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Insulin resistance, often referred to as impaired insulin sensitivity. This clinical case focusses on a woman with insulin resistance and a long-standing and recurring history of obesity to demonstrate how diet therapy can be applied in addition to standard medication therapy.

The paper is dedicated to the consideration of the metal-carbon mesocomposites application possibilities for the medicine magnetic transport. This trend is determined by correspondent peculiarities of content and structure of mesoscopic composites. The main peculiarities of these nanosized particles are the following: a) the presence of unpaired electrons on the carbon shell; b) the structure of carbon shell from poly acetylene and carbine fragments; c) the atomic magnetic moment of inner metal is equaled to more than 1–3 μB. The creation of reactive mesoscopic materials with regulated magnetic characteristics which can find application as medicine magnetic transport within an organism is very topical. The present investigation has fundamental character. It’s based on the ideas concerning to the change of metal-carbon mesocomposites reactivity. The use is possible as metal-carbon mesocomposites both and they are modified analogously.

Background: The frequency of latex allergy is increasing, posing a major health problem. This increase is related to the widespread use of latex materials and cross-reactions between latex proteins and certain foods. This cross-reactivity makes latex avoidance difficult, and latex sensitization is likely to worsen atopic conditions. Objective: The authors evaluated the role of latex sensitization in the poor control of asthma and rhinitis. Methodology: An analytical cross-sectional study was conducted on 1860 patients of all ages and genders, followed up for allergic asthma and rhinitis since March 2012 in the Immuno-Allergology Unit of the Cocody University Hospital in Abidjan. Prick tests with native extracts and the European standard battery were performed to identify allergenic sensitization. The impact of latex sensitization on asthma and rhinitis control was assessed by calculating odds ratios. Results: A high frequency of latex sensitization was associated with asthma and rhinitis. The risks of poor control were related to monosensitization to latex and were even higher in the context of polysensitization. Conclusion: The impact of latex sensitization on the progression of asthma and rhinitis has been well demonstrated. It is recommended to integrate the latex sensitization status into the therapeutic management strategy of these two pathologies.

Background: One of the problems in vitro fertilization (IVF) treatment for infertility is the high frequency of embryo developmental arrest in the preimplantation stages. Arrested embryos were not selected for transfer and were usually discarded. Case report: We present a case of clinical pregnancy and live birth following IVF treatment and transfer of one arrested embryo. A 31-year-old woman with unexplained infertility underwent IVF treatment. Using the IVF procedure, 7 embryos were produced which were frozen on day 3. In order to embryo transfer in the blastocyst stage, two embryos were thawed and cultured for 2 days. After thawing, one of them was not suitable for transfer and another embryo was arrested at the 10-12 cell stage. Discussion: The Clinical pregnancy and live birth happened after the transfer of an arrested embryo on day 5.Conclusion: This case showed that arrested embryos may resume growth after the transfer to the uterus and result in a successful pregnancy and live birth.

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.

Fibrothecal tumors of the ovary are rare neoplasms, comprising less than 4% of all ovarian tumors and primarily affecting post-menopausal women. These benign tumors arise from the stromal tissue of the ovary and may produce hormones, particularly estrogen. Their diagnosis presents considerable challenges, frequently leading to misclassification as malignant ovarian tumors or uterine myomas. This report describes the case of a 59-year-old woman who presented with abdominal distension and pelvic pain. Clinical examination revealed a large, lobulated mass and imaging studies classified the right ovarian mass as ORADS 4. An exploratory laparotomy confirmed the absence of metastasis, resulting in total hysterectomy, bilateral adnexectomy, and omentectomy. The anatomopathological analysis identified the latero-ovarian mass as a fibrothecoma. Generally, fibrothecal tumors are benign with a favorable prognosis following surgical intervention. Common symptoms include pelvic pain and abdominal distension, and diagnosis typically relies on imaging techniques such as ultrasound and CT, with definitive confirmation achieved through histopathological examination. Given their potential to mimic malignant ovarian cancer, accurate diagnosis is critical and necessitates a multidisciplinary approach.

Chronic Hepatic deficiency due to the ingestion of alcohol remains as one of the main causes of morbidity and mortality in our country. From it a variety of complications arise, one of them is the Hepatopulmonary Syndrome, which usually goes unnoticed and undiagnosed; this syndrome is distinguished by the presence of hypoxemia and pulmonary vasodilation. The gold standard to establish a diagnostic is contrast-enhanced Echocardiogram. No pathognomonic sign is known for this syndrome, which leads the present elaboration to evaluate the use of orthodeoxia by pulse oximetry as a screening test in the detection of Hepatopulmonary Syndrome cases. 

Background and aim: Cirrhosis leads to sarcopenia and to life-threatening complications in decompensated stages. The objective of this study is to show the impact of the loss of muscle mass and function on hepatic decompensations. Methods: Our study compares a group of cirrhotic patients with controls matched with the same sex and age. A questionnaire was created to collect demographic, anthropometric, and cirrhosis characteristics. Several CT scan sections were analyzed and the average measurements have been grouped into tertiles to estimate the impact on cirrhotic complications.Results: Our study included 33 controls and 33 cirrhotic patients of which 59.4% had NASH. Anthropometric characteristics were similar in cirrhotics men and women. Grip strength was significantly lower in cirrhotic men. Using the skeletal muscle index we found 39.39% of cirrhotic patients were sarcopenic mostly men 84.61%. In Cirrhotic men, the density of the psoas and paravertebral muscles was lower than in controls. In women psoas and paravertebral muscle areas were comparable and the total muscle surface in cirrhotic patients was higher. There was a negative correlation between this surface and the density of the psoas (r = -0.293 p = 0.017) indicating the presence of myosteatosis in women. Analysing tertile groups showed a significantly higher incidence of complications related to liver disease and liver failure in patients with the psoas and paravertebral muscle density in the lowest tertile and in the frail population according to the frailty index.Conclusion: Cirrhotic patients have myosteatosis and sarcopenia associated with a higher incidence of complications related to hepatic failure.

Introduction: Immediate postoperative gastrointestinal bleeding following bariatric bypass surgery is a major complication, and usually results from staple line hemorrhage or conventional gastro-esophageal causes. Dieulafoy`s lesion is a rare cause of gastrointestinal bleeding and is usually managed by endoscopic means. Herein we present a case of massive intraoperative bleeding resulting from gastric Dieulafoy`s lesion single anastomosis gastric bypass surgery necessitating resection of the gastric pouch. This is the first description of this complication, and the difference of such a lesion from the sporadic ones is discussed. Discussion: Gastric bypass surgery is an effective procedure for morbid obesity. The approach we have adopted for massive upper GI hemorrhage in the immediate postoperative period should be distinguished from delayed bleeding after gastric bypass. In these latter cases, marginal ulceration is more common than bleeding from the remnant gastric pouch. It is also likely that bleeding from a Dieulafoy`s lesion following gastric bypass surgery represents a different disease compared to other Dieulafoy`s cases. Conclusion: This is the first description of an intraoperative Dieulafoy`s lesion bleeding during the conduct of a single anastomosis gastric bypass procedure which required gastric pouch resection. Such a lesion differs from sporadic Dieulafoy`s cases, and must be considered in every case of intraoperative bleeding during gastric bypass. 

Septic arthritis of the shoulder joint is rare and might affect around 3% of the general population [1]. A delay in diagnosis may increase morbidity and lead to bone and cartilage destruction [2]. Septic arthritis is an unusual complication of pregnancy and can progress to permanent arthropathy and disability [3]. Septic arthropathy in pregnancy requires multidisciplinary team involvement for prompt recognition and treatment to improve both maternal and fetal outcomes. High index of suspicion is vital when clinical and laboratory findings suggest septic arthritis. There are multiple predisposing factors reported previously for septic arthritis of the shoulder in pregnancy such as medical conditions, pyelonephritis and trauma. We report a 37 year old lady who presented at 26 weeks gestation with acute left shoulder pain and high temperature following minor left palm trauma. She also had left mastectomy with axillary clearance ten years earlier. She underwent arthroscopic wash out of her left shoulder joint and was covered with antibiotics with rapid improvement and recovery. We reinforce the importance of early multidisciplinary involvement when septic arthritis of the shoulder in pregnancy is suspected especially in women who have had previous mastectomy and axillary clearance which could be a predisposing factor for such a rare and serious joint condition in pregnancy.