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OBJECTIVE: To determine if initial fluid resuscitation with balanced crystalloid (e.g., multiple electrolytes solution [MES]) or 0.9% saline adversely affects kidney function in children with septic shock. DESIGN: Parallel-group, blinded multicenter trial. SETTING: PICUs of four tertiary care centers in India from 2017 to 2020. PATIENTS: Children up to 15 years of age with septic shock. METHODS: Children were randomized to receive fluid boluses of either MES (PlasmaLyte A) or 0.9% saline at the time of identification of shock. All children were managed as per standard protocols and monitored until discharge/death. The primary outcome was new and/or progressive acute kidney injury (AKI), at any time within the first 7 days of fluid resuscitation. Key secondary outcomes included hyperchloremia, any adverse event (AE), at 24, 48, and 72 hours, and all-cause ICU mortality. INTERVENTIONS: MES solution (n = 351) versus 0.9% saline (n = 357) for bolus fluid resuscitation during the first 7 days. MEASUREMENTS AND MAIN RESULTS: The median age was 5 years (interquartile range, 1.3-9); 302 (43%) were girls. The relative risk (RR) for meeting the criteria for new and/or progressive AKI was 0.62 (95% CI, 0.49-0.80; p < 0.001), favoring the MES (21%) versus the saline (33%) group. The proportions of children with hyperchloremia were lower in the MES versus the saline group at 24, 48, and 72 hours. There was no difference in the ICU mortality (33% in the MES vs 34% in the saline group). There was no difference with regard to infusionrelated AEs such as fever, thrombophlebitis, or fluid overload between the groups. CONCLUSIONS: Among children presenting with septic shock, fluid resuscitation with MES (balanced crystalloid) as compared with 0.9% saline resulted in a significantly lower incidence of new and/or progressive AKI during the first 7 days of hospitalization. [ABSTRACT FROM AUTHOR]

Archaea (Archaebacteria) are a phenotypically diverse group of microorganisms distributed mainly in extreme environments throughout the world. To study the community of archaea present in the extreme salty marshes of the Rann of Kutch, Gujarat, India culturedependent approach was employed for isolating archaea by mimicking extreme hypersaline environment and 25 extreme halophilic archaea were obtained. Phylogenetic analysis revealed the presence of a number of uncultivated and unidentified members of archaea among the isolates present. Phylogenetic analysis involving the sequence data of 16S rRNA of 25 haloarchaeal isolates, keeping Methanospirillium hungatei DSM864 (M60880) as the out-group, also identified a novel lineage of three isolates. The 16S rRNA sequences of the strains 3A1-DGR, H9-DGR and 2ANA-DGR showed less than 93% similarity with the available known type strains and these three strains belong to a distinct novel lineage within the family Halobacteriaceae, near an uncultivated environmental cluster. [ABSTRACT FROM AUTHOR]