International criteria for acute kidney injury: advantages and remaining challenges

• Acute Kidney Injury (AKI) is defined using widely accepted international criteria that are based on changes in serum creatinine concentration and degree of oliguria. • AKI, when defined in this way, has a strong association with poor patient outcomes, including high mortality rates and longer hospital admissions with increased resource utilisation and subsequent chronic kidney disease. • The detection of AKI using current criteria can assist with AKI diagnosis and stratification of individual patient risk. • The diagnosis of AKI requires clinical judgement to integrate the definition of AKI with the clinical situation, to determine underlying cause of AKI, and to take account of factors that may affect performance of current definitions

Clinical Characteristics and Outcomes of Drug-Induced Acute Kidney Injury Cases

Introduction Drug-induced acute kidney injury (DI-AKI) is a frequent adverse event. The identification of DI-AKI is challenged by competing etiologies, clinical heterogeneity among patients, and a lack of accurate diagnostic tools. Our research aims to describe the clinical characteristics and predictive variables of DI-AKI. Methods We analyzed data from the DIRECT study (NCT02159209), an international, multi-center, observational cohort study of enriched clinically adjudicated DI-AKI cases. Cases met the primary inclusion criteria if the patient was exposed to at least one nephrotoxic drug for a minimum of 24 hours prior to acute kidney injury (AKI) onset. Cases were clinically adjudicated and inter-rater reliability (IRR) was measured using Krippendorff's alpha. Variables associated with DI-AKI were identified using L1 regularized multivariable logistic regression. Model performance was assessed using the area under the receiver operating characteristic curve (ROC AUC). Results 314 AKI cases met the eligibility criteria for this analysis, and 271 (86%) cases were adjudicated as DI-AKI. The majority of the AKI cases were recruited from the United States (68%). The most frequent causal nephrotoxic drugs were vancomycin (48.7%), non-steroidal anti-inflammatory drugs (18.2%), and piperacillin/tazobactam (17.8%). The IRR for DI-AKI adjudication was 0.309. The multivariable model identified age, vascular capacity, hyperglycemia, infections, pyuria, serum creatinine trends, and contrast media as significant predictors of DI-AKI with good performance, ROC AUC 0.86. Conclusions The identification of DI-AKI is challenging even with comprehensive adjudication by experienced nephrologists. Our analysis identified key clinical characteristics and outcomes of DI-AKI compared to other AKI etiologies

A STUDY ON AUTOMATIC PVC PIPE CUTTING

In the process of production of any components from steel bar stock, the preliminary process is that of cutting-of bar stock to length according to the finished size requirement of work piece. This process is normally done by an power hacksaw machine.The sequence of operation is as follows:1.Feed bar stock to stopper that is set according to length of work piece to becut.2.Clamp the bar stock.3.Feed the cutter blade to cut the requiredlength.4.Retract thecutter.5.De-clamp the work piec

Research on Natural Polymer in Execution of Raft Forming Gastro- Retentive Drug Delivery System

For the treatment of gastrointestinal ulcers, raft forming systems incorporating Nizatidine were developed to provide sustained drug release and prolong gastric residence time. The raft forming formulations contained Nizatidine as a raft forming agent, Isabgol as a gelling polymer and sodium bicarbonate as an agent to generate gas and calcium carbonate as an agent to strengthen gels. Sodium bicarbonate, along with divalent Ca++ ions, forms a floating raft loaded with drugs. Raft formulation was optimized by applying Full Factorial Design of 33. Testing was done on all batches for pH, In-Vitro Floating, Raft strength, Acid Neutralizing capacity, viscosity, and drug release. The majority of formulations using Isabgol as a gelling agent have a gelled raft in less than 2 minutes and are buoyant for more than 8 hours in 0.1N hydrochloric acid having pH 1.2. Optimized batches show good administration capabilities and better stability over six months. The studies conducted suggested that raft forming systems made from natural polymers carrying drugs could be used to deliver gastroretentive drugs

Presence of a widely disseminated Listeria monocytogenes serotype 4b clone in India

Details about the members of the Indian Listeria Consortium are provided in the Supplementary Data.Emerging Microbes and Infections (2016) 5, e55; doi:10.1038/emi.2016.55; published online 8 June 201

Global epidemiology and outcomes of acute kidney injury

Acute kidney injury (AKI) is a commonly encountered syndrome associated with various aetiologies and pathophysiological processes leading to decreased kidney function. In addition to retention of waste products, impaired electrolyte homeostasis and altered drug concentrations, AKI induces a generalized inflammatory response that affects distant organs. Full recovery of kidney function is uncommon, which leaves these patients at risk of long-term morbidity and death. Estimates of AKI prevalence range from <1% to 66%. These variations can be explained by not only population differences but also inconsistent use of standardized AKI classification criteria. The aetiology and incidence of AKI also differ between high-income and low-to-middle-income countries. High-income countries show a lower incidence of AKI than do low-to-middle-income countries, where contaminated water and endemic diseases such as malaria contribute to a high burden of AKI. Outcomes of AKI are similar to or more severe than those of patients in high-income countries. In all resource settings, suboptimal early recognition and care of patients with AKI impede their recovery and lead to high mortality, which highlights unmet needs for improved detection and diagnosis of AKI and for efforts to improve care for these patients