially overlap with Kawasaki disease (KD) with regard to clinical symptoms, but they are unlikely to share the same disease entity. We conducted a systematic review and meta-analysis to characterize the laboratory parameters of MIS-C compared with those of KD and Kawasaki disease shock syndrome (KDSS). Databases were searched for studies on laboratory parameters of MIS-C (hematology, inflammatory markers, cardiac markers, and biochemistry) through May 31, 2021. Twelve studies with 3073 participants yielded 969 MIS-C patients. In terms of hematology, MIS-C patients had lower levels of leukocytes, absolute lymphocyte count and platelet count (PLT) than KD patients and had similar absolute neutrophil count (ANC) and hemoglobin (Hb) levels. In terms of inflammatory markers, MIS-C patients had higher levels of C-reactive protein, D-dimer and ferritin than KD patients and had similar levels of procalcitonin and erythrocyte sedimentation rate (ESR). In terms of cardiac markers, MIS-C patients had higher CPK levels than KD patients. The levels of N-terminal pro-brain natriuretic peptide, troponin and aspartate aminotransferase were not significantly different between MIS-C and KD patients. In terms of biochemistry, MIS-C patients had lower levels of albumin, sodium and alanine aminotransferase and higher levels of creatinine than KD patients. In addition, MIS-C patients had lower levels of PLT, Hb and ESR and higher levels of ANC than KDSS patients. Measurement of laboratory parameters might assist clinicians with accurate evaluation of MIS-C and further mechanistic research.