Drainage Of Secretions Research Articles

A rare case of mucocele of the Blandin and Nuhn glands with review of literature

Oral mucocele is the most common benign minor salivary gland lesion of the oral cavity. Usually it occurs on lower lip, buccal mucosa and ventral surface of the tongue and rarely seen on ventral surface of the tongue, floor of mouth and palate. It is classified in two types of lesions, one is extravasation type which is more common and other is retention type. We present case report of a 37-year-old healthy male with complaint of swelling on ventral surface of the tongue, which was sessile, soft and fluctuant with smooth overlying mucosa with diagnosis of mucocele associated with Blandin and Nuhn gland. Management included marsupialization and drainage of thick mucus secretions. This article discusses on clinical features, diagnosis and management of mucoceles associated with Blandin and Nuhn gland.

Retroperitoneal pancreas transplantation with a Roux-en-Y duodenojejunostomy for exocrine drainage.

Pancreatic transplantation is the only definitive surgical treatment for diabetes mellitus. Currently, most transplant centers use enteric exocrine drainage of pancreatic secretions; however, experts disagree on which part of the gastrointestinal tract is preferable for enteric anastomosis. We analyzed the outcomes of retroperitoneal pancreatic transplantation with enteric drainage of pancreatic secretions. We evaluated the outcomes of 60 simultaneous retroperitoneal pancreas-kidney transplantations. Based on the type of enteric anastomosis, the patients were divided into two groups: the study group consisted of 10 patients who underwent enteric drainage via Roux-en-Y duodenojejunostomy, and the control group included 50 patients who underwent exocrine drainage via duodenoduodenal anastomosis. No statistically significant differences were observed between the groups in terms of the main parameters. The rate of surgical complications did not differ significantly between the groups (p > 0.05). Clavien IVb complications occurred only in the control group (n = 4.8%). The in-hospital pancreatic graft survival rate in both groups was 80%, whereas the recipient survival rates were 90% and 84%, in the study and control groups, respectively (p < 0.05). Retroperitoneal pancreatic transplantation with exocrine drainage via a Roux-en-Y duodenojejunostomy is an effective alternative technique that reduces the rate of severe surgical complications.

Pancreatic Duct Stenting: Does Interventional Radiology Have a Role?

AbstractPancreatic duct stenting involves the placement of a stent into the pancreatic duct to restore drainage and flow of pancreatic secretions. It relieves upstream duct dilation, facilitates drainage of pancreatic secretions, and alleviates associated symptoms like pain, nausea, malnutrition, and recurrent pancreatitis. Additionally, it is utilized to treat a variety of pancreatic duct pathologies, including obstructions from conditions like chronic pancreatitis, malignancy, and pancreatic leaks. Depending on the clinical scenario, different types of stents can be placed using endoscopic, percutaneous, or surgical approaches. Endoscopic approaches, such as endoscopic retrograde cholangiopancreatography and endoscopic ultrasound-guided stenting, are often considered first-line procedures for managing pancreatic duct pathologies. However, in cases where these procedures fail, interventional radiology (IR) becomes crucial in managing these conditions, providing a safe and minimally invasive alternative that effectively addresses the underlying issues. This review aims to discuss the clinical, radiological, and technical considerations for pancreatic duct stenting and specifically highlight the role of IR in managing various pancreatic duct pathologies.

Essential Considerations for Radiologists in Diagnosing Hidradenitis Suppurativa.

Hidradenitis suppurativa, also referred to as inverse acne, manifests as a persistent inflammatory skin disorder characterized by lesions such as deep nodules, abscesses, sinus tracts, and fibrotic scars. These manifestations predominantly occur in skin folds and intertriginous areas, notably in the axillary, inguinal, perianal, perineal, and inframammary regions. Due to similarities with other conditions in its initial stages, accurate diagnosis of hidradenitis suppurativa is often delayed, sometimes spanning several years. Diagnosis relies on identifying specific morphologic features (such as deep, inflamed, and painful nodules; sinus tracts; and scars), considering the affected sites (skin folds and areas with apocrine glands), and recognizing the chronic nature of the condition (persistent course with periods of exacerbation and remission). There are no definitive biologic or pathologic diagnostic tests, and biopsy of the affected area is not necessary. Treatment varies based on severity and may include topical and systemic antibiotics, hormonal therapy, immunomodulators, and surgery. Due to associated pain, increased site sensitivity, secretion drainage, odor, and scarring, this condition can have a negative psychosocial impact. Imaging studies, including high-frequency US and MRI with subsequent three-dimensional reconstruction, serve as valuable tools for precise staging, monitoring disease activity, and preoperative assessment. Currently, high-frequency US stands as the preferred method, incorporating sonographic classifications, while MRI and thee-dimensional imaging represent an emerging and promising approach. Imaging helps identify the extent of sinus tracts, assess involvement dimensions in advanced disease stages, and monitor proposed treatments. ©RSNA, 2024 Supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.

Evolution of Pancreas Transplantation At A Single Institution-50+ Years and 2500 Transplants.

To describe the evolution of pancreas transplantation, including improved outcomes and factors associated with improved outcomes over the past 5 decades. The world's first successful pancreas transplant was performed in December 1966 at the University of Minnesota. As new modalities for diabetes treatment mature, we must carefully assess the current state of pancreas transplantation to determine its ongoing role in patient care. A single-center retrospective review of 2500 pancreas transplants was performed over >50 years in bivariate and multivariable models. Transplants were divided into 6 eras; outcomes are presented for the entire cohort and by era. All measures of patient and graft survival improved progressively through the 6 transplant eras. The overall death-censored pancreas graft half-lives were >35 years for simultaneous pancreas and kidney (SPK), 7.1 years for pancreas after kidney (PAK), and 3.3 years for pancreas transplants alone (PTA). The 10-year death-censored pancreas graft survival rate in the most recent era was 86.9% for SPK recipients, 58.2% for PAK recipients, and 47.6% for PTA. Overall, graft loss was most influenced by patient survival in SPK transplants, whereas graft loss in PAK and PTA recipients was more often due to graft failures. Predictors of improved pancreas graft survival were primary transplants, bladder drainage of exocrine secretions, younger donor age, and shorter preservation time. Pancreas outcomes have significantly improved over time through sequential, but overlapping, advances in surgical technique, immunosuppressive protocols, reduced preservation time, and the more recent reduction of immune-mediated graft loss.

Nasal Histoplasmosis in an Immunocompetent Patient - A Case Report

The clinical case described below deals with the diagnosis and treatment of a fungal infection in the nasal region, rare in immunocompetent patients and with few reports in the literature. A 49-year-old woman from the south of Brazil, with no previous comorbidities, began to suffer from swelling in the right nasal and orbital region for around 4 weeks, accompanied by intense pain, fever and drainage of purulent secretion from the nostril. The first biopsy was inconclusive, but subsequent biopsies led to the identification of a fungal infection and finally the diagnosis of histoplasmosis. Treatment with antifungal drugs was then started, which consequently allowed the condition to improve after several hospitalizations.

Specialized nursing intervention on critically ill patient in the prevention of intubation-associated pneumonia: an integrative literature review.

Healthcare-associated infections are adverse events that affect people in critical condition, especially when hospitalized in an intensive care unit. The most prevalent is intubation-associated pneumonia (IAP), a nursing-care-sensitive area. This review aims to identify and analyze nursing interventions for preventing IAP. An integrative literature review was done using the Medline, CINAHL, Scopus and PubMed databases. After checking the eligibility of the studies and using Rayyan software, ten final documents were obtained for extraction and analysis. The results obtained suggest that the nursing interventions identified for the prevention of IAP are elevating the headboard to 30º; washing the teeth, mouth and mucous membranes with a toothbrush and then instilling chlorohexidine 0.12%-0.2% every 8/8 hr; monitoring the cuff pressure of the endotracheal tube (ETT) between 20-30 mm Hg; daily assessment of the need for sedation and ventilatory weaning and the use of ETT with drainage of subglottic secretions. The multimodal nursing interventions identified enable health gains to be made in preventing or reducing IAP. This area is sensitive to nursing care, positively impacting the patient, family, and organizations. Future research is suggested into the effectiveness of chlorohexidine compared to other oral hygiene products, as well as studies into the mortality rate associated with IAP, with and without ETT for subglottic aspiration.

REGRESSÃO DE LESÃO RADIOTRANSPARENTE ÓSSEA APÓS TERAPIA ENDODÔNTICA CONSERVADORA

Periapical lesions are found associated with the apex of a tooth without vitality, after contamination of the root canals, characterized radiographically by the presence of a radiolucent image at the apex of the affected element. The objective of this work is to report the regression of a periapical lesion, with a diagnosis of periapical abscess without fistula, after conventional endodontic treatment, confirmed through radiographic examinations and clinical images. A 24-year-old female patient complained of pain in the right anterior region and, days before the initial consultation, reported drainage of purulent secretion through the gums. In the intraoral physical examination, edema was observed at the bottom of the vestibule close to the incisors, pain on horizontal and vertical percussion and on the periapical radiograph the presence of a radiolucent image was observed close to the apex of tooth 36. A cold pulp sensitivity test was performed, obtaining a negative result. . With the purpose of decontaminating the root canals, endodontic treatment was carried out, using a preparation technique associated with the activation of chemical irrigants and intracanal medication between sessions. After a few weeks, the remission of clinical signs of inflammation and infection was observed and, after 3 months, radiographically, the beginning of repair of the lesion with bone formation was evident. The reported case highlights the importance of effective decontamination of the root canal as a determining factor for the regression process of periapical lesions. A longer period of clinical and radiographic follow-up of the case is necessary to verify complete repair.

Endoscopic control after retroperitoneal pancreas transplantation with a Roux-en-Y duodenojejunostomy for exocrine drainage

Background. Simultaneous pancreas and kidney transplantation is a gold standard in the treatment of diabetes mellitus complicated by stage 5 chronic kidney disease as a result of diabetic nephropathy. One of the main problems of clinical pancreas transplantation is the pancreas graft exocrine drainage. In order to preserve the advantages of the retroperitoneal graft location and avoid the main disadvantage of duodenal drainage, namely, fatal complications potentially arising in case of necessary graft removal, we have proposed a modified method of retroperitoneal pancreatic transplantation with exocrine drainage via a modified Roux-en-Y duodenojejunostomy. It reduces the number of severe surgical complications and increases the recipient survival rate. When this method was used in previous years, it was not possible to assess the condition of donor duodenum mucosa and interintestinal anastomoses.Objective. To demonstrate the possibility of endoscopic assessment of interintestinal anastomoses when performing retroperitoneal pancreas transplantation with small intestine drainage of exocrine secretions.Results. The article presents the initial experience of endoscopic assessment of the interintestinal anastomoses and the mucous membrane of the donor duodenum after retroperitoneal pancreas transplantation with exocrine drainage via a Roux-en-Y duodenojejunostomy.Conclusion. The presented case demonstrates the feasibility of diagnostic endoscopic interventions when performing retroperitoneal pancreas transplantation with small intestine drainage of pancreatic secretions.

Use of Figueiredo’s technique for treating extensive infected skin lesions – a case report

Demonstrate that a low-complexity surgical technique can effectively solve problems of extensive skin lesions in cities where microsurgical techniques are not available. We present a 59-year-old male patient with diabetes mellitus and an extensive and infected lesion in his right ankle region, suggestive of a diabetic foot. Urgent surgical treatment was performed with debridement of the devitalized tissues, drainage of a large amount of purulent secretion, and exhaustive washing with 0.9% saline solution. After a new debridement, abundant washing with 0.9% saline solution and coverage of the extensive bloody area with a polypropylene prosthesis were performed. He remained under outpatient follow-up, and subsequently, twice, new cleanings were performed, and a small diameter mesh was applied due to the good evolution of healing. A good range of motion was maintained in the right ankle and foot, with the medial wound completely healed, leaving only a small area of the lateral wound to complete the healing process. Figueiredo’s technique, described in 2017 for fingertip lesions, uses a flexible thermoplastic polymer, which can be obtained from a small portion of silicone from a saline bag, to form a semi-occlusive dressing that allows the drainage of secretions and provides a favorable environment and temperature for healing. The exact limits of this technique are not yet well established, but the practice has shown excellent results in larger lesions. Figueiredo’s technique is a simple, low-cost, and effective option for treating extensive infected skin lesions. Level of Evidence IV; Therapeutic studies; Case Report.

Successful Management of the Omphalomesenteric Fistula: About Three Case Reports

The omphalomesenteric duct is an embryologic connection between the midgut and yolk sac, which typically disappears at the 5th to 7th week of gestation. Failure of the obliteration process can lead to omphalomesenteric duct remnants. It usually has a difficult diagnosis, manifested by a variety of cutaneous signs, such as an umbilical mass, granulation tissue, or discharge. This article reports three cases of total persistence of the OMD and reviews the surgical management of those lesions. The first case reports a 6-day-old boy with a patent omphalomesenteric duct fistula opening to the umbilicus presenting with feces sprouting from the umbilical stump. The second one reports a one-month-old infant brought to the hospital with umbilical granuloma, with no response to topical treatment that later started draining feces from the umbilical cord. The third one reports a three-day-old male newborn that manifested a granuloma-like lesion on the umbilical scar with no improvement with topical treatment. A simple catheterization with a relation catheter was performed in all cases showing drainage of a bilious secretion. they were then diagnosed with a persistence of the Vitelline Duct. All infants had a similar surgical approach, with an abdominal elective incision made around the lesion on the abdominal wall. Identification of the fistula trajectory, followed by resection of the bowel segment that contains the fistulae and a formation of a terminal-terminal anastomosis.

Volume-based subglottic secretion drainage: a randomized controlled trial.

This study proposed to explore individual management mode for patients with subglottic secretion drainage. Randomly chosen within the hospital ICU 68 patients from 7 April to 15 June 2023, all the patients randomly assigned to the control group or observation group, and control group adopts the model of intermittent drainage management, observation group based on the volume of subglottic secretion in patients with individualized management, and then analysis the two groups of patients clinical trial results. The clinical trial results showed that there were statistically significant differences (P<0.05) between the control group and the observation group in the incidence of tube blockage events (11 vs. 2), average diurnal pumping frequency (9 vs. 7, 5 vs. 4) between the two groups and the patient satisfaction scores (6 vs. 7), In the partial mucosa injure (22 vs 19) and VAP (5 vs. 1) there were no statistically significant difference (P>0.05). Although there was no statistically significant difference (P>0.05) in the average aspiration volume (12.68±3.41 vs. 12.19±2.68, 8 vs. 8) between the two groups, but the management mode of the observation group indicated that based on patient secretion volume was more consistent with the characteristics of the body's diurnal metabolic differences, because there was a big difference between the average total amount of daytime and nighttime suction between the two groups. Individualized management based on the volume of subglottic secretions produced by patients can further optimize the airway management of patients and reduce the risk of adverse events of subglottic secretions aspiration.

Continuous Versus Intermittent Control Cuff Pressure for Preventing Ventilator-Associated Pneumonia: An Updated Meta-Analysis.

This study aimed to evaluate the effect of continuous control cuff pressure (CCCP) versus intermittent control cuff pressure (ICCP) for the prevention of ventilator-associated pneumonia (VAP) in critically ill patients. Relevant literature was searched in several databases, including PubMed, Embase, Web of Science, ProQuest, the Cochrane Library, Wanfang Database and China National Knowledge Infrastructure between inception and September 2022. Randomized controlled trials were considered eligible if they compared CCCP with ICCP for the prevention of VAP in critically ill patients. This meta-analysis was performed using the RevMan 5.3 and Trial Sequential Analysis 0.9 software packages. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the level of evidence. We identified 14 randomized control trials with a total of 2080 patients. Meta-analysis revealed that CCCP was associated with a significantly lower incidence of VAP compared with ICCP (relative risk [RR] = 0.52; 95% confidence interval [CI]: 0.37-0.74; P < 0.001), although considerable heterogeneity was observed (I2 = 71%). Conducting trial sequential analysis confirmed the finding, and the GRADE level was moderate. Subgroup analysis demonstrated that CCCP combined with subglottic secretion drainage (SSD) had a more significant effect on reducing VAP (RR = 0.39; 95% CI = 0.29-0.52; P < 0.001). The effect of CCCP on ventilator-associated respiratory infection (VARI) incidence was uncertain (RR = 0.81; 95% CI = 0.53-1.24; P = 0.34; I2 = 61%). Additionally, CCCP significantly reduced the duration of mechanical ventilation (MV) (mean difference [MD] = -2.42 days; 95% CI = -4.71-0.12; P = 0.04; I2 = 87%). Descriptive analysis showed that CCCP improved the qualified rate of cuff pressure. However, no significant differences were found in the length of intensive care unit (ICU) stay (MD = 2.42 days; 95% CI = -1.84-6.68; P = 0.27) and ICU mortality (RR = 0.86; 95% CI = 0.74-1.00; P = 0.05). Our findings suggest that the combination of CCCP and SSD can reduce the incidence of VAP and the duration of MV and maintain the stability of cuff pressure. A combination of CCCP and SSD applications is suggested for preventing VAP.

Ceragenin-coated endotracheal tubes for the reduction of ventilator-associated pneumonia: a prospective, longitudinal, cross-over, interrupted time, implementation study protocol (CEASE VAP study)

BackgroundCritically ill patients are at high risk of acquiring ventilator-associated pneumonia (VAP), which occurs in approximately 20% of mechanically ventilated patients. VAP results either from aspiration of pathogen-contaminated oropharyngeal secretions...

Risk factors in ICU patients with initial acquisition of carbapenemase-resistant Klebsiella Pneumoniae.

OBJECTIVE: To identify the risk factors associated with antimicrobial use on the initial acquisition of carbapenem-resistant Klebsiella pneumoniae (CRKP) in elderly intensive care unit (ICU) patients.METHODS: Respiratory secretion, blood, urine, anal swab and peritoneal drainage samples from all elderly patients with non-colonised CRKP who had been hospitalised from January 2021 to December 2022 were collected, and screened for CRKP colonisation using surveillance culture at the time of the first ICU admission and weekly thereafter in Zhejiang Provincial Hospital of Chinese Medicine, Zhejiang, China. Cumulative antibiotic variables included duration of antibiotic use, total amount of antimicrobials received in grams, total antibiotic consumption (defined daily dose) and the types of antimicrobial exposure. A time-dependent model based on Cox regression analysis was used to investigate the effect of each variable on the initial acquisition of CRKP infection or colonisation.RESULTS: Of 214 patients, 44 were infected or had CRKP colonies and death rate was 34.1%. males were the risk factor for acquiring CRKP in culture (HR 2.12, 95% CI 1.06-4.21; P = 0.033). It is notable that the hazard of acquiring CRKP increased by 9% with every single-point increase in the APACHE II score (HR 1.09, 95% CI 1.01-1.18; P = 0.025). The hazard of acquiring CRKP doubled when carbapenems were administered (HR 1.81, 95% CI 1.42-2.30; P < 0.001), In contrast, exposure to quinolone antimicrobials had a smaller effect on acquiring CRKP (HR 1.07; 95% CI 1.01-1.14; P = 0.024).CONCLUSION: This study found that male sex, APACHE II score and exposure to quinolones and carbapenems were independent risk factors for acquiring CRKP.

RETRACTED: Dewi et al. Efficacy of Intermittent and Continuous Subglottic Secretion Drainage in Preventing the Risk of Ventilator-Associated Pneumonia: A Meta-Analysis of Randomized Control Trials. Medicina 2023, 59, 283.

The journal retracts the article entitled "Efficacy of Intermittent and Continuous Subglottic Secretion Drainage in Preventing the Risk of Ventilator-Associated Pneumonia: A Meta-Analysis of Randomized Control Trials" [...].

Differences in residual volume above different tracheostomy tube cuffs depending on tube structure, tube tilt angle, and liquid viscosity

IntroductionProper management of aspirated material above the tracheostomy tube cuff is crucial to prevent complications, such as aspiration pneumonia. This study aimed to thoroughly examine the effects of aspirated liquid viscosity, suction port positioning, and tube tilt angle on residual volume above the cuff (RVAC).MethodsFive types of tracheostomy tubes (approximately 9 mm outer diameter) were placed through a transparent cylinder with an inner diameter of 18 mm. The cuff was inflated to completely seal the interior of the cylinder. Four liquids with different viscosities were poured onto the cuff, and the liquid above the cuff was suctioned from the side port. The cylinder was angled at 90° and 20°, and each test was performed thrice to determine the average RVAC.ResultsAfter side-port suctioning, some liquid residue was observed on the cuff of all tracheostomy tubes. The RVAC increased with higher liquid viscosity. The tubes with a longer distance from the suction port opening to the cuff top exhibited more RVAC. Moreover, the RVAC was almost the same regardless of the cylinder angle for tubes with a suction port on the lateral side. However, tubes with backside ports showed a decreased RVAC with cylinder tilt.ConclusionsThis study underscores the persistence of residual material on cuffed tracheostomy tubes even with regular subglottic secretion drainage. This emphasizes the need for specialized tracheostomy tube development aimed at reducing post-suction RVAC. Improved designs can potentially minimize complications associated with residue accumulation.

Prevalence, associated factors and predictors of post stroke pneumonia in a Nigerian population: A retrospective study

ObjectivesStroke can trigger an immune response that can raise the risk of infection, alter tracheal epithelium, reduce pulmonary clearance and impair secretions drainage capacity. Infection, altered tracheal epithelium, reduced pulmonary clearance, impaired secretions drainage capacity and aspiration can cause pneumonia after stroke. The aim of this study is to find out the prevalence of post stroke pneumonia in a Nigerian population and factors that are associated with it. Materials and MethodStudy data was extracted from the case files of patients with stroke who were managed between 1st January, 2011 and 1st February, 2021 in the study setting. ResultsThe result showed that, there was a record of only 591 patients with stroke (mean age, 62.78 ± 14.86 years) who were managed in the two hospitals during the period of the study. Out of this number, only 102 (17.3 %) had pneumonia. Presence of the pneumonia was only significantly (p < 0.05) associated with sex, type of stroke, lower limb muscle power, and outcome (died or alive). However, only those with ischaemic stroke are less likely to have pneumonia (Odds ratio= 0.467; CI: 0.275 to 0.791, p= 0.005), and patients who survived the stroke and are alive are less likely to develop pneumonia (Odds ratio= 0.150; CI: 0.092 to 0.245, p < 0.001). ConclusionsPneumonia occurs to a large extent after stroke. Therefore, it is important measures are taken to prevent it or complications arising from it especially in those with a hemorrhagic stroke.

Diagnostic accuracy of fluorescein dye disappearance test in comparison with lacrimal syringing in evaluation of epiphora

Epiphora is the overflow of tear in the lid margin. It can be due to hyper secretion or inadequate tear drainage. Inadequate drainage of tears may be due to mechanical or physiological causes. Physiological cause is due to lacrimal pump failure or weakness of orbicularis muscle. Mechanical causes are due to obstruction in the lacrimal passages. Evaluation of epiphora can be done by lacrimal syringing, fluoresceine dye disappearance test, Jones dye test, contrast dacryocystography, nuclear lacrimal scintigraphy, CT, MRI etc. Fluoresceine dye test is a non invasive method to study tear flow drainage system. Our study evaluate the effectiveness of dye disappearance test to lacrimal syringing which is a invasive test. Aim of this study was to evaluate the accuracy of fluorescein dye disappearance test [FDDT] in evaluating epiphora in comparison to lacrimal syringing.: A prospective observational study was conducted in 90 consecutive patients of age group of 40 to 70 years who presented with epiphora in Department of ophthalmology at tertiary care centre. Any cause like foreign body, trauma, blepharitis, lid disorders like ectropion, entropion, history of lacrimal sac surgeries in the recent past, and allergy to sodium fluorescein excluded from the study.A thorough medical history and comprehensive ophthalmological examination done in all patients. Epiphora evaluated with regurgitation over pressure on the lacrimal sac area, lacrimal syringing, and fluorseceine dye disappearance test.FDDT resulte were graded as grade 1 to 4 according to the quantity of flouorseceine stain in the conjunctival sac, Grade 1 and 2 considered as normal and grade 3 and 4 considered as abnormal.Results of FDDT, syringing, ROPLAS compared in the patients with epiphora.: In the study group, the 90 samples were analysed. The sample population were 62% males and 38% females. There were co-morbidities like diabetes mellitus and cataract noticed in the population. When we examined the diabetes mellitus patients presented with epiphora, showed lacrimal passage obstruction is more common in diabetes patients [67% patients among diabetes patients have FDDT of grade 2-3]. Regurgitation on pressure over lacrimal sac] test were done in all patients presented with epiphora, and the test was positive in 21 patients. FDDT were done in these patients and the results showed only 14 patients were Grade 2-3 [67%]. We compared the FDDT and lacrimal syringing tests in epiphora patients. Among the 90 patients we found that 60 individuals had patent nasolacrimal passages, verified by free flow in Lacrimal syringing test. FDDT showed majority of the patients were under grade 0-1 [patent nasolacrimal passages]. The patients with blocked nasolacrimal passages verified by lacrimal syringing were found grade 2-3 in FDDT [Blocked nasolacrimal passages]. Sensitivity, specificity, and positive and negative predictive value of FDDT were calculated.: FDDT is a safe and effective test for the evaluation of epiphora. It can be done as a screening test in pre operative evaluation of cataract surgery.

Design and Develop a Non-Invasive Pulmonary Vibration Device for Secretion Drainage in Pediatric Patients with Pneumonia

The study aimed to develop a non-invasive pulmonary vibration device, specifically tailored for pediatric patients, to address a range of pulmonary conditions. The device employs a PID control system to ensure consistent and precise vibrations. The primary contribution of this research is the successful development, testing, and implementation of this innovative device. Utilizing technical components such as an Arduino, a vibration DC motor, and an ADXL335 accelerometer, the device was engineered to deliver stable and continuous vibrations even when subjected to external pressures or interactions with the patient. Controllers, including P, PI, PD, and PID types, were rigorously compared. The Ziegler-Nichols tuning technique was applied for meticulous evaluation of vibration control specifically within the context of this non-invasive pulmonary vibration device. Our findings revealed that the PID controller displayed superior accuracy in vibration control compared to P, PI, and PD controllers. Clinical trials involving pediatric patients showed that the PID-controlled device achieved treatment outcomes comparable to conventional methods. The device's precise control of vibration strength provides an added benefit, making it a well-tolerated, non-invasive treatment option for various pulmonary conditions in pediatric patients. Future research is necessary to assess the long-term effectiveness of the device and to facilitate its integration into standard clinical practice. In summary, this study represents a significant advancement in pediatric pulmonary care, demonstrating the critical role that PID control systems adapted for non-invasive pulmonary vibration devices can play in enhancing treatment precision and outcomes.