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Abstract Background Primary acquired nasolacrimal duct obstruction (PANDO) is a condition in which tear ducts are blocked, leading to epiphora and dacryocystitis. This systematic review and meta-analysis aimed to measure the ability of transcanalicular dacryocystorhinostomy (TC-DCR) as an alternative approach to PANDO compared to traditional external dacryocystorhinostomy (EX-DCR). Methods Our search included Embase, Medline, and the Cochrane Central Register of Controlled Trials (CENTRAL). We included only observational studies, randomized controlled trials (RCTs), and quasi-experimental studies that compared TC-DCR and EX-DCR. The outcomes measured were anatomical and functional success rates, intraoperative complications, postoperative complications, and surgical time. Statistically significant results were determined as a p value of less than 0.05; thus, a confidence interval of 95% was used. Dichotomous outcomes were reported via risk ratios (RR), whereas continuous outcomes were reported using standardized mean differences (SMD). Results There was a statistically significant difference in anatomical success (RR = 0.84, 95% CI 0.72–0.97; P = 0.02), favoring EX-DCR; functional success (RR = 0.87, 95% CI 0.78–0.97; P = 0.01), favoring EX-DCR; operative (OR) time (SMD = -2.42, 95% CI -2.92 – -1.91; P

Abstract Background Vision-related disorders are common in children. Therefore, eye examination and thorough visual assessment by first-contact physicians are crucial in children. This study aimed to evaluate the knowledge of and attitude toward children’s eye disorders among pediatricians and family physicians in the Ministry of National Guard Health Affairs-Western Region (MNGHA-WR) of Saudi Arabia. Methods In this observational, cross-sectional study, we used a self-administered, web-based questionnaire. The sample size was calculated to be 148 pediatricians and family physicians (of 240 in total) currently working at MNGHA-WR. The first section of the questionnaire dwelled on demographics, while the second section addressed the physician’s knowledge of and attitude toward commonly encountered ophthalmological pathologies in children. Data collected were entered into Microsoft Excel and then transferred to IBM SPSS version 22 for statistical analysis. Results A total of 148 responses (92 family physicians and 56 pediatricians) were received. Most of the participants were residents or staff physicians (n = 105, 70.9%). The mean knowledge score of the respondents was 54.67% ± 14.5%. Participants’ knowledge was further subclassified using Bloom’s original cutoff points into high (n = 4, 2.7%), moderate (n = 53, 35.8%), and low (n = 91, 61.5%) levels of knowledge. Regarding practices, 120 (81%) participants performed ophthalmic examinations; however, only 39 (26.4%) conducted routine examinations as part of every child’s visit. Fundus examinations were performed by 25 (16.9%) physicians. A significant deficiency in knowledge was noted in those with

BackgroundLaser photocoagulation and/or intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections constitute the current standard treatment for retinopathy of prematurity (ROP). This systematic review and meta-analysis aimed to assess the efficacy and safety of anti-VEGF monotherapy for ROP treatment using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.MethodsWe searched the Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. We included randomized controlled trials (RCTs) that compared intravitreal anti-VEGF monotherapy (e.g., bevacizumab, ranibizumab, aflibercept, and pegaptanib) with laser photocoagulation in preterm infants with ROP. We evaluated the rates of recurrence, treatment switching, retreatment, adverse events, and mortality. The risk ratio (RR) was used to represent dichotomous outcomes. Data were pooled using the inverse variance weighting method. The quality of evidence was assessed using the GRADE approach. Risk of bias was assessed using the Revised Cochrane risk of bias tool for randomized trials.ResultsSeven RCTs (n = 579; 1,158 eyes) were deemed eligible. Three RCTs had an overall low risk of bias, three had some concerns, and one had an overall high risk of bias. The pooled effect estimate showed a statistically significant reduction in adverse events in favor of anti-VEGF monotherapy [RR = 0.17, 95% confidence interval (CI) 0.07–0.44]. The pooled analysis showed no significant difference between the anti-VEGF and laser groups in terms of recurrence rate (RR = 1.56, 95% CI 0.23–10.54), treatment switching (RR = 2.92, 95% CI 0.40–21.05), retreatment (RR = 1.56, 95% CI 0.35–6.96), and mortality rate (RR = 1.28, 95% CI 0.48–3.41).ConclusionOverall, intravitreal anti-VEGF monotherapy was associated with fewer adverse events than laser therapy, rated as high quality of evidence according to the GRADE criteria. Pooled analysis revealed no significant difference between the two arms with respect to the recurrence rate, treatment switching, retreatment, and mortality rate, with quality of evidence ranging from moderate to very low as per the GRADE approach.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/#recordDetails], identifier [CRD42021270077].

Introduction: Peters anomaly is a rare developmental malformation involving the anterior segment of the eye, which culminates in amblyopia or congenital blindness. Multiple ocular and/or systemic malformations have been observed with this anomaly, and novel comorbidities continue to be reported. Case Presentation: The probands were monozygotic twin boys (twin I and twin II) born to consanguineous parents at 36 weeks of gestation. Coarse facial features and deep-seated eyes were noted at birth. At 6 months, ophthalmic examination revealed that both twins were unable to blink in response to light, or to fixate and follow a moving object. Both twins had prominent horizontal nystagmus. Slit-lamp examination demonstrated varying degrees of central leukoma (corneal opacity) associated with iridocorneal adhesion, which is characteristic of type I Peters anomaly. No cataractous changes were observed. Normal intraocular pressure and disorganized retina were observed. Pupillary abnormalities included bilaterally underdeveloped pupils and bilateral absence of pupils was noted. Ocular MRI showed bilateral microphthalmia and optic nerve hypoplasia, with a small optic chiasm in both twins. At this age, the diagnosis of Peters anomaly was made. At 16 months of age, both twins developed deep venous thrombosis and purpuric skin lesions. Investigations revealed a hereditary thrombophilia secondary to a homozygous mutation causing protein C deficiency, which is a rare thrombotic condition. Ocular ultrasonography revealed bilateral vitreous hemorrhaging linked to altered coagulation. One twin developed bilateral inguinal hernia and cryptorchidism. Conclusion: The novel concordance of Peters anomaly in these monozygotic twins sharing a mutation in PROC gene provides further evidence that this anomaly has a genetic basis. Hypoplasia of the optic nerves and optic chiasm, along with severe protein C deficiency and bilateral absence of the pupils, are associated comorbidities that have not previously been reported with this anomaly.

This paper presents the dynamic response of Bernoulli-Euler homogeneous isotropic fractionally-damped simply-supported beam. The beam is attached to multi single-degree-of-freedom (SDOF) fractionally-damped systems, and it is subjected to a vehicle moving with a constant velocity. The damping characteristics of the beam and SDOF systems are described in terms of fractional derivatives. Three coupled second-order fractional differential equations are produced and then they are solved by combining the Laplace transform with the decomposition method. The obtained numerical results show that the dynamic response decreases as (a) the number of absorbers attached to the beam increases and (b) the damping-ratios of used absorbers and beam increase. However, there are some critical values of fractional derivatives which are different from unity at which the beam has less dynamic response than that obtained for the full-order derivatives model. Furthermore, the obtained results show very good agreements with special case studies that were published in the literature.

Background: Primary acquired nasolacrimal duct obstruction (PANDO) is a condition in which tear ducts are blocked, leading to epiphora and dacryocystitis. This systematic review and meta-analysis aimed to measure the ability of transcanalicular dacryocystorhinostomy (TC-DCR) as an alternative approach to PANDO compared to traditional external dacryocystorhinostomy (EX-DCR). Methods: Our search included Embase, Medline, and the Cochrane Central Register of Controlled Trials (CENTRAL). We included only observational studies, randomized controlled trials (RCTs), and quasi-experimental studies that compared TC-DCR and EX-DCR. The outcomes measured were anatomical and functional success rates, intraoperative complications, postoperative complications, and surgical time. Statistically significant results were determined as a p value of less than 0.05; thus, a confidence interval of 95% was used. Dichotomous outcomes were reported via risk ratios (RR), whereas continuous outcomes were reported using standardized mean differences (SMD). Results: There was a statistically significant difference in anatomical success (RR = 0.84, 95% CI 0.72–0.97; P = 0.02), favoring EX-DCR; functional success (RR = 0.87, 95% CI 0.78–0.97; P = 0.01), favoring EX-DCR; operative (OR) time (SMD = -2.42, 95% CI -2.92 – -1.91; P < 0.00001) favoring TC-DCR; and intraoperative complications (RR = 0.16, 95% CI 0.06–0.43; P = 0.0003), favoring TC-DCR. Moreover, the subgroup analysis comparing single-diode TC-DCR to EX-DCR revealed a statistically significant difference in terms of anatomical success and functional success; however, the comparison of multidiode TC-DCR to EX-DCR revealed no statistically significant difference. Conclusions: More research should be conducted to compare the anatomical and functional success of muli-diode TC-DCR with EX-DCR because the analysis performed comparing them revealed no statistical significance. [ABSTRACT FROM AUTHOR]

The production routing problem seeks to simultaneously optimize production, routing, and inventory decisions for the plant and the suppliers. In this article an integrated multi-objective sustainable pricing-production-workforce-routing problem is presented for perishable products. Total profit, workforce planning, and vehicle fuel consumption are considered as objective functions due to the importance of operational performance, social, and environmental concerns. The application of the proposed approach is investigated using real case data from a dairy product supply chain. Furthermore, a new solution approach, called Fuzzy Domination Self-Learning Non-Dominated Sorting Algorithm (FDSL-NSGA-II), is developed to solve the problem. The results show that the Pareto solutions of FDSL-NSGA-II outperform those of the classic NSGA-II. Moreover, the findings show that the proposed model can create a surpassing tradeoff between the various aspects of a supply chain, including production, distribution, and workforce planning. In addition, it concurrently optimizes the selling price and protects the environment from the negative impacts of greenhouse gas emissions (GHGs). A comprehensive analysis of the results reveals several managerial insights for decision makers in the logistics industry. Keywords Sustainable supply chain, production routing, workforce planning, pricing, perishable products, Climate change is not just a phenomenon related to the rising temperature in a specific region; rather, it refers to the average long-term changes such as the increased frequency of [...]

In this study, the effect of rolling angle orientation namely; 0ο, 45ο, and 90ο degrees, and three rolling passes on the mechanical behavior of Al-Cu after vanadium addition were investigated. Al-4%Cu and Al-4%Cu-0.1%V sheets were produced and rolled from 4 mm to 3 mm followed by 3 to 2 mm, and finally from 2 mm to 1.3 mm. After each pass, the tensile test was performed in three directions from which the maximum tensile force, deformation energy, microhardness, and average surface roughness (Ra) were determined. A pronounce finding is that the addition of both additions of 0.1% vanadium to Al-4%Cu alloy and multi-rolling passes resulted in reducing the deformation energy by 85.4, and the maximum tensile forces reduced by 56.6%, this resulted in reduction of production cost of AlCuV alloys, furthermore, it resulted in reducing the anisotropy of AlCuV alloy. Additionally, the average microhardness was enhanced for Al-Cu and AlCuV alloy, whereas the Ra was in maximum enhanced for AlCuV alloy of about 64.9%. [ABSTRACT FROM AUTHOR]