Background: Lumbar segmental stability is an important biomechanical component that influences symptoms amongst patients with Mechanical low back pain. Aims: To compare the efficacy of segmental stabilization exercises utilizing multifidus and transversus abdominis muscles versus a placebo treatment in patients with lumbar segmental instability. Materials and methods: The study was an observer-blinded randomized placebo-controlled cross-over study of 18 adults (12 men, 6 women), of mean age 22.5 ± 1.09 yrs who scored 7/13 in subjective aspects and 8/14 in objective aspects of Delphi criteria for lumbar segmental instability. The selected subjects were then randomized to receive either placebo-control (prone lying) or experimental (lumbar segmental stabilization) as a first treatment. Each treatment was followed by a wash-out period of 24 hours. Outcomes were measured four times- pre- and post- first intervention, pre- and post- second intervention. The outcome measures used were pain on Visual analogue scale, Pressure pain threshold and Joint play grading scale (0-6 scale) on that level. Results: Two-way analysis of variance and post-hoc analysis using Bonferonni test were used with level of significance set at p<.05 using Statistical package for social sciences version 12.0.1 for Windows. Visual analogue scale changed significantly in both the periods of intervention- in control (P =.016) and experimental (P =.000) periods. However this improvement was more significant in the experimental period. The Joint play grading scale scores improved only in the experimental condition compared to the control condition significantly. The Pressure pain threshold also improved significantly in the experimental condition (P =.000) while the changes in control condition was not statistically significant (P=.816). Conclusion: Segmental stabilization exercise was more effective than placebo intervention in symptomatic lumbar segmental instability.

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Context: Schistocytes are fragmented red blood cells due to the flow of blood through damaged capillaries and indicate endothelial injury. They are typical of microangiopathic hemolytic anemia seen in life threatening conditions like disseminated intravascular coagulation or thrombotic thrombocytopenic purpura/hemolytic uremic syndrome .We report a rare sub-acute presentation of pernicious anemia with hemolysis, thrombocytopenia and numerous schistocytes that was initially diagnosed as a more serious thrombotic thrombocytopenic purpura. Case Report : A 31-year-old Caucasian woman presented with fatigue and paresthesia of both feet for 1 week. Past medical history included hypertension and gastro-esophageal reflux disease. Examination revealed scleral icterus and pallor. Examination of the abdomen did not show hepatosplenomegaly. Initial laboratory tests showed severe anemia, and low platelets. Indirect bilirubin and serum Lactate De Hydrogenase were elevated. Prothrombin time, partial thromboplastin time, serum fibrinogen, and serum fibrin degradation product levels were normal. Peripheral smear revealed numerous schistocytes, anisocytosis and macro-ovalocytes. Thrombotic thrombocytopenic purpura (TTP) was suspected due to the constellation of sub-acute onset of fatigue and paresthesia along with thrombocytopenia, schistocytes and an elevated LDH. Plasmapheresis was initiated for possible TTP. However, platelet count worsened despite plasmapheresis for 4 days. On re-evaluation, vitamin B ₁₂ was found to be low. Treatment with intra-muscular vitamin B ₁₂ led to symptomatic and hematologic improvement. Pernicious anemia was confirmed by the presence of anti-intrinsic factor antibodies, elevated serum gastrin level and atrophic gastritis. Conclusion : Clinicians must be aware of unusual clinical presentation of vitamin B ₁₂ deficiency with schistocytes as the management is simple and effective.

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Background : Dengue fever and dengue hemorrhagic fever are caused by dengue virus. Dengue infection remains a burning problem of many countries. To diagnose acute dengue in the early phase we improve the low cost, rapid SYBR green real time assay and compared the sensitivity and specificity with real time Taqman^® assay and conventional nested PCR assay. Aims: To develop low cost, rapid and reliable real time SYBR green diagnostic dengue assay and compare with Taqman real-time assay and conventional nested PCR (modified Lanciotti). Materials and Methods: Eight cultured virus strains were diluted in tenth dilution down to undetectable level by the PCR to optimize the primer, temperature (annealing, and extension and to detect the limit of detection of the assay. Hundred and ninety three ELISA and PCR proved dengue clinical samples were tested with real time SYBR^® Green assay, real time Taqman^® assay to compare the sensitivity and specificity. Results: Sensitivity and specificity of real time SYBR® green dengue assay (84% and 66%, respectively) was almost comparable to those (81% and 74%) of Taqman real time PCR dengue assay. Real time SYBR^® green RT-PCR was equally sensitive in primary and secondary infection while real time Taqman was less sensitive in the secondary infection. Sensitivity of real time Taqman on DENV3 (87%) was equal to SYBR green real time PCR dengue assay. Conclusion: We developed low cost rapid diagnostic SYBR green dengue assay. Further study is needed to make duplex primer assay for the serotyping of dengue virus.

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Background : This quantification process is made through electromyography analysis. This technique of analysis is able to provide a general view of the tension decrease in the superior muscle fibers of the trapezius after therapy. Aims : The focus of the present work is to evaluate the treatment of the cervicobrachialgia by Positional Release Therapy (PRT). Material and Methods : The present work studies six patients, with ages 44 to 63 (1 male and 5 female) who present tension in the trapezius upper portion fibers. All patients were submitted to 10 session of 30 minutes each. The electromyography was collected on the first and tenth day of treatment. Results : The results demonstrated a progressive decrease of pain in each session. The tension was evaluated by the electromyography analysis, which showed the relations between time of treatment and less pain. Conclusion : With these results, it was possible to verify quantitatively the efficiency of the PRT in the improvement of life quality.

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Background: Elective caesarean section rates have risen over the last decade worldwide. The increase in this rate is not associated with clear benefit for the baby or mother but proportionally associated with increased morbidity for both. Neonatal adverse outcomes in infants born before 39 weeks of gestation are increased and increase progressively as gestational age at birth declines Aim: To compare neonatal outcomes of elective caesarean section performed at or beyond completed 37 weeks of gestation with ≥ 38 weeks of gestation. Material and Method: This is a prospective observational study. During the period from July 2010 through April 2011 a total 134 neonates delivered by elective Cesareans at term and were divided into two groups, those who were born (early term) before 38 weeks of gestation (37+0 - 37+6) and those who were born (late term) at or greater than 38 weeks of gestation. We analyzed the following variables sex, number of maternal parities, mode of anesthesia, Apgar score at first and fifth minute, respiratory complications, hypothermia, hypoglycemia, feeding difficulties and admission to neonatal intensive care unit. Results: During the period of the study , 890 live births whether delivered by Cesarean section or normal vaginal delivery. Of these only 134 neonates fulfilling the inclusion criteria were included. About 50% of them were delivered before 38 weeks of gestation. We performed our analysis on those 134 neonates and we found a significant risk in the early Cesareans group in comparison to later group for development of respiratory complications (P=0.0001), hypothermia (P=0.0001) and feeding difficulty (P=0.0001). Conclusion: Significant reduction in the neonatal morbidities if the time of elective Cesareans is at completed 38 weeks or beyond 38 weeks of gestation. Further larger studies are needed to analyze the factors responsible for our new date regarding the hypothermia and feeding difficulty in neonates born electively by Cesareans before 38 completed weeks of gestation.

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Context : Tattoos are produced by introducing colorants of various compositions into the skin, either accidentally or for cosmetic purposes. Case Report: A 62-year-old male presented with a cosmetic tattoo and requested a total excision of the lesion. Dermatopathologic analysis of the excised tissue with hematoxylin and eosin examination, as well as immunohistochemistry was performed. H&E staining demonstrated classic histologic features of a tattoo. Utilizing immunohistochemistry, dermal histiocytic antigen presenting cells stained with HAM56 and CD68 antibodies; the staining was present surrounding the tattoo pigment. Conclusions : We identified two macrophage markers (HAM56 and CD68) surrounding dermal tattoo pigment. A minimal dermal inflammatory immune was noted to the tattoo pigment. Moreover, the immune response and/or tolerance to tattoos is not well characterized. We suggest that tattoo materials and techniques could be utilized in therapeutic delivery for diseases such recessive dystrophic epidermolysis bullosa, potentially preventing immune rejection of gene therapy agents.

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Context: Vitamin D deficiency is extremely common in multiple myeloma, and it represents a surrogate for clinical multiple myeloma disease status. Patients may complain of dull, persistent, generalized musculoskeletal aches and pains with fatigue or decrease in muscle strength. Case Report: A 63 year old male with multiple myeloma on Bortezomib presented with worsening generalized musculoskeletal pain, weakness, and multiple falls. On initial examination he was pale with a depressed affect. He had resting tremor, generalized bony tenderness, worse on movement and weight bearing, muscle weakness, and a waddling gait. His bone studies showed features of osteomalacia with a very low Vitamin D level of less than 20 nmol/L. He was treated with 3000 units of Vitamin D daily and physiotherapy. After 4 months, although his multiple myeloma deteriorated, there was a significant decrease in his generalized musculoskeletal pain. Conclusions: This case highlights that vitamin D deficiency is common in patients with multiple myeloma, and can cause generalized musculoskeletal pain and increase the risk of falls, yet it often goes unrecognized. In patients with non-specific musculoskeletal pain, and inadequate sun-exposure medical practitioners must have a high index of suspicion for vitamin D deficiency.

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Background : Intestinal parasitic infections have been described as constituting the greatest single worldwide cause of illness and disease. Aim : The objective of this study is to investigate the prevalence of intestinal parasitic infections in relation to sex and age as well as seasons of the year in Benin city, Nigeria. Materials and Methods : The stool samples were processed using saline and iodine mounts and examined microscopically for ova and cysts of parasites. Results : The overall prevalence of intestinal parasitic infections was 3.9% while gender and season had no correlation with the prevalence of intestinal parasites (P = 0.548, P = 0.696). There was a significant relationship between intestinal parasitic infection and age (P < 0.033). Ascaris lumbricoides was the most prevalent (51.4%) while Entamoeba histolytica had the least prevalence (5.4%). Conclusion : The results of this study concluded that 36 patients were infected with various intestinal parasites and that age significantly affected the prevalence of parasitic infections. Effective treatment of infected patients and improved sanitary habits is advocated.

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Context: A nasogastric tube is utilized routinely by many bariatric surgeons to assist creation of gastrojejunal anastomosis during roux-en-y gastric bypass or duodenojejunal anastomosis during biliopancreatic diversion. However, inadvertent stapling or suturing of the nasogastric tube has been known as a potential complication of this technique. Case Report: We describe a successful endoscopic removal of an inadvertently sutured nasogastric tube at the level of the duodenojejunal anastomosis in a 30-year-old woman undergoing a robotically assisted laparoscopic biliopancreatic diversion with duodenal switch for super morbid obesity. Conclusions: Endoscopic technique is a feasible and safe minimally invasive technique to release a retained nasogastric tube with preservation of the newly created anastomosis. This option gives major advantages of avoiding a re-operation, as well as the potential general anesthetic complications.

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