Physiology and Anatomy

Cardiac evidence of Lyme disease are relatively infrequent, occurring within weeks after the infectious tick bite (median of 21 days), and resulting at this stage from a direct borrelial infection of the myocardium, as indicated by reports of spirochete isolation from pericardium and myocardium. Lyme carditis typically presents with a fluctuating degree of atrioventricular block that spontaneously resolves in several days. The management of Lyme carditis does not differ from the treatment of Lyme disease without carditis.

Penile duplication is a very rare common congenital anomaly. It occurs alone, but the more prominent examples are usually associated with anomalies of the remnants of the genito-urinary tract and the lower gastrointestinal tract. The quantity of the anomaly ranges from a partial duplication of the glans to two separate penis situated at some distance from each other. A demonstrated classification is presented. The cause is unidentified but is best explained by an early disturbance in the embryologic development of the hindgut and ventral abdomen. Treatment must be personalized and consists of various processes to restore normal appearance and function.

Objective: Analyze the body weight, serum insulin, blood glucose, A1C and Insulin resistance in Escitalopram treated type 2 diabetic subjects (T2DM). Study design: Observational study Place and Duration: Department of Medicine, Liaquat University of Medical and Health Sciences Jamshoro/Hyderabad from June 2015 to August 2016. Methodology: A sample of 50 diagnosed cases of T2DM subjects taking Escitalopram 10 mg/kg were selected according to pre-defined criteria. Physical examination was performed. After 3 months of Escitalopram intake, the blood samples were taken for biochemical analysis. Body weight, blood pressure, fasting serum insulin, fasting and random blood glucose, A1C and Insulin resistance (HOMA-IR%) were estimated. Statistix 10.0 (USA) software for data analysis (95% Confidence interval). Results: Mean ± SD of age was noted as 51.5± 6.5 years (p=0.51). Body weight (kg) at baseline and three months decreased from 79.8±11.6 to 76.0±9.4 kg (p=0.031). Fasting insulin, fasting glucose and insulin resistance (HOMA-IR) at baseline and after 3 months were noted as 133.0±21.7 vs. 128.0±11.7 mg/dl (p=0.0001), 16.0±5.50 vs. 13.5± 3.5 ?IU/ml (p=0.0001) and 7.15 vs. 6.09% (p=0.0001) respectively. Conclusion: Escitalopram improves fasting insulin, fasting glucose and insulin resistance and decreases body weight in type 2 DM subjects.

Intra-orbital foreign corps is relatively rare cause of consultation in neurosurgical and ophthalmologic emergencies. Anatomical contiguity between the orbit and the middle cranial fossa is the reason why a neurosurgical approach could be necessary, for the extraction of a foreign body. This case report is about a06 years old girl, admitted to ophthalmologic emergencies, for intra-orbital foreign body, through a wound located at the inner corner of the left eye. The extraction, of a pencil of 06 cm, has been carried out jointly by neurosurgeons and ophthalmologists by a sub-conjonctival approach. The medium-term follow up is 12 months, a surgical wound healed, but no functional recovery of vision or eye movement. Foreign intra-orbital corps are rare in neuro-ophtalmological emergencies, require vigilance in clinical diagnosis as they may go unnoticed. Adequate imaging, and relevant therapeutic approach aimed at “surgical” extraction, are necessary, because, foreign corps are exposed to the infection, panophtalmitis, brain abscess, or even very serious complications).

Retrocaval ureter is a rare disease found most often in young adult males, the usual clinical manifestation is right lumbar pain due to obstruction of the upper urinary tract. The diagnosis is based on CT and the treatment is mainly laparoscopic as our observation shows.

Survivability studies are integral part of cancer research and are particularly important in testicular cancer (TC) studies as TC appears to affect young adults most and is the most curable of all cancers leaving a long life ahead for TC survivors. Numerical models were developed correlating several different parameters documented in SEER (Surveillance, Epidemiology and End Results) database to survivability of TC patients and comparing the model predicted results with actual survival times. The study demonstrates the importance of tumor markers AFP, hCG, and LDH in maintaining strong correlations.

Cloacal malformation is a rare but important anomaly. The cloacal anomaly is characterised by the persistence of a common channel draining the urinary, genital and alimentary tracts through a single orifice. It results from abnormal compartmentalization of features that are normal in the primitive female embryo. Abnormal embryology and cloacal anatomy are described in detail. Cloacal abnormalities are usually diagnosed promptly in the neonatal period

Patients are expected to adhere to physician treatment recommendations. Noncompliance to prescription medication is however often problematic in the elderly for different reasons. The consequence of failure to follow medical treatment may lead to increased medical costs, hospitalizations, and even death. The elderly average 12.7 prescriptions per year, consume 30% of prescription medications, spend $15 billion annually, and receive eight or more medications per day. This qualitative study involved a phenomenological design, as the aim was to explore pharmacological noncompliance by those under the treatment of a licensed medical practitioner. The participants included a purposeful sample of 20 elderly African Americans for this study, from the state of Wisconsin in the United States, drawn from the congregation of an inner city Church. The open-ended nature of the questions facilitated participants to provide insights into a personal medical condition and deeper conversations associated with medication compliance. The normative decision-making theory served to underpin the study and aid acquiring a deeper understanding of the motivations that drive, or constrain compliance to medication. The analysis of the data took place after completion of the interviewing process. The interviews conducted were recorded, coded, transcribed, and categorized to facilitate the analysis of the data using an appropriate qualitative data analytical software program. The findings of the study drawn from an analysis of the interviews of patient, aided in gaining a deeper understanding of compliance to physician directives in pharmacologic treatment by participants in this study.

The cholesteatoma of the middle ear is a chronic otitis qualified as dangerous because of the risk of evolution of potentially serious complications. Labyrinthine fistula represents an erosive loss of the endochondral bone overlying the labyrinth. Labyrinthine fistula occurrence is one of the most common complications in chronic otitis media with cholesteatoma(2-3). Very commonly , the fistula is seen in the lateral semicircular canal(6-7). But very rarely cases of lysis for the three semicircular canals. We report the case of 30-year-old man admitted to the emergency for right fetid purulent otorrhea and rotary type vertigo for 15 days, who presented a chronic right sided otorrhea 8 years ago and homolateral hypoacousis. Computed tomography shows lysis of the 3 semicircular canals. The treatment is essentially surgical with open technique. Regression of vertigo and dry ear is the benefits.

Elephantiasis results of chronic lymphedema due to a variety of obstructive diseases of the lymphatic system. It’s a rare disease outside areas where filariasis is endemic. Peno-scrotal Elephantiasis is characterized by gross enlargement of the genitalia and legs. Observation: We return a case of a 45-year-old patient referred for a giant scrotum for 10 years. The disease become disabling in that it makes sexual relations difficult, affects urination and also limited the patient mobility. He underwent a complete surgical resection of pathological tissue and peno-scrotal reconstruction, with good functional and aesthetic results. Pathology of the specimen was suggestive of either a non-specific fibrosis. We update through a review of the literature aspects of the diagnostic and therapeutic care of the peno-scrotal elephantiasis.