Children and adolescents with type 1 and type 2 diabetes mellitus in the Pediatric Diabetes Consortium Registries: comparing clinical characteristics and glycaemic control.

AIM: To compare the characteristics of children and adolescents with type 1 vs. type 2 diabetes in the Pediatric Diabetes Consortium (PDC) registries. METHODS: Participants were 10 to < 21 years of age at diagnosis; there were 484 with type 1 diabetes and 1236 with type 2 diabetes. RESULTS: Children and adolescents with type 2 diabetes were more likely to be female, overweight/obese, and from low-income, minority ethnic families. Children and adolescents with type 1 diabetes were more likely to present with diabetic ketoacidosis and have higher mean HbA1c levels at diagnosis. More than 70% in both cohorts achieved target HbA1c levels < 58 mmol/mol (< 7.5%) within 6 months, but fewer participants with type 1 than type 2 diabetes were able to maintain target HbA1c levels after 6 months consistently throughout 3 years post diagnosis. Of the 401 participants with type 2 diabetes with ≥ 24 months diabetes duration on enrolment in the registry, 47% required no insulin treatment. Median C-peptide levels were 1.43 mmol/l in the subset of participants with type 2 diabetes in whom it was measured, but only 0.06 mmol/l in the subset with type 1 diabetes. CONCLUSIONS: Although families of children and adolescents with type 2 diabetes face greater socio-economic obstacles and risk factors for poor diabetes outcomes, the greater retention of residual endogenous insulin secretion likely contributes to the increased ability of children and adolescents with type 2 diabetes to maintain target HbA1c during the first 3 years of diabetes diagnosis.

Visual function at baseline and 1 month in acute optic neuritis: predictors of visual outcome.

OBJECTIVE: To identify cutpoints for visual measures at baseline and 1 month predictive of abnormal 6-month vision that could be used as eligibility criteria in a clinical trial to test potential neuroprotection or myelin repair agents in patients with optic neuritis. To determine whether moderate-to-severe dysfunction in one or more visual measures at baseline or 1 month correlates with having major vision loss at 6 months. METHODS: We used the Optic Neuritis Treatment Trial database to evaluate various cutpoints for baseline and 1-month vision levels that predicted abnormal 6-month vision. For selected cutpoints, we computed a 95% CI for positive predictive value and the required sample size if the cutpoint was to be used for clinical trial eligibility. We evaluated whether the degree of visual loss at baseline, 1 month, or change in visual function from baseline to 1 month correlated with 6-month visual acuity, contrast sensitivity, or threshold visual field. RESULTS: The best cutpoints for baseline and 1 month were visual acuity

Corticosteroids for treating optic neuritis.

BACKGROUND: Optic neuritis is an inflammatory disease of the optic nerve. It occurs more commonly in women than in men. Usually presenting with an abrupt loss of vision, recovery of vision is almost never complete. Closely linked in pathogenesis to multiple sclerosis, it may be the initial manifestation for this condition. In certain patients, no underlying cause can be found. OBJECTIVES: To assess the effects of corticosteroids on visual recovery of patients with acute optic neuritis. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (issue 4, 2005), MEDLINE (1966 to December 2005), EMBASE (1980 to January 2006), NNR (issue 4, 2006), LILACS and reference lists of identified trial reports. SELECTION CRITERIA: We included randomized trials that evaluated corticosteroids, in any form, dose or route of administration, in people with acute optic neuritis. DATA COLLECTION AND ANALYSIS: Two authors independently extracted the data on methodological quality and outcomes for analysis. MAIN RESULTS: We included five randomized trials which included a total of 729 participants. Two trials evaluated low dose oral corticosteroids and two trials evaluated a higher dose of intravenous corticosteroids. One three-arm trial evaluated low-dose oral corticosteroids and high-dose intravenous corticosteroids against placebo. Trials evaluating oral corticosteroids compared varying doses of corticosteroids with placebo. Hence, we did not conduct a meta-analysis of such trials. In a meta-analysis of trials evaluating corticosteroids with total dose greater than 3000 mg administered intravenously, the relative risk of normal visual acuity with intravenous corticosteroids compared with placebo was 1.06 (95% CI 0.89 to 1.27) at six months and 1.06 (95% CI 0.92 to 1.22) at one year. The risk ratio of normal contrast sensitivity for the same comparison was 1.10 (95% CI 0.92 to 1.32) at six months follow up. We did not conduct a meta-analysis for this outcome at one year follow up since there was substantial statistical heterogeneity. The risk ratio of normal visual field for this comparison was 1.08 (95% CI 0.96 to 1.22) at six months and 1.02 (95% CI 0.86 to 1.20) at one year. Quality of life was assessed and reported in one trial. AUTHORS' CONCLUSIONS: There is no conclusive evidence of benefit in terms of recovery to normal visual acuity, visual field or contrast sensitivity with either intravenous or oral corticosteroids at the doses evaluated in trials included in this review.

The SKILL Card test in optic neuritis: experience of the Optic Neuritis Treatment Trial. Smith-Kettlewell Institute Low Luminance. Optic Neuritis Study Group.

OBJECTIVES: To assess the value of the Smith-Kettlewell Institute Low Luminance (SKILL) Card test, designed to measure vision at reduced contrast and luminance, among patients with previous optic neuritis. MATERIALS AND METHODS: The SKILL Card test was administered to 295 patients participating in the Optic Neuritis Treatment Trial (ONTT) follow-up study, concurrent with measurement of visual acuity, visual field, contrast sensitivity, and color vision. Health-related quality of life (HRQL) was also assessed in a subset of patients using the National Eye Institute Visual Function Questionnaire and an ONTT-developed questionnaire. RESULTS: The SKILL Card difference score (high-contrast acuity score minus low-contrast acuity score) was only weakly associated with the other measures of vision function (rs absolute range, 0.05-0.31) and with the HRQL measures (rs absolute range, 0.02-0.15). In contrast, the light and dark component scores of the SKILL Card test had higher associations with the other vision measures (rs absolute range, 0.27-0.54) and with the HRQL measures (rs absolute range, 0.10-0.40). CONCLUSIONS: The SKILL Card difference score is not a meaningful measure for patients with optic neuritis; however, the test appears to have clinical usefulness as a method to measure high-contrast and low-contrast acuity.

Risk factors associated with hypothyroidism after laryngectomy.

Hypothyroidism is a well-documented complication after treatment of head and neck cancer and is particularly significant among patients undergoing laryngectomy. The objective of this study was the identification of factors associated with the development of hypothyroidism in this population. Records of 136 patients treated with laryngectomy were retrospectively reviewed in an attempt to define a risk factor profile for patients in whom hypothyroidism is most likely to develop after laryngectomy. The Cox proportional hazards model was used to identify factors significantly related to an increased risk for development of hypothyroidism. The actuarial method was used to estimate the period of greatest risk for the development of hypothyroidism. Increased risks were found for patients who were female (P = 0.0049), received preoperative radiation therapy (P = 0.0022), had invasion of the thyroid gland by tumor (P = 0.0003), had presence of cervical metastases (P = 0.0022), and had postoperative fistula (P = 0.0095). From the actuarial method, we estimated that the period of time when patients were at greatest risk for development of hypothyroidism was between 0 and 14 months after surgical intervention. Wound complications were twice as frequent in hypothyroid patients. Perioperative awareness of risk factors associated with the development of hypothyroidism in patients undergoing laryngectomy allows for early recognition and management of hypothyroidism and may reduce the number of complications related to wound healing and fistula.

Interaction between HLA-DR2 and abnormal brain MRI in optic neuritis and early MS. Optic Neuritis Study Group.

The association of the human leukocyte antigen (HLA)-DR2 allele with brain MRI signal abnormalities and with the development of MS was assessed in 178 patients enrolled in the Optic Neuritis Treatment Trial. HLA haplotype DR2 was present in 85 (48%) of the 178 patients. Its presence was associated with increased odds of probable or definite MS at 5 years (odds ratio, 1.92; 95% confidence interval, 1.01 to 3.67; p = 0.04). The association was most apparent among patients with signal abnormalities on baseline brain MRI.

The National Eye Institute Visual Function Questionnaire: experience of the ONTT. Optic Neuritis Treatment Trial.

PURPOSE: To describe the health-related quality of life, measured with the National Eye Institute Visual Function Questionnaire (NEI-VFQ), of patients several years after the onset of optic neuritis, according to their neurologic and visual status; to assess the relationship between the NEI-VFQ subscales and clinical measures of visual function; and to assess the internal consistency reliability of the NEI-VFQ subscales. METHODS: The NEI-VFQ was administered to 244 patients 5 to 8 years after treatment for an episode of acute optic neuritis as part of the Optic Neuritis Treatment Trial. Visual acuity, visual field, contrast sensitivity, and color vision were measured at the same time as questionnaire completion. RESULTS: The NEI-VFQ scores generally were lower than those reported for a disease-free group. Reported dysfunction was greater when multiple sclerosis was present and when visual acuity was abnormal, supporting the construct validity of the NEI-VFQ. Rank correlations between the NEI-VFQ subscales and clinical measures of visual function were moderate at best. Internal consistency reliability was generally high for most of the NEI-VFQ subscales. CONCLUSIONS: These findings add support to the use of the NEI-VFQ as a valuable measure of self-reported visual impairment.

Assessment of plate use for mandibular reconstruction: has changing technology made a difference?

Reconstruction of mandibular defects with a variety of alloplastic materials during a 22-year period was reviewed. Outcomes were examined to determine whether specific plating technology affected the incidence of plate-related complications including plate exposure, plate fracture, and plate removal. Repair with the miniplate, reconstruction plate, titanium hollow screw reconstruction plate, and locking reconstruction plate was evaluated. Although the incidence of plate fractures has decreased, there was no significant change in the rate of plate exposure. Recurrent disease was noted to be a significant contributing factor in the development of plate-related complications.

Repair of mandibular fractures using the 2.0 mm system. A review.

The mandible is a commonly injured facial bone with mandibular fractures occurring 3 times more frequently than those in the zygoma. Requirements for repair vary with the type of fracture, the location of the fracture, and the condition of the teeth and bone. Repair of the mandible is complicated by the complex range of function of the mandible. This article presents a brief, historical overview of techniques and systems that have been used for fracture stabilization. The authors report on the results of a study in which the 2.0 mm plate was used to repair 89 fractures. The use of 2.0 mm mandibular plates appears to provide adequate stability for patients with healthy bone and minimal comminution.