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Background: Modern fluoroscopic C-arms have substantially expanded the use of fluoroscopic C-arms in a variety of orthopaedic surgical procedures. Fluoroscopy professionals who are exposed to radiation for an extended period of time have an increased risk of developing radiation-induced cancer. The study aimed to evaluate the radiation protection precautions taken by theater staff in two selected hospitals to reduce occupational radiation doses during fluoroscopy-guided common orthopaedic surgeries. Methods: After examining the theatre records for three months in two selected hospitals in Sri Lanka, the three major orthopaedic surgeries for both hospitals were selected (Dynamic Hip Screw, Tibial Plateau Fracture, and Distal Radial Fracture). The study used a checklist for an unbiased observation, containing the internationally recommended guidelines for Fluoroscopy inside an interventional suit published in the International Commission on Radiological Protection (ICRP) 139 publication to check whether the theatre personnel followed the radiation protective measures during their procedures. Results: Fluoroscopy technical-based protective measures and the quality assurance-related criteria were satisfied to a 100% level. Both hospitals, A and B, did not have an adequate number of lead shielding devices to be utilized in theatres. A lack of individual exposure monitoring and the use of two dosimeters were identified as the main problems. Conclusions: The staff of both hospitals adhered to the standard international guidelines on radiation protection during C-arm guided orthopaedic surgeries despite the unavailability of a proper personal monitoring system.

Children with autism spectrum disorder may exhibit nutritional deficiencies due to reduced intake, genetic variants, autoantibodies interfering with vitamin transport, and the accumulation of toxic compounds that consume vitamins. Importantly, vitamins and metal ions are essential for several metabolic pathways and for neurotransmitter functioning. The therapeutic benefits of supplementing vitamins, minerals (Zinc, Magnesium, Molybdenum, and Selenium), and other cofactors (coenzyme Q10, alpha-lipoic acid, and tetrahydrobiopterin) are mediated through their cofactor as well as non-cofactor functions. Interestingly, some vitamins can be safely administered at levels far above the dose typically used to correct the deficiency and exert effects beyond their functional role as enzyme cofactors. Moreover, the interrelationships between these nutrients can be leveraged to obtain synergistic effects using combinations. The present review discusses the current evidence for using vitamins, minerals, and cofactors in autism spectrum disorder, the rationale behind their use, and the prospects for future use.

Introduction: Hepatic encephalopathy (HE) is a neuropsychiatric complication of liver disease and/or portosystemic blood shunting, characterized by alterations of alertness, personality, cognition, and motor functions. Its severity is defined from mild symptoms to coma according to four grades. This disease may affect several brain regions including the cingulate gyrus, the insular cortex, and the globus pallidus. The pathophysiology of HE is thought to be multifactorial and involves manganese accumulation in the brain, damaging effect of ammonia on glial cells, etc. Previous studies describe the pathophysiology of HE or the effect of manganese in the central nervous system but there is no review addressing both topics from an integrative perspective and using a systematic methodology. This scoping review aims to evaluate the role of manganese in HE. Methods: Published studies (all publication types) will be retrieved from Web of Science, MEDLINE, Scopus, EBSCOhost, Ovid, and Google Scholar. Inclusion criteria are: studies reporting manganese levels in any biological sample or tissue of patients with HE, any experimental model reporting the effect of manganese administration on measures of neuroprotection in models of liver damage, or showing an effect on manganese levels in the liver and/or the brain. Exclusion criteria are: studies reporting subjects exposed occupationally or environmentally to manganese, or written in languages different than Spanish or English that could not be appropriately translated, or whose full-text files could not be retrieved. Either clinical or preclinical studies will be analyzed separately but might be discussed together. Data summaries will be presented in graphs, figures, and tables. A narrative synthesis will be presented. This protocol complies with PRISMA-P.

Autism spectrum disorders (ASD) are a heterogeneous group of neurodevelopmental disorders characterized by impaired social interaction, limited communication skills, and restrictive and repetitive behaviours. The pathophysiology of ASD is multifactorial and includes genetic, epigenetic, and environmental factors, whereas a causal relationship has been described between ASD and inherited metabolic disorders (IMDs). This review describes biochemical, genetic, and clinical approaches to investigating IMDs associated with ASD. The biochemical work-up includes body fluid analysis to confirm general metabolic and/or lysosomal storage diseases, while the advances and applications of genomic testing technology would assist with identifying molecular defects. An IMD is considered likely underlying pathophysiology in ASD patients with suggestive clinical symptoms and multiorgan involvement, of which early recognition and treatment increase their likelihood of achieving optimal care and a better quality of life.