Perioperative glycaemic control in diabetic patients undergoing cataract surgery under local anaesthesia: a survey of practices of Singapore ophthalmologists and anaesthesiologists

<p><b>INTRODUCTION</b>Perioperative glycaemic control is an important aspect of clinical management in diabetic patients undergoing cataract surgery under local anaesthesia. While poor long-term glycaemic control has significant implications for surgery, perioperative hypoglycaemia or hyperglycaemia may also compromise patient safety and surgical outcomes. We aimed to survey ophthalmologists and anaesthesiologists on their approach and to identify the prevalent practice patterns in Singapore.</p><p><b>METHODS</b>This was a cross-sectional questionnaire-based survey conducted in four public hospitals in Singapore with established ophthalmology and anaesthesia units. Respondents were approached individually, and the self-administered questionnaires comprised questions related to practice patterns, clinical scenarios and awareness of pre-existing guidelines.</p><p><b>RESULTS</b>A total of 129 doctors responded to the questionnaire survey. 76 (58.9%) were from ophthalmology departments and 53 (41.1%) were from anaesthesia departments. The majority chose to withhold oral hypoglycaemic agents (82.9%) and/or insulin (69.8%), and keep the patient fasted preoperatively. A blood glucose level ≥ 17 mmol/L prompted 86.0%-93.8% of respondents to adopt a treat-and-defer strategy, while a level ≥ 23 mmol/L prompted 86.0%-96.9% of respondents to cancel the cataract surgery. The respondents were consistently more concerned about perioperative hyperglycaemia (n = 99, 76.7%) than intraoperative hypoglycaemia (n = 83, 64.3%).</p><p><b>CONCLUSION</b>The current study presented the prevalent practice patterns of ophthalmologists and anaesthesiologists in the perioperative management of diabetic patients undergoing cataract surgery in four public hospitals in Singapore. Further research in this field is required, and may be useful for the future formulation of formal guidelines and protocols.</p>

Assessing protein energy malnutrition in children: biochemical markers serum total protein, serum albumin and serum protein electrophoresis

Protein Energy Malnutrition [PEM] is a global problem among children. Worldwide 27% under five children are malnourished. PEM is more prevalent in India where almost half [47%] the children are underweight. Assessment of PEM has traditionally been clinical which is time consuming and skill dependent, with considerable inter-observer variability. Hence, biochemical markers like serum protein and albumin measurements may be used for the assessment of nutritional status. At the same time, there is a controversy, whether edema can be considered as a reliable clinical marker of hypoalbuminemia. Readily available and reliable tests and can often detect nutritional deficiencies before they have an adverse effect on biological functions and certainly before deficiencies can be detected by physical examination. The study was designed to assess PEM in children using biochemical markers like serum protein, albumin and protein electrophoresis and establishing a correlation between edema and hypoalbuminemia. This analytical case control study was done in the Narayana Medical College and Hospital from September 2007 to September 2009. The material for the study consisted of 50 cases of PEM and 20 normal healthy children. In PEM cases, total protein and serum albumin were found to be significantly lower in comparison to normal healthy controls. Thus total protein and serum albumin may become useful indicators of the nutritional status of the malnourished children and good markers of PEM. Albumin and beta fractions of Serum Protein Electrophoresis were significantly lower while alpha 1, alpha 2 and gamma globulin fractions were significantly higher in malnourished children in comparison to controls