Naimina: Legend of an Explorer

The Black Sea Fleet has 2 dreadnoughts, 4 cruisers, 3 destroyers, 3 ironclads, and 1 submarine. The Navy, while large, is not as high in quality as the Arab, African, and Asian powers. The Air Force is decent, but small. It possesses 75 recon aircraft, 60 fighters, 25 heavy bombers, and 40 light bombers. The Polish economy is completely self sufficient. Coal is harvested in southern Poland, oil pumped in Belarus and Ukraine, and industry located throughout the kingdom.

Trade with the outside is limited for fear of harming Polish culture, so the economy is not at its full potential, mostly inward focused. Infrastructure is very good, due to the flatness of much of the land. Railroads are the most popular form of transport, and they crisscross the country, as well as decent roads. While not the best, it certainly isn't the worst in the world. Scientific Research and Development: Most science is agricultural and industrial related. It isn't the most advanced in the world, due to its self sufficiency and inward focus, but it allows for industry and agriculture to be better.

Militarily, the country has decent tech, though not the best. Ensure the survival of the nation and church, become more involved in international trade, solidify alliances. As in real life, the plague did not much affect Poland, especially the area around Warsaw. With the fall of Rome and much of Italy to the disease, the Pope made the decision to move to the largest surviving Catholic region, in Poland. The Kingdom of Poland weathered the century of disease, seemingly through the work of God alone. Requiring more room to support the population, it wasn't long before settlers began living in the area around Warsaw, and slowly expanding outwards.

They assimilated what survivng Europeans they came across. Over hundreds of years, lands as far east as Ukraine were settled, and as far north as Estonia. With the settling of these lands came conflicts with Arab and Africa settlers. This led to the Polish people becoming xenophobic and inward facing, never colonizing in the New World. During the industrial revolution, spies discovered the new technology, and it began being used in Poland, after which time their own technology evolved and was used.

The Enlightenment was mostly ignored, with the monarchy and religion remaining an integral part of the government and culture. Since then, the country has evolved in economic and military might, though wars have been infrequent and sparse due to neutrality in most conflicts. This is so me and other Co-Op s are able to find your apps easily.

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Incan Empire Short Nation Name: Western South America Colonies: Quechua Form of Government: Absolute Monarchy Head of State: Incan culture changes during s when another civil war happen which the culture of the Inca today are more like westernized but doesn't mean that they were westernized by any powers. The Incan culture were flourished and one of the most influential culture in South America and the East.

They were once a polytheist religion, now a monotheist religion, their god was called 'Inti', their saviour. The Incan Imperial Army is the most dangerous, fierce, and brutal army in the world where they were taught that they will have no mercy on their enemies. Many people who are jobless were drafted.

They have a specialty for making a booby traps and ambush. They also have armoured vehicles like this , this , and this. Over 95, sailors are active. Over 12, pilots were active.

Very wealthy nation, the Incas have a unique resources like gold, platinum because of the Andes Mountains. Their economy is unique, mixed with agrarian and industrialisation. Trading is also the reason why the Incan Empire are very wealthy nation, they are already a very wealthy nation since s. The Incan infrastructure were developed during s, the infrastructures became rich-like.

The Incan Empire are currently researching a bio-chemical materials. Keep expanding their empire. Continue the Asian campaign. Maintain relationships with the Songhais and the other empires. Upgrade more economy and military. The Incan Empire was established in by the first Incan Emperor, Pachacuti, Pachacuti was the king of Cuzco who united with the other kingdoms and tribes in the Andes Mountains. The early period in the Incan Empire were polytheistic which believed in many gods. People in the Incan Empire considered their king as the "son of the sun" during that time and the Incan Civilization arose from the highlands of present-day Peru.

Pachacuti reorganized the kingdom of Cusco into the Tahuantinsuyu, which consisted of a central government with the Inca at its head and four provincial governments with strong leaders: Chinchasuyu, Antisuyu, Kuntisuyu,and Qullasuyu. Pachacuti is also thought to have built Machu Picchu, either as a family home or as a summer retreat, although there is speculation that Machu Picchu was constructed as an agricultural station. Pachacuti sent spies to regions he wanted in his empire; they brought reports on the political organization, military might and wealth.

He would then send messages to the leaders of these lands extolling the benefits of joining his empire, offering them presents of luxury goods such as high quality textiles, and promising that they would be materially richer as subject rulers of the Inca. Most accepted the rule of the Inca as a fait accompli and acquiesced peacefully.

The ruler's children would then be brought to Cusco to be taught about Inca administration systems, then return to rule their native lands. This allowed the Inca to indoctrinate the former ruler's children into the Inca nobility, and, with luck, marry their daughters into families at various corners of the empire. His most important conquest was the Kingdom of Chimor, the Inca's only serious rival for the coast of Peru. At its height, the Inca Empire included Peru and Bolivia, most of what is now Ecuador, a large portion of what is today Chile north of the Maule River in central Chile.

The advance south halted after the Battle of the Maule where they met determined resistance by the Mapuche. The empire's push into the Amazon Basin near the Chinchipe River was pushed back by the Shuar in The empire also extended into corners of Argentina and Colombia. However, most of the southern portion of the Inca empire, the portion denominated as Qullasuyu, was located in the Altiplano. The Inca Empire was an amalgamation of languages, cultures and peoples.

The components of the empire were not all uniformly loyal, nor were the local cultures all fully integrated. The Inca empire as a whole had an economy based on exchange and taxation of luxury goods and labour. The following quote reflects a method of taxation: There were even provinces where, when the natives alleged that they were unable to pay their tribute, the Inca ordered that each inhabitant should be obliged to turn in every four months a large quill full of live lice, which was the Inca's way of teaching and accustoming them to pay tribute. With a new government established in the Empire at , this new government began on militaristic policy and conquered many territories outside the heartland of the Incan Empire but a smallpox appeared in the Incan Empire after the civil war and devastated the population in The Incan Empire conquered the North in and the South in , the campaign was completed in , the campaign was very long since the Incans conquered gigantic mountainous region in the North and South.

The Incans created a boat for the first time in and developed their navy in The Incans sailed to the West and found a new territory which is the New Zealand and colonised the territory, the Incans didn't slave the Maoris because they are humans, not slaves.

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The Incans arrive in Australia in as their navy gets more developed and colonized the territory, the Incans arrive in Papua New Guinea in and colonized it and the Incans arrive in the Philippines, particularly Mindanao in and conquered the Rajahnates there, their expansion stop to focus on industrialisation. The Incans finally created a writing system in for the Quechua language, the talking knots for the communication were keep in storage and it is on the museum today. In s, the Incan Imperial Military began to modernised, soldiers are well-equipped and ready for war.

Aircrafts were built and industrialisation were more focus than agrarian but the government balances their economy of agrarian and industrial which became a mixed and unique economy. This era were peaceful until the Songhais, who were friendly to them turn against the Incan government, the Incans considered the Songhais an hostile, two powerful empires heated in s as a Songhai battalion attacked the Incan Borderguards in Northern Amazon for no reason, until today, they hate each other, but today, the Incan Empire is a richest empire in the world.

Original NS account was banned created in Dec. Shwetang teleported out of the car. A Communal, based around local councils. Elements of anarcho-communism and syndicalism are influential, as are ideas of libertarian socialism. Trade unions are ever present, equality and democracy are thriving. Voluntary Action is a necessity, with many work needed to be done. For matters of national importance, such as war, the People's Council is called, which normally operates once a year with representatives from all territories.

Those representatives are mostly volunteers or chosen by the majority of the populace. No representative can be a member of the People's Council, which is situated either in Taiwa or Havana, for more than three years. Local councils, based around towns and villages on every place in Chatlahaw, which cooperate with one another, and the People's Council, from where the nation has taken its name, is situated in Tiawa and Havana and takes important national decisions, with representatives from around the nation, to inform the Council of any events in their own area. Where there is work to be done, volunteers are asked to be brought in, from around the country, which they do, to aid.

Money aren't used, but everything is provided. Labor Marks are used instead, for items that aren't provided, which are mostly luxuries. They aren't usually used. Same as above Capital City: None Most inhabited and popular cities: Seminole are the dominant tribe and culture, although there are other tribes who have influence over the culture, combining many aspects of different tribes and some African influence in the culture.

The Army is comprised of militias, with experienced warriors acting as advisors. They are comprised of volunteers, who can leave whenever they want, as well as experienced soldiers who act as advisors. The standard equipment is a Tak wepaon, a rifle which can shoot multiple bullets before needing to reload, a knife and a Kur, a handgun which holds eight bullets. There are other weapons, although given to selected soldiers, such as the Fie Got, a long range weapon with a scipe, which can hold up to nine bullets, the Hakh, a powerful, short range weapon which holds up to six bullets, and the Wakar, a weapon capable of firing up to forty bullets, although it isn't common to use.

There are 50, active soldiers with , in reserve. In times of a hard war, many join either voluntarily pr through conscription which has rarely been used and can raise up to , soldiers. The Navy is a central part of Chatlahaw. There are multiple ships available, either reinforced with steel or wooden used for transportation and war. The system of hierarchy is similar to the army. The quality of the battleships, dreadnoughts and submarines are fair, with the transportation vessels being of good quality due to a need for them to. The Air Force is comprised of ten airships, and 20 reinforced hot air balloons, primarily used in defense.

There are attempts at strengthening the Air Force. Chatlahaw isn't a wealthy "nation" but benefits from fishing, agriculture. There is a developing industry, mostly in Taiwa, Cuba, and Haiti. It is used mainly for making necessities and rarely are those necessities sold to other countries. It also has,as well, a developing tourism. It is mostly isolated, with goods transferred between the different islands and peninsulas, wherever they are needed.

Most of the "country" is situated in small communes and towns. The bigger cities are few but well-maintained. The biggest city, in terms of size, is Taiwa amd the most populated Havana. There are settlements throughout the territory, with restaurants, places to sleep and warehouses to take clothes off, that are provided.

The villages and towns are connected through paved roads. There are few railroads, only in Cuba, Taiwa and Haiti. Most houses are made of stone and in some cases wood. A small but growing percentage of them are made from reinforced steel. Science is highly valued in Chatlahaw, with many schools and universities existing, which are provided, as well.

Scientists are valued members of the community. Due to the hardships of Chatlahaw, few scientists can afford the equipment necessary for experiments, however there are every year, candidates to be tested. Biochemistry is currently studied. Survive, Improve living conditions, Make alliances with native empires and few others, Liberate colonies from other empires History: The plague didn't affect every day life for the tribes of the Caribbean.

It wasn't until the empires started arriving that the tribes understood they had to work together to battle the imperial overlords. The leader of the revolution, Ahal Kenwa, was a highly influential figure, who first came up with the idea of having as a system,a libertarian socialist and anarcho-communist system.

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He died fighting for the revolution, which lasted until , and is credited as the father of Chatlahaw. He was a Seminole, who was born in Cuba. The revolution finished with the creation of the Chatlahaw, a libertarian socialist confederation of islands and Taiwa. Soon, they were engulfed in another war, in , in which they liberated most of the islands in the Caribbean Sea, except Boriken.

That was when many people who shared their ideology, mostly from Africa and some from Asia arrived at Chatlahaw. They were mostly stationed in Cuba, Taiwa and Haiti. They created a system where everyone was equal, free, living in a democratic society. After years of peace, in , the Yucatan peninsula, after a successful revolution joined the Chatlahaw.

It was a short and almost bloodless revolution, one that gave the people much hope and the system, was rejuvenated. There were almost thirty years of non-revolution when, in , Boriken, the last island in the Caribbean that haven't joined Chatlahaw, had a revolution of its own. This revolution was entirely bloodless, with no people dying. Revolutionary Equality, 93 Liberty and 29 Stability. The origins of the Vijayanagara Empire is murky at best, and despite attempts to uncover the truth, there are differing theories on how it came to be - some suggest that the two founders, Harihara I and Bukka, were commanders of the Hoysola Empire who had been assigned to lead armies to repel Muslim invasions.

Others claim that the Telugu peoples seized areas from the declining Hoysola Empire to found Vijayanagara, Whichever may be the case, the founders of the Empire would eventually create one of the wealthiest and strongest empires in Asia. In the early years of the Empire, it continued to expand, and by the early-to-mid 14th century, it encompassed nearly all of Southern India; with nowhere else to expand, and with the threat of Muslim invasion heavily diminished when the plague devastated Northern India, it continued to integrate territory, assimilating the few survivors left and conquering the few weakened states that had managed to hang on despite the plague.

However, it's conquests were halted as the Empire was forced to consolidate its gains. Various Rajas would begin to develop the Empire, and the capital was moved from a small town IOTL's Karnataka to Vijayanagara which, over the centuries, would become one of the most important if not the most important cities in the nation.

Important works of fortifications, defenses, and irrigation projects were constructed to fend off a potential Mongol invasion, which had begun to spread into Northern India and was seen as a threat by the leaders of the nation, as well as boost the nation's agriculture. Deva Raya II, seen as one of the best rulers of Vijayanagara, ascended to the throne, crushing the various feudal lords and chieftains which remained outside of his jurisdiction, and launched an invasion of Lanka, in order to subjugate the peoples there and expand the Empire.

The Empire, after the death of Deva Raya II, would experience a gradual decline throughout much of the s, as it resisted several attempted Mongol invasions, which were all repelled, although at a bloody cost for the Vijayanagari armies. However, it experienced a revival in the late s, when trade began to take hold in the nation and Arab and African merchants began to arrive in the ports. By the s, the Rajas began to incorporate modern military weapon and tactics into his military, and began to push its imperialistic interests elsewhere.

A colony was established in Sri Lanka, and Vijayanagari explorers began to explore what would eventually become the Vijayanagari East Indies. Around this time, the Empire also experienced an influx of Jews, as news of this vast new Empire tolerant of all faiths spread across the globe. This would contribute to the later so-called Intellectual Revolution.

By the early s, the New World - a vast landmass that had managed to escape detection from European, Arab, African, and Asian explorers and merchants for so long - had been discovered, and with this came imperialist fervors, and a small colony was established on the island of Sumatra. Throughout the s, an attempt at a colony was established by using ports on the Cape in present-day Argentina, but it soon failed, and Vijayanagara decided to instead focusing their resources and efforts on the colony on Sumatra.

Multiple wars were fought with powers in the region, but given Vijayanagara's military might, they soon succumbed, and by the mid-to-late s, half of Sumatra was under their control, while additional incursions were being made into the Malay peninsula. Vijayanagara would begin to finally open official diplomatic with other Arab and African countries, particularly those who could benefit the empire most. The entire nation began to centralize, as the Maharaja now called Chakravartin gained more powers at the expense of local 'Nayakas' people who ruled pieces of land that were required to supply the government with troops in the case of war.

The years passed, as Vijayanagara would establish outposts on Borneo and Sulawesi; as the sufficient technology developed to explore deeper into the islands and colonize it more efficiently, the small outposts expanded into towns, towns expanded into settlements, settlements expanded into full-fledged colonies. By the mids, the islands of Sumatra, Borneo, and Sulawesi had finally been conquered and subjugated, while most of the Malay Peninsula had been colonized and parts of Burma were now a part of the nation's colonial Empire. The next major event that would affect the Empire was the Industrial Revolution; as it started in the Songhai Empire, and slowly spread across the world, the Chakravartin ignored this, and instead focused on trade, colonization, and agriculture.

Industry would not be developed until the s, and Vijayanagara was a late comer to the Revolution. However, the Industrial Revolution and the Enlightenment would result in a spread of democratic and liberal ideals; people began to call for a more democratic form of government in the Vijayanagara. Not wishing to spark a rebellion, the Chakravartin, in all of his wisdom, created a Sangam a council of elected representatives , to act as a sort of legislature for the Empire.

In addition to this, he produced a document which served a very similar purpose to a constitution; the people, now satisfied, settled down, although there were still, of course, some who called for the installation of a republic and the abolishment of the monarchy.

This was a time when art, literature, and architecture began to flourish in Vijayanagara, and major cities became learning centers. An intellectual elite began to develop, universities were constructed and the education system of the nation improved. Scholars from all across the world would flock to Vijayanagara, sharing their ideas, theories, and whatnot. Vijayanagara would became the main nation for others to exchange knowledge and ideas.

While the initial embers of the Intellectual Revolution would die down, the heart still remains, and the Revolution continues even today. By the s, the nation finally began a slow, gradual process of industrialization, as it improved relations and struck a number of deals with the already industrialized Songhai Empire, in order to assist with their industrialization and to develop the necessary infrastructure and tools to begin to drill for oil reserves and coal, both of which were becoming increasingly important in a world which was becoming more reliant on this nonrenewable resources.

The Navy was expanded and dozens of new ships constructed, but while this sudden focus on the military did put strain on the economy, it has ultimately resulted in a capable military willing to defend the Empire, it's people, and it's interests. It has yet to be tested in combat, but with the tensions of the world rising, many places seem like a powder keg ready to spark, ranging from the unstable Mongol Empire to the intense rivalry between the Songhai and Ethiopian Empires - and when it explodes, the world will be plunged into war.

Canaan; Phoenicia; Israel; Zion; Syria native: Monarchy Head of State: Jewish, Lebanese, Syriac, Mashriqi Arab though, in dated terminology, they all fit under the "Syrian" ethnicity Culture: Canaanite Hebrew and Phoenician cultures are, indeed, so similar, that there was once a time they were not even considered separate ethnicities Religion: Yahwism to be explained in history Army: The Canaanite army consists of approximately 1 million active personnel of both male and female types, as both are seen as being required to defend the homeland. They use the most up-to-date equipment they can find, such as bolt-action rifles and gas grenades.

The army is given the second priority, however, to the navy, according to ancient traditions. When able, mercenaries are also known to be employed to aid in battles against superior enemies. There is no set amount of soldiers operating tanks or artillery in contrast to general infantry, with the number fluctuating depending on the needs. When such fluxes occur, secondary specialists may be employed in another field, or specialists may be converted to general infantry.

The navy is given the higher priority over the army, and is thus granted more funding. In order to ensure maximum effectiveness, the navy as well as the army is typically divided by ethnicity, with Arab groups, Canaanite groups, and Aramaic groups. A sergeant will command one of these groups, a lieutenant will look over several of the same type, a major will overlook several of two ethnic groups, and a general or admiral overlooks multiple of these.

Due to the ship-based structure of the navy, entire ships will likely be filled by one ethnicity rather than the looser squad-based grouping of the army. The air force, like most during the historical World War 1, is not the peak of the military. It consists of biplanes and bombers, entirely lacking an airship component.

These planes are mostly experimental, with more expensive models having a machine gun mounted on them, and less expensive ones giving the pilot a rifle. The economy has, historically, been one of excellence. Phoenician trade legacy carried on to the state after its independence, and the neutral religious position allowed for trade between both Islamic and Christian worlds in the Middle Ages and beyond.

Thus, it acted almost like a second Constantinople, providing exotic goods to Europeans, and the number of Jewish bankers and traders coming from Europe where those professions were some of the few they were allowed to have in olden days aided further in building wealth.

It is highly prosperous for its size, competing decently with larger powers, but not quite a superpower. Infrastructure is moderately maintained. There are a few paved roads crossing the entirety of the nation. These highways are the most well-maintained, with a couple train lines also cooperating. While far from the ideal, it does well enough.

Governmental buildings are probably the peak of infrastructure, with a few impressive palaces appearing near major cities, both left over from previous countries and newly built. The navy holds a larger portion, having about 1. The scientific progress of the nation is, aside from military, lagging slightly behind others due to its relative strength. While other nations are superpowers governing vast territory, Canaan instead holds a much more humble kingdom.

With the funding placed into military, something had to suffer, and so development otherwise is between 10 and 20 years behind. Survival, economic growth, possible colonization. Around the time of the Crusades, before Plague wiped the lands of Europe, fierce warriors would travel across the sea and land to fight the Caliphs in West Asia. Both European and Islamic states were weakened overall by this, though it would eventually lead to increased wealth in the world via the revival of open trade in previously closed regions.

The native populations were typically suppressed under both Christian and Islamic rule, with none but a few Norman knights taking pity and giving mercy. In outrage, the Jewish and Syriac Christian populations rose up, taking advantage of the weakened nature of their overlords to establish a new kingdom. Initially unstable due to religious differences among the population, the Jewish populace came to take hold of the government. Policies of tolerance were quickly established to protect the internal stability, and the small amount of people who still spoke Phoenician gained protection and even encouragement as a movement to contain Islam and the Arabic habits from dominating.

Alliances with whomever would take them were quickly established, and a safe position was found. In time, the Plague came and went. Europeans suffered the most, but it did indeed hit the Jewish kingdom briefly. Population did, over the next century, recover steadily. With trade routes having been long established in the region, its power as a trade node grew rapidly with the collapse of Europe and its merchant republics.

There was, for a brief time, very little competition in the Western market. Steps were taken within the rising Phoenician populace to reunite the Canaanite people. Scholars of Judaism noted the similarities between their faith and the Phoenician polytheistic one, and eventually a priest-king by the name of Ahirom would found the Third Temple, painstakingly created to biblical description, and officially declare the Phoenician polytheistic faith and Judaism to be separate sects of a singular, united religion. Thus, Judaism became synonymous with "Yahwism" or "Elohism", the reverence of the common king of the gods over all others.

Over what would've been the Renaissance era, the united Canaanite culture prospered. Phoenicians found rapid expansion, from their original numbering of less than in a single village, to tens of thousands by the end of the 16th century. The speakers in the village were initially employed to teach others in the Lebanese region, as well as urban centers in Damascus and Jerusalem. The Phoenician identity, being cognate to the dominant Hebrew one, was quickly adopted by many of the native Lebanese and Syrian Arabs, who had the Phoenician lineage but had been forcibly converted to Arabs in the earlier days of the Caliphs.

Over the next few centuries, the Canaanites became the dominant populace by far. Syriac Christians, known colloquially as Arameans, were left to majority within inland Syria, while the Mashriqi Arabs were only a majority in Jordan by the turn of the 20th century. In the course of the next years, secularization would begin to be implemented, though the official state religion remained as Natib Qadish, the native name for the Canaanite faith.

The nation would begin to lag behind, just a bit, in most aspects as the ways of the world began to shift. It now holds position as a secondary power, on par historically with nations like Mexico, Greece, and Bavaria, who held significant importance without being dominant. You probably know already. The Songhai Empire National Flag: I can't find anything about their flag, so this piece of crap will do.

The South American colonies, as seen above. Songhai, Arabic Form of Government: Political parties are elected to the office of President, who holds much power. The raining Mansa, a word meaning emperor, still holds power, and is beloved by the population. Democracy is one of the empires core values, though the power possessed by the Mansa may not make this clear. A range of West Africans inhabit the homeland. The Songhai ethnicity has multiplied and come to dominate it.

Smaller numbers of Moroccan's, Carthaginians, Egyptians, and other Arabs live inside the border. The Brazilian colonies consist of almost entirely Songhai settlers who have travelled there over the years. Small numbers of natives, as well as a few Inca populate the outermost parts. The Songhai culture is by far dominant, though nearly all others are accepted in the Empire. Ethiopians are one of the least welcomed, due to years of conflict along the border. With hundreds of years of peace, the Songhai culture flourished without interruption.

They are now the most influential culture in all of Africa, and possibly the world. Islam has always been dominant, since the original Ghana Empire and the first Mansa's. The Incan religion, who worship a false god named 'Inti', has been growing quite fast in the colonies. A militant group known Allah's Soldiers have made it their duty to wipe out these heathens. Secularism is officially practised, though Islam still holds much power in the government.

The Royal Songhai Army is the best equipped and trained in the entire world. Men who sign up for the army are put through 2 years of tough training. This includes survival training, improvising weapons, and long marches through the hot deserts of the homeland. Their job is to keep the Brazilian colonies safe from any who would attempt to encroach on it. The navy has long focused on quantity, rather than quality. This is starting to be phased out now that much more powerful ships are being built.

It's made up of: As opposed to the navy, quantity is still preferred. It is hoped that the massive numbers will be able to bomb any opposing forces into submission. The Songhai economy is absolutely enormous. The Empire is self sufficient in food, thanks to massive irrigation using the Niger River.

Large tracts of land that were once desert, are now teeming with productivity. Vast oil reserves off the southern coast drive industry. There are over 5, factories throughout the country, which pump out steel and refined products. The country trades with every possible nation that they can. Paved roads run across the Empire, linking the smallest towns to the largest. Railroads crisscross not only the homeland, but also the colonies.

Houses are mostly made out of steel, though the homes in the colonies are a mixture of wood and stone. Songhai has long been a centre of science, the industrial revolution being one of its many inventions. This tradition continues to today, with schools being built in every town across the Empire. Industry is a large priority. A new revolution in military technology, the 'landship', is being worked on. It is like cavalry but made out of steel and with far larger guns mounted on it.

Develop relations relation's with most countries. Solve the problem of Ethiopia once and for all. Help to liberate colonies from opposing empires to weaken them. Thanks to the isolation the Sahara desert provided, the Songhai Empire remained unaffected by the plague. The Moroccans suffered widespread death, stopping them from ever interfering in the Empire's expansions again. Under a series of successful Mansa's, the borders of the Empire kept growing, until they encompassed all of the Niger River territory. The population was able to grow at a massive rate, due to peace and surplus food production.

Having so many people, there was bound to be a few geniuses come along. One of them was the sailor, Admiral Askia. After word of the New World reached the Empire from Arabia, he went on a voyage to see it for himself. He discovered the continent of South America, and founded the first city there, called New Gao. The natives were easily subdued thanks to more advanced technology, such as gunpowder. Settlers moved there in droves, and expanded all across the coast of the continent. Expansion inward would lead to the growth of the colony, and it was far more prosperous than any could have thought.

No other colonies were ever settled, due to powers such as Carthage and Ethiopia claiming them, and the native kingdoms fighting back. The greatest inventor in the history of the Songhai Empire, and possibly the world, was Ishaq Mohammad. He was always fascinated by the way the lid of his teapot would rise up once the water began boiling. Finding a way to utilize this was an obsession of his. Many prototypes came and went, until at the age of 32, he invented the steam engine, and changed the world. The new technology allowed the Songhai Empire to enter a golden age that would last for what seemed like forever.

Factories using the steam engine were able to produce more than any human could by hand. The Gatling Gun, the most ferocious weapon that had ever been seen, was able to mow down any man who came near it. Over were used in the invasion of central Africa, which conquered most of it in just 2 years. The Ethiopian Empire, the last known bastion of Christianity, was the eternal enemy of the Songhai. Little known to them, was that it would be their greatest defeat. After central Africa was cleared up, an army of , invaded Ethiopia.

If they had the technological advantage, then it would have been a walk in the park. Ethiopia had somehow stolen the technology, or developed it on their own. Drafting an absolutely enormous army, Ethiopia fought back, and pushed the Songhai back to a border far away from them. The Kongo took this time to steal some of the central African holdings.

Never again would the Empire expand that far. Since then, peace has been maintained. Irrigation using the Niger River main vast amounts of desert fertile, and the population exploded. Geniuses continued to be born, and the Empire always innovated. The first airplane was tested in the year , and their design has improved since.

The Songhai Empire enters the year , as the most advanced, and possibly the most country, in the entire world. The future is looking bright, though war lies on the horizon. Why is this still here? Koku Republic Head of State: Koku Reishi Naimin Head of Government: Gulai no Kokuni Capital City: Penutian races, Japanese Culture: Penutian is the main culture, which is basically an offshoot of Japanese at this point with a little bit of actual native Penutian. Secular state but the philosophers of old are revered Army: While Penutia tries to be a mostly neutral state except when it comes to controlling resources and national security , that neutrality must be defended somehow.

Differential diagnosis of hyponatraemia. The appropriate management of hyponatraemia is reliant on the accurate identification of the underlying cause of the hyponatraemia. In the light of evidence which has shown that the use of a clinical algorithm appears to improve accuracy in the differential diagnosis of hyponatraemia, the European Hyponatraemia Network considered the use of two algorithms. Both of these algorithms concurred on the importance of assessing effective blood volume status and the measurement of urine sodium concentration in the diagnostic process.

To demonstrate the importance of accurate diagnosis to the correct treatment of hyponatraemia, special consideration was given to hyponatraemia in neurosurgical patients. The differentiation between the syndrome of inappropriate antidiuretic hormone secretion SIADH , acute adrenocorticotropic hormone ACTH deficiency, fluid overload and cerebral salt-wasting syndrome was discussed. In patients with SIADH, fluid restriction has been the mainstay of treatment despite the absence of an evidence base for its use. An approach to using fluid restriction to raise serum tonicity in patients with SIADH and to identify patients who are likely to be recalcitrant to fluid restriction was also suggested.

Distribution of late gadolinium enhancement in various types of cardiomyopathies: Significance in differential diagnosis , clinical features and prognosis. The recent development of cardiac magnetic resonance CMR techniques has allowed detailed analyses of cardiac function and tissue characterization with high spatial resolution. CMR in ICM shows segmental wall motion abnormalities or wall thinning in a particular coronary arterial territory, and the subendocardial or transmural LGE.

LGE in NICM generally does not correspond to any particular coronary artery distribution and is located mostly in the mid-wall to subepicardial layer. The analysis of LGE distribution is valuable to differentiate NICM with diffusely impaired systolic function, including dilated cardiomyopathy, end-stage hypertrophic cardiomyopathy HCM , cardiac sarcoidosis, and myocarditis, and those with diffuse left ventricular LV hypertrophy including HCM, cardiac amyloidosis and Anderson-Fabry disease.

A transient low signal intensity LGE in regions of severe LV dysfunction is a particular feature of stress cardiomyopathy. Finally, the analyses of LGE distribution have potentials to predict cardiac outcomes and response to treatments. Differential diagnosis of rheumatic diseases. Which imaging modalities are appropriate for the Differential diagnosis of Rheumatic diseases. MRI has far most the highest sensitivity and is unequaled in its brilliant presentation of Anatomy and Pathology. But it is sometimes forgotten, that this is at least in part the result of carefully selected sequences, dedicated to the expected result.

In a method totally independent of any result, this should not be the case. In contrary this method should be highly standardised and regardless what will be the findings. This is true for Plain X-ray. It will be shown, that already the outer silhouette of the soft parts with different features of swelling, and differences in density and even more - defects or appositions of the bony silhouette in the majority of cases at least will allow to classify the patient for a group of diseases and in many cases will lead to a definite diagnosis.

Differential diagnoses like Rheumatoid Arthritis versus Psoriatic Arthritis or simply but not always simple - inflammatory Arthritis versus degenerative disease - are allowed to be answered definitely, not always so in MRI. The condition of the subchondral bone can give hints, how advanced and how active the disease is at present. Plain X-ray offers high specifity in the differential diagnoses of Rheumatic diseases, it is well standardised and it is a device, to use independent from any suspected findings.

So it is the method of choice for questions of differential diagnosis. This is even more true, thinking of the possibility, to investigate all clinically involved regions with not to much extended efforts, whereas MRI and CT are used normally for only one region. CMR in ICM shows segmental wall motion abnormalities or wall thinning in a particular coronary arterial territory, and the suben Differences in clinical features and computed tomographic findings between embolic and non-embolic acute ischemic stroke.

A quantitative differential diagnosis. A diagnosis based on the presumed mechanism of stroke onset is useful for management strategies in acute ischemic stroke. Ninety-two patients with embolic cardiac or artery-to-artery and with non-embolic thrombotic or hemodynamic stroke were diagnosed on strict cerebral angiographic criteria alone. To clearly discriminate between these two groups, the neurological and computed tomographic CT findings were then compared.

Rapidity of onset, vomiting, urinary incontinence, level of consciousness, cervical bruit, anisocoria, tongue deviation, sensory disturbance, and CT findings location of hypodense area, findings of brain edema and hemorrhagic transformation were discriminatory factors between the two groups p differential diagnosis. A diagnostic accuracy of The differences in clinical features and CT findings between embolic and non-embolic stroke may reflect the pathophysiological mechanisms of the occlusive process of cerebral artery as well as the extent and severity of ischemia.

The GH hypersecretion leads to overproduction of insulin-like growth factor 1 IGF-1 which results in a multisystem disease characterized by somatic overgrowth, multiple comorbidities, physical disfigurement, and increased mortality. This article aims to review the clinical features of acromegaly at diagnosis. The typical coarsening of facial features include furrowing of fronthead, pronounced brow protrusion, enlargement of the nose and the ears, thickening of the lips, skin wrinkles and nasolabial folds, as well as mandibular prognathism that leads to dental malocclusion and increased interdental spacing.

Excessive growth of hands and feet predominantly due to soft tissue swelling is present in the vast majority of acromegalic patients. The disease also has rheumatologic, cardiovascular, respiratory, neoplastic, neurological, and metabolic manifestations which negatively impact its prognosis and patients quality of life. The presentation of acromegaly is more often related to its systemic comorbidities or to local tumor effects. The neuromuscular differential diagnosis of joint hypermobility. Joint hypermobility is the defining feature of various inherited connective tissue disorders such as Marfan syndrome and various types of Ehlers-Danlos syndrome and these will generally be the first conditions to be considered by geneticists and pediatricians in the differential diagnosis of a.

Full Text Available The data of different firms of hereditary galactosemia was analyzed in this article. Clinical and biochemical characteristics and molecular and genetic features of diagnostics of this disease were described. The information about differential diagnosis and problems, related with hereditary galactozemia screening in Russia was given. To explore the value of application of support vector machine-recursive feature elimination SVM-RFE method in Raman spectroscopy for differential diagnosis of benign and malignant breast diseases. Fresh breast tissue samples of patients all female; ages were obtained by routine surgical resection from May to May at the Department of Breast Surgery, the First Hospital of Jilin University.

Among them, there were 51 normal tissues, 66 benign and 51 malignant breast lesions. All the specimens were assessed by Raman spectroscopy, and the SVM-RFE algorithm was used to process the data and build the mathematical model. Mahalanobis distance and spectral residuals were used as discriminating criteria to evaluate this data-processing method. Based on spectral profiles, the presence of 1 , 1 , 1 , 1 , 1 , and 1 cm -1 peaks were identified in the normal tissues; and 1 , 1 , 1 , 1 , 1 , 1 , and 1 cm -1 peaks were found in the benign and malignant tissues.

The main characteristic peaks differentiating benign and malignant lesions were 1 and 1 cm There are distinct differences among the Raman spectra of normal, benign and malignant breast tissues, and SVM-RFE method can be used to build differentiation model of breast lesions. No appetite Fever Headaches Diagnosis To check for hepatitis viruses, your doctor will test your blood.

Asthma and COPD chronic obstructive pulmonary disease are the most important obstructive pulmonary diseases. Patient's history and physical evaluation give major hints of the underlying disease. Further diagnostic measures comprise lung function analysis including spirometry, plethysmography and--in severe cases--blood gas analysis.

Bronchial hyperreactivity may be quantified with an unspecific inhalative provocation test. In many cases allergic diseases are accompanied by asthma. Thus, allergy tests--particularly skin prick tests--have to be carried out. To further define an underlying allergy, in some cases even specific inhalative provocation tests have to be performed. X-ray of the thorax and other imaging techniques, detailed blood analysis, further diagnosis of the upper respiratory tract and the cardiac system may have to be carried out a to quantify the effects of a severe form of asthma or COPD on other organs, and b for differential diagnostic examinations.

Intramural hemorrhage of the thoracic aorta - imaging features and differential diagnosis ; Das intramurale Haematom der thorakalen Aorta: Bildgebende Diagnostik und Differentialdiagnose. Klinik fuer Herz- und Gefaesschirurgie; Busch, M. Germany Radiologische Klinik; Bierhoff, E. Germany Radiologische Klinik; Kuhl, C. Germany Radiologische Klinik; Lutterbey, G.

Germany Radiologische Klinik; Keller, E. Germany Radiologische Klinik; Schild, H. Aortic wall thickening due to intramural hemorrhage may be the only sign of aortic dissection. The aim of this study was to evaluate the incidence, imaging features and differential diagnoses of intramural hemorrhage IMH of the thoracic aorta. Diagnosis of IMH based on the presence of smooth crescentic or concentric wall thickening over a longer segment of the thoracic aorta without flow visualization and without compression or distortion of the aortic lumen.

One patient with IMH of the ascending aorta died of aortic rupture and subsequent pericardial tamponade 12 hours after onset of symptoms. In one patient with IMH of the descending aorta on initial examination, there was a progression of overt aortic dissection at follow-up after three weeks. In two patients with IMH of the descending aorta, wall thickening decreased in size at follow-up weeks , whereas in one patient it remained unchanged.

IMH of the aorta should be considered a precursor of aortic dissection. At follow-up IMH may decrease in size, rupture or progress to overt aortic dissection. Eine aortale Wandverdichtung als Ausdruck eines intramuralen Haematoms kann die einzige Manifestation einer Aortendissektion sein. Ziel dieser Arbeit war die Evaluierung der Inzidenz, bildgebenden Aspekte und Differentialdiagnosen dieses in der deutschsprachigen Literatur wenig bekannten Krankheitsbildes.

Kriterium fuer das Vorliegen eines intramuralen Haematoms war der Nachweis einer laengerstreckigen aortalen Wandverdickung ohne Flussnachweis sowie ohne Konfigurationsaenderung des aortalen Lumens. Magnetic resonance imaging features of extremity sarcomas of uncertain differentiation. The purpose of this review is to illustrate the pertinent clinical and imaging features of extremity sarcomas of uncertain differentiation , including synovial sarcoma, epithelioid sarcoma, clear-cell sarcoma, and alveolar soft part sarcoma. These tumours should be considered in the differential diagnosis when a soft-tissue mass is encountered in the extremity of an adolescent or young adult.

CT diagnosis and differential diagnosis of malignant pleural mesothelioma. To study the CT features of malignant pleural mesothelioma and improve diagnostic accuracy. The CT findings of 14 patients with malignant pleural mesothelioma proven by surgery or histopathology were analyzed retrospectively. Pleural thickness which was more than 1. Obvious characteristics in cases with malignant pleural mesothelioma was showed in CT examination, which plays an important role in the diagnosis and differential diagnosis of this disease.

Joint hypermobility is the defining feature of various inherited connective tissue disorders such as Marfan syndrome and various types of Ehlers-Danlos syndrome and these will generally be the first conditions to be considered by geneticists and pediatricians in the differential diagnosis of a patient presenting with such findings. However, several congenital and adult-onset inherited myopathies also present with joint hypermobility in the context of often only mild-to-moderate muscle weakness and should, therefore, be included in the differential diagnosis of joint hypermobility.

In fact, on the molecular level disorders within both groups represent different ends of the same spectrum of inherited extracellular matrix ECM disorders. In this review we will summarize the measures of joint hypermobility, illustrate molecular mechanisms these groups of disorders have in common, and subsequently discuss the clinical features of: The aim of this review is to assist clinical geneticists and other clinicians with recognition of these disorders.

Disorders of sexual libido are seldom organic, in general they are of psychological origin. It is, however, difficult to obtain a differential diagnosis. One of the first diagnostic considerations must be the establishment of primary or secondary libidinal dificit, or indeed, whether there is no libido at all. In cases of libido disorders with primary libido dificit, depression, organic disease, or side effects of pharmaca may be the cause. Libido disorders in the presence of functional libido, however, must be regarded as primarily psychologically caused.

An exception are libido problems in the presence of diabetes mellitus and peripheral vasculatory defeciencies. In these cases libido is either totally absent or appears only secondarily. The symptomatology of libido disorders in the presence of depression, diabetes melitus, and peripheral vasculatory disturbancies, as well as psychologically caused erectile and ejaculatory difficulties are discussed in detail.

These groups are compared with respect to libido and behavior involving erection, ejaculation, anxiety and avoidance. Approaches to differential diagnosis , treatment. The characteristic features of MFS are given in its diagnostic criteria. Diagnosticcriteria for polymyalgia rheumatica are given. A MFS treatment algorithm is presented. Local exposure methods applied to altered musculoligamentous structures in combination with myorelaxants and non-steroidal anti-inflammatory drugs assume paramount importance in MFS.

Differential diagnosis of radiation injury. A single haematological alteration is not sufficient to diagnose whether it is a radiation-induced change or not. For the differential diagnosis of possibly radiation-induced changes in the peripheral blood and blood-forming organs, information on the radiation exposure in terms of time, quality, quantity and localization, and the clinical symptoms have to be taken into account.

Ionizing radiation within the dosage range considered here produces cell division delay, mitotic inhibition, chromosomal damage or interphase cell death; it thereby interferes with the steady-state equilibria in the cell-renewal systems of the organism Bond et al. The cause of haematological changes appearing immediately after a short-term, external whole-body radiation exposure has been described and analysed elsewhere in this Manual.

The critical cell component is the 'stem cell compartment' which is highly radiosensitive and suffers damage but, because stem cells cannot be identified morphologically, a direct study of stem cell injury is not possible. Diagnosis and differential diagnosis of hydrocephalus in adults. Hydrocephalus is caused by an imbalance of production and absorption of cerebrospinal fluid CSF or obstruction of its pathways, resulting in ventricular dilatation and increased intracranial pressure.

Imaging plays a crucial role in the diagnosis , differential diagnosis and planning of treatment. This review article presents the different types of hydrocephalus und their typical imaging appearance, describes imaging techniques, and discusses differential diagnoses of the different forms of hydrocephalus. Imaging plays a central role in the diagnosis of hydrocephalus. While magnetic resonance MR imaging is the first-line imaging modality, computed tomography CT is often the first-line imaging test in emergency patients.

Aids to radiological differential diagnosis. This book is composed of lists of differential diagnoses divided into categories: It does not contain any reproductions of radiographs. Differential diagnosis of disseminated periventricular calcifications. Juvenile disseminated periventricular calcifications may occur in tuberous sclerosis, toxoplasmosis, cytomegaly, and in tuberculous meningitis.

Cysticercosis, by contrast, does not result in corresponding intracerebral foci until an older age. Differential diagnosis is no problem if clinical findings are typical tuberous sclerosis or if serological verification is positive. However, any unclear clinical diagnosis can often be secured by CT. Full Text Available The lecture considers the problem of rare systemic connective tissue diseases, such as idiopathic inflammatory myopathies IIMs. It underlines the clinical and immunological heterogeneity of their subtypes, which defines therapeutic tactics and prognosis.

The diagnostic criteria for IIMs are given. A differential diagnostic algorithm based on the exclusion of phenotypically similar forms of myopathies of different genesis is proposed. To evaluate the feasibility of using chest radiography to differentiate between three different etiologies of pulmonary edema.

Plain chest radiographs of 77 patients, who were clinically confirmed as having pulmonary edema, were retrospectively reviewed. The patients were classified into three groups: We analyzed the radiologic findings of air bronchogram, heart size, peribronchial cuffing, septal line, pleural effusion, vascular pedicle width, pulmonary blood flow distribution and distribution of pulmonary edema. In a search for radiologic findings which would help in the differentiation of these three etiologies, each finding was assessed. Cardiogenic and renal pulmonary edema showed overlapping radiologic findings, except for pulmonary blood flow distribution.

On plain chest radiograph, permeability edema can be differentiated from cardiogenic or renal pulmonary edema. The radiographic findings which most reliably differentiated these two etiologies were air bronchogram, distribution of pulmonary edema, peribronchial cuffing and heart size. Only blood flow distribution was useful for radiographic differentiation of cardiogenic and renal edema. Differential diagnosis of retinal vasculitis.

Retinal vaculitis is a sight-threatening inflammatory eye condition that involves the retinal vessels. Detection of retinal vasculitis is made clinically, and confirmed with the help of fundus fluorescein angiography. Active vascular disease is characterized by exudates around retinal vessels resulting in white sheathing or cuffing of the affected vessels. In this review, a practical approach to the diagnosis of retinal vasculitis is discussed based on ophthalmoscopic and fundus fluorescein angiographic findings. Radiological diagnosis in AIDS - associated diseases: Radiologic examinations provide substantial information to narrow the differential diagnosis.

This article reviews clinically important HIV-associated diseases for the radiologist. The braod spectrum of possible manifestations is illustrated by the accompanying case reports that typify the complexity of diagnoses in this growing problem worldwide.

Maasai Mara

Despite the frequency of functional abdominal pain, potentially dangerous causes of abdominal pain need to be excluded. Medical history and clinical examination must focus on red flags and signs for imflammatory or malignant diseases. See the patient twice in the case of severe and acute abdominal pain if lab parameters or radiological examinations are normal. Avoid repeated and useless X-ray exposure whenever possible. In the case of subacute or chronic abdominal pain, lab tests such as fecal calprotectin, helicobacter stool antigen and serological tests for celiac disease are very useful.

Elderly patients may show atypical or missing clinical signs. Take care of red herrings and be skeptical whether your initial diagnosis is really correct. Abdominal pain can frequently be an abdominal wall pain. Specific phobias in older adults: Differential diagnosis implies identifying shared and divergent characteristics between clinical states. Clinical work with older adults demands not only the knowledge of nosological features associated with differential diagnosis , but also recognition of idiosyncratic factors associated with this population.

Several factors can interfere with an accurate diagnosis of specific phobia in older cohorts. The goal of this paper is to review criteria for specific phobia and its differential diagnosis with panic disorder, agoraphobia, post-traumatic stress disorder and obsessive compulsive disorder, while stressing the specific factors associated with aging. A literature search regarding specific phobia in older adults was carried out using PubMed.

Relevant articles were selected and scanned for further pertinent references. In addition, relevant references related to differential diagnosis and assessment were used. Etiologic factors, specificity of feared stimulus or situation, fear predictability and the nature of phobic situations are key points to be assessed when implementing a differential diagnosis of specific phobia.

First, age-related sensory impairments are common and interfere both with information processing and communication. Second, medical illnesses create symptoms that might cause, interfere with, or mimic anxiety. Third, cohort effects might result in underreporting, through the inability to communicate or recognize anxiety symptoms, misattributing them to physical conditions. Finally, diagnostic criteria and screening instruments were usually developed using younger samples and are therefore not adapted to the functional and behavioral characteristics of older samples.

Basic pattern in CT of the lung and differential diagnosis. Infectious, physical, chemical or other noxae elicit a limited number of reactions in lung tissue. As in the case of other organs and tissues, lung tissue has specific reactions that are often more indicative of the particular organ than the harmful agent.

The resulting radiological features are usually ambiguous and therefore prevent definitive diagnosis. This complicates etiological categorization of the disease. Pathognomonic findings are rare. The same noxa can yield different radiographic features and clinical pictures for different patients.

A diagnosis is generally not comprised of a single radiographic feature , but rather of a combination of a plurality of features. Although the number of possible diagnoses can be limited via radiological means, a final diagnosis is determined in conjunction with the medical history, the clinical picture, as well as lab and histopathological values. This article defines the most common pulmonary changes and also discusses differential diagnostic criteria.

Developing a semantic web model for medical differential diagnosis recommendation. In this paper we describe a novel model for differential diagnosis designed to make recommendations by utilizing semantic web technologies. The model is a response to a number of requirements, ranging from incorporating essential clinical diagnostic semantics to the integration of data mining for the process of identifying candidate diseases that best explain a set of clinical features.

We introduce two major components, which we find essential to the construction of an integral differential diagnosis recommendation model: Both approaches are driven by disease diagnosis ontologies designed specifically to enable the process of generating diagnostic recommendations. These ontologies are the disease symptom ontology and the patient ontology. The evidence-based diagnosis process develops dynamic rules based on standardized clinical pathways. The proximity-based component employs data mining to provide clinicians with diagnosis predictions, as well as generates new diagnosis rules from provided training datasets.

This article describes the integration between these two components along with the developed diagnosis ontologies to form a novel medical differential diagnosis recommendation model. This article also provides test cases from the implementation of the overall model, which shows quite promising diagnostic recommendation results. Diagnosis and Differential Diagnosis of Hydrocephalus in Adults. Full Text Available Objective: A female patient aged 51 years sought medical advice for complaints of spinal column and bone pains, periodic dizziness, and hand numbness.

The patient underwent clinical and biochemical blood tests, determination of the blood levels of calcium, phosphorus, parathyroid hormone, concentrations of total vitamin D, calciuria, electrocardiography, thyroid ultrasonography, and neck computed tomography. Based on her complaints, examination evidence, evaluation of the clinical presentations of the disease, and objective and instrumental examination findings, the patient was diagnosed with left parathyroid adenoma and primary hyperparathyroidism; stage II hypertensive disease, grade I, a moderate risk; retinal angiopathy of both eyes; stage I dyscirculatory encephalopathy with liquor and venous dyscirculation and moderate vestibular ataxia; urolithiasis; kidney stones; and spondylosis mainly involving the lumbar spine.

The diagnostic determinants for verifying the diagnosis were the results of neck computed tomography, namely: The history of urolithiasis, repeated lithotripsy, as well as spondylosis with lumboischalgia was an absolute indication for surgical treatment. The practical interest in this case is due to the complexity of diagnosing normocalcemic hyperparathyroidism after vitamin D deficiency. This clinical case demonstrates the importance of routinely determining vitamin D concentrations.

Diagnosis and differential diagnosis of Graves' orbitopathy in MRI. Imaging of Graves' orbitopathy GO includes radiological and nuclear medicine procedures. Depending on the method used they provide information about the distribution and activity of the disease. Magnetic resonance imaging MRI is not only a helpful tool for making the diagnosis it also enables differentiation of the active and inactive forms of GO due to intramuscular edema.

The modality is therefore appropriate to evaluate the disease activity and the course of therapy. The disease leads to the typical enlargement of the muscle bodies of the extraocular muscles. The inferior rectus, medial rectus and levator palpebrae muscles are mostly involved. Signal changes of the intraconal and extraconal fat tissue are possible and a bilateral manifestation is common. The differential diagnosis includes inflammatory diseases and tumors, of which orbital pseudotumor idiopathic, unspecific orbital inflammation , ocular myositis and orbital lymphoma are the most important.

The specific patterns localization, involvement of orbital structures and signal changes can be differentiated by MRI. Differential diagnosis of myelitis; Differenzialdiagnostik der Myelitis. Langner, Soenke [Universitaetsmedizin Greifswald Germany. Acute transverse Myelitis is an inflammatory myelopathy characterized by rapid onset of bilateral neurological symptoms. There is a vast array of differential diagnoses and the underlying pathology often cannot be identified on clinical examination alone.

Therefore neuroimaging has a central role in narrowing the differential diagnosis. This review aims to provide a summary of common causes of non-traumatic myelopathies, many of which may have similar radiological appearance. Full Text Available Symptomatic prostatic paracoccidioidomycosis PCM is a very rare condition; however, it may express as a typical benign prostatic hyperplasia or a simulating prostatic adenocarcinoma. This case report presents PCM mimicking prostatic adenocarcinoma. The purpose of this paper is to call the general physician's attention to this important differential diagnosis.

Differential diagnosis of ataque de nervios. Characteristics of ataque de nervios, a culturally condoned expression of distress that is most frequently seen in Hispanic women, are described. It has symptoms in common with affective and anxiety disorders, with which it can co-occur, and these are delineated for purposes of differential diagnosis.

Possible reasons for the preponderance of the condition in women are discussed, along with suggested intervention strategies. Differential diagnosis in the pediatric radiology. The book on differential diagnosis in the pediatric radiology covers the following issues: Differential diagnosis of Jakob-Creutzfeldt disease. To identify the misdiagnoses of patients with sporadic Jakob-Creutzfeldt disease sCJD during the course of their disease and determine which medical specialties saw patients with sCJD prior to the correct diagnosis being made and at what point in the disease course a correct diagnosis was made.

Retrospective medical record review. A specialty referral center of a tertiary academic medical center. One hundred sixty-three serial patients over a 5. The study used the subset of 97 patients for whom we had adequate medical records. Other diagnoses considered in the differential diagnosis and types of medical specialties assessing patients with sCJD. Ninety-seven subjects' records were used in the final analysis. The most common individual misdiagnoses were viral encephalitis, paraneoplastic disorder, depression, vertigo, Alzheimer disease, stroke, unspecified dementia, central nervous system vasculitis, peripheral neuropathy, and Hashimoto encephalopathy.

The mean time from onset to diagnosis was 7. Diagnosis of sCJD is quite delayed. Primary care physicians and neurologists need improved training in sCJD diagnosis. CT on diagnosis and differential diagnosis of adrenal neuroblastoma from nephroblastoma in children. To evaluate the effect of CT on diagnosis and differential diagnosis of children's adrenal neuroblastoma from nephroblastoma.

To analyse the CT manifestations on 36 cases of adrenal neuroblastoma and 32 cases of nephroblastoma both confirmed by postoperative pathologic diagnosis. The adrenal neuroblastoma is a kind of extrarenal tumor, so the kidney kept its original form and showed some compressive features.

The incidence of tumor calcification appeared mostly in rough and speckle-piece form was high. While the nephroblastoma is a renal tumor. The surrounding renal parenchyma showed a specific 'new-moon shape' intensification. CT is one of the most valuable and effective means of examination to diagnose adrenal neuroblastoma and differentiate it from nephroblastoma.

It can provide important information for making correct diagnosis , planning proper therapy and assessing prognosis. Case report and differential diagnosis. While rarely seen in the present-day Western world, phocomelia is not uncommon in underdeveloped countries. Phocomelia is an abnormality in which the limbs are not fully formed. It may be inherited as an autosomal recessive or dominant disorder. This case concerns a year-old Afghan boy with multiple skeletal anomalies, most prominently of his right arm, including aplasia of the entire proximal humerus, hypoplasia of the clavicle and scapula, and absence of the radial ray and thumb.

A hypoplastic left thumb was also present. Other anomalies included thoracic scoliosis, upper thoracic hemivertebrae, and mild cardiomegaly. The differential diagnosis and likely diagnosis are discussed. Labaratory capacity of differential anemia diagnosis. Full Text Available The paper presents the laboratory values by which modern differential diagnosis of anemias can be performed.

This takes into account a widerange of laboratory tests, including: Full Text Available Background. Galactosemia type I, or classic galactosemia CG, is the most severe form of hereditary disorders of carbohydrate metabolism, in particular, galactose. Galactosemia is not included in the program of massive neonatal screening in Ukraine.

The CG is characterized by the non-specific onset symptoms and leads to high mortality among infants in the neonatal period. The problem of early diagnosis and treatment of infants with CG in the absence of a program for massive neonatal screening in Ukraine requires solution. The purpose was to analyse the clinical and laboratory, molecular genetic features of patients with CG; to define a set of clinical symptoms and to form selective groups of patients for administration of diet therapy and laboratory diagnosis ; to develop schemes-stages of effective early diagnosis and treatment of patients with CG in the absence of mass neonatal screening in order to reduce infant mortality and prevent the disability of patients with this pathology.

In —, patients with a diagnosis of hepatitis of uncertain origin were examined. In all patients, a polysyndromic clinical picture with predominant lesion in the liver function was observed. All patients were examined for the activity of galactosephosphate uridylyltransferase GALT enzyme in the red blood cells and underwent DNA diagnosis for the detection of major mutations in the GALT gene. All patients were examined for viral hepatitis, underwent biochemical blood tests for hepatic transaminases, alkaline phosphatase, bilirubin levels, and coagulopathy.

Five patients with suspected glycogenosis have been subjected to a quantitative glycogen test in the. Differential diagnosis of calf pain by ultrasonography. Full Text Available This paper aims to evaluate the recent and numerous applications of ultrasonography in the differential diagnosis of conditions that affect the popliteal fossa and lower limbs, resulting in calf pain.

Popliteal cysts and their ruptures, aneurysms, hematomas, cellulitis, abscesses, soft tissue tumors and other fluid collections are easily identified by this technique. Moreover, post-trauma and inflammatory conditions affecting muscles and tendons, muscle necrosis, deep venous thrombosis and superficial thrombophlebitis are very well demonstrated by the ultrasonographic screening.

The purpose of work is development and clarification of roentgenology displays of tumoroidea variant of abscess of lungs for differential diagnostics him with the cancer of lungs. Practically in most cases abscess of lungs there is a necessity of leadthrough of differential diagnostics with in a number of nosology forms, including with the cavernous form of peripheral cancer of lungs. The features of flow of roentgenologic picture of tumoroidea variant are resulted, alike symptoms, differ ences and signs which allow to set a correct diagnosis , are resulted, the value of follow-up of roent genologic research and use of computed tomography is underlined.

Differential diagnosis of AD is still a challenge due to overlapping features with other types of dementia. Biomarkers for the differential diagnosis of AD can improve the diagnostic value of the disease and ensure an appropriate treatment of patients. The aim of this study was to evaluate Extramedullary plasmacytoma in the carotid space: Expanding the differential diagnosis. Plasma cell neoplasms have been classified into various types, with a range of clinical and radiological presentations.

Extramedullary plasmacytoma EMP is a subset of plasma cell neoplasms which presents as an isolated non-osseous soft tissue mass. Though carotid space neoplasms are commonly encountered, EMP in the carotid space is rare and seldom considered in the initial differential diagnosis of a carotid space mass. These tumors can be treated by surgery or radiotherapy. On the other hand, the commonly encountered tumors in the carotid space are treated surgically. Also, it is mandatory to exclude multiple myeloma in the patients presenting with EMP.

Hence, accurate and early diagnosis has therapeutic and prognostic implications. We report a rare case of EMP of the carotid space, describing the imaging features and the differential diagnoses with clues pointing to this rare entity. Pathology and differential diagnosis of chronic, noninfectious gastritis.

The histologic finding of chronic inflammation in an endoscopic mucosal biopsy of the stomach chronic gastritis is very common and usually reflects the presence of Helicobacter pylori infection. However, infectious organisms are not always present in biopsy material, and some cases of chronic gastritis do not result from H. Thus, the differential diagnosis of this finding is an important one for pathologists to keep in mind. This review presents the three most common and clinically significant causes of chronic, noninfectious gastritis, namely, autoimmune atrophic gastritis, lymphocytic gastritis, and gastric involvement in the setting of inflammatory bowel disease, especially Crohn disease.

For each entity, a brief discussion of its etiology and pathogenesis, a review of the clinical and endoscopic features , and a description of the microscopic findings are presented in the context of the differential diagnosis of chronic gastritis with emphasis on helpful histopathologic hints and long-term sequelae. Differential diagnosis of benign intrahepatic tumours. Differential diagnosis of benign intrahepatic tumours can be very difficult despite numerous non-invasive diagnostic approaches, as is evident from two case reports presented here.

The problem appears particularly intricate if two or more masses or space-occupying growths are present at the same time, the diagnostic aspects being different. In the first case, echinococcus alveolaris occurred simultaneously with a cavernous haemangioma and a focal nodular hyperplasia FNH. In the second case, FNH as a pendulating tumour was combined with a second focus in the superior part of the liver. These two examples are used as basis for discussing various diagnostic approaches, such as sonography, computed tomography and scintiscanning.

Radiological possibilities in differential diagnosis of hypertension. The radiological methods have their definite place within the pattern of differential diagnosis of hypertension. To detect renal hypertension, urography and radionuclide techniques with separate clearance are employed. Morphological proof of arterial stenoses is effected by means of angiography. Changes in the adrenal causing hypertension are covered by sonography and computerized tomography which are supplemented mainly by adrenal phlebography and selctive withdrawal of blood for hormonal determination.

The chest x-ray film yields information on cardiac adaptation to enhanced pressure load. Differential diagnosis of small solid pancreatic lesions. Pancreatic ductal adenocarcinoma PDAC is typically diagnosed at a late stage. Little is known about the incidental finding of early-stage PDAC. The differential diagnosis of ritual abuse allegations. Because psychiatrists do not have a consistent way to classify and define the forms of child abuse that may be mistaken for ritual abuse, the objective of this paper is to create a comprehensive differential diagnosis of allegations of ritual abuse.

The authors reviewed 60 articles, chapters, and books that contained allegations of ritual abuse or behaviors that might be mistaken for ritual abuse, that were made by patients or caretakers. This paper clarifies the behaviors that represent or may be mistaken for ritual abuse: Cult-based ritual abuse, pseudoritualistic abuse, activities by organized satanic groups, repetitive psychopathological abuse, sexual abuse by pedophiles, child pornography portraying ritual abuse, distorted memory, false memory, false report due to a severe mental disorder, pseudologia phantastica, adolescent behavior simulating ritual abuse, epidemic hysteria, deliberate lying, and hoaxes.

The differential diagnosis of allegations of ritual abuse is important in both clinical and forensic psychiatry. In some cases, it will not be possible to tell whether a particular allegation is factual or what the underlying mental processes are. It is important to separate the role of the mental health professional as therapist from the role as an expert witness in court.

Psoriasis is a chronic, immune-mediated, inflammatory disease which affects primarily the skin and joints. It occurs worldwide, but its prevalence varies considerably between different regions of the world. Genetic susceptibility as well as environmental factors play an important role in determining the development and prognosis of psoriasis. Epidemiological studies identified several modifiable risk factors that may predispose individuals to developing psoriasis or exacerbate pre-existing disease.

These include smoking, obesity, alcohol consumption, diet, infections, medications and stressful life events. The exact mechanism by which they trigger psoriasis remains to be elucidated; however, existing data suggest that they are linked through Th1-mediated immunological pathways. The natural history of psoriasis varies depending on the clinical subtype as well as special circumstances, including pregnancy and HIV infection.

In general, psoriasis is a chronic disease with intermittent remissions and exacerbations. The differential diagnosis is vast and includes many other immune-mediated, inflammatory disorders. Clinical phenotype, differential diagnosis and disease progression. Parkinsonian syndromes include idiopathic Parkinson's disease IPD , other neurodegenerative diseases with parkinsonism, the so-called atypical parkinsonian syndromes, and symptomatic parkinsonian syndromes, such as Wilson's disease. IPD is the most frequent disease with parkinsonism as the main clinical feature and is responsible for approx.

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Atypical parkinsonian syndromes are the most important differential diagnoses of IPD. For clinical diagnosis it is essential to take a careful medical history and to examine the patients physically in regular intervals. However, various clinico-pathological studies have shown that approx. Selected technical investigations, in particular functional imaging of the central dopaminergic system using PET or SPECT, may help to make clinical diagnosis more secure.

This paper reviews the clinical features and diagnostic findings in diseases with parkinsonism and summarises the difficulties in establishing early and differential diagnoses. Glioblastoma as differential diagnosis of autoimmune encephalitis. To identify the clinical and radiological features that should raise suspicion for the autoimmune encephalitis AE -like presentation of glioblastoma.

This is an observational, retrospective case series of patients referred to the French National Reference Center on Paraneoplastic Neurological Diseases for suspected AE possible, probable or definite, using the criteria who later received a final diagnosis of glioblastoma according to WHO criteria. An extensive literature search was also conducted for similar existing cases. Between and , patients were referred to our center for suspected AE. Thirteen patients 9 male were included for analysis 6 from the present series and 7 from the literature ; median age was Initially, a diagnosis of AE was clinically suspected based on: Five patients exhibited initial slight contrast enhancement.

An alternative diagnosis of glioblastoma should be considered in patients presenting initially as AE, especially in patients who do not fulfill the criteria for definite AE and in those with a poor clinical evolution despite initial improvement. Differential diagnosis of gigantic pulmonary abscesses. The paper is concerned with an analysis of the clinical X-ray picture in patients with gigantic pulmonary abscesses the diameter over 6 cm and in patients with retrostenotic abscesses in central lung cancer, gigantic peripheral cancer with disintegration, tuberculous infiltrate with dissociation, an echinococcal cyst with suppuration and rupture in the bronchus.

The reliable clinical differential diagnostic symptoms were not revealed. The chief method of X-ray examination is tomography. In addition to examination of the gigantic focus of lesion in the lung, tomography of the major bronchi should be also performed. The difference between a gigantic pulmonary abscess and peripheral lung cancer is in the nature of the walls and contours; of particular importance is the symptom of nodularity and radiance of the outlines of the pathological shadow which is more distinctive in peripheral cancer.

Correct diagnosis was established in Differential diagnosis and management. Diabetes insipidus DI is a syndrome characterized by the excretion of abnormally large volumes of dilute urine. It can be caused by any of 4 fundamentally different defects that must be distinguished for safe and effective management. This review describes several methods of differential diagnosis , indicates the advantages and disadvantages of each and presents a new approach that is simpler and less costly but just as reliable as the best of the older methods.

The various treatments for the different types of DI and recent findings on the genetic basis of the familial forms of DI are also discussed with emphasis on their contributions to improved diagnosis and management. Differential diagnosis of neuromyelitis optica spectrum disorders. Nevertheless, the differential diagnosis of NMOSD in clinical practice is often challenging despite the phenotypical and serological characteristics of the disease because: Understanding the detailed clinical, serological, radiological, and prognostic differences of these diseases will improve the proper management as well as diagnosis of patients.

Hospital readmission is considered an adverse outcome, and the hospital readmission ratio is an indicator of health care quality. Published studies show a wide variability and heterogeneity, with large groups of patients with different diagnoses and prognoses. The aim of the study was to analyse the differences between patients readmitted and those who were not, in patients grouped into the diagnosis related group DRG A retrospective observational study was conducted on DRG patients discharged in Of the patients included in the study, were readmitted.

On multivariate analysis, significant variables were: DRG readmitting patients have some distinctive features that could allow early detection and prevent hospital readmission. Published by Elsevier Espana. Mechanisms underlying narcolepsy are not fully understood. Experimental data indicate that the disease is caused by a loss of hypocretin neurons in the hypothalamus, likely due to an autoimmune process triggered by environmental factors in susceptible individuals. Most patients with narcolepsy and cataplexy have very low hypocretin-1 levels in the cerebrospinal fluid.

An appropriate clinical history, polysomnogram, and multiple sleep latency test are necessary for diagnosis of the disease. Additionally, two biological markers, i. The treatment of narcolepsy is aimed at the different symptoms that the patient manifests. Excessive daytime sleepiness is treated with psychostimulants amphetamine-like, modafinil and armodafinil.

Cataplexy is treated with sodium oxybate GHB, tricyclic antidepressants, or selective serotonin and noradrenaline reuptake inhibitors. Sleep paralysis, hallucinations, and fragmented sleep may be treated with sodium oxybate. Patients with narcolepsy should follow proper sleep hygiene and avoid strong emotions.

Diagnosis , Classification and Clinical Features. These events encompass abnormal sleep related movements, behaviors, emotions, perceptions, dreaming, and autonomic nervous system functioning. Parasomnias are classified as: This sleep disorders in childhood are common, and often more frequent than in adults. Clinicians should be aware that many pediatric parasomnias have benign and self-limited nature. Most of the parasomnias may not persist into late childhood or adolescence. Parasomnias in adults often differ in type from childhood parasomnias and may portend significant psychiatric disturbances or neurodegenerative disorders.

A reliable diagnosis can often be made from a detailed history from the patient and, if possible, the parents or bed partner. Detailed overnight investigations of parasomnias are usually not required. The non-REM parasomnias are more common in community although REM parasomnias are more likely to be seen in general neurological practice. Sleep related eating disorder, sleep related dissociative disorders and sleep related sexual behavior and sleep related violence are novel and rarely reported sleep disorders.

REM sleep behavior disorder is common and should be sought in all neurodegenerative diseases.