We used clearance and free-flow micropuncture techniques to evaluate the influence of several diuretic agents, given both individually and in various combinations, on transport of sodium, potassium, and fluid, and on acidification and ammonium transport, within the distal tubule of the rat kidney. The loop diuretics, furosemide and piretanide, sharply increased fractional delivery of fluid, sodium, and potassium into the distal tubule, and, as a result, sodium reabsorption and potassium secretion were enhanced in this nephron segment. These two drugs also stimulated urinary acidification and increased urinary phosphate, titratable acid, and ammonium excretion. These effects took place both within the loop of Henle and along the distal tubule. Amiloride and triamterene alone inhibited distal tubular sodium reabsorption and potassium secretion, and, when given with one of the loop diuretics, suppressed both the kaliuresis and the increased acid and ammonium excretion induced by the latter agents. Hydrochlorothiazide and tizolemide inhibited sodium reabsorption within the distal tubule, and were associated with a stimulation of potassium secretion within this segment. Addition of one of these two latter distally acting agents to either of the loop diuretics led to a further augmentation of sodium excretion, but to a reduction of potassium excretion, compared to the responses seen after the loop diuretics alone.

SARS-CoV-2, and its clinical manifestation as COVID-19, is an ongoing global pandemic. Patients with COVID-19 can present with numerous otolaryngologic conditions, such as Bell palsy (BP). Bell palsy is a unilateral peripheral facial nerve palsy of sudden onset. Several case reports and series have described peripheral facial nerve palsies associated with COVID-19. 1 In addition, since the US Food and Drug Administration's (FDA) emergency use authorization of several COVID-19 vaccines, there have been media reports of BP associated with vaccination. 2 Such concerns could erode vaccine confidence and exacerbate public hesitancy to obtain a COVID-19 vaccine. We used data from a large health research network to estimate the incidence of BP in patients with COVID-19 vs individuals vaccinated against the disease.Methods | The institutional review board at Case Western Reserve University deemed this cohort study exempt from review and waived the requirement for patient informed consent because deidentified information, aggregated counts, and statistical summaries of electronic medical records were used. These data were collected from 41 health care organizations worldwide and accessed through TriNetX, a global federated research network. Queries were made on April 7, 2021, to identify patients diagnosed with COVID-19 (January 1, 2020, to December 31, 2020) with or without a diagnosis code of BP within 8 weeks of the COVID-19 diagnosis. Among these patients, we identified those with a history of BP. To account for vaccination, the queries were restricted from January 1, 2021, to March 31, 2021. Using TriNetX to evaluate BP as our outcome, we matched 63 551 non-vaccinated patients with COVID-19 to those who were vaccinated against the disease and had no history of COVID-19 infection.

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