Risk factors and outcomes of acute kidney injury in South African critically ill adults: a prospective cohort study.

BACKGROUND: There is a marked paucity of data concerning AKI in Sub-Saharan Africa, where there is a substantial burden of trauma and HIV. METHODS: Prospective data was collected on all patients admitted to a multi-disciplinary ICU in South Africa during 2017. Development of AKI (before or during ICU admission) was recorded and renal recovery 90 days after ICU discharge was determined. RESULTS: Of 849 admissions, the mean age was 42.5 years and mean SAPS 3 score was 48.1. Comorbidities included hypertension (30.5%), HIV (32.6%), diabetes (13.3%), CKD (7.8%) and active tuberculosis (6.2%). The most common reason for admission was trauma (26%). AKI developed in 497 (58.5%). Male gender, illness severity, length of stay, vasopressor drugs and sepsis were independently associated with AKI. AKI was associated with a higher in-hospital mortality rate of 31.8% vs 7.23% in those without AKI. Age, active tuberculosis, higher SAPS 3 score, mechanical ventilation, vasopressor support and sepsis were associated with an increased adjusted odds ratio for death. HIV was not independently associated with AKI or hospital mortality. CKD developed in 14 of 110 (12.7%) patients with stage 3 AKI; none were dialysis-dependent. CONCLUSIONS: In this large prospective multidisciplinary ICU cohort of younger patients, AKI was common, often associated with trauma in addition to traditional risk factors and was associated with good functional renal recovery at 90 days in most survivors. Although the HIV prevalence was high and associated with higher mortality, this was related to the severity of illness and not to HIV status per se.

Development of predictive models for geosmin-related taste and odor in Kansas, USA, drinking water reservoirs.

The presence of taste and odor compounds can greatly reduce the quality of drinking water supplies. Because the monetary costs associated with the removal of these compounds can be high, it is impractical for most facilities to continuously treat their raw water. Instead, new tools are needed to help predict when taste and odor events may be most likely to occur. Water quality data were collected between June and October in 2006-2007 from five Kansas (USA) reservoirs in order to develop predictive models for geosmin, a major taste and odor compound; two of these reservoirs were also sampled during specific taste and odor events in December 2006 and January 2007. Lake trophic state alone was not a good predictor of geosmin concentrations as the highest average geosmin concentration was observed in the reservoir with the lowest nutrient and chlorophyll a concentrations. In addition, taste and odor events were not confined to summer months; elevated geosmin concentrations were observed in several reservoirs during the winter. Growth limitation by inorganic phosphorus appeared to be the primary determinant of geosmin production by algal cells in these reservoirs.

Improving access to genitourinary medicine by satellite clinics: an evaluation of the use of pump-priming funding.

Pump-priming funding was used to implement a three-month pilot project of two satellite clinics. We conducted a review to determine the impact of the satellite clinics on the local genitourinary (GU) medicine service and the level of success with reference to priorities in the National Strategy for Sexual Health and HIV. A total of 140 patients attended a university clinic and 52 attended a market town clinic. In all, 14% of university clinic and 15% of market town patients were chlamydia positive. Targets for offering/uptake of HIV testing (as outlined in the National Strategy) for 2004 were all met, and those for 2007 were all met except for one. Both satellites were judged successful. After effective implementation of a satellite service, staffing could be transferred to general practitioners with special interest in GU medicine/nurse specialists. This could allow additional satellites to be developed without compromising the main service, helping to improve access to local GU medicine services and promoting local clinical networks.