Suggested physical therapy protocol for reduction of lipomatosis dolorosa of the legs

The purpose of this study was to investigate the efficacy of suggested physical therapy protocol in lipomatosis dolorosa of the legs. Twenty female patients with stage I lipomatosis dolorosa of the legs ranged in age from 30 to 45 years. They received a complete decongestive physical therapy program and diet regimen. Body Mass Index [BMI] of all patients was assessed before and after the treatment program. Lower limb volumes were assessed for all patients before and after treatment by using volumetric measurement. The patients received diet regimen plus complete decongestive physical therapy program for sixty minutes three times weekly for six months and pneumatic compression for thirty minutes three time weekly for six months. The results revealed a significant improvement [P < 0.05] in BMI and the lower limb volumes. It could be concluded that, suggested physical therapy protocol consisting of a complete decongestive physical therapy program and diet regimen had an effect in the treatment of lipomatosis dolorosa of the legs in females

Management of bile duct injuries: comparative study between Roux-en-Y hepaticojejunostomy and primary repair with stent placement

Bile duct injury [BDI] is a major complication in biliary surgery such as laparoscopic cholecystectomy. The management of major BDI is a surgical challenge even for experienced hepatobiliary surgeons. The aim of this study was to introduce a new surgical technique for reconstruction of the biliary duct by primary repair after stent placement. The present study was carried out on a selected group of BDI patients [34 patients], who were referred for management of BDIs. Patients were divided into two equal groups: group A underwent primary repair of the bile duct by placement of a plastic stent [which is used in endoscopic retrograde cholangiopancreatography] and group B underwent Roux-en-Y hepaticojejunostomy. The study included 34 patients, 10 men [30.9%] and 24 women [69.1%] with a mean age of 40.84 years, whose main presentations were postoperative jaundice [82%] and bile leak [15%]. All the patients underwent surgery successfully. There was no intraoperative mortality and bile leakage during the observation period, but primary repair of the bile duct with plastic stent placement was associated with better results as regards operation time, hospital stay, cost, safety, and postoperative complications. Primary repair of the bile duct with stent placement showed good results, involved minimal morbidity, hospital stay, and cost; and helped avoid the drawbacks of Roux-Y hepaticojejunostomy. It also replaced exploration of the common bile duct with a T-tube, with advantages of function of the Oddis sphincter

Helium Neon laser therapy for post mastectomy lymphedema and shoulder mobility

The aim of this work was to evaluate the efficacy of Helium Neon [He-Ne] laser therapy on post mastectomy lymphedema and shoulder mobility. Thirty female patients with axillary lymph node dissection [ALND], with or without radiotherapy had been participated in this study. The patients were randomly divided into two groups of equal numbers. Group A received He-Ne laser therapy and decongestive lymphatic therapy. Group B received placebo laser therapy in addition to decongestive lymphatic therapy. Measurements of limb volume and shoulder mobility [by tape measurement and standard goniometer] were collected before treatment and after six months of treatment. The mean values of limb volume and Shoulder mobility after 6 months of treatment showed a significant improvement [p < 0.05] for the two groups of the study with a greater improvement for patients in group A. Helium Neon laser therapy has a positive effect in reducing post mastectomy lymphedema and increasing range of motion of shoulder joint

Relationship between facial identity discrimination and social function in schizophrenic patients

People with schizophrenia have deficits in interpersonal and social skills associated with social dysfunction. Facial processing ability is an effective component of social functioning. The purpose of this study was to examine the relationship between facial identity discrimination and social functioning in 20-55 years old schizophrenic patients and comparison with normal matched group. The method of this study was analytical- descriptive and comparative. Twenty normal individuals and 20 schizophrenic patients matched in age, sex and educational level, were assessed about facial identity by researcher- made test, and interaction skills by [Assessment of Communication and Interaction Skills][ACIS] questionnaire. Available sampling was used for census patients [who inhabited Tolou rehabilitation center and supported houses in Tehran] and normal group. There were significant difference in scores of [communication and interaction skills] [p<0.01] without any significant difference between facial identity discrimination testing variables [p>0.05] between two groups. The relationships between [facial identity discrimination] and [communication and interaction skills] in schizophrenia were compared with control group and did not show significant difference. [p>0.05]. The facial identity in schizophrenic patients and healthy adults were processed globally [configural]. However, its relation with Communication and Interaction Skills in schizophrenic patients requires further study

Effect of low-level environmental lead exposure intellectual functions of children of EI-Minia city, EI-Minia Governorate, Egypt

Lead [Pb] is a confirmed neurotoxin. Clear adverse effects of blood Pb level [BLL] >/= 10 microg/dl have been documented in children, but questions remain about Pb-associated intellectual disorders at these BLL and whether lower exposures are associated with greater disorders. To study the intellectual functions associated with environmental low-level Pb exposure in children of the villages of the east coast of the River Nile of EI-Minia city that located nearby EI-Minia industrial area. This study was conducted at Suzan Mubarak Hospital, EI-Minia University during the period from 1[th] August, 2008 to the 31[st] of July, 2010. It included 120 children aged 7-9 from the nearest 2 villages to EI-Minia industrial area [60 children each] namely, EI-Newayrat and AI-Shorafaa, and 60 children from Talla, a village located to the west of EI-Minia city far away from EI-Minia industrial area, as a control group. For all patients, BLL had been estimated, and intellectual functions has been evaluated using Wechsler's Intelligence Scale for Children, 3[rd] ed. BLL of children of EI-Newayrat and AI-Shorafaa were significantly increased when compared to that of Talla children with higher affection reported with EI-Newayrat. The outcome of Wechsler's Intelligence Scale revealed a significant reduction of verbal, performance and full scale IQs in EI-Newayrat and AI-Shorafaa when compared to Talla with higher affection reported with EI-Newayrat, with a strong negative correlation to BLL of 5-10 microg/dl. It could not be estimated that every microg/dl increase in BLL was accompanied by a fixed lowered score. There was no statistically significant difference between males and females regarding the BLL and Wechsler's Intelligence Scale scores. in conclusion, Low-level Pb exposure in children of the villages of the east coast of the River Nile of in EI-Minia city that located nearby EI-Minia industrial area was accompanied with intellectual function impairment which is not associated with sex and reported to be nonlinear relationship. It is advised to perform a national study to evaluate how big the problem is and to put Pb-toxicity in the list of the national health problems

Comparison of BCG test and tuberculin test in children

In recent years, several articles have been published about BCG test in the diagnosis of tuberculosis infection particularly in children. The test is reportedly more sensitive and more specific than tuberculin test [PPD]. We evaluated the results of simultaneous application of tuberculin and BCG tests in order to assess their efficacy in normal children [n=52]. The study also included children suffering from PEM [n=38] and children on steroid therapy [n=20]. Assessment of the results of the tests was done after 48 and 72 hours. We found that there were more positive cases with BCG test [44 cases 84.6%] against [23 cases 44.2%] with tuberculin test in normal children. We noticed also that there were no positive cases with tuberculin test in children suffering from PEM while there were 25 positive cases [65.8%] with BCG test which showed that BCG test is better than tuberculin test for detection of tuberculosis infection and less affected by nutritional status. We also found that there were 10 positive cases [50%] with children under steroid therapy with BCG test while there were 7 positive cases [35.0%] with tuberculin test. We noticed also that there were no side effects from BCG vaccination which make it safe to be used. Our results revealed no relation of age to the response to BCG or tuberculin tests. We recommend that BCG test showed more positive results than tuberculin test to detect TB infection and that BCG not only provides immunization against tuberculosis but can be also used as a screening test to detect TB infection less affected by nutritional status. For these reasons we recommend wide use of BCG vaccine as a test to detect TB infection over tuberculin test especially in malnourished children and children under steroid therapy. Wide scale studies are required on tuberculosis patients to .highlight the importance and superiority of BCG over tuberculin tes

study of the effect of low-level environmental lead exposure on the intellectual functions of children of El Minia city, El Minia governorate, Egypt

Lead [Pb] is a confirmed neurotoxin. Clear adverse effects of blood Pb level [BLL] >/= 10 micro g/dl have been documented in children, but questions remain about Pb-associated intellectual disorders at these BLL and whether lower exposures are associated with great disorders. The study aim to study the intellectual functions associated with environmental low-level Pb exposure in children of the villages of the east coast of the River Nile of El-Minia city that located nearby El-Minia industrial area. This study was conducted at Suzan Mubarak Hospital, El-Minia University during the period from 1st August, 2008 to the 31st of July, 2010. It included 120 children aged 7-9 years from the nearest 2 villages to El-Minia industrial area [60 children each] namely, El-Newayrat and Al-Shorafaa, and 60 children from Talla, a village located to the west of El-Minia city far away from El-Minia industrial area, as a control group. For all patients, BLL had been estimated, and intellectual functions have been evaluated using Wechsler's Intelligence Scale for Children, 3[rd] ed. BLL of children of El-Newayrat and Al-Shorafaa were significantly increased when compared to that of TalIa children with higher affection reported with El-Newayrat. The outcome of Wechsler's Intelligence Scale revealed a significant reduction of verbal, performance and full scale IQs in El-Newayrat and Al-Shorafaa when compared to Talla with higher affection reported with El-Newayrat, with a strong negative correlation to BLL of 5-10 micro g/dl. It could not be estimated that every 1 micro g/dl increase in BLL was accompanied by a fixed lowered score. There was no statistically significant difference between males and females regarding the BLL and Wechsler's Intelligence Scale scores. Low-level Pb exposure in children of the villages of the east coast of the River Nile of El-Minia city that is located nearby El Minia industrial area was accompanied with intellectual function impairment which is reported to be nonlinear relationship between BLL and intellectual functions impairment. It is advised to perform a national study to evaluate how big the problem is and to put Pb-toxicity in the list of the national health problems

Nephrotoxicity of long-term occupational exposure to gasoline in El-Minia governorate

The current study was carried out to evaluate the nephrotoxic effect of long-term occupational exposure to gasoline in El-Minia governorate. 76 male subjects aging 18-42 years were involved in this study. They were divided into 4 groups: control group 1: consists of 20 normal subjects with no history of long-term gasoline exposure or previous history of blood, hepatic or renal disorders, group II: consist of 15 gas stations workers for a period of 1 year +/- 2 months with daily exposure to gasoline, group III: consists of 21 gas stations workers for a period of 5 years +/- 2 months with daily exposure to gasoline, and group IV: consists of 20 gas stations workers for a period of 10 years +/- 2 months with daily exposure to gasoline. All subjects sere investigated for blood urea nitrogen [BUN], serum creatinine [S.Cr.], beta[2] microglobulin [beta[2]MG] and cystatin C. The levels BUN, S.Cr., beta[2]MG, and cystatin C of the subjects of group II were within normal with no significant differences when compared to those of group I. The values BUN, S.Cr., beta[2]MG, and cystatin C of the subjects of group III were significantly elevated when compared to those of groups I and II. The levels BUN, S.Cr., beta[2]MG, and cystatin C of the subjects of group IV were significantly elevated when compared to those of group I, II and III. In group III, there was a positive correlation between S.Cr. to the level of beta[2] MG. Also, there was a positive correlation of the level of S.Cr. to the levels of beta[2] MG, and cystatin C among the subjects of group IV. Long-term exposure of the gas station workers to gasoline may carry the risk of nephrotoxicity. This raises the importance of increasing the safety protective measures at these stations, and to develop a more safe fuel in the near future

Role of MDCT colonography and conventional colonoscopy in evaluation of colo-rectal neoplasms

The study was conducted to evaluate the role of MDCT colonography in diagnosis of cob-rectal neoplasms compared to conventional colonoscopy. Fifty patients were included in the present study 28 males and 22 females with age ranged from 2 1-75 years old. Patients were presented with variable-size large bowel masses examined by MDCT colonography and conventional colonoscopy. Twenty three-cases were diagnosed by CT colonography as colonic malignancy, 18 cases diagnosed by colonoscopy as colorectal benign polyps "8 polyps measured less than 5mm, 6polyps from 5-10mm and 4 more than 10mm", those were correlated with findings of CT colonography which revealed only 12 benign polyps with size ranged from 6mm to more than 10 mm. The other 9 cases proved to be extra colonic metastases. MDCT colonography allows more definitive evaluation of the different cob-rectal and extra-colonic masses as it is anon-invasive modality. It has a higher sensitivity for detecting a clinically suspected colonic neoplastic mass. The conventional colonoscopy may still have an advantage of detecting very small and superficial mucosal lesions and taking biopsy from the suspected superficial areas

use of gabapentin in the control of endometriotic pain

Endometriotic pain is a combined nociceptive and neuropathic pain. Nociceptive endometriotic pain is caused by infiltrating endometrtotic lesions as well as fibrotic traction on different pelvic contents. Neuropathic endomnetriotic pain is due to nerve infiltration by endometriotic lesions, fibrotic traction on the nerve, and nerve irritation by inflammator mediators and cytokines in peritoneal fluids. The study was conducted on 33 patients with pain as the only or main symptom. All patients received hormonal and NSAIDs [ +/- Tramadol] treatment for at least 6 months and pain failed to be controlled. All patients received gabapentin for 3 months. Pain was evaluated using SF McGill mean overall pain score and NRS to evaluate the intensity of deep dyspareunia and dysmenorrhea. Serum IL-6 and CA-125 were evaluated. There is a significant improvement of SF McGill mean overall pain score. deep dyspareunia and dysmenorrhea 2 weeks, 4 weeks and 3 months after treatment. SF McGill mean overall pain score showed significant improvement with the rates of 46.54%, 56.18% and 59.31% at 2 weeks. 4 weeks and 3 months respectively. Also, deep dyspareunia showed significant improvement in the rates of 30. 76%, 52.14% and 58.12% at 2 weeks, 4 weeks and 3 months respectively. Dysmenorrhea showed improvement with the rates of 18.87%. 2 7.52% and 35.85% at 2 weeks. 4 weeks and 3 months respectively [All shows P value < 0.01]. This was associated with different degrees of clinical improvement in 72.73% of patients. Serum levels of IL6 showed significant decrease after 3 months with the treatment [P-value < 0.05] while CA-125 showed insignificant decrease of serum levels with treatment [P-value> 0.05]. This study proved an effective role of GABAPENTIN, not only in controlling the mean overall endometriotic pain, but also in deep dyspareunia and dysmenorrhea. This pain control is associated with significant decrease in the level of IL-6, but not CA-125

Effect of some cryoprotectant agents on physiochemical properties of frozen stored bolti [Tilapia Nilotica] fish fillets

The effectiveness of four cryoprotectant agents i.e. mixture of sucrose and sorbitol 8% [w/v] [S/S], sodium lactate 8% [w/v] [SL], sodium tripolyphosphate 11.8% [w/v] [STPP], and polydextrose 8% [w/v] [PDT] on protein denaturation of bolti fish fillets during freezing and frozen storage for 6 months were studied. The parameters of extractable proteins [salt and water-soluble factions], water holding capacity, total sulfhydryl content, and expressible moisture [drip under pressure] content were used to measure the protein denaturation. The used cryoprotectant agents were significantly [p<0.5] retarded protein denaturation during freezing storage [6 months]. Among all cryoprotectants used, polydextrose exhibited the greatest protective effect on protein denaturation as shown by the effectiveness in maintaining protein solubility. Sucrose/sorbitol provided more effective cryoprotection than sodium lactate in preservation of protein structure. Polydextrose and sodium lactate appeared to be promising alternative cryoportectants for fish muscle and its products owing to their low sweetness and caloric value

Effect of acute antioxidant overdose on blood hemostasis: experimental study

The current study was carried out to investigate the effects of the excessive use of large doses of the most widely used antioxidants, d-alpha-tocopherol [vitamin E], retinol acetate [vitamin A], and l-ascorbic acid [vitamin C], on the blood hemostasis. 140 albino rats were divided into 4 experimental groups of 40 animals each as follows: Group I: A control group [negative and positive]; Group II: Each animal of this group received a daily oral dose of 24 mg of d-alpha-tocopherol; Group III: Each animal of this group received a daily oral dose of 1mg of Trans-retinol acetate, and; Group IV: Each animal of this group received a daily oral dose of 20 mg of l-ascorbic acid. The results of the current study have revealed that both d-alpha-tocopherol and retinol acetate produced a significant prolongation of prothrombin time [PT] and activated partial thromboplastine time [PTT] with a significant reduction of factor X activity. On the contrary, l-ascorbic acid produced no significant effect on these parameters. Histopathological examination of liver, kidney, and brain specimens of the different treated animal groups revealed the presence of significant hemorrhages in most samples of both d-alpha-tocopherol- and retinol acetate-treated animals, while the specimens of l-ascorbic acid-treated animals showed no hemorrhage in nearly all samples. These histopathological changes were confirmatory to the biochemical ones. It could be concluded that the excessive use of large doses both d-alpha-tocopherol and retinol acetate alters the blood hemostasis with increased bleeding tendencies, while l-ascorbic acid doesn't. In fact, l-ascorbic acid could be considered a safe drug even in excessive doses for long periods

Neurotoxicity of the commenest volatile substances abused in El-Minia Governorate: clinical and experimental study

The current study was. performed to investigate the possible neurotoxic effects of chronic solvent abuse of some of the commonest abused substances in El-Minia governorate, namely, acetone and diethyl ether, and whether these changes, if present, are reversible or not. It was carried out as 2 parts: 1[st] part; 50 male persons aging between 20-45 were divided into 5 groups of 10 subjects each: group I; a normal volunteer control group, group II exposed daily to acetone for 1-2 year[s], group III: exposed daily to acetone for 8-10 year[s], group IV: exposed daily to diethyl ether for 1-2 year[s], group IV: exposed daily to diethyl ether for 8-10 year[s]. All subjects were examined thoroughly for any neuropsychiatric disorders 3 times 3 months apart. The 2[nd] part; 180 albino rats divided into 9 groups of 20 rats each as follows: group I: a control group received a daily oral dose of 1.5 ml of physiological saline for 1 month, group II: exposed to a daily dose of acetone [1250 ppm. / 30 min.] for 1 month, then examined immediately, group III: exposed to a daily dose of acetone [1250 ppm. / 30 min.] for 1 month, left for 1 month without any medical intervention, then examined, group IV: exposed to a daily dose of acetone [1250 ppm. / 30 min.] for 3 months, then examined immediately, group V: exposed to a daily dose of acetone [1250 ppm. / 30 min.] for 3 months, left for 1 month without any medical intervention, then examined, group VI: exposed to a daily dose of diethyl ether [2000 ppm. / 30 min.] 1 month, then examined immediately, group VII: exposed to a daily dose of diethyl ether [2000 ppm. / 30 min.] 1 month, left for I month without any medical intervention, then examined, group VIII: exposed to a daily dose of diethyl ether [2000 ppm. / 30 min.] for 3 months, then examined immediately, and group IX: exposed to a daily dose of diethyl ether [2000 ppm. / 30 min.] for 3 months, left without any medical intervention for 1 month, then examined. The results of the 1[st] part of the current study revealed that persons of the groups II and IV had mild neuropsychyatric disorders and that these changes were much more severe in the persons of group III and V as well as the appearance of another serious disorders including parkinsonism, cerebellar dysfunction, and cranial nerve affection. The results of the 2[nd] part revealed that animals of groups II and VI showed profound pathological changes of the cerebral cortex and cerebellum ranging from mild to moderate degrees with higher incidence towards the mild one. In addition, the animals of groups IV and VIII showed similar changes with increased incidence of the moderate degree. Moreover, animals of groups III and VII showed a mild improvement of the reported pathological changes when compared to those examined immediately after the last dose. On the other hand, animals of groups V and IX showed no improvement and nearly were the same when compared to those of groups IV and VIII. It could be concluded that volatile substance abuse induces serious neuropsychiatric and pathological changes, and that severity of the pathological changes increases with the increase of period of abuse, while reversibility becomes less likely

Primary tension - free epigastric hernioplasty: procedure and outcome

Between January 1992 and May 1998, we operated upon 110 patients with large epigastric hernias [3cms or more] performing a primary pure prosthetic tension-free repair using the onlay polypropylene mesh graft technique, aiming to reduce the expected high recurrence rate after other repairs [1,4]. This group is retrospectively reviewed. There were 77.3% females and 22.7% males. Only elective repairs were included. All recurrent cases, the pediatric age group and those with ascites were not included. 7 patients [6.4%] has other types of hernia while 13 [11.8%] had more than one epigastric hernia. 8 patients [7.3%] presented with diastases [divarication] of recti in addition to their hernias. No perioperative mortality. Removal of the mesh, mesh extrusion or deep mesh infection did not occur in any case. Recurrence rate was 2.7% [3 cases] and was attributed either to emergence of a new hernia [in 2 cases] or to a correctable technical error [in one case]. Total complication rate was 18% while, complication rate related to mesh application was 10.7%. All complications were not serious and easily controlled as they necessitated minor surgical reintervention in only 4.5% of cases. It is to be concluded that the results are gratifying and the technique used is simple, durable and has a few and easily treatable complications. So, we recommend this repair as the primary repair of all epigastric hernias 3 cm or more to reduce the high recurrence rates noticed with other repairs

Effect of insulin on plasma endothelin-I and arterial blood pressure in normal and diabetic rats

This study was designed to compare the plasma level of Endothelin - I and the arterial blood pressure in both normal and streptozotocin induced diabetic rats and to study the effect of insulin treatment on the two tested parameter in normal and diabetic rats. Sixty male rats were used and divided into 5 groups: group [1] [normal rats, served as control A], Group 2 [normal rats treated with insulin for 8 weeks], group 3 [diabetic rats served as control B],Group 4 [diabetic rats treated with insulin for 4 weeks] and Group 5 [diabetic rats treated with insulin for 8 week]. Our results showed that the mean arterial blood pressure was significantly decrease in diabetic rats, while their plasma level of Endothelin- I was higher than the non diabetic rats. Insulin administration to normal and diabetic rats produced significant rise in both tested parameters

Effect of different flows during hypothermic cardiopulmonary bypass on open heart surgery on oxygen consumption and serum levels of lactate and pyruvate

This study was designed to investigate the effects of low flow versus high flow on hemodynamic variables, oxygen consumption and metabolic products in the form of lactate and pyruvate in thirty patients undergoing open heart surgery due to rheumatic heart disease. The results showed that hemodynamic parameters [central venous pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure and systolic and diastolic blood pressure] were not significantly different between the two studied groups in pre-and post bypass. During bypass, the mean arterial blood pressure was significantly higher in high flow rate group than the low flow rate group i.e. blood pressure was flow dependent. In both groups, the systemic vascular resistance was reduced post bypass than pre bypass and the cardiac output was significantly increased during post bypass than pre bypass period and no significant difference could be detected between the two studied groups

investigation on the shear bond strength of one dentin adhesive at two different dentin depths

The aim of this investigation was to study the effect of dentin depth and patient's age on the shear bond strength of one dentin adhesive [ART Bond], using an Instron Universal testing machine at a cross-head speed of 0.5 mm/min. Forty human molar teeth were used and were divided into two main groups, twenty each representing two age groups of patients, i.e., between 20 to 30 years and between 30-40 years of age. Every group was further subdivided into two subgroups of different dentin depths, i.e., superficial and deep. Results were recorded in Kg/Cm[2] and converted into MPa units, then tabulated and statistically analyzed. A Duncan's range statistic test at P

Evaluation of new scoring system for dye penetration for in vitro comparative microleakage studies

This study was designed to evaluate one of the commonly used scoring systems -Score I- [categories from 0-5] to other two suggested scoring systems -Score II and III- [categories from 0-1 and 0-2 respectively], to test the degree of dye penetration for leakage studies. Class V cavities were prepared on 100 extracted human upper central incisors and filled with light cured composite. Herculite, and high copper amalgam. Tytin. All teeth were immersed in sodium fluorescein dye to test the degree of dye penetration. The results revealed that the suggested score II is very easy, simplified and representitive but not indicative regarding the severity of dye penetration as score I. Score III are indicative and obvious discussion can be obtained rather than score I. For any leakage study the use of non parametric measurement is preferable than parametric ones

Corrosion behaviour of dispersalloy amalgam and non precious alloys in artificial saliva of different pH

Corrosion behavior of dispersalloy amalgam and non-precious alloys in artificial saliva of different pH was studied using potential and capacitance measurements. In slightly acidic media, the amount of potential shift for all alloys studied is, small as compared to more acid media, pH = 1.85. On the other hand, in alkaline saliva, especially of higher pH, 12.01, the potential shift for dispersalloy amalgam, is higher than that of non-precious alloys. Further, Wiron S alloy showed the most resistive alloy in such media. The results of capacitance measurements are in general accord with those implied by the potential. The corrosion potential of the non-precious alloys-amalgam combinations reflect the activity of Wiron S - amalgam combination and inertness of the other combination. All amalgam samples exhibit a gradual loss of the surface luster with blackish discoloration and pitting after a long exposure period to the medium