Infusion Of Solution Research Articles

A bioadhesive pacing lead for atraumatic cardiac monitoring and stimulation in rodent and porcine models.

Current clinically used electronic implants, including cardiac pacing leads for epicardial monitoring and stimulation of the heart, rely on surgical suturing or direct insertion of electrodes to the heart tissue. These approaches can cause tissue trauma during the implantation and retrieval of the pacing leads, with the potential for bleeding, tissue damage, and device failure. Here, we report a bioadhesive pacing lead that can directly interface with cardiac tissue through physical and covalent interactions to support minimally invasive adhesive implantation and gentle on-demand removal of the device with a detachment solution. We developed 3D-printable bioadhesive materials for customized fabrication of the device by graft-polymerizing polyacrylic acid on hydrophilic polyurethane and mixing with poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS) to obtain electrical conductivity. The bioadhesive construct exhibited mechanical properties similar to cardiac tissue and strong tissue adhesion, supporting stable electrical interfacing. Infusion of a detachment solution to cleave physical and covalent cross-links between the adhesive interface and the tissue allowed retrieval of the bioadhesive pacing leads in rat and porcine models without apparent tissue damage. Continuous and reliable cardiac monitoring and pacing of rodent and porcine hearts were demonstrated for 2 weeks with consistent capture threshold and sensing amplitude, in contrast to a commercially available alternative. Pacing and continuous telemetric monitoring were achieved in a porcine model. These findings may offer a promising platform for adhesive bioelectronic devices for cardiac monitoring and treatment.

Разработка программы для персонализированного подхода в лечении субретинальных кровоизлияний

Abctract Software development for a personalized approach in the treatment of subretinal hemorrhages R.R. Fayzrakhmanov, E.D. Вosov, V.A. Bogdanova, I.I. Tumanov, G.O. Karpov N.I. Pirogov National Medical Surgical Center, Moscow, Russian Federation Institute of Advanced Training of Physicians N.I. Pirogov National Medical Surgical Center, Moscow, Russian Federation Design Bureau «Rus’», Moscow, Russian Federation Purpose. Development and clinical application of software for individual calculation of the volume of fibrinolytic infusion solution for surgical treatment of submacular hemorrhages. Material and methods. Based on the processing of optical coherence tomography data using threedimensional visualization, the program 3D volume calculator was developed. As a vitreoretinal intervention, a two-port 27G surgery was performed with controlled subretinal administration of a calculated recombinant prourokinase solution through a 38G cannula and hexafluoroethane tamponade at 20% of the volume of the vitreal cavity. Results. Developed software makes it possible to measure the volume of submacular hemorrhage, and also calculates an individualized amount of subretinal infusion solution for reliable displacement of the blood clot to the periphery. 2 weeks after surgery for submacular hemorrhage, complete dislocation was observed in 40 cases (93%). Conclusion. Сurrently, minimally invasive surgery and a personalized approach are the fundamental directions in modern ophthalmology. Application of the proposed software in clinical practice has proven its effectiveness in relation to morphological and functional perspectives in the treatment of submacular hemorrhages. Key words: submacular hemorrhage, software, calculation of fibrinolytic volume, minimally invasive surgery

Effects of induced subclinical hypocalcemia in early-lactation Holstein cows without milking during infusion on parathyroid hormone and serotonin concentrations

The transition to lactation demands a substantial amount of calcium (Ca) to support colostrum and milk production. Extensive research has been focused on elucidating the interplay between the traditional Ca-parathyroid hormone-vitamin D axis and mammary-derived factors, such as serotonin (5-HT) and parathyroid-hormone-like hormone (PTHLH), in regulating Ca metabolism during the transition period. Here, we investigate the impact of induced subclinical hypocalcemia (SCH) on 5-HT and parathyroid hormone (PTH) concentrations in early-lactation dairy cows under conditions of 24-h milk stasis. Twelve multiparous Holstein cows in early lactation received either continuous intravenous infusion of saline solution or 5% ethylene glycol tetraacetic acid (EGTA) to maintain blood ionized calcium (iCa) below 1 mM (n = 6/treatment). Blood samples were collected hourly during infusion and 4, 8, 12, 24, and 48 h post-infusion. Urine samples were collected every 4 h during infusion and at 12, 24, and 48 h post-infusion, and milk samples were collected daily from 2 d pre-infusion to 4 d post-infusion. Infusion of EGTA resulted in decreased blood iCa during the infusion period, with iCa concentrations rebounding 24 h post-infusion. No significant treatment effects were observed on 5-HT and PTH blood concentrations. These findings underscore the importance of considering physiological distinctions in studies of Ca metabolism during the transition period.

Impact of continuous-infusion meropenem degradation and infusion bag changes on bacterial killing of Pseudomonas aeruginosa based on model-informed translation

BackgroundContinuous infusion of meropenem has been proposed to increase target attainment in critically ill patients, although stability might limit its practical use. This study investigated the impact of meropenem degradation and infusion bag changes on the concentration-time profiles and bacterial growth and killing of P. aeruginosa given different continuous-infusion solutions. MethodsA semi-mechanistic pharmacokinetic-pharmacodynamic (PK-PD) model quantifying meropenem concentrations (CMEM) and bacterial counts of a resistant P. aeruginosa strain (ARU552, MIC = 16 mg/L) over 24 h was used to translate in vitro antibiotic effects to patients with severe infections. Concentration-dependent drug degradation of saline infusion solutions was considered using an additional compartment in the population PK model. CMEM, fT>MIC (time that concentrations exceed the MIC) and total bacterial load (BTOT) after 24 h were simulated for different scenarios (n = 144), considering low- and high-dose regimens (3000/6000 mg/day±loading dose), clinically relevant infusion solutions (20/40/50 mg/mL), different intervals of infusion bag changes (every 8/24 h, q8/24 h), and varied renal function (creatinine clearance 40/80/120 mL/min) and MIC values (8/16 mg/L). ResultsHighest deviations between changing infusion bags q8h and q24h were observed for 50 mg/mL solutions and scenarios with CMEM_24h close to the MIC, with differences (Δ) in CMEM_24h up to 4.9 mg/L, ΔfT>MIC≤65.7%, and ΔBTOT_24h≤1.1 log10 CFU/mL, thus affecting conclusions on whether bacteriostasis was reached. ConclusionsIn summary, this study indicated that for continuous infusion of meropenem, eight-hourly infusion bag changes improved PK/PD target attainment and might be beneficial particularly for high meropenem concentrations of saline infusion solutions and for plasma concentrations in close proximity to the MIC.

Development and validation of analytical method for determination of elemental impurities in micafungin for injection

Elemental impurities contained in drug product create a risk for patients and potential toxic elemental impurities defined and classified in Guideline for Elemental Impurities Q3D(R1). Among the finished product dosage forms, parenteral products could be critical for elemental impurities because elemental impurities are given directly to systemic circulation. For determination of elemental impurities, one of the most frequently used methods is inductively coupled plasma–mass spectrometry (ICP–MS). In this study we aimed to develop and validate an ICP-MS method for determination of 24 elemental impurities in micafungin powder for concentrate for solution for infusion manufactured in our own facility. Results showed that correlation coefficients of calibration curves were found higher than 0.99 for all elements in determined ranges and all validation parameters were achieved successfully. With this method, all 24 elemental impurities can be tracked throughout the shelf life of the product.

Esketamine Combined with Dexmedetomidine toreduce Visceral Pain Duringelective Cesarean Section Under Combined Spinal-Epidural Anesthesia: A double-Blind Randomized Controlled Study.

We aimed to evaluate the effect of intravenous esketamine combined with dexmedetomidine as supplemental analgesia inreducing intraoperative visceral pain duringelective cesarean section under combined spinal-epidural anesthesia (CSEA). A total of 269 parturients scheduled for elective cesarean section under CSEA between May 2023 and August 2023 were assessed. The parturients were randomly allocated to receiving either intravenous infusion of 0.3-mg/kg esketamine combined with 0.5-μg/kg dexmedetomidine (group ED, n=76), 0.5-μg/kg dexmedetomidine (group D, n=76), or normal saline (group C, n=76) after umbilical cord clamping. The primary outcomewas intraoperative visceral pain. Secondary outcomes included the visual analog scale (VAS) score for pain evaluation and other intraoperative complications. The incidence of visceral pain was lower in group ED [9 (12.7%)] than in group D [32 (43.8%)] and group C [36 (48.6%), P <0.0001]. The VAS score was also lower in group ED when exploring abdominal cavity [0 (0), P <0.0001] and suturing the muscle layer [0 (0), P =0.036]. The mean arterial pressure was higher in group D [83 (9) mmHg] and group ED [81 (11) mmHg] than in group C [75 (10) mmHg, P <0.0001] after solution infusion. The heart rate after infusion of the solution was lower in group D [80 (12) bpm] than in group C [86 (14) bpm] and group ED [85 (12) bpm, P = 0.016]. The incidence of transient neurologic or mental symptoms was higher in group ED compared to group C and group D (76.1% vs 18.9% vs 23.3%, P<0.0001). During cesarean section, 0.3-mg/kg esketamine combined with 0.5-μg/kg dexmedetomidine can alleviate visceral traction pain and provide stable hemodynamics. Parturients receiving this regimen may experience transient neurologic or mental symptoms that can spontaneously resolve at the end of the surgery.

Development of standard operating procedure "Quality control of sodium chloride solution 0.9% (350 ml) for infusion (intra-pharmacy preparation) in pharmacy organizations manufacturing pharmaceuticals"

To develop a standard operating procedure (SOP) for quality control of 0.9% sodium chloride solution (350 ml) for infusion (intra-pharmacy preparation) in accordance with the requirements of the current regulatory documentation. Materials and Methods. Sodium chloride 0.9% sodium chloride solution (350 ml) for infusion (intra-pharmacy preparation) served as the object of the study. The SOP was developed taking into account the requirements of updated regulatory documents used in the field of quality control of medicines: Federal Law No. 61 dated 12.04.2010 "On Circulation of Medicines", Order of the Ministry of Health of the Russian Federation dated 22.05.2023 No. 249n, Order of the Ministry of Health of the Russian Federation dated 22.05.2023 No. 647n dated 31.08.2016, State Pharmacopoeia XV ed. and GOST R 52249-2009. Results. The main stages of the SOP in accordance with the current regulatory documentation are given, reagents, instruments and equipment required for testing are listed, mandatory and sample types of control are indicated. For this dosage form the mandatory controls will be organoleptic, written, control at release, physical and full chemical control. The methods of pH and authenticity tests are described, and the chemistry of qualitative reactions is given. For quantitative determination by the method of argentometry according to Mohr, the method of analysis is given, chemical reactions occurring during titration, the necessary calculations are made: the titer of silver nitrate solution of sodium chloride, the preliminary volume of titrant, the content of sodium chloride in the dosage form in grams. Permissible content limits are given in accordance with OFS.1.8.0001 "Medicinal preparations of pharmacy manufacture". Based on the results of the SOP development, a working instruction for quality control of sodium chloride solution 0.9% (350 ml) for infusion was drawn up. Conclusion. The presented SOP for quality control of sodium chloride solution 0.9% (350 ml) for infusion (intra-pharmacy preparation) describes the requirements for the organization and conditions of testing in assessing the quality of this dosage form and can be implemented in the work of manufacturing pharmacies as a detailed instruction for intra-pharmacy control.

Cardiopulmonary function, anesthetic effects, quality of arousal, hematology, and blood biochemistry during continuous intravenous infusion of a combination solution of xylazine, butorphanol, and propofol in calves.

General anesthesia in calves is easier to perform under field conditions, total intravenous anesthesia (TIVA) than using inhalation anesthesia. In the present study, cardiopulmonary function, anesthetic effects, quality of arousal, hematology, and blood biochemistry were assessed during continuous infusion of a combination solution of 0.01% xylazine, 0.001% butorphanol, and 0.2% propofol (XBP) at doses of 6 (G6; 10μg/kg/min xylazine, 1μg/kg/min butorphanol, 200μg/kg/min propofol) and 9mL/kg/h (G9; 15μg/kg/min xylazine, 1.5μg/kg/min butorphanol 300μg/kg/min propofol). For both groups, five castrated Holstein calves received intravenous injections of xylazine (0.2mg/kg) and propofol (2mg/kg), followed by a continuous infusion of XBP for 60min to maintain anesthesia. Respiratory management consisted of tracheal intubation followed by spontaneous inhalation of pure oxygen. Cardiopulmonary, anesthesia, hematology, and blood biochemistry variables were assessed at rest (baseline) and every 5 or 15min after the start of the XBP infusion. Quality of arousal was assessed based on the swallowing reflex recovery time from the stop of XBP infusion, and the sternal position time and standing time after atipamezole administration. XBP produced adequate sedation, analgesia, and muscle relaxation in all calves and maintained stable anesthesia for 60min. As XBP infusion time passed, rectal temperature and heart rate became lower, and mean arterial blood pressure increased. In both groups, hematologic and blood biochemical effects were mild. The quality of arousal was not different, and all calves were standing. The results of the present study suggested that XBP is useful for TIVA in calves.

Displacement Micropump with Check Valves for Diabetes Care—The Challenge of Pumping Insulin at Negative Pressure

The displacement micropump with passive check valves is an attractive solution for precise insulin infusion in patients with type I diabetes. Unlike most insulin pumps that push insulin from a cartridge using a piston, a displacement micropump will first pull insulin from the reservoir before infusing it into the patient. This dual sequence introduces new challenges in terms of insulin stability, notably if the reservoir is not pressurized. After an introduction to displacement micropumps and a brief review of the insulin degradation mechanism, micropump design rules are discussed in light of microfluidic theory.

Definition of Design Space for Preparation and Stability of Tramadol Hydrochloride Loaded Nanoparticles Using OFAT Experiments for Infusion in Pain Management

This paper presents an experimental study on preparation of tramadol hydrochloride (TrH) loaded nanoparticles, and stability determination in various infusion solutions. In this study, various nanoparticle preparation parameters based on w/o/w emulsification solvent evaporation method, including stabilizer type, stabilizer concentration, polymer concentration, homogenization speed and initial drug amount were systematically tested to verify their versatility for preparing nanoparticles. Initially both particle size and encapsulation efficiency of nanoparticles were changed significantly with the change in surfactant and polymer ratio (p<0.05). However, homogenization speed only changed particle size (average size 339.3±1.8 nm for 15000 rpm, 318.9±6.4 nm for 20000 rpm and 237.2±7.8 nm for 25000 rpm) (p<0.05) and initial drug concentration is only affected the encapsulation efficiency (34.2±0.7% for 4 mg/mL and 33.2±0.9 for 1.6 mg/mL) (p<0.05). Storage at room temperature for 3 months resulted in an increase in particle size and polydispersity index. Prepared nanoparticles showed the best stability after storage at – 20 °C for in 3 months. Finally, storage of nanoparticles in various infusion solutions resulted an undesirable changes for 6% Hydroxyethyl starch in 0.9% sodium chloride injection, 10% Dextran 40 and 4% Succinyl gelatin solutions. It was shown that an appropriate delivery of TrH loaded PLGA nanoparticles as infusion can be prepared only in water for injection, 20% Mannitol, 0.9% Sodium chloride and 5% Dextrose solutions.

Pre-clinical evaluation of effectiveness of infusion solutions with different osmolarity during acute blood loss in experiments on rats

The aim of the research was to experimentally evaluate the effectiveness of infusion solutions with different osmolarity during acute blood loss in experiments on rats. Material and methods. Experiments approved by the local Ethics Committee, have been done on 30 male rats line Vistar (320 ± 35 g). Design of the research included anesthesia, simulation of acute blood loss to 50 % of circulating blood volume, its replenishment with experimental infusion solutions based on polyglycan derivatives (estimated osmolarity 1026.6, 1784.2, 2566.6 mOsm/l), research of survivability, functional state of cardiovascular and respiratory systems, blood acid-base status and gas partial pressure 5, 30, 60, 120, 180 min after the beginning of replenishment of circulating blood volume. The infusion solution Hemostabil was used as a comparison product. Results. The highest survival rate, restoration of hemodynamics and acid-base state and blood acid-base status and gas partial pressure were obtained as a result of infusion of solution with osmolarity 1026.6 mOsm/l. In this group of animals survivability accounted for 100 %, arterial pressure restored in 5 minutes after the start of infusion, indicators of blood acid-base status and gas partial pressure normalized in 120 min of experiment. All of the results had statistically significant differences (p &lt; 0.05) relative to values in other experimental groups. Conclusions. Sample of solution with osmolarity 1026.6 mOsm/l is the most effective in restoration of hemodynamics of rats with the blood loss up to 50 % of circulating blood volume. The expediency of the researches of safety of this infusion solution based on polyglucan derivatives in the capacity of medication for replenishment acute blood loss is substantiated.

Tactics of infusion therapy in patients with acute destructive pancreatitis: a narrative review

INTRODUCTION: Infusion therapy is the main method of correcting pathological changes that occur during the phase of “aseptic” inflammation in acute pancreatitis. OBJECTIVE: Summarize current data on infusion therapy regimens in patients with acute destructive pancreatitis, the advisability of using various infusion solutions and options for monitoring the effectiveness of therapy. MATERIALS AND METHODS: The study was carried out in accordance with international reporting requirements for reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The search was carried out in the following Internet search engines Pubmed and Cochrane Controlled Clinical Trials Register. To select articles, a literature reference search method was also used. The search strategy did not include restrictions on language, article type, or date. RESULTS: The analysis of literature data revealed two approaches to infusion therapy. The initial interest in “aggressive (4 liters per day or more)” infusion therapy regimens in the first 24 hours of the disease has now been replaced by a trend towards less “aggressive” regimens due to the publication of works on the high incidence of various complications (progression of organ dysfunction, local complications). When considering the qualitative composition of infusion therapy, preference should certainly be given to crystalloids. Basic monitoring of infusion therapy should include non-invasive methods: heart rate, blood pressure, diuresis rate. CONCLUSIONS: The analysis demonstrated different approaches to the tactics of infusion therapy in this category of patients. further research into the effectiveness and safety of infusion therapy, taking into account the varying severity of acute pancreatitis, the possibility of the influence of the qualitative composition of the infusion on the course of this disease and the formation of recommendations for initial and maintenance infusion therapy based on the principles of personalized medicine.

Dexmedetomidine versus ketamine in improving tolerance to noninvasive ventilation after blunt chest trauma: A randomized, double-blinded, placebo-controlled trial

Abstract Background and Aims: Even though patient tolerance is critical to the success of noninvasive ventilation (NIV), research on using sedation to improve tolerance to NIV after traumatic chest injuries is limited. We hypothesized that dexmedetomidine would be superior to ketamine in terms of patient tolerance and lengthening the NIV sessions after blunt chest trauma. Material and Methods: This randomized, double-blinded, placebo-controlled trial included 45 patients of both genders aged 18–60 who needed NIV after blunt chest trauma. The patients were randomly assigned to one of three groups (n = 15) for receiving dexmedetomidine, ketamine, or placebo (0.9% sodium chloride solution) infusion to maintain a Richmond Agitation Sedation Scale (RASS) score between 0 and − 3 during two successive NIV sessions. Patients were evaluated for the duration of the NIV sessions, RASS, Visual Analog Scale (VAS), and the total amount of rescue analgesia consumed. Results: The mean duration of the NIV sessions was significantly longer in patients who received dexmedetomidine (P &lt; 0.001) or ketamine (P &lt; 0.001) compared to placebo. However, the NIV durations did not differ significantly between the dexmedetomidine and ketamine groups (P &gt; 0.05). The dexmedetomidine group had a significantly lower RASS score compared to the ketamine (P &lt; 0.001) and placebo (P &lt; 0.001) groups, whereas the ketamine group had a significantly lower VAS compared to the dexmedetomidine (P = 0.005) and placebo (P = 0.022) groups and required significantly less total morphine (P = 0.001) compared to the other groups. Conclusion: The duration of the NIV sessions for patients with blunt chest trauma did not differ significantly between the dexmedetomidine and ketamine groups.

Glofitamab (Columvi)

CADTH reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class. The assessments inform non-binding recommendations that help guide the reimbursement decisions of Canada's federal, provincial, and territorial governments, with the exception of Quebec. This review assesses glofitamab (Columvi), concentrate for solution for infusion, 2.5 mg/2.5 mL vial and 10 mg/10 mL vial, IV infusion. Indication: For the treatment of adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) not otherwise specified, arising from follicular lymphoma (trFL), or primary mediastinal B-cell lymphoma (PMBCL), who have received two or more lines of systemic therapy and are ineligible to receive or cannot receive CAR-T cell therapy or have previously received CAR-T cell therapy.

Effects of Rhodiola rosea injection on intrapulmonary shunt and blood IL-6 and TNF-α levels during single lung ventilation in patients undergoing radical resection of esophageal cancer

To explore the effects of Rhodiola rosea injection on pulmonary shunt and serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels during single lung ventilation in patients undergoing radical resection of esophageal cancer. Forty-six patients undergoing radical operation for esophageal cancer were randomized equally into control group and Rhodiola rosea injection group. In the Rhodiola group, 10 mL of Rhodiola rosea injection was added into 250 mL of normal saline or 5% glucose solution for slow intravenous infusion, and normal saline of the same volume was used in the control group after the patients entered the operation room. At T0, T1 and T3, PaO2 of the patient was recorded and 2 mL of deep venous blood was collected for determination of serum TNF-α and IL-6 levels. The incidence of postoperative atelectasis of the patients was recorded. Compared with those in the control group, the patients receiving Rhodiola rosea injection had significantly higher PaO2 and Qs/Qt at T1 and T2 (P<0.05) and lower serum IL-6 and TNF-α levels at T3 (P<0.05). No significant difference in the incidence of postoperative atelectasis was observed between the two groups (P>0.05). Rhodiola rosea injection before anesthesia induction can reduce intrapulmonary shunt during single lung ventilation, improve oxygenation, reduce serum IL-6 and TNF-α levels, and alleviate intraoperative lung injury in patients undergoing radical resection of esophageal cancer.

The role of QRFP43 in the secretory activity of the gonadotrophic axis in female sheep

In mammals reproduction is regulated by many factors, among others by the peptides belonging to the RFamide peptide family. However, the knowledge concerning on the impact of recently identified member of this family (QRFP43) on the modulation of the gonadotrophic axis activity is still not fully understood and current research results are ambiguous. In the present study we tested the in vivo effect of QRFP43 on the secretory activity of the gonadotrophic axis at the hypothalamic-pituitary level in Polish Merino sheep. The animals (n = 48) were randomly divided into three experimental groups: controls receiving an icv infusion of Ringer-Locke solution, group receiving icv infusion of QRFP43 at 10 μg per day and 50 μg per day. All sheep received four 50 min icv infusions at 30 min intervals, on each of three consecutive days. Hypothalamic and pituitaries were collected and secured for further immunohistochemical and molecular biological analysis. In addition, during the experiment a blood samples have been collected for subsequent RIA determinations. QRFP43 was found to downregulate Kiss mRNA expression in the MBH and reduce the level of IR material in ME. This resulted in a reduction of GnRH IR material in the ME. QRFP43 increased plasma FSH levels while decreasing LH levels. Our findings indicate that QRFP43 inhibits the activity of the gonadotropic axis in the ovine at the level of the hypothalamus and may represent another neuromodulator of reproductive processes in animals.

Superhydrophilic conformal polydopamine coating on nanostructured surface formed by capillary-induced solution infusion

As a material-independent adhesive coating agent with excellent functionality on interfaces of materials, polydopamine (PDA) has been widely applicable in bioengineering, environment, and energy fields. Conventional coating methods using dopamine (DA) solutions suffer from slow deposition rates, hindering the attainment of adequate thickness and durability. This work introduces a technique involving rapid capillary-induced solution infusion and in-air polymerization to overcome these limitations. By immersing nanostructured surfaces for just 10 s into the solution, the DA solution is uniformly infused onto the surface, and distributed evenly over the nanostructured surfaces. Polymerization is facilitated by oxygen diffusion from the air, resulting in the formation of a conformal coating up to a micrometer thick. These PDA coatings exhibit persistent superhydrophilicity with water contact angle below 10° and maintain resistance to abrasion, sonication, and oil fouling. Additionally, when applied to microfiber textiles, the PDA coating leads to excellent underwater oil repellency. Our method holds promise for compatibility with various wet-based coating techniques such as drop casting, spraying, spin coating, or ink-jet printing, opening avenues for versatile applications in diverse fields.

Short-term effects of small volume saline infusion on acid base equilibrium in critically ill patients.

Short-term acid-base effects of 0.9% saline solution infusion are not well described. Aim of this study was to assess the effects of a fluid challenge with 0.9% saline in critically ill patients according to the Stewart's approach, which allows a precise determination of acid base equilibrium. In 40 mechanically ventilated critically ill patients, acid-base variables according to Stewart's approach were measured before and after 30 minutes from the infusion of 0.5L of 0.9% saline. Patients were divided in saline responder (fractional sodium excretion increase <0.5) and non-responders, and in patients with (estimated glomerular filtration rate >63 mL/min) and without renal impairment. After saline infusion, plasma sodium concentration did not change (138 [135-141] vs. 138 [135-140] mEq/L, P=0.646), while chloride concentration significantly increased (102 [100-106] vs. 104 [191-106] mEq/L, P=0.003), reducing strong ion difference (37.0 [34.9-38.0] vs. 35.4 [32.7-37.5] mEq/L, P=0.004) without any impact on pH, due to the concomitant albumin dilution. In saline non-responders, the increase of plasma chloride concentration caused a reduction in strong ion difference, while in saline responders both plasma chloride concentration and strong ion difference remained similar. Patients with and without renal impairment presented a similar acid-base response. The infusion of 0.9% saline reduced strong ion difference by increasing plasma chloride concentration, with no effect on pH due to concomitant albumin dilution. Saline non-responders, characterized by the ability to excrete the sodium excess, were more likely to suffer the acidifying effects of saline infusion, while renal function did not affect the acid-base response to saline infusion.

Episode of renal dysfunction in a child with eating disorder: a case report

Among the various organ dysfunctions seriously affected by eating disorders (EDs) is kidney damage. The kidneys are vital organs responsible for several essential functions, including the balance of the body's acid-base and mineral metabolism, the removal and excretion of substances, and the regulation of blood volume and pressure. Eating disorders are a widespread and clinically relevant class of multiorgan disorders that occur mainly in adolescence. EDs often have serious clinical manifestations, which are determined by electrolyte imbalance, endocrine and mental disorders, renal failure, and other disorders. Common eating disorders discussed in the literature and frequently encountered in clinical practice are anorexia nervosa and bulimia nervosa. Anorexia nervosa is a type of abnormal eating behaviour that involves the consumption of very little food and may include intentional vomiting or the misuse of laxatives or diuretics. Kidneys perform a number of vital functions to maintain homeostasis in our body. One of the main functions of the kidneys is blood filtration and the removal of metabolic products. This allows you to maintain the optimal level of fluid and electrolytes and remove toxins. Restriction of fluid intake and abuse of diuretics can cause a decrease in blood flow to the kidneys and further renal failure. The result of the latter is the development of serious violations of vital functions. Low dietary protein intake in people following a restricted diet (restrictive anorexia) leads to a decrease in glomerular filtration rate (GFR) and renal plasma flow. Treatment of acute kidney injury on the background of volume deficit due to fluid loss involves its termination and hydration orally or with the help of intravenous infusions of physiological solution depending on the severity of volume deficit and kidney damage, which was observed and described in this clinical case. Aim. To analyze the peculiarities of kidney injury in a child with an eating disorder. Materials and Methods. A detailed analysis of the case history of a pediatric patient diagnosed with eating disorder complicated with an acute episode of renal dysfunction was done. Basic anamnestic, clinical, laboratory, and instrumental data were analyzed and given in the paper. A graphic presentation is done with PowerPoint. Results. We describe a 14-year-old female patient diagnosed with ED and acute kidney injury (AKI) leading to intensive care unit interventions. Conclusions. AKIs can result from a number of conditions that are common among anorexics and include dehydration, high blood pressure, toxins, inadequate nutrition and possibly altered electrolytes. Serum creatinine, blood urea nitrogen (BUN), glomerular filtration rate (GFR), and electrolytes are among the kidney function markers that need to be monitored in the early stages of AKI linked to anorexia. The right medical care, which includes normalizing blood pressure and adequate hydration, leads to the patient's recovery. Further follow-ups on kidney function in such patients are of high importance

Justification of Intensive care management of children with severe COVID19 (а case study)

the unprecedented COVID-19 pandemic that spread across the world and lasted for more than 3 years had significant medical and social consequences. Despite the fact that in the children's population the coronavirus infection has a milder course and a much lower risk of mortality, there are individual cases with pre-existing comorbidities that cause severe acute respiratory distress syndrome. Thus, in most cases, severe COVID-19 developed in children with pre-existing conditions, including: immunodeficiency, diabetes mellitus, bronchial asthma, etc. Therefore, comorbidities disposed children to progress to severe Covid-19 which requires treatments with more aggressive therapeutic tactics and personalised management. The article presents a clinical case of severe acute respiratory distress syndrome caused by the SARS-CoV-2 virus in an early age child. The patient was observed in the Anesthesiology and Intensive Therapy Department of the Chernivtsi Regional Children's Clinical Hospital. Due to acute respiratory infection, the child has been developing signs of respiratory failure. The available instrumental findings confirmed right lung pneumonia, complicated by pneumothorax. Laboratory tests confirmed leukocytosis, thrombocytopenia, hypertransfusion, increased procalcitonin, increased level of C-reactive protein, D-dimer and interleukin-6 as well as circulating immune complexes. The treatment regimen included respiratory protection (oxygen therapy), support of hemodynamics (infusion of glucose-saline solutions), administration of intravenous normal human immunoglobulin, a short course of parenteral glucocorticosteroids, the use of step-by-step combined antibacterial therapy and a direct-acting antiviral drug (remdesivir), and thromboembolism prophylaxis (low-molecular-weight heparin). Following intensive treatment, the child's condition was characterised by a slow positive dynamics, leading to full recovery. This case demonstrates the need for timely detection of life-threatening conditions caused by COVID-19 and requires an aggressive management of child's condition using a complex intensive therapy.