M.Tech. / The most common cause of chronic cervicogenic headache is believed to be mechanical pain from the muscles, ligaments and joints of the upper cervical spine (Hubka and Hall, 1994). Much controversy and debate surrounds all aspects of cervicogenic headache, including the aetiology and treatment of these headaches. The purpose of the study was to determine the effectiveness of chiropractic spinal manipulation of the upper cervical spine alone as a treatment form for cervicogenic headache, with regards to pain, disability and cervical spine range of motion. Method: This study consisted of a single group of thirty participants between the ages of eighteen and thirty-five, with a half male to female ratio. The potential participants were examined and accepted according to the inclusion and exclusion criteria. The only method of treatment administered to each participant was chiropractic manipulation, delivered to restrictions of the upper cervical spine, from which the objective and subjective findings were based. Procedure: Treatment consisted of seven consultations, with two consultations being performed per week. Objective data and subjective data was taken at the beginning of the first, fourth and seventh consultations. Objective data consisted of cervical range of motion readings taken using a Cervical Range of Motion measuring instrument (CROM). The subjective data collected was in the form of a Vernon-Mior Neck Pain and Disability Index and a Numerical Pain Rating Scale. Spinal manipulative therapy based on restrictions identified during motion palpation was applied at the first six consultations with the seventh consultation consisting of data gathering only. Results: Clinically and statistically, significant improvements in the entire group were noted over the course of the treatment with regards to cervical range of motion, pain and disability. Conclusion: The results show that upper cervical spine manipulation is effective, both clinically and statistically, in decreasing pain and disability and increasing cervical spine vi range of motion in those with cervicogenic headache. As the study consisted of a small group of participants treated as a single group, further study is needed in the form of randomised, controlled clinical trials.

>Magister Scientiae - MSc / Cervical cancer is the leading cause of cancer mortality among black women in South Africa. It is estimated that this disease kills approximately 8 women in South Africa every day. Cervical cancer is caused by the human papillomavirus (HPV) with the most common screening method for cervical cancer being Papanicolaou (Pap) smear, test amongst others. However, less than 20% of South African women go for these tests. There are several reasons why women do not go for these tests but the invasiveness of the test is one of the major causes for the low rate of screening. Lateral flow devices offer medical diagnosis at the point- of-care, allowing for the quick initiation of the appropriate therapeutic response. These tests are more cost-effective for the healthcare delivery industry, and can potentially be used by patients to self-test in the privacy of their homes and allow them to make informed decisions about their health. Therefore, the aim of this study was to use computational methods to identify serum biomarkers for cervical cancer that can be used to develop a point-of-care diagnostic device for cervical cancer. An in silico approach was used to identify genes implicated in the initiation and development of cervical cancer. Several bioinformatics tools were employed to extract a list of genes from publicly available cancer repositories. Multiple gene enrichment analysis tools were employed to analyze the selected candidate genes. Through this pipeline, ~28190 genes were identified from the various databases and were further refined to only 10 genes. The 10 genes were identified as potential cervical cancer biomarkers. A subcellular compartmentalization analysis clustered the proteins encoded by these genes as cell surface, secretory granules and extracellular space/matrix proteins. The selected candidate genes were predicted to be specific for cervical cancer tissue in a cancer tissue specificity meta-analysis study. The expression levels of the candidate genes were compared relative to each other and a graph constructed using gene expression data generated by GeneHub-GEPIS and TiGER databases. Further gene enrichment analysis was performed such as protein-protein interactions, transcription factor analysis, pathway analysis and co-expression analysis, with 9 out of the10 of the candidate genes showing co-expression. A gene expression analysis done on cervical cancer cell lines, other cancer cell lines and normal fibroblast cell line revealed differential expression of the candidate genes. Three candidate genes were significantly expressed in cervical cancer, while the seven remaining genes showed over expression in other cancer types. The study serves as basis for future investigations to diagnosis of cervical cancer, as well as for cancers. Thus, they could also serve as potential drug targets for cancer therapeutics and diagnostics.

Multi-echo T2 relaxation measurements of the human spinal cord (SC) reveal a short T2 pool of water believed to arise from water trapped between myelin bilayers, where the proportion of this water to the total water signal is called the myelin water fraction (MWF). In the present study, MWF were measured in the healthy human cervical spine at the C4-C6 vertebral levels in vivo using a 3D modified 32 echo CPMG sequence to acquire axial slices perpendicular to the cord. Volunteers were recruited in two age ranges, under 30 years old and over 50 years old, and a subset of both groups were scanned twice to test reproducibility. Mean MWF in the dorsal and lateral column WM of the group under 30 years of age was 0.29 (0.01) (mean(SE)), which agrees with previously reported MWF values in the cervical spine. The mean absolute difference between two scans was 0.06 or 26%. A negative correlation between WM MWF and age was hinted at in these findings, however more subjects are required to improve statistical power. This study paves the way for the use of 3D myelin water imaging in the cervical spine at 3.0T for the assessment of SC WM pathology. / Science, Faculty of / Physics and Astronomy, Department of / Graduate

The aim of this study was to establish reference data for the cervical spine’s dynamic force characteristics in a healthy adult urban South African population aged 19 to 69 years. The reference data was classified according to gender discriminate age categories. In total ten gender discriminate age categories, five male and five female, were created; 19 to 29, 30 to 39, 40 to 49, 50 to 59 and 60 to 69-year-olds. The force characteristics measured, analysed and used to generate reference data in stanine format were: absolute peak torque (P-), relative peak torque (P-/BW), peak power (Pow-), relative peak power (Pow-/BW), peak work (W-), relative peak work (W-/BW), torque acceleration energy (TAE-), maximal voluntary cervical muscle contraction range of motion (MVCR-), controlled full range of joint motion (CFR-), joint angle at peak torque (Jang@P-) and peak torque ratios for cervical flexion (-F), extension (-E), lateral flexion to the dominant (-LD) and non-dominant (-LN) sides. In addition biographic and anthropometric data was also collected. Data, grouped in the ten gender discriminate age categories were compared and statistically and practically significant differences were highlighted between the gender discriminate age categories. Inferential statistics used included ANOVA and Cohen’s d. A significance level of α = .05 was used in all inferential statistical analyses. Correlations between various anthropometric and isokinetic strength variables were also explored.

M.Tech. / Purpose: The aim of this study was to evaluate the relative effectiveness of the application of soft tissue massage to the posterior neck muscles before, and after, chiropractic adjustment to the cervical spine in the treatment of cervical facet syndrome. To determine the most effective treatment protocol; the patient‟s perceptions and objective findings were used. These findings were assessed by completing a Visual Analogue Scale, a McGill Pain Questionnaire and a Vernon-Mior Neck Pain and Disability Index, and measuring the cervical spine range of motion using a Cervical Range of Motion goniometer. The questionnaires were completed and the ROM readings taken prior to treatment on the first, fourth and seventh visits. Method: Forty participants who met the inclusion criteria were randomly allocated to two different groups of twenty each. One group received soft tissue massage to the posterior neck musculature prior to the application of chiropractic adjustments to the subluxations of the cervical spine. The second group received the chiropractic adjustments to subluxations of the cervical spine that was followed by soft tissue massage to the posterior neck. Treatment took place over a period of three weeks, and participants were treated six times out of a total of seven visits. Procedure: Subjective data was collected at the first and fourth visit prior to treatment, as well as on the seventh visit by means of a Visual Analogue Scale (VAS), McGill Pain Questionnaire as well as a Vernon-Mior Neck Pain and Disability Index to assess pain and disability levels. Objective data was collected at the first and fourth visit prior to treatment, and at the seventh visit by means of a Cervical Range of Motion goniometer (C.R.O.M.). Data collected was analysed by STATCON. Results: Both groups improved well over time subjectively and objectively but none more superior. Statistically significant improvements in group 1 and group 2 were noted over the duration of the study with regards to pain, disability, and cervical spine range of motion.

Made available in DSpace on 2014-06-12T23:04:21Z (GMT). No. of bitstreams: 2 arquivo8859_1.pdf: 6632768 bytes, checksum: 3eea3f9b4557f82246cf37945c70c6c4 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2007 / Objetivo: Comparar os diferentes métodos de diagnóstico das neoplasias intraepiteliais cervicais uterinas, no que diz respeito a citopatologia oncótica convencional pela técnica de Papanicolaou, como rastreio ou screening para aprofundarmos a nossa propedêutica, a seguir lançamos mão da colposcopia, verificando os seus achados menores e maiores, bem como biopsiando o local exato da lesão, comparando os achados encontrados nestes exames com a histopatologia. Pacientes e Métodos: Por um estudo de corte retrospectivo, transversal, analítico, não aleatório, tipo ensaio clínico de validade de teste diagnóstico, em que foi utilizada uma metodologia uni e bivariada de controle e análise de variáveis, constituído de 100 pacientes oriundas do ambulatório de Patologia Cervical-Uterina do Instituto Cândida Vargas, da Prefeitura Municipal de João Pessoa, compreendido entre agosto de 2006 a agosto de 2007. Foram comparados os achados da citopatologia e colposcopia com histopatologia. Os critérios de inclusão foram: pacientes com exame citológico prévio alterado (alterações atípicas de lesões intra-epiteliais cervicais) ; qualquer condição clínica suspeita para neoplasia da cérvix como sangramento pós-coito ou ao exame especular e mácula rubra extensa do colo; colposcopia com alterações colposcópicas menores e maiores e finalmente um diagnóstico histopatológico alterado (lesões histopatológicas de NICs) .Foram excluídas aquelas com diagnóstico de carcinoma invasor e as submetidas a histerectomias Foi utilizado o Índice Kappa para verificação da acurácia entre as variáveis independentes a citopatologia e a colposcopia. Resultados: A acurácia da citopatologia foi de 93,4%, com uma sensibilidade e especificidade de 96,2% e 69,3%, respectivamente; a concordância encontrada entre este e as biópsias colpodirigidas foi de 0,93 para uma concordância esperada de 0,51, dando um Índice Kappa 0,86, Z(Kappa) 8,3 e um p<0,01, significando uma concordância muito boa entre os dois exames. Em relação a colposcopia obtivemos uma acurácia de 89,13% com uma sensibilidade e especificidade de 88,7% e 78,7% respectivamente; a concordância observada entre esta e os resultados das biópsias colpodirigidas foi de 0,89 para uma concordância esperada de 0,51, dando um Índice Kappa de 0,78, Z(Kappa) 7,5 e um p<0.01 que corresponde uma boa acurácia entre os dois exames. Os resultados foram mais concordantes para as lesões mais graves, como nos casos de adenocarcinoma, carcinoma invasor e nas lesões de alto graus..O padrão ouro do diagnóstico ficou com a histopatologia. Conclusão: Houve concordância estatisticamente significante entre a citopatologia e as biópsias colpodirigidas, sobretudo nas lesões de alto grau e nas formas invasoras da doença; índices semelhantes também foram encontrados entre a colposcopia e os achados histopatológicos.Conclui-se que os indicadores usados na acurácia do exame citopatológico e colposcópico são influenciados, por vários fatores que dizem respeito a época a realização do exame, a coleta e a leitura da citopatolologia; em relação a colposcopia fatores como a época de realização do exame e a experiência do observador são decisivos na acurácia do exame

Este trabalho avaliou a incidência de pacientes com lesão traumática da coluna cervical causada por mergulho em águas rasas, que foram atendidos nos Hospitais da cidade de Ribeirão Preto-SP, entre janeiro de 1989 a dezembro de 1996. O estudo epidemiológico foi realizado mediante investigação feita nos prontuários médicos desses pacientes. Complementou-se as informações por meio de uma entrevista realizada com 12 deles. Com base nos números apresentados, elaborou-se um programa de prevenção decorrente desses traumatismos a implantou-se uma Campanha de prevenção das lesões cervicais por mergulho em águas rasas em Ribeirão Preto. Um Programa de Campanha foi encaminhado à Assembléia Legislativa do Estado e transformado em Projeto de Lei. Os resultados mostraram que, dos 355 casos estudados, 69 deles foram por acidentes em águas rasas, a dentre estes, 58% tiveram danos neurológicos. Os locais mais freqüentes dos acidentes foram rios, córregos, lagos, cachoeiras,com a ocorrência de 75,4% dos casos, enquanto que a incidência em piscinas foi de 24,6%. A média de idade variou entre 10 a 30 anos, havendo diferença significativa com outras faixas etárias. Quanto ao sexo, 92,8% ocorreram em homens a 7,2% com mulheres. Em relação ao estado civil, 68,2% eram solteiros e 31,9% eram casados. O período do ano em que houve um número mais elevado dos traumatismos da coluna cervical causado pelo mergulho nas chamadas águas rasas foi nos meses de estações mais quentes na região (primavera, verão a outono). Dos 17,4% dos pacientes entrevistados de um total de 40 que tiveram lesão medular, todos mostraram desconhecimento desse tipo de acidente, bem como suas conseqüências. A Campanha de prevenção teve início em setembro de 1996 e está em fase de desenvolvimento em Ribeirão Preto. O Projeto de Lei estadual nº 183 aguarda aprovação da Assembléia. Conclui-se que, a incidência de acidentes com lesão traumática da coluna cervical por mergulho em águas rasas é elevada, sendo a terceira causa de danos traumáticos. A desinformação da população no que diz respeito ao perigo de um mergulho em águas rasas é elevado. A redução deste tipo de acidente pode acontecera partir de um processo educacional da população a da atuação decisiva do poder público. / This study is an evaluation of the incidence of patients treated in the hospitals in Ribeirão Preto - SP for traumatic injury of the cervical cord caused by diving in shallow waters. The epidemiological study was held by means of an investigation of the medical charts of patients who underwent treatment from January 1989 to December 1996. The information on the charts was complemented through interviews held with 12 of these patients. Based on the results of these investigations, a campaign to prevent cervical injury caused by diving into shallow waters was elaborated and sent to the State Legislature, where it was transformed into a bill. The study revealed that in the 355 cases of cervical injury investigated, 69 were the result of accidents in shallow waters, and of these, 58% suffered neurological dysfunction. Rivers, lakes and waterfalls were most frequently cited as locations for the occurrence of these injuries (75,4% of the cases), with the incidence of accidents in swimming pools at 24,6%. The average age of patients varied between 10 to 30 years of age, with a significant difference in other age groups. In relation to sex, 92,8% of the accidents occurred in men, and only 7,2% in women. As to marital status, 68,2% were single and only 31,9% were married. The greatest number of cases of trauma of the cervical cord caused by diving in shallow waters occurred in the warmer seasons of the year (spring summer and fall). 17,4% of the patients interviewed out of a total of 40 with medullar injury, claimed not to know about this kind of accident and its consequences. The Prevention Campaign began in September 1996 and is presently being carried out in the city of Ribeirão Preto. The Bill of Law no. 183 awaits approval from the State Legislature. One may conclude that the incidence of traumatic injury of the cervical cord due to diving in shallow waters is high (third place as the cause of injury). The lack of information on the part of the population regarding the dangers of this type of accident may be one of the reasons behind these high statistics. The reduction of this type of accident may occur as the result of an educational process involving the population as well as decisive action on the part of the government.

Objective: To determine the general and genotype-specific prevalence of HPV and to identify potential risk factors for the infection in a population-based screening of Peruvian women. Results: A total of 524 samples were analyzed by PCR and a total of 100 HPV positive samples were found, of which 89 were high-risk, 19 were probably oncogenic, 9 were low-risk and 27 other HPV types. The 26–35 and 36–45 age groups showed the highest proportion of HPV positive samples with a total of 37% (37/100) and 30% (30/100), respectively. Moreover, high-risk HPV was found in 33.7% of both groups and probably oncogenic HPV in 52.6% and 31.6%, respectively. High-risk HPV were the most frequent types identified in the population studied, being HPV-52, HPV-31 and HPV-16 the most commonly detected with 17.6%, 15.7% y 12.9%, respectively. Demographic characteristics and habits were assessed in the studied population. A total of 62% high-risk HPV were detected in married/cohabiting women. Women with two children showed the highest proportion (33.8%) of high-risk HPV, followed by women with only one child (26.9%). Those women without history of abortion had a higher frequency of high-risk HPV (71.9%), followed by those with one abortion (25.8%). / Revisión por pares

Cerebrovascular accidents are a leading cause of morbidity and mortality in the United States. Many conditions exist which may mimic this disease process including seizures, migraines, metabolic derangements, infections, space-occupying lesions, neurodegenerative disorders, peripheral neuropathy, cervical myelopathy, syncope, other vascular disorders, and functional neurologic disorder. Timely diagnosis and treatment are important in order to preserve functional status in these patients. A 48-year-old male presented to the emergency department with a 28-hour history of worsening left sided numbness, tingling, weakness, and feeling off balance. The patient stated that for the past several months he had noticed these symptoms, but they suddenly became worse the day prior. He also described shooting pains down the left arm with certain movements of his neck. The patient denied any difficulty with speaking, understanding words, performing mental tasks, bowel or bladder incontinence, or right sided symptoms. Physical exam showed intact cranial nerves II-XII, 5/5 strength of upper and lower extremities on the right side, 4/5 strength of upper and lower extremities on the left side. Romberg test was normal, heel to shin and finger to nose were intact bilaterally. Foot drop was noted on the left side and placement of the foot on the ground was noted to be clumsy. Initial head CT in the emergency department showed a frontal lobe hypodensity and was without intracranial hemorrhage. Computed tomography angiography of the head and neck showed no large vessel thrombosis or stenosis. Echocardiography revealed normal chamber sizes, normal left ventricular ejection fraction, no patent foramen ovale, and no left atrial or left ventricular thrombus. Telemetry monitoring throughout the stay remained sinus rhythm. Magnetic resonance imaging of brain and cervical spine was performed showing multifocal acute infarcts of the right and left frontal lobes and severe cervical spondylosis at C4-C6 with spinal cord edema in T2 sequences slightly below that level. The patient subsequently underwent a cervical spine decompression for the spinal cord compression during the hospital stay. Due to the multifocal lesions noted on the brain MRI, a vasculitis workup was performed which returned negative for any abnormal test findings. The patient was also diagnosed with diabetes mellitus type 2 during the stay as he was found to have a glycosylated hemoglobin A1C of >12. He was initially hypertensive during hospitalization, but this resolved on its own after day three of the hospitalization so anti-hypertensives were not required. The patient was discharged home on high intensity statin therapy, dual oral hypoglycemic therapy for his diabetes mellitus, home physical therapy, and he was scheduled to start dual antiplatelet therapy seven days after cervical spine surgery. This dual antiplatelet therapy with clopidogrel and aspirin was to be continued for three weeks after which continuation with low dose aspirin was advised. As seen in this case, patients that present with a cerebrovascular accident should always be evaluated for other etiology behind his or her symptoms and having a low threshold for pursing other additional diagnoses is reasonable.

BACKGROUND: Cervical cancer is one of the most common forms of gynecologic cancers both in the United States and worldwide. The morbidity and mortality associated with cervical cancer has decreased significantly with the development of effective screening for cervical cancer.1 However, refugee women in the United States are often impacted by the disparities in health care and experience increased risk of adverse health outcomes. LITERATURE REVIEW: Current research finds that refugee women in the United States often receive inadequate sexual and reproductive health services, including Pap smears for cervical cancer screening. This disparity leads to a higher burden of preventable morbidity and mortality. For refugee populations, numerous barriers to access have been identified including language, financial, and cultural barriers. Previous studies have identified that refugee women may have limited experience with preventative health care or confront cultural barriers in accessing sexual and reproductive health services. Further research must be done to study barriers to accessing cervical cancer screening among specific populations of refugee women. METHODS AND INTERVENTION: This study proposes to interview Iraqi, Bhutanese, and Somali refugee women in the greater-Boston area in order to better characterize experiences and understanding of cervical cancer screening. Investigators will conduct semi-structured interviews to collect narrative data, which will then be analyzed using qualitative analysis software to identify major themes. CONCLUSION: This study will seek to characterize perceptions and experiences of cervical cancer screening services among female refugees in the greater-Boston area. Limitations of this study include lack of generalizability and question-order bias. SIGNIFICANCE: The goal of characterizing barriers to access affecting refugee women in the greater-Boston community is to inform development of more effective public health interventions that will be targeted to the specific needs of local refugee populations. Efforts to increase uptake of cervical cancer screening services could result in decreased morbidity and mortality from cervical cancer for a vulnerable sector of the population.