Background and Clinical Significance: Overlap of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) in children is a rare but life-threatening metabolic emergency. The coexistence of hyperosmolality and ketoacidosis increases neurologic vulnerability and complicates fluid and insulin management. Early identification and osmolality-guided therapy are essential to prevent cerebral edema and other complications. This case describes a 5-year-old boy with new-onset type 1 diabetes mellitus (T1D) presenting with DKA/HHS overlap two weeks after influenza vaccination—an unusual temporal association without proven causality. Case Presentation: A previously healthy 5-year-old presented with progressive polyuria, polydipsia, nocturnal enuresis, fatigue, and drowsiness. Two weeks earlier, he had received the influenza vaccine. Examination revealed moderate dehydration without Kussmaul respiration or altered consciousness. Laboratory evaluation showed glucose 45.9 mmol/L (826 mg/dL; reference 3.9–7.8 mmol/L), venous pH 7.29 (reference 7.35–7.45), bicarbonate 12 mmol/L (reference 22–26 mmol/L), moderate ketonuria, and measured serum osmolality 344 mOsm/kg (reference 275–295 mOsm/kg), fulfilling diagnostic criteria for DKA/HHS overlap. After an initial 20 mL/kg 0.9% NaCl bolus, fluids were adjusted to maintenance plus approximately 10% deficit using 0.45–0.75% NaCl according to sodium/osmolality trajectory. Intravenous insulin (approximately 0.03–0.05 IU/kg/h) was initiated once blood glucose no longer decreased adequately with fluids alone and had stabilized near 22.4 mmol/L (≈400 mg/dL). Dextrose was added when glucose reached 13.9 mmol/L (250 mg/dL) to avoid rapid osmolar shifts. Hourly neurological and biochemical monitoring ensured a glucose decline of 2.8–4.2 mmol/L/h (50–75 mg/dL/h) and osmolality decrease ≤3 mOsm/kg/h. The patient recovered fully without cerebral edema or neurologic sequelae. IA-2 antibody positivity with low C-peptide and markedly elevated HbA1c confirmed new-onset T1D. Conclusions: This case highlights the diagnostic and therapeutic challenges of pediatric DKA/HHS overlap. Osmolality-based management, conservative insulin initiation, and vigilant monitoring are crucial for preventing complications. The temporal proximity to influenza vaccination remains incidental.

Introduction: Ataxia is defined as impaired coordination of voluntary motor activity. Clinical features include broad-based gait, tremor, truncal instability, dysarthria, and nystagmus. In most children, gait disturbance is the predominant symptom; However, cerebellar dysfunction may also manifest as fine motor impairment or tremor. Post-infectious cerebellitis is a rare but important cause of acute ataxia in pediatrics. Case Presentation: We report the case of a 10-year-old male who presented to the pediatric emergency department with a 5-day history of acute gastroenteritis, showing moderate dehydration, oral intolerance, persistent vomiting, asthenia, and adynamia . Twelve days before admission, he had a respiratory infection with fever, treated with cefotaxime for 7 days. Neurological examination revealed dysarthria, horizontal nystagmus, mildly decreased tone, dysdiadochokinesia, dysmetria, truncal and lateropulsion gait ataxia, impaired tandem gait, and intention tremor. Pediatric neurology evaluation confirmed the diagnosis of post-infectious cerebellitis , with a pancerebellar syndrome. Management and Outcome: Systemic corticosteroid therapy was initiated, leading to clinical improvement and remission of neurological symptoms. Conclusion: Post infectious cerebellitis should be considered in pediatric patients presenting with acute ataxia and a recent infectious history. Early recognition and appropriate management are crucial to ensure favorable outcomes and avoid unnecessary interventions.

The mechanism of optimized two-step osmo-protection in regulating the cell homeostasis of 'Light Yellow' Petunia × Calibrachoa callus.

Subcutaneous infusion: Indications, practical considerations, and tolerability

In this study, the transformation of 2,5-furandicarboxylic acid (FDCA) to 2,5-bis(aminomethyl)furan (BAMF) is proposed and investigated for the first time. Using FDCA as the substrate, the process involves two key steps: first, converting FDCA to 2,5-dicyanofuran (DCF) via carboxy-cyanation, followed by the heterogeneous catalytic hydrogenation of DCF to produce BAMF. For the carboxy-cyanation, two ammoniation routes were compared, including the molten ammoniated dehydration route and the moderate ammoniated dehydration route. The difference between the ammoniation of bio-based cyclic dicarboxylic acid and that of petroleum-based aliphatic dicarboxylic acid was discovered. A moderate ammoniated dehydration route that is more suitable for bio-based cyclic dicarboxylic acid has been developed. SOCl2 was found to effectively activate the stable carboxyl group and act as a dehydrating agent, facilitating the dehydration of the intermediate 2,5-furandicarboxamide (FDAM) to DCF with higher efficiency. For the hydrogenation reaction of DCF, Raney Co exhibited excellent catalytic performance, achieving a 94.5% yield of BAMF from DCF. Based on industrial practice, this research represents the first exploration of the pathway from bio-based FDCA to BAMF, which opens a new line for the sustainable production of bio-based diamines.

Objective. To determine the clinical features of antibiotic-associated diarrhea (AAD) in young children, to compare differences between infectious and non-infectious forms, and to assess patterns of fever response, dehydration, and the distribution of key symptoms. Materials and Methods. A total of 140 children aged 1 month to 3 years, hospitalized with clinically confirmed AAD following antibacterial therapy, were analyzed at the Samarkand State Medical University and the Samarkand Multidisciplinary Medical Children’s Center during 2023–2025. Results. Higher body temperatures (38–39 °C and >39 °C) were more frequent in infectious forms. In the Cl.difficile (Cl+) group, meteorism (82.3%), loss of appetite (67.7%), and abdominal pain (53.2%) predominated. In the non-infectious form, mild to moderate dehydration was more frequently observed. Conclusion. AAD in early childhood varies depending on its etiology: infectious forms are associated with a stronger inflammatory response, while the Cl+ phenotype has distinctive clinical indicators. In contrast, non-infectious forms are characterized predominantly by mild to moderate dehydration.

In developing countries like Vietnam, childhood diarrhea remains frequent and is often treated empirically without an etiological diagnosis. Patients aged under five years, hospitalized at a gastroenterology department with acute diarrhea, were recruited at one hospital. Enteric pathogens were tested by real-time PCR. 451 children with diarrhea were included, 65.2% were male. 56.3% were aged under 12 months. Upon inclusion, 49.7% (224/451) had nausea and vomiting, and 17.5% had bloody diarrhea. 27.1% of children had a fever, and 37.7% and 4.2% had moderate and severe dehydration, respectively. Almost all patients (437/451, 96.9%) received empirical antimicrobial treatment. 76.5% of children were positive for at least one pathogen, with 37.9% positive for two to four pathogens. Adenovirus, norovirus, and enterovirus were the most frequent viruses detected, with a proportion of 35.7%, 25.7%, and 20.6%, respectively, while Campylobacter jejuni was the most frequent bacterium detected (14.2%), followed by Salmonella spp. and Escherichia coli pathotypes. Male gender, patients positive for at least one virus, and rotavirus were associated with an increased risk of severe disease (OR = 1.55, p = 0.04, OR = 2.23, p < 0.001, and OR = 1.86, p = 0.03, respectively). These findings underscore the complex interplay of viral and bacterial pathogens in pediatric diarrheal illness and highlight the need for targeted interventions focusing on appropriate diagnostic strategies, antimicrobial stewardship, and gender-specific considerations to mitigate the burden of childhood diarrhea in resource-limited settings like Vietnam.

Background: Acute watery diarrhea (AWD) remains a leading cause of death in children. Probiotics, when used alongside standard therapy, can improve clinical outcomes. Objective: To compare the effectiveness of Bacillus clausii versus Saccharomyces boulardii, each combined with zinc and oral rehydration solution (ORS), in the management of AWD in children. Method: This randomized controlled trial was conducted in the Department of Pediatric Medicine, Children’s Hospital Lahore, from April to September 2023. Sixty children aged 3 months to 5 years with AWD and mild to moderate dehydration were randomly assigned to Group A (Bacillus clausii + Zinc + ORS) or Group B (Saccharomyces boulardii + Zinc + ORS). Primary outcomes were stool frequency and consistency; secondary outcome was hospital stay duration. Results: In a total of 60 children, 30 each group, 28 (46.7%) were male. Both groups showed decreased stool frequency from day 1 to day 5. Group A reduced from 4.43 ± 1.72 to 1.56 ± 0.57 stools per day, while Group B decreased from 4.96 ± 1.56 to 1.76 ± 0.63 stools per day. Group A had a higher efficacy rate (96.7%) compared to Group B (90%) and faster symptom improvement (2.48 ± 0.74 days vs. 3.14 ± 1.06 days, p = 0.007). Group A had a shorter mean hospital stay (34.86 hours vs. 48.40 hours, p=0.014). Conclusion: Bacillus clausii in comparison to Saccharomyces boulardii is more effective in reducing the duration as well as frequency of diarrhea in children.

Background: Acute gastroenteritis (AGE) is a common disease observed in emergency departments (ED). Most cases of AGE are of viral causes and are self-limiting; however, in some patients, this can lead to acute kidney injury (AKI), which can lead to serious complications. Several variables have been studied to diagnose and measure the extent of morbidity due to these conditions, with neutrophil gelatinase-associated lipocalin (NGAL) being important. The present study was conducted with the aim to ascertain whether plasma NGAL levels can be used as a marker for diagnosing AKI in patients with dehydration due to AGE. Patients and Methods: A prospective cohort study was conducted among patients admitted to the ED of a tertiary healthcare centre between the years 2015 and 2017. Patients aged between 15 and 65 years who were diagnosed with AGE were included in the study. Patients with known major comorbidities or drug use were excluded from this study. The classification of dehydration was calculated in conjunction with measurements of plasma NGAL, serum creatinine (SCr), and blood urea nitrogen. Results: Of the 50 selected patients, most participants (72%) reported a SCr &lt; 1.1 (normal). Plasma NGAL levels &gt;100 ng/mL were observed among 44% patients, while 28% had plasma NGAL &lt;100. There was a significant difference (p &lt; 0.001) between the mean plasma NGAL levels in patients with mild dehydration (104.88 ± 51.38 ng/mL) when compared to those with moderate dehydration (243.83 ± 120.62 ng/mL). SCr also showed a similar trend with p &lt; 0.002, with mean SCr of mild and moderately dehydrated groups being 0.78 ± 0.23 and 1.03 ± 0.30, respectively. Plasma NGAL and SCr levels showed a significant positive correlation (r = 0.486; p &lt; 0.001), whereas plasma NGAL and glomerular filtration rate showed a significant negative correlation (r = −0.428; p &lt; 0.002). Conclusion: Mild and moderately dehydrated AGE patients had significantly higher plasma NGAL concentrations, even in the early stages, with normal SCr values. Plasma NGAL levels may be used as an early biomarker to identify adults with mild or moderate dehydration who are at increased risk for developing AKI.

Impacts of projected precipitation decline on water balance in the black land crab, (Gecarcinus ruricola) in The Bahamas.

Introduction: Acute gastroenteritis is a leading cause of dehydration in children and is commonly encountered in healthcare settings. It presents with symptoms such as diarrhea and vomiting, which lead to significant fluid and electrolyte loss. If not managed promptly, dehydration can result in serious complications, including death. Oral rehydration therapy (ORT) has long been recommended as a first-line, effective treatment for mild to moderate dehydration in pediatric patients. This study aimed to evaluate the effectiveness of oral rehydration solution (ORS) in treating dehydration caused by acute gastroenteritis in children. Methods: This descriptive case study involved two male pediatric patients, aged 1 and 2 years, who presented with dehydration due to gastroenteritis. The intervention included administration of ORS at a dosage of 40–100 ml/kg within the first 4–6 hours, accompanied by clinical monitoring over three days. Clinical parameters observed included frequency of defecation, skin turgor, oral mucosa condition, eye appearance, and level of consciousness. Results: Both patients showed improvement in clinical signs of dehydration. The frequency of defecation decreased from 4–5 times to 1–2 times per day. Skin turgor normalised, oral mucosa became moist, eyes appeared less sunken, and both children became more active and responsive. No adverse effects were reported, and both subjects responded positively to the therapy. Conclusion: Oral rehydration therapy using ORS effectively manages dehydration caused by acute gastroenteritis in children. It is a safe, simple, and accessible method that can be utilised in clinical settings and at home as a first-line response to dehydration

BackgroundIn calves with diarrhea, it is critical to accurately determine the severity of dehydration and provide adequate fluid therapy. However, objective criteria are still limited. The aim of this study, a prospective cohort diagnostic study, is to compare caudal vena cava maximum diameter with expiration (CVCmax), caudal vena cava minimum diameter with inspiration (CVCmin), and caudal vena cava collapsibility index (CVC-CI) measurements before and after fluid therapy and to establish cut-off values for distinguishing between moderately and severely dehydrated calves. Twenty-four calves, with their degree of dehydration assessed based on enophthalmos and skin elasticity duration, were divided into two equal groups. Group I: consisted of 12 calves with an estimated degree of dehydration of 8–10% and were considered moderately dehydrated (degree of enophthalmos 4–6 mm, skin elasticity duration (s) 2–5). Group II: consisted of 12 calves with an estimated degree of dehydration 10–12% and were considered severely dehydrated (degree of enophthalmos 6–8 mm, skin elasticity duration (s) 5–10). Clinical examination, complete blood count and blood gas analysis, hemodynamic parameters (heart rate, respiratory rate, capillary refill time (CRT), L-lactate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP)) and ultrasonographic examinations were performed for 48 h: before treatment (hour 0), immediately after the first fluid bolus, and at hours 8, 24, and 48 after the first fluid bolus. The Friedman test was used for within-group comparisons over time, and the Mann-Whitney U test was used for between-group comparisons at different time points. Categorical data were analysed using the chi-squared test, and Fisher’s exact test was used when expected cell counts were less than 5. Receiver operating characteristic (ROC) analysis was performed to determine the sensitivity, specificity, and cut-off (lower limit) of CVC diameter and CVC-CI (%) compared with selected parameters (SBP, DBP, MAP, and L-lactate) to discriminate between moderate and severe dehydration. Statistical significance was set at P < 0.05.ResultsCVCmax and CVCmin increased significantly after treatment in diarrheic calves (P < 0.05). Additionally, a significant decrease in CVC-CI (%) was observed in the treated diarrheic calves. Receiver operating characteristic (ROC) analysis showed that the area under the curve (AUC) of CVCmax was 0.885 (95% CI: 0.823–0.946; P < 0.001), with 82% sensitivity and 85% specificity at the intercept point of 1.05, the AUC of CVCmin was 0.913 (95% CI: 0.861–0.964; P < 0.001), with 89% sensitivity and 84% specificity at the intercept point of 0.66, and were the most reliable parameters in differentiating between moderate and severe dehydration.ConclusionA significant increase in CVCmax and CVCmin diameters, along with a significant decrease in CVC-CI, was observed with fluid therapy. The CVCmax and CVCmin diameters can provide valuable information for distinguishing between moderately and severely dehydrated calves.

Dehydration continues to be a major contributor to morbidity and mortality in children globally. Oral rehydration salts (ORS) solutions can successfully treat mild to moderate dehydration. However, the uptake of this simple and cost-effective intervention remains low in both high-income and low-to-mid-income countries. The low-osmolality ORS solution recommended by the World Health Organization (WHO) contains an appropriate balance of electrolytes and glucose that helps effectively absorb water and electrolytes, irrespective of the cause of gastroenteritis. ORS solution can be administered orally in most cases of mild to moderate dehydration; however, a nasogastric tube can be used in cases of oral intolerance in selected cases. The amount of ORS solution required for rehydration depends on the estimates of fluid losses and the child's weight. Severe dehydration could be managed with intravenous fluids initially; however, oral rehydration therapy can be used as soon as the patient is stable. The few contraindications for the use of oral rehydration solution include altered mental status, inability to tolerate oral or nasogastric intake of fluids, underlying gastrointestinal problems such as ileus, anatomical abnormalities, and gut malabsorption. This review describes the use of different ORS solutions in the United States and discusses the newly studied, non-glucose-based ORS solutions. The review also discusses hydration strategies for fluid loss during exercise and in hot environments.

Plasmalyte versus saline solution for rapid rehydration in gastroenteritis: prospective observational study.

Background.Effective cholera outbreak response requires accurate bedside rapid diagnostic tests (RDTs) because access to laboratories is often limited. Formative studies suggest cholera diagnostics have multiple vulnerabilities, including antibiotics and predation by bacteriophage (‘phage’) specific to Vibrio cholerae (Vc).Methods.We conducted a prospective nationwide study in Bangladesh among over 2000 patients with diarrhoeal disease to characterize how these vulnerabilities impact RDT performance. Assays included culture, qPCR and mass spectrometry.Findings.With the current gold standard of culture or qPCR Vc positivity, we found no effect of phage on RDT performance. When the diagnostic criteria were expanded to include phage, there was a small decrease in RDT sensitivity. In contrast, large increases in sensitivity and specificity were observed among patients with moderate and severe dehydration. Using the expanded definition, the odds of RDT positivity decreased among cholera patients with phage exposure. The effect was most robust among patients with severe dehydration. Antibiotic were detected in over 80% of samples by LC-MS/MS which limited testing for effects on RDTs. Applying these findings, we estimated that restricting RDT use to severe patients with no reported antibiotic exposure increases sensitivity by 50% compared to unrestricted use. If phage were a diagnostic proxy for Vc, we estimate RDT would miss an additional 17% of cholera cases.Interpretation.Cholera RDTs have critical limitations that require consideration in global deployments. Inclusion of phage detection in diagnostic criteria may improve case detection which requires further study. The impact of these findings likely extends to other diseases where diagnostics share similar vulnerabilities.

Background: Worldwide, diarrheal disease continues to be a leading cause of pediatric morbidity and mortality, particularly in areas with limited resources. Acute kidney damage (AKI) is a dangerous but avoidable consequence that is frequently brought on by electrolyte imbalance and dehydration from diarrhea. Improving outcomes for children and minimizing long-term kidney impairment require early detection and intervention. Objective: to evaluate related clinical parameters, including the degree of dehydration, length of illness, and laboratory abnormalities, and to ascertain the prevalence of acute kidney damage (AKI) in children admitted with severe diarrhea to a tertiary care hospital in Quetta, Pakistan. Methods: 200 children with acute diarrhea, ages 1 month to 12 years, were enrolled in this six-month observational study. Individuals with congenital urinary tract abnormalities or a history of renal disease were not included. Using the most recent KDIGO criteria, AKI was diagnosed and staged following clinical evaluation and laboratory testing. Results: Acute kidney injury (AKI) occurred in 24% of the 200 children who were admitted with acute diarrhea. In 88% of instances, there was severe or moderate dehydration, and the majority of affected children were younger than five. All individuals with AKI had elevated blood urea nitrogen (BUN), and almost all had elevated serum creatinine. 64.6% of AKI cases had metabolic acidosis and electrolyte abnormalities, especially those involving salt and potassium. 43.8% were in Stage 1, which indicates early but perhaps reversible kidney damage, based on KDIGO staging. Conclusion: AKI was observed in 24% of children with acute diarrhea, which is frequently associated with severe dehydration and delayed treatment. The majority of instances were in the early stages, indicating that they might be reversible with prompt treatment. In order to stop progression and long-term renal impairment, the study emphasizes the importance of early diagnosis, timely rehydration, ORS use, and increased clinical awareness.

Diarrhea is a change of the feces form as well as an increase of the frequency of defecation more than three times in 24 hours. Causes of diarrhea can be either infection or non-infection. The cause of infectious diarrhea that is often unnoticed is intestinal parasite infection. Epidemiologically, there is not much data about intestinal parasite infection in diarrhea patients. The aim of this study is to describe the description of intestinal parasite infection in feces specimen of diarrhea patients that treated at the pediatric ward of Dr. M. Djamil Padang Hospital in 2016-2021 .This research is a descriptive observational research using secondary data from the medical records of diarrhea patients that treated at the pediatric ward. The sample includes all that fulfilled the criteria, with total 108 patients. The data were analyzed using univariate analysis. The results showed that the majority of patients were in the age between 0 to 5 years old (56,5%) and male (33.8%). Most diarrhea was acute diarrhea (97,2%) with mild to moderate dehydration (76,9%). Patients that infected by intestinal parasite were found in three people (2.8%) with the same parasite which was Entamoeba histolytica in the cyst stage, and also there were no helminth found in this research. Laboratory examination showed that all three had normal Hb and leukocyte levels, there was no blood in the feces and one had mucus in the feces. Three diarrhea patients that infected by intestinal parasite were given rehydration therapy (100%) and antiparasitic drug such as metronidazole (100%). The conclusion of this study is all of the feces specimens of diarrhea patients from this research described that the diarrhea was not caused by intestinal parasites.

Pyropia haitanensis (T.J. Chang and B.F. Zheng) undergoes periodic dehydration and rehydration cycles, necessitating robust adaptive mechanisms. Despite extensive research on its physiological responses to desiccation stress, the comprehensive metabolic pathways and recovery mechanisms post-rehydration remain poorly understood. This study investigated the metabolic responses of P. haitanensis to varying degrees of desiccation stress using LC-MS and UPLC-MS/MS. Under mild dehydration, the thallus primarily accumulated sugars and proline, while moderate and severe dehydration triggered the accumulation of additional osmoprotectants like alanine betaine and trehalose to maintain turgor pressure and water retention. Concurrently, the alga activated a potent antioxidant system, including enzymes and non-enzymatic antioxidants, to counteract the increased reactive oxygen species levels and prevent oxidative damage. Hormonal regulation also plays a crucial role in stress adaptation, with salicylic acid and jasmonic acid upregulating under mild dehydration and cytokinins and gibberellin GA15 accumulating under severe stress. Rehydration triggered the recovery process, with indole acetic acid, abscisic acid, and jasmonic acid promoting rapid cell recovery. Additionally, arachidonic acid, acting as a signaling molecule, induced general stress resistance, facilitating the adaptation of the thallus to the dynamic intertidal environment. These findings reveal P. haitanensis' metabolic adaptation strategies in intertidal environments, with implications for enhancing cultivation and stress resistance in this economically important seaweed.

Calcium-dependent protein kinases CPK3/4/6/11 and 27 respond to osmotic stress and activate SnRK2s in Arabidopsis.

Acute Gastroenteritis (AGE) is a major contributor to morbidity, dehydration, and hospitalizations among young children in low-resource settings. Electrolyte disturbances are common complications that may worsen disease severity and outcomes. Objective: To evaluate the clinical presentation and laboratory findings, particularly serum electrolyte levels, in children aged 6 months to 3 years diagnosed with AGE, and to assess their association with dehydration severity. Methods: A descriptive-analytical cross-sectional study was conducted at MTI DHQ Hospital, Dera Ismail Khan, involving 110 children with AGE. Data on demographics, clinical features, hydration status, and laboratory results (including serum electrolytes) were recorded. Statistical analysis was performed using SPSS Version 25.0. Chi-square, ANOVA, Kruskal-Wallis, and Tukey’s HSD post-hoc tests were applied. A p-value ≤ 0.05 was considered statistically significant. Results: Vomiting (76.4%) and fever (64.5%) were the most frequent clinical features. Moderate dehydration was most common. Significant differences (p ≤ 0.05) in electrolyte levels were observed across dehydration groups: sodium, potassium, chloride, urea, and creatinine levels were elevated in severe cases, while bicarbonate and magnesium were lower. No significant associations were found between dehydration severity and demographic or most clinical variables. Conclusions: Electrolyte abnormalities were significantly associated with dehydration severity in children with AGE, emphasizing the need for routine electrolyte monitoring and individualized fluid management, especially in moderate to severe cases. These findings support improved diagnostic protocols and targeted treatment strategies in paediatric gastroenteritis care.