Introduction and case report: we report the case of an 82-year-old man with pheochromocytoma and colon adenocarcinoma who developed rapidly progressive Guillain-Barré syndrome with severe dysautonomia following a recent SARS-CoV-2 infection. In this setting, he developed progressive hyponatremia secondary to syndrome of inappropriate antidiuretic hormone secretion (SIADH). Marked autonomic instability related to the coexistence of Guillain-Barré syndrome and pheochromocytoma limited conventional therapeutic options. After an inadequate response to fluid restriction and oral sodium chloride supplementation, oral urea therapy was initiated, resulting in a gradual and safe correction of serum sodium without significant adverse events. Normalization of serum sodium enabled completion of preoperative management and successful adrenalectomy and colon cancer surgery, without recurrence of hyponatremia. Discussion: to our knowledge, this is the first reported case describing the successful use of oral urea for SIADH in a patient with concomitant Guillain-Barré syndrome, severe dysautonomia, and pheochromocytoma, supporting its role as an effective and safe therapeutic option when conventional treatments are limited or ineffective.
INTRODUCTION:syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the leading cause of euvolemic hypoosmolar hyponatremia and represents a therapeutic challenge in elderly patients. CASE REPORT:we report an 81-year-old woman with severe chronic obstructive pulmonary disease (COPD) and depressive disorder treated with drugs potentially associated with SIADH, who developed chronic euvolemic hyponatremia. DISCUSSION:fluid restriction and oral sodium supplementation were ineffective. Tolvaptan induced a rapid increase in serum sodium and was discontinued due to risk of overcorrection. Subsequently, oral urea (15 g/day) maintained serum sodium levels within the normal range throughout follow-up. In conclusion, this case supports oral urea as an effective, safe, and cost-efficient therapeutic option for chronic SIADH, particularly in elderly patients in whom vasopressin V2 receptor antagonists may carry a risk of overly rapid correction.
INTRODUCTION:syndrome of inappropriate antidiuretic hormone secretion (SIADH) is one of the most common causes of euvolemic hyponatremia and is especially relevant in patients with central nervous system disorders. CASE REPORT:we present the case of a 37-year-old man with a history of cerebellar medulloblastoma treated in childhood with surgery, radiotherapy, and chemotherapy, who developed long-term endocrine sequelae and intracranial tumor recurrence in adulthood, and was admitted with symptomatic hyponatremia secondary to chronic SIADH. Evaluation showed hypoosmolar hyponatremia, elevated urinary sodium, and inappropriately high urine osmolality, after excluding adrenal insufficiency by ACTH stimulation testing and confirming adequate control of central hypothyroidism. Given the recurrence of the condition and the limited suitability of vaptans, oral urea was indicated as maintenance treatment, initially at 7.5 g/day and later at 15 g every 12 hours, achieving stabilization of serum sodium levels and good clinical tolerance. DISCUSSION:this case highlights the diagnostic and therapeutic complexity of SIADH in neuro-oncological patients with associated endocrinopathies and supports the role of oral urea as an effective and safe therapeutic alternative.
INTRODUCTION:electrolyte disorders are the most common complication following pituitary surgery, with hyponatremia occurring in up to 25 % of cases. The triphasic response of antidiuretic hormone is a rare entity characterized by a sequence of transient vasopressin deficiency secondary to damage of the neurohypophyseal axonal tracts, followed by a phase of syndrome of inappropriate antidiuretic hormone secretion (SIADH) due to the release of preformed vasopressin, and finally by permanent vasopressin deficiency secondary to neuronal gliosis. CASE REPORT:we present the case of a 34-year-old woman who underwent pituitary adenoma resection and subsequently developed this complication. DISCUSSION:this case highlights the importance of close postoperative monitoring and early treatment to prevent potentially serious complications.
INTRODUCTION:the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of chronic hyponatremia. Persistent hyponatremia has been associated with multiple long-term complications. Consequently, there is increasing interest in identifying safe and effective strategies for the long-term management of this condition. CASE REPORT:we report the case of a middle-aged woman with underlying pulmonary disease and multiple hospital admissions during the previous year, who presented with moderate chronic hyponatremia meeting the diagnostic criteria for SIADH, as well as disease-related malnutrition. DISCUSSION:given her history of cancer treatment-related sequelae, outpatient treatment with oral urea was initiated. During follow-up, the patient achieved sustained eunatremia without adverse effects, and showed no deterioration in nutritional status, as assessed by bioelectrical impedance analysis.
INTRODUCTION:syndrome of inappropriate antidiuretic hormone secretion (SIADH) is an important cause of euvolemic hyponatremia and may represent the first clinical manifestation of an underlying malignancy, particularly small cell lung carcinoma. CASE REPORT:we report the case of a 71-year-old active smoker who presented to the emergency department with a three-week history of encephalopathy, including disorientation, psychomotor slowing, reduced appetite, occasional night sweats, and weight loss. Initial evaluation revealed severe symptomatic hyponatremia, requiring treatment with 3 % hypertonic saline and close monitoring. Subsequent assessment fulfilled the diagnostic criteria for SIADH. A targeted etiological work-up, including imaging studies and biopsy, confirmed the presence of pulmonary small cell carcinoma. After acute management of hyponatremia, and given its persistence, oral urea was initiated, first at a dose of 15 g/day and subsequently increased to 30 g/day, achieving progressive and sustained normalization of serum sodium levels. DISCUSSION:this case highlights the importance of considering paraneoplastic SIADH in patients with severe euvolemic hyponatremia and supports oral urea as an effective, safe, cost-effective, and practical therapeutic option for both inpatient and outpatient management of SIADH secondary to small cell lung carcinoma.
INTRODUCTION:sodium disorders following pituitary represent one of the most common complications. Differential diagnosis between syndrome of inappropriate antidiuretic hormone secretion (SIADH) and a triphasic response is critical to avoid overcorrection. CASE REPORT:we report a case of a 58-year-old male who underwent surgery for a pituitary macroadenoma and developed a triphasic response: initial polyuria, followed by transient SIADH. Due to a suboptimal response to fluid restriction and the risk of transitioning to a new polyuric phase, oral urea (30 g/day) was started. Gradual and safe sodium correction was achieved (128 to 132 mmol/l in 36 h), allowing early detection of the final shift back to diabetes insipidus without exceeding safety limits. DISCUSSION:all in all, oral urea is an effective alternative for postoperative SIADH, providing more predictable and reversible osmotic control in scenarios of fluctuating natremia.
BACKGROUND:treatment of pediatric patients with hematologic malignancies (HM) affects their nutritional status and body composition. Bioelectrical impedance analysis (BIA) parameters [resistance (R), reactance (Xc), phase angle (PhA)] are non-invasive tools for assessing these changes. The objective was to compare standardized BIA parameters [R/height (h), Xc/h] and PhA of pediatric patients with HM against a healthy reference population. METHODS:pediatric patients with HM (active treatment), anthropometric parameters [height, weight, mid-upper arm circumference (MUAC), waist circumference (WC), triceps skinfold thickness (TSF), handgrip strength (HGS)] and BIA parameters were measured before chemotherapy. Data were compared with an ethnically matched healthy reference population using t-tests and multivariate analysis of covariance (MANCOVA) with WC. RESULTS:twenty-seven children (99 months) participated. Compared to the reference population, patients showed higher R/ht (+47.8 ohms/m, p = 0.020), lower Xc/ht (-26.2 ohms/m, p < 0.001), and PhA (-2.79°, p < 0.001). HGS was lower (-2.36 kg, p = 0.002), while WC (+9.38 cm, p < 0.001), TSF (+1.60 mm, p = 0.041), and arm fat area (+2.98 cm², p < 0.001) were higher. After adjusting for WC, the differences persisted (Pillai trace = 0.773, p < 0.001). PhA remained lower in patients (adjusted difference -2.78°, p < 0.001) and was independent of WC (p = 0.969). CONCLUSIONS:patients showed impaired cellular health (low PhA) and muscle function (low HGS) coexisting with increased adiposity (WC, TSF). The reduction in PhA was independent of WC, reinforcing its role as a specific marker of cellular deterioration. Direct BIA parameters, particularly PhA, offer a valuable non-invasive tool for the early identification of nutritional risk.
OBJECTIVE:to examine associations of dietary diversity and specific food intake with abnormal sleep duration (< 6 h or > 8 h) and sleep quality among older adults in China. METHODS:this cross-sectional study used data from the 2018 Chinese Longitudinal Healthy Longevity Survey and included 12,760 adults aged ≥ 65 years. A simplified food frequency questionnaire was used to assess 15 food categories and calculate a dietary diversity score (0-15). Sleep duration was classified as normal (6-8 h) or abnormal (< 6 h or > 8 h), and sleep quality was self-rated on a five-point scale. Binary logistic regression was used for abnormal sleep duration and ordinal logistic regression for sleep quality, adjusting for sociodemographic, lifestyle, and health-related factors. RESULTS:each 1-point increase in dietary diversity score was associated with lower odds of abnormal sleep duration (OR 0.935, 95 % CI 0.919-0.951) and higher odds of better sleep quality (OR 1.117, 95 % CI 1.100-1.135). Compared with Q4, Q1 was associated with lower odds of abnormal sleep duration (OR 0.659, 95 % CI 0.588-0.739) and higher odds of better sleep quality (OR 1.804, 95 % CI 1.633-1.994), with significant dose-response relationships (p for trend < 0.001). After false discovery rate correction, higher intake of fresh fruits and vegetables was associated with lower odds of abnormal sleep duration, while higher intake of fresh fruits, eggs, legumes, and nuts was associated with better sleep quality. CONCLUSIONS:higher dietary diversity was independently associated with lower odds of abnormal sleep duration and better sleep quality among older adults.
OBJECTIVE:the single-point insulin sensitivity estimator (SPISE) is a novel insulin resistance marker; however, the longitudinal impacts of cumulative SPISE (cuSPISE) and its control patterns on cardiovascular disease (CVD) remain unclear. We investigated the associations of SPISE, cuSPISE, and its longitudinal control patterns with incident CVD in middle-aged and older adults with dysglycemia (diabetes or prediabetes). METHODS:data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). Long-term SPISE exposure and its longitudinal control patterns were characterized using cuSPISE and k-means clustering. Multivariable Cox models, restricted cubic splines (RCS), subgroup, and mediation analyses were employed to evaluate the associations between SPISE and incident CVD. RESULTS:during a median 5-year follow-up of 2,598 participants, 575 incident CVD cases were identified. SPISE and cuSPISE were inversely associated with CVD risk. Compared with the lowest cuSPISE quartile (Q1), the highest (Q4) showed a 40 % lower risk (HR = 0.60; 95 % CI: 0.44-0.81; p for trend < 0.001). RCS analysis further confirmed this inverse relationship. Furthermore, well-controlled group (HR = 0.74; 0.55-0.99, p = 0.048) and moderately-controlled group (HR = 0.80; 0.65-0.98, p = 0.031) trends were associated with lower CVD incidence than the poorly-controlled group (Cluster 3). White Blood Cell (WBC) mediated 4.49 % of the cuSPISE-CVD association. Findings remained consistent across subgroups. CONCLUSION:our findings suggest that higher SPISE and cuSPISE levels, along with well-controlled or moderately-controlled groups, are associated with a reduced risk of CVD. These results suggest that longitudinal monitoring of SPISE may provide valuable insights for CVD risk stratification among middle-aged and older populations with dysglycemia.
INTRODUCTION:evidence suggests that lifestyle habits are largely acquired within the family, where parents serve as behavioral role models. The presence of type 2 diabetes mellitus (T2D) in parents not only reflects a genetic predisposition but also indicates the coexistence of environmental and behavioral factors that increase metabolic risk within the household Objective: to evaluate dietary patterns in children with parents diagnosed with type 2 diabetes mellitus and to compare the dietary intake between parents and their children. METHODS:a cross-sectional, analytic, observational study was performed in a primary care unit, including a total of 182 individuals: 77 parents with T2D and 105 children. Dietary intake was assessed using the Mexican Food Equivalents System, macronutrient intake was calculated using a 24-hour dietary recall. RESULTS:no significant differences were observed in macronutrient intake. No participant met criteria for a healthy diet. Overall, 54.4 % were classified as having an unhealthy diet and 45.6 % as intermediate. Parents showed a higher proportion of unhealthy dietary patterns compared to children (67.5 % vs. 44.8 %, p = 0.002). Elevated consumption of sugar-sweetened beverages and low physical activity levels were observed in both groups. CONCLUSION:parents with T2D and their children exhibit predominantly inadequate dietary patterns. Although children showed slightly better dietary behavior than parents, diet quality remains poor in both groups. These findings highlight the necessity for family-based interventions targeting diet and lifestyle to reduce the intergenerational risk of metabolic diseases.
Dysphagia is a prevalent disorder that compromises the safety and efficiency of swallowing, increasing the risk of complications such as aspiration, malnutrition, and dehydration. Swallowing is a complex process involving both motor and sensory mechanisms, with sensory input playing a crucial role in bolus perception and control. In this context, modifying food texture and liquid viscosity has become a key strategy to promote safe oral intake. In addition, the experience of eating is related to the sensory perception of food, including characteristics such as taste, aroma, texture, and temperature, which influence the acceptance, enjoyment, and effectiveness of the eating process. Historically, the lack of standardized terminology has hindered clinical practice and communication among professionals, the International Dysphagia Diet Standardisation Initiative (IDDSI) framework was developed to address this gap, providing an internationally standardized system with defined levels to classify food textures and liquid consistencies. The framework includes simple, practical testing methods suitable for clinical use. Implementation of IDDSI has been associated with improved consistency in dietary adaptations and enhanced interdisciplinary communication, however, its effectiveness relies on adequate professional training, teamwork, and institutional support. IDDSI is a support tool that does not replace screenign, clinical assessment or individualized management of patients with dysphagia.
BACKGROUND:the aim of our study was to evaluate the association between neck circumference (NC) and cardiometabolic risk factors in children and adolescents with obesity. MATERIALS AND METHODS:a cross-sectional study was conducted from October to December 2024, involving 364 children and adolescents with obesity (aged 5 to 17.9 years). Participants were categorized as metabolic syndrome (MetS) or non-MetS according to the International Diabetes Federation criteria. Subjects were further divided into pre-pubertal, mid-pubertal, and post-pubertal groups. RESULTS:the cohort comprised 188 females and 176 males, with a median age of 12.7 years and a median BMI of 29.37 kg/m². MetS was diagnosed in 111 participants (30.5 %), with a prevalence of 19.8 % in pre-pubertal, 34.8 % in mid-pubertal, and 38.1 % in post-pubertal individuals. Participants with MetS had higher NC and NC z-scores, BMI, waist circumference (WC), hip circumference (HC), waist-to-height ratio (WHtR), and systolic and diastolic blood pressure. They also had higher fasting triglycerides, uric acid, fasting plasma glucose, insulin levels, and HOMA-IR. NC demonstrated significant correlations with age, BMI, WC, HC, and metabolic parameters. In multivariate logistic regression analysis, NC emerged as an independent predictor of MetS. Threshold NC values indicative of MetS were identified as 32.75 cm (pre-pubertal), 35.50 cm (mid-pubertal), and 36.25 cm (post-pubertal). CONCLUSION:this study shows that NC is markedly increased in children and adolescents with MetS and independently predicts MetS. Moreover, our findings indicate that associations between NC and cardiometabolic risk factors, supporting NC as a practical marker for cardiometabolic risk stratification in pediatric obesity.
BACKGROUND:the appropriate anthropometric indicator for identifying prevalent type 2 diabetes mellitus (T2DM) in Chinese adults, who often develop the disease at lower BMI levels, remains uncertain. METHODS:we conducted a dual-study analysis integrating longitudinal and cross-sectional evidence. First, using the Global Burden of Disease (GBD) 2023 data, we assessed the long-term trends (1990-2023) in T2DM burden attributable to high BMI among Chinese adults aged ≥ 45 years. Second, using cross-sectional data from the China Health and Retirement Longitudinal Study (CHARLS, 2015 wave, n = 8,841), we evaluated and compared the associations of eight anthropometric indices-BMI, waist circumference (WC), waist-to-height ratio (WHtR), body roundness index (BRI), conicity index (CI), weight-adjusted waist index (WWI), tri-ponderal mass index (TMI), and a body shape index (ABSI)-with prevalent T2DM. RESULTS:GBD analysis showed a sustained increase in the age-standardized burden of high BMI-attributable T2DM from 1990 to 2023, with greater rises in men than in women. In the CHARLS analysis, central obesity-related indices-particularly BRI, WC, and WHtR-showed relatively strong associations with prevalent T2DM and slightly higher discriminative performance (areas under the curve [AUC] ≈ 0.67) than BMI (AUC = 0.66) and other indices. BRI, WC, and WHtR demonstrated robust, stable associations across all demographic and lifestyle subgroups. ABSI showed the lowest discriminative ability (AUC = 0.59). CONCLUSION:central obesity-related anthropometric indices, especially BRI, WC, and WHtR, showed slightly better performance than BMI in identifying prevalent T2DM among middle-aged and older Chinese adults. These findings, against the backdrop of a longitudinally increasing population-level burden, highlight the value of incorporating simple waist-based indices into diabetes screening and prevention strategies in China.
BACKGROUND:the brain-gut axis was recognized as a bidirectional communication system linking the central and enteric nervous systems through neural, hormonal, immune, and metabolic pathways. It played a pivotal role in early-life neurodevelopment, immune programming, and gastrointestinal function. Although the field had grown rapidly, a comprehensive bibliometric evaluation of global research trends, hotspots, and collaborations was lacking. METHODS:we conducted a bibliometric and visualized analysis of publications on the brain-gut axis in early life from 2004 to 2024, using the Web of Science Core Collection (WoSCC) database. CiteSpace was used to generate co-authorship, institutional collaboration, keyword co-occurrence, and co-citation networks, as well as burst detection, timeline views, and dual-map overlays. RESULTS:a total of 1,429 publications were analyzed. Research output increased steadily from 2015 and peaked in 2023, reflecting growing global interest. The United States and China were the most productive countries, with strong collaborative ties observed among institutions in North America, Europe, and East Asia. University College Cork, University of California System, and Harvard University were the leading institutions, while J. F. Cryan, T. G. Dinan, and G. Clarke were the most influential authors. Early studies focused on anatomical and developmental aspects, while recent hotspots included autism spectrum disorder, intestinal permeability, fecal microbiota transplantation, and psychological stress. Mechanistic keywords highlighted short-chain fatty acids, tryptophan metabolism, vagus nerve signaling, and microglia-immune interactions. CONCLUSIONS:this study provided a comprehensive bibliometric overview of early-life brain-gut axis research over the past two decades. It revealed dynamic thematic evolution, expanding interdisciplinary collaboration, and the emergence of translational opportunities. These findings offer a valuable reference for future research directions in pediatric neurogastroenterology and microbiota-based interventions.
