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2.
PLoS One ; 15(10): e0239160, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33027293

RESUMO

Diabetic ketoacidosis (DKA) is associated with dehydration and which can cause acute kidney injury (AKI). The proportion of AKI in children and adolescents with DKA has not been reported in East Asian population. This study aimed to identify the prevalence of AKI and to determine whether there is an association between AKI severity and recovery time from metabolic acidosis in children and adolescents with DKA. Medical records of children and adolescents (aged <18 years) presenting with type 1 or type 2 diabetes mellitus and DKA between 2000-2017 at the MacKay Children's Hospital were retrospectively reviewed. AKI was defined by an admission creatinine level >1.5 times the calculated expected baseline creatinine level. Patients were divided into three groups based on AKI severity: no AKI, mild AKI, and severe AKI. In total, 170 (56.5%) patients with DKA presented AKI (mild AKI, 116 [38.5%]; severe AKI, 54 [18.0%]). Heart rate and laboratory parameters related to dehydration, such as corrected sodium level and blood urea nitrogen, were strongly associated with AKI development (P<0.01). Blood pH, plasma glucose, and potassium levels were also associated with AKI. A negative correlation with borderline significance between the estimated glomerular filtration rate (eGFR) and recovery time from metabolic acidosis was observed in the severe AKI group. AKI was highly prevalent in children and adolescents with DKA. An association between AKI and biomarkers indicating dehydration was noted. The recovery time from metabolic acidosis following treatment may be longer in children with a decreased eGFR who present with severe AKI. AKI is a common complication in children with DKA.


Assuntos
Lesão Renal Aguda/etiologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Cetoacidose Diabética/complicações , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/metabolismo , Adolescente , Biomarcadores/metabolismo , Criança , Desidratação/complicações , Desidratação/metabolismo , Cetoacidose Diabética/metabolismo , Feminino , Humanos , Masculino , Prevalência , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia
3.
Acta Gastroenterol Belg ; 83(2): 315-318, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32603052

RESUMO

Most episodes of vomiting, reduced intake and diarrhoea in children can be evaluated and treated without additional tests. However, when the degree of clinical dehydration is not in line with the patient's medical history, other diagnoses should be suspected. In the presence of a hyponatraemic hypochloraemic metabolic alkalosis, cystic fibrosis (CF) should be included in the differential diagnosis, especially if there is failure to thrive even in the absence of respiratory symptoms. Furthermore, young patients diagnosed with CF have a higher risk for an acute electrolyte decompensation caused by increased salt and fluid losses. We present 4 paediatric cases to raise the awareness of electrolyte disturbances in CF patients.


Assuntos
Alcalose , Fibrose Cística , Desidratação , Hiponatremia , Criança , Fibrose Cística/complicações , Desidratação/complicações , Insuficiência de Crescimento , Humanos , Hiponatremia/etiologia , Vômito
4.
Clin Hemorheol Microcirc ; 75(4): 475-487, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32417766

RESUMO

BACKGROUND: Dehydration occurs frequently in older patients and constitutes a significant clinical problem. OBJECTIVE: This proof-of-concept study examines whether 1) sublingual measurement in dehydrated old patients is feasible, 2) frailty and incompliance in old, awake patients affects video-quality, 3) dehydration impacts microcirculationMETHODS:This prospective observational study included clinically dehydrated patients aged ≥65 years immediately after admission. Dehydration was assessed clinically. A sidestream dark field camera (SDF) was used for measurement. Video-quality was evaluated with MIQS (microcirculation image quality score). Both AVA 4.3C- and AVA POEM-software analyzed the videos. Seventeen patients ≥65 years not showing dehydration served as control. RESULTS: Thirteen patients (8 female) were included. The average age was 83±8 years. The mini-mental test was 17±15 points, the Clinical Frailty Scale 4±3, the Barthel-Index 59±39. None of these parameters correlated with MIQS (3.4±4.2 SD ("acceptable")). Dehydrated patients had a slightly impaired microcirculation, with a significantly lower percentage of perfused small vessels compared to control (83.1±7.7% versus 88.0±6.0%, P < 0.05). After rehydration, there was acute improvement in the microcirculation. CONCLUSIONS: Sublingual microcirculatory SDF-measurement is both, safe and valid for dehydrated old patients - regardless of frailty, age or cognitive performance. Dehydration leads to an impaired microcirculation.


Assuntos
Desidratação/complicações , Microcirculação/fisiologia , Soalho Bucal/irrigação sanguínea , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Estudos Prospectivos
6.
Psychol Aging ; 35(4): 517-528, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32352804

RESUMO

Adequate hydration is essential for health, with even mild forms of dehydration often having negative effects on cognition and well-being. Despite evidence of higher risk for dehydration among older adults, links between dehydration and cognitive or well-being outcomes have not been established in old age. In this study, we used longitudinal data from the Berlin Aging Study II (age range 60-89) to investigate whether trajectories of cognitive functioning (digit symbol, N = 1,111) and well-being (Diener satisfaction with life, N = 1,066; Socio-Economic Panel Study life satisfaction, N = 1,067; and Lawton morale, N = 1,067) are associated with objective dehydration (osmolarity; 33% dehydrated). Our results revealed that higher dehydration was associated with steeper decline in cognitive functioning and well-being over time, and lower well-being among those with higher body mass index. These associations were independent of sociodemographic and physical health characteristics. Our findings highlight the importance of adequate hydration for preserved cognition and well-being across old age. We discuss potential mechanisms and consider practical implications arising from our results. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Envelhecimento/fisiologia , Cognição/efeitos dos fármacos , Desidratação/complicações , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estudos Longitudinais , Masculino
7.
J Clin Neurosci ; 77: 81-84, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32446809

RESUMO

OBJECTIVES: Migraine is a common type of headaches and disabling disorder. Based on evidences dehydration is closely related to promote migraine headcahe frequency and severity. The Water intake is the best intervention to reduce or prevent headache pain. water intake in migraine patients has rarely been studied. the present study aimed to evaluate the relation between water intake and headache properties in migraine. METHODS AND MATERIALS: The present study was conducted using a cross-sectional design on 256 women 18-45 years old referred to neurology clinics for the first time. The diagnosis of migraine by a neurologist the according to ICHD3 criteria and To assess migraine severity the Migraine disability assessment questionnaire (MIDAS), visual analog scale (VAS), and a 30-day headache diary were used. One-way analysis was used to evaluate the associations between MIDAS and VAS with daily water intake. Pearson correlation analysis was used to evaluate the relationship between the number of days and duration of headache with daily water intake. Data were analyzed using SPSS software and P-values < 0.05 considered statistically significant. RESULTS: The results showed that the severity of migraine disability (P < 0.001), pain severity (P < 0.001), headaches frequency (P < 0.001), and duration of headaches (P < 0.001) were significantly lower in those who consumed more water or total water. CONCLUSION: The present study found a significant negative correlation between daily water intake and migraine headache characteristics but further clinical trials are needed to interpret the causal relationship.


Assuntos
Desidratação/complicações , Água Potável , Ingestão de Líquidos/fisiologia , Transtornos de Enxaqueca/etiologia , Adolescente , Adulto , Estudos Transversais , Avaliação da Deficiência , Feminino , Cefaleia/etiologia , Humanos , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Inquéritos e Questionários , Escala Visual Analógica , Adulto Jovem
8.
Rev. cuba. med. trop ; 72(1): e444, ene.-abr. 2020. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1126698

RESUMO

Introducción: La diarrea del viajero es causa frecuente de hospitalización en turistas internacionales. Objetivo: Describir las características sociodemográficas y clínico-epidemiológicas de los pacientes adultos ingresados por diarrea del viajero en la Clínica Internacional de Trinidad durante los años 2015 al 2017. Métodos: Estudio descriptivo de los 699 pacientes adultos con diarrea del viajero que requirieron de ingreso en el periodo de estudio. Se revisaron sus historias clínicas para analizar la frecuencia en que estuvieron presentes algunas variables sociodemográficas y clínico-epidemiológicas. Para analizar los datos se utilizó la estadística descriptiva con distribución de frecuencias y porcentajes. Resultados: El grupo etario entre 19 y 40 años tuvo un 60,52 por ciento de pacientes afectados; el 58,23 por ciento en el sexo femenino, con una incidencia mayor en los meses de julio (12,88 por ciento) y febrero (12,44 por ciento). Los viajeros procedentes de países europeos representaron el 76,97 por ciento ; el 74,96 por ciento se hospedó en casas particulares. El 1,85 por ciento de los afectados presentaba antecedentes de enfermedad gastrointestinal; el 76,11 por ciento requirió de 1 a 6 h de observación, con deshidratación leve (59,66 por ciento) y moderada (21,75 por ciento). El vómito y las náuseas se presentaron en el 58,37 por ciento de los pacientes y en el 60,73 por ciento la causa no fue precisada. Conclusiones: Las variables sociodemográficas y clínico-epidemiológicas seleccionadas permitieron describir características de los pacientes adultos ingresados por diarrea del viajero. Se recomienda profundizar en el estudio para contribuir a su prevención y optimizar la atención(AU)


Introduction: Traveler's diarrhea is a frequent cause of hospitalization of international tourists. Objective: Describe the sociodemographic and clinical-epidemiological characteristics of adult patients admitted for traveler's diarrhea to Trinidad International Clinic in the period 2015-2017. Methods: A descriptive study was conducted of the 699 adult patients with traveler's diarrhea who required hospitalization in the study period. The patients' medical records were reviewed to analyze the frequency of some sociodemographic and clinical-epidemiological variables. Data analysis was based on descriptive statistics with frequency and percentage distribution. Results: 60.52 percent of the patients affected were in the 19-40 years age group, 58.23 percent were female, and the highest incidence was observed in the months of July (12.88 percent) and February (12.4 4 percent ). Travelers from European countries represented 76.97 percent, and 74.96 percent were staying in private dwellings. Of the patients affected, 1.85 percent had a history of gastrointestinal disease; 76.11percent required 1-6 hours of observation; dehydration was mild in 59.66 percent and moderate in 21.75 percent. Vomiting and nausea were present in 58.37 percent of the patients; in 60.73 percent the cause was not determined. Conclusions: The sociodemographic and clinical-epidemiological variables selected made it possible to characterize the adult patients admitted for traveler's diarrhea. Further research is recommended to contribute to the prevention this disease. Further research is recommended to contribute to the prevention this disease and optimize care(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Desidratação/complicações , Diarreia/prevenção & controle , Doença Relacionada a Viagens , Demografia/métodos , Assistência Hospitalar/métodos
9.
Arch Dis Child ; 105(7): 648-654, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32169853

RESUMO

BACKGROUND: We explored who actually provides most admission care in hospitals offering supervised experiential training to graduating clinicians in a high mortality setting where practices deviate from guideline recommendations. METHODS: We used a large observational data set from 13 Kenyan county hospitals from November 2015 through November 2018 where patients were linked to admitting clinicians. We explored guideline adherence after creating a cumulative correctness of Paediatric Admission Quality of Care (cPAQC) score on a 5-point scale (0-4) in which points represent correct, sequential progress in providing care perfectly adherent to guidelines comprising admission assessment, diagnosis and treatment. At the point where guideline adherence declined the most we dichotomised the cPAQC score and used multilevel logistic regression models to explore whether clinician and patient-level factors influence adherence. RESULTS: There were 1489 clinicians who could be linked to 53 003 patients over a period of 3 years. Patients were rarely admitted by fully qualified clinicians and predominantly by preregistration medical officer interns (MOI, 46%) and diploma level clinical officer interns (COI, 41%) with a median of 28 MOI (range 11-68) and 52 COI (range 5-160) offering care per study hospital. The cPAQC scores suggest that perfect guideline adherence is found in ≤12% of children with malaria, pneumonia or diarrhoea with dehydration. MOIs were more adherent to guidelines than COI (adjusted OR 1.19 (95% CI 1.07 to 1.34)) but multimorbidity was significantly associated with lower guideline adherence. CONCLUSION: Over 85% of admissions to hospitals in high mortality settings that offer experiential training in Kenya are conducted by preregistration clinicians. Clinical assessment is good but classifying severity of illness in accordance with guideline recommendations is a challenge. Adherence by MOI with 6 years' training is better than COI with 3 years' training, performance does not seem to improve during their 3 months of paediatric rotations.


Assuntos
Fidelidade a Diretrizes , Internato e Residência/estatística & dados numéricos , Corpo Clínico Hospitalar/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde , Pré-Escolar , Competência Clínica , Desidratação/complicações , Desidratação/epidemiologia , Diarreia/complicações , Diarreia/epidemiologia , Feminino , Hospitais/estatística & dados numéricos , Humanos , Lactente , Internato e Residência/normas , Quênia/epidemiologia , Malária/epidemiologia , Masculino , Corpo Clínico Hospitalar/normas , Mortalidade , Multimorbidade , Pneumonia/epidemiologia , Guias de Prática Clínica como Assunto
10.
Rev. cuba. pediatr ; 92(1): e919, ene.-mar. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1093744

RESUMO

Introducción: La séptima pandemia del cólera llegó a las Américas en 1991. En Cuba hacía más de 130 años no se registraba ningún caso. Objetivos: Identificar y caracterizar las complicaciones por cólera y su relación con características clínicas y de tratamiento. Métodos Se realizó un estudio descriptivo y prospectivo desde el año 2013-2017 a los pacientes a los que se les confirmó el V. cholerae como causa exclusiva de enfermedad diarreica aguda. Las variables cualitativas se describieron estadísticamente mediante frecuencias absolutas y relativas y para las variables cuantitativas se utilizó la media, la mediana, la desviación estándar y el rango intercuartílico como medidas de dispersión. Resultados: El 36,5 por ciento de los enfermos presentó complicaciones donde la deshidratación fue la más frecuente. El valor de la mediana del tiempo que medió entre la aparición de los síntomas y la atención en el centro fue menor en los pacientes con complicaciones comparado con el observado en los no complicados, pero la diferencia no fue significativa: (24 horas [RI: 24,0-72,0 horas] vs. 48 horas [RI: 24,0-72,0 horas], p= 0,355). Conclusiones: La mayoría de los enfermos no presentaron complicaciones y la más frecuente es la deshidratación ligera(AU)


Introduction: The seventh cholera pandemic arrived to the Americas in 1991. In Cuba for more than 130 years there were no case reports. Objectives: To identify and characterize the complications by cholera and its relation with clinical characteristics and treatment. Methods: A descriptive and prospective study was conducted from 2013 to 2017 to the patients who had been confirmed with V. cholerae as exclusive cause of acute diarrheal disease. The qualitative variables were described statistically using absolute and relative frequencies, and for the quantitative variables were used the average, medium, and standard deviation and the interquartile range as dispersion measures. Results: 36.5 percent of the patients presented complications where dehydration was the most frequent. The value of the median time between the onset of symptoms and attention in the center was lower in patients with complications in comparison with the observed in non-complicated patients, but the difference was not significant (24.0 h [RI: 24,0-72,0 h] vs. 48,0 h [RI: 24,0-72,0 h], p= 0.355). Conclusions: Most of the patients did not present complications and the most frequent is the slight dehydration (AU)


Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Cólera/complicações , Cólera/terapia , Desidratação/complicações
11.
BMC Pregnancy Childbirth ; 20(1): 82, 2020 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-32033597

RESUMO

BACKGROUND: Water requirements increases with gestational age. Insufficient water intake causes dehydration, which may adversely affect maternal health and birth outcomes. However, few related studies have been conducted. The purposes are to assess the water intake and hydration state among pregnant women, and to investigate the associations with pregnancy complications and maternal and infant outcomes. METHODS: A prospective observational cohort study will be applied. A total of 380 pregnant women will be recruited from the First Affiliated Hospital of Hainan Medical University. Hydration biomarkers and health outcomes will be tested during 15~17 weeks' gestation, 20~22 weeks' gestation, 30~32 weeks' gestation, during childbirth and 42 days after childbirth. Daily fluid intake will be collected using a 24-h fluid intake record for 7 consecutive days. A semi-quantified food frequency method will be used to assess food intake and water intake from food. Anthropometric measurement will be taken following standardized processes. Intracellular fluid (ICF) and extracellular fluid (ECF) will be measured using a body composition analyzer. Morning fasting urine and blood osmolality will be tested by laboratory physicians using an osmotic pressure molar concentration meter. Pregnancy complications will be assessed and diagnosed throughout pregnancy and childbirth. Maternal-infant outcomes will be monitored using related indicators and technologies. In order to explore the internal mechanism and interactions from the perspective of endocrine, pregnancy related hormones (estradiol, prolactin, progesterone) and the hydration-related hormones (copeptin) will be tested during pregnancy. A mixed model of repeated measures ANOVA will be analyzed using SAS 9.2. RESULTS: The results may provide basic data on water intake among pregnant women. The association between hydration state and maternal-infant outcomes will also be explored. CONCLUSIONS: This preliminary exploratory study findings will fill the gaps in the research on water intake, hydration and maternal health, birth outcomes, provide scientific reference data for updating recommendation on water adequate intake among pregnant women, and provide suggestion for developing water intake interventions. TRIAL REGISTRATION: The protocol has been registered on the website of Chinese Clinical Trial Registry. The Identifier code is ChiCTR1800019284. The Registry date is 3 November, 2018. Registry name is "Study for the correlation between hydration state and pregnancy complications, maternal and infant outcomes during pregnancy".


Assuntos
Desidratação/complicações , Ingestão de Líquidos/fisiologia , Complicações na Gravidez/etiologia , Trimestres da Gravidez/fisiologia , Equilíbrio Hidroeletrolítico/fisiologia , Adulto , Biomarcadores/análise , Desidratação/fisiopatologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Saúde Materna , Estudos Observacionais como Assunto , Gravidez , Complicações na Gravidez/fisiopatologia , Resultado da Gravidez , Estudos Prospectivos , Projetos de Pesquisa , Adulto Jovem
12.
Nephrology (Carlton) ; 25(2): 156-162, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31099943

RESUMO

AIM: Kidney disease of unknown aetiology (CKDu) has been a health problem in the rural farming community of the North Central province of Sri Lanka since the 1990s and various environmental factors have been postulated as contributing factors for this disease. The aim of our study was to find out whether farmers undergo dehydration which would lead to concentration of urine and the water soluble potentially toxic substance in the kidney, leading to damage of the renal tubules. Therefore, we studied a sample of healthy farmers who were CKDu-free to determine whether they were dehydrated. METHODS: Sample included healthy male paddy farmers of Padaviya in the Anuradhapura district. Plasma and urine osmolarity were recorded upon waking up in the morning and evening during the non-farming and farming seasons. Basic statistics and a 2 × 2 anova was done to test the interaction of time of day with farming activity. RESULTS: Farmers were dehydrated according to the plasma osmolarity especially in the mornings, irrespective of whether they were farming or not. Approximately 40% of the sample also demonstrated acute dehydration at the end of the day due to farming activity as indicated by both plasma and urine osmolarity and specific gravity. CONCLUSION: This study revealed that the farmers of the Padaviya area were either dehydrated or at the upper limit of euhydration sometime during the day irrespective of their activities during the day.


Assuntos
Desidratação , Fazendeiros , Rim/fisiopatologia , Concentração Osmolar , Insuficiência Renal Crônica , Adulto , Desidratação/sangue , Desidratação/complicações , Desidratação/diagnóstico , Desidratação/epidemiologia , Exposição Ambiental , Humanos , Masculino , Sintomas Inexplicáveis , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Sri Lanka/epidemiologia , Urinálise/métodos
13.
J Matern Fetal Neonatal Med ; 33(4): 593-597, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30196730

RESUMO

Objectives: To determine the prevalence of dehydration fever in infants admitted to the Neonatal Intensive Care Unit (NICU) from the well newborn nursery with fever in the first days of life.Study design: Retrospective data analysis of term infants admitted to the NICU from the well newborn nursery with fever (n = 75). Infants were divided into two groups based on hydration status using clinical and laboratory signs of dehydration. Clinical and laboratory variables were compared between the two groups.Results: Fifty-three of the 75 infants admitted to the NICU with fever had clinical and laboratory signs of dehydration (71%). Infants with dehydration were more likely to be exclusively breast fed and present with fever at >24 h of age. There were no positive blood or cerebrospinal fluid cultures in infants with dehydration. The incidence of dehydration fever increased after implementation of an "Exclusive Breast Feeding" policy from 1.4/1000 to 3.5/1000 live births (p ≤ .01).Conclusions: Dehydration is associated with fever in exclusively breast fed infants during the first several days of life. There were no cases of serious bacterial or viral infections in the cohort of febrile infants with clinical and laboratory signs of dehydration.


Assuntos
Aleitamento Materno , Desidratação/complicações , Febre/etiologia , Adulto , Desidratação/epidemiologia , Feminino , Febre/epidemiologia , Humanos , Recém-Nascido , Infecções/epidemiologia , Masculino , Philadelphia/epidemiologia , Estudos Retrospectivos , Adulto Jovem
14.
Cienc. tecnol. salud ; 7(1): 39-46, 2020. ^c27 cmilus
Artigo em Espanhol | LILACS | ID: biblio-1120258

RESUMO

La flexibilidad laboral es característica de la producción estacional agroindustrial, cuyo principal problema es aprovechar con intensidad los períodos en los que se incrementa la producción. Pero, ¿cómo la demandante competitividad laboral influye en las estrategias de los trabajadores para incrementar su productividad? A partir de esta pregunta, se identificaron los aspectos económicos, sociales y laborales que inciden en la salud, así como las respuestas para disminuir el dolor físico y aumentar las exigencias de competitividad, flexibilización y desregularización del mercado de trabajo. La exposición ambiental y ocupacional en las condiciones de trabajo, el estrés térmico asociado a la deshidratación en la actividad física intensa, el limitado acceso a los servicios de salud, la mala alimentación y la pobre calidad de vida, también pueden producir otras enfermedades como diabetes e hipertensión, así como infecciones y lesiones renales. En ese contexto, en los últimos 20 años, se empezaron a reportar casos de enfermedad renal. La metodología cualitativa aplicada a este estudio, permitió llevar a cabo un proceso investigativo descriptivo e interpretativo sobre la forma en que los sujetos interactúan. Para ello se utilizaron las trayectorias laborales como técnicas en la recolección de datos. Los resultados arrojaron información relevante sobre las estrategias que los trabajadores utilizan para incrementar su rendimiento laboral, entre ellas la automedicación de vitaminas y analgésicos para tratar los espasmos musculares, que estimulan el sistema nervioso central, así como de bebidas saborizadas y energizantes con posibles repercusiones en la excreción renal.


Labor flexibility is characteristic of seasonal agroindustrial production whose main problem is to take advantage of the periods in which production increases. But, how does this demanding labor competitiveness influence workers' strategies to increase their productivity? From this question, the economic, social and labor aspects that affect health were identified, as well as the answers to reduce physical pain and increase the demands for competitiveness, flexibility and deregulation of the labor market. Environmental and occupational exposure in working conditions, thermal stress associated with dehydration in intense physical activity, limited access to health services, poor diet and quality of life, can also cause other diseases such as diabetes and hypertension, as well as infections and kidney lesions. In that context, in the last 20 years, cases of kidney disease began to be reported. The qualitative methodology applied to this study, allowed to carry out a descriptive and interpretive investigation process on the way in which the subjects interact, for this, the work trajectories were used as techniques in data collection. The results yielded relevant information on the strategies that workers use to increase their work performance, including self-medication of "vitamins" and analgesics to treat muscle spasms, drugs that stimulate the central nervous system, as well as flavored and energizing drinks with possible repercussions on renal excretion.


Assuntos
Humanos , Masculino , Adolescente , Adulto , Pessoa de Meia-Idade , Trabalhadores Rurais , Condições de Trabalho , Insuficiência Renal Crônica/economia , Dor/tratamento farmacológico , Automedicação , Vitaminas/administração & dosagem , Costa , Desidratação/complicações , Mercado de Trabalho , Bebidas Energéticas/efeitos adversos , Eliminação Renal , Desempenho Profissional , Guatemala , Analgésicos/efeitos adversos
15.
BMC Nephrol ; 20(1): 449, 2019 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-31801476

RESUMO

BACKGROUND: Elderly, patients with chronic kidney disease (CKD) and patients with heart failure who continue using renin-angiotensin-aldosterone-system (RAAS) inhibitors, diuretics, or non-steroidal-anti-inflammatory drugs (NSAIDs) during times of fluid loss have a high risk of developing complications like acute kidney injury (AKI). The aim of this study was to assess how often advice to discontinue high-risk medication was offered to high-risk patients consulting the general practitioner (GP) with increased fluid loss. Furthermore, we assessed the number and nature of the complications that occurred after GP consultation. METHODS: We performed a cross-sectional study with patients from seven Dutch general practices participating in the Family Medicine Network between 1 and 6-2013 and 1-7-2018. We included patients who used RAAS-inhibitors, diuretics, or NSAIDs, and had at least one of the following risk factors: age ≥ 70 years, CKD, or heart failure. From this population, we selected patients with a 'dehydration-risk' episode (vomiting, diarrhoea, fever, chills, or gastrointestinal infection). We manually checked their electronic patient files and assessed the percentage of episodes in which advice to discontinue the high-risk medication was offered and whether a complication occurred in 3 months after the 'dehydration-risk' episode. RESULTS: We included 3607 high-risk patients from a total of 44.675 patients (8.1%). We found that patients were advised to discontinue the high-risk medication in 38 (4.6%) of 816 'dehydration-risk' episodes. In 59 of 816 episodes (7.1%) complications (mainly AKI) occurred. CONCLUSIONS: Dutch GPs do not frequently advise high-risk patients to discontinue high-risk medication during 'dehydration-risk' episodes. Complications occur frequently. Timely discontinuation of high-risk medication needs attention.


Assuntos
Lesão Renal Aguda , Antagonistas de Receptores de Angiotensina , Inibidores da Enzima Conversora de Angiotensina , Anti-Inflamatórios não Esteroides , Desidratação , Desprescrições , Diuréticos , Insuficiência Cardíaca/tratamento farmacológico , Risco Ajustado/métodos , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/prevenção & controle , Idoso , Antagonistas de Receptores de Angiotensina/efeitos adversos , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/uso terapêutico , Desidratação/complicações , Desidratação/fisiopatologia , Desidratação/terapia , Diuréticos/efeitos adversos , Diuréticos/uso terapêutico , Feminino , Medicina Geral/métodos , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Insuficiência Renal Crônica/fisiopatologia , Fatores de Risco , Suspensão de Tratamento/normas
17.
Indian J Pediatr ; 86(12): 1142-1145, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31701427

RESUMO

The objective of the present study was to identify risk factors for mortality at admission in children admitted to the Pediatric Intensive Care Unit (PICU) with acute gastroenteritis (AGE) with severe dehydration and shock. This was a retrospective chart review of all cases of AGE with severe dehydration and shock admitted to the PICU from 2012 to 2017. Children who died during hospital stay were compared with those who survived. A total of 62 children were admitted with AGE to the PICU during this period. Twenty-four children (39%) died. The following variables were found to be significantly associated with death on univariate analysis: clinical pallor (p = 0.01), thrombocytopenia (p = 0.018), elevated leucocyte count (p = 0.02), hypoalbuminemia (p = 0.02) and severe acute malnutrition (SAM) (p = 0.04). On multivariate analysis, only hypoalbuminemia {RR [95% CI: 2.6 (1.27 to 9.21)]; 0.039} and SAM {RR [95% CI: 4.9 (1.12 to 10)]; 0.045} remained statistically significant. Children admitted with severe dehydration and shock had high mortality rates. These children were a sicker subset with probable sepsis. Severe acute malnutrition and hypoalbuminemia were associated with increased risk of death in these patients.


Assuntos
Criança Hospitalizada , Desidratação/complicações , Desidratação/mortalidade , Gastroenterite/complicações , Gastroenterite/mortalidade , Hospitalização , Adolescente , Criança , Pré-Escolar , Desidratação/fisiopatologia , Feminino , Gastroenterite/fisiopatologia , Humanos , Hipoalbuminemia/epidemiologia , Índia/epidemiologia , Lactente , Unidades de Terapia Intensiva Pediátrica , Tempo de Internação , Masculino , Desnutrição/epidemiologia , Mortalidade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Sepse , Choque , Trombocitopenia/epidemiologia
18.
J Pharmacol Sci ; 141(1): 49-55, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31611174

RESUMO

BACKGROUND: Contrast-induced nephropathy (CIN) is a frequent cause of hospital-acquired acute kidney injury. Previous animal models developed to explore the pathogenesis of CIN were based primarily on surgery or indomethacin treatment. Thus, we sought to explore a novel CIN rat model comparable to the human CIN. METHODS AND RESULTS: Both serum creatinine and tubular injury score were used to assess the successful establishment of the present model. In our study, dehydration duration and the iohexol dosage were found to be the two most important factors to develop a rat CIN model. And, dehydration for 3 days plus furosemide (10 mL/kg) injection before iohexol (15 mL/kg) administration was demonstrated the optimal strategy. Renal injury induced by 15 mL/kg iohexol was almost twice more severe than 10 mL/kg. Moreover, significant renal function decrease, morphological damage and mitochondrial dysfunction occurred as early as 6 h after iohexol injection, not 24 h as previous studies reported. Unexpectedly, we firstly discovered that dehydration after iohexol administration did not increase the extent of renal damage, indicating that hydration after contrast media exposure may be ineffective. CONCLUSIONS: A novel CIN rat model based on dehydration and iohexol exposure was established and validated to assist in understanding and preventing CIN.


Assuntos
Lesão Renal Aguda , Meios de Contraste/efeitos adversos , Desidratação/complicações , Modelos Animais de Doenças , Iohexol/efeitos adversos , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/patologia , Lesão Renal Aguda/prevenção & controle , Animais , Biomarcadores/sangue , Meios de Contraste/administração & dosagem , Creatinina/sangue , Furosemida/administração & dosagem , Furosemida/efeitos adversos , Iohexol/administração & dosagem , Túbulos Renais/patologia , Masculino , Ratos Sprague-Dawley
19.
J Stroke Cerebrovasc Dis ; 28(12): 104397, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31582273

RESUMO

AIM OF THE STUDY: Diffusion-weighted image (DWI) of magnetic resonance imaging (MRI) can reveal high signal lesion in up to 50% of transient ischemic attack (TIA) patients. However, it is not well-known which factors determine developing DWI positivity. In order to answer this question, we analyzed factors relevant to DWI positivity in TIA patients. METHODS: We had 257 stroke patients at a university emergency/neurology wards. They were 140 men, 117 women, mean age 72 (45-88) years. Among them, 24 (9.3%) had TIA (14 men, 10 women, mean age 71 [58-82] years). All patients underwent a 1.5T MRI. In 24 TIA patients, we investigated the following parameters in relation with stroke maturation: ABCD2 score, smoking habits, blood profile, HbA1C, dyslipidemia, coagulation factors, carotid echography, electrocardiography, cardiac echography, chest X-ray, neurological symptom/signs, imaging, and recurrence of neurological symptom on follow-up. RESULTS: In 24 TIA patients, 13 (54%) were DWI positive and 11 (46%) were DWI negative. After an extensive analysis, all parameters were not relevant to DWI positivity except for plasma osmolarity, i.e., plasma osmolarity in DWI positive cases (305.3 mOsm/l) is significantly higher than that in DWI negative cases (301.3 mOsm/l) (P = .0064). As for recurrence, 4 of 24 TIA patients recurred. They were 1 (9.0%) of 11 DWI negative cases and 3 (23.1%) of 13 DWI positive cases. Therefore, DWI positive cases recurred more frequently than DWI negative cases did, although it did not reach statistical significance. CONCLUSIONS: TIA with DWI positivity in our institute was 54%, closely associated with initial dehydration and might predict stroke recurrence.


Assuntos
Desidratação/complicações , Imagem de Difusão por Ressonância Magnética , Ataque Isquêmico Transitório/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Desidratação/sangue , Desidratação/diagnóstico , Desidratação/fisiopatologia , Feminino , Humanos , Ataque Isquêmico Transitório/sangue , Ataque Isquêmico Transitório/etiologia , Masculino , Pessoa de Meia-Idade , Estado de Hidratação do Organismo , Concentração Osmolar , Valor Preditivo dos Testes , Recidiva , Medição de Risco , Fatores de Risco
20.
Artigo em Inglês | MEDLINE | ID: mdl-31370256

RESUMO

Chronic kidney disease of unknown etiology (CKDu) is a global epidemic. Sri Lanka has experienced a doubling of the disease every 4 or 5 years since it was first identified in the North Central province in the mid-1990s. The disease primarily affects people in agricultural regions who are missing the commonly known risk factors for CKD. Sri Lanka is not alone: health workers have reported prevalence of CKDu in Mexico, Nicaragua, El Salvador, and the state of Andhra Pradesh in India. A global search for the cause of CKDu has not identified a single factor, but rather many factors that may contribute to the etiology of the disease. Some of these factors include heat stroke leading to dehydration, toxic metals such as cadmium and arsenic, fluoride, low selenium, toxigenic cyanobacteria, nutritionally deficient diet and mycotoxins from mold exposure. Furthermore, exposure to agrichemicals, particularly glyphosate and paraquat, are likely compounding factors, and may be the primary factors. Here, we argue that glyphosate in particular is working synergistically with most of the other factors to increase toxic effects. We propose, further, that glyphosate causes insidious harm through its action as an amino acid analogue of glycine, and that this interferes with natural protective mechanisms against other exposures. Glyphosate's synergistic health effects in combination with exposure to other pollutants, in particular paraquat, and physical labor in the ubiquitous high temperatures of lowland tropical regions, could result in renal damage consistent with CKDu in Sri Lanka.


Assuntos
Doenças dos Trabalhadores Agrícolas/etiologia , Glicina/análogos & derivados , Herbicidas/toxicidade , Exposição Ocupacional/efeitos adversos , Insuficiência Renal Crônica/etiologia , Doenças dos Trabalhadores Agrícolas/epidemiologia , Desidratação/complicações , Glicina/toxicidade , Transtornos de Estresse por Calor/complicações , Humanos , Paraquat/toxicidade , Prevalência , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco , Sri Lanka/epidemiologia
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