Should colloid boluses be prioritized over crystalloid boluses for the management of dengue shock syndrome in the presence of ascites and pleural effusions?

<p>Abstract</p> <p>Background</p> <p>Although the WHO guideline for the management of dengue fever considers the presence of ascites or pleural effusions in the diagnosis of DSS, it does not emphasize the importance of their presence when selecting fluids for resuscitation.</p> <p>Case presentation</p> <p>We highlight three patients with DSS who received boluses of crystalloids on priority basis as recommended by WHO guidelines during resuscitation. All three patients had varying degrees of third space fluid loss (ascites and pleural effusions) at the time of development of DSS. Ascites and pleural effusions were detected in all 3 patients at the time of shock irrespective of whether iv fluids were given or not. All three patients had documented liver involvement at the time of shock evidenced by elevation of AST (4800 iu/L, 5000 iu/L and 1960 iu/L). One patient who had profound shock died 6 hours after admission with evidence of acute pulmonary oedema in the convalescence phase. All of them needed CPAP ventilator support and potent diuretics.</p> <p>Conclusions</p> <p>We therefore feel that resuscitation of patients with DSS who already have third space fluid accumulation with crystalloid boluses on priority basis may contribute to recovery phase pulmonary oedema.</p

The MOSAiC ice floe: Sediment-laden survivor from the Siberian shelf

In September 2019, the research icebreaker Polarstern started the largest multidisciplinary Arctic expedition to date, the MOSAiC (Multidisciplinary drifting Observatory for the Study of Arctic Climate) drift experiment. Being moored to an ice floe for a whole year, thus including the winter season, the declared goal of the expedition is to better understand and quantify relevant processes within the atmosphere-ice-ocean system that impact the sea ice mass and energy budget, ultimately leading to much improved climate models. Satellite observations, atmospheric reanalysis data, and readings from a nearby meteorological station indicate that the interplay of high ice export in late winter and exceptionally high air temperatures resulted in the longest ice-free summer period since reliable instrumental records began. We show, using a Lagrangian tracking tool and a thermodynamic sea ice model, that the MOSAiC floe carrying the Central Observatory (CO) formed in a polynya event north of the New Siberian Islands at the beginning of December 2018. The results further indicate that sea ice in the vicinity of the CO ( \u3c 40 km distance) was younger and 36 % thinner than the surrounding ice with potential consequences for ice dynamics and momentum and heat transfer between ocean and atmosphere. Sea ice surveys carried out on various reference floes in autumn 2019 verify this gradient in ice thickness, and sediments discovered in ice cores (so-called dirty sea ice) around the CO confirm contact with shallow waters in an early phase of growth, consistent with the tracking analysis. Since less and less ice from the Siberian shelves survives its first summer (Krumpen et al., 2019), the MOSAiC experiment provides the unique opportunity to study the role of sea ice as a transport medium for gases, macronutrients, iron, organic matter, sediments and pollutants from shelf areas to the central Arctic Ocean and beyond. Compared to data for the past 26 years, the sea ice encountered at the end of September 2019 can already be classified as exceptionally thin, and further predicted changes towards a seasonally ice-free ocean will likely cut off the long-range transport of ice-rafted materials by the Transpolar Drift in the future. A reduced long-range transport of sea ice would have strong implications for the redistribution of biogeochemical matter in the central Arctic Ocean, with consequences for the balance of climate-relevant trace gases, primary production and biodiversity in the Arctic Ocean

The MOSAiC ice floe: sediment-laden survivor from the Siberian shelf

In September 2019, the research icebreaker Polarstern started the largest multidisciplinary Arctic expedition to date, the MOSAiC (Multidisciplinary drifting Observatory for the Study of Arctic Climate) drift experiment. Being moored to an ice floe for a whole year, thus including the winter season, the declared goal of the expedition is to better understand and quantify relevant processes within the atmosphere–ice–ocean system that impact the sea ice mass and energy budget, ultimately leading to much improved climate models. Satellite observations, atmospheric reanalysis data, and readings from a nearby meteorological station indicate that the interplay of high ice export in late winter and exceptionally high air temperatures resulted in the longest ice-free summer period since reliable instrumental records began. We show, using a Lagrangian tracking tool and a thermodynamic sea ice model, that the MOSAiC floe carrying the Central Observatory (CO) formed in a polynya event north of the New Siberian Islands at the beginning of December 2018. The results further indicate that sea ice in the vicinity of the CO (<40 km distance) was younger and 36 % thinner than the surrounding ice with potential consequences for ice dynamics and momentum and heat transfer between ocean and atmosphere. Sea ice surveys carried out on various reference floes in autumn 2019 verify this gradient in ice thickness, and sediments discovered in ice cores (so-called dirty sea ice) around the CO confirm contact with shallow waters in an early phase of growth, consistent with the tracking analysis. Since less and less ice from the Siberian shelves survives its first summer (Krumpen et al., 2019), the MOSAiC experiment provides the unique opportunity to study the role of sea ice as a transport medium for gases, macronutrients, iron, organic matter, sediments and pollutants from shelf areas to the central Arctic Ocean and beyond. Compared to data for the past 26 years, the sea ice encountered at the end of September 2019 can already be classified as exceptionally thin, and further predicted changes towards a seasonally ice-free ocean will likely cut off the long-range transport of ice-rafted materials by the Transpolar Drift in the future. A reduced long-range transport of sea ice would have strong implications for the redistribution of biogeochemical matter in the central Arctic Ocean, with consequences for the balance of climate-relevant trace gases, primary production and biodiversity in the Arctic Ocean

Current clinical applications of spectral tissue Doppler echocardiography (E/E' ratio) as a noninvasive surrogate for left ventricular diastolic pressures in the diagnosis of heart failure with preserved left ventricular systolic function

Congestive heart failure with preserved left ventricular systolic function has emerged as a growing epidemic medical syndrome in developed countries, which is characterized by high morbidity and mortality rates. Rapid and accurate diagnosis of this condition is essential for optimizing the therapeutic management. The diagnosis of congestive heart failure is challenging in patients presenting without obvious left ventricular systolic dysfunction and additional diagnostic information is most commonly required in this setting. Comprehensive Doppler echocardiography is the single most useful diagnostic test recommended by the ESC and ACC/AHA guidelines for assessing left ventricular ejection fraction and cardiac abnormalities in patients with suspected congestive heart failure, and non-invasively determined basal or exercise-induced pulmonary capillary hypertension is likely to become a hallmark of congestive heart failure in symptomatic patients with preserved left ventricular systolic function. The present review will focus on the current clinical applications of spectral tissue Doppler echocardiography used as a reliable noninvasive surrogate for left ventricular diastolic pressures at rest as well as during exercise in the diagnosis of heart failure with preserved left ventricular systolic function. Chronic congestive heart failure, a disease of exercise, and acute heart failure syndromes are characterized by specific pathophysiologic and diagnostic issues, and these two clinical presentations will be discussed separately

Clinical approach for the classification of congenital uterine malformations

A more objective, accurate and non-invasive estimation of uterine morphology is nowadays feasible based on the use of modern imaging techniques. The validity of the current classification systems in effective categorization of the female genital malformations has been already challenged. A new clinical approach for the classification of uterine anomalies is proposed. Deviation from normal uterine anatomy is the basic characteristic used in analogy to the American Fertility Society classification. The embryological origin of the anomalies is used as a secondary parameter. Uterine anomalies are classified into the following classes: 0, normal uterus; I, dysmorphic uterus; II, septate uterus (absorption defect); III, dysfused uterus (fusion defect); IV, unilateral formed uterus (formation defect); V, aplastic or dysplastic uterus (formation defect); VI, for still unclassified cases. A subdivision of these main classes to further anatomical varieties with clinical significance is also presented. The new proposal has been designed taking into account the experience gained from the use of the currently available classification systems and intending to be as simple as possible, clear enough and accurate as well as open for further development. This proposal could be used as a starting point for a working group of experts in the field

World ocean review: Mit den Meeren leben 6: Arktis und Antarktis – extrem, klimarelevant, gefährdet

Die sechste Ausgabe des „World Ocean Review“ (WOR) widmet sich der Arktis und Antarktis, diesen zwei extremen und ausgesprochen gegensätzlichen Regionen der Erde. Mit profunden Informationen zur Entstehungs- und Entdeckungsgeschichte bietet der WOR 6 ein tiefes Verständnis der Bedeutung der Pole für das Leben auf unserer Erde. Er zeigt zudem die zu beobachtenden Veränderungen in der Tier-und Pflanzenwelt und analysiert die zum Teil schon dramatischen Folgen, die der Klimawandel in diesen äußerst gefährdeten Regionen bewirkt