Water quality under the changing climatic condition: a review of the Indian scenario

The current work reviews the state of Indian water quality under the climate change regime. Rising temperatures will lead to higher concentration of pollutants like nutrients (nitrates, phosphates etc.), persistent organic pollutants and pesticides. Probable negative consequences include increase in harmful algal blooms, toxicity hazards in people etc. Rising temperatures could lead to release of higher amounts of fluoride and uranium due to prevalence of drier oxic conditions, and also arsenic due to release from iron (hydr)oxides. Implications on emerging contaminants, a new class of pollutants without any regulatory status, is not clearly understood. Prevalence of microbes in water is also predicted to increase. Coastal aquifers appear to be at risk from salt water intrusion. Conflicts on the international and national platform is predicted to rise due to issues with sharing of water. Lastly, we also discuss the sustainability options for water in India under a changing climatic regime, under three broad subcategories signifying the roles of (1) science, (2) policies and legal framework and the (3) people perspective, while also highlighting the existing lacunae.by Nilotpal Das, Chandan Mahanta and Manish Kuma

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran