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Neubrand LB, van Leeuwen TG, Faber DJ. Towards non-invasive tissue hydration measurements with optical coherence tomography. JOURNAL OF BIOPHOTONICS 2024:e202300532. [PMID: 38735734 DOI: 10.1002/jbio.202300532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 05/14/2024]
Abstract
The attenuation coefficient (μ OCT $$ {\mu}_{\mathrm{OCT}} $$ ) measured by optical coherence tomography (OCT) has been used to determine tissue hydration. Previous dual-wavelength OCT systems could not attain the needed precision, which we attribute to the absence of wavelength-dependent scattering of tissue in the underlying model. Assuming that scattering can be described using two parameters, we propose a triple/quadrupole-OCT system to achieve clinically relevant precision in water volume fraction. In this study, we conduct a quantitative analysis to determine the necessary precision ofμ OCT $$ {\mu}_{\mathrm{OCT}} $$ measurements and compare it with numerical simulation. Our findings emphasize that achieving a clinically relevant assessment of a 2% water fraction requires determining the attenuation coefficient with a remarkable precision of 0.01m m - 1 $$ \mathrm{m}{\mathrm{m}}^{-1} $$ . This precision threshold is influenced by the chosen wavelength for attenuation measurement and can be enhanced through the inclusion of a fourth wavelength range.
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Affiliation(s)
- Linda B Neubrand
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Atherosclerosis and Ischemic Syndromes, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Ton G van Leeuwen
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Atherosclerosis and Ischemic Syndromes, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Dirk J Faber
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Atherosclerosis and Ischemic Syndromes, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
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Gazza C, Marcilly R, Kovacs B, Schiro J, Pelayo S. Integration of a new technology into a work system: a case study of a smart drinking glass in French nursing homes. Disabil Rehabil Assist Technol 2024; 19:1249-1261. [PMID: 36622869 DOI: 10.1080/17483107.2022.2162612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 09/04/2022] [Accepted: 12/20/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE To reduce the risk of dehydration in older adults, the French company Auxivia has developed a smart drinking glass (SDG) that can measure the amount of water drunk. The present study looked at the various work systems (WSs) designed for use of the SDG in a nursing home. The study's objectives were to (i) determine the WSs' impact on the staff's ability to comply with the device's prerequisites and ensure the device's effective use and (ii) draw up guidelines on designing work systems. MATERIALS AND METHODS At three nursing homes in France, two independent observers performed 9 h of observations at each site and a total of 29 interviews. RESULTS Decisions concerning implementation and the resulting WSs have an impact on the tasks to be performed, the tasks' inherent constraints and the use of the SDG. It is essential to take account of the sociotechnical system as a whole before integrating a technology. Ideally, the introduction of an SDG will go unnoticed by staff and residents; however, our results emphasize the value of highlighting work constraints via a human factors analysis. CONCLUSIONS It is essential to take account of sociotechnical WSs as a whole when integrating a technology.
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Affiliation(s)
- Clément Gazza
- Univ. Lille, Inserm, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
- Inserm, CIC 1403 - Centre d'investigation clinique, Lille, France
- CHU Lille, CIC 1403, Lille, France
| | - Romaric Marcilly
- Univ. Lille, Inserm, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
- Inserm, CIC 1403 - Centre d'investigation clinique, Lille, France
- CHU Lille, CIC 1403, Lille, France
| | | | - Jessica Schiro
- Univ. Lille, Inserm, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
- Inserm, CIC 1403 - Centre d'investigation clinique, Lille, France
- CHU Lille, CIC 1403, Lille, France
| | - Sylvia Pelayo
- Univ. Lille, Inserm, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
- Inserm, CIC 1403 - Centre d'investigation clinique, Lille, France
- CHU Lille, CIC 1403, Lille, France
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Spyraki F, Maniewicz S, Mojon P, Müller F. A novel test for hyposalivation using a sugar cube. J Oral Rehabil 2024. [PMID: 38685706 DOI: 10.1111/joor.13715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/28/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Hyposalivation is a highly prevalent condition in old persons. OBJECTIVES The aim of this study was to assess a novel tool for the diagnosis of hyposalivation using a sugar cube and to compare its reliability to other validated test methods. METHODS Five tests were performed: unstimulated salivary flow test by draining method (USFT), oral moisture device Mucus® (MCS), sugar cube test (SCT), stimulated salivary flow test by chewing gum (CG) and Saxon test (SX). The sugar cube test consisted in measuring the time needed to disintegrate a standard-sized sugar cube N°4 (5.6 g) placed beneath the tongue. Bivariate correlation analyses were performed. ROC curve analysis and the Youden Index were used to determine the cut-off value. Sensitivity and specificity were calculated according to the determined cut-off point. RESULTS A total of 121 participants were recruited, with an average age of 49.8 ± 18.2 years. The USFT was best correlated with the SCT. No correlation was found between SCT and the stimulated saliva tests (CG, SX) as well as the MCS test. According to the Youden index, 140 s is appropriate to diagnose hyposalivation. Sensitivity of .64 and specificity of .91 were found for SCT using USFT as gold standard. The mean subjective evaluation score of the SCT was 3.1 ± 1, significantly higher than USFT 2.6 ± 1.1 (p < .05). CONCLUSIONS The sugar cube test proved to be a useful method for assessing unstimulated salivation, reducing test execution time and causing less participant discomfort than the gold standard unstimulated salivary flow test.
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Affiliation(s)
- Foteini Spyraki
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Sabrina Maniewicz
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Philippe Mojon
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Frauke Müller
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, University Hospitals of Geneva, Thônex, Switzerland
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Hahn RG. Detection of low urine output by measuring urinary biomarkers. BMC Nutr 2024; 10:13. [PMID: 38217039 PMCID: PMC10785494 DOI: 10.1186/s40795-024-00823-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 01/05/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Urine output < 1 L per 24 h is a clinical warning sign that requires attention from hospital staff, who should determine whether the low flow is due to low habitual intake of water or disease-induced dehydration. The incidence of this condition is unclear. METHODS A cohort of 20 healthy volunteers (mean age 42 years, range 23-62 years) recorded their food and water intakes daily for 8 days. They also collected and measured all urine and delivered first morning urine samples for analysis of osmolality and creatinine. Optimal cutoffs for these biomarkers to indicate urine output of < 1 L or 15 mL/kg during the preceding 24 h were applied with and without correction for age to cross-sectional data from 1,316 subjects in various clinical settings, including healthy volunteers, preoperative patients, patients seeking acute care at a hospital, and patients receiving institutional geriatric care. RESULTS The urine output amounted to < 1 L during 22 of the 159 evaluable study days and was indicated by urine osmolality > 760 mosmol/kg or urine creatinine > 13 mmol/L, which had sensitivity and specificity of approximately 80%. Days with urine output < 1 L were associated with significantly less intake of both water (-41%) and calories (-22%) compared to other days. Application of age-corrected biomarker cutoffs to the 1,316 subjects showed a stronger dependency of low urine output on age than the clinical setting, occurring in 44% of the 72 participants aged 15-30 years and 18% of the 62 patients aged 90-104 years. CONCLUSION Biomarkers measured in morning urine of young and middle-aged volunteers indicated urine output of < 1 L with good precision, but the cutoffs should be validated in older age groups to yield reliable results. TRIAL REGISTRATIONS ISRCTN12215472 at http://www.isrctn.com ; NCT01458678 at ClinicalTrials.gov, and ChiCTR-TNRC-14,004,479 at the chictr.org/en.
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Affiliation(s)
- Robert G Hahn
- Karolinska Institutet at Danderyds Hospital (KIDS), Stockholm, 182 88, Sweden.
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5
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Zhao M, Lv H, Zhang Y, Zhao H, Qin H. Associations between genetically predicted sex and growth hormones and facial aging in the UK Biobank: a two-sample Mendelian randomization study. Front Endocrinol (Lausanne) 2023; 14:1239502. [PMID: 37916150 PMCID: PMC10616234 DOI: 10.3389/fendo.2023.1239502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/27/2023] [Indexed: 11/03/2023] Open
Abstract
Background Aging is an inescapable process, but it can be slowed down, particularly facial aging. Sex and growth hormones have been shown to play an important role in the process of facial aging. We investigated this association further, using a two-sample Mendelian randomization study. Methods We analyzed genome-wide association study (GWAS) data from the UK Biobank database comprising facial aging data from 432,999 samples, using two-sample Mendelian randomization. In addition, single-nucleotide polymorphism (SNP) data on sex hormone-binding globulin (SHBG) and sex steroid hormones were obtained from a GWAS in the UK Biobank [SHBG, N = 189,473; total testosterone (TT), N = 230,454; bioavailable testosterone (BT), N = 188,507; and estradiol (E2), N = 2,607)]. The inverse-variance weighted (IVW) method was the major algorithm used in this study, and random-effects models were used in cases of heterogeneity. To avoid errors caused by a single algorithm, we selected MR-Egger, weighted median, and weighted mode as supplementary algorithms. Horizontal pleiotropy was detected based on the intercept in the MR-Egger regression. The leave-one-out method was used for sensitivity analysis. Results SHBG plays a promoting role, whereas sex steroid hormones (TT, BT, and E2) play an inhibitory role in facial aging. Growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels had no significant effect on facial aging, which is inconsistent with previous findings in vitro. Conclusion Regulating the levels of SHBG, BT, TT, and E2 may be an important means to delay facial aging.
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Affiliation(s)
- Mingjian Zhao
- Graduate School, Dalian Medical University, Dalian, Liaoning, China
| | - Huiyun Lv
- Department of Oncology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yunshu Zhang
- Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Hongliang Zhao
- Department of Burns and Plastic Surgery, Miyun Hospital, Capital Medical University, Beijing, China
| | - Hongzhi Qin
- Graduate School, Dalian Medical University, Dalian, Liaoning, China
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Deißler L, Wirth R, Frilling B, Janneck M, Rösler A. Hydration Status Assessment in Older Patients. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:663-669. [PMID: 37583084 PMCID: PMC10644957 DOI: 10.3238/arztebl.m2023.0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Hydration disturbances are common in old age: the reported prevalence of dehydration in elderly patients ranges from 19% to 89%, depending on the definition and the population in question. However, the clinical assessment of patients' hydration status is difficult. In this review, we discuss the diagnostic value of currently used methods that may or may not be suitable for assessing older patients' hydration status. METHODS We conducted a selective literature search for relevant studies concerning patients aged 65 and above. Of the 355 articles retrieved by the initial search, a multistep selection process yielded 30 that were suitable for inclusion in this review. RESULTS 107 different methods for the diagnostic assessment of dehydration in older persons were evaluated on the basis of the reviewed publications. High diagnostic value, especially for the determination of hyperosmolar dehydration, was found for serum osmolality, serum sodium concentration, inferior vena cava ultrasonography, a history (from the patient or another informant) of not drinking between meals, and axillary dryness. On the other hand, a variety of clinical signs such as a positive skin turgor test, sunken eyes, dry mouth, tachycardia, orthostatic dysregulation, and dark urine were found to be of inadequate diagnostic value. CONCLUSION Only five of the 107 methods considered appear to be suitable for determining that a patient is dehydrated. Thus, the available scientific evidence indicates that all clinicians should critically reconsider their own techniques for assessing hydration status in elderly patients. To optimize the clinical assessment of patients' hydration status, there seems to be a need for the rejection of unsuitable methods in favor of either newly developed criteria or of a combination of the best criteria already in use.
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Affiliation(s)
- Linda Deißler
- Medical Faculty, University of Hamburg, Hamburg, Germany
| | - Rainer Wirth
- Marien Hospital Herne, University Hospital of the Ruhr University Bochum, Herne, Germany
| | - Birgit Frilling
- Albertinen House – Center for Geriatrics and Gerontology, Hamburg, Germany
| | | | - Alexander Rösler
- Department of Geriatrics, Agaplesion Bethesda Hospital HH-Bergedorf, Hamburg, Germany
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Frith J. New horizons in the diagnosis and management of dehydration. Age Ageing 2023; 52:afad193. [PMID: 37847795 PMCID: PMC10581537 DOI: 10.1093/ageing/afad193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Indexed: 10/19/2023] Open
Abstract
Hydration is a fundamental aspect of clinical practice and yet it is an under-researched topic, particularly in older people, leading to many areas of uncertainty. There are two types of dehydration; hypertonic, which is a water deficit, and isotonic, which is a deficit of both water and salt. Individual clinical signs and bedside tests are poor diagnostic tools, making dehydration difficult to identify. However, the diagnostic value of a holistic clinical approach is not known. The gold-standard clinical test for dehydration is serum osmolality, but this cannot diagnose isotonic dehydration and may delay diagnosis in acute situations. Salivary osmolality point-of-care testing is a promising and rapid new diagnostic test capable of detecting both hypertonic and isotonic dehydration in older people, but further evidence to support its clinical utility is needed. Daily fluid requirements may be less than previously thought in adults, but the evidence specific to older people remains limited. Hydration via the subcutaneous route is safer and easier to initiate than the intravenous route but is limited by infusion speed and volume. Prompting older adults more frequently to drink, offering a wider selection of drinks and using drinking vessels with particular features can result in small increases in oral intake in the short-term. The ongoing clinically-assisted hydration at end of life (CHELsea II) trial will hopefully provide more evidence for the emotive issue of hydration at the end of life.
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Affiliation(s)
- James Frith
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
- Falls and Syncope Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Parkinson E, Hooper L, Fynn J, Wilsher SH, Oladosu T, Poland F, Roberts S, Van Hout E, Bunn D. Low-intake dehydration prevalence in non-hospitalised older adults: Systematic review and meta-analysis. Clin Nutr 2023:S0261-5614(23)00185-1. [PMID: 37330324 DOI: 10.1016/j.clnu.2023.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/11/2023] [Accepted: 06/05/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND & AIMS Low-intake dehydration amongst older people, caused by insufficient fluid intake, is associated with mortality, multiple long-term health conditions and hospitalisation. The prevalence of low-intake dehydration in older adults, and which groups are most at-risk, is unclear. We conducted a high-quality systematic review and meta-analysis, implementing an innovative methodology, to establish the prevalence of low-intake dehydration in older people (PROSPERO registration: CRD42021241252). METHOD We systematically searched Medline (Ovid), Cochrane CENTRAL, Embase (Ovid), CINAHL and Proquest from inception until April 2023 and Nutrition and Food Sciences until March 2021. We included studies that assessed hydration status for non-hospitalised participants aged ≥65 years, by directly-measured serum/plasma osmolality, calculated serum/plasma osmolarity and/or 24-h oral fluid intake. Inclusion, data extraction and risk of bias assessment was carried out independently in duplicate. RESULTS From 11,077 titles and abstracts, we included 61 (22,398 participants), including 44 in quality-effects meta-analysis. Meta-analysis suggested that 24% (95% CI: 0.07, 0.46) of older people were dehydrated (assessed using directly-measured osmolality >300 mOsm/kg, the most reliable measure). Subgroup analyses indicated that both long-term care residents (34%, 95% CI: 0.09, 0.61) and community-dwelling older adults (19%, 95% CI: 0.00, 0.48) were highly likely to be dehydrated. Those with more pre-existing illnesses (37%, 95% CI: 0.14, 0.62) had higher low-intake dehydration prevalence than others (15%, 95% CI: 0.00, 0.43), and there was a non-significant suggestion that those with renal impairment (42%, 95% CI: 0.23, 0.61) were more likely to be dehydrated than others (23%, 95% CI: 0.03, 0.47), but there were no clear differences in prevalence by age, sex, functional, cognitive or diabetic status. GRADE quality of evidence was low as to the exact prevalence due to high levels of heterogeneity between studies. CONCLUSION Quality-effects meta-analysis estimated that a quarter of non-hospitalised older people were dehydrated. Widely varying prevalence rates in individual studies, from both long-term care and community groups, highlight that dehydration is preventable amongst older people. IMPLICATIONS One in every 4 older adults has low-intake dehydration. As dehydration is serious and prevalent, research is needed to better understand drinking behaviour and assess effectiveness of drinking interventions for older people.
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Affiliation(s)
- Ellice Parkinson
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
| | - Judith Fynn
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
| | | | - Titilopemi Oladosu
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
| | - Simone Roberts
- The Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, Hatfield, United Kingdom.
| | - Elien Van Hout
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
| | - Diane Bunn
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, United Kingdom.
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Gray M, Birkenfeld JS, Butterworth I. Noninvasive Monitoring to Detect Dehydration: Are We There Yet? Annu Rev Biomed Eng 2023; 25:23-49. [PMID: 36854261 DOI: 10.1146/annurev-bioeng-062117-121028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
The need for hydration monitoring is significant, especially for the very young and elderly populations who are more vulnerable to becoming dehydrated and suffering from the effects that dehydration brings. This need has been among the drivers of considerable effort in the academic and commercial sectors to provide a means for monitoring hydration status, with a special interest in doing so outside the hospital or clinical setting. This review of emerging technologies provides an overview of many technology approaches that, on a theoretical basis, have sensitivity to water and are feasible as a routine measurement. We review the evidence of technical validation and of their use in humans. Finally, we highlight the essential need for these technologies to be rigorously evaluated for their diagnostic potential, as a necessary step to meet the need for hydration monitoring outside of the clinical environment.
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Affiliation(s)
- Martha Gray
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA;
- MIT linQ, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Judith S Birkenfeld
- MIT linQ, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Instituto de Óptica "Daza de Valdés," Consejo Superior de Investigaciones Científicas, Madrid, Spain;
| | - Ian Butterworth
- MIT linQ, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Leuko Labs Inc., Boston, Massachusetts, USA
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Regolisti G, Rebora P, Occhino G, Lieti G, Molon G, Maloberti A, Algeri M, Giannattasio C, Valsecchi MG, Genovesi S. Elevated Serum Urea-to-Creatinine Ratio and In-Hospital Death in Patients with Hyponatremia Hospitalized for COVID-19. Biomedicines 2023; 11:1555. [PMID: 37371650 DOI: 10.3390/biomedicines11061555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
Hyponatremia is associated with adverse outcomes in hospitalized patients. An elevated value of the serum urea-to-creatinine ratio (UCR) has been proposed as a proxy of hypovolemia. The aim of this study was to investigate the relationship between the UCR and in-hospital death in patients hospitalized with COVID-19 and hyponatremia. We studied 258 patients admitted for COVID-19 between January 2020 and May 2021 with serum sodium at < 135 mmol/L. The primary end-point was all-cause mortality. A 5-unit increase in the serum UCR during hospital stays was associated with an 8% increase in the hazard of all-cause death (HR = 1.08, 95% CI: 1.03-1.14, p = 0.001) after adjusting for potential confounders. In patients with a UCR > 40 at baseline, a > 10 mmol/L increase in serum sodium values within the first week of hospitalization was associated with higher odds of in-hospital death (OR = 2.93, 95% CI: 1.03-8.36, p = 0.044) compared to patients who experienced a < 10 mmol/L change. This was not observed in patients with a UCR < 40. Hypovolemia developing during hospital stays in COVID-19 patients with hyponatremia detected at hospital admission bears an adverse prognostic impact. Moreover, in hypovolemic patients, a > 10 mmol/L increase in serum sodium within the first week of hospital stays may further worsen the in-hospital prognosis.
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Affiliation(s)
- Giuseppe Regolisti
- Clinica e Immunologia Medica, Azienda Ospedaliero-Universitaria di Parma, 43100 Parma, Italy
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Paola Rebora
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Giuseppe Occhino
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Giulia Lieti
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Giulio Molon
- Cardiology Department, Istituto Ricovero Cura Carattere Scientifico (IRCCS) Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy
| | - Alessandro Maloberti
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
- Cardiology 4, Cardio Center, ASST-GOM Niguarda, Niguarda Hospital, 20162 Milan, Italy
| | - Michela Algeri
- Cardiology 4, Cardio Center, ASST-GOM Niguarda, Niguarda Hospital, 20162 Milan, Italy
| | - Cristina Giannattasio
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
- Cardiology 4, Cardio Center, ASST-GOM Niguarda, Niguarda Hospital, 20162 Milan, Italy
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics, Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Simonetta Genovesi
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
- Istituto Auxologico Italiano, Istituto Ricovero Cura Carattere Scientifico (IRCCS), 20135 Milan, Italy
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Sri-On J, Thong-On K, Kredarunsooksree T, Paksopis T, Ruangsiri R. Prevalence and Risk Score for Hypertonic Dehydration among Community-Dwelling Older Adults: An Analysis of the Bangkok Falls Study. Gerontology 2023; 69:953-960. [PMID: 37011597 DOI: 10.1159/000530359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
INTRODUCTION Dehydration is associated with morbidity, and many factors affect dehydration in older adults including age and medication use. This study determined the prevalence of hypertonic dehydration (HD) and factors affecting HD in older adults and developed a risk score (a set of consistent weights that assign a numerical value to each risk factor) which is potentially useful in predicting HD among community-dwelling Thai older adults. METHODS Data were obtained from a cohort study of community-dwelling older adults aged ≥60 years in Bangkok, Thailand, between October 1, 2019, and September 30, 2021. Current HD was defined as a serum osmolality >300 mOsm/kg. Univariate and multivariate logistic regression analyses were used to identify factors associated with current and impending HD. The risk score for current HD was developed based on the final multiple logistic regression model. RESULTS A total of 704 participants were included in the final analysis. In this study, 59 (8.4%) participants had current HD and 152 (21.6%) had impending HD. We identified three risk factors for HD in older adults: age ≥75 years (adjusted odds ratio [aORs] 2.0, 95% confidence interval [CI]: 1.16-3.46), underlying diabetes mellitus (aORs 3.07, 95% CI: 1.77-5.31), and use of β-blocker medication (aORs 1.98, 95% CI: 1.04-3.78). The increasing risks of current HD with increasing risk scores were 7.4% for a score of 1, 13.8% for a score of 2, 19.8% for a score of 3, and 32.8% for a score of 4. CONCLUSION One-third of the older adults in this study had current or impending HD. We identified risk factors for HD and created a risk score for HD in one group of community-dwelling older adults. Older adults with risk scores of 1-4 were at 7.4%-32.8% risk for current HD. The clinical utility of this risk score requires further study and external validation.
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Affiliation(s)
- Jiraporn Sri-On
- Geriatric Emergency Medicine Unit, The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Kwannapa Thong-On
- Geriatric Emergency Medicine Unit, The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | | | - Thitiwan Paksopis
- Geriatric Emergency Medicine Unit, The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Rasida Ruangsiri
- Thai Health Promotion Organization (ThaiHealth), Bangkok, Thailand
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12
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Sabanovic K, Skjøde Damsgaard EM, Gregersen M. Preoperative dehydration identified by serum calculated osmolarity is associated with severe frailty in patients with hip fracture. Clin Nutr ESPEN 2022; 52:94-99. [PMID: 36513491 DOI: 10.1016/j.clnesp.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND & AIMS Preoperative dehydration is a well-known predictor of in-hospital complications and poor functional outcomes in older patients with hip fractures. In an orthopedic and geriatric cooperative setting, we aimed to investigate whether preoperative dehydration was associated with frailty, prolonged hospital stays and short-term mortality in older patients with hip fractures. METHODS This retrospective cohort study was conducted in a Danish university hospital. The study population consisted of patients 65+ years surgically treated for hip fracture. Dehydration was defined as serum calculated osmolarity above 295 mmol/L. Outcomes were frailty at discharge measured by the Multidimensional Prognostic Index, hospital stay of 7 days or more and 90-day mortality. RESULTS In total, 214 patients were consecutively included in the study from March 11, 2018, to August 31, 2020. The mean age was 81.2 (SD: 7.6) and 69% of the patients were women. The prevalence of preoperative dehydration was 40%. It was associated with severe frailty (Odds Ratio (OR): 2.08 [95% confidence interval (CI): 1.11-3.90]; p = 0.02) and prolonged hospital stay (OR: 2.28 [95% CI: 1.29-4.04]; p = 0.02). Seven percent died when dehydrated compared to 5% in the non-dehydrated (p = 0.91). CONCLUSION Prevalence of preoperative dehydration is high among older patients with hip fractures and is associated with severe frailty and length of hospital stay. Systematic screening for dehydration on admission is advisable and may contribute to more adequate fluid management in the perioperative phase.
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Affiliation(s)
- Kenan Sabanovic
- Department of Geriatrics, Aarhus University Hospital, Denmark.
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13
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Atjo NM, Soraya GV, Natzir R, Kasyim H, Rasyid H, Chana G, Erlichster M, Skafidas E, Hardjo M. Point-of-Care Saliva Osmolarity Testing for the Screening of Hydration in Older Adults With Hypertension. J Am Med Dir Assoc 2022; 23:1984.e9-1984.e14. [PMID: 36174654 DOI: 10.1016/j.jamda.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 08/14/2022] [Accepted: 08/25/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Older adults have an elevated risk of dehydration, a state with proven detrimental cognitive and physical effects. Furthermore, the use of diuretics by hypertensive patients further compounds this risk. This prospective study investigated the diagnostic accuracy of point-of-care (POC) salivary osmolarity (SOSM) measurement for the detection of dehydration in hypertensive adults with and without diuretic pharmacotherapy. DESIGN Prospective diagnostic accuracy study. SETTING Home visits to patients recruited from 4 community health centers in West Sulawesi, Indonesia. PARTICIPANTS A total of 148 hypertensive older adults (57 men, 91 women). The mean ages of male and female patients were 69.4 ± 11.4 and 68.1 ± 7.8 years, respectively. METHODS Hypertensive adults were divided into 2 groups based on the presence of diuretics in their pharmacotherapeutic regimen. First-morning mid-stream urine samples were used to perform urine specific gravity (USG) testing. Same-day SOSM measurements were obtained using a POC saliva testing system. RESULTS Both USG (P = .0002) and SOSM (P < .0001) were significantly elevated in hypertensive patients with diuretic pharmacotherapy. At a USG threshold of ≥1.030, 86% of diuretic users were classified as dehydrated compared with 55% of non-using participants. A strong correlation was observed between USG and SOSM measurements (r = 0.78, P < .0001). Using a USG threshold of ≥1.030 as a hydration classifier, an SOSM threshold of ≥93 mOsm had a sensitivity of 78.6% and a specificity of 91.1% for detecting dehydration. CONCLUSIONS AND IMPLICATIONS Hypertensive patients on diuretics have significantly higher first-morning USG and SOSM values, indicating a higher likelihood of dehydration relative to those on other classes of antihypertensive medication. POC SOSM assessment correlates strongly with first-morning USG assessment, and represents a rapid and noninvasive alternative to urinary hydration assessment that may be applicable for routine use in populations with elevated risk of dehydration.
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Affiliation(s)
- Neng Mira Atjo
- Department of Biomedicine, Graduate School Hasanuddin University, Makassar, Indonesia; Department of Nursing, Faculty of Health Sciences, University of West Sulawesi, Majene, Indonesia
| | - Gita Vita Soraya
- Department of Biomedicine, Graduate School Hasanuddin University, Makassar, Indonesia; Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Rosdiana Natzir
- Department of Biomedicine, Graduate School Hasanuddin University, Makassar, Indonesia; Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Hasyim Kasyim
- Division of Renal Diseases and Hypertension, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Haerani Rasyid
- Division of Renal Diseases and Hypertension, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Department of Clinical Nutrition, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Gursharan Chana
- MX3 Diagnostics Inc., VIC, Australia; Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, VIC, Australia
| | | | - Efstratios Skafidas
- MX3 Diagnostics Inc., VIC, Australia; Department of Electrical and Electronic Engineering, Melbourne School of Engineering, The University of Melbourne, VIC, Australia
| | - Marhaen Hardjo
- Department of Biomedicine, Graduate School Hasanuddin University, Makassar, Indonesia
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14
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Gerlier C, Forster M, Fels A, Zins M, Chatellier G, Ganansia O. Head computed tomography for elderly patients with acute altered mental status in the emergency setting: value for decision-making and predictors of abnormal findings. Clin Exp Emerg Med 2022; 9:333-344. [PMID: 36447401 PMCID: PMC9834826 DOI: 10.15441/ceem.22.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/03/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE This study evaluated the impact of head computed tomography (CT) on clinical decision-making about older adults with acute altered mental status (AMS) in the emergency department in terms of CT's diagnostic yield, emergency department length of stay, and changes in medical strategy. It also attempted to find predictors of an acute imaging abnormality. METHODS This was a 1-year, retrospective, single-center observational study of patients aged ≥75 years who underwent noncontrast head CT because of an isolated episode of AMS. The acute positive CT findings were ischemic strokes, hemorrhages, tumors, demyelinating lesions, hydrocephalus, and intracranial infections. RESULTS A total of 594 CTs were performed, of which 38 (6.4%) were positive. The main etiology of AMS was sepsis (29.1%). Changes in medical strategy were more common in patients with a positive CT, and the major changes were ordering additional neuro exams (odds ratio [OR], 95.3; 95% confidence interval [CI], 38.4-233.8; P<0.001), adjusting treatments (OR, 12.2; 95% CI, 5.0-29.5; P<0.001), and referral to a neurologic unit (OR, 7.3; 95% CI, 3.0-17.5; P<0.01). Three factors were significantly associated with a positive outcome: Glasgow Coma Scale <13 (OR, 8.5; 95% CI, 2.3-28.9; P<0.001), head wound (OR, 3.1; 95% CI, 1.1-8.2; P=0.025), and dehydration (OR, 0.3; 95% CI, 0.1-0.4; P=0.021). For elderly patients with a Glasgow Coma Scale ≥13 and no head wound or clinical dehydration, the probability of a positive CT was 0.02 (95% CI, 0.01-0.04). Considering only those patients, the diagnostic yield fell to 1.7%. CONCLUSION In elderly patients, the causes of AMS are primarily extracerebral. Randomized clinical trials are needed to validate a clinical pathway for selecting patients who require emergent neuroimaging.
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Affiliation(s)
- Camille Gerlier
- Department of Emergency, Hospital Paris Saint-Joseph, Paris, France,Correspondence to: Camille Gerlier Department of Emergency, Hospital Paris Saint-Joseph, 185 Rue Raymond Losserand, Paris 75014, France E-mail:
| | - Mélanie Forster
- Department of Emergency, Hospital Paris Saint-Joseph, Paris, France
| | - Audrey Fels
- Department of Clinical Research, Hospital Paris Saint-Joseph, Paris, France
| | - Marc Zins
- Department of Radiology, Hospital Paris Saint-Joseph, Paris, France
| | - Gilles Chatellier
- Department of Clinical Research, Hospital Paris Saint-Joseph, Paris, France,Department of INSERM CIC 14-18, European Hospital Georges Pompidou, Paris, France
| | - Olivier Ganansia
- Department of Emergency, Hospital Paris Saint-Joseph, Paris, France
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15
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Rosi IM, Milos R, Cortinovis I, Laquintana D, Bonetti L. Sensitivity and specificity of the new Geriatric Dehydration Screening Tool: an observational diagnostic study. Nutrition 2022; 101:111695. [DOI: 10.1016/j.nut.2022.111695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/10/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
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16
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Liaqat S, Dashtipour K, Rizwan A, Usman M, Shah SA, Arshad K, Assaleh K, Ramzan N. Personalized wearable electrodermal sensing-based human skin hydration level detection for sports, health and wellbeing. Sci Rep 2022; 12:3715. [PMID: 35260675 PMCID: PMC8904452 DOI: 10.1038/s41598-022-07754-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/15/2022] [Indexed: 12/24/2022] Open
Abstract
Personalized hydration level monitoring play vital role in sports, health, wellbeing and safety of a person while performing particular set of activities. Clinical staff must be mindful of numerous physiological symptoms that identify the optimum hydration specific to the person, event and environment. Hence, it becomes extremely critical to monitor the hydration levels in a human body to avoid potential complications and fatalities. Hydration tracking solutions available in the literature are either inefficient and invasive or require clinical trials. An efficient hydration monitoring system is very required, which can regularly track the hydration level, non-invasively. To this aim, this paper proposes a machine learning (ML) and deep learning (DL) enabled hydration tracking system, which can accurately estimate the hydration level in human skin using galvanic skin response (GSR) of human body. For this study, data is collected, in three different hydration states, namely hydrated, mild dehydration (8 hours of dehydration) and extreme mild dehydration (16 hours of dehydration), and three different body postures, such as sitting, standing and walking. Eight different ML algorithms and four different DL algorithms are trained on the collected GSR data. Their accuracies are compared and a hybrid (ML+DL) model is proposed to increase the estimation accuracy. It can be reported that hybrid Bi-LSTM algorithm can achieve an accuracy of 97.83%.
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Affiliation(s)
- Sidrah Liaqat
- School of Engineering and Computing, University of the West of Scotland, Paisely, PA1 2BE, UK.
| | - Kia Dashtipour
- School of Computing, Edinburgh Napier University, Edinburgh, EH10 5DT, Scotland, UK
| | - Ali Rizwan
- Qatar Mobility Innovations Center, Qatar, Qatar Science & Technology Park, Doha, Qatar
| | - Muhammad Usman
- James Watt School of Engineering, University of Glasgow, Glasgow, UK
| | - Syed Aziz Shah
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, UK
| | - Kamran Arshad
- Artificial Intelligence Research Centre College of Engineering and Information Technology, Ajman University, Ajman, UAE
| | - Khaled Assaleh
- Artificial Intelligence Research Centre College of Engineering and Information Technology, Ajman University, Ajman, UAE
| | - Naeem Ramzan
- School of Engineering and Computing, University of the West of Scotland, Paisely, PA1 2BE, UK
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17
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ESPEN practical guideline: Clinical nutrition and hydration in geriatrics. Clin Nutr 2022; 41:958-989. [DOI: 10.1016/j.clnu.2022.01.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/15/2022]
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18
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Michelsen CF, Svendsen MBS, Bagger ML, Konradsen H. A study on accuracy and precision of fluid volume measurements by nurses, patients and healthy persons in a clinical setting. Nurs Open 2022; 9:1303-1310. [PMID: 34985207 PMCID: PMC8859054 DOI: 10.1002/nop2.1173] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 10/13/2021] [Accepted: 12/15/2021] [Indexed: 11/08/2022] Open
Abstract
AIM To evaluate the accuracy and precision for assessing fluid intake by examining the ability of nurses, patients and healthy people to visually estimate fluid volumes, thereby reflecting the fluid monitoring process in clinical practice. DESIGN A cross-sectional study. METHODS This study used the convenience sampling method and involved twenty-five participants from three groups; nurses, patients and healthy people. The participants carried out a set of different visual volume assessments of two types of fluids using two fluid containers. The exact volumes were measured, and the results were compared with the target volumes. RESULTS High variations were observed in the fluid volume assessments for patients, nurses and healthy persons and also were observed to be an effect of environmental factors (fluid container or fluid type) on volume perceptions. This highlights the importance of finding new and innovative ways of measuring fluids for oral intake in a hospital setting, to ensure accurate and reliable data on fluid balance and thereby increase patient safety.
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Affiliation(s)
| | | | | | - Hanne Konradsen
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Gastroenterology, Herlev and Gentofte University Hospital, Hellerup, Denmark
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19
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Lehmann F, Schenk LM, Bernstock JD, Bode C, Borger V, Gessler F, Güresir E, Hamed M, Potthoff AL, Putensen C, Schneider M, Zimmermann J, Vatter H, Schuss P, Hadjiathanasiou A. Admission Dehydration Status Portends Adverse Short-Term Mortality in Patients with Spontaneous Intracerebral Hemorrhage. J Clin Med 2021; 10:jcm10245939. [PMID: 34945232 PMCID: PMC8708142 DOI: 10.3390/jcm10245939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 01/25/2023] Open
Abstract
The impact of dehydration at admission of patients with spontaneous intracerebral hemorrhage (ICH) on short-term mortality remains ambiguous due to scarce data. All of the consecutive patients with spontaneous ICH, who were referred to our neurovascular center in 2018/19, were assessed for hydration status on admission. Dehydration was defined by a blood urea-to-creatinine ratio > 80. In a cohort of 249 patients, 76 patients (31%) were dehydrated at the time of admission. The following factors were significantly and independently associated with increased 30-day mortality in multivariate analysis: “signs of cerebral herniation” (p = 0.008), “initial midline shift > 5 mm” (p < 0.001), “ICH score > 3” (p = 0.007), and “admission dehydration status” (p = 0.007). The results of the present study suggest that an admission dehydration status might constitute a significant and independent predictor of short-term mortality in patients with spontaneous ICH.
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Affiliation(s)
- Felix Lehmann
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, 53127 Bonn, Germany; (C.B.); (C.P.)
- Correspondence: ; Tel.: +49-228-287-14119
| | - Lorena M. Schenk
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Joshua D. Bernstock
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Christian Bode
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, 53127 Bonn, Germany; (C.B.); (C.P.)
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Florian Gessler
- Department of Neurosurgery, University Hospital Rostock, 18055 Rostock, Germany;
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Anna-Laura Potthoff
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care, University Hospital Bonn, 53127 Bonn, Germany; (C.B.); (C.P.)
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Julian Zimmermann
- Department of Neurology, University Hospital Bonn, 53127 Bonn, Germany;
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Patrick Schuss
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
| | - Alexis Hadjiathanasiou
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (L.M.S.); (V.B.); (E.G.); (M.H.); (A.-L.P.); (M.S.); (H.V.); (P.S.); (A.H.)
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20
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Mukherjee U, Napier C, Oldewage-Theron W. ‘Drink clean, safe water and/or other fluids through-out the day even if you do not feel thirsty’: a food-based dietary guideline for the elderly in South Africa. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2021. [DOI: 10.1080/16070658.2021.1947037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Upasana Mukherjee
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas, USA
| | - Carin Napier
- Department of Food & Nutrition Consumer Sciences, Durban University of Technology, Durban, South Africa
- Centre for Longitudinal Research, The University of Auckland, Auckland, New Zealand
| | - Wilna Oldewage-Theron
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas, USA
- Department of Sustainable Food Systems and Development, University of the Free State, Bloemfontein, South Africa
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21
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Sanson G, Marzinotto I, De Matteis D, Boscutti G, Barazzoni R, Zanetti M. Impaired hydration status in acutely admitted older patients: prevalence and impact on mortality. Age Ageing 2021; 50:1151-1158. [PMID: 33320928 DOI: 10.1093/ageing/afaa264] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND impaired hydration is common in the older people, however studies of its effects on outcome in the acute setting are limited. OBJECTIVES to assess (i) the prevalence of impaired hydration, (ii) its relationship with laboratory markers of altered hydration and with (iii) short- and long-term mortality. DESIGN retrospective cohort study. SETTING University Hospital-Internal Medicine Department. SUBJECTS a total of 5,113 older patients consecutively acutely admitted from October 2015 to July 2016. METHODS according to calculated serum osmolarity at admission hydration status was stratified in: low osmolarity (<275 mmol/L), euhydration (275-295 mmol/L), impending (296-300 mmol/L) and current dehydration (>300 mmol/L). Relationships with serum sodium, potassium, glucose, urea, estimated glomerular filtration rate (eGFR), haematocrit, urea/creatinine ratio (Urea/Cr) and urine specific gravity (USG) were determined. Charlson Comorbidity Index, Modified Early Warning Score, Glasgow Prognostic Score, Norton score and Nutritional Risk Screening-2002 were calculated. RESULTS current and impending dehydration, euhydration and low-osmolarity were detected in 51.7, 17.1, 28.5 and 2.7% of the patients, respectively. Osmolarity correlated with urea (r = 0.846). Associations with serum sodium, creatinine, eGFR and urea/Cr were low but significant, being negligible that with USG and haematocrit. Serum sodium and urea increased in the transition from low- to high-osmolarity (P < 0.001 in all pairwise comparisons). In multivariate modelling current dehydration, functional dependence, clinical instability and high nutritional risk were associated (P < 0.001) with reduced short- and long-term survival. CONCLUSIONS impaired hydration is common in older people acutely admitted to medical care and is associated with poor outcome. Early assessment of calculated serum osmolarity is mandatory to target dehydration and hypoosmolar disorders.
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Affiliation(s)
- Gianfranco Sanson
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, 34149 Italy
| | - Ilaria Marzinotto
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, 34149 Italy
| | | | - Giuliano Boscutti
- Nephrology and Dialysis Department, University Hospital, Udine, 33100 Italy
| | - Rocco Barazzoni
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, 34149 Italy
| | - Michela Zanetti
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, 34149 Italy
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22
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A Portable Biodevice to Monitor Salivary Conductivity for the Rapid Assessment of Fluid Status. J Pers Med 2021; 11:jpm11060577. [PMID: 34205354 PMCID: PMC8235451 DOI: 10.3390/jpm11060577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/12/2021] [Accepted: 06/17/2021] [Indexed: 01/29/2023] Open
Abstract
The evaluation of fluid status can save adults from life-threatening conditions, but the current methods are invasive or time-consuming. Therefore, we developed a portable device for measuring salivary conductivity. This prospective observational study enrolled 20 volunteers with no history of systemic diseases. Participants were observed for 13 h, including water restriction for 12 h followed by rehydration with 1000 mL water within 1 h. Serum and urine biomarkers for fluid status, thirst scales, and salivary conductivity were collected during dehydration and rehydration. No significant differences in age, body mass index, glycohemoglobin, and estimated glomerular filtration rate were noted between sexes. Salivary conductivity increased after water restriction and decreased after rehydration. Similarly, urine osmolality, urine specific gravity, thirst intensity scales, and body weight followed the same trend and were statistically significant. The angiotensin-converting enzyme and aldosterone levels showed the same trend, without reaching statistical significance. The red blood cell count and hemoglobin concentration also followed the same trend. Analyzing the receiver operating characteristic curves, the area under the curve was 0.707 (95% confidence interval 0.542–0.873, p = 0.025). Using the Youden index, the optimal cutoff determined as 2678.09 μs/cm (sensitivity: 90%, specificity: 55%). This biodevice effectively screened dehydration among healthy adults.
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23
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Cohen R, Fernie G, Roshan Fekr A. Fluid Intake Monitoring Systems for the Elderly: A Review of the Literature. Nutrients 2021; 13:nu13062092. [PMID: 34205234 PMCID: PMC8233832 DOI: 10.3390/nu13062092] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/13/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022] Open
Abstract
Fluid intake monitoring is an essential component in preventing dehydration and overhydration, especially for the senior population. Numerous critical health problems are associated with poor or excessive drinking such as swelling of the brain and heart failure. Real-time systems for monitoring fluid intake will not only measure the exact amount consumed by the users, but could also motivate people to maintain a healthy lifestyle by providing feedback to encourage them to hydrate regularly throughout the day. This paper reviews the most recent solutions to automatic fluid intake monitoring both commercially and in the literature. The available technologies are divided into four categories: wearables, surfaces with embedded sensors, vision- and environmental-based solutions, and smart containers. A detailed performance evaluation was carried out considering detection accuracy, usability and availability. It was observed that the most promising results came from studies that used data fusion from multiple technologies, compared to using an individual technology. The areas that need further research and the challenges for each category are discussed in detail.
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Affiliation(s)
- Rachel Cohen
- The Kite Research Institute, Toronto Rehabilitation Institute—University Health Network, Toronto, ON M5G2A2, Canada; (G.F.); (A.R.F.)
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S3G9, Canada
- Correspondence:
| | - Geoff Fernie
- The Kite Research Institute, Toronto Rehabilitation Institute—University Health Network, Toronto, ON M5G2A2, Canada; (G.F.); (A.R.F.)
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S3G9, Canada
| | - Atena Roshan Fekr
- The Kite Research Institute, Toronto Rehabilitation Institute—University Health Network, Toronto, ON M5G2A2, Canada; (G.F.); (A.R.F.)
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S3G9, Canada
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24
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Faidah N, Soraya GV, Erlichster M, Natzir R, Chana G, Skafidas E, Hardjo M, Ganda IJ, Bahar B. Detection of voluntary dehydration in paediatric populations using non-invasive point-of-care saliva and urine testing. J Paediatr Child Health 2021; 57:813-818. [PMID: 33373495 DOI: 10.1111/jpc.15325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/29/2020] [Accepted: 12/12/2020] [Indexed: 11/29/2022]
Abstract
AIM Voluntary dehydration, or lack of fluid intake despite water availability, is common in otherwise healthy children, and can lead to adverse effects. Most dehydration biomarkers are impractical for routine assessment in paediatric populations. This study aimed to assess two non-invasive hydration assessment tools, urine specific gravity (USG ) and a novel point-of-care (POC) salivary osmolarity (SOSM) sensor, in healthy children. METHODS Volunteers were tested by colorimetric USG and a handheld SOSM system. Observed values were compared against previous studies to determine hydration status, as was the concordance between parameters. RESULTS At the common USG threshold of 1.020, 42.4% of the 139 healthy children were dehydrated. The same prevalence was found using the 70-mOSM cut-off value. Comparative analysis of SOSM at varying USG thresholds demonstrated significantly higher SOSM in dehydrated children with a USG ≥ 1.030 (P = 0.002). CONCLUSION At the USG threshold of 1.020 and SOSM threshold of 70 mOSM, 42.4% of healthy children were found to be voluntarily dehydrated. Significantly higher SOSM was observed in dehydrated children (USG ≥ 1.030). As the first study on the utility of POC SOSM measurements for detecting dehydration, these results provide a foundation for future POC characterisation of SOSM in other populations and clinical contexts.
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Affiliation(s)
- Nur Faidah
- Faculty of Medicine and Health Sciences, Muhammadiyah University, Makassar, Indonesia.,Department of Biomedicine, Graduate School Hasanuddin University, Makassar, Indonesia
| | - Gita V Soraya
- Department of Biomedicine, Graduate School Hasanuddin University, Makassar, Indonesia.,Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | | | - Rosdiana Natzir
- Department of Biomedicine, Graduate School Hasanuddin University, Makassar, Indonesia.,Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Gursharan Chana
- MX3 Diagnostics Inc., Melbourne, Victoria, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Efstratios Skafidas
- MX3 Diagnostics Inc., Melbourne, Victoria, Australia.,Department of Electrical and Electronic Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marhaen Hardjo
- Department of Biomedicine, Graduate School Hasanuddin University, Makassar, Indonesia.,Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Idham J Ganda
- Department of Paediatrics, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Burhanuddin Bahar
- Department of Nutrition, Faculty of Public Health, Hasanuddin University, Makassar, Indonesia
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Bennet D, Khorsandian Y, Pelusi J, Mirabella A, Pirrotte P, Zenhausern F. Molecular and physical technologies for monitoring fluid and electrolyte imbalance: A focus on cancer population. Clin Transl Med 2021; 11:e461. [PMID: 34185420 PMCID: PMC8214861 DOI: 10.1002/ctm2.461] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/11/2021] [Accepted: 05/29/2021] [Indexed: 12/23/2022] Open
Abstract
Several clinical examinations have shown the essential impact of monitoring (de)hydration (fluid and electrolyte imbalance) in cancer patients. There are multiple risk factors associated with (de)hydration, including aging, excessive or lack of fluid consumption in sports, alcohol consumption, hot weather, diabetes insipidus, vomiting, diarrhea, cancer, radiation, chemotherapy, and use of diuretics. Fluid and electrolyte imbalance mainly involves alterations in the levels of sodium, potassium, calcium, and magnesium in extracellular fluids. Hyponatremia is a common condition among individuals with cancer (62% of cases), along with hypokalemia (40%), hypophosphatemia (32%), hypomagnesemia (17%), hypocalcemia (12%), and hypernatremia (1-5%). Lack of hydration and monitoring of hydration status can lead to severe complications, such as nausea/vomiting, diarrhea, fatigue, seizures, cell swelling or shrinking, kidney failure, shock, coma, and even death. This article aims to review the current (de)hydration (fluid and electrolyte imbalance) monitoring technologies focusing on cancer. First, we discuss the physiological and pathophysiological implications of fluid and electrolyte imbalance in cancer patients. Second, we explore the different molecular and physical monitoring methods used to measure fluid and electrolyte imbalance and the measurement challenges in diverse populations. Hydration status is assessed in various indices; plasma, sweat, tear, saliva, urine, body mass, interstitial fluid, and skin-integration techniques have been extensively investigated. No unified (de)hydration (fluid and electrolyte imbalance) monitoring technology exists for different populations (including sports, elderly, children, and cancer). Establishing novel methods and technologies to facilitate and unify measurements of hydration status represents an excellent opportunity to develop impactful new approaches for patient care.
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Affiliation(s)
- Devasier Bennet
- Center for Applied NanoBioscience and MedicineThe University of ArizonaCollege of MedicinePhoenixUSA
| | - Yasaman Khorsandian
- Center for Applied NanoBioscience and MedicineThe University of ArizonaCollege of MedicinePhoenixUSA
| | | | | | - Patrick Pirrotte
- Collaborative Center for Translational Mass SpectrometryTranslational Genomics Research InstitutePhoenixUSA
| | - Frederic Zenhausern
- Center for Applied NanoBioscience and MedicineThe University of ArizonaCollege of MedicinePhoenixUSA
- HonorHealth Research InstituteScottsdaleUSA
- Collaborative Center for Translational Mass SpectrometryTranslational Genomics Research InstitutePhoenixUSA
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Buaprasert P, Piyapaisarn S, Vanichkulbodee A, Kamsom A, Sri-On J. Prevalence and risk factors of hypertonic dehydration among older patients admitted to the emergency department: A prospective cross-sectional study. Geriatr Gerontol Int 2021; 21:485-491. [PMID: 33847031 DOI: 10.1111/ggi.14168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/23/2021] [Accepted: 03/28/2021] [Indexed: 11/28/2022]
Abstract
AIM The prevalence of hypertonic dehydration (HD) among community-dwelling and hospitalized populations has been evaluated. However, to our knowledge, no study had previously focused on older patients admitted to the emergency department (ED). The present study aimed to evaluate the prevalence, risk factors and short-term outcomes of HD among Thai older patients admitted to the ED. METHODS This was a prospective cross-sectional study at one urban ED in Thailand. Patients aged ≥65 years who were admitted to the ED were enrolled into the study. Data including clinical hydration status, Charlson Comorbidity Index (CCI) score, activities of daily living score, current use of medications, laboratory examination results and serum osmolarity level were collected. HD was defined as a serum osmolarity level of >300 mOsm/kg. The short-term outcomes were a 30-day ED revisit, hospital readmission and mortality rates. RESULTS In total, 80 (21.6%) of 370 patients presented with HD. A CCI score of ≥5 was found associated with HD among older patients (adjusted odds ratio: 1.82; 95% confidence interval: 1.03-3.21). The ED revisit rates were 18.1% in the dehydrated group and 10.9% in the non-dehydrated group. The hospital readmission rates were 8.3% in the dehydrated group and 10.6% in the non-dehydrated group. Furthermore, the 30-day mortality rates were 6.9% and 5.3% in the dehydrated and non-dehydrated groups, respectively. CONCLUSIONS One-fifth of older patients admitted to the ED presented with HD. A CCI score of ≥5 was considered a risk factor of HD. Moreover, further studies should focus on the long-term outcomes of HD and risk reduction. Geriatr Gerontol Int 2021; 21: 485-491.
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Affiliation(s)
- Phudit Buaprasert
- The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sawangwarach Piyapaisarn
- Department of Emergency Medicine, Srinagarind Hospital, Khon Kaen University, Khonkaen, Thailand
| | - Alissara Vanichkulbodee
- The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Anucha Kamsom
- The Department of Biostatistic, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Jiraporn Sri-On
- The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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27
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Making the choice between bioelectrical impedance measures for body hydration status assessment. Sci Rep 2021; 11:7685. [PMID: 33833322 PMCID: PMC8032770 DOI: 10.1038/s41598-021-87253-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 03/25/2021] [Indexed: 02/07/2023] Open
Abstract
Situational or persistent body fluid deficit (i.e., de- or hypo-hydration) is considered a significant health risk factor. Bioimpedance analysis (BIA) has been suggested as an alternative to less reliable subjective and biochemical indicators of hydration status. The present study aimed to compare various BIA models in the prediction of direct measures of body compartments associated with hydration/osmolality. Fish (n = 20) was selected as a biological model for physicochemically measuring proximate body compartments associated with hydration such as water, dissolved proteins, and non-osseous minerals as the references or criterion points. Whole-body and segmental/local impedance measures were used to investigate a pool of BIA models, which were compared by Akaike Information Criterion in their ability to accurately predict the body components. Statistical models showed that ‘volumetric-based’ BIA measures obtained in parallel, such as distance2/Rp, could be the best approach in predicting percent of body moisture, proteins, and minerals in the whole-body schema. However, serially-obtained BIA measures, such as the ratio of the reactance to resistance and the resistance adjusted for distance between electrodes, were the best fitting in predicting the compartments in the segmental schema. Validity of these results should be confirmed on humans before implementation in practice.
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28
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Munk T, Bech CB, Klausen TW, Rønholt F, Suetta C, Knudsen AW. Accuracy of the calculated serum osmolarity to screen for hyperosmolar dehydration in older hospitalised medical patients. Clin Nutr ESPEN 2021; 43:415-419. [PMID: 34024549 DOI: 10.1016/j.clnesp.2021.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/04/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Simple hyperosmolar dehydration, also termed water-loss dehydration (HD), is common in older hospitalised patients, thus increasing the risk of morbidity and mortality. Directly measured serum osmolality is the reference standard to determine HD; however, it is not a routine test due to its complexity and cost. Thus, a simple valid objective diagnostic tool to detect HD is needed. Consequently, we aimed to validate the agreement between measured s-osmolality (mOsm/kg) and calculated s-osmolarity (mOsm/L). METHODS Patients aged >65 were included from the emergency medical department at Herlev Hospital, Copenhagen, Denmark. Exclusion criteria were: eGFR< 30 mmol/L, severe heart failure, decompensated cirrhosis, alcohol intake or initiated rehydration treatment. We obtained data for measured s-osmolality as well as calculated osmolarity, using the by ESPEN recommended equation [1.86x (Na+ + K+)+1.15 ∗glucose + urea+14]. To determine accuracy, we used cut-off values of >295 mOsm/L versus >300 mOsm/kg. RESULTS A total of 90 patients (female 53%), age median 78 yrs (72-86 yrs) were included. According to the measured mOsm/kg, impending HD was evident in 32% (n = 10), of these 11% (n = 10) had current HD. There was a significant association between calculated mOsm/L and measured Osm/kg (r2 = 0.7513, p < 0.0001). A sensitivity of 90% (95% CL: 56%-100%), a specificity of 68% (95% CL: 56%-78%), Positive predictive value (PPV) of 26% (95% CL: 12%-43%), and Negative predictive value (NPV) of 98% (95% CL: 90%-100%) were observed. Notably, only 20% (n = 2) of the patients who were dehydrated according to the measured Osm/kg were correctly clinically diagnosed with dehydration. CONCLUSIONS The equation recommended by ESPEN to calculate osmolarity was found to be an accurate objective diagnostic tool to assess HD in older hospitalised medical patients. The method is markedly superior to the current clinical practice.
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Affiliation(s)
- Tina Munk
- Dietetic and Nutritional Research Unit (EFFECT), Herlev Gentofte University Hospital, Herlev, Denmark.
| | - Camilla Balle Bech
- Dietetic and Nutritional Research Unit (EFFECT), Herlev Gentofte University Hospital, Herlev, Denmark
| | | | - Finn Rønholt
- Geriatric Research Unit, Medical Department, Herlev Gentofte University Hospital, Denmark
| | - Charlotte Suetta
- Geriatric Research Unit, Medical Department, Herlev Gentofte University Hospital, Denmark; Geriatric Research Unit, Geriatric and Palliative Department, Bispebjerg and Frederiksberg Hospitals, Denmark; Copenhagen Centre for Clinical Age Research, University of Copenhagen, Denmark
| | - Anne Wilkens Knudsen
- Dietetic and Nutritional Research Unit (EFFECT), Herlev Gentofte University Hospital, Herlev, Denmark
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James S, Tyrrell-Price J, Atkinson C, Hunt L, Searle A, Phillips K, Penfold C, Carter J, Ness A. Evaluation of urinary chloride dipsticks for the rapid estimation of hydration status in patients receiving artificial nutrition: Feasibility study. Clin Nutr ESPEN 2021; 42:339-347. [PMID: 33745603 DOI: 10.1016/j.clnesp.2021.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS The home parenteral nutrition (HPN) population face many challenges, especially with respect to fluid balance management. A low urinary sodium concentration of <20 mmol/L is commonly used as an indicator of dehydration that requires clinical assessment in these patients. The Quantab titrator dipstick measures chloride concentration of a solution and correlates with sodium concentration. We assessed whether it would be feasible to use the Quantab dipstick in the HPN population and explored relationships between Quantab dipstick estimated chloride concentration and quality of life (QOL). METHODS Patients on HPN were asked to collect urine samples at 5 specific times points (day 0,7,14, 21 and 28) to send to the laboratory for formal electrolyte analysis. The participant and a member of laboratory staff tested these samples with the Quantab dipstick to estimate urinary chloride concentration. Participants were instructed to complete a QOL questionnaire at each of the 5 time-points in addition to a baseline demographic questionnaire and an end-of-study questionnaire. Six participants completed an interview at the end of the study period. The relationship between participant-derived and laboratory-derived data was assessed using rank correlation coefficients. QOL assessment was correlated with urine dipstick measurements. RESULTS 10 patients on HPN completed the study. Data on chloride concentration as estimated by the dipstick (assessed by participants and by the laboratory) and sodium concentration from the laboratory were available for 47 urine samples. There was a positive relationship between participant dipstick estimated chloride concentration and laboratory sodium (Kendall's τ = 0.45; P < 0.001; Spearman's rs = 0.58 P < 0.001; 47 pairs). There was a strong correlation between chloride concentrations estimated by dipstick in the laboratory and by participants (Kendall 0.58 p < 0.001, Spearman's 0.69 p < 0.001; 47 pairs). In exploratory analyses, there was no relationship between QOL and dipstick estimated chloride concentration. Participants had no issues collecting urine samples but some difficulties were reported with determining the dipstick reading. CONCLUSIONS Patients on HPN are able to collect urine specimens, complete QOL questionnaires, and are capable of using the Quantab dipstick to estimate urinary chloride concentration. The Quantab dipstick correlates with laboratory measured sodium and chloride concentrations. Further work is required to fully establish whether this point-of-care test could be used to guide fluid balance management in the HPN population.
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Affiliation(s)
- S James
- Department of Gastroenterology and Nutrition, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
| | - J Tyrrell-Price
- Department of Gastroenterology and Nutrition, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - C Atkinson
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - L Hunt
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - A Searle
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - K Phillips
- Department of Biochemistry, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - C Penfold
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - J Carter
- Department of Gastroenterology and Nutrition, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - A Ness
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
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Belasco R, Edwards T, Munoz AJ, Rayo V, Buono MJ. The Effect of Hydration on Urine Color Objectively Evaluated in CIE L *a *b * Color Space. Front Nutr 2020; 7:576974. [PMID: 33195369 PMCID: PMC7649145 DOI: 10.3389/fnut.2020.576974] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/15/2020] [Indexed: 11/26/2022] Open
Abstract
Urine color has been shown to be a viable marker of hydration status in healthy adults. Traditionally, urine color has been measured using a subjective color scale. In recent years, tristimulus colorimetry developed by the International Commission on Illumination (CIE L*a*b*) has been widely adopted as the reference method for color analysis. In the L*a*b* color space, L* indicates lightness ranging from 100 (white) to 0 (black), while a* and b* indicate chromaticity. a* and b* are color directions: –a* is the green axis, +a* is the red axis, –b* is the blue axis, and +b* is the yellow axis. The L*a*b* color space model is only accurately represented in three-dimensional space. Considering the above, the purpose of the current study was to evaluate urine color during different hydration states, with the results expressed in CIE L*a*b* color space. The study included 28 healthy participants (22 males and 6 females) ranging between the age of 20 and 67 years (28.6 ± 11.3 years). One hundred and fifty-one urine samples were collected from the subjects in various stages of hydration, including morning samples after 7–15 h of water deprivation. Osmolality and CIE L*a*b* parameters were measured in each sample. As the urine osmolality increased, a significant linear increase in b* values was observed as the samples became more pronouncedly yellow (τb = 0.708). An increase in dehydration resulted in darker and significantly more yellow urine, as L* values decreased in lightness and b* values increased along the blue–yellow axis. However, as dehydration increased, a notable polynomial trend in color along the green–red axis was observed as a* values initially decreased, indicating a green hue in slightly dehydrated urine, and then increased as urine became more concentrated and thus more dehydrated. It was determined that 74% of the variance seen in urine osmolality was due to CIE L*a*b* variables. This newfound knowledge about urine color change along with the presented regression model for predicting urine osmolality provides a more detailed and objective perspective on the effect of hydration on urine color, which to our knowledge has not been previously researched.
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Affiliation(s)
- Rebekah Belasco
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, United States
| | - Tory Edwards
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, United States
| | - A J Munoz
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, United States
| | - Vernon Rayo
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, United States
| | - Michael J Buono
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, United States
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Hypotheses about sub-optimal hydration in the weeks before coronavirus disease (COVID-19) as a risk factor for dying from COVID-19. Med Hypotheses 2020; 144:110237. [PMID: 33254543 PMCID: PMC7467030 DOI: 10.1016/j.mehy.2020.110237] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/20/2020] [Accepted: 08/30/2020] [Indexed: 02/03/2023]
Abstract
To address urgent need for strategies to limit mortality from coronavirus disease 2019 (COVID-19), this review describes experimental, clinical and epidemiological evidence that suggests that chronic sub-optimal hydration in the weeks before infection might increase risk of COVID-19 mortality in multiple ways. Sub-optimal hydration is associated with key risk factors for COVID-19 mortality, including older age, male sex, race-ethnicity and chronic disease. Chronic hypertonicity, total body water deficit and/or hypovolemia cause multiple intracellular and/or physiologic adaptations that preferentially retain body water and favor positive total body water balance when challenged by infection. Via effects on serum/glucocorticoid-regulated kinase 1 (SGK1) signaling, aldosterone, tumor necrosis factor-alpha (TNF-alpha), vascular endothelial growth factor (VEGF), aquaporin 5 (AQP5) and/or Na+/K+-ATPase, chronic sub-optimal hydration in the weeks before exposure to COVID-19 may conceivably result in: greater abundance of angiotensin converting enzyme 2 (ACE2) receptors in the lung, which increases likelihood of COVID-19 infection, lung epithelial cells which are pre-set for exaggerated immune response, increased capacity for capillary leakage of fluid into the airway space, and/or reduced capacity for both passive and active transport of fluid out of the airways. The hypothesized hydration effects suggest hypotheses regarding strategies for COVID-19 risk reduction, such as public health recommendations to increase intake of drinking water, hydration screening alongside COVID-19 testing, and treatment tailored to the pre-infection hydration condition. Hydration may link risk factors and pathways in a unified mechanism for COVID-19 mortality. Attention to hydration holds potential to reduce COVID-19 mortality and disparities via at least 5 pathways simultaneously.
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32
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Seymour KA, Turner MC, Kuchibhatla M, Sudan R. Gastroesophageal Reflux Predicts Utilization of Dehydration Treatments After Bariatric Surgery. Obes Surg 2020; 31:838-846. [PMID: 33051789 DOI: 10.1007/s11695-020-05043-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Dehydration treatments (DT) provide intravenous fluids to patients in the outpatient setting; however, the utilization of DT is not well-described. We characterize the cohort receiving DT, the first year it was recorded in a bariatric-specific database. SETTING A retrospective cohort analysis of patients undergoing bariatric surgery between January 1, 2016, and December 31, 2016, in 791 centers in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data file. METHODS Patients ≥ 18 years with a body mass index (BMI) ≥ 35 kg/m2 who underwent laparoscopic adjustable gastric band (LAGB), sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (LRYGB), and biliopancreatic diversion with duodenal switch (LBPD/DS) were identified. Unadjusted and adjusted rates of DT were analyzed. In addition, adjusted rates and indication for readmission were reviewed. RESULTS The overall rate of dehydration treatments was 3.5% for the 141,748 bariatric surgery cases identified. Patient comorbidities of gastroesophageal reflux (GERD) (odds ratio (OR) 1.49; 95% CI, 1.40-1.59), insulin-dependent diabetes (OR = 1.19; 95% CI, 1.07-1.33), and LRYGB (OR = 1.45; 95% CI, 1.36-1.54) were associated with higher odds of DT. DT only had the highest odds of readmission (OR = 6.22; 95% CI, 5.55-6.98) compared to other outpatient visits. Nausea and vomiting, or fluid, electrolyte, or nutritional depletion was the most common indication for readmission in all groups. CONCLUSIONS Patients with GERD utilized dehydration treatments after bariatric surgery. DT was highly associated with readmissions, and a better understanding of the clinical application of DT will allow bariatric centers to develop programs to further optimize outpatient treatments.
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Affiliation(s)
- Keri A Seymour
- Department of Surgery, School of Medicine, Duke University, 407 Crutchfield St, Durham, NC, 27704, USA.
| | - Megan C Turner
- Department of Surgery, School of Medicine, Duke University, 407 Crutchfield St, Durham, NC, 27704, USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Ranjan Sudan
- Department of Surgery, School of Medicine, Duke University, 407 Crutchfield St, Durham, NC, 27704, USA
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Zhan Y, Hägg S. Association between genetically predicted telomere length and facial skin aging in the UK Biobank: a Mendelian randomization study. GeroScience 2020; 43:1519-1525. [PMID: 33033864 PMCID: PMC8190204 DOI: 10.1007/s11357-020-00283-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/28/2020] [Indexed: 12/21/2022] Open
Abstract
Are shorter telomeres causal risk factors for facial aging on a large population level? To examine if longer, genetically predicted telomeres were causally associated with less facial aging using Mendelian randomization analysis. Two-sample Mendelian randomization methods were applied to the summary statistics of a genome-wide association study (GWAS) for self-reported facial aging from 417, 772 participants of the UK Biobank data. Twenty single-nucleotide polymorphisms (SNPs) that were of genome-wide significance were selected as instrumental variables for leukocyte telomere length. The main analyses were performed primarily using the random-effects inverse-variance weighted method and were complemented with the MR-Egger regression, weighted median, and weighted mode approaches. The intercept of MR-Egger regression was used to assess horizontal pleiotropy. Longer genetically predicted telomeres were associated with a lower likelihood of facial aging (β = − 0.02, 95% confidence interval: − 0.04, − 0.002). Comparable results were obtained using MR-Egger regression, weighted median, and weighted mode approaches. The intercept of MR-Egger regression was close to zero (0.002) that was not suggestive of horizontal pleiotropy. Our findings provided evidence to support a potential causal relationship between longer genetically predicted telomeres and less facial aging.
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Affiliation(s)
- Yiqiang Zhan
- German Center for Neurodegenerative Diseases, Ulm, Germany. .,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Sara Hägg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Bruno RR, Masyuk M, Muessig JM, Binneboessel S, Bernhard M, Bäz L, Franz M, Kelm M, Jung C. Sublingual microcirculation detects impaired perfusion in dehydrated older patients. Clin Hemorheol Microcirc 2020; 75:475-487. [DOI: 10.3233/ch-200859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Dehydration occurs frequently in older patients and constitutes a significant clinical problem. OBJECTIVE: This proof-of-concept study examines whether 1) sublingual measurement in dehydrated old patients is feasible, 2) frailty and incompliance in old, awake patients affects video-quality, 3) dehydration impacts microcirculation METHODS: This prospective observational study included clinically dehydrated patients aged ≥65 years immediately after admission. Dehydration was assessed clinically. A sidestream dark field camera (SDF) was used for measurement. Video-quality was evaluated with MIQS (microcirculation image quality score). Both AVA 4.3C- and AVA POEM-software analyzed the videos. Seventeen patients ≥65 years not showing dehydration served as control. RESULTS: Thirteen patients (8 female) were included. The average age was 83±8 years. The mini-mental test was 17±15 points, the Clinical Frailty Scale 4±3, the Barthel-Index 59±39. None of these parameters correlated with MIQS (3.4±4.2 SD (“acceptable”)). Dehydrated patients had a slightly impaired microcirculation, with a significantly lower percentage of perfused small vessels compared to control (83.1±7.7% versus 88.0±6.0%, P < 0.05). After rehydration, there was acute improvement in the microcirculation. CONCLUSIONS: Sublingual microcirculatory SDF-measurement is both, safe and valid for dehydrated old patients - regardless of frailty, age or cognitive performance. Dehydration leads to an impaired microcirculation.
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Affiliation(s)
- Raphael Romano Bruno
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Maryna Masyuk
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Johanna M. Muessig
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephan Binneboessel
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Michael Bernhard
- Emergency Department, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Laura Bäz
- Department of Internal Medicine I, University Hospital Jena, Jena, Germany
| | - Marcus Franz
- Department of Internal Medicine I, University Hospital Jena, Jena, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
- Cardiovascular Research Institute Düsseldorf (CARID), Düsseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
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Hoteit S, Babacanli A, Babacanli MR, Šikić A, Olujić V, Radovanić S, Radeljić V, Zeljković MK, Manola Š, Zeljković I. Impact of mobility on degree of hydration in octogenarian population examined in the emergency department. Am J Emerg Med 2020; 46:681-683. [PMID: 32933809 DOI: 10.1016/j.ajem.2020.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sara Hoteit
- Duga Resa Long-term Care Hospital, Ulica Jozefa Jeruzalema 7, Duga Resa 47250, Croatia
| | - Alen Babacanli
- Department of Emergency Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | | | - Aljoša Šikić
- Department of Emergency Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Vida Olujić
- Department of Internal Emergency Medicine, Split University Hospital Centre, Split, Croatia
| | - Sandra Radovanić
- Department of Internal Emergency Medicine, Split University Hospital Centre, Split, Croatia
| | - Vjekoslav Radeljić
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Matea Kolačević Zeljković
- Unit of Clinical Pharmacology and Toxicology, Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Šime Manola
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ivan Zeljković
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia.
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Ekman L, Johnson P, Hahn RG. Signs of Dehydration after Hip Fracture Surgery: An Observational Descriptive Study. ACTA ACUST UNITED AC 2020; 56:medicina56070361. [PMID: 32708421 PMCID: PMC7404771 DOI: 10.3390/medicina56070361] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 12/05/2022]
Abstract
Background and Objectives: Dehydration might be an issue after hip fracture surgery, but the optimal tools to identify the dehydrated condition have not been determined. The aim of the present study was to compare the characteristics of elderly postoperative patients who were classified as dehydrated according to the methods used in the clinic. Materials and Methods: Thirty-eight patients aged between 65 and 97 (mean, 82) years were studied after being admitted to a geriatric department for rehabilitation after hip fracture surgery. Each patient underwent blood analyses, urine sampling, and clinical examinations. Results: Patients ingested a mean of 1,008 mL (standard deviation, 309 mL) of fluid during their first day at the clinic. Serum osmolality increased significantly with the plasma concentrations of sodium, creatinine, and urea. Seven patients had high serum osmolality (≥300 mosmol/kg) that correlated with the presence of tongue furrows (p < 0.04), poor skin turgor (p < 0.03), and pronounced albuminuria (p < 0.03). Eight patients had concentrated urine (urine-specific gravity ≥ 1.025) that correlated with a low intake of liquid and with a decrease in body weight during the past month of −3.0 kg (25–75 th percentiles, −5.1 to −0.9) versus +0.2 (−1.9 to +2.7) kg (p < 0.04). Conclusions: Renal fluid conservation of water, either in the form of hyperosmolality or concentrated urine, was found in 40% of the patients after hip fracture surgery. Hyperosmolality might not indicate a more severe fluid deficit than is indicated by concentrated urine but suggests an impaired ability to concentrate the urine.
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Affiliation(s)
- Louise Ekman
- Department of Geriatrics, Dalens Hospital, 121 31 Enskededalen, Sweden;
| | - Peter Johnson
- Department of Geriatrics, Nacka Clinic, 131 37 Nacka, Sweden;
| | - Robert G. Hahn
- Department of Research, Södertälje Hospital, 152 86 Södertälje, Sweden
- Karolinska Institutet at Danderyds Hospital (KIDS), 182 57 Danderyd, Sweden
- Correspondence: or ; Tel.: +46-790745354
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Abstract
Dehydration and overhydration can help to improve medical implications on health. Therefore, it is vital to track the hydration level (HL) specifically in children, the elderly and patients with underlying medical conditions such as diabetes. Most of the current approaches to estimate the hydration level are not sufficient and require more in-depth research. Therefore, in this paper, we used the non-invasive wearable sensor for collecting the skin conductance data and employed different machine learning algorithms based on feature engineering to predict the hydration level of the human body in different body postures. The comparative experimental results demonstrated that the random forest with an accuracy of 91.3% achieved better performance as compared to other machine learning algorithms to predict the hydration state of human body. This study paves a way for further investigation in non-invasive proactive skin hydration detection which can help in the diagnosis of serious health conditions.
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Design of Appropriate Technology-Assisted Urine Tester Enabling Remote and Long-Term Monitoring of Health Conditions. SUSTAINABILITY 2020. [DOI: 10.3390/su12125165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A novel design idea supported by affordable design processes can address unresolved social problems such as the imbalance of opportunity in healthcare services, owing to high costs and a lack of access. We designed an appropriate technology-assisted urine tester to provide healthcare services for the elderly and underprivileged in order to monitor their health conditions daily and remotely help them determine whether to visit hospitals/clinics for in-depth diagnoses. To minimize production costs, we used a charge-coupled device camera for colorimetric-type urine analysis in conjunction with commercially available urine test strips; all other electronic components were mass-produced. We calibrated this urine tester and compared it with a commercially available high-end tester; the results showed high accuracy for most urine compounds. We verified its major device functions by recruiting four participants who tested their urine over four weeks and provided self-surveys of their health conditions. The proposed tester demonstrates a low price-to-performance ratio with high reliability, while its production and maintenance costs are as low as 20 USD per set. We focused on a human-centered technological approach from a simple and innovative design point of view in order to serve people and healthcare providers in an affordable way. We believe that the tester can be widely distributed, exemplifying appropriate technological application for those who require, but cannot enjoy, proper medical services, thereby improving social healthcare sustainability.
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Diagnosing dehydration in the nursing home: international consensus based on a modified Delphi study. Eur Geriatr Med 2020; 11:393-402. [PMID: 32297264 PMCID: PMC7280358 DOI: 10.1007/s41999-020-00304-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/27/2020] [Indexed: 11/17/2022]
Abstract
Aim To assess which method (or combination of methods) are relevant and feasible to diagnose dehydration in nursing home residents. Findings International experts agreed on the relevance and feasibility of 9 anamnestic items, 8 physical symptoms and 3 blood tests to diagnose dehydration. This resulted in a diagnostic strategy consisting of a suspicion phase (including anamnestic items and physical symptoms) and a confirmation phase (including blood tests). Message This is the first study reaching international consensus about a strategy to diagnose dehydration in the nursing home. Electronic supplementary material The online version of this article (10.1007/s41999-020-00304-3) contains supplementary material, which is available to authorized users. Purpose Even though dehydration is a big problem among nursing home residents, a universally agreed method to diagnose dehydration among nursing home residents is missing. Therefore, this study aimed to establish consensus on a method to diagnose dehydration in this population. Methods Using an international Delphi study, 53 experts (physicians and advanced nurse practitioners) were asked to judge various methods to diagnose dehydration on relevance and feasibility in the nursing home. Based on the methods that gained consensus in the first and second round (≥ 75% consensus), a step-by-step diagnostic strategy was developed which was presented to, and judged by, the experts in round three. Results After the first and second round, consensus was reached on nine anamnestic items, eight physical symptoms and three blood tests. In the third round, 24 experts agreed with the developed step-by-step diagnostic strategy as a standard to diagnose dehydration in nursing home residents. Conclusion This is the first study reaching international consensus on a strategy to diagnose dehydration in the nursing home. This strategy comprehends a presumption phase, where anamnestic items and physical symptoms are examined, followed by a confirmation phase with blood tests to confirm the diagnosis of dehydration. Using this strategy, it is important to take the individual characteristics (e.g. co-morbidity) of the resident and its care environment (e.g. ambient temperature) into account. Electronic supplementary material The online version of this article (10.1007/s41999-020-00304-3) contains supplementary material, which is available to authorized users.
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McGregor D, Sharma S, Gupta S, Ahmed S, Harris T. Emergency department non-invasive cardiac output study (EDNICO): an accuracy study. Scand J Trauma Resusc Emerg Med 2020; 28:8. [PMID: 32005274 PMCID: PMC6995135 DOI: 10.1186/s13049-020-0704-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/19/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND There is little published data investigating non-invasive cardiac output monitoring in the emergency department (ED). We assess here the accuracy of five non-invasive methods in detecting fluid responsiveness in the ED: (1) common carotid artery blood flow, (2) suprasternal aortic Doppler, (3) bioreactance, (4) plethysmography with digital vascular unloading method, and (5) inferior vena cava collapsibility index. Left ventricular outflow tract echocardiography derived velocity time integral is the reference standard. This follows an assessment of feasibility and repeatability of these methods in the same cohort of ED patients. METHODS This is a prospective observational study of non-invasive methods for assessing fluid responsiveness in the ED. Participants were non-ventilated ED adult patients requiring intravenous fluid resuscitation. Sensitivity and specificity of each method in determining the fluid responsiveness status of participants is determined in comparison to the reference standard. RESULTS Thirty-three patient data sets were included for analysis. The specificity and sensitivity to detect fluid responders was 46.2 and 45% for common carotid artery blood flow (CCABF), 61.5 and 63.2% for suprasternal artery Doppler (SSAD), 46.2 and 50% for bioreactance, 50 and 41.2% for plethysmography vascular unloading technique (PVUT), and 63.6 and 47.4% for inferior vena cava collapsibility index (IVCCI), respectively. Analysis of agreement with Cohen's Kappa - 0.08 for CCABF, 0.24 for SSAD, - 0.04 for bioreactance, - 0.08 for PVUT, and 0.1 for IVCCI. CONCLUSION In this study, non-invasive methods were not found to reliably identify fluid responders. Non-invasive methods of identifying fluid responders are likely to play a key role in improving patient outcome in the ED in fluid depleted states such as sepsis. These results have implications for future studies assessing the accuracy of such methods.
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Affiliation(s)
- David McGregor
- Queen Mary University London and Barts Health NHS Trust, London, UK.
| | - Shrey Sharma
- University of Western Australia School of Medicine and Pharmacology, Perth, Australia
| | - Saksham Gupta
- University of Western Australia School of Medicine and Pharmacology, Perth, Australia
| | - Shanaz Ahmed
- Emergency Department Research Group, Royal London Hospital, London, UK
| | - Tim Harris
- Queen Mary University London and Barts Health NHS Trust, London, UK
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Davidson J, Folkard S, Hinckley M, Uglow E, Wright O, Bloomfield T, Patel M. A multicentre prospective audit of bedside hydration in hospital. ACTA ACUST UNITED AC 2020; 29:50-54. [PMID: 31917945 DOI: 10.12968/bjon.2020.29.1.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION access to water at the bedside is a cornerstone of patient care. Among bedbound inpatients, water within reach at the bedside is a basic human dignity and one that ought not to be neglected. AIM the authors sought to identify the extent to which accessible hydration facilities were provided to a bedbound inpatient population. METHODS a cross-sectional, point-prevalent audit of hospitalised medical inpatients across five centres was conducted. Data were collected between meal times and noted baseline demographics and admission details, adequacy of oral hydration provision at the bedside and, where provision was inadequate, factors associated with this. RESULTS across a total surveyed patient population of 559 we identified 138 patients who were bedbound. Among these bedbound patients, 6% (n=8) had no water provided at the bedside. However, 7 of these were deemed to be unable to swallow safely. In total, 44 (32%) of the 138 bedbound patients were unable to reach the water at their bedside; 18 of these patients would have been able to drink for themselves had the water been in reach. CONCLUSION there is significant room for improvement in ensuring patients who are immobile are able to reach drinking apparatus at the bedside. In the five centres surveyed, approximately one in five bedbound patients with no contraindication are unable to reach an essential means of hydration.
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Affiliation(s)
| | - Samuel Folkard
- Foundation Doctor, Royal Sussex County Hospital, Brighton, and Princess Royal Hospital, Hayward's Heath
| | | | | | - Oliver Wright
- Foundation Doctor, Eastbourne District General Hospital
| | - Thomas Bloomfield
- Foundation Doctor, Royal Sussex County Hospital, Brighton, and Princess Royal Hospital, Hayward's Heath
| | - Mehool Patel
- Consultant Physician, University Hospital Lewisham, London
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Abstract
Anorexia, weight loss and muscle wasting commonly affect people approaching the end of life. It is critical that clinicians caring for people with advanced illness and progressive frailty can assess the nutritional and hydration needs of these people, engage them in shared decision making and support them to plan ahead regarding their nutritional care preferences as their health deteriorates.
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Affiliation(s)
- Adam Hurlow
- Consultant in Palliative Medicine, Department of Palliative Medicine, Robert Ogden Centre, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF
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Cognitive performance in relation to hydration status and water intake among older adults, NHANES 2011–2014. Eur J Nutr 2019; 59:3133-3148. [DOI: 10.1007/s00394-019-02152-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/20/2019] [Indexed: 12/14/2022]
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Preoperative Dehydration does not Increase the Risk of Complications Following Elective Lumbar Surgery. Spine (Phila Pa 1976) 2019; 44:E1336-E1341. [PMID: 31689256 DOI: 10.1097/brs.0000000000003149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE The aim of this study was to evaluate the effect of preoperative dehydration on hospital length of stay (LOS), rates of 30-day postoperative complications, related reoperations, and readmissions. SUMMARY OF BACKGROUND DATA Preoperative dehydration has long been associated with postoperative infection, deep vein thrombosis (DVT), acute renal failure, and an increased hospital LOS. To our knowledge, the effect of preoperative dehydration on complication rates for patients undergoing elective lumbar spine surgery has not been well described. METHODS An analysis of American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data from 2006 to 2013 was performed. Patients undergoing elective lumbar procedures were identified and exclusion criteria eliminated patients who underwent any emergency procedures, infections, tumor cases, or revision surgeries. Patient dehydration was defined as preoperative blood urea nitrogen/creatinine (BUN/Cr) ratio greater than 20. RESULTS Patients (4698; 34.5%) with preoperative dehydration based on BUN/Cr ratio were identified. Univariate analysis was suggestive of an association between preoperative dehydration and an increased risk of DVT (1.1% compared with 0.6%; P = 0.002), urinary tract infection (2.5% compared with 1.6%; P < 0.001), and need for transfusion postoperatively (17.6% compared with 14.4%; P < 0.001). However, on the basis of multivariate regression, no significant association between dehydration and increased odds of aforementioned outcomes was identified. CONCLUSION Preoperative dehydration does not appear to negatively affect perioperative outcomes or readmission in patients undergoing elective lumbar spine surgery. LEVEL OF EVIDENCE 3.
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Management of Dehydration in Patients Suffering Swallowing Difficulties. J Clin Med 2019; 8:jcm8111923. [PMID: 31717441 PMCID: PMC6912295 DOI: 10.3390/jcm8111923] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 12/17/2022] Open
Abstract
Swallowing difficulties, also called dysphagia, can have various causes and may occur at many points in the swallowing process. The treatment and rehabilitation of dysphagia represent a major interdisciplinary and multiprofessional challenge. In dysphagic patients, dehydration is frequent and often accelerated as a result of limited fluid intake. This condition results from loss of water from the intracellular space, disturbing the normal levels of electrolytes and fluid interfering with metabolic processes and body functions. Dehydration is associated with increased morbidity and mortality rates. Dysphagic patients at risk of dehydration thus require close monitoring of their hydration state, and existing imbalances should be addressed quickly. This review gives an overview on dehydration, as well as its pathophysiology, risk factors, and clinical signs/symptoms in general. Available management strategies of dehydration are presented for oral, enteral, and parenteral fluid replacement.
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Multifrequency bioelectrical impedance analysis may represent a reproducible and practical tool to assess skeletal muscle mass in euvolemic acutely ill hospitalized geriatric patients. Eur Geriatr Med 2019; 11:155-162. [PMID: 32297228 DOI: 10.1007/s41999-019-00253-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/21/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE Geriatric patients with low skeletal muscle mass (SMM) and strength have a poor clinical outcome following acute illness. Consequently, it is recommended to assess SMM and strength in patients admitted to the acute care geriatric ward. Bio-impedance analysis (BIA) is a practical tool to assess SMM in hospitalized patients. However, the reproducibility of this assessment may be compromised due to changing clinical conditions. The objective was to study the reproducibility of SMM assessment using multifrequency BIA (mf-BIA) in acutely ill geriatric patients. METHODS A total of 47 geriatric patients (age: 83 ± 7 years; n = 31 female) admitted to the acute geriatric ward participated in this pilot study. SMM was assessed on three occasions within the first week of hospital admission using the Maltron Bioscan-920-II. RESULTS Total skeletal SMM averaged 21.4 ± 5.7, 20.7 ± 5.4, and 20.8 ± 5.1 kg assessed at 2 ± 1, 3 ± 1 and 5 ± 2 days after hospital admission, respectively. Coefficient of variation (COV) of the three SMM measurements was 4.9 ± 4.5% with an intraclass correlation coefficient (ICC) of 0.976 (CI 95%: 0.961-0.986; P < 0.001). Hydration status affected the reproducibility of the measurement, with non-euvolemic patients (n = 16) showing a significantly higher COV (7.6 ± 5.9% vs 3.5 ± 2.9%; P < 0.01) and a lower ICC (0.983 vs 0.913; P < 0.001) when compared to the euvolemic patients (n = 31). CONCLUSION Mf-BIA seems a highly reproducible and reliable method to assess SMM throughout the first week of hospitalization in geriatric patients. However, since abnormal hydration status may compromise reliability of the measurement, assessment of SMM using mf-BIA may better be performed when euvolemic status has been established.
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A Portable System to Monitor Saliva Conductivity for Dehydration Diagnosis and Kidney Healthcare. Sci Rep 2019; 9:14771. [PMID: 31611585 PMCID: PMC6791883 DOI: 10.1038/s41598-019-51463-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/28/2019] [Indexed: 12/13/2022] Open
Abstract
Chronic kidney disease (CKD) has become a major issue in long-term healthcare. It is caused by recurrent kidney injury, which is possible induced by dehydration and heat stress. Therefore, it is important to access the dehydration diagnosis on fields. Conventional instruments for assessing dehydration from blood and urine samples are expensive and time-consuming. These disadvantages limit their applications in high-risk groups susceptible to kidney disease. To address this unmet need, this study presents a portable miniaturized device for dehydration diagnosis with clinical saliva samples. With co-plane coating-free gold electrodes, the dehydration diagnosis was achieved with a saliva specimen at low volumes (50–500 μL). To examine the characteristics, the developed device was assessed by using standard conductivity solutions and the examined variation was <5%. To validate the use for field applications, saliva samples were measured by the developed device and the measured results were compared with standard markers of serum osmolality (N = 30). These data indicate that the measured saliva conductivity is consistent with serum osmolality. And it shows significant difference between healthy adults and healthy farmers (p < 0.05), who typically suffer high risks of CKD. Based on this work, the proposed device and measurement offer a useful method to diagnosis dehydrations and indicate possible potential for CKD.
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Brennan M, O’Keeffe ST, Mulkerrin EC. Dehydration and renal failure in older persons during heatwaves-predictable, hard to identify but preventable? Age Ageing 2019; 48:615-618. [PMID: 31268494 DOI: 10.1093/ageing/afz080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/04/2019] [Accepted: 06/06/2019] [Indexed: 11/14/2022] Open
Abstract
Extremes of temperature are likely to increase in frequency associated with climate change. Older patients are particularly vulnerable to the effects of heat with excess mortality well documented in this population. Age-associated neurohormonal changes particularly affecting the renin angiotensin aldosterone system (RAAS), alterations in thermoregulatory mechanisms, changes in renal function and body composition render older persons vulnerable to dehydration, renal failure, heat stroke and increased mortality. Barriers to diagnosis and recognition of dehydration and renal failure include the absence of reliable clinical signs and cost-effective diagnostic tools. Regularly used medications also impact on physiological responses to excess heat as well as interfering with the recognition and management of dehydration during heat waves. In view of the above, anticipatory measures should be instituted ideally prior to the onset of heat waves to minimise morbidity and mortality for older people during periods of excess heat.
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Affiliation(s)
- Michelle Brennan
- Department of Geriatric Medicine, University Hospital Galway, Galway Ireland
| | - Shaun T O’Keeffe
- Department of Geriatric Medicine, University Hospital Galway, Galway Ireland
| | - Eamon C Mulkerrin
- Department of Geriatric Medicine, University Hospital Galway, Galway Ireland
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Salivary Metabolome and Soccer Match: Challenges for Understanding Exercise induced Changes. Metabolites 2019; 9:metabo9070141. [PMID: 31336760 PMCID: PMC6680540 DOI: 10.3390/metabo9070141] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/01/2019] [Accepted: 07/05/2019] [Indexed: 01/21/2023] Open
Abstract
Saliva samples of seventeen soccer players were analyzed by nuclear magnetic resonance before and after an official match. Two different ways of normalizing data are discussed, using total proteins and total metabolite concentrations. Changes in markers related to energy, hydration status, amino acids and other compounds were found. The limits and advantages of using saliva to define the systemic responses to exercise are examined, both in terms of data normalization and interpretation, and the time that the effect lasts in this biofluid, which is shorter to that commonly observed in blood. The heterogeneous nature and different timing of the exercise developed by players also plays an important role in the metabolic changes that can be measured. Our work focuses mainly on three different aspects: The effect that time sampling has on the observed effect, the type of normalization that is necessary to perform in order to cope with changes in water content, and the metabolic response that can be observed using saliva.
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