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Introduction: Acute pain in the right lower quadrant during pregnancy is difficult to approach and acute appendicitis must be excluded. The complication rate in pregnant acute appendicitis increases as a result of delayed diagnosis due to physiological and anatomic changes. The systemic immune inflammatory index (SII), which includes several inflammatory tests, is considered to be a good indicator of acute inflammation. The aim of the present study was to investigate the diagnostic value of SII in the diagnosis of acute appendicitis and complicated appendicitis in pregnant women. Material-method: This was designed as a retrospective, single-center case-control study. This study was performed in pregnant women over 12 weeks of gestation who were diagnosed with acute appendicitis as indicated by pathology report and met the inclusion criteria. Vital parameters, demographic characteristics, laboratory values, presence of complicated appendicitis, and pathology reports were taken into analysis. Results: The present study was performed with 76 pregnant women, including 38 pregnant women with acute appendicitis and 38 pregnant women with healthy controls. SII had a sensitivity of 82.0% and specificity of 66.7% with a cut-off value of 840.13 in pregnant acute appendicitis cases (AUC: 0.790; 95% CI: 0.686–0.984; p < 0.001) and SII level was significantly higher in complicated appendicitis cases with a sensitivity and specificity of 66.7% and 91.3%, respectively, with a cut-off value of 2301.66 (AUC: 0.812; 95% CI: 0.665–0.958; p = 0.001). Conclusion: SII is a cost-effective, rapid, easily calculated, and powerful marker that can be used for the diagnosis of both acute and complicated appendicitis in pregnant patients. [ABSTRACT FROM AUTHOR]

During pregnancy, dental care is important for the overall health of the mother and unborn baby. However, it is essential to take into account certain aspects when planning dental treatments in a pregnant woman with cardio-vascular pathological implications. It is important to coordinate with your medical and dental team to ensure a safe and effective treatment plan. Pregnancy can bring additional challenges for patients with cardiovascular pathological implications during dental treatments. The medical team must know these aspects to ensure safe and effective dental treatment. Pregnancy itself can affect the cardiovascular system, and this aspect should be taken into account during dental treatments in pregnant women. It is also important to pay attention to medications and procedures used in dentistry to minimize the risk of cardiovascular complications during this delicate period. The dental management of a pregnant patient in the third trimester of pregnancy in the 7th month should be approached with caution and special attention to ensure the safety of both lives. In general, dental treatments are recommended during pregnancy to prevent dental complications that can affect the general health of the mother and fetus

Delayed Plasmodium falciparum malaria in immigrants from disease-endemic countries is rare. Such cases pose a challenge for public health because mosquitoborne transmission must be rigorously investigated. We report a case of delayed P. falciparum malaria in a pregnant woman with sickle cell trait 11 years after immigration to the United States.

The given document is a compilation of articles and studies covering various topics related to oral health, pregnancy, orthodontics, and other dental subjects. The articles discuss subjects such as the impact of periodontal disease on pregnancy outcomes, oral hygiene practices of pregnant women, the use of adhesive systems in orthodontic treatment, and the effects of composite resin on enamel after debonding. Other topics include the prevention of SARS-CoV-2 cases in healthcare settings, the use of dental lasers in restorative dentistry, and the relationship between glycemic control and cardiovascular risk in non-diabetic individuals. The document also includes studies on the effects of medications and therapeutic decisions in dental treatment during pregnancy. [Extracted from the article]

A pregnant patient had symptomatic atrial standstill and indications for pacing therapy with an expected high ventricular pacing ratio. With the consideration of potential pacing-induced cardiomyopathy in the future we conducted zero-fluoro left bundle branch pacing (zLBBP) implantation for heart failure prevention. An ex vivo 3D cardiac model (Medtronic, USA) was used preoperatively to simulate the zLBBP implantation to improve procedure safety and efficiency. Intraoperatively, the simulation steps were followed, and a combination of electroanatomic navigation systems (EANS) and intracardiac echocariography (ICE) were used to ensure that the procedure was performed efficiently and safely.

Ongoing controversies persist regarding risk factors associated with the failure of transition from epidural labor analgesia to cesarean section anesthesia, including the duration of labor analgesia, gestational age, and body mass index (BMI). This study aims to provide an updated analysis of the incidence of conversion from epidural analgesia to general anesthesia, while evaluating and analyzing potential risk factors contributing to the failure of this transition to cesarean section anesthesia. We conducted an extensive literature search utilizing databases such as PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WANGFANG, and the Chinese Biomedical Literature Database (CBM) up to September 30, 2022. The meta-analysis was performed using STATA 15.1 software. The quality of the included studies was assessed using the 11-item quality assessment scale recommended by the Agency for Healthcare Research and Quality (AHRQ). A total of 9,926 studies were initially retrieved, and after rigorous selection, 19 studies were included in the meta-analysis. The overall incidence of conversion from epidural analgesia to general anesthesia was found to be 6% (95% confidence interval [CI]: 5–8%). Our findings indicate that, when compared to patients in the successful conversion group, those in the failure group tended to be younger (weighted mean difference [WMD] = −1.571, 95% CI: −1.116 to −0.975) and taller (WMD = 0.893, 95% CI: 0.018–1.767). Additionally, the failure group exhibited a higher incidence of incomplete block in epidural anesthesia, received a higher dosage of additional epidural administration, experienced a greater rate of emergency cesarean sections, and received anesthesia more frequently from non-obstetric anesthesiologists. However, no statistically significant differences were observed in gestational age, depth of the catheter insertion into the skin, epidural catheter specifics, duration of epidural analgesia, infusion rate of epidural analgesia, primiparity status, cervical dilatation during epidural placement, BMI, or weight. Our study found that the incidence of conversion from epidural analgesia to cesarean section under general anesthesia was 6%. Notably, the failure group exhibited a higher rate of incomplete block in epidural anesthesia, a greater incidence of emergency cesarean sections, a more frequent provision of anesthesia by non-obstetric anesthesiologists, a higher dosage of epidural administration, and greater height when compared to the success group. Conversely, women in the failure group were younger in age compared to their counterparts in the success group. [ABSTRACT FROM AUTHOR]

At present, the optimal treatment for Bell's palsy remains controversial, and the combination of corticosteroids and antiviral medication is usually recommended in the early stage. However, treatment is often delayed because the effects of these drugs on pregnant women and fetuses are still unclear. As a safe and effective complementary alternative therapy, acupuncture can alleviate Bell's palsy symptoms and improve the quality of life of the patient. Herein, we report the clinical presentation of a 27-year-old woman with Bell's palsy who was 26 weeks pregnant at the time of diagnosis. After five courses of treatment, the patient made a complete recovery. [ABSTRACT FROM AUTHOR]

Abstract Background Metastatic pheochromocytoma in the spine is a very rare complication during pregnancy. We report anesthesia in a pregnant woman for resection of an undiagnosed spinal tumor, accompanied by remarkable hemodynamic changes and massive bleeding. Case presentation A 33-year-old woman at 17 weeks of gestation presented with the rapid progress of bilateral lower leg paralysis. A diagnosis of spinal tumor was made, and surgical resection was planned. Although the surgery was suspended because of remarkable hemodynamic changes and massive bleeding, fetal heart rate was stable. Postoperative examination revealed pheochromocytoma in the urinary bladder as a primary lesion with spinal metastasis. Conclusion Although spinal pheochromocytoma is extremely rare in pregnant women, it should be suspected when abnormal hypertension is observed with accompanying neurological deficits. Preservation of maternal circulation and uteroplacental blood flow should be the first priority during anesthesia.

Pregnant women with aortic dissection are hemodynamically outmost complex patients. The two major diagnoses that should be considered in pregnant patients with congenital heart disease (CHD) and acute type A aortic dissection presenting with postoperative right ventricular dysfunction are pulmonary thromboembolism and right ventricular infarction. We present a rare case of postoperative right ventricular dysfunction in pregnant women with CHD and acute aortic dissection, which was diagnosed by pulmonary computed tomography angiography and treated by percutaneous coronary intervention.

In clinical practice, we encounter more and more errors and complications of pharmacotherapy, which are related to the ignorance of the pharmacokinetic profile occurring in the population of pregnant patients and in the pediatric population. Unfortunately, incorrect dosing of drugs in pregnant women is still common, and in practice they are treated in the same way as non-pregnant patients, and this can lead to errors in pharmacotherapy. This is important in pregnant patients hospitalized in the ICU. In this particular patient population, changes in pharma)cokinetics associated with pregnancy overlap with changes in pharmacokinetics that are associated with severe illness requiring ICU hospitalization. The paper collects the most important information on pharmacotherapy in pregnant patients. [ABSTRACT FROM AUTHOR]

Abstract Background The present study aimed to propose a new foetal shielding device for pregnant cancer patients to reduce the foetal dose associated with treatment techniques using multiple gantry angles, such as intensity-modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT). Methods Three shielding structures were designed to minimise the scattered and leaked radiation from various gantry angles and radiation scattering within the patient. The base-plate part that can be placed on the treatment couch was designed to reduce the scattered and leaked radiation generated at gantry angles located near 180°. A body shielding part that can cover the lower chest and abdomen was designed, and a neck-shielding structure was added to reduce the internal and external radiation scattering from the treatment area. Evaluation plans were generated to assess the foetal dose reduction by the foetal shielding device in terms of the shielding material thickness, distance from the field edge, and shielding component using the flattened 6 MV photon beam (6MV) and flattening filter-free 6 MV photon beam (6MV-FFF). In addition, the effectiveness of the foetal shielding device was evaluated in a pregnant brain tumour patient. Results The shielding material consisting of three parts was placed on frames composed of four arch shapes with a vertical curved structure, connection bar at the top position, and base plate. Each shielding part resulted in reductions in the radiation dose according to the treatment technique, as the thickness of the shielding material increased and the foetal dose decreased. In addition, a foetal dose reduction of approximately 50% was confirmed at 50 cm from the field edge by using the designed shielding device in most delivery techniques. In patients, the newly designed shielding structures can effectively eliminate up to about 49% of the foetal dose generated from various gantry angles used in VMAT or IMRT. Conclusions We designed a foetal shielding device consisting of three parts to effectively reduce the dose delivered to the foetus, and evaluated the device with various treatment techniques for a pregnant patient with brain tumour. The foetal shielding device shielded the scattered/leaked radiation from the treatment machine, and also effectively reduced internal scattering from the treatment area in the patient.

Background: Metastatic pheochromocytoma in the spine is a very rare complication during pregnancy. We report anesthesia in a pregnant woman for resection of an undiagnosed spinal tumor, accompanied by remarkable hemodynamic changes and massive bleeding. Case presentation: A 33-year-old woman at 17 weeks of gestation presented with the rapid progress of bilateral lower leg paralysis. A diagnosis of spinal tumor was made, and surgical resection was planned. Although the surgery was suspended because of remarkable hemodynamic changes and massive bleeding, fetal heart rate was stable. Postoperative examination revealed pheochromocytoma in the urinary bladder as a primary lesion with spinal metastasis. Conclusion: Although spinal pheochromocytoma is extremely rare in pregnant women, it should be suspected when abnormal hypertension is observed with accompanying neurological deficits. Preservation of maternal circulation and uteroplacental blood flow should be the first priority during anesthesia. [ABSTRACT FROM AUTHOR]

Urgent cardiac surgery was performed in a pregnant woman at 12 weeks of gestation for prosthetic valve thrombosis as result of noncompliance to anticoagulation. With this report we emphasize the importance of proper anticoagulation regimens and follow-up. (Level of Difficulty: Intermediate.)

Pregnancy is a dynamic process, which induces a multitude of anatomic, physiological, biochemical, and psychological changes. Physiological changes during pregnancy allow the body to meet the increased metabolic demands of the mother and fetus by maintaining adequate uteroplacental circulation, and ensure fetal growth and development. These changes begin early in the first trimester and are brought on by the increased circulating levels of progesterone and estrogen, which are produced by the ovary in the first 12 weeks of pregnancy and thereafter by the placenta. While some of these cause a change in biochemical values, others may mimic symptoms of medical disease. For instance, cardiac changes such as sinus tachycardia, systolic heart murmurs, and cardiac enlargement could be interpreted as signs of heart disease. It is thus crucial, to differentiate between normal physiological changes and pathological changes, particularly for clinicians involved in the care of pregnant patient. [ABSTRACT FROM AUTHOR]

Abstract Hereditary angioedema is an autosomal dominant disorder, presenting as sudden and recurring episodes of variable severity of subcutaneous and mucosa edema that may occur spontaneously or in response to triggers. There are three knwon types of hereditary angioedema. The disorder is caused by decrease in the plasma level or change in the functional capacity of C1 inhibitor, with increase in bradykinin and in vascular permeability, and consequent edema. Several measures are required in the perioperative period in order to avoid an acute attack. Prophylaxis should be carried out throughout pregnancy before any surgical procedure, before dental procedures, upon airway handling, on patients with previous episodes of angioedema, and when there are significant changes in volemia. The literature is scarce in regard to the association between hereditary angioedema and pregnancy. We describe a successful case of a pregnant patient with type I hereditary angioedema submitted to a C-section.

Background: The present study aimed to propose a new foetal shielding device for pregnant cancer patients to reduce the foetal dose associated with treatment techniques using multiple gantry angles, such as intensity-modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT).Methods: Three shielding structures were designed to minimise the scattered and leaked radiation from various gantry angles and radiation scattering within the patient. The base-plate part that can be placed on the treatment couch was designed to reduce the scattered and leaked radiation generated at gantry angles located near 180°. A body shielding part that can cover the lower chest and abdomen was designed, and a neck-shielding structure was added to reduce the internal and external radiation scattering from the treatment area. Evaluation plans were generated to assess the foetal dose reduction by the foetal shielding device in terms of the shielding material thickness, distance from the field edge, and shielding component using the flattened 6 MV photon beam (6MV) and flattening filter-free 6 MV photon beam (6MV-FFF). In addition, the effectiveness of the foetal shielding device was evaluated in a pregnant brain tumour patient.Results: The shielding material consisting of three parts was placed on frames composed of four arch shapes with a vertical curved structure, connection bar at the top position, and base plate. Each shielding part resulted in reductions in the radiation dose according to the treatment technique, as the thickness of the shielding material increased and the foetal dose decreased. In addition, a foetal dose reduction of approximately 50% was confirmed at 50 cm from the field edge by using the designed shielding device in most delivery techniques. In patients, the newly designed shielding structures can effectively eliminate up to about 49% of the foetal dose generated from various gantry angles used in VMAT or IMRT.Conclusions: We designed a foetal shielding device consisting of three parts to effectively reduce the dose delivered to the foetus, and evaluated the device with various treatment techniques for a pregnant patient with brain tumour. The foetal shielding device shielded the scattered/leaked radiation from the treatment machine, and also effectively reduced internal scattering from the treatment area in the patient. [ABSTRACT FROM AUTHOR]

• National and hospital guidelines on management of pregnant patients undergoing radiology procedures differ considerably. • Large number of foetal dosimetry methods are used in clinical routine practice. • Large variability in estimated foetal doses was found among dosimetry experts for the same cases of pregnant patient. • Need for international clinical guidelines for radiology procedures on pregnant or potentially pregnant patients exists. It is well known that foetuses are highly sensitive to ionising radiation and special attention to justification and optimisation of radiological procedures involving a pregnant patient is required. A task to review, validate and compare different approaches to managing the pregnant patient and to estimating the associated foetal doses arising from a diagnostic or interventional radiology (DIR) procedure was designed in the framework of EURADOS working group 12. As a first step, a survey of radiation protection practice including dosimetry considerations among EURADOS members was performed using online questionnaire. Then, to evaluate the possible differences in the estimated foetal doses, a comparison of assessed dose values was made for three cases of pregnant patients that underwent different CT procedures. More than 120 professionals from 108 institutions and 17 countries that are involved in managing pregnant patients undergoing DIR procedures answered the questionnaire. Most of the respondents use national or hospital guidelines on the management of pregnant patients undergoing DIR procedures. However, the guidelines differ considerably among respondents. Comparison of foetal dose assessments performed by dosimetry experts showed the variety of methods used as well as large variability of estimated foetal doses in all three cases. Although European and International commission on radiation protection guidelines already exist, they are more than 20 years old and, in some aspects, they are obsolete. This paper shows that there is a need to revise and update these guidelines. [ABSTRACT FROM AUTHOR]

The clinical picture of ethanol intoxication can present a broad range of signs and symptoms, from mild perception disorders to cardiac arrest and death. Although ethanol intoxication is a common condition, it is reported in literature here for the first time in a patient treated percutaneously for a hydatid cyst of the liver. The case was additionally complex given the fact that the patient was in the first trimester of pregnancy. Presented here is a case of ethanol intoxication in a 13-week pregnant woman who was treated percutaneously using 800 ml of ethanol for a hydatid cyst in the liver. [Med-Science 2016; 5(1.000): 296-300]

O angioedema hereditário é uma doença autossômica dominante, que se manifesta por crises súbitas, recorrentes e de gravidade variável de edema subcutâneo e submucoso, que podem ocorrer espontaneamente ou em resposta a gatilhos. São conhecidos três tipos de angioedema hereditário. A doença é condicionada por diminuição do nível plasmático ou alteração da capacidade funcional do inibidor de C1, com aumento da bradicinina e da permeabilidade vascular, com consequente edema. Várias medidas devem ser tomadas no período perioperatório de forma a evitar uma crise aguda. A profilaxia deverá ser realizada durante a gravidez antes de qualquer procedimento cirúrgico, antes de procedimentos dentários, quando existe manuseamento da via aérea, nos doentes com episódios prévios de angioedema e quando há alterações significativas da volemia. A literatura é escassa no que que diz respeito à associação de angioedema hereditário e gravidez. Descrevemos um caso de sucesso de uma grávida com angioedema hereditário tipo I submetida a cesariana. Hereditary angioedema is an autosomal dominant disorder, presenting as sudden and recurring episodes of variable severity of subcutaneous and mucosa edema that may occur spontaneously or in response to triggers. There are three knwon types of hereditary angioedema. The disorder is caused by decrease in the plasma level or change in the functional capacity of C1 inhibitor, with increase in bradykinin and in vascular permeability, and consequent edema. Several measures are required in the perioperative period in order to avoid an acute attack. Prophylaxis should be carried out throughout pregnancy before any surgical procedure, before dental procedures, upon airway handling, on patients with previous episodes of angioedema, and when there are significant changes in volemia. The literature is scarce in regard to the association between hereditary angioedema and pregnancy. We describe a successful case of a pregnant patient with type I hereditary angioedema submitted to a C‐section. [ABSTRACT FROM AUTHOR]

Abstract: The management of a pregnant patient in radiation oncology is an infrequent event requiring careful consideration by both the physician and physicist. The aim of this manuscript was to highlight treatment planning techniques and detail measurements of fetal dose for a pregnant patient recently requiring treatment for a brain cancer. A 27‐year‐old woman was treated during gestational weeks 19–25 for a resected grade 3 astrocytoma to 50.4 Gy in 28 fractions, followed by an additional 9 Gy boost in five fractions. Four potential plans were developed for the patient: a 6 MV 3D‐conformal treatment plan with enhanced dynamic wedges, a 6 MV step‐and‐shoot (SnS) intensity‐modulated radiation therapy (IMRT) plan, an unflattened 6 MV SnS IMRT plan, and an Accuray TomoTherapy HDA helical IMRT treatment plan. All treatment plans used strategies to reduce peripheral dose. Fetal dose was estimated for each treatment plan using available literature references, and measurements were made using thermoluminescent dosimeters (TLDs) and an ionization chamber with an anthropomorphic phantom. TLD measurements from a full‐course radiation delivery ranged from 1.0 to 1.6 cGy for the 3D‐conformal treatment plan, from 1.0 to 1.5 cGy for the 6 MV SnS IMRT plan, from 0.6 to 1.0 cGy for the unflattened 6 MV SnS IMRT plan, and from 1.9 to 2.6 cGy for the TomoTherapy treatment plan. The unflattened 6 MV SnS IMRT treatment plan was selected for treatment for this particular patient, though the fetal doses from all treatment plans were deemed acceptable. The cumulative dose to the patient's unshielded fetus is estimated to be 1.0 cGy at most. The planning technique and distance between the treatment target and fetus both contributed to this relatively low fetal dose. Relevant treatment planning strategies and treatment delivery considerations are discussed to aid radiation oncologists and medical physicists in the management of pregnant patients. [ABSTRACT FROM AUTHOR]

Introduction: This review aims to summarize challenges in clinical management of concomitant gliomas and pregnancy and provides suggestions for this management based on current literature.Methods: PubMed and Embase databases were systematically searched for studies on glioma and pregnancy. Observational studies and articles describing expert opinions on clinical management were included. The strength of evidence was categorized as arguments from observational studies, consensus in expert opinions, or single expert opinions. Risk of bias was assessed by the Newcastle-Ottawa Scale (NOS).Results: 27 studies were selected, including 316 patients with newly diagnosed (n = 202) and known (n = 114) gliomas during pregnancy. The median sample size was 6 (range 1-65, interquartile range 1-9). Few recommendations originated from observational studies; the remaining arguments originated from consensus in expert opinions.Conclusion: Findings from observational studies of adequate quality include (1) There is no known effect of pregnancy on survival in low-grade glioma patients; (2) Pregnancy can provoke clinical deterioration and tumor growth on MRI; (3) In stable women at term, there is no benefit of cesarean section over vaginal delivery, with respect to adverse events in mother or child. Unanswered questions include when pregnancy should be discouraged, what best monitoring schedule is for both mother and fetus, and if and how chemo- and radiation therapy can be safely administered during pregnancy. A multicenter individual patient level meta-analysis collecting granular information on clinical management and related outcomes is needed to provide scientific evidence for clinical decision-making in pregnant glioma patients. [ABSTRACT FROM AUTHOR]

When performing CT examinations on pregnant patients, great effort should be dedicated towards optimising the exposure of the mother and the conceptus. For this purpose, many radiology departments use high-Z garments to be wrapped around the patient's lower abdomen for out-of-plane organ shielding to protect the fetus. To assess their current protection efficiency, we performed a literature review and compared the efficiencies mentioned in the literature to Monte-Carlo calculations of CT protocols for which the overall scan length was reduced. We found 11 relevant articles, all of them reporting uterus exposure due to CT imaging performed for exclusion of pulmonary embolism, one of the leading causes of peripartum deaths in western countries. Uterus doses ranged between 60 and 660 µGy per examination, and relative dose reductions to the uterus due to high-Z garments were between 20 and 56%. Calculations showed that reducing the scan length by one to three centimetres could potentially reduce uterus dose up to 24% for chest imaging, and even 47% for upper abdominal imaging. These dose reductions were in the order of those achieved by high-Z garments. However, using the latter may negatively influence the diagnostic image quality and even interfere with the automatic exposure control system thus increasing patient dose if positioned in the primary beam, for example in the overranging length in helical acquisition. We conclude that efforts should be concentrated on positioning the patient correctly in the gantry and optimising protocol parameters, rather than using high-Z garments for out-of-plane uterus shielding. [ABSTRACT FROM AUTHOR]

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Trauma is the most common cause of nonobstetric death among pregnant women. Many physiologic changes occur during pregnancy. Therefore, comprehension of these change is important in pregnant trauma care because it enables the best outcome for both mother and fetus to be achieved. Optimal care of the pregnant trauma patient is achieved when there is good communication among multidisciplinary group of physicians. This review article presents an overview of management of the pregnant trauma patient, including anatomical and physiologic changes, key for history taking and physical examination, laboratory investigation and management guideline. Prevention of trauma in the pregnant patient is also included in this article.

In this work the head and neck cancer treatment of a pregnant patient was experimentally simulated. A female anthropomorphic Alderson phantom was used and the absorbed dose to the fetus was evaluated protecting the patient's abdomen with a 7 cm lead layer and using no abdomen shielding. The target volume dose was 50 Gy. The fetus doses evaluated with and without the lead shielding were, respectively, 0.52±0.039 and 0.88±0.052 cGy. [ABSTRACT FROM AUTHOR]

Pregnancy is a unique time in a woman's life and is characterized by complex physiological changes affecting general oral health. Pregnancy is also an opportune time to educate women about preventing dental caries in young children, a common childhood problem. This article reviews physiological changes associated with pregnancy and general considerations for the dental treatment of pregnant dental patients as well as for pregnant dental professionals. The limitations and uses of drugs are also discussed. [ABSTRACT FROM AUTHOR]

The purpose of this article is to update general dentists and maxillofacial surgeons in the perioperative management of the pregnant patient. Pregnancy results in physiologic changes in almost all organ systems in the body mediated mainly by hormones; which influences the treatment schedule. Understanding these normal changes is essential for providing quality care for pregnant women. The general principles that apply in this situation are discussed, followed by the relevant physiologic changes and their treatment implications, the risks of various medications to the mother and fetus, the management of concomitant medical problems in the pregnant patient, appropriate timing of oral and maxillofacial surgery during pregnancy, and management of emergencies during pregnancy. Information about the compatibility, complications, and excretion of the common drugs during pregnancy is provided. Guidelines for the management of a pregnant patient in the dental office are summarized. [ABSTRACT FROM AUTHOR]

Research to improve the health of pregnant and fetal patients presents ethical challenges to clinical investigators, institutional review boards, funding agencies, and data safety and monitoring boards. The Common Rule sets out requirements that such research must satisfy but no ethical framework to guide their application. We provide such an ethical framework, based on the ethical concept of the fetus as a patient. We offer criteria for innovation and for Phase I and II and then for Phase III clinical trials to improve the health of pregnant patients and of fetal patients and also criteria to responsibly manage the transition from investigation to clinical practice. Basing ethical criteria for research involving pregnant women on the ethical concept of the fetus as a patient insulates the proposed ethical framework and therefore research on pregnant women from the divisive and politicized concepts and discourses of personhood, fetal rights, and unborn child. [ABSTRACT FROM AUTHOR]

In this study, computational modeling was applied to evaluate medical and occupational exposure, to ionizing radiation, during the Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure of a pregnant woman in the second gestational trimester. The fetal dose evaluation and the construction of a photon fluence map inside the procedure room were also performed. The medical staff and patient were represented by virtual anthropomorphic phantoms. These phantoms were incorporated to the radiation transport code MCNPX (version 2.7.0). The photon beam was projected on the right lateral lower section of the liver of the patient, producing a FOV of 15×15 cm2. The spectral influence was evaluated using tube voltages of 70 kVp and 80 kVp with a total filtration of 5 mmAl. The influence of the suspended shield, lead curtain and fetal shield were evaluated on the Conversion Coefficients for Equivalent Dose (CC[H T ]) and Effective Dose (CC[E]) for the medical staff and patient. The removal of the lead curtain and suspended shield was considered the most critical configuration to the medical staff. In this situation, an increase up to 633 % in the CC[H T ] eye lens and 900 % in CC[E], for the medical staff, was reached. The CC[E] Patient ranged between 0.13 mSv/Gy.cm2 (70 kVp with all protective devices) and 0.15 mSv/Gy.cm2 (80 kVp without fetal shield) and the values obtained are in agreement with the literature. The CC[H T ] fetus oscillated between 2.2E-1 mSv/Gy.cm2 (70 kV with fetal shield) and 2.7E-1 mSv/Gy.cm2 (80 kV without fetal shield). The outcomes of this work are useful in the prior monitoring of the radiation doses and risks, and a reduction on these may be reached for the medical team and patient, which is a complicated arrangement in ERCP procedures. • Computational modeling was applied to evaluate medical and occupational exposure. • We evaluated a pregnant woman in the second gestational trimester. • The lower section of the liver of the patient was irradiated. • The fetus absorbed dose oscillated between 1.5 mGy and 2 mGy. [ABSTRACT FROM AUTHOR]

We report a case of drainage of Ludwig's angina in a pregnant patient conducted under general anaesthesia using awake fibreoptic intubation with least possible anaesthetic drugs. [ABSTRACT FROM AUTHOR]

Introduction Since the discovery of X-rays by Rontgen in 1895, lead (Pb) has been used to limit ionising radiation for both operators and patients due to its high density and high atomic number (Z = 82). This study explores the attitudes and perceptions of diagnostic radiographers applying Pb protection during general radiographic examinations, an area underexplored within a contemporary radiographic environment(s). Methods This paper presents findings from a wider ethnographic study undertaken in the United Kingdom (UK). The use of participant observation and semi-structured interviews were the methods of choice. Participant observation enabled the overt researcher to uncover whether Pb remained an essential tool for radiographers. Semi-structured interviews later supported or refuted the limited use of Pb protection by radiographers. These methods enabled the construction of original phenomena within the clinical environment. Results Two themes are discussed. Firstly, radiographers, underpinned by their own values and beliefs towards radiation risk, identify a dichotomy of applying Pb protection. The cessation of Pb may be linked to cultural myths, relying on ‘word of mouth’ of peers and not on the existing evidence-base. Secondly, radiographers acknowledge that protecting pregnant patients may be primarily a ‘personal choice’ in clinical environments, which can alter if a patient requests ‘are you going to cover me up?’ Conclusion This paper concludes by affirming the complexities surrounding Pb protection in clinical environments. It is proposed that the use of Pb protection in general radiography may become increasingly fragmented in the future if radiographers continue rely on cultural norms. [ABSTRACT FROM AUTHOR]