The use of optical coherence tomography in the assessment of diabetic retinopathy and maculopathy

This review was performed to assess the use of optical coherence tomography in diabetic retinopathy and maculopathy and its application in the diagnosis and management of these conditions. A comprehensive literature search on MEDLINE was performed for studies published until 2013 with key words 'diabetes mellitus', 'optical coherence tomography', 'diabetic retinopathy', 'diabetic maculopathy', 'intersessional repeatability', 'diurnal variation' , 'fundus autofluorescence' and 'treatment'. Search results were limited to studies published in English and in human subjects only. The Early Treatment Diabetic Retinopathy Study established the current standard of care for diabetic retinopathy and maculopathy with the diagnosis based on slit-lamp biomicroscopy, indirect ophthalmoscopy, and fluorescein angiography. There has been a recent shift to the use of optical coherence tomography in the qualitative and quantitative assessment of such diseases. Furthermore, the advancement of optical coherence tomography from time-domain to spectraldomain technology allows us to visualize pathological changes of diabetic maculopathy in details in different retinal layers. Such observed changes have been used to establish new classifications of diabetic maculopathy. The high sensitivity and quantitative nature of optical coherence tomography make it a highly popular modality used extensively to monitor disease progression and efficacy of new treatment modalities. Optical coherence tomography plays a crucial role in the modern clinical management of diabetic retinopathy and maculopathy. Its use has revolutionized the understanding and management of these eye diseases.published_or_final_versio

Risk Factors for and Clinical Outcome of Congenital Cytomegalovirus Infection in a Peri-Urban West-African Birth Cohort

BACKGROUND: Congenital cytomegalovirus (CMV) infection is the most prevalent congenital infection worldwide. Epidemiology and clinical outcomes are known to vary with socio-economic background, but few data are available from developing countries, where the overall burden of infectious diseases is frequently high. METHODOLOGY/PRINCIPAL FINDINGS: As part of an ongoing birth cohort study in The Gambia among term infants, urine samples were collected at birth and tested by PCR for the presence of CMV DNA. Risk factors for transmission and clinical outcome were assessed, including placental malaria infection. Babies were followed up at home monthly for morbidity and anthropometry, and at one year of age a clinical evaluation was performed. The prevalence of congenital CMV infection was 5.4% (40/741). A higher prevalence of hepatomegaly was the only significant clinical difference at birth. Congenitally infected children were more often first born babies (adjusted odds ratio (OR) 5.3, 95% confidence interval (CI) 2.0-13.7), more frequently born in crowded compounds (adjusted OR 2.9, 95%CI 1.0-8.3) and active placental malaria was more prevalent (adjusted OR 2.9, 95%CI 1.0-8.4). These associations were corrected for maternal age, bed net use and season of birth. During the first year of follow up, mothers of congenitally infected children reported more health complaints for their child. CONCLUSIONS/SIGNIFICANCE: In this study, the prevalence of congenital CMV among healthy neonates was much higher than previously reported in industrialised countries, and was associated with active placental malaria infection. There were no obvious clinical implications during the first year of life. The effect of early life CMV on the developing infant in the Gambia could be mitigated by environmental factors, such as the high burden of other infections.Journal ArticleResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe

Comparing very low birth weight versus very low gestation cohort methods for outcome analysis of high risk preterm infants

© 2017 The Author(s). Background: Compared to very low gestational age (<32 weeks, VLGA) cohorts, very low birth weight (<1500 g; VLBW) cohorts are more prone to selection bias toward small-for-gestational age (SGA) infants, which may impact upon the validity of data for benchmarking purposes. Method: Data from all VLGA or VLBW infants admitted in the 3 Networks between 2008 and 2011 were used. Two-thirds of each network cohort was randomly selected to develop prediction models for mortality and composite adverse outcome (CAO: mortality or cerebral injuries, chronic lung disease, severe retinopathy or necrotizing enterocolitis) and the remaining for internal validation. Areas under the ROC curves (AUC) of the models were compared. Results: VLBW cohort (24,335 infants) had twice more SGA infants (20.4% vs. 9.3%) than the VLGA cohort (29,180 infants) and had a higher rate of CAO (36.5% vs. 32.6%). The two models had equal prediction power for mortality and CAO (AUC 0.83), and similarly for all other cross-cohort validations (AUC 0.81-0.85). Neither model performed well for the extremes of birth weight for gestation (<1500 g and ≥32 weeks, AUC 0.50-0.65; ≥1500 g and <32 weeks, AUC 0.60-0.62). Conclusion: There was no difference in prediction power for adverse outcome between cohorting VLGA or VLBW despite substantial bias in SGA population. Either cohorting practises are suitable for international benchmarking

A new look at bronchopulmonary dysplasia:Postcapillary pathophysiology and cardiac dysfunction

Abstract. Pulmonary hypertension (PH) and right ventricular function are the focus of cardiovascular effects of bronchopulmonary dysplasia (BPD). We assessed cardiac indexes reflecting systemic afterload and pulmonary venous back pressure as pathophysiologic factors. Cardiac parameters were measured by conventional echocardiography in 20 preterm infants with severe BPD and compared with those of 10 preterm infants with no BPD and 20 healthy term infants. In infants with severe BPD, PH was noted in 5 (25%) by tricuspid regurgitation Doppler jet ≥2.8 m/s and in 15 (75%) by time to peak velocity/right ventricular ejection time <0.34. Among systemic cardiac indexes, significant impairment of diastolic measures was noted in the BPD group compared with infants with no BPD and term infants. The significance persisted after adjusting for gestational age and birth weight. These included transmitral E/A ratio (1.07 ± 0.07 vs. 0.91 ± 0.04 vs. 0.89 ± 0.09; P < 0.0001), isovolumic relaxation time (68.8 ± 3.9 vs. 58.5 ± 7.8 vs. 54.2 ± 5.7 ms ; P < 0.0001), mitral valve stroke volume (4.7 ± 0.7 vs. 5.6 ± 0.6 vs. 5.9 ± 0.1; P = 0.002), and myocardial performance index (0.33 ± 0.05 vs. 0.28 ± 0.01 vs. 0.27 ± 0.05; P = 0.03). Left ventricular output was significantly lower in the BPD cohort (183 ± 45 vs. 189 ± 9 vs. 191 ± 32 mL/kg/min; P = 0.03). Altered systemic (left-sided) cardiac function was noted in infants with BPD, which may lead to pulmonary venous congestion contributing to a continued need for respiratory support

Incidence of chest wall paresthesia after video-assisted thoracic surgery for primary spontaneous pneumothorax

Objective: Video-assisted thoracic surgery (VATS) is an established treatment for recurrent or complicated primary spontaneous pneumothorax (PSP). However, a proportion of patients still complains of chronic pain or discomfort after VATS pleurodesis. We aimed to investigate if paresthesia is a distinct component of the post-operative discomfort in patients receiving VATS for PSP. Methods: Telephone interviews were conducted with 52 patients who had received VATS pleurodesis for PSP in our institute during a defined 24 month period. A standardized questionnaire was used to identify paresthetic discomforts which the patients themselves could distinguish from their wound pain. Responses were obtained from 51 patients (42 male, 9 female) with a mean age of 24.1 years (range 14-63 years), giving a response rate of 98.0%. Results: With a median observation time of 19 months (range 2-24 months), 27 patients (52.9%) reported experiencing paresthesia as a post-operative complication distinct from their wound pain. The most commonly described characteristics of the paresthesia were 'pins and needles' (37.0%), 'numbness' (25.9%) or a sensation of abnormal 'swelling' in the chest wall (11.1%). Although only two of the affected patients (7.4%) described the paresthesia as 'severe', consequent functional disturbances in daily life were noted by seven patients (25.9%), and 11 patients (40.7%) actively sought medical or alternative, holistic therapies to relieve the paresthesia. Eight (21.0%) of the 38 patients followed-up for over 12 months after surgery still experienced the paresthesia. Conclusions: Although it should not detract from the proven advantages of VATS, paresthesia in the chest wall represents a distinct but previously overlooked post-VATS complication. It is a potential source of significant post-operative morbidity, and may run a chronic course in some patients. Further study is warranted to elucidate its mechanisms and optimum management. © 2004 Elsevier B.V. All rights reserved.link_to_subscribed_fulltex