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1.
Salt Toxicity: A Systematic Review and Case Reports.
Metheny, NA, Krieger, MM
Journal of emergency nursing. 2020;(4):428-439
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Abstract
INTRODUCTION Salt toxicity is a rare form of hypernatremia that typically occurs after a single massive ingestion of salt over a short period of time (minutes/hours). It is a dangerous imbalance capable of causing significant neurological injury; quick recognition of salt toxicity is crucial to allow treatment before permanent brain injury occurs. The purpose of this review is to assist emergency nurses in gaining knowledge on the causes, pathophysiology, symptoms, and treatment of salt toxicity. METHODS A systematic search for case reports of hypernatremia due to salt toxicity was conducted in the PubMed and Scopus electronic databases. The search terms used were salt, sodium, hypernatremia, toxicity, poisoning, case reports, case series, and cases. The following were the inclusion criteria: publication dates between January 1, 2000, and September 30, 2019; evidence of an acute large oral or gastric tube ingestion of salt over a short period of time (minutes/hours); admission for treatment within hours of the event; laboratory verification of hypernatremia; and full-text article available electronically in English. The following were the exclusion criteria: an unclear history, high salt consumption over a period of days, high sodium intake via the intravenous route, and breast feeding. RESULTS Only 15 cases met the inclusion criteria for the review. Patients described in the case reports ranged in age from 5 days to 73 years. Forty percent of the patients were children less than 15 years old. Of the 14 cases with known outcomes, 50% were fatal. The most frequent causes of salt toxicity were salt water emetics, intentional administration of large quantities of salt to a child by a caregiver, and suicide attempts. Among the other causes were unintentional salt overload in infant formula, an exorcism ritual, and a college prank. DISCUSSION Findings from this review of 15 case reports in which a large salt load was ingested over a short period of time suggest that salt toxicity is a rare condition associated with high mortality. In addition, salt toxicity can occur in patients of all ages for a variety of reasons; the most frequently identified reasons in this review were use of salt water as an emetic and child abuse by the intentional administration of a high salt load by a caregiver. For patients whose massive exposure to salt is recent (such as minutes to hours), rapidly reducing the serum sodium concentration may prevent irreversible neurological injury.
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Evaluation the Effects of Alpha-tocopherol in Comparison with N-acetylcystein for Prevention of Contrast Induced Nephropathy (CIN) in CKD Patients.
Samadi, K, Naghibi, M, Shabestari, M, Sharifipour, F, Khajeh Dalooee, M, Raeesi, V, Moosavi Nik, S, Samadi, M
Iranian journal of kidney diseases. 2020;(1):26-30
Abstract
INTRODUCTION Contrast induced nephropathy (CIN), a well-known complication of using radio contrast media, dramatically increases the likelihood of patient morbidity and mortality following coronary angiography. As there is no specific treatment for CIN, prevention could be the best strategy to address this issue. Since now, the only approved preventing strategy was hydration with normal saline while antioxidant agents as a new yet unapproved remedy for this purpose could be applied .The present study was conducted to examine the effect of alpha tocopherol in CIN prevention. METHODS This prospective controlled trial was carried out on 201 patients with chronic kidney disease (eGFR < 60 cc/min) underwent coronary angiography. We assigned three groups of CKD patients: 72 patients who received prophylaxis administration with isotonic saline (Group A), 66 patients with isotonic saline plus N-acetylcysteine (1200mg twice a day) for 2 days (Group B) and 63 patients who received isotonic saline plus daily alpha tocopherol (600 IU once daily from one day before till 2 days after angiography) for 4 days (Group C). The contrast media in all three groups was nonionic iso-osmolal agent, Visipaque. RESULTS Even though CIN didn't developed in any of the three aforementioned groups but there was statistically significant reduction in eGFR from baseline in all three groups (P < .001). Moreover, We found no statistically significant difference in GFR reduction between three studied groups. CONCLUSION Administration of alpha tocopherol has no additive beneficial effect over isotonic saline in CIN prevention in CKD patients.
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Analysis of Membrane Transport Equations for Reverse Electrodialysis (RED) Using Irreversible Thermodynamics.
Kujawski, W, Yaroshchuk, A, Zholkovskiy, E, Koter, I, Koter, S
International journal of molecular sciences. 2020;(17)
Abstract
Reverse electrodialysis (RED) is an electro-membrane process for the conversion of mixing energy into electricity. One important problem researchers' face when modeling the RED process is the choice of the proper membrane transport equations. In this study, using experimental data that describe the membrane Nafion 120 in contact with NaCl aqueous solutions, the linear transport equation of irreversible thermodynamics was applied to calculate the power density of the RED system. Various simplifying assumptions about transport equation (i.e., four-, three-, and two-coefficients approaches) are proposed and discussed. We found that the two-coefficients approach, using the membrane conductivity and the apparent transport number of ions, describes the power density with good accuracy. In addition, the influence of the membrane thickness and the concentration polarization on the power density is also demonstrated.
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Effect of Salt Supplementation on Sympathetic Activity and Endothelial Function in Salt-Sensitive Type 2 Diabetes.
Baqar, S, Kong, YW, Chen, AX, O'Callaghan, C, MacIsaac, RJ, Bouterakos, M, Lambert, GW, Jerums, G, Lambert, EE, Ekinci, EI
The Journal of clinical endocrinology and metabolism. 2020;(4)
Abstract
CONTEXT Lower sodium intake is paradoxically associated with higher mortality in type 2 diabetes (T2D). OBJECTIVE To determine whether sympathetic nervous system (SNS) activation and endothelial dysfunction contribute to these observations, we examined the effect of salt supplementation on these systems in people with T2D with habitual low sodium. We hypothesized that salt supplementation would lower SNS activity and improve endothelial function compared to placebo. DESIGN We conducted a randomized, double-blinded, placebo-controlled crossover trial. SETTING The study took place in a tertiary referral diabetes outpatient clinic. PARTICIPANTS Twenty-two people with T2D with habitual low sodium intake (24-hour urine sodium <150 mmol/24h) were included. INTERVENTION Salt supplementation (100 mmol NaCl/24h) or placebo for 3 weeks was administered. MAIN OUTCOME MEASURES The primary outcome of SNS activity and endothelial function was assessed as follows: Microneurography assessed muscle sympathetic nerve activity (MSNA), pulse amplitude tonometry assessed endothelial function via reactive hyperemic index (RHI), and arterial stiffness was assessed via augmentation index (AI). Secondary outcomes included cardiac baroreflex, serum aldosterone, ambulatory blood pressure monitoring (ABPM), heart rate variability (HRV), and salt sensitivity. RESULTS Compared to placebo, salt supplementation increased MSNA (burst frequency P = .047, burst incidence P = .016); however, RHI (P = .24), AI (P = .201), ABPM (systolic P = .09, diastolic P = .14), and HRV were unaffected. Salt supplementation improved baroreflex (slope P = .026) and lowered aldosterone (P = .004), and in salt-resistant individuals there was a trend toward improved RHI (P = .07). CONCLUSIONS In people with T2D and low habitual sodium intake, salt supplementation increased SNS activity without altering endothelial function or blood pressure but improved baroreflex function, a predictor of cardiac mortality. Salt-resistant individuals trended toward improved endothelial function with salt supplementation.
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Submucosal Saline Injection Followed by Endoscopic Ultrasound versus Endoscopic Ultrasound Only for Distinguishing between T1a and T1b Esophageal Cancer.
He, LJ, Xie, C, Wang, ZX, Li, Y, Xiao, YT, Gao, XY, Shan, HB, Luo, LN, Chen, LM, Luo, GY, et al
Clinical cancer research : an official journal of the American Association for Cancer Research. 2020;(2):384-390
Abstract
PURPOSE To examine whether submucosal saline injection (SSI) can improve traditional endoscopic ultrasound (EUS) accuracy in distinguishing between T1a and T1b stage esophageal squamous cell carcinoma (ESCC). EXPERIMENTAL DESIGN Patients with T1N0M0 stage ESCC (n = 180) ages 18 to 85 years were enrolled between February 14, 2012 to June 4, 2018 at Sun Yat-sen University Cancer Center (Guangdong, China). They were randomly assigned (1:1) to receive either EUS examination after 3-5 mL SSI or EUS only examination. All the patients were referred to thoracic surgeons to receive endoscopic resection (ER) or esophagectomy 5 to 10 days after EUS examination. Standard EUS criteria were used to preoperatively stage the ESCC cases, and surgical pathology reports after referral were used to postoperatively stage the cases. The primary endpoint was the diagnostic accuracy of T1b staging [defined as the sum of the true positive (T1b) and true negative (T1a) cases divided by the total number of cases]. RESULTS Among the per-protocol population, the SSI+EUS group (n = 81) was superior to the EUS-only group (n = 85) in terms of the diagnostic accuracy for T1b staging [93.8% (95% confidence interval (CI), 88.6-99.1) vs. 65.9% (95% CI, 55.8-76.0); P < 0.001]. The positive predictive value of SSI+EUS for diagnosing T1b ESCC reached 90.9% (95% CI, 81.1-100), which was significantly superior to that of EUS only [0.576 (0.450-0.702), P = 0.001]. CONCLUSIONS SSI significantly improves the diagnostic accuracy of EUS in distinguishing between T1a and T1b ESCC, which might help avoid unnecessary esophagectomy and diagnostic ER.
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Nature and bioprospecting of haloalkaliphilics: a review.
Uma, G, Babu, MM, Prakash, VSG, Nisha, SJ, Citarasu, T
World journal of microbiology & biotechnology. 2020;(5):66
Abstract
The haloalkaliphilics are an important subset of extremophiles that grow in salt [upto 33% (wt/vol) NaCl] and alkaline pH (> 9). They are found in hypersaline environments especially in the brines in arid, coastal and deep sea locations, and in alkaline environments, such as soda soils, lakes and deserts. Some authors have described haloalkaliphilic bacteria as moderate halophilic bacteria, but the molecular and classical studies revealed that they belong to moderately to extremely halophilic bacteria and archaea. Organic solutes, such as glycine, betaine and other amino acid derivatives, sugars such as, sucrose and trehalose, and sugar alcohols present in the haloalkaliphilics help for their osmoadaptation, and also serve as stabilizers. Haloalkalphilics secrete exoenzymes like proteases, amylases, xylanases, cellulases and peroxidases which have potential industrial applications. They also produce bacteriorhodopsin, compatible solutes, pigments, biopolymers, secondary metabolites like biosurfactants, polyhydroxyalkanoate (PHA) and exopolysaccharides and antimicrobial/anticancer compounds. They have unique metabolic pathways which can be used to treat industrial pollutants, heavy metals and waste water.
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Strain Variability of Listeria monocytogenes under NaCl Stress Elucidated by a High-Throughput Microbial Growth Data Assembly and Analysis Protocol.
Aalto-Araneda, M, Pöntinen, A, Pesonen, M, Corander, J, Markkula, A, Tasara, T, Stephan, R, Korkeala, H
Applied and environmental microbiology. 2020;(6)
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Abstract
Listeria monocytogenes causes the severe foodborne illness listeriosis and survives in food-associated environments due to its high stress tolerance. A data assembly and analysis protocol for microbial growth experiments was compiled to elucidate the strain variability of L. monocytogenes stress tolerance. The protocol includes measurement of growth ability under stress (step 1), selection of a suitable method for growth parameter calculation (step 2), comparison of growth patterns between strains (step 3), and biological interpretation of the discovered differences (step 4). In step 1, L. monocytogenes strains (n = 388) of various serovars and origins grown on media with 9.0% NaCl were measured using a Bioscreen C microbiology reader. Technical variability of the growth measurements was assessed and eliminated. In step 2, the growth parameters determined by Gompertz, modified-Gompertz, logistic, and Richards models and model-free splines were compared, illustrating differences in the suitability of these methods to describe the experimental data. In step 3, hierarchical clustering was used to describe the NaCl tolerance of L. monocytogenes measured by strain-specific variation in growth ability; tolerant strains had higher growth rates and maximum optical densities and shorter lag phases than susceptible strains. The spline parameter area under the curve best classified "poor," "average," and "good" growers. In step 4, the tested L. monocytogenes lineage I strains (serovars 4b and 1/2b) proved to be significantly more tolerant toward 9.0% NaCl than lineage II strains (serovars 1/2a, 1/2c, and 3a). Our protocol provides systematic tools to gain comparable data for investigating strain-specific variation of bacterial growth under stress.IMPORTANCE The pathogen Listeria monocytogenes causes the foodborne disease listeriosis, which can be fatal in immunocompromised individuals. L. monocytogenes tolerates several environmental stressors and can persist in food-processing environments and grow in foodstuffs despite traditional control measures such as high salt content. Nonetheless, L. monocytogenes strains differ in their ability to withstand stressors. Elucidating the intraspecies strain variability of L. monocytogenes stress tolerance is crucial for the identification of particularly tolerant strains. To enhance reliable identification of variability in bacterial stress tolerance phenotypes, we compiled a large-scale protocol for the entire data assembly and analysis of microbial growth experiments, providing a systematic approach and checklist for experiments on strain-specific growth ability. Our study illustrated the diversity and strain-specific variation of L. monocytogenes stress tolerance with an unprecedented scope and discovered biologically relevant serovar- and lineage-dependent phenotypes of NaCl tolerance.
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Efficacy of Furosemide, Oral Sodium Chloride, and Fluid Restriction for Treatment of Syndrome of Inappropriate Antidiuresis (SIAD): An Open-label Randomized Controlled Study (The EFFUSE-FLUID Trial).
Krisanapan, P, Vongsanim, S, Pin-On, P, Ruengorn, C, Noppakun, K
American journal of kidney diseases : the official journal of the National Kidney Foundation. 2020;(2):203-212
Abstract
RATIONALE & OBJECTIVE First-line therapy for syndrome of inappropriate antidiuresis (SIAD) is fluid restriction. Additional treatment for patients who do not respond to fluid restriction are water restriction with furosemide or water restriction with furosemide and salt supplementation. However, the efficacy of these treatments has never been tested in a randomized controlled study. The objective of this study was to investigate whether, combined with fluid restriction, furosemide with or without sodium chloride (NaCl) supplementation was more effective than fluid restriction alone in the treatment of hyponatremia in SIAD. STUDY DESIGN Open-label randomized controlled study. SETTING & PARTICIPANTS Patients with serum sodium concentrations ([Na+]) ≤ 130mmol/L due to SIAD. INTERVENTION(S): Random assignment to 1 of 3 groups: fluid restriction alone (FR), fluid restriction and furosemide (FR+FM), or fluid restriction, furosemide, and NaCl (FR+FM+NaCl). Strictness of fluid restriction (<1,000 or<500mL/d) was guided by the urine to serum electrolyte ratio. Furosemide dosage was 20 to 40mg/d. NaCl supplements were 3g/d. All treatments were continued for 28 days. OUTCOMES The primary outcome was change in [Na+] at days 4, 7, 14, and 28 after randomization. RESULTS 92 patients were recruited (FR, n=31; FR+FM, n=30; FR+FM+NaCl, n=31). Baseline [Na+] was 125±4mmol/L, and there were no significant differences between groups. Mean [Na+] on day 4 in all treatment groups was significantly increased from baseline by 5mmol/L (P<0.001); however, the change in [Na+] was not significantly different across groups (P=0.7). There was no significant difference in percentage of patients or time to reach [Na+] ≥ 130 or≥135mmol/L across the 3 groups. Acute kidney injury and hypokalemia (potassium≤3.0mmol/L) were more common in patients receiving furosemide. LIMITATIONS Open-label treatment. CONCLUSIONS In patients with SIAD, furosemide with NaCl supplement in combination with fluid restriction did not show benefits in correction of [Na+] compared with treatment with fluid restriction alone. Incidences of acute kidney injury and hypokalemia were increased in patients receiving furosemide. FUNDING None. TRIAL REGISTRATION Registered at the Thai Clinical Trial Registry with study number TCTR20170629004.
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Traversing the "Omic" landscape of microbial halotolerance for key molecular processes and new insights.
Kumar, S, Paul, D, Bhushan, B, Wakchaure, GC, Meena, KK, Shouche, Y
Critical reviews in microbiology. 2020;(6):631-653
Abstract
Post-2005, the biology of the salt afflicted habitats is predominantly studied employing high throughput "Omic" approaches comprising metagenomics, transcriptomics, metatranscriptomics, metabolomics, and proteomics. Such "Omic-based" studies have deciphered the unfamiliar details about microbial salt-stress biology. The MAGs (Metagenome-assembled genomes) of uncultured halophilic microbial lineages such as Nanohaloarchaea and haloalkaliphilic members within CPR (Candidate Phyla Radiation) have been reconstructed from diverse hypersaline habitats. The study of MAGs of such uncultured halophilic microbial lineages has unveiled the genomic basis of salt stress tolerance in "yet to culture" microbial lineages. Furthermore, functional metagenomic approaches have been used to decipher the novel genes from uncultured microbes and their possible role in microbial salt-stress tolerance. The present review focuses on the new insights into microbial salt-stress biology gained through different "Omic" approaches. This review also summarizes the key molecular processes that underlie microbial salt-stress response, and their role in microbial salt-stress tolerance has been confirmed at more than one "Omic" levels.
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Chloride as a Beneficial Macronutrient in Higher Plants: New Roles and Regulation.
Colmenero-Flores, JM, Franco-Navarro, JD, Cubero-Font, P, Peinado-Torrubia, P, Rosales, MA
International journal of molecular sciences. 2019;(19)
Abstract
Chloride (Cl-) has traditionally been considered a micronutrient largely excluded by plants due to its ubiquity and abundance in nature, its antagonism with nitrate (NO3-), and its toxicity when accumulated at high concentrations. In recent years, there has been a paradigm shift in this regard since Cl- has gone from being considered a harmful ion, accidentally absorbed through NO3- transporters, to being considered a beneficial macronutrient whose transport is finely regulated by plants. As a beneficial macronutrient, Cl- determines increased fresh and dry biomass, greater leaf expansion, increased elongation of leaf and root cells, improved water relations, higher mesophyll diffusion to CO2, and better water- and nitrogen-use efficiency. While optimal growth of plants requires the synchronic supply of both Cl- and NO3- molecules, the NO3-/Cl- plant selectivity varies between species and varieties, and in the same plant it can be modified by environmental cues such as water deficit or salinity. Recently, new genes encoding transporters mediating Cl- influx (ZmNPF6.4 and ZmNPF6.6), Cl- efflux (AtSLAH3 and AtSLAH1), and Cl- compartmentalization (AtDTX33, AtDTX35, AtALMT4, and GsCLC2) have been identified and characterized. These transporters have proven to be highly relevant for nutrition, long-distance transport and compartmentalization of Cl-, as well as for cell turgor regulation and stress tolerance in plants.