Measuring and Analyzing the Impact of Investment Spending on Achieving Growth for the Real Iraqi GDP

The study aim to measurement Investment spending in economic activity Via its effect on the production of sectors of the national economy, and due to the fact that investment spending is linked to public revenues, especially petroleum, because of the economy’s direction, its direction has made investment spending allocations fluctuate with the fluctuation of these revenues and then Its weak impact on the real output in Iraq and then a weakness in achieving the real economic growth aims that are expected from this spending, as the research reached a significant weakness in the impact of investment spending on the real output with and without petroleum, as the increases did not match The big investment spending with real output growth with and without petroleum. which indicates weak efficiency and performance of the national economy in achieving the required real economic growth and a lot of use of the policy of transfer between expenditures as well as the lack of a long and short-term balance relationship between investment spending and real output with and without petroleum.

Physical and Neurological Development of a Girl Born to a Mother with Methylmalonic Acidemia and Kidney Transplantation and Review of the Literature

Background: actual literature suggests that children of methylmalonic acidemia patients are mostly healthy, but data are only partial, especially regarding long-term outcome. Therefore, our aim was to evaluate the possible long-term neurological effects of fetal exposure to high levels of methylmalonic acid in a child of a renal transplant recipient. Methods: we retrospectively evaluated the clinical and neurological records of a girl whose mother is a kidney transplant recipient affected by methylmalonic acidemia. Subsequently, we compared our results with the ones already published. Results: the girl’s weight and stature were within the normal range in the first years of life but, starting from 4 years of age, she became progressively overweight. Regarding the neurodevelopment aspects, for the first time we performed a complete and seriated neuropsychological evaluation, highlighting a mild but significant weakness in the verbal domain, with a worsening trend at three-year revaluation. Conclusions: since children of MMA patients are exposed to methylmalonic acid, the efforts of the physicians caring for these children should be directed on careful evaluation of growth, prevention of obesity and regular neurological examination together with structured neuropsychological tests to achieve a better insight in possible complications of pregnancy in patients suffering from this condition.

A case report of open appendectomy in treating acute perforated appendicitis with necrotizing fasciitis of the abdominal wall: a rare complication of a common disease*

We present a case of a 37-year-old woman referred to our hospital with a 1-week history of significant weakness, anorexia, and mild abdominal pain. According to laboratory and radiographic data, the patient was diagnosed with perforated appendicitis and gangrene.

Assessment of knee flexor muscles strength in patients with patellar instability and its clinical implications for the non-surgical treatment of patients after first patellar dislocation - pilot study

Background Biomechanical studies indicate that during outward rotation of the tibia and the valgus knee joint position, the patella is shifted in the lateral direction. After first-time patellar dislocation, the dynamic position of the femur in relation to the tibia plays an important role in joint stability, because the medial stabilizer of the patella (mostly the MPFL) is damaged or inefficient. The most important factor in controlling the rotational movement of the tibia in relation to the thigh are the hamstring muscles. The aim of the study therefore is to determine whether patients with patellar instability have a significant weakness in the knee flexor muscles, which can predispose to recurrent dislocations. This is an important consideration when planning the rehabilitation of patients with first-time patellar dislocation. Methods The study enrolled 33 patients with confirmed recurrent patellar dislocation, including six patients with bilateral involvement. In the study group, the hamstring muscles (both sides) were evaluated at velocities of 60 and 180 deg/s for the following parameters: peak torque, torque at 30 degrees of knee flexion, angle of peak torque and peak torque hamstring to quadriceps ratio (H/Q ratio). Results In the recurrent patellar dislocation group, a statistically significant weakness in knee flexors was observed for both angular velocities compared to age and gender normative data. No such relationship was observed in the control group of heathy subjects. In patients with one-sided dislocation, no differences were found in knee flexors peak torque, torque at 30 degrees of knee flexion, angle of peak torque or H/Q ratio between the healthy and affected limbs for either angular velocity. Conclusions In patients with recurrent patellar dislocation, knee flexors strength is decreased significantly in both the unaffected and affected limbs. This may indicate a constitutional weakening of these muscles which can predispose to recurrent dislocations. Trial registration The study was retrospectively registered on ClinicalTrials.gov (NCT04838158), date of registration; 22/03/2021.

Radicular arm pain

Cervical radiculopathy is a neurological condition caused by dysfunction or compression of a cervical nerve root. Patients often report unilateral neck pain with radiation to the ipsilateral arm, often with sensory changes in a dermatomal distribution. Weakness and reflex changes are also commonly found and can be very troubling for patients. Careful history and examination is important to identify any more concerning features such as progressive symptoms and features of myelopathy, which could prompt surgical management. Although the majority of patients will see an improvement in their symptoms over time with conservative management, surgery is indicated in patients with debilitating pain, progressive neurology, significant weakness, instability or myelopathy. Advancements in surgical techniques offer a range of potential operations that should be considered carefully for each patient. This article outlines the clinical approach to presentation, pathophysiology, diagnosis and management.

Muscle weakness assessment in non-hypoxemic COPD out-patients at tertiary care hospitals

Objective: To determine frequency of Muscle Weakness in Non-Hypoxemic COPD out-patients and Comparison with age matched non-COPD Controls. Methods: This cross-sectional study was conducted at OPD of Ojha Institute of Chest Diseases and Medicine, Dow University of Health Sciences, Karachi, Pakistan, during the period 8th September 2019 till 30th May 2020. Patients of both genders aged 25-70 years who were satisfying GOLD criteria for COPD and having SpO2 ≥ 94% were included. An age matched control group was added as control. Hand Grip Strength (HGS) and Chair to Stand time (CST) were recorded. Results: Two hundred fifty-six patients were inducted with aged and BMI matched group of non-COPD Control patients in ratio of 1:2 (n = 128). Comparison of HGS between Control and COPD Groups showed significant weakness in COPD group. Significant weakness in lower limbs in COPD Group with longer timings to complete the task. Mean FEV1 had significant low values in COPD Group. Age correlated negatively with HGS & positively with CST. BMI correlated positively with FEV1 and CST but negatively with HGS. HGS correlated positively with FEV1 and no correlation was found with CST. No correlation was found of CST with FEV1. Conclusion: Muscle weakness in COPD patients was shown by simple validated bedside tools. The older COPD patients had less HGS and were slower in doing CST whereas those COPD ones who had higher FEV1 had more HGS. Abbreviations:COPD: Chronic Obstructive Pulmonary Disease, BMI: Body Mass Index, FEV: Forced Expiratory Volume in first second, GOLD: Global Initiative for Chronic Obstructive Lung Disease, HGS: Hand Grip Strength, CST: Chair to Stand Time. doi: https://doi.org/10.12669/pjms.37.2.3127 How to cite this:Zuberi FF, Zuberi BF, Ali FS, Bader N. Muscle weakness assessment in non-hypoxemic COPD out-patients at tertiary care hospitals. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.3127 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Crisis política (y social) y Derecho constitucional

El sistema institucional español tiene debilidades preocupantes. Aunque las raíces son anteriores, el deterioro ha sido particularmente intenso desde 2015. En este trabajo se analizan distintas instituciones del derecho constitucional como reflejo de esta situación. Circunstancias extraordinarias como la crisis de Cataluña o la sanitaria han agravado esta situación.The Spanish institutional system has worrying weaknesses. Although the roots are older, the deterioration has been particularly intense since 2015. In this work, different institutions of constitutional law ara analyzed as a reflection of this situation. Extraordinary circumstances as the crisis in Catalonia or the health crisis have aggravated this situation. The conclusión is a significant weakness of the rule of law.

Policing the Rural

This chapter focuses on the role of the ‘village constable’ in the Highland and Islands of Scotland. It identifies an approach to policing that was mostly diffusive and conciliatory in terms of the settled population. This was facilitated by the rural officer’s role as a generalist, geographically embedded within the village as primary point of contact. More ‘robust’ tactics were used in relation to male migrant labour although officers also acted as mediators between the settled population and those constructed as ‘outsiders’ (including members of Gypsy/Traveller communities). The authors show that the high levels of autonomy accorded the rural constable led in some cases to high levels of trust, but also had potential to expose significant weakness.

Thinking Normatively about Global Justice without Systematic Reflection on Global Capitalism

Given the huge impact of capitalism on global justice, it is a significant weakness of liberal political philosophy devoted to global justice that it has paid relatively little attention to this impact. Symptomatic of this weakness are the political ineffectiveness and explanatory reticence of liberal theories of global justice in the face of the large and arguably growing gap between theory and practice. This chapter discusses Rawls’s Law of Peoples as an paradigmatic case, taking particular issue with his vision of a realistic utopia and his idea of democratic peace. It aims to show how the mainstream liberal approach is vitiated in its grasp of relevant facts and in its normative plausibility by the separation of the political and the economic, of the normative and the causal, and by the resulting ideological reconciliation with the status quo.

A rare complication of systemic lupus erythematosus in a 9-year-old girl: Questions

Serious renal involvement in systemic diseases is common and generally constitutes a pivotal prognostic factor, making those pathology frequently seen in nephrology departments. Authors describe the case of a nine-year-old girl with lupus nephritis. After admission the patient’s state deteriorated over a period of a few days, with an unremitting high-grade fever, significant weakness and drowsiness, generalized erythema, and decrease of the kidney function to eGFR nadir of 56 ml/min/1,73m 2. Treatment with pulsed methylprednisolone was started. After the first pulse the general state of the patient improved slightly, although laboratory tests showed an alarming evolution, with the exacerbation of anemia, leukopenia, neutropenia, increase of serum CRP concentration, extremely high D-dimer concentration and increase in activity of lactate dehydrogenase. The concentration of ferritin rose reaching the level of 540 μg/l, triglicerydes level was also high. Intravenous cyclophosphamide pulse therapy was added to the ongoing steroid treatment, and resulted in a radical patient improvement. Authors underline that it seems important to be aware of rare, non-renal, but potentially devastating complications of systemic diseases, like in this clinical case: the secondary hemophagocytic lymphohistiocytosis (HLH). When HLH complicates a rheumatic disease, it is also referred to as macrophage activation syndrome (MAS). Unfortunately treatment of MAS is still based on reports provided by individual centres and gathered own experiences so drawing up unambiguous diagnostic criteria will be valuable in future. The treatment should be individually tailored, and more specific evidence-based recommendations are needed.