Risk stratification is essential for both clinical risk prediction and comparative audit. There are a variety of risk stratification tools available for use in major noncardiac surgery, but their discrimination and calibration have not previously been systematically reviewed in heterogeneous patient cohorts.Embase, MEDLINE, and Web of Science were searched for studies published between January 1, 1980 and August 6, 2011 in adult patients undergoing major noncardiac, nonneurological surgery. Twenty-seven studies evaluating 34 risk stratification tools were identified which met inclusion criteria. The Portsmouth-Physiology and Operative Severity Score for the enUmeration of Mortality and the Surgical Risk Scale were demonstrated to be the most consistently accurate tools that have been validated in multiple studies; however, both have limitations. Future work should focus on further evaluation of these and other parsimonious risk predictors, including validation in international cohorts. There is also a need for studies examining the impact that the use of these tools has on clinical decision making and patient outcome.

A comprehensive acute toxicity trial was conducted using a static water system to study the toxic effect of ammonia on haematology and enzyme profiles of Cirrhinus mrigala H. The LC50 of total ammonia‐nitrogen (TAN) was 11.8 mg L−1 TAN (1.029 mg L−1 NH3‐N). The sub‐lethal test revealed that with increasing concentration of TAN, the total erythrocyte counts were reduced in lower concentrations (1–4 mg L−1 TAN) followed by higher levels in fish exposed to higher concentrations (8–16 mg L−1 TAN). In contrast, the total leucocyte counts were opposite. With increasing concentration of TAN, haemoglobin and serum protein content were reduced, whereas the blood glucose level increased. As the concentration of ammonia increased, there was a reduction in acetylecholinesterase activity in the brain and liver; alkaline phosphatase activity in the serum, brain and gill; and acid phosphatase (ACP) activity in the gill. The activity of lactate dehydrogenase in the gill, liver, kidney and brain increased with increased concentration of ammonia. In addition, activities of ACP in the serum and brain, alanine aminotransferase in the serum, brain and gill, and aspartate aminotransferase in the serum, brain and gill were increased.

T he extensive use of antimicrobials has selected resistance in many bacterial species, and this has become a major public health issue worldwide (1). The problem of multidrug resistance is currently most acute in Gram-negative bacteria, where treatment options can be severely limited, and there are few promising new antibiotics with activity against Gram-negative bacteria under advanced development (1). Clonal spread of resistant strains and horizontal transfer of resistance genes both contribute to the rising global prevalence of multiresistant Gram-negative bacteria, with horizontal transfer enabling the acquisition of multidrug resistance by previously susceptible bacteria (2).Most methods currently employed by clinical diagnostic laboratories, e.g., the Vitek (bioMérieux, Marcy l'Etoile, France) and MicroScan (Siemens, Camberley, United Kingdom) (3) systems, provide insight only into the resistance phenotypes, require susceptibility testing following bacterial culture, and can take from approximately 9 to 20 h to obtain results. Molecular methods are faster but present their own challenges. In particular, conventional or real-time PCR, single-gene sequencing, or in situ hybridization usually detects only a few resistance genes simultaneously. Microarrays, however, offer the potential for simultaneous detection of large numbers of resistance genes, allowing prediction of an isolate's repertoire of resistances to multiple antibiotic classes (4-7).We previously developed a microarray that detected 51 resistance genes in Escherichia coli and Salmonella and facilitated epidemiological studies (4, 8). Its coverage included genes that conferred acquired resistance to a range of antimicrobials of clinical importance as well as two integrase genes associated with class 1 and class 2 integrons and not just those genes encoding ␤-lactamases (6). This work sought to extend the microarray to make it relevant to the broader range of Gram-negative bacterial genera commonly encountered in clinical diagnostic or reference laboratories and to include in its coverage newly critical gene groups, including genes encoding carbapenemases. MATERIALS AND METHODS Bacterial strains used and determination of antibiotic susceptibilities.A panel of 132 bacterial isolates from our laboratory collections and clinical isolates representing a diverse range of Enterobacteriaceae and nonfermenter genera, including Pseudomonas and Acinetobacter, was assembled. The antimicrobial susceptibilities (MICs) of these isolates to 19 antibiotics (tobramycin, amikacin, gentamicin, streptomycin, ampicillin, amoxicillin-clavulanic acid [co-amoxiclav], aztreonam, cefotaxime, ceftazidime, cefpirome, cefoxitin, piperacillin, imipenem, meropenem, chloramphenicol, ciprofloxacin, sulfonamide, tetracycline, and trimethoprim) were determined using the British Society for Antimicrobial Chemotherapy (BSAC) agar dilution methodology or disk diffusion (9). Susceptibility was defined using BSAC/European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinic...

The antiulcer effect of melatonin on gastric lesions caused by restraint-cold stress was studied with the intent of determining the mechanism of action of this agent. Melatonin dose-dependently prevented restraint-cold stress-induced gastric damage with around 90% inhibition at a dose of 60 mg/kg BW. When compared with already marketed antiulcer drugs such as ranitidine and omeprazole, melatonin was found to be more effective than ranitidine but less effective than omeprazole in preventing stress ulcer. As stress-induced gastric lesions are mainly caused by oxidative damage because of hydroxyl radicals (*OH), the effect of melatonin in scavenging the.OH generated during stress conditions in vivo as well as in an in vitro model system were studied. The results indicate that melatonin caused an 88% reduction of endogenous *OH during stress in vivo, an observation confirmed in an established in vitro system. Furthermore, a decrease in the activity of gastric peroxidase (GPO) and an increase in the gastric mitochondrial superoxide dismutase (Mn-SOD) activity because of restraint-cold stress was attenuated by melatonin pretreatment indicating that the indole possibly exerts its gastroprotective effects through its direct as well as indirect antioxidant activities. Moreover, in separate experiments, cotreatment of rats with melatonin and ranitidine or omeprazole was found to protect against stress ulceration in doses at which either of these alone could not protect the stomach. The findings raise the possibility of melatonin being considered as an effective gastroprotective agent individually or as a cotreatment with either ranitidine and omeprazole.

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Changes in water parameters were studied in a yard experiment for 7 weeks after application of cow dung at 20, 50 and 100 t ha−1, poultry manure at 4, 10 and 20 t ha−1, feed mixture (groundnut oil cake and rice bran at 1:1) at 10, 20 and 30 t ha−1 and inorganic fertilizers at 100 kg urea+50 kg single super phosphate (SSP) ha−1, twice this dose (2x ha−1) and thrice this dose (3x ha−1). To study the role of soil in the mineralization process, each treatment was divided into two groups – one with and the other without soil substrate. Higher degree of changes in water parameters was observed at higher input levels. Both organic amendment and inorganic fertilization caused significant reduction (P<0.05) in dissolved oxygen and increase in free CO2, dissolved organic matter, total ammonia, nitrite, nitrate and phosphorus contents of water. Organic inputs significantly decreased (P<0.05) water pH and increased total alkalinity and hardness. In contrast, inorganic fertilization caused a significant increase in pH; alkalinity and hardness increased significantly in the presence of soil, but reduced in its absence. In organic input, presence of soil substrate caused significantly lower value of pH, dissolved oxygen, dissolved organic matter and phosphate‐phosphorus and significantly higher free CO2, alkalinity, hardness, ammonia, nitrite and nitrate contents, compared with those in the absence of soil, revealing enhanced microbial mineralization in the presence of soil.