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  • A patient with dysphagia and muscle weakness

    BACKGROUND: There are five major types of inflammatory myopathies (IM), including dermatomyositis, polymyositis, immune-mediated necrotizing myopathy, antisynthetase syndromes, and inclusion body myositis. Grouped together, the incidence of IM is >4 cases/100,000 with a prevalence of 14-32/100,000. Type-specific IM diagnoses are based on the pattern of muscle weakness and the results of electromyographs, MRIs, muscle biopsies, and measurements of myositis-specific autoantibodies1. We report the case of an elderly man with an inflammatory myopathy whose presenting complaint was dysphagia. OBJECTIVE: To review the clinical and laboratory manifestations of inflammatory myopathy-associated dysphagia. CASE REPORT: The patient is an 81-year-old retired Navy aviator who presented with a chief complaint of difficulty in swallowing both solids and liquids of several months duration. The dysphagia was associated with bouts of coughing, the expectoration of white foamy sputum, increased production of saliva, a weight loss of 5 kg, generalized myalgias, and worsening fatigue and weakness. The patient had a past medical history of essential hypertension, hyperlipidemia, autoimmune thyroiditis, V617F JAK2 + essential thrombocytosis, white matter microangiopathy, and a small lacunar infarction of the right caudate nucleus. There was no family history of autoimmune disease. On neurological examination, testing of cranial nerves II-XII and sensation to light touch, pin, temperature, and vibration was normal. The shoulder and upper arm strength was diminished bilaterally without evident muscle tenderness, atrophy or fasciculations. The patient could not rise from the supine position without assistance nor keep his arms elevated above his head without fatiguing. The strength in his lower extremities was normal. Deep tendon reflexes were normal and plantar responses were flexor. He had a single Gottron’s nodule and a faint erythematous rash involving his scalp, back and forearms. His Myositis Disease Activity Assessment (MDAAT) is shown in Table 1. Table 1. Myositis Disease Activity Assessment Tool (MDAAT) Findings on laboratory…

  • Percutaneous Nephrolithotomy in the supine flank free modified position for the removal of a 3 year Double-J ureteral stent in a horseshoe kidney

    Horseshoe kidney is one of the most common congenital renal abnormalities with increased incidence of stone formation. We present a case of an HIV seropositive patient with a both-ends encrustated 3 year forgotten DJ stent and a staghorn stone in the left moiety of a horseshoe kidney. He was treated with percutaneous nephrolithotomy in the supine flank free modified position and simultaneous cystolitholapaxy. Supine percutaneous nephrolithotomy is safe and feasible in horseshoe kidney and facilitates simultaneous thansurethral access for cystolitholapaxy.

  • Street Businesses in Addis Ababa: Causes, Consequences and Administrative Interventions

    Street vending has long been a source of debate among development economists. It has been argued that direct government intervention that aids this sector will encourage rural to urban migration. Others have argued that this sector deserves government help as often more than 50% of the urban labor force is employed by this sector. This study is designed to assess the causes, consequences and administrative interventions of street vending in Addis Ababa with particular reference to Yeka sub-city. Data were collected from randomly selected samples of 330 street vendors, 14 code enforcers and 9 government officials through questionnaires and interview of key respondents. The finding shows most of the traders came from outside Addis Ababa in search of jobs. Street vending proliferated as a way of life and a coping mechanism adopted by those economically under privileged segment of the society. Factors that led to street vending were complex and varied. According to the findings, absence of opportunity in the formal sector was the main factor that led the operators to street vending. This is followed by the need to support their family and themselves. The authorities stated that unless managed well street vending will have negative impact on traffic movement, encroach on public space and create unfair completion with formal businesses. To mitigate these problems the City administration has issued street vending regulation No. 5 in 2018 so that specific vending plots are allocated and the vendors need to do their business legally and those who fail to do so will be dealt with by the law.

  • Governance and Leadership Practices and Challenges in Ethiopia. The Case of Dukem Town in Oromia Regional State

    The purpose of this study is to assess the impact of leadership on governance effectiveness in Dukem town. The population of this study were development team coordinators, representatives of private business organizations, and community institutions of the town. In addition, cabinet members and civil servants of the town administration were the target population for the source of data in this assessment. A total of 145 samples were selected using purposive and random sampling methods. The findings show that important traits of a leader that results in effective and better performance were missing. The informants argued that poor commitment is noticeable in the implementation of good governance in the town. Leaders are promoted to higher positions without being sufficiently prepared for the leadership role and with less sufficient understanding of the significance of good governance principles. In addition, lack of competence, inefficient and ineffective monitoring and evaluation system were major factors that contributed to ineffectiveness of leadership practices of the town administration. This poor achievement is manifested in poor coordination with stakeholders, rent seeking attitudes and poor commitment of the leadership and employees. Although various initiatives have been pursed in Oromia National Regional State to ensure good governance such as citizen charter, fighting rent seeking attitudes and making some arrangements in running town affairs, still ineffective leadership and bad governance is reported in different urban centers of the region.

  • Determinants of Group Loan Repayment Performance of Micro and Small Scale Enterprises: Case study Oromia Credit and Saving Share Company (Eastern Wollega Zone Branch)

    The study was intended to analyze the determinants of group loan repayment performance of MSE’s sectors a case of Oromia Credit and Saving Share Company operating in the East Wollega Zone. The survey data was conducted by using the structured questionnaire in order to collect primary data from the purposively selected branches whereas secondary data were collected from published and unpublished documents. Out of 424 total number of groups owned of MSE’s sectors 168 sample size were selected and only 162 of the respondents have filled the questionnaire properly by their respective enterprise’s group leaders. The collected data were analyzed by employing descriptive statistics and ordered logit model by using STATA soft ware version 12. Result of this study shows that out of the predicting variables used in this study, group leaders education level, group leaders experience in similar business, the enterprise’s beginning capital, loan repayment period, loan follow up, Training offered by the loan officers of OCSSCO and access to output market for the enterprises finished products were found to positively influence while the enterprises group size, additional loan they received, problem of information disclosure among members, the problem of financial statement recording experience in the business, loan interest rate, problem of power interruption and shortage of water supply around the enterprise working area have negatively influenced the group loan repayment performance of MSE‘s sectors in the study area. Based on this result, the author recommended that OCSSCO has to focus on the smaller the group size through which the problem of information disclosure would be resolved ,they has to give frequent training about the financial statement recording experience, they have to deal with the concerned body to solve the problem of power interruption as well as about the shortage of water supply around the enterprise’s business area and…


    Oral mucositis is a sequel of cytoreductive treatment induced by radiotherapy and / or chemotherapy, with signs and symptoms ranging from pain, swelling and burning sensation, to ulcerations in the oral mucosa. The nursing staff should be able to offer therapies that give the patient better quality of life, once because the professionals develops closer contact with the patient and family. To analyze the scientific evidences about nursing assistant in the management of oral mucositis in oncology patients. Integrative Review in databases LILACS, Scopus, SciELO, LILACS and BDENF with complete articles published in the last 10 years, in Portuguese, English and Spanish. It was demonstrated that nurses can provide treatments such as oral hygiene, administration of analgesics, cryotherapy, treatment of xerostomia, chlorhexidine rinses, sodium bicarbonate and other substances that promotes pain control in patients with consequent increase of quality of life. The impact of nurses’ actions in improving the patient, control of oral mucositis, as well as studies that generate strong evidence for the development and / or enhancement of new nursing care are aspects to consider this issue.


    Objective: To analyse the frequency of haemoglobin variants detected in the neonatal screening program in the state of Pernambuco from January / 2015 to July / 2016. Methodology: Descriptive study based on data provided by the health secretary of the state of Pernambuco referring to newborns submitted to the Guthrie’s test between 01/01/2015 to 07/31/2016. Results: During the period included in the study, 162,236 children participated in the neonatal screening program to evaluate haemoglobinopathies through the health department. From these, 5,997 (3.69%) presented some haemoglobin variant, being 5.019 (3.09%) carrying HbS in hetero or homozygous. Conclusions: It was possible to observe a high incidence of children diagnosed as having haemoglobin variants, especially HbS, showing the importance of performing this test so that all children can be assisted from the beginning of their lives.


    Breastfeeding is internationally promoted as the ideal method of infant nutrition due to its numerous benefits to mothers, children, and communities. To enlighten the benefits of breastfeeding and to investigate the influence of breastfeeding preparation and techniques on the frequencies of exclusive breastfeeding. This systematic literature review was built from a bibliography research of scientific papers, publications and materials available on the Internet in English and Portuguese. From this research, four essential themes were identified: benefits of breastfeeding, clinical management of breastfeeding, breastfeeding preparation and techniques, pain and discomfort in the practice of breastfeeding and nipple trauma. In the end, it was possible to notice that counseling sections with the mother throughout the pregnancy and after giving birth are fundamental to the effectiveness and exclusivity of breastfeeding.


    Introduction: Moebius syndrome is a rare congenital neurological disease of unknown etiology, that involves several cranial nerves. The main clinical characteristic of this syndrome is the “mask-like face”, that is, the absence of facial expression in situations of sorrow or joy. Objective: This study aims to describe the characteristics of Moebius syndrome and its main implications for dentistry. Methodology: In this study, a literature review was carried out, with searches in the following databases:, pubmed and medline. Furthermore, eight articles were selected, among which three were literature reviews and five were reports of clinical cases. Results: In addition to the genetic relation of the syndrome, there are factors that lead to this disorder, such as the use of misoprostol during pregnancy, for example. Conclusion: Early care for patients with Moebius syndrome by a multidisciplinary team is extremely important, since it will attenuate the effects of this pathology.


    Introduction: Rett syndrome (RS) consists in a neurological severe disorder caused by a mutation in the X chromosome, mainly on the MECP2 gene, affecting the neuropsychomotor development. It is known too that the disease manifests, with higher indices in the female gender. Objective: This work is designed to present, through a review of the literature, the general aspects about the Rett syndrome and their principal implications in the dentistry. Methodology: In the present study was conducted a review of the literature with the clearance of information on the following database: Scielo, Periódicos CAPES and Google Acadêmico. There were selected eleven articles, six of these articles were review of literature and the others five were cases report. Results: Besides the genetic linkage of the syndrome, there are factors which aggravate demonstrations on individual’s overall health, mainly lack of adequate dental care’s monitoring. Conclusion: It is very important the frequency of dentistry ambulatory and clinical care to the patient with the syndrome, with the objective of promoting an oral health and prevent grievances to the general health, providing a better quality of life to this patients.