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/Aims: The irregular Z-line, defined as a segment of columnar mucosa less than 1 cm in the distal esophagus, is often biopsied despite guidelines advising against it due to a low risk of progression to esophageal adenocarcinoma (EAC). However, the clinical significance of an irregular Z-line remains unclear. This meta-analysis examines the prevalence of Barrett’s esophagus, dysplasia, and EAC in patients with an irregular Z-line. Methods: We searched Medline, Embase, and Scopus databases up to October 2023 for studies on the prevalence of Barrett’s esophagus, dysplasia, and EAC in these patients. A random-effects model was used for meta-analysis, and heterogeneity was assessed using I2 statistics. Results: Nine studies involving 17,637 patients were analyzed. Among those with an irregular Z-line, the prevalence of intestinal metaplasia was 29.4%. In patients with intestinal metaplasia, dysplasia was found in 6.2%, low-grade dysplasia in 5.9%, high-grade dysplasia in 1.6%, and EAC in 1.5%. These rates were higher compared to those without intestinal metaplasia. Conclusions Patients with an irregular Z-line and intestinal metaplasia may be at higher risk and could benefit from endoscopic surveillance. Further studies are needed to determine the necessity of biopsying irregular Z-lines.

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.

Purpose: To determine the effect of lower eyelid blepharoplasty (LEB) surgery on corneal biomechanical parameters before and 4 months after the procedure. Methods: In this prospective longitudinal study, corneal biomechanical parameters measured by Corneal Visualization Scheimpflug Technology device were evaluated before and 4 months after LEB surgery. Results: The study included 19 eyelids of the right eyes of 19 patients who underwent LEB, with a mean age of 49.0 ± 10.1 years (range, 37–72 years). Four months after the procedure, significant increases were observed in the first applanation time (p = 0.007), second applanation time (p < 0.001), highest concavity time (p = 0.004), intraocular pressure (p = 0.009), and biomechanical-compensated intraocular pressure (p = 0.007). In addition, the absolute value of highest concavity delta arc length and stress-strain index showed a significant decrease after the LEB (p = 0.021 and p = 0.037, respectively). Other corneal biomechanical parameters did not show significant differences following the LEB procedure (p < 0.05). Conclusions The resection and repositioning of the fat pockets in LEB lead to biomechanical changes of the cornea in the direction of increasing corneal stiffness.

Background: Parkinson’s disease is a debilitating and the second most common neurodegenerative disorder with a high prevalence. Parkinson’s disease has a multifaceted etiology characterized by an altered redox state and an excessive inflammatory response. In this study, we investigated the potential neuroprotective properties of carvacrol in a haloperidol-induced Parkinson’s model. In female Sprague-Dawley rats, the animal Parkinson model was induced by intraperitoneally administering 1 mg / kg of haloperidol once daily for fifteen days. Carvacrol was administered at a dose of 25 and 50 mg / kg once daily for fifteen days before haloperidol administration. In order to further illustrate the vital role of the tumor necrosis factor (TNF-α) pathway, we administered 50 mg / kg of the TNF-α inhibitor thalidomide once daily for 15 days. Results: Our results showed that haloperidol-induced motor deficits, changed endogenous antioxidant enzymes, along with higher levels of inflammasome (NLRP3) and other inflammatory mediators. Moreover, increased levels of lipid peroxidase (LPO) indicated a significant rise in oxidative stress due to haloperidol. Moreover, carvacrol reduced these effects by preventing pyroptosis mediated by the inflammasome (NLRP3) and TNF-α. The administration of thalidomide mitigated oxidative stress and suppresses inflammatory pathways through the augmentation of the intrinsic antioxidant system. Further, co-treatment of carvacrol with thalidomide synergized the neuroprotective effect of carvacrol as demonstrated by various immunoassays and histology analyses. Conclusions Taken together, our findings suggest that carvacrol mitigated haloperidol-induced Parkinson-like symptoms, partially through the downregulation of TNF-α and NLRP3.

Delayed rupture of intracranial aneurysms after endovascular treatment is a rare but serious complication. We report the first documented case of late aneurysmal rupture following treatment with a Contour intrasaccular device. A patient in their 60s with a basilar tip aneurysm underwent endovascular treatment using a 14-mm Contour device. Fifteen months later, the patient presented with a fatal intraventricular hemorrhage, and imaging revealed device displacement and aneurysm growth. This case underscores the importance of meticulous device sizing and follow-up, especially for large aneurysms.

Purpose: Curcumin as a potent anti-inflammatory and cancer-prevention molecule was labeled with n.c.a 177Lu. The combi-nation of 177Lu as a theranostic agent and curcumin as an anti-cancer can be considered for nuclear medicine. Methods: First, n.c.a 177Lu (specific activity = 48 Ci/mg) was prepared using the extraction chromatography method. Then,semi-empirical quantum chemical calculations were applied to get a deeper insight into the complexation reaction between Lu+3 and curcumin ligand. UV-Vis spectrophotometry was used for the determination of the metal-to-curcumin ratio. Sub-sequently, a mixture of (111–333 MBq) n.c.a 177Lu, 50 µL curcumin solution in ethanol, and 450 µL acetate buffer at pH = 5was incubated for 1  h at 95 ºC. The Lu-curcumin complex chemical structure was characterized using IR spectroscopy.Finally, the prepared complex was analyzed by different quality control tests. Results: Complexometry using UV-Vis studies showed a 1:2 ratio for Lutetium: curcumin complex which is in agreement with theoretical calculations. The IR-spectra analysis also confirmed the complex formation. The radiochemical purity of n.c.a 177Lu -curcumin was more than 95% as determined by radio-TLC. The stability of up to 48 h was observed for theprepared complex in serum. The partition coefficient was calculated for the compound (logP = -0.31). Evaluating biodistri-bution in tumoral mice exhibited high tumor uptake (%ID/gtissue = 2.03). Conclusion The promising results showed that n.c.a 177Lu-curcumin can be considered as a possible radiopharmaceutical agent for therapeutic applications.