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

Avaliação da lordose lombar e sua relação com a dor lombopélvica em gestantes

O objetivo deste trabalho foi avaliar a magnitude da lordose lombar, sua influência na dor lombopélvica e a qualidade de vida em gestantes. Para tal, foi realizado um estudo com 20 mulheres não gestantes (C) e 13 gestantes ao longo dos trimestres gestacionais (G1, G2 e G3). Todas as mulheres foram submetidas à avaliação inicial para registro dos dados pessoais, hábitos de vida, antecedentes pessoais, uso de medicamentos, história ginecológica e obstétrica. Posteriormente, as voluntárias do grupo controle foram avaliadas uma vez e as gestantes foram avaliadas em três momentos distintos, no 10, 20 e 30 trimestres gestacionais. A avaliação do grau de lordose lombar foi realizada por meio de técnica fotogramétrica; a avaliação de locais de dor, o tipo de dor e sua intensidade foram feitas por meio do Questionário McGill de dor; e a avaliação da qualidade de vida foi feita pelo Questionário WHOQOL-bref. Neste trabalho, não foi possível observar padrão de alteração da curvatura lombar no decorrer da gestação. Também não foi observada relação entre a curvatura lombar e a dor lombopélvica relacionada à gestação.The purpose of this study was to evaluate the magnitude of lumbar lordosis, its influence on lumbopelvic pain and quality of life in pregnant women. To this end, a study was done with 20 non-pregnant women (C) and 13 pregnant women during the trimesters of pregnancy (G1, G2 and G3). All women underwent initial assessment for registration of personal data, lifestyle, personal history, medications, gynecological and obstetric history. Later, the volunteers in the control group were evaluated once and pregnant women were evaluated at three different times, the first, second and third trimesters of pregnancy. The evaluation of the degree of lumbar lordosis was performed by a photogrammetric technique. The assessment of points/places of pain, the kind of pain and its intensity were made by McGill Pain Questionnaire, and the quality of life assessment was made by WHOQOL-bref. In this study, it was not possible to observe a pattern of change in lumbar curvature during pregnancy. There was also no relationship between lumbar curvature and lumbopelvic pain related to pregnancy