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ABSTRACTAims To explore the global trends in blended learning in undergraduate dental education during the COVID pandemic and during the recovery phase by engaging with the students and faculty and evaluate the implications for dental education in the post-COVID era.Methods It was a pilot cross-sectional study which employed a convenience sampling technique to recruit representatives of dental faculty and undergraduate students in 80 dental institutions globally. A previously validated questionnaire consisting of a combination of closed and open-ended items was used for data collection. Responses to these online questionnaires were processed and analysed using the R statistical computing environment.Results A total of 320 dental students and 169 faculty members from 47 different dental institutions participated in the study. Video and Live Online Tutorials were considered to be the most effective method of online learning followed by online question banks by both groups. Significant differences were noted between faculty and students regarding time spent and effectiveness of online teaching and learning, respectively, both before and after the start of COVID. The results highlight the faculty need to engage more closely with the students to address their learning needs. Finally, the participants provided several recommendations regarding the future development of teaching and learning strategies as well as assessments in the post-pandemic era.Conclusions This is the first study which explores blended learning in dental education with participants from multiple institutions in different regions of the globe. Compared to the faculty, students considered online learning to be less interactive and preferred learning activities and all assessments to be delivered face-to-face. The results underscore the need to adapt teaching practices to suit the learning needs of the students.

The COVID-19 pandemic has caused various psychological problems worldwide, such as fear, anxiety, and depression. Since the fear of the pandemic can adversely affect disease management, it must be measured appropriately. This study aims to verify the validity and reliability of the Arabic version of FCV-19S and its relation to future anxiety in Jordanians. This cross-sectional study was conducted from September 8 to 28, 2020 on a sample of 760 Jordanian participants. According to the results, the seven items of the scale were loaded on one component, and they explained 66.3% of the total variance. Both the classical test theory and the item response theory (Rasch model) were used to evaluate the psychometric properties of the fear of COVID-19 scale items. The internal consistency (α) was0.91. The concurrent validity was supported by the future anxiety scale (r = 0.87).The Rasch model offered good psychometric properties for the Jordanian version of the FCV-19S. The measurement invariance showed no differences concerning gender or age. The Jordanian FCV-19S was thus found to be an effective screening scale for assessing the fear of COVID-19 among the adult Jordanian population.

Bullous pemphigoid (BP), the by far most frequent autoimmune subepidermal blistering disorder (AIBD), is characterized by the deposition of autoantibodies against BP180 (type XVII collagen; Col17) and BP230 as well as complement components at the dermal-epidermal junction (DEJ). The mechanisms of complement activation in BP patients, including the generation of C5a and regulation of its two cognate C5aRs, i.e., C5aR1 and C5aR2, are incompletely understood. In this study, transcriptome analysis of perilesional and non-lesional skin biopsies of BP patients compared to site-, age-, and sex-matched controls showed an upregulated expression of C5AR1, C5AR2, CR1, and C3AR1 and other complement-associated genes in perilesional BP skin. Of note, increased expressions of C5AR2 and C3AR1 were also observed in non-lesional BP skin. Subsequently, double immunofluorescence (IF) staining revealed T cells and macrophages as the dominant cellular sources of C5aR1 in early lesions of BP patients, while C5aR2 mainly expressed on mast cells and eosinophils. In addition, systemic levels of various complement factors and associated molecules were measured in BP patients and controls. Significantly higher plasma levels of C3a, CD55, and mannose-binding lectin-pathway activity were found in BP patients compared to controls. Finally, the functional relevance of C5aR1 and C5aR2 in BP was explored by two in vitro assays. Specific inhibition of C5aR1, resulted in significantly reduced migration of human neutrophils toward the chemoattractant C5a, whereas stimulation of C5aR2 showed no effect. In contrast, the selective targeting of C5aR1 and/or C5aR2 had no effect on the release of reactive oxygen species (ROS) from Col17-anti-Col17 IgG immune complex-stimulated human leukocytes. Collectively, this study delineates a complex landscape of activated complement receptors, complement factors, and related molecules in early BP skin lesions. Our results corroborate findings in mouse models of pemphigoid diseases that the C5a/C5aR1 axis is pivotal for attracting inflammatory cells to the skin and substantiate our understanding of the C5a/C5aR1 axis in human BP. The broad expression of C5aRs on multiple cell types critical for BP pathogenesis call for clinical studies targeting this axis in BP and other complement-mediated AIBDs.

The rapid spread of smart mobile technology is transforming the way how governments provide information and services to their citizens. We all are rely more on our devices, namely smartphones, laptops, or desktop to get information and a wide range of services from government websites. Such heavy usage of government websites results in an increased need for efficient and effective delivery of government services. Therefore, mobile government websites’ usability and accessibility are essential dimensions that determine the quality and accessibility of mobile e-government. The main objective of this research is to analyze the accessibility and usability aspects of selected public sector websites in Saudi Arabia. This study investigates how well the Saudi mobile e-government websites comply with usability standards and accessibility guidelines recommended in the Web Content Accessibility Guidelines (WCAG). Websites assessments were conducted using manual evaluation and complemented by different automated analysis tools. This study applies a number of evaluation techniques to assess Saudi government websites accessed from desktop or mobile devices, such as an automated website testing technique, mobile-friendliness testing, and content observation technique. Various tools have been used for site evaluation, such as GTmetrix (PageSpeed Score, YSlow Score), WAVE, Google mobile-friendly test, and Dareboost for mobile websites. The study uncovers shortcomings regarding non-compliance to international web standards recommendations. The findings revealed usability and accessibility problems that affect the performance of government websites. In order to improve these websites within these aspects, several recommendations were suggested for improving the usability and accessibility of websites in Saudi Arabia that will make sure different groups of citizens are satisfied with the website features and services provided by them.

Abstract Background Optimal orthodontic force results in maximum rate of tooth movement without tissue damage. Even though starting orthodontic treatment with a thicker archwire may shorten treatment duration, the evidence on the effect of using 0.018-inch NiTi as the first alignment archwire on pulpal blood flow (PBF) status is still scarce. Objectives to record PBF changes and pain scores associated with using 0.018-inch NiTi as the first alignment archwire during fixed orthodontic treatment. Methodology Patients were selected from subjects attending postgraduate orthodontic teaching clinics at Jordan University of Science and Technology. In total, forty healthy patients who exhibited mild lower arch crowding were included. A split-mouth trial design was used. Each patient received two archwire sizes at one time joined in the midline by crimpable hook and applied in the lower arch. Patients were assigned into one of two groups based on archwire sizes used. Group 1: 0.014-inch and 0.018-inch NiTi (Six males, 14 females aged 19.4±1.33 years) and Group 2: 0.016-inch and 0.018-inch NiTi (Seven males, 13 females aged 19.6±1.45 years). The archwire size group was randomly allocated with a 1:1 allocation ratio. A Laser Doppler Flowmeter was used to measure PBF at different time intervals (T0-T5). Pain scores were recorded using a visual analogue scale (VAS). A repeated measures ANOVA and a post-hoc Bonferroni comparison tests were conducted to examine differences at the different time points before and during orthodontic alignment. Results For all studied archwire sizes, PBF decreased 20 minutes after their placement. Most PBF changes occurred within 24hours and continued to decrease until 72 hours after archwire placement where the maximum reduction was reached. Eventually, normal values were reverted within 1 month. PBF changes were similar between all alignment – groups. Conclusions Initial orthodontic alignment with 0.018-inch NiTi does not cause irreversible changes to pulpal vasculature or produces higher pain scores.

Background: TK2 is a nuclear gene encoding the mitochondrial matrix protein thymidine kinase 2 (TK2), a critical enzyme in the mitochondrial nucleotide salvage pathway. Deficiency of TK2 activity causes mitochondrial DNA (mtDNA) depletion, which in humans manifests predominantly as a mitochondrial myopathy with onset typically in infancy and childhood. We previously showed that oral treatment of the Tk2 H126N knock-in mouse model (Tk2−/−) with the TK2 substrates, deoxycytidine (dCtd) and thymidine (dThd), delayed disease onset and prolonged median survival by 3-fold. Nevertheless, dCtd + dThd treated Tk2−/− mice showed mtDNA depletion in brain as early as postnatal day 13 and in virtually all other tissues at age 29 days. Methods: To enhance mechanistic understanding and efficacy of dCtd + dThd therapy, we studied the bioavailability of dCtd and dThd in various tissues as well as levels of the cytosolic enzymes, TK1 and dCK that convert the deoxynucleosides into dCMP and dTMP. Findings: Parenteral treatment relative to oral treatment produced higher levels of dCtd and dThd and improved mtDNA levels in liver and heart, but did not ameliorate molecular defects in brain or prolong survival. Down-regulation of TK1 correlated with temporal- and tissue-specificity of response to dCtd + dThd. Finally, we observed in human infant and adult muscle expression of TK1 and dCK, which account for the long-term efficacy to dCtd + dThd therapy in TK2 deficient patients. Interpretations: These data indicate that the cytosolic pyrimidine salvage pathway enzymes TK1 and dCK are critical for therapeutic efficacy of deoxynucleoside therapy for Tk2 deficiency. Fund: National Institutes of Health P01HD32062. Keywords: Thymidine kinase 2, TK2, mtDNA depletion syndrome, Nucleoside, Deoxycytidine, Thymidine

Introduction: Ankle arthrodesis using the Ilizarov technique provides high union rate with the added benefits of early weight-bearing, and the unique advantage of its ability to promote regeneration of soft tissue around the bone, including skin, muscle and neuro-vascular structures, and its versatility to allow correction of the position of the foot by adjusting the frame post-operatively as needed. We describe our experience with this technique and the functional outcomes in our patients. Materials and Methods: This retrospective study was conducted in 20 ankle fusion cases using the Ilizarov method between the years 2007 and 2017. We defined success in treatment by loss of preoperative symptoms and radiological union on plain radiographs of the ankle. Results: Fusion was achieved in all patients (100%). Immediate post-operative ambulation was with full weight bearing (FWB) in 16 (83%) of the participants and non-weight bearing (NWB) in 3 patients (17%). Postprocedure 11 patients (67%) of the participants who were full weight bearing required some form of support for walking for 2-3 weeks. Post-operatively three patients had pin tract infection requiring intravenous antibiotics. Radiological union took range of 6-12 weeks, mean union time was 8 weeks. Only one patient required bone grafting due to bone loss. Average follow-up period was 10-45 months. Conclusion: The Ilizarov technique has a high union rate and leads to general favourable clinical outcome and may be considered for any ankle arthrodesis but is especially useful in complex cases such as for revisions, soft-tissue compromise, infection and in patients with risk for non-union. Early weight bearing is an extra benefit.

Blended learning is growing in popularity particularly following the emergence of COVID-19 pandemic. One of the fields that the pandemic has substantially affected is dental education. Purpose: The aim of this study was to evaluate the quality and effectiveness of the online dental education. Students’ perceptions and experiences of blended learning were also investigated. Methods: A 28-question online survey was designed to gauge students’ perceptions of the effect of blended learning on their academic performance. Results: 314 participants in preclinical and clinical years completed the questionnaire (223 females and 91 males). The majority of students (89%) believed that clinical and practical courses cannot be given by the internet. In terms of students’ opinion in the assessment process, more females (65.8%) preferred traditional exams than males (50.5%) (p < 0.05). Most clinical students (83%) preferred a combination of online and traditional teaching compared to 72% of preclinical students (p < 0.05). Clinical year students were more willing to communicate electronically with their classmates and instructors. The majority of dental students (65%) reported that future dental courses should be blended. Conclusions: In the pandemic era, blended learning, should become the preferred method of education whereby theoretical knowledge is delivered through online tutorials and clinical training is resumed on-site, to ensure competency of dental graduates while maintaining safety of the dental team. Current facilities and course designs should be improved in order to improve students’ experiences with blended learning.

The purpose of this study is to specify the length-weight relationship and to evaluate the relative condition factor of toothpony (Gazza minuta Bloch 1795) in Pabean Bay, Indramayu, West Java. The fish collection was carried out monthly from January 2016 to December 2016, and a total of 190 individual fishes were caught using gillnet with mesh sizes varying from 1 to 2 inches. The fish samples ranged from 30 – 138mm in length and 0.41 – 35.83 g in weight. The length-weight relationship was W= 1.51 10-4 L2.388, and the condition factors of fish varied from 1.1 ± 0.22 to 2.03 ± 2.29. These results indicate that the growth pattern of toothpony (Gazza minuta Bloch 1795) in Pabean Bay was allometric negative.

Intoxication from cannabis impairs cognitive performance, in part due to the effects of Δ9-tetrahydrocannabinol (THC, the primary psychoactive compound in cannabis) on prefrontal cortex (PFC) function. However, a relationship between impairment in cognitive functioning with THC administration and THC-induced change in hemodynamic response has not been demonstrated. We explored the feasibility of using functional near-infrared spectroscopy (fNIRS) to examine the functional changes of the human PFC associated with cannabis intoxication and cognitive impairment. Eighteen adult regular cannabis users (final sample, n = 13) performed a working memory task (n-back) during fNIRS recordings, before and after receiving a single dose of oral synthetic THC (dronabinol; 20–50 mg). Functional data were collected using a continuous-wave NIRS device, in which 8 Sources and 7 detectors were placed on the forehead, resulting in 20 channels covering PFC regions. Physiological changes and subjective intoxication measures were collected. We found a significant increase in the oxygenated hemoglobin (HbO) concentration after THC administration in several channels on the PFC during both the high working memory load (2-back) and the low working memory load (0-back) condition. The increased HbO response was accompanied by a trend toward an increased number of omission errors after THC administration. The current study suggests that cannabis intoxication is associated with increases in hemodynamic blood flow to the PFC, and that this increase can be detected with fNIRS.

Background: Blended learning is growing in popularity particularly following the emergence of COVID-19 pandemic. One of the fields that the pandemic has substantially affected is dental education. Purpose: The aim of this study was to evaluate the quality and effectiveness of the online dental education. Students' perceptions and experiences of blended learning were also investigated. Methods: A 28-question online survey was designed to gauge students' perceptions of the effect of blended learning on their academic performance. Results: 314 participants in preclinical and clinical years completed the questionnaire (223 females and 91 males). The majority of students (89%) believed that clinical and practical courses cannot be given by the internet. In terms of students' opinion in the assessment process, more females (65.8%) preferred traditional exams than males (50.5%) (p < 0.05). Most clinical students (83%) preferred a combination of online and traditional teaching compared to 72% of preclinical students (p < 0.05). Clinical year students were more willing to communicate electronically with their classmates and instructors. The majority of dental students (65%) reported that future dental courses should be blended. Conclusions: In the pandemic era, blended learning, should become the preferred method of education whereby theoretical knowledge is delivered through online tutorials and clinical training is resumed on-site, to ensure competency of dental graduates while maintaining safety of the dental team. Current facilities and course designs should be improved in order to improve students' experiences with blended learning.

Aims: To explore the global trends in blended learning in undergraduate dental education during the COVID pandemic and during the recovery phase by engaging with the students and faculty and evaluate the implications for dental education in the post-COVID era. Methods: It was a pilot cross-sectional study which employed a convenience sampling technique to recruit representatives of dental faculty and undergraduate students in 80 dental institutions globally. A previously validated questionnaire consisting of a combination of closed and openended items was used for data collection. Responses to these online questionnaires were processed and analysed using the R statistical computing environment. Results: A total of 320 dental students and 169 faculty members from 47 different dental institutions participated in the study. Video and Live Online Tutorials were considered to be the most effective method of online learning followed by online question banks by both groups. Significant differences were noted between faculty and students regarding time spent and effectiveness of online teaching and learning, respectively, both before and after the start of COVID. The results highlight the faculty need to engage more closely with the students to address their learning needs. Finally, the participants provided several recommendations regarding the future development of teaching and learning strategies as well as assessments in the post-pandemic era. Conclusions: This is the first study which explores blended learning in dental education with participants from multiple institutions in different regions of the globe. Compared to the faculty, students considered online learning to be less interactive and preferred learning activities and all assessments to be delivered face-to-face. The results underscore the need to adapt teaching practices to suit the learning needs of the students. [ABSTRACT FROM AUTHOR]

Introduction: Thiamin deficiency, which is an overlooked but important cause of lactic acidosis, can lead to several clinical symptoms, including neuropathy, cardiogenic shock, and death, even though it can be easily treated in critically ill children. Methods: A single-center, retrospective cohort study conducted between March 2020 and March 2022. Results: Twenty-two patients were included in the study. The mean age was 26.5 (range, 1-214) months. The median thiamin dose was 50 (range, 3-100) milligrams and the mean thiamin treatment duration was 4 (range, 1-16) days. The mean length of PICU when thiamin treatment was started was 8 (range, 2-177) days. Thiamin treatment was administered on the 2nd (1-5) day of lactic acidosis. The mean lactate values after thiamin treatment was 5.5 (range, 5-17) mmol/L at the 6th hour, 4.1 (range, 1.5-17) mmol/L at the 12th hour, 3.1 (1.4-20) mmol/L at the 24th hour, and 2.7 (range, 0.15-17) mmol/L at 48th hour. Eleven (50%) patients’ lactate levels decreased below 4 mmol/L at the 12th hour of thiamin treatment. Blood gas values before thiamin treatment, lactate decrease trends, thiamin treatments’ duration, and form, and patients’ risk factors were not statistically significant in the two groups by 28-day mortality. Conclusion: We believe that in patients with lactic acidosis not directly related to a circulatory disorder, low clinical suspicion and early thiamin treatment of lactic acidosis is the right approach in the absence of specific diagnostic tests.

Introduction: The discharge rates of newborns dependent on medical technology and in need of palliative care have increased. Specialized care units aimed to reduce patient load in neonatal intensive care units (NICU), and increase the quality of home care. In our country, there are few specialized care units for these patients. This study aimed to determine the characteristics of patients who were hospitalized in NICU and transferred to pediatric intensive care unit (PICU) due to continuing care. Methods: The data of patients who were hospitalized in NICU between January 1, 2008 and July 31, 2022 and transferred to PICU were analyzed. Results: Twenty (51%) of 39 patients were male, 46% had congenital anomaly(s), 33% had neurometabolic diseases. Fourty-nine percent (n=19) of patients died during PICU stay, 2.6% (n=1) died after discharge. Demographic findings of died and survived patients were similar. Ninety percent of patients received invasive respiratory support (IRS) for a median of 43 days during NICU, 97% received IRS for a median of 31 days during PICU. Percutaneous endoscopic gastrostomy (PEG) and tracheostomy were performed 31%, and 51% of patients, respectively. The median length of stay in NICU and PICU were 55 days and 37 days, respectively. The discharged patients had a higher rate of PEG or tracheostomy (p

Objectives: To evaluate and compare the maxillary sinus (MS) dimensions and volume in unilaterally displaced palatal and buccal maxillary canines. Methods: CBCT images for 133 patients were included in the study. Maxillary canines were unilaterally displaced palatally in 83 patients (PDCs) and buccally in 50 patients(BDCs). The following variables were measured: canine position in relation to MS walls, MS pneumatization and MS dimensions and volume. Results: MS was extended to the incisor region in 10% and 13% and to the canine region in 48% and 23% in BDCs and PDCs subjects, respectively. In BDC subjects, maxillary canine crown tip was more laterally (24.23 mm compared to 22.93 mm (p < 0.05)) and closer vertically (5.82 mm compared to 9.58 mm (p < 0.001)) to the MS, maxillary canine root tip was closer to the MS anterior (0 mm compared to 1.64 mm (p < 0.05)) and lateral (19.70 mm compared to 22.02 mm (p < 0.001)) walls and the MS volume (11.57mm3 compared to 9.09 mm3 (p < 0.001)) was increased in the displaced side compared to the non-displaced side. In PDC subjects, a significant difference between the displaced and non-displaced sides was detected in the vertical (3.28 mm compared to 5.89 mm (p < 0.001)) and lateral (21.63 mm compared to 24.25 mm (p < 0.001)) position of maxillary canine to the MS wall, the anterior (− 0.84 mm compared to 1.13 mm (p < 0.05)) and lateral (20.48 mm compared to 22.44 mm (p < 0.001)) position of canine root tip to the MS and the MS volume (7.71mm3 compared to 9.14mm3 (p < 0.001)). PDC sides differed from BDC sides in the lateral and vertical position of canine crown tip to MS and in MS volume. PDC showed negative association with MS volume and anteroposterior skeletal relationship and a positive association with MS height. Conclusions: PDCs subjects have a reduced MS volume and BDCs subjects have an increased MS volume. PDCs are associated with reduced MS volume, increased MS height and Class III skeletal relationship. [ABSTRACT FROM AUTHOR]

The primary aim of this work was to determine the effects of production parameters, such as wood species and timber strength classes, on some mechanical properties of cross-laminated timber (CLT) panels using artificial neural network (ANN) prediction models. Subsequently, using the models obtained from the analyses, the goal was to identify the optimum layer combinations of timber strength classes used in the middle and outer layers that would provide the highest mechanical properties for CLT panels. CLT panels made from spruce and alder timbers, as well as hybrid panels created from combinations of these two wood species, were produced. The strength classes of the timbers were determined non-destructively according to the TS EN 338 (2016) standard using an acoustic testing device. The bending strength and modulus of elasticity values of the CLT panels were determined destructively according to the TS EN 408 (2019) standard. According to ANN results, the optimum timber strength classes and layer combinations were determined for bending strength as C24-C27-C24 for spruce CLT, D18-D24-D18 for alder CLT, C30-D40-C30 and D18-C30-D18 for hybrid panels; and for modulus of elasticity, C22-C27-C22 for spruce, D35-D30-D35 for alder, C16-D24-C16, and D24-C24-D24 for hybrid panels.

Metaverse offers opportunities for companies to create innovative business models by providing a virtual platform where they can sell products and services and interact with customers in new and unique ways. Extended Reality (XR), Augmented Reality (AR), Mixed Reality (MR) and Mirror World technologies are important technological pathways for the metaverse. The metaverse concept is changing organizational structures with new opportunities and shaping the workforce for the future environment. The purpose of this review article is to discuss the concept of metanomics, the business implications of the metaverse in the context of the economy, business and employee-based value, future workforce, B2B opportunities and new business models. The concept of metaptation was associated with the metaverse in later studies to be conceptualized within the framework of adaptation theory. This review concludes by asserting that as the metaverse continues to evolve, driven by advancements in XR, AR, MR, and Mirror World technologies, it will not only revolutionize traditional business models but also necessitate a new paradigm of metaptation, where businesses must continuously adapt to harness the full potential of the metaverse in the realms of economic growth, innovative B2B opportunities, workforce development, and customer engagement. In order to be successful in this dynamic change process, businesses should adopt a strategic approach to adopting these innovative technologies. These strategic steps of businesses will contribute to gaining competitive advantage by enabling them to make the most of the commercial potential of the Metaverse.

This study focuses on the comparative analysis of ABS polymer samples produced using two distinct manufacturing techniques: 3D printing and the sol-gel methods. In the first approach, ABS polymer was augmented with rare earth oxides, Er2O3 and Gd2O3, in nano powder form and fabricated into test specimens using 3D printing technology. In the second approach, identical samples were prepared via the sol-gel technique involving mold-based fabrication. Elemental content analysis revealed no significant differences between the samples produced by the two methods. The study proceeds to evaluate the gamma-ray shielding, neutron shielding, temperature resistance, and SEM/EDS pictures of ABS samples generated through both techniques. 3D printing method exhibited more favorable results in terms of structure morphology and thermal stability while there is no significant difference for radiation shielding. The results provide insights into the performance and suitability of each production method for radiation shielding applications. This research not only contributes to enhancing radiation shielding technology but also informs the selection of the most appropriate fabrication method for specific applications in nuclear technologies and diagnostic energy range in medical purposes.

Abstract Background This research investigated surgical interventions for the treatment of extremity and pelvic fractures and aimed to provide an analysis of management challenges under crisis conditions in a Level I Trauma Center after Türkiye’s February 6, 2023, earthquakes. Methods The study was a retrospective examination of the medical records of 243 fracture cases associated with the earthquakes. The age, gender, time of admission, types of extremity and pelvic fractures, anatomical localizations, and surgical treatment methods for fractures were recorded. The results of these parameters were evaluated in detail, together with the results of other surgical treatments performed in the hospital in the first week after the disaster, such as fasciotomy, amputation, and wound debridement. Results Most of the 243 (119 males and 124 females) patients with extremity fractures and pelvic fractures receiving surgical treatment were adults (n = 182, 74.9%). The most common lower extremity fractures among all fracture cases were tibial shaft (30.8%) and femoral shaft (20.6%) fractures. A total of 33 patients had surgical procedures for the treatment of two or more significant bone fractures involving either the extremity or the pelvic ring. The analysis showed that the median age of patients who underwent surgery due to extremity and pelvic fractures was 36 years, with a range of 1 to 91 years, which was statistically increased compared to patients who received surgery for other musculoskeletal injuries such as fasciotomy, amputation and debridement (p

ObjectiveThe objective of this study was to evaluate the efficacy and safety of isotonic and hypotonic intravenous fluids in maintenance fluid therapy for term infants.MethodsThis was a multi-centre, prospective, observational study conducted in 21 participating centres from December 30, 2020, to June 30, 2023. The study included term newborns requiring parenteral fluid therapy for maintenance (NCT04781361). The fluid treatment was divided into two groups based on the concentration of sodium in the parenteral fluid, designated as hypotonic (NaCl 145 mmol/L), and the occurrence of clinically significant changes in sodium levels (∆pNa >0.5 mmol/L/h).ResultsA total of 420 patients from 21 centers were included. The ∆pNa was negative in the hypotonic fluid group and positive in the isotonic fluid group, with a significant difference between the groups [respectively −0.07 ± 0.03 (95% CI: −0.13 to −0.02); 0.04 ± 0.03 (95%CI: −0.02 to 0.09), p = 0.04]. There was no difference between the groups in terms of the development of hypernatremia or a clinically meaningful pNa increase. The hypotonic fluid group had a higher incidence of hyponatremia and a clinically meaningful sodium decrease compared to the isotonic fluid group [7.9% vs. 1.2% (OR:6.5, p:0.03)] and [12.2% vs.4.2% (OR:2.9, p = 0.03)].ConclusionContrary to current understanding, this large-scale study is the first to demonstrate that the use of hypotonic fluids in maintenance fluid therapy for newborns poses a risk of hyponatremia development, whereas isotonic fluid therapy appears safe.