Water intoxication presenting as maternal and neonatal seizures: a case report.

Introduction We present an unusual case of fitting in the mother and newborn child, and the challenges faced in the management of their hyponatraemia due to water intoxication. Case presentation A previously well 37-year-old, primigravid Caucasian woman presented with features mimicking eclampsia during labour. These included confusion, reduced consciousness and seizures but without a significant history of hypertension, proteinuria or other features of pre-eclampsia. Her serum sodium was noted to be low at 111 mmol/litre as was that of her newborn baby. She needed anti-convulsants with subsequent intubation to stop the fitting and was commenced on a hypertonic saline infusion with frequent monitoring of serum sodium. There is a risk of long-term neurological damage from central pontine myelinolysis if the hyponatraemia is corrected too rapidly. Mother and baby went on to make a full recovery without any long-term neurological complications. Conclusion There is little consensus on the treatment of life-threatening hyponatraemia. Previous articles have outlined several possible management strategies as well as their risks. After literature review, an increase in serum sodium concentration of no more than 8–10 mmol/litre in 24 hours is felt to be safe but can be exceeded with extreme caution if life-threatening symptoms do not resolve. Formulae exist to calculate the amount of sodium needed and how much hypertonic intravenous fluid will be required to allow safer correction. We hypothesise the possible causes of hyponatraemia in this patient and underline its similarity in symptom presentation to eclampsia

Bio-sensing textile based patch with integrated optical detection system for sweat monitoring

Sensors, which can be integrated into clothing and used to measure biochemical changes in body fluids, such as sweat, constitute a major advancement in the area of wearable sensors. Initial applications for such technology exist in personal health and sports performance monitoring. However, sample collection is a complicated matter as analysis must be done in real-time in order to obtain a useful examination of its composition. This work outlines the development of a textile-based fluid handling platform which uses a passive pump to gather sweat and move it through a pre-defined channel for analysis. The system is tested both in vitro and in vivo. In addition, a pH sensor, which depends on the use of a pH sensitive dye and paired emitter-detector LEDs to measure colour changes, has been developed. In vitro and on-body trials have shown that the sensor has the potential to record real-time variations in sweat during exercise

Large-sample estimation and inference in multivariate single-index models

By optimizing index functions against different outcomes, we propose a multivariate single-index model (SIM) for development of medical indices that simultaneously work with multiple outcomes. Fitting of a multivariate SIM is not fundamentally different from fitting a univariate SIM, as the former can be written as a sum of multiple univariate SIMs with appropriate indicator functions. What have not been carefully studied are the theoretical properties of the parameter estimators. Because of the lack of asymptotic results, no formal inference procedure has been made available for multivariate SIMs. In this paper, we examine the asymptotic properties of the multivariate SIM parameter estimators. We show that, under mild regularity conditions, estimators for the multivariate SIM parameters are indee

Impact of acute versus repetitive moderate intensity endurance exercise on kidney injury markers.

Exercise may lead to kidney injury through several mechanisms. Urinary Kidney Injury Molecule-1 (uKIM1) and Neutrophil Gelatinase-Associated Lipocalin (uNGAL) are known biomarkers for acute kidney injury, but their response to repetitive exercise remains unknown. We examined the effects of a single versus repetitive bouts of exercise on markers for kidney injury in a middle-aged population. Sixty subjects (aged 29-78 years, 50% male) were included and walked 30, 40 or 50 km for three consecutive days. At baseline and after exercise day 1 and 3, a urine sample was collected to determine uNGAL and uKIM1. Furthermore, urinary cystatin C, creatinine, and osmolality were used to correct for dehydration-related changes in urinary concentration. Baseline uNGAL was 9.2 (5.2-14.7) ng/mL and increased to 20.7 (11.0-37.2) ng/mL and 14.2(8.0-26.3) ng/mL after day 1 and day 3, respectively, (P ≤ 0.001). Baseline uKIM1 concentration was 2.6 (1.4-6.0) ng/mL and increased to 5.2 (2.4-9.1) ng/mL (P = 0.002) after day 1, whereas uKIM1 was not different from baseline at day 3 (2.9 [1.4-6.4] ng/mL (P = 0.52)). Furthermore, both uNGAL and uKIM1 levels were higher after day 1 compared to day 3 (P < 0.01). When corrected for urinary cystatin C, creatinine, and osmolality, uNGAL demonstrated a similar response compared to the uncorrected data, whereas differences in uKIM1 between baseline, day 1 and day 3 (Ptime = 0.63) were no longer observed for cystatin C and creatinine corrected data. A single bout of prolonged exercise significantly increased uNGAL concentration, whereas no changes in uKIM1 were found. Repetitive bouts of exercise show that there is no cumulative effect of kidney injury markers

¿Cuán igualador es el gasto público en educación en Argentina?

El objetivo de este trabajo es cuantificar el efecto distributivo del gasto público en educación en Argentina, en lo que respecta tanto a la provisión de la Educación de Gestión Pública como al subsidio a la Educación de Gestión Privada. Utilizando datos provenientes del Ministerio de Educación de la Nación y de la Encuesta Permanente de Hogares del año 2017 se analiza cómo se modifica la distribución de ingresos de los hogares al adicionarle el monto correspondiente al gasto público en educación por alumno para todos aquellos niños y jóvenes que asisten a establecimientos públicos, y el monto asignado en subsidios para aquellos que asisten a establecimientos de gestión privada subsidiados. La adición de ese gasto como un ingreso del hogar al que pertenece el niño o joven da como resultado una distribución más progresiva para los cuatro niveles, es decir, menos desigual que la distribución de los ingresos sin incorporarlo. Esta progresividad se observa cuando se analizan ambos tipos de gasto por nivel educativo –provisión pública del servicio y subsidio a la provisión privada-, tanto en forma conjunta como por separado. A su vez, se observa que el gasto tiene un efecto progresivo y pro-pobre en los niveles inicial, primario y secundario -es decir, la distribución de ingresos es más igualitaria que antes de la provisión de estos niveles educativos, y, además, esta transferencia está concentrada entre los hogares que tienen menores ingresos-. El gasto correspondiente al nivel superior tiene un efecto progresivo, pero no pro-pobre. Fecha de recepción: 13/7/2021 Fecha de aceptación: 6/9/202

Hyponatremia revisited: Translating physiology to practice

The complexity of hyponatremia as a clinical problem is likely caused by the opposite scenarios that accompany this electrolyte disorder regarding pathophysiology (depletional versus dilutional hyponatremia, high versus low vasopressin levels) and therapy (rapid correction to treat cerebral edema versus slow correction to prevent osmotic demyelination, fluid restriction versus fluid resuscitation). For a balanced differentiation between these opposites, an understanding of the pathophysiology of hyponatremia is required. Therefore, in this review an attempt is made to translate the physiology of water balance regulation to strategies that improve the clinical management of hyponatremia. A physiology-based approach to the patient with hyponatremia is presented, first addressing the possibility of acute hyponatremia, and then asking if and if so why vasopressin is secreted non-osmotically. Additional diagnostic recommendations are not to rely too heavily of the assessment of the extracellular fluid volume, to regard the syndrome of inappropriate antidiuresis as a diagnosis of exclusion, and to rationally investigate the pathophysiology of hyponatremia rather than to rely on isolated laboratory values with arbitrary cutoff values. The features of the major hyponatremic disorders are discussed, including diuretic-induced hyponatremia, adrenal and pituitary insufficiency, the syndrome of inappropriate antidiuresis, cerebral salt wasting, and exercise-associated hyponatremia. The treatment of hyponatremia is reviewed from simple saline solutions to the recently introduced vasopressin receptor antagonists, including their promises and limitations. Given the persistently high rates of hospital-acquired hyponatremia, the importance of improving the management of hyponatremia seems both necessary and achievable. Copyrigh

SIADH and hyponatraemia: foreword

Hyponatraemia is common, affecting about one in five of all hospitalized patients. Minor degrees of chronic hyponatraemia cause cognitive and motor impairment, and severe hyponatraemia is associated with substantial morbidity and mortality. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a common cause of hyponatraemia and is often poorly understood and inappropriately treated. Clinical evaluation and simple biochemical assessment should guide management. The introduction of vasopressin antagonists, or vaptans, into clinical practice heralds the beginning of a new and exciting era for this important group of disorders

Acute Severe Symptomatic Hyponatremia Following Coronary Angiography

Hyponatremia is a relatively common electrolyte disorder. Although severe acute hyponatremia following coronary angiography is rare, potentially lethal neurologic manifestations may result. We describe a patient with severe, symptomatic hyponatremia, an unusual complication of coronary angiography. Lack of familiarity with contrast media-related hyponatremia caused a delay in diagnosis and therapy in our case. The diagnosis of acute hyponatremia should be considered in any patient who develops behavioral or neurologic manifestations following coronary angiography. Prompt diagnosis and treatment is essential to avoid permanent neurologic damage or death

Fluid and Electrolyte Disturbances in Critically Ill Patients

Disturbances in fluid and electrolytes are among the most common clinical problems encountered in the intensive care unit (ICU). Recent studies have reported that fluid and electrolyte imbalances are associated with increased morbidity and mortality among critically ill patients. To provide optimal care, health care providers should be familiar with the principles and practice of fluid and electrolyte physiology and pathophysiology. Fluid resuscitation should be aimed at restoration of normal hemodynamics and tissue perfusion. Early goal-directed therapy has been shown to be effective in patients with severe sepsis or septic shock. On the other hand, liberal fluid administration is associated with adverse outcomes such as prolonged stay in the ICU, higher cost of care, and increased mortality. Development of hyponatremia in critically ill patients is associated with disturbances in the renal mechanism of urinary dilution. Removal of nonosmotic stimuli for vasopressin secretion, judicious use of hypertonic saline, and close monitoring of plasma and urine electrolytes are essential components of therapy. Hypernatremia is associated with cellular dehydration and central nervous system damage. Water deficit should be corrected with hypotonic fluid, and ongoing water loss should be taken into account. Cardiac manifestations should be identified and treated before initiating stepwise diagnostic evaluation of dyskalemias. Divalent ion deficiencies such as hypocalcemia, hypomagnesemia and hypophosphatemia should be identified and corrected, since they are associated with increased adverse events among critically ill patients