Community-acquired acute kidney injury in India: data from ISN-acute kidney injury registry.

Background: Acute kidney injury (AKI), particularly community-acquired AKI (CA-AKI), is a major health concern globally. The International Society of Nephrology's "0 by 25" initiative to reduce preventable deaths from AKI to zero by 2025 is not achievable in low and middle income countries, such as India, possibly due to a lack of data and measures to tackle this urgent public health issue. In India, CA-AKI predisposes younger patients to hospitalization, morbidity, and mortality. This is the first multicenter, prospective, cohort study investigating CA-AKI and its consequences in India. Methods: This study included data from patients with CA-AKI (>12 years of age) housed in the Indian Society of Nephrology-AKI registry, involving 9 participating tertiary care centers in India, for the period between November 2016 and October 2019. The etiological spectrum and renal and patient outcomes of CA-AKI at the index visit and at 1-month and 3-month follow-ups were analyzed. The impact of socioeconomic status (SES) on outcomes was also analyzed. Findings: Data from 3711 patients (mean [±SD] age 44.7 ± 16.5 years; 66.6% male) were analyzed. The most common comorbidities included hypertension (21.1%) and diabetes (19.1%). AKI occurred in medical, surgical, and obstetrical settings in 86.7%, 7.3%, and 6%, respectively. The most common causes of AKI were associated with sepsis (34.7%) and tropical fever (9.8%). Mortality at the index admission was 10.8%. Complete recovery (CR), partial recovery (PR), and dialysis dependency among survivors at the time of discharge were 22.1%, 57.7%, and 9.4%, respectively. Overall, at 3 months of follow-up, mortality rate, CR, PR, and dialysis dependency rates were 11.4%, 72.2%, 7.2%, and 1%, respectively. Multivariate analysis revealed that age >65 years, alcoholism, anuria, hypotension at presentation, thrombocytopenia, vasopressor use, transaminitis, and low SES were associated with mortality at the index admission. Interpretation: Sepsis and tropical fever were the most common causes of CA-AKI. Presentation of CA-AKI to tertiary care units was associated with high mortality, and a significant number of patients progressed to CKD. Individuals with a low SES had increased risk of mortality and require immediate attention and intervention. Funding: This study was funded by the Indian Society of Nephrology.

Use of appropriate statistical tools in biomedical research: Current trend & status.

Background & objectives: Due to lack of appropriate statistical knowledge, published research articles contain various errors related to the design, analysis and interpretation of results in the area of biomedical research. If research contains statistical error, however, costly, it may be of no use and the purpose of the investigation gets defeated. Many biomedical research articles published in different peer reviewed journals may retain several statistical errors and flaws in them. This study aimed to examine the trend and status of application of statistics in biomedical research articles. Study design, sample size estimation and statistical measures are crucial components of a study. These points were evaluated in published original research articles to understand the use or misuse of statistical tools. Methods: Three hundred original research articles from the latest issues of selected 37 journals were reviewed. These journals were from the five internationally recognized publication groups (CLINICAL KEY, BMJ Group, WILEY, CAMBRIDGE and OXFORD) accessible through the online library of SGPGI, Lucknow, India. Results: Among articles assessed under present investigation, 85.3 per cent (n=256) were observational, and 14.7 per cent (n=44) were interventional studies. In 93 per cent (n=279) of research articles, sample size estimation was not reproducible. The simple random sampling was encountered rarely in biomedical studies even though none of the articles was adjusted by design effect and, only five articles had used randomized test. The testing of assumption of normality was mentioned in only four studies before applying parametric tests. Interpretation & conclusions: In order to present biomedical research results with reliable and precise estimates based on data, the role of engaging statistical experts need to be appreciated. Journals must have standard rules for reporting study design, sample size and data analysis tools. Careful attention is needed while applying any statistical procedure as, it will not only help readers to trust in the published articles, but also rely on the inferences the published articles draw.

Correlates of Cigarette Smoking Among Adolescents in India.

BACKGROUND: The use of cigarettes/tobacco among adolescents is quite high in India. Worldwide, nearly, all (88%) initiation of smoking occurs before the age of 18 years. Smoking caused about 1 million deaths or 10% of all deaths in India, with about 70% of these deaths occurring at the ages of 30-69 years. AIMS AND OBJECTIVES: Different correlates of cigarette smoking among adolescents were investigated, which may help to improve public health interventions in India. MATERIALS AND METHODS: Global Youth Tobacco Survey data collected in India during 2009 were taken. Bivariate analysis, logistic regression, receiver operating characteristic, and nomogram were used to examine association between exposure and outcome variables. Cigarette smoking within the past 30 days preceding the survey was the outcome variable while independent variables were age, education, gender, parental smoking, people smoking at home/smoking in the presence of adolescents, felt boys/girls who smoke have more friends, accepting cigarette offered by one of the best friends, perception of attractiveness of boys/girls who smoke, perception smoking makes one loss or gain weight, and perception cigarettes smoking harmful. RESULTS: 11768 adolescents participated, of which 9951 (48% males and 52% female) responded on cigarette smoking. Current cigarette smoking was associated with female gender (odds ratio [OR]: 0.68; 95% confidence interval [CI]: 0.52-0.90), parental smoking (OR: 1.00; 95% CI: 0.62-1.60), smoking cigarette at home (OR: 3.66; 95% CI: 2.64-5.09), and smoking cigarette in presence of adolescent (OR: 4.14; 95% CI: 2.92-5.87). Observed associations between the outcome and exposure variables reported in this study should be considered in the design of public health interventions. CONCLUSION: To eliminate smoking habits, efforts should also be made in the exploration of new ideas and their implementation by the public health experts in collaboration with international agencies, various nongovernmental organizations, and academic and research institutions. Let's plan for active action to make smoke-free environment based on evidence.