Evaluation of Contrast-Induced Acute Kidney Injury (CI-AKI)

Background: The risk of contrast-induced acute kidney injury (CI-AKI) has been accepted lately by medicalliterature and practice since it is the third leading cause of acute kidney injury in hospitalized patients. Differentmeasures in practice are being used to prevent the incidence of CI-AKI. Objective: In this review, we aimed todiscuss the different methods of prevention of CI-AKI mentioned in the literature. Methods: A comprehensivesearch was done using biomedical databases including Medline, and PubMed, for studies concerned with theassessment of Contrast-Induced Acute Kidney Injury. Keywords used in our search through the databases were“Contrast-Induced Kidney Failure” and “Diagnosis & Management”. Conclusion: Intravenous (IV) fluidhydration is the mainstay of practice in the prevention of CI-AKI. Intravenous administration of sodiumbicarbonate has also gained notable importance in the prevention of CI-AKI, but it is still not confirmed. Despitethat the application of N-acetyl cysteine to prevent CI-AKI is controversial, N-acetyl cysteine remains a commonlyutilized agent even without solid scientific evidence. The application of statins for the prevention of CI-AKI afterintravascular contrast medium administration revealed some promising results but it is still premature toimplement their application in daily clinical practice. Therefore, there is a need for additional well designed andsufficiently powered randomized controlled trials to clarify these issues and to assess the risk vs benefit of allother methods for the purpose of CI-AKI prevention

Determinants of functional status among survivors of severe sepsis and septic shock: one-year follow-up

Sepsis is a leading cause of intensive care unit [ICU] admissions worldwide and a major cause of morbidity and mortality. Limited data exist regarding the outcomes and functional status among survivors of severe sepsis and septic shock. This study aimed to determine the functional status among survivors of severe sepsis and septic shock a year after hospital discharge. Adult patients admitted between April 2007 and March 2010 to the medical-surgical ICU of a tertiary hospital in Saudi Arabia, were included in this study. The ICU database was investigated for patients with a diagnosis of severe sepsis or septic shock. Survival status was determined based on hospital discharge. Patients who required re-admission, stayed in ICU for less than 24 hours, had incomplete data were all excluded. Survivors were interviewed through phone calls to determine their functional status one-year post-hospital discharge using Karnofsky performance status scale. A total of 209 patients met the eligibility criteria. We found that 38 [18.1%] patients had severe disability before admission, whereas 109 [52.2%] patients were with severe disability or died one-year post-hospital discharge. Only one-third of the survivors had good functional status one-year post-discharge [no/mild disability]. After adjustment of baseline variables, age [adjusted odds ratio [aOR] = 1.03, 95% confidence interval [CI] = 1.01-1.04] and pre-sepsis functional status of severe disability [aOR = 50.9, 95% CI = 6.82-379.3] were found to be independent predictors of functional status of severe disability one-year post-hospital discharge among survivors. We found that only one-third of the survivors of severe sepsis and septic shock had good functional status one-year post-discharge [no/mild disability]. Age and pre-sepsis severe disability were the factors that highly predicted the level of functional status one-year post-hospital discharge

Diabetic ketoacidosis at diagnosis of type 1 diabetes mellitus in Malaysian children and adolescents

Background: Diabetic ketoacidosis (DKA) is a late presentation of newly diagnosed type 1 diabetes mellitus (DM) in children. The aim of this study was to determine the clinical characteristics of type 1 DM at presentation so that appropriate actions can be taken to promote early diagnosis. Methods: This was a retrospective cohort review from a patient registry database. Data on all patients younger than 20 years old diagnosed with type 1 DM who had been registered with the Malaysian Diabetes in Children and Adolescents Registry (DiCARE) from its inception in 2006 until 2009 were analysed. Results: The study included 490 children and adolescents, out of which 57.1% were female. The mean (SD) age at diagnosis was 7.5 (3.7) years, which increased from year 2000 to 2009 [6.6 (3.3) years to 9.6 (3.5) years; p = 0.001]. An increasing percentage of DKA at diagnosis was observed from year 2000 (54.5%) to year 2009 (66.7%), which remained high and leveled between 54.5% and 75.0%. DKA was more common in patients with normal weight (p = 0.002) with no significant association with age, gender, ethnicity and status of family history of diabetes mellitus. Conclusion: An increasing trend of age at diagnosis of patients with type 1 DM was observed. Besides that, proportion of DKA at diagnosis had remained high over the past decade. This study found that normal weight was associated with status of DKA, thus more detailed investigations are required to determine the risk factors for DKA.