Health care staff support for mothers in NICU: a focused ethnography study.

BACKGROUND: Mothers of premature newborns in the neonatal intensive care unit (NICU) have complex needs and require a significant amount of support during the NICU admission. However, little is known about mothers' support needs in the NICU. This study aimed to explore health care staff and mothers' experiences of meeting the mothers support needs in the NICU. This study aimed to explore health care staff and mothers' experiences of meeting the mothers' support needs in the NICU. METHODS: A focused ethnographic approach was adopted. Observations and interviews with 21 mothers, 18 nurses, and five physicians were undertaken over a seven months period. Qualitative data analysis was conducted using the Roper and Shapira (2000) five-step framework. RESULT: Two main themes of "insufficient provision of the mothers' support needs" (subthemes: inadequate accompany of the mothers in care, assigning monitoring and care to the mothers, inadequate sharing of medical the information) and "supporting the mothers in certain circumstances" (subthemes: reassuring the mothers, supporting the mothers with reduced functional capacity, providing information) were obtained. CONCLUSION: The mothers experienced a gap between expected and actual support provided by health care staff. Although, the health care staff believed that mothers' support was a necessity, it was not their main concerns, and they considered workload as a barrier for the mothers support in the NICU.

Mutual trust in infant care: the nurses and mothers experiences.

The relationship between healthcare providers and parents of infants in neonatal intensive care unit is based on trust and constitutes a core measure of family-centred care and health. The aim of the present qualitative study was to explore mothers and nurses experiences of trust in one another around the caregiving of the hospitalised infant in intensive neonatal care unit. Focused ethnographic research study conducted through observations and in-depth interviews with 20 mothers and 16 nurses in NICU of Tabriz (Iran) in 2017. Two main themes of 'gradual and fragile trust of mother-to-nurse' (subthemes: Primary trust-mistrust, mother's trust to responsible nurse, mother trust Increase with skilful nurse performance, and vulnerability to trust) and 'gradual and fragile trust of nurse-to-mother' (subthemes: Nurse's initial assessment of trust to mother's readiness to participate, Development of trust to mother, and vulnerability of nurse's trust to mother) were obtained. The present study revealed that mutual trust between the nurse and the mother in the care of the infant was a gradual and progressive process that was achieved over time. Complexities around the care of a hospitalised infant influenced how fragile or vulnerable the trust became between nurse and mother. Findings from this research can be used in supporting increased maternal participation in infant care and improvement of family-centred care in the neonatal intensive care unit.

Mothers' Emotional Experiences Providing Care for Their Infants Within the Culture of an Iranian Neonatal Unit.

BACKGROUND: Each year, 5% to 8% of Iranian newborns require care in a neonatal unit (NU). Reasons for admission include prematurity, infection, and congenital anomalies. Little research has been conducted on the culture of Iranian NUs and the impact this has on mothers' emotional caregiving experiences. PURPOSE: To explore the emotional caregiving experiences of mothers in an Iranian NU. METHODS: Focused ethnography was used for this study. Mothers (n = 19) of term and preterm infants participated. Data were collected using observations and interviews. Roper and Shapira's 5-step framework was used to analyze the data. FINDINGS: Four major themes emerged: (a) fear, (b) loneliness, (c) competence, and (d) pleasure. Fear occurred when mothers felt unprepared to care for their infants. They were afraid of harming their infant or repeating previous mistakes. Loneliness consisted of bearing the burden of care while feeling alone. Competence occurred when the mothers experienced an increasing ability to provide care for their infants and a growing self-confidence. Finally, the mothers described pleasure as they began to feel worthiness as mothers and intense love for their infants. IMPLICATIONS FOR PRACTICE: The sense of fear and loneliness shared by these mothers has significant implications for practice. While it may be a challenge for nurses to provide adequate support for mothers due to the heavy workload of Iranian NUs, close relatives and other support persons may play a key role. IMPLICATIONS FOR RESEARCH: Future research should be conducted on the impact of maternal support on mothers' NU experiences in Iran.

Mesenchymal Chondrosarcoma of the Orbit Attached to the Optic Nerve.

Mesenchymal chondrosarcoma (MCS) is a rare tumor in the orbit. Although optic nerve displacement is a common finding in intraorbital MCS, optic nerve tissue involvement in tumor has rarely been reported in huge tumors associated with intracranial extension. Herein the authors report a patient with MCS involving optic nerve tissue without intracranial extension. A 59-year-old woman with a 2-month history of progressive proptosis and normal vision presented to us. Computed tomography revealed a clearly outlined heterogeneous mass with calcified foci in its center, which was attached to the optic nerve, magnetic resonance imaging showed the mass to be isointense to gray matter on T1- and T2-weighted images. She underwent lateral orbitotomy and partial tumor excision. Histopathologic study confirmed MCS. She refused exenteration till 1 year but the tumor recurred and her vision decreased to no light perception. Then exenteration was performed with obtaining free margin and she is now free of tumor after 6 months without radiotherapy or chemotherapy. Mesenchymal chondrosarcoma must be differentiated from more common calcified tumors attached to optic nerve like meningioma.

Investigating the Association between Angiogenic Cytokines and Corneal Neovascularization in Sulfur Mustard Intoxicated Subjects 26 Years after Exposure.

OBJECTIVES: This study aimed to evaluate the associations between the concentrations of three major angiogenic cytokines-vascular endothelial growth factor-A165 (VEGF-A165), basic fibroblast growth factor (bFGF), and platelet-derived growth factor-BB (PDGF-BB)-in the tear of sulfur mustard (SM)-exposed subjects and corneal neovascularization (CNV) 26 years after exposure. MATERIALS AND METHODS: The concentrations of VEGF-A, bFGF, and PDGF-BB were measured by enzyme-linked immunosorbent assay (ELISA) in reflex tears of (i) SM-injured patients with CNV (positive case group including 18 individuals) and (ii) SM-injured patients without CNV (negative case group including 22 individuals). Then results were compared to corresponding values obtained from tears of 40 healthy control subjects. RESULTS: The mean concentrations of all investigated growth factors, VEGF-A165, bFGF, and PDGF-BB, were significantly higher in positive cases than controls (P ≤ 0.001, P = 0.028, and P = 0.041, respectively). Whereas, VEGF-A165 was the only growth factor which displayed significantly elevated concentrations in negative case group compared to the healthy individuals (P = 0.030). Additionally, the mean level of VEGF-A165 was also higher in positive patient group than negative patients (P = 0.022). Subjects with increased concentrations of tear VEGF-A165 were more than 10 times more likely to suffer from CNV than normal individuals (odds ratio (OR) = 10.43, confidence interval (CI): 2.14-38.46, P = 0.001), while elevated levels of bFGF and PDGF-BB increased the risk of CNV by about twofold. CONCLUSION: Although all investigated cytokines had increased in tears of positive patients, VEGF-A was the only one which showed a significant correlation with the severity of CNV, and thus played a crucial role in corneal angiogenesis.

The impact of Dimethyl itaconate on c-Fos expression in the spinal cord in experimental pain models.

Itaconate has been found to have potent anti-inflammatory effects and is being explored as a potential treatment for inflammatory diseases. However, its ability to relieve nociception and the mechanisms behind it are not yet understood. Our research aims to investigate the nociception-relieving properties of dimethyl itaconate (DMI) in the formalin test and writhing test. In male Wistar rats, Itaconic acid was injected intraperitoneally (i.p.). The formalin test and writhing test were conducted to determine the nociceptive behaviors. The spinal cords were removed from the rats and analyzed for c-fos protein expression. The study found that administering DMI 10 and 20 mg/kg reduced nociception in formalin and writhing tests. Injection of formalin into the periphery of the body led to an increase in the expression of c-fos in the spinal cord, which was alleviated by DMI 20 mg/kg. Similarly, acetic acid injection into the peritoneal cavity caused an increase in c-fos expression in the spinal cord, which was then reduced by 20 mg/kg. According to our findings, DMI reduced nociception in rats during the formalin and writhing tests. One possible explanation for this outcome is that the decrease in c-fos protein expression may be attributed to the presence of DMI.

Impact of polyvinyl chloride microplastic and paraquat herbicide on the blood cells, biochemical parameters, liver enzymes and morphological changes of aqueduct fish.

In recent years, the surge in plastic production has led to pervasive pollution across all environments, earning us the title of inhabiting a "plastic world." Consequently, this research endeavors to explore alterations in biochemical parameters, liver enzymes, and tissue integrity within the gills, intestines, and liver of black fish subjected to polyvinyl chloride (PVC) microplastics and paraquat herbicide, both individually and in combination. For this purpose, we allocated 90 blackfish specimens into 9 groups consisting of 10 individuals each through random selection. Following a period of 28 days, we carried out an assessment to investigate the toxic effects of PVC and paraquat, both separately and in combination. Subsequently, The results indicate that the number of red blood cells (RBCs, millions/mm3) in all studied groups (Group G: 3.6 ± 0.18; Group H: 3.5 ± 0.17; and Group I: 3.2 ± 0.16) is significanly lower than the control group (Pvalue<0.05). The glucose levels in all studied groups (Group B: 47 ± 5.12; Group C: 48 ± 3.79; Group D: 51 ± 4.14; Group E: 48 ± 5.37; Group F: 53 ± 7.48; Group G: 53 ± 9.24; Group H: 58 ± 10.43; and Group I: 61 ± 8.71) are higher than the control group (46 ± 3.71). The results indicate that the levels of AST enzyme in all studied groups (group B: 30 ± 0.17; group C: 32 ± 1.61; group D: 34 ± 1.92; group E: 33 ± 1.17; group F: 38 ± 2.27; group G: 38 ± 1.71; group H: 43 ± 2.15; and group I: 46 ± 2.33). Groups F, G, H, and I exhibit significantly higher levels of AST enzyme compared to the control group, with a p-value<0.05. Morphological changes observed in erythrocytes include deformation and cell vacuolation. The maximum amount of changes in the morphology of erythrocytes occurs when black fish is exposed to 2 mg/L of PVC and 0.4 mg/L of paraquat (group I). The histological harm caused by the combination of PVC and paraquat is significant. Findings indicate that increasing the concentration of both microplastics and paraquat enhances their toxicity when combined. Consequently, it's imperative to assess the toxic impact of microplastics (MPs) and paraquat individually, as well as in combination, on aquatic organisms to safeguard them from the detrimental effects of these substances.

The landscape of non-coding RNAs in the immunopathogenesis of Endometriosis.

Endometriosis is a complex disorder that is characterized by the abnormal growth of endometrial-like tissue outside the uterus. It is associated with chronic inflammation, severe pelvic pain, infertility, and significantly reduced quality of life. Although the exact mechanism of endometriosis remains unknown, inflammation and altered immunity are considered key factors in the immunopathogenesis of the disorder. Disturbances of immune responses result in reduced clearance of regurgitated endometrial cells, which elicits oxidative stress and progression of inflammation. Proinflammatory mediators could affect immune cells' recruitment, fate, and function. Reciprocally, the activation of immune cells can promote inflammation. Aberrant expression of non-coding RNA (ncRNA) in patient and animal lesions could be suggestive of their role in endometriosis establishment. The engagement of these RNAs in regulating diverse biological processes, including inflammatory responses and activation of inflammasomes, altered immunity, cell proliferation, migration, invasion, and angiogenesis are widespread and far-reaching. Therefore, ncRNAs can be identified as a determining candidate regulating the inflammatory responses and immune system. This review aims in addition to predict the role of ncRNAs in the immunopathogenesis of endometriosis through regulating inflammation and altered immunity based on previous studies, it presents a comprehensive view of inflammation role in the pathogenesis of endometriosis.

Postmenopausal women's usage of complementary and alternative medicine and its relationship to sexual function: A cross-sectional study in southeastern Iran.

Background and Aims: Sexual dysfunction is one of the most common problems in postmenopausal women that affect their lives. Due to the widespread disadvantages and age limit of drug and hormone therapy, the demand for complementary and alternative medicine (CAM) methods has increased. Methods: This was a descriptive-analytical study. A total of 297 postmenopausal women who were referred to health centers in Kerman, southeastern Iran, were selected during the years 2020-2021. The use of CAM and sexual function were examined by Complementary and Alternative Medicine Questionnaire and the Female Sexual Function Index, respectively. Data were collected through a combination of face-to-face and online forms. Results: More than half of the participants used at least one type of CAM in the preceding year for any general reason. The mean satisfaction score for CAM use was 21.7 ± 5.84; Most reasons of use were for improving quality of life, improving physical function, reducing sleep disorders, improving mood status, reducing vasomotor symptom, and improving sexual function, respectively. Most reasons of use were related to sexual dysfunction. Specifically, the mean score for sexual function was 17.96 ± 7.50 which was lower than the scale's midpoint of 28. According to different subscales of sexual function, 52.9% of participants had good desire, 49.5% good arousal, 34.7% good lubrication, 56.9% good orgasm, and 2% had no pain, and 52.5% were satisfied with their sexual function. There were no significant differences between CAM users and nonusers about sexual functions and all its subscales. Conclusion: There were no significant differences between CAM users and nonusers about sexual functions and all its domains. Further research in different communities with different health systems is recommended to investigate the relationship between CAM and sexual function among postmenopausal women.

Menopause symptoms in women and its relation with using complementary and alternative medicines: A survey in southeast Iran.

Background: Postmenopausal women are interested in using complementary and alternative medicine because of their menopausal symptoms and the side effects of chemical medications and hormone therapy. Therefore, this study aimed to investigate the relationship between the use of complementary medicine (CAM) and menopausal symptoms among postmenopausal women. Methods: This cross-sectional study was conducted among 288 postmenopausal women who were referred to health centers in Kerman, southeastern Iran, from 2020 to 2021. Data were collected using a demographic questionnaire, the CAM questionnaire, and the Menopause Rating Scale (MRS). Results: The mean score for the menopausal symptoms of the participants was 8.73 ± 6.11. Only 28.8% of the participants had no/little symptoms. About 65.3% of the participants used at least one type of CAM in the previous year. The most commonly used types of CAM were nutritional supplements, prayer, and medicinal herbs. A significant association was found between the use of medicinal herbs, dry cupping, relaxation and meditation, prayer, and menopausal symptoms. Women experiencing menopausal symptoms used more CAM methods than those without menopausal symptoms (Odds ratio = 2.25, 95% confidence interval = 1.33-3.80). Conclusion: The study results indicated that the severity of menopausal symptoms and scores in somatic-vegetative and urogenital domains were higher in CAM users compared to non-CAM users. But there was no significant difference in the psychological domain between CAM and non-CAM users. Based on the results, it is suggested that more research be done in different communities with different healthcare systems to find out how complementary and alternative medicine affects menopausal symptoms in women.

Nanocarriers: A novel strategy for the delivery of CRISPR/Cas systems.

In recent decades, clustered regularly interspaced short palindromic repeat/CRISPR-associated protein (CRISPR/Cas) has become one of the most promising genome-editing tools for therapeutic purposes in biomedical and medical applications. Although the CRISPR/Cas system has truly revolutionized the era of genome editing, the safe and effective delivery of CRISPR/Cas systems represents a substantial challenge that must be tackled to enable the next generation of genetic therapies. In addition, there are some challenges in the in vivo delivery to the targeted cells/tissues. Nanotechnology-based drug delivery systems can be employed to overcome this issue. This review discusses different types and forms of CRISPR/Cas systems and the current CRISPR/Cas delivery systems, including non-viral carriers such as liposomes, polymeric, and gold particles. The focus then turns to the viral nanocarriers which have been recently used as a nanocarrier for CRISPR/Cas delivery.

Intraorbital Steroid Injection for Active Thyroid Ophthalmopathy.

PURPOSE: To evaluate the effect of orbital steroid injections in patients with active thyroid ophthalmopathy resistant to or dependent on systemic steroids, or with complications related to systemic steroid use. METHODS: This prospective non-comparative case series includes 31 eyes of 17 patients with active thyroid ophthalmopathy and clinical activity score (CAS) of 3 or more, without compressive optic neuropathy or overt exposure keratopathy. All subjects had a history of previous systemic steroid use (with steroid resistance or dependence) or had developed complications related to steroids. A combination of steroids including triamcinolone acetonide 20 mg and dexamethasone 4 mg was injected in the upper and lower retroseptal orbital spaces three or four times at one-month intervals. The patients were examined periodically after each injection and at least three months after the last injection. RESULTS: Mean pre-injection CAS was 5.2 ± 1.3 which was improved to 1.6 ± 1 after the fourth injection (P < 0.001). Upper and lower lid retraction improved in 100% and 68.2% of the affected eyes, respectively. Strabismus completely resolved in one of five affected patients and the most significant improvement was observed in supraduction. Mean improvement in exophthalmos was 1.2 ± 1.1 mm. Visual acuity did not significantly change after the injections. Eyelid ecchymosis and/or subconjunctival hemorrhage was observed in 7.1% and intraocular pressure rise occurred in 8.8% of eyes. CONCLUSION: Orbital steroid injections can be used for the treatment of active thyroid ophthalmopathy when the patient is resistant to or dependent on systemic steroids or has developed complications of systemic steroids.

Medial rectus muscle loss: Is immediate lateral rectus disinsertion a solution? A case report with review of the literature.

PURPOSE: To report a case of medial rectus (MR) muscle loss during the strabismus surgery with a late successful management and review of the literature. METHODS: The left MR was lost during resection in a 14-year-old girl who had undergone strabismus surgery elsewhere. The surgeon disinserted the antagonist lateral rectus (LR) muscle in the same session following unsuccessful attempts to retrieve the lost muscle. She was referred to our clinic two months later with a large angle exotropia and a complete lack of adduction. We performed a half-tendon transposition of vertical rectus muscles to the MR insertion and attached the residual fibers of the LR to the orbital periosteum. RESULTS: She was orthotropic after the surgery and remained stable until 6 months with a significant improvement of the adduction. CONCLUSIONS: Simultaneous LR disinsertion is not a solution for MR loss. Half-tendon transposition of the vertical recti to the original insertion of the lost MR and periosteal fixation of the LR are good options as a second-stage operation in patients with MR loss during strabismus surgery.

Intravitreal Bevacizumab with or without Triamcinolone for Wet Age-related Macular Degeneration: Twelve-month Results of a Prospective, Randomized Investigation.

PURPOSE: The purpose of this study is to compare the long-term outcomes of intravitreal bevacizumab (IVB) with a combination therapy including IVB/intravitreal triamcinolone acetonide (IVB/IVTA) in neovascular age-related macular degeneration (AMD). MATERIALS AND METHODS: This prospective, randomized clinical trial was conducted on 136 eyes of 136 patients with neovascular AMD. Eyes were randomly assigned to receive IVB alone (71 eyes) or in combination with IVTA (65 eyes). In the IVB group, three consecutive injections of 1.25 mg/0.05 ml of bevacizumab were administered 1 month apart, whereas in the IVB/IVTA group, 4 mg/0.05 mL of triamcinolone acetonide was added to bevacizumab in the first injection. Additional IVB injections were administered in eyes demonstrating active choroidal neovascularization. Best-corrected visual acuity (BCVA) and optical coherence tomography were performed at baseline as well as at all follow-up visits. RESULTS: No differences were seen between the patients receiving IVB and those receiving IVB/IVTA in terms of baseline BCVA (P = 0.97) and baseline central macular thickness (CMT) (P = 0.77). BCVA improved, and CMT reduced significantly in both study arms at almost all follow-up intervals. IVB/IVTA intervention, compared with IVB, was statistically more effective in improving BCVA (P = 0.01) and in reducing CMT (P = 0.02) after 12 months. The average number of reinjections was 1.25 ± 0.92 in the IVB group and 1.06 ± 1.01 in the IVB/IVTA group (P = 0.44). CONCLUSION: Our results suggest that the synergistic effect of intravitreal triamcinolone and IVB for treatment of neovascular AMD shows itself most apparently after 8 months of follow-up.

Optimal Glycemic and Hemoglobin A1c Thresholds for Diagnosing Diabetes Based on Prevalence of Retinopathy in an Iranian Population.

BACKGROUND: The use of glycemic thresholds for diabetes diagnosis is controversial. However, no information is available regarding glycemic and glycated hemoglobin (HbA1c) thresholds for detecting diabetic retinopathy (DR) in the Iranian population. OBJECTIVES: The main purpose of the current investigation was to examine the association of fasting plasma glucose (FPG) and HbA1c levels with diabetic retinopathy (DR), and to determine the relevant cut-off levels in an Iranian population. PATIENTS AND METHODS: This cross-sectional, population-based study was performed during 2012-2013 in Urmia, the capital of West Azerbaijan province, Iran. The subjects were 3,010 Iranians aged 40-81 years. The FPG levels were determined using the glucose oxidase method whereas, the HbA1c values were measured using a standardized assay by high performance liquid chromatography. DR was evaluated by an examination of the fundus photograph of each eye. The photographs were graded according to the international clinical diabetic retinopathy disease severity scale by photograph graders who were masked to the clinical information. RESULTS: Of the subjects, 59 had DR. The prevalence of DR increased steeply between the ninth and the tenth deciles for both variables. The ROC curve analysis showed overall glycemic thresholds for DR of 6.5 mmol/L (117 mg/dL) for FPG and 6.2% (44 mmol/mol) for HbA1c. The sensitivities and specificities were 78.0% and 87.1% for FPG and 89.8% and 89.5% for HbA1c, respectively. The areas under the ROC curves indicated that HbA1c was a stronger discriminator of retinopathy: the area under curve was 0.880 for FPG and 0.946 for HbA1c P < 0.001). However, the thresholds for detecting DR for the two measures showed no significant differences after excluding individuals receiving anti-hyperglycemic medication. CONCLUSIONS: These findings suggest that the HbA1c and FPG thresholds for detecting diabetes in the Iranian population are lower than the current diagnostic criteria.

Detection of Hydroxychloroquine Retinal Toxicity by Automated Perimetry in 60 Rheumatoid Arthritis Patients with Normal Fundoscopic Findings.

Hydroxychloroquine (HCQ) is an antimalarial drug used extensively in treatment of autoimmune diseases such as rheumatoid arthritis. Retinal toxicity is the most important side effects of this drug. Even after the drug is discontinued, retinal degeneration from HCQ can continue to progress. Consequently, multiple ophthalmic screening tests have been developed to detect early retinopathy. The aim of the current study was to evaluate the value of central 2-10 perimetry method in early detection of retinal toxicity. This prospective cross-sectional investigation was carried out on 60 rheumatoid arthritis patients, who had been receiving HCQ for at least 6 months and still were on their medication (HCQ intake) at the time of enrollment. An ophthalmologist examined participants using direct and indirect ophthalmoscopy. Visual field testing with automated perimetry technique (central 2-10 perimetry with red target) was performed on all included subjects twice in 6 months interval: The first one at the time of enrollment and the second one 6 months later. Males and females did not show any significant difference in terms of age, duration of therapy, daily and cumulative HCQ dose, anterior or posterior segment abnormalities, hypertension, body mass index, and best corrected visual acuity. Anterior segment was abnormal in 9 individuals including 3 subjects with macular pigmentary changes, 4 individuals with cataract and 2 cases with dry eyes. Moreover, 12 subjects had retinal pigmented epithelium (RPE) in their posterior segments. After 6 months, depressive changes appeared in 12 subjects. Additionally, HCQ therapy worsened significantly the perimetric results of 5 (55.6%) patients with abnormal anterior segment. A same trend was observed in perimetric results of 6 (50.0%) subjects with abnormal posterior segments (P=0.009). The daily dose of HCQ (P=0.035) as well as the cumulative dose of hydroxychloroquine (P=0.021) displayed statistically significant associations with perimetric results. Central 2-10 perimetry is a useful method for early detection of HCQ retinal toxicity, but more comprehensive studies, with larger sample size, longer-term follow-up and more precise techniques are mandatory to confirm HCQ retinal toxicity.

Monocanalicular versus bicanalicular silicone intubation for congenital nasolacrimal duct obstruction.

PURPOSE: To compare the success rate of monocanalicular versus bicanalicular silicone intubation of the nasolacrimal duct for congenital nasolacrimal duct obstruction (CNLDO). METHODS: In a prospective randomized clinical trial, 70 eyes of 57 children with CNLDO underwent either monocanalicular silicone intubation (MCI) (n = 35 eyes) or bicanalicular silicone intubation (BCI) (n = 35 eyes). All procedures were performed by 1 oculoplastic surgeon. Tube removal was planned for 3 months postoperatively. The results were assessed using a Munk score. Treatment success was defined as Munk score 0-1 at 3 months after tube removal. RESULTS: The surgical outcome was assessed in 29 eyes with MCI and 27 eyes with BCI. The mean age of treatment was 34.9 ± 12.7 months for MCI and 38.7 ± 18.6 months for BCI. Treatment success was achieved in 25 of 29 eyes (86.2%; 95% CI, 79%-96%) in the MCI group compared with 24 of 27 eyes (89%; 95% CI, 84%-94%) in the BCI group (RR = 0.96; 95% CI, 0.79-1.18). There were no corneal or canalicular complications in either group. CONCLUSIONS: MCI and BCI were successful in a similar percentage of children with CNLDO. The mainadvantage of the former technique was easy tube removal without sedation in the office.