Critical appraisal of the clinical practice guideline for the management of dyslipidaemia and prevention of cardiovascular disease: AACE 2017 guidelines.

Objective: This study aims to appraise 2017 AACE Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease by using Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Method: A total of seven investigators who have obtained a postgraduate Doctor of Pharmacy or Masters of Clinical Pharmacy, appraised the dyslipidaemia guidelines independently, by using AGREE II tool. Key findings: Among all the domains, the highest-scoring domain was the clarity of presentation (87%), and the lowest was the applicability (26%). The assessors gave the top ranking for both ‘scope and purpose’ (78%) and ‘Editorial independence’ (79%). The overall guideline assessment was 61%. Most of the investigators (four out of seven) recommended using the guidelines in clinical practice with modifications. Conclusion: The appraisal obtained in this article can be utilized by guideline developers to improve the quality of their upcoming guidelines. Healthcare professionals can be aware of guideline limitations and the importance of quality assessment of the guideline before applying their recommendations whenever possible by using Agree II tool

Analysis of Scheimpflug Tomography Parameters for Detecting Subclinical Keratoconus in the Fellow Eyes of Patients with Unilateral Keratoconus in the Eastern Province of Saudi Arabia

Abdulaziz Al Somali,1 Hatim Najmi,2 Hend Alsawadi,2 Hassan Alsawadi,3 Assaf AlMalki,2 Mustafa Alhamoud,2 Hatlan Alhatlan,4 Nada Alwohaibi5 1Department of Ophthalmology, King Faisal University, Alahsa, Saudi Arabia; 2Department of Ophthalmology, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia; 3Department of Electrical and Computer Engineering, King Abdulaziz University, Jeddah, Saudi Arabia; 4Department of Ophthalmology, King Fahad Hospital, Hofuf, Saudi Arabia; 5Cornea, External Diseases, and Refractive Surgery Fellow, Dhahran Eye Specialist Hospital, Dhahran, Saudi ArabiaCorrespondence: Hatim Najmi, Department of Ophthalmology, Dhahran Eye Specialist Hospital, Dhahran, Al Ameen 6927, Khobar, Eastern Province, 34446, Saudi Arabia, Tel +966533677784, Fax +966133583898, Email [email protected]: We compared the characteristics of subtle morphological changes in subclinical keratoconus (KC) and normal corneas using Scheimpflug tomography (Pentacam®) and assessed the efficacy of these parameters for distinguishing KC or subclinical KC from normal eyes.Patients and Methods: In this multicenter comparative study at Dhahran Eye Specialist Hospital and Al Kahhal Medical Complex in the Eastern Province of Saudi Arabia, we analyzed the Scheimpflug tomography charts of patients with topographically normal eyes and those with unilateral KC. Patients were divided into the normal (NL: patients considered for refractive surgery and with normal topographic/tomographic features, 129 eyes), KC (30 patients with manifest KC in one eye based on biomicroscopy and topographical findings), and forme fruste KC (FFKC: fellow eyes of patients in the KC group that met the NL group criteria) groups. Corneal morphological parameters were analyzed using the area under the receiver operating characteristic (ROC) curves (AUCs).Results: For distinguishing NL and KC groups, all measured corneal morphological parameters, except for flat keratometry, maximum Ambrósio relational thickness index, and minimum sagittal curvature, had AUCs > 0.75. The surface variance index yielded the largest AUC (0.999). For distinguishing NL and FFKC groups, all corneal morphological parameters had AUCs < 0.8. Total higher-order aberrations (RMS HOA) yielded the highest AUC, followed by Belin/Ambrỏsio Enhanced Ectasia total deviation (BAD-D), back elevation at the thinnest location, average pachymetric progression index (PPIave), and deviation of Ambrỏsio relational thickness (Da) (AUC 0.74– 0.78).Conclusion: The diagnostic performance of all tested topographic and tomographic parameters measured using Scheimpflug tomography for discriminating subclinical KC was fair at best, with the top parameters being RMS HOA, BAD-D, back elevation at the thinnest location, PPIave, and Da. Distinguishing between subclinical KC and healthy eyes remains challenging. Multimodal imaging techniques may be required for optimal early detection of subtle morphological changes.Plain language summary: Normal fellow eyes in patients with unilateral keratoconus were found to exhibit the mildest form of subclinical keratoconus. The parameters of these eyes were compared with those of normal eyes in the Saudi population using Scheimpflug tomography to detect early, subtle morphological changes. Most of the evaluated parameters were unsatisfactory in terms of their ability to discriminate between subclinical keratoconus and normal eyes, implying the need for multimodal imaging techniques for the optimal early detection of subclinical keratoconus.Keywords: ectatic corneal disease, forme fruste keratoconus, keratoconu

Acute kidney injury requiring kidney replacement therapy in childhood lupus nephritis: a cohort study of the Pediatric Nephrology Research Consortium and Childhood Arthritis and Rheumatology Research Alliance

Acute kidney injury (AKI) is common in lupus nephritis (LN) and a risk factor for development of chronic kidney disease. In adults with LN, AKI severity correlates with the incidence of kidney failure and patient survival. Data on AKI outcomes in children with LN, particularly those requiring kidney replacement therapy (KRT), are limited. A multicenter, retrospective cohort study was performed in children diagnosed between 2010 and 2019 with LN and AKI stage 3 treated with dialysis (AKI stage 3D). Descriptive statistics were used to characterize demographics, clinical data, and kidney biopsy findings; treatment data for LN were not included. Logistic regression was used to examine the association of these variables with kidney failure. Fifty-nine patients (mean age 14.3 years, 84.7% female) were identified. The most common KRT indications were fluid overload (86.4%) and elevated blood urea nitrogen/creatinine (74.6%). Mean follow-up duration was 3.9 ± 2.9 years. AKI recovery without progression to kidney failure occurred in 37.3% of patients. AKI recovery with later progression to kidney failure occurred in 25.4% of patients, and there was no kidney recovery from AKI in 35.6% of patients. Older age, severe (> 50%) tubular atrophy and interstitial fibrosis, and National Institutes of Health (NIH) chronicity index score > 4 on kidney biopsy were associated with kidney failure. Children with LN and AKI stage 3D have a high long-term risk of kidney failure. Severe tubular atrophy and interstitial fibrosis at the time of AKI, but not AKI duration, are predictive of kidney disease progression. A higher resolution version of the Graphical abstract is available as Supplementary information

True Yellow Light-Emitting Diodes as Phosphor for Tunable Color-Rendering Index Laser-Based White Light

An urgent challenge for the lighting research community is the lack of efficient optical devices emitting in between 500 and 600 nm, resulting in the “green-yellow gap”. In particular, true green (∼555 nm) and true yellow (∼590 nm), along with blue and red, constitute four technologically important colors. The III-nitride material system, being the most promising choice of platform to bridge this gap, still suffers from high dislocation density and poor crystal quality in realizing high-power, efficient devices. Particularly, the high polarization fields in the active region of such 2D quantum confined structures prevent efficient recombination of carriers. Here we demonstrate a true yellow nanowire (NW) light emitting diode (LED) with peak emission of 588 nm at 29.5 A/cm² (75 mA in a 0.5 × 0.5 mm² device) and a low turn-on voltage of ∼2.5 V, while having an internal quantum efficiency of 39%, and without “efficiency droop” up to an injection current density of 29.5 A/cm². By mixing yellow light from a NW LED in reflective configuration with that of a red, green, and blue laser diode (LD), white light with a correlated color temperature of ∼6000 K and color-rendering index of 87.7 was achieved. The nitride-NW-based device offers a robust, long-term stability for realizing yellow light emitters for tunable color-rendering index solid-state lighting, on a scalable, low-cost, foundry-compatible titanium/silicon substrate, suitable for industry uptake

Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK)

IntroductionContinuous renal replacement therapy (CRRT) is used for the symptomatic management of acute kidney injury (AKI) and fluid overload (FO). Contemporary reports on pediatric CRRT are small and single center in design. Large international studies evaluating CRRT practice and outcomes are lacking. Herein, we describe the design of a multinational collaborative.MethodsThe Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) is an international collaborative of pediatric specialists whose mission is to improve short- and long-term outcomes of children treated with CRRT. The aims of this multicenter retrospective study are to describe the epidemiology, liberation patterns, association of fluid balance and timing of CRRT initiation, and CRRT prescription with outcomes.ResultsWe included children (n&nbsp;= 996, 0-25 years) admitted to an intensive care unit (ICU) and treated with CRRT for AKI or FO at 32 centers (in 7 countries) from 2018 to 2021. Demographics and clinical characteristics before CRRT initiation, during the first 7 days of both CRRT, and liberation were collected. Outcomes include the following: (i) major adverse kidney events at 90 days (mortality, dialysis dependence, and persistent kidney dysfunction), and (ii) functional outcomes (functional stats scale).ConclusionThe retrospective WE-ROCK study represents the largest international registry of children receiving CRRT for AKI or FO. It will serve as a broad and invaluable resource for the field of pediatric critical care nephrology that will improve our understanding of practice heterogeneity and the association of CRRT with clinical and patient-centered outcomes. This will generate preliminary data for future interventional trials in this area