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Anti-glomerular basement membrane (GBM) antibody glomerulonephritis is an extremely rare glomerular disease. Around 90% of the patients are positive for serum anti-GBM antibodies while up to 10% can be negative. In such patients, only a kidney biopsy can reveal the anti-GBM disease it is then labeled as an atypical anti-GBM disease. Though anti-GBM disease can be associated with Anti Neutrophil Cytoplasmic Antibodies (ANCA) positivity, it is extremely rare to find atypical anti-GBM with ANCA positivity so much so that till now there are very few such cases reported from across the world.The case presented here is one such case where the patient presented with adult-onset nephrotic syndrome features with active urinary sediments and mildly deranged renal function. Myeloperoxidase (MPO) ANCA was positive and it was considered ANCA-associated crescentic glomerulonephritis (GN) but after the renal biopsy the picture was of anti-GBM disease. She was treated with pulse methylprednisolone but her creatinine increased in the meantime and considering anti-GBM she was put on Plasma Exchange (PLEX). She received 5 sessions of PLEX after which her renal function improved. She was also planned for Rituximab which could not be given due to local infection. As there are no protocols for treating such cases because of the extremely rare nature of the presentation, this case will increase the understanding of such presentations for the clinicians. This will help to plan for building the approach for such cases.

Syringomyelia in combination with inherent or acquired hindbrain abnormalities is the non seldom and at the same time controversial issue. Purpose: The etiology and pathogenesis creates a lot of discussion. Methods: Experimental syringomyelia was induced in 20 anesthetized rabbits by injecting 0.5 ml of 25% kaolin suspension into the cisterna magna. Six rabbits with puncture and injection sterile saline NaCl were used as a control. The animals were sacrificed 1, 2, 4 and 6 months after the kaolin injection. Four hydrocephalus rabbits were sacrificed in 17 hours after the puncture of lateral ventricle with injection of solution of colloidal gold labeled human albuminum. The sections of the brain and spinal cord were stained with hematoxylin and eosin by Nissle and Marchi methods and with immunogold technique. Retropharyngeal lymph nodes of the animals were examined by electron microscopy. Conclusion: Our observation showed that water hammer effect and internal destruction of the spinal cord may lead to continuous antigen stimulation of regional lymph nodes and play an important role in pathogenesis of experimental syringomyelia.

Chronic kidney disease (CKD) is a highly prevalent disease, imposing high mortality rates worldwide, and it is closely related to cardiovascular events. Vitamin D deficiency is very prevalent in patients with CKD from the earliest stages of the disease, and it has been associated with higher mortality. In order to assess the prognostic implications of vitamin D deficiency in CKD, we undertook a literature review, searching different databases in October 2018 for publications related to vitamin D in patients with CKD and hypovitaminosis D, and not on dialysis. The main cause of death in these patients is cardiovascular disease. Vitamin D is one of the first parameters that CKD changes and has an important prognostic role in this entity. Deficient levels in blood are associated with increased cardiovascular risk and survival impacts, independently of cardiovascular disease. Treatment with paricalcitol appears to reduce this risk. However, the evidence analyzed is insufficient to establish an association between vitamin D levels and the progression of kidney disease. 

Background: Today’s older adults are often well informed and want to participate in decision-making processes. The coordinated individual planning process offers them active involvement in deciding and owning how their care will be managed. Aim: The aim of the study was to explore active older adults’ knowledge and views regarding coordinated individual planning. Methods: The study has an exploratory inductive approach. Five focus-group discussions were conducted with 40 participants from different organizations and associations. A qualitative interpretive description framework was used, and the analysis resulted in four unique themes. Results: The four themes resulting from the analysis are collaboration and continuity, participation and involvement in decision, individual need for support, and access to information and service. Collaboration between different levels of the healthcare system and between professionals is crucial. Older adults wanted to be participating actors in their healthcare. They worried about the lack of continuity and thought that services were not responsive or did not meet individuals’ needs. Conclusion: Older adults want their views and preferences to be taken into consideration, and they want to be actively engaged in the decision-making process regarding their care.

Phytoplasmas belong to the parasitic group of mollicutes, which represent a phylogenetically coherent group of pathogens that colonize a wide spectrum of hosts and insects [1].

Typhoid fever is a systemic infection caused by Salmonella enterica serotype typhi. It is of major concern in tropical regions of the world. Highest episodes of typhoid fever occur in Asia i.e.93%. Early diagnosis of the disease is mandatory to lower the mortality rate associated with it as well as to prevent the emergence of antimicrobial drug resistance by Salmonella typhi. Research work was conducted in Immunology Department of the Children’s Hospital, Lahore for the period of one year including a total of 60 patients suspected of having typhoid fever. Serum samples of these patients were tested for typhidot IgG and IgM antibodies as well as for the antibodies against TO and TH antigens using Widal test. Of the total 60 patients, 10 (16.7%) were positive for both typhidot IgG and IgM, 16 (26.7%) were positive for typhidot IgM, 3 (5%) were Positive for typhidot IgG and 31 (51.66%) were negative for both typhidot IgG and IgM. Reading the results of Widal test, 8 (13.33%) were positive for Widal TO and TH antigens, 3 (5%) were positive for Widal TO antigen, 19 (31.7%) were positive for Widal TH antigen and 30 (50%) were negative for Widal TO and TH antigens. IgM is positive at the early stage of acute typhoid fever, IgM along with IgG positive means the middle stage of acute illness. The detection of only IgG cannot discriminate between acute and convalescent phases as it can stay in the serum for at least 2 years or more. The typhidot test is much helpful for the rapid diagnosis of typhoid fever as compared to Widal test which is still being used in some set ups in poor countries, although has become mostly obsolete. By testing the rise of IgM and IgG antibodies against Salmonella typhi, we can detect the infection at early and late stages, respectively

Obesity is a multifactorial epidemic disease of environmental origin that affects subjects of all countries and whose origin is not in the stomach or intestines. Surgical treatment represents a unique case of surgery for operating healthy organs, which are not the cause of the disease and do not improve after the operation. Kremen and Linner [1] and Varco and Buchwald teams of in Minneapolis, MN began the intestinal deviation (ID) of malabsorption in 1954. Payne [2] and Scott [3] developed these ID techniques in the 1960s leaving only 14- 4 inches (35 -10 cm) as an absorption zone and were abandoned in the 1970s due to its serious metabolic (malnutrition) and liver complications (liver failure).

Background: The measures are being put in place for the management of Hepatitis B virus (HBV) infection in Hargeisa, Somaliland among pregnant women remain the most vulnerable to develop chronic hepatitis. Routine screening in pregnant women is therefore necessary for effective control. However, the performance of the commonly used the HBsAg sero test strips has been available. Also, identifying the risk factors of transmission in pregnant women is importance for the implementation of preventive measures. Hence, the goal of this study was to determining seroprevalence and associated risk factors with HBV infection among pregnant women. Material & Methods: The study area was carried out at Hargeisa group hospital in Somaliland from May 2018 up to December 2018. The researcher was collected research pregnancy woman data through questionnaire & used diagnostics methods such as Hepatitis B surface antigen (HBsAg) test, antibodies test (HBsAb) by used anti-card test and ELIZA system. In order to find specific full information’s about patients & relationship the associated risk factors with hepatitis B in pregnancy. Data processed and analyzed by used both words and SPSS package. The sample size investigated was 80 patients. Of these, 28 were excluded; among the reasons for exclusion were prior HBV vaccination and known HBsAg sero-positive status. Aims of Study: The study was designed & aimed to determine seroprevalence and associated factors of HBV infection among pregnant women. To assess and establish if there is significant relationship between blood transfusion and hepatitis B virus at Hargeisa group hospital (HGH). Results and Discussion: The results in the current study shown that the pregnancy with hepatitis BV and it relation with appeared some symptoms in our study was 24(46.15%) of patients appeared they have cirrhosis symptom, 12(23.08%) of patients answered they have liver failure, while 9(17.31%) of patients appeared yellowish of eyes & skin and 5(9.62%) showed hepatic cancer. Overall, HBV prevalence: HBsAg was detected in fifteen 15(31.3%) of the participants while all fifteen (100%) had total HBcAb (both IgM and IgG). Of the HBsAg sero-positive women, 26(42.7%) were positive for HBeAg; eight (13.3%) were positive for HBeAb and four 4(9%) were negative for both HBeAg and HBeAb which was close similar with other previous studies. On the other hand, We found identify statistically significant p-values < 0.05 and high relationship between HBV and some demographic and clinical risk factors such as blood transfusions, levels of knowledge about HBV infection in addition to age and marital status. Conclusion: The results of this study showed that the seroprevalence of HBV infections in pregnant women and it relationship with blood transfusion in Hargeisa Group Hospital, Hargeisa, Somaliland is high. However, further studies are needed to assess the role of other demographic and clinical risk. Urgent action is required to improve hepatitis B infection control measures to reduce dependence on blood transfusions and make new policies for treatment of anemia in HGH

Clinical physicians believe they are drowning . . . because they are! Between complying with an ever-changing landscape of time-wasting federal regulations, avoiding Health Insurance Portability and Accountability Act violations, plus the entire billing process, who can keep up with the literature, study a patient’s medical history, or even talk with a patient?!? 

The question raised in the title of this letter is a natural consequence of the findings and conclusions that have been growing steadily in recent years regarding the results of treatment for acute pneumonia (АР). If you look at the publications of recent years in this field of medicine, it turns out that one of the main obstacles to progress in improving the results of treatment of this disease is the lack of appropriate methods for determining the pathogen. Thus, the lack of timely diagnostic information about the etiology of the disease excludes the possibility of targeted antibiotic therapy. In recent years, such regrets have become more and more relevant, playing the role of the main explanation for treatment failures .Continuing to narrow the unidirectional view of the problem and to pay attention only to the microbial factor as the main cause of the disease, such views are in fact another illusion, which, even in the case of its hypothetical implementation, will not make significant changes in the overall trend. This statement is easy to verify if you rely on well-known facts, and not use as arguments assumptions and guesses.