December 2020

Le psoriasis est une maladie auto-immune dont la physiopathologie est mal élucidée. Il s’agit d’une dermatose érythémato squameuse chronique fréquente le plus souvent bénigne. Néanmoins, La forme pustuleuse généralisée reste rare mais grave et peut engager le pronostic vital. L’association à une hypocalcémie est peu fréquente. Cette dernière peut être un facteur déclenchant les poussées cutanées généralisées. Nous rapportant le cas d’un patient suivi depuis 8 ans pour psoriasis et qui fait, suite à un stress professionnel, une forme pustuleuse généralisée, associée à une hypocalcémie sévère symptomatique, révélée par des spasmes laryngés et des crises convulsives et dont la correction par supplémentation en calcium et vitamine D a permis la régression des lésions cutanées.

The condition of care in the critical care unit scenario, based on the perception of the patient hospitalized in an ICU, is being analyzed as an object of study because it represents a situational crisis for the patient, caused by the critical condition of his health, in an environment with advanced technology where the nursing professional and the patient coincide. In such a way that the connection of the patient with the environment is broken, which implies that he depends on humanized care. The objective of this study was to determine the patient's perception of humanized nursing care during his stay in the ICU at the Naval Medical Center. In view of this, a Descriptive and Cross-Sectional (Observational) study was carried out, using the instrument "Perception of humanized nursing care behaviors 3rd version". It was applied to 30 patients hospitalized upon discharge from the ICU between October and November 2020. To do this, we considered variables such as sex, age, days of hospital stay. Corresponding statistical analysis was developed to determine the distribution of the data in a parametric or non-parametric manner, as well as to perform Pearson or Spearman correlation tests as appropriate between the level of satisfaction with the nursing service and the different variables measured, with the support of the GraphPadPrism 7 software. Obtaining the following results: It was observed that 50% of the patients "always" felt with the humanized care measures described in the survey conducted. The average perception of humanized care for the 30 patients surveyed was 3.97 out of a maximum of 4 points, which is equivalent to 99.25 as a percentage. Therefore, we could assert that the way in which the nursing services carry out their work is highly professional. The age range of the patients was mostly over 40 years old with 53%, then patients between 31-40 years old equivalent to 37% and only 10% patients between 26 and 30 years old. A 37% of people were male (37%, n=11) and mostly female with 63% n=19). It was concluded that the patients' perception of humanized care was highly satisfactory in all patients surveyed at the Naval Medical Center. No statistically significant relationship was found between the days of hospital stay and the patient's humanized care.

Objective: To compare the efficacy of the Cubbin-Jackson and Braden scales for assessing pressure ulcer risk in patients hospitalized in the Adult Intensive Care Unit of the Naval Medical Center. Background: There is evidence that 3-34% of patients hospitalized in general wards develop ulcers during their stay. Patients admitted to Intensive Care Units are at high risk of developing pressure ulcers, with an incidence ranging from 3.3 to 52.9%(1). On average, 7-23% of hospitalized patients in Europe and North America have pressure ulcers. In Iran, it has been estimated that 19% of hospitalized patients develop pressure ulcers(2). Material and methods: For the study, data were collected in one phase, lasting 20 days, and with a time window of 4 months. Data were extracted from nursing records, with prior authorization from the research ethics committee. Complete clinical records were taken into account. It was subsequently verified that the patient had been hospitalized for a period equal to or greater than 24 hours, without the presence of pressure ulcers upon admission. During data collection, people not involved in the present study were involved in order to avoid bias due to interest. At the end of the data collection period, the data were tabulated in an Excel spreadsheet and transferred to SPSS to run the respective statistical analysis.

Saudi Arabia is among the countries that have very high prevalence rates of diabetes and hypertension, with prevalence rates of almost 18% and 25%, respectively. The majority of patients with diabetes and hypertension fail to manage their diseases and to show up for their follow up appointments. Mhealth technology is among the interventions that have been recently adopted to overcome these issues and improve the quality of healthcare services. This study aims to evaluate the effectiveness of a mobile phone application named diabetes and hypertension application (DHA Tracking) to promote adherence for patients with diabetes and hypertension in Mecca, Saudi Arabia. The proposed intervention was designed to promote adherence via two features, namely, refill medication reminder (RMR) and doctor appointment reminder (DAR). The third feature, which is managing the number of unnecessary visits, was covered by the cumulative blood sugar test (Hemoglobin A1c) for patients with their doctors. The study examined the difference in adherence level before the intervention and after the intervention with samples of n = 199 and n = 165 for diabetes and hypertension, respectively. The mhealth intervention was found to have significant effects on both the refill medication reminder and the doctor's appointment reminder. Also, it was found that the intervention was efficient in reducing the number of unnecessary follow-up visits to around 20%. This study supports the evidence in the literature on the effectiveness of mhealth in promoting adherence to medication for patients with chronic diseases in the developing countries and specifically in Saudi Arabia. Positive social change that may result from this study is for better management of chronic disease symptoms and increase the awareness of using mhealth applications. This would improve the quality of life for patients, their families, and the community.

Kala Sharir is an important part of Ayurved anatomy but not explained clearly in text. Kala is supposed to be situated between Dhatu and concerning Ashaya. It is formed with layers or membranes of our body and correlated with mucous, serous, fibrous membrane. There are many layers or membranes in the body which form an envelope over the organs. They provide support and protections to the organs. Kala are seven in number and Pittadhara Kala is sixth one present in between Amashya and Pakwashaya that is Grahani correlated as small intestine. Pittadhara Kala is correlated with the lining membranes of small intestine which plays vital role in digestion and absorption of all nutritive substances like Vit B12, Folic acid and iron which are the main factors for the process of formation and maturation of R.B.C. Acharya Dalhan had stated Pittadhara Kala as Majjadhara Kala. Majja Dhatu is present in the cavity of long bones which is correlated with bone marrow where R.B.C production takes place by Erythropoisis. Erythropoiesis is the process of the origin, development and maturation of erythrocytes. Impaired Pittadhara Kala causes malabsorption of Vit B12 and iron and leads to anemia.

Background: Itch (Latin pruritus) is been defined as unpleasant sensation that elicits the desire to scratch pruritus has been well recognized as a common and sometimes unbearable complication in patients who undergo hemodialysis uremia is well known as the most common cause of pruritus in chronic hemodialysis patients uremic pruritus has significant impact on mental and physical capacity of patients, contributing to day time fatigue, agitation, sleep disturbance and depression. Many metabolic factors have been implicated in the pathogenesis of itching in hemodialysis patients for examples, hypercalcemia, hyperphosphatemia, secondary hyper-parathyroidism and hypermagnesemia which considered one of causes of uremic pruritus which also includes: anemia, increase of mast cells in dermis of hemodialysis patients, xerosis and renal toxins. Transcutaneous electrical nerve stimulation (TENS) is an inexpensive form of analgesia that could also ameliorate itching, NB UVB phototherapy has efficacy in alleviating uremic pruritus with minimal adverse effect so both therapy consider safe for most of cases suffering from uremic pruritus. Objective: The purpose of this study was to compare the efficacy of TENS with that of NBUVB on pruritus hemodialysis patients. Methods: Thirty hemodialysis patients were randomly assigned into two group of equal number,15 patients for each group aged between 30-50 years old, all patients was assessed by physician carefully before starting of the study procedures, all patients had diagnosed with chronic renal failure stage 5, subjects of female was included, all patients was received the same physical care, medications and diet, area of maximum intensity of pruritus was back area and all participants was informed about the nature and the effect of the treatment and measurements device, the patients was instructed to reported any side effects during the treatment sessions. Group A (TENS group) received treatment with convetional TENS three times per weeks while group B (NBUVB group) received treatment with ultra violet B for , three times per weeks and duration of treatment session depended on erythema1 for each patient. Duration of treatment was two months for both groups. All groups received the same medical therapy (anti histaminic drugs, topical emollients) , assessment of patients was done pre and after 4,8 weeks of treatment For subjective measurements we used: The visual analogue scale (VAS) and 10 point pruritus questionaire. Results: there was statistically insignificant difference between both groups regarding mean value of VAS after 4,8 weeks of treatment (p-value 0.512 and 0.624 respectively), at the end of study 2 patients (13.3%) from each group showed complete responde to treatment, (53.3% of TENS group and 66.7% in NBUVB showed partial response) while (33.4% in TENS group and 20% in NBUVB were resistant to treatment. Conclusion: from the finding of this study there was no significant statistical difference between response to TENS or NBUVB after end duration of study which continued for 2 months. TENS and NBUVB therapy holds promise as a palliative, alternative, safe and inexpensive treatment for patients with chronic pruritic conditions.

Cyber insurance is an influential means for educating Internet security. Cyber insurance has progressed from outmoded insurance rules to primary cyber risk insurance rules to contemporary compete cyber insurance products. E-insurance rules are attractive more complete as insurance corporations better comprehend the sight of dangers and detailed commercial requirements. More precisely, cyber-operators discourse what remained measured insuperable difficulties (e.g., asymmetric data, moral threat, negative collection, etc.). Many weaknesses incline to misrepresent web and contemporary submissions in the physical world, permitting attackers to recuperate delicate info and use it as a stage for malware actions. Adding technologies necessity be industrialized from big desktop computer systems to devices such as smartphones, and glasses, smart watches. As there is a necessity for security manufacturing on operator information so that no operator is allowable unauthorized access to the data.

Background: Neurological disorders requiring surgical treatment, according to the World Health Organization (WHO), are the second leading cause of death worldwide. In Mexico, there have been nearly 170,000 cerebral infarctions as of October 2018, causing primary brain injuries and increasing admissions to intensive care units. Postoperative diagnoses of neurological disorders that are not treated correctly can cause secondary brain injuries and, consequently, permanent disabilities. Specialized nursing care for neurocritical patients is a fundamental guideline for the patient to have a favorable clinical evolution, since providing specific care reduces secondary brain injuries. Objectives: To analyze the clinical evolution of postoperative patients for neurological disorders who were admitted to the intensive care unit of the naval medical center in the period: from March 1, 2019 to February 28, 2020, to know the clinical characteristics described in the literature of the evolution of postoperative patients for neurological disorders, determine the importance of nursing interventions for the evolution of postoperative patients for neurological disorders, describe the sociodemographic characteristics of postoperative patients for neurological disorders and identify the prevalence of discharges that occurred in the ICU (intensive care unit) of CEMENAV (naval medical center) of postoperative patients for neurological disorders. Material and methods: a retrospective, observational, descriptive, longitudinal study was carried out; The study population consisted of 39 patients who entered the intensive care unit with a postoperative diagnosis of a neurological disorder (surgical or endovascular) in the period from March 1, 2019 to February 28, 2020. The necessary information was obtained from the patient's medical record to apply the measurement instruments that were three APACHE II scales, SOFA SCORE and TISS-28, in two measurements upon admission of the patient to the ICU and upon discharge from it. Results: It was obtained as a result that there was a favorable clinical evolution of patients undergoing surgical treatment for neurological disorders, on the Apache scale 13% of postoperative patients entered with a score of ≥ 68 points, which decreased by 10% upon discharge, being only 3%. On the SOFA score scale, the favorable evolution was also significant, which was demonstrated by showing that 100% of the patients who discharged had a score of zero. With the TISS-28 scale, the result also indicated a favorable evolution since the demand for specialized care that at the beginning was 64%, at discharge was only 5%. Conclusion: the clinical evolution of the patients is favorable,According to the literature, when a patient does not present secondary brain injuries that condition their discharge and that could cause permanent sequelae based on the score obtained by each patient on each scale.

This study explores the question of the reintegration of migrants into the land game of their native region, and therefore attempts to highlight the social issues linked to their reintegration. The recent political crisis of 2010 in Ivory Coast has indeed affected migratory flows in some regions of the country. We have therefore seen the massive return of some populations to their regions of origin. The objective of this study is to understand the strategies developed by resident populations and migrants in the latter's quest to integrate the land arena of their families of origin. At the end of the field investigations which mobilized both the investigation, the interview and the observation, in the constituency of Zoukougbeu and Gregbeu (Western Ivory Coast), the study shows that the final or partial return of migrant reflects a repositioning challenge, both for them and for residents. There is real paradox with the returning migrants. Although they are frustrated by land scarcity, their contributions in the social, economic, and political governance are very important. In short, this study is an advocacy for modernizing rural’s agriculture so that the hope of the returning migrants leads to a successful integration, with productive investments.

Purpose: To determine the relationship of collapsibility of the jugular vein as a predictor of fluid response in patients during the transoperative period at the Naval Medical Center. Methods: A cross-sectional study was conducted on 75 patients who underwent surgery at the Naval Medical Center. The internal jugular vein distensibility was measured by ultrasonography. Correlations, logistic regression analysis, ANOVA or Kruskall-Wallis and chi-square tests were used to determine differences (P ≤ 0.05) between initial compliance and final compliance during the transoperative period. Results: The distensibility of the internal jugular vein is positively related to the fluid load during the transoperative period. In the asa III and IV patients the difference was significant unlike the patients with asa I and II. Conclusions: The determination of the distensibility of the internal jugular vein in patients who will undergo surgery represents an important parameter to determine the response to fluids during the transoperative period.