Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus

Background: Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these tests varies substantially. Approach: An expert committee compiled evidence-based recommendations for the use of laboratory testing for patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. Draft guidelines were posted on the Internet and presented at the 2007 Arnold O. Beckman Conference. The document was modified in response to oral and written comments, and a revised draft was posted in 2010 and again modified in response to written comments. The National Academy of Clinical Biochemistry and the Evidence-Based Laboratory Medicine Committee of the American Association for Clinical Chemistry jointly reviewed the guidelines, which were accepted after revisions by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association. Content: In addition to long-standing criteria based on measurement of plasma glucose, diabetes can be diagnosed by demonstrating increased blood hemoglobin A$_{1c}$ (HbA$_{1c}$) concentrations. Monitoring of glycemic control is performed by self-monitoring of plasma or blood glucose with meters and by laboratory analysis of HbA$_{1c}$. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. Summary: The guidelines provide specific recommendations that are based on published data or derived from expert consensus. Several analytes have minimal clinical value at present, and their measurement is not recommended

WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis

Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.Peer reviewe

Risk factors for intra-abdominal abscess post laparoscopic appendicectomy for gangrenous or perforated appendicitis: A retrospective cohort study

Introduction: Acute appendicitis is one of the most common causes of abdominal pain. Post-operative Intra-abdominal Abscess (PIA) frequently complicates appendicectomy and increases morbidity and cost (1). Its incidence is increased in perforated or gangrenous appendicitis (2). Risk factors for the development of PIA within this high-risk group have not been established in adults. This study aimed to identify risk factors associated with PIA following laparoscopic appendicectomy for gangrenous or perforated appendicitis in adults. Secondary aims were to describe the timing and anatomical location of PIA occurrence. Methods: A retrospective cohort study was performed. The data of all adults that underwent laparoscopic appendicectomy for gangrenous or perforated appendicitis at Logan Hospital (Queensland, Australia) from July 2010 to June 2014 were reviewed using a database from a previous study (3). The Primary outcome was the association between the development of PIA and; age, gender, American Society of Anaesthesiologists class, Disease Severity Score (4), blood tests on admission (white cell count (WCC), C-reactive protein, total bilirubin) and histopathology of the appendix. Results: Of 143 patients, 13 developed PIA (9.1%). There was a weakly positive association between elevated preoperative WCC and the risk of PIA (Spearman’s correlation coefficient 0.174, P ¼ 0.038). No other factors were significantly associated with increased risk of PIA. The median post-operative day of diagnosis was day nine (mean 7.9, range 2e17). Conclusions: In this cohort, there was a weakly positive association between preoperative WCC and PIA. Prospective trials investigating other potential risk factors are required.Griffith Health, School of MedicineFull Tex