Management of severe hyponatremia: Infusion of hypertonic saline and desmopressin or infusion of vasopressin inhibitors?

Rapid correction of severe hyponatremia carries the risk of osmotic demyelination. Two recently introduced methods of correction of hyponatremia have diametrically opposite effects on aquaresis. Inhibitors of vasopressin V2 receptor (vaptans) lead to the production of dilute urine, whereas infusion of desmopressin causes urinary concentration. Identification of the category of hyponatremia that will benefit from one or the other treatment is critical. In general, vaptans are effective in hyponatremias presenting with concentrated urine and, with the exception of hypovolemic hyponatremia, can be used as their primary treatment. Desmopressin is effective in hyponatremias presenting with dilute urine or developing urinary dilution after saline infusion. In this setting, desmopressin infusion helps prevent overcorrection of the hyponatremia. Monitoring of the changes in serum sodium concentration as a guide to treatment changes is imperative regardless of the initial treatment of severe hyponatremia

Evolución de los ácidos grasos en el mesocarpo del níspero (Mespilus germanica. L.) a diferentes estados de maduración

The fatty acid composition of medlar (Mespilus germanica L.) varied significantly among the ripening stages sampled at 157, 172 and 187 DAFs (days after full bloom). Twenty-one different fatty acids were detected in preclimacteric fruit and 17 when the climacteric began. Principal fatty acids, determined in medlar fruit harvested from October (157 and 172 DAFs) to November (187 DAF) were mainly palmitic acid (16:0), linoleic acid (18:2n-6), and a-linolenic acid (18:3n-3). While the content of saturated fatty acids [palmitic acid (16:0) and stearic acid (18:0)] increased, the content of the essential polyunsaturated fatty acids [linoleic acid (18:2n-6) and linolenic acid (18:3n-3)] decreased through ripening, in parallel with pulp darkening. The percentage of linoleic acid and a-linolenic acid in ripe, hard fruits was 60.0 and 13.5 % of dry wt at 157 DAF which decreased throughout ripening, remaining at 28.7 and 5.6 % of dry wt, respectively, in the fully softened and darkened pulp. A marked decreases in the double bond index, percentage of unsaturation and the ratio of unsaturation/saturation were also seen throughout the medlar ripening. The contribution of unsaturated fatty acid to the total fatty acid content decreased markedly as the medlar fruit became progressively softer and darkened.La composición en ácidos grasos del níspero (Mespilus germanica L.) varió significativamente entre los estados de maduración muestreados a los 157, 172 y 187 DAFs (días después de la floración). Veinte y un ácidos grasos diferentes fueron detectados en el fruto preclimatérico y 17 cuando comenzó el climaterio. Los ácidos grasos principales encontrados en nísperos, recolectados desde Octubre (157 y 172 DAFs) hasta Noviembre (187 DAF), fueron principalmente ácido palmítico (16:0), ácido linoléico (18:2n-6), y ácido a-linolénico (18:3n-3). En tanto que el contenido en ácidos grasos saturados (ácido palmítico (16:0) y ácido esteárico (18:0)) aumentó, el contenido en ácidos grasos esenciales (ácido linoleico (18:2n-6) y ácido linolénico (18:3n-6)) disminuyó durante la maduración, en paralelo con el oscurecimiento de la pulpa. El porcentaje de ácido linoleico y de ácido a-linolénico en frutos maduros sin reblandecer fue de 60.0 y 13.5 % del peso seco a 157 DAF, disminuyendo durante la maduración, y permaneciendo a 28.7 y 56 % del peso seco, respectivamente, en la pulpa completamente blanda y oscura. También se observó durante la maduración del níspero una marcada disminución en el número de dobles enlaces, en el tanto por ciento de instauración y en la relación instauración / saturación. La contribución de los ácidos grasos insaturados al contenido de ácidos grasos totales disminuyó marcadamente cuando el níspero comenzó progresivamente a reblandecerse y oscurecerse

Phase angle correlates with n-3 fatty acids and cholesterol in red cells of Nigerian children with sickle cell disease

OBJECTIVE: To determine the cholesterol content and fatty acid composition of red cell membrane phospholipids (PL) of children with sickle cell disease (SCD) and to correlate these levels with whole body phase angle that is related to the integrity and function of cell membranes. STUDY DESIGN: Blood samples were obtained from 69 children with SCD and 72 healthy age- and gender-matched controls in Nigeria for the determination of the cholesterol content and proportions of fatty acids in red cell PL. Bioelectrical impedance analysis was used to obtain resistance (R) and reactance (Xc) from which phase angle was calculated as arctan Xc/R. Cholesterol (normalized to lipid phosphorus) and the proportions of individual fatty acids were correlated with phase angle. RESULTS: The proportions of palmitic (p < 0.001), stearic acid (p = 0.003) and cholesterol (p < 0.001) were significantly higher in the red cells of children with SCD, whereas the proportions of arachidonic acid and docosahexaenoic acid were reduced (p = 0.03 and < 0.001, respectively) compared to controls. The phase angle was inversely correlated with the proportions of palmitic acid (p = 0.03) and oleic acid (p < 0.001) and cholesterol (p = 0.003). Three n-3 polyunsaturated fatty acids-eicosapentaenoic acid, docosapentaenoic acid and docosahexaenoic acid- were positively correlated with phase angle (p < 0.001). CONCLUSIONS: The fatty acid composition and cholesterol content of tissue membranes in SCD correlate with the phase shift measured by bioelectrical impedance analysis. Phase angle measurements may provide a non-invasive method for monitoring interventions aimed at altering the lipid composition of membranes

Nutritional Factors Associated with Anaemia in Pregnant Women in Northern Nigeria

This study was conducted to assess the relative contribution of iron, folate, and B12 deficiency to anaemia in pregnant women in sub-Saharan Africa. In total, 146 pregnant women, who attended two antenatal clinics in Gombe, Nigeria, were recruited into the study. The majority (54%) of the women were in the third trimester. Blood samples were obtained for determination of haematocrit and for measurement of serum iron, total iron-binding capacity, ferritin, folate, vitamin B12, and homocysteine. Malaria was present in 15 (9.4%) women. Based on a haemoglobin value of <105 g/L, 44 (30%) women were classified as anaemic. The major contributing factor to anaemia was iron deficiency based on the serum concentration of ferritin (<10 ng/mL). The mean homocysteine concentration for all subjects was 14.1 μmol/L, and homocysteine concentrations were inversely correlated with concentrations of folate and vitamin B12. The serum homocysteine increased markedly at serum vitamin B12 levels below 250 pmol/L. The most common cause of anaemia in the pregnant women in northern Nigeria was iron deficiency, and the elevated concentrations of homocysteine were most likely due to both their marginal folate and vitamin B12 status

Towards A Microgrid Based Residential Home Energy Management Using Genetic Algorithm

This paper proposes a load scheduling approach for a residential home in an islanded PV microgrid scenario based on a Genetic Algorithm (GA). The primary aim is to inform on how a Demand Side Management (DSM) could reduce the capital cost of the residential home energy use and operational cost of the microgrid by minimizing the use of fossil fuel generator. The research study proposes and describes the design for load allocation to achieve utilization of solar PV resources optimally. The proposed scheme is based on the time-of-use (TOU) and improvement of electricity users' comfort. The demonstration of the concept is presented and discussed based on a single smart home scenario using a solar PV microgrid and battery in a rural community of Enugu State, Nigeria

Fluid balance concepts in medicine: Principles and practice.

The regulation of body fluid balance is a key concern in health and disease and comprises three concepts. The first concept pertains to the relationship between total body water (TBW) and total effective solute and is expressed in terms of the tonicity of the body fluids. Disturbances in tonicity are the main factor responsible for changes in cell volume, which can critically affect brain cell function and survival. Solutes distributed almost exclusively in the extracellular compartment (mainly sodium salts) and in the intracellular compartment (mainly potassium salts) contribute to tonicity, while solutes distributed in TBW have no effect on tonicity. The second body fluid balance concept relates to the regulation and measurement of abnormalities of sodium salt balance and extracellular volume. Estimation of extracellular volume is more complex and error prone than measurement of TBW. A key function of extracellular volume, which is defined as the effective arterial blood volume (EABV), is to ensure adequate perfusion of cells and organs. Other factors, including cardiac output, total and regional capacity of both arteries and veins, Starling forces in the capillaries, and gravity also affect the EABV. Collectively, these factors interact closely with extracellular volume and some of them undergo substantial changes in certain acute and chronic severe illnesses. Their changes result not only in extracellular volume expansion, but in the need for a larger extracellular volume compared with that of healthy individuals. Assessing extracellular volume in severe illness is challenging because the estimates of this volume by commonly used methods are prone to large errors in many illnesses. In addition, the optimal extracellular volume may vary from illness to illness, is only partially based on volume measurements by traditional methods, and has not been determined for each illness. Further research is needed to determine optimal extracellular volume levels in several illnesses. For these reasons, extracellular volume in severe illness merits a separate third concept of body fluid balance

Lipid Profiles and trans Fatty Acids in Serum Phospholipids of Semi-nomadic Fulani in Northern Nigeria

The Fulani are semi-nomadic pastoralists of West Africa whose diet, culture, and economy are centred on cattle. Previous studies have shown that the Fulani of northern Nigeria derive 50% of their total calories from fat and 30% of their calories from milk, cheese, yogurt, and butter oil that contain significant amounts of trans fatty acids (TFAs), primarily vaccenic acid, which raise total serum cholesterol and low-density lipoproteincholesterol (LDL-C), and lower high-density lipoprotein-cholesterol (HDL-C). The study was conducted to know how the consumption of relatively large amounts of dairy products by adult Fulani affected the TFA content of their serum phospholipids. Blood samples were collected from 22 male and 29 female Fulani, aged 35-60 years, who were living in rural areas of Gombe state in northeastern Nigeria. The total serum phospholipid fraction was isolated, and its fatty acid composition was determined. Surprisingly, vaccenic acid was not detected, and three other TFAs\u201418:1-t6, 18:1-t9, and 18:2-t9,t12\u2014together accounted for only 0.16% of the total fatty acid. The mean serum total cholesterol, LDL-C, and triglyceride concentrations of the subjects were within the normal range for populations in developed countries; however, at 32 mg/dL, the mean serum HDL-C concentration of the Fulani males was slightly below the lower limit of the reference range. No correlations were observed between the total TFA percentage or that of the three individual TFAs and any of the parameters of the serum lipid profile. These findings indicate that, with respect to TFAs at least, the fatty acid pattern of the serum phospholipids of Fulani pastoralists does not reflect the high TFA content of their traditional diet. Despite the consumption of rumenic acid-rich dairy products, for unknown reasons, the semi-nomadic Fulani manage to maintain a low level of TFAs in their blood and a relatively healthful serum lipid profile. While the mechanism that accounts for this disconnect between the consumption of TFAs by Fulani pastoralists and the proportion of TFAs in their serum phospholipids is obscure, possibilities include discrimination against rumenic acid during the process of triglyceride synthesis and chylomicron synthesis in the intestine and the preferential oxidation of TFAs by Fulani the people compared to other ethnic groups