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Aims To examine the rates of diabetic kidney disease ( DKD) progression and associated factors, we undertook a study of estimated glomerular filtration rate ( eGFR) in a historical cohort of UK primary care patients with type 2 diabetes mellitus (T2 DM) and associated DKD from the Clinical Practice Research Datalink. Methods Our eligible population were patients with definitive T2 DM from a recorded diagnostic code with either a diagnosis of chronic kidney disease ( CKD) or renal function test values and renal abnormalities consistent with a CKD diagnosis, identified between 1 October 2006 and 31 December 2011. Only patients with albuminuria results reported in mg/l were used for the longitudinal statistical analyses of the eGFR rate of change using multilevel models. Results We identified 111,030 patients with T2 DM. Among them 58.6% (95% confidence interval ( CI): 58.3-58.9) had CKD and 37.2% (95% CI: 36.9-37.5%) had presumed DKD at baseline. Only 19.4% of patients had urinary albumin test results expressed as mg/l in the year prior to index date. Almost two-thirds (63.8%) of patients with T2 DM and presumed DKD received prescriptions for angiotensin-converting enzyme ( ACE) inhibitors or angiotensin type 1 receptor blockers ( ARB) or both. Time-dependent variables that predict subsequent eGFR decline include increased albuminuria, time from index date and older age. Conclusion Only a minority of diabetic patients with DKD had quantitative albuminuria assessments. The relatively low proportion of DKD patients with ACEi or ARB prescriptions suggests a gap between healthcare practice and available scientific evidence during the study period. Increased albuminuria and older age were the most consistent predictors of subsequent eGFR decline. [ABSTRACT FROM AUTHOR]

Objective: Anal incontinence (AI) affects up to 40% of women who sustained obstetric anal sphincter injuries (OASIs) due to persistent defects after primary repair or undiagnosed lesions. Aim of our research was to assess the reliability of clinical assessment of OASIs at the delivery as compared to three-dimensional endoanal ultrasonography (3D-EAUS)., Methods: An observational prospective study was conducted between December 2015 and December 2022. Consecutive women with clinically diagnosed OASIs at the delivery were evaluated by 3D-EAUS two months post-partum. The primary aim was to evaluate the agreement between clinical and ultrasonographic assessment. The secondary aim was to investigate the correlation between ultrasound findings (grade of OASIs and anterior thickness of the external anal sphincter - EAS) and the severity of AI symptoms., Results: One hundred and sixty women were enrolled, median age 33.6 years (range 19-44; IQR, 30-37). Ninety-eight (61 %) were primiparous and sixty-two (39 %) were multiparous. In one hundred and thirty-seven cases (86 %) there was a perfect agreement between the clinical and ultrasonographic classification of OASIs. Twenty-three women (14 %) were clinically over-staged (17 % of cases) or under-staged (83 % of cases). The agreement between clinical assessment and 3D-EAUS was higher for OASIs grade 3a and 4 than for OASIs grade 3b and 3c (Fisher's test, P < 0.001). Similar findings were found after controlling for age, time interval between clinical evaluation and 3D-EAUS, number of previous deliveries and EAS thickness (R-squared = 0.674). The median anterior thickness of the EAS was 10.4 mm (range 7.2-13.6). The thickness did not correlate to the severity of OASIs (P = 0.215) but it positively correlated with the severity of incontinence symptoms (P < 0.001)., Conclusion: The agreement between clinical and ultrasonographic assessment was high for grade 3a and 4 OASIs. In case of uncertainty, clinical evaluation tended to underestimate the severity of sphincter lesions. The anterior thickness of the EAS was positively correlated with the severity of incontinence symptoms., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Fracture liaison services (FLS) have been proven clinically effective and cost-effective in preventing subsequent fractures among patients with an existing fragility fracture. Little is known about their monetary benefits such as their return on investment (ROI). This systematic review aimed to investigate the ROI of FLS and identify the FLS characteristics with better ROI. Studies on the cost-effectiveness of FLS published between January 2000 and December 2022 were searched from MEDLINE, EMBASE, PubMed, and Cochrane Central. Two independent reviewers conducted study selection and data extraction. ROI was calculated based on the difference between monetary benefits and FLS costs divided by the FLS costs. Subgroup analysis of ROI was performed across FLS types and FLS design details. A total of 23 FLS were included in this review. The majority of them were targeting patients aged over 50 years having fractures without identified sites. The mean ROI of these FLS was 10.49 (with a median ROI of 7.57), and 86.96% of FLS had positive ROI. FLS making treatment recommendations yielded the highest ROI (with a mean ROI of 18.39 and a median of 13.60). Incorporating primary care providers (with a mean ROI of 16.04 and a median of 13.20) or having them as program leaders (with a mean ROI of 12.07 and a median of 12.07) has demonstrated a high ROI. FLS for specific fracture sites had great monetary return. Intensive FLS such as type A and B FLS programs had higher ROI than non-intensive type C and D FLS. This review revealed a 10.49-fold monetary return of FLS. Identified characteristics contributing to greater economic return informed value-for-money FLS designs. Findings highlight the importance of FLS and the feasibility of expanding their contribution in mitigating the economic burden of osteoporotic fracture and are conducive to the promotion of FLS internationally., (© 2024. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)

Aim: The purpose of this retrospective case study is to describe the body mass index in a group of children, from 3 to 6 years old with ECC and a similar group of caries-free children., Materials and Methods: This case-control analysis involves two groups of children: the first was of 244 healthy children, 3 to 6 year-old and caries-free; the second was of 586 otherwise healthy children, same age, with Early Childhood Caries divided into three subgroups according the AAPD definition. Demographics, dmft, number teeth with pulpal involvement, BMI percentile, weight at birth, weight and height of both parents were measured during the clinical evaluation. Statistical analyses were performed using standard statistical software (SPSS Version 13). BMI distribution of the subjects with caries was graphically compared with the use of confidence intervals to a similar caries-free sample., Results: Results are expressed as mean ± SD and frequencies (percentages), depending on the data type. The distribution of BMI percentiles of the ECC group was: underweight = 10%; normal weight = 55.90%; at risk of overweight = 22.22 %; overweight = 11.11%. Significantly, more children in the case group were underweight than in the control group (10% vs. 4.94%)., Conclusion: The ECC population does not have a typical weight distribution, and the underweight finding in a significant number of Severe ECC (S-ECC) children may be due to the chewing alteration related to the dental pain due to caries and to missing teeth after hard tissues breakdown.

Background: Anticoagulation management of patients with atrial fibrillation (AF) should be tailored individually on the basis of ischemic stroke risk. The objective of this study was to compare the predictive ability of 15 published stratification schemes for stroke risk in actual clinical practice in the UK., Methods: AF patients aged ≥ 18 years in the General Practice Research Database, which contains computerized medical records, were included. The c-statistic was estimated to determine the predictive ability for stroke for each scheme. Outcomes included stroke, hospitalizations for stroke, and death resulting from stroke (as recorded on death certificates)., Results: The study cohort included 79,844 AF patients followed for an average of 4 years (average of 2.4 years up to the start of warfarin therapy). All risk schemes had modest discriminatory ability in AF patients, with c-statistics for predicting events ranging from 0.55 to 0.69 for strokes recorded by the general practitioner or in hospital, from 0.56 to 0.69 for stroke hospitalizations, and from 0.56 to 0.78 for death resulting from stroke as reported on death certificates. The proportion of patients assigned to individual risk categories varied widely across the schemes, with the proportion categorized as moderate risk ranging from 12.7% (CHA(2) DS(2)-VASc) to 61.5% (modified CHADS(2)). Low-risk subjects were truly low risk (with annual stroke events < 0.5%) with the modified CHADS(2), National Institute for Health and Clinical Excellence and CHA(2) DS(2) -VASc schemes., Conclusion: Current published risk schemes have modest predictive value for stroke. A new scheme (CHA(2) DS(2) -VASc) may discriminate those at truly low risk and minimize classification of subjects as intermediate/moderate risk. This approach would simplify our approach to stroke risk stratification and improve decision-making for thromboprophylaxis in patients with AF., (© 2010 International Society on Thrombosis and Haemostasis.)