Hydration therapy in oligohydraminos in Ain Shams University Maternity Hospital: Randomized Controlled Clinical Trial

Background Amniotic fluid surrounds the fetus within first gestational weeks. acts physiologically and anatomically in a protective manner preventing fetal and umbilical cord compressive forces, besides have antibacterial features keeping the fetal temperature stable, and avoiding adhesive attachment to developing fetal membrane system. Amniotic fluid volume and constituents continuously change in a dynamic manner as the gestation progresses. Sufficient amniotic fluid volume is crucial for fetal mechanophysiological well-being adding in normal musculoskeletal wellbeing besides aminiotic fluid consituents refelect physiological integrity of fetal systems particularly the renal and gastrointestinal systems. Objective The aim of this study is to find out if there is significant increase in amniotic fluid index after acute maternal hydration in pregnant women with oligohydraminos and to evaluate therapeutic effectiveness of two different modalities of hydration therapy. Methods We conducted randomized controlled open labeled clinical trial on 300 cases with oligohydraminos admitted to Ain Shams University Maternity Hospital (ASUMH) in the period from September 2019 to March 2020. These patients were classified to three groups, Patients in group A were Oral hydration group: 100 participants while Patients in group B were Intravenous hydration group: 100 participants, patients in Group 3 No hydration group: 100 participants. Results The demographic data analysis of the current study have shown that there was no statistical significant difference between the investigated research groups as regards the demographic characteristics (age, BMI, Parity gestational age p values 0.171,0.370,0.840,0.290 consecutively). The study results also showed that oligoydramnios recurrence frequency was highest among control group, followed by intravenous group and least in oral group, the differences were statistically nonsignificant. Conclusion Hydration can be considered an effective way of decreasing the chance of oligohydraminos because maternal dehydration increases the chance of the condition. Therefore both serum and oral hydration therapies are hypothesized to be effective treatment for oligohydraminos. Previous studies have supported this hypothesis. Maternal hydration may theoretically increase amniotic fluid volume may by causing fetal diuresis.

Preventive Effect of Shenduning Prescription Combined with Hydration Therapy on Contrast Induced Nephronpathy after Elective Percutaneous Coronary Intervention

Objective — To explore the preventive effect of Shenduning prescription combined with hydration therapy on contrast induced nephronpathy (CIN) after elective percutaneous coronary intervention. Methods — 159 patients undergoing selective coronary intervention were divided into simple hydration group, intensive statin group and Shenduning prescription group randomly, with 53 cases in each group. The simple hydration group received conventional drugs for coronary heart disease and preoperative routine hydration therapy. The intensive statin group received intensive treatment with atorvastatin calcium tablets on the basis of the simple hydration group, and the Shenduning prescription group received Shenduning prescription treatment on the basis of the hydration group. Serum creatinine (Scr), malondialdehyde (MDA), superoxide dismutase (SOD) and glomerular filtration rate (eGFR) were detected by blood samples at 24h before and after operation, as well as 72h after operation respectively. The primary endpoint event was the occurrence of CI-AKI. Results — The Scr level of the intensive statin group and the Shenduning prescription group was significantly lower than that of the simple hydration group, while the eGFR level was significantly higher than that of the simple hydration group, which is of statistical significance (P<0.05). The incidence of CI-AKI was 15.1% in simple hydration group, 5.7% in intensive statin group and 3.8% in Shenduning prescription group respectively after operation (χ2 = 5.194, P=0.075), of which there was significant statistical difference between simple hydration group and Shenduning prescription group (χ2 = 3.975, P=0.046). After 72h of the operation, MDA level in Shenduning prescription group was significantly lower than that in simple hydration group and intensive statin group, while its SOD level was significantly higher than that in simple hydration group and intensive statin group, which is of statistical significance (P<0.05). The proportion of abnormal liver function in intensive statin group and the Shenduning prescription group was 13.1% and 3.8%, respectively, and the difference was statistically significant (χ2 = 4.867, P=0.027). Conclusion — The combination treatment of Shenduning prescription with hydration therapy may protect the patient’s renal function after elective coronary interventional therapy, while reducing the incidence of CIN and the oxidative stress reaction caused by contrast agent, thus effectively reducing adverse reactions.

Oral versus intravenous maternal hydration in isolated third trimester oligohydramnios

Background: To study the effect of oral and intravenous maternal hydration in patients with isolated oligohydramnios in terms of mean change in amniotic fluid.Methods: A total number of 38 patients included in the study which fulfill the selection criteria. Patients were randomly divided in two groups. Amniotic fluid index (AFI) of all patients was measured before the hydration therapy according to the method of Phelan et al. In maternal oral hydration (Group A), every patient was instructed to drink two liters of water over two hours daily for 1 week. In intravenous hydration (Group B), every woman infused two liters of 0.9% normal saline in two hour daily for 1 week. After 48 hours and 1 week of oral and intravenous hydration, the AFI was reassessed by the same observer. Patients were monitored closely for sign and symptoms of fluid overload. Data was stratified for mean difference in improvement in amniotic fluid index.Results: After oral hydration therapy AFI was 5.926±0.4593 after 48 hours and 8.286±0.6000 after 7 days in Group A. In Group B AFI was 5.784±0.4622 after 48 hours and 7.868±0.2810 after 7 days of intravenous hydration. P value after 48 hours is 0.348 and p=0.014 after 7 days means oral hydration therapy significantly increase amniotic fluid index.Conclusions: Oral maternal hydration significantly increase the amniotic fluid index in patients with isolated oligohydramnios. It is simple, safe and non-invasive method.

Effect of Combining Furosemide With Standard Hydration Therapy on Contrast-Induced Acute Kidney Injury Following Coronary Angiography or Intervention in a High-Risk Population

This study aimed to investigate whether combining furosemide with standard hydration therapy results in increased preventive effects on contrast-induced acute kidney injury (CI-AKI) following coronary angiography (CA) or percutaneous coronary intervention (PCI). Patients (n = 230) were enrolled in the study and were randomized to the furosemide group or the control group. Patients in the furosemide group received 0.2 to 0.5 mg/kg of furosemide as a continuous intravenous infusion for 24 hours postoperatively and the same standard hydration regimen received by the control group. Blood samples were obtained 24 hours before and 48 hours after the procedure and urine volume was recorded postprocedure. Patients were followed up for an average of 6 months after the procedure. The incidence of CI-AKI in the furosemide group was significantly lower than that in the control group (8.7% vs 18.3%, P = .034). Multivariate logistic regression showed that age-glomerular filtration rate-ejection fraction score and V/estimated glomerular filtration rate ratio were independent risk factors for CI-AKI. During the average 6-month follow-up, incidence of major adverse cardiovascular events (MACEs) in the furosemide group was also significantly lower. Furosemide combined with standard hydration therapy may reduce the incidence of CI-AKI and MACEs following CA or PCI.

Clinical Manifestations and Therapeutic Findings of the Children with Glucose-6-Phosphate Dehydrogenase Deficiency Presenting Favism

Aim: Favism is characterized as acute anemia, due to Glucose-6-phosphate dehydrogenase (G6PD) deficiency as a result of fava beans intake. It is associated with paleness, jaundice, and hemoglobinuria. In this study, signs, symptoms and therapeutic findings of the patients with hemolysis due to G6PD deficiency were investigated in Shahid Madani Hospital of Khorramabad, Lorestan. Methods: This is a single-center cross-sectional descriptive study that was conducted on all children with G6PD deficiencyinduced hemolysis. Results: 308 children (64.3% male and 35.7% female) were included in this study. The most common complaint was jaundice (82.5%) and the most common cause of hemolysis was the intake of fava bean (85.7%). 68% of the children were treated with hydration/fluid therapy. Blood transfusion was conducted in 36.36% of the cases and the mean of blood administered was 18.9 cc/kg. Conclusion: In this study, hydration therapy was performed in most of the children presenting favism. Also, the incorrect calculation of the amount of blood needed for transfusion has increased the frequency of blood transfusions and prolonged hospitalization time.

Comparative study of the efficacy of oral and intravenous maternal hydration in the management of third trimester oligohydramnios and it’s effect on maternal and foetal outcome

Background: Amniotic fluid is derived from maternal plasma in very early pregnancy by the 10th week of pregnancy. It forms an aquatic pond inside the amniotic cavity surrounding the fetus. It helps in fetal development. Aim of this study was to determine the impact of hydration therapy in patients complicated by oligohydramnios.Methods: This was a prospective randomized clinical trial conducted on 200 women.Results: Mean AFI in Group I was 4.47±0.90 cm before hydration therapy and 7.16±1.57 cm after hydration therapy with elevation by 60.18%, similarly mean AFI in Group II was 4.52±0.83 cm before hydration therapy and 7.48±1.56 cm after hydration therapy with elevation by 65.48%. However, on comparing the two groups elevations in mean AFI was found statistically insignificant (p >0.05).Conclusions: Oral hydration is non-invasive, low costing, does not exhaust the resource, convenient to the women with minimum side effects and can be done at home.