Factors Affecting Inpatient Mortality in Elderly People with Acute Kidney Injury

Background: Acute Kidney Injury (AKI) is common in elderly people (EP). There is paucity of data on predictor of mortality in EP with AKI. Objective: This study was done to know more about factors associated with inpatient mortality in EP with AKI. Methods: We retrospectively reviewed medical records of patients aged 65 years or above hospitalized with a diagnosis of AKI at Aga Khan University Hospital, Karachi, between January 2005 and December 2010. Binary logistic regression models were constructed to identify factors associated with mortality in EP with AKI. Results: 431 patients had AKI, with 341 (79.1%) having stage I AKI, 56 (13%) having stage II AKI, and 34 (7.9%) having stage III AKI. Out of 431 patients, 142 (32.9%) died. Mortality increased with increasing severity of AKI. Mortality was 50% (17/34) in AKI stage III, 44.6% (25/56) in AKI stage II, and 29.3% (100/341) in AKI stage I. Factors associated with increased inpatients mortality were presence of stage III AKI (OR: 3.20, P = 0.04, 95% CI: 1.05-9.72), presence of oliguria (OR: 3.42, P = 0.006, 95% CI: 1.42-8.22), and need for vasopressors (OR: 6.90, P \u3c 0.001, 95% CI: 2.42-19.65). Median bicarbonate 18 versus 17 between those who survived and those who died was associated with less mortality (OR: 0.94, P = 0.02, 95% CI: 0.89-0.99). History of hypertension (OR: 0.49, P = 0.03, 95% CI: 0.25-0.95) and high admission creatinine (OR: 0.68, P = 0.01, 95% CI: 0.50-0.91) were also associated with less mortality. Conclusion: Mortality in EP increases with increasing severity of AKI. Presence of stage III AKI, oliguria, and hemodynamic instability needing vasopressor are associated with increased mortality. Increased median bicarbonate, presence of hypertension, and high admission creatinine were various factors associated with decreased inpatient mortality. Increasing age and need for dialysis did not increase mortality in elderly populatio

TURBULENCE AND TURMOIL: A CASE OF SELF-TRANSCENDENCE AND MEANING SEEKING IN THE NOVEL FOR WHOM THE BELL TOLLS BY EARNEST HEMINGWAY

Hemingway the prominent literary figure of English novel is well known by his code heroes. Through code heroes and their turbulence, Hemingway had presented his thoughts and the culture of the times in his writing. The treatment of the characters could be possible through the elements Frankl‘s Logotherapy as the love and hope are prescribed by him in his book Man‘s search for Meaning. Hemingway ‘s characters are being presented by him in the diverse social and socio-political atmosphere where the common people are not given prestige in giving choice of living life and the they are dealt as the flies whom the super class and military authoritative utilize for their own purposes. The creating of such atmosphere give birth to the new thinking of meaning seeking in characters and the characters after manipulation of the situation, comes towards the truth of the life where they were standing alone. The study is qualitative in its nature and prescriptive in method in which Hemingway’s novel For Whom the Bell Tolls is analyzed under the elements of Frankl’s Logotherapy that how the characters move towards the meanings of the life after bearing the brutality of the war. The results of the study describe that Frankl,s Logotherapy can present the best mental treatment of the characters who are victims of the brutality of the war but if it can only be applicable and can be understood when there is end of the crucial stages of the war. It can also be concluded through the study that when the crucial stage of brutality of the situation continues, the character comes towards the stage of self-transcendence because at that time they love to die rather live even they have got the meanings of the life

Spontaneous Bacterial Peritonitis and Anasarca in a Female Patient with Ovarian Hyperstimulation Syndrome Complicated by Respiratory and Kidney Failure

Ovarian hyperstimulation syndrome (OHSS) was first described in 1960. It may occur as a complication of gonadotropin hormone therapy during assisted pregnancy or for primary infertility. A 26-year-old female patient with polycystic ovarian syndrome and primary infertility was treated to conceive. She received intravenous gonadotropin-releasing hormone (GnRH) along with follicle-stimulating hormone in an outside private clinic. She presented to the emergency department with abdominal and chest pain, loose stool, vomiting, shortness of breath and decreasing urine output. She was found to have edema, ascites, effusion and acute kidney injury (AKI). Considering the symptoms preceding the drug history and anasarca, a diagnosis of severe OHSS was made. Ascites was further complicated by spontaneous bacterial peritonitis (SBP), which had already been reported before. We speculate that low immunity due to decreased immunoglobulin in patients with OHSS makes them prone to SBP. In our case, septicemia secondary to SBP and fluid loss due to capillary leakage from OHSS resulted in AKI and respiratory failure. This critically ill patient was treated in a special care unit, and she fully recovered with supportive measures. Severe OHSS may present as anasarca including ascites which can develop SBP leading to sepsis and multiorgan failure