Correlation of the Endoscopic Gastroesophageal Flap Valve with Pathologic Reflux.

BACKGROUND: The Hill classification characterizes the geometry of gastroesophageal junction and Hill grades (HGs) III and IV have a high association with pathologic reflux. This study aimed to understand the use of the Hill classification and correlate the prevalence of pathologic reflux across different HGs. STUDY DESIGN: A retrospective review of 477 patients who underwent upper endoscopy and BRAVO pH monitoring between August 2018 and October 2021 was performed. These charts were reviewed for endoscopic findings for hiatal hernia and association of HGs with pathologic reflux, defined as an abnormal esophageal acid exposure time (AET) of ≥4.9%. RESULTS: Of 477 patients, 252 (52.8%) had an HG documented on the endoscopy report. Of the 252 patients, 61 had HG I (24.2%), 100 had HG II (39.7%), 61 had HG III (24.2%), and 30 had HG IV (11.9%). The proportion of patients with abnormal AET increases with increasing HGs (p < 0.001) as follows: I (39.3%), II (52.5%), III (67.2%), and IV (79.3%). The mean overall AET is as follows: HG I (5.5 ± 6%), HG II (7.0 ± 5.9%), HG III (10.2 ± 10.3%), and HG IV (9.5 ± 5.5%). The proportion of patients with hiatal hernia was 18% for HG I, 28% for HG II, 39.3% for HG III, and 80% for HG IV. CONCLUSIONS: Use of the Hill classification in clinical practice is low. There is an association of increasing HGs with increasing proportion of patients with abnormal AET. There is a high proportion of patients within HGs I and II with documented pathologic reflux and the presence of a hiatal hernia as observed on endoscopic examination. Our study suggests that endoscopic grading of the gastroesophageal junction may not adequately differentiate between normal vs abnormal reflux status, particularly for HGs I and II.

Determination of breast cancer biomarkers with poly acrylic acid/ MIL-88(Fe)-NH2 hydrogel as a coating for stir bar sorptive extraction.

The Poly acrylic acid/MIL-88(Fe)-NH2 composite material, carefully prepared, is employed as a sorbent for the stir bar. The best formula of the composite was selected by investigation of two parameters including the cross-linker of PAA and MIL-88(Fe)-NH2 content. The prepared stir bar was used for extraction of 2-pentanone, 2-heptanone, ethyl propionate, para-xylene, 1,2,4-trimethylbenzene, o-cresol, m-cresol in urine samples as breast cancer biomarkers with gas chromatography-flame ionization detector. The prepared Poly acrylic acid / MIL-88(Fe)-NH2 as sorbent for the stir bar demonstrate good repeatability of one bar (relative standard deviation (RSD%) < 4.61 %) and satisfactory reproducibility between two bars (RSD% < 6.85 %). The central composite design method was applied for the optimization of extraction parameters. Under the optimum conditions, linear dynamic ranges for compounds were in the acceptable range with correlation coefficients higher than 0.99. Detection limits of them were less than 1.71 µg L-1.

Material extrusion additive manufacturing of poly(lactic acid)/Ti6Al4V@calcium phosphate core-shell nanocomposite scaffolds for bone tissue applications.

The use of porous scaffolds with appropriate mechanical and biological features for the host tissue is one of the challenges in repairing critical-size bone defects. With today's three-dimensional (3D) printing technology, scaffolds can be customized and personalized, thereby eliminating the problems associated with conventional methods. In this work, after preparing Ti6Al4V/Calcium phosphate (Ti64@CaP) core-shell nanocomposite via a solution-based process, by taking advantage of fused deposition modeling (FDM), porous poly(lactic acid) (PLA)-Ti64@CaP nanocomposite scaffolds were fabricated. Scanning electron microscope (SEM) showed that nanostructured calcium phosphate was distributed uniformly on the surface of Ti64 particles. Also, X-ray diffraction (XRD) indicated that calcium phosphate forms an octacalcium phosphate (OCP) phase. As a result of incorporating 6 wt% Ti64@CaP into the PLA, the compressive modulus and ultimate compressive strength values increased from 1.4 GPa and 29.5 MPa to 2.0 GPa and 53.5 MPa, respectively. Furthermore, the differential scanning calorimetry results revealed an increase in the glass transition temperature of PLA, rising from 57.0 to 62.4 °C, due to the addition of 6 wt% Ti64@CaP. However, it is worth noting that there was a moderate decrease in the crystallization and melting temperatures of the nanocomposite filament, which dropped from 97.0 to 89.5 °C and 167 to 162.9 °C, respectively. The scaffolds were seeded with human adipose tissue-derived mesenchymal stem cells (hADSCs) to investigate their biocompatibility and cell proliferation. Calcium deposition, ALP activity, and bone-related proteins and genes were also used to evaluate the bone differentiation potential of hADSCs. The obtained results showed that introducing Ti64@CaP considerably improved in vitro biocompatibility, facilitating the attachment, differentiation, and proliferation of hADSCs. Considering the findings of this study, the 3D-printed nanocomposite scaffold could be considered a promising candidate for bone tissue engineering applications.

Synergistic effect of CaCO3 addition and in-process cold atmospheric plasma treatment on the surface evolution, mechanical properties, and in-vitro degradation behavior of FDM-printed PLA scaffolds.

The ease of processing and biocompatibility of polylactic acid (PLA) have made it a widely used material for fused deposition modeling (FDM)-based 3D printing. In spite of this, PLA suffers from some limitations for its extensive use in tissue engineering applications, including poor wettability, low degradation rate, and insufficient mechanical properties. To address the previously mentioned limitations, this study examined how combining in-process cold atmospheric plasma treatment with the inclusion of CaCO3 influences the properties of FDM-printed PLA scaffolds. Differential scanning calorimetry results showed that by incorporating CaCO3 micro-particles into the PLA matrix, heterogeneous nucleation promoted the matrix's crystalline content. Scanning electron microscopy analysis revealed that the surface of the PLA-CaCO3 scaffold exhibited increased roughness and improved interlayer bonding after undergoing plasma treatment. Atomic force microscopy revealed a significant (up to 80-fold) increase in the roughness value of PLA scaffolds after the incorporation of CaCO3 and subsequent cold plasma treatment. Furthermore, X-ray photoelectron spectroscopy analysis indicated that atmospheric plasma treatment substantially increased the presence of oxygen-containing bonds, leading to a significant reduction in the water contact angle, which decreased from 89° to 37°. According to the tensile test, the tensile modulus (634.1 MPa) and ultimate tensile strength (25.4 MPa) of PLA were markedly increased and reached 914.3 and 37.2 MPa, respectively, for the plasma-treated PLA-CaCO3 (PT-PLA-CaCO3). Additionally, the in-vitro degradation test showed that PT-PLA-CaCO3 scaffold exhibited higher degradation rate compared to the PLA-CaCO3 sample. Based on the obtained results, it appears that in-process cold atmospheric plasma treatment could serve as an efficient and straightforward method to enhance the properties of 3D-printed composite parts, particularly for tissue engineering applications.

Zinc oxide-aluminum oxide nanocomposite solid phase microextraction for diazepam and oxazepam trace determination.

A new efficient ZnO-Al2O3 nanocomposite (ZANC) was synthesized to form solid-phase microextraction (SPME) fiber. The prepared fiber was used for trace determination of benzodiazepines by gas chromatography-flame ionization detector in urine samples. The effective parameters on the extraction process including extraction time, salt percentage, desorption time and sample pH were optimized by a factorial design method. The method was evaluated at the optimum conditions and limits of detection (LODs) were calculated 20 µg/L for diazepam and oxazepam. The method repeatability for oxazepam and diazepam (50 µg/L, n = 4) was calculated at 8.8 % and 6.4 %. Also, the method reproducibility was obtained, 7.45 % and 6.61 % for oxazepam and diazepam (50 µg/L, n = 4). Also, fiber-to-fiber relative standard deviation (RSDs%) for the target analytes were less than 15.5 %. The method linearity is within the range of 62-500 µg/L for diazepam and oxazepam. The ZANC-SPME fiber showed a good lifetime (60 times) with high chemical stability. The high thermal stability of ZANC-SPME fiber was attained at 280 °C. The extraction results of poly dimethylsiloxan/divinyl benzene (PDMS/DVB) fiber were compared by ZANC-SPME fiber. Therefore, the method is proposed as a suitable technique for benzodiazepines detection in the urine sample.

Improving physio-mechanical and biological properties of 3D-printed PLA scaffolds via in-situ argon cold plasma treatment.

As a bone tissue engineering material, polylactic acid (PLA) has received significant attention and interest due to its ease of processing and biocompatibility. However, its insufficient mechanical properties and poor wettability are two major drawbacks that limit its extensive use. For this purpose, the present study uses in-situ cold argon plasma treatment coupled with a fused deposition modeling printer to enhance the physio-mechanical and biological behavior of 3D-printed PLA scaffolds. Following plasma treatment, field emission scanning electron microscopy images indicated that the surface of the modified scaffold became rough, and the interlayer bonding was enhanced. This resulted in an improvement in the tensile properties of samples printed in the X, Y, and Z directions, with the enhancement being more significant in the Z direction. Additionally, the root mean square value of PLA scaffolds increased (up to 70-fold) after plasma treatment. X-ray photoelectron spectroscopy analysis demonstrated that the plasma technique increased the intensity of oxygen-containing bonds, thereby reducing the water contact angle from 92.5° to 42.1°. The in-vitro degradation study also demonstrated that argon plasma treatment resulted in a 77% increase in PLA scaffold degradation rate. Furthermore, the modified scaffold improved the viability, attachment, and proliferation of human adipose-derived stem cells. These findings suggest that in-situ argon plasma treatment may be a facile and effective method for improving the properties of 3D-printed parts for bone tissue engineering and other applications.

Managing Cancer Treatment in Patients with Renal Dysfunction: The Role of Chemotherapy.

Malignancy is characterized by damage to several vital organs, and utilizing chemotherapy as a treatment option can have toxic effects on healthy body tissues. Kidney function is commonly compromised by cancer and chemotherapy. These effects can be pre-renal, intrarenal, or postrenal. Tumor lysis syndrome and electrolyte disturbances are also common in this group of patients. Etiologies of this dysfunction are poorly understood; therefore, careful monitoring and management of renal function are required in such cases. This narrative review aimed to highlight some of the common renal abnormalities among patients receiving cancer and chemotherapy.

Impact of COVID-19 Pandemic on Management and Outcomes of Acute Cholecystitis at US Academic Centers.

BACKGROUND: The COVID-19 pandemic has had wide-ranging effects on management of medical conditions. Many hospitals encountered staffing shortages, limited operating room availability, and shortage of hospital beds. There was increased psychological stress and fear of contracting COVID-19 infection, leading to delay in medical care for various disease processes. The objective of this study was to examine changes in management and outcomes attributed to the COVID-19 pandemic in patients presenting with acute calculus cholecystitis at US academic centers. STUDY DESIGN: Using the Vizient database, patients with the diagnosis of acute calculus cholecystitis who underwent intervention during the 15 months before the pandemic (prepandemic, October 2018 to December 2019) were compared with 15 months during the pandemic (pandemic, March 2020 to May 2021). Outcomes measures included demographics, characteristics, type of intervention, length of stay, in-hospital mortality, and direct cost. RESULTS: There were 146,459 patients with acute calculus cholecystitis identified (prepandemic: 74,605 vs pandemic: 71,854). Patients in the pandemic group were more likely to undergo medical management (29.4% vs 31.8%; p < 0.001) or percutaneous cholecystostomy tube placement (21.5% vs 18%; p < 0.001) and less likely to undergo laparoscopic cholecystectomy (69.8% vs 73.0%; p < 0.001). Patients in the pandemic group who underwent procedural intervention had longer length of stay (6.5 days vs 5.9 days; p < 0.001), higher in-hospital death (3.1% vs 2.3%; p < 0.001), and higher cost ($14,609 vs $12,570; p < 0.001). CONCLUSIONS: In this analysis of patients with acute calculus cholecystitis, there were distinct changes in the management and outcomes of patients due to the COVID-19 pandemic. Changes in the type of intervention and outcomes are likely related to delayed presentation with increases in the severity and complexity of the disease.

Analysis of Veno-Venous Extracorporeal Membrane Oxygenation for COVID-19 Compared to Non-COVID Etiologies.

OBJECTIVE: This study analyzed the characteristics and outcomes of veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) due to COVID-19 versus non-COVID causes at US academic centers. BACKGROUND DATA: V-V ECMO support has been utilized for COVID-19 patients with ARDS since the beginning of the pandemic. Mortality for ECMO in COVID-19 has been reported to be high but similar to reported mortality for ECMO support for non-COVID causes of respiratory failure. METHODS: Using ICD-10 codes, data of patients who underwent V-V ECMO for COVID-19 ARDS were compared with patients who underwent V-V ECMO for non-COVID causes between April 2020 and December 2022. The primary outcome was in-hospital mortality. Secondary outcome measures included length of stay and direct cost. Multivariate logistic regression modeling was performed to analyze differences in mortality between COVID and non-COVID groups, adjusting for other important risk factors (age, sex, and race/ethnicity). RESULTS: We identified and compared 6382 patients who underwent V-V ECMO for non-COVID causes to 6040 patients who underwent V-V ECMO for COVID-19. There was a significantly higher proportion of patients aged ≥ 65 years who underwent V-V ECMO in the non-COVID group compared with the COVID group (19.8% vs. 3.7%, respectively, P <0.001). Compared with patients who underwent V-V ECMO for non-COVID causes, patients who underwent V-V ECMO for COVID had increased in-hospital mortality (47.6% vs. 34.5%, P <0.001), length of stay (46.5±41.1 days vs. 40.6±46.1, P <0.001), and direct hospitalization cost ($207,022±$208,842 vs. $198,508±205,510, P =0.02). Compared with the non-COVID group, the adjusted odds ratio (OR) for in-hospital mortality in the COVID group was 2.03 (95% CI: 1.87-2.20, P <0.001). In-hospital mortality for V-V ECMO in COVID-19 improved during the study time period (50.3% in 2020, 48.6% in 2021, and 37.3% in 2022). However, there was a precipitous drop in the ECMO case volume for COVID starting in quarter 2 of 2022. CONCLUSIONS: In this nationwide analysis, COVID-19 patients with ARDS requiring V-V ECMO support had increased mortality compared with patients who underwent V-V ECMO for non-COVID etiologies.

Teleexercise for geriatric patients with failed back surgery syndrome.

Introduction: Failed back surgery syndrome (FBSS) is defined as back pain which either persists after attempted surgical intervention or originates after a spine surgery. There is a high risk of perioperative morbidity and a high likelihood of extensive revision surgery in geriatric patients with FBSS or post-laminectomy foraminal stenosis. Methods: There is a need for less invasive methodologies for the treatment of FBSS, such as patient-tailored exercise training, with attention to the cost and special needs of the geriatric patients with FBSS. This commentary will provide some background regarding teleexercise (utilizing an internet-based platform for the provision of exercise-related care) for FBSS and will propose three exercises which are easy to administer over online-based platforms and can be the subject of future investigation. Results: Given the documented benefits of regular rehabilitative exercises for patients with FBSS, the high cost of face-to-face services, and the need for infection mitigation in the wake of the COVID-19 Pandemic, teleexercise may be a practical and cost-beneficial method of exercise delivery, especially for geriatric patients with limitations in mobility and access to care. It should be noted that, prescription of these exercises should be done after face-to-face evaluation by the physician and careful evaluation for any "red flag" symptoms. Conclusion: In this commentary, we will suggest three practical exercise training methodologies and discuss the benefits of teleexercise for geriatric patients with FBSS. Future research should aim to assess the efficacy of these exercises, especially when administered through telehealth platforms.

Enhanced bone tissue regeneration using a 3D-printed poly(lactic acid)/Ti6Al4V composite scaffold with plasma treatment modification.

The mechanical and biological properties of polylactic acid (PLA) need to be further improved in order to be used for bone tissue engineering (BTE). Utilizing a material extrusion technique, three-dimensional (3D) PLA-Ti6Al4V (Ti64) scaffolds with open pores and interconnected channels were successfully fabricated. In spite of the fact that the glass transition temperature of PLA increased with the addition of Ti64, the melting and crystallization temperatures as well as the thermal stability of filaments decreased slightly. However, the addition of 3-6 wt% Ti64 enhanced the mechanical properties of PLA, increasing the ultimate compressive strength and compressive modulus of PLA-3Ti64 to 49.9 MPa and 1.9 GPa, respectively. Additionally, the flowability evaluations revealed that all composite filaments met the print requirements. During the plasma treatment of scaffolds, not only was the root-mean-square (Rq) of PLA (1.8 nm) increased to 60 nm, but also its contact angle (90.4°) significantly decreased to (46.9°). FTIR analysis confirmed the higher hydrophilicity as oxygen-containing groups became more intense. By virtue of the outstanding role of plasma treatment as well as Ti64 addition, a marked improvement was observed in Wharton's jelly mesenchymal stem cell attachment, proliferation (4',6-diamidino-2-phenylindole staining), and differentiation (Alkaline phosphatase and Alizarin Red S staining). Based on these results, it appears that the fabricated scaffolds have potential applications in BTE.

Additive manufacturing of PLA-Mg composite scaffolds for hard tissue engineering applications.

Polylactic acid (PLA) is considered as a great option to be employed as 3D porous scaffold in hard tissue engineering applications owing to its excellent biocompatibility and processability. However, relatively weak mechanical properties and inappropriate biodegradability limit its extensive usage. In order to overcome the mentioned challenges, micrometric magnesium particles were incorporated into the PLA matrix by the fused deposition modeling (FDM) technique. The effects of various Mg contents (i.e., 2, 4, 6, 8 and 10 wt%) on the structural, thermal, rheological, mechanical, wettability, degradability characteristics and cellular behavior of the 3D porous PLA-Mg composite scaffolds were examined. The developed PLA-Mg composites exhibit an interconnected porous structure with a mostly uniform distribution of Mg particles in the PLA matrix. It was found that incorporation of Mg particles into the PLA matrix enhances the mechanical, physical, chemical and biological characteristics of PLA. The cell studies demonstrate that the PLA-6Mg composite scaffold provides the best cellular response in terms of cell atachment and viability. The obtained results in this investigation greatly suggest that the 3D-printed PLA-Mg composite scaffold is a promising candidate for hard tissue engineering applications.

Two-way Road of Kidney and Hypercalcemia: A Narrative Review.

Calcium homeostasis is regulated by the dyad of parathyroid hormone and calcitriol, whereas kidney, intestine, and bone are the primary target sites. Elevation of serum calcium levels and hypercalcemia are likely markers of pathological conditions, particularly malignancy and hyperparathyroidism. Similarly, several dysfunctions within the body can direct hypercalcemia. Furthermore, chemicals and drugs can also drive this condition. Owing to the significant role of the kidney in calcium homeostasis, renal abnormalities lead to hypercalcemia and increased calcium levels can have pathological effects on the kidney. This review is designed to highlight some of the commonly known causes of hypercalcemia and their effects on the kidney.

Understanding the use of oral rehydration therapy: A narrative review from clinical practice to main recommendations.

Background and Aims: Fluid loss due to diarrhea remains a significant cause of mortality among children under the age of 5. Methods: Oral rehydration therapy (ORT) is a first-line therapeutic measure to compensate the volume loss due to diarrhea and vomiting among gastroenteritis patients. Despite adequate knowledge, the practice of ORT is limited, particularly in developing countries. Results: Several recommendations are provided regarding the use of ORT to treat hypovolemia, however, the information regarding its adequate usage is restricted within the healthcare centers and professionals. Conclusion: This review highlights the importance of providing recommendations regarding the use of ORT. We also discuss the barriers and alternatives that might limit its use.

Clinical Post-Transplant Lymphoproliferative Disorders.

Post-transplant lymphoproliferative disorders (PTLDs) are characterized by hyperproliferation of B cells due to solid organ or allogeneic hematopoietic stem cell transplant. Based on histological findings, it is divided into 4 categories. Most PTLD patients are Epstein-Barr virus (EBV) positive. Additionally, aggressive immunosuppressive therapies can also lead to PTLD. Reducing immunosuppressive regimes, antivirals, monoclonal antibodies, chemotherapy, and radiotherapy are available therapeutic options, depending on the nature and phase of the disease. This review briefly highlights pathogenesis, risk factors, prevention, and therapeutic strategies regarding PTLDs.

Lead analysis by µSPE/FF-AAS: A comparative study based on dimethylglyoxime functionalized silica-coated magnetic iron/graphene oxides.

Here, four new sorbents based on dimethylglyoxime (DMG) functionalized silica-coated magnetic iron/graphene oxides (Fe3O4/MGO) were synthesized. A comparative study was performed among them to evaluate the different substrates and the role of the spacer in improving the lead extraction efficiency and selecting the most efficient sorbent. Based on experimental results, MGO@SiO2@3-chloropropyltrimethoxysilane@DMG was selected for magnetic dispersive µSPE of lead followed by flame (FAAS) and graphite furnace atomic absorption spectroscopy (GFAAS). The sorbents were characterized by FT-IR, FE-SEM, EDX, TEM, and Zeta potential. Sorbent amount (40.5 mg), sample pH (7.7), sonication time of adsorption and desorption procedures (9 min), and volume and acid concentration (2.2 mL of 2.7 mol L-1 nitric acid) were optimized using experimental design. Linearity of 20.0-600.0 ng mL-1 and 0.5-3.0 ng mL-1 resulted by FAAS and GFAAS, respectively. LODs were 7.0 and 0.2 ng mL-1 by FAAS and GFAAS, respectively. Intra- and inter-day RSDs% (n = 3) at two concentration levels of 3.0 and 100.0 ng mL-1 were below 7.6%.The adsorption capacity was 45.05 mg g-1. The adsorption isotherm showed a better fitting with the Langmuir model. Relative recoveries (%) of 87.8-115.1% were obtained for measuring trace amounts of lead in water, hair, and nail samples.

Fabrication of a new SPME fiber based on Polyacrylic acid/ MIL-88(Fe)-NH2 composite as a self-healing coating for the analysis of breast cancer biomarkers in the urine sample.

Analysis of cancer biomarkers in the body fluids is a new method for early detection of illness. However, due to the complex matrices of samples, the application of a pre-treatment method is unavoidable before the final analysis by gas chromatography (GC). Solid-phase microextraction (SPME) is a simple and, promising pre-concentration and separation method that its coatings are modified with different materials on the fibers. A new innovative self-healing polyacrylic acid PAA/MIL-88(Fe)-NH2 composite was synthesized as an SPME coating. The parameters including pH, crosslinker, and MIL-88(Fe)-NH2 content were optimized to formulate the composite. The prepared fiber was used to extract 2-pentanone, 2-heptanone, ethyl propionate, p-xylene, 1,2,4-trimethylbenzene, and o-cresol as a biomarker in breast cancer from urine samples. The prepared PAA/MIL-88(Fe)-NH2 SPME fibers demonstrate excellent repeatability (relative standard deviation (RSD%)< 3.4%) and satisfactory reproducibility (RSD%<6.9%). The central composite design method was applied for the optimization of extraction parameters. Under the optimum conditions, linear dynamic ranges for biomarkers were in the acceptable range with correlation coefficients higher than 0.98. The detection limits of them were less down 0.0016 µg L-1. Self-healing ability of fiber coating increased useful lifetime (about 120 times extraction with one fiber) as well as accuracy, reproducibility, and recovery of fibers.

Surgical Outcome in Laparoscopic Abdominal Surgical Operations with Clostridium Difficile Infection.

Introduction: Postoperative Clostridium difficile infection (CDI) has associated morbidity, but it is unknown how it impacts different operations. We sought to determine the incidence and postoperative morbidity following abdominal surgery.Method: The National Surgical Quality Improvement Program database (2015-2019) was utilized to evaluate adult (≥18 years-old) patients who developed CDI following laparoscopic abdominal operations. Univariate and multivariate analysis were performed to evaluate outcomes.Results: A total of 973 338 patients were studied and the overall incidence of CDI was .3% within 30 days of operation. Colorectal surgery had the highest incidence of CDI (1601/167 949,1.0%) with significantly longer mean length of stay (LOS) (8.0 days± 9.0, P < .01) compared to other surgical procedures. CDI patients also had a longer mean length of stay (6.6± 8.0 vs 2.1 ± 3.6 days, P < .01) and increased mortality (1.8% vs .2%, AOR: 4.64, CI: 3.45-5.67, P < .01) compared to patients without CDI.Conclusions: This national analysis demonstrates that CDI is a significant complication following abdominal surgery and is associated with increased LOS and mortality. Furthermore, laparoscopic colorectal surgery appears to have the greatest risk of CDI. Future research is needed to determine the exact cause in order to decrease the incidence of CDI by reconsidering the protocol of antibiotic use within the high-risk population.

Chronic hemodialysis: Evaluation of dialysis adequacy and mortality.

Objective: Dialysis efficacy is one of the important issues in patients undergoing hemodialysis. This study aimed to determine the adequacy of dialysis with mortality and hospital admissions in patients undergoing hemodialysis. Methods: This retrospective cohort study was conducted on patients who underwent dialysis. Dialysis adequacy was measured based on the Kt/V criterion. Age, sex, disease etiology, duration of dialysis, and access dialysis were evaluated. Results: 128 patients with a mean age of 61.48 ± 13.36 years were included in the study. 8 patients had a history of kidney transplantation. The mean dialysis time in the patients was 4.30 ± 3.39 years. The mean Kt/V in the patients was 1.40 ± 1.8 years. Of the 128 patients, 53 were hospitalized for cardiac or renal reasons. The number of fatalities was 9 cases out of 128. The cause of death in all the cases was heart problems. There was a statistically significant correlation between the adequacy of dialysis in terms of Kt/V and mortality, but it was not associated with hospitalization. Conclusion: Inadequate dialysis in terms of Kt/V is likely to increase the rate of mortality among dialysis patients.

Measuring serum sodium levels using blood gas analyzer and auto analyzer in heart and lung disease patients: A cross-sectional study.

Objective: Emergency services require precise and rapid measurement of electrolytes to initiate treatment. Blood gas analyzers (BGA) analyzes blood samples in seconds however, its accuracy is still debatable. The aim of this study was to compare the level of serum sodium measured through BGA and auto analyzer in the laboratory analyzers. Methods: This cross-sectional study was performed on 79 patients with heart and lung disease in the intensive care unit of the center. Patient information was recorded along with serum sodium levels measured through BGA and auto analyzer in the laboratory. Results: The mean sodium level measured by BGA was 138.38 mEq/L and by auto analyzer was 137.42 mEq/L. The difference was statistically significant, p = 0.007. Among lung disease patients, the mean sodium levels from BGA and autoanalyzer did not differ significantly p = 0.052 where in patients with heart disease, these levels were 138.54 mEq/L and 137.23 mEq/L, respectively. The difference was significantly different, p = 0.015. Acidic pH measured using BGA and autoanalyzer also differed significantly, p = 0.006. Conclusion: Blood gas analyzer method has a high correlation with laboratory analyzer, but in cases of hypernatremia, the accuracy of blood gas analyzer method decreases and especially in acidosis and in patients with pulmonary problems, the difference with laboratory method increases.