AIM: To identify various risk factors that may play a significant role in the development of congenital nasolacrimal duct obstruction(CNLDO).METHODS: This observational case-control study included a case group of 122 children less than two years of age with CNLDO who underwent probing and irrigation treatment at the ophthalmology department of Imam Khomeini Hospital in Ahvaz, Iran, from June 2022 to June 2024. A control group of 122 age-matched children without CNLDO was also included for comparison. Data was collected from the children's medical records. RESULTS:The study found a significant correlation between the occurrence of CNLDO and several maternal factors, such as preeclampsia, the use of levothyroxine, hypothyroidism, having more than three pregnancies(gravidity >3), natural pregnancy, and gestational diabetes mellitus. Additionally, in children, factors, such as oxygen therapy, anemia, reflux, jaundice, and a family history of CNLDO in first-degree relatives were associated with CNLDO, and maternal preeclampsia and hypothyroidism were found to significantly increase the risk of developing CNLDO in children.CONCLUSION: Given that CNLDO affects both premature and full-term children, the present findings may potentially facilitate the early identification of children and infants at risk of nasolacrimal duct obstruction, thereby preventing the onset of chronic dacryocystitis.

Background: Type 1 diabetes (T1D) results in autoreactive T cells chronically destroying pancreatic islets. This often results in irreplaceable loss of insulin-producing beta cells. To reverse course, a combinatorial strategy of employing glucose-responsive insulin restoration coupled with inhibiting autoreactive immune responses is required. Methods: Non-obese diabetic mice received a single intraperitoneal implantation of a novel biomaterial co-seeded with insulin-producing islets and T regulatory cells (Tregs). Controls included biomaterial seeded solely with islets, or biomaterial only groups. Mice were interrogated for changes in inflammation and diabetes progression via blood glucose monitoring, multiplex serum cytokine profiling, flow cytometry and immunohistochemistry assessments. Results: Islet and Tregs co-seeded biomaterial recipients had increased longevity, insulin secretion, and normoglycemia through 180 days post-implantation compared to controls. Serum profile revealed reduced TNFα, IFNγ, IL-1β and increased IL-10, insulin, C-Peptide, PP and PPY in recipients receiving co-seeded biomaterial. Evaluation of the resected co-seeded biomaterial revealed reduced infiltrating autoreactive CD8 + and CD4 + T cells concomitant with sustained presence of Foxp3 + Tregs; further analysis revealed that the few infiltrated resident effector CD4+ or CD8+ T cells were anergic, as measured by low levels of IFNγ and Granzyme-B upon stimulation when compared to controls. Interestingly, studies also revealed increased Tregs in the pancreas. However, there was no restoration of the pancreas beta cell compartment, suggesting normoglycemia and production of insulin levels were largely supported by the implanted co-seeded biomaterial. Conclusion These studies show the efficacy of a combinatorial approach seeding Tregs with pancreatic islets in a novel self-assembling organoid for reversing T1D.

The radial artery is currently the main vascular access site for cardiac catheterization. Radial artery occlusion (RAO), although a relatively silent complication, raises concerns because of its potential impact on future procedures. This pilot randomized controlled trial compared the efficacy and safety of two anticoagulation regimens—subcutaneous enoxaparin and oral rivaroxaban—in resolving symptomatic ultrasound-confirmed RAO in 40 patients (median age 55 years [interquartile range, 48-64], including 26 female patients [70.3%]) who underwent diagnostic cardiac catheterization without requiring dual antiplatelet therapy. Thirty-seven patients completed the 28-day ultrasound-based follow-up, demonstrating comparable complete or partial resolution rates between rivaroxaban (16 of 20 patients [80.0%]) and enoxaparin (14 of 17 patients [82.3%]), with an odds ratio of 0.85 (95% confidence interval: 0.16 to 4.50). No major bleeding events occurred during the 28-day follow-up period. While rivaroxaban shows potential in resolving RAO, larger studies are necessary to validate these findings and evaluate the long-term outcomes.

Background: Fine needle aspiration (FNA) is a widely utilized technique for assessing thyroid nodules; however, its inherent non-diagnostic rate poses diagnostic challenges. The present study aimed to evaluate and compare the diagnostic efficacy of FNA, core needle biopsy (CNB), and their combined application in the assessment of thyroid nodules. Methods: A total of 56 nodules from 50 patients was analyzed using both FNA and simultaneous CNB. The ultrasound characteristics were categorized according to the American College of Radiology Thyroid Imaging Reporting and Data Systems classification system. The study compared the sensitivity, specificity, and accuracy of FNA, CNB, and the combination of the two techniques. Results: The concordance between FNA and CNB was notably high, with a kappa coefficient of 0.837. The sensitivity for detecting thyroid malignancy was found to be 25.0% for FNA, 66.7% for CNB, and 83.3% for the combined FNA/CNB approach, with corresponding specificities of 84.6%, 97.4%, and 97.4%. The accuracy of the FNA/CNB combination was the highest at 94.1%. Conclusions The findings of this study indicate that both CNB and the FNA/CNB combination offer greater diagnostic accuracy for thyroid malignancy compared to FNA alone, with no significant complications reported. Integrating CNB with FNA findings may enhance management strategies and treatment outcomes for patients with thyroid nodules.

Objectives: This study aimed to investigate the role of time preferences in compliance with coronavirus disease 2019 (COVID-19) preventive behaviors in an adult population of Iran. Methods: A web-based questionnaire was utilized to conduct a cross-sectional survey of 672 Iranian adults. The parameters of time preferences were estimated using a quasi-hyperbolic discounting model, and the relationship between COVID-19 preventive behaviors and time preferences was examined using a probit regression model. Results: A significant association was observed between the preventive behaviors of COVID-19 and the levels of patience and present-biased preferences among the study participants. Individuals who exhibited low levels of patience were found to be 12.8 percentage points less inclined to follow preventive behaviors compared to those with high levels of patience. The likelihood of having good preventive behaviors of COVID-19 was found to decrease by 14.3 percentage points among individuals with a present bias as opposed to those with a bias toward future. Conclusions Patience and present-biased preferences are important determinants of adopting preventive behaviors against COVID-19. These behavioral characteristics should be considered in the design of control and prevention programs. Considering people’s discounting behavior and time (in)consistency in their preferences in the design of COVID-19 policy interventions can provide valuable insights for developing tailored public health policy interventions.

Purpose: We evaluated the effectiveness of early start of long-acting insulin during management of diabetic ketoacidosis (DKA) in pediatric patients. Methods: Patients with DKA were randomly assigned to receive either a traditional DKA management protocol or concurrent administration of subcutaneous (SC) long-acting insulin alongside intravenous insulin during DKA treatment. The primary outcomes were duration of insulin infusion and adverse effects of the intervention, mainly hypoglycemia and hypokalemia. Results: For this study, 100 pediatric patients with DKA were enrolled, 50 in each group (group I received the conventional DKA management and group II received conventional DKA management plus SC long-acting insulin once daily). Patients in group II showed a significant reduction in both duration and dose of insulin infusion compared to group I, with a median (interquartile range) of 68.5 hours (45.00–88.25 hours) versus 72 hours (70.25–95.5 hours) (P=0.0001) and an insulin dose of 3.48±1.00 units/kg versus 4.04±1.17 units/kg (P=0.016), respectively. Concurrent administration of SC long-acting insulin with intravenous insulin during DKA treatment was associated with a decreased risk of hypoglycemia (number of hypoglycemia events: group I, 22 events; group II, 12 events, P=0.029), with no increased risk of hypokalemia compared to the control group (number of hypokalemia events: group I, 12 events; group II, 19 events, P=0.147). Conclusion The current study showed that coadministration of SC long-acting insulin in addition to the usual insulin infusion during DKA management in the pediatric population can lead to a shorter duration of insulin infusion. In addition, this approach is not associated with increased risk of hypoglycemia or hypokalemia. Moreover, coadministration of long-acting insulin may be associated with a decreased incidence of hypoglycemia.

Type 2 diabetes mellitus (T2DM) management demands innovative strategies that address its complex nature. Telerehabilitation and conventional rehabilitation, which utilize wearable devices, represent promising avenues in this regard. This narrative review synthesizes the current literature to comprehensively compare these modalities in terms of accessibility, monitoring mechanisms, patient adherence, cost-effectiveness, and social support. Telerehabilitation offers unparalleled convenience, real-time monitoring, and personalized feedback through wearables, thereby fostering greater patient engagement and adherence compared to conventional rehabilitation. However, conventional rehabilitation provides face-to-face interactions, immediate feedback, and a more personalized touch, albeit with logistical challenges and higher costs. This review emphasizes the significance of patient preferences, technological access, and healthcare infrastructure in selecting the appropriate approach. It also calls for further research into long-term outcomes, cost-effectiveness, and the optimal integration of wearable technology in diabetes management programs. Ultimately, both telerehabilitation and conventional rehabilitation demonstrate considerable potential in empowering individuals with T2DM, underlining the imperative for tailored and patient-centric interventions in diabetes care. The review also stresses the significance of integrating patient preferences and their level of comfort with technology when deciding on treatment approaches. It also takes into account the diverse socioeconomic contexts and healthcare infrastructures globally, which can affect the viability and efficacy of both telerehabilitation and conventional rehabilitation. Moreover, the integration of wearable technology in diabetes management programs holds promise for enhancing self-management capabilities and promoting healthier lifestyles. However, it is essential to tackle prospective discrepancies in access to these technologies and ensure fair distribution. Looking forward, ongoing research efforts should focus on justifying long-term outcomes, optimizing cost-effectiveness, and refining implementation strategies to maximize the benefits of both modalities.

Purpose: As the number of older adults with gastric cancer requiring gastrectomy has increased, it has become increasingly important to use techniques that enhance surgical safety and reduce postoperative complications in this vulnerable patient population. Articulating laparoscopic instruments (ALIs) may improve maneuverability and precision, leading to better outcomes in older patients. This study aimed to compare postoperative outcomes of older adults undergoing laparoscopic distal gastrectomy for gastric cancer using conventional versus ALIs. Methods: This retrospective study included 147 older patients (aged ≥70 years) who underwent laparoscopic distal gastrectomy for gastric cancer between 2017 and 2024. Surgery was performed using conventional laparoscopic instruments in 61 patients and ALIs in 86 patients. The median follow-up period was 20 months. Results: Postoperative hospital stay was significantly shorter in the articulating group than in the conventional group (4.6 ± 2.0 days vs. 5.4 ± 2.4 days, P = 0.030). Time to first flatus was also significantly shorter in the articulating group (2.4 ± 0.7 days vs. 2.8 ± 1.0 days, P = 0.022). However, there were no significant differences in overall complications, major (≥grade III) complications (conventional, 1.2% vs. articulating, 0%; P = 0.398) overall survival, or recurrence-free survival between groups. Conclusion The use of articulating instruments in older adults undergoing laparoscopic distal gastrectomy for gastric cancer was associated with shorter postoperative hospital stays and faster recovery of bowel function, with no apparent detrimental effects on complications, recurrence, or survival. These findings suggest that ALIs enhance recovery and possibly overall surgical outcomes in this patient population.

Background and Objectives: This study aimed to evaluate Mal de Debarquement syndrome (MdDS) in high-risk pilots using the Istanbul MdDS Symptom Questionnaire (IMdDSSQ) and investigate the effect of flight time. Subjects and Methods: The IMdDSSQ was administered to 150 healthy pilots, ≥18 years (37.47±11.14 years), on active duty, using a Google Forms link. The responses to the questionnaire were assessed based on flight time (<4 h and >4 h) and age group, for all subfactors. Results: For the MdDS diagnosis subfactor of the questionnaire, 32.1% of males and 66.7% of females reported a suspicion of MdDS after flights <4 h. As flight time increased, the number of participants reporting suspected MdDS increased in both sexes. There was a significant difference between short and long flights for all subfactors of the questionnaire across all age groups and sex comparisons (p<0.05). Conclusions As flight time and age increased, the severity of the symptoms of MdDS increased for all subfactors. With advancing age, dizziness and the severity of intolerance to visual motion increase in long flights compared to short flights, and the quality-of-life decreases. The quality-of-life of female pilots was lower than that of male pilots.

Background and Objectives: Virtual reality (VR) applications change the perception of reality, resulting in a feeling of being in a natural environment. The occurrence of cybersickness (CS) when using VR applications is a well-documented side effect, and the Simulator Sickness Questionnaire (SSQ) has been used to assess CS. Considering the speed of VR technology development, CS will likely become a frequently researched and discussed topics in the near future. Therefore, the aim of this study was to conduct a Turkish validity and reliability study and introduce the SSQ to Turkish medical literature. Materials and Methods: A total of 160 healthy individuals (80 females and 80 males) aged >18 years (28.4±7.2 years) were included in our study. The SSQ was provided to the participants through Google Forms before and after the VR provocation experience and within the scope of the test and retest protocol. Results: The reliability and internal consistency of the questionnaire were observed at a high level (Cronbach’s alpha=0.854, Spearman-Brown coefficient r=0.871). Factor analysis was performed and the questionnaire was divided into three subfactors, consistent with the original questionnaire. In the responses obtained from the participants before and after VR provocation, statistically significant differences were observed in 13 of the 16 items in the questionnaire that are related to VR provocation (p<0.05). Statistically, the differences in fatigue, dizziness, and vertigo were greater in females than in males (p<0.05). Conclusions The Turkish version of the SSQ is an effective tool for measuring the side effects in VR environments. The inclusion of the SSQ in the Turkish literature enables the inclusion of non-English-speaking participants in research, especially for disciplines that consider peripheral and central vestibular disorders.