Physiology and Anatomy

Microscopic colitis, including lymphocytic colitis (CL) and collagenous colitis (CC), is a chronic inflammation of the colon accompanied by non-bloody aqueous diarrhea, while the colonic mucosa has a normal or almost normal macroscopic appearance. It is a benign affection that can evolve spontaneously towards remission or, more often, evolve with phases of respite and relapse. The physical examination is strictly normal and laboratory tests do not reveal any anomalies. The diagnosis will be confirmed by colonic biopsies staged per-colonoscopy. CL is characterized by an increase in intraepithelial lymphocytes, while CC is characterized by a thickening of the subepithelial collagen band. In the light of data from the literature, we will study the epidemiological, clinical, endoscopic and histological characteristics of microscopic colitis through a series of 20 cases collected in the Medical Clinic B of IbnSina University Hospital in Rabat.

Extra-pulmonary tuberculosis (TB) is a common bacillary infection in our population but primary tuberculous liver abscess in a non-immunocompromised patient is an extremely rare occurrence. Only a few cases have been reported in the literature to this day to our knowledge. Its management often requires medical treatment or in combination with percutaneous drainage, but it may take on a surgical appearance. We report here a new case of an isolated tuberculous liver abscess extended to the chest wall in a 32 years old female which was successfully managed with surgical approach and anti tubercular therapy. This location presents a considerable diagnosis challenge. It should be considered in the differential diagnosis of liver cystic lesions, especially in a high tuberculosis prevalence country.

Reversible Posterior Leukoencephalopathy Syndrome (RPLS) is generally a rare complication, little-known, and remains probably under-diagnosed. Its causes and favorable factors are numerous. Eclampsia is widely one of those factors. The diagnosis is raised based on clinical and radiological signs and an adequate and early management usually help prevent the occurrence of irreversible sequels.

Castleman’s disease is a rare pathology of unknown etiology with different clinical manifestations, which creates both diagnostic and therapeutic dilemmas. It’s abdominal localization is rarely described. There are no characteristic signs in imaging, and the diagnosis of certainty is histological. The management of Castleman's disease and its prognosis differ depending on whether it is localized or pluricentric. The localized form usually develops favorably after surgical excision. We present a particular case located in the mesentery, revealed by repeated hematemesis.

HHE syndrome is characterized by the occurrence of prolonged clonic seizures with unilateral predominance occurring during fever in infancy, who subsequently develop a transient or definitive hemiplegia. Later partial epilepsy is often observed. We report a case of a four-year and nine-month-old boy with hemiconvulsion–hemiplegia–epilepsy (HHE) syndrome documented by magnetic resonance imaging (MRI) in its acute phase. In particular, T2 and DWI abnormalities appear to be well correlated with parenchymal damage that results from sustained ictal activity.

Our study proposes a quantitative investigation to identify trends of anxiety and physical activity among medical students or graduates while studying for the United State Examination Licensure Examination Steps at Pass Program in Champaign, Illinois. The research emphasizes students' physical activity and anxiety contributing to study performance, such as retention and concentration with USMLE question bank improvement. The quantitative research study aims to evaluate medical students and graduates by providing participants with questionnaires. The study is divided into two phases. The first phase provides a clinical questionnaire to participants, and the second phase interviews to evaluated responses and eliminate any barriers in the research. Students or graduates engaged in physical activity are more likely to retain and have efficient concentration while studying for the USMLE examination. Physical activity controlled participants' anxiety; however, physical activity did not significantly change the daily USMLE test banks. Medical students and graduates are less physically active and have developed generalized high levels of anxiety. The study estimated that 73.3% of students claimed that they suffer from anxiety, contributing to test banks' low performance. The research has shown that medical students and graduates are not regularly physically active. Females are less physically active than males. The concentration results presented that 59.7% of participants stated daily physical activity improved concentration by providing efficiency on USMLE question banks. 59.5% of participants mentioned that physical activity significantly helped students and graduates control their anxiety levels. 51.1% of participants stated they did not witness any significant changes (increase or decrease) in daily question bank performance with regular physical activity. 46.9% of students stated that physical activity improved retention of study material with daily physical exercise activity. The research has significantly shown medical students' and graduates' study hectic schedules hinder participants' physical activity. The stress of USMLE has caused students and graduates to experience a high level of anxiety. Students or graduates engaged in physical activity are more likely to retain and have efficient concentration while studying for the USMLE examination. Physical activity controlled participants' anxiety; however, physical activity did not significantly change the daily USMLE test banks.

Peripartum cardiomyopathy is a rare disease accountable for giving a heart failure, which affects women in the last month of pregnancy or within the first 5 postpartum months. Early signs and symptoms of heart failure may not be seen, they are often considered as a normal part of pregnancy. When such symptoms and signs are not diagnosed or managed accurately, the consequences can be deleterious for the patient. We are going to briefly report a case of a 28-years-old woman, without any preexisting structural heart disease. The woman, after 3 months of vaginal delivery following normal pregnancy, was admitted for cardiogenic shock and distal lower Limb Necrosis secondary to peripartum cardiomyopathy. Such complications are uncommon, and the management was not easily accepted by the patient.

Cronkhite Canada Syndrome (CCS) is a rare, non-hereditary disease that combines chronic diarrhea, diffuse intestinal polyposis and onychodystrophy. We are reporting on the observation of the first case of Cronkhite Canada Syndrome in Morocco. The case has to do with a 33-year-old patient with chronic bloody diarrhea associated with alopecia and onychodystrophy within a context of general deterioration and significant weight loss. The biological assessments were characterized by the presence of microcytic anemia with hypo albuminemia, malabsorption syndrome and hydro electrolyte disorders. The colonoscopy had shown several hamartomatous polyps located at the recto sigmoid level. The histopathological examination showed hyperplastic inflammatory polyps with extensive propria oedematous lamina, and cystic glands. The diagnosis of CCS was made in the face of a host of clinical, biological, endoscopic and histological arguments. Our patient received oral corticosteroids as treatment, along with nutritional support and a treatment of electrolyte disorders. Cronkhite Canada syndrome is associated with high mortality and a risk of malignant transformation. Clinicians should considerand think about CCS for a patient with unexplained chronic diarrhea and dermatological manifestations (Alopecia, Onychodystrophy, Hyperpigmentation).

This study assessed the effect of lemongrass tea (LGT) on liver function indices in humans. One hundred and five participants ingested the LGT prepared from 2, 4, and 8g of LGL powder once daily for 30 days. Serum ALP level increased throughout the study period; although only the increase at day 30 reached statistical significance, while serum AST and ALT were not significantly different from baseline values. At days 10 and 30, serum total bilirubin significantly increased and decreased respectively. Ingestion of LGT may be associated with transient hyperbilirubinemia, and sustained elevation of ALP.

More than millions of people are living under the threat of influenza virus over the world countries including Nepal. The pathogenesis of this disease is not clearly understood and is probably attributed to genomic variations in viral strains as well as the host genetic makeup. The present study is to determine the role of polymorphism of TNF-alpha promoter regions at positions -238G/A, -308G/A, -857C/T and -863C/A in the severity of Influenza A Pdm/09 patients. Total of 500 patients including 300 Influenza A Pdm/09 (RT-PCR positive) and 200 apparently healthy individuals (Influenza A Pdm/09 Negative by RT-PCR) were included in the study. Polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) using site specific restriction enzymes were implemented for polymorphism study of TNF alpha promoter. Following the analysis of the digestion patterns of four polymorphic sites of the TNF- alpha promoter region, a significant association was observed between the allele -308A with the patients of Influenza A Pdm /09 patients. TNF- alpha 308 G/A has been shown to be associated with elevated TNF- alpha transcriptional activity. As per the literature search, this is the first study to identify the role of TNF- alpha promoter in Influenza A Pdm/09 infection. Our results show that subjects with - 308A more vulnerable to the severe form of Influenza A Pdm/09 infection