Background/Aims: Publications on acute kidney injury (AKI) have concentrated on the inpatient population. We wanted to determine the extent of AKI in the community, its follow-up and patient impact. Method: Primary Care creatinine results for May 2012-April 2013 from Cornwall, United Kingdom, were screened for AKI. Results: Over 12 months, 991 AKI episodes were identified (0.4% of all Primary Care creatinine requests); 51% were AKI1, 29% AKI2 and 10% AKI3. Of these, 51% AKI1s, 72% AKI2s and 77% AKI3s had a repeat creatinine requested within 14 days as per National Institute for Health and Care Excellence (NICE) guidelines. Admissions (May 2012-July 2013) were identified on 46% AKI1s, 58% AKI2s and 65% AKI3s (p < 0.05). The median time from AKI identification to hospital admission was 33 days for AKI1, 12 days for AKI2 and 1 day for AKI3 (p < 0.05); with a median length of stay of 2, 4 and 7 days, respectively (p < 0.05). The 90-day mortality from AKI identification for the admitted patients was 12% AKI1s, 20% AKI2s and 27% AKI3s (p < 0.05) vs. 11, 21 and 65% (p < 0.05) for those that were not admitted. There was no significant difference in mortality for admitted patients vs. non-admitted patients, except for the AKI3s. Conclusion: AKI is associated with increased admission and mortality rates; although a large proportion of patients had repeat creatinine testing within 14 days, there was still a significant number with delayed follow-up. Education within Primary Care is required on how to prevent, identify, follow-up and manage AKI.

Objective-To determine the relation between maternal serum cx fetoprotein and free 1 human chorionic gonadotrophin concentrations in pregnancies complicated by trisomy 18 IntroductionBiochemical screening for trisomy 21 can now identify 65-75% of cases early in the second trimester, particularly when combinations of a fetoprotein and free 1 human chorionic gonadotrophin concentrations are used as markers. 1-6The prospect of first trimester screening with these analytes to achieve detection rates exceeding 50% seems a definite possibility.7-9 The impetus for all this development was the finding by one of us of a low matemal serum ot fetoprotein concentration in a case of trisomy 18.10Trisomy 18 is the second most frequent autosomal trisomy (after trisomy 21) and has a birth incidence of

Early intervention in the management of acute kidney injury (AKI) has been shown to improve outcomes. To facilitate early review we have introduced real time reporting for AKI. An algorithm using the laboratory computer system was implemented to report AKI for inpatients. Over 6 months there were 1,906 AKI reports in 1,518 patients: 56.3% AKI1, 26.9% AKI2 and 16.8% AKI3. 51.0% were male. Median age was 78 (interquartile range [IQR] 17) years. 62.6% were from general medical wards, 16.9% from surgical wards, 6.9% from orthopaedic wards and 5.3% from specialty wards. 8.3% were from peripheral hospitals. 31% of patients with AKI reports were clinically coded for AKI. 9% (n = 139) showed progression of AKI (mortality 42%). Patients with AKI had a signifi cantly higher length of stay and mortality than those that did not. 4% of patients with AKI received acute renal replacement therapy (RRT). An e-alert system is feasible, allowing early identifi cation of inpatients with AKI.

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The NMR spectra of eighteen 701-and 7p-substituted 6,14-bridged thebaine derivatives are reported and the steric and other effects of the 7-substituent on the C-5-H atoms examined. Although the €I-5 proton shift enabled compounds epimeric at C-7 to be distinguished in the examples studied (values falling between 6 4.75-4.40 ppm in the 701 series and 6 5.21-4.97 ppm in the 7 8 series), the C-5 shift values proved less useful owing to overlapping ranges.