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In Portugal, around 2500 patients with end-stage chronic kidney disease (CKD stage 5) start a renal replacement therapy (RRT) for the first time each year [1]. They have four main treatment options: kidney transplantation (TX); haemodialysis (HD); peritoneal dialysis (PD) and conservative treatment (CT). RRT selection is quite complex due to the specificities of each option and to their profound effect on patient’s quality of life. Patients must play a decisive role in the choice of treatment modality and select the option that best suits to their values and needs.

Blunt chest trauma leads to a wide range of lesions, relatively minor parietal injuries to potentially fatal cardiac lesions, making diagnosis and management difficult. The diagnosis is currently facilitated by imaging, however, these lesions may go unnoticed and be discovered late through complications. We report the case of a neglected heart wound revealed by a heart failure. This case is notable due to a favourable outcome despite a delay in diagnosis due to a lack of pericardial effusion and the absence of cardiac symptoms, and a long delay from injury to appropriate treatment in the presence of a penetrating cardiac wound deep enough to cause a muscular ventricular septal defect and lacerate the anterior mitral leaflet.

Perineal burns are a rare finding in children that may cause severe complications. Vesicovaginal fistulas are an uncommon complication of a perineal burn that can be a tragedy for girls suffering from them. Fistula and/or its treatment are a socially debilitating problem with significant medicolegal implications. We present a rare case of a girl with a history of traumatic perineal burns who was diagnosed with a vesicovaginal fistula and repaired through a transvaginal approach.

Climate change is increasing the frequency of climate-related disasters, creating greater risks of hunger and the breakdown of food systems. The sustainability of our planet is currently a major concern for the global community and has been a central theme for a number of major global initiatives in recent years. Climate change has prevalent, multi-faceted, and temporal impacts on food security. Higher temperatures, water scarcity, extreme events like droughts and floods and greater CO2 concentrations in the atmosphere have already begun to impact staple crops around the world. The warming climate is already taking a toll on human health, causing widespread hunger and illness that will grow exponentially worse, and will pose a major threat to human well-being. In this article, an attempt has been made to discuss some critical issues relevant to the four dimensions of food security and to provide broader perspectives on climate change and its impacts on the food system, food security and human well-being.“Humanity is facing a rare challenge. But it is a common challenge. There are no sides in the fight for climate justice” (Kofi Annan’s message prior to the UN Climate Conference in Copenhagen 2009).

Single-level Anterior Cervical Decompression and Fusion (ACDF) was initially performed using Iliac Crest Bone Graft (ICBG) [1]. Fusion rates improved when a surgical technique change, the addition of anterior plate fixation, was incorporated decades later [2,3]. Single level ACDFs with a machined allograft and plate fixation technique eventually became the industry standard as it demonstrated equivalent fusion rates with fewer complications than single level ACDFs with ICBG. This surgical technique was extended for use in patients with contiguous disk herniations. Multilevel ACDFs performed with machined allografts or interbody spacers and a two-level plate offered shorter operative times, less blood loss, better restoration of lordosis, and less immediate pain [4]. Successful multi-level ACDFs were strongly influenced by the bone graft source [5], the smoking addiction [6], and the construct stability [7]. Placement of two additional fixation screws in the central vertebral body, another improvement in the surgical technique, increased the construct strength compared to constructs with screws only placed into the end vertebral bodies [8]. Using allografts for multilevel ACDFs was a device disadvantage as they often resulted in high non-union rates [9,10].

A comprehensive study was carried out to assess the microbiological, nutritional, biochemical and essential oil characteristics of three Egyptian traditional cultivars seeds, namely, cumin (Cuminum cyminum) and coriander (Coriandum sativum) spices as well as basil whole herb (Ocimum basilicum) collected from different Egyptian export centers as being ready for export. The found values for humidity in dry seeds of cumin (7.4%) and coriander (6.4%), as well as total ash and ash insoluble in acid (in cumin 7.7% and 0.74%, but in coriander 5.3% and 0.55%, respectively), were lower than the maximum limits indicated by the Egyptian Specification Standards (ES) and by International Standards Organization (ISO) for cumin and coriander seeds. Analysis of essential minerals in seed spices and herbs indicated that they were rich in K, Ca, Na, Fe and Zn. The total bacterial count was low content in seeds of cumin and coriander as well as fresh whole basil herb. The microbiological load in all tested seed spices and herbs was found lower than those indicated by the ES and ISO for cumin and coriander seeds. Yields in hydro-distilled essential oils (EOs) were the highest in cumin seeds (3.762%), while both coriander and basil herbs had lower amounts (0.285% and 0.686%, respectively). EOs contents were found higher than the maximum limits for cumin (1.5% - 2.5% on a dry weight basis), but within the limits for coriander (0.1% - 0.5% on a dry weight basis) as indicated by the ES and ISO for cumin and coriander seed oils. Gas chromatography of extracted EOs from seeds of cumin and coriander as well as basil herbs indicated the presence of 41, 35 and 47 compounds, respectively, where cumin aldehyde was the major component in cumin volatiles but was linalool in volatiles of both coriander seeds and basil herbs. EOs of basil herbs grown in Egypt were of the high linalool chemotype which was characterized by high contents of linalool and relatively lower amounts of eugenol. However, the major compounds in the three tested EOs from seeds or herbs grown in Egypt are in accordance with literature reports from different parts of the world. Volatile oil components in EOs of the three tested Egyptian spices and herbs were classified into groups, based on the relative area (%). The proportion of the major and the other main components in EOs from seeds of cumin and coriander cultivars were within the ranges indicated by both the ES and ISO for cumin seed oils (cumin aldehyde between 15% - 46%) and for coriander seed oils (linalool between 65% - 78%). The aim of the present work was to Assessment study certain commonly used Egyptian spices and herbal products for characterizing their physical, biochemical and microbiological properties.

Background: Latin America has always had high maternal and infant mortality rates. However, the prevalence of asthma in pregnant patients and their outcomes are unknown. We aimed at answering those questions in a developing country’s maternity hospital. Methods: Since January 2011, a cohort of 591 pregnant asthma patients was prospectively recruited for 60 consecutive months. Patients were followed up by a multidisciplinary team until delivery. They were divided into two groups: one of 186 smokers or morbidly obese patients and another of 405 nonobese nonsmokers. Outcomes of mothers and their babies were documented.Results: Out of 57,031 deliveries, the overall estimated prevalence of 591 asthmatic pregnant patients was 1.03%. When adjusted for age standardized prevalence, it turned to 9.2%.With 28 maternal deaths (49 per 100,000 live births). None of these women had asthma. There were also 413 deaths among newborns (7.24/1000 live births). One occurred in the smoker/obese group (5.37/1000 live births) and two in the nonsmoker nonobese group (4.84/1000 live births). The prevalence of asthma during pregnancy seemed lower than in some affluent societies. Overall maternal mortality rates were similar to national figures; however, data on mothers’ mortality with asthma were unexpectedly absent.Conclusion: A multidisciplinary approach and the use of a low-cost inhaled steroid seemed to be the reasons for this. However, infant mortality rate remained high, which could be related to the risk of asthma itself. We believe there’s a worldwide need for agreements on a standardized approach for asthma’s epidemiological surveys, in order to make them comparable

Objective: Sentinel lymph node mapping is an acceptable standard for lymph node evaluation in patients with endometrial cancer. The purpose of this study was to evaluate the adoption of this technique at two academic institutions, including which patient and disease features are associated with rates of successfully identifying sentinel lymph nodes with fluorescent mapping. In addition, we sought to characterize if and how surgeons experience the technique related to successful bilateral sentinel lymph node mapping. Methods: A retrospective chart review was performed of patients at two academic institutions who underwent sentinel lymph node mapping prior to a minimally invasive hysterectomy for endometrial cancer over the first 30 months during which the technique was adopted at each institution. A modified Poisson regression model was used to determine the relationships between patient, disease, and surgeon factors on outcomes of sentinel lymph node mapping. Results: A total of 460 charts were reviewed. The mean age was 64 and the median body mass index was 34.2. The most disease was stage I (83%), endometrioid (89%), and Grade I (64%). The bilateral sentinel lymph node mapping success rate was 65%, while unilateral or bilateral success occurred in 91% of cases. Sentinel lymph node mapping was significantly more likely to be successful in premenopausal women (RR 1.25; 95% CI 1.07 - 1.46; p = 0.005) and Asian women (RR 1.48; 95% CI 1.3-1.68; p < 0.001). BMI was not significantly predictive of mapping success (RR 1.03; 95% CI 1.00 - 1.07; p = 0.05). Increasing surgeon experience with the technique did predict successful bilateral sentinel lymph node mapping (RR 1.02; 95% CI 1.00 - 1.03; p = 0.02).Conclusion: Premenopausal status and surgeon experience with the technique increases the likelihood of bilateral sentinel lymph node detection for endometrial cancer.

This is demonstration of selected ECGs for learning or for exams; guided by lessons from great teachers as Prof. Hein Wellens MD. Here we provide advanced examples with comment and analysis.

Implantable cardioverter defibrillators (ICDs) are electronic devices that can prevent sudden cardiac death (SCD) caused by arrhythmic events in patients. The latest ESC/EAS and ACC/AHA Guidelines deem the placement of an ICDs appropriate in patients with heart failure class NYHA II and III in the presence of an ejection fraction less than or equal to 35% [1,2]. ICDs are usually not indicated in either class I or IV patients. The Guidelines recommendations for primary prevention of SCD with ICD implantation do not take into account the age of the patients but only their life expectancy which must be at least 1 year. Our patients usually are over eighty years old with heart failure and severely reduced ejection fraction. We must consequently decide if it is right to implant these patients with an ICD. Is the use of ICD in the patients over 80, in particular over 90 years old, really make sense becomes particularly important considering demographic changes that await us in the coming decades.