Background This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. Methods This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score‐matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score‐matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. Results A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score‐matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). Conclusion There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast‐induced nephropathy should not be used as a reason to avoid contrast‐enhanced CT.

The peri-operative use of angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers is thought to be associated with an increased risk of postoperative acute kidney injury. To reduce this risk, these agents are commonly withheld during the peri-operative period. This study aimed to investigate if withholding angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers peri-operatively reduces the risk of acute kidney injury following major non-cardiac surgery. Patients undergoing elective major surgery on the gastrointestinal tract and/or the liver were eligible for inclusion in this prospective study. The primary outcome was the development of acute kidney injury within seven days of operation. Adjusted multi-level models were used to account for centre-level effects and propensity score matching was used to reduce the effects of selection bias between treatment groups. A total of 949 patients were included from 160 centres across the UK and Republic of Ireland. From this population, 573 (60.4%) patients had their angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers withheld during the peri-operative period. One hundred and seventy-five (18.4%) patients developed acute kidney injury; there was no difference in the incidence of acute kidney injury between patients who had their angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers continued or withheld (107 (18.7%) vs. 68 (18.1%), respectively; p = 0.914). Following propensity matching, withholding angiotensin-converting enzyme inhibitors or angiotensin-2 receptor blockers did not demonstrate a protective effect against the development of postoperative acute kidney injury (OR (95%CI) 0.89 (0.58-1.34); p = 0.567).

Aim: to investigate the prevalence of diabetes mellitus type 2 (T2DM) and association of HbA1c with the severity of coronary artery disease (CAD) in patients presenting at tertiary care center as acute coronary syndrome and non-diabetic. Study Design: Prospective observational study Duration and Place Study was conducted at department of general medicine Nishter Hospital, Multan from January 2021 to January 2022 in 1 year duration. Methodology: A total of 200 patients were enrolled in study. Main variables of study were BMI, smoking status, dyslipidemia, hypertension, STEMI, angina, HbA1c and treatment strategy. SPSS version 23 was used for data analysis. P value below or equal to 0.05 was taken as significant. Results: Among total 83.5% patients intervened by therapeutic, whereas 48.0% used thrombolytic drug in STEMI. 70.7% patients were thrombolysis in therapeutic intervention and 44.8% were streptokinase in thrombolytic drug. In fasting blood sugar, 53.0% patients were diabetic, whereas in HbA1c levels, 52.3% patients were diabetic. Conclusion: This study highlights the significance of testing for diabetes in individuals in poor nations who report with non-diabetic acute coronary syndrome. One of manifestations of diabetes mellitus may be the acute coronary syndrome. Keywords: Acute coronary syndrome, Coronary angiography, Diabetes, HbA1c.

ABSTRACT… Objectives:To determine the frequency of acute kidney injury in hospitalized patients at Nishtar hospital, Multan. Study Design: Cross sectional study. Setting: Medical Unit-IV, Nishtar Hospital, Multan. Duration: Duration of study was 6 months from 17/07/2015 to 16/01/2016. Material and Methods: This study involved 383 patients of either sex aged between 37-60 years admitted to medical ward for various medical conditions. Results: The mean age of the patients was 48.96±7.24 years. There were 198 (51.7%) male and 185 (48.3%) female patients in the study group. The most frequent underlying cause requiring hospital admission was a respiratory tract disease observed in 153 (39.9%) patients. AKI was observed in 104 (27.2%) patients. When stratified the frequency of AKI increased significantly with increasing age of the patient; 37-42 years vs. 43-48 years vs. 49-54 years vs. 55-60 years (17.3% vs. 22.7% vs. 26.2% vs. 42.0%; p=.001). It was also significantly (p=.000) higher in patients with diabetes (47.4%) and hepatobiliary disease (34.7%) at admission followed by infections (26.4%) and respiratory tract diseases (17.6%). However, there was no significant difference in the frequency of AKI across genders; male vs. female (25.8% vs. 28.6%; p=.525). Conclusion: Very high frequency of acute kidney injury was observed in our study. Acute kidney injury was significantly associated with increasing age particularly more than 50 years and underlying medical conditions with particular reference to the diabetes mellitus and hepatobiliary diseases. Serial renal parameters monitoring should be adopted for early diagnosis followed by timely management of acute kidney disease. It will decrease associated disease morbidities and mortalities and will also improve quality of life of these patients.

Objectives: To determine the frequency of acute kidney injury in hospitalizedpatients at Nishtar hospital, Multan. Study Design: Cross sectional study. Setting: MedicalUnit-IV, Nishtar Hospital, Multan. Duration: Duration of study was 6 months from 17/07/2015to 16/01/2016. Material and Methods: This study involved 383 patients of either sex agedbetween 37-60 years admitted to medical ward for various medical conditions. Results: Themean age of the patients was 48.96±7.24 years. There were 198 (51.7%) male and 185 (48.3%)female patients in the study group. The most frequent underlying cause requiring hospitaladmission was a respiratory tract disease observed in 153 (39.9%) patients. AKI was observedin 104 (27.2%) patients. When stratified the frequency of AKI increased significantly withincreasing age of the patient; 37-42 years vs. 43-48 years vs. 49-54 years vs. 55-60 years (17.3%vs. 22.7% vs. 26.2% vs. 42.0%; p=.001). It was also significantly (p=.000) higher in patientswith diabetes (47.4%) and hepatobiliary disease (34.7%) at admission followed by infections(26.4%) and respiratory tract diseases (17.6%). However, there was no significant difference inthe frequency of AKI across genders; male vs. female (25.8% vs. 28.6%; p=.525). Conclusion:Very high frequency of acute kidney injury was observed in our study. Acute kidney injury wassignificantly associated with increasing age particularly more than 50 years and underlyingmedical conditions with particular reference to the diabetes mellitus and hepatobiliary diseases.Serial renal parameters monitoring should be adopted for early diagnosis followed by timelymanagement of acute kidney disease. It will decrease associated disease morbidities andmortalities and will also improve quality of life of these patients.