The urgency for climate action is recognised by international government and healthcare organisations, including the United Nations (UN) and World Health Organisation (WHO). Climate change, biodiversity loss, and pollution negatively impact all life on earth. All populations are impacted but not equally; the most vulnerable are at highest risk, an inequity further exacerbated by differences in access to healthcare globally. The delivery of healthcare exacerbates the planetary health crisis through greenhouse gas emissions, largely due to combustion of fossil fuels for medical equipment production and operation, creation of medical and non-medical waste, and contamination of water supplies. As representatives of radiology societies from across the globe who work closely with industry, and both governmental and non-governmental leaders in multiple capacities, we advocate together for urgent, impactful, and measurable changes to the way we deliver care by further engaging our members, policymakers, industry partners, and our patients. Simultaneous challenges including global health disparities, resource allocation, and access to care must inform these efforts. Climate literacy should be increasingly added to radiology training programmes. More research is required to understand and measure the environmental impact of radiological services and inform mitigation, adaptation and monitoring efforts. Deeper collaboration with industry partners is necessary to support innovations in the supply chain, energy utilization, and circular economy. Many solutions have been proposed and are already available, but we must understand and address barriers to implementation of current and future sustainable innovations.

Bone and mineral metabolism in the human body undergoes significant adaptations during pregnancy and lactation to meet the physiological demands of both the mother and fetus. The growing fetus requires approx imately 30 g of calcium, with 80% of this transferred from the mother during the third trimester. These adap tations involve complex hormonal changes, such as increased parathyroid hormone-related peptide (PTHrP) and 1,25-dihydroxyvitamin D, ensuring the mother maintains calcium balance despite fetal demands. However, these changes can also exacerbate pre-existing metabolic bone disorders, presenting unique challenges during preg nancy. This narrative review, framed around illustrative case examples, focuses on the management of metabolic bone disorders in pregnancy. Relevant case studies of hypercalcemia, hypocalcemia, hypophosphatemia, and osteoporosis and chronic kidney disease mineral bone disorder are reviewed to illustrate the biochemical changes, clinical implications, and therapeutic strategies available during pregnancy and lactation. We analyze literature from case reports and existing guidelines to provide practical clinical recommendations. The review highlights critical pregnancy-related metabolic adaptations, such as increased intestinal calcium absorption and skeletal resorption. Disorders like primary hyperparathyroidism (PHPT) and familial hypocalciuric hypercalce mia present significant maternal and fetal risks, including miscarriage, growth restriction, and neonatal com plications. Early identification and tailored treatment, including hydration, parathyroidectomy, and vitamin D supplementation, mitigate these risks, with surgical interventions in PHPT improving pregnancy outcomes compared to conservative management. Management of metabolic bone disorders during pregnancy and lacta tion requires a nuanced approach to meet the dual needs of the mother and fetus.

Purpose: The Cow’s Milk-related Symptom Score (CoMiSS) improves the recognition of cow milk allergy (CMA) symptoms. A score of ≥10 should raise awareness of CMA. The median CoMiSS in healthy European infants aged <6 months is 3. This study aimed to determine the impact of different regions on CoMiSS in healthy infants aged <12 months to evaluate regional and age-related differences. Methods: A prospective cross-sectional study was conducted at one hospital each in Indonesia (Jakarta) and Brazil (Sergipe). CoMiSS was assessed in healthy infants aged –12 months old. Results: In Jakarta, a total of 286 infants (50.7% boys) were included. The median (interquartile range) CoMiSS was 1.5 (0–4); the 95th percentile was 7. In Sergipe, 101 infants (60.4% boys) were included. The median (interquartile range) CoMiSS was 4 (4–6); the 95th centile was 10.9. Age (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.94–0.99;p<0.001) and country (OR, 2.40; 95% CI, 2.06–2.79; p<0.001) were significant independent predictors of changes in mean CoMiSS in a linear regression model (r2 =0.27). Conclusion Median CoMiSS in healthy infants differed between Jakarta and Sergipe (1.5 vs. 4.0).These findings highlight that the perceived normality of parents may be region-dependent.

This is a case of a 33-year-old, G3P3(3003) female patient with a clinical presentation of vaginal bleeding associated with on and off hypogastric pain. The patient was diagnosed and managed as a case of tubo-ovarian abscess and subsequently underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAHBSO). Microscopic sections of both ovaries, however, showed dual population of tumor cells composed of medium-sized, mononucleated cells admixed with multinucleated giant cells with marked pleomorphism, extensive hemorrhage and necrosis. Immunohistochemistry studies using beta-hCG was diagnostic of ovarian choriocarcinoma, favoring non-gestational in origin. Classification of non-gestational choriocarcinoma (NGOC) was established using diagnostic criteria for NGOC established by Saito et al., and Mangla et al. DNA analysis, however, remains to be the gold-standard for differentiating between gestational (GOC) and non-gestational (NGOC) etiology.

This study investigates indoor environmental factors in several offices from one of the university at Malaysia's East Coast, focusing on enhancing occupational health and well-being among university staff by examining lighting quality and thermal comfort. Monitoring sampling were done based on hazard reports logged and data from three main offices or location were collected in this study. Utilizing Extech HD450 Heavy Duty Data Logging Light Meter to measure illuminance, the study found that most sampled points fell below the Occupational Safety and Health Guidelines' recommended range of 300-500 lux, indicating insufficient lighting that can cause visual discomfort and reduce productivity. Thermal comfort assessments, conducted with EVM-7 Indoor Air Quality 3M QUEST and AirPro Solution Models AP500, revealed acceptable temperature and humidity levels but often inadequate air velocity, particularly in the Science Officer's Office, leading to poor air circulation and potential health issues. The study highlights the necessity of improving lighting solutions by installing additional fixtures or upgrading existing ones for sufficient and evenly distributed illumination and enhancing ventilation systems to ensure adequate air movement. Addressing these deficiencies is crucial for creating a conducive working environment, promoting employee satisfaction and productivity. This research focuses solely on monitoring and analyzing the collected data. No qualitative evaluation has been conducted as part of this study. This research advocates for a holistic approach to Indoor Environmental Quality (IEQ), involving regular assessment and targeted interventions to enhance the overall quality of university office environments, ultimately fostering a healthier and more productive workplace.

The urgency for climate action is recognised by international government and healthcare organisations, including the United Nations (UN) and World Health Organisation (WHO). Climate change, biodiversity loss, and pollution negatively impact all life on earth. All populations are impacted but not equally; the most vulnerable are at highest risk, an inequity further exacerbated by differences in access to healthcare globally. The delivery of healthcare exacerbates the planetary health crisis through greenhouse gas emissions, largely due to combustion of fossil fuels for medical equipment production and operation, creation of medical and non-medical waste, and contamination of water supplies. As representatives of radiology societies from across the globe who work closely with industry, and both governmental and non-governmental leaders in multiple capacities, we advocate together for urgent, impactful, and measurable changes to the way we deliver care by further engaging our members, policymakers, industry partners, and our patients. Simultaneous challenges including global health disparities, resource allocation, and access to care must inform these efforts. Climate literacy should be increasingly added to radiology training programmes. More research is required to understand and measure the environmental impact of radiological services and inform mitigation, adaptation and monitoring efforts. Deeper collaboration with industry partners is necessary to support innovations in the supply chain, energy utilization, and circular economy. Many solutions have been proposed and are already available, but we must understand and address barriers to implementation of current and future sustainable innovations.

Bone and mineral metabolism in the human body undergoes significant adaptations during pregnancy and lactation to meet the physiological demands of both the mother and fetus. The growing fetus requires approx imately 30 g of calcium, with 80% of this transferred from the mother during the third trimester. These adap tations involve complex hormonal changes, such as increased parathyroid hormone-related peptide (PTHrP) and 1,25-dihydroxyvitamin D, ensuring the mother maintains calcium balance despite fetal demands. However, these changes can also exacerbate pre-existing metabolic bone disorders, presenting unique challenges during preg nancy. This narrative review, framed around illustrative case examples, focuses on the management of metabolic bone disorders in pregnancy. Relevant case studies of hypercalcemia, hypocalcemia, hypophosphatemia, and osteoporosis and chronic kidney disease mineral bone disorder are reviewed to illustrate the biochemical changes, clinical implications, and therapeutic strategies available during pregnancy and lactation. We analyze literature from case reports and existing guidelines to provide practical clinical recommendations. The review highlights critical pregnancy-related metabolic adaptations, such as increased intestinal calcium absorption and skeletal resorption. Disorders like primary hyperparathyroidism (PHPT) and familial hypocalciuric hypercalce mia present significant maternal and fetal risks, including miscarriage, growth restriction, and neonatal com plications. Early identification and tailored treatment, including hydration, parathyroidectomy, and vitamin D supplementation, mitigate these risks, with surgical interventions in PHPT improving pregnancy outcomes compared to conservative management. Management of metabolic bone disorders during pregnancy and lacta tion requires a nuanced approach to meet the dual needs of the mother and fetus.

Purpose: The Cow’s Milk-related Symptom Score (CoMiSS) improves the recognition of cow milk allergy (CMA) symptoms. A score of ≥10 should raise awareness of CMA. The median CoMiSS in healthy European infants aged <6 months is 3. This study aimed to determine the impact of different regions on CoMiSS in healthy infants aged <12 months to evaluate regional and age-related differences. Methods: A prospective cross-sectional study was conducted at one hospital each in Indonesia (Jakarta) and Brazil (Sergipe). CoMiSS was assessed in healthy infants aged –12 months old. Results: In Jakarta, a total of 286 infants (50.7% boys) were included. The median (interquartile range) CoMiSS was 1.5 (0–4); the 95th percentile was 7. In Sergipe, 101 infants (60.4% boys) were included. The median (interquartile range) CoMiSS was 4 (4–6); the 95th centile was 10.9. Age (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.94–0.99;p<0.001) and country (OR, 2.40; 95% CI, 2.06–2.79; p<0.001) were significant independent predictors of changes in mean CoMiSS in a linear regression model (r2 =0.27). Conclusion Median CoMiSS in healthy infants differed between Jakarta and Sergipe (1.5 vs. 4.0).These findings highlight that the perceived normality of parents may be region-dependent.

Background and Objectives: Understanding worsening heart failure events (WHFEs) and clinical practices in the real world is essential in heart failure (HF) management. The primary objective of this single-center, retrospective, observational study, including a patient survey, was to characterize WHFEs and associated factors during the first year after the incident HF diagnosis in Finnish patients. Secondly, implementation and adherence to guideline-directed medical therapy (GDMT) and mortality during the whole follow-up were assessed. Methods: Incident HF patients (International Classification of Diseases, 10th Revision: I50) with reduced ejection fraction (HFrEF; <40%) were identified between 2013–2019 from the hospital data lake of Southwest Finland. Clinical characteristics, healthcare resource utilization, medication prescriptions and purchases, and deaths were collected from hospital records and national registers between 2011–2021. A survey was linked with register data for a subgroup of patients. Associations between explanatory factors, WHFEs, and mortality were studied using logistic and Cox regression models. Results: Among 570 HFrEF patients, 23% (n=133) experienced a WHFE within the first year after the incident diagnosis. During this 1-year period, 85% used angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, 90% beta-blockers, and 44% mineralocorticoid receptor antagonists, and >80% of patients were adherent to these medications. WHFEs were associated with higher risk of mortality (hazard ratio [HR], 1.82; 95% confidence interval [CI], 1.31–2.53; p<0.001), whereas adherence was associated with a lower risk of WHFEs (odds ratio, 0.31; 95% CI, 0.20–0.48; p<0.001) and mortality (HR, 0.66; 95% CI, 0.47–0.94; p=0.021) in multivariate models. Quality of life was lower in patients with (n=47) than without WHFEs (n=100). Conclusions Improving adherence is crucial for mitigating adverse outcomes in HF.