Abstract-A successful pregnancy requires an accommodating environment. Salt and water availability are critical for plasma volume expansion. Any changes in sodium intake would alter aldosterone, a hormone previously described beneficial in pregnancy. To date, it remains ambiguous whether high aldosterone or high salt intake is preferable. We hypothesized that increased aldosterone is a rescue mechanism and appropriate salt availability is equally effective in maintaining a normotensive blood pressure (BP) phenotype in pregnancy. We compared normotensive pregnant women (n=31) throughout pregnancy with young healthy female individuals (n=31-62) and performed salt sensitivity testing within the first trimester. Suppression of urinary tetrahydro-aldosterone levels by salt intake as measured by gas chromatography-mass spectrometry and urinary sodium excretion corrected for creatinine, respectively, was shifted toward a higher salt intake in pregnancy (P<0.0001). In pregnancy, neither high urinary tetrahydro-aldosterone nor sodium excretion was correlated with higher BP. In contrast, in nonpregnant women, systolic BP rose with aldosterone (P<0.05). Testing the impact of salt on BP, we performed salt sensitivity testing in a final cohort of 19 pregnant and 24 nonpregnant women. On salt loading, 24-hour mean arterial pressure rose by 3.6±1.5 and dropped by -2.8±1.5 mm Hg favoring pregnant women (P<0.01; χ 2 =6.04; P<0.02). Our data suggest first that salt responsiveness of aldosterone is alleviated in conditions of pregnancy without causing aldosterone-induced hypertension. Second, salt seems to aid in BP lowering in pregnancy for reasons incompletely elucidated, yet involving renin suppression and potentially placental sensing mechanisms. and Blood Pressure in Pregnancy 363a homozygous loss-of-function mutation of the CYP11B2 on salt supplementation. 13To date, it remains uncertain whether high aldosterone levels and high salt intake are preferable in pregnancy. Given the current evidence, we hypothesized first that increased aldosterone is a rescue mechanism to maintain a BP reasonable for pregnancy, and second that appropriate salt availability is required to maintain a normotensive BP phenotype in pregnancy. As a corollary, inappropriately low aldosterone levels for a given gestational age might be counterbalanced by increased salt availability, thus substituting for the missing aldosterone effect. To verify our hypothesis, we have first studied the BP in women along pregnancy as related to salt intake and aldosterone levels and then compared first trimester salt sensitivity in pregnant women with young female nonpregnant individuals. Methods PatientsA first set of pregnant women from the Bernese pregnancy registry and nonpregnant women matched for age with a complete prospective sampling of serum and urine was used for the study. Clinical data were collected prospectively including standardized measurement of office BP and pregnancy outcome. Only normotensive pregnant women were included in the analysis. Visits we...
Objectives In hospitalized patients with skin and soft tissue infections (SSTIs), intravenous (IV) empiric antibiotic treatment is initiated. The best time point for switching from IV to oral treatment is unknown. We used an algorithm-based decision tree for the switch from IV to oral antibiotics within 48 hours and aimed to investigate the treatment outcome of this concept. Methods In a non-randomized trial, we prospectively enrolled 128 patients hospitalized with SSTI from July 2019 to May 2021 at three institutions. Clinical and biochemical response data during the first week and at follow-up after 30 days were analyzed. Patients fulfilling criteria for the switch from IV to oral antibiotics were assigned to the intervention group. The primary outcome was a composite definition consisting of the proportion of patients with clinical failure or death of any cause. Results Ninety-seven (75.8%) patients were assigned to the intervention group. All of them showed signs of clinical improvement (i.e.; absence of fever or reduction of pain) within 48 hours IV treatment, irrespective of erythema finding or biochemical response. The median total antibiotic treatment duration was 11 (IQR 9–;13) days in the invention and 15 (IQR 11-24) days in the non-intervention group (p<0.001). The median duration of hospitalization was 5 (IQR 4-6) days in the intervention group and 8 (IQR 6-12) days in the non-intervention group (p<0.001). There were five (5.2%) failures in the intervention group and one (3.2%) in the non-intervention group after a median follow-up of 37 days. Conclusions In this pilot trial, the proposed decision-algorithm for early switch from IV to oral antibiotics for SSTI treatment was successful in 95% of cases.
Les maux de dos avec ou sans irradiation dans les jambes représentent l'un des motifs les plus fréquents de consultation chez le médecin de famille. Des altérations dégénératives de la colonne vertébrale en sont le plus souvent à l'origine. Résumé pour la pratiqueLes altérations dégénératives de la colonne vertébrale comptent parmi les causes les plus fréquentes du syndrome lombo-radiculaire. Il convient d'en distinguer d'autres causes, telles que les inflammations, les infections et les néoplasies. Il est essentiel pour le diagnostic approfondi et le traitement de distinguer un syndrome lombo-radiculaire d'un syndrome pseudo-radiculaire, ainsi que d'une plexopathie ou d'une lésion nerveuse périphérique.En cas de résultats incertains (en particulier avec un examen d'imagerie non concluant) ou de parésies invalidantes, une évaluation par un neurologue, y compris avec un examen électroneuromyographique, peut être pertinente.
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