A prospective study correlating fluid balance and outcome in critically ill patients

Background: Fluid administration can be lifesaving as fluid accumulation after initial resuscitation and stabilization of hemodynamics can lead to avoidable adverse effects and less favorable outcomes.Objective: The aim of the work was to evaluate whether even fluid balance in comparison to negative or even fluid status is correlated with increased morbidity and mortality rates in critically ill patients.Patients and Methods: An observational prospective study was done on 145 patients older than eighteen years, admitted to the general intensive care (Medical & Surgical ICU) units in Helwan University Hospitals and Ain Shams University Hospitals during the period from November 2020 till May 2021.Results: One hundred twenty-four patients (85.5%) who survived, having the median cumulative fluid balance of -110ml (IQR-2.1 – 2.2L) after four days following randomization while the median cumulative fluid balance of the 21 patients (14.5%) who didn’t survive was 3800 ml (IQR 1.7-5.2L), after four days of ICU admission. Fluid balance more than 1.2 liters per day in our study had higher ICU complications: Increased risk of AKI, longer ICU and hospital stays, mechanical ventilation and fluid balance was an independent factor associated with increased mortality.Conclusion: It could be concluded that negative fluid balance for 4 days in critically ill patients was associated with less length of stay in the general ICU, and less mechanical ventilation duration, while positive fluid balance, leads to higher mechanical ventilation duration, vasopressors requirements, and significantly associated with higher mortality

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

The Potential of Using Bisr Date Powder as a Novel Ingredient in Beef Burgers: The Effect on Chemical Composition, Cooking Properties, Microbial Analysis, and Organoleptic Properties

Overproduction of date fruits with limited industrial utilization leads to huge waste and losses, especially in bisr (the first stage of date maturity). Therefore, this study aimed to investigate the potential of using bisr date powder (BDP), which is rich in dietary fiber, flavonoids, and phenolic and antioxidant compounds, as a replacement for breadcrumbs in the beef burgers. The beef burger samples were produced by replacing breadcrumb powder with different concentration levels of BDP (0.0, 25, 50, 75, and 100%). All the samples were evaluated for their quality characteristics, including chemical composition, cooking properties, texture profile, organoleptic characteristics, and microbial profile. The results revealed that the gradual replacement of breadcrumbs with BDP in beef burgers significantly decreased moisture, protein, and lipid contents and significantly increased ash and carbohydrate contents compared to the control. The substitution of breadcrumbs with BDP at 50, 75, and 100% significantly decreased the cooking yield and increased the cooking loss and shrinking percentage of a beef burger. On the other hand, the textural profile of all beef burger samples showed a significant decrease in burgers’ hardness, gumminess, and chewiness with increasing substitution levels of breadcrumbs by BDP compared to the control. However, the treatment containing 25% BDP was more resilient than the control. In addition, the replacement of breadcrumbs with BDP up to 100% did not significantly affect the organoleptic properties of beef burger products compared to the control. Moreover, the microbiological analysis revealed that all beef burger treatments were safe with acceptable levels of bacterial load according to the Council of the European Communities’ standard specifications. In conclusion, there is a possibility of using BDP as a promising natural replacer of breadcrumbs to produce beef burgers without deteriorating the quality profile and safety of the product

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

BackgroundTranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding.MethodsWe did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124.FindingsBetween July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98).InterpretationWe found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial.</div