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Hereditary haemorrhagic telangiectasia (HHT) is diagnosed clinically by the Curaçao Criteria of spontaneous recurrent nosebleeds, mucocutaneous telangiectasia at characteristic sites, visceral involvement (arteriovenous malformations [AVMs]; gastrointestinal telangiectasia), and family history. [1] Early diagnosis is important to enable AVM screening and preventative treatments.[2-5] HHT is caused by loss-of-function DNA variants in ENG, ACVRL1 ̧ SMAD4 or GDF2,[6-9] though older manuscripts describing linkage to additional loci[10,11] continue to be referenced heavily. In whole genome sequencing performed prospectively for HHT “gene negative” patients recruited to the NHS 100,000 Genomes Project,[12] no candidate variants were identified in the HHT3 or HHT4 loci. “HHT gene negative” families receiving a clinical positive test result included the original HHT3 family, and a family diagnosed with a related vasculopathy (CM-AVM2[13]), due to a heterozygous variant in EPHB4 that lies on the same chromosome as the HHT4 locus. Clinically, we conclude that molecular testing is advisable to confirm HHT as it is possible to meet three Curaçao Criteria without having HHT. For some HHT family members who meet 3 criteria ‘only’ through nosebleeds, telangiectasia and family history, a designation of “likely” not “definite” HHT may be preferred. Scientifically, reference to early linkage studies unsupported by confirmatory sequence identification of a causal gene is discouraged, and there is no longer evidence for an independent HHT3 locus.

Desk-based assessment of an area proposed for development.

This study explored the approaches to integrating multicultural concepts as input to a multicultural teacher education program using qualitative research design through content analysis. This investigation used purposive sampling in selecting the participants for the individual interviews and focus group discussions (FGD), while complete enumeration identified the key participants including their ethnicity profile. Results revealed that the school failed to keep the ethnicity profile of the students, faculty and staff. The indigenous group is not well represented in the student organizations. Multicultural issues are not introduced early in the teacher education program. Infusion of multicultural concepts in the syllabus is limited only to meet the felt needs of the diverse students. Based on these findings, the study suggests a Multicultural Teacher Education Program that clearly integrates multiculturalism in the campus, and boosts its identity as a Multicultural Education Hub.

SUMMARY: The facial artery (a branch of the external carotid artery) is the main artery of the face. It gives rise to seven branches viz. inferior labial, superior labial, inferior alar, superior alar, lateral nasal and angular arteries, which are variable. This study included a dissection of twenty embalmed adult cadaveric head and neck specimens. The parameters of origin, branching patterns, termination and variations were analysed and compared with sex and laterality. The facial artery followed the standard anatomical description of origin in 84.62 % of the sample. Variations: (i) origin as a linguofacial trunk in 12.82 % and (ii) high origin in 2.56 % was observed. Male specimens displayed a higher number of linguofacial trunk origins (7.69 %). The branching patterns of the facial artery was classified into six types, with subtypes for Types 1 and 2. Subtype 1-A (standard anatomical description with early termination) occurred in most of the sample (46.15 %). Males were found to have more variations in branching patterns than females (48.72 % and 41.03 % respectively). Termination of the facial artery was as follows: inferior labial artery (5.13 %), superior labial artery (10.26 %), inferior alar artery (10.26 %), superior alar artery (46.15 %), lateral nasal artery (5.13 %), and angular artery (20.51 %). A single case (2.56 %) of an abortive artery was noted. Statistical analysis showed that sex was independent of each parameter observed in this study. Anatomical knowledge of the facial artery is of importance to clinicians and surgeons during procedures such as musculomucosal, island flaps and aesthetic dermatology. RESUMEN: La arteria facial (una rama de la arteria carótida externa) es la arteria principal de la cara. Da lugar a siete ramas: labial inferior, labial superior, alar inferior, alar superior, arterias nasales y angulares laterales, además de ramas pequeñas variables. Este estudio incluyó una disección de veinte muestras de cabeza y cuello de cadáveres adultos fijados. Los parámetros de origen, patrones de ramificación, terminación y variaciones fueron analizados y comparados con el sexo y la lateralidad. La arteria facial se originó de manera normal en el 84,62 % de la muestra. Variaciones: (i) origen como tronco linguofacial en 12.82 % y (ii) se observó un origen alto en 2,56 %. Las muestras en los hombres mostraron un mayor número de orígenes del tronco linguofacial (7,69 %). Los patrones de ramificación de la arteria facial se clasificaron en seis tipos, con subtipos para los Tipos 1 y 2. El subtipo 1-A (descripción anatómica normal con terminación temprana) se observó en (46,15 %) de la muestra. Las muestras de varones tenían una mayor variación en los patrones de ramificación que las muestras de mujeres, 48,72 % y 41,03 % respectivamente. La terminación de la arteria facial fue la siguiente: arteria labial inferior (5,13 %), arteria labial superior (10,26 %), arteria alar inferior (10,26 %), arteria alar superior (46,15 %), arteria nasal lateral (5,13 %) y arteria angular (20,51 %). Se observó un solo caso (2,56 %) de una arteria abortiva. El análisis estadístico mostró que el sexo era independiente de cada parámetro observado en este estudio. El conocimiento anatómico de la arteria facial es importante para los médicos y cirujanos durante procedimientos como colgajos musculomucosal y en la dermatología estética.