Salt Tablets Safely Increase Serum Sodium in Hospitalised Elderly Patients With Hyponatraemia Secondary to Refractory Idiopathic Syndrome of Inappropriate Anti-Diuresis.

Hyponatraemia is the most common electrolyte abnormality encountered in the inpatient setting and is associated with increased morbidity, mortality, and length of hospital stay. Syndrome of inappropriate anti-diuresis (SIAD) remains the most common cause. Hyponatraemia due to SIAD presents various challenges in treatment approaches, including poor concordance (e.g., to fluid restriction), medication intolerance (e.g., demeclocycline), and risk of rapid sodium shifts (e.g., with vaptan therapy). The use of oral sodium chloride (NaCl) tablets is a recognised treatment approach. However, it is not commonly advocated. We present the cases of two elderly patients in whom the temporary use of NaCl tablets, as an adjunct to fluid restriction, led to safe and effective correction of SIAD-related hyponatraemia with resultant reduced length of hospital admission.

The excess insulin requirement in severe COVID-19 compared to non-COVID-19 viral pneumonitis is related to the severity of respiratory failure and pre-existing diabetes.

Introduction: Severe COVID-19 has been anecdotally associated with high insulin requirements. It has been proposed that this may be driven by a direct diabetogenic effect of the virus that is unique to SARS-CoV-2, but evidence to support this is limited. To explore this, we compared insulin requirements in patients with severe COVID-19 and non-COVID-19 viral pneumonitis. Methods: This is a retrospective cohort study of patients with severe COVID-19 admitted to our intensive care unit between March and June 2020. A historical control cohort of non-COVID-19 viral pneumonitis patients was identified from routinely collected audit data. Results: Insulin requirements were similar in patients with COVID-19 and non-COVID-19 viral pneumonitis after adjustment for pre-existing diabetes and severity of respiratory failure. Conclusions: In this single-centre study, we could not find evidence of a unique diabetogenic effect of COVID-19. We suggest that high insulin requirements in this disease relate to its propensity to cause severe respiratory failure in patients with pre-existing metabolic disease.

Systematic review and meta-analysis regarding the association of endometriosis and preeclampsia in women conceiving spontaneously or through assisted reproductive technology.

OBJECTIVE: To investigate the association between endometriosis and preeclampsia and/or its severe forms (eclampsia and/or the hemolysis, elevated liver enzymes and low platelet count [HELLP] syndrome) in pregnancies conceived either spontaneously or by assisted reproductive technology (ART). DESIGN AND METHODS: Systematic review and meta-analysis of observational studies. Search in PubMed-Medline, Scopus, Web of Science, Cochrane Library, Clinicaltrials.gov, the UK Clinical Trials Gateway, and the Australian New Zealand Clinical Trials Registry was conducted from inception through 21 June 2017, without language restrictions. Primary outcome was preeclampsia and/or its severe forms (eclampsia and/or HELLP syndrome) in pregnant women. Random-effects models were used for meta-analyses. Endometriosis effect was estimated as odds ratio (OR) with 95% confidence interval (CI). RESULTS: A total of 9 cohort and 4 case-control studies were eligible for data analysis, including 39,816 pregnancies with endometriosis and 2,831,065 without. Women with endometriosis diagnosed through biopsy did not have a higher preeclampsia, eclampsia and HELLP syndrome risk as compared to those without (OR 1.01, 95% CI 0.56-1.82); this was found the same even if endometriosis was diagnosed using other procedures (OR 1.15, 95% CI 0.94-1.40). Preeclampsia, eclampsia and HELLP syndrome risk was also not increased in women with endometriosis conceiving spontaneously (OR 1.21; 95% CI 0.94-1.56) or through ART (OR 0.74; 95% CI 0.41-1.35). CONCLUSION: This meta-analysis evidences that endometriosis was not associated to a higher risk of preeclampsia and/or its severe forms in pregnancies either conceived spontaneously or through ART.

Effect of programmed exercise on insulin sensitivity in postmenopausal women: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effect of programmed exercise for at least 12 weeks, in postmenopausal women on insulin sensitivity-related outcomes (ISROs), including fasting insulin, C-peptide, insulin growth factor (IGF-1) and IGF-binding protein (IGFBP-3), Homeostatic Model Assessment-Insulin Resistance (HOMA-IR), and anthropometric variables. METHODS: Searches were conducted in PubMed-Medline, Embase, Scopus, Web of Science, and Cochrane Library from inception through May 3, 2016, for studies published in all languages. Extracted data included characteristics of the study design, study participants, intervention, and outcome measures. Types of exercise were classified into "mid-term exercise intervention" (MTEI, 3-4 months exercise duration) and a "long-term exercise intervention" (LTEI, 6-12 months exercise duration). Risk of bias in RCTs was evaluated with the Cochrane tool. We used random-effects models for meta-analyses. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Seven RCTS (n = 580) evaluating the effects of programmed exercise on ISROs were included. In three RCTs, MTEI significantly lowered insulin levels (mean difference [MD] -6.50 pmol/L, 95% confidence interval [CI] -11.19, -1.82, P = 0.006) and HOMA-IR values (MD -0.18, 95% CI -0.34, -0.03, P = 0.02) when compared with controls. LTEI had no significant effect on insulin levels (P = 0.19) or HOMA-IR values (P = 0.68) in four and three RCTs, respectively. There were no significant differences between exercise intervention versus controls in circulating IGF-1, glucose, triglycerides with both MTEI and LTEI, and in IGFBP-3 with LTEI. There were significant reductions in body mass index (BMI, kg/m) (MD -1.48, 95% CI -2.48, -0.48, P = 0.004) and in body fat percentage (MD -2.99, 95% CI -4.85, -1.14, P = 0.01) after MTEI; and in waist circumference after both MTEI (MD -1.87, 95% CI -3.02, -0.72, P = 0.001) and LTEI (MD -3.74, 95% CI -6.68, -0.79). Heterogeneity of effects among studies was moderate to low. CONCLUSION: Exercising for 3 to 4 months significantly lowered insulin levels and HOMA-IR values, BMI waist circumference, and percentage body fat mass; exercising for 6 to 12 months lowered waist circumference in postmenopausal women.