Objective To compare the accuracy of infrared (IR)-reflex assessment using a prototype imaging device to standard nonmydriatic red-reflex screening with direct ophthalmoscope (DO) in the diagnosis of neonatal and childhood cataract. Methods The comparison of the techniques was made in two distinct cohorts: in the first, newborns underwent IR and red-reflex testing by a medical student, with results compared to a reference red-reflex examination by an experienced midwife. In the second, an enriched cohort of children attending a specialist paediatric ophthalmology clinic had IR and red-reflex testing by a medical student to reference examination by a paediatric ophthalmologist. The medical students were considered inexperienced screeners due to their limited exposure to ophthalmology. The sensitivity and specificity of the IR and red-reflex assessments in respect to reference examination were calculated. Diagnostic accuracy was compared in Caucasian and non-Caucasian eyes. Results IR and red-reflex imaging were possible in all 180 neonatal eyes examined. A total of 5% of newborn eyes were found to have embryological remnants in the anterior segment of the eye with IR-reflex imaging which were not detected on reference red-reflex examination. IR-reflex assessment had significantly better sensitivity (100 vs 71%, p < 0.05) and specificity (100 vs 63%, p < 0.01) than red-reflex assessment in the diagnosis of childhood cataract. Red-reflex specificity was particularly poor in non-Caucasian eyes compared to Caucasian eyes (32 vs 72%, p < 0.05). Conclusion This pilot study indicates that IR-reflex imaging has the potential to improve the diagnostic accuracy of eye screening for cataract by inexperienced healthcare staff, particularly in non-Caucasian children.

Children are disproportionately affected by disasters. They have greater physiological, psychological and sociological vulnerabilities, often exacerbated by the fact that their unique needs can be overlooked during relief efforts. This article provides an overview of disasters, including how they are categorised, and the factors that need to be considered by military and civilian healthcare teams that respond to them. Information is drawn from a variety of previous disasters, with the effects considered across a range of different populations and communities. The lessons learnt from previous disasters need to inform the ongoing discussions around how to best train and supply both individual healthcare workers and the wider teams that will be expected to respond to future disasters. The importance of role-specific training incorporating caring for children, consideration of paediatric casualties during planning exercises and teaching scenarios, and the requirement for paediatric equipment and medications cannot be overemphasised. While provision of paediatric care may not be the primary role of an individual healthcare worker or their broader team, it still remains their ethical and often legal duty to plan for and deliver care for children when responding to a disaster. This is a paper commissioned as part of the Humanitarian and Disaster Relief Operations special issue of BMJ Military Health.

AimsCongenital cataract is the leading cause of childhood blindness worldwide; surgery before 9–10 weeks of age is necessary to optimise visual outcome. We investigated the accuracy of the Newborn Infant Physical Examination (NIPE) red reflex test in the detection of cataracts and compared it to CatCam, a novel hand-held infrared digital imaging device.MethodsWe first reviewed the notes of all children having cataract surgery under 3 years of age over a 2 year period to determine how and when referral had occurred. Subsequently, we undertook proof-of–concept testing for CatCam in two populations: one of normal neonates undergoing NIPE screening, and secondly in an enriched population of children attending a tertiary paediatric ophthalmology clinic. Evaluation of ease of use and statistical comparison of diagnostic accuracy was made between CatCam and red reflex testing by direct ophthalmoscope (DO).Results33 children (45 eyes) underwent cataract surgery during the 2 year study period. Only 10 were referred following abnormal NIPE and fewer than 50% were referred before 9 weeks of age. Of the 90 normal newborns examined at the first NIPE check, visually insignificant congenital media opacities were detected in 9 (10%) infants on CatCam imaging alone. CatCam examination was subjectively easier than red reflex testing, particularly in non-Caucasian infants. Finally, 111 subjects attending a specialist clinic were examined with DO and CatCam prior to pupil dilatation and specialist review. The sensitivity and specificity for media opacity was 100% for CatCam and 71% and 62% respectively for the DO (p=0.01).ConclusionAlthough some cataracts may have developed postnatally, our audit suggests that the sensitivity of the NIPE examination is poor and that many infants with cataracts are diagnosed late. The clinical studies demonstrate the advantages of CatCam over DO examination, particularly its high sensitivity and specificity due to the absence of pupil constriction, better reflectivity of infrared light from non-Caucasian fundi and ability to document the images facilitating a second opinion.

Purpose Management of rectal cancer with a complete clinical response (cCR) to neoadjuvant chemoradiotherapy (NACRT) is controversial. Some advocate “watch and wait” programmes and organ-preserving surgery. Central to these strategies is the ability to accurately preoperatively distinguish cCR from residual disease (RD). We sought to identify if post-NACRT (preoperative) inflammatory markers act as an adjunct to MRI and endoscopy findings for distinguishing cCR from RD in rectal cancer. Methods Patients from three specialist rectal cancer centres were screened for inclusion (2010–2015). For inclusion, patients were required to have completed NACRT, had a post-NACRT MRI (to assess mrTRG) and proceeded to total mesorectal excision (TME). Endoluminal response was assessed on endoscopy at 6–8 weeks post-NACRT. Pathological response to therapy was calculated using a three-point tumour regression grade system (TRG1-3). Neutrophil–lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), serum albumin (SAL), CEA and CA19-9 levels post-NACRT (preoperatively) were recorded. Variables were compared between those who had RD on post-operative pathology and those with ypCR. Statistical analysis was performed using SPSS (version 21). Results Six hundred forty-six patients were screened, of which 422 were suitable for inclusion. A cCR rate of 25.5% (n = 123) was observed. Sixty patients who achieved cCR were excluded from final analysis as they underwent organ-preserving surgery (local excision) leaving 63 ypCR patients compared to 359 with RD. On multivariate analysis, combining cCR on MRI and endoscopy with NLR < 5 demonstrated the greatest odds of ypCR on final histological assessment [OR 6.503 (1.594–11.652]) p < 0.001]. This method had the best diagnostic accuracy (AUC = 0.962 95% CI 0.936–0.987), compared to MRI (AUC = 0.711 95% CI 0.650–0.773) or endoscopy (AUC = 0.857 95% CI 0.811–0.902) alone or used together (AUC = 0.926 95% CI 0.892–0.961). Conclusion Combining post-NACRT inflammatory markers with restaging MRI and endoscopy findings adds another avenue to aid distinguishing RD from cCR in rectal cancer.

Objectives: To report the experience of civilian penetrating neck trauma (PNT) at a UK level I trauma centre, propose an initial management algorithm and assess the degree of correlation between clinical signs of injury, operative findings and radiological reports.Design: Retrospective case note review.