The effect of potassium supplementation and concomitant medications on potassium homeostasis for hospitalized patients.

PURPOSE: Hospitalized patients receive potassium (K+) supplementation for hypokalemia, with clinicians often estimating a rise in serum K+ levels of 0.1 mEq/L per 10 mEq delivered. However, there is limited evidence to support this expectation. Patients also concomitantly take medications that may alter K+ levels, and it is not known to what degree these may impact interventions to correct K+ levels via supplementation. The objective of this study was to identify the impact of oral and/or intravenous K+ supplementation on serum K+ levels, including the influence of selected concomitant medications, in adult hospitalized patients. METHODS: A single-center, retrospective descriptive study of adult hospitalized patients receiving K+ supplementation at a tertiary hospital between 2021 and 2022 was conducted. Patients were included if they received at least one dose of potassium chloride while admitted to the general medicine ward. The primary outcome was the daily median change in serum K+, normalized per 10 mEq of supplementation administered. The secondary outcome was the impact of selected concomitant medication use on supplement-induced changes in serum K+. RESULTS: A total of 800 patients and 1,291 daily episodes of K+ supplementation were evaluated. The sample was approximately 53% women, was 78% white, and had a median age of 68 years. The overall daily median change in serum K+ level was 0.05 mEq/L per 10 mEq of supplementation delivered. Patients received a median of 40 mEq of supplementation per day, primarily via the oral route (80.6%). Among the concomitant medications assessed, loop diuretics significantly dampened the impact of K+ supplementation. CONCLUSION: Supplementation of K+ in non-critically ill hospitalized patients is variable and dependent on concomitant medication use.

2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty

OBJECTIVE: This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA). METHODS: A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence and the strength of recommendations, using a group consensus process through a convened Voting Panel of rheumatologists and orthopedic surgeons. The strength of the recommendation reflects the degree of certainty that benefits outweigh harms of the intervention, or vice versa, considering the quality of available evidence and the variability in patient values and preferences. RESULTS: The guideline addresses the perioperative use of antirheumatic drug therapy including traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib, and glucocorticoids in adults with RA, SpA, JIA, or SLE who are undergoing elective THA or TKA. It provides recommendations regarding when to continue, when to withhold, and when to restart these medications, and the optimal perioperative dosing of glucocorticoids. The guideline includes 7 recommendations, all of which are conditional and based on low- or moderate-quality evidence. CONCLUSION: This guideline should help decision-making by clinicians and patients regarding perioperative antirheumatic medication management at the time of elective THA or TKA. These conditional recommendations reflect the paucity of high-quality direct randomized controlled trial data.

[Medical and sociocultural aspects of alcoholism in Chile, Colombia and Mexico (1)]. / Aspectos médicos y socioculturales del alcoholismo en Chile, Colombia y México (Primera parte).

The consumption of alcohol by the population becomes a theme of medical-social relevance in so far as the excessive or problematic habit of drinking alcohol leads to the syndrome of alcoholism and may affect substantially the mental health of the population. This paper tries to introduce the theoretical and practical study of the psychocultural development of the alcohol drinking behaviour, based on some exemplary cases of Chile, Columbia and Mexico, in Latin America. Essential themes are: Which kind of relations does exist between the socio-economic conditions and the alcohol consumption behaviour in each particular case? Which are the social and/or age groups with greater propensity towards problematic drinking habits? Which of the autochthnous cultural elements are available for preventive activities inside the community?

Aspectos médicos y socioculturales del alcoholismo en Chile, Colombia y México (Primera parte). / [Medical and sociocultural aspects of alcoholism in Chile, Colombia and Mexico (1)]

The consumption of alcohol by the population becomes a theme of medical-social relevance in so far as the excessive or problematic habit of drinking alcohol leads to the syndrome of alcoholism and may affect substantially the mental health of the population. This paper tries to introduce the theoretical and practical study of the psychocultural development of the alcohol drinking behaviour, based on some exemplary cases of Chile, Columbia and Mexico, in Latin America. Essential themes are: Which kind of relations does exist between the socio-economic conditions and the alcohol consumption behaviour in each particular case? Which are the social and/or age groups with greater propensity towards problematic drinking habits? Which of the autochthnous cultural elements are available for preventive activities inside the community?

Rural dental program in Haiti.

A rural dental program located on La Gonâve, an island near the coast of Haiti is described along with demographic characteristics of the local population. The oral health of 61 adolescents and young adults seen during screening examinations was assessed. Caries free individuals made up 14.8% of the population. The mean DMFT for the group was 4.20. The OHIS score for the sample was 1.35; the PI score was 0.39. No significant association was found between DMFT, OHIS, PI and sex. One subject had a PI score 5.8 standard deviations from the mean score for the group and exhibited signs suggesting juvenile periodontitis.

Venezuelan equine encephalitis virus: comparison of infectivity and virulence of strains V-38 and P676 in donkeys.

Two strains of Venezuelan equine encephalitis (VEE) virus were examined for the ability to replicate in, as well as to produce death among donkeys. One, a low passage strain known as strain P676 was originally isolated from mosquitos in Venezuela. The other, strain V-38 was isolated from a horse brain in 1938 and had undergone an unknown number of laboratory passages; it is used extensively for the preparation of inactivated VEE vaccine. Both strains were found to be approximately equal in their ability to infect donkeys. However, a quantity as small as 50% hamster intraperitoneal infectious units of strain V-38 resulted in fatal infection. On the other hand, as much as 631 million infectious units of strain P676 were nonfatal in one of two donkeys. It appears that strain V-38 is approximately 100 million times more virulent than strain P676 in equine species. One donkey which received strain P676 demonstrated a biphasic pattern of clinical illness and viremia, and there is suggestive evidence that another animal experienced a second and fatal clinical response 3 weeks after virus inoculation.

Public health importance of rodents in South America.

Indigenous South American rodents are abundant, varied, and adaptable, and occupy most of the available natural habitats. Knowledge of their taxonomy and biology is generally superficial. Near human habitations the introduced Rattus and Mus are common and their contacts with man are often close. Cities in South America are expanding to keep pace with increases in the human population and hitherto virgin land is being settled or cleared for food production. Thus domestic rodents are brought into contact with indigenous species and the inevitable exchange of parasites may then produce unpredictable threats to human health. The role of both wild and domestic rodents in the transmission of certain infectious diseases, such as plague, sylvatic Venezuelan encephalitis, South American haemorrhagic fevers, murine typhus, and cutaneous leishmaniasis, is well established. The involvement of rodents in some other diseases, such as leptospirosis, American trypanosomiasis, South American hydatid disease, and vesicular stomatitis, is less well understood. In certain other infections, including bartonellosis and the South American spotted fevers, a wild rodent reservoir is inferred but not yet identified.