Assessment of Age-Dependent Effective Dose and Toxicity Risks of 226Ra and 228Ra In River Water Samples In Ondo State. Nigeria

Activity concentrations of natural radionuclides in some river waters in southwestern Nigeria were measured using high-purity germanium (HPGe) detector. The activity concentrations ranged from 0.12 to 2.31, 0.17 to 2.85, and 7.86 to 65.51 Bq l-1 for 226Ra, 228Ra, and 40K respectively. The calculated mean of the total annual effective dose were 9.86, 2.46, 1.71, 2.43, 5.74 and 0.99 mSv y-1 for age groups ≤1y, 1-2y, 2-7y, 7-12y, 12-17y, and >17y respectively. Estimated cancer mortality and morbidity risks ranged from 0.04x10-3 to 0.77x10-3 with a mean of 0.42x10-3 and 0.04x10-3 to 0.80x10-3 with a mean of 0.44x10-3 respectively for 226R while they ranged from 0.11x10-3 to 1.89x10-3 with a mean of 0.96x10-3 and 0.16x10-3 to 2.66x10-3 with a mean of 1.38x10-3 respectively for 228Ra. The lifetime average daily dose (LADD) of 226Ra and 228Ra ranged from 9.39x10-14 µg kg-1 d-1 to 181.01x10-14 µg kg-1 d-1 with a mean of 100.06x10-14 µg kg-1 d-1 and 4.82x10-16 µg kg-1 d-1 to 80.70x10-16 µg kg-1 d-1 with a mean of 40.90x10-16 µg kg-1 d-1 respectively.. Radiological hazard indicator of radium is of concern in these drinking river water samples.

Surgical treatment of patients, suffering goiter with compressive syndrome

Objective. To analyze the operative interventions character, performed in patients, suffering goiter of large size and cervico-retrosternal localization of thyroid gland with signs of compressive syndrome, and to determine preventive measures for prophylaxis of suboperative complications. Materials and methods. The data were obtained, concerning operative treatment of 331 patients, suffering various forms of large size goiter, coincided with compressive syndrome and changes in anatomic-topographic interrelationship of the thyroid gland and adjacent organs and structures with their activity disorders, in Department of Surgery of the Second Clinical Hospital of Poltava (clinical base Department of Surgery No 1 of Ukrainian Medical Stomatological Academy) in 2004 - 2018 yrs period. Results. There were depicted the operative interventions character, peculiarities of operative technique for patients, suffering large size goiter, as well as the ways for optimal prevention of injury of laryngeal nerves, parathyroid glands and other adjacent organs and structures. Original procedure of suboperative determination of the tracheomalacia presence and creation of external tracheal carcass was depicted. Conclusion. The measures and procedures in operations, performed for goiter of large size proposed, have permitted to reduce the operative morbidity risks.

Are all erythropoiesis-stimulating agents created equal?

Erythropoiesis-stimulating agents (ESAs) are effective drugs to correct and maintain haemoglobin (Hb) levels, however, their use at doses to reach high Hb targets has been associated with an increased risk of cardiovascular adverse events, mortality and cancer. Presently used ESAs have a common mechanism of action but different pharmacokinetic and pharmacodynamic characteristics. Accordingly, the mode of activation of the erythropoietin (EPO) receptor can exert marked differences in downstream events. It is unknown whether the various ESA molecules have different efficacy/safety profiles. The relative mortality and morbidity risks associated with the use of different types of ESAs remains poorly evaluated. Recently an observational study and a randomized clinical trial provided conflicting results regarding this matter. However, these two studies displayed several differences in patient characteristics and ESA molecules used. More importantly, by definition, randomized clinical trials avoid bias by indication and suffer less from confounding factors. Therefore they bring a higher degree of evidence. The scenario becomes even more complex when considering the new class of ESAs, called prolyl-hydroxylase domain (PHD) inhibitors. They are oral drugs that mimic exposure to hypoxia and stabilize hypoxia-inducible factor α. They profoundly differ from presently used ESAs, as they have multiple targets of action, including the stimulation of endogenous EPO synthesis, direct mobilization/absorption of iron and a higher reduction of hepcidin. Accordingly, they have the potential to be more effective in inflamed patients with functional iron deficiency, i.e. the setting of patients who are at higher risk of cardiovascular events and mortality in response to present ESA use. As for ESAs, individual PHD inhibitors differ in molecular structure and degree of selectivity for the three main PHD isoforms; their efficacy and safety profiles may therefore be different from that of presently available ESAs.

What is the meaning of (statistical) life? Benefit–cost analysis in the time of COVID-19

Efforts to support public policy decisions need to be conducted carefully and thoughtfully. Recent efforts to estimate the social benefits of reductions in mortality risks associated with COVID-19 interventions are likely understated. There are large uncertainties over how much larger the social benefits could be. This raises questions about how helpful conventional approaches to valuing mortality and morbidity risks for benefit–cost analyses can be in contexts such as the current crisis.

Comparison Among Fern, Amnisure, Creatinine and Urea Tests in Vaginal Wash for Detection of Rupture of Membrane in Iraqi Women

Prelabour rupture of membrane (PROM) is a cause for 85% of the neonatal period morbidities and fatalities. PROM is the main cause of preterm deliveries and accounts for 30-40% of these cases, indeed it complicates three percent of all pregnancies. The fetal and maternal mortality and morbidity risks of PROM, increases when the rupture occurs early in the course of pregnancy. In this study we sought to compare the detection efficiency of the standard diagnostic test of PROM with other new methods such as urea and Creatinine of vaginal fluid and Amnisure tests. The study sample is composed of 90 women divided into three groups; each woman had informed consent, questionnaire with full history, clinical examination (general and abdominal and sterile speculum examination to detect cervical dilatation, amniotic fluid leakage for sample collection to do Fern, Amnisure, Creatinine and urea tests. General investigations and ultrasound were done for each patient. Mean vaginal fluid Creatinine level among the group (1) were 0.44±0.14, versus 0.38±0.12, and 0.24±0.08 among group (2) and (3) respectively. When the results of the tests compared with the standard method of diagnosis, the specificity was 100% for Amnisure, vaginal fluid Creatinine and urea, while it was 80% for fern test. The sensitivity was 97% for Amnisure, 95% for vaginal fluid urea, 91% for vaginal fluid Creatinine and 60% for fern test. Amnisure is superior for other tests followed by vaginal fluid urea level, Creatinine and lastly Fern test.

Heatwave Events and Mortality Outcomes in Memphis, Tennessee: Testing Effect Modification by Socioeconomic Status and Urbanicity

Heatwave studies typically estimate heat-related mortality and morbidity risks at the city level; few have addressed the heterogeneous risks by socioeconomic status (SES) and location within a city. This study aimed to examine the impacts of heatwaves on mortality outcomes in Memphis, Tennessee, a Mid-South metropolitan area top-ranked in morbidity and poverty rates, and to investigate the effects of SES and urbanicity. Mortality data were retrieved from the death records in 2008–2017, and temperature data from the Applied Climate Information System. Heatwave days were defined based on four temperature metrics. Heatwave effects on daily total-cause, cardiovascular, and respiratory mortality were evaluated using Poisson regression, accounting for temporal trends, sociodemographic factors, urbanicity, and air pollution. We found higher cardiovascular mortality risk (cumulative RR (relative risk) = 1.25, 95% CI (confidence interval): 1.01–1.55) in heatwave days defined as those with maximum daily temperature >95th percentile for more than two consecutive days. The effects of heatwaves on mortality did not differ by SES, race, or urbanicity. The findings of this study provided evidence to support future heatwave planning and studies of heatwave and health impacts at a coarser geographic resolution.

Excess Mortality in Istanbul during Extreme Heat Waves between 2013 and 2017

Heat waves are one of the most common direct impacts of anthropogenic climate change and excess mortality their most apparent impact. While Turkey has experienced an increase in heat wave episodes between 1971 and 2016, no epidemiological studies have examined their potential impacts on public health so far. In this study excess mortality in Istanbul attributable to extreme heat wave episodes between 2013 and 2017 is presented. Total excess deaths were calculated using mortality rates across different categories, including age, sex, and cause of death. The analysis shows that three extreme heat waves in the summer months of 2015, 2016, and 2017, which covered 14 days in total, significantly increased the mortality rate and caused 419 excess deaths in 23 days of exposure. As climate simulations show that Turkey is one of the most vulnerable countries in the Europe region to the increased intensity of heat waves until the end of the 21st century, further studies about increased mortality and morbidity risks due to heat waves in Istanbul and other cities, as well as intervention studies, are necessary.