Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Some estimators for estimating the average fish catch from the inland water resources

The paper attempts to study the problem of estimating the average fish catch from inland water resources. Alternative estimators of average fish catch on the basis of per pond and per unit area are considered. These estimators make use of auxiliary information on area of water unit, fish catch in the first round/phase of the survey, number of ponds etc.. An illustrative study, based on fish catch data taken from an actual survey,is also included

Response of central nervous system aspergillosis to voriconazole

Fungal infections of the central nervous system (CNS) usually present as subacute meningitis. Other manifestations include mass effect and focal neurological deficits. [1] Cerebrospinal fluid (CSF) examination and biopsy of the lesion are helpful in disclosing the organism involved. Aspergillosis presents as brain abscess or granuloma with predominant neutrophils in CSF. Voriconazole is a broad spectrum triazole antifungal agent. It can be given orally and has lesser adverse effects We report a 69-years-old diabetic male, with aspergilloma of para-nasal sinus invading the CNS, who responded well to voriconazole treatment. He discontinued the medication by himself as it was costly. Within a month of stopping the medication, he developed features of subacute meningitis. However he showed clinical improvement after the medication was restarted. The case is reported for the clinical evidence of antifungal activity of voriconazole against aspergillosis

Efficacy of Guduchi Swarasa (Bhavaprakasa) in the Management of Madhumeh

Nowadays due to change in lifestyle, a human beings is attracting many diseases because of poor quality of food, eating more than necessary, sleeping during day time, eating fast food and improved stress in society. Madhumeha can be linked with Diabetes mellitus in modern medicine, which is attracting the whole world as a non-infectious epidemic. A total of 25-patients with classical symptoms of Madhumeh, irrespective of sex, occupation, etc was chosen for the clinical trial. The assessment was done on the basis of evolution in Rogabala, Dehabala, Chetasabala, and Agnibala by specific scoring patterns. The results were analyzed statistically by Paired t-test. In symptom-wise statistical analysis, it is seen that Guduchi Swarasa is significantly effective in the symptoms of Madhumeha. Guduchi Swarasa has major hypoglycemic action and it is more on post-meal blood sugar level