At first, patients may have severe pain which can be described as a deep dull ache similar to sharp stabbing pain. Some people also experience tingling, numbness, muscle weakness in knee, hip or ankle movements. The shin or sciatica is typically worsened by sneezing, coughing, bending or prolonged sitting. Causes: Degeneration of the disc or disc aging is a gradual process. A lumbar disc prolapse occurs when the annulus is too weak for preventing the nucleus prolapsing out.
It can be caused due to birth defects, during adolescence, over stretching in sports, extensive manual labour, weight lifting, obesity, prolonged sitting etc. Clinical features The signs and symptoms of disc herniation can range from mild to severe pain in areas like neck, shoulder, lower back, etc even radiating to the arms, legs and even the chest. Cervical disc herniation is majorly responsible for numbness, pain and weakness in the neck, head, arms, shoulders and hands along with a tingling sensation. While lumbar disc herniation affects the lower back along with dull or shooting pain in the buttocks, thigh and groin by dint of the perennial nerve. This will further radiate to the foot.
health care professionals as the patient is oblivious to the effect that non-adherence is having on their overall health status. Medication non-adherence is the outcome from a patient forgetting to take their medicine and this is considered to be wholly unintentional. Intentional adherence in comparison, relates to an intellectual decision on the patient’s behalf, not to take their prescribed medication. Non-adherence may be influenced by a number of factors including modifiable factors; patient beliefs about medicines, knowledge about conditions, perceived personal benefits from their decisions and non-modifiable factors; age and ethnicity. (19) Specific barriers relating to medication non-adherence include drug regimen complexity, patient forgetfulness, patient misconception/lack of understanding, adverse events/side effects and cost of therapy.
Although a negative ERG is seen in 50% of patients with XLRS, it is neither necessary nor pathognomonic for the diagnosis of XLRS.2,3,10 Therefore, even in the absence of this electrophysiological finding in one of the brothers, the findings were still considered highly suggestive of XLRS. However, the mother and sister had both abnormal fundus findings associated with abnormal FAF and ERG which have never been reported in female carriers of XLRS.2,10,15 In fact, phenotypic expression of XLRS in carrier state has only been reported in monosomy X, consaguinuity, uniparental dysomy, or skewed X-inactivation.10,15–17 Indeed on further testing, our family had a deletion in exon 4 of the CRX gene. This proved the maculopathy to be cystoid and associated with an autosomal dominant retinal dystrophy. The overlap in FAF findings between CME and non-CME macular cystoid spaces suggests that perhaps FAF is helpful in early detection of macular changes rather than in diagnosing a specific retinal disorder. The possible involvement of various retinal layers in XLRS makes the differentiation from cystoid macular edema (CME) or cystoid maculopathy associated with other retinal dystrophies difficult by OCT
Introduction Medication non-adherence can be understood as lack of compliance with the provider recommendations with regards to medications. (1) The WHO defines adherence as “the extent to which the persons' behaviour (including medication-taking) corresponds with agreed recommendations from a healthcare provider”. It is a complicated and multidimensional health care problem which involved the discontinuation of medications temporarily or permanently by the patients or even taking the medication at inaccurate dose or frequency. (1) Non-adherent of medications can occur in various stage where patients may choose to not to refill their prescriptions or even do not want to start the treatment at all. The reasons for the patient to deviate from the prescribed medications may vary and can occur intentionally or unintentionally.
Primary non-adherence refers to the refilling and initiation of the pharmacotherapy. For an instance, the patient does not adhere or fill the prescription with new medications. However, for secondary non-adherence, it is referring to those who adhere to the treatment although the prescriptions are
The restriction of generic drugs made in the agreement by the Untied States will increase the patent production to nearly thirty years and that these generic drugs will become less accessible in Morocco (Stiglitz, 2006, p. 104). The generic drugs in Morocco would have helped and saved many people that are suffering from various diseases. The United States had an advantage over Morocco due to the fact they placed a patent on the
3. NALCO has been fairly successful in satisfying its customers and shareholders and employees and stakeholders. 4. NALCO’s success is also enhanced and is easily attainable because of it very eminent and reliable R&D which it always believes in intensifying for various technological development. 5.
• Non-repudiation: to determine that each party has a non- deniable evidence of receipt. • Confidentially: to ascertain that transactions are safeguarded from potential