Fluid and electrolyte overload in critically ill patients: An overview

Fluids are considered the cornerstone of therapy for many shock states, particularly states that are associated with relative or absolute hypovolemia. Fluids are also commonly used for many other purposes, such as renalprotection from endogenous and exogenous substances, for the safe dilution of medications and as "maintenance" fluids. However, a large amount of evidence from the last decade has shown that fluids can have deleterious effects on several organ functions, both from excessive amounts of fluids and from their non-physiological electrolyte composition. Additionally, fluid prescription is more common in patients with systemic inflammatory response syndrome whose kidneys may have impaired mechanisms of electrolyte and free water excretion. These processes have been studied as separate entities(hypernatremia, hyperchloremic acidosis and progressive fluid accumulation) leading to worse outcomes in many clinical scenarios, including but not limited to acute kidney injury, worsening respiratory function, higher mortality and higher hospital and intensive care unit lengthof-stays. In this review, we synthesize this evidence and describe this phenomenon as fluid and electrolyte overload with potentially deleterious effects. Finally, we propose a strategy to safely use fluids and thereafter wean patients from fluids, along with other caveats to be considered when dealing with fluids in the intensive care unit.

Reinfection, recontamination and revaccination for SARS-CoV-2

The reports on coronavirus disease 2019(COVID-19)describe the pandemic in waves.Similar to the ocean’s waves,the frequency and amplitude of the number of new cases and the number of deaths were globally quite regular;nevertheless,they showed important regional irregularities and the direction of spread has been generally rather unpredictable for COVID-19.One of the major reasons for the repeated outbreaks is the mutating capacity of the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)that allows the virus to infect persons who have natural immunity or have been vaccinated.Vaccination began in vast campaigns from the second year of the pandemic that was supposed to decrease the magnitude of the waves.Although it reduced the complications,the expected attenuation of the disease expansion has not yet been met.This paper provides a short overview of the most recent data on the rate of reinfection in vaccinated and non-vaccinated individuals.It points out that testing positive for a second time for SARS-CoV-2 does not necessarily mean a reinfection;it can also be interpreted as recontamination.The symptom free outcome as well as the rapid reconversion of the polymerase chain reaction test may help to determine the difference between reinfection and recontamination.Awareness of this phenomenon may be valuable in times of human resource difficulties.The available evidence may suggest that the protective value of a prior infection could be better considered for vaccine distribution in the future.

Socioeconomic inequality in screen time frequency in children and adolescents: the weight disorders survey of the CASPIAN IV study

Background This study aimed to assess the socioeconomic inequality and determinants of screen time (ST) frequency in Iranian children and adolescents. Methods This nationwide study was conducted as part of a national school-based surveillance program among 36,486 students consisting of 50.79% boys and 74.23% urban inhabitants, aged 6–18 years, living in urban and rural areas of 30 provinces of Iran. Socioeconomic inequality in ST, including the time spent for ST, watching TV and leisure-time work-ing with computer, was assessed across quintiles of SES using concentration index (C) and slope index of inequality (SII). Results Overall, 36,486 students completed the study (response rate 91.25%). Their mean (SD) age was 12.14 (3.36) years. The national estimation of frequency of ST was 31.66% (95% CI 31.16–32.17) with ascending change from 20.80% (95% CI 19.81–21.82) to 36.66% (95% CI 35.47–37.87) from the first to the last quintal of SES. EstimatedC value at national level was positive (0.08), which indicate inequality was in favor of low SES groups. Considering the SII values, at national level [? 0.16 (? 0.39, 0.06)], the absolute difference in ST frequency between the bottom and top of the socioeconomic groups had descending trends. In multivariate logistic regression model, family history of obesity, generalized obesity and age were the main significant determinants of prolonged ST, watching TV, and computer working (P < 0.001). Conclusions Socioeconomic inequality in ST frequency was in favor of low SES groups. These findings are useful for health policies, better programming and future complementary analyses.