20 research outputs found
Diabetic eye screening in multi ethnic population of Malaysia: epidemiological risk factors for development of diabetic retinopathy
Background:The objective of this study is to evaluate epidemiological risk factors for development of diabetic retinopathy.Methods:The cases of type-2 diabetes mellitus attending Melaka Manipal medical college, Malaysia were retrospectively reviewed. The epidemiological characteristics of diabetic retinopathy were estimated. The cases were graded according to degree of retinopathy in to: non-diabetic retinopathy group and diabetic retinopathy. Clinical and biochemical studies were used for studying the risk factors associated with development of retinopathy.Results:The prevalence of diabetic retinopathy in the population was 21% in known diabetic subjects and was significantly higher in men than in women (21.3% vs. 14.6%) with increasing age and duration of diabetes. Ethnicity is a complex, independent risk factor for diabetic retinopathy. Sight threatening diabetic retinopathy, and clinically significant macular edema was higher in people of Malaysia (20%) when compared with Chinese (16%) and Indonesians (12%). In all, 55 percent of patients with known diabetes mellitus had never undergone an eye examination. Among patients who had undergone eye examinations, 32.8 percent had the last examination within the last one year, 49.8 percent within the last one to two years, and 17.4 percent more than two years ago.Conclusion:Diabetic retinopathy is highly prevalent in the patients with type-2 diabetes mellitus in Malaysia. Besides blood glucose, many factors are associated with the present and development of diabetic retinopathy.
Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study
Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk