We present a case of a 38-year -old man was admitted to the hospital with biliary obstruction and Clostridium Difficile infection. He presented with moderate increases in the aminotransferase and bilirubin levels suggesting the diagnosis of an autoimmune hepatobiliary disease; intestinal protein loss needs to evaluate an associated inflammatory bowel disease. The clinical diagnosis of autoimmune hepatobiliary disease associated with inflammatory bowel disease is based on the patients symptoms and the presence of a protein-losing enteropathy which are more suggestive of Crohn disease, while moderate increases in the aminotransferase levels in proportion to the increase in the bilirubin level suggesting the diagnosis of primary sclerosing cholangitis. The pathological and positive diagnosis needs an endoscopic retrograde cholangiopancreatography and a biopsy of gastric and duodenum mucosae who showed severe inflammation findings that are diagnostic of Crohn disease.

Non-adherence to medical managements or non-compliance with standard shielding maneuvers is a familiar topic in the field of medicine. But now, after delivery of trustable vaccines, though in different brands, refusal of some people, due to personal alibis, to take part actively in vaccination programs against the dominant pandemic of SARS-CoV-2, and energetic encouragement of others to take the same antagonistic attitude, while immunization is the first-line strategy for controlling and preventing the aforementioned sickness, has augmented the said problem, especially when the delivered vaccines are not unreachable for them. Such an attitude, though not prevalent, may be considered as an intruding factor during implementing community vaccination, and if remains unanswered, may delay in some way the desired national outcomes. In the present article the said quandary, along with the plausible psychodynamic, psychopathologic, cultural or administrative causes, as well as available proofs and statistics, has been discussed, concisely.

Background: Predicting success of inpatient rehabilitation after hip fracture is an unmet challenge Objective: To assess whether a first impression Functional Independence Measure (FIM) before comprehensive evaluation may be useful to predict success in rehabilitation Setting: Geriatric rehabilitation center. Design: Retrospective observational study Subjects: 42 consecutive elderly patients with proximal hip fracture. Methods: The Functional Independence Measure (FIM) was assessed on the day of admission by a nurse (PreFIM), on day 3-5 by a multidisciplinary team (FimAdm) and on the day before discharge by the same multidisciplinary team (FIMDis). The potential of motor PreFIM to predict rehabilitation success, corresponding to motor FIMDis >58, was assessed, along with the length of stay in rehabilitation (LOS). Results: The mean motor PreFIM was 43.3 (SD 11.4), motor FIMAdm 48.9 (SD 13.7), motor FIMDis 63.8 (SD 16.7), LOS 22.5 days (SD 9.7). Motor PreFIM predicted motor FIM discharge >58, the surrogate measure for success of rehabilitation, with 76.7% sensitivity and 83.3% specificity. Motor PreFIM relation to LOS was statistically insignificant. Conclusions: In a population of disabled elderlies, the motor PreFIM on admission-day was helpful to predict success in rehabilitation after hip fracture, but not the necessary duration of rehabilitation. Large prospective studies are needed to validate this data.

In this work, a device for the evaluation of the muscular effort through the electromyogram signal is produced. This device consists essentially of three parts: the sensor part, the shaping portion, the acquisition part and the software part. The sensor part allows the EMG signal to be collected by means of surface electrode. The shaping port is realized based on an instrumentation amplifier. The acquisition part concerns the analogue digital conversion and the transfer of the digital data to the pc; this is done via an arduino card, which is equipped with a microcontroller for the visualization in real time and the storage of the EMG signal on the pc on which the processing logitiels will be implemented. The signal thus processed must be displayed with the data allowing the evaluation of the effort on the monitor of the pc through a graphical interface; these are the different steps that are carried out to finalize this work.

Objective: Penetrating abdominal trauma in children is a life threatening emergency. The objective of this study was to evaluate our experience in the management of penetrating abdominal trauma in children in a tertiary hospital in Enugu, Nigeria. Materials and Methods: This was a retrospective study of children that were managed for penetrating abdominal injury at the pediatric surgery unit of Enugu State University Teaching Hospital, Enugu, Nigeria. Medical records of the patients over a 10-year period were evaluated. Results: During the study period, there were 21 cases of penetrating abdominal injuries with an age range of 9 to15 years (median: 11 years) and male to female ratio of 4.25:1. Fourteen (66.7%) patients presented after 48 hours from the time of the incident. Gunshot injury was the most common mechanism of injury. Five (23.8%) patients were in a clinical state of shock on presentation to the hospital and 10 (47.6%) patients had evisceration of intra-abdominal organ. Small intestine was the most damaged intra-abdominal organ while head injury was the most associated extra-abdominal injury. Surgical site infection was a common post-operative complication and 2 (9.5%) patients expired. Conclusion: Penetrating abdominal trauma in children is uncommon. Late presentation is common in low income countries and the small intestine is the most damaged intra-abdominal organ.