Enteral Sodium Chloride Supplementation and Fluid Balance in Children Receiving Diuretics

The use of sodium chloride (NaCl) supplementation in children being prescribed diuretics is controversial due to concerns that supplementation could lead to fluid retention. This is a single-center retrospective study in which fluid balance and diuretic dosing was examined in children prescribed enteral NaCl supplements for hyponatremia while receiving loop diuretics. The aim of this study was to determine whether significant fluid retention occurred with the addition of NaCl. Fifty-five patients with 68 events were studied. The median age was 5.2 months, and 82% were hospitalized for cardiac disease. Daily fluid balance the seven days prior to NaCl supplementation was lower than the seven days after, with measurement of: median 17 mL/kg/day (7–26) vs. 22 mL/kg/day (13–35) (p = 0.0003). There was no change in patient weight after supplementation (p = 0.63). There was no difference in the median loop diuretic dose before and after supplementation, with the diuretic dose in furosemide equivalents of 3.2 mL/kg/day (2.3–4.4) vs. 3.2 mL/kg/day (2.2–4.7) (p = 0.50). There was no difference in the proportion of patients receiving thiazide diuretics after supplementation (56% before vs. 50% after (p = 0.10)). NaCl supplementation in children receiving loop diuretics increased calculated fluid balance, but weight was unchanged, and this was not associated with an increase in diuretic needs, suggesting clinicians did not consider the increase in fluid balance to be clinically significant.

The Applicability of eVTOLs in Emergency Medical Care in Japan

Background: The present study aims to elucidate the applicability of electric vertical takeoff and landing (eVTOL) aircraft that dispatch only a doctor to provide a solution to the operational challenges of utilizing a helicopter to transport a doctor to the patient/s, with such physician-staffed emergency medical helicopters being known as doctor heli (DH), in Japan.Methods: This study conducted interviews with 17 parties related to DHs in five prefectures in Japan to depict challenges of DHs and eVTOL requirements. Subsequently, this study analyzed the Hokusoh DH flight data, as an example, in terms of cases for which flight doctors consider condition assessment and initial treatment provision by a doctor would be particularly effective, to assess the hypothesis that a two-seater is applicable for emergency medical care (EMS) and that eVTOLs help reduce duplicate dispatch requests for DHs as well as the percentage and delayed dispatch time of duplicate requests.Results: Challenges of DHs and eVTOL requirements were identified and classified into six major categories. Data analysis results indicated that two-seater eVTOLs would be particularly effective for trauma, cardiac disease, brain disease cases, and pediatric patient cases and help solve duplicate requests.Conclusions: Two-seater eVTOLs are likely applicable in EMS in Japan.

Advance Care Planning Preferences for Adolescents With Cardiac Disease

BACKGROUND AND OBJECTIVES: Adolescents with cardiac disease are at risk for life-changing complications and premature death. The importance of advance care planning (ACP) in adults with congenital heart disease and in pediatric patients with HIV and cancer has been demonstrated. ACP preferences of adolescents with heart disease have not been evaluated. We describe ACP preferences of adolescents with heart disease and compare with those of their caregivers. METHODS: Outpatient adolescents aged 12 to 18 years with heart failure, cardiomyopathy, heart transplantation, or who were at risk for cardiomyopathy, as well as their caregivers, completed self-administered questionnaires which evaluated participants’ opinions regarding content and timing of ACP discussions, preferences for end-of-life communication, and emotional responses to ACP. RESULTS: Seventy-eight adolescents and 69 caregivers participated, forming 62 adolescent-caregiver dyads. Adolescents and caregivers reported that adolescent ACP discussions should occur early in the disease course (75% and 61%, respectively). Adolescents (92%) wanted to be told about terminal prognosis, whereas only 43% of caregivers wanted the doctor to tell their child this information. Most adolescents (72%) and caregivers (67%) anticipated that discussing ACP would make the adolescent feel relieved the medical team knew their wishes. Most caregivers (61%) believed that adolescents would feel stress associated with ACP discussions, whereas only 31% of adolescents anticipated this. CONCLUSIONS: Adolescents and their caregivers agree that ACP should occur early in disease course. There are discrepancies regarding communication of prognosis and perceived adolescent stress related to ACP discussions. Facilitated conversations between patient, caregiver, and providers may align goals of care and communication preferences.

Cardiac Disease Prediction using Supervised Machine Learning Techniques.

Diagnosis of cardiac disease requires being more accurate, precise, and reliable. The number of death cases due to cardiac attacks is increasing exponentially day by day. Thus, practical approaches for earlier diagnosis of cardiac or heart disease are done to achieve prompt management of the disease. Various supervised machine learning techniques like K-Nearest Neighbour, Decision Tree, Logistic Regression, Naïve Bayes, and Support Vector Machine (SVM) model are used for predicting cardiac disease using a dataset that was collected from the repository of the University of California, Irvine (UCI). The results depict that Logistic Regression was better than all other supervised classifiers in terms of the performance metrics. The model is also less risky since the number of false negatives is low as compared to other models as per the confusion matrix of all the models. In addition, ensemble techniques can be approached for the accuracy improvement of the classifier. Jupyter notebook is the best tool, for the implementation of Python Programming having many types of libraries, header files, for accurate and precise work.

Transpercutaneous closure of perimembranous ventricular septal defects by symmatric occluder

Background: Ventricular septal defect ( VSD ) is the most frequently occurring congenital cardiac disease, accounts nearly 15-30% of all cases. Surgery is still the corrective therapy with high success and low complication but having some problems with: cardiopulmonary bypass, anesthesia, ICU, sternalitis, chest scar, AV block... Recently many progress in cardiac intervention applied to treat congenital heart disease especially percutaneous VSD closure. Currently patients with VSD have other choice to cure safely, effectively and less complication. Objectives: To evaluate 12 months rusults from transpercutaneous closure of perimembranous VSD by modified double – disk symmatric devices ( symmatric occluder). Methods: This is the descriptive clinical trial and follow-up. Result: 41 patients selected by echocardiography, 37 patients were closed successfully (90,2% success rate). No significant complication (AVB…) and 1 patient nonsignificant shunt is 2.7% after 12 month follow-up. Conclusions: Transpercutaneous closure of perimembranous VSD by symmatric occluder is effective and safe and more, longer follow-up.

Pulse Wave Velocity as a Marker of Vascular Dysfunction and Its Correlation with Cardiac Disease in Children with End-Stage Renal Disease (ESRD)

One of the main markers of arterial stiffness is pulse wave velocity (PWV). This parameter is well studied as a marker for end-organ damage in the adult population, being considered a strong predictor of major cardiovascular events. This study assessed PWV in children with chronic kidney disease (CKD) as a marker of cardiovascular risk. We conducted a prospective observational single-center cohort study of 42 consecutively pediatric patients (9–18 years old) with terminal CKD and dialysis, at the Hemodialysis Department of the “M. S. Curie” Hospital, Bucharest. We measured PWV by echocardiography in the ascending aorta (AscAo) and the descending aorta (DescAo), and we correlated them with left ventricular hypertrophy (LVH). Fifteen patients (35.7%) presented vascular dysfunction defined as PWV above the 95th percentile of normal values in the AscAo and/or DescAo. Cardiac disease (LVH/LV remodeling) was discovered in 32 patients (76.2%). All patients with vascular damage also had cardiac disease. Cardiac damage was already present in all patients with vascular disease, and the DescAo is more frequently affected than the AscAo (86.6% vs. 46.9%). Elevated PWV could represent an important parameter for identifying children with CKD and high cardiovascular risk.