Extracorporeal Immunoparmacotherapy in Rheumatoid Arthritis

This disease causes inflammatory changes in the synovial membranes and periarticular structures associated with severe pain, joint stiffness up to ankylosis, and bone atrophy. The blood serum of the patients with rheumatoid arthritis contains high titres of antistreptokinase and anti-plasminogen autoantibodies of class IgG and IgA, as a rule after streptococcal infection. There are also antineutrophil autoantibodies – both anti-nuclear and cytoplasmic. Plasminogen synthesized by the liver is distributed in the vessels both internally and externally. At activation plasminogen turns in plasmin, regulating extracellular proteolytic activity, activating proteases. In these patient’s fibrinogen level is increased, and insoluble fibrin is found on the synovial membranes. Plasmin, in turn, inhibits the cartilages proteoglycan. All of it leads to destruction of the joints and the synovial membranes proliferation.

Current management of cholesterol for atherosclerotic cardiovascular disease (ASCVD) in clinical medical practice

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Daily improvement of glucose variability by Continuous Glucose Monitoring (CGM)

Continuous Glucose Monitoring (CGM) has been recently applied in the clinical diabetic practice. Authors have continued research of glucose variability. In this study, 51 year-old female patient with Type 1 diabetes mellitus (T1DM) was investigated. She has given multiple daily insulin injection (MDI) for long and her recent daily glucose profile was unstable. After applied with FreeStyle Libre, her blood variability was improved with the average glucose from 222 mg/dL to 135 mg/dL, which was partly from her motivation for better diabetic control. Thus, CGM may become a trigger to give beneficial influence for regular lifestyle of the patients.

Guillain-Barré Syndrome Variant presenting as Acute Descending Paralysis in Diabetes

Guillain-Barré Syndrome (GBS) is an acute monophasic immune-mediated polyradiculopathy. Neuropathic or radicular pain and dysautonomia are common features in all forms of GBS. Phenotypic variants are hypothesized to be mediated by molecular mimicry targeting peripheral nerve motor axons, with resulting weakness deviating from the classic symmetric “ascending” pattern. Weakness can range from mild to severe flaccid quadriplegia and respiratory failure within days of onset. Urinary retention and gastrointestinal dysfunction are seen in approximately 5% of variant cases. A spectrum of clinical features necessitates the use of laboratory testing and diagnostic modalities to exclude mimics and confirm a diagnosis of GBS. A high clinical suspicion must exist as GBS responds to treatment with plasmapheresis or IVIG. Our patient embodied both a diagnostically challenging presentation and clinical response consistent with variant GBS.

A Comparative Study of Current Methods and Recent Advances in the Diagnosis and Assessment of Osteoporosis

Osteoporosis is an abnormality that is manifested by a decrease in bone density. People with light skin, fine skeletons, a family history of osteoporosis, smokers, sedentary people and postmenopausal women are more likely to develop the disease. Early diagnosis of this disease can be of great help to improve one's future life course and prevent potential risks. There are currently ways to diagnose the disease that is discussed below. But what is important in this study is how to diagnose the disease further in this study and to use the tools that are least risky for the individual. In this case, almost all people in the community, including children and sick people, can also be tested. The person with the disease will receive early treatment.

Novel Design and Evaluation of an Automatic and Portable Phototherapy Device Using for Newborn Jaundice Treatment

Jaundice in infants is one of the most common diseases at birth. In preterm infants, the risk is more than 80%, and in term infants, the rate is reduced to about 60%. One of the most effective and low-risk ways to treat neonatal jaundice is the use of light therapy or phototherapy. Fluorescent lamps, tungsten halogen lamps, LEDs, optical fibers and etc are used in these devices. Bilirubin reacts to green light and blue light. The green light's wavelength is in the range of 570-495 nm. The blue light has a wavelength of 495-450 nm and an absorption range of 450 nm. Studies have found that the best light for phototherapy devices is a light that has the wavelength of 400 to 520 nm, and because the blue light absorption rate is about 450 nm, so it is used in phototherapy. In addition to its proper absorption rate, it also has antimicrobial activity against bacteria. It is difficult to determine the exact duration of the phototherapy, because each infant has his/her specific conditions and the exact duration cannot be determined generally. Phototherapy should be continued until the bilirubin level in the baby's blood is sufficiently reduced, monitored by the supervision, and does not pose a threat to the baby. Phototherapy devices have different types, each with advantages over their predecessors. In existing models, because of their unique features like high sensitivity to bilirubin reduction, higher power, and efficiency, lighter, lower heat generation, lower cost and longer life devices, LED light sources are widely used in phototherapy devices. According to all the studies, we are looking for a device with proper coverage, portability, and moving the baby with the device without separating the baby from the baby as well as providing a quiet space for the mother and baby away from the hospital environment.

Knowledge, Attitude, Practice and associated factors towards Self-Insulin Administration among Diabetic Patients in Hawassa Referral Hospital, Southern Ethiopia

Diabetes Mellitus which is a heterogeneous clinical syndrome secondary to defects in insulin secretions recognized as one of the leading causes of death and disability worldwide. Knowledge about Diabetes Mellitus is a prerequisite for individuals and communities to take action for control the diabetes, but there is inadequate knowledge and poor practice level on insulin self-administration among Diabetes Mellitus patients. To assess the knowledge, Attitude and practice of self-insulin administration and associated factors among diabetic patient in Hawassa referral hospital. Institutional based descriptive cross-sectional study was conducted on 180 diabetic patients by systematic random sampling technique, in Hawassa referral hospital. Structured and pre tested questionnaire was used to collect the data. The collected data was processed and analyzed using manual and computer software. Chi square test was done between two variables and P-value less than 0.05 were taken as statistically significant. A total of 180 people were included in the study of which the majority 107(59%) were men and in the age group of 35-44 years (23.9%).One hundred twenty-seven (70.6%) of the participant were married followed by single 40(22.2%).As to their occupation government employee accounts (25%) and above half (52.8%) of the respondents gets >1200 birr per month. One hundred twenty eight (71.1%) participants had favorable attitude. Literacy and marital status were significantly associated with good knowledge with p-value of 0.001, 0.011 and x2= 10.401, 6.467 respectively. The current study was identified the gap in knowledge regarding diabetes. The gap might be due to high illiteracy rate of the study participants, less devoted time by physicians to the patients, and less participation of media and Non-Governmental Organization (NGO) in awareness creation about diabetes in our setting.

Glycemic control may be influenced by climate changes in type 2 diabetes mellitus (T2DM)

Authors have continued clinical research on type 2 diabetes mellitus (T2DM). The trigger of this research was to make notice of elevated HbA1c of younger male diabetics for hot climate in the summer 2018. Enrolled subjects were 89 male patients with T2DM. Methods include the classification of 6 groups by the age, which are 21-40, 41-50, 51-60, 61-70, 71-80 and 81-90. HbA1c values in median were calculated for five seasons of 15 months. Basal HbA1c in 6 groups was 7.0%, 7.1%, 7.2%, 7.2%, 6.9% and 7.0%, respectively. Seasonal changes in HbA1c values are as follows: i) groups 21-50 showed highest in the summer, ii) groups 51-70 showed gradually decrease from winter to summer, iii) groups 71-90 showed gradually decrease from winter to autumn, and increase for winter. For seasonal HbA1c changes, influence of hot climate during from spring to summer may be involved for 21-50 years. More activity in spring to summer may be related for 51-70 years. Less exercise and more eating may be observed for 71-90 years. There are not enough analyze for related factors, then further study concerning various biomarkers would be expected.

Hyperglycemic hemianopia as a stroke mimic in hyperosmolar non ketotic state in type 2 Diabetes

Stroke mimics are differential presentations of various systemic disorders that simulate an acute stroke. The conditions vary from numerous metabolic and psychiatric conditions to central nervous system involvement in the form of cerebral tumours, complicated migraine, myasthenia gravis and multiple sclerosis. Metabolic disorders represent a small mimicking subgroup of acute focal neurological deficits. They include hypoglycemia, hyperglycemia, hyponatremia, hypoxia, uremia encephalopathy and hepatic encephalopathy. Here we report a case of transient homonymous hemianopia and seizures in a patient with hyperosmolar non ketotic state which got completely reversed as euglycemia was achieved.