16/02/2018

Asphalt Compaction (ENG. HASSAN M. ELRAMLI)(BENGHAZI - LIBYA)

HOPPER LOADING المهندس/ حسن محمد الرملي)

Grilled Garlic & Herb Shrimp - How to Make Grilled Garlic Herb Shrimp Sk...

Football tournament and BBQ for Libya through Ummah Welfare Trust UWT2.MOV

Football tournament and BBQ for Libya through Ummah Welfare Trust UWT2.MOV

14/02/2018


Urinary Stones

Stones of the urinary tract (kidney, ureters and bladder) are a very common condition affecting up to 12% of the US population. Stones occur in both men and women of all ages; however, they most commonly occur in Caucasian males between 45 and 55 years. Children may also get kidney stones but it is not common.
Anatomy
  • The kidneys are a pair of bean shaped reddish-brown organs that lie on either side of the spinal column and just below the diaphragm. They are about 5 inches (12.5 cm.) long and 3 inches (7.5 cm.) wide (Figures 1and 2 )
    1. Urine is produced in the kidneys and travels down through the ureters to enter the bladder
    2. On the medial (facing the spine) border the kidney is notched at the hilus, the point where the major artery to the kidney enters and vein leaves
    3. The ureter also leaves from the hilus
    4. The kidney is made up of over a million renal tubules (nephrons). All the nephrons together form the cortex. The nephrons filter the blood of waste products that pass into the urine
    5. The urine passes from the nephrons into collecting tubes called calyxes and then into the renal pelvis (the dilated upper portion of the ureter) and into the ureter, which conducts the urine into the urinary bladder
    6. A capsule of thin tissue encloses each kidney
    7. The bladder is located in the pelvis. It is held in place by ligaments and can be felt in the lower abdomen when full
  • The urinary bladder is a hollow muscular organ that serves as a reservoir of urine. Normally the bladder can hold 250 - 450 cc (8 - 15 ounces) of urine
    1. The urethra is located at the base (lowest part) of the bladder and drains the urine out of the bladder. In women the outlet of the urethra can be seen just in front of the vagina. In men the urethra lies within the penis
    2. In males, the bladder has the prostate gland below (through which the urethra passes). In females, the uterus and the vagina lie behind the bladder
الوصف: http://www.yoursurgery.com/procedures/stones/images/kidneyAnat.jpg
الوصف: http://www.yoursurgery.com/procedures/stones/images/Stone1.jpg
Figure 1 - Anatomy of the kidney. The upper portion of the kidney is cut away to expose the cortex, calyxes and renal pelvis. The renal artery and ureter enter and the renal vein leaves the kidney at the hilus. The adrenal gland rests on the upper pole of the kidney. © N. Gordon
Figure 2 - On the left side are seen the kidney and adrenal glands along with the ureter extending from the kidney to the bladder. On the right side are seen a staghorn stone in the kidney pelvis as well as stones in the ureter, bladder and urethra.© C. McKee
Pathology
  • Stone formation in the urinary tract occurs due to the precipitation (particles coming out of a solution) of substances in the urine in the following situations:
    1. Increased concentration of the urine due to dehydration may lead to precipitation of stones
    2. Alkaline urine predisposes to some stones while an acid urine leads to other types of stones
    3. The presence of a foreign body like bacteria, blood or pus in the urine may cause crystallization of minerals around these bodies
    4. Abnormal mineral/substance content of the urine - increased excretion of calcium, uric acid, oxalate, etc., can cause these to deposit as stones
  • Conditions that may lead to urinary stone formation include:
    1. Increase in calcium. Some of the conditions that increase urine calcium are hormonal abnormalities (hyperparathyroidism, Cushing's disease, hyperthyroidism), Vitamin D toxicity, increased calcium intake, prolonged bed rest (as with paralysis) and tumors such as multiple myeloma and metastatic cancer to bone
    2. Increase in oxalate. Some of the conditions that increase urine oxalate are an increase in oxalate intake, short gut syndrome (patients who have had considerable length of their bowel removed for Crohn's disease, morbid obesity or trauma) and excess Vitamin C
    3. Increase in uric acid. Some of the conditions that increase urine uric acid are certain tumors like leukemias and lymphomas, side effects of drugs like aspirin and some sulfa drugs and certain metabolic conditions such as gout
    4. High cystine levels in the urine are seen in an inherited condition called cystinuria, which causes cystine stone formation.
    5. Stones occur more in hot weather as loss of water through sweat concentrates the urine inducing stone formation
  • Composition of urinary stones:
    1. Calcium oxalate with or without calcium phosphate - 75%
    2. Calcium phosphate only - 7%
    3. Magnesium ammonium phosphate - 12%
    4. Uric acid - 7%
    5. Cystine - 2%
  • The most common locations for deposition of stones are in the areas of narrowing of the urinary tract (Figure 2):
    1. Junction of the kidney and ureter (the ureteropelvic junction)
    2. At mid ureter where it crosses over the iliac bone to enter into the pelvis or where the ureter crosses over the iliac blood vessels
    3. Junction of the ureter and bladder
    4. In women, where the ureter passes under the uterine artery
History and Examination
  • Symptoms of urinary stones may vary according to the location of the stone
  • Renal colic (pain) is the predominant symptom of urinary stone disease. This pain is caused by spasm of the ureter and distension of the ureter and capsule of the kidney above the stone. The pain may start in the flank and radiate down to the bladder and genitalia. The pain is usually intermittent and can be excruciating and associated with nausea and vomiting. These symptoms have to be differentiated from gallbladder disease, appendicitis, pancreatitis and intestinal obstruction
  • Blood in their urine (hematuria). The urine is usually blood tinged, but the bleeding can be significant. Occasionally, no blood may be found in the urine
  • Signs and symptoms of a urinary tract infection (UTI) with urinary urgency, frequency, fever and painful urination (dysuria). Urinary obstruction by stones can predispose to frequent UTIs
  • Long standing stones may cause partial obstruction of the ureters at the ureteropelvic junction and can lead to swelling of the kidneys (hydronephrosis) with a constant dull ache in the flank. Long standing hydronephrosis can lead to kidney failure
Diagnostic studies
  • Tests to evaluate for an infection:
    1. Blood white cell count (WBC) may be raised
    2. Urine analysis may show evidence of blood, pus or stone crystals
    3. Urine culture for bacteria
    4. Urine for Increased or decreased acid content
  • Determination of blood or urine levels of calcium, proteins, phosphorus, oxalate, uric acid or cystine in cases of patients with known recurrent stones is carried out to identify the possible conditions causing stone formation. In most cases no specific cause is found
  • X-ray of the abdomen may show a stone and its location. About 90% of stones with calcium can be seen on X-ray. Cystine and uric acid stones usually are not seen
  • Intravenous pyelogram (IVP). Contrast (X-ray dye) is injected into a vein and passed into the urine by the kidneys. Serial X-rays of the abdomen are obtained to see the kidney and ureters. Significant findings include delay in seeing the affected kidney (due to possible decreased kidney function), evidence of swelling of the kidney and ureter (hydronephrosis and hydroureter) and location of the stone
  • Ultrasound of the abdomen may be done without contrast and may locate stones
  • Computerized tomography scan (CT scan) may be used to locate and determine the size of a stone (Figure 3)
الوصف: http://www.yoursurgery.com/procedures/stones/images/StonesCT.jpg
Figure 3 - CT scan of the abdomen showing both kidneys and small calcified stones (arrowheads). Courtesy L. Ashker, DO
Acute care
  • About 90% of stones will pass spontaneously. Patients are given increased fluids to flush out the stone and pain medication. Fluid intake is increased to about 3 liters (quarts) per day to maintain a urine output of about 2 liters a day
  • Stones less than 4 mm (1/8 inch) in size almost always pass through. Stones above 6 mm have less than a 10% chanced of passing
  • Patients are advised to strain their urine to watch for passed stones. The stone may take several days before it passes. Stones are usually examined for chemical content
Indications for surgery
  • Large stones. In long standing UTI, very large stones that may fill the entire kidney pelvis may develop. These are sometimes known as "staghorn" calculi (stones)
  • Complete obstruction of the urinary system by a stone
  • Demonstrated poor renal function
  • Evidence of serious urinary tract infection such as a kidney abscess
  • Stones in high risk patients (e.g., airplane pilots) or in transplant patients who cannot tolerate infection
  • A stone in a patient with only one kidney
Surgical procedures
  • Surgical therapy for urinary stones has seen new advances in the past decade with the introduction of laser and ultrasound
  • Treatment of urinary stones is determined by the size, location, and composition of the stone; anatomy of the urinary system and function of the kidney
  • Small stones (less than 2 cm):
    1. Stenting the ureter - Small stones which take longer to pass than expected or are causing symptoms may be managed inserting a long plastic tube into the ureter on the side of the stone. The stent (tube) acts to keep the ureter open and urine flowing, so that there is no loss of renal function or infection. The stent is inserted by first placing a cystoscope into the bladder. The cystoscope is a lighted instrument with a lens system at the end within the bladder and an eyepiece at the other end for viewing. The stent is positioned in the ureter through a separate 'working' channel in the cystoscope and dilates the ureter
    2. Shock Wave Lithotripsy (SWL) - This treatment is effective for smaller stones. Shock waves are transmitted through the skin and muscles until they reach the stoned that have a different density. The sound waves then cause fragmentation of the stones. It is noninvasive and has a low risk for complications. The need for anesthesia depends on the intensity of shock waves needed. The shock waves are timed with an EKG to prevent any abnormal heart rhythms. SWL may not be effective in obese patients. Cystine stones are also resistant to SWL therapy. SWL is usually not effective in breaking up of large stones. (Figure 4)
الوصف: http://www.yoursurgery.com/procedures/stones/images/Stone2.jpg
Figure 4 - Breaking up a kidney stone using Shock Wave Lithotripsy. The stone is centered in the machine following which the stone is broken up with soundwaves. © C. McKee
  • Larger stones (over 2 cm) (Figure 5)
    1. Percutaneous NephroLithotomy (PNL) - This procedure is usually done under anesthesia and with X-ray guidance. A tract is made from the skin into the pelvis of the kidney. A balloon catheter about 10 mm in diameter is used to form this tract. Hollow dilators are passed along the tract from skin to kidney. Once the tract is formed, a flexible scope is inserted into the kidney to visualize the stone(s). The stone may be extracted through this tract or may be broken up by ultrasonic lithotripsy (UL), electrohydraulic lithotripsy (EHL), laser lithotripsy or pneumatic (air) lithotripsy (lithotripsy, breaking up of a stone). The fragmented stones are then removed through the tract. The tract usually closes spontaneously once the dilator is removed with minimal scarring. PNL is successful in 70-100% of cases. Smaller retained fragments in the urinary system may pass spontaneously or may require additional SWL
الوصف: http://www.yoursurgery.com/procedures/stones/images/ScopeStone1.jpg
الوصف: http://www.yoursurgery.com/procedures/stones/images/ScopeStone2.jpg
Figure 5a - Urinary stone in a ureter as seen through an ureteroscope. Courtesy D. Harold, MD
Figure 5b - Stone is broken up into smaller fragments before removal. Courtesy D. Harold, MD
    1. Ureterorenoscopy (ureteroscope)- A delicate fiberoptic scope is inserted through the bladder into the ureter to the kidney. The stone(s) are seen and using ultrasonic, electrohydraulic, laser or pneumatic lithotripsy are broken down. Smaller stones may be pulled out using thin grasping instruments or a fine wire basket. (Figure 6) This procedure is about 90% successful. Once again, smaller retained stones may need an additional SWL
الوصف: http://www.yoursurgery.com/procedures/stones/images/Stone3.jpg
Figure 6 - Urinary stones may be removed using a grasping forceps or wire basket, or broken up using the electrohydraulic and laser lithotriptors. © C. McKee
    1. Ultrasonic lithotripsy (UL) - Sound waves, vibrating at about 25000 times a second, are passed down a probe to the tip. The tip causes fragmentation of stones upon contact. The probe is passed though the tract from a PNL or ureteroscope (see above) to reach the stone. 
    2. Electrohydraulic lithotripsy (EHL) - An electrical discharge is passed down an insulated probe to create a spark at its tip. The heat of the spark creates a shock wave, which is transmitted to the stone on contact. About 50-100 sparks are discharged per second. EHL is very effective for hard stones.
    3. Laser lithotripsy (LL) - laser is passed down a flexible probe through a PNL tract or ureteroscope to break up the stones
    4. Pneumatic lithotripsy (PL) - Compressed air pushes a metal projectile against the head of a probe at a frequency of 15 times a second. This causes fragmentation of the stones on contact with the probe.
  • Staghorn calculi
    1. Staghorn calculi are so named because these extremely large stones fill up the entire collecting system of the kidney (pelvis and calyses) with branching resembling the horns of a stag. These stones are almost always caused by infection of the urine
    2. SWL or PNL may be used to break up these stones. If there is extreme dilation of the collecting system or multiple branching of the stone, open nephrolithotomy may be necessary
    3. Open nephrolithotomy - This procedure is done under general anesthesia. The patient is usually placed on the side opposite the affected kidney. An incision is made on the side at the lower ribs. The muscles of the back are divided to reach the kidney. The pelvis of the kidney is opened, and the stone removed. The pelvis of the kidney is closed as well as the muscles and skin. A drain may be left in place.(Figure 7)
  • Lower tract stones. Stones in the lower ureter, bladder or urethra are usually managed by cystoscopy or ureterorenoscopy with one of the methods mentioned above
الوصف: http://www.yoursurgery.com/procedures/stones/images/Stone4.jpg
Figure 7 - Nephrolithotomy with direct surgical removal of a kidney stone. © C. McKee
Complications
  • SWL has a very low incidence of complications. Bleeding into or around the kidney, scarring of the kidney or later development of hypertension has been reported
  • Percutaneous nephrostolithotomy (PNL) can cause bleeding, infection, urinary leak or damage to abdominal organs, which may require surgery. Retained stones may cause symptoms again. Use of contact lithotripsy (UL, EHL, LL or PL) may be associated with damage to the ureters.
  • Ureteroscopy may cause ureter damage that may require open surgical repair.
  • Open nephrolithotomy may cause respiratory complications such as atelectasis (unexpanded lung near the diaphragm), pneumonia, chronic pain from damage to the ribs and the nerves that run along the ribs, bleeding and infection
After care
  • Minimally invasive techniques like SWL, PNL or ureterorenoscopy have minimal recovery times. Patients usually require minimal pain medication and are usually discharged the same day
  • Hematuria (blood in urine) is usually seen after such procedures and usually resolves in a few days
  • Open nephrolithotomy usually requires a few days of admission. Patients will require breathing exercises to prevent respiratory complications. Drains may be removed in a few day
  • If a cause for stone formation is discovered, this should be treated to prevent formation of other stones. Diet modifications, which include avoiding dairy and meat products may reduce calcium levels. Drugs may be prescribed to reduce calcium or uric acid levels


08/02/2018

Happinese


Benefits of Dust

Benefits of Dust
Despite the repeated warnings to warn of the waves of dust and dust and caused by the low visibility and impact on the health of people, especially Asthma patients or people with chest diseases, but the dust is a great virtue to us, and begin the positive effects of dust from the Almighty said in his book: From the sky is water, and we will gather you with stones. "
Benefits of Dust
The idea of ​​the benefits of dust that is absent from the minds of many people, what Ibn Khaldun said in his introduction, "The earth after the fluctuation of seasons from chapter to chapter .. Any winter to summer .. Start with the words diseases and insects if left to destroy the world, God sends dust .. These dust and dust kill .. The size of the grain of sand according to the insect, some small enter their eyes and some enter the noses and some in the cave and some in the ears and dead .. And also uttered the disease diseases after moisture during the winter .. Do not destroy only dust.
This is what Ibn Khaldun said about the dust, confirmed by some scientific sources, and revealed the sources of its composition as "a generic name for any solid particles whose diameter is estimated to be less than 50 micrometers. Dust occurs in the earth's atmosphere for many reasons, Pollen in homes and offices. Dust is made up of dead human or animal skin, pollen, tissue and paper particles, and human or animal hair. "
And regardless of the dust damage that many scientists have talked about and are known by the public and the most important of which is the human being affected by the health and psychological, and many of his interests and work, and this makes him feel tired and bored in the days when the wind is loaded with dust.
However, the benefits of dust are related, as some scientists have emphasized human life, being the wall of the wall that transforms between harmful organisms and humans as mentioned, as well as other important benefits, including the prevention of harmful radiation, killing microbes in the air, prevents evaporation of water in the plant any process of transpiration, Of temperature, and has a role in the process of inoculating plants,.
Reduction of toxic gases
The experts say that such wind and dust benefit the atmosphere of industrial cities that removes tons of toxic gases and gases from the atmosphere, it renews the air with the ability of God, as experts say such dust if followed by rain it becomes - any dust - such as fertilizer to the ground Vivid trees And the plant in general.
This was expressed by Dr. Abdul-Malik bin Abdul Rahman Al-Sheikh, General Supervisor of the Prince Sultan Institute for Environmental, Water and Deserts Research at King Saud University and Secretary-General of the Prince Sultan bin Abdulaziz International Prize for Water, said that dust is a great addition to us. : And we sent the wind to the hawk, and we brought down water from the sky, and we brought it to you.
In addition, dust transported to the sea and ocean surfaces is the primary source of supply for important elements in the oceans such as iron, phosphorus, silicon, manganese and copper. The pollutant is an essential process of fertilization and seed formation. The pollen grains are transferred from the male elements of the flower to the female elements where they are fertilized. Zinc, and these elements play an important role in the nutrition and reproduction of marine plant microorganisms, and the increase and growth of these organisms leads to reduced atmospheric concentration of carbon dioxide - one of the most important greenhouse gases - and the increase In the activity of dust causing precipitation; which helps to collect the fine clay dust particles from the relatively high areas, and deposited in the low areas as the bottoms of rainwater pools and valleys running, and these bodies of water soon evaporate and dry leaving behind a layer of surface rich in clay grains accurate increase Soil fertility.
Some interpreters believe that the meaning of the "wind to the wind" in the previous verse is the role of wind in the transfer of pollen to the members of feminization in the flowers to be fertilized and the formation of fruits is a known role and scientific constant, but the sentence that follows does not support this interpretation, Indicate that the process of sending the wind to the frankness is directly related to the descent of rain, and the use of the letter "flex", which indicates the order and comment, suggests the rapid descent of rain after the wind sent to the hawk.
Another explanation by Dr. Zaghloul Al-Najjar in his talk about the scientific miracle of the Holy Quran, that there are three types of pollination takes place in the clouds:
1 - hot drawing of the clouds with cold drawing, which increases the process of condensation and thus rain
2. Inoculation of the positive charge by negative charge withdrawal and discharge and electric evaporation. The rain is accompanied by lightning and thunder, which is the sound of the air expansion caused by discharge.
3 - Pollination III The most important types of pollination all is that the wind polluted the clouds by the descent of rain, as the nuclei of condensation, the nuclei that collect the molecules of water vapor to be points of water growing inside the clouds, are the first components of the rain carried by the wind, This is the idea of ​​artificial rain, when some planes spray the clouds that have been formed by some materials act as condensate condensates, the rain condenses and collapses any wind. A key factor in cloud configuration, Inseminated and the descent of the rain, and always connects the Qur'an between the wind and the rain, in the Al-mores (who sends the winds as heralds of His mercy even if discharged clouds heavies dead country mentioned about Vonzlna by water Vokrzina the

18/01/2018

3 complementary natural remedies for the flu

3 complementary natural remedies for the flu

With flu season in full swing, "Good Morning America" looked into some natural, and complementary, remedies for flu symptoms that may offer some relief if you or a family member has fallen ill this year.
Late last week, the U.S. Centers for Disease Control and Prevention announced that it believes the nation reached peak flu season, and that the disease was considered to be an epidemic based on its medical impact, as hospitalizations across the country soared.
ABC News' chief medical correspondent Dr. Jennifer Ashton appeared live on "GMA" today to break down how to use three well-researched, complementary natural remedies for flu symptoms.
Getting a flu vaccine, however, still remains the best protection for you and your family against the flu, according to Ashton. She also recommends talking to your pediatrician before trying any of these remedies on children.
In addition, peer-reviewed, evidence-based data currently does not recommend any complementary natural remedies as a first line protection against, or as a treatment for, the flu, according to Ashton. Ashton also said it is important to note that natural does not always mean safe when it comes to medical treatments.

1. Oil of oregano

PHOTO: Oil of oregano is believed to be a remedy for the flu. (Stock/Getty Images)
Oregano oil, also known as P73, has been shown in small lab studies to have antiviral, antibacterial and anti-inflammatory properties.
To use oil of oregano, simply drop three to 20 drops of it into a glass of water four times a day, swish the concoction around in your mouth, and then swallow.

2. Olive leaf capsules

In a 2010 study published in the medical journal Scientia Pharmaceutica, this extract was described as having antiviral properties to the respiratory viruses R.S.V. and parainfluenza, although it has not yet been proven to be effective against influenza.
Studies about its effect on treating influenza, however, are currently being conducted, mainly looking at olive leaf's major ingredient, oleuropein.

3. Black elderberry extract

Black elderberry extract, which is available in tea, liquid and capsule form, is thought to work by blocking the flu proteins called hemagglutinin, according to Ashton.

04/01/2018

ONION AND EYES


Clearing irritant from the eyeAnyone who has ever cut an onion in an enclosed room knows that it’s sure to make you cry unless you jump through hoops to prevent the acrid sulfur emanating from the cut onion from reaching your eye, such as putting on fans or submerging them in cold milk or water.
This can be an annoyance, but it can also come in handy if you have debris or other irritant caught in your eye. In this case instead of rubbing your eye and risking worsening your condition:
Cut an onion in half.Take half the onion and hold it directly below the irritated eye—careful not to touch!Let the tears flow and help to clear the debris from the eyeB