CAN ANXIETY LEVEL DURING TRAINING AND COMPETITION AFFECT THE PERFORMANCE SCORE AMONG ELITE YOUTH SHOOTERS? A CORRELATION STUDY

BACKGROUND: Shooting is one of the sports that can be taken up by an individual regardless of age and gender for professional involvement. It has higher mental fitness demands, which might re?ect the ranking in top-level competition. However, it is unclear what type of anxiety affects the performance score. Therefore, the current study is to find the anxiety pattern, i.e., cognitive, somatic, and self-confidence among the elite youth shooters during training and competition correlating with their sports performance. METHOD: We analyzed the sports performance during training and competition and conducted Personal interviews with elite youth pistol and rifle shooters. The subject's Mental fitness was assessed by using the Competitive state anxiety inventory-2 methodology, which was evaluated just before 30mins on two occasions and correlated with scoring sheets. RESULTS: The Difference in mean of COGNITIVE ANXIETY score during match day and training day was statistically significant (p-value >0.05). The Difference in mean of SOMATIC ANXIETY, SELF CONFIDENCE, SCORE-TRAINING during match day and training day was not statistically significant. (p-value >0.05). CONCLUSION: Thus competitive anxiety is one of the determinant factors experienced by young elite shooters, and training them with appropriate modalities can help them to pursue the highest level of performance.

Acute kidney injury in obstetrics: a five-year study in a tertiary centre

Background: Pregnancy Related Acute Kidney Injury (PRAKI) is a major cause of maternal and foetal morbidity and mortality in developing countries. The incidence has declined due to improvements in reproductive health but it is still associated with significant perinatal mortality and maternal morbidity. It may be due to decrease in renal perfusion or ischemic tubular necrosis from a variety of conditions encountered during pregnancy. Our study aims at determining the predisposing factors and causes of AKI during pregnancy and its impact on maternal and foetal outcome.Methods: A retrospective cohort study over a period of 5 years was conducted on pregnant women with AKI as per inclusion and exclusion criteria. The detailed history, events, mode of delivery, cause leading to AKI, management, hospital stay, maternal and foetal outcome were studied in detail and evaluated. These patients were classified according to RIFLE criteria and were followed up for hospital stay and residual morbidities.Results: The incidence of PRAKI in the study was 0.07% (36 out of 50,735 deliveries) and among obstetric ICU patients, it was 6.8%. Most of the majority of the cases were unbooked (66.7%) and multipara (61.1%). Maternal morbidity was seen in 66.7% and mortality was 27.8%. Poor foetal outcome was seen in 44.4%.Conclusions: Haemorrhage is the most common cause of PRAKI, followed by toxaemia of pregnancy and sepsis. Early detection and meticulous management of haemorrhage, hypertension and sepsis reduce the incidence of PRAKI and associated maternal mortality.

Prevalence and Correlation of Intra-abdominal Hypertension with Incidence of Acute Kidney Injury in ICU Patients: A Cohort Study from A Tertiary Care Centre

Introduction: Intra-abdominal hypertension (IAH), asustained and repeated steady state rise in intra-abdominalpressure (IAP) above 12 mmHg, was reported as a hiddencause contributing to morbidity and mortality in criticallyill patients. This study was aimed to find out the possiblerelationship between IAH and acute kidney injury (AKI) inICU patients.Material and methods: Prospective cohort study wasconducted among patients admitted in medical and surgicalICU. Consecutive patients coming under the inclusioncriteria were selected and IAH was measured using pressuretransducer technique. IAP was measured at the time ofadmission, at 24 hours, 48hours and also at the end of 72hours.Other parameters were collected based on a standard proformaprepared.Results: Eighty patients were included in our study, of which24 patients had IAH. Mean age in patients with IAH wasobtained as 63.08 ± 12.37 years with a male predominance.Maximum patients were belonging to age group of 61-70yrs (25%), 9 patients were below 40 yrs and 14 patientswere above 81yrs. Mean IAP was calculated to be 11.65 ±3.15. Only 9 patients were in grade IV (11.3%). Risk factorsassociated were found to be ascites, upper GI bleed andmetabolic encephalopathy. IAH and AKI were found to besignificantly correlated (odds ratio=2.666 with CI 0.98-7.25).Conclusion: Rising intra-abdominal pressure is found to havehigher incidence of renal failure than those with establishedIAH. IAH has been found to be a clinically significant riskfactor for development of AKI in ICU patients.

Comparison of the accuracy of RIFLE, AKIN and KDIGO criteria in predicting early death after liver transplantation / 器官移植

Objective To compare the accuracy of three acute kidney injury (AKI) criteria of RIFLE, Acute Kidney Injury Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO) in predicting the early (30 d) postoperative death of liver transplant recipients. Methods Clinical data of 173 liver transplant recipients were retrospectively analyzed. The incidence of postoperative AKI was calculated according to the three criteria of RIFLE, AKIN and KDIGO. The all-cause fatality rate and cause of death at postoperative 30 d were analyzed. The risk factors of death within 30 d after operation were analyzed by binary Logistic regression. The prediction accuracy of three criteria for death within 30 d after operation was compared by the receiver operating characteristic (ROC) curve. Results According to the RIFLE, AKIN and KDIGO criteria, the incidences of postoperative AKI were 48.0%, 51.4% and 53.8%, respectively. Thirteen patients died within 30 d after operation and the fatality rate was 7.5%. RIFLE, AKIN and KDIGO stages were the independent risk factors for death within 30 d after operation (all P < 0.05). The area under the curve (AUC) of RIFLE, AKIN and KDIGO stages to predict death within 30 d after liver transplantation were 0.828, 0.766 and 0.844, respectively. There was a statistically significant difference between AKIN and KDIGO (P < 0.05). Conclusions KDIGO criterion is better for predicting early death after liver transplantation. However, as a tool, the comparative selection among these three criteria still needs the evidence support from a large multicenter sample.

Fatigue: Impact of Muscular Co-Ordination among Rifle Shooters

It has been well reported that fatigue is an important factor which hinders performance. The resultant effect of it is loss ofco-ordination and efficiency. The main aim of this investigation was to find out the effect of fatigue on muscular coordination among rifle shooters. Ten rifle shooters aged between 22-28 years were selected as subjects. The index ofmuscular co-ordination was tested with three series. A steadiness tester was used with the diameters of 0.5, 0.31, 0.25, 0.18,0.15, 0.12, 0.10, 0.09, 0.07 inches and stylus of 0.062. Grip dynamometer was utilized for measuring local fatigue. Theresults indicated that 50% of rifle shooters were adversely affected by local fatigue of the arm, 80% of the subjects statedalteration in their muscular co-ordination after overall fatigue was induced. It was concluded that performance wassubstantially reduced when general fatigue was induced compared to local fatigue.

Incidencia acumulada de insuficiencia renal aguda en el posoperatorio de cirugía cardíaca / Accumulated incidence of acute renal failure in the postoperative period of cardiac surgery

Resumen: Introducción: la insuficiencia renal aguda (IRA) constituye una causa frecuente de morbimortalidad en el posoperatorio de cirugía cardíaca, con incidencia variable según la definición utilizada y los factores derivados del paciente y del procedimiento quirúrgico. Objetivo: los objetivos de este artículo fueron determinar la incidencia de IRA en un centro de cirugía cardíaca, la presencia de predictores y su asociación con mortalidad quirúrgica. Métodos: estudio prospectivo y observacional con elementos analíticos. Se incluyeron todos los pacientes con función renal normal y sin antecedentes de enfermedad renal sometidos a cirugía cardíaca en el período julio 2014 - julio 2015. Se determinó la creatininemia basal y a las 24 y 48 horas de la cirugía. La IRA fue definida utilizando el criterio RIFLE. Se valoró mortalidad quirúrgica y se analizaron variables pre e intraoperatorias como predictoras de desarrollo de IRA utilizando análisis uni y multivariado. Resultados: cumplieron los criterios de inclusión 400 pacientes. La incidencia de IRA por criterio RIFLE fue 10,3% (IC95% 8,7-11,8); la mortalidad quirúrgica en este grupo alcanzó 19,5%, mientras que en los controles fue 1,9%. Las variables asociadas al desarrollo de IRA fueron EuroSCORE más elevado, cirugía combinada, uso de circulación extracorpórea (CEC) y clampeo aórtico. La cirugía de revascularización miocárdica (CRM) presentó una asociación inversa con la aparición de IRA y constituyó predictor independiente en el análisis multivariado. La presencia de IRA fue un predictor independiente de mortalidad quirúrgica. Conclusiones: la incidencia de IRA es frecuente en el posoperatorio de cirugía cardíaca y se encuentra dentro de los valores internacionales. Su presencia implica mayor mortalidad quirúrgica.

Summary: Introduction: acute renal failure (ARF) is a frequent cause of morbidity and mortality in the postoperative period of cardiac surgery, with variable incidence depending on the definition used, factors derived from the patient and the surgical procedure. Objective: determine the incidence of ARF in a cardiac surgery center, the presence of predictors and its association with surgical mortality. Methods: this is a prospective and observational study with analytical elements. All patients with normal renal function and no history of kidney disease undergoing cardiac surgery were included in the period from July 2014 to July 2015. Baseline creatininemia was determined, and 24 and 48 hours later, after surgery. Acute renal failure was defined using the RIFLE criterion. Surgical mortality, pre and intra-operative variables were assessed using univariate and multivariate analysis. Results: four hundred patients met the inclusion criteria. The incidence of acute renal failure by RIFLE criterion was 10,3% (95% CI 8,7-11,8), surgical mortality in this group reached 19,5% while in controls it was 1,9%. The variables associated with the presence of ARF were the higher EuroSCORE, combined surgery, use of extracorporeal circulation and aortic clamping. The CRM presented an inverse association and was an independent predictor in the multivariate analysis. The presence of ARF was an independent predictor of surgical death. Conclusions: the incidence of ARF is frequent in the postoperative period of cardiac surgery and is within the international values. Its presence implies greater surgical mortality.

Clinical profile and treatment outcome of acute kidney injury (AKI) in a tertiary care hospital

Background: Acute Kidney Injury (AKI) is one of the major cause of in-hospital mortality rates globally. The current study was conducted to study the etiological profile, severity and management of acute kidney injury.Methods: The study was a prospective observational study, conducted in the department general medicine, Dhanalakshmi Srinivasan Medical college and Hospital, Permabalur, Tamil Nadu. The study population included all the patients admitted to Intensive Care Unit (ICU) with acute Kidney injury (AKI) between January 2015 to December 2016. All the study participants were recruited to the study by convenient sampling. Descriptive analysis was carried out by frequency and proportion for categorical variables.Results: A total of 100 subjects were included. Participants were almost uniformly distributed in each of a decadal age group till above 60 years. Males (57%) were slightly higher than females (43%). Oliguria was present in 88% of the study population. The most common etiology was acute diarrhoeal disease (44%), followed by multiple infections in 12% and Sepsis in 10% of the subjects. As per RIFLE criteria 46% participants were at risk, 26.0% had injury, 28% had failure. All at risk people were treated conservatively, among injury category, 38.5% were treated by haemodialysis and 3.84% by peritoneal dialysis. In failure group, 60.71% and 3.57% were treated by haemodialysis and peritoneal dialysis respectively.Conclusions: Acute kidney Injury (AKI) can be a consequence of varied aetiologies and all the age groups and both the genders at risk of developing it. RIFLE criteria may be a useful tool in guiding the management

Efficient connectivity analysis of electroencephalogram in the pre-shot phase of rifle shooting based on causality method / 生物医学工程学杂志

The directed functional connectivity in cerebral cortical is the key to understanding the pattern of the behavioral tissue. This process was studied to explore the directed functional network of rifle shooters at cerebral cortical rhythms from electroencephalogram (EEG) data, aiming to provide neurosciences basis for the future development of accelerating rifle skill learning method. The generalized orthogonalized partial directed coherence (gOPDC) algorithm was used to calculate the effective directed functional connectivity of the experts and novices in the pre-shot period. The results showed that the frontal, frontal-central, central, parietal and occipital regions were activated. Moreover, the more directed functional connections numbers in right hemispheres were observed compared to the left hemispheres. Furthermore, as compared to experts, novices had more activated regions, the stronger strength of connections and the lower value of the global efficiency during the pre-shot period. Those indirectly supported the conclusion that the novices needed to recruit more brain resources to accomplish tasks, which was consistent with "neural efficiency" hypothesis of the functional cerebral cortical in experts.

The Risk Factors and Outcomes of Acute Kidney Injury after Thoracic Endovascular Aortic Repair

BACKGROUND: We aimed to evaluate the incidence, predictive factors, and impact of acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR). METHODS: A total of 53 patients who underwent 57 TEVAR operations between 2008 and 2015 were reviewed for the incidence of AKI as defined by the RIFLE (risk, injury, failure, loss, and end-stage kidney disease risk) consensus criteria. The estimated glomerular filtration rate was determined in the perioperative period. Comorbidities and postoperative outcomes were retrospectively reviewed. RESULTS: Underlying aortic pathologies included 21 degenerative aortic aneurysms, 20 blunt traumatic aortic injuries, six type B aortic dissections, five type B intramural hematomas, three endoleaks and two miscellaneous diseases. The mean age of the patients was 61.2+/-17.5 years (range, 15 to 85 years). AKI was identified in 13 (22.8%) of 57 patients. There was an association of preoperative stroke and postoperative paraparesis and paraplegia with AKI. The average intensive care unit (ICU) stay in patients with AKI was significantly longer than in patients without AKI (5.3 vs. 12.7 days, p=0.017). The 30-day mortality rate in patients with AKI was significantly higher than patients without AKI (23.1% vs. 4.5%, p=0.038); however, AKI did not impact long-term survival. CONCLUSION: Preoperative stroke and postoperative paraparesis and paraplegia were identified as predictors for AKI. Patients with AKI experienced longer average ICU stays and greater 30-day mortality than those without AKI. Perioperative identification of high-risk patients, as well as nephroprotective strategies to reduce the incidence of AKI, should be considered as important aspects of a successful TEVAR procedure.

Scorpion Sting and Acute Kidney Injury: Case Series from Pakistan.

Objectives: We aim to report here a series of cases developing AKI after scorpion stings. Patients and Methods: During a period of 25 years that is; from January 1990- December 2014 all the patients coming to Sindh Institute of Urology and Transplantation, with AKI after scorpion sting are included in study. AKI was defined according to RIFLE criteria and Scorpion sting was labeled on history of person stung by scorpion. Results: During studied period 18 patients were brought with scorpion sting. Mean age of patients was 29.22±18.48 years, 7 were male and 11 females. Mean duration of insult was 8.94±4.12 days. Sixteen out of 18 patients were either oliguric or anuric on presentation. Uremia was advanced on arrival with mean urea of 324.38±116.82 and creatinine of 11.8±4.30 mg/dl. Hyponatremia was a common finding with mean sodium of 129.16±8.76 meq/l. Extensive tissue damage at site of sting observed in many patients and mean values for LDH and CK were 2349.71±3499.15 and 3116.23±5468.22 U/L respectively. Hemodialysis required in all patients. Complete renal recovery seen in 13 patients, 2 expired and 3 discharged from hospital in partial state of recovery and never turned for follow up. Conclusion: Scorpion sting is major health problem in many parts of our country, in majority it takes a benign course but in some may affect multiple organs and result in death, especially if initial treatment is delayed.

Acute kidney injury in a tropical country: a cohort study of 253 patients in an infectious diseases intensive care unit

Introduction: Acute kidney injury (AKI) is a frequent and potentially fatal complication in infectious diseases. The aim of this study was to investigate the clinical aspects of AKI associated with infectious diseases and the factors associated with mortality. Methods: This retrospective study was conducted in patients with AKI who were admitted to the intensive care unit (ICU) of a tertiary infectious diseases hospital from January 2003 to January 2012. The major underlying diseases and clinical and laboratory findings were evaluated. Results: A total of 253 cases were included. The mean age was 46±16 years, and 72% of the patients were male. The main diseases were human immunodeficiency virus (HIV) infection, HIV/acquired immunodeficiency syndrome (AIDS) (30%), tuberculosis (12%), leptospirosis (11%) and dengue (4%). Dialysis was performed in 70 cases (27.6%). The patients were classified as risk (4.4%), injury (63.6%) or failure (32%). The time between AKI diagnosis and dialysis was 3.6±4.7 days. Oliguria was observed in 112 cases (45.7%). The Acute Physiology and Chronic Health Evaluation (APACHE) II scores were higher in patients with HIV/AIDS (57±20, p-value=0.01) and dengue (68±11, p-value=0.01). Death occurred in 159 cases (62.8%). Mortality was higher in patients with HIV/AIDS (76.6%, p-value=0.02). A multivariate analysis identified the following independent risk factors for death: oliguria, metabolic acidosis, sepsis, hypovolemia, the need for vasoactive drugs, the need for mechanical ventilation and the APACHE II score. Conclusions: AKI is a common complication in infectious diseases, with high mortality. Mortality was higher in patients with HIV/AIDS, most likely due to the severity of immunosuppression and opportunistic diseases. .

Analysis of Prognostic Risk Factors in Patients with Community Acquired Pneumonia Complicated with Acute Kidney Injury / 天津医药

Objective To explore clinical characteristics and prognostic risk factors in patients with community ac-quired pneumonia(CAP)complicated with acute kidney injury(AKI).Methods In total, 456 CAP patients were included based on the diagnostic guide.According to whether the patients were accompanied with AKI,the patients were divided in-to two groups(non-AKI group and AKI group). AKI group were further divided into risk group, injury group and failure group by RIFLE criteria using admission creatinine.Severity in CAP patients,clinical indexes and prognostic evaluation in-dexes were compared between different groups. Multiple factors were analyzed using Logistic regression model,survival analysis were examined by Kaplan-Meier, which analyzed the risk factors of poor prognosis in CAP patients and the role of RIFLE criteria in prognostic evaluation. Results Thirty percent(135)of the total 456 CAP patients were accompanied with AKI. Patients in AKI group were further divided into risked group (45.2%, 61 patients), injury group (17%, 23 pa-tients) and failure group (37.8%, 51 patients) according to the RIFLE diagnostic criteria using basal creatinine level. Among the 300 patients with PSI gradeⅠtoⅢ,23.3%(70)of patients developed AKI while among 156 patients who are with PSI gradeⅣor over, 65 patients (41.7%) developed AKI(P<0.01).The 30-day mortality of CAP patients accompanied with AKI were increased compared to Non-AKI group(Non-AKI:6.2%;Risk:14.8%;Injury:21.7%;Failure:45.1%).With de-teriorating in RIFLE criteria,the portion of patients who required mechanical ventilation, inotropic support(MV/IS)and re-nal replacement therapy(RRT)increased too. Logistic analysis revealed that AKI,age of 75 years or older and extra-renal or-gan failure were the risk factors of poor prognosis in patients with CAP. The rate of survivors was decreased in the CAP pa-tients accompanied with AKI compared with those who did not.Conclusion There is certain incidence of AKI to compli-cate CAP patients who will have a poor prognosis.RIFLE diagnostic criteria is a valuable tool to evaluate prognosis of CAP patients complicated with AKI.

Insuficiencia renal aguda en el pos-trasplante hepático / Acute kidney injury following liver transplantation

Objetivo: Estudiar la incidencia de Insuficiencia renal aguda (IRA) en el postrasplante hepático, sus factores de riesgo y evaluar mortalidad en la internación y al año postrasplante. Material y métodos: Se realizó un análisis retrospectivo de 157 pacientes trasplantados hepáticos mayores de 18 años en el período comprendido entre diciembre de 2001 a mayo 2011. Fue analizada la función renal dentro de las 48 hs. previas al trasplante y postrasplante durante la internación. Se definió IRA al aumento de creatinina sérica en 1.5 veces el valor basal. Resultados: la incidencia de IRA postrasplante hepático fue del 33% (n=53). En el análisis multivariado la edad y la diabetes mostraron una asociación significativa con la presencia de IRA postrasplante hepático. La estadía hospitalaria entre los pacientes del grupo IRA promedió los 20 días (15-31) versus 14 días (11-23) del grupo no IRA (p=0,009). La mortalidad hospitalaria del grupo IRA fue de 16.9% (n=9) versus 3.8%(n=4) del grupo no IRA (p=0.005). La mortalidad al año postrasplante del grupo IRA fue de 26.4%(n=14) versus 7.6%(n=8) del grupo no IRA (p=0.001). Conclusión: la IRA en el postrasplante hepático es una complicación frecuente que está asociada a un aumento de la estadía hospitalaria, mortalidad a corto plazo y menor sobrevida al año postrasplante. La edad y la diabetes fueron factores independientes asociados a la presencia de IRA postrasplante hepático.

Objectives: Assessing: a).- The incidence of Acute Kidney Injury (AKI) in post-liver transplantation and its risk factors; b).- Mortality during hospitalization and one year after the transplantation. Materials and Methods: A retrospective analysis in 157 liver transplantation patients over 18 years of age was conducted from December of 2001 to May of 2011. Kidney function was assessed within 48 hours prior to the transplantation and during hospitalization after the transplantation. AKI was defined as a 1.5-fold serum creatinine increase from baseline. Results: AKI incidence following liver transplantation was 33% (n=53). In the multivariate analysis, age and diabetes showed significant association with the presence of AKI following liver transplantation. Average length of stay in hospital among patients in the AKI group was 20 days (15-31) versus 14 days (11- 23) in the non-AKI group (p=0.009). Hospital mortality in the AKI group was 16.9% (n=9) versus 3.8% (n=4) in the non-AKI group (p=0.005). Mortality one year following transplantation in the AKI group was 26.4% (n=14) versus 7.6%(n=8) in the non-AKI group (p=0.001).Conclusion: AKI following liver transplantation is a common complication which is associated withan increased stay in hospital, short-term mortality, and lower survival one year after transplantation. Age and diabetes were independent factors associated with the presence of AKI following liver transplantation.

RIFLE and AKIN criteria for mortality and risk factors of acute kidney injury in hospitalized patients / 中南大学学报(医学版)

Objective:To evaluate the mortality and risk factors for acute kidney injury (AKI) in hospitalized patients by the risk, injury, failure, loss, end stage kidney disease (RIFLE) and acute kidney injury network (AKIN). Methods:We constructed a retrospective study of all AKI patients in the Second Xiangya Hospital of Central South University between February 2006 and January 2011. The diagnosis and classiifcation of AKI were reconifrmed and categorized by RIFLE and AKIN criteria. To compare the clinical characteristics, mortality and associated risk factors in AKI patients by the RIFLE and AKIN stage, univariate analysis and multivariate logistic regression analysis were performed. Results:The patients were diagnosed as AKI by AKIN (n=1027) or by RIFLE criteria (n=1020). There was no signiifcant difference in the hospital mortality, hospital length stay (days), or the proportion of complete recovery in each stage of AKI patients by RIFLE and AKIN (P>0.05). In the univariate analysis, age, pre-renal causes, proportion of hospital acquired AKI, mechanical ventilation, hypotension, the number of failed organs, acute tubular necrosis-index severity score (ATN-ISS), and the peak of serum potassium ion concentration were signiifcantly higher in the non-survivors than in the survivors (P<0.05). Logistic regression analysis revealed that age older than 65, hospital acquired AKI, hypotension, number of failed organs, ATN-ISS scores, and the peak of serum potassium ion concentration were independent risk factors for hospital mortality. Conclusion:Both RIFLE and AKIN criteria have similar scientiifc value in assessing hospital mortality. AKI stage is associated with the recent prognosis of AKI patients.

The study of morbidity and mortality of acute kidney injury with the diagnosis criteria of RIFLE / 中华急诊医学杂志

Objective To evaluate the value of the RIFLE criteria of acute kidney injury (AKI) for predicting the incidence and prognosis in critically ill patients and to identify the risk factors associated with the outcomes of those patients.Methods All ICU patients admitted over three years and 6-month period were retrospectively studied at Subei People's Hospital.Based on RIFLE criteria,AKI patients were diagnosed and classified into four groups:NAKI (non-AKI),R (risk),I (injury),F (failure)groups.Results (1) AKI occurred in 404 of the 2472 patients (16.3％) during their ICU stay.The mean age of the patients was (61.4 ± 17.4) years.Infectious disease,pulmonary disease,neurological disease and trauma were the major cause of AKI.(2) Mortality in the ICU was much higher in patients with AKI than in patients without AKI (47.3％ vs.23.0％,P ＜ 0.05).The mortality rate was 35.6％ in R group,48.9％ in I group and 60.6％ in F group.(3) The logistic regression suggested that MODS and septic shock were the independent risk factors of AKI,but continuous renal replacement therapy (CRRT) are the independent protective factor of AKI.Conclusions In these ICU patients,AKI is associated with increased hospital mortality.The RIFLE classification is a simple and useful diagnosis tool to detect and stratify the severity of AKI and aid in predicting outcome of patients.

Early Peritoneal dialysis after repair of congenital heart disease in children / 中华胸心血管外科杂志

Objective The mortality rate of the children after surgical repair of congenital heart disease associated with acute renal injure has been reported to be 30％-79％.Peritoneal dialysis is the common treatment method for those patients,but the optimal time to initiate peritoneal dialysis is still controversial.The aim of this study was to investigate the clinic outcome of early peritoneal dialysis to the children following cardiac surgery.Methods We performed a retrospective chart of children following cardiac surgery from January 2008 to December 2009.The total number was 4561,62 of them were performed PD treatment.Data on the PD treatment children were collected from pre-operation to hospital discharge.Early peritoneal dialysis group was defintes as PD initiated at operation room or the interval between the end of operation to starting peritoneal dialysis less than 3hrs.the others were traditional PD group.Results The whole PD treatment rate was 1.36％,15 patients died.The mortality were 10.71％ (3/28) in early PD and 35.29％ (12/34) in conditional PD group respectively (P =0.036).2 patients were met RIFLE(risk,injury,failure,loss,and end-stage renal disease,RIFLE)classification as failure grade in early PD group while 10 patients in traditional PD group (P =0.001).After PD treatment 24hrs,the Vasoactive-Inotrope Scores and serum creatinine values were much lower in the early PD group children than those in the traditional PD group[(19.00 ±2.39) vs(37.00±5.22),P=0.002;(50.51 ±21.84) vs(130.13±76.09),P=0.001)].Conclusion This study shows that early PD can prevent the children after congenital heart surgery to develop AKI,and reduce the severity of the clinic status.Early intervention with PD is associated with low mortality.

Epidemiología de la injuria renal aguda en unidades de cuidados críticos de un hospital general de agudos / Epidemiology of acute renal injury in the critical care units of a general hospital for acute patients

Introducción: La Injuria Renal Aguda (IRA) se presenta en el 1 al 25% de los pacientes críticos con una mortalidad entre el 15 y el 60%. En el 2004, la ADQI publicó la definición del consenso RIFLE. Objetivos: Evaluar: 1- incidencia, evolución, y mortalidad asociada a la IRA en Unidades Criticas (UCC) del HIGA San Martín de La Plata. 2- características demográficas y clínicas. Métodos: Se estudiaron los pacientes mayores de 16 años admitidos en las UCC desde el 01-06-2010 al 31-05-2011 internados al menos 24 hrs. y que contaron con 2 determinaciones de laboratorio como mínimo, desde su ingreso hasta el día 30 de internación, alta de la UCC u óbito. Se registraron patologías preexistentes, tratamientos farmacológicos previos y durante la internación, estado hemodinámico, requerimiento de ARM y parámetros bioquímicos. La IRA fue definida según la clasificación RIFLE. Resultados: Se incluyeron 290 pacientes, edad x 49.6 años, 71% masculino, etiologías de ingreso: cardiovasculares 23.3%, neurológicas 22.6%. trauma 17.4% e infecciosas 15.3%. Se observó progresión a categorías de mayor severidad del sistema RIFLE (p 0.001). El desarrollo de IRA se asoció con mayor edad (p 0.001) y comorbilidades previas (p 0.002). El requerimiento de HD fue de 5.17% (15 ptes.). La mortalidad fue mayor con la progresión en la clasificación RIFLE (R 46.5%; 1 55.8%, F 69.2%) y con el requerimiento de HD (80%). Conclusiones: La IRA fue frecuente en las UCC, predominando en los grupos de más edad y con comorbilidades. El desarrollo y progresión del daño renal muestran correlación con mayor mortalidad.

Introduction: Acute kidney injury (AKI) occurs in 1 to 25% of critically ill patients with a morality rate between 15 and 60%. In 2004, the ADQI published the RIFLE consensus definition. Objectives: To evaluate; 1 - incidence, evolution and mortality associated with AKI in critical units of HIGA San Martín de La Plata. 2 – Demographic and clinical characteristics. Methods: We studied patients over 16 years admitted in the UCC from 06/01/2010 to 05/31/2011 hospitalized at least 24 hours and that included two laboratory determinations al least, from entry to day 30 of hospitalization, discharge from the UCC or death. Preexisting pathologies were registered, also previous drug treatments during hospitalization, hemodynamic status, requirement for ARM and biochemical parameters. The IRA was defined according to the RIFLE classification. Results: 290 patients were included, 49.6 x age years, 71% male, etiologies of income: 23.3% cardiovascular, neurological 22.6%, 17.4% trauma and infectious 15.3%. Progression to more severe categories of RIFLE system was observed (p 0.001). The development of AKI was associated with older age (p 0.001) and previous comorbidities (p 0.002). The requirement for HD was 5.17% (15 patients). Mortality was higher with progression in the RIFLE classification (R 46.5% 55.8% I, F 69.2%) and with the requirement of HD (80%). Conclusions: AKI was frequent in UCC, predominantly in older age groups and with comorbidities. The development and progression of renal damage show a correlation with an increased mortality.

Diferentes abordagens na detecção da disfunção renal aguda em pacientes graves / Different approaches in the detection of acute renal dysfunction in serious patients

JUSTIFICATIVA E OBJETIVOS: As diversas definições para disfunção renal aguda (DRA) têm dificultado intervenções precoces nestes quadros, recentemente a classificação Risk, Injury, Failure, Loss and End-stage Renal Desease (RIFLE) tem contribuído para reverter esse quadro. O objetivo deste estudo foi comparar o método tradicional com a classificação RIFLE/AKIN (AcuteKidney Injury Network) para o diagnóstico de DRA. MÉTODO: Estudo retrospectivo transversal por análise de prontuáriosdos pacientes internados no período de 15 meses, na unidadede terapia intensiva do Hospital Universitário de Alagoas.Os indivíduos, classificados em dois grupos (I - com lesão renal e II - sem lesão renal), foram avaliados quanto ao sexo, idade, motivo da admissão, necessidade de ventilação mecânica e fármacos vasoativos, sepse, escore de Sepsis Occurrence in Acutely ill Patients(SOFA) e mortalidade. A avaliação para DRA foi comparada com a registrada em prontuários pelo médico plantonista.RESULTADOS: A ocorrência de DRA foi de 21%, com maior gravidade e tempo de internação neste grupo. Em relação ao diagnóstico, osplantonistas levaram o dobro do tempo para detectar DRA, utilizandoos critérios tradicionais, quando comparado ao uso do RIFLE/AKIN (p = 0,0056). Pacientes classificados com lesão e falência pelo RIFLE foram os que apresentaram maior gravidade e pior evolução. CONCLUSÃO: A taxa de DRA encontrada foi compatível com a literatura. A escassa utilização da classificação RIFLE/AKIN pelos plantonistas dificulta ações preventivas e o tratamento da DRA, o que prejudica a evolução e o prognóstico dos pacientes,sendo necessária maior atenção destes médicos.

BACKGROUND AND OBJETIVES: The various definitions for acute kidney injury (AKI) have hampered early intervention in these clinical conditions, recently the Risk, Injury, Failure, Loss and End-stage Renal Disease (RIFLE) classification has helped to reverse this. Our study aimed to compare the traditional method with RIFLE/AKIN (Acute Kidney Injury Network) classification for the diagnosis of AKI. METHOD: Retrospective cross-section studies by medical records analysis of patients admitted within 15 months in the intensive care unit of University Hospital of Alagoas. Individuals were classified into two groups (I - with renal injury and II - without renal injury); they were evaluated for sex, age, admission reason, mechanical ventilation need and vasoactive drugs, sepsis, Sepsis Occurrence in Acutely ill Patients (SOFA) score and mortality. Our assessment for AKI was compared with that recorded in medical records by the doctor on duty.RESULTS: The occurrence of AKI was 21%, with greater severity and duration of hospitalization in this group. Regarding diagnosis, doctor on duty took twice as long to detect AKI using the traditional criteria, when compared to the use of RIFLE/AKIN (p = 0.0056). Patients classified with injury and failure, by RIFLE, were those with greater severity and worse outcome. CONCLUSION: The rate of AKI has been found compatible to the literature. The little use of the RIFLE/AKIN classification, by doctors, hampers preventive actions and treatment of AKI that affect the evolution and prognosis, requiring more attention these doctors.

Lipid peroxidation and DNA damage in different stages of acute renal failure.

Introduction: Oxidative stress is an imbalance between the formation of Reactive oxygen species and protective antioxidant defense. It is known that oxidative stress increases the Acute renal failure. Measurement of oxidative stress parameters may be a simple tool for monitoring the progression of acute renal failure. Aim: The aim of this study was to evaluate oxidative stress in acute renal failure patients by Lipid peroxidation product Malondialdehyde (MDA), Total antioxidant capacity (TAC) and oxidative DNA damage product and compare its level among the patients of varying severity as per RIFLE classification. Materials and methods. We conducted a cross sectional study to compare oxidative stress parameters. Blood samples were collected from 62 patients with ARF, admitted to the Vinayaka Mission’s Medical College & Hospital, Salem from March 2009 to July 2010. We further subdivided the patients according to RIFLE classification. Results: The levels of MDA, Index of oxidative status MDA/TAC and DNA damage product 8 OH deoxy guanosine were significantly higher among failure group when compared to risk and injury. Total antioxidant capacity and super oxide dismutase (SOD) were found to be decreased.

Acute Kidney Injury: Definition, Incidence, Etiology, Outcome / 대한내과학회지

Acute kidney injury (AKI) is characterized as acute decline of renal function. AKI is frequently combined in hospitalized patients and worsen the outcome of the affected patients. Recently new criteria named RIFLE and AKIN were made to define AKI more uniformly. Recent studies with RIFLE/AKIN showed that even less severe forms of AKI are associated with reduced survival and worse outcome. In this review, we will discuss on the definition, Incidence, Etiology and outcome of AKI.