Hydration, kidney injury and clinical outcome

Studies in health care professional (HCPs) have demonstrated a high prevalence of dehydration, which has been linked with morphological brain changes as well as cognitive impairment in other groups. Moreover, many age-related pathophysiological changes result in increased susceptibility to fluid and electrolyte imbalance, rendering older adults vulnerable to dehydration which may be associated with poor outcome. This thesis investigates the prevalence of dehydration and impact on cognitive function amongst HCPs. It also investigates the prevalence of dehydration in hospitalised older adults and the association between dehydration, acute kidney injury (AKI) and clinical outcome. Hydration status and cognition were objectively assessed in nurses and doctors working on emergency medical and surgical wards. This study demonstrated that a significant proportion of HCPs were dehydrated at the start and end of their shifts and many were oliguric. The prevalence of dehydration varied with level of experience and speciality and was associated with short-term memory impairment. Using serum osmolality, the key regulated variable in fluid homeostasis as a measure of hydration status in hospitalised older adults, prospective assessment of 200 patients demonstrated that over a third had hyperosmolar dehydration (HD) at admission, two-thirds of which were dehydrated 48 hours later. Dehydration at admission was independently associated with a six-fold increase in 30-day mortality. Subsequent retrospective assessment of 32,980 hospitalised older adults demonstrated that dehydration was diagnosed clinically in 8.9% of patients and was independently associated with a two fold increase in mortality. Nearly half of those dehydrated had a concomitant diagnosis of AKI and the median length of hospital stay (LOS) was nearly three times greater than those without the condition. Despite the widespread use of serum osmolality in human physiology studies, it is rarely used clinically to assess hydration. Analysis of published equations estimating osmolality, demonstrated that an equation by Khajuria and Krahn was 90% sensitivity and 97% specificity at diagnosing hyperosmolar dehydration. Using this equation, we demonstrated that 27.2% of 6632 older adults had HD at admission to hospital and the risk of developing AKI 12-24 hours after admission in these patients was five times those euhydrated at admission. Moreover, the 30-day mortality was nearly twice that of euhydrated patients, independent of key confounders. The median LOS in dehydrated patients was almost double. This work has highlighted the need to educate both patients and HCPs on the importance of hydration. Further work is required to prospectively assess the use of serum osmolality as a predictor of dehydration, AKI and outcomes. Given that hydration and nutrition are the hallmarks of compassionate care, there is clear room for improvement with findings from this thesis suggesting the need for further investigation and intervention in both community and hospital settings

Hydration, kidney injury and clinical outcome

Studies in health care professional (HCPs) have demonstrated a high prevalence of dehydration, which has been linked with morphological brain changes as well as cognitive impairment in other groups. Moreover, many age-related pathophysiological changes result in increased susceptibility to fluid and electrolyte imbalance, rendering older adults vulnerable to dehydration which may be associated with poor outcome. This thesis investigates the prevalence of dehydration and impact on cognitive function amongst HCPs. It also investigates the prevalence of dehydration in hospitalised older adults and the association between dehydration, acute kidney injury (AKI) and clinical outcome. Hydration status and cognition were objectively assessed in nurses and doctors working on emergency medical and surgical wards. This study demonstrated that a significant proportion of HCPs were dehydrated at the start and end of their shifts and many were oliguric. The prevalence of dehydration varied with level of experience and speciality and was associated with short-term memory impairment. Using serum osmolality, the key regulated variable in fluid homeostasis as a measure of hydration status in hospitalised older adults, prospective assessment of 200 patients demonstrated that over a third had hyperosmolar dehydration (HD) at admission, two-thirds of which were dehydrated 48 hours later. Dehydration at admission was independently associated with a six-fold increase in 30-day mortality. Subsequent retrospective assessment of 32,980 hospitalised older adults demonstrated that dehydration was diagnosed clinically in 8.9% of patients and was independently associated with a two fold increase in mortality. Nearly half of those dehydrated had a concomitant diagnosis of AKI and the median length of hospital stay (LOS) was nearly three times greater than those without the condition. Despite the widespread use of serum osmolality in human physiology studies, it is rarely used clinically to assess hydration. Analysis of published equations estimating osmolality, demonstrated that an equation by Khajuria and Krahn was 90% sensitivity and 97% specificity at diagnosing hyperosmolar dehydration. Using this equation, we demonstrated that 27.2% of 6632 older adults had HD at admission to hospital and the risk of developing AKI 12-24 hours after admission in these patients was five times those euhydrated at admission. Moreover, the 30-day mortality was nearly twice that of euhydrated patients, independent of key confounders. The median LOS in dehydrated patients was almost double. This work has highlighted the need to educate both patients and HCPs on the importance of hydration. Further work is required to prospectively assess the use of serum osmolality as a predictor of dehydration, AKI and outcomes. Given that hydration and nutrition are the hallmarks of compassionate care, there is clear room for improvement with findings from this thesis suggesting the need for further investigation and intervention in both community and hospital settings

A reproducible protocol for regeneration and transformation in canola (Brassica napus L.)

The objective of the present study is to develop an efficient protocol for shoot and plant regeneration using five commercial canola cultivars grown under the Egyptian agricultural conditions. The regeneration efficiency from hypocotyl explants was examined. The data indicated that embryonic calli were formed within two weeks in the presence of 1 mgl-1 2,4-D. Adventitious shoots emerged from the embryonic callus in the presence of 4.5 mgl-1 BA. The cultivars showed a varied response to shoot regeneration. Regeneration frequency was high in the cultivar Sarow-4 (68%) followed by Masrri L-16 (64%) compared with the other cultivars tested. Hypocotyl explants from the cultivars Sarow-4 and Semu-249 were inoculated and co-cultivated with Agrobacterium tumefaciens strain LBA4404 harboring a binary vector pBI-121 containing the neomycin phosphotransferase-II gene (NPT-II). The resulted putative transgenic plantlets were able to grow under knanamycin containing medium. The stable integration of the NPT-II gene into the plant genomes was tested by PCR using NPT-II -specific primers. The GUS gene expression can be detected only in the transgenic plants. The reported protocol in the present study is repeatable and can be used to regenerate transgenic canola plants expressing the genes present in A. tumifaciens binary vectors.Keywords: Agrobacterium, canola, GUS assay, regeneration, fransformation, NPT II gen

Parathormone (PTH) is strongly related to left ventricular mass index (LVMI) in hypertensives, obese, and normal control

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Comparison between Sigma metrics in four accredited Egyptian medical laboratories in some biochemical tests: an initiative towards sigma calculation harmonization

Introduction: Analytical quality is an essential requirement for best practice in any medical laboratory. Lack of a harmonized approach for sigma calculation is considered an obstacle in the objective comparability of analytical performance among laboratories adopting sigma metrics. It is urgently needed that all laboratory professionals interested in the analytical quality to work hard towards harmonization protocol for sigma calculation in order to properly select their analytical goals. This study aims at harmonization of Sigma metrics calculation in four accredited Egyptian laboratories. Materials and methods: This observational cross sectional study compared the sigma levels for certain biochemical parameters in the four participating laboratories. Results: Coefficient of variation (CV) and bias were determined for some biochemical analytes, data assayed by different automated analysers in the four different accredited laboratories. The sigma level for the four medical laboratories was calculated for each biomedical parameter with changed sigma level after total allowable error (Tea) unification among participating laboratories. Conclusion: Each laboratory should select the TEa goal based on clear standardized criteria of selection without any subjective preferences as either under or over estimation of Sigma metrics will affect the patient centred care negatively if laboratories use quality control procedures wrongly based on incorrect Sigma metrics calculation with subsequent misleading medical decisions

Preterm Small Gestational Age Newborns: Impact on Renal Size and Function

OBJECTIVE: The objective of the study was to evaluate the size and function of the kidney in high-risk premature small gestational age (PT/SGA) newborns. Furthermore, estimation of the glomerular filtration rate (GFR) was done by comparing Cystatin C-based method with the creatinine –based method in those preterm newborns. PATIENTS AND METHODS: The study included 20 PT/SGA and controls (20 preterm appropriate for gestational age [PT/AGA] and 20 full-term [FT] newborns). Serum creatinine, blood urea nitrogen, and cystatin C were determined on days 3 and 7 of the study for all newborn infants. GFR was assessed by cystatin C-based method and creatinine-based method. Evaluation of the renal size by ultrasound was done on day 7 of neonatal life. RESULTS: A significant difference was found in the length and transverse diameter of both kidneys, comparing PT/SGA group with PT/AGA and FT group. Cystatin C on day 3 of PT/SGA group had a significant difference than PT/AGA and FT group. Estimation of GFR (eGFR) calculated by filler Zappitelli, Grubb, Larsson, and Dorum formulae of PT/SGA group had a significant difference comparing with PT/AGA and FT group on days 3 and 7. CONCLUSION: PT/SGA newborns have reduced renal size and immature renal function. Cystatin C is a marker for renal function superior to creatinine as it is not affected by body mass index, gestational age, and birth weight. Cystatin C-based eGFR is more accurate and more sensitive to minor changes in GFR than creatinine-based equation

Hyperosmolar dehydration: a predictor of kidney injury and outcome in hospitalised older adults

© 2019 The Author(s) Background & aims: Hospitalised older adults are vulnerable to dehydration. However, the prevalence of hyperosmolar dehydration (HD) and its impact on outcome is unknown. Serum osmolality is not measured routinely but osmolarity, a validated alternative, can be calculated using routinely measured serum biochemistry. This study aimed to use calculated osmolarity to measure the prevalence of HD (serum osmolarity >300 mOsm/l) and assess its impact on acute kidney injury (AKI) and outcome in hospitalised older adults. Methods: This retrospective cohort study used data from a UK teaching hospital retrieved from the electronic database relating to all medical emergency admissions of patients aged ≥ 65 years admitted between 1st May 2011 and 31st October 2013. Using these data, Charlson comorbidity index (CCI), National Early Warning Score (NEWS), length of hospital stay (LOS) and mortality were determined. Osmolarity was calculated using the equation of Krahn and Khajuria. Results: A total of 6632 patients were identified; 27% had HD, 39% of whom had AKI. HD was associated with a median (Q1, Q3) LOS of 5 (1, 12) days compared with 3 (1, 9) days in the euhydrated group, P < 0.001. Adjusted Cox-regression analysis demonstrated that patients with HD were four-times more likely to develop AKI 12–24 h after admission [Hazards Ratio (95% Confidence Interval) 4.5 (3.5–5.6), P < 0.001], and had 60% greater 30-day mortality [1.6 (1.4–1.9), P < 0.001], compared with those who were euhydrated. Conclusion: HD is common in hospitalised older adults and is associated with increased LOS, risk of AKI and mortality. Further work is required to assess the validity of osmolality or osmolarity as an early predictor of AKI and the impact of HD on outcome prospectively

A randomized, controlled, double-blind crossover study on the effects of isoeffective and isovolumetric intravenous crystalloid and gelatin on blood volume, and renal and cardiac hemodynamics

Background & aimsBlood volume expanding properties of colloids are superior to crystalloids. In addition to oncotic/osmotic properties, the electrolyte composition of infusions may have important effects on visceral perfusion, with infusions containing supraphysiological chloride causing hyperchloremic acidosis and decreased renal blood flow. In this non-inferiority study, a validated healthy human subject model was used to compare effects of colloid (4% succinylated gelatin) and crystalloid fluid regimens on blood volume, renal function, and cardiac output.MethodsHealthy male participants were given infusions over 60 min > 7 days apart in a randomized, crossover manner. Reference arm (A): 1.5 L of Sterofundin ISO, isoeffective arm (B): 0.5 L of 4% Gelaspan®, isovolumetric arm (C): 0.5 L of 4% Gelaspan® and 1 L of Sterofundin ISO (all B. Braun, Melsungen, Germany). Participants were studied over 240 min. Changes in blood volume were calculated from changes in weight and hematocrit. Renal volume, renal artery blood flow (RABF), renal cortex perfusion and diffusion, and cardiac index were measured with magnetic resonance imaging.ResultsTen of 12 males [mean (SE) age 23.9 (0.8) years] recruited, completed the study. Increase in body weight and extracellular fluid volume were significantly less after infusion B than infusions A and C, but changes in blood volume did not significantly differ between infusions. All infusions increased renal volume, with no significant differences between infusions. There was no significant difference in RABF across the infusion time course or between infusion types. Renal cortex perfusion decreased during the infusion (mean 18% decrease from baseline), with no significant difference between infusions. There was a trend for increased renal cortex diffusion (4.2% increase from baseline) for the crystalloid infusion. All infusions led to significant increases in cardiac index.ConclusionsA smaller volume of colloid (4% succinylated gelatin) was as effective as a larger volume of crystalloid at expanding blood volume, increasing cardiac output and changing renal function. Significantly less interstitial space expansion occurred with the colloid

Performance evaluation of a waste-heat driven adsorption system for automotive air-conditioning: Part II - Performance optimization under different real driving conditions

[EN] In this part, Part 11, of a two-part study, the validated model of part I is integrated into a general vehicle model in order to predict the performance of the system under real driving conditions. The overall model takes into account all the system components to simulate the dynamic performance of the entire system and predict the cabin temperature at the available waste heat. The system was implemented in a Fiat Grande Punto vehicle and the experimental tests were performed at the Centro Ricerche Fiat (CRF), Italy laboratories. Different design configurations were investigated to explore further improvements of the performance. Results showed that the model was able to well predict the transient performance of the system under different start-up and ambient conditions as well as the normal operating conditions. Using two radiators instead of one radiator increases the cooling capacity by 7.0% and decreases the cabin temperature by 9.1%. At the warming up period, the adsorption system faces serious difficulties to start producing the required cooling. Possible strategies to avoid this problem were studied and compared. In general, it has been proved that the amount of engine waste heat available is sufficient to produce enough cooling to keep reasonably comfortable temperatures in the cabin. (C) 2016 Elsevier Ltd. All rights reserved.This work has been partially supported by the Thermally Operated Mobile Air Conditioning Systems (TOPMACS). The authors are very grateful to the Energy Research Center of Netherlands (ECN) for their support with the experimental work.This work has been partially supported by the Thermally Operated Mobile Air Conditioning Systems (TOPMACS). The authors are very grateful to the Energy Research Center of Netherlands (ECN) for their support in the experimental work.Verde Trindade, M.; Harby Mohamed Abd Alaal, K.; De Boer, R.; Corberán, JM. (2016). Performance evaluation of a waste-heat driven adsorption system for automotive air-conditioning: Part II - Performance optimization under different real driving conditions. Energy. 115:996-1009. doi:10.1016/j.energy.2016.09.086S996100911