Understanding body fluid balance, dehydration and intravenous fluid therapy.

This article examines the role of water in the body, the balance of fluids in the body and the provision of intravenous (IV) fluids to patients who are dehydrated, providing a comprehensive overview of these topics for nurses. The author details various aspects of practice in IV fluid therapy, including the types of fluids used, their indications, administration and potential side effects. The article also discusses dehydration and how nurses can identify and treat this complication, which can occur as a result of many different conditions. Drawing on the relevant research, this article aims to advance nurses' knowledge of the care of patients who are dehydrated and require IV fluid therapy.

A rare case of CardioMEMS™ sensor migration.

The CardioMEMS™ system remotely monitors changes in pulmonary artery pressures, which allows for early detection of heart failure worsening. It is a safe and reliable invasive monitoring system. We report a case in which there was a late migration of the device at 6 months of follow-up to the contralateral pulmonary artery. The mechanisms, consequences, and management of device migration are discussed. To our knowledge, there are very few published data on late sensor migration.

The CardioMEMS™ system keeps track of changes in lung artery pressure from a distance. This helps spot early signs of heart failure getting worse. It is a safe and dependable way to keep an eye on things inside the body. We describe a situation where the sensor moved to the opposite lung artery 6 months later. We talk about why this happens, what it means, and how to handle it. There is not much info out there about sensors moving late, as far as we know.

Development of methodology for the visual identification of Tributyltin (TBT) in antifouling paint matrices.

Organotin compounds (OTC), mainly tributyltin (TBT), have been used since the 1970s as biocides in the composition of antifouling paints. Due to its physical-chemical characteristics, TBT has high toxicity to the marine environment affecting non-target organisms. The present study aims to develop a method of direct visual identification of TBT in antifouling paints using the cyclopalladate complex, 4- (2-thiazolylazo) resorcinol (TAR-Pd), synthesized in our laboratory. Tests were performed in blank and in the paint matrix with the following OTC: TBT-O; TBT-Cl; TPT-Cl; DBT-Cl (tributyltin oxide, tributyltin chloride, triphenyltin chloride, dibutyltin chloride), in addition to the SnCl4 and SnCl2 compounds (tin IV chloride and tin II chloride), all at a concentration of approximately 20 g/ kg of dry paint). The test was performed by applying paint samples to test bodies and scraping a few tens of milligrams of the dry paint film. The scraped paint samples were submitted to the test, showing a different staining reaction for the TBT-Cl and SnCl4 samples concerning blank and other samples (TBT-O, TPT, DBT-Cl, and SnCl2). Solution tests were performed to characterize reaction products by spectroscopy in the visible band. The method developed has potential for application in real samples, being selective for TBT-Cl and SnCl4 in an acid medium, obtaining a limit of detection, in the range of 1-10 mg/kg dry paint.

Simulation in nursing: the importance of involving service users.

The term 'service user' is an amorphous concept that can refer to a variety of groups. It refers to people who use or have used a service, or to the carers or parents of service users, or it can be used to refer to lay people, the public or non-professionals. It can also be used to refer to all or any combination of these. To maximise the potential of simulation, it is crucial to involve service users: their inclusion in the co-design of simulations, alongside patient educators and participatory decision-makers, provides invaluable input from a patient perspective. They also make an important contribution by portraying patients in the scenarios within which students interact, providing perspectives based on real-life experiences, offering students an insight into how patients could respond. Such an approach to designing simulations as part of nursing education will help develop professionals who are more patient-centred, culturally competent and more responsive to patient needs.

Dietary restriction and hepatic cancer: Systematic review and meta-analysis of animal studies.

The effect of calorie restriction, fasting, and ketogenic diets on the treatment of liver cancer remains uncertain. Therefore, we conducted a systematic review to evaluate the effect of restrictive diets on the development and progression of liver cancer in animal models. We did a meta-analysis using the Cochrane Collaboration's Review Manager software, with the random effects model and the inverse variance technique. We examined 19 studies that were conducted between 1983 and 2020. Of these, 63.2% investigated calorie restriction, 21.0% experimented with a ketogenic diet, and 15.8% investigated the effects of fasting. The intervention lasted anything from 48 h to 221 weeks. Results showed that restrictive diets may reduce tumor incidence and progression, with a significant reduction in the risk of liver cancer development. Thereby, our results suggest that putting limits on what you eat may help treat liver cancer in more ways than one.

Can supplementing vitamin B12 improve mental health outcomes?: a literature review.

AIM: This study reviews research into the effects of the supplementation of B12 in the prevention and recovery of mental illness, and the potentiation of psychotropic medication. METHODOLOGY: This literature review follows a systematic approach to searching databases CINAHL, EMBASE, Medline, and PsycINFO where 287 non-duplicated articles results were received. Appropriate articles were identified through title and abstract screening and inclusion and exclusion criteria were applied. Five articles were chosen to address the research question following critical appraisal. Thematic analysis was then conducted. FINDINGS: This review identified five randomised controlled trials into the supplementation of various doses of B12 in conjunction with folic acid and B6. The supplement was measured against post-stroke depression prevention, the reduction of symptoms of depression in woman with cardiovascular disease, the effect on negative symptoms in schizophrenia, the reduction and prevention of depression in older adults, and the potentiation of psychotropic interventions. The papers reviewed showed inconclusive results, but evidence to support sub-groups and specific high-risk groups. Strong evidence showed supplementation of B12, folic acid and B6 has high rates of preventing post-stroke depression. CONCLUSION: The findings show that this area of research is still to be developed. The effects of B12 supplementation with other B vitamins on mental health have shown to be inconclusive. There is a case for its use to be considered within certain patient groups to aid recovery of mental health or in some high-risk patient groups. Recommendations are made for further research into high-risk groups of people that may have symptoms or symptoms that could be improved through the supplementation of B12.

Loneliness in older adults.

This article aims to provide an overview on loneliness in older people, with an emphasis on how insights from this body of literature can significantly contribute to the enhancement of care provided by community nurses. This review aims to provide a nuanced understanding of the factors contributing to loneliness, its impact on the physical and mental health of older individuals, and the role community nurses can play in mitigating and addressing loneliness.

Cardiopulmonary Exercise Testing in Patients with Heart Failure: Impact of Gender in Predictive Value for Heart Transplantation Listing.

BACKGROUND: Exercise testing is key in the risk stratification of patients with heart failure (HF). There are scarce data on its prognostic power in women. Our aim was to assess the predictive value of the heart transplantation (HTx) thresholds in HF in women and in men. METHODS: Prospective evaluation of HF patients who underwent cardiopulmonary exercise testing (CPET) from 2009 to 2018 for the composite endpoint of cardiovascular mortality and urgent HTx. RESULTS: A total of 458 patients underwent CPET, with a composite endpoint frequency of 10.5% in females vs. 16.0% in males in 36-month follow-up. Peak VO2 (pVO2), VE/VCO2 slope and percent of predicted pVO2 were independent discriminators of the composite endpoint, particularly in women. The International Society for Heart Lung Transplantation recommended values of pVO2 ≤ 12 mL/kg/min or ≤14 if the patient is intolerant to ß-blockers, VE/VCO2 slope > 35, and percent of predicted pVO2 ≤ 50% showed a higher diagnostic effectiveness in women. Specific pVO2, VE/VCO2 slope and percent of predicted pVO2 cut-offs in each sex group presented a higher prognostic power than the recommended thresholds. CONCLUSION: Individualized sex-specific thresholds may improve patient selection for HTx. More evidence is needed to address sex differences in HF risk stratification.

Age Differences in Cardiopulmonary Exercise Testing Parameters in Heart Failure with Reduced Ejection Fraction.

Background and Objectives: Cardiopulmonary exercise testing (CPET) is a cornerstone of risk stratification in heart failure with reduced ejection fraction (HFrEF). However, there is a paucity of evidence on its predictive power in older patients. The aim of this study was to evaluate the prognostic power of current heart transplantation (HTx) listing criteria in HFrEF stratified according to age groups. Materials and Methods: Consecutive patients with HFrEF undergoing CPET between 2009 and 2018 were followed-up for cardiac death and urgent HTx. Results: CPET was performed in 458 patients with HFrEF. The composite endpoint occurred in 16.8% of patients ≤50 years vs. 14.1% of patients ≥50 years in a 36-month follow-up. Peak VO2 (pVO2), VE/VCO2 slope and percentage of predicted pVO2 were strong independent predictors of outcomes. The International Society for Heart and Lung Transplantation thresholds of pVO2 ≤ 12 mL/kg/min (≤14 if intolerant to ß-blockers), VE/VCO2 slope > 35 and percentage of predicted pVO2 ≤ 50% presented a higher overall diagnostic effectiveness in younger patients (≤50 years). Specific thresholds for each age subgroup outperformed the traditional cut-offs. Conclusions: Personalized age-specific thresholds may contribute to an accurate risk stratification in HFrEF. Further studies are needed to address the gap in evidence between younger and older patients.

Associação entre insegurança e consumo alimentar em universitários brasileiros durante a pandemia de COVID-19 / Association between food insecurity and consumption in Brazilian university students during the COVID-19 pandemic

Introdução. A COVID-19 impactou a garantia de uma alimentação adequada e saudável, inclusive entre universitários, que parecem constituir um grupo suscetível à Insegurança Alimentar (IA). Objetivo. Verificar a associação entre IA e marcadores de consumo alimentar em universitários durante a pandemia de COVID-19. Materiais e métodos. Estudo transversal com 5407 estudantes de instituições de ensino superior de todas as regiões do Brasil. Os dados foram coletados entre agosto/2020 e fevereiro/2021. O consumo alimentar foi avaliado por marcadores de alimentação saudável utilizados num inquérito nacional de saúde (VIGITEL). Os níveis de IA foram classificados pela Escala Brasileira de Insegurança Alimentar em Segurança Alimentar (SA) e IA leve, moderada e grave. A associação entre IA e marcadores de consumo foi avaliada por meio de regressão logística, considerando frequência semanal de consumo < 3 dias e ≥ 3 dias. Resultados. 37% dos universitários estavam em algum grau de IA. Verificou-se maior chance de baixa frequência de consumo de feijão (OR 1,81), verduras e legumes (OR 4,76), frutas (OR 3,99), lácteos (OR 3,98) e carnes (OR 3,41), e maiores chances de maior consumo de frango (OR 1,14) e ovos (OR 2,04) entre aqueles em IA (p<0,05). Em sua maioria, os valores foram mais expressivos quanto maior o grau de IA. Conclusões. Maiores níveis de IA mostraram-se associados a uma menor chance de consumo alimentar saudável por universitários. Instituições de ensino superior podem executar papéis importantes no combate e assistência à IA nessa população(AU)

Introduction. COVID-19 has impacted access to an adequate and healthy diet, including university students, who seem to constitute a group susceptible to Food Insecurity (FI). Objective. To verify the association between FI and food consumption markers in university students during the COVID-19 pandemic. Materials and Methods. We conducted a cross- sectional study with 5407 students from higher education institutions from all regions of Brazil. Data were collected between August/2020 and February/2021. We evaluated food consumption using the healthy eating markers from a Brazilian national health survey (VIGITEL). We classified the FI levels according to the Brazilian Food Insecurity Scale into Food Security (FS) and mild, moderate, and severe FI. We evaluated the association between FI and consumption markers using logistic regression, considering the weekly frequency of consumption of < 3 days and ≥ 3 days. Results. 37% of the university students had in some degree of FI. We found a greater chance of lower frequency of consumption of beans (OR 1.81), vegetables (OR 4.76), fruits (OR 3.99), dairy products (OR 3.98), and meat (OR 3. 41), and greater chances of increased consumption of chicken (OR 1.14) and eggs (OR 2.04) among those in FI (p<0.05). Overall, the values were more expressive the higher the degree of FI. Conclusions. Higher FI levels were associated with a lower chance of healthy food consumption in university students. Higher education institutions can play a relevant role in addressing and administering the FI in this population(AU)

Cardiopulmonary Exercise Testing in the Age of New Heart Failure Therapies: Still a Powerful Tool?

BACKGROUND: New therapies with prognostic benefits have been recently introduced in heart failure with reduced ejection fraction (HFrEF) management. The aim of this study was to evaluate the prognostic power of current listing criteria for heart transplantation (HT) in an HFrEF cohort submitted to cardiopulmonary exercise testing (CPET) between 2009 and 2014 (group A) and between 2015 and 2018 (group B). METHODS: Consecutive patients with HFrEF who underwent CPET were followed-up for cardiac death and urgent HT. RESULTS: CPET was performed in 487 patients. The composite endpoint occurred in 19.4% of group A vs. 7.4% of group B in a 36-month follow-up. Peak VO2 (pVO2) and VE/VCO2 slope were the strongest independent predictors of mortality. International Society for Heart and Lung Transplantation (ISHLT) thresholds of pVO2 ≤ 12 mL/kg/min (≤14 if intolerant to ß-blockers) and VE/VCO2 slope > 35 presented a similar and lower Youden index, respectively, in group B compared to group A, and a lower positive predictive value. pVO2 ≤ 10 mL/kg/min and VE/VCO2 slope > 40 outperformed the traditional cut-offs. An ischemic etiology subanalysis showed similar results. CONCLUSION: ISHLT thresholds showed a lower overall prognostic effectiveness in a contemporary HFrEF population. Novel parameters may be needed to improve risk stratification.

Clinical and molecular characterization of parathyroid carcinoma in multiple endocrine neoplasia type 1.

Nineteen cases of parathyroid carcinoma in patients with multiple endocrine neoplasia type 1 have been reported in the literature, of which 11 carry an inactivating germline mutation in the MEN1 gene. Somatic genetic abnormalities in these parathyroid carcinomas have never been detected. In this paper, we aimed to describe the clinical and molecular characterization of a parathyroid carcinoma identified in a patient with MEN1. A 60-year-old man was diagnosed with primary hyperparathyroidism during the postoperative period of lung carcinoid surgery. Serum calcium and parathyroid hormone levels were 15.0 mg/dL (8.4-10.2) and 472 pg/mL (12-65), respectively. The patient underwent parathyroid surgery, and histological findings were consistent with parathyroid carcinoma. Analysis of the MEN1 gene by next-generation sequencing (NGS) identified a novel germline heterozygous nonsense pathogenic variant (c.978C>A; p.(Tyr326*)), predicted to encode a truncated protein. Genetic analysis of the parathyroid carcinoma revealed a c.307del, p.(Leu103Cysfs*16) frameshift truncating somatic MEN1 variant in the MEN1 gene, which is consistent with MEN1 tumor-suppressor role, confirming its involvement in parathyroid carcinoma etiology. Genetic analysis of CDC73, GCM2, TP53, RB1, AKT1, MTOR, PIK3CA and CCND1 genes in the parathyroid carcinoma DNA did not detect any somatic mutations. To our knowledge, this is the first report of a PC case presenting both germline (first-hit) and somatic (second-hit) inactivation of the MEN1 gene.

Improving startups through excellence initiatives: addressing circular economy and innovation.

This study analyses how startups implement circular business models supported by innovation and Industry 4.0, in which strategic stakeholders for value creation are to be found in this specific business ecosystem. The theoretical framework of circular business models supported by innovation was used for analysing the startups based on some assumptions of stakeholder theory. Fifty-one startups were selected, which correspond to the unit of analysis for this study on the improvement of supply chains through circular business models supported by innovation aimed at sustainability in organizations. We conducted a multiple case study whose results suggest that: (i) circularity is strategic for the business to assume its commitment to a sustainable development agenda, especially regarding pollution prevention and proactive action; (ii) visionary entrepreneurs are actively engaged with circular economy practices and technological innovation to promote a circular flow for their business ecosystem; (iii) Industry 4.0 is still incipient, but it is synergistic and beneficial for a successful circular economy in startups; and (iv) primary stakeholders are the activators of circular cycles in the startups surveyed. The present study contributes to the literature in four ways by: (i) presenting a framework which brings together exploratory theoretical propositions on strategic stakeholders for startups, innovative capabilities and assumptions of circular business models; (ii) validating exploratory theoretical propositions with 51 startups; (iii) providing lessons learned so far by the startups which are in line with the assumptions of circular business models for triggering their innovation capabilities and promoting Industry 4.0; (iv) providing an original typology of circular economy assumptions and technological innovations adopted by startups. The originality of this study lies in presenting useful insights for motivating managers to: (i) invest in circular business to become one of the first entrants and earn extra profits; (ii) make investments in circular business and technological innovations to obtain efficiency, practicality and process optimization; (iii) internalize Industry 4.0 technologies concomitantly with technological innovations and circular economy to generate systemic effects; (iv) integrate relevant stakeholders of the business ecosystem to generate a synergistic and effective effect for sustainable development.

Threading the needle: a case report of double-wiring technique and double intracoronary imaging guidance for a multifenestrated iatrogenic coronary artery dissection.

Background: Iatrogenic coronary artery dissection (ICAD) may represent a serious complication of percutaneous coronary intervention. Stenting the dissected segment is recommended in large dissections with compromised distal blood flow, although wiring the true lumen is often difficult. Case summary: A 64-year-old woman with effort angina was submitted to invasive coronary angiography that revealed a severe stenosis in the distal right coronary artery. A large spiral ICAD occurred after pre-dilatation and guidewire position is lost. We report the treatment of this multifenestrated dissection using combined intracoronary imaging guidance with angiographic co-registered optical coherence tomography and real-time intravascular ultrasound, which were crucial to achieve a successful outcome. Discussion: A double-wiring technique with double intracoronary imaging guidance enables a comprehensive depiction of the compromised artery and should be considered in selected cases to guide true lumen wiring and stent implantation.

Sacubitril/Valsartan Improves Left Atrial and Ventricular Strain and Strain Rate in Patients with Heart Failure with Reduced Ejection Fraction.

BACKGROUND: Data on the impact of sacubitril/valsartan (SV) therapy on phasic left atrial (LA) and left ventricular (LV) strain in heart failure with reduced ejection fraction (HFrEF) are limited. The aim of this study was to evaluate changes in two-dimensional speckle tracking (2D-STE) parameters with SV therapy in HFrEF patients. METHODS: Prospective evaluation of HFrEF patients receiving optimized medical therapy. Two-dimensional speckle tracking (2D-STE) parameters were assessed at baseline and after 6 months of SV therapy. LA strain and strain rate (SR) in reservoir, conduit, and contraction phases were compared with LV longitudinal, radial, and circumferential strain and SR and stratified according to heart rhythm and HFrEF etiology. RESULTS: A total of 35 patients completed the 6-month follow-up, with a mean age of 59 ± 11 years, 40% in atrial fibrillation, 43% with ischemic etiology, and LVEF of 29 ± 6%. There were significant improvements in LA reservoir, conduit, and contractile strain and SR following SV therapy, particularly among patients in sinus rhythm. There were significant improvements in longitudinal, radial, and circumferential LV function indices. CONCLUSION: SV therapy in HFrEF was associated with improved longitudinal, radial, and circumferential function, particularly among patients in sinus rhythm. These findings can provide insights into the mechanisms underlying the improvement of cardiac function and help assess subclinical responses to the treatment.

Dilated Cardiomyopathy: A Comprehensive Approach to Diagnosis and Risk Stratification.

Dilated cardiomyopathy (DCM) represents one of the most common causes of non-ischemic heart failure, characterised by ventricular dilation alongside systolic dysfunction. Despite advances in therapy, DCM mortality rates remain high, and it is one of the leading causes of heart transplantation. It was recently recognised that many patients present minor structural cardiac abnormalities and express different arrhythmogenic phenotypes before overt heart-failure symptoms. This has raised several diagnostic and management challenges, including the differential diagnosis with other phenotypically similar conditions, the identification of patients at increased risk of malignant arrhythmias, and of those who will have a worse response to medical therapy. Recent developments in complementary diagnostic procedures, namely cardiac magnetic resonance and genetic testing, have shed new light on DCM understanding and management. The present review proposes a comprehensive and systematic approach to evaluating DCM, focusing on an improved diagnostic pathway and a structured stratification of arrhythmic risk that incorporates novel imaging modalities and genetic test results, which are critical for guiding clinical decision-making and improving outcomes.