Accuracy of transcutaneous bilirubin measurement in preterm low-birth-weight neonates

The objective of this study was to evaluate the correlation and agreement between transcutaneous and serum bilirubin among preterm low-birth-weight neonates. Neonates born at <35 weeks of gestation with birth weight <2,000 g were enrolled prospectively. Transcutaneous bilirubin (TcB) was measured at forehead, sternum, and abdomen at 24?±?6 and 72?±?12 h after birth and when icterus involved arms or legs (Kramer zone 4–5). Serum total bilirubin (STB) was measured by microbilimeter (STB-M) at all these time-points and by high-performance liquid chromatography (STB-H) at one randomly chosen time-point. A total of 1,619 observations were made in 256 neonates (median gestation, 34 weeks (IQR, 32–35), birth weight 1,522?±?288 g). Overall there was excellent correlation and agreement between TcB and STB-M with TcB on forehead being most accurate (r?=?0.84, mean difference, 0.3?±?1.9 mg/dL) followed by TcB on abdomen (r?=?0.73, mean difference, 1.5?±?2.6 mg/dL) and sternum (r?=?0.72, mean difference, 1.5?±?2.6 mg/dL). TcB performed well at all three points of measurement with best correlations being observed at icterus level 4/5. Correlation between TcB and STB-H measured by high-performance liquid chromatography was less strong but significant (r?=?0.59 to 0.69 at different time points of measurement). Conclusions: TcB has good correlation and agreement with STB in preterm low-birth-weight neonates born at ≥28 weeks of gestation.     

Dental restorative composite materials: A review

BackgroundThis review article discusses the effect of reinforcements in the parent dental restorative materials that results in enhanced performance in real-time situations.HighlightThe review article includes the details of the properties of different reinforced dental composite materials such as mechanical strength, thermal properties, physical/chemical properties, tribological performance.ConclusionIt revealed that nanofiller particles enhance the properties of various dental composite materials. The hybrid dental composites also contribute significantly in increasing the mechanical and tribological properties. A silane-treated filler improved the dental composite bonding strength.     

Burden of diabetic foot disorders,guidelines for management and disparities in implementation in Europe: a systematic literature review

The study aimed to assess the economic and quality of life burden of diabetic foot disorders and to identify disparities in the recommendations from guidelines and the current clinical practice across the EU5 (Spain, Italy, France, UK and Germany) countries. Literature search of electronic databases (MEDLINE^®, Embase^® and Cochrane Database of Systematic Reviews) was undertaken. English language studies investigating economic and resource burden, quality of life and management of diabetic foot disease in the EU5 countries were included. Additionally, websites were screened for guidelines and current management practices in diabetic foot complication in EU5. Diabetic foot complications accounted for a total annual cost of €509m in the UK and €430 per diabetic patient in Germany, during 2001. The cost of diabetic foot complications increased with disease severity, with hospitalizations (41%) and amputation (9%) incurring 50% of the cost. Medical devices (orthopaedic shoes, shoe lifts and walking aids) were the most frequently utilized resources. Patients with diabetic foot complications experienced worsened quality of life, especially in those undergoing amputations and with non‐healed ulcers or recurrent ulcers. Although guidelines advocate the use of multidisciplinary foot care teams, the utilization of multidisciplinary foot care teams was suboptimal. We conclude that diabetic foot disorders demonstrated substantial economic burden and have detrimental effect on quality of life, with more impairment in physical domain. Implementation of the guidelines and set‐up of multidisciplinary clinics for holistic management of the diabetic foot disorders varies across Europe and remains suboptimal. Hence, guidelines need to be reinforced to prevent diabetic foot complications and to achieve limb salvage if complications are unpreventable. Copyright © 2014 John Wiley & Sons, Ltd.     

Social adaptability index predicts overall mortality in patients with diabetes

BackgroundA quantifiable assessment of socioeconomic status and its bearing on clinical outcome in patients with diabetes is lacking. The social adaptability index (SAI) has previously been validated in the general population and in patients with chronic kidney disease, including those on dialysis and with kidney transplant. We hypothesize that SAI could be used in diabetes practice to identify a disadvantaged population at risk for inferior outcomes.MethodsThe NHANES-3 database of patients who have diabetes was analyzed. The association of the SAI (calculated as the linear combination of indicators of education status, employment, income, marital status, and substance abuse) with patient survival was evaluated using Cox model.ResultsThe study population consisted of 1634 subjects with diabetes mellitus with mean age of 61.9±15.3 years; 40.9% males; 38.5% white, 27.7% African American, and 31.3% Mexican American. The highest SAI was in whites (6.9±2.5), followed by Mexican Americans (6.5±2.3), and then African Americans (6.1±2.6) (ANOVA, P<.001). SAI was higher in subjects living in metropolitan areas (6.8±2.6) compared to the rural population (6.3±2.4) (T test, P<.001). Also, SAI was greater in males (7.1±2.4) than in females (6.1±2.4) (T test, P<.001).SAI had significant association with survival (hazard ratio 0.9, P<.001) in the entire study population and in most of the subgroups (divided by race, sex, and urban/rural location). Furthermore, SAI divided into tertiles (≤5, 6 to 8, >8) demonstrated a significant and “dose-dependent” association with survival.ConclusionSocial adaptability index is associated with mortality in the diabetic population and is useful in identifying individuals who are at risk for inferior outcomes.     

Heads-up 3D viewing system in rhegmatogenous retinal detachment with proliferative vitreoretinopathy - A prospective randomized trial

Purpose:To compare the outcomes of vitreoretinal surgery in patients with primary and recurrent rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) on 3 dimensional digitally assisted visualization system (3D-DAVS) and conventional analogue microscope (CAM).Methods:68 patients with primary (50) and recurrent (18) RRD with PVR > C1 were included. One group underwent surgery on 3D-DAVS while the other on CAM. The parameters studied included detachment rate, best-corrected visual acuity (BCVA), duration of surgery, mean endo-illumination levels of 23 G (Gauge) micro incision vitrectomy system (MIVS) and microscope and satisfaction of surgeon and observers based on a framed questionnaire. The mean duration of follow up was three months.Results:68 eyes of 68 patients with median age 52.5 (range 18–68) years were included. 50 had primary RRD and 18 had recurrent RRD. Detachment rate at the end of three months was comparable in both groups of primary (P > 0.99) and recurrent (P = 0.21) RRD. Mean duration of surgery in minutes for 3D DAVS and CAM group was 61.8 (±22.07) and 58.04 (±12.33), respectively, in primary RRD and 37.22 (±10.27) and 36.55 (±5.92), respectively, in recurrent RRD group. Mean endo-illumination in 3D DAVS (14.5%) group was half of that in CAM (34.17%) group. Surgeon and observer satisfaction scores were significantly higher for 3D DAVS group.Conclusion:3D DAVS is a safe and effective modality or performing VR surgery in RRD with PVR. 3D DAVS allows lower endo-illumination levels provides superior surgeon ergonomics and offers better learning opportunities to the trainees.     

Guide to surgical procedures on hollow viscera: part 1--Esophageal, gastric, and restrictive bariatric procedures

OBJECTIVE: The objective of this article is to explore with a surgical perspective the key radiologic features after common esophageal, gastric, and bariatric procedures. CONCLUSION: An understanding of procedures on the hollow viscera is essential for radiologists at any level. The ability to quickly recognize postoperative anatomy is critical to accurately and efficiently interpret routine imaging studies and to diagnose postoperative complications.     

18F-FDG PET/CT in evaluation of radiofrequency ablation of liver metastasis

Image-guided radiofrequency ablation (RFA) is a minimally invasive therapy option in the treatment of primary and secondary hepatic malignancies, which are not suitable for surgery/chemotherapy, and more recently, for tumors with limited hepatic involvement and solitary liver metastasis. Accurate assessment of treatment response after RFA remains a concern. Conventional imaging modalities have limitations of differentiation between residual/recurrence from post-RFA changes. We illustrate images of 3 patients in whom (18)F-FDG PET/CT was used for response assessment and restaging after RFA in liver tumors.