Psoas hematoma in the elderly patient, a diagnostic challenge, a case report

Background: A psoas hematoma is an uncommon condition in patients on anticoagulant therapy and patients with bleeding disorders. It can present itself with non-specific symptoms, as anemia, pain and hemodynamically instability. The CT angioscan is the diagnostic test of choice. Case presentation: We report a series of 3 cases of iliopsoas hematoma in older patients. These patients were all on anticoagulant therapy and presented with non-specific symptoms as pain in back or groin, anemia and weakness of the leg. These symptoms could be well explained by other, concurrent diseases. Moreover in one case it was not possible to obtain a reliable history due to cognitive impairment of the patient. In our cases the diagnosis of a psoas hematoma was made after performing many diagnostics or found fortuitously. All three patients recovered well after (temporarily) ceasing of anticoagulant therapy. Discussion: The diagnosis of a psoas hematoma is difficult, especially in elderly patients as illustrated in these cases. The symptoms of a psoas hematoma are often aspecific and can also be explained by other, comorbid diseases. Moreover, elderly patients often have an unusual presentation of illness and the presence of cognitive impairment compromises the reliability of a patients history. It is important to be aware of this diagnosis and perform a CT-scan when a psoas hematoma is possible. Conclusion: A psoas hematoma is easily overlooked in older patients due to an unusual presentation of illness, comorbidity and cognitive impairment

The effects of nickel on the structure and functioning of a freshwater plankton community under high dissolved organic carbon conditions : a microcosm experiment

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Analisa Pembayaran Pajak Dan Persepsi Penghasilan Menurut Wajib Pajak Orang Pribadi Yang Membayar Persepuluhan

Penelitian ini bertujuan untuk mengetahui persepsi penghasilan menurut Wajib Pajak Orang Pribadi yang membayar persepuluhan. Penelitian ini dilakukan dengan melihat definisi penghasilan menurut Wajib Pajak melalui pembayaran persepuluhan yang dilakukannya, karena pembayaran persepuluhan didasari oleh pemikiran masing-masing individu terkait apa saja yang termasuk dalam penghasilan (self-defined income). Jumlah responden yang digunakan dalam penelitian ini adalah 30 Wajib Pajak Orang Pribadi di Surabaya yang menganut agama Kristen. Teknik analisa yang digunakan adalah metode sequential explanatory design, yang diawali dengan analisa kuantitatif menggunakan Uji Beda Dua Kelompok dan kemudian dilanjutkan dengan analisa kualitatif.Hasil penelitian menunjukkan bahwa Wajib Pajak cenderung memiliki persepsi bahwa yang termasuk dalam definisi penghasilan adalah penerimaan kas, yang diukur dengan jumlah total kas yang diterima dalam suatu periode tertentu. Kemudian juga ditemukan bahwa tidak terdapat perbedaan antara pembayaran persepuluhan yang dilakukan oleh Wajib Pajak dengan pembayaran Pajak Penghasilan, yang artinya bahwa perilaku pembayaran Pajak Penghasilan dilakukan sesuai dengan persepsi penghasilan menurut Wajib Pajak. Dari analisa kualitatif dalam penelitian ini, ditemukan bahwa persepsi Wajib Pajak terkait dengan praktek perpajakan di Indonesia juga berperan dalam pembayaran pajak yang dilakukan oleh Wajib Pajak

The Role of Frequency and Duty Cycle on the Gate Reliability of p-GaN HEMTs

In this letter, we present an extensive analysis on the role of both switching frequency (ranging from 100 kHz to 1 MHz) and duty cycle (from 10% to 90%) on the time-dependent gate breakdown of high electron mobility transistors (HEMTs) with Schottky metal to p-GaN gate. More specifically, results show how the gate lifetime of GaN HEMTs increases by reducing the frequency and the duty cycle of the stressing gate signal (VG). Such behavior is ascribed to the OFF-time, which is responsible to alter the electrostatic potential in the p-GaN layer during the rising phases of VG (from OFF- to ON-state). Findings of this analysis are useful both for further technology improvement and for GaN-based power circuit designers

Empirical maximum lifespan of earthworms is twice that of mice

We considered a Gompertzian model for the population dynamics of Eisenia andrei case-cohorts in artificial OECD soil under strictly controlled conditions. The earthworm culture was kept between 18 and 22°C at a constant pH of 5.0. In all, 77 lumbricids were carefully followed for almost 9 years, until the oldest died. The Eisenia median longevity is 4.25 years and the oldest specimen was 8.73 years. Eisenia cocoons were hand-sorted every 3 weeks, washed in distilled water, placed in Petri dishes, and counted. Regular removal did not reduce breeding. Each fertile cocoon contained on average two or three embryos. The failure rates (mortality and infertility percentages) are smooth power functions where the rate at time (n + 1) captured most of the phenomenology of the previous rate at time n, as expected by the considered law, but not at both the beginning and the end of this long-term laboratory study

Ecotoxicological models for Dutch environmental policy: Models to be addressed in the Stimulation Program Systems-Oriented Ecotoxicological Research (NWO/SSEO)

Contains fulltext : 32440.pdf (publisher's version ) (Open Access)91 p

Icodextrin as salvage therapy in peritoneal dialysis patients with refractory fluid overload

BACKGROUND: Icodextrin is a high molecular weight, starch-derived glucose polymer, which is capable of inducing sustained ultrafiltration over prolonged (12–16 hour) peritoneal dialysis (PD) dwells. The aim of this study was to evaluate the ability of icodextrin to alleviate refractory, symptomatic fluid overload and prolong technique survival in PD patients. METHODS: A prospective, open-label, pre-test/post-test study was conducted in 17 PD patients (8 females/9 males, mean age 56.8 ± 2.9 years) who were on the verge of being transferred to haemodialysis because of symptomatic fluid retention that was refractory to fluid restriction, loop diuretic therapy, hypertonic glucose exchanges and dwell time optimisation. One icodextrin exchange (2.5 L 7.5%, 12-hour dwell) was substituted for a long-dwell glucose exchange each day. RESULTS: Icodextrin significantly increased peritoneal ultrafiltration (885 ± 210 ml to 1454 ± 215 ml, p < 0.05) and reduced mean arterial pressure (106 ± 4 to 96 ± 4 mmHg, p < 0.05), but did not affect weight, plasma albumin concentration, haemoglobin levels or dialysate:plasma creatinine ratio. Diabetic patients (n = 12) also experienced improved glycaemic control (haemoglobin Alc decreased from 8.9 ± 0.7% to 7.9 ± 0.7%, p < 0.05). Overall PD technique survival was prolonged by a mean of 11.6 months (95% CI 6.0–17.3 months). On multivariate Cox proportional hazards analysis, extension of technique survival by icodextrin was only significantly predicted by baseline net daily peritoneal ultrafiltration (adjusted HR 2.52, 95% CI 1.13–5.62, p < 0.05). CONCLUSIONS: Icodextrin significantly improved peritoneal ultrafiltration and extended technique survival in PD patients with symptomatic fluid overload, especially those who had substantially impaired peritoneal ultrafiltration