Morphological and morphometrical study of the nasal opening of nasolacrimal duct in man

Background: Epiphora constitutes one of the major and very common problems in all age groups. Recent developments in ophthalmology such as balloon dilatation, stent implantation, laser therapy and endoscopy of the lacrimal drainage system raise the need for a detailed anatomical knowledge of this system. It is also important for formulation of principles and techniques in the management of acrimal problems. The aim of this study was to demonstrate variations in shape, size and location of the opening of the nasolacrimal duct and of the lacrimal fold.Materials and methods: Twenty sagittal head sections were obtained, the nasal septum was removed and the lateral wall of the nasal cavity was exposed and examined. The opening of the nasolacrimal duct (NLD) was demonstrated and was subjected to anatomical observations for the shape, site, size, opening type and the presence of the lacrimal fold. The different measurements for the distances between the opening of NLD and anterior nasal spine, palate and inferior concha were made.Results: The examined specimens showed that the opening of the NLD was variable in shape taking the form of sulcus in 70% and fissure in 30% of specimens. The sulcus was either vertical or oblique while the fissure was either vertical, oblique or in the form of anteroposterior one. Regarding the location, the opening of the NLD was located at anterior one third below line of attachment of the inferiorconcha in nearly half of cases (45%). The lacrimal fold was present in most of examined specimens (70%) and absent in 30%. The fold take 5 different forms.Conclusions: The knowledge of the morphology and morphometry of the lacrimal drainage system enables the ophthalmologist to plan intervention on the lacrimal drainage system precisely and avoid unnecessary manipulations and also minimizing the risk of injury during intra-nasal surgery

Regression-Based Models for Predicting Discharge Coefficient of Triangular Side Orifice

- This study introduced another technique to predict the discharge coefficient (Cd) of the triangular side orifice (TSO). This technique is based on the SPSS software as multiple linear regression (MLR) and multiple nonlinear regression (MNLR) models. These models were established using 570 experimental datasets, 70 and 30% for calibration and testing stages, respectively. These sets considered five non-dimensional parameters, including (orifice crest height, orifice length, orifice height, upstream flow depth, and Froude number of the main channel). Results showed that the MLR and MNLR models in the calibrating stage had higher determination coefficients and lower errors. In addition, the importance of the input parameters was investigated, showing that the orifice crest height and Froude number highly affect the discharge coefficient value by 36%. In the testing stage, the estimated discharge coefficient by the MLR and MNLR models stayed within the range ±12 and ‡5%, respectively, of the experimental values. The MNLR model demonstrated a high level of equivalence compared to previous studies, which provided a mathematical expression to easily predict the TSO\u27s discharge coefficient

Religious Concepts in Organ Transplantation

Beside cultural, social, and educational issues, religious beliefs are assumed to play a significant role on the attitude towards organ transplantation much more often than clinicians believe. At the same time, health-care providers may lack sufficient knowledge on religious issues pertaining to transplantation

Impact of probiotic intake on the glycemic control, lipid profile and inflammatory markers among patients with type 2 diabetes mellitus

Background and aims: Type 2 diabetes mellitus (T2DM) is a chronic disease with many dramatic complications. It has also been suggested that altered intestinal microbiota leads to increased intestinal permeability and mucosal immune response, contributing to the development of diabetes. We aimed to investigate the effect of introduction of probiotic products on glycemic control and inflammatory markers among patients with T2DM. Methods: the present work was carried on 150 patients with T2DM. The studied patients were subjected to full history taking, clinical examination and laboratory investigations including fasting blood glucose (FBG), 2 hours post prandial blood glucose (2hpp), glycated hemoglobin (HbA1c), total cholesterol (TC), triglycerides (TG), HDL-C, LDL-C, C-reactive protein (CRP), interleukin 6 (IL6) and tumor necrosis factor alpha (TNF α). They were divided into 3 groups each of 50 patients, they were all instructed to eat well balanced diet. The first group was instructed to eat the well balanced diet only, the second group received 2 cups of yogurt daily in addition to diet and the third group received one teaspoonful yeast daily in addition to diet. The effect of the intervention was evaluated after 16 weeks. Results: Patients receiving yogurt and the patients receiving yeast showed significant reduction of FBG,HbA1c, IL6, TNF α, CRP and significant elevation of HDL-C compared to patients on diet only. The 3 groups showed significant reduction in 2hpp blood glucose and LDL-C. Conclusion: Probiotic intake in patients with T2DM has beneficial effect on glycemic control, lipid profile and inflammatory markers after 16 weeks

Validation of a Model for Identification of Patients With Compensated Cirrhosis at High Risk of Decompensation

Background & Aims: It is important to rapidly identify patients with advanced liver disease. Routine tests to assess liver function and fibrosis provide data that can be used to determine patients’ prognoses. We tested the validated the ability of combined data from the ALBI and FIB-4 scoring systems to identify patients with compensated cirrhosis at highest risk for decompensation.Methods: We collected data from 145 patients with compensated cirrhosis (91% Child A cirrhosis and median MELD scores below 8) from a cohort in Nottingham, United Kingdom, followed for a median 4.59 years (development cohort). We collected baseline clinical features and recorded decompensation events. We used these data to develop a model based on liver function (assessed by the ALBI score) and extent of fibrosis (assessed by the FIB-4 index) to determine risk of decompensation. We validated the model in 2 independent external cohorts (1 in Dublin, Ireland and 1 in Menoufia, Egypt) comprising 234 patients.Results: In the development cohort, 19.3% of the patients developed decompensated cirrhosis. Using a combination of ALBI and FIB-4 scores, we developed a model that identified patients at low vs high risk of decompensation (hazard ratio [HR] for decompensation in patients with high risk score was 7.10). When we tested the scoring system in the validation cohorts, the HR for decompensation in patients with a high-risk score was 12.54 in the Ireland cohort and 5.10 in the Egypt cohort.Conclusion: We developed scoring system, based on a combination of ALBI and FIB-4 scores, that identifies patients at risk for liver decompensation. We validated the scoring system in 2 independent international cohorts (Europe and the Middle East), so it appears to apply to diverse populations

Ultrasonography in surveillance for hepatocellular carcinoma in patients with non-alcoholic fatty liver disease

International guidelines recommend six monthly ultrasounds as the primary surveillance tool for patients at risk of hepatocellular carcinoma (HCC). The dominant driver of liver disease in HCC surveillance populations is shifting, particularly in Europe and the United States, from chronic viral hepatitis (B or C), towards non-alcoholic fatty liver disease (NAFLD). Today, the population requiring HCC surveillance is also characterised by a high prevalence of overweight/obesity. These patient characteristics significantly impair ultrasound quality which can impede the detection of early HCC lesions. This diagnostic limitation has significant implications considering that eligibility for curative treatment depends upon the stage at which the cancer is detected. In this narrative review, we provide a comprehensive overview of the published evidence and national/international guidelines regarding ultrasound surveillance for HCC in people with NAFLD. We examine ultrasound sensitivity in this cohort for the detection of all stage and early HCC, the impact of steatosis and abdominal obesity on ultrasound performance, evidence for the addition of serum alpha-fetoprotein measurement, optimal timing of surveillance, emerging modalities for risk stratification and screening, and outline the challenges of case finding and surveillance eligibility criteria in this patient cohort. Finally, amalgamating all available evidence, we propose a pragmatic surveillance pathway for patients with NAFLD.</jats:p