The linear no-threshold hypothesis (LNT)-the basis of radiation regulatory policy-extrapolates from observed high-dose harm to assumed low-dose harm, entailing that all ionizing radiation is harmful, by denying any biological response to damage and asserting cumulative lifetime harm, regardless of dose or dose rate. All aspects of LNT are demonstrably false. There are evolved biological responses that repair or remove radiogenic damage from low doses and dose rates, thereby averting acute harm and precluding the alleged cumulative damage. LNT and its offspring, the “as low as reasonably achievable” principle, do not err on the side of caution; neither is truly conservative. The public needs protection from radiophobia, rather than from low-dose radiation exposure. Neither radiation regulations nor medical practice should be based on LNT, but rather, at least as a first step, on a linear (down to a) threshold (LT) model.

Background: The foot is an important and complex structure that provides support, balance and propulsion to locomotion, thus, its proper care can help to have a better life quality avoiding pain. The medial longitudinal arch is an important structure that is related to injury risks when it shows some impairment. The purpose of this study was to characterize the foot arch index in people in relation to age and gender. Methods: The sample was composed of a total of 122 subjects, 79 healthy young subjects (40 women and 39 men) and 43 healthy elderly subjects (32 women and 11 men). Ten seconds of standing barefoot plantar pressure was measure through Tekscan F-Scan device, and the data processing, filtering, and arch index (AI) calculation were performed using MATLAB™ 7.0. Findings: The elderly group presented a lower arch (AI-0.23) than the young group (AI-0.13) (p=0.000); young female and male groups show similar AI, while the elderly female group showed lower arch (AI-0.23) than the elderly male group (AI-0.18) (p=0.033). Interpretation: The foot arch has a trend to be lower with aging, and even lower within elderly female subjects, probably due to some decrease within plantar muscle’s stiffness, that in turn may be related to lower physical activity and footwear choices.

Despite its high incidence and the great development of literature, there is still controversy about the optimal management of Achilles tendon rupture. The several techniques proposed to treat acute ruptures can essentially be classified into: conservative management (cast immobilization or functional bracing), open repair, minimally invasive technique and percutaneous repair with or without augmentation. Although chronic ruptures represent a different chapter, the ideal treatment seems to be surgical too (debridement, local tissue transfer, augmentation and synthetic grafts). In this paper we reviewed the literature on acute injuries.

Prostate specific membrane antigen, a type II transmembrane protein is an excellent target for the radionuclide therapy in advanced prostate cancer patients due to its high expression in the prostate cancer cells. We present the case of a 69-year old man with advanced metastatic castration resistant prostate cancer. In view of rising serum PSA levels despite hormonal and chemotherapy, we decided to perform a 68Ga-PSMA-HBED-CC PET/CT scan (prostate specific membrane antigen). It revealed intense radiotracer uptake in the prostate, lymph nodes and multiple skeletal sites. Five cycles of 177Lu-PSMA-DKFZ-617 radioligand therapy were administered in the patient followed by an intrim 68Ga-PSMA-HBED-CC PET/CT. Intrim 68Ga-PSMA-HBED-CC PET/CT scan demonstrated a near complete remission of disease with a corresponding decrease in the sPSA levels. During the follow-up duration of 12 months, the patient did not develop haematological, kidney and liver toxicity during the course of treatment and follow-up. 177Lu-PSMA-DKFZ-617 is a promising therapeutic option in metastatic castration resistant prostate cancer (mCRPC) patients.

NMDA receptor encephalitis is a rare disease first described in 2007. Anti-NMDA receptor encephalitis affects mostly young women as neoplasms, mostly ovarian teratomas, are the underlying cause. The disease is caused by antibodies binding to extracellular epitopes of neuronal cell-surface, which leads to an internalization of NMDA-receptors. The characteristic syndrome of patients with anti-NMDAR as well as its recovery follows a certain pattern. Treatment includes immunotherapy and removal of the immunologic trigger. This case report describes a young woman with anti-NMDA receptor encephalitis caused by an ovarian teratoma. 

The greater risk of hypernatremia in patients over 65 years old are associated with impaired mental status and physical disability which may result in impaired sensation to thirst, impaired ability to express thirst, and/or decrease access to water [1,2]. Normally, anti-diuretic hormone (ADH, also known as arginine-vasopressin, AVP) is secreted in response to 1-2% increase in osmolality which stimulate thirst, as do hypovolemia and hypotension.

The patient is a 28-year old Caucasian man with six month history of arthralgia and crampy abdominal pain who presented with acute dyspnea and cough for 6 months associated with migratory polyarthralgias involving his knees, ankles, wrists, and shoulders.

Aim: To evaluate sexual dimorphism in horizontal lip position in adults with different skeletal patterns. Material and Methods: The sample comprised of 120 patients (Females 18 years and above, Males 21 years and above) with no history of previous orthodontic treatment or functional jaw orthopaedic treatment. They were divided into different groups based on the ANB angle and gender. Group I and II included 30 males and 30 females with skeletal class I malocclusion (ANB 0-4 degree). Group III and IV included 30 males and 30 females with skeletal class II malocclusion respectively (ANB above 4 degree). Results: When comparison between males and females (Class I+Class II) was done S-line (p<0.001), B-line (p<0.001), E-line (p<0.001), Holdaways angle (p<0.001) and Merrifield angle (p<0.001) were found to be statistically significant. S-line (p<0.001), E-line (p<0.001) and Holdaways angle (p<0.001) were found to be statistically significant when comparison was done between males and females (Class I). When comparison was done between males and females (Class II) only Holdaways angle (p<0.001) showed a significant statistical difference. Conclusion: Sexual dimorphism was found in various lip parameters. Significant amount of differences were found between Class I and Class II (male and female) subjects.

The rehabilitation of partially or completely edentulous patients with implant supported prostheses has been widely used, achieving high success rates. However, many studies consider the presence of bruxism as a contraindication for this treatment modality. The purpose of this study was to review the literature and identify risk factors in implant supported rehabilitation planning in subjects with bruxism. The rehabilitation of bruxers using implant supported prostheses, using implants with adequate length and diameter, as well as proper positioning, seems to be a reliable treatment with reduced risks of failure. Bruxism control through the use of a night guard by rigid occlusal stabilization appliance, relieved in the region of implants, is highly indicated. Although it is clear that implant supported rehabilitation of patients with bruxism requires adequate planning and follow-up, well-designed randomized controlled trials are needed to provide reliable evidence on the long-term success of this treatment modality.

This observational study assessed the knowledge of pregnant women attending antenatal clinics at two selected hospitals in Abeokuta South, Nigeria on the causes and risk factors of maternal mortality, identified barriers to knowledge acquisition, and examined the influence of parity of respondents on their knowledge of factors causing maternal mortality. Maternal mortality is extremely high in Nigeria, it is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. Descriptive research design was used in this study and qualitative data from 136 respondents selected randomly, were obtained through a self-designed questionnaire that comprised three sections. Data were analyzed and indicated that parity of the pregnant women do not have an influence on their knowledge of factors responsible for maternal mortality. Findings revealed that majority (67.6%) of the respondents had high knowledge on the causes of maternal mortality – haemorrhage, sepsis, prolonged/obstructed labour, anaemia, unsafe abortion, infection, hypertensive disorders, care rendered by unskilled medical practitioners and its risk factors - parity, poverty, place of last delivery and low attendance at antenatal clinic. Educational background, marital status, irregular antenatal visits, socio-cultural practices and occupational status were identified as barriers to knowledge acquisition. This paper concluded that pregnant women may have a high knowledge about the factors responsible for maternal mortality. This is probably due to the fact that all respondents had formal education and because they were interviewed on antenatal clinic days, which suggests that they might have heard about the causes and risk factors for maternal mortality during their visits. Authors recommended that government should employ qualified health professionals and provide medical subsidy, it is hoped that this will ensure that pregnant women get quality care throughout the period of pregnancy and delivery.

Morbidly adherent placenta (MAP) includes the spectrum of placenta accreta, increta, and percreta. It is a major cause of obstetric hemorrhage. Caesarean section is main risk factor for MAP. Ultrasound scan is highly sensitive method for MAP diagnosis and sometime Magnetic resonance image is of choice. Early diagnosis timed elective planned intervention after preparation under skillful multidisciplinary team improve the outcome and minimize the morbidity. Caesarean hysterectomy, major arteries ligation, arteries embolization and leave the placenta in-situ all are choices of management. Use of Methotrexate for the placenta in-situ in MAP is still debatable. We present a case of MAP in which placenta left in- situ followed by multiple Methotrexate injection during postpartum with good outcome and acceptability.

Background: Previous studies highlighted the negative effect of premature progesterone elevation (PE) during IVF cycles on the cycle outcomes. The aim of this study was to assess the validity of progesterone level on hCG day (P4) in the prediction of IVF/ICSI cycles’ outcome. Methods: In a retrospective cohort study, all fresh cycles of 256 patients who underwent IVF or ICSI cycles in 2017 at reproductive endocrinology & infertility unit/ Obg/Gyn department at King Abdulaziz Medical city, Riyadh, Saudi Arabia, were followed up. They were started on gonadotropin medications for ovarian hyperstimulation, followed by serial transvaginal U/S and serum estrogen levels each visit. Patients having 2 or more 18mm follicles were triggered by hCG 10,000 IU and ovum pickup was done 34-36 hrs after. Data were collected on patients’ characteristics [age, BMI infertility type], cycles’ characteristics [number of follicles and endometrium thickness on hCG day, P4 and estrogen levels], rates of pregnancy and pregnancy outcomes. Receiver operating characteristic curve was applied to determine the cut-off of P4 that corresponds with a negative pregnancy test. Logistic regression analysis was used and significance was considered at p - value of ≤0.05. Results: Pregnancy rate in the study sample was 36.7%. The mean P4 level in cycles with negative pregnancy tests was significantly higher than the mean in cycles with positive tests (p = 0.018). After adjusting for confounders, significant negative association between P4 and pregnancy rate was evident (p < 0.03). The optimum trade-off of P4 for prediction of a negative pregnancy test was 1.5nmol/L. This cut-off level had a 59% sensitivity, 51% specificity and 68% positive predictive value and 10% & 15% absolute and relative risk reductions respectively. Cycles with mean P4 of ≥1.5nmol/L were significantly associated with primary infertility (p = 0.011), lower mean BMI (p = 0.009) higher mean estrogen level (p < 0.001), lower live birth rate (p = 0.048), higher abortion rate (p = 0.039), and higher ovarian hyperstimulation rate (p = 0.027). Conclusion: Premature elevation of progesterone level on the hCG day in IVF/ICSI cycles may have adversely impacted the pregnancy rate and pregnancy outcome. The cutoff point of 1.5nmol/L for this P4 was not valid in predicting pregnancy outcomes. 

Background: Breast cancer (BC) is one of the most prevalent malignancies. BC survivors have higher risk of second primary cancers than the general population. There is an increased interest in BC survivor management, including the prevention of these second cancers. The aim of this study was to assess the risk of gynaecological malignancy (GM) as second neoplasm among BC patients in our population. Methods: Patients with invasive BC diagnosed from 1980 to 2014 included in the Girona Cancer Registry were included. The incidence of second GM in these patients was compared to those in the general population. Second primary cancer was stated as a tumour diagnosed after 2 months from the BC diagnosis. Standardized incidence ratios (SIR) and absolute excess of risk (AER) were calculated. Results: 9,717 patients were diagnosed with invasive BC during this period, with a median age at diagnosis of 61 years, and a median follow-up of 7.9 years. 117 of them developed a second GM. By tumour type, the only statistically significant higher SIR was observed for corpus uteri cancer (SIR:2.28 95% CI 1.82-2.83; AER:6.43 95% CI 4.13-9.14). After reviewing the histology of the corpus uteri cancer cases, we found that 71.4% were type I (endometrioid adenocarcinoma), 15.5% type II (serous adenocarcinomas and clear cell carcinomas), 10.7% carcinosarcomas, 2.4% sarcomas and there were no unspecified malignant neoplasms. Conclusion: BC survivors have an increased risk of corpus uteri cancer, with an increase in unfavourable histologies compared to the general population. Lifelong primary and secondary prevention interventions should be recommended for these patients.

Objectives: The role of perioperative hemofiltration (HF) in adult patients with impaired renal function undergoing cardiac surgery is controversial. There are suggestions that it may be beneficial for high risk patients undergoing prolonged cardiopulmonary bypass (CPB) surgery. However, long term outcomes in coronary artery bypass graft (CABG) surgery patients have not been investigated. Methods: To address this we retrospectively followed 7620 patients who underwent CABG between April 2001 and March 2006. Logistic regression was used to risk adjust in-hospital outcomes. Cox proportional hazards analysis was used to risk adjust Kaplan-Meier freedom from death curves. Outcomes were adjusted for American Heart Association and American College of College of Cardiology recommended variables. Results: 113 patients had intraoperative HF, 38 had postoperative HF and control group of 7006 that had no HF. After adjusting for differences in case-mix, patients with preoperative kidney disease who received postoperative HF proportionately had significantly higher rates of hospital deaths as compared with intraoperative HF patients. In addition, 5-year follow-up risk-adjusted freedom from death indicated significant differences between intraoperative HF group and postoperative HF patients. Conclusions: These findings support the hypothesis that after adjusting for differences in case mixes, the use of intraoperative hemofiltration may offer superior short term clinical outcomes and longer-term survival benefits for patients with preoperative kidney disease.

Despite the background of advances in cardiac surgery procedures for higher risk population, the postoperative complication has already been a challenge for cardiac surgeon and Heart-Team. Future perspectives to exceed this challenge could be periodically patient’s follow up and advance diagnostic workup. We describe the diagnosis of a large sub mitral left Ventricle Pseudoaneurysm that was identified in a 59-year-old woman 17 years after she underwent aortic and mitral valve replacement for rheumatic valvular disease

The Objective: to improve the treatment results for patients with cerebral arterial saccular aneurysms by optimizing of differentiated approach to the using of endovascular assisting occlusion techniques. Materials and Methods: The work is based on the comprehensive survey and treatment of 1345 patients with cerebral saccular arterial aneurysms (AA), who were treated at the SO “Scientific-Practical Center of endovascular neuroradiology of NAMS of Ukraine” from 2002 to 2016. 214 cases were selected for further clinical-instrumental dynamic observation in follow-up period. All patients were operated by endovascular approach in “before hemorrhage” period, in acute or “cold” period of the disease on for symptomatic or asymptomatic intracranial saccular AA in both vascular pools with balloon-remodeling or stent-assisting techniques using with the coiling or just detachable coils (DC) using-mono-coils occlusion technique. Depending on the initial endovascular occlusion method, the patients were divided into three groups for observation: I group (mono-coils occlusion)-82 (38.3%) patients, II group (balloon-remodeling technique using)-68 (31.8%) patients, group III (stent-assisting technique occlusion)-64 (29.9%) patients. The life quality and the level of social adaptation were evaluated before hospital discharge and at the follow-up control examinations by Glasgow Outcome Scale (GOS) and by the modified Rankine scale (mRS). AA radicalism occlusion was assessed by Modified Raymond-Roy Scale (MRRS) (Mascitelli JR, et al., 2015). AA occlusion I and II by MRRS was considered as “Effective”. Results: 9 criteria of cerebral saccular AA complexity inherent in endovascular surgery have been developed based on the technical and surgical features of endovascular methods of the cerebral AA occlusion and X-ray-anatomical characteristics of aneurysms, which complicated the “effective” reconstructive occlusion of AA cavity. The evaluation of the AA complexity criteria prognostic significance to achieve the “effective” primary occlusion, shown different results in different groups: high prognostic significance of 4 criteria was shown in group I, of 2 criteria - in group III, and no any criteria significance in group II. There was no statistically significant difference between groups in the primary AA occlusion efficacy and initial good results by GOS and mRS. It was proved that endovascular occlusion of complex cerebral AA with the assisting methods using has high efficiency in all periods of the disease, unlike the method of mono-coils occlusion, which is most effective in acute and “cold” periods. There was no statistically significant difference between the number of intraoperative, postoperative and non-surgical complications (p>0.05). It was found that all methods of complex AA endovascular occlusion can effectively prevent the disease recurrence despite the differences between them in the stability of the AA cavity occlusion. Conclusions: Consideration of developed AA complexity criteria during endovascular surgery planning allows to choose the most optimal and safe individual method of primary or phased AA occlusion and helps to reduce the frequency of AA recanalization in follow-up period. The choice of the complex AA occlusion method doesn’t effect on result of primary treatment, the number of intraoperative complications and the quality of primary occlusion. However, an analysis of the long-term treatment results indicates that the assisting techniques have proven advantages according to the occlusion stability.

The Transcatheter Aortic Valve Implantation (TAVI) had emerged more and more in the last twenty years. According to the scientific literature, this is an approved, suitable and alternative therapeutic choice to conventional surgery for aortic valve disease in high risk patients. The most of patients are octogenarians or nonagenarians, with multiple comorbidities (neurological,vascular,oncologic, haematological, etc). The evolution of TAVI techniques and its devices have improved the quality of results and reduced the peri- and post-procedural complications. Cardiac anaesthesia and analgesia in TAVI patients is very important and fundamental to a quickly and complete clinical restoring after the procedure. An optimal balance of drugs and peri-procedural management could reduce the neurological events (such as delirium), the days of hospitalization and the admission of intensive care unit. According to our experience in transapical approach, the low dose of propofol and desflurane allowed to optimal cardiac anaesthesia and rapid mechanical ventilation weaning in complex patient undergone to transcatheter valve implantation with transapical approach. Moreover, our protocol reduced considerably the incidence of perioperative delirium.

Objective: To evaluate whether the occurrence of maternal pathologies, mainly Diabetes Mellitus and Hypertensive Syndromes in the gestational or pre-gestational period may be related to hearing impairment in postpartum women. Methods: Observational, prospective study including 361 puerperal women who had their deliveries at a reference University Hospital for pregnant women with clinical history of risk. Auditory evaluation was performed by Distortion Product Otoaccoustic Emissions (DPOAE) within 14 days after delivery. Measures of central tendency and absolute and relative frequencies were used to describe the sample and the chi-square test and binary logistic regression to assess the correlation among variables. Significance higher than 95% was observed and the study was approved by the Research Ethics Committee. Results: A total of 361 postpartum women were studied and 7.5% had hearing impairment. The frequency of gestational hypertension was 13.9%, that of gestational diabetes was 8.6% and that of pre-pregnancy diabetes mellitus was 5.8%. The presence of hearing impairment was significantly correlated with the occurrence of pre-pregnancy diabetes mellitus (OR: 4.5 - CI: 1.51-1.47), and maternal age greater than 29 years (OR: 3.72 - 1, 58-8.76); A correlation was also found between maternal age and the presence of pre-pregnancy diabetes mellitus (OR: 3.84 - CI: 1.45-10.15). Conclusion: In the population of postpartum women evaluated, having Diabetes Mellitus prior to pregnancy and belonging to the age group older than 29 years increases the chance of having hearing loss.

The incidence of recurrent vulvovaginal candidiasis (RVVC) is extremely high. RVVC is likely to have a greater impact on patients. The aim of the study was to explore the risk factors of recurrent vulvovaginal candidiasis (RVVC) in the tropical coastal area. In this case-control study, a questionnaire survey was conducted in patients with VVC in the Sanya area from July 2014 to December 2016. The data included demographic characteristics, host factors, and behavioural characteristics. According to the maximum number of symptomatic episodes per year, the participants were classified into a non-recurrent VVC (NRVVC; < 4 episodes/year, including the current one) group or a RVVC group (≥ 4 episodes/year, including the current one). Crude odds ratios were calculated for potential risk factors and were adjusted using logistic regression. All vaginal secretions of patients with RVVC were cultured. Of the 728 cases of VVC, 69.0% (502/728) were NRVVC, and 31.0% (226/728) were RVVC. Previous antibiotic treatment (adjusted OR: 4.41, p < 0.01), repeat abortion (p < 0.05), and vaginal lavage (adjusted OR: 1.62, p < 0.05) were significantly associated with RVVC. A total of 230 yeasts isolates were obtained from 226 patients. C. albicans were the predominant Candida species (194 strains) in all patients of VVC. Our results demonstrate that in the tropical coastal area, a significant association was found between previous antibiotic treatment and incident RVVC. Host factors may be the most important factors in the occurrence of RVVC.

Objective: To evaluate the impact of adding two different doses of dexmedetomidine to local anesthetic mixture on the quality of single injection peribulbar block in vitreoretinal operations Design: A prospective, double-blinded and randomized study. Setting: carried out in operating room of our university hospital. Patients: The study included 120 patients with viteroretinal diseases who were scheduled for vitreoretinal operations during the period from April 2016 to March 2017. Interventions: 120 patients were randomly allocated to three groups of 40 patients each. Group I (the control group) received 5-7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase, group II received5- 7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase +15 µgdexmedetomidine, and group III received5- 7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase + 30 µg dexmedetomidine Measurements: The primary outcome was to evaluate the impact of adding two different doses of dexmedetomidine on the onset of globe anesthesia and akinesia. Secondary outcomes were the duration of globe anesthesia and akinesia, overall patient satisfaction and surgeon satisfaction. Results: The onset of globe anesthesia was significantly shorter in group II and III in comparison with group I. Adding dexmedetomidine to the local anesthetic mixture prolonged the duration of globe analgesia, and this difference was statistically significant in group II and III in comparison with the group I. Conclusion: Adding dexmedetomidine to a mixture of lidocaine 2% and levobupivacaine/hyaluronidase mixture in single injection peribulbar block shortened sensory and motor block onset, extended the analgesia period and the motor block duration with high patient and surgeon satisfaction.