Fractional excretion of electrolytes in volume-responsive and intrinsic acute kidney injury in dogs: Diagnostic and prognostic implications

Background: The value of fractional excretion (FE) of electrolytes to characterize and prognosticate acute kidney injury (AKI) is poorly documented in dogs. Objectives: To evaluate the diagnostic and prognostic roles of FE of electrolytes in dogs with AKI. Animals: Dogs (n=135) with AKI treated with standard care (February 2014-December 2016). Methods: Prospective study. Clinical and laboratory variables including FE of electrolytes, were measured upon admission. Dogs were graded according to the AKI-IRIS guidelines and grouped according to AKI features (volume-responsive, VR-AKI; intrinsic, I-AKI) and outcome (survivors/non-survivors). Group comparison and regression analyses with hazard ratios (HR) evaluation for I-AKI and mortality were performed. P<.05 was considered significant. Results: Fifty-two of 135 (39%) dogs had VR-AKI, 69/135 (51%) I-AKI and 14/135 (10%) were unclassified. I-AKI dogs had significantly higher FE of electrolytes, for example, FE of sodium (FENa, %) 2.39 (range 0.04-75.81) than VR-AKI ones 0.24 (range 0.01-2.21; P<.001). Overall, case fatality was 41% (55/135). Increased FE of electrolytes were detected in nonsurvivors, for example, FENa 1.60 (range 0.03-75.81) compared with survivors 0.60 (range 0.01-50.45; P=.004). Several risk factors for death were identified, including AKI-IRIS grade (HR=1.39, P=.002), FE of electrolytes, for example, FENa (HR=1.03, P<.001), and urinary output (HR=5.06, P<.001). Conclusions and Clinical Importance: Fractional excretion of electrolytes performed well in the early differentiation between VR-AKI and I-AKI, were related to outcome, and could be useful tools to manage AKI dogs in clinical practice

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A cadeia de abastecimento energético global foi significativamente afetada pela guerra Rússia-Ucrânia (GRU), que levou a uma crise energética. Isto porque a Rússia sempre foi um importante exportador de petróleo e gás natural. As pesquisas indicaram que os países mais impactados pelas sanções impostas à Rússia, devido à invasão da Ucrânia, concentraram seus esforços em substituir os seus exportadores de energia no curto prazo e planejar uma mudança estratégica no mix energético no médio e longo prazo. O objetivo deste trabalho consistiu em verificar os impactos dos movimentos provocados pela guerra na aceleração ou desaceleração do progresso das fontes renováveis de energia (FERs) e, consequentemente, na transição energética. A revisão da literatura sobre momentos de crises mostrou interferências na cadeia de suprimentos de energia. Períodos de guerras mostraram o aumento dos preços do petróleo e a busca dos países por diversificarem o fornecimento de energia; inicialmente, com o crescimento de usinas nucleares e, posteriormente, com o desenvolvimento do gás natural. Contudo, desastres ambientais tiveram efeitos negativos sobre a geração nuclear. Em 2000, as preocupações com as emissões de gases de efeito estufa (GEE) aumentaram; levando à adoção e ao desenvolvimento de políticas de redução de emissões. A análise das políticas energéticas nos países analisados revela que as crises obrigaram os governos a repensarem suas políticas. Por exemplo, a crise de 2014 pela anexação da Crimeia afetou o fornecimento de gás natural, fazendo com que as importações europeias diminuíssem. A Energiewende na Alemanha estimulou a maior participação das FERs. A crise financeira de 2008 levou os Estados Unidos a adotarem créditos financeiros e leis de energia renovável. O Brasil criou o Proálcool em 1975 para reduzir a dependência do petróleo. A pandemia covid-19 na China levou a bloqueios e a redução do transporte, ocasionando a diminuição do consumo de petróleo e das emissões de GEE. Os resultados mostraram que a GRU teve consequências no setor de energia dos países, com base nas importações de combustíveis, na geração de eletricidade e no consumo de energia. Por tomarem decisões diferentes durante a guerra, alguns países aceleraram a transição energética, enquanto outros desaceleraram.The global energy supply chain was significantly affected by the Russia-Ukraine (GRU) war, which resulted in an energy crisis. This is because Russia has always been an important exporter of oil and natural gas. Research has shown that the countries most impacted by the sanctions imposed on Russia due to the invasion of Ukraine focused their efforts on replacing their energy exporters in the short term and planning a strategic change in the energy mix in the medium and long term. The objective of this work was to verify the impacts of movements caused by the war on acceleration or slowing down the progress of renewable energy sources (RES) and, consequently, on the energy transition. The literature review about moments of crisis showed interference in the energy supply chain. Periods of wars showed the increase in oil prices and the search for countries to diversify their energy supply; initially, with the growth of nuclear power plants and then, with the development of natural gas. However, environmental disasters had negative effects on nuclear generation. In 2000, concerns about greenhouse gas (GHG) emissions grew, leading to the adoption and development of emission reduction policies. The analysis of energy policies implemented in the analyzed countries reveals that crises have forced governments and formulators to rethink their policies. For example, the 2014 crisis between Russia and Ukraine over the annexation of Crimea affected the supply of natural gas, causing European imports to decline. The Energiewende in Germany has stimulated greater participation of RES. The 2008 financial crisis led the United States to adopt financial credits and renewable energy laws. Brazil created Proalcohol in 1975 with the aim of reducing dependence on oil. The COVID-19 pandemic in China has led to lockdowns and reduced transportation, leading to a decrease in oil consumption and GHG emissions. The results showed that the RUW had consequences on the countries energy sector, based on fuel imports, electricity generation and energy consumption. Because they took different decisions during the war, some countries accelerated the energy transition, while others slowed it down

Multihospital surveillance of nosocomial methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococcus, and Clostridium difficile: analysis of a 4-year data-sharing project, 1999-2002.

BACKGROUND: This study sought to establish a benchmark of resistant organism rates among a cohort of regional hospitals. METHODS: The Centers for Disease Control and Prevention (CDC) definitions were used to standardize the methodology for obtaining rates per 1000 patient days of nosocomial infection and colonization with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE), and nosocomial infection with Clostridium difficile (CDIF). Only newly acquired nosocomial cases were counted. Data were reported as individual hospital control charts and as cohorted aggregate data. VHA East Coast Infection Control Professionals from 32 hospitals in New Jersey and Pennsylvania were involved. RESULTS: Benchmarks were established with pooled mean rates for each cohort. During the observational period, a statistically significant downward trend was observed for VRE and MRSA (P = .02 and .0007, respectively), and an upward trend was observed for CDIF (P = .0256). CONCLUSION: Benchmarks were established to compare nosocomial MRSA, VRE, and CDIF rates. Although significant changes in rates were observed, no attempt was made to establish a causal relationship between infection control practices and observed rates. However, a secondary gain was achieved through sharing best practices

Prospective evaluation of the acute patient physiologic and laboratory evaluation score and an extended clinicopathological profile in dogs with systemic inflammatory response syndrome

OBJECTIVE: To investigate the prognostic value of the acute patient physiologic and laborartory evaluation (APPLE) score and relevant clinicopathological markers in dogs with systemic inflammatory response syndrome (SIRS). DESIGN: Prospective observational cohort study. SETTING: Veterinary teaching hospital. ANIMALS: Thirty-three dogs with SIRS admitted to the intensive care unit (ICU) were compared to 35 healthy control dogs. Dogs with SIRS were divided into septic (n = 20) and nonseptic (n = 13) etiologies and as survivors (alive to discharge, n = 22) and nonsurvivors (n = 11: died, n = 6, or humanely euthanized, n = 5). MEASUREMENTS AND MAIN RESULTS: For all dogs, physiological and laboratory parameters were prospectively collected for the calculation of the APPLEfast score. No difference between septic and nonseptic SIRS dogs was detected for any parameter evaluated. Survivors had significantly higher total protein, albumin concentrations, antithrombin activity (ATA), and base excess (BE), as well as significantly lower lactate, urea, creatinine concentrations, urinary protein to creatinine ratio and APPLEfast score compared to nonsurvivors. Higher values of creatinine, lactate, anion gap, alanine transaminase (ALT), and APPLEfast score were significantly associated with an increased risk of death in SIRS dogs, while higher values of total protein, albumin, ATA, and BE were associated with a significantly reduced risk of mortality. When a multivariate binary logistic regression analysis was performed, the APPLEfast score was the only significant parameter retained. CONCLUSIONS: The determination of the APPLEfast score in clinical setting, as well as the measurement of APP, ATA, lactate, BE, anion gap, ALT, urinary proteins, and electrolytes may be beneficial for a better assessment of dogs with SIRS. Identified parameters were significantly related with the presence of SIRS and their evaluation should be considered for the assessment of disease severity, and guidance of the decision-making process in critically ill dogs