Recent Articles

We present a case of an 81-year-old asthmatic female with a left foot drop and an incidental finding of hypereosinophilia with an initial differential diagnosis of Eosinophilic Granulomatosis with Polyangiitis (EGPA). However, after extensive investigations, all causes of hypereosinophilia were excluded and the left foot drop was secondary to a radiculopathy. This led to a diagnosis of Idiopathic Hypereosinophilic Syndrome (IHES), a diagnosis of exclusion. This is the first case report where hypereosinophilia and a left foot drop where unrelated conditions occurring simultaneously thus posing a diagnostic dilemma. Therefore, this case report aims to highlight the importance of a systematic approach in the investigation of hypereosinophilia, to ascertain the cause and to rule out organ damage as this will affect the management and the outcome.

This study critically inspected the Mangima conflict resolution within Gumuz society in Metekel Zone, Bineshangul Gumuz National Regional state, Ethiopia. Mangima institution played a significant role in resolving conflicts as well as contributed to the establishment of peaceful relations within Gumuz communities in each districts of region. Gumuz are one of the indigenous peoples have settled in the region. Their conflict was instigated by the problems related to marriage, abducting girls, elopement, adultery, incest, belief in evil eye, Gäfia (Witch doctor), deliberate killings for heroism, competitions over the use of land resources, insults and failure to pay back debts. The Gumuz inhabited areas of Metekel was purposively selected for this study. The data was collected using key informants interview and focus group discussion. Gumuz elders and local leaders that appointed during the regime were independently interviewed and focus group discussions attended by five groups through 20 peoples in each group on the issues of conflict generating practices and the role Mangima conflict resolution within Gumuz communities. The sources are critically collected, examined and then analyzed. The legitimacies of the sources are cross-checked one against the other.

Purpose of the study: To assess body mass index (BMI) and trimester specific iodine status among pregnant women of Assam and study their association with congenital malformations (CM). Methods: Anthropometric, obstetric and socioeconomic data was obtained from pregnant women and apparently healthy women attending Assam Medical College and Hospital, Dibrugarh. Urinary iodine (UI) level was estimated in each trimester. BMI was classified based on Asian criteria suggested by WHO and the iodine intake was classified using WHO reference medians. Student’s t-test and univariate logistic regression analysis were used to determine the risk factors. Results: 156 pregnant women (age 18-35 years) and 160 controls were enrolled in the study. 55.8% pregnant women were underweight and 3.8% were overweight. Malformations were observed in 16 babies. The median urinary iodine concentration (MUIC) of pregnant women in their 1st trimester was 170 µg/l (IQR 100 µg/l) which increased to 275 µg/l (IQR 166 µg/l) during the 2nd trimester and decreased to 265 µg/l (IQR 160 µg/l) at the 3rd trimester. In the univariate analysis, maternal BMI > 23 kg/m2 (OR 3.67, 95% CI 0.20-67.65) and MUIC

To solve the problem of EMU maintenance planning time, we established a hybrid linear programming model based on adaptive genetic algorithm. According to the different levels of bullet train maintenance and the different arrival time, the constraint conditions are found, and the overall minimum maintenance time is taken as the objective function. Then the problem is transformed into a hybrid Flow-shop scheduling problem with unique process constraints, and an adaptive genetic algorithm is used to solve it again. It is concluded that the total maintenance takes 1125 minutes, and no blockage occurred in all EMU during the maintenance period. To provide a consistent basis for bullet train maintenance time and scheduling.

Morphofunctional changes of the placenta during the gestational period may be influenced by the pathological condition of Gestational Diabetes Mellitus. From this perspective, this chapter will address this theme as a way to evaluate the placental differences caused by this pathology.

The existence of different types of diabetes contributes to a varied therapy, conditioned to the advance that this pathology is. In Gestational Diabetes Mellitus this condition is no different. In this context, this chapter will address Gestational Diabetes Mellitus, as well as its risk factors, prevention and consequences of this pathological condition.

Recurrences of Graves’ disease (GD) after total thyroidectomy (TT) are uncommon, with few cases reported in literature. This article describes the case of a 58-year-old man who was treated with TT due to GD over 15 years ago. A progressive reduction of levothyroxine treatment was observed due to persistent subclinical hyperthyroidism. Thyroid-stimulating hormone receptor antibodies were detected in blood analysis and in the imaging test, a lesion was identified in the upper left anterolateral cervical region. A histopathological study of the lesion revealed colloid goiter. The patient was diagnosed with GD recurrence in a thyroid remnant and was remitted to an otorhinolaryngologist to remove the lesion. The histopathological study showed diffuse thyroid hyperplasia. The objective of this clinical case report is to highlight this unusual recurrence to better treat and improve long-term outcomes in patients treated with TT.

INDRODUCTION: Microcephaly is a neurological condition with a craniofacial anomaly where it has a reduced cephalic perimeter, resulting in malformation of the central nervous system. In 2015, Brazil registered an outbreak of the disease, mainly in the states of northeastern Brazil, causing a state of alert in the entire population and a problem for public health that after investigative studies, concluded that the responsible for the outbreak would be the Zika virus. In general, the disease may present a delay in the neuropsychomotor development, the application of an early intervention program should be done in a systematic and individual way, respecting the various changes in each case. With the physiotherapist applicability occurs the contribution with the physical and psychic benefits, creating more possibilities for psychosocial rehabilitation. OBJECTIVE: To show the approach of physiotherapy to minimize the impairment caused by microcephaly, through appropriate treatments mediating the disability of each individual. METHODOLOGY: For this summary, a study was made on the need for physiotherapy in patients with microcephaly. It was conducted by electronic research in the databases Scielo, Pubmed and Bireme RESULTS: Microcephaly is a pathology that causes severe functional and cognitive alterations, being important the rehabilitation with purpose the stimulation of the child according to the neuropsychomotor age. The conduct of any technique in the first years of life helps in the process of maturation of the central nervous system, being considered important for the development of motor, cognitive and sensory skills. The study demonstrated that in addition to early interventions, the care with an interdisciplinary health team and the support of the family environment favors the development and functionality leading to the autonomy and independence of the child. CONCLUSION: Microcephaly is a pathology that requires continuous treatment for the rest of life. The early stimulation through a conduct with kinesiotherapeutic…

Diverticulae are uncommonly encountered in the stomach. They can be congenital or acquired- the latter variety being the less frequent of the two. This article details one such rare case from Lagos, Nigeria and discusses certain aspects of its clinical and endoscopic presentation. We present a 59-year old with a background history of non-steroidal anti-inflammatory drugs abuse presented with hematemesis and melena and was in hemorrhagic shock. After stabilization, the gastroscopy findings were of a gastric diverticulum (GD) in the anterior prepyloric wall. There was a Forrest IIb ulcer in the GD’s wall with surrounding erythema and edema. The patient was successfully managed medically and conservatively and with good long term results.

Background: Homocystinuira is a rare autosomal recessive disorder in the metabolism of sulfur-containing amino acid caused by mutations in the cystathionine beta-synthase gene which encodes the pyridoxine (Vitamin B6) dependent enzyme cystathionine beta-synthase. It is characterized by significant elevations in plasma and urine homocysteine concentrations, which could be associated with increased risk of fracture. Methods: We describe a case of Homocystinuria who suffered from a low impact patellar fracture with a literature review to highlight the critical relationship between homocysteine level and bone health. Results: We reported a 36-year-old female with a diagnosis of Homocystinuria due to pyridoxine (B6) unresponsive severe Cystathionine Beta-Synthase deficiency. After a minor knee injury she developed a right patellar fracture and her X-ray revealed osteopenia. On examination, she has severe scoliosis in the spine with bilateral aphakia (absence of the lens of the eye). Her labs showed, persistent high Homocysteine above 100 umol/L, Methionine: 383 umol/L (10-42), Vitamin D 12 ng/ml. Her spine X-ray revealed very severe scoliosis with osteopenia but no vertebra fracture. Her DXA scan showed her Z-Score was within the expected range for her age in hip, spine and 1/3 radius areas, however her ultra-distal radius Z-Score was -4.0. Her Homocystine level was mostly higher than 100 due to non-compliance with dietary advice and treatment. High homocysteine levels in Homocystinuric patients impair the function of bone cells that regulate bone remodeling as well as bone material properties such as collagen cross-linking. This imbalance between bone formation and resorption may lead to a low BMD and fracture in patients with homocystinuria. Interestingly, even in general population hyperhomocystinemia with a plasma level of more than > 13 nmol/ml has been found to be associated with low BMD and an increased risk of fractures that is independent of BMD. Deficiencies in vitamin B6, B12, or…