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Fulltext Plausible impact of forward head posture on upper cervical spine stability

Chu ECP, Lo FS, Bhaumik A

J Family Med Prim Care, 2020 May;9(5):2517-2520.
PMID: 32754534 DOI: 10.4103/jfmpc.jfmpc_95_20

The cervical spine is responsible for allowing mobility and stability to the head and neck. Any deviation to the center of gravity of the head results in an increase in cantilever loads, which can be particularly damaging to the upper cervical joints. Excessive neck bending also exaggerates stretching through the cervical spine and all of the spinal structures below. It has been reported that forward head posture (FHP) can cause a multitude of disorders including cervical radiculopathy, cervicogenic headaches and cervicogenic dizziness. Most of these conditions manifest with clusters of painful symptoms and spine dysfunctions. The purpose of this case study is to describe the radiographic imaging considerations and to illustrate the potential impacts in symptomatic adults with FHP. We randomly selected radiographs of three individuals with FHP who had undergone cervical adjustment for cervical pain. The occipito-axial (C0-C2) and atlanto-axial (C1-C2) joints were assessed via the C0-2 distance from the C2 base to the McGregor line (Redlund-Johnell criterion) and the Ranawat C1-2 index, in addition to subjective radiographic parameters. By comparing the radiographs of before-and-after intervention of each patient, a regressive joint spacing was observed from both indices. Such a long-lasting stretching concordant with FHP was assumed to be hazardous to joint stability. A definite conclusion, however, cannot be drawn due to the small sample size and a lack of convincing measurements.

Matched MeSH terms: Neck Pain
Fulltext Clinical assessment and grading of back pain in horses

Mayaki AM, Abdul Razak IS, Adzahan NM, Mazlan M, Rasedee A

J Vet Sci, 2020 Nov;21(6):e82.
PMID: 33263229 DOI: 10.4142/jvs.2020.21.e82

BACKGROUND: The clinical presentation of horses with back pain (BP) vary considerably with most horse's willingness to take part in athletic or riding purpose becoming impossible. However, there are some clinical features that are directly responsible for the loss or failure of performance.
OBJECTIVES: To investigate the clinical features of the thoracolumbar region associated with BP in horses and to use some of the clinical features to classify equine BP.
METHODS: Twenty-four horses comprised of 14 with BP and 10 apparently healthy horses were assessed for clinical abnormality that best differentiate BP from normal horses. The horses were then graded (0-5) using the degree of pain response, muscular hypertonicity, thoracolumbar joint stiffness and overall physical dysfunction of the horse.
RESULTS: The common clinical features that significantly differentiate horses with BP from non-BP were longissimus dorsi spasm at palpation (78.6%), paravertebral muscle stiffness (64.3%), resist lateral bending (64.3%), and poor hindlimb impulsion (85.7%). There were significantly (p < 0.05) higher scores for pain response to palpation, muscular hypertonicity, thoracolumbar joint stiffness and physical dysfunction among horses with BP in relation to non-BP. A significant relationship exists between all the graded abnormalities. Based on the cumulative score, horses with BP were categorized into mild, mild-moderate, moderate and severe cases.
CONCLUSIONS: BP in horse can be differentiated by severity of pain response to back palpation, back muscle hypertonicity, thoracolumbar joint stiffness, physical dysfunctions and their cumulative grading score is useful in the assessment and categorization of BP in horses.

Matched MeSH terms: Back Pain
The effect of core stability training with ball and balloon exercise on respiratory variables in chronic non-specific low back pain: An experimental study

Mohan V, Paungmali A, Sitilertpisan P, Henry LJ, Omar FA, Azhar FZ

J Bodyw Mov Ther, 2020 Oct;24(4):196-202.
PMID: 33218511 DOI: 10.1016/j.jbmt.2020.07.007

BACKGROUND: Studies have shown the involvement of respiratory characteristics and their relationship with impairments in non-specific low back pain (NS-LBP). The effects of core stability with a combined ball and balloon exercise (CBB) on respiratory variables had not been investigated.
OBJECTIVE: To evaluate the effectiveness of CBB on respiratory variables among NS-LBP patients.
STUDY DESIGN: pre- and post-experimental study.
PARTICIPANTS: Forty participants were assigned to an experimental group (EG) [n = 20] and control group (CG) [n = 20] based on the study criteria.
INTERVENTIONS: The EG received CBB together with routine physiotherapy and the CG received routine physiotherapy over a period of 8 weeks. Participants were instructed to carry out the exercises for 3 days per week. The training was evaluated once a week and the exercises progressed based on the level of pain.
OUTCOME MEASURES: Primary outcomes were maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP) and maximum voluntary ventilation (MVV). The secondary outcomes were measured in the numeric rating scale (NRS), total faulty breathing scale (TFBS), cloth tape measure (CTM) and lumbo-pelvic stability.
RESULTS: The MIP increased significantly among the EG when compared with that in the CG (p > 0.05).The EG showed a significant increase in MVV (p = 0.04) when compared to the CG (p = 0.0001). There was a significant reduction in pain for both groups. The MEP, TFBS, chest expansion and core stability showed no changes in either group.
CONCLUSION: CBB was effective in improving respiratory variables among NS-LBP patients.

Matched MeSH terms: Low Back Pain
Fulltext Spontaneous Omental Infarction: An Unusual Etiology of Abdominal Pain

Khairuddin A, Teng WW, Azizan N, Hayati F, Sahid NA, Kadir F

Kathmandu Univ Med J (KUMJ), 2019 10 1;17(68):347-349.
PMID: 33311048

A 49-year-old lady with previous scars complained of acute abdominal pain for two days. Her right hypochondrium was tender and guarding upon assessment. The laboratory investigations were unremarkable. Due to a diagnostic incongruity, computed tomography of the abdomen was performed showing a suspicious lesion at anterolateral aspect of the ascending colon. Surgical intervention was decided and intraoperative finding was consistent with spontaneous omental infarction. Omentectomy was undertaken and final histology was compatible with the intraoperative diagnosis. Although it is exceptional, omental infarction should be considered as part of the differential diagnoses of right-sided acute abdominal pain with normal laboratory investigations. This case highlights its unexpected discovery and we describe its literature reviews.

Matched MeSH terms: Abdominal Pain
Fulltext Novel technique using amplatzer AVP I stent in management for giant renal artery pseudoaneurysm

Sarmukh S, Putera MP, Tan KL, Chew LG

Urol Case Rep, 2021 Mar;35:101515.
PMID: 33318942 DOI: 10.1016/j.eucr.2020.101515

Renal artery pseudoaneurysm (RAP) is an uncommon vascular lesion. Early detection and treatment of renal artery pseudoaneurysm is important because it can rupture and lead to life-threatening hemorrhage. Recent advances in endovascular interventions can prevent potentially challenging open surgery. We describe a case 66 year old patient who presented with a painful abdominal lumbar mass. CT scan show a giant renal artery pseudoaneurysm. We discuss management of giant renal artery pseudoaneurysm, both open surgery and endovascular surgery. Endovascular arterial embolization and stent techniques is feasible. However, open surgical treatment remains to be most effective and radical method in emergency setting.

Matched MeSH terms: Abdominal Pain
Fulltext A Case of Retroperitoneal Liposarcoma Mimicking an Adrenocortical Carcinoma

Kang W, Singarayar C, Wahab NA, Sukor N, Kamaruddin NA

J ASEAN Fed Endocr Soc, 2019;34(1):95-98.
PMID: 33442143 DOI: 10.15605/jafes.034.01.15

An adrenal mass can be a diagnostic challenge as it is not easy to differentiate the adrenal glands from other adrenal pseudotumours with only radio-imaging. We report a 28-year-old patient who was diagnosed radiologically as an adrenal cortical carcinoma after he presented with abdominal pain and fullness. Biochemically, he demonstrated secondary hyperaldosteronism. Intra-operatively there was a huge mass, inferior to a normal right adrenal, which was histopathologically proven to be a dedifferentiated liposarcoma.

Matched MeSH terms: Abdominal Pain
Fulltext Bilateral idiopathic optic perineuritis in a young Malay woman: A case report

Ayesha Mohd Zain, Umi Kalthum Md Noh, Mushawiahti Mustapha, Norshamsiah Md. Din, Bastion, Mae Lynn Catherine

Neurology Asia, 2015;20(4):407-409.
MyJurnal

A 28-year-old Malay woman presented with severe loss of vision in both eyes associated with periocular pain on eye movement. She was completely blind at presentation and examination showed optic discs
swelling. Optic nerve imaging showed ‘doughnut sign’, characteristic of optic perineuritis. Steroid was
given over six months. Visual function improved gradually and was maintained at one year follow-up.
This case highlights the importance of differentiation between optic neuritis and optic perineuritis as
visual recovery depends on prolonged management with corticosteroid in optic perineuritis.

Matched MeSH terms: Pain
Fulltext Dentists Perception of their Patients in Malaysia

Razak, I.A.

Ann Dent, 1995;2(1):-.
MyJurnal

A postal questionnaire concerning the Malaysian dentists' attitudes towards their patients yielded a 73.1% response rate. The results of this study indicated that a majority of dentists felt that patients had more negative than positive attributes. Private practitioners attributed more negative traits to their patients than their public sector colleaques. About 88% of dentists indicated that the most negative patient attribute was fear of pain. Fear of pain was perceived to be stronger than fear of the dentist (62.2%). likewise the patients' inability to seek treatment soon enough (78.4%), to come for regular check-up (72.7%) and to follow advice on personal oral hygiene(70.1%) were worrisome.

Matched MeSH terms: Pain
Fulltext Antrochoanal polyp as a rare presentation of fungal ball

Nazli Zainuddin, Irfan Mohamad, Khan, Shamim Ahmed

Archives of Orofacial Sciences, 2010;5(2):58-60.
MyJurnal

Fungal ball is an extramucosal mycosis. The patient may present with facial pain, nasal blockage, purulent nasal discharge and cacosmia, the fungal ball being present unnoticed for years. Some patients do present as having other nasal problems and later on are found out to have a fungal ball incidentally. We present a case of 38 yearold man who was clinically diagnosed as having left antrochoanal polyp. Intraoperatively, a fungal ball was discovered in the left maxillary antrum.

Matched MeSH terms: Facial Pain
Fulltext Are COX-2 inhibitors a solution to problems associated with current oral analgesics? a revisit with a perspective of local need

Ngeow, W.C., Ong, S.T.

Malaysian Dental Journal, 2008;29(2):84-93.
MyJurnal

The primary obligation and ultimate responsibility of a dental surgeon is not only to restore aesthetic and function, but also to relieve pain which originates from dental pathology or surgical procedures performed. Post operative dental pain is mainly of inflammatory origin. Common traditional oral analgesics, namely salicylates, paracetamol and non-steroidal anti-inflammatory drugs have been the drugs of choice, but are increasingly being superseded by newer designer analgesics, the cyclooxygenase-2 (COX-2) inhibitors. This article reviews the advantages and disadvantages of prescribing common traditional oral analgesics as well as exploring the potential use of COX-2 inhibitors as an alternative to these analgesics for the control of post operative pain in dentistry.

Matched MeSH terms: Pain, Postoperative
Fulltext The prevalence of oro-facial pain and discomfort among 16-year old students In Kelantan - a pilot study

Jaafar, N., Saub, R., Razak, I.A.

Ann Dent, 1997;4(1):9-12.
MyJurnal

A pilot study was conducted on 135 sixteen-year-old students from three rural schools in Kelantan to establish the prevalence of orofacial pain and discomfort. About 44% reported to have experienced some oro-facial pain in the preceding four weeks. About 27% of those with pain, still experienced the pain at the time of clinical examination but only 8% have consulted professional help. Most of the pain encountered were only mild or moderate in nature. Only 7% and 10% respectively, reported that the pain affected their sleep and concentration to study. The main cause was toothache and sensitivity. The prevalence of discomfort was 22%, the most common causes being recurrent oral ulcers and bleeding gums. The impacts of orofacial pain was mainly manifested at the personal level, and very few affecting social functioning. However, untreated decay and missing teeth were very low (mean DT 0.47, mean MT 0.27), while filled teeth (mean Ff 2.9) was the main component of the DMFf (mean 3.66, sd ± 2.6). Severe periodontal disease and the prevalence of traumatised teeth was not a major public health problem. The high prevalence of pain merit further research. Therefore a larger study involving other age-groups in other states is planned.

Matched MeSH terms: Facial Pain
Fulltext Schoolbag weight, its content, and incidence of back pain in different medium primary schools in Kuala Lumpur

Nor Azlin M. N., Asfarina, Z., Wan Chee, L.

Malaysian Journal of Medicine and Health Sciences, 2010;6(2):59-64.
MyJurnal

Introduction: Schoolbag weight across different types of school and schoolbag content has not been
studied in Malaysia. This cross sectional survey determines the weight of schoolbags, its content and
occurrence of back pain among primary school children in different medium primary school in Kuala
Lumpur. Methods: Students’ body weight, and schoolbags weight were measured using a calibrated
scale. Schoolbag content was examined, and weighed according to necessary learning materials
or unnecessary materials. Back pain in the past one week was assessed using a self-administered
questionnaire, adapted from previous studies. Results: A total of 358 students (167 male, 191 female)
were enrolled, of which 119 were from National School (NS), 122 from Chinese Medium School (CMS)
and 117 from Tamil Medium School (TMS). The mean schoolbag weight was 4.55±1.62kg for NS,
8.53±1.94kg for CMS and 6.06±2.09kg for TMS, which was 11.7%, 22.0% and 16.6% of body weight,
respectively. The mean weight of unnecessary schoolbag content was 0.64(0.91)kg for NS, 2.18(1.49)kg for CMS and 1.96(1.56) for TMS students. Back pain was detected in 87.0% NS students, 68.0% CMS students and 66.7% TMS students. Significant association was found between occurrence of back pain and types of school ( 2=16.64,p=0.00). Conclusions: Students from all the three mediums primary school, in particular Chinese medium school carry school bag heavier than that generally recommended, with unnecessary materials weigh up to 2kg. The occurrence of back pain is high and this is associated with the types of school.

Matched MeSH terms: Back Pain
Fulltext Factitious dermatitis: a non infective cause of subcutaneous emphysema

Manohar, A., Azhar, M.Z.

Malaysian Journal of Medicine and Health Sciences, 2012;8(1):69-72.
MyJurnal

We report a case of factitious dermatitis in a 17 year female student who presented with recurrent pain .swelling and subcutaneous crepitations of the forearm. A thorough investigation was done. Full blood count, erythrocyte sedimentation rate was normal. Plain radiographs revealed the presence of subcutaneous emphysema. MRI showed similar findings and revealed normal muscles. Colonoscopy and OGDS were normal. except for a small polyp at the gastro-esophageal junction. Based on the clinical findings and lack of correlation with the investigations a diagnosis of factitious subcutaneous emphysema was made.

Matched MeSH terms: Pain
Fulltext Endoscopic Transoral Resection of an Axial Chordoma: A Case Report

Taran S, Yusof AH, Yusof MI

Malays Orthop J, 2015 Nov;9(3):75-77.
PMID: 28611918 MyJurnal DOI: 10.5704/MOJ.1511.015

Upper cervical chordoma (UCC) is rare condition and poses unique challenges to surgeons. Even though transoral approach is commonly employed, a minimally invasive technique has not been established. We report a 44-year old Malay lady who presented with a 1 month history of insidious onset of progressive neck pain without neurological symptoms. She was diagnosed to have an axial (C2) chordoma. Intralesional resection of the tumour was performed transorally using the Destandau endoscopic system (Storz, Germany). Satisfactory intralesional excision of the tumour was achieved. She had a posterior fixation of C1-C4 prior to that. Her symptoms improved postoperatively and there were no complications noted. She underwent adjuvant radiotherapy to minimize local recurrence. Endoscopic excision of UCC via the transoral approach is a safe option as it provides an excellent magnified view and ease of resection while minimizing the operative morbidity.

Matched MeSH terms: Neck Pain
Fulltext Baseline adjustment for statistical efficiency on clinical controlled trial

Loh, S.Y.

JUMMEC, 2009;12(1):31-34.
MyJurnal

In a clinical controlled trial involving repeated measures of continuous outcomes such as quality of life, distress, pain, activity level at baseline and after treatment, the possibilities of analyzing these outcomes can be numerous with quite varied findings. This paper examined four methods of statistical analysis using data from an outcome study of a clinical controlled trial to contrast the statistical power on those with baseline adjustment. In this study, data from a CCT with women with breast cancer were utilized. The experiment (n=67) and control (n=74) were about equal ratio. Four method of analysis were utilized, two using ANOVA for repeated measures and two using ANCOVA. The multivariate between subjects of the combined dependents variables and the univariate between subjects test were examined to make a judgement of the statistical power of each method. The results showed that ANCOVA has the highest statistical power. ANOVA using raw data is the least power and is the worst method with no evidence of an intervention effect even when the treatment by time interaction is statistically significant. In conclusion, ANOVA using raw data is the worst method with the least power whilst ANCOVA using baseline as covariate has the highest statistical power to detect a treatment effect other than method. The second best method as shown in this study was in using change scores of the repeated measures.

Matched MeSH terms: Pain
Fulltext Diagnosing angina using a simple neural network architecture

Bulgiba, A.M.

JUMMEC, 2006;9(1):39-43.
MyJurnal

The aim of the study was to research the use of a simple neural network in diagnosing angina in patients complaining of chest pain. A total of 887 records were extracted from the electronic medical record system (EMR) in Selayang Hospital, Malaysia. Simple neural networks (simple perceptrons) were built and trained using a subset of 470 records with and without pre-processing using principal components analysis (PCA). These were subsequently tested on another subset of 417 records. Average sensitivity of 80.75% (95% CI 79.54%, 81.96%), specificity of 41.64% (95% CI 40.13%, 43.15%), PPV of 46.73% (95% CI 45.20%, 48.26%) and NPV of 77.39% (95% CI 76.11%, 78.67%) were achieved with the simple perceptron. When PCA pre-processing was used, the perceptrons had a sensitivity of 1.43% (95% CI 1.06%, 1.80%), specificity of 98.32% (95% CI 97.92%, 98.72%), PPV of 32.95% (95% CI 31.51%, 34.39%) and NPV of 61.33% (95% CI 59.84%, 62.82%). These results show that it is possible for a simple neural network to have respectable sensitivity and specificity levels for angina.

Matched MeSH terms: Chest Pain
Fulltext Case Report: Total hip replacement for recurrent histiocytosis X of the pelvis involving the hip joint

Wazir,N.N., Ravindran, T., Mukundala, V.V., Choon, S.K.

Malays Orthop J, 2007;1(2):21-23.
MyJurnal

In 1977, a female patient, aged 31y, presented with histiocytosis X in the right pelvis and was treated with radiotherapy. She presented again in 1999 at the age of 53y with a similar problem at the same location this time also involving the acetabulum. The affected right hip was treated with cemented total hip replacement. Two years postoperatively, the patient was pain free with no evidence of local recurrence or loosening of implant, thus demonstrating that total hip replacement is a viable treatment option for histiocytosis involving the hip.

Matched MeSH terms: Pain
Fulltext Comparison of Fusion Rate Between Autogenous Tricortical Iliac Crest Bone Graft and Hydroxyapatite Block Graft inAnterior Cervical Discectomy and Fusion Surgery

Zulkefli, A., Jeyasilan, K., Zairul, A.K.B., Ramanathan, R.

Malays Orthop J, 2009;3(2):36-39.
MyJurnal

Objective: To compare the fusion rate between autogenous tricortical iliac crest bone graft and hydroxyapatite block graft in anterior cervical discectomy and fusion (ACDF) surgery. Methodology: Retrospective review of cases that underwent ACDF surgery between 2005 and 2008. They were divided into two groups based on the graft material used. Assessment of fusion at 6 months post-surgery was carried out based on the static lateral cervical radiograph. Results: 32 cases were reviewed; 16 in each arm. There were 29 discectomies performed in the hydroxyapatite group as compared to 22 in the iliac crest group. 18 levels in the hydrxyapatite group showed radiological fusion while in the iliac crest group there were 21 levels fused. Seven patients had donor site pain. Conclusion: The fusion rate for autogenous tricortical iliac crest bone graft in anterior cervical discectomy and fusion surgery was 95%, a more superior fusion rate than that of hydroxyapatite block graft which was 62.1%.

Matched MeSH terms: Pain
Fulltext Bipolar Hemiarthroplasty in Elderly Patients Presenting WithDisplaced Intracapsular Femoral Neck Fractures ..

Krishnan, H., Yoon, T.R., Park, K.S.

Malays Orthop J, 2010;4(1):26-31.
MyJurnal

This retrospective study was undertaken to analyze perioperative parameters, functional outcomes and complications of cemented versus uncemented bipolar hemiarthroplasty in elderly patients presenting with displaced intracapsular femoral neck fracture. The authors reviewed 17 patients that underwent cemented bipolar hemiarthroplasty and 21 patients that underwent uncemented bipolar hemiarthroplasty. The mean follow-up duration in the cemented and uncemented group was 29.9 and 30.5 months respectively. Intraoperative and postoperative blood loss was higher in the cemented group. On the last follow-up the mean HHS was 74.7 in the cemented group and 84.2 in the uncemented group. No statistically significant difference was evident in the pain score. In summary, bipolar hemiarthroplasty was found to be a good option for displaced intracapsular femoral neck fractures, and overall outcome was marginally better in the uncemented group in terms of postoperative of blood loss and functional outcome at last follow up.

Matched MeSH terms: Pain
Fulltext Conservative Treatment in Patients With Type 2 Odontoid Fracture - Functional Outcome Following Halovest Immobilization

Zairul, A., Vicknesh, A., Zulkefli, A., Ramanathan, R.

Malays Orthop J, 2010;4(2):13-16.
MyJurnal

Objective: to assess the severity of neck pain and functional status (neck motion and return to pre-injury daily activity) in patients with type 2 odontoid fracture following conservative treatment by halo vest immobilization. Methodology: A retrospective cohort study of 21 patients with type 2 odontoid fracture treated conservatively with halo ves immobilization from January 2007 and followed-up til December 2009. Fracture union and complications related to treatment were documented. At the final follow up visit (1 year post injury), the patientâ€™s neck pain, neck range o motion and return to pre-injury daily activities were assessed. Result: Twenty-one patients were included in the study. Fracture union was documented in 17 patients (81%) only 4 suffered from nonunion. Despite the good union rate only 8 patients (38.1%) achieved a good neck range o motion and returned to pre injury daily activity. Neck pain was minimal in all patients. Conclusion: Type 2 odontoid fractures treated with halo vest results in good union and minimal residual neck pain; however, it causes neck stiffness.

Matched MeSH terms: Neck Pain

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