Recommendations for active correction of hypernatremia in volume-resuscitated shock or sepsis patients should be taken with a grain of salt: A systematic review

Background: Healthcare-acquired hypernatremia (serum sodium >145 mEq/dL) is common among critically ill and other hospitalized patients and is usually treated with hypotonic fluid and/or diuretics to correct a “free water deficit.� However, many hypernatremic patients are eu- or hypervolemic, and an evolving body of literature emphasizes the importance of rapidly returning critically ill patients to a neutral fluid balance after resuscitation. Objective: We searched for any randomized- or observational-controlled studies evaluating the impact of active interventions intended to correct hypernatremia to eunatremia on any outcome in volume-resuscitated patients with shock and/or sepsis. Data sources: We performed a systematic literature search with studies identified by searching MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ClinicalTrials.gov, IndexCatalogue of the Library of the Surgeon General’s Office, DARE (Database of Reviews of Effects), and CINAHL and scanning reference lists of relevant articles with abstracts published in English. Data synthesis: We found no randomized- or observational-controlled trials measuring the impact of active correction of hypernatremia on any outcome in resuscitated patients. Conclusion: Recommendations for active correction of hypernatremia in resuscitated patients with sepsis or shock are unsupported by clinical research acceptable by modern evidence standards.ECU Open Access Publishing Support Fun

Self‐medication among pregnant women attending outpatients' clinics in northern Jordan‐a cross‐sectional study

Abstract Self‐medication can facilitate patients’ access to medicinal products, save time, and reduce financial and health‐care service use burden. On the other hand, irresponsible use of self‐medications can result in adverse consequences. Self‐medication is common among different demographic groups including pregnant women. In general, medicinal products might have harmful effects on mothers and baby. This study aimed to assess self‐medication practices among pregnant women in the northern region of Jordan. A cross‐sectional study was conducted on pregnant women attending outpatient clinics in the northern region of Jordan. Self‐medication practices among the target population were assessed using a survey questionnaire that was administered through interviewer‐assisted mode. Data were collected between December 2019 and September 2020, and descriptive statistics and inferential analysis were applied. A total of 1,313 pregnant women were surveyed (response rate = 95.50%). Self‐medication and the use of herbal remedies were practiced by 33.10% and 32.14% of the participant, respectively. Headaches and general pains were the most frequently reported conditions treated by self‐medication practice with either conventional medicinal products or herbal remedies. The gravidity (≥4) and the gestational stage (≥28 weeks) were the predictors of self‐medication practice. This study showed that self‐medication was not widely practiced by pregnant women in the northern region of Jordan. Disease simplicity and previous history were the main motives for self‐medicating. Efforts should be made by health‐care providers to address pregnant women and educate them to increase their awareness about the unsafe use of medicines and the harmful effects on fetus

Characterization of laser-diode end-pumped intracavity frequency doubled, passively Q-switched and mode-locked Nd:YVO<SUB>4</SUB> laser

Simultaneous Q-switching and mode-locking in a laser-diode end-pumped intracavity frequency doubled Nd:YVO4/KTP green laser using Cr4+:YAG saturable absorber is experimentally demonstrated. The influence of the initial transmission (T0) of the Cr4+:YAG crystal on the Q-switched mode-locked green pulses as well as on the average green power is characterized by using Cr4+:YAG crystal with various T0. The effect of T0 on the pulse build-up time in intracavity second harmonic configuration is theoretically investigated. It was found that the depth of modulation for the mode-locked pulses is greatly improved at the second harmonic wavelength as compared to that for the fundamental wavelength. The average pulse duration of the individual mode-locked pulse for the second harmonic beam measured to be less than 500 ps with a repetition rate of 400 MHz

Simultaneous Q-switching and mode-locking in an intracavity frequency doubled diode-pumped Nd:YVO<SUB>4</SUB>/KTP green laser with Cr<SUP>4+</SUP>:YAG

We report intracavity second harmonic (at 532 nm) generation in a passively Q-switched mode-locked Nd:YVO4 laser. The width of a typical Q-switched envelope of the mode-locked pulses for the green laser was around 65 &#177; 5 ns and the repetition rate for the mode-locked pulses was 400 MHz. The intracavity frequency doubling significantly improves the depth of modulation of the mode-locked pulses. The peak power of a single mode-locked green pulse near the center of the Q-switched envelope was estimated to be more than 2 kW and the average green power was 6 times higher than the CW green power at an incident diode pump power of 6 W

Analysis of laser-diode end-pumped intracavity frequency-doubled, passively Q-switched and mode-locked Nd:YVO 4 laser

Simultaneous Q-switching and mode locking in a laser-diode end-pumped intracavity frequency-doubled Nd:YVO4/KTP green laser using a Cr4+:YAG saturable absorber with 81% initial transmission is experimentally demonstrated. At an incident pump power of 6 W, 300 mW of average green power was obtained, which is around four times higher than the cw green power obtained without the Cr4+:YAG crystal. The repetition rate of the mode-locked green pulses was 400 MHz and the individual mode-locked pulse width was measured to be 500 ps. The repetition rate of the Q-sw itched envelope of the mode-locked pulses was 15 kHz at 6 W of incident pump power. The energy of the mode-locked pulse at the peak of the Q-sw itched envelope was estimated to be 1 &#956;J and the peak power was estimated to be 2.4 kW. The measured width and the total energy of the Q-sw itched envelope of the mode-locked pulses was 47 ns and 21 &#956;J, respectively, at the maximum incident pump power. An analysis of the system by incorporating a nonlinear loss term due to the intracavity second-harmonic generation to the general recurrence relation for the mode-locked pulses under the Q-sw itched envelope at the fundamental wavelength has been presented. Using a hyperbolic secant square function to model the mode-locked pulse, the temporal shape of a single Q-sw itched pulse at the second-harmonic wavelength has been reconstructed. The theoretical calculations of the pulse parameters like pulse energy, peak power, pulse width and pulse-symmetry factor have shown fairly good agreement with the experimental results