The Piriformis Syndrome: Evaluation of Seven Cases

Low back pain is one of the causes of Piriformis syndrome. Low back pain is the second most common medical complaints encountered by physicians. More than 50% of the population will complain of low back pain at the same time. Piriformis syndrome may constitute up to 5% of cases of low back pain, buttock pain, and lower limb pain. This is a prospective and case–control study. In this study, we study 268 cases with low back pain; in 268 cases, seven cases had Piriformis syndrome. We studied pain, severity pain, radicular pain, limping, and painful sitting. Evaluation of musculoskeletal, BMI, and physical examination of Piriformis sign, Freiberg sign, and pace sign. Neurological evaluation was taken by paraclinical examination elevated through X-ray, computed tomography scan, magnetic resonance imaging, and electromyography. Data as mean + standard deviation. And SPSS software for analysis. In 268 cases with conservative method, 100% of cases were cure treatment after 4 months, in contrast to surgery methods after 1 month. The result illustrated the significantly improved between two methods of treatment (P < 0.0025). In seven cases, four cases had a history of blunt trauma and one case had a history of surgery that after 6 months had complication of surgery and scare tissue that with the second surgery release of scare was done with 100% cure. Anomaly of Piriformis muscle was seen in one case that surgery was done. Tumor was seen in one case that had pressure effect on sciatic nerve that surgery was done. Heterotopic ossification was seen in two cases. BMI of all cases was in normal range. All cases with diagnosis of disc herniation were excluded from the study. They were need to surgical operation for herniated disc. Piriformis syndrome is differentiated primary from secondary type, in which it is done according to history and physical examination. According to the etiology of Piriformis syndrome, the treatments are different. If you see mass that compressed the sciatic nerve, you must remove it. If the patient had sacroiliitis, it must be treated in early phase. Surgery of Piriformis is not accepted by all surgeons. It is limited to release Piriformis tendon and insertion to femur

Prevalence of co-trimoxazole induced hyperkalemia in chronic and acute users in a tertiary teaching hospital.

Objective: The primary purpose of this research is to evaluate the risk of hyperkalemia in patients receiving co-trimoxazole. The secondary purpose is to detect the changes of potassium levels from baseline to 7, 14, 21, and 30 days, determine the association between co-trimoxazole dose and potassium level and examine the relationship between renal function and hyperkalemia. Methods: The approach was through retrospective observation of all patients treated with co-trimoxazole during Jan 2012 till Jan 2013. Key finding: There was no significant correlation between co-trimoxazole doses and hyperkalemia (29% in 480 mg, 31.6% in 960 and 19.4% in 1920 mg; p = 0.129) within each dose group, however, around 62% of hyperkalemia cases were associated with significant increase in serum creatinine (p = 0.00). The highest mean change of potassium level in once daily dosing was at “baseline–7 days” interval, while it was highest at 'baseline-30 days' interval in every other day dosing. However; none of the changes from baseline to 7, 14, 21 and 30 days was found to be significant. 40.9% of the studied patients were female and 59.1% were male and the mean age 54 ± 15 was significant higher in hyperkalemia group compare to 42.6 ± 20 in non hyperkalemia group (p = 0.001). Conclusion: Although many patients taking co-trimoxazoledeveloped Hyperkalemia, the effect of age, dose, renal function and the use of other concomitant medications can't be ignored

Biochemical Changes in Relation to Blood Hemoglobin of Anemic Heamodialysis Patients Treated with Mircera at AL- Hussein Dialysis Center in Thi-Qar Province / Iraq

Background : Anemia is a reduction in the number of RBC count and resulting mainly from reduced erythropoietin production due to the damage or loss of kidneys function in chronic renal failure ( Renal anemia) and is a common complications in hemodialysis patients. The objectives: This study design to evaluate the changes in some biochemical parameters and the relation with blood hemoglobin, for post-heamodialysis patients treated with stable dosage of Mircera ( Methoxy polyethylene glycol - epoetin beta 75 µg/0.3 ml, Germany). Patients and method: Blood of 95 patients were collected from AL- hussien dialysis center in Thi-Qar province / Iraq within three months period, number of dialysis session was two time per week for two hours each session. After heamodialysis session, patients treated with stable dosage of Mircera (0.6 µg) for every kilogram of body weight once every 2 weeks . The data and biochemical finding of their blood sample collected after heamodialysis session. Results: A ninety fife HD patients included 65 (68.4%) were male and 30 (31.6%) were female, aged between 19 to 65 years, their total body weight was 59.34 ± 1.33 Kg and their blood analysis are normal glycemia 5.4 ± 0.51 mmol/l , normal natraemia 137± 0.77 mmol/l, but hyperkalamia (6.1 ± 0.9 mmol/l) , hyperuraemia (21.78± 4.13 mg/dl) , hypercreatinaemia (2.2 ± 0.98 mg/dl) , and the mean HB value was (8.38 ± 1.18 g/dl). The results of response to Mircera show only one patient (1.05 %) had mean HB values (12.0 g/dL) within the target range recommended by KDOQI guideline. Seventy patients (73.69 %) had mean HB value between 8.0 to 10.9 g/dL, twenty four patients (25.26 %) had mean HB values between 5 - 7.9 g/dL and there are no one (0.0 %) had exceed the recommended range (>12 g/dL). Anemia degree positively related with hyperuraemia and hypercreatinaemia . Conclusions: There are Hyporesponsiveness to mircera (75µg/0.3 ml) therapy in hemodialysis patients associated with reducing dialysis efficiency slightly for potassium, urea and creatinine and that positively related with anemia degree . Keywords: Anemia , Mircera , Blood Urea, Blood Creatinine and Heamodialysis patients

Efeitos toxicológicos do glifosato

Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas MonizO glifosato é um herbicida de largo espetro sintético e não seletivo, sendo mesmo o mais utilizado na agriculta para o controlo de ervas. O seu efeito herbicida advém de inibir uma enzima essencial no ciclo de vida das plantas, a 5-enolpiruvilchiquimato-3-fosfato sintase. Esta enzima participa na via chiquimato, uma via metabólica usada pelas plantas e algumas bactérias na síntese de folatos e aminoácidos. Visto que, esta enzima não está presente nos mamíferos, a utilização do glifosato tem sido referida como potencialmente segura. Com a contaminação ambiental e a crescente sobredosagem, podem haver resíduos nos alimentos, no ar, solos e água. Foram realizados muitos estudos em que, se analisou o teor de glifosato nos alimentos e apesar destes não se encontrarem acima dos valores máximos estabelecidos de resíduos, a verdade é que, ainda não são claras as consequências a nível da saúde. Além disso, a exposição ambiental parece ter cada vez maior relevância. Assim, e apesar de variadas agências reguladoras internacionais terem classificado o glifosato como seguro e não tóxico, a IARC classificou-o como potencialmente cancerígeno. Mais, vários cientistas têm vindo a estudar os efeitos deste composto a vários níveis, conforme abordado ao longo desta dissertação. Nesta monografia fez-se uma revisão do estado de arte mais recente no que toca aos potenciais efeitos tóxicos do glifosato, em particular nos sistemas hepatorrenal, neurológico, cardiovascular e reprodutivo e os seus eventuais efeitos carcinogénicos e teratogénicos. Foram também abordadas as lesões e os sintomas encontrados no caso de intoxicações agudas. Esta monografia contribui para uma integração atual dos estudos sobre os vários efeitos nocivos deste composto nos organismos, com os potenciais mecanismos de ação, e em estudos populacionais. São também apresentadas as limitações existentes e a necessidade de se incluírem metodologias mais rigorosas, nomeadamente nos estudos epidemiológicos, para se afirmar, com rigor e segurança a toxicidade do glifosato.Glyphosate is a synthetic and non-selective broad spectrum herbicide, which have been mostly used in the agriculture for the control of herbs. Its herbicide effect comes from inhibiting an essential enzyme in the plants life cycle, the 5-enolpiruvilchiquimate-3-phosphate synthase. This enzyme participates in the chiquimate pathway, a metabolic pathway used by plants and some bacteria in the synthesis of folates and amino acids. Since this enzyme is not present in mammals, the use of glyphosate has been reported as potentially safe. There may be residues in food, air, soil and water with environmental contamination and increasing overdose. Many studies have been carried out in which the glyphosate content in food has been analysed and although these are not above the maximum established residue values, the fact is that the health consequences are still unclear. In addition, environmental exposure seems to be increasingly relevant. Thus, and although several international regulatory agencies have classified glyphosate as safe and non-toxic, IARC classified it as potentially carcinogenic. Moreover, several scientists have been studying the effects of this compound at various levels, as discussed throughout this dissertation. In this monography, a review of the most recent state-of-the-art regarding the potential toxic effects of glyphosate, in particular on the hepatorenal, neurological, cardiovascular and reproductive systems and its possible carcinogenic and teratogenic effects was made. The lesions and symptoms found in the case of acute intoxications were also addressed. This monography contributes to a current integration of studies on the various harmful effects of this compound on organisms, with potential mechanisms of action, and in population studies. The existing limitations and the need to include more rigorous methodologies, particularly in epidemiological studies, to affirm the toxicity of glyphosate with accuracy and safety are also presented

Optimum conditions for Inulinase production by Aspergillus niger using solid state fermentation

Thirty local fungal isolates according to Aspergillus niger were screened for Inulinase production on synthetic solid medium depending on inulin hydrolysis appear as clear zone around fungal colony. Semi-quantitative screening was performed to select the most efficient isolate for inulinase production. the most efficient isolate was AN20. The optimum condition for enzyme production from A. niger isolate was determined by busing a medium composed of sugar cane moisten with corn steep liquor 5;5 (v/w) at initial pH 5.0 for 96 hours at 30 0C . Enzyme productivity was tested for each of the yeast Kluyveromyces marxianus, the fungus A. niger AN20 and for a mixed culture of A. niger and K. marxianus. The productivity of A. niger gave the highest specific activity of 153 U/mg, as compared with K. marxianus which gave 86 U/mg

Numerical method for evaluation triple integrals by using midpoint's rule

In this paper, we derive method to find the values of the triple integrals numerically its integrands continuous but have singularity in partial derivatives in the region of the integrals by using Midpoint's rule on the three x,y and dimensions z , and  how to findthe general form of the errors (correction terms) and we will improve the results by using Romberg acceleraion[3],[6] from correction terms that we found it when the number of (l)subintervals that divided interval integral on the exterior dimension z equal to twice the number of subintervals(n) on the interior dimension x and the number of subintervals (m) on the middle dimension y ,that is mean ( h3=1/2 h1 , h1 = h2 ) when h1 means the distances between the ordinates on the x- axis, h2 means the distances between the ordinates on the y- axis and h3 means the distances between the ordinates on the z-axis and we denote to this method by  Mid3 (h1,h2,h3 ) and we can depend on it to calculate the triple integrals because it gave high accuracy in results by few subintervals

Microcredit, Microenterprises And Social Welfare Of The Rural Poor In North-Eastern Trinidad: An Evaluation Of "Hope"

The study examined the relationship between microcredit, microenterprises, and the social welfare of the rural poor in north-eastern Trinidad. Guided by the main propositions of social capital theory, the researchers held 45 semi-structured interviews with active participants/clients within a case study research design. The data showed that access to microcredit through Helping Others Prosper Economically (HOPE) positively affected their microenterprises and social welfare, though marginally. Findings also revealed that fragmented social relations within the network, conflict, distrust, and the loose structure of the program limited the impact of their access to microcredit on social welfare as well as the financial potential of the lending organisation, that is, HOPE. It is the contention of this paper, therefore, that such questionable social relations dynamics 'hijack' the promise of collective social networks as exercised through goodwill and resource building. Implications of this study and directions for future research are discussed

Assessment of medication adherence and factors contributing to non-adherence to calcium and vitamin D as mainstay in treatment and prophylaxis of osteoporosis.

Objective: This study aimed to assess the adherence and persistence to Calcium and vitamin D, and address the reasons of non-adherence. Methods: All patients attending a secondary care rheumatology clinic in a teaching hospital serving a multiethnic population, in the period between April and June fulfill the inclusion criteria. Patients were asked verbally before distributing the question air about the duration and reason of prescribed Calcium and vitamin D, only patients who are receiving Calcium and Vitamin D for duration of one year or more for purpose of osteoporosis management (treatment and prophylaxis) and are welling to participate in the question are were given the consent formand included in the study. Key finding: There was no statistically significant difference between calcium and vitamin D group in terms of adherence score (p = 0.175). About third of patients in both groups showed low adherence score; 31% (53/171), 38.2% (128/335) in calcium and vitamin D groups, respectively. Overall, there was significant difference in adherence score between age groups (p = 0.001). Low adherence score was mostly reported in young age group (18–39 years) for both medications but not related to level of education. Forget to take medication was the most reported reason of non adherence in both groups (29.5%, 89/302). Quarter of patients stated that multi-reasons contributed to their non adherence (24.8%, 75/302). Conclusion: Low adherence was high among both Calcium and Vitamin D groups (around third of both groups), however; there were no significant differences in medications adherence between the two groups

Leveraging BIM and big data to deliver well maintained highways

The Highway infrastructure is one of the most valuable assets for any state or national Government. Efficient operations of Highways lead to success of national and local economies as well as improve the quality of life of the general public dependent on it.  In order to ensure aging road networks continues to move with its ever increasing number of users, requires maintenance and improvements to the road network at the highest standard. Increasing scrutiny over the cost of maintenance along with increasing pressure from Government and the public for transparency over road network spending, has made a strong case for more efficient management of the Highway road asset and traffic management data. Better management of information could allow for life cycle management of asset data and predictive analytics. This paper focuses on proposing a platform that integrates various technologies and systems of Highways Authority and its supply chain, to allow for continuous flow of data throughout an assets life-cycle, leading to seamless, collaborative and effecting working. The integration takes into account developments in the area of BIM and big data; BIM provides a platform to better integrate information whereas big data can provide analytical platform to draw insights

The Challenge of Da’wa in Multicultural Communities in Central Kalimantan

This paper examines the challenges of da‘wa in multicultural communities in three regencies of Central Kalimantan. These three regencies are usually dubbed ad watersheds because they are the initial pathways for the spread of Islam in Central Kalimantan which at present, the majorities of population are muslims. The main problem of this study is how the challenge of da‘wa in multicultural societies and the study is aimed at mapping da‘wa with various challenge faced in community. This paper based on research field result on basis interview, FGD, and documentation. This study finds : Broadly speaking, da'wa challenges on multicultural communiries consist of internal and external factors. From internal factors derived from da'i; mad'u ; the approach and method of da'wa and the media.From external factors namely the existence of Christianization activities .Another fact was that although the majority Muslim community, in certain areas politically / governmentally was controlled by non-Muslims. This had animpact on policies and budgets that were not considered significant enough for the development of good da'wa