Central hypothyroidism is a thyroid hormone deficiency due to a disorder of the pituitary, hypothalamus or hypothalamic -pituitary portal system, leading to diminished thyroid –stimulating hormone (TSH), thyrotropin–releasing hormone (TRH) or both. It has an estimated prevalence of approximately 1 in 100.000. It is rarely isolated and occurs more commonly in conjunction with other pituitary hormones deficiency as well as neurological signs. The clinical manifestations of isolated central hypothyroidism are usually non -specific and are often delayed or miss diagnosised. The diagnosis can be difficult and usually based on low level of free hormone (FT4) and low to normal level of thyroid –stimulating hormone (TSH). The diagnostic value of Thyrotropin –releasing hormone (TRH) test has been evaluated in such situation. The screening, in the majority relay on TSH measurement. In this article we describe three infants who were diagnosed with congenital isolated central hypothyroidism at the KKUH, Riyadh, Saudi Arabia during the period from January 2016 to April 2019, as pediatricans need to be aware of this rare condition to avoid diagnostic delay and to start the appropriate replacement therapy

Sarcoidosis is a disease in which inflammatory granulomas cells are formed in the affected areas of body. Sarcoidosis, without a known aetiology commonly affects lymph nodes, lung tissues, skin, CNS, eyes, muscles, bone and heart. Cardiac sarcoidosis (CS) an infiltrative granulomatous disease of the myocardium that may present in about 2-7% of sarcoidosis patients and more than 20% cases are clinically silent. CS patients may suffer from asymptomatic left ventricular dysfunction, congestive heart failure, atrioventricular block, atrial or ventricular arrhythmia and sudden death. These symptoms are common in CS. The diagnosis could be done by using echocardiography, endocardiography, nuclear imaging like PET, CMR imaging and endomyocardial biopsy. Although randomized therapeutic trials have not been done but still corticosteroids (alone or combined with additional immunosuppressive medications) are usually used for the treatment. The natural approaches have also proved to be very beneficial for the management of the disease. These methods offer a cheaper, easily available and effective therapy devoid of side effects. The current manuscript mainly highlights the clinical manifestations, diagnosis, imaging techniques and therapies including the natural approaches to treat the disease.

Visual acuity loss and colour defects among young adults often times occur without notice. The aim of this study was to determine the visual acuity status and colour defects amongst secondary school subjects in Ogoja urban of Cross River state, Nigeria. A descriptive cross-sectional study was conducted using the multi- stage sampling technique amongst 500 secondary school students in Ogoja urban. The standard Snellen’s chart was used to assess visual acuity. The Ishihara chart Plates 1-15 of the 2008 edition of the Ishihara’s colour album were used to detect colour defects. The mean age of the subjects was 13.33 ±0.12 years for the male subjects while that for the females was 12.83 ±0.16 years. The heights of the male subject was 165.01 ±1.22cm while that for the females was 153.53 ±1.24cm, with the males being taller than the females (p<0.001); but the body weights did not differ. The visual acuity did not differ between the male and female subjects. However, when the visual acuity was categorised, only 80 subjects (16.1%) for the right eye and 77 subject (15.5%) for the left eye had normal visual acuity (6/6 to 6/8). The bulk of the other subjects belonged to the categories of mild (6/9 to 6/18), moderate (6/19 to 6/48) to severe (6/49 to 6/60) impairment in visual acuity: 235(47.2%) and 238(47.8%) for the right and left respectively having mild visual impairment; 78(15.7%) and 78(15.7%) for right and left respectively having moderate visual impairment; severe visual impairment was seen in 105(21.1%) and 105(21.1%) for the right and left eyes respectively. The frequency of distribution of colour defects amongst the secondary school subject showed that 0.75% of the subjects studies were red colour blind while 2.46% of the subjects were red-green colour blind. Therefore, in this population with a perceived normal visual acuity, the percentage of subject with visual impairment seemed higher than those with normal visual acuity. It is not clear what could be responsible for this

Flap design in facial reconstruction is particularly delicate given the face is the most visible structure of the body and has some of the most complex three-dimensional topography. The goals of facial reconstruction center on closing defects in an inconspicuous manner. Fortunately, the robust vascular supply of the face allows for many reconstructive options using flaps that are localized to the face.

We report the case of Mr IS 50 years old without notable antecedents, admitted in our service in a haemorrhagic table of shock associated with an abdominal mass giving the lumbar contact in connection with a broken aneurysm in the right renal artery associated with ipsilateral renal ischemia. A right nephrectomy was carried out and a subtotal resection of aneurysm with installation of a drainage. The operational continuations were simple. We review the literature regarding epidemiology, classification, symptomatology and management of aneurysms of the renal artery

Objective: This study was planned to determine what role nurses can perform in health screening of school children and what is their importance in identifying common ailments in school children. Methods: A cross sectional study was conducted between December 2014 to Jan 2015. Data was collected by using structure questionnaire after pilot testing. Head to toe screening of children was done by trained nurses and data was analyzed by using statistical package for social sciences (SPSS) version 22. Percentages and frequencies were calculated for various ailments found in school children. Results: In total 367 school children were screened. Mean age of the participants’ was13.56±1.9 years respectively. Out of 367 students, 154 were male and 213 were females. The common ailments found after thorough screening includes, malnourishment (14.2%), dental carries (20.4%), diarrhea (2.2%), vision problem (1.1%) and deviated nasal septum was (2.2%). Results were presented by using figure and table. Conclusion: School nurses can play a significant role in identification and management of common school ailments by timely performing health screening. School health nurses can also become a fundamental part for health promotion by promoting healthy habits among children at school level. Adequate attention needs to be paid to implent school health nurses for better future health of community.

International Dual Diploma Programs in undergraduate programs is one of the goals established by the internationalization of higher education institutions. Hence, each institution organizes itself in legal, administrative, teaching, political and financial terms in order to implement such a program. Objective: To report the experience of developing and implementing a Dual Diploma Program in undergraduate nursing programs in Brazil and Portugal. Method: Experience report. Results: An International Dual Diploma Program was established between the Undergraduate Nursing Programs of the Federal University of Santa Catarina (UFSC), Brazil and the Nursing School of Coimbra (ESenfC), Portugal. In Brazil, the process was initiated by the Coordination of the Undergraduate Nursing Program at UFSC, was considered by the university’s higher boards and by International Relations and Legal offices within the university. In Portugal, at the Nursing School of Coimbra, the International Relations Office together with the Technical-Scientific Council and the Office of the President of the ESenfC prepared the process. Two Brazilian students started attending the program in the second semester of 2018, after being selected through a public selection process. Conclusion: The program is in place and has proven to be feasible.

Nursing Managers hold a vital role in matching the vision of the institution with the vision of staff at the bed-side. Study Aim: Assess nursing manager's situational leadership style and nurses' work readiness levels. Study subject: nursing managers No=84 and 420 nurses. Setting: Assiut and Sohag Universities hospitals. Tools; consists of; 1) Personal data sheet, 2) Situational leadership styles questionnaire, 3) Work readiness scale validity and reliability were ensured Results: highest percentage of nursing managers at Assiut and Sohag universities hospitals utilize participative style (50% & 47.6%) respectively, meanwhile lowest percentage of them utilize delegative leadership style (4.8%, and 2.4%) respectively. Also the highest percentages of nurses at Assiut and Sohag Universities Hospitals had moderate work readiness level (54.8%, & 48.6%) respectively, followed by high work readiness level (38.1%, 28.6) respectively. Conclusions; this study concluded that; the majority of Assiut and Sohag Universities hospitals nursing managers not utilize situational leadership style. But only more than half of nursing managers at Assiut and less than half of nursing managers at Sohage utilize participative style, also highest percent of nurses work readiness levels were moderate. Recommendation: Condensed training for nursing managers must be done to enable nursing managers to utilize leadership styles that best fit with nurse's work readiness level.

Visual function is the most important sensory function of the human body; visual impairment is a common and debilitating health problem among elderly. It is affected elderly s’ daily life and leads to functional disabilities and other health problems. Thus: The aim of the current study was to assess relationship between visual impairment of elderly and their quality of life. Design: A descriptive correlational research design was adopted in this study. Setting: The study was conducted at outpatient clinics in Governmental Ophthalmic Hospital in Kafer El-Sheikh governorate, Egypt. Tools: Data were collected through interviewing elderly using two tools: I) Elderly Client Interviewing Questionnaire Tool which divided into two parts, 1st part: the demographic characteristics of the elderly and 2nd part: medical history and chronic disease. II) An Arabic Version of National Eye Institution Visual Function Questionnaires Tool (ARB-VFQ-25). Results: results revealed that, the main cause for visual impairment was cataract (84%). The highest mean score of subscale were vision health and color vision (66.13±34.67). A statistically significance correlation was found between visual impairment and quality of life among elderly (p= 0.012). Conclusion: Visual impairment is associated with significant reduction in different quality of life domains for the elderly. Quality of life becomes poor with increasing severity of visual impairment. Recommendations: the study recommended conducting a health education programs for elderly with visual impairment to promote their quality of life.

Eyelid scars usually aren’t thick, but they’re important because they inhibit the movement of small, delicate structures. For concerns, both cosmetic and functional, post-traumatic scarring of eyelids and periorbital area can pose a challenge for ophthalmologists. But the antimetabolite 5-fluorouracil (5-FU) offers a versatile option for approaching this common problem. 5-FU injections given at the first sign of contracture can help minimize scar tissue and dramatically improve eyelid function. Given its proven and long-standing track record in oncology, off-label applications of 5-FU have expanded in recent years into orbital and adnexal efforts to modify keloids and hypertrophic scars.

This study was carried out to examine the proximate and mineral contents of an edible mushroom, P.sajor-caju in Ekiti State, Nigeria at different stages of development. The mushroom was cultivated on sterilized wood shavings and the fruit bodies were harvested at four stages corresponding to 7, 21, 35 and 49 days after fruiting. The proximate and mineral contents of the mushroom were determined using standard methods. After forty nine days of fruiting, the contents (%) of moisture and crude fiber increased from 90.47 to 94.00 and 0.06 to 0.21 respectively while the contents of protein, fat, ash, carbohydrate and energy (kcal/100g) reduced from 1.21to 0.74, 0.1 to 0.08, 1.07 to 0.69, 7.09 to 5.97 and 32.33 to 25.71 respectively. The mushroom exhibited different variation patterns in their mineral contents with advancing age. The contents (mg/100g) of Mg, Fe and Cu decreased with age while that of K, P, Ca and Zn increased with age. Age had no effect on the content of Mn. This suggests that the recommended harvesting stages would be determined by the particular mineral deficiency being addressed. However, results of the proximate analysis suggest that the mushroom should be harvested early in order not to compromise the nutritional quality.

Multiple myeloma is a malignant hematological neoplasm which, primarily involving the bone marrow, but it has a potent extension towards other organs and to present with various clinical manifestations. Involvement of the stomach presenting with epigastric pain and vomiting is extremely rare. We report a case of a 73-year-old male presented at the Gastroenterology Unit with epigastric pain and uncontrollable vomiting. He was known to have a history of multiple myéloma and had previously been treated with a very good partial response. The patient underwent esogastroduodenoscopy witch revealed nodular gastritis without ulceration. Histopathological and immunological analyses showed diffuse atypical plasma cell infiltration with prominent staining for CD138 of the gastric mucosa. Relapsing multiple myeloma was diagnosed. This case illustrates a very atypical presentation of recurrence multiple myeloma and should be kept in mind in a patients with atypical gastric pain, especially those with a history of hematologic malignancy.

Intestinal parasitic infections have been described as the greatest single globalcause of disease and illness.A survey of prevalence of intestinal parasites among the native Libyan people attending several health centers (governmental and private) in the city of Zawia. The study was designed to cover the period of 2010-2015. Stool tests from 12,850 patients was performed. 8950 specimens of the 12,850 examined were found to be infected with intestinal parasites. The infection rates were 69.6% among the native population. The rate of infection in females (65%) was higher than in males (34.9%). Overall, protozoa infections (92.4%) were higher thanhelminths infections (7.6%). Entamoeba histolytica (60.70%) and Giardia lamblia (31.73%) were the most common intestinal parasites identified. Among the helminths, Ascaris lumbricoides, Trichiuris trichiura and Hymenolepis nana were the frequentones. The high prevalence rate of intestinal parasitic infections among the local Libyan people clearly indicates that there is continuous ongoing transmission of various parasitic infections in the community.

The arrangement of vascular tissues differs in the root and shoots in angiosperms. The root has a solid triarch or tetrarch exarch xylem whereas the stems possess endarch xylem made of individual vascular bundles arranged in a ring form. A continuous flow of water and minerals is not disrupted in spite of this difference in the arrangement of xylem tissue in the two organs. This happens because of a transition region extending from the upper portion of the root, ending in either the hypocotyl or epicotyl where a gradual alteration in the arrangement of the xylem tissue occurs. The aim of the study was to investigate the extent of transition region and the structural anatomy of xylem in the transition region of three tropical legume species viz. Vigna radiata, V. unguiculata (red variety) and Cicer arietinum. Sequential transverse sections from the base of the root, hypocotyl and epicotyl were obtained from five day old seedlings of the three selected legumes, stained with safranin and viewed under the light microscope. Sections were digitally photographed. In all the three species studied, the transition region commenced a few millimeters below the soil surface. In Vigna radiata and Vigna unguiculata it ended in the hypocotyl region above the soil surface whereas in Cicer arietinum it ended in the epicotyl region. The beginning of transition region showed appearance of a pith in the center of the xylem core. Gradual widening of pith resulted in separation of xylem tissue. This was followed by reorientation of exarch to endarch xylem. A variation in the structural anatomy of xylem among the three species was also observed in the length of transition region and structural anatomy of xylem.

Possible Effect of Citrus Limon Juice and Tamoxifen on the Tumour growth mass Indices, Cell Proliferation, Cell Viability and Cytogenetic (Mitotic Index) of Sprague Dawley Rats Induced MCF-7 Breast Cancer Cells was carried using, over one hundred and twenty Sprague dawley rats of 40 days old with average body weight 180-220g were divided into Ten (10) groups with 12 animals per group, group 1 was control, fed only with rat chow and water, group 2 was MCF-7 cell line induced Breast cancer rat alone (BCIR only), group 3 Citrus limon juice (CLJ) at 8.88%, Group 4 Citrus limon juicen (CLJ) at 17.32%, group 5 Citrus limon juice (CLJ) at 25.98%, group 6 was given 0.2mg/kg of Tamoxifen alone, group 7 (BCIR+ CLJ at 8.88%), group 8 (BCIR+ CLJ at 17.32%), group 9 (BCIR+CLJ at 25.98%) and group (BCIR+ 0.2mg/kg of Tamoxifen). Acute and sub – acute toxicity were carried out after the establishment of safety dose following determination of LD50, on the fresh Citrus limon juice, Tumour growth mass Indices were carrying out on weekly basis on the experimental rats, on completion of the administration of the treatments, animals were sacrificed, Blood was collected into Plain and hepariniced bottles simultaneously for Cytogenetic (Mitotic Index) analysis, Tumour tissues were also extracted, passaged and cells were cultured and analysed for Cell Proliferation and Cell Viability assays. Microscopically, it was revealed that DMSO at 1.5% was highly toxic to the MCF-7 cells and other components of media, meanwhile the Citrus limon juice at 8.88%, 17.32% and 25.98% showed minimum cell growth inhibition of MCF-7 cell lines and permit cell viability at 40%, 25% and 10% respectively without any effect on the media components. In conclusion, this study showed that Citrus limon juice posses anticancer activities and does not pose pathological conditions on the body during and after usage, hence it could be used as alternative therapy in the treatment of Breast cancer that are hormonal dependant in similar manner to Tamoxifen.