Excess Fluids and Pediatric Outcomes

Fluid overload or excess positive balance in pediatric critical illness is associated with adverse outcomes – mortality, lung and kidney injury, length of stay.  jama

While there are lots of caveats – observational, retrospective meta analysis, and association is not causation, the study joins the growing adult consensus that after aggressive early shock resuscitation, fluids should then be judiciously/conservatively administered and monitored.

Weekly General News

e-cigarettes’ effects need further research, but while they may increase transition to smoking in youths, they may also aid smoking cessation in adults. Either way, nicotine is addictive. link

Anti thyroid medications in the first trimester may increase congenital birth defects link

Interest in ketogenic diet for sustained weight loss link

Triple antiplatelet therapy in acute stroke doesn’t help and increases bleeding. Choose aspirin with dipyridamole, or clopidogrel alone.link

Seafood may help Alzheimer’s, despite the mercury concern link

Worsening anxiety-depressive symptoms a marker for preclinical Alzheimer’s link

Paintball, BB and pellet guns pose eye injury danger to kids. Who’d have guessed? NYtimes link

Extended release Naltrexone and Suboxone equally effective in preventing opioid relapse (but 28% of Nal group relapsed waiting to detox until Naltrexone could be started) jama link

A troubling 1 in 3 women don’t have their Cervical smear test because of embarrassment link

Gynecological but not medical complications increased over 1 and 3 year after hysteroscopic vs laparoscopic sterilization. Hysteroscopic seems to have too many gyn complications to replace lap yet, including higher pregnancy link

Influenza associated with a sixfold greater risk of myocardial infarction acutely nejm

For stroke, Endovascular Thrombectomy (plus medical Rx) for internal carotid or proximal middle cerebral artery occlusion with favourable perfusion findings benefits up to 16 hours and AHA extends time window to 24 hours  nejm

Much hype about ‘liquid biopsy’  blood test “CancerSEEK” detecting multiple cancers using cfDNA and protein biomarkers, specific but not always sensitive (many false negatives) and yet to show value in Stage I cancer, where we really need it for early detection  Hopkins link

Parents who supply alcohol to their teenagers just increase their risk of alcohol-related harm lancet link

Prior use of NOACs, compared with prior use of warfarin, was associated with lower risk of in-hospital mortality in intracerebral hemorrhage  Jama

Use paracetamol (acetaminophen) for most sore throats, says NICE NICE guidelines