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Study design: A consecutive case series study Purpose: To investigate whether Low Back Pain (LBP) in women with primary singleton pregnancy induces disability. Background: LBP is reported to be increased in pregnants than in non-pregnant women. Different outcome measures have been used to search for correlations between pain and disability. Methods: 167 pregnant women aged 30 ± 3.5 years participated. Two equal categorial age groups were constructed: Group A included women aged 23 - 29 years, and Group B women aged 30-39 years. Their weight was 76 ± 13 kg prepartum and the Body Mass index (BMI) was 28 ± 4 prepartum. Visual Analogue Scale (VAS) was used for LBP pain intensity and Oswestry Disability Scale (ODI) for disability estimation in the last three months prepartum and in the first three months postpartum. Results: The women weight was 67 ± 13 kg postpartum. The BMI was 24 ± 4 postpartum. There was no difference in VAS and ODI scores versus BMI, weight and height between the two age groups in both periods of observation: prepartum and postpartum. Prepartum, 81.4% of women claimed LBP that dropped to 55.5% postpartum. ODI score dropped from 19.5 ± 13.6% prepartum to 11 ± 12% postpartum. The ODI subscales that showed significant reduction postpartum were: Pain intensity (P = 0.002); working (P = 0.009); sitting (P = 0.004); standing (P = 0.003); sleeping (P = 0.008); and traveling (P = 0.006). VAS prepartum was increasing as the weight was increasing in both periods of observation (P = 0.015 and P=0.051) respectively. VAS prepartum was significantly correlated with BMI prepartum (P = 0.019) and postpartum (P = 0.028). Discussion: Physical disability in pregnant women was low and reduced following delivery. Disability was linked with LBP intensity, weight, BMI and height, but not with age or educational level. 

A clinical case of treatment of two severe intrabony defects on the aesthetic zone is reported and followed for one year. The biomaterial of choice was enamel matrix derivative (Emdogain®; Straumann™) alone with a preservation papilla flap and a minimally invasive surgical technique. After surgical treatment, the patient was kept in a supportive periodontal therapy programme with 6-month interval between appointments. In the one year after surgery appointment, clinical and radiographic changes were observed, showing periodontal health and stability. 

Oral cavity is the gateway of the human body, and also provides vital clues of our systemic health. Here in this COVID-19 pandemic, oral manifestations such as dysgeusia, ulcers, xerostomia are noticed and are an an important predictors of this viral disease. This short review describes the oral manifestations of this new disease.

Background: The effect of salpingectomy on ovarian response is a matter of debate. Due to conflicting data, alternative techniques were developed to perform salpingectomy for treatment of hydrosalpinges in infertile patients. This study aims to evaluate the effect of salpingectomy on ovarian response after stimulation with gonadotropins. Methods: In a retrospective analysis, one hundred fifty-seven patients with tubal infertility were divided into three groups according to their surgical histories: bilateral salpingectomy (BS group); unilateral salpingectomy (US group); and no history of salpingectomy (NS group). Ovarian response and IVF outcomes were compared between groups by analysis of variance. Prognostic factors for ovarian response were estimated by linear regression models. Results: In the BS group, the total numbers of oocytes retrieved, and embryos obtained were significantly lower than those in the NS group (p = 0.02). Poor ovarian response was also more frequent in the BS group (p = 0.02). In the US group, follicle development was reduced on the operated side. This effect was more pronounced when salpingectomies were performed for hydrosalpinges than when performed for ectopic pregnancies, and significant decreases were observed in follicle recruitment (p = 0.005) and oocyte retrieval (p = 0.02) on the operated side. Conclusion: Salpingectomy could have a minor negative effect on ovarian response. This is particularly true with bilateral salpingectomies, in which the ovarian blood supply could be disrupted, with no possible compensation by the contralateral side.

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.

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.

Triploidy is one the most common chromosomal abnormality in humans, complicating about 1% of all human pregnancies. Most affected conceptions undergo spontaneous abortion in the first trimester, making the prevalence of second trimester triploidy low. Viable triploidy is associated with high rates of maternal morbidity, including hypertensive disorders, hemorrhage, and persistent trophoblasic disease, as well as fetal and neonatal severe adverse outcomes. Given these complications, early identification of triploidy in ongoing pregnancies may inform patient counseling and management.

Objective: The primary aim of this study was to measure pressure generated on a Tuohy needle during the epidural procedure in labouring women of varying body mass indices (BMI) with a view of utilising the data for the future development of a high fidelity epidural simulator. High-fidelity epidural simulators have a role in improving training and safety but current simulators lack a realistic experience and can be improved. Methods: This study was approved by the National Research Ethics Service Committee South Central, Portsmouth (REC reference 11/SC/0196). After informed consent epidural needle insertion pressure was measured using a Portex 16-gauge Tuohy needle, loss-of-resistance syringe, a three-way tap, pressure transducer and a custom-designed wireless transmitter. This was performed in four groups of labouring women, stratified according to BMI kg/m2: 18-24.9; 25-34.9; 35-44.9 and >=45. One-way ANOVA was used to compare difference in needle insertion pressure between the BMI groups. A paired t-test was performed between BMI group 18-24.9 and the three other BMI groups. Ultrasound images of the lumbar spine were undertaken prior to the epidural procedure and lumbar magnetic resonance imaging (MRI) was performed within 72h post-delivery. These images will be used in the development of a high fidelity epidural simulator. Results: The mean epidural needle insertion pressure of labouring women with BMI 18-24.9 was 461mmHg; BMI 25-34.9 was 430mmHg; BMI 35-44.9 was 415mmHg and BMI >=45 was 376mmHg, (p=0.52). Conclusion: Although statistically insignificant, the study did show a decreasing trend of epidural insertion pressure with increasing body mass indices.

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.

An investigation into the pathological lesions of Cypermethrin on the testes, accessory sexual and pituitary glands of Yankasa rams was carried out. Sixteen Yankasa rams aged 18 - 30 months and weighing between 21.5 - 46.5kg were used. The 16 rams were divided equally into two groups (A and B) A served as the treatment group while B served as the control. Group (A) were given Cypermethrin (3%) at the dose rate of 3mg/kg (0.1ml/kg) body weight, topically. Group (B) rams were given distilled water at the same dose rate and route. These treatments were repeated every two weeks for a period of 12 weeks. The rams were sacrificed at the end of 12 weeks and the following organs (testes, pituitary, vesicular and prostate glands), were collected and weighed, gross pathological lesions were observed and photographs were taken. The samples were kept for histopathology. Results showed that there were no gross pathological lesions found on the testes, pituitary, prostate glands and the seminal vesicles of both groups. The mean weight of the pituitary gland, the prostate glands and the seminal vesicles of the treated and control groups were statistically not significant (P>0.05). No histologic lesions were found on them. The mean testicular weights of the treated (143.81±7.71g) and the control (130.43±0.63g) were significantly different (P<0.05). There was a reduced number of spermatozoa in the lumen of the seminiferous tubules of the treated group. It was concluded that Cypermethrin reduced spermatozoa in the lumen of the seminiferous tubules.

We wish to present our case of the rare Meckel-Gruber syndrome, diagnosed prenatally at 18 weeks’ gestation. Informed consent was obtained from both parents for publishing this case and including photos.

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.

Medical postgraduate trainees are given increasing levels of responsibility during training in the apprenticeship-model of training [1-3]. Responsibility is said to be a key driver of deep learning and understanding [4-7]. Trainees with greater levels of responsibility for decision making have higher levels of motivation to learn compared with trainees who self-assess as having less autonomy [5]. The Royal College of Pathologists (RCPath) indicate that ‘graded responsibility’ is part of training histopathologists and provided a framework for implementation with increasingly complex specimens suitable for reporting by more senior trainees [8,9]. 

Drug addiction is one of the burning problems in the modern society. Annually there is a steady increase in the level of drug abuse. United Nations Office on Drugs and Crime publishes “World Drugs Report 2018”, where it was reported that about 275 million people (almost 5.6% of the world population) aged 15-64 used drugs at least once in their lives, and opium production increased by 65% in 2016-2017 [1-3]. Therefore, the question of studying the influence of drugs on the structural organization of organs remains open and relevant [4,5].

Background: Leiomyoma itself is not a rare disease, but it is rarely found intravascularly. Case presentation: A 54-year old female sought medical help after noticing her leg being swelling. A diagnosis of deep vein thrombosis (DVT) was made and antithrombotic treatment was given after her initial imaging exam. Several days later, a contrast CT and sequential pathology revealed the real diagnosis was intravascular leiomyoma. The patient was discharged after a successful surgery. Conclusion: Intravascular leiomyoma should not be confused with DVT.

Deliveries prior to 28 weeks’ gestation (extreme preterm birth) pose a global health concern, according to the World Health Organization (WHO). Extreme preterm birth is associated with several complications in the newborn and management in neonatal intensive care unit would incur high expenses. In parallel, advancements in in vitro fertilization will give an opportunity for women to conceive in cases of ovarian failure. At the same time, health providers also encourage patients to receive more than one embryo simultaneously during an embryo transfer. Here we report a case of a patient in coma condition of triplet pregnancy, post ovum donation with three-embryo transfer. Following stabilization, cranial computed tomography (CCT) was performed. The result showed bleeding in the brainstem and into intraventricular spaces at 25+4 gestation weeks. Furthermore, ICH during pregnancy is considered as a rare case in obstetrical field, especially involving the brainstem. This could lead to life-threatening conditions and serious disability in the future. On the fifth day of hospitalization, she suffered from pneumonia and pulmonary edema. On the eight day (26+5 gestations weeks), an emergency caesarean section was performed due to fully dilated of the cervix with breech presentation of all fetuses. Mother and the children survived with some non-life-threatening disabilities. This is the very first case reported of intracerebral hemorrhage in the brainstem in triplet pregnancy after receiving ovum donation. Heterologous conception could be an iceberg phenomenon of gestational complications among the population. Reproductive tourism could still become greater in the future. 

Background: Pre-eclampsia is a frequent and serious pregnancy complication contributing for the increasing maternal morbi-mortality rates. This study was designed to evaluate the effect of calcium supplementation during pregnancy, on the incidence of pre-eclampsia and eclampsia among primigravid women. Method: In a hospital-based, opened, randomized and controlled clinical trial carried out in the city of Yaounde, 70 women were randomized to either 1.5 g daily calcium supplements (n = 35) or vitamins at the same time (n = 35) from 20 weeks gestation till delivery. Were included all singleton healthy, primigravid women who offered their signed inform consent and were excluded, all women with any chronic condition. Primary outcomes were pre-eclampsia and eclampsia. Results: No significant difference was observed between the two study groups with respect to the baseline characteristics obtained at enrollment. We recorded a sevenfold decrease in the incidence of preeclampsia in the calcium group (RR = 0.26, CI 0.06 – 0.44, p = 0.024). The onset of pre-eclampsia was delayed 3 weeks in the calcium group. Meanwhile the mean diastolic blood pressure at delivery was of no significant difference (p = 0.126), the mean systolic blood pressure at delivery however, presented a significant difference between both groups (p = 0.009). Conclusion: A 1.5 g daily calcium supplementation of healthy normotensive primigravid women during pregnancy seems to be effective in reducing the incidence of pre-eclampsia.