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

Establishing a baseline trend and diversity of snake rescues in the Kali Tiger Reserve, Karnataka.

As human-snake encounters become increasingly frequent, snake rescuers play a significant role in protectingboth snakes and humans. To improve the procedures of snake rescues in human-dominated areas and ensuregreater accountability, providing structured protocols and establishing evidence-based snake-human encounter managementis increasingly important. Herein we analyze snake rescues in and around the Kali Tiger Reserve, Karnataka,India, to identify trends and document the diversity of snake species encountered in human-dominated landscapes.Snake rescues by the Forest Department staff of the Kali Tiger Reserve from 2012 to 2022 involved 31 species in 22genera, with Ptyas (29.3%), Naja (21.7%), Chrysopelea (9.9%), and Python (9.7%) being the most frequently rescued.The numbers of frequently rescued species is indicative of the overall quality of habitat, whereas the frequency of rescuesof near-threatened species in the genera Python (278 rescues) and Eryx (54 rescues) demonstrates the importanceof implementing effective conservation policies. We also highlight the need for proper record-keeping of rescues forfurther research and decision-making, monitoring survival of translocated individuals, and the need for educationalawareness programs about threatened and venomous snakes directed to the area’s human populations