Evaluation of striate keratopathy after manual small-incision cataract surgery and its final outcomes in a tertiary hospital

Purpose: To study the demographic profile, contributing and precipitating factors, the severity of striate keratopathy and its relation with endothelial cell count, and evaluate the final treatment outcome of striate keratopathy. Methods: This observational analytical cohort study was conducted on 75 patients developing striate keratopathy after MSICS in the immediate postoperative period. Demographic profile, preoperative risk factors, and intraoperative complications were evaluated retrospectively. Postoperatively, slit-lamp grading of striate keratopathy was done, and specular microscopy of both eyes was taken. Treatment of striate keratopathy was initiated, and patients were followed up for 6 to 10 weeks for improvement. Results: Striate keratopathy was most commonly associated with surgeries performed by resident surgeons (92%), longer duration of surgery, associated predisposing factors, and intraoperative or postoperative complications. On postoperative day 1, the majority of patients had moderate and severe striate keratopathy (66% and 32%, respectively). It was associated with significant endothelial cell loss (ECL) at the final follow-up (P = 0.0016). Striate keratopathy resolved in 97.3% of patients, irrespective of the treatment with hypertonic saline. At 6 to 10 weeks, 92% of patients achieved a BCVA of ?6/9. Conclusion: A careful preoperative evaluation, adequate training of resident surgeons, meticulous surgical technique, and prompt management of postoperative complications can lead to a decrease in the incidence of striate keratopathy in the majority of cases. The use of hypertonic saline eye drops does not change the final outcome, and most cases resolve spontaneously during follow-up

A Comparative Study of Nebulized 3% Hypertonic Saline Versus Nebulized Adrenaline in The Treatment of Acute Bronchiolitis

Background: Acute bronchiolitis is the most common lower respiratory tract infection in young infants and young children. The respiratory syncytial virus is the commonest cause of bronchiolitis. Recently the role of nebulized 3% saline has come into focus. Nebulized adrenaline has also been suggested as another treatment option, its primary role being the reduction of mucosal edema, which is an important part of the disease pathology in bronchiolitis. Objective: To see the effects of nebulized adrenaline in comparison to nebulized 3% hypertonic saline in the treatment of acute bronchiolitis. Material & Methods:This was a randomized controlled trial, carried out in the Department of Pediatrics, Bangladesh Shishu Hospital and Institute from October 2017 to March 2020. A total of 90 children from 1 month to 2 years of age of either sex who were diagnosed and admitted with acute bronchiolitis were enrolled. After enrollment, they were randomly assigned to either 3% nebulized hypertonic saline (group A=45) or to the nebulized adrenaline-1:1000 group (group B=45). Monitoring was done by respiratory distress assessment instrument (RDAI) score at 12 hours interval for 1st 24 hours and then 24 hourly till the patient was ready for discharge. The efficacy was determined by assessing clinical severity score/RDAI score and length of hospital stay. Data were analyzed using SPSS version-23.Results:The mean age was found 6.34±3.89 months in group A and 6.06±3.55 months in group B. The majority of patients were males in both groups. All patients had a cough, breathing difficulty, Ronchi, and chest indrawing in both groups. Changes in heart rate were 5.68±6.61/min in group A and 2.86±5.87/min in group B, which was significantly decreasing in group A than in group B. Mean clinical severity scores at 12 hours and at 24 hours were statistically significant (p<0.05). However, mean clinical severity scores at baseline, at 48 hours, at 72 hours, and at 96 hours were not statistically significant. The mean duration of oxygen therapy was found 15.00±5.36 hours in group A and 24.63±11.64 hours in group B. Which indicates that the duration of oxygen therapy was significantly higher in group B than in group A. Majority of the patients of group A and group B were discharged within 72 hours 39(86.7%) and 28(62.2%) respectively, which was statistically significant.Conclusions:Nebulization with 3% hypertonic saline significantly reduced clinical severity score and length of hospital stay in case of acute bronchiolitis in comparison to nebulized adrenaline.

Uso de solución salina hipertónica al 3 por ciento en niños con bronquiolitis aguda / Usage of 3 percent Hypertonic Saline Solution in Children with Acute Bronchitis

Introducción: La bronquiolitis aguda es la infección del tracto respiratorio inferior más frecuente en el lactante. Tiene una incidencia anual del 10 por ciento en los lactantes y una tasa de ingreso de entre el 2 y el 5 por ciento con un incremento importante en los últimos años. Objetivo: Determinar la efectividad del uso de solución salina hipertónica al 3 por ciento nebulizada en pacientes con bronquiolitis aguda. Métodos: Se realizó un estudio analítico longitudinal prospectivo de tipo casos y controles. El universo estuvo constituido por 132 pacientes distribuidos en 66 casos y 66 controles. Resultados: La edad media fue de 3,6 ± 2,5 meses. Los sibilantes se hallaron en 129 pacientes, lo que representó el 97,7 por ciento. Se encontró una estadía hospitalaria media de 3,19 ± 1,41 días en los casos, mientras que en los controles se encontró una media de 4,97 ± 1,77 días, diferencia que resultó altamente significativa (p < 0,001). Conclusiones: Aunque los pacientes tratados con solución salina hipertónica al 3 por ciento necesitaron más días con oxigenoterapia, el tratamiento resultó ser efectivo al mostrar una menor estadía hospitalaria y un menor número de complicaciones en pacientes con bronquiolitis aguda(AU)

Introduction: Acute bronchiolitis is the most frequent lower respiratory tract infection in the infant. It has a yearly incidence of 10 percent in infants and an admission rate of 2 percent to 5 percent, with a significant increase in recent years. Objective: To determine the effectiveness of nebulized 3 percent hypertonic saline solution treatment in patients with acute bronchiolitis. Methods: A prospective, longitudinal and analytical study of case-control design was carried out. The universe consisted of 132 patients distributed into 66 cases and 66 controls. Results: The mean age was 3.6±2.5 months. Wheezing was found in 129 patients, accounting for 97.7 percent. A mean hospital stays of 3.19±1.41 days was found in cases, while a mean of 4.97±1.77 days was found in controls, a difference that was highly significant (P<0.001). Conclusions: Although patients treated with 3 percent hypertonic saline solution required more days with oxygen therapy, the treatment proved to be effective by showing a shorter hospital stay and a lower number of complications in patients with acute bronchiolitis(AU)

Efficacy of 20% Mannitol versus 3% hypertonic saline in decreasing intracranial pressure in the pediatric age group: A systematic review

@#<p><strong>Background:</strong> There are no established guidelines preferring mannitol over hypertonic saline in managing increased intracranial pressure in children.</p><p><strong>Objective:</strong> This systematic review aimed to assess the available data on the efficacy of 20% mannitol and 3% hypertonic saline in decreasing intracranial hypertension in the pediatric age group.</p><p><strong>Method:</strong> Search was done through PubMed/MEDLINE, Cochrane Central Registry of Clinical Trials (CENTRAL) and EMBASE. The search of articles yielded 280 studies. After applying the inclusion and exclusion criteria, a total of 7 articles were deemed eligible for assessment.</p><p><strong>Results:</strong> Seven studies with a total of 1,892 pediatric patients met the eligibility criteria: three RCTs and four retrospective studies. From these studies, two randomized controlled studies showed statistically significant evidence that 3% hypertonic saline was superior to 20% mannitol in reducing increased intracranial pressure (ICP) while two other studies had results that were insufficient to establish statistical significance. A study showed that Glasgow coma scale (GCS) scores were higher and length of stay was shorter in patients given hypertonic saline than in the mannitol group. Relative risk of mortality was comparable in both groups. While more episodes of hypotension and rebound increase in ICP was seen with mannitol, both agents reported occurrences of acute kidney injury, hemolysis and hyperchloremic metabolic acidosis.</p><p><strong>Conclusion:</strong> This review showed that while both agents effectively decreased intracranial pressure, 3% hypertonic saline showed better results compared with 20% mannitol. Due to the limited number and heterogeneity of studies, a pooled analysis of the effects in ICP could not be done. Recommendations: Larger prospective controlled studies using 20% mannitol and 3% hypertonic saline in the treatment of increased ICP in the pediatric age group are needed to render valid affirmations.</p>

Safety, tolerability and efficacy of LEGA-Kid® mechanical percussion device versus conventional chest physiotherapy in children: a randomised, single-blind controlled study

INTRODUCTION@#Chest physiotherapy (CPT) may benefit children aged below five years who suffer from lower respiratory tract infection (LRTI). However, its effects depend on the technique used. This study aimed to determine whether mechanical CPT using the LEGA-Kid® mechanical percussion device is superior to manual CPT in children with LRTI.@*METHODS@#Children aged five months to five years who were admitted and referred for CPT from January to April 2017 were randomised to either manual CPT or mechanical CPT with LEGA-Kid. Outcomes measured before intervention and two hours after intervention were respiratory rate (RR), oxygen saturation and modified Respiratory Distress Assessment Instrument (mRDAI) score.@*RESULTS@#All 30 enrolled patients showed significant reduction in post-intervention RR and mRDAI scores. There was an 8% reduction in RR for the manual CPT group (p = 0.002) and a 16.5% reduction in the mechanical CPT group (p = 0.0001), with a significantly greater reduction in the latter (p = 0.024). mRDAI scores decreased by 2.96 in the manual group (p = 0.0001) and 3.62 in the mechanical group (p = 0.002), with no significant difference between the groups. There was no significant improvement in oxygen saturation, and no adverse events were observed after CPT.@*CONCLUSION@#Children receiving both manual and mechanical CPT showed improvements in respiratory distress symptoms, with no adverse effects. A combined strategy of nebulised hypertonic saline followed by CPT for LRTI removes airway secretions and results in improvements in moderately severe respiratory distress. The LEGA-Kid mechanical CPT method is superior to manual CPT in reducing the RR.

Uso de Solución Hipertónica en pacientes con insuficiencia cardiaca aguda como terapia adyuvante a altas dosis de diuréticos / Use of Hypertonic Solution in patients with acute heart failure as adjunctive therapy to high-dose diuretics

Resumen La insuficiencia cardíaca aguda descompensada (ICAD) es una causa común de hospitalización, con repercusiones significativas en los sistemas de salud. El manejo agudo se basa en la reducción de la volemia con diuréticos de asa, sin embargo, un porcentaje de pacientes presenta resistencia o no logra la respuesta clínica esperada con este tratamiento. Una de las medidas que ha comprobado ser efectiva en este contexto, es el uso de solución salina hipertónica (SSH) en conjunto con dosis altas de diuréticos de asa, como medida terapéutica temida por sus posibles repercusiones sobre la función renal y posible sobrecarga de sodio. Objetivos: Determinar si el uso de solución salina hipertónica en pacientes con falla cardiaca aguda e hipervolemia genera un deterioro de la función renal. Determinar la respuesta del Pro-BNP ante el uso de la solución salina hipertónica en pacientes con falla cardiaca aguda como marcador de respuesta terapéutica. Determinar si el uso de solución salina hipertónica aumenta la diuresis sin generar cambios importantes en el sodio. Se muestran datos de pacientes con insuficiencia cardiaca aguda descompensada, que tras no presentar mejoría con altas dosis de diurético de asa en bolo, se les aplicó la solución hipertónica como adyuvante a este tratamiento. Se toma un total de 26 pacientes analizando datos generales clínicos y de laboratorio, se valoran curvas con la respuesta diurética y por parámetros de laboratorio a las 48 y 72 horas. El uso de solución salina hipertónica consigue un aumento de más de un 200% de la diuresis en 24 horas, con un descenso del Pro BNP de más de un 60% a las 48 horas, sin mostrar un cambio importante en los niveles de creatinina, nitrógeno ureico y sodio. Se requirió reposición de potasio en la totalidad de los pacientes. Se concluye que la infusión de furosemida más solución hipertónica es efectiva tanto en disminuir niveles de NT Pro-BNP en los pacientes, como en generar un aumento en el volumen de diuresis. La principal complicación fue la hipokalemia, sin cambios considerables en el valor de sodio, creatinina y nitrógeno ureico séricos.

Abstract Uso de Solución Hipertónica en pacientes con insuficiencia cardiaca aguda como terapia adyuvante a altas dosis de diuréticos Acute decompensated heart failure (AHF) is a common cause of hospitalization, with significant repercussions on health systems. Acute management is based on the reduction of blood volume with loop diuretics; however, a percentage of patients show resistance or do not achieve the expected clinical response with this treatment. One of the measures that has proven to be effective in this context is the use of hypertonic saline (HSS) in conjunction with high doses of loop diuretics, as a therapeutic measure feared due to its possible repercussions on kidney function and possible sodium overload. Objetives: To determine if the use of hypertonic saline in patients with acute heart failure and hypervolemia leads to a deterioration in renal function. To determine the response of Pro-BNP to the use of hypertonic saline in patients with acute heart failure as a marker of therapeutic response. Determine if the use of hypertonic saline increases urine output without causing significant changes in sodium. Data are shown from patients with acute decompensated heart failure, who after not presenting improvement with high doses of bolus loop diuretic, the hypertonic solution was applied as an adjunct to this treatment. A total of 26 patients are taken analyzing general clinical and laboratory data, curves with the diuretic response and by laboratory parameters are evaluated at 48 and 72 hours. The use of hypertonic saline solution achieves an increase of more than 200% in diuresis in 24 hours, with a decrease in Pro BNP of more than 60% at 48 hours, without showing a significant change in creatinine levels, urea nitrogen and sodium. Potassium replacement was required in all patients. It is concluded that the infusion of furosemide plus hypertonic solution is effective both in reducing levels of NT Pro-BNP in patients, and in generating an increase in the volume of diuresis. The main complication was hypokalemia, without significant changes in serum sodium, creatinine, and urea nitrogen.

Efficacy of nasal irrigation with hypertonic saline on chronic rhinosinusitis: systematic review and meta-analysis / Eficácia da irrigação nasal com solução salina hipertônica na rinossinusite crônica: revisão sistemática e metanálise

Abstract Introduction: Currently, several different concentrations of saline are recommended for use in nasal irrigation. Increasing studies show that nasal irrigation with hypertonic saline is more effective than traditional saline in the treatment of rhinosinusitis, but there have been few systematic analyses of the effect of nasal irrigation with hypertonic saline on chronic rhinosinusitis. Objective: We sought to compare the effects of hypertonic saline and isotonic saline in the treatment of rhinosinusitis in order to provide a reference for clinical nasal irrigation for chronic rhinosinusitis treatment. Methods: Medline, cochrane library, EMBASE, PubMed, Chinese biomedical journal database, China national knowledge infrastructure, Wanfang database, and other databases were searched, and the searching was supplemented by manual searches for relevant references to treatment of rhinosinusitis by saline nasal irrigation. The last retrieval date was March 2018. The included studies were evaluated for quality, and data were extracted for meta-analysis using RevMan 5.3. Results: Seven studies were included. Effects favoring hypertonic saline on nasal symptoms were greater in 4 subgroups. These were (1) patients with nasal secretion (SMD = 1.52; 95% CI: 1.04, 2.00; p < 0.01), (2) patients with congestion (SMD = 1.52; 95% CI: 1.04, 2.00; p < 0.01), (3) patients with headache (SMD = 0.82; 95% CI: 0.38, 1.26; p < 0.01), (4) patients with overall symptomatic relief (SMD = 1.63; 95% CI: 0.83, 2.44; p < 0.01). However, no difference was shown in smell improvement (SMD = 0.47; 95% CI: −0.65, 1.59; p = 0.41) and radiologic scores improvement (SMD = 2.44; 95% CI: -3.14, 8.02; p < 0.01). Besides, hypertonic saline showed greater improvement in mucociliary clearance time scores than did the isotonic saline group (SMD = 1.19; 95% CI: 0.78, 1.60; p < 0.01). Hypertonic saline brought greater minor adverse effects. Conclusion: Compared with isotonic saline, hypertonic saline nasal irrigation for the treatment of chronic rhinosinusitis is significantly more effective and has mild side effects in improving nasal symptoms and ciliary movement, but there is no significant difference in imaging findings and smell improvement. Although hypertonic saline is worthy of widespread use in clinical practice, it is still necessary to further study the exact manner and concentration of nasal irrigation.

Resumo Introdução: Atualmente, o uso de várias concentrações diferentes de solução salina é recomendado na irrigação nasal. Um número crescente de estudos mostra que a irrigação nasal com solução salina hipertônica é mais eficaz do que a solução salina tradicional no tratamento de rinossinusite, mas existem poucas análises sistemáticas do efeito da irrigação nasal com solução salina hipertônica em rinossinusite crônica. Objetivo: Comparar os efeitos da solução salina hipertônica com a solução salina isotônica no tratamento da rinossinusite, para fornecer uma referência clínica de irrigação nasal no tratamento da rinossinusite crônica. Método: Foram pesquisados os bancos de dados Medline, Cochrane Library, Embase, PubMed, Chinese biomedical journal database, China national knowledge infrastructure, Wanfang database e outros, e a pesquisa foi complementada por pesquisas manuais de referências relevantes ao tratamento da rinossinusite por irrigação nasal com solução salina. A data da última recuperação de dados foi março de 2018. Os estudos incluídos foram avaliados quanto à qualidade e os dados foram extraídos para a metanálise com o software RevMan 5.3. Resultados: Sete estudos foram incluídos. Os efeitos favoráveis à solução salina hipertônica nos sintomas nasais foram maiores em quatro subgrupos. Esses foram (1) pacientes com secreção nasal (DMP = 1,52; IC95%: 1,04, 2,00; p ˂ 0,01); (2) pacientes com congestão (DMP = 1,52; IC95%: 1,04, 2,00; p ˂ 0,01); (3) Pacientes com dor de cabeça (DMP = 0,82; IC95%: 0,38, 1,26; p ˂ 0,01); (4) Pacientes com alívio sintomático geral (DMP = 1,63; IC95%: 0,83, 2,44; p ˂ 0,01). Entretanto, não houve diferença na melhoria do olfato (DMP = 0,47; IC95%: -0,65, 1,59; p = 0,41) e na melhoria dos escores radiológicos (DMP = 2,44; IC95%: -3,14, 8,02; p < 0,01). Além disso, o grupo solução salina hipertônica mostrou maior melhoria nos escores do tempo de clearence mucociliar do que o grupo solução salina isotônica (DMP = 1,19; IC95%: 0,78, 1,60; p ˂ 0,01). A solução salina hipertônica causou efeitos adversos menores. Conclusão: Em comparação com a solução salina isotônica, a irrigação nasal com solução salina hipertônica para o tratamento da rinossinusite crônica é significantemente mais eficaz e apresenta efeitos colaterais mais leves, melhoria mais acentuada dos sintomas nasais e no movimento ciliar, mas não há diferença significante nos achados de imagem e na melhoria do olfato. Embora a solução salina hipertônica seja digna de uso generalizado na prática clínica, ainda são necessários mais estudos sobre a forma de uso e a concentração ideal da solução nasal.

Efficacy of Nebulisation with 3 % (Hypertonic Saline) vs 0.9 % (Normal Saline) in the Treatment of First Episode of Wheeze in Children <18 Months- A Randomized Controlled Study

Nebulised hypertonic saline for bronchiolitis is becoming a popular modality in the treatment of bronchiolitis. Definite guidelines in the management of bronchiolitis are still lacking. We wanted to compare the efficacy of nebulized 3% saline versus nebulized normal saline (0.9%) when used with levosalbutamol in infants <18 months, hospitalized with first episode of wheeze.METHODSThis is a randomized controlled study conducted in a tertiary care setting, over a period of one year, among infants <18 months of age, who presented with 1st episode of wheezing, meeting the clinical diagnostic criteria for bronchiolitis. The Respiratory Distress Assessment Instrument (RDAI) score was calculated at admission and regular intervals. The duration from enrollment to readiness for discharge was recorded. Infants were considered as fit to discharge when the RDAI becomes zero.RESULTSIn this group of 72 infants, the pre inhalation mean RDAI score was 3.8 as compared to post inhalation score of 3.1 in the normal saline group and 4.2 and 3.1 respectively in the hypertonic saline group. Though both the groups showed a statistically significant clinical improvement (p=0.000) in terms of RDAI scoring at the end of one hour, the improvement was substantially more in case of hypertonic saline nebulisation (mean difference 1.1) compared to normal saline (mean difference 0.7). Hence patients receiving hypertonic saline nebulization had better improvement in terms of RDAI scoring at the end of I hr.CONCLUSIONSHypertonic saline nebulisation is a better alternative to normal saline for nebulisation in children <18 months of age with first episode of wheeze.

Randomized trial of physiotherapy and hypertonic saline techniques for sputum induction in asthmatic children and adolescents

OBJECTIVES: This study aimed to analyze the efficiency of physiotherapy techniques in sputum induction and in the evaluation of pulmonary inflammation in asthmatic children and adolescents. Although hypertonic saline (HS) is widely used for sputum induction (SI), specific techniques and maneuvers of physiotherapy (P) may facilitate the collection of mucus in some asthmatic children and adolescents. METHODS: A randomized crossover study was performed in patients with well-controlled asthma, and 90 sputum samples were collected. Children and adolescents were assessed using spirometry and randomized at entry into one of three sputum induction techniques: (i) 3% hypertonic saline - HS technique; (ii) physiotherapy (oscillatory positive expiratory pressure, forced expiration, and acceleration of expiratory flow) - P technique; and (iii) hypertonic saline + physiotherapy - HSP technique. ClinicalTrials.gov: NCT03136042. RESULTS: The total cells (mL) and the percentage (%) of differential inflammatory cells were similar in all techniques. The sputum weight (g) in the HSP technique was significantly higher than that in the HS technique. In all techniques, the percentage of viable cells was >50%, and there was no difference between the HS and P techniques. Moreover, sputum induction did not cause any alterations in the pulmonary function of patients. CONCLUSION: The physiotherapy sputum collection technique was effective in obtaining viable cells from mucus samples and yielded the same amount of sputum as the gold standard technique (hypertonic saline). In addition, the physiotherapy maneuvers were both safe and useful for sputum induction in asthmatic children and adolescents with well-controlled asthma.

Bronchiolitis epidemic: experience of the mother and child teaching hospital of Tsaralalàna Madagascar

Background: An increase in the number of children hospitalized for bronchiolitis has been observed on February to April over the past 5 years. This study aimed to describe the bronchiolitis characteristic during the 2019 epidemic as well as its management at the Tsaralalàna Teaching Hospital.Methods: This is a 3 months retrospective descriptive study, from February to April 2019, including all children diagnosed with bronchiolitis.Results: Bronchiolitis was diagnosed in 1704 children (40.1%) and 425(29.4%) were hospitalized. Severe bronchiolitis was found in 212 children (49.9%) which were aged under 3 months in 46.7%. Secondary bacterial infection was noted in 359 children (84.5%) and cardiac failure in 145 children (34.1%). Hypertonic saline 3% was prescribed at 76.4% of children.Conclusions: Younger infant under 3 months were the most frequently admitted in hospitalization. Severe or complicated bronchiolitis are predominant. Using a pediatric plan adapted to bronchiolitis epidemic may improve care of children.

Hypertonic saline and adrenaline nebulization in the treatment of bronchiolitis: a retrospective study

Background: Bronchiolitis is the leading cause of acute illness and hospitalization in young children. There is limited role for diagnostic laboratory or radiographic tests in typical cases of bronchiolitis. Several large recent trials have revealed lack of efficacy of either bronchodilators or corticosteroids. Novel treatment like hypertonic saline and adrenaline nebulizations need to be evaluated for their efficacy.Methods: In this retrospective case control study, we included children aged between 6 months to 2 years admitted for bronchiolitis between August 2017 till July 2018. Each of the 45 children treated with adrenaline nebulisation was assigned a child who was given hypertonic saline nebulization only matched for age and duration of symptoms.Results: 45 children given adrenaline nebulization and 45 children given only hypertonic saline nebulization were compared. Mean duration of stay for children treated with adrenaline nebulization was 5.3 days and those given hypertonic saline was 4.8 days.' p value of 0.29.Conclusions:' Adrenaline nebulization did not shorten hospital stay in children admitted for bronchiolitis as compared to children given hypertonic saline.

Hypertonic saline and pentoxifylline enhance survival, reducing apoptosis and oxidative stress in a rat model of strangulated closed loop small bowel obstruction

OBJECTIVES: Intestinal obstruction has a high mortality rate when therapeutic treatment is delayed. Resuscitation in intestinal obstruction requires a large volume of fluid, and fluid combinations have been studied. Therefore, we evaluated the effects of hypertonic saline solution (HS) with pentoxifylline (PTX) on apoptosis, oxidative stress and survival rate. METHODS: Wistar rats were subjected to intestinal obstruction and ischemia through a closed loop ligation of the terminal ileum and its vessels. After 24 hours, the necrotic bowel segment was resected, and the animals were randomized into four groups according to the following resuscitation strategies: Ringer's lactate solution (RL) (RL-32 ml/kg); RL+PTX (25 mg/kg); HS+PTX (HS, 7.5%, 4 ml/kg), and no resuscitation (IO-intestinal obstruction and ischemia). Euthanasia was performed 3 hours after resuscitation to obtain kidney and intestine samples. A malondialdehyde (MDA) assay was performed to evaluate oxidative stress, and histochemical analyses (terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling [TUNEL], Bcl-2 and Bax) were conducted to evaluate kidney apoptosis. Survival was analyzed with another series of animals that were observed for 15 days. RESULTS: PTX in combination with RL or HS reduced the MDA levels (nmol/mg of protein), as follows: kidney IO=0.42; RL=0.49; RL+PTX=0.31; HS+PTX=0.34 (p<0.05); intestine: IO=0.42; RL=0.48; RL+PTX=0.29; HS+PTX=0.26 (p<0.05). The number of labeled cells for TUNEL and Bax was lower in the HS+PTX group than in the other groups (p<0.05). The Bax/Bcl-2 ratio was lower in the HS+PTX group than in the other groups (p<0.05). The survival rate on the 15th day was higher in the HS+PTX group (77%) than in the RL+PTX group (11%). CONCLUSION: PTX in combination with HS enhanced survival and attenuated oxidative stress and apoptosis. However, when combined with RL, PTX did not reduce apoptosis or mortality.

Soluções salinas em diferentes temperaturas e concentrações melhoram o pico de fluxo inspiratório nasal em escolares? / Do saline solutions at different temperatures and concentrations improve peak nasal inspiratory flow in students?

Introdução: A higiene nasal com solução salina mostrou aliviar a congestão, manter a cavidade nasal limpa e úmida e reduzir o espessamento do muco. Evidências que apoiam solução salina aquecida ou solução salina à temperatura ambiente, em diferentes concentrações, são controversas. Objetivo: Avaliar se soluções salinas aquecidas, em diferentes concentrações, são melhores que soluções salinas em temperatura ambiente para aumentar o fluxo inspiratório nasal em crianças saudáveis. Métodos: Estudantes entre 8 e 12 anos de idade foram submetidos a quatro procedimentos com soluções salinas em diferentes concentrações e temperaturas. O pico de fluxo inspiratório nasal foi medido antes e 30 minutos após cada procedimento. A análise estatística foi realizada por meio do teste t de Student, considerando p < 0,05. Resultados: Avaliamos 46 crianças em todas as etapas, cada criança foi controle de si mesma. Solução salina a 3% apresentou melhores resultados, mas não houve diferença significativa no pico de fluxo inspiratório nasal quando comparadas solução salina a 0,9% e solução salina a 3%, aquecida ou em temperatura ambiente. Quando perguntado, as crianças prefeririam solução salina a 0,9% e aquecida. Conclusão: A solução salina a 3% apresentou maiores médias de pico de fluxo inspiratório nasal, mas não foi significativamente superior à solução salina a 0,9%. A solução salina aquecida não foi superior à solução salina em temperatura ambiente. É importante oferecer várias opções aos pacientes.

Introduction: Nasal hygiene with saline has been shown to relieve congestion, keep nasal cavity clean and moist, and reduce thickened mucus. Evidence supporting warmed saline or room temperature saline at different concentrations are controversial. Objective: To evaluate whether warmed saline at different concentrations is better than room temperature saline for improving peak nasal inspiratory flow in healthy children. Methods: Students between 8 and 12 years of age underwent 4 procedures with saline solutions at different concentrations and temperatures. Peak nasal inspiratory flow was measured before and 30 minutes after each procedure. Statistical analysis was performed using Student's t-test, with p < 0.05. Results: We evaluated 46 children at all stages, and each child was self-controlled. Three percent saline had better results, but there was no significant difference in peak nasal inspiratory flow when compared to 0.9% saline, either warmed or at room temperature. Children reported preferring warmed 0.9% saline. Conclusion: Three percent saline had higher mean nasal inspiratory peak flow, but it was not significantly different from 0.9% saline. Warmed saline was not superior to room temperature saline. Providing patients with various options is important.

Comparison of the effects of volemic reposition with 7. 5 % NaCl or blood in an experimental model of muscular compression and hemorrhagic shock / Comparação dos efeitos da reposição volêmica com NaCl 7, 5 % ou sangue em um modelo experimental de compressão muscular e choque hemorrágico

ABSTRACT Objective: Crush syndrome is characterized by traumatic muscular injuries with severe systemic clinical repercussions. The systemic inflammatory reaction characterized acutely by infiltration of neutrophils in the lungs has been studied as part of the spectrum of crush syndrome. Experimental research may demonstrate alternative treatments for crush syndrome. The authors studied the hypothesis that hypertonic saline solution (7.5% NaCl) could minimize the local and systemic effects in a model of muscular compression and hemorrhagic shock. Methods: Rabbits were submitted to a new model of muscle compression associated with hemorrhagic shock. Compression was applied through an Esmarch bandage, used for 1 h on the entire right lower limb. Hemorrhagic shock was induced for 1 h by dissection and catheterization of the carotid artery. Blood replacement or hypertonic saline solution was used to treat the shock. Biochemical analysis of plasma, quantification of muscular edema, and infiltration of inflammatory cells in the lungs were carried out. Results: Animals treated with hypertonic solution presented the same hemodynamic response as the blood treated patients, less water in the compressed muscles and less infiltration of inflammatory cells in the lungs. The blood group presented hypocalcemia, a facet of crush syndrome. Conclusions: The proposed model was effective for the study of crush syndrome associated with hemorrhagic shock. The treatment with hypertonic solution showed benefits when compared with blood volume replacement.

RESUMO Objetivo: A síndrome de esmagamento é caracterizada por lesões musculares traumáticas com graves repercussões clínicas sistêmicas. A reação inflamatória sistêmica, caracterizada agudamente por infiltração de neutrófilos nos pulmões, tem sido estudada como parte do espectro da síndrome de esmagamento. A pesquisa experimental pode demonstrar opções de tratamento para a síndrome de esmagamento. Os autores estudaram a hipótese de que solução salina hipertônica (NaCl 7,5%) pudesse minimizar os efeitos locais e sistêmicos da síndrome de esmagamento em um modelo de compressão muscular e choque hemorrágico. Métodos: Coelhos foram submetidos a um novo modelo de compressão muscular associado ao choque hemorrágico. A compressão foi feita por uma faixa de Esmarch aplicada por uma hora em todo membro inferior direito. O choque hemorrágico foi induzido durante uma hora por dissecção e cateterização da artéria carótida. O choque foi tratado com reposição de sangue ou solução salina hipertônica. Foram feitas análises bioquímicas do plasma, quantificação do edema muscular e infiltração de células inflamatórias nos pulmões. Resultados: Os animais tratados com solução hipertônica apresentaram a mesma resposta hemodinâmica observada naqueles tratados com sangue, menor quantidade de água nos músculos comprimidos e menor infiltração de células inflamatórias nos pulmões. O grupo tratado com sangue apresentou hipocalcemia, característica da síndrome de esmagamento. Conclusões: O modelo proposto mostrou-se efetivo para o estudo da síndrome de esmagamento associada ao choque hemorrágico. O tratamento com solução hipertônica apresentou benefícios quando comparado com a reposição volêmica com sangue.

Effects of hypertonic saline vs normal saline on lactate clearance after cardiovascular surgery / Efectos del salino hipertónico versus el salino normal en la depuración de lactato después de cirugía cardiovascular

Abstract Background: The postoperative care of patients subjected to cardiac surgery frequently require a complete recovery with intravenous fluids, but crystalloid solutions like normal saline may increase the interstitial oedema, and it is also well known that fluid overload increases mortality. Objective: To compare the effect of 7.5% hypertonic saline (HS) with 0.9% normal saline (NS) on lactate clearance, as well as the haemodynamic response of patients during the first day after cardiovascular bypass surgery. Methods: The study included patients 18 years of age and older with coronary artery disease and/or heart valve disease, and who underwent bypass surgery and/or cardiac valve replacement and were randomly assigned to receive 4 mL/kg of HS or NS intravenously for 30 min once they were admitted to the ICU. Lactate, arterial blood gases, heart rate, central venous pressure, and pulmonary wedge pressure were measured at 0, 6, 12, and 24 h after being admitted to the ICU. The analyses were carried out with an intention-to-treat principle. Results: Out of a total of 494 patients evaluated, 102 were included and assigned to the HS groups (51 patients) or NS (51 patients). The mean age of the participants was 59 ± 14 years, and 59.8% were male. No statistically significant differences were observed between two groups in the lactate clearance, or in any of the secondary outcomes. Conclusions: Our study failed to show a better lactate clearance in the group on hypertonic saline, and with no evidence of a higher incidence of adverse effects in that group. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Resumen Introducción: El cuidado postoperatorio de pacientes sometidos a cirugía cardíaca requiere frecuentemente una reanimación completa con líquidos intravenosos, pero las soluciones cristaloides pueden incrementar el edema intersticial y la sobrecarga de líquidos incrementa la mortalidad. Objetivo: Comparar el efecto del salino hipertónico (SH) al 7.5% con respecto al salino normal (SN) del 0.9% en la depuración de lactato y la respuesta hemodinámica durante el primer día postoperatorio de pacientes con cirugía cardiovascular con circulación extracorpórea. Métodos: Pacientes mayores de 18 años con cirugía de arterias coronarias o de enfermedad valvular cardíaca fueron aleatorizados a recibir 4 ml/kg de SH o SN intravenosos en los primeros 30min de admisión a UCI. Se midieron los valores de lactato, estado ácido-base, frecuencia cardíaca, presión venosa central y presión en cuña pulmonar a las horas 0, 6, 12 y 24 después del ingreso a UCI. Se hizo un análisis con el principio de intención de tratar para un modelo de datos longitudinales. Resultados: Se evaluaron 494 pacientes y se aleatorizaron 102 a los grupos de SH (n = 51) o SN (n = 51). El promedio de edad fue 59 ± 14 años y el 59.8% fueron hombres. No se observó ninguna diferencia estadísticamente significativa entre los 2 grupos en la depuración de lactato o en cualquiera de los desenlaces secundarios. Conclusiones: Nuestro estudio no mostró mejor depuración de lactato con el uso de una dosis de SH ni mayor frecuencia de efectos adversos en ese grupo. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Comparing the efficacy of 7%, 5% hypertonic saline and 0.9% normal saline in acute bronchiolitis: a randomized controlled trial

Background: The study aimed to investigate the effect of nebulized 5% and 7% Hypertonic Saline (HS) versus Normal Saline (NS) in acute viral bronchiolitis.Methods: This is a prospective, randomized controlled trial study that has been done on 90 infants presenting with acute bronchiolitis. All infants divided randomly in three equal size and matched groups (n=30). Subjects received 4ml nebulized 5% and 7% HS along with 0.15mg/kg Adrenaline or 4 ml 0.9%NS every 6 hours from enrolment until hospital discharge. For all patients, clinical symptoms such as sputum, wheezing, retraction rate, heart rate, fever, crackle, irritability, week nutrition and breathing were recorded in baseline and length of wheezing, cough, and crackle, length of stay (LOS), fever and sputum based on days in the end of study. Collected data analyzed by statistical methods in SPSS.19.Results: At baseline, study groups were similar in demographic and clinical characteristics. The mean age of all patients was 5.5±3.6 months, and 59 (65.6%) were male. The length of cough and crackle, and the length of LOS in 5% and 7% HS groups was significantly lower than NS group.Conclusions: Among infants admitted to the hospital with viral bronchiolitis, treatment with nebulized 5% HS and 7% HS had significant effect on decreasing clinical symptoms length and LOS when compared with NS.

Effect of different concentrations of hypertonic sodium fluid resuscitation on intestine injury in rats at the early stage of severe burn / 中华危重病急救医学

Objective To investigate the effect of different concentrations of hypertonic saline solution (HS) on intestine injury in rats at the early stage of severe burn. Methods 104 adult healthy female Sprague-Dawley (SD) rats were randomly divided into five groups: sham group (n = 8), lactated Ringer solution (LR) group (n = 24) and 200, 300, 400 mmol/L HS group (HS200 group, HS300 group, HS400 group, all n = 24). All the rats in LR group and different concentrations of HS groups were scalded for 30% total body surface area (TBSA) with Ⅲ degree, after immediately, the rats were given burn resuscitation therapy by LR or corresponding concentrations of HS through the tail vein. Eight rats were sacrificed on the 2nd, 8th and 24th post-injury hour (PIH), respectively, to collect abdominal aorta blood and intestinal tissues. The rats in sham group were given simulation of burns without resuscitation, which were immediately sacrificed and the specimens were harvested. The serum Na+concentration was determined by automatic biochemical analyzer. Tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) contents in serum were determined by enzyme-linked immunosorbent assay (ELISA). The moisture content of intestine reflected by intestine wet/dry weight (W/D) ratio was determined. The content of malondialdehyde (MDA) and the activity of diamine oxidase (DAO) in intestinal tissue were determined by ultraviolet spectrophotometer. The activation of von Willebrand factor (vWF) was assessed by using immunohistochemistry. Results Compared with sham group, and the contents of TNF-α and IL-1β in blood and W/D ratio and MDA contents in intestine at each time point after injury in LR group and three HS groups were significantly increased, and the activity of intestinal DAO was significantly decreased. The serum Na+concentration was significantly reduced in the LR group as compared with that in the sham group, which was significantly higher in the three HS groups than that in the sham group, with the most obvious change on the 8th PIH. Compared with LR group, the serum Na+concentration and the activity of intestine DAO at each time point after injury in different concentrations of HS groups were significantly increased, and the serum contents of TNF-α, IL-1β and the W/D ratio, MDA contents in intestine were significantly lowered showing a dose dependent. The changes of HS400 group was the most significantly, and the difference on the 8th PIH was statistically significant as compared with LR group [blood Na+(mmol/L): 145.51±0.72 vs. 131.52±0.85, intestinal DAO (U/g): 4.85±0.30 vs. 3.50±0.45, blood TNF-α (ng/L):88.47±4.91 vs. 153.21±13.45, blood IL-1β (ng/L): 85.77±3.42 vs. 140.57±10.46, intestinal W/D ratio: 3.32±0.05 vs. 3.73±0.09, intestinal MDA (nmol/mg): 0.58±0.01 vs. 0.82±0.04, all P < 0.05]. The immunohistochemical results showed that the vWF activity in the LR group and different concentrations of HS groups was significantly reduced as compared with that of the sham group. Compared with LR group, the activity of intestinal vWF at each time point in different concentration of HS groups was increased to some extent with a dose dependent. The positive staining in HS400 group was the deepest, which showed that the activity of intestinal vWF was the strongest after treated by 400 mmol/L HS. Conclusion Compared with LR, HS can attenuate intestinal tissue injury of rats at the early stage of severely burned, and of all, the curative effect of 400 mmol/L HS is the best.

A clinical study on nasal atomization of budesonide combined with hypertonic saline / 实用医学杂志

Objective To study the clinical efficacy of respiratory allergic diseases in children treated by nasal atomization of budesonide combined with 3% hypertonic saline. Methods Children diagnosed as upper air-way cough syndrome or mild to moderate asthma without being controlled by anti-asthma treatment were included in the study.They contracted with complications of nasal congestion and/or running noseand other symptoms,and na-sal CT confirmed the nasal lesions.Thirty children undergoing conventional treatment(conventional drug therapy+keeping away from allergen)were defined as the control group. 89 children treated with nasal spray therapy(con-ventional drug therapy + keeping away from allergen + nasal spray treatment)were defined as the therapy group. The treatment group was subdivided into IgE-mediated group and non-IgE-mediated group according to IgE level. The treatment course was 7 days.The clinical symptoms score,nasal symptom visual scale(VAS),peak expirato-ry flow(PEF)index were observed and analyzed. Results The clinical symptom score and nasal VAS showed a decreasing trend and the percentage of PEF showed an increasing trend in the two groups within 1 week after treat-ment.The clinical symptom score and nasal VAS score of the treatment group were significantly lower than those of the control group,while the PEF%value was significantly higher.The difference in treatment method was interact-ed with the treatment time(P<0.05).The percentage of PEF in the non-IgE-mediated group was significantly high-er than that of IgE-mediated group 1 week after treatment(P < 0.05). Conclusion The nasal atomization of budesonide combined with hypertonic saline in the treatment of children with respiratory allergic diseases is effec-tive and of a good clinical value.

Administração seriada de salina hipertônica 7, 5% na terapia para sepse grave decorrente da síndrome da diarreia hemorrágica aguda em cães / Serial administration of 7. 5% hypertonic saline solution in the therapy of severe sepsis due to acute hemorrhagic diarrhea syndrome in dogs

Na clínica de animais de companhia é frequente cães com síndrome da diarreia hemorrágica aguda associada a quadros de sepse, o que acarreta alta mortalidade. Nesse contexto, objetivou-se, em um ensaio clínico controlado aleatorizado de centro único, estudar os efeitos tardios da solução salina hipertônica a 7,5% em aplicações seriadas, sobre variáveis hemodinâmicas, clínicas e laboratoriais em cães com quadro de sepse grave decorrente desta síndrome. Para tal, 12 cães foram aleatoriamente distribuídos em dois grupos de igual número, sendo um controle (CON) e o outro, solução salina hipertônica 7,5% (SSH). Variáveis clínicas e laboratoriais foram avaliadas imediatamente após a admissão do paciente (T0), 24 (T24), 48 (T48) e 72 (T72) horas após a admissão. O grupo SSH recebeu Ringer com lactato, antibioticoterapia, analgésico e SSH 7,5% em bolus (5mL kg-1 em 4 minutos) no T24 e no T48. O grupo CON recebeu a mesma terapia acima, porém ao invés da utilização de SSH a 7,5%, administrou-se bolus de solução de Ringer lactato na mesma dose e tempos utilizado. As avaliações em cada tempo foram realizadas anteriormente à administração dos bolus, nos dois grupos. Avaliaram-se hemograma completo e as variáveis clínicas (escala AVDN, grau de desidratação, frequência respiratória e temperatura retal), frequência cardíaca (FC), pressão arterial sistólica (PAS). Os dados paramétricos foram avaliados pelos testes Student Newman Keuls e teste t de Student, e os não paramétricos pelo teste de Friedman e Mann Whitney, com nível de significância de P≥0,05. Nas variáveis clínicas estudadas não se observou diferença entre os grupos e entre os momentos avaliados. Observou-se diferença significativa no grupo SSH no T72, com elevação da PAS e redução da FC, fato não observado no grupo CON, onde esses parâmetros não se alteraram. O hematócrito e a concentração de hemoglobina diminuíram em ambos os grupos com o tempo. As contagens dos leucócitos totais e dos monócitos apresentaram uma elevação significativa no grupo SSH, estando os leucócitos dentro da faixa de normalidade no T72. Não houve diferenças significativas em relação aos neutrófilos segmentados, porém no grupo SSH verificou-se aumento de 9,5 vezes no T72 comparado com o T24 (P=0,09), enquanto que este aumento foi de apenas 2,5 vezes no grupo CON (P=0,30). Observou-se ainda redução nas contagens de plaquetas e na concentração de globulinas no grupo COM, enquanto essas variáveis se mantiveram estáveis no grupo SSH. Conclui-se que a administração seriada de SSH 7,5% se mostrou promissora no tratamento de cães com síndrome da diarreia hemorrágica aguda, pois auxilia na estabilização dos leucócitos, plaquetas e globulinas de cães com sepse grave decorrente da síndrome da diarreia hemorrágica aguda.(AU)

The association between acute hemorrhagic diarrhea syndrome and sepsis is frequent in dogs and causes high mortality. In this context we investigated in a randomized single-center controlled trial the late effects of 7.5% hypertonic saline solution in serial applications on hemodynamic, clinical and laboratory variables in dogs with severe sepsis due to the syndrome. Twelve dogs were randomly distributed into two groups of equal numbers, control (CON) and 7.5% hypertonic saline solution (SSH). Clinical and laboratory variables were evaluated immediately after admission of patients (T0), 24 (T24), 48 (T48) and 72 (T72) hours after the admission. The SSH group received Ringer with lactate, antibiotic therapy, analgesic and 5mL/kg-1 bolus of 7.5% SSH over 4 minutes on T24 and T48. The CON group received the same therapy, but instead of 7.5% SSH, Ringer with lactate bolus was given at the same dosis and times. All evaluations were performed prior to the administration of the bolus in both groups. Data collection included complete blood count and clinical variables (AVDN scale, degree of dehydration, respiratory rate and rectal temperature), heart rate (HR) and systolic blood pressure (SBP). Parametric data were evaluated by the Student Newman Keuls and Student t tests, and the nonparametric ones by the Friedman and Mann Whitney test, with a significance level of 0.05. There were no significant differences between the groups and moments in clinical variables. Nevertheless, the SSH group presented a significant elevation of SBP and HR reduction at T72. Hematocrit and hemoglobin concentration decreased in both groups over time. Total leukocyte and monocyte counts showed a significant elevation in the SSH group, however the leukocytes were within the normal range at T72. There were no significant differences in the segmental neutrophils, but a 9.5-fold increase in T72 compared to T24 (P=0.09) in the SSH group was observed, whereas this increase was only 2.5-fold in the CON group (P=0.30). A decrease in platelet counts and globulin concentration was observed in the CON group, while these variables remained stable in the SSH group. In conclusion, serial administration of 7.5% SSH is promising in the therapy of dogs with acute hemorrhagic diarrhea syndrome, since it assists in the stabilization of leukocytes, platelets and globulins in dogs with severe sepsis due to this syndrome.(AU)

Effect of nimodipine combined with 7.5％ hypertonic saline on postoperative cognitive function in aged rats / 中华麻醉学杂志

Objective To evaluate the effect of nimodipine combined with 7.5％ hypertonic saline (HS) on postoperative cognitive function in aged rats.Methods Ninety-six healthy male Wistar rats,aged 18 months,weighing 450-500 g,were assigned into 4 groups (n=24 each) using a random number table:splenectomy group (group S),nimodipine group (group N),group HS and nimodipine plus HS group (group N+HS).Nimodipine 1 mg/kg was intraperitoneally injected in group N.In group HS,7.5％ HS 4 ml/kg was injected via the caudal vein.The equal volume of normal saline was injected intraperitoneally or via the caudal vein in group S.Splenectomy was performed under sevoflurane anesthesia at 30 min after the end of administration.On 1 day before operation and 3 and 7 days after operation,Morris water maze test was performed,and blood sainples from the caudal vein were simultaneously collected for determination of the concentrations of serum S100β protein and neuron-specific enolase (NSE) by enzyme-linked immunosorbent assay.Results Compared with group S,the frequency of crossing the original platform was significantly increased,the escape latency was shortened,and the concentrations of serum S100β protein and NSE were decreased at each time point after operation in N,HS and N+HS groups (P＜0.05).Compared with group N or group HS,the frequency of crossing the original platform was significantly increased,the escape latency was shortened,and the concentrations of serum S100β protein and NSE were decreased at each time point after operation in group N+HS (P＜0.05).Conclusion Nimodipine combined with 7.5％ HS exerts better efficacy than either alone in improving postoperative cognitive function in aged rats.