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

Emerging antimicrobial resistance in early and late-onset neonatal sepsis

Abstract Background Compared to developed countries, the use of antimicrobials in Egypt is less regulated and is available over the counter without the need for prescriptions. The impact of such policy on antimicrobial resistance has not been studied. This study aimed to determine the prevalence of early and late onset sepsis, and the frequency of antimicrobial resistance in a major referral neonatal intensive care unit (NICU). Methods The study included all neonates admitted to the NICU over a 12-month period. Prospectively collected clinical and laboratory data were retrieved, including blood cultures and endotracheal aspirate cultures if performed. Results A total of 953 neonates were admitted, of them 314 neonates were diagnosed with sepsis; 123 with early onset sepsis (EOS) and 191 with late onset sepsis (LOS). A total of 388 blood cultures were obtained, with 166 positive results. Total endotracheal aspirate samples were 127; of them 79 were culture-positive. The most frequently isolated organisms in blood were Klebsiella pneumoniae (42%) and Coagulase negative staphylococcus (19%) whereas in endotracheal cultures were Klebsiella pneumoniae (41%) and Pseudomonas aeruginosa (19%). Gram negative organisms were most resistant to ampicillins (100%), cephalosporins (93%–100%) and piperacillin-tazobactam (99%) with less resistance to aminoglycosides (36%–52%). Gram positive isolates were least resistant to vancomycin (18%). Multidrug resistance was detected in 92 (38%) cultures, mainly among gram negative isolates (78/92). Conclusions Antibiotic resistance constitutes a challenge to the management of neonatal sepsis in Egypt. Resistance was predominant in both early and late onset sepsis. This study supports the need to implement policies that prohibits the non-prescription community use of antibiotics

Phytochemicals of mustard (Brassica Campestris) leaves tuned the nickel-cobalt bimetallic oxide properties for enzyme-free sensing of glucose

The fabrication of enzyme-free glucose sensors is highly demanded for the biological, clinical, and food applications. In this study, we have developed a green method for tuning the surface properties of nickel-cobalt bimetallic oxide (NiCo2O4) by adding mustard (Brassica Campestris) leaves extract during hydrothermal growth. The mustard (Brassica Campestris) leaves extract is rich with a variety of phytochemicals, which can easily tune the surface properties of NiCo2O4 nanostructures, thereby paving the way toward the development of sensitive and selective non-enzymatic glucose sensors. The effect of various amounts of mustard (Brassica Campestris) leaves extract (0-20 ml) was also studied to find out the optimal conditions for growing surface-modified NiCo2O4 nanostructures. The morphology and crystalline structure of the nanomaterials were studied by scanning electron microscopy (SEM) and powder X-ray diffraction (XRD) techniques, respectively. The presence of an increasing quantity of mustard (Brassica Campestris) extract keeps the crystalline structure and the morphology of the NiCo2O4 nanostructures unaltered but changes their dimensions. All nanostructures show the same cubic spinel structure of NiCo2O4 and a morphology of spherical urchins composed of nanorods, but the diameter of the urchins decreases from similar to 10 mu m to several nanometers, thus increasing the surface area of the nanomaterial. Furthermore, NiCo2O4 nanostructures were deposited onto glassy carbon electrodes (CGE), showing excellent catalytic properties toward the enzyme-free detection of glucose using cyclic voltammetry. Importantly, the intensity of the oxidation current peak was linear over a wide range of glucose concentrations (from 0.1 to 10 mM) and the limit of detection (LOD) was estimated around 0.001 mM. Additionally, NiCo2O4 nanostructures grown in the presence of 20 ml of mustard leaf extract demonstrated good repeatability and excellent selectivity for glucose, without interference by other components such as urea, lactic acid, uric acid, ascorbic acid, as well as potassium and sodium ions. The combined results attest that mustard leaf extract has high potential as a green approach to improve the electrochemical properties of nanostructured materials, and could be useful for a wide range of materials for future electrochemical applications