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Subject(s)
Anti-Bacterial Agents , Appendicitis , Humans , Anti-Bacterial Agents/therapeutic use , Appendicitis/surgery , Pakistan , Appendectomy , Acute DiseaseABSTRACT
BACKGROUND: Acute kidney injury (AKI) after cardiac surgery is associated with an increased mortality and morbidity. Different definitions for AKI have been used such as Acute Kidney Injury Network (AKIN), Kidney Disease: Improving Global Outcomes (KDIGO), or risk, injury, failure, loss, end-stage kidney disease (RIFLE). Each of these definitions has their own benefits and limitations for predicting the degree of AKI and adverse outcomes following cardiac surgery. This study was aimed to compare the three AKI definitions to diagnose AKI and their predictive ability for mortality and morbidity after isolated coronary artery bypass surgery (CABG) in a South Asian cohort. MATERIAL AND METHODS: A single-center retrospective review was conducted on 1,508 patients having undergone isolated CABG surgery from January 2015 to January 2019. AKI was assessed on three definitions, and comparative receiver operating characteristics curves were built against the outcomes to assess discriminative power of each. RESULTS: Mean age of participants was 59.43 (±1.12) years, predominantly males (82.6%). Patients with AKI were elder, more likely to be diabetic and hypertensive. AKI by any definition occurred in 58.7% (885/1,508) patients. Frequency of AKI was 508 (33.7%), 517 (34.4%), and 871 (57.8%) on AKIN, KDIGO, and RIFLE criteria, respectively. The proportion of patients with RIFLE-risk 619 (41%) was greater compared with AKIN stage 1 (342 [22.7%]) and KDIGO stage 1 (330 [21.9%]), while for stages 2 and 3 the proportions were comparable across the three systems. Area under the curve (AUC) for 30-day mortality for AKIN was (0.786, [95% CI: 0.764-0.806]), KDIGO: (0.796, [95% CI: 0.775-0.816]) and for RIFLE (0.844, [95% CI: 0.825-0.862]). AUC for overall morbidity was in undesirable ranges (i.e., >0.5-≤0.7) for all three definitions. CONCLUSION: In a South Asian cohort, performance of AKIN and KDIGO criteria was comparable to diagnose AKI, while RIFLE definition, though overestimated the incidence of AKI particularly stage 1, and had an excellent discriminatory power to predict mortality compared to other two definitions.
Subject(s)
Acute Kidney Injury , Cardiac Surgical Procedures , Acute Kidney Injury/diagnosis , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Aged , Cardiac Surgical Procedures/adverse effects , Female , Hospital Mortality , Humans , Kidney , Male , Middle Aged , Retrospective StudiesSubject(s)
Relaxation Therapy , Stress, Psychological , Students, Medical/psychology , Female , Humans , India , MaleABSTRACT
OBJECTIVE: Assess the perception of stress amongst medical students and their coping strategies. METHODOLOGY/STUDY DESIGN: A cross sectional study using a semi-structured self administered questionnaire was carried out over four weeks, using a small sample of students of all categories and classes of a medical college. RESULTS: A total of 264 students out of 300 (88%) filled in the questionnaire. Inability to cope, helplessness, increased psychological pressure, mental tension and too much workload are 'stress factors' for students. A considerable majority (> 90%) think that they have been stressed at one time or another. Ninety-four per cent of males have experienced stress. The senior students of the fourth and final year feel more stressed (95% and 98% respectively). Low moods, inability to concentrate, loss of temper are most common symptoms. Females report more symptoms. Academics and exams are the most powerful stressors. Sports, music, hanging out with friends, sleeping or going into isolation are various coping mechanisms. Stress can affect the academic performance. If needed, students prefer to talk to a peer. They demand more recreational activities on campus, revised schedule of academics and exams, better counselling facilities and improvement in student-teacher relationship. CONCLUSION: The prevalence of perceived stress seems to be high among medical students, which tends to affect not only their academic performances but also all aspects of health. Review of academics and exam schedules, more leisure time activities, better interaction with the faculty and proper guidance, advisory services and peer counselling at the campus could do a lot to reduce the stress.