Oral Load Research Articles

#5079 THE EVALUATION OF RENAL FUNCTIONAL RESERVE WITH ORAL PROTEIN LOAD OR ULTRASOUND TEST: A REAL-LIFE PERSPECTIVE

Abstract Background and Aims The RFR (renal functional reserve) is the difference between the stimulated glomerular filtration rate (GFR) and the baseline GFR. This difference can be expressed in absolute terms (mL/min) or relative terms (percentage of increment relative to the baseline GFR). This index makes it possible to highlight a subclinical renal functional deterioration when the laboratory values of creatinine are still within the normal range. Measurement of RFR by protein load (1 g/kg of oral protein) (RFR-T) is now considered the gold standard for RFR assessment. RFR measured with protein load (RFR-T) predicts the risk of acute kidney injury (AKI) or chronic kidney disease (CKD) in both healthy and diseased patients and is particularly useful in patients with apparently normal renal function before stress candidate for interventions at real risk of renal failure (kidney donors, cardiac surgery, bone marrow transplants). However, the protein load test has a long duration (about 5 hours), requires numerous blood and urine samples, and is challenging to use on a large scale. Recent studies have proposed another method based on the variation of the renal intraparenchymal resistance index (IRRIV-T). In this case, the stress to which the kidney is mechanical. That is a weight (saline bag, representing 10% of the body weight) placed on the abdomen of the supine patient, which induces maximal renal vasodilation. The sampling of the intraparenchymal resistance doppler indices before and after the weight application would correlate, in preliminary studies, with the RFR tested with the protein load. Thus, offering a fast and non-invasive method. Eventually, comparing these divergent diagnostic procedures can guide us in choosing the most cost-effective approach to gain deeper insight into renal health. (Fig. 1) Method Our cross-sectional study aimed to compare the classic protein loaded RFR test (RFR-T) with the new IRRIV ultrasound test (IRRIV-T). This real-life study includes a normal-renal function population of 42 patients. Anthropometric parameters and cardiovascular risk factors were evaluated, and blood and urinary tests were performed. The inclusion criteria were: (i) age greater than 18 years; (ii) eGFR CKD-EPI > 60 mL/min/1.73 m2. Exclusion criteria were: (i) non-steroidal inflammatory drugs (NSAIDs), (ii) ultrasound evidence of renal morphological changes or artery stenosis. Each patient underwent oral protein load testing (RFR-T) and an ultrasound test (IRRIV-T). Pearson's correlation index analyzed the comparison between the 2 tests. Results There was no statistically significant correlation between RFR-T and IRRIV-T in terms of the RFR either in absolute numbers (R = 0.14, p = 0.37) or in percentage values (R = 0.15, p = 0.33). (Fig. 2) Based on our experience, the IRRIV test proved unreliable in evaluating RFR compared with the gold standard (RFR-T). Therefore, not suitable to be used as a possible alternative to the oral protein load test. Conclusion Unlike previous studies, our survey is a real-life study. Many of our patients have pathologies or take drugs that could alter the hemodynamic and the renal vascular response, consequently changing the outcome of the IRRIV test. However, it is a real-life experience that aims to offer a practical point of view, bringing to light the possible limitations of the ultrasound test when applied to a standard evaluation population and not to a healthy or highly selected population as in the only three previous works published in the literature up to now. Our work is the first original real-life study in this field.

#5993 KINETICS IN RENAL FUNCTIONAL RESERVE USING DTPA-CLEARANCE MEASUREMENTS

Abstract Background and Aims Kidneys have an intrinsic reserve capacity to respond to a higher workload by increasing filtration in their nephrons, called renal functional reserve (RFR). Despite the high clinical relevance of RFR, the necessary dynamic measurements are rarely done in the clinical routine, due to time- and workload as well as lack of standardized protocols. Method We developed a novel RFR protocol using 99mTc-DTPA (DTPA-Cl) before and after an oral protein load performed in an outpatient clinical setting within one day. Following a weak of low protein diet and using standardized hydration baseline and post-stimulation GFR were measured. 50 MBq activity were given i.v. at 0 and 240 mins, the plasma clearance was calculated based on the activity course at 13 time-points over 480 mins. RFR was expressed as the difference of post-protein stimulation peak mGFR to baseline mGFR in fasting state. Results In the pilot study we measured RFR in 7 healthy participants. The results showed a high heterogeneity. Therefore, we modified the study protocol for the next 16 patients by (a) extending the time of measurements to 330 min post-stimulation and (b) increasing the frequency of activity measurements to every 30 mins. In addition, we used a protein load of 1.5 g/kg bwt of beef protein. These standardized measurements showed inter-individual time differences in reaching the peak GFR values post-protein load, the peaks detectable between 150 to 270 mins after the protein meal. The mean RFR (±SD) was 14 (±13) ml/min/1.73 m2 corresponding to 16 (±15)% [Fig. 1]. All participants demonstrated a significant fall in DTPA-Cl 60 mins post-stimulation. Conclusion RFR can be measured with a same day pre- and post-stimulation DTPA-clearance protocol. Using a high oral load of beef protein and a long, post-stimulation period of measurements demonstrates inter-individual differences in reaching the hyperfiltration peak and a significant, previously not appreciated, post-prandial drop in GFR.

Preprocedural Viral Load Effects of Oral Antiseptics on SARS-CoV-2 in Patients with COVID-19: A Systematic Review.

(1) There are limited clinical trials to support the effectiveness of mouth rinses when used as a preprocedural rinse against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This systematic review aims to evaluate the efficacy of antiseptic mouth rinses as a preprocedural rinse in reducing SARS-CoV-2 oral viral load in-vivo. (2) Methods: A literature search was conducted through November 2022 for the following databases: PubMed, Web of Science, Cochrane Library, and Google Scholar. The evaluated outcomes were quantitative changes in viral load and the statistical significance of that change after using antiseptic mouth rinses. (3) Results: 14 randomized controlled trials (RCT) were selected for risk of bias assessment and data extraction. (4) Conclusion: Within the limits of this systematic review, preprocedural mouth rinses may significantly reduce SARS-CoV-2 in the mouth, thus, reducing the viral particles available for airborne dispersion. Preprocedural mouth rinses may be an effective strategy for reducing airborne SARS-CoV-2 dispersion in the environment. Their use may be a preventive strategy to reduce the spread of COVID-19 in selected medical and healthcare facilities, including dental clinics. Potential preprocedural mouth rinses are identified for use as an integral part of safe practice for healthcare protocols. This systematic review was registered with the National Institute for Health Research, international prospective register of systematic reviews (PROSPERO): CRD42022315177.

Effect of Mouthwash in Reducing the Oral Load of SARS-CoV-2

The use of mouthwash as an oral antimicrobial agent against SARS‐CoV‐2 infection. It is important to investigate the efficacy of mouthwash solutions against salivary SARS-CoV-2 in order to reduce the exposure of the dental team during dental procedures. This review aims to evaluate current knowledge on the effect of mouthwash in reducing the oral load of SARS-CoV-2. The article was conducted of two databases and were limited to period January 2018 to May 2023 with combination of the following keywords: “effect” and “mouthwash” and “oral” and “SARS CoV-2”. The results obtained were 21 articles found at the beginning of the search in both databases, and the 11 full text articles were selected for further review and discussion. Chlorhexidine gluconate (0.12%) was effective in reducing salivary SARS-CoV-2 load for at least 60 min. Povidone-iodine 1% oral solutions are effective preprocedural mouthwashes against SARS CoV-2 in dental treatments. Cetylpyridinium Chloride 0,05% could reduce viral load in SARS-CoV-2–positive patients. H2O2 concentrations (1.5% and 3%), verifying a minimal reduction in viral titer after 30s. Benzalkoniumchloride as antiseptic mouthrinse only mildly reduces viral infectivity in vivo, despite its high efficacy in vitro. The use of mouthwash chlorhexidine, povidone-iodine, cetylpyridinium chloride, hydrogen peroxide, benzalkoniumchloride can reduce the number of viruses, one of which is the SARS virus in the oral cavity. Antiseptics are effective in the first stage of contamination, before they enter the cell in the early period.

EPS3.02 The cystic fibrosis urine test: A comprehensive analysis of all renal acid-base parameters following acute oral bicarbonate loading

Objective: Urine HCO-3 excretion depends on renal CFTR and is markedly impaired in people with CF (pwCF). Urine HCO-3 excretion following an oral HCO-3 load may be a simple in vivo biomarker of CFTR function. Urine acid and base excretion is a function of the sum of all acids and bases. The objective of this study was to investigate the value of all urine acid-base parameters as test read-outs following oral HCO-3 loading.

MP-453091-9 COMPARISON OF TRADITIONAL THREE-DAY ORAL SOTALOL LOADING TO A SINGLE-DAY INTRAVENOUS SOTALOL INITIATION PROTOCOL: AN OBSERVATIONAL STUDY

Sotalol is an antiarrhythmic medication used to prevent atrial fibrillation (AF). In March 2020, intravenous (IV) sotalol received FDA approval to be used as a loading dose for initiation in patients with AF. The IV administration shortens the time to achieve steady-state to just one day, in comparison to a traditional three-day oral sotalol load. There is limited data comparing IV sotalol to oral sotalol loading regarding efficacy and safety. This study aims to compare the efficacy and safety of initiating a three-day oral sotalol load to a single-day IV sotalol dosing protocol in patients with AF. This is a retrospective study that included patients initiated with either IV or oral sotalol between January 2018 and August 2022 at a single academic medical center. The primary endpoint was maintenance of sinus rhythm (SR) at discharge and 30 days post initiation. The secondary endpoints included incidence of QTc prolongation >500ms, heart rate <40bpm, ventricular arrhythmias, and discontinuation of sotalol after initiation. A total of 95 patients (64.2% male) underwent a single-day IV sotalol loading protocol and 96 patients (67.7% male) received a three-day oral sotalol initiation. When comparing to the oral group at baseline, patients in the IV group were more likely to have persistent AF (77.9% vs 51%, p<0.001), advanced age (71.6 + 7.4 yrs vs 68.4 + 8.6 yrs, p=0.008), and alcohol use (45.3% vs 18.8%, p<0.001). They were also less likely to be in SR on admission (1.1% vs 16.7%, p<0.001) compared to the oral group. SR was maintained at discharge in 81.1% and 83.3% (p=0.4) and at 30-days in 59% and 66.7% (p=0.141) in the IV and oral groups, respectively. A QTc >500ms was observed at discharge in 6.6% and 9.9% (p=0.591) and at 30-days in 10.3% and 12.5% (p=0.798) in the IV and oral group, respectively. Discontinuation of sotalol during initiation occurred in 4 patients (4.2%) in the IV group and 7 patients (7.29%) in the oral group, due to adverse events such as bradycardia, QTc prolongation, and failure to maintain SR (p=0.537). No patients experienced ventricular arrhythmias. Despite more risk factors for treatment failure, AF patients initiated on sotalol therapy with IV loading achieved similar maintenance of SR at discharge and at 30 days compared to oral loading with no difference in adverse events.

Abstract #1392589: Triphasic Response of Pituitary Stalk Injury Post Traumatic Brain Injury – A Rare and Often Unrecognized Endocrine Phenomenon

The triphasic response to pituitary stalk injury encompasses an initial phase of diabetes insipidus (DI), followed by anti-diuretic hormone (ADH) mediated hyponatremia and a subsequent phase of diabetes insipidus. It is uncommonly seen post-pituitary surgery and its occurrence after traumatic brain injury (TBI) is even less recognized. We present a case of classic triphasic response post TBI. A 24-year-old Female presented to the Emergency Department after a road traffic accident where she had been flung from a motorcycle. She sustained bilateral maxillary and facial fractures, dental injuries, mild lung contusions and lacerations. She was adjudged to have mild traumatic brain injury based on computed tomography findings of small subarachnoid hemorrhage. She had initial hypernatremia with peak serum sodium of 160mmol/L, serum osmolality of 340mmol/kg and urine osmolality of 225 mmol/kg. This suggests partial DI, which improved with hypotonic fluid administration and did not require desmopressin therapy. Serum cortisol and thyroid function tests were normal. No features of pituitary apoplexy were seen on the computed tomography scan. Magnetic resonance imaging was contraindicated post-facial fracture fixation. On day 7 post injury, she developed severe hyponatremia with serum sodium nadir of 118mmol/L. The serum osmolality was 256mmol/kg and the urine osmolality was 864mmol/kg, which suggests severe ADH mediated hyponatremia. She was managed aggressively with fluid restriction, nutritional supplementation and high dose oral salt loading with good effect. After 7 days of hyponatremic phase, she developed polyuria with mild hypernatremia and dilute urine. She responded well to a trial of oral desmopressin and was discharged to a rehabilitation facility. Diabetes insipidus is an uncommon sequela of TBI. It has been attributed to pituitary vascular injury, diffuse axonal injury to the hypothalamus or direct pituitary stalk damage from trauma. It can occur in the absence of anterior pituitary failure. While severity of brain injury does correlate to likelihood of DI, permanent DI has been described even in mild TBI. As symptoms of hyponatremia or hypernatremia may be non-specific and may be masked by depressed consciousness post-injury, careful laboratory and urine output monitoring coupled with clinical vigilance is required to make the diagnosis. To avoid significant morbidity and mortality, careful use of desmopressin, sodium supplementation and fluid restriction is required. Knowledge of the expected time course and expectant titration of intervention can help to avoid rapid fluctuations in serum sodium levels.

Prevention of COVID-19 with oral vitamin D supplemental therapy in essential healthcare teams (PROTECT): protocol for a multicentre, triple-blind, randomised, placebo-controlled trial

IntroductionIn the COVID-19 pandemic, healthcare workers (HCWs) were at high risk of infection due to their exposure to COVID infections. HCWs were the backbone of our healthcare response to this...

Association between salt sensitivity of blood pressure and the risk of hypertension in a Chinese Tibetan population.

Epidemiological studies have confirmed salt sensitivity as a crucial risk factor for the development of hypertension. However, few studies have investigated the association between salt sensitivity of blood pressure (SSBP) and hypertension in Chinese Tibetan population. Therefore, we conducted a cross-sectional study based on a Tibetan population to evaluate the association between SSBP and the risk of hypertension. Seven hundred and eighty-four participants with hypertension and 645 participants without hypertension were included from five villages in Tibetan Autonomous Region of Gannan during 2013-2014. The assessment of salt sensitivity (SS) and non-salt sensitivity (NSS) was performed according to mean arterial pressure (MAP) changes by the modified Sullivan's acute oral saline load and diuresis shrinkage test (MSAOSL-DST). Logistic regression models and restricted cubic models were used to examine the association between SSBP and hypertension. There were 554 (70.5%) salt-sensitive participants with hypertension and 412 (63.9%) salt-sensitive participants without hypertension in this study. Compared with individuals with NSS, individuals with SS had a significantly increased risk of hypertension, and the multiple-adjusted odds ratios were 2.582 with 95% confidence interval of 1.357-4.912. Furthermore, a significant linear trend was found between MAP changes and hypertension. Subgroup analyses showed significant and stronger associations between SSBP and the risk of hypertension in the older (age≥55years old), males and participants who took exercise less than 1 time per week. Our results suggest that SS is associated with an increased risk of hypertension in Tibetan population, indicating a need for clinicians dealing with SSBP to decrease the risk of hypertension.

«Pressure diuresis» phenomenon: mechanisms and physiological significance in diving medical support practice: prospective cohort study

INTRODUCTION: When staying in hyperbaric conditions there is an increase in diuresis, developing a negative water balance, loss of electrolytes and tissue dehydration after diving different in depth, duration, intensity and other parameters, which can be conditionally combined into specific physiological symptom complex – “pressure diuresis” phenomenon (or “diver diuresis”). OBJECTIVE: To investigate the mechanisms of “pressure diuresis” under the action of high gaseous medium pressure and determine the physiological nature of this phenomenon in divers. MATERIALS AND METHODS: 44 men aged 19–23 were examined. In the first study all the subjects had initial sustainability to hyperbaric adverse factors (decompression gas formation – DG, hypoxic hypoxia – HH, nitrogen toxic effect – NTE and oxygen toxic effect – OTE). Hormonal status and body’s osmotic homeostasis rates were defined in all the subjects. The second study evaluated changes of the subjects’ water-electrolyte metabolism, kidney function and osmotic homeostasis during the oral loading renal test with the water load in the baseline and conditions of hyperbaric adverse factor exposure on divers. Statistics: To perform statistical analysis, application packages of Statistica for Windows 10.0 were used. RESULTS: 17 (38,6 %), 29 (65,9 %), 20 (45,5 %) and 35 (79,6 %) subjects had medium and low resistance to DG, HH, OTE and NTE, respectively; 27 (61,4 %), 15 (34,1 %), 24 (54,5 %) and 9 (20,4 %) subjects had high resistance to DG, HH, OTE and NTE. Increase in the concentration of antidiuretic hormone was identified in the diving group with low and medium resistance to NTE, HH, and OTE (by 146,8, 141,1 and 93,2 %, respectively, compared to the results before hyperbaric adverse factor exposure). The highest concentration increase of aldosterone was found among the divers with low and medium resistance to OTE, DG and HH (by 41,5, 39,1 and 36,2 %, respectively). The increase in blood plasma osmolality was observed in the subjects with low and medium resistance to OTE (an increase by 6,6 % compared to the divers with high resistance). A significant reduction in blood plasma osmolality was recorded in the subject group with low and medium resistance to NTE and HH (reduction by 5,2 and 4,2 %, compared to the group with high resistance). The most significant decrease in urine osmolality was identified in the diving group with low and medium resistance to DG and OTE (reduction by 14,5 and 17,7 %, respectively). A significant increase in urine osmolality under the action of hyperbaric factors was defined in the diving group with low and medium resistance to NTE and HH (by 19,8 and 19,3 %). DISCUSSION: The data obtained indicate the emergence of a new body hydration status during person’s staying in hyperbaric conditions. Body hydration status will be connected with its individual resistance to hyperbaric adverse factor effect. Thus, with the development of marked DG iso-osmotic (isotonic) hyperhydration is formed, with OTE hyperosmotic (hypertonic) hyperhydration occurs, with NTE and HH hypo-osmolar (hypotonic) hyperhydration develops. CONCLUSION: The study showed a certain connection (correlation) between types of hyperhydration in the tissues of a diver’s body, mechanisms of occurrence, low and medium initial resistance to a particular hyperbaric factor. “Pressure diuresis” phenomenon (“diver diuresis”), that occurs in divers with high resistance to hyperbaric adverse factors, will be a normal body’s physiological response, aimed at eliminating hypervolemia and reduction in the volume of circulating plasma.

A Detailed Review on Dihydropyrimidine Dehydrogenase Enzyme Deficiency-Autosomal Recessive Condition

Abstract: Dihydropyrimidine dehydrogenase deficiency (DPD) is an autosomal recessive condition. The DPD enzyme is in charge of the 5-fluorouracil drug’s metabolism. Patients having DPD deficiency, when get administered with 5-fluorouracil drug, leads to drug toxicity due to increased concentration of drug in the body. Determining the DPYD (gene encoding DPD) genotyping and DPYD phenotyping will provide the best strategy to know the DPD deficiency in patients. Tegafur and Capecitabine are available prodrugs for the 5-fluorouracil medication. Genomic techniques appear to be a superior indirect evaluation for screening DPD deficiency in the clinical environment. Other than this there are several diagnostic tests such as Uracil oral loading dose, Uracil Breath test, Rapid UPLC-UV (Ultra performance liquid chromatography-Ultravoilet) method, and DPD activity in mononuclear cells from the peripheral circulation. An antidote Uridine Triacetate is available for treating the toxicity produced by 5-FU (5-Fluorouracil) in DPD deficient patient. Hence, this review explains briefly about the DPD enzyme, its deficiency, its diagnosis, and how to manage the DPD deficient patient undergoing chemotherapy. Keywords: DPD, 5-Fluorouracil, Capecitabine, Tegafur, Uracil Breath test, Uridine triacetate.

Effect of omega-3 fatty acid ethyl esters on postprandial arterial elasticity in patients with familial hypercholesterolemia

Impaired arterial elasticity reflects increased risk of atherosclerotic cardiovascular disease in patients with familial hypercholesterolemia (FH). Treatment with omega-3 fatty acid ethyl esters (ω-3FAEEs) in FH patients has been shown to improve postprandial triglyceride-rich lipoprotein (TRL) metabolism, including TRL-apolipoprotein(a) [TRL-apo(a)]. Whether ω-3FAEE intervention also improves postprandial arterial elasticity in FH has not been demonstrated. We carried out an 8-week open-label, randomized, crossover trial to test the effect of ω-3FAEEs (4g/day) on postprandial arterial elasticity in 20FH subjects following ingestion of an oral fat load. Fasting and postprandial large (C1) and small (C2) artery elasticity at 4 and 6h were measured by pulse contour analysis of the radial artery. The area under-the-curves (AUCs) (0-6h) for C1, C2, plasma triglycerides and TRL-apo(a) were determined using the trapezium rule. Compared with no treatment, ω-3FAEEs significantly increased fasting (+9%, P<0.05) and postprandial C1 at 4h (+13%, P<0.05) and at 6h (+10%, P<0.05), with improvement in the postprandial C1 AUC (+10%, P<0.01). ω-3FAEEs also decreased postprandial triglyceride and TRL-apo(a) AUCs (-17% and-19%, respectively, P<0.05). ω-3FAEEs had no significant effect on fasting and postprandial C2. The change in C1 AUC was inversely associated with the changes in the AUC of triglycerides (r=-0.609, P<0.01) and TRL-apo(a) (r=-0.490, P<0.05). High-dose ω-3FAEEs improves postprandial large artery elasticity in adults with FH. Reduction in postprandial TRL-apo(a) with ω-3FAEEs may contribute to the improvement in large artery elasticity. However, our findings need to be confirmed in a larger population. https://www. com/NCT01577056.

The effect of high oral loading dose of cholecalciferol in non-alcoholic fatty liver disease patients. A randomized placebo controlled trial.

Background and Aim: Non-alcoholic fatty liver (NAFLD) is one of the most common progressive metabolic disorders worldwide. There are increasing scientific interests nowadays for the association between vitamin D status and Non-alcoholic fatty liver. Earlier studies have revealed that vitamin D deficiency is highly prevalent in Non-alcoholic fatty liver patients that contributes to poor outcomes. Hence, the present study aimed to assess the efficacy and safety of oral cholecalciferol on Non-alcoholic fatty liver patients. Subjects and Methods: This study was conducted on 140 patients that were randomized either to group 1 that received the standard conventional therapy in addition to placebo or group 2 that received the standard conventional therapy in addition to cholecalciferol during the 4 months study period. Results: At the end of the study group 2 revealed significant decrease (p < 0.05) in the mean serum level of TG, LDL-C, TC, hsCRP as compared to their baseline results and group 1 results. Additionally, a significant improvement in the serum levels of ALT (p = 0.001) was seen in group 2 at the end of the study when compared to group 1. Whereas group 1 did not show any change in these parameters when compared to group 2 and their baseline results. Conclusion: Cholecalciferol was shown to have beneficial effects on serum ALT levels, hsCRP levels and lipid profile of NAFLD patients. Clinical Trial Registration: https://prsinfo.clinicaltrials.gov/prs-users-guide.html, identifier NCT05613192.

Impact of nutritional compliance within ERAS protocols for hepatopancreatobiliary, radical cystectomy, and head and neck procedures: A case-matched analysis adjusted for major complications

Enhanced recovery after surgery (ERAS®) pathways aim to improve patient outcomes by applying multimodal practices before, during, and after operative procedures. Compared with standard care before ERAS, we investigated whether compliance to ERAS guidelines for nutritional care, preoperative oral carbohydrate loading and postoperative oral nutrition, was associated with a decrease in hospital length of stay (LOS) after pancreaticoduodenectomy, distal pancreatectomy, hepatectomy, radical cystectomy, and head and neck tumor resection with reconstruction. Compliance to ERAS nutrition recommendations was evaluated. Post-ERAS cohort was retrospectively analyzed. Pre-ERAS cohort consisted of case matched patients one year before ERAS: age more than or less than 65 years, body mass index (BMI) more than greater than or less than 30kg/m2, diabetes mellitus, sex, and procedure. Each cohort consisted of 297 patients. Binary linear regressions evaluated the incremental effect of postoperative nutrition timing and preoperative carbohydrate loading on LOS. Multivariate regressions adjusted for postoperative complications. Compliance with preoperative carbohydrate loading for the post-ERAS cohort was 81.7%. Mean hospital LOS was significantly shorter for the post-ERAS cohort compared with pre-ERAS cohort (8.3 vs 10.0 days, p<0.001). By procedure, LOS was significantly shorter for patients undergoing pancreaticoduodenectomy (p=0.003), distal pancreatectomy (p=0.014), and head and neck procedures (p=0.024). Early postoperative oral nutrition was associated with a 3.75-day shorter LOS (p<0.001); no nutrition was associated with a 3.29-day longer LOS (p<0.001). Compliance with ERAS protocols for specific nutritional care practices was associated with a statistically significant decrease in LOS without subsequent increases in 30-day readmission rates and positive financial impact. These findings suggest that ERAS guidelines for perioperative nutrition are a strategic pathway to improved patient recovery and value-based care in surgery.

Transcutaneous delivery of sodium bicarbonate increases intramuscular pH.

Introduction: Oral bicarbonate loading improves the buffering of metabolic acidosis and may improve exercise performance but can also result in gastric distress. Momentous' PR Lotion contains a novel composition intended to provide a transdermal delivery vehicle for sodium bicarbonate which could allow the same ergogenic effect without the gastric distress. The present study explored the effect of transdermal delivery of sodium bicarbonate in a resting condition. Methods: We measured the pH from intramuscular dialysate, via microdialysis, of the vastus lateralis during a 2h application of PR Lotion (40g of lotion per leg) in 9 subjects (3 women, 6 men). Venous blood samples were obtained for serum pH before and after application. A placebo time control was also performed in 4 subjects (2 women, 2 men). We hypothesized that PR Lotion application would increase pH of intramuscular dialysate. Results: PR Lotion resulted in a rise in pH of 0.13 ± 0.04 units (p < 0.05), which translates to a 28% reduction in [H+]. Increases in serum pH were smaller (∼9%) yet consistent (p < 0.05). In contrast, placebo time control pH tended to decrease (p = 0.08). The effect of PR Lotion on pH tended to correlate with the dose per kg body weight of each individual (r = 0.70, p = 0.08). Conclusion: These observations support the idea of transdermal bicarbonate delivery impacting pH buffering both systemically and intramuscularly. Further work investigating these potential benefits in an exercising model would be critical to establishing PR Lotion's utility as an ergogenic aid.

Oral Streptococcus mutans load among Indian children with cerebral palsy.

The motor impairments of cerebral palsy (CP) are typically accompanied by subsequent musculoskeletal issues, seizures, and abnormalities of sensation, intelligence, communication, and behaviour. These kids have a lower capacity for regulating oral health because of their poor voluntary movements. Poor oral hygiene brought on by insufficient brushing and flossing, increased use of sugary foods, and orally administered drugs puts people at risk for periodontal disorders and dental caries. Poor dental health and rising therapy demands establish a sadistic cycle that affects patient overall health and wellbeing. The purpose of this investigation was comparing kids with CP against healthy kids of comparable age group and demographic situation in order to evaluate status of oral heath, current caries behavior using measurement of Streptococcus mutans concentrations in saliva, and treatment required. 204 study participants were divided into two categories: Category A and category B. Both categories consisted of 102 study participants. Category A consisted of study participants having CP while category B consisted of healthy normal controls with same age of same demographic features. Malocclusion, trauma, DMFS/defs, gingival index, and Oral hygiene score (OHI), and were recorded for oral examinations of al study participants However, no radiological assistance was utilized since minimal patient compliance existed in CP patients. When compared with the control category, the CP category had a higher detection of the DMFS index in the permanent teeth. The estimated defs for the CP category did not differ noticeably from the control category. In the CP category, status of hygiene of oral cavity was discovered to be substantially subpar. In comparison to the control category, the gingival condition of the CP category was noticeably worse. Treatment requirements were seen to require greater preventative care in the control category while, stainless steel crowns, pulpectomy and extractions were needed in the CP category. S. mutans was found in high concentrations in the salivary specimens of the CP category compared to the control category, indicating active dental caries and greater probability of further development.

Implementation of an intravenous sotalol initiation protocol: Implications for feasibility, safety, and length of stay.

Oral sotalol initiation requires a multiple-day, inpatient admission to monitor for QT prolongation during loading. A 1-day intravenous (IV) sotalol loading protocol was approved by the United States Food and Drug Administration in March 2020, but limited data on clinical use and administration currently exists. This study describes implementation of an IV sotalol protocol within an integrated health system, provides initial efficacy and safety outcomes, and examines length of stay (LOS) compared with oral sotalol initiation. IV sotalol was administered according to a prespecified initiation protocol to adult patients with refractory atrial or ventricular arrhythmias. Baseline characteristics, safety and feasibility outcomes, and LOS were compared with patients receiving oral sotalol over a similar time period. From January 2021 to June 2022, a total of 29 patients (average age 66.0 ± 8.6 years, 27.6% women) underwent IV sotalol load and 20 patients (average age 60.4 ± 13.9 years, 65.0% women) underwent oral sotalol load. The load was successfully completed in 22/29 (75.9%) patients receiving IV sotalol and 20/20 (100%) of patients receiving oral sotalol, although 7/20 of the oral sotalol patients (35.0%) required dose reduction. Adverse events interrupting IV sotalol infusion included bradycardia (seven patients, 24.1%) and QT prolongation (three patients, 10.3%). No patients receiving IV or oral sotalol developed sustained ventricular arrhythmias before discharge. LOS for patients completing IV load was 2.6 days shorter (mean 1.0 vs. 3.6, p < .001) compared with LOS with oral load. IV sotalol loading has a safety profile that is similar to oral sotalol. It significantly shortens hospital LOS, potentially leading to large cost savings.

Feasibility and Safety of Intravenous Sotalol Loading in Adult Patients With Atrial Fibrillation (DASH-AF)

BackgroundInpatient initiation of sotalol is recommended owing to its proarrhythmic effects. ObjectivesThe DASH-AF (Feasibility and Safety of Intravenous Sotalol Administered as a Loading Dose to Initiate Oral Sotalol Therapy in Adult Patients With Atrial Fibrillation) trial evaluates the safety and feasibility of intravenous (IV) sotalol, achieving a steady state with maximum QTc prolongation within 6 hours instead of the traditional 5-dose inpatient oral (PO) titration. MethodsDASH-AF is a prospective, nonrandomized, multicenter, open-label trial consisting of patients who underwent IV sotalol loading dose to initiate rapid oral therapy for atrial arrhythmias. IV dose was calculated based on the target oral dose as indicated by baseline QTc and renal function. Patients’ QTc (in sinus) was measured via electrocardiography at 15-minute intervals and after IV loading completion. Patients were discharged 4 hours after first oral dose. All patients were monitored via mobile cardiac outpatient telemetry for 72 hours. The control group was composed of patients admitted for the traditional 5 PO doses. Safety outcomes were assessed in both groups. ResultsA total of 120 patients from 3 centers were enrolled from 2021 to 2022 in the IV loading group (compared with type of AF– and renal function–matched patients in the conventional PO loading cohort). This study demonstrated no significant change in ΔQTc in both groups, with a significantly lower number of patients requiring dose adjustment in the IV arm compared with the PO arm (4.1% vs 16.6%; P = 0.003). This led to potential cost savings of up to $3,500.68 per admission. ConclusionsThe DASH-AF trial shows that rapid IV sotalol loading in atrial fibrillation/flutter patients for rhythm control is feasible and safe compared with conventional oral loading with significant cost reduction. (Feasibility and Safety of Intravenous Sotalol Administered as a Loading Dose to Initiate Oral Sotalol Therapy in Adult Patients With Atrial Fibrillation [DASH-AF]; NCT04473807)

Association of Serum Metabolites and Salt Sensitivity of Blood Pressure in Chinese Population: The EpiSS Study.

To identify novel metabolites associated with salt sensitivity of blood pressure (SSBP) in Chinese Han population. A case-control study was conducted with 25 salt sensitive (SS) and 26 salt resistant (SR) participants, which was selected from the Systems Epidemiology Study on Salt Sensitivity of Blood Pressure (EpiSS) study. The modified Sullivan's acute oral saline load and diuresis shrinkage test (MSAOSL-DST) was conducted to identify SS. Untargeted, ultra-high performance liquid chromatograph-high resolution mass spectrometer (UPLC-HRMS) was conducted and orthogonal partial least squares-discriminate analysis (OPLS-DA) and multivariable logistic regression model were used to screen the metabolites related to SS, mixed linear regressions models were used to examined the association of SSBP with metabolites during saline load period and diuresis shrinkage period. Receiver operating characteristic (ROC) curve analysis was performed. The area under the curve's (AUC) sensitivity and specificity were calculated to identified metabolites biomarkers for SS. There were 39 differentially expressed metabolites (DE-metabolites) between SS and SR. Thirty-five and four of DE-metabolites were inversely or positively associated with SS, respectively. Four biochemical pathways demonstrated significant enrichment for identified metabolites. In single-metabolite analyses, L-Glutamine displayed the best diagnostic performance (AUC = 0.88, 95% CI: 0.78-0.97). In multi-metabolites analyses, L-Glutamine + Cholesterol ester 22:5n6 combination showed the best diagnostic performance (AUC = 0.96, 95% CI: 0.91-1.00). Adjusted for traditional risk factors, L-Glutamine and Cholesterol ester 22:5n6 explained an additional 38.3% of SS susceptibility. This study provide potential evidence for clarifying the mechanism of SS and provide novel biological insights into salt sensitive hypertension.

PS-C21-9: REVISITING ORAL SALT LOADING TEST: A NEW CHEMILUMINESCENT IMMUNOASSAY OF 24-HOUR URINE ALDOSTERONE MEASUREMENT

Primary aldosteronism (PA) is widely recognized as the most frequent cause of secondary hypertension, and its prevalence ranges from 5% to 10% in hypertensive patients. The number of patients diagnosed with PA has increased due to more frequent screening in JAPAN. PA is diagnosed by a screening test, followed by a confirmatory or exclusionary test and a subtype test using computed tomography and adrenal vein sampling. Measuring of the urinary aldosterone concentration is important in oral sodium loading test (OSLT), one of the confirmatory tests. Therefore, an accurate aldosterone measurement method is required for clinical practice. Since April 2021, the plasma aldosterone concentration has been measured by chemiluminescent enzyme immunoassay (CLEIA) in Japan. In the present study, we developed a new CLEIA using a two step sandwich method to measure the 24 hour urine aldosterone level. We collected urine samples and measured 24 hour urine aldosterone levels employing radioimmunoassay (RIA), CLEIA, and liquid chromatography tandem mass spectrometry (LC MS/MS). The results showed that the 24-hour urine aldosterone levels measured using CLEIA and LC MS/MS were significantly correlated. The 24 hour urine aldosterone levels measured using CLEIA and RIA were also significantly correlated. However, the aldosterone level measured by CLEIA was lower than that measured by RIA (slope, 0.729; intercept, 120.9). In Japan, a new guideline for primary aldosteronism has been announced, with changes in the aldosterone measurement method, and the cutoff values for oral sodium loading test (OSLT) were changed. Therefore, we examined the cut off value of the 24 hour urine aldosterone level after the OSLT. Receiver operating characteristic analysis revealed a cut off value for primary aldosteronism of 3 mcg/day.