07/31/2018
Clinical Image

Chronic recurrent bilateral granulomatous iridocyclitis in an 18-year-old woman

Marie-Helene Errera*, Cameron F Parsa, Jonathan Benesty, Neila Sedira, Raphael Thouvenin, Emmanuel Heron and Jose-Alain Sahel

A case of recurrent tuberculosis-related uveitis in a young female patient of North African origin.

Right eye: Slit-lamp photograph of broad-based posterior synechiae (formed by macrophage-laden iris tissue when brushing against and then adhering to, the anterior lens capsule) rendering the pupils irregular, clover- or, here, “Mickey Mouse”©-shaped. Cycloplegic agents can increase the pupillary circumference, displacing iris tissue further away from the crystalline lens to help reduce adhesions from forming that beget lens opacities as well as block aqueous humor flow.

07/31/2018
Research Article

Perinatal Morbidity and Mortality following repeat Cesarean section due to five or more previous Cesarean Section done in Tertiary centre in KSA

Somia Osman, Gehan Farid* Reem Mohamed Kamal , Sarah Rabie Ali and Mohamed AH Swaraldahab

Objectives: To highlight and determine the maternal and neonatal outcome and associated risks for patients who have undergone their 6th and more caesarean sections. 

Design: Case control study.

Setting: Tertiary Centre (Security Forces Hospital – Riyadh – Saudi Arabia).

Patients: 80 patients selected to study group who have undergone their sixth and more caesarean sections in Security Forces Hospital. Between June 2006 and May 2010. This group was compared to 80 patients who have undergone their third to fifth caesarean sections during the same time period and immediately following the studied case.

Main outcome measured: Age and parity of women in study and the control group were correlated with the number of previous caesarean sections. Intra operative and post-operative maternal complications including presence and grade of adhesions, intra partum and postpartum hemorrhage, use of measurement and methods (both medical and surgical) to control bleeding such as Bakry balloon, Internal iliac artery ligation, etc., were highlighted. Bowel injury, blood transfusion, admission to surgical intensive care, incidence of placenta previa and accreta, post-operative complications like paralytic ileus, wound infection were also noted. Further, neonatal outcome including birth weight, Apgar score, and need for neonatal intensive care unit admission were reviewed.

Results: Patients in the study group had higher incidence of extensive adhesions (41.25%) compared to (12.25%) in the control group. Bowel injury was (2.5%) in study group with none in the control group. The incidence of placenta previa was (8.75%) in the study group as compared to (2.5%) in the control group, with placenta accreta complicating (28.57%) of placenta previa seen only in the study group. Blood transfusion was higher in the study group (20%) as compared to (5%) in the control group.

Neonatal admission to NICU was higher in the study group (27.5%) in comparison to the control group (12.5%). Also birth weight was lower in the study group.

Conclusion: The more the number of caesarean sections, the more the maternal and neonatal morbidity.

Patients should have proper counselling during antenatal follow up about the risks of repeated caesarean sections, and offered bilateral tubal ligation after the third or fourth caesarean sections.

07/27/2018
Case Report

Herpes simplex virus (HSV)-1 encephalitis can induce chronic anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis

Susanne Buechner*, Gabriele J Sixt and Igor Florio

Herpes simplex virus (HSV)-1 encephalitis is the most common infectious cause of sporadic encephalitis. Despite treatment with acyclovir, HSV encephalitis is still associated with severe morbidity characterized by persistent neurological deficits. HSV encephalitis usually follows a monophasic course, however, some patients might develop relapsing symptoms caused by the formation of auto-antibodies directed against the N-methyl-D-aspartate receptor (NMDAR). Here we present an 82-year-old male patient with HSV encephalitis who developed shortly after his hospital discharge a Post-HSV NMDAR encephalitis, characterized by recurrent epileptic seizures and deterioration of his residual aphasia. First-line immunotherapy with intravenous immunoglobulins (IgIV) was administered and the patient returned almost to his baseline residual deficits of HSV encephalitis. Subsequently, he presented with recurrent relapses of NMDAR encephalitis. Since periodic treatment with IgIV has been started the patient is seizure-free and his neuropsychiatric condition is stable. In conclusion, the recognition of Post-HSV NMDAR encephalitis is very important because neurological manifestations can markedly improve with immunotherapy. Interestingly, in some patients cerebral HSV infection seems to trigger a chronic inflammatory disorder with persistent autoimmune activation which requires chronic treatment.

07/27/2018
Review Article

Behavioral transformation through inner conflict resolution: A new Nursing Theory

Thomas A Sharon*

The discipline of Hassidic Philosophy, which emanates from a particular movement in Orthodox Judaism called Hassidism, begins with the premise that all of creation is a dichotomous world of opposites with both sides in a perpetual conflict with one another. The human construct is therefore a dichotomous spiritual entity manifested in the physical world through a mind-body. One side of this soul is the Godly intellect giving rise to the human identity or self-awareness and the other side is the animal soul whose purpose is to galvanize the body. Having learned that this discipline provides its followers with tools for behavioral transformation through inner conflict resolution, I find that it offers a clearer understanding of the spiritual component of holistic health and nursing theory as well as a tool for behavioral transformation that has practical application in nursing practice. Therefore, the purpose of this paper is to present the basic constructs of Hassidism as it pertains to human behavior, demonstrate its compatibility with existing nursing theory and offer a new methodology for advanced practice nurses (APN’s) to assist their clients in achieving behavioral transformation through inner conflict resolution.

07/28/2018
Research Article

Clinically and Radiological isolated syndrome (MS risk)

Hassan Ahmed Hashem*, Yasser Hamed Mustafa, Abdelazim M Reda, Sameh Azab and Ahmed M Solaiman

Background: The use of brain magnetic resonance imaging (MRI) for evaluation of neurological disorders has increased in the past two decades. This has led to an increased detection of incidental findings on brain MRI.The most common of these asymptomatic abnormalities are white matter lesions that are interpreted as demyelinating based on radiological criteria. However, in the absence of associated clinical symptoms suggestive of multiple sclerosis (MS), a definite diagnosis of MS can’t be made in patients with these incidental white matter lesions. These patients are diagnosed as CIS (clinically isolated syndrome) and RIS (radiologically isolated syndrome).Using the revised McDonald criteria now allows some patients who would have been diagnosed with CIS to be diagnosed as having MS before a second episode.

Method: Sixty one patients, 40 females and 21 males, age ranged between 15 years and 58 years, were included in our study. In addition to a detailed medical and neurological history and examination, CSF and blood analysis for oligoclonal bands and IgG index were performed for all patients.

Result: 41 patients had positive oligoclonal bands and IgG index. After clinical, MRI results and laboratory results 44 (72.1%) were diagnosed CIS and 17 (27.9%) were RIS.

Conclusion: Diagnosis of MS not depend only on MRI finding but need clinical and laboratory work up including CSF and blood analysis for oligoclonal bands and IgG index to confirm diagnosis.

 
 

07/28/2018
Case Report

Incidental findings in traditional nuclear medicine practice

Giuseppe De Vincentis, Mariano Pontico, Maria Ricci, Viviana Frantellizzi* and Mauro Liberatore

The presence of an incidental finding, defined as an abnormality which is unrelated to the initial scanning indication, is widely increases due to the access to new devices and imaging modalities. This growing number of incidental findings can lead to additional medical care including unnecessary tests nevertheless, in a minority of patients, can lead to diagnosis of an important and unexpected condition that could be crucial for the patient. We reported three cases in which nuclear medicine imaging, performed for different reasons and showed a relevant and unexpected pathology. In the case 1, a bone scan, performed in a 66 aged woman for breast cancer staging, allowed the diagnosis of a uterine fibroma. In the case 2, a HMPAO labeled-WBC scintigraphy performed because of a suspect of osteomyelitis, showed a remarkable heart-shaped photopenic area, highly suggestive of cardiac global dilatation. In the case 3, a 62 aged man referred to bone scintigraphy for the staging of recent diagnosed lung cancer. The bone scan allowed the diagnosis of a meningioma. Therefore, the occurrence of incidental findings could lead to reveal relevant abnormalities for the diagnostic pathway.  

07/27/2018
Editorial

Ocular changes and disorders associated with Obesity

Burak Turgut*

Obesity is a chronic and metabolic disease with a high increasing prevalence worldwide. It has multifactorial pathogenesis including genetic and behavioral factors [1-5]. Overweight and obesity have been defined and classified by the World Health Organization (WHO) and the National Institutes of Health (NIH) [2,3].A person with a normal weight has Body Mass Index (BMI) of 18.5-24.9. A person with a BMI under 18.5 is called underweight. An adult having a BMI of 25-29.9 is overweight and pre-obese. Class 1 obesity is defined as a BMI between 30.00-34.99. Class 2 (Severe) Obesity is to have a BMI between 35.00-39.99. Morbid (Extreme, Class 3) obesity is to have a BMI over 40 [1-5]. Obesity is significantly associated with enhanced morbidity and mortality rates. It has also various economic, medical and psychological effects and causes health problems including many systemic diseases, economic costs and burdens, social and occupational stigmatization and discrimination and productivity loss [4-6]. Obesity carries the increased risk of development of many systemic and chronic diseases, including sleep apnea, depression, insulin resistance, Type 2 (adult-onset) diabetes, Gout and related arthritis, degenerative arthritis, hypertension, dyslipidemia, heart disease such as myocardial infarction, congestive heart failure, or coronary artery disease, polycystic ovary syndrome and reproductive disorders, Pickwickian syndrome (obesity, red face and hypoventilation), metabolic syndrome, non-alcoholic fatty liver disease, cholecystitis, cerebrovascular accident, colonic and renal cancer, rectal and prostatic cancer in males, and gallbladder, uterus and breast cancer in females [6-12].

07/25/2018
Research Article

The incidence of hemodynamic and respiratory adverse events in morbidly obese presenting for Bariatric surgery

Veronica Atterhem, Magnus Hultin and Tomi Myrberg*

Context: Perioperative management of morbidly obese patients undergoing bariatric surgery is challenging. Lacking standardized perioperative protocols, complication rates may be high. This retrospective study aims to quantify the incidence of significant blood pressure decreases on induction of anesthesia and intraoperative hypoxemia, before implementation of a standardized protocol designed for bariatric surgery.

Design: Retrospective, observational study.

Setting: A 250-bed county hospital in northern Sweden.

Subjects: 219 morbidly obese patients (body mass index > 35 kg/m2) who underwent bariatric surgery between 2003 and 2008.

Main outcome measures: Incidence of systolic blood pressure (SAP) falls to less than 70% of the preoperative baseline during induction of anesthesia and incidence of perioperative hypoxemia.

Results: The incidence of confirmed SAP falls to below 70% of baseline at induction of anesthesia was 56.2% (n = 123/219). This incidence rose with increasing age (p < 0.001) but not with body mass index (BMI). 3.7% (n = 8/219) of cases were marked as difficult intubations. A transient period of hypoxemia was observed in 6.8% (n = 15/219) and was more common with increasing BMI (p = 0.005). Fourteen different drug combinations were used in the study population. Of those administered an induction anesthetic drug, 72.6% (n = 159/193) were given an overdose when calculated by lean body weight, but this did not correlate significantly to SAP falls (p = 0.468).

Conclusion: The incidence of a significant blood pressure fall upon induction of anesthesia was common. The incidence of airway and ventilation problems were low. Overdosing of anesthetics and excessive variation in applied anesthesia methods were found.

07/25/2018
Research Article

Staining susceptibility of recently developed resin composite materials

Olivier Duc, Emilie Betrisey, Enrico Di Bella, Ivo Krejci and Stefano Ardu*

Objectives: To evaluate the colour stability of 3 recently developed resin based materials continuously exposed to various staining agents.

Methods: 144 disc-shaped specimens were made of each of the 3 tested composites (Essentia, Brillant, Inspiro). Half of them were of 1mm thickness, the other half 1.2mm thickness. The thicker group was than polished up to 4000 grit and reduced to 1mm thickness, too. All specimens after 24 h dry storage in an incubator (INP-500, Memmert), received an initial colour measurement by means of a calibrated reflectance spectrophotometer (SpectroShade, MHT, Niederhasli, Switzerland). Specimens were then divided into 6 groups (n=6) and immersed in 5 staining solutions or artificial saliva (control). All specimens were kept in an incubator at 37°C for 28 days. Staining solutions (red wine, curry mixed water, curry mixed oil, tea and coffee) were changed every 7th day to avoid bacteria or yeast contamination. After 28 days of storage spectrophotometric measurements were repeated and L*a*b* scores once more recorded to determine the colour (ΔE00) changes.

Results: All tested materials showed significant color changes after 28 days staining immersion.

When considered over a black background ΔE00 of polished samples varied from 1.7 (Brillant/distilled water) to 24.1 (Brillant/wine).

When considered over a white background ΔE00 of polished samples varied from 1.1 (Essentia/distilled water) to 32.5 (Inspiro/wine).

When considered over a black background ΔE00 of unpolished samples varied from 1.1 (Essentia, Inspiro/distilled water) to 25.8 (Essentia/wine).

When considered over a white background ΔE00 of unpolished samples varied from 1.4(Inspiro/distilled water) to 33.1 (Inspiro/wine).

Conclusions: Staining of restorative materials seems to be dependent on the composition of the product itself. Unpolished samples demonstrated to be more prone to staining than the polished ones

07/23/2018
Research Article

Livestock insurance a tool to reduce economical loss of farmers from climate change related Hazards

Ananta Koirala* and Priyanka Bhandari

Climate change brings extreme events like drought, landslide, flood and anticipated more constraint to profitable livestock production causing huge economical loss in the livestock sector of the country. Deaths of livestock and damage to farms and farm infrastructure is causing a huge loss, small livestock holders are highly venerable to such climatic hazards. So to cope with these uncertain climatic hazards livestock insurance is the one of the best strategies. This study reveals that different climatic hazards is been experienced by the livestock holders of Kaski, Dolakha and Jhapa district of Nepal, 62% of the respondent has observed the change in climate. Of the total respondents perceived around 47% farmer have insured their livestock in Kaski district, 33% in Jhapa and 20 % in Dolakha district. Beside the proper vaccination, deworming, management and feeding of animals people are insuring their livestock assets due to uncertain in the climatic pattern and its consequences, this shows that livestock insurance is the one of the tool to mitigate with changing climate and climate relate hazard in livestock sector of Nepal.

07/19/2018
Case Report

Biologic therapy-Related demyelinating peripheral neuropathy in a child with Juvenile Idiopathic Arthritis

Heba A Alqurashi, Ghada Al-Salmi, Mohammad A Al-Muhaizea and Sulaiman M Al-Mayouf*

Demyelinating peripheral neuropathy has been described in association with tumor necrosis factor (TNF) inhibitors. It is rarely developed after treatment discontinuation. We present the case of a child with juvenile idiopathic arthritis who developed peripheral neuropathy few months after TNF inhibitor withdrawal with clinical worsening of the neurological sequelae while undergoing treatment with abatacept.

07/17/2018
Review Article

Role of the Kidneys in the Regulation of Intra-and Extra-Renal Blood Pressure

Seriki A Samuel*, Adebayo O Francis and Odetola O Anthony

Hypertension is one of the most common chronic diseases of human, affecting more than one billion people worldwide. When it becomes chronic, hypertension leaves behind cardiac hypertrophy, heart failure, stroke, and kidney disease, resulting in substantial morbidity and mortality. Treatments that effectively reduce blood pressure can prevent these complications. Abnormalities in the production of urine by the kidneys have been implicated in increased vascular resistance, leading to high blood pressure and increased cardiac mass. By matching urinary excretion of salt and water with dietary intake, balance is usually attained, thereby maintaining a constant extracellular fluid volume and blood pressure. Based on the capacity for the kidney to excrete sodium, this blood pressure-altering mechanism should have sufficient advantage to limit intravascular volume and consequently lower blood pressure in response to a range of stimuli from elevated heart rate to increase peripheral vascular resistance. A major determinant of the level of intra- and extra- renal blood pressure is therefore sodium handling, and it is controlled by complex physiological mechanism by hormones, inflammatory mediators, and the sympathetic nervous system. Homoeostasis and favourable influence sodium balance are a basic mechanism of efficacy for diuretics and dietary sodium restriction in hypertension. Renin Angiotensin System (RAS) inhibitors, vasodilators, and β-blockers work to facilitate pressure-natriuresis. Also, WNK signaling pathways, soluble inflammatory mediators, and pathways regulating extra-renal sodium disposition may be the focus towards elimination of sodium and reducing blood pressure in hypertension.

07/17/2018
Prospective

The Courage to implement Samplings to evaluation efficiency Medical Clinics OECD

Antonin Cuc*

We are able to test with statistic method Based Evidence Medicine the new Medicaments on common World Market or the new Medical Devices - Orthopaedic implants. Of course, with usage the same principles we could Tests similar ways the explicit efficiency, legalities and Technical Requirements Laws by Medical processing for implanting by standard Health care in Orthopaedic Clinics in network OECD.

I have been opened the new Epoche, for examples to comparison of workflow and efficiency in produce Health care in Orthopaedic Clinic OECD with authorised my Utility model 21532 CZ 2010 The Equipment for Search and Retrieval sufficient information to Mass reuse for repeated similar strategic decision making with risks and computer support.

The continual Mass produce Health care services Patients OECD in Medical Clinics could be analysed regularly with double parallely degrese levels of realised random Samplings. The first random choice of selection could be organised by the views of the randomized choice specific medical Clinics, for example defined as Orthopady Clinic in frame network OECD. And the basal first level could be defined as the elementary statistic Unit - the hospitalised orthopaedic Patient in defined finished year for description, for example in year 2016, which were hospitalised in some Orthopaedic Clinic at least the 3 days or more days.

There are no problem to define statistic Population N for year 2016 of orthopaedic Patients, recommending proportional dimension n, for example as 3% from the origin statistic population N. The main aims of analyses should be resulting the multilateral views on the medical legality and technical quality, economic Costs and Health efficiency of used standard Medical processing by the Diagnostics and Treatments and prevency risks of orthopaedic Patients in statistic comparison the Orthopady Clinics in countries OECD. We could take to statistic collections from„ the Secondary Health Patient Datas “derived by specific algorithm - from the origin living full databases Electronic Health Documentation of all hospitalised Patients in Clinics. It could be clever fulfilling enough - with specific next statistic views, with next additional small „Unique Primary Terain Samplings“ with about random in Dimension about 200 statistical Units, for example with primary medical forensic testing namely - the mortalities and heavy injuring of orthopaedic Patients in duration 10 months after surgeries realised in year 2016, or with additional statistic analyses - long being post operational locomotion and mental abilities in comparison Orthopaedic a few US Orthopaedic Clinic, and Samplings oriented on views on rest quality „Well Being“ of lives some living orthopaedic Patients with Surgeon Total Arthroplasty in 2016 - for example after probable 3 years from the orthopaedic standard primary surgeries with usage always full Anesthesy for all types Total Arthroplasty: hips, Knees, Spinal elements, so as the all causalities for inforced preliminary reoperational surgeries under limits 10 years from the primary arthroplasty surgeries. The Results of such scientist independent Samplings will be changed revolutionaire innovations of all medical praxes in workflow and managing styles in all Orthopady Clinics in network OECD!

 

 
There are no problem to define statistic Population N for year 2016 of orthopaedic Patients, recommending proportional dimension n, for example as 3% from the origin statistic population N. The main aims of analyses should be resulting the multilateral views on the medical legality and technical quality, economic Costs and Health efficiency of used standard Medical processing by the Diagnostics and Treatments and prevency risks of orthopaedic Patients in statistic comparison the Orthopady Clinics in countries OECD. We could take to statistic collections from„ the Secondary Health Patient Datas “derived by specific algorithm - from the origin living full databases Electronic Health Documentation of all hospitalised Patients in Clinics. It could be clever fulfilling enough - with specific next statistic views, with next additional small „Unique Primary Terain Samplings“ with about random in Dimension about 200 statistical Units, for example with primary medical forensic testing namely - the mortalities and heavy injuring of orthopaedic Patients in duration 10 months after surgeries realised in year 2016, or with additional statistic analyses - long being post operational locomotion and mental abilities in comparison Orthopaedic a few US Orthopaedic Clinic, and Samplings oriented on views on rest quality „Well Being“ of lives some living orthopaedic Patients with Surgeon Total Arthroplasty in 2016 - for example after probable 3 years from the orthopaedic standard primary surgeries with usage always full Anesthesy for all types Total Arthroplasty: hips, Knees, Spinal elements, so as the all causalities for inforced preliminary reoperational surgeries under limits 10 years from the primary arthroplasty surgeries. The Results of such scientist independent Samplings will be changed revolutionaire innovations of all medical praxes in workflow and managing styles in all Orthopady Clinics in network OECD!
 

07/16/2018
Research Article

Cardiovascular damage during lupus in black African subjects

Yaméogo NV*, Tougouma SJ-B, Zabsonré J, Kologo KJ, Tiemtoré WS, Kagambega LJ, Bagbila WPAH, Traore A, Samadoulougou AK and Zabsonre P

Introduction: Systemic lupus is a disseminated inflammation of the conjunctive tissue. Cardiovascular lesions are the first cause of morbidity and mortality in the course of that disease. These lesions are prevalent in 30 to 62% of cases, depending on whether the diagnostic tool is clinical, echocardiographic, or autopsic. Any part of the heart can be affected, yielding manifestations of pericarditis, endocarditis, coronary heart disease, conduction disorders, and rarely myocarditis.

Objective: Describe cardiac manifestations during the follow up of patients diagnosed with systemic lupus.

Patients and Methods: We conducted a transversal descriptive study over a period of 27 months, in the departments of Internal Medicine, Dermatology, and Cardiology of Yalgado Ouedraogo University Hospital of Ouagadougou. All patients diagnosed with systemic lupus according to the American College of Rheumatology criteria, and having done an EKG, a Holter EKG, or a transthoracic echocardiography, were included in the study. Data were collected from inpatient medical records, outpatient follow up registry and booklets.

Results: Cardiovascular lesions were prevalent in 7 cases (43.75%) out of 16 patients diagnosed with systemic lupus. Mean age of patients was 36 years, with extremes of 23 and 51 years. Only female patients were affected in our study. Cardiac manifestations were mainly benign pericarditis, heart failure, and conduction disorders.

Conclusions: Cardiovascular manifestations are frequent during the course of systemic lupus, and occur after few years of disease progression. Transthoracic echocardiography and EKG remain useful non-invasive explorations for the assessment of cardiovascular lesions, despite minor shortcomings.

07/17/2018
Case Report

Leiomyosarcoma of Maxillary Sinus – A Rare Clinical Entity

Sah BP*, Chettri ST, Karki S, Shah SP, Manandhar S and Jaiswal RK

Leiomyosarcoma is a malignant smooth-muscle tumor that has a predilection for the gastrointestinal and female genital tract and is a rare entity in the paranasal sinuses. It is locally fast-spreading and highly aggressive, and the prognosis is poor. We report a rare case of leiomyosarcoma of the maxilla in a patient who sought treatment for maxillary swelling, nasal obstruction with no epistaxis, orbital involvement or cervical lymph node metastasis. The patient underwent total maxillectomy followed by radiotherapy. At present after 5 years of follow up, he is symptom free with no recurrence.

07/24/2018
Research Article

Mindset kinetics and some depression status: A new quantitative model under biochemical - toxicology approach?

Luisetto M*, Ghulam Rasool Mashori, Behzad Nili-Ahmadabadi, Farhan Ahmad Khan and Kausar Rehman Khan

Depression: According Pubmed Health: Depression is a state of low mood and aversion to activity that can affect a person’s thoughts, behavior, feelings and sense of well-being (moderate or severe).

Can we consider some depression status due to high amount of some stressant stimulus? Or continuous stress in a limited (or long) period? How can react mindset and brain in management an high amount of negative stressing thinking? Observing some relevant literature also mindset kinetics must be considered to better classify this kind of disorder under a specific endogenous –exogenous biochemical-toxicological aspect.

Concept like Kinetics, reaction velocity limits, saturation of the systems, residual buffer properties are currently used in biochemistry and related discipline.

This concepts can be applied also in some depression condition to better explain some phenomena?

07/10/2018
Research Article

In at the deep end: Psychosocial aspects of developing autonomy in histopathology training

Finall AI

Medical postgraduate trainees are given increasing levels of responsibility during training in the apprenticeship-model of training [1-3]. Responsibility is said to be a key driver of deep learning and understanding [4-7]. Trainees with greater levels of responsibility for decision making have higher levels of motivation to learn compared with trainees who self-assess as having less autonomy [5].

07/17/2018
Review Article

Cardiovascular risk reduction: Past, present and future in Mexico

Martin Rosas-Peralta, Gabriela Borrayo-Sanchez*, Erick Ramirez-Arias, Gladys M Jimenez-Genchi, Martha Alicia Hernandez-Gonzalez, Rafael Barraza-Felix, Lidia Evangelina Betacourt-Hernandez, Rocio Camacho-Casillas, Rodolfo Parra-Michel, Hector David Martinez Chap and Jose de Jesus Arriaga-Davila

Atherosclerotic cardiovascular disease (ASCVD) is globally defined as coronary heart disease, cerebrovascular disease, or peripheral arterial disease presumed to be of atherosclerotic origin and it is the leading cause of morbidity and mortality for individuals with or without diabetes and is the largest contributor to the direct and indirect catastrophic costs of cardiovascular disorder. Very common conditions coexisting into the cardiovascular risk (e.g., obesity, hypertension, diabetes and dyslipidemia) are clear risk factors for ASCVD, and diabetes itself confers independent risk. Numerous studies have shown the efficacy of controlling individual cardiovascular risk factors in preventing or slowing ASCVD in people with these disorders. In other words it is not enough control one risk factor. We need to develop novel strategies to detect and control all of them at the same time. Thus, large benefits are seen when multiple cardiovascular risk factors are addressed simultaneously. Under the current paradigm of aggressive risk factor modification in patients with cardiovascular risk, there is evidence that measures of 10-year coronary heart disease (CHD) risk among U.S. adults with cardiovascular risk have improved significantly over the past decade and that ASCVD morbidity and mortality have decreased. In Mexico the Mexican Institute of Social Security is implementing new strategies of primary and secondary prevention in order to confront this pandemic.

In this review, we analyze the state of the art to approach at the same time the different cardiovascular risk factors, in an integral form because of this is the real worldwide challenge of health.

07/13/2018
Research Article

Agricultural Residues for Future Energy Option in Sudan: An Analysis

Abdeen Mustafa Omer*

Like many tropical countries, Sudan has ample biomass resources that can be efficiently exploited in a manner that is both profitable and sustainable. Fuel-wood farming offers cost-effective and environmentally friendly energy solutions for Sudan, with the added benefit of providing sustainable livelihoods in rural areas. This article provides an overview of biomass energy activities and highlights future plans concerning optimum technical and economical utilization of biomass energy available in Sudan. Results suggest that biomass energy technologies must be encouraged, promoted, implemented, and fully demonstrated in Sudan.

07/11/2018
Case Report

Hepatic adenomatosis: A clinically challenging rare liver disease

Sunitha Ramachandra*, Lakshmi Rao and Masoud Al Kindi

43-year-old lady presented with incidentally discovered liver lesions while she was being managed for her complaints of menorrhagia. CT and MRI showed hepatomegaly with multiple lesions in both lobes of the liver with vascular element in the background of diffuse fatty infiltration. Patient underwent laparoscopic core biopsy. Histopathology showed extensive steatosis, intracytoplasmic giant mitochondria and absence of portal tracts, features highly suggestive of hepatic adenomatosis. IHC staining showed membranous and cytoplasmic positivity in hepatocytes for B-catenin consistent with multiple hepatic adenomatosis. Hepatic adenomatosis is a new clinical entity in the hepatological practice characterized by the presence of 10 or more nodules in the liver known for its major complication of bleeding. Hepatic adenomatosis is managed by regular imaging and resection of large (> 5cm) superficial and painful adenomas along with liver function tests and tumor markers to rule out malignant transformation. However, the potential cure being the liver transplantation.

07/03/2018
Case Report

Cystic adventitial disease of the external iliac artery with disabling claudication: A case report and short review

Nalaka Gunawansa*

Chronic occlusive arterial disease of the periphery is primarily caused by atherosclerotic disease. In young patients with no identifi able risk factors for atherosclerosis, who present with symptoms of claudication or critical ischemia, other rare causes need to be suspected. Cystic adventitial disease is one such condition affecting young healthy patients. Although it has been reported most commonly in relation to the popliteal artery, other sites including the iliac artery can also get affected. Isolated short segment stenosis or occlusion can lead to signifi cant disabling symptoms restricted to one side. Imaging studies show pristine arterial anatomy with no evidence of systemic atherosclerotic disease and an isolated area of luminal stenosis. Defi nitive treatment involves open surgical excision with interposition grafting for optimal long-term results. We report a case of cystic adventitial disease affecting the external iliac artery in an otherwise healthy young man.

07/03/2018
Letter to the Editor

The Exercise continuum and the role of Doctors

Andrew Hague*

Everyone can be placed somewhere on an exercise continuum with the idle at one end and the hyperactive at the other. At both extremes, health suffers. Exercise is essential to health and managing it is the responsibility of individuals but few know what they should do. Doctors seldom teach how to be healthy and act only when repair is needed.

The Idle

In the oceans, lakes and rivers are creatures that stay in one place and water flows over them bringing food to their open mouths and removing waste from the opposite end of their bodies. Of all land animals, humans are the only creatures able to exist by the same idle method. The human brain can contrive a situation in which other humans care for idle ones and this is not about looking after a patient in bed, it is feeding an idle person who commands others. That image, perhaps of ancient kings, is seen by many to represent ultimate ambition; servants supplying all needs. The reality is that the idle one is the one that suffers and those scurrying around have more benefits.