Introduction: Celiac disease (CD) is an autoimmune disease that typically occurs in childhood and young age. Late-onset forms (after 60 years) are rare and often underestimated in current medical practice, as is joint damage during this disease. We report an original case of CD in an elderly patient revealed by acute polyarthritis. Observation: A 62-year-old patient with no significant pathological history was explored for acute polyarthritis of both large and small joints. The physical examination noted synovitis of the hands and wrists without articular deformities, and a marked mucocutaneous pallor. The biology revealed a microcytic anemia at 8 g/dl with stigmas of malabsorption (low cholesterol and hypocalcemia). No inflammatory syndrome was noted. Joint X-rays were without abnormalities. Immunological tests for chronic inflammatory rheumatisms were negative. Gastroduodenal fibroscopy was performed and histological examination of duodenal biopsies showed diffuse villous atrophy with marked inflammatory infiltrate. Anti- endomysium and anti-transglutaminase antibodies were positive confirming the diagnosis of CD. Under gluten-free diet, the evolution was favorable with totally disappearance of articular signs. Conclusion: Joint manifestations during CD are rare. The revealing forms are exceptional and can make a differential diagnosis with chronic inflammatory rheumatism, in particular that associations with CD was described. CD deserves to be evoked in front of any unexplained arthritis of the elderly, even without any specific digestive symptomatology of this disease.

Primary care physicians (PCP) needs to plan, organize, implement, and evaluate as care director and coordinator. In primary care there is need to implement leadership model in health sector and medicine. Transformational leadership can be described as style of leadership which is appropriate for health sector. It is alike to the approach which is patient centered. Case management must be well organized, prepared, arranged and described as per needs of patient. The same must be agreed and implemented with suitable individual roles. Leaders are required to do numerous aspects linked to management, managerial and decision making process to carry out the requisite actions. Same process and procedures are also required be completed by Primary care physicians for achievement of patient’s targeted administration, supervision and management. Such happenings and actions contain from preparation, planning, development till structuring networks. Primary care physicians are anticipated to possess transformational leadership capabilities and to assist their performance in role of care coordinators. This all can be attained through integrated, holistic, continuous, comprehensive approach and by building relations with all stakeholders.

Malnutrition is common among hospitalized bed ridden patients. Nutritional management of hospitalized patients is a necessity in order to improve their nutritional status and disease conditions. The objectives of nutritional management of malnourished bedridden patient diagnosed with deep vein thrombosis and pulmonary embolism were to improve nutritional status of the patient through gradual provision of calorie and protein intake, to improve body protein status and control muscle wasting. Nutritional status was assessed by anthropometric, biochemical, clinical and dietary information. SGA was used to assess the malnutrition status of the patient. Since the patient was severely malnourished, she was fed with NG feeds followed by PEG feeds by gradually increasing calorie and protein up to the target level mainly through nutritional supplements for the one and half months of hospital stay. Patient’s serum protein, albumin levels and muscle mass were improved. According to the SGA, the patient was at normal/ well-nourished condition after nutrition management. Dietary management incorporating nutrition supplements indicated improvement of nutritional status of severely malnourished bedridden patient.

Hypereosinophilic syndrome (HES) is a rare systemic disease in which cardiac manifestations are the leading cause of morbidity and mortality. HES involvement of the heart can often clinically mimic acute coronary syndrome (ACS) with the patient undergoing repeat cardiac catheterizations when no conclusive diagnosis is arrived at, and no effective treatment is suggested to alleviate recurrent symptoms of chest discomfort.

ver many years, laboratory testing of platelet aggregability have been carried out in attempts to develop drugs that would prevent thrombosis in arteries. The problems encountered included the question of methodology. Blood samples have to be anticoagulated in order to study the platelets. Anti-coagulation with citrate and tests on derived platelet rich plasma did not correlate at all well with thrombus growth in the stenosed coronary arteries of experimental animals and citrate removes the calcium ions which are vital for platelet function. Anticoagulation with heparin also interfered with platelet function, so that now, hirudins are the preferred anticoagulant. However it was observed that if, instead of stimulating platelet aggregation with adrenaline or ADP, serotonin was applied to the preparation, very little aggregation took place in spite of serotonin 5HT2A antagonists being the most potent inhibitors of thrombus growth in experimental animals. Another indicator that primary platelet agggregation is not a predictor of in vivo efficacy was the finding that 5HT2A antagonism inhibited aggregate growth. In a stenosed artery the platelets are activated by increased shear stress and blood turbulence with release of platelet serotonin causing positive feedback activation of more platelets. At present, there does not seem to be a bench in vitro test that accurately predicts in vivo efficacy in stenosed artery occlusive thrombosis.

The used of monosodium glutamate (MSG) oftenly found in almost every food that we consumed everyday. It suggested that MSG can increase appetite, can caused intake much foods, and increased the bodyweight. The aim of study is to prove the changes that occur in male mice by induce of MSG. The experimental study used 24 male mice, 30-45 gram, 12-14 weeks divided into 4 groups, ie group-I (negative control/placebo given aquadest 0.2 cc/20gBW mice); group-II, MSG with the dose of 5 mg/gBW mice); group-III, MSG with the dose of 10 mg/gBW mice and group-IV, MSG with the dose of 20 mg/gBW mice. All of these treatments were administered orally for 14 days. Permanent cervical fracture execution was performed at the end of the study. The body weight measured in pre and post treatment. The significant difference of data between different groups was compared by ANOVA followed by Tukey test. The compared of between pre –post treatment used paired test to analyze the changes of bodyweight This study proved that the comparison of mean values ± SEM of body weight between groups were not significantly different; group I (39,83±3,26), group II (39,33±2,04), group III (38,00±1,39) and group IV (38,33±1,76) (p = 0.930) and the changes of bodyweight pre and post treatmen also not significantly different, whereas p > 0.05. The study concluded that no changes in the body weight between groups and pasca induced by MSG. In the future studies, we consider to examining the effects MSG with longer of duration and more variations doses in MSG.

West Nile Virus (WNV) can cause neurological disease and death in people. WNV is commonly found in Africa, Europe, the Middle East, North America and West Asia. WNV is maintained in nature in a cycle involving transmission between birds and mosquitoes. Humans, horses and other mammals can be infected. On web page of World Health Organisation [1], can be read how approximately 80% of people who are infected will not show any symptoms. West Nile virus is mainly transmitted to people through the bites of infected mosquitoes. The virus can cause severe disease and death in horses. Vaccines are available for use in horses but not yet available for people. Birds are the natural hosts of West Nile virus. Human infection is most often the result of bites from infected mosquitoes. Mosquitoes become infected when they feed on infected birds, which circulate the virus in their blood for a few days. The virus eventually gets into the mosquito salivary glands. During later blood meals (when mosquitoes bite), the virus may be injected into humans and animals, where it can multiply and possibly cause illness.

Sonography is a quick, easy, reliable and low cost examination device for recognition of illnesses; tumors, cysts, and fat in patient’s organs. In this study Mat lab picture recognition statements are used in a program to read sonography picture and convert it to negative picture of sonography, to high light cysts and recognize them, using another function in Mat lab the volume of appropriate lump is calculated, but since most sonography devices have noise, that adds to the volume of the lump a 10% of the lumps area is deducted to cater for incurred noise, so future sonography to measure the growth of lump using new sonography picture, could be conducted. Other tumor measurement methods also applied for the same sonography pictures to compare the measured results, our results proved to be more accurate.

Context: the fragility of the elderly served in a community health area and to characterize elderlies according to fragility criteria. Objective: to characterize the functional state in fragile bigger adults from the medical practice. Material and Methods: a descriptive, cross-sectional investigation with a quantitative approach was carried out between April 2017 and April 2018. Results: prevailed the alterations of mobility and balance in 54,8 %, only 16,1 % was alterations of the emotional state and 29,0 % was alterations functional cognitive. Conclusion: the presence of several fragility criteria such as elderlies older female sex with associated pathologies as hypertension.

Increasingly in the modern research world there are questions raised about actions taken by academics who do now have full control of their choice of action. In the laboratory setting, graduate students, postdoctoral fellows and even junior professors are often compelled to follow courses of action that are determined by their supervisors or senior members of their departments. So the question of moral determinism derives from the more fundamental question of what actions are voluntary, and to what degree — a question that has informed the thought of philosophers as far back as Aquinas and Duns Scotus. What follows is a personal reflection on currents in this line of inquiry.

Medical ethics is a system of moral principles that applies values to the practice of clinical medicine and to scientific research. They are based on a set of values that professionals can refer to in the event that they are in conflict or are confused. The values include: beneficence, non-maleficence, autonomy, justice, veracity, dignity. The code of ethics is based on the understanding of the goals of medicine dating back to the 5th century B.C. and Hippocrates. By 1847, the code of ethics was based greatly on Thomas Percivals work. He was an English physician-philosopher and wrote a code of medical ethics for hospitals in 1803.

Most of these diseases can be prevented, as an important role in their development has been attributed to a variety of personal and social habits, behavioural patterns and culturally influenced factors, such as smoking, poor or unhaelty diet, excessive drinking, physical inactivity, being overweight, risky sexual and repropductive behaviour, etc.; all these can be summarized as lifestyle-related risk factors. (For the lifestyle-concept, see Mark Lalond’s paper.2) The adoption of these lifestyle-related determinants of disease is largely voluntary, although influenced by the social environment, therfore they can be modified, thus, the risk of disease development can be substancially reduced. According to epidemiological researches, instrinsic factors and environmental hazards are considered to have a relatively small impact on total disease burden.

Primary care physicians (PCP) needs to plan, organize, implement, and evaluate as care director and coordinator. In primary care there is need to implement leadership model in health sector and medicine. Transformational leadership can be described as style of leadership which is appropriate for health sector. It is alike to the approach which is patient centered. Case management must be well organized, prepared, arranged and described as per needs of patient. The same must be agreed and implemented with suitable individual roles. Leaders are required to do numerous aspects linked to management, managerial and decision making process to carry out the requisite actions. Same process and procedures are also required be completed by Primary care physicians for achievement of patient’s targeted administration, supervision and management. Such happenings and actions contain from preparation, planning, development till structuring networks. Primary care physicians are anticipated to possess transformational leadership capabilities and to assist their performance in role of care coordinators. This all can be attained through integrated, holistic, continuous, comprehensive approach and by building relations with all stakeholders.