Syndrome of inappropriate secretion of antidiuretic hormone in the practice of endocrinologist

Hyponatremia is the most common disorder of water and electrolyte balance encountered in clinical practice. Conditions associated with hyponatremia require hospitalization in 15–20% of cases. Hyponatremia is a predictor of poor outcome in a wide range of diseases and therefore requires an interdisciplinary approach. This problem leads to an increase in complications and the length of hospital stay and mortality. The review focuses on the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), which accounts for approximately one third of all cases of hyponatremia and is more common in endocrinology than other fluid and electrolyte disorders along with central diabetes insipidus. The article presents modern approaches to the treatment of SIADH based on international clinical guidelines.

CURRENT STRATEGIES FOR HYDRATION IN SPORT

The article shows modern methods of hydration control in sports and strategies for ensuring water and electrolyte balance, taking into account the nature and specifics of sports activity

Angiotensin dependent and angiotensin independent protective effects of renin-b in H9c2 cells after anoxia

The renin-angiotensin system is known to regulate blood pressure as well as water- and electrolyte balance. An activated RAS is involved in the development of hypertension and hypertension-related organ damage. Thus, inhibitors of the RAS are protective and markedly increasing the life span of patients. In contrast, renin transcripts have been discovered encoding a cytoplasmatic renin isoform, termed renin-b, which is not harmful but may be even protective. Here we demonstrate that depletion of renin-b encoding transcripts by small interference RNA decreased ATP levels and increased basal necrosis as well as apoptosis rates. Furthermore, renin-b depletion potentiated the anoxia-induced increase of necrosis rates. Vice versa, overexpression of renin-b prevented the anoxia-induced increase of caspase-mediated apoptosis rates. Besides, cells overexpressing renin-b exhibited even reduced mitochondrial mediated apoptosis rates under anoxia, when compared with normoxic conditions, as indicated by Annexin V labeling. However, whereas the protective effect of renin-b on caspase-mediated apoptosis was completely blocked by the renin inhibitor CH732, the effect on mitochondrial-mediated apoptosis was not affected by CH732 at all. From these data we conclude that renin-b overexpression mediates cardioprotective effects under anoxia with respect to mitochondrial induced apoptosis angiotensin-independently, but with respect to caspase induced apoptosis likely in an angiotensin-dependent manner.

Effects of glucocorticoids on the skin

Glucocorticoids are widely used in the treatment of many diseases. They have multiple therapeutic applications mainly because of their anti-inflammatory, immunosuppressive and antiproliferative activity. Glucocorticoids are broadly used in the therapy of dermatological diseases. Various routes of glucocorticoids administration are known. In the treatment of skin disorders, glucocorticoids are often administered topically. It must be noted that glucocorticoid-induced complications may occur not only as a result of systemic treatment, but also topical application of glucocorticoids to the skin. Commonly reported cutaneous adverse effects resulting from glucocorticoid therapy include changes in facial appearance – rounded appearance of the face, redness, development of stretch marks, difficulty in wound healing, and easy bruising. It needs to be highlighted that glucocorticoids also affect metabolism, water and electrolyte balance, and bones. Therefore, in addition to dermatological disorders, they may also cause many other types of complications. As a result, a degree of caution is advised in the use of drugs of this class. In order to reduce the risk of adverse effects, glucocorticoids should be used at the smallest effective dose for the shortest possible time.

Osmolality of Components and Their Application in the Design of Functional Recovery Drinks

Measuring the osmolality of electrolytes, carbohydrates, and other components that contain them, can be very helpful in the design of functional recovery drinks. This study aimed to develop functional recovery drinks based on natural fruit components with the addition of electrolytes and carbohydrates to improve water and electrolyte balance and provide energy after intense physical exertion, as well as ensuring a high content of bioactive ingredients and being of a good sensory quality. The study material consisted of blackcurrant fruit powders obtained by freeze-drying and spray-drying, along with other components such as electrolytes and carbohydrates. The osmolality of the fruit components was measured in aqueous solutions with concentrations from 2.5 to 10%, as well as electrolytes at 0.1 to 4.0% and carbohydrates from 1 to 30%. The sensory quality of drinks was assessed using a scaling method. The content of polyphenols and antioxidant properties were measured spectrophotometrically and the vitamin C content by high-pressure liquid chromatography. Based on the obtained results, five versions of recovery drinks were prepared of defined compositions. These drinks contained fruit powders ranging from 3 to 7%, glucose at 1 to 5%, sucrose 5%, and added electrolytes ranged 0.1 to 0.2% for NaCl and KCl at 0.025%. Their osmolalities ranged from 401 to 564 mOsm/kg H2O, the total polyphenol content was 43 to 62 mg GAE/100 mL, and vitamin C 26 to 35 mg/100 mL. All drinks possessed satisfactory sensory quality. It was established that it is possible to obtain fruit recovery drinks containing defined amounts of electrolytes, carbohydrates, and osmolality values recommended for this type of drink.

Aquaporins in the nervous structures supplying the digestive organs

Aquaporins (AQPs) are a family of integral membrane proteins which form pores in cell membranes and take part in the transport of water, contributing to the maintenance of water and electrolyte balance and are widely distributed in various tissues and organs. The high expression of AQPs has been described in the digestive system, where large-scale absorption and secretion of fluids occurs. AQPs are also present in the nervous system, but the majority of studies have involved the central nervous system. This paper is a review of the literature concerning relatively little-known issues, i.e. the distribution and functions of AQPs in nervous structures supplying the digestive organs.

Comparative Assessment of Nutrient Composition of Aquacultured and Wild Catfish (Clarias gariepinus) in Cross Rivers State Nigeria

Aim: Aquafarming of catfish has become very popular in Nigeria recently, raising concerns about the nutritional benefits of this fish to consumers especially when compared to the wild catfish. Study Design: Fishes were obtained from Calabar Cross Rivers State Nigeria. A total of 30 catfishes were harvested, 15 aquacultured and 15 wild. The fishes weighed between 150 – 200 g at the time of harvest. Place and Duration of Study: The study was carried out at the central laboratory of the University of Calabar, Nigeria and lasted for a period of 6 months. Methodology: Fishes were cleaned and dried under the sun for a period of 14 days. Dried fishes were eventually ground into fine powder which was used for the nutrient analysis. The proximate, mineral and vitamin contents of aquacultured and wild catfish were investigated. The results revealed that aquacultured catfish contained significantly higher amounts of protein than the wild catfish. Conclusion: While the aquacultured fish may be preferable for children, young adults and pregnant women who require a lot of protein for body-building, growth and development, the wild catfish may be more suitable for the maintenance of general health, water and electrolyte balance and optimum productivity being richer in most minerals.

Uromodulin – biomarker of renal function with promising clinical application

Uromodulin (also known as Tamm-Horsfall protein) is a glycoprotein produced exclusively in the kidneys, mainly in the epithelial cells of the thick ascending limb of the loop of Henle. Under physiological conditions, it is the most abundant urinary protein. A small proportion is released into the renal interstitium and then into the blood, where it can be detected and used as a potential parameter of renal function. Uromodulin has numerous physiological roles and potential pathogenetic significance, including providing protection against urinary tract infections and the formation of urinary deposits, as well as being involved in the immunomodulatory functions and regulation of water and electrolyte balance by the kidneys. Unlike classic renal markers (such as creatinine), uromodulin levels decrease with progressive renal dysfunction. A significant advantage of this parameter is therefore the detectable changes in concentration at the early stages of development of chronic kidney disease. In addition, assessment in clinical materials, such as urine and blood, is relatively simple by immunoenzymatic methods. It is evident that the quantitative determination of uromodulin in blood serum is associated with a lower risk of laboratory error and has a better correlation with renal function. Based on previous studies, Tamm-Horsfall protein / uromodulin can be considered a valuable parameter for standard diagnostics of kidney function and renal diseases. It appears that no other marker is currently able to reflect the integrity and functional state of the renal tubules as sensitively as uromodulin. Due to the potential of this parameter, the article presents and overview of the current information available about uromodulin, as well as the available diagnostic tests and the frequency of their use in clinical practice.

Hyperosmolar Treatment for Patients at Risk for Increased Intracranial Pressure: A Single-Center Cohort Study

Treatment with osmoactive agents such as mannitol or hypertonic saline (HTS) solutions is widely used to manage or prevent the increase of intracranial pressure (ICP) in central nervous system (CNS) disorders. We sought to evaluate the variability and mean plasma concentrations of the water and electrolyte balance parameters in critically ill patients treated with osmotic therapy and their influence on mortality. This cohort study covered patients hospitalized in an intensive care unit (ICU) from January 2017 to June 2019 with presumed increased ICP or considered to be at risk of it, treated with 15% mannitol (G1, n = 27), a combination of 15% mannitol and 10% hypertonic saline (HTS) (G2, n = 33) or 10% HTS only (G3, n = 13). Coefficients of variation (Cv) and arithmetic means (mean) were calculated for the parameters reflecting the water and electrolyte balance, i.e., sodium (NaCv/NaMean), chloride (ClCv/ClMean) and osmolality (mOsmCv/mOsmMean). In-hospital mortality was also analyzed. The study group comprised 73 individuals (36 men, 49%). Mortality was 67% (n = 49). Median NaCv (G1: p = 0.002, G3: p = 0.03), ClCv (G1: p = 0.02, G3: p = 0.04) and mOsmCv (G1: p = 0.001, G3: p = 0.02) were higher in deceased patients. NaMean (p = 0.004), ClMean (p = 0.04), mOsmMean (p = 0.003) were higher in deceased patients in G3. In G1: NaCv (AUC = 0.929, p < 0.0001), ClCv (AUC = 0.817, p = 0.0005), mOsmCv (AUC = 0.937, p < 0.0001) and in G3: NaMean (AUC = 0.976, p < 0.001), mOsmCv (AUC = 0.881, p = 0.002), mOsmMean (AUC = 1.00, p < 0.001) were the best predictors of mortality. The overall mortality prediction for combined G1+G2+G3 was very good, with AUC = 0.886 (p = 0.0002). The mortality of critically ill patients treated with osmotic agents is high. Electrolyte disequilibrium is the independent predictor of mortality regardless of the treatment method used. Variations of plasma sodium, chloride and osmolality are the most deleterious factors regardless of the absolute values of these parameters

A case report of an undiagnosed COVID-19 infection

Background: A very serious new type of coronavirus infection has recently erupted in China. For new viruses, data and information in all aspects need to be improved.Case Presentations: During the early COVID-19 outbreak, a 38-year-old man experienced COVID-19 infection in Shenzhen (nonendemic area-related personnel) and underwent SARS-CoV-2 nucleic acid screening multiple times due to an initial positive COVID-19 screening at the beginning of the disease. The results of these additional tests were negative, and the initial SARS-CoV-2 nucleic acid screening result for this patient was suspected as being a false positive.Diagnosis: After nearly 17 days of hospitalization in two hospitals, a variety of tests were performed to diagnosis this new coronavirus infection (due to the positive results of the initial screening).Intervention: Early in the onset of the disease, treatment was given to maintain water and electrolyte balance, and antibiotics and proprietary Chinese medicines were given as the treatment. The symptoms were controlled at an early stage.Outcomes: The patient developed symptoms on the first day and had pneumonia in the lungs, as shown by a chest CT examination on the 7th day of onset. The subsequent prognosis was good. The family members living with this patient did not show similar symptoms.Conclusion: The diagnostic process of COVID-19 needs to be improved, and the development of SARS-CoV-2 diagnostic reagents needs to be strengthened under certain conditions. Screening should be performed at an early stage when a COVID-19 infection is suspected and should distinguish between patients with a COVID-19 infection and with a non-COVID-19 infection. Patients are more conducive to controlling the COVID-19 epidemic.