Topical Intranasal Fluorescein to Diagnose and Localize Cerebrospinal Fluid Leak: A Systematic Review

Objective:This study evaluates the available evidence regarding using topical intranasal fluorescein (TINF) to diagnose and localize nasal cerebrospinal fluid (CSF) leak.Methods:A literature search was conducted through PubMed, the Cochrane Database, Scopus, and Ovid to identify the articles providing insight into using TINF to diagnose CSF leak preoperatively or to localize the leak intraoperatively. The articles from the database were screened and filtered by two authors according to the selection criteria. A spreadsheet was created to collect the data including demographic characteristics, the sensitivity and specificity of TINF for diagnosing and localizing a CSF leak, the protocol of applying TINF, and the complications.Results:After excluding duplicates and articles that did not meet our selection criteria, we included five reports in the final analysis. The average age of the 94 participants was 39.5, and there was an equal distribution of males and females. The sensitivity of TINF to make a preoperative diagnosis of CSF leak was 100%, and it was 97% to localize the site intraoperatively. Complications associated with TINF were not reported in any of the reports. This review showed a grade C recommendation based on five case series.Conclusion:Based on the current evidence, TINF cannot be recommended for standard clinical practice. It can, however, be considered in situations where other gold standard tools are unavailable since it is feasible and easy to use. A standardized control trial should be conducted to yield additional unbiased evidence

European Position Paper on Rhinosinusitis and Nasal Polyps 2020

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise. The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included.Peer reviewe

Use of insulin pumps by children and young people in the management of type 1 diabetes mellitus

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Use of insulin pumps by children and young people in the management of type 1 diabetes mellitus

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Images of Job Oppression and its Jurisprudential Provisions

The issue of career oppression is one of the most recent issues in public and private sector institutions, where these institutions have different images of the persecution of employees by their superiors at work. The purpose of this research is to explain the concept of occupational oppression, its image and its jurisprudence. This topic was discussed in an introduction, two papers and a conclusion that included the most important conclusions and recommendations, in which we discussed the problem of the study, its importance. In the first section, we discussed the reality of occupational oppression through the definition of the concept of persecution in the language and terminology, the meaning of the function of language and terminology, and the meaning of functional oppression as a composite term

Relationship between Hormonal Changes and Self-Perceived Halitosis in Females: A Cross-Sectional Study

Halitosis is a growing concern for patients seeking dental treatment. Women experience hormonal changes throughout different phases of their life. These changes may affect volatile organic compound (VOC) production and can be linked to halitosis. The aim of this study was to evaluate the effect of hormonal changes on self-perceived halitosis in a sample of females using a self-administered questionnaire. This study used a cross-sectional observational design. The questionnaire was distributed electronically through Google forms. A total of 1089 participants completed the questionnaire. Almost 50% of participants were below the age of 25; and 12% were of menopausal age (defined as 45 years and older). Most participants reported having regular menstrual cycles (63.5%) while only 20% reported having hormonal disturbances. Almost 62% of the sample reported that they notice halitosis on themselves with 27.6% indicating their perception of halitosis occurred at different times of the month. Around 12% of the sample thought that a relationship between halitosis and their menstrual cycle existed with 4.6% reporting halitosis during menstruation. The present study found that regularity of menstrual cycle and hormonal disturbances can affect females’ self-perceived halitosis and the prevalence of oral health symptoms

10-Year Risk Estimation for Type 2 Diabetes Mellitus and Coronary Heart Disease in Kuwait: A Cross-Sectional Population-Based Study

<div><p>Background</p><p>Type 2 diabetes mellitus (T2DM), coronary heart disease (CHD) and metabolic syndrome (MetS) are major healthcare problems in Kuwait. The present study was designed to determine the prevalence of MetS, and to estimate the 10-year risk for developing T2DM and CHD among the general population in Kuwait.</p><p>Methods</p><p>A descriptive, cross-sectional survey was undertaken in 1800 individuals without diabetes or a history of cardiovascular disease (CVD). They were selected from six governorates using two stage convenience sampling. The questionnaire was developed using the Finnish Diabetes Risk Score (FINDRISK), Framingham Risk Score [FRS] and the 2009 Joint Statement criteria for diagnosis of MetS as a framework. Descriptive and multivariate logistic regression analyses were used.</p><p>Results</p><p>The response rate was 89.4%. More than half (60.8%; 95% CI: 58.4–63.2) of responders were either overweight or obese. One hundred and ninety seven (12.2%) subjects had blood pressure (BP) ≥ 140/90 mm Hg. Almost three-in-ten (28.3%: 26.2–30.6) subjects had fasting plasma glucose (FPG) levels ≥ 5.6 mmol/l, of whom 86.0% and 14.0% had impaired fasting glucose (IFG) and screen detected T2DM, respectively. MetS was present in 512 (31.8%; 29.5–34.2) respondents. Just under one third (n = 481; 29.9%; 27.7–32.2) of participants were at moderate, high, or very high risk of developing T2DM, while 283 (17.6%: 15.8–19.6) were at moderate/high 10-year risk of developing CHD. Approximately one-in-ten (8.5%; 7.2–9.9) subjects were at moderate/high/very high 10-year risk of developing both T2DM/CHD. T2DM risk was higher for females compared to males (p < 0.001); however, the pattern was reversed in terms of the risk of developing CHD or T2DM/CHD. The risk of developing T2DM, CHD, or T2DM/CHD was greater among those aged ≥ 45 years, and those having MetS (p<0.001).</p><p>Conclusions</p><p>The current findings highlight the need for multifaceted interventions for prevention.</p></div

Association between participants at moderate/high/very high risk to develop T2DM and/or CHD, and their characteristics.

<p>Association between participants at moderate/high/very high risk to develop T2DM and/or CHD, and their characteristics.</p

Estimated risk of developing T2DM within 10-years in the study population per FINDRISK (n = 1610).

<p>Estimated risk of developing T2DM within 10-years in the study population per FINDRISK (n = 1610).</p

Association quantified by sample weighted regression between participants at moderate/high/very high risk to develop T2DM and/or CHD, and their characteristics.

<p>Association quantified by sample weighted regression between participants at moderate/high/very high risk to develop T2DM and/or CHD, and their characteristics.</p