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The National Medical Journal of India 2019Administration of intravenous fluids is the most common therapy given to patients admitted to a hospital. Evidence suggests that the use of normal saline (NS) in large... (Meta-Analysis)
Meta-Analysis
Administration of intravenous fluids is the most common therapy given to patients admitted to a hospital. Evidence suggests that the use of normal saline (NS) in large quantities is not without adverse effects. Balanced salt solutions (BSS) contain bicarbonate or one of its precursors that act as a buffer, and the electrolyte composition resembles that of plasma. We reviewed studies across different setups such as intensive care units (ICUs), major surgeries, renal transplants and emergency departments to identify the effect(s) of NS and to find evidence favouring the use of BSS over NS. The use of NS is strongly associated with hyperchloraemic acidosis in almost all the studies. In the largest and latest trial in ICUs, it was found that higher chloride levels were associated with renal injury. No significant difference was found in mortality in any of the trials. In surgical patients, studies found only transient hyperchloraemia and increase in the base deficit in patients receiving NS. Systematic reviews and meta-analyses did not find any significant differences in adverse outcomes such as the need for renal replacement therapy or mortality with the use of saline; however, blood chloride levels were consistently higher with saline compared to BSS. There is a need for larger trials with better methodology to determine if the physiological benefits of BSS translate into better clinical outcomes.
Topics: Acute Disease; Adult; Child; Child, Preschool; Critical Care; Crystalloid Solutions; Humans; Infant; Water-Electrolyte Balance
PubMed: 32769243
DOI: 10.4103/0970-258X.291297 -
International Journal of Molecular... Nov 2019Several environmental factors, such as drought, salinity, and extreme temperatures, negatively affect plant growth and development, which leads to yield losses. The... (Comparative Study)
Comparative Study Meta-Analysis
Several environmental factors, such as drought, salinity, and extreme temperatures, negatively affect plant growth and development, which leads to yield losses. The tolerance or sensitivity to abiotic stressors are the expression of a complex machinery involving molecular, biochemical, and physiological mechanisms. Here, a meta-analysis on previously published RNA-Seq data was performed to identify the genes conferring tolerance to chilling, osmotic, and salt stresses, by comparing the transcriptomic changes between tolerant and susceptible rice genotypes. Several genes encoding transcription factors (TFs) were identified, suggesting that abiotic stress tolerance involves upstream regulatory pathways. A gene co-expression network defined the metabolic and signalling pathways with a prominent role in the differentiation between tolerance and susceptibility: (i) the regulation of endogenous abscisic acid (ABA) levels, through the modulation of genes that are related to its biosynthesis/catabolism, (ii) the signalling pathways mediated by ABA and jasmonic acid, (iii) the activity of the "Drought and Salt Tolerance" TF, involved in the negative regulation of stomatal closure, and (iv) the regulation of flavonoid biosynthesis by specific MYB TFs. The identified genes represent putative key players for conferring tolerance to a broad range of abiotic stresses in rice; a fine-tuning of their expression seems to be crucial for rice plants to cope with environmental cues.
Topics: Dehydration; Disease Resistance; Gene Expression Profiling; Gene Expression Regulation, Plant; Oryza; Osmoregulation; Plant Proteins; Salt Tolerance; Transcription Factors
PubMed: 31726733
DOI: 10.3390/ijms20225662 -
PloS One 2018The cultivation of bananas and other plants is limited by environmental stresses caused by climate change. In order to recognize physiological, biochemical and molecular...
BACKGROUND
The cultivation of bananas and other plants is limited by environmental stresses caused by climate change. In order to recognize physiological, biochemical and molecular components indicated to confer tolerance to water stress in Musa spp. we present the first systematic review on the topic.
METHODS
A systematic literature review was conducted using four databases for academic research (Google Academic, Springer, CAPES Journal Portal and PubMed Central). In order to avoid publication bias, a previously established protocol and inclusion and exclusion criteria were used.
RESULTS
The drought tolerance response is genotype-dependent, therefore the most studied varieties are constituted by the "B" genome. Tolerant plants are capable of super-expressing genes related to reisistance and defense response, maintaining the osmotic equilibrium and elimination of free radicals. Furthermore, they have higher amounts of water content, chlorophyll levels, stomatic conductance and dry root matter, when compared to susceptible plants.
CONCLUSIONS
In recent years, few integrated studies on the effects of water stress on bananas have been carried out and none related to flood stress. Therefore, we highlight the need for new studies on the mechanisms of differentially expressed proteins in response to stress regulation, post-translational mechanisms and epigenetic inheritance in bananas.
Topics: Acclimatization; Chlorophyll; Droughts; Epigenesis, Genetic; Free Radicals; Gene Expression Regulation, Plant; Musa; Organism Hydration Status; Osmoregulation; Plant Proteins; Plant Stomata; Protein Processing, Post-Translational
PubMed: 30507957
DOI: 10.1371/journal.pone.0208052 -
Blood Purification 2018Overhydration is common among peritoneal dialysis (PD) patients and can affect PD-related outcomes. This paper aims to systematically investigate whether... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Overhydration is common among peritoneal dialysis (PD) patients and can affect PD-related outcomes. This paper aims to systematically investigate whether bioimpedance-assessed overhydration is a predictor for mortality and technique failure in PD patients.
METHODS
We conducted a systematic review and meta-analysis of cohort studies on overhydration and prognosis in PD patients, strictly complying with the Preferred Reporting Items for Systematical Reviews and Meta-analyses.
RESULTS
Eight articles met the selection criteria and 5 studies were included in the meta-analysis. Meta-analyses-revealed overhydration, defined as a high ratio of extracellular water/total body water (ECW/TBW), was significantly associated with higher risk for all-cause mortality and technique failure. Other higher dichotomized overhydration indicators and continuous hydration variables all indicated overhydration as a significant risk factor for all-cause mortality.
CONCLUSION
Overhydration, defined by a higher ratio of ECW/TBW, might be an independent predictor for all-cause mortality and technique failure among PD patients. However, more studies are needed to confirm this conclusion. Video Journal Club 'Cappuccino with Claudio Ronco' at https://www.karger.com/Journal/ArticleNews/223997?sponsor=52.
Topics: Female; Humans; Male; Mortality; Peritoneal Dialysis; Water-Electrolyte Balance
PubMed: 30189422
DOI: 10.1159/000492148 -
Journal of Advanced Nursing Jul 2018To identify effective treatments and risk factors associated with death rattle in adults at the end of life. (Review)
Review
AIM
To identify effective treatments and risk factors associated with death rattle in adults at the end of life.
BACKGROUND
The presence of noisy, pooled respiratory tract secretions is among the most common symptoms in dying patients around the world. It is unknown if "death rattle" distresses patients, but it can distress relatives and clinicians. Treatments appear unsatisfactory, so prophylaxis would be ideal if possible.
DESIGN
Quantitative systematic review and narrative summary following Cochrane Collaboration guidelines.
DATA SOURCES
CINAHL, MEDLINE, Health Source Nursing and Web of Science were searched for international literature in any language published from 1993 - 2016 using MeSH headings and iterative interchangeable terms for "death rattle".
REVIEW METHODS
Randomized controlled trials were appraised using the Cochrane Collaboration's tool for assessing risk of bias. Non-randomized studies were assessed using ROBINS-I tool for assessing risk of bias in non-randomized studies of interventions. Instances of treatment and risk were extracted and relevant key findings extracted in line with Cochrane methods.
RESULTS
Five randomized trials and 23 non-randomized studies were analysed. No pharmacological or non-pharmacological treatment was found superior to placebo. There was a weak association between lung or brain metastases and presence of death rattle, but otherwise inconsistent empirical support for a range of potential risk factors.
CONCLUSIONS
Clinicians have no clear evidence to follow in either treating death rattle or preventing it occurring. However, several risk factors look promising candidates for prospective analysis, so this review concludes with clear recommendations for further research.
Topics: Adult; Age Factors; Cholinergic Antagonists; Consciousness; Cough; Deglutition Disorders; Female; Humans; Length of Stay; Male; Patient Positioning; Prospective Studies; Randomized Controlled Trials as Topic; Respiratory Sounds; Respiratory System; Respiratory System Agents; Respiratory Tract Infections; Risk Factors; Sex Factors; Terminal Care; Terminally Ill; Water-Electrolyte Balance
PubMed: 29495089
DOI: 10.1111/jan.13557 -
Perioperative Medicine (London, England) 2018Dehydration is highly prevalent and is associated with adverse cardiovascular and renal events. Clinical assessment of dehydration lacks sensitivity. Perhaps a patient's... (Review)
Review
BACKGROUND
Dehydration is highly prevalent and is associated with adverse cardiovascular and renal events. Clinical assessment of dehydration lacks sensitivity. Perhaps a patient's thirst can provide an accurate guide to fluid therapy. This systematic review examines the sensitivity of thirst in responding to changes in plasma osmolality in participants of any age with no condition directly effecting their sense of thirst.
METHODS
Medline and EMBASE were searched up to June 2017. Inclusion criteria were all studies reporting the plasma osmolality threshold for the sensation of thirst.
RESULTS
A total of 12 trials were included that assessed thirst intensity on a visual analogue scale, as a function of plasma osmolality (pOsm), and employed linear regression to define the thirst threshold. This included 167 participants, both healthy controls and those with a range of pathologies, with a mean age of 41 (20-78) years.The value ±95% CI for the pOsm threshold for thirst sensation was found to be 285.23 ± 1.29 mOsm/kg. Above this threshold, thirst intensity as a function of pOsm had a mean ± SEM slope of 0.54 ± 0.07 cm/mOsm/kg. The mean ± 95% CI vasopressin release threshold was very similar to that of thirst, being 284.3 ± 0.71 mOsm/kg.Heterogeneity across studies can be accounted for by subtle variation in experimental protocol and data handling.
CONCLUSION
The thresholds for thirst activation and vasopressin release lie in the middle of the normal range of plasma osmolality. Thirst increases linearly as pOsm rises. Thus, osmotically balanced fluid administered as per a patient's sensation of thirst should result in a plasma osmolality within the normal range. This work received no funding.
PubMed: 29344350
DOI: 10.1186/s13741-017-0081-4 -
JACC. Cardiovascular Interventions Feb 2017The objective of this meta-analysis of randomized trials was to evaluate if the administration of furosemide with matched hydration using the RenalGuard System reduces... (Meta-Analysis)
Meta-Analysis Review
Prevention of Contrast-Induced Acute Kidney Injury by Furosemide With Matched Hydration in Patients Undergoing Interventional Procedures: A Systematic Review and Meta-Analysis of Randomized Trials.
OBJECTIVES
The objective of this meta-analysis of randomized trials was to evaluate if the administration of furosemide with matched hydration using the RenalGuard System reduces contrast-induced acute kidney injury (CI-AKI) in patients undergoing interventional procedures.
BACKGROUND
CI-AKI is a serious complication following angiographic procedures and a powerful predictor of unfavorable early and long-term outcomes.
METHODS
Online databases were searched up to October 1, 2016, for randomized controlled trials. The primary outcome was the incidence of CI-AKI, and the secondary outcomes were need for renal replacement therapy, mortality, stroke, and adverse events.
RESULTS
A total of four trials (n = 698) published between 2011 and 2016 were included in the analysis and included patients undergoing percutaneous coronary procedures and transcatheter aortic valve replacement. RenalGuard therapy was associated with a lower incidence of CI-AKI compared with control treatment (27 of 348 [7.76%] patients vs. 75 of 350 [21.43%] patients; odds ratio [OR]: 0.31; 95% confidence interval [CI]: 0.19 to 0.50; I = 4%; p < 0.00001) and with a lower need for renal replacement therapy (2 of 346 [0.58%] patients vs. 12 of 348 [3.45%] patients; OR: 0.19; 95% CI: 0.05 to 0.76; I = 0%; p = 0.02). No major adverse events occurred in patients undergoing RenalGuard therapy.
CONCLUSIONS
The main finding of this meta-analysis is that furosemide with matched hydration by the RenalGuard System may reduce the incidence of CI-AKI in high-risk patients undergoing percutaneous coronary intervention or transcatheter aortic valve replacement. However, further independent high-quality randomized trials should elucidate the effectiveness and safety of this prophylactic intervention in interventional cardiology.
Topics: Acute Kidney Injury; Chi-Square Distribution; Contrast Media; Diuretics; Evidence-Based Medicine; Furosemide; Humans; Incidence; Kidney; Odds Ratio; Percutaneous Coronary Intervention; Protective Factors; Radiography, Interventional; Randomized Controlled Trials as Topic; Renal Replacement Therapy; Risk Assessment; Risk Factors; Stroke; Transcatheter Aortic Valve Replacement; Treatment Outcome; Water-Electrolyte Balance
PubMed: 28231903
DOI: 10.1016/j.jcin.2016.11.006 -
The Cochrane Database of Systematic... Jun 2016Fluid excess may place people undergoing surgery at risk for various complications. Hypertonic salt solution (HS) maintains intravascular volume with less intravenous... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Fluid excess may place people undergoing surgery at risk for various complications. Hypertonic salt solution (HS) maintains intravascular volume with less intravenous fluid than isotonic salt (IS) solutions, but may increase serum sodium. This review was published in 2010 and updated in 2016.
OBJECTIVES
To determine the benefits and harms of HS versus IS solutions administered for fluid resuscitation to people undergoing surgery.
SEARCH METHODS
In this updated review we have searched the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 4, 2016); MEDLINE (January 1966 to April 2016); EMBASE (January 1980 to April 2016); LILACS (January 1982 to April 2016) and CINAHL (January 1982 to April 2016) without language restrictions. We conducted the original search on April 30th, 2007, and reran it on April 8th, 2016.
SELECTION CRITERIA
We have included randomized clinical trials (RCTs) comparing HS to IS in people undergoing surgery, irrespective of blinding, language, and publication status.
DATA COLLECTION AND ANALYSIS
Two independent review authors read studies that met our selection criteria. We collected study information and data using a data collection sheet with predefined parameters. We have assessed the impact of HS administration on mortality, organ failure, fluid balance, serum sodium, serum osmolarity, diuresis and physiologic measures of cardiovascular function. We have pooled the data using the mean difference (MD) for continuous outcomes. We evaluated heterogeneity between studies by I² percentage. We consider studies with an I² of 0% to 30% to have no or little heterogeneity, 30% to 60% as having moderate heterogeneity, and more than 60% as having high heterogeneity. In studies with low heterogeneity we have used a fixed-effect model, and a random-effects model for studies with moderate to high heterogeneity.
MAIN RESULTS
We have included 18 studies with 1087 participants of whom 545 received HS compared to 542 who received IS. All participants were over 18 years of age and all trials excluded high-risk patients (ASA IV). All trials assessed haematological parameters peri-operatively and up to three days post-operatively.There were three (< 1%) deaths reported in the IS group and four (< 1%) in the HS group, as assessed at 90 days in one study. There were no reports of serious adverse events. Most participants were in a positive fluid balance postoperatively (4.4 L IS and 2.5 L HS), with the excess significantly less in HS participants (MD -1.92 L, 95% confidence interval (CI) -2.61 to -1.22 L; P < 0.00001). IS participants received a mean volume of 2.4 L and HS participants received 1.49 L, significantly less fluid than IS-treated participants (MD -0.91 L, 95% CI -1.24 to -0.59 L; P < 0.00001). The maximum average serum sodium ranged between 138.5 and 159 in HS groups compared to between 136 and 143 meq/L in the IS groups. The maximum serum sodium was significantly higher in HS participants (MD 7.73, 95% CI 5.84 to 9.62; P < 0.00001), although the level remained within normal limits (136 to 146 meq/L).A high degree of heterogeneity appeared to be related to considerable differences in the dose of HS between studies. The quality of the evidence for the outcomes reported ranged from high to very low. The risk of bias for many of the studies could not be determined for performance and detection bias, criteria that we assess as likely to impact the study outcomes.
AUTHORS' CONCLUSIONS
HS reduces the volume of intravenous fluid required to maintain people undergoing surgery but transiently increases serum sodium. It is not known if HS affects survival and morbidity, but this should be examined in randomized controlled trials that are designed and powered to test these outcomes.
Topics: Crystalloid Solutions; Fluid Therapy; Humans; Isotonic Solutions; Randomized Controlled Trials as Topic; Saline Solution, Hypertonic; Sodium; Surgical Procedures, Operative; Water-Electrolyte Balance
PubMed: 27271480
DOI: 10.1002/14651858.CD005576.pub3