X-linked adrenoleukodystrophy (X-ALD) is a devastating genetic disease with three main phenotypes (childhood cerebral forms, adrenomyeloneuropathy(AMN) and Addison disease(AD). Tuberculosis is the commonest cause of AD in underdeveloped countries whereas autoimmune destruction accounts for 75-80% cases in developed countries. This is the first case report of X-AMN/ALD in two brothers in Bangladesh confirmed by raised very long chain fatty acid (VLCFA). Our index patient of 19 years presented with anorexia, weakness, vomiting, weight loss for three years with increased pigmentation in perioral skin, lips, tongue, mucus membrane, palmar creases, knuckles, reduced scalp hair(figure-1a-d), postural hypotension, low BMI, was found to have low basal Cortisol (9.00 am),  ACTH >1250  pg/ml (normal<46), was diagnosed with AD. After three months he developed progressive spastic paraparesis along with cognitive declination and behavioral abnormality. His only brother was normotensive, clinically asymptomatic at presentation had only increased pigmentation on tongue, palmar crease, scanty scalp hair(figure-1,2a-d) and extensor planter reflexes. He had high ACTH(>1250 pg/ml) with normal basal cortisol (9.00am). Plasma VLCFA analysis revealed significantly high C26:0 with abnormal ratio of C24:0/C22:0 and C26:0/C22:0 in both brothers, with normal level in mother(table-1). MRI (T2 & FLAIR) showed bilateral hyperintense basal ganglia in index patient(Figure2:3a-c). Electrophysiological studies of nerve (SEPs, VEPs, BAEPs, NCS, EMG) were normal in both. Both were given steroid replacement. After three years, index patient became bed bound with slurred speech, urinary urge incontinence and his asymptomatic brother developed spastic paraparesis with cognitive impairment. None had gonadal impairment. Follow up MRI revealed lesion in brainstem in both along with atrophy of thoracic segment of spinal cord in index patient(Figure2:4a-f) and cerebellum, internal capsule involvement in his brother(Figure3:5a-d). Both were of pure AMN variety but due to presence of cognitive impairment and behavioral abnormality they can be categorized as rare cerebral variety of AMN.

Cervical cancer is the most frequent cancer among women in Senegal. However, there are few data concerning the HPV types inducing neoplasia and cervical cancers and their prevalence, in the general population of Senegal

.AIMS:

The aim of this study is to determine the prevalence of HPV infection in Senegalese women aged from 18 years and older.

MATERIALS AND METHODS:

A study was performed on 498 cervix samples collected from healthy women aged 18 and older in Dakar. 438 other samples were collected from three other regions, Thiès, Saint Louis and Louga. The samples were screened for 21 HPV genotypes using an HPV type-specific E7 PCR bead-based multiplex genotyping assay (TS-MPG) which is a laboratory-developed method for the detection of HPV.

RESULTS:

The prevalence for pHR/HR-HPV in the region of Dakar was 20.68%. HPV 52 (3.21%) was the most prevalent HPV type, followed by HPV 16 (3.01%) and HPV 31 (3.01%). In the regions of Thiès, Louga and Saint Louis, the prevalence for pHR/HR-HPV was 29.19%, 23.15% and 20%, respectively

CONCLUSION:

The study revealed the specificity of the HR-HPV prevalence in Dakar and other regions of Senegal. The patterns differs from the one observed in the other regions of the world and rise the issue of the development of vaccination program in the country. Such a program should take into account the real HPV prevalence for an effective protection of HPV-associated diseases.

Previous research on periodontal structure and function has shown a significant relationship between periodontal tissue and teeth. This study assessed dentist's beliefs about the relative efficacy of the health of periodontal tissue. A total of 505 patients in general pracrice were asked to respond to a list of 25 obligatory nourishment for a child while going to have the first teeth, for its effectiveness in dealing with patient's periodontal health especially include chewing hard food. They were also asked to select the three most effective nutrition for periodontal tissue. The imdices of patient perceived importance of the periodontal health were derived and each compared with actual effectiveness as determined from a sample of 250 patients.

Although the majority of patient's rated 18 of 25 nutrition as being very effective, there was no significant association between patient perceived nourishment effectiveness and actual effectiveness. The implications for patient training are discussed.

This study supported by only me and my supervisor Alla grigorivna demitrova.

Global climate change is directly affects the main environmental components: water, air, weather, and ecosystems (aquatic and terrestrial). Changes in precipitation, temperatures, and melting of ice caps are already occurred and will create new changes in the availability and quality of water and temperature.

Although, the purpose of this paper is to understand the impacts of global climate change on human health and how the world manage both mitigate and adapt of climatic changes on the biosphere. This paper is organized around the categories of human health consequences of global climate change such as asthma, respiratory allergies, air quality diseases, cancer, cardiovascular Disease and stroke, food-, water-borne, vector-borne and zoonotic diseases, nutrition, weather and heat-related morbidity and mortality, human developmental impacts, mental health and stress-related disorders, neurological diseases and disorders, etc. These risks give early warning systems and greater public awareness of an individual’s or community's health risk from global climate change, which should translate into more successful mitigation and adaptation strategies.

The paper will identify a number of crosscutting issues that are critical discussion including sensitive, vulnerable, and displaced populations; public health and health care infrastructure; capacities and skills needed; and communication and education to increase awareness of climate change health effects.

The community of world public health is in the early stages of developing modelling skills and capacity in relation to the global climate change, for combining the models of global climate changes with environmental and other health outcome models for use in projecting dynamics of disease under various climate scenarios. Today, we need a coordinated global approach will bring the unique skills, capacities, and missions of the various agencies together to maximize the potential for discovery of new information and opportunities for success in providing key information to support responsive and effective decisions on climate change and health.

In this prospective and open design study, a cannabis formulation with predominant CBD content and very low THC content will be evaluated to treat pediatric treatment-resistant epilepsy (TRE) in Panama. We plan to include in a simple random way twenty participants in this study between the ages of 0-18 years (TRE). Patients with prior pharmacological reaction to cannabinoids, family history of schizophrenia, sensitivity to cannabinoids or heart, liver or kidney disease, and congenital metabolic will be excluded.

Patients will be subject to a 4-week pre-intervention period in which a diary of seizures and quality of life will be completed. A 24-hour ambulatory electro-encephalogram (EEG), blood levels of antiepileptic drugs, and liver tests will be obtained, both at the beginning and at the end of the study.

Upon completion of the observation period, patients will receive an oral pharmaceutical grade formulation containing predominantly purified CBD and a minimum ratio of THC oil, in a 50: 1 ratio, maintaining a dose of THC at least 0.5 mg / kg / day, with an initial dose of 2 mg / kg / day of CBD and 0.04 mg / kg / day of THC, divided twice a day and the dose will be determined and adjusted until optimal levels are achieved for the patient. The treatment period will 5 take months.

Our main outcome will be the absence of seizures. Our secondary outcome measure will be the frequency of seizures, quality of life and the side effects associated with the cannabinoid formulation. Such measures will be determined after every month of treatment, as well as the safety and tolerability of the treatment. Secondary measures will be evaluated by completing a questionnaire on the quality of life by the guardian. An outpatient EEG will also be performed after the 1st month of treatment, the 3^rd month and at the end of the study.

Also, these reviews will be repeated for neurological examination monthly. A univariate analysis will be performed using measures of central tendency, dispersion, means and medians according to the trend of the data. For the analysis of the effect of the formulation dose on the incidence of seizures, we plan to use non-parametric tests. For the comparison of the results before and after the intervention, we plan to use paired tests.

Attention is a cognitive and behavioral process that selectively focuses on the individual aspects of subjective or objective information. It has been shown that transcranial magnetic stimulation of the brain, or rTMS, can affect the networks of attention in the brain of some peoples. In this study we report the effects of our experimental setup(Beta-1 Device) on human brain. Current research shows the influences of our setup on human concentration and attention. Respected to the low number of sessions of this stimulation using the beta1 device and the significant effect of this stimulation, the beta1 system can be helpful in the treatment or improvement of attention deficit disorders. It is suggested that the effectiveness of this machine in increasing attention and focus should be studied by repeating this research and increasing the number of magnetic stimulation sessions of the brain. Due to the results of the previous researches in the stimulation of the DLPFC area and its relevance with the recovery of depression, the effect of stimulation of brain by this device on depression is expected. In the present study, the final scores of attention and visual and auditory focus in the IVA test were considered. It seems that repeating the research and measuring the different components of attention mentioned in this test can illuminate the dark angles of the present study

Peutz-Jeghers syndrome(PJS) is an autosomal dominant syndrome characterized by multiple hamartomatous polyps in the gastrointestinal tract, mucocutaneous pigmentation and an increased risk of gastrointestinal cancer. Polyps are found throughout the gastrointestinaltract but commonly in the small bowel (60-90%), colon (50-64%), stomach (15-30%) and presents with gastrointestinal bleeding, anaemia, abdominal pain due to intussusceptions, obstruction of small intestine or infarction. PJS as a cause of gastric outlet obstruction is rare.A young female of 13 years presented with recurrent attack of abdominal pain, vomiting with significant weight loss for last 4 years. Pain was severe, colicky, in epigastric, periumbilical region aggravated after taking food, relieved with vomiting (spontaneous and induced), vomitous contained 2-3 previous days undigested food. She lost 8 kg weight in last 1 year. She underwent appendicectomy 3 years back. There was no history of fever, jaundice, haematemesis, melaena, alteration of bowel habit. She was moderately anaemic, nonicteric, BMI 15 kg/m²with black pigmentation in lower lip, mucous membrane, at finger tips and sole of foot(figure:1) with an ill-defined lump in epigastric region. Other systemic examination revealed normal. Her haemoglobin was 9 gm/dl, ESR, CRP, LFT, creatinine, CXR were normal with hyponatremia (Na 125), hypokalemia (K 2.5). USG of abdomen suggested gastric mass. After one unit of blood transfusion and correction of electrolyte imbalance, UGI endoscopy revealed multiple gastric & duodenal polyps with largest one was situated at lower body along the lesser curvature with a long pedicle, body of the polyp was impacted into pylorus(figure2). Endoscopic polypectomy(figure2) was done for larger polyps of stomach & duodenum, relieved obstruction with significant symptomatic improvement. Histopathology revealed hamartomatous polyp. Later on colonoscopy also revealed multiple polyps of variable sizes followed by colonoscopic polypectomy, histologically hamartomatous polyps. Our final diagnosis was PJS with gastric outlet obstruction due to gastric polyp with polyposis coli.

Objective: Primary spinal cord tumors are very rare (incidence 0.26/100,000 person/years) in children and adolescents (0-19 years), commonly presents with low back pain, pain radiating to thigh/knee, lower extremity numbness/weakness, urinary dysfunction and abnormal gait. Here we present a case of spinal cord ependymoma in sacral region presented with neurogenic bowel which is very rare in paediatric age group. Methodology: A 5 years old girl from Dhaka presented with increased bowel frequency, 8-12 times/day, semi solid for 2 years without any systemic or neurological complaints. On query, her parents disclosed history of urinary retention 2 years back which improved with intermittent self-catheterization over 3 months with subsequent normal bladder habit for 2 years. General examination, vital parameters were normal. Anal area appeared normal with reduced anal tone. Neurological examination including motor, sensory examination of both lower limbs and other systems revealed normal. Results: CBC, RBS, TSH, creatinine, electrolytes, CXR, USG of whole abdomen, stool R/E, culture, colonoscopy were normal. MRI of lumbo sacral spine (sagittal precontrast T1W1)(Figure1a) revealed a heterogenous, iso-intermediate intense (in comparison to spinal cord) lobulated mass  at S2-S5, with mild inhomogenous  enhancement on post contrast T1W1(figure1b). It was clearly delineated as mild heterogenous, hyperintense lobulated lesion in Sagittal T2W1(figure1c) suggesting  intracanalicular myxopapillary  ependymoma/ Schwannoma/ neurofibroma involving S2-S5 spine.  Conus medullaris(L1), disk heights were normal without any sign of tethered cord or disc herniation. After laminectomy an extradural tumour (S1-S4) was removed near totally(Figure1de), histopathology revealed cellular ependymoma (WHO grade II). Leukocyte common antigen, CD20, CD3 was negative. It was followed by palliative Radiotherapy (total T.D 4400cGy,22Fr,31days). Conclusion: Patient regained her normal bowel habit within 6 months of surgery.  After 8 years she was completely symptoms free without any tumor recurrence which supports long term survival and complete functional recovery of spinal cord ependymoma with specific therapy.