Osmoprotection in Salvia hispanica L seeds under water stress attenuators / Osmoproteção em sementes de Salvia hispanica L sob atenuadores do estresse hídrico

Salvia hispanica cultivation is recent in Brazil and occurs in the off-season, when there is lower water availability in the soil. Water deficit is one of the abiotic factors that most limit germination for compromising the sequence of metabolic events that culminate with seedling emergence. Several attenuating substances have been used to mitigate the effects resulting from this stress and give higher tolerance to the species. Thus, the objective of this study was to evaluate the action of different agents as water stress attenuators in the germination and accumulation of organic compounds in S. hispanica seedlings. The treatments consisted of pre-soaking the seeds for 4 hours in salicylic acid (1 mM.L-¹), gibberellic acid (0.4 mM.L-¹), distilled water and control treatment (without soaking). The seeds were germinated at osmotic potentials of 0.0, -0.1, -0.2, -0.3 and -0.4 MPa, using PEG 6000 as an osmotic agent. The variables germination percentage, germination speed index, shoot and primary root lengths, total dry mass, proline, total soluble sugars and total free amino acids were analyzed. Salicylic acid and gibberellic acid led to the best results among the attenuators tested, increasing germination, length, dry mass and biochemical components of S. hispanica seedlings under water deficit. Therefore, salicylic and gibberellic acids are efficient in mitigating water stress in S. hispanica seeds up to the potential of -0.4 MPa.

O cultivo da Salvia hispanica é recente no Brasil e se dá no período de entressafra, quando há menor disponibilidade hídrica no solo. O déficit hídrico é um dos fatores abióticos que mais limitam a germinação por comprometer a sequência de eventos metabólicos que culminam com a emergência da plântula. Diversas substâncias atenuadoras têm sido empregadas com a finalidade de mitigar os efeitos resultantes desse estresse e conferir maior tolerância às espécies. Desse modo, objetivou-se avaliar a ação de diferentes agentes como atenuadores do estresse hídrico na germinação e acúmulo de compostos orgânicos em plântulas de S. hispanica. Os tratamentos consistiram na pré-embebição das sementes durante 4 horas em ácido salicílico (1 mM.L-¹), ácido giberélico (0,4 mM.L-¹), água destilada e o tratamento controle (sem embebição). As sementes foram germinadas sob os potenciais osmóticos 0,0, -0,1, -0,2, -0,3 e -0,4 MPa, utilizando PEG 6000 como agente osmótico. Analisaram-se as variáveis porcentagem de germinação, índice de velocidade de germinação, comprimento da parte aérea e da raiz primária, massa seca total, prolina, açúcares solúveis totais e aminoácidos livres totais. O ácido salicílico e o ácido giberélico apresentaram os melhores resultados, dentre os atenuadores testados, incrementando a germinação, o comprimento, a massa seca e os componentes bioquímicos de plântulas de S. hispanica sob déficit hídrico. Logo, os ácidos salicílico e giberélico são eficientes na mitigação do estresse hídrico em sementes de S. hispanica até o potencial -0,4 MPa.

Deshidratación. Revisión de terapia de rehidratación / Dehydration. Review on oral rehydration therapy

La deshidratación es el cuadro clínico caracterizado por el balance negativo de agua y electrolitos. La deshidratación por gastroenteritis aguda es una de las causas más importantes de morbimortalidad en pediatría. La edad más frecuente es en menores de 18 meses. El diagnóstico de deshidratación es clínico. No existe ningún examen de laboratorio con suficiente sensibilidad y especificidad para estimar el grado de deshidratación. La terapia de rehidratación oral es el tratamiento de primera línea, efectiva en más del 90 % de los casos. Actualmente, se recomiendan las soluciones de rehidratación oral con bajo contenido de sodio (≤75 mEq/l). La rehidratación intravenosa está indicada en los pocos casos en los que la rehidratación oral ha fracasado, está contraindicada o las pérdidas son graves y persistentes

Dehydration is characterized by a negative balance of water and electrolytes. The dehydration from acute gastroenteritis is one of the most important causes of morbidity and mortality in pediatrics. It is most common in those under 18 months of age. The diagnosis of dehydration is clinical. There is no laboratory test that is either sensitive or specific to estimate the degree of dehydration. Oral rehydration therapy is the first-line treatment, effective in more than 90% of the cases. Currently, low sodium rehydration solutions (≤75 mEq/l) are recommended. Intravenous fluid rehydration is indicated in the few cases when oral rehydration therapy has failed, is contraindicated or the losses are serious and persistent

Diarrea aguda en el lactante y preescolar / Acute diarrhea in toddlers and infants

Acute diarrhea (AD) is the increase in frequency and volume of bowel movements with decrease in their consistency that lasts less than 14 days. AD is a major public health problem and is still nowadays a cause of significant morbidity and mortality during childhood, especially in children with nutritional deficits. At a younger age, there is a greater susceptibility to diarrhea, which is more intense and more likely cause dehydration. The prevention and management of dehydration is the mainstay of treatment. The use of medications must be used with caution, analyzing individual cases and based on the best available evidence. We will analyze the subject with special emphasis on treatment according to scientific evidence.

La diarrea aguda (DA) se define como el aumento en la frecuencia y volumen de las deposiciones con disminución de la consistencia y que dura menos de 14 días. La DA es un gran problema de salud pública y es aún hoy en día una causa de importante morbimortalidad durante la infancia en especial en niños con déficits nutricionales. A menor edad hay mayor susceptibilidad de presentar diarrea, siendo ésta de mayor intensidad y con mayores posibilidades de producir deshidratación. La prevención y el manejo de la deshidratación es el pilar fundamental del tratamiento. El uso de medicamentos debe ser criterioso, analizando cada caso individual y basado en la mejor evidencia disponible. Analizaremos el tema con especial énfasis en el tratamiento según evidencia científica.

A temperatura dos repositores hídricos pode influenciar a capacidade aeróbia? / Does the fluid replacers' temperature may influence the aerobic capacity?

O aumento da temperatura interna (Ti) é considerado importante causa da fadiga durante exercícios prolongados realizados no calor. Dentre as estratégias empregadas para atenuá-la, a reposição hídrica é a que mais se destaca por sua praticidade e baixo custo. Por outro lado, pouco se sabe a respeito da influência que a temperatura dos repositores hídricos exerce sobre respostas termorregulatórias e o desempenho aeróbio durante exercícios prolongados em ambientes quentes. Teoricamente, as bebidas em baixa temperatura poderiam conferir vantagem fisiológica, agindo como dissipadores de calor ou proporcionando uma sensação agradável, levando à manutenção da ativação do drive central. Combinados, esses mecanismos podem diminuir os efeitos deletérios da elevação da Ti ao desempenho. Mesmo assim, o número de estudos investigando tal hipótese é escasso. Logo, o objetivo deste Ponto de Vista foi examinar se as evidências existentes apoiam a hipótese de modulação da Ti e melhora do desempenho aeróbio a partir da ingestão de bebidas em baixas temperaturas durante os exercícios prolongados realizados no calor. Encontramos grande heterogeneidade na metodologia dos estudos, sobretudo no que diz respeito 1) ao baixo número amostral; 2) à ausência de soluções controle; 3) à falta de padronização do momento de administração dos repositores hídricos; e 4) ao protocolo de exercício utilizado. Isso dificulta o estabelecimento de conclusões definitivas sobre o assunto, e, portanto, mais estudos são necessários. Contudo, evidências oriundas de poucos estudos bem controlados sugerem que repositores hídricos em baixa temperatura podem atenuar o aumento na Ti e melhorar a capacidade aeróbia durante a realização de exercícios prolongados no calor....(AU)

The increase in internal temperature (Ti) is considered a major cause of fatigue during prolonged exercise in the heat. Among the strategies employed to attenuate it, the fluid replacement is the most used due its cost-effectiveness and practicality. On the other hand, little is known about the influence that the beverage temperature exerts on the thermoregulatory responses and aerobic capacity during prolonged exercise in hot environments. Theoretically, fluid replacers at a low temperature may provide a physiological advantage by acting as a 'heat sink', and providing a pleasant sensation, leading to increased central drive activation. These mechanisms would mitigate the side effects of an increased Ti on performance. Nevertheless, the number of studies dedicated to investigate this hypothesis is scarce. Thus, the aim of this Point of View was to examine whether the existing evidence support the modulation of Ti and improved aerobic capacity hypothesis from fluid replacers at low temperatures during prolonged exercise in hot environments. We have found substantial heterogeneity in the methodology inherent in these studies with regards to the 1) low sample size; 2) absence of control solutions; 3) lack of standardization of the moment of administration of the fluid replacers; and 4) exercise protocol. This causes difficulty in establishing definitive conclusions on this topic, and therefore more studies are required. However, the few existing evidence from well-controlled studies suggest that the fluid replacers at low temperatures can attenuate the increase in Ti and improve aerobic capacity during prolonged exercise in the heat....(AU)

Costos de la rehidratación oral y nasogástrica comparadas con la rehidratación endovenosa en niños con diarrea en Colombia / Costs of oral and nasogastric rehydration compared to intravenous rehydration in children under 5 years of age with diarrhea in Colombia

RESUMEN Objetivo Evaluar los costos de las terapias de rehidratación oral (TRO) y de rehidratación nasogástrica (TRN) comparadas con la terapia de rehidratación endovenosa (TRE) para corregir la deshidratación por diarrea en niños. Metodología Análisis de minimización de costos desde la perspectiva del Sistema de Salud colombiano comparando TRO (seguida de TRN ante falla de la TRO), con la TRE. El horizonte temporal fue la duración de la rehidratación. La medida de efectividad se extrajo de una revisión sistemática de literatura. Para determinar costos, se construyó un caso típico y un árbol de decisiones, a partir de revisión de guías e historias clínicas, validado con expertos. Los costos unitarios se obtuvieron de bases de datos colombianas. Costos fueron calculados en pesos colombianos (COP) y dólares americanos (USD). Se realizaron análisis de sensibilidad de una y dos vías. Resultados La TRO y la TRE son similares en efectividad para prevenir hospitalización y lograr rehidratación. En el caso base, el costo de la TRO fue $91,221COP (40.5 USD) y para TRE $112,944COP (50.14USD), es decir, un ahorro de $21,723 COP (9.64 USD). En los análisis de sensibilidad por regímenes de aseguramiento y complejidad del hospital, la TRO suele ser la estrategia menos costosa. Discusión Ambas intervenciones son similares en efectividad, pero la TRO, seguida de TRN ante falla de la primera resulta menos costosa que la TRE. La TRO es recomendable como primera opción para corregir la deshidratación. Deberían continuarse esfuerzos por implementar TRO y TRN en los servicios de salud en Colombia.(AU)

ABSTRACT Objective To evaluate the costs of oral rehydration therapy (ORT) and nasogastric rehydration therapy (NRT) compared with intravenous rehydration therapy (IRT) to treat dehydration in children under 5 years of age with diarrhea. Methodology Cost-minimization analysis from the perspective of the Colombian Health System, comparing ORT, (followed by NRT when ORT fails), with IRT. The time horizon was the duration of rehydration. The effectiveness measure was obtained from a systematic review of the literature. To determine costs, a typical case was created based on current guidelines and medical records; this case was validated by experts. Unit costs were obtained from Colombian databases and were provided in Colombian pesos (COP) and US dollars (USD) for 2010. One- and two-way sensitivity analyzes were performed. Results ORT and ERT are similarly effective to prevent hospitalization and to achieve rehydration. In the base case, the expected cost of ORT was $91,221 COP (40.5 USD) and for IRT was $112,944 COP ($50.14 USD), saving $21,723 COP ($9.64 USD) per case. In the sensitivity analyzes by health insurance and hospital level, ORT is often the least costly strategy. Discussion Both interventions are similarly effective, but ORT, followed by NRT when ORT fails, is less costly than IRT. ORT is recommended as the first option to treat dehydration since it is effective and less expensive. Efforts should be continued to implement TRO and NRT in the health services of Colombia.(AU)

Resurgence of Cholera Outbreak in Yemen

The current cholera outbreak in Yemen, started in October 2016, showed a sign of decline in the first three months of the year. An upsurge of cases and deaths were recorded from 27 April 2017. As of 28 May 2017, a cumulative total of 88,849 suspected cholera cases including 657 associated deaths [CFR: 0.73%] were recorded from 261 districts in 19 governorates across the country since the beginning of the outbreak in 2016 [Please see the graph]

Emergency meeting on scaling up AWD/Cholera preparedness and response in EMR

An emergency sub-Regional meeting was co-hosted, for two days, by WHO and UNICEF in collaboration with the Ministry of Health of Lebanon, in Beirut from 8–9 July 2017, to discuss the ongo-ing Acute watery diarrhoea [AWD]/cholera outbreak in Somalia, Sudan and Yemen and the risk of spillover to neighboring countries, due to frequent movement of population fleeing countries affected by conflict and other reasons. A total of 51 participants representing six Regional Ministries of Health, WHO, UNICEF, and IFRC-MENA attended the meeting

Study of isotherms and adsorption kinetic of DI [2-Ethylhexyl] phthalate by nano cellulose from aqueous solutions

Introduction: Di [2-ethylhexyl] phthalate is one of the most abundant phthalate esters and it is widely used as softeners in plastic products. Malformation, carcinogenicity, the poisoning of the reproductive system, and also the disruption of the human endocrine system are the harmful effects of these substances

Materials and Methods: In this research, the removal of di [2-ethylhexyl] phthalate from aqueous solutions by cellulose nanofiber non-continuous was studied. The effects of some variables such as the initial concentration of the di [2-ethylhexyl] phthalate, the adsorbent dosage, the contact time, and the pH at room temperature were tested. The pseudo-first-order and pseudo-second-order kinetic models were used to describe the kinetic data, furthermore, the Freundlich and Langmuir adsorption models were tested based on the optimum conditions

Results: The results indicated that the adsorption of DI [2-ethylhexyl] phthalate follows the pseudo-second-order kinetic model [R[2] = 0.9674] and the Langmuir isotherm [R[2] = 0.9573]

Conclusion: Due to the high adsorption capacity of the cellulose nano fiber , [312.5 mg/gr], it can be concluded that it is an appropriate adsorbent for removal of di [2-ethylhexyl] phthalate from aqueous solutions. Diethylhexyl Phthalate, Nano Cellulose, Aqueous Solutions, Adsorption Kinetic

Poor utilization and wrong preparation of oral rehydration salt solution during childhood diarrhea in Ilesa, Nigeria

Background and Aim: Diarrheal deaths are largely preventable with the use of oral rehydration salt (ORS) solution. The aim of this study was to investigate the preparation and use of ORS for the treatment of childhood diarrhea in Ilesa, Nigeria. Materials and Methods: The characteristics of the present diarrheal illness as well as biodata, social class, use of ORS solution, and the method of preparation were documented in 250 children with diarrhea at the Wesley Guild Hospital, Ilesa, Nigeria. Data were analyzed using the statistical program for the social sciences (SPSS) version 16.0. Results: A total of 151 (60.4%) of the children had been given ORS before the presentation. The ORS was correctly prepared in 38 (25.2%) of them, whereas hypertonic ORS solution was mostly given to the others. A significantly higher proportion (66.7%) of those from high social class had their ORS correctly prepared, compared with 16.1% of those from low social class (P = 0.000). The use of ORS was more prevalent among children with longer duration of diarrhea (P = 0.004). A significantly higher proportion of children who were still breastfeeding were given ORS, compared with those who had stopped breastfeeding (P = 0.007). Conclusion: Teachings on the use and correct preparation of ORS should not be limited to diarrhea treatment units, but should rather be included in the routine health talks given to mothers at antenatal and immunization clinics. The provision of a 1 L measure to be used for measuring water for ORS preparation should be seriously considered to combat the problem of hypertonic ORS preparations

Rehidratación oral del paciente adulto con diarrea aguda / Oral rehydration of the adult patient with acute diarrhea

Como primer paso para abordar el manejo de rehidratación oral se debe realizar una estratifcación de la severidad de la deshidratación utilizando preferentemente el "método Dhaka" [5]; tabla 1. El défcit de líquidos puede estimarse mediante la diferencia del peso corporal entre los momentos previos y al momento de la atención (relación 1 Kg equivale a 1 litro). Se recomienda iniciar la hidratación preferentemente por vía oral; reponiendo primero las pérdidas producidas por las deposiciones y luego dar un mantenimiento de los líquidos. Para adultos, las sales de rehidratación oral (SRO) se administrarían a dosis de 50-100 mL/Kg cada 4 a 6 horas, ingeridas en sorbos pequeños y entre 200 y 400 mL luego de cada nueva deposición. Debe considerarse también la posibilidad de administrar SRO por sonda nasogástrica para casos de deshidratación severa cuando la rehidratación intravenosa no sea posible hasta llegar a un centro con las facilidades necesarias.

Ronda clínica y epidemiológica: club de revistas / Clinical and epidemiological round: journal club / Ronda clínica e epidemiológica: clube de revistas

En esta nueva edición de la Ronda Clínica y Epidemiológica analizamos cuatro estudios que consideramos importantes para la práctica clínica. El estudio SOME, en el cual Carrier y colaboradores evaluaron la eficacia de la tamización para el cáncer oculto en pacientes con primer episodio no provocado de tromboembolia venosa. El estudio de Freedman y colaboradores muestra que el uso de jugo de manzanas y líquidos elegidos libremente no es inferior a las soluciones hidroelectrolíticas en la terapia de rehidratación oral en pacientes pediátricos con gastroenteritis aguda de bajo riesgo. Gágyor y colaboradores investigaron sobre el uso de ibuprofeno comparado con el de fosfomicina en el tratamiento sintomático de las infecciones urinarias no complicadas. Finalmente, el metaanálisis de Martindale y colaboradores consolida una información valiosa respecto a las pruebas que se deben hacer en el diagnóstico de falla cardíaca aguda.

In this new edition of Ronda Clínica y Epidemiológica, four studies that we consider important for clinical practice are analyzed. The SOME study, in which Carrier et al., evaluated the efficacy of a screening strategy for occult cancer in patients with a first unprovoked venous thromboembolism. The study by Freedman et al., shows that the use of apple juice is not inferior to oral electrolyte maintenance solution in children with mild gastroenteritis. Gágyor et al., investigated about the use of ibuprofen versus fosfomycin for treating symptoms of uncomplicated urinary tract infection. Finally, the meta-analysis of Martindale et al., provided valuable information about the tests that should be done in the diagnosis of acute heart failure.

Nesta nova edição da Ronda Clínica e Epidemiológica analisamos quatro estudos que consideramos importantes para a prática clínica. O estudo SOME, no qual Carrier e colaboradores avaliaram a eficácia da tamisação para o câncer oculto em pacientes com primeiro episódio não provocado de tromboembolia venosa. O estudo de Freedman e colaboradores mostra que o uso de suco de maçãs e líquidos elegidos livremente não é inferior às soluções hidroeletrolíticas na terapia de reidratação oral em pacientes pediátricos com gastroenterite aguda de baixo risco. Gágyor e colaboradores investigaram sobre o uso de Ibuprofeno comparado com o de Fosfomicina no tratamento sintomático das infeções urinárias não complicadas. Finalmente, a meta-análise de Martindale e colaboradores consolida uma informação valiosa com respeito às provas que se deve fazer no diagnóstico de falha cardíaca aguda.

Effects of water ingestion throughout exercise and recovery on cardiac autonomic modulation during and after exercise

Purpose: To analyze the effects of water intake on heart rate variability (HRV) during and after exercise. Methods: Thirty-one young males performed three different procedures: I) a maximal exercise test to determine the load for the protocols; II) the control protocol (CP); III) the experimental protocol (EP). The protocols comprised 10 minutes at rest, 90 minutes of treadmill exercise (60% of VO2 peak), and 60 minutes of recovery. No rehydration beverage consumption was allowed during the CP. During the EP, the participants were given water every 15 minutes, being that the amount of water to be ingested by each volunteer was divided over the time of exercise and recovery. For the analysis of HRV data, time and frequency domain indices were investigated in the following moments (M): M1 (5 minutes final of rest), M2 (25-30 minutes of exercise), M3 (55-60 minutes of exercise), M4 (85-90 minutes of exercise), M5 (5-10 minutes of recovery), M6 (15-20 minutes of recovery), M7 (25-30 minutes of recovery), M8 (40-45 minutes of recovery), and M9 (55-60 minutes of recovery). Results: There was no statistically significant difference between the groups that were examined during the exercise. HRV values for the CP and EP at the end of the exercise period were as follows SDNN (5.95±1.89 vs 6.89±2.11); RMSSD (3.29±0.78 vs 3.39±0.95); HF [nu] (24.06±14.26 vs 19.10±11.94); LF [nu] (75.93±14.26 vs 80.89±11.94); HF [ms2] (0.90±1.16 vs 0.94±0.89); LF [ms2] (4.65±5.94 vs 5.35±5.09); and LF/HF ratio (4.64±3.15 vs 6.95±5.57). HRV values for the CP and the EP at the end of the recovery period were as follows: SDNN (39.63±19.63 vs 49.95±17.79); RMSSD (21.63±15.55 vs 36.43±22.73); HF [ms2] (285.51±392.27 vs 699.29±699.66); LF [nu] (74.55±13.25 vs 61.19±19.27); and HF [nu] (25.44±13.25 vs 38.8±19.27). Conclusion: The hydration with water was not enough to significantly influence the linear HRV indices during exercise; however, it promoted faster recovery of these variables after exercise

Effect of milk consumption on healthy young men rehydration and endurance performance after dehydration due to intermittent exercise in warm environmental condition

Background and Objective: Rapid and adequate rehydration is important for many athletes, especially those taking multiple sessions of exercise each day, or those involved in weight category sports. The macronutrient and electrolyte concentration of the fluid ingested following exercise can affect the amount retained within the body can influence hydration status. This study was done to compare the effect of milk consumption on healthy young men rehydration and endurance performance after dehydration due to intermittent exercise in warm environmental condition

Methods: In this quasi-experimental study, the labroratory protocol was carried out by ten young healthy men in three sessions within one week intervals. Participants were on drinking regiment including water, low-fat milk, and powerade. Urine samples were collected pre-exercise, post-exercise, post-drinking and 1, 2 and 3 hours over recovery. Exercise capacity test commenced within 10 min after 3h recovery. This was undertaken in warm environmental condition at a power output corresponding to 70% V02 max. Exercise continued until voluntary exhaustion. Heart rate and RPE were recorded at 5 min intervals throughout exercise

Results: Pre-exercise urine specific gravity value was not different between the milk and the, powerade and the water groups. Total urine output was significantly reduced in the milk group in compared to powerade and the water consumption [P<0.05]. At the end of the study, net fluid balance was significantly positive in milk group compared to powerade and water groups [P<0.05]. Time of exhaustion on the exercise capacity test [70% V02 max] was significantly more in milk in comparision with powerade group [P<0.05]

Conclusion: Low-fat milk is more effective at rehydrating compared to water and exercise capacity in intermittent activity of heat in healthy young men

Efficacy of Pre-procedural Rehydration against Thromboembolic Complications for Ruptured Aneurysm Embolization

OBJECTIVE: To report effects of the pre-procedural rehydration for reduce thromboembolic complications in acute phase aneurysmal subarachnoid hemorrhage coil embolization. MATERIALS AND METHODS: From January 2009 to December 2013, 190 patients with ruptured aneurysmal subarachnoid hemorrhage (aSAH) treated by coil embolization at our institution were consecutively enrolled in this study. In period 1 (from January 2009 to June 2012, n = 122), pre-procedural fluid was not supplied. In period 2 (from July 2012 to December 2013, n = 68), depending on the state of the patient's body weight and degree of dehydration, intravenous fluid was started with infusion of approximately 7 mL/kg of 0.9 percent saline (minimum 300 to maximum 500 mL) over 30 minutes. RESULTS: A total of 190 patients were hospitalized due to aSAH and underwent coil embolization for five years between January 2009 and December 2013. Of these, 122 patients underwent coil embolization based on the old protocol before June 2012 (period 1) and 68 underwent the procedure based on the new protocol after the period 2. Neck size, width, maximum diameter of the aneurysm and procedure time were associated with procedure related thromboembolic complications in entire periods (multivariate analysis, p < 0.05, in respectively). The frequency of thromboembolism showed a drastic decrease in period 2 (re-hydration period), from 18.0% (22/123) to 4.4% (3/67), which was also statistically significant (p = 0.007, Chi-square test). CONCLUSION: Pre-procedural administration of a sufficient dose of fluid considering the patient's dehydration reduced the frequency of thromboembolism in cases of emergency coil embolization for ruptured aneurysm, without increasing additional specific complications.

Initial 12-h operative fluid volume is an independent risk factor for pleural effusion after hepatectomy / 华中科技大学学报（医学）（英德文版）

Pleural effusion after hepatectomy is associated with significant morbidity and prolonged hospital stays. Several studies have addressed the risk factors for postoperative pleural effusion. However, there are no researches concerning the role of the initial 12-h operative fluid volume. The aim of this study was to evaluate whether the initial 12-h operative fluid volume during liver resection is an independent risk factor for pleural effusion after hepatectomy. In this study, we retrospectively analyzed clinical data of 470 patients consecutively undergoing elective hepatectomy between January 2011 and December 2012. We prospectively collected and retrospectively analyzed baseline and clinical data, including preoperative, intraoperative, and postoperative variables. Univariate and multivariate analyses were carried out to identify whether the initial 12-h operative fluid volume was an independent risk factor for pleural effusion after hepatectomy. The multivariate analysis identified 2 independent risk factors for pleural effusion: operative time [odds ratio (OR)=10.2] and initial 12-h operative fluid volume (OR=1.0003). Threshold effect analyses revealed that the initial 12 h operative fluid volume was positively correlated with the incidence of pleural effusion when the initial 12-h operative fluid volume exceeded 4636 mL. We conclude that the initial 12-h operative fluid volume during liver resection and operative time are independent risk factors for pleural effusion after hepatectomy. Perioperative intravenous fluids should be restricted properly.

Diarreia aguda: manejo baseado em evidências / Acute diarrhea: evidence-based management

Resumo Objetivos: Descrever as recomendações atuais sobre a melhor maneira de conduzir o paciente pediátrico com doença diarreica aguda. Fonte dos dados: PubMed, Scopus, Scholar Google. Síntese dos dados: Houve pouco avanço no uso dos sais de reidratação oral (SRO) nas últimas décadas apesar de ser amplamente divulgado por meio de diretrizes internacionais. Vários estudos vêm sendo feitos na tentativa de melhorar a eficácia do SRO. Hidratação venosa com solução salina isotônica, infundida de forma rápida, deve ser indicada em casos de desidratação grave. A nutrição deve ser assegurada logo após a resolução da desidratação e é primordial para a saúde intestinal e imunológica. Restrições alimentares usualmente não são benéficas e podem ser prejudiciais. As medicações sintomáticas têm indicação restrita e antibióticos são indicados em casos específicos, cólera e shiguelose moderada a grave. Conclusões: A hidratação e a nutrição continuam a ser as intervenções com melhor impacto sobre o curso da diarreia aguda.

Abstract Objectives: To describe the current recommendations on the best management of pediatric patients with acute diarrheal disease. Data source: PubMed, Scopus, Google Scholar. Data summary: There has been little progress in the use of oral rehydration salts (ORS) in recent decades, despite being widely reported by international guidelines. Several studies have been performed to improve the effectiveness of ORS. Intravenous hydration with isotonic saline solution, quickly infused, should be given in cases of severe dehydration. Nutrition should be ensured after the dehydration resolution, and is essential for intestinal and immune health. Dietary restrictions are usually not beneficial and may be harmful. Symptomatic medications have limited indication and antibiotics are indicated in specific cases, such as cholera and moderate to severe shigellosis. Conclusions: Hydration and nutrition are the interventions with the greatest impact on the course of acute diarrhea.

Etat des lieux de la prise en charge de la diarrhee avec SRO a faible osmolarite et le zinc dans les districts pilotes de Joal; Kolda et Fatick au Senegal

Introduction. Aujourd'hui encore; les maladies diarrheiques chez les enfants demeurent un veritable probleme de sante publique dans les pays en developpement. Au Senegal; elle se positionne; avec le recul du paludisme; comme une des principales affections en competition avec les Infections Respiratoires Aigues (IRA). Cette etude a pour objectif d'evaluer la prise en charge de la diarrhee selon les nouvelles directives nationales a tous les niveaux du systeme relatives a l'utilisation des SRO a faible osmolarite et le Zinc dans les districts pilote de Joal (Thies); Kolda et Fatick. Methode. Cette etude descriptive et analytique; qualitative et quantitative; realisee du 14 novembre au 10 decembre 2010; a porte sur l'ensemble des personnes qui etaient impliquees dans la mise en ouvre du projet pilote a tous les niveaux du systeme afin de recueillir leur point de vue et leur suggestion pour un passage a l'echelle; de meme que les beneficiaires de soins dans les trois (03) regions pilotes. Ainsi; plusieurs outils de collecte des donnees ont ete concus et adaptes en fonction de la cible et selon la nature de l'information a renseigner; permettant ainsi a l'equipe de terrain d'adopter soit la demarche de l'enquete quantitative ou qualitative pour la collecte. La saisie et l'analyse des donnees ont ete effectuees grace au logiciel SPSS version 12; avec le calcul des moyennes et frequences. Resultats. Sur l'ensemble des 203 enfants de moins de 5 ans enquetes dans les trois (03) districts; 44 avaient une diarrhee soit une incidence de 21;7%. Les enfants de plus de 24 mois dans les milieux ruraux paraissaient les plus frequemment atteints. Malgre la disponibilite de ces intrants sur l'ensemble des trois (03) districts; seulement 31;8% des enfants souffrant de diarrhee ont recu la prescription de SRO/Zinc recommandes contre 68;2% pour autres traitements. Discussion-Conclusion. Le niveau de prescription de l'association SRO/Zinc pour la prise en charge des cas de diarrhee chez les enfants n'est pas satisfaisant pour l'ensemble des districts; meme si celui-ci etait meilleur en milieu rural qu'en milieu urbain. Ces resultats soulignent l'interet d'elaborer des strategies novatrices; efficientes et socialement acceptables pour la prise en charge precoce et adequate de la diarrhee en vue d'atteinte le quatrieme Objectif du Millenaire pour le Developpement

Clinical value of 24-hour urinary sodium determination in children with postural tachycardia syndrome / 中华儿科杂志

<p><b>OBJECTIVE</b>To analyze the clinical value of 24-hour urinary sodium determination in children with postural tachycardia syndrome (POTS).</p><p><b>METHOD</b>Fifty-eight POTS children and 10 healthy children (control group) from Peking University First Hospital during June 2012 to May 2014 were enrolled. Their 24-hour urinary sodium and plasma sodium levels were compared. Correlation analysis was done between 24-hour urinary sodium and symptom scores in children with POTS. All patients were treated with oral rehydration salts. The POTS patients were divided into hyponatriuria group (urinary sodium < 124 mmol/24 h) and hypernatriuria group (urinary sodium ≥ 124 mmol/24 h). Kaplan-Meier curve was used to analyze the effects of different 24-hour urinary sodium levels in children with POTS receiving rehydration salts therapy.</p><p><b>RESULT</b>The 24-hour urinary sodium levels of children with POTS were significantly lower than that of control group ((110. 0 ± 45. 8) vs. (221. 3 ± 103. 6) mmol/24 h, t =3. 339, P = 0. 008), while no statistical significance was found in plasma sodium between the two groups ((139. 7 ± 2. 1) vs. (139. 7 ± 2. 3) mmol/L, t = 0. 082, P = 0. 935). Pearson correlation analysis showed that 24-hour urinary sodium and severity of symptoms in children patients were negatively correlated (r = - 0. 654, P < 0. 001) . Urinary sodium < 124 mmol/24 h was used as the cut-off value, there were 43 cases in hyponatriuria group and 15 cases in hypernatriuria group. The symptom scores were significantly higher in hyponatriuria group (10. 2 ± 3. 7 vs. 5. 0 ± 1. 8, P < 0. 001), there was no significant difference in other basic information and hemodynamic data between groups (P > 0. 05). Logistic regression analysis revealed that urine sodium < 124 mmol/24 h was independent risk factor for effectiveness of rehydration salts in POTS patients (OR = 0. 043, 95% CI:0. 004 - 0. 499, P = 0. 012). Kaplan-Meier survival analysis showed the long-term effect of patients receiving oral rehydration salts in hyponatriuria group was significantly better than that in hypernatriuria group (86. 0 % vs. 60. 0%, χ2 = 8. 471, P = 0. 004).</p><p><b>CONCLUSION</b>Twenty-four hours urinary sodium is a good indicaor for guiding children with POTS receiving rehydration salts therapy.</p>