Background: Diabetes mellitus is a common health problem in the world and Africa including Ethiopia. Its complication is the major cause of morbidity and mortality of people due to improper self-care practice. Objective: To assess self-care practices and associated factors among type 2 adult diabetic patients on follow-up clinic of Dessie referral hospital, Ethiopia. Method: Institutional based cross sectional study was conducted. Total of 278 type 2 diabetic patients was selected by systematic random sampling technique and data was collected by interviewer administered pretested questionnaire. Epidata 3.1 and SPSS version 23 software were used for data entry and analysis, respectively. In bivariate analysis, variables having a p - value of < 0.2 were entered to multivariate analysis model and statistical significance was declared at p - value of < 0.05 and 95% confidence interval. Results: The response rate was 269 (96.76%) of the total 278 participants. Among the respondents 150(55.8%) had good diabetic self-care practice. This study showed that primary school education level (AOR=2.592, 95%CI=1.104-6.087, p = 0.029), secondary school education level (AOR=3.873, 95%CI=1.325-11.323, p = 0.013), college/university graduate (AOR=3.030, 95%CI=1.276-7.197, 0.012), attended diabetic education regularly (AOR=2.981, 95%CI=1.050-8.462, p = 0.040), member of diabetic association (AOR=3.496, 95%CI=1.440-8.483, p = 0.006) and having glucometer at home (AOR=2.634, 95%CI=1.357-5.111, p = 0.004) were significantly associated with diabetes self-care practice. Conclusion: Nearly half of diabetic patients had poor self care practice. Hence, there is a need to improve diabetic self-care practice. Attention should be given by policy makers, Dessie referral hospital, health care professionals, diabetic associations and researchers.

Background: Popliteal artery aneurysms (PAAs) are rare, but the diagnosis should not be missed because of the limb and life threatening complications. The purpose of this study was to reach a consensus about the management of PAA based on our own experience and the available literature. Materials and Methods: This is a retrospective analysis of all patients who underwent an open surgical PAA repair at our institution from January 2015 to December 2016. Demographic data, risk factors, clinical presentation, aneurysm characteristics, type of repair and results were reviewed. Results include patency and major complications. Results: Seven patients underwent an open surgical PAA repair (six men). Median age was 72 years. A posterior approach (PA) was chosen four times and a medial approach (MA) was chosen three times. We performed six resections with interposition of a graft and only one ligation with a bypass. Five patients recovered well, did not develop any complication and did not need a second intervention to guarantee patency. These patients underwent a resection of the aneurysm and interposition of a graft (four via a PA and one via a MA). One patient treated by resection and interposition of a Dacron graft via a MA underwent an above-the-knee amputation at postoperative day 14. This patient had a preoperatively dysfunctional leg since several months with no patent outflow vessels. Our patient treated by ligation and bypass via a MA, developed an acute ischemia four months postoperatively because of an extreme flexion of the knee during several hours while watching TV. After unsuccessful trombolysis, he underwent a femorotibial bypass and a partial forefoot amputation. No long-term results are yet available. Conclusions: In our opinion, open surgical repair of PAAs by resection of the aneurysm and interposition of a venous graft has the best results. Depending on the relation to the knee joint and thus the accessibility of the aneurysm, a posterior approach is preferred. We are not convinced of endovascular techniques in the treatment of popliteal artery aneurysms

According to recent guidelines, endovascular angioplasty is the standard treatment for TASC A and B primary aorto-iliac occlusive (AIOD) disease, and the first-line approach for TASC C lesions [1,2]. Extended TASC D occlusive disease is usually treated by open surgery yielding excellent patency rates at a cost of a higher mortality (2%-4%) and a severe morbidity (up to 10%) [3]. However, several studies have reported promising results after endovascular treatment of extensive AIOD and full reconstruction of the aortic bifurcation [4,5]. In a recent meta-analysis, Jongkind et al., concluded that endovascular treatment of extensive AIOD can be performed successfully by experienced interventionists in selected patients [6]. Although primary patency rates seem to be lower than those reported for surgical revascularization, reinterventions can often be performed percutaneously yielding a secondary patency comparable to surgical repair.

Purpose: The purpose of the study was to examine the health status of rural adolescents and young adults in the United States through a comprehensive review of detailed health information, behavior and health awareness. The disparity in health awareness between rural and non-rural residents compared and evaluated. Methods: Rural-Urban Commuting Area (RUCA) codes were combined with respondent-level data from the Longitudinal Survey of Adolescent to Adult Health (Add Health) to classify individuals as rural/non-rural residents. Health characteristics and perceived health awareness was tested for statistically significant differences using ANOVA. Differences in weight perception accuracy was compared for systematic differences controlling for self-selection into rural areas using a two-stage logistic selection model. Findings: Analysis revealed that rural residents have a higher incidence of major health conditions including epilepsy, high cholesterol, high blood pressure and diabetes. Additionally, they have a higher prevalence of unhealthy behaviors including drinking and drug use. Rural residents are less likely to be insured, but more likely to be overweight or obese. While rural adolescents are more likely to mis-classify their body weight, this misclassification is a result of the higher incidence of overweight rather than the residential location. Conclusion: The higher prevalence of chronic conditions combined with the income and education levels suggests the rural environment is a unique and potentially challenging context for adolescent health. Improving rural adolescent health will require innovative solutions appropriate for rural environments and changes in individual health literacy. Solutions must be multisectoral, engaging education, economic development, and other community perspectives to establish key drivers for health equity.

This opinion paper provides a summary of the current reconstructive surgical techniques for the scapholunate interosseous ligament (SLIL) and critically highlights their benefits and shortcomings. Due to limited success with direct repair of the ligament, current practice focuses on achieving biomechanical stabilization and does not allow for tissue regeneration to occur. In addition, the biomechanical behaviour of the ligament is still poorly described and understood, resulting in a very large variation in published mechanical parameters. Therefore, a thorough understanding of the biomechanics of the joint, via both experimental testing and numerical modelling is necessary for enabling the design of the next generation of implants in order to address mechanical stabilisation and regeneration.

Background: Corona virus disease is a highly infectious disease caused by the newly innovated corona virus. An emerging respiratory disease was abbreviated as COVID-19, after it has been first reported in December 2019 in Wuhan city of China. Ethiopia Ministry of health initiated multidisciplinary approach to tackle COVID-19 of which awareness creation is the main. The aim of this study is to assess knowledge, practice and associated factors towards prevention of novel corona virus among clients in Debre Tabor general hospital, Northwest Ethiopia, 2020. Methods: Institution based cross sectional study design was conducted in Debre Tabor General hospital from May 15 to May 30, 2020. A structured questionnaire was used for data collection. The data were entered into epi data version 4.4 and exported to SPSS window version 25 for analysis. Binary and multivariable logistic regression was fitted. Odds Ratios with 95% Confidence interval and p - value ≤ 0.05 were considered to assert significance. Result: A total of 345 clients were analyzed and the response rate was 96.4%. The mean age was 32.95 with S.D ± 13.18 years. Majority of the respondents were male (75.7%). Among the study participants 54.2% with (95% CI: [49.0, 59.2%]) and 49.0% with (95% CI: [43.5, 53.4%]) have good knowledge and god practice on COVID-19 preventions respectively. Sex AOR: 4.33 (2.06, 9.09), family size AOR: 2.49 (1.01, 6.15 and heard from social media AOR: 2.78 (1.21, 6.39) were significantly associated with knowledge of respondents. Knowledge AOR: 3.11 (1.59, 6.10) was significantly associated with practice of clients. Residency and those heard from TV were significant variables for both. Conclusion and recommendation: In this study the overall knowledge and preventive practices of the respondents were found to be low. Sex, family size, residency and sources of information were associated factors for knowledge. In addition to this knowledge was significant factor for practice. Health education programs aimed at mobilizing and improving COVID-19 related knowledge and practice intend to be strengthened.

Background: The endemic nature of poliomyelitis in Nigeria was a source of concern to many given the global efforts aimed at eradicating the scourge. In this study, the factors that influenced the eradication of this malady in South-South Nigeria (Akwa Ibom and Cross River State) were investigated. Four null hypotheses, drawn on these factors (including culture belief, religious difference, language and the prevalence of ethnic conflict) guided the investigation. The main thrust of this study was to examine how socio-cultural factors negatively influenced the eradication of polio in the study area. Methods: Through stratified random and purposive sampling techniques, 600 adult men and women who had children were selected for the study. A structured questionnaire constructed by the researcher was used in data collection. Data analysis was carried out using one-way ANOVA and independent t-test statistical tools. Results: The findings were that cultural belief and religious affiliation exerted significant influence on the people’s effort towards polio eradication. Conclusion: The study indicated that the low use of health services by the people was brought about by variation in these variables. Among other things, it was suggested that continuous awareness campaigns be carried out to educate the people on the need for immunization anchored in science and technology.

The morphological evolution kinetics and instabilities of alpha helical peptide 3.613, which involves large amount of stored torsional elastic deformation energy (3-40 eV/molecule), is formulated by the variational method based on the connection between the rates of internal entropy production and the changes in the global Gibbs free energy, assuming that one has isobaric irreversible processes under the isothermal conditions. The present mesoscopic nonequilibrium thermodynamic approach relies on the fact that the global Gibbs free energy of helical conformation involves not only the bulk Gibbs free energy of the amino-acid back bone structure but also the interfacial Gibbs free energy of the enclosing cylindrical shell or the cage associated with the side-wall molecular branches, and their interactions with the immediate surroundings. The proposed variational analysis applied directly on the proposed macro-model has furnished a nonlinear integral equation in terms of the normalized and scaled internal and external variables. This allows us to track down the motion of the total pitch height of the alpha polypeptide along the well-defined trajectories in the displacement-time space, dictated not only by the initial configuration of the helix but also through the gradients of the global Gibbs free energy of the strained helical conformation as the main driving force. In the negative manifold, there is a well-defined region below the dynamic instability regime, in which the helical conformation can evolve towards the nonequilibrium stationary states by expanding, or contracting, depending upon whether the interfacial free energy and/or the applied stress system are below or above the well-defined thresholds level dictated by the initial pitch height. The highest life time may be realized along that trajectory, which follows up the threshold level of the interfacial specific Gibbs free energy, which is gs = -315 erg/cm2. In the upper region of the negative manifold, the helical conformations are driven by the very large applied uniaxial tension or the negative pressure induced by the thermal expansion, in the range of p > 1GPa and/or the strong negative interfacial free energies [3-4 pH] or their combinations, they show strong kinematic instabilities, which can cause not only the accelerated unfolding phenomenon but also cause large extensions that end up with the catastrophic decimations by ruptures and fragmentations. In the positive manifold, the aging behavior of the polypeptide follows up a S-shape path having rather speedy aging behavior compared to the negative manifold, which is separated from by a well-defined boundary, which represents the isochoric path having longest relaxation times, which can be achieved with great stability. Finally, one could attempt to estimate the upper limit of the relaxation time of aging for the modern hominin, from samples of exceptional preservations, relying on the present nonequilibrium theory as well as on the very limited knowledge on the post-mortem DNA and the present pitch heights of the modern hominin, which is found to be about 25,840 yrs, with a life expectation of 451,800 yrs. These figures are very close to those calculated for Neanderthals (SH), which are found to be 31,820 yrs and 499,100 yrs, respectively.

The Human three-dimensional (3D) musculoskeletal model is based on motion analysis methods and can be obtained by particular motion capture systems that export 3D data with coordinate 3D (C3D) format. Unique cameras and specific software are essential for analyzing the data. This equipment is quite expensive, and using them is time-consuming. This research intends to use ordinary video cameras and open source systems to get 3D data and create a C3D format due to these problems. By capturing movements with two video cameras, marker coordination is obtainable using Skill-Spector. To create C3D data from 3D coordinates of the body points, MATLAB functions were used. The subject was captured simultaneously with both the Cortex system and two video cameras during each validation test. The mean correlation coefficient of datasets is 0.7. This method can be used as an alternative method for motion analysis due to a more detailed comparison. The C3D data collection, which we presented in this research, is more accessible and cost-efficient than other systems. In this method, only two cameras have been used.

Advances in metagenomics have facilitated population studies of associations between microbial compositions and host properties, but strategies to minimize biases in these population analyses are needed. However, the effects of storage conditions, including freezing and preservation buffer, on microbial populations in fecal samples have not been studied sufficiently. In this study, we investigated metagenomic differences between fecal samples stored in different conditions. We collected 46 fecal samples from patients with lung cancer. DNA quality and microbial composition within different storage Methods were compared throughout 16S rRNA sequencing and post analysis. DNA quality and sequencing results for two storage conditions (freezing and preservation in buffer) did not differ significantly, whereas microbial information was better preserved in buffer than by freezing. In a metagenomic analysis, we observed that the microbial compositional distance was small within the same storage condition. Taxonomic annotation revealed that many microbes differed in abundance between frozen and buffer-preserved feces. In particular, the abundances of Firmicutes and Bacteroidetes varied depending on storage conditions. Microbes belonging to these phyla differed, resulting in biases in population metagenomic analysis. We suggest that a unified storage Methods is requisite for accurate population metagenomic studies.

Due to the urgent need for water in all parts of industrial or developing societies, water supply, and transmission facilities are suitable targets for biological risks. Given that even a short interruption in water supply and water supply operations has a great impact on daily activities in the community, the deliberate contamination of urban water resources has irreparable consequences in the field of public health, and the economy of society will follow. Unfortunately, most officials in the public health control departments in our country have received limited training in detecting accidental or intentional contamination of water resources and dealing with the spread of waterborne diseases both naturally and intentionally. For this reason, there is low preparedness in the responsible agencies to deal with waterborne diseases during biological risks. In the first step of this research, a review study has been conducted on water biological risks and operational strategies to deal with them. In the following, it has studied how Escherichia coli (E. coli) bacteria spread in aqueous media. In this regard, the kinetic model of the studied microorganism was analyzed based on the implementation of (Fick Law) in polar coordinates and the combination of (Dirac Distribution) with (Legendre polynomial) distribution. Finally, after studying the factors affecting the microbial pollutant emission coefficient, the effects of all three factors of linear velocity, linear motion time period, and angle of motion on the pollutant emission flux and biofilm diffusion time in the water supply network environment were investigated. Studies have shown that the linear velocity parameter of Escherichia coli with a nonlinear relationship has the greatest effects on the release of microbial contaminants.

The research concerning a preventive treatment of an osteoporitic femoral neck fracture started in 1990 because the surgical procedure of unstable femoral neck fractures is difficult. After effects are frequent and their number will increase in the next decade. The goal is to reinforce the femur with a biomaterial acting as a bone graft. Natural coral is bioresorbable and biocompatible. It acts as an autofocus bone graft for reconstruction of either cortex or cancellous bone and increases their mechanical resistance. This work shows evidence of new bone formation in an osteoporotic unbroken femoral neck femur. Consequently, the preventive surgical treatment of osteoporosis should be taken in consideration [1]. The purpose of this work is to show the results on the mineralization of the cancellous bone of an upper femoral metaphyses when a natural biomaterial is set in an unbroken osteoporotic femoral neck. Summary: Mrs. L is an 84 years old lady. Her osteoporotic unbroken right hip was grafted preventively with a biomaterial in order to prevent the high risk of break in case of fall. The biomaterial used is beads of natural coral. The reasons of this preventive treatment is discussed, as well as the choice of the biomaterial. The results are shown including a two years follow up. Brief History: Before going further, few words of history. Three centuries BC, an Aristote’s follower, Théophraste thinks that Natural coral is a petrified plant. For Ovide natural coral is a soft alga air-hardening. Al Biruni classes it among animals, because that respond to touch. At the beginning of the XVIIth century, Marsigli thinks that they are flowers which open out there in aquarium. The French Jean-André Peyssonnel, a young naturalist, says as Biruni, that in fact, corals are animals. At last, Buffon claims: These marine plants, were classified first in the rank of minerals, then in those of plants, and finally in that of animals. Natural coral is obviously an animal. After the Second World War, coral samples were analyzed by American scientists. Among 800 corail species, 3 where specially analyzed: Acropora, Porites and Libophylia. Mrs Nane Guillemin did in France her PHD on natural coral and with her team made a complete fundamental analysis (physical, chemical and biological properties) of the material, while the American scientists worked on the chemical bone’s properties. In France, Pr Ohayoun and his team worked on the surgical application in the dental field, Dr. Yves Cirotteau in the orthopedic surgery, specifically for osteoporotic disease and for the traumatologic field

Summary: Myelodysplastic Syndrome (MDS) is a heterogeneous group of clonal hematopoietic malignancies characterized by progressive cytopenias, ineffective hematopoiesis, bone marrow hypercellularity and transformation to acute myeloid leukemia (AML). Objectives: Identify plasma proteins from MDS patients and from two healthy controls groups (young and elderly) by SDS-Page. Methods: Plasma from 08 healthy young, 08 healthy elderly and 08 MDS patients were used for this study. Proteins were fractionated, precipitated, used for SDS-PAGE gel analysis, stained with comassie brilliant blue, scanned and bands were analyzed. Results: It was possible to identify in both, 20% fraction and supernatant, proteins that were differentially expressed in each group. The ones that have showed some clinical relevance. Fibronectin was highly expressed only in the young control group. α2-Macroglobulin was also expressed in both control groups, but it was not expressed in the MDS group. Haptoglobin was highly expressed only in the elderly control and SMD groups. Conclusion: Protein expression in plasma can be a biomarker for MDS, and may play a key role in the process of aging and hematologic malignancies development.

In 2013, the World Health Organization (WHO) reported that small, pet turtles had caused multistate Salmonella outbreaks in the United States, from where small turtles were subsequently exported into the Republic of Korea. We investigated cases of salmonellosis in South Korea associated with domestic small turtles and analysed genetic characteristics of Salmonella isolates in commercially-available small turtles. We traced six Salmonella serovars, known to have caused human infection in the United States (S. Sandiego, S. Pomona, S. Poona, S. Newport, I 4,(5),12:i:-, and S. Typhimurium), in isolates from suspected Salmonella infection cases in Korea from 2006 to 2015. Additionally, we conducted a pilot study of isolates from small turtles being sold in Korean markets, and performed molecular genetic analysis on the identified strains. S. Pomona was identified in one Salmonella infection case, while all strains isolated from small turtles belonged to either subspecies I (enterica, n = 10, 71.4%) or subspecies IIIb (diarizonae, n = 4, 28.6%). Two serovars (S. Pomona and S. Sandiego) that were highly associated with turtle-to-human transmission were identified with 100% homology to human isolates. Previous to this study, turtle-associated human S. Pomona infections were not well reported in Korea. We report Salmonella infection in small turtles in Korea, and confirm that small turtles should be considered the first infectious agent in S. Pomona infection. We therefore suggest quarantine measures for importing small turtles be enhanced in Korea.

We interviewed 207 pig raisers from seven different districts of Bangladesh to explore their practices related to their pig farming. We used structured questionnaires to interview the pig raisers and used descriptive statistics for analysis. Most of the pig raisers (54%) were illiterate. 50% (104) of them had a monthly income of less than 10000 BDT and 60% (124) were landless. Most of the pig raisers (92%, 191) were rearing local breed and 67% of them were practicing semi-scavenging system. As feed source 55% (114) pig owners used kitchen waste and 54% (111) used rice husk. The pig raisers mentioned different types of challenges such as social problem (16%), disease (50%), less profitable (20%) and unavailability of feed (19%). In our study, we found that 31% respondents visited veterinarians, 28% visited quack and 21% do not take any action when their pigs were sick. Only 16% pig raisers used vaccines against different infectious diseases and 36% used anthelmintics against parasitic diseases. Awareness buildup of the pig raisers may help them raising pigs in a better way which will improve the farming system and reduce the probability of disease transmission.

Currently brain connectivity modelling, constructed from data acquired by non-invasive technique such as functional magnetic resonance imaging (fMRI), is a well-received approach to illustrate brain function. However, not all connectivity models contains equal amount of information. There are two types of connectivity model that could be constructed from fMRI data, functional and effective connectivity. Effective connectivity includes information about the direction of the connection, while functional connectivity does not. This makes interpretation of effective connectivity more meaningful than functional connectivity. The objective of this study is to show the improvement in interpretability of effective connectivity model in comparison to functional connectivity model. In this study, we show how the difference in the information contained within these two model impacts the interpretation of the resulting connectivity model by analyzing resting-state fMRI data on episodic memory-related cognitive function using CONN Toolbox bivariate correlation measurement for functional connectivity analysis and Tigramite causal discovery framework for effective connectivity analysis on an episodic memory related resting-state fMRI dataset. The comparison between functional and effective connectivity results show that effective connectivity contains more information than the functional connectivity, and the difference in the information contained within these two types of model could significantly impact the intepretation of true brain function. In conclusion, we show that for the connectivity between specific pair of brain regions, effective connectivity analysis reveals more informative characteristic of the connectivity in comparison to functional connectivity where the depicted connectivity lack any additional characteristic information such as the direction of the connection or whether it is a unidirectional or bidirectional. These additional information improve interpretability of brain connectivity study. Thus, we would like to emphasis the important of brain function study using effective connectivity modelling to obtain valid interpretation of true brain function as currently a large body of research in this field focuses only on functional connectivity model.

The authors present the case of a 45-year-old female patient with diabetes and chronic kidney disease (CKD). She had unsatisfactory glycemic control, and showed some intellectual limitations. Her urine exam was unremarkable, and her renal ultrasound revealed single right kidney with aspects suggesting ureteropelvic junction syndrome. Her mother had also suffered from diabetes and CKD G5D presenting in the sixth to seventh decade. An hereditary cause for CKD was considered, which led the authors to investigate an autosomal dominant cause for CKD with a tubulointerstitial phenotype, taking into account the personal and family history for diabetes and also the renal imaging; a large deletion in the HNF-1β gene was identified through Multiplex Ligand Probe Assay (MLPA) analysis, explaining the phenotype. Genetic causes of CKD should be considered in the presence of positive family history for CKD, and the coexistence of diabetes with bland urine sediment should raise the possibility of a syndromic cause of the phenotype, namely involving HNF-1β gene mutations or deletions. 

Introduction: Neurocysticercosis (NCC) is a common helminthic infection of the nervous system that occurs when humans become intermediate hosts in the life cycle of the pig tapeworm (Taenia solium) after ingesting its eggs. The objective of this study was to analyze socio-demographic, clinical and paraclinical features of patients with NCC in Lubumbashi, DRC. Methods: This is a cross-sectional study conducted over a period of 2 years within the Neuropsychiatric Center of Lubumbashi. Socio-demographic, clinical, paraclinical and therapeutic features were studied. Results: A total of 18 patients with NCC were listed. Epilepsy was found in 72.2% (13/18) of the cases. The mean age of the patients was 30.2 ± 13.5 years; males accounted for 61.2% of the cases. 84.6% were consumers of pork. Generalized epilepsy was found in 84.6% of the cases and hypereosinophilia in 38% of the cases. On the neuroimaging, the parietal location of lesions represented 92.3%; calcifications were the type of lesion in 53.8% of the cases and 69.2% of the cases presented lesions in the 4th evolutionary stage. Electroencephalogram was normal in 84.4% of the cases. Phenobarbital was the antiepileptic drug used in 69.3%; albendazole and prednisone were used in 53.9% of the cases. Conclusion: This study shows that NCC is one of the causes of epilepsy in Lubumbashi. Generalized tonic-clonic seizures are the most common form of presentation and calcified parenchymal lesions are the most common radiological feature of NCC. So, any patient with acute onset of afebrile seizure should be screened for NCC provided other common causes been ruled out.

Sleep related breathing disorders (SRBD) are among seven well-established major categories of sleep disorders defined in the third edition of The International Classification of Sleep Disorders (ICSD-3), and Obstructive Sleep Apnea (OSA) is the most common SRBD [1,2]. Several studies have demonstrated that obstructive sleep apnea treatment increases the quality of life in OSA patients [3-8]. Indeed, excessive daytime sleepiness (EDS), cognitive impairment (e.g., deficits in attention-concentration, memory, dexterity, and creativity), traffic accidents, and deterioration of social activities are frequently reported in untreated patients [9-11]. Furthermore, an increase in cardiovascular morbidities and mortality (systemic hypertension, stroke, cardiac arrhythmias, pulmonary arterial hypertension, heart failure) [12], metabolic dysfunction, cerebrovascular ischemic events and chemical/structural central nervous system cellular injuries (gray/white matter) has been reported in OSA patients [13-17].  Continuous positive airway pressure (CPAP) therapy is considered the gold standard for treatment of moderate-severe OSA, nevertheless there is an increasing body of evidence supporting the usefulness of mandibular advancement devices (MADs) for improving quality of life and respiratory parameters even among patients with a high severity of OSA burden [5,10,18,19]. According to the standard of care of the American Academy of Sleep Medicine (AASM), MADs are indicated for mild to moderate OSA particularly in the context of CPAP intolerance or refusal, surgical contraindication, or the need for a short-term substitute therapy [9,15,20-22]. In Cuba, CPAP machines are not readily available; they are expensive and the majority of OSA patients cannot obtain this mode of therapy. Taking into account this problem, our hypothesis was based in the scientific evidences of MAD effectiveness, considering that low cost MADs could offer a reasonable alternative treatment for patients with OSA where CPAP technology are not handy. In this way our purpose was to assess the efficacy of one of the most simple, low cost, manufactured monoblock MAD models (SAS de Zúrich) in terms of improvements in cerebral function, sleep quality and drowsiness reports in a group of Cuban OSA patients with mild to severe disease. Outcome measures included changes in the brain electrical activity, sleep quality, and respiratory parameters, measured by EEG recording with qEEG analysis and polysomnographic studies correspondingly, which were recorded before and during treatment with an MAD, as well as subjective/objective improvements in daytime alertness. 

A 61-year-old Brazilian black woman consulted with a nephrologist due to proteinuria identified on a routine urine test. She has a personal history of thymoma resection five years ago, followed by multiple episodes of pulmonary infections including mycobacteriosis, recurrent mucocutaneous candidiasis, and paraneoplastic pemphigus. Physical examination showed no edema or hypertension and laboratory tests identified proteinuria of 2.43 g/day without hematuria, serum creatinine of 0.69 mg/dl, urea 34 mg/dl, serum albumin of 2.4 g/dl, hemoglobin 10.9 g/dl, platelets 292,000/mm3, leukocytes 4950/mm3, lymphocytes 594/mm3 and neutrophils 3910/mm3. The hemolysis tests were negative and serum iron was low. Analysis of glicemia and serum lipids levels were normal as well as serum complement and imunoglobulins, except for an IgM level of 283 mg/dl (normal values 40 to 230 mg/dl) and undetectable IgE. Serologies for Syphilis, HIV, hepatitis B, C and antibodies for autoimmune diseases were negative.