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A 60-year-old man presented with an unusual history of lower limb flushing. A CT scan suggested a pancreatic neuroendocrine tumor. After a robotic distal pancreatectomy, his symptoms completely resolved. The tumor was positive for synaptophysin and chromogranin. This case emphasizes the importance of recognizing atypical features in patients, especially with an unusual skin presentation that might indicate rare tumor types.

Hypertension (HTN) is a widely prevalent disease across the globe. Recent reports from National Health and Nutrition Examination Surveys (NHANES) indicate that the prevalence of HTN is 29% in adults more than 18 years in the US [1]. This is about 72 million adults. Worldwide, about 1.3 billion people are affected by HTN [2]. This number is projected to increase several-fold in the coming years. Given the huge burden of this disease to the healthcare system and the many deleterious effects that can result from uncontrolled HTN, we need strong guidelines to manage the same. The recently published 2017 ACC/AHA guidelines [3] on hypertension management are very meticulous and include a comprehensive stepwise approach in treating hypertension. Here we present a summary of the major changes and a concise review of the new guidelines.

Background: Orthoses need to support physiotherapy as well as surgical treatment. Related to patient’s rehabilitative goals and pathological gait pattern, orthotists have to produce an orthoses that using an adjustable ankle joint system with preloaded disc springs can store the energy brought in by the body weight and produce a tuning effect on patient’s gait and sense of balance. The purpose of this study was to establish how a personalized proprioceptive individualized rehabilitative treatment could influence the functional response of different AFOs (Ankle Foot Orthoses) in a cohort of patients affected by neurological gait pattern. Methods: Five patients affected by different neurological gait pattern and volunteered to participate to this study were recruited. The comparative spatio-temporal and functional effect on gait pattern of 3 types of AFOs was investigated under 4 study conditions: 1) without AFO or free-walk (FW); 2) wearing a Codivilla spring, 3) wearing a carbon unjointed AFO (“Toe-Off”); 4) wearing an innovative carbon-kevlar dynamic joint DAFO (DAFONS=Dynamic Ankle Foot Orthoses with Neuroswing). In line with our rehabilitative model, patients underwent to a weekly treatment session, 80 minutes duration per session, for 4 weeks. Evaluation was made before (time T3=time of recruitment) and after our individualized rehabilitative treatment course (time T4=1 month from T3) by using: a. G-Walk sensor (by BTS) spatio-temporal measures in different gait performances; b. clinical/functional outcome measures (Modified Ashworth Scale or MAS for the affected upper and lower limb; Medical Research Council or MRC; orthostatic stability evaluation by using the Berg Balance Scale or BBS). Findings: A comparative analysis of clinical and instrumental data, performed in the pre-defined four investigational conditions, showed: √ a statistical insignificant change of MRC and MAS scales at time T4, with a significance trend outcome observed at the same time by using the Wilcoxon Signed Rank Test √ a statistical significant difference between test duration (sec) by using Toe-Off vs DAFONS and by using Codivilla spring vs Toe-Off √ a statistical significant increase of the stride length on the left side (% cycle length) by using DAFONS compared to Toe-Off for patient P1, P3 and P5 with a parameter decrease by using DAFONS compared to Codivilla spring and Toe-Off use for patient P2 √ a statistical significant correlation between BBS trend and test duration (sec) by using Codivilla spring at time T3 and T4 √ a statistical significant correlation between the BBS trend and the double gait support duration on the right side (% cycle) with number of left step cycles by using DAFONS at time T3 and T4 √ in a comparative post-treatment visual gait analysis a modification of each patient’s static and dynamic postural assessment by using 3 different types of orthoses Interpretation: In line with our study design we noted at the end of the proposed rehabilitative treatment an amelioration of gait quality with the use of DAFONS in all those patients (P1, P3 and P5) who showed a neurocognitive competence with a related functional grade of neurorehabilitative re-learning attitude of the physiological gait pattern and with a compromised perceptive control of gait and core stability. The proprioceptive profile of our rehabilitative program could promote the pro-adaptive and facilitation properties of a personalized gait control, induced by an innovative dynamic ankle foot orthoses with a modulable ankle joint system called Neuroswing. In the daily clinical practice, the personalized integration of a neurorehabilitative program and DAFONS can perform an individualized peripheral neuro-facilitation of gait cycle (peripheral perceptive facilitation), a neurorehabilitative re-learning process of physiological gait pattern (peripheral assisted neuroplasticity facilitation DAFONS induced) and an increase of patient’s motor abilities and quality of life in all daily performances.

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.

Climate change and the increasing global population pose a severe threat to the availability of freshwater in the world. Over consumption of water and deteriorating water quality are problems that should be addressed in order to ensure water availability for the coming decades. In this context, the increasing presence of micropollutants in water has shown to cause detrimental impact on water quality, given the negative disturbances that they can cause on human health and on the environment. Thus, it is important to study and quantify the presence of micropollutants in water bodies and also in regenerated wastewater based irrigation systems. 

Background and Purpose: Injuries for the pre-adolescent female Irish Dancer (FID) are not well recognized. The purpose of this case study is to report imaging assisted diagnosis and management of atypical medial and plantar foot pain (MPFP) in an 8-year-old FID. Description: The patient presented with chief complaint of diffuse left MPFP. The patient was initially evaluated by a Physical Therapist for persistent foot pain. The patient experienced minimal pain in non-weightbearing (NWB). Pain intensified in weightbearing (WB) escalating with a heel raise. The patient experienced pain with resistance testing, ankle passive range of motion (PROM) and first metatarsophalangeal joint (MTPJ) PROM. Diffuse tenderness with palpation over the medial column of the left foot was noted. The patient was unable to complete single leg dynamic activity on the left foot. There was suspicion for a metatarsal stress fracture (MSF). Radiographs were ordered and read as negative. The patient was treated with immobilization in a walking boot, WB as tolerated and relative rest including cessation of dance. The patient returned for re-evaluation 2 weeks after reporting no change in symptoms. Magnetic Resonance Imaging (MRI) was then ordered. Outcome: Results of the MRI identified 2 stress fractures in the first metatarsal. The treatment plan changed to NWB status with immobilization for an additional 6 weeks. The patient returned to full WB status and participated in all dance activity 15 weeks after the initial presentation to the Physician and 27 weeks after the initial onset of MPFP. Discussion/Conclusion: In this pre-adolescent FID, the presentation of MPFP can be misinterpreted as a soft tissue injury. It is important to consider the diagnosis of first MSF in a pre-adolescent FID to allow appropriate management.

Mesenchymal stem cell (MSC) transplantation may be an alternative to liver transplantation for patients with end-stage liver disease. A 24-year-old patient with Hepatic Encephalopathy due to alcoholic liver cirrhosis underwent UCMSC transplantation because there were no donors available for liver transplants involving adult deceased and living individuals. The patient was given allogeneic Umbilical cord-derived MSCs, which were then cultured following accepted practices. Subsequently, the UCMSCs were infused through the intravenous route 3 times at the interval of 30 days. Serum bilirubin, globulin, and ammonia levels were improved after the infusion and the morphology of the liver and spleen had also improved.

Infantile cystinosis is a lysosomal storage disease leading to end stage kidney disease at early ages. There is no effective treatment and patients require long term dialysis or kidney transplant for survival. We present our experience on three affected children who received HLA matched allogeneic stem cell transplant. The protocol used was novel and designed to promote engraftment. The primary endpoint was safety for treatment related mortality or morbidity; All three children survived without serious adverse effects during extended follow up for over 4 years. Although we could not prove engraftment, all three children met secondary end point of sustained target functions over a 6 month follow-up. Further studies are warranted to further evaluate safety and efficacy of MSC treatment for infantile cystinosis.

Environmental electromagnetic fields are nowadays available in all environments today. These areas affect the biological system. Controlled interactions with elecrtomagnetic fields can have positive effects when unrestricted interactions have negative effects. Uncontrolled exposure to low-frequency electromagnetic fields can cause adverse effects such as signal transduction in cells and tissues, cell membrane structure, ion channels, molecular interactions, DNA damage. But contrary to controlled exposure, it positively affects tissues. The most obvious example of this is seen in the bone and cartilaginous tissue. Repairing fractures and damage in bone and cartilage. This has been shown in many studies. Below is a summary of the relevant information.

In this investigation, solid dispersions were prepared and characterized to improve the solubility and dissolution of poorly water soluble drug Ketoprofen, using glucosamine HCl as a carrier. For the improvement of the solubility and dissolution rate of poorly water soluble drugs different techniques are used such as solubilization, salt formation, particle size reduction and solid dispersion etc, but in the present study, solid dispersions (SDs) of poorly water soluble NSAID Ketoprofen were prepared to improve its solubility and dissolution rate, using solvent evaporation method with drug-carrier ratio of 1:1, 1:2 and 1:3. Our results indicate that all solid dispersions of Ketoprofen and Glucosamine HCl exhibited more enhancements in solubility and dissolution rates than corresponding physical mixtures. The DSC thermograms and X-ray diffraction patterns showed a slight reduction in crystallinity in solid dispersions which were further verified by FT-IR and SEM. It is concluded that solid dispersion is an effective technique for enhancing the solubility and dissolution rate of poorly water-soluble drug Ketoprofen using Glucosamine HCl as a carrier. This amino sugar (Glucosamine HCl) could be used as a novel potential carrier for preparation and formulation of SDs and would have potential commercial benefits.