A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Doctor of Philosophy Johannesburg 2017. / Neck pain is one of the most common debilitating musculoskeletal complaints seen in physiotherapy practice. It is often associated with headache, upper back and shoulder/arm pain (cervico-brachial pain) and such patients are more disabled than patients with neck pain only. Cervico-brachial pain syndrome is an upper quarter pain syndrome in which neural tissue sensitivity to mechanical stimulus is thought to play a role. Neuropathic pain is a problem associated with and prevalent in neck and arm pain. Psychosocial factors, such as fear-avoidance beliefs and catastrophising, have been shown to play an important role in treatment outcomes. Neural mobilisation (NM) is often used to influence the neural structures in conditions with signs of neural involvement or neural mechano-sensitivity. It seems reasonable to use neural mobilisation in cervico-brachial pain as neural structures play an important role in this condition The optimal treatment intervention for cervico-brachial pain is yet to be established. The prevalence of cervico-brachial pain in a South African population is also unknown. Aims of the study The aims of the study were to: i. To establish the prevalence of cervico-brachial pain in patients being seen in physiotherapy practices in Pretoria, South Africa. ii. To establish the effect of neural mobilisation on the pain, function and quality of life of patients with acute and sub-acute cervico-brachial pain. iii. To establish the influence of high catastrophising scores and neuropathic pain on treatment outcomes. iv. To establish the effect of demographic factors on the pain, function and quality of life of patients with cervico-brachial pain. Methods Research Question 1. A retrospective survey of physiotherapy patient records dated 1 January 2011 to 31 December 2011 was conducted. The prevalence of patients with neck pain in relation to other musculoskeletal complaints was calculated and expressed as a percentage. Symptoms recorded included the following; headache, dizziness, pins and needles, feeling of weakness, other sensations, more than one symptom and pain in other area/s. Based on body charts, areas of pain were coded as neck pain only, pain in the shoulder, shoulder and upper arm, shoulder to elbow, lower arm, hand, neck and arm up to wrist, neck and arm including hand. Research Questions 2, 3 and 4 A single blind randomised clinical trial was conducted to establish the effect of neural mobilisation on cervico-brachial pain. The intervention group (IG) received cervical and thoracic mobilisation exercises, advice and NM. The usual care (UC) had the same treatment without NM. Outcomes were assessed at 3 weeks, 6 weeks, 6 months and 12 months. The Numerical Pain Rating Scale was used to determine the effect of NM on pain. The Patient Specific Functional Scale was used to determine the effect of NM on function and the EuroQual5 instrument was used to establish the effect of NM on the quality of life. At 6 weeks the Global Rating of Change was administered to measure patient’s perception of recovery. The Neuropathic Diagnostic Questionnaire (DN4) was used to classify patients with neuropathic pain and the Pain Catastrophising Scale to identify catastrophisers. Results and Discussion Prevalence of neck and radiating arm pain in physiotherapy private practice, Pretoria South Africa The prevalence of neck pain in private physiotherapy practices in Pretoria, SA is high (46.4% of the total musculoskeletal complaints) with radiating arm pain (52.2% of neck pain population) and pain in other areas (22.6% of neck pain population) being commonly associated with neck pain. Furthermore, other symptoms such as headache (25.4% of the neck pain population) and paraesthesia (11.2%) are also frequently present. Neck pain is multi-faceted and this has implications for its management. Future studies with a bigger, representative population sample are needed to establish the prevalence of neck pain in SA. The effect of neural mobilisation on cervico-brachial pain All patients improved significantly in terms of pain, function and quality of life over the 12-month period. However, the IG had significantly less pain than the UC group at 6 months (p=0.03 95% CI 0.96 - 2.03) and this difference was more pronounced in patients with neuropathic pain (IG 2.91 95%CI 1.74 - 4.08 and CG 5.5 95% CI 3.45 - 7.55 p=0.01). There were no significant differences between groups in terms of function or quality of life. Patients with neuropathic pain had significantly more pain at 6 months (positive neuropathic pain 3.71 95%CI 2.57 – 4.84; negative neuropathic pain 1.44 95% CI 0.93 – 1.96 p=0.0001) and 12 months (positive neuropathic pain 3.23 95% CI 1.74 – 4.71; negative neuropathic pain 1.38 95% CI 0.88 – 1.91 p=0.01) compared to those without neuropathic pain. At 12 months function was also negatively affected by the presence of neuropathic pain (positive neuropathic pain 23.91 95%CI 20.96 – 26.86; negative neuropathic pain 27.15 95% CI 25.95 – 28.36 p=0.04). It did not have an effect on quality of life. Catastrophisers had more pain at 6 months (catastrophisers 4.25 95% CI -1.90 – 10.40; non-catastrophisers 1.70 95% CI 1.22 – 2.17 p=0.02) and 12 months (catastrophisers 3.56 95% CI 1.10 – 6.02) compared to non-catastrophisers (1.47 95% CI 0.96 – 1.99 p=0.02). There was no difference in their function at any time, however at baseline they reported a lower quality of life (Catastrophisers 61.96 95% CI 52.04 – 71.87; non-catastrophisers 75.79 95% CI 71.91 – 79.66 p=0.002). Conclusion The addition of NM to cervical and thoracic mobilisation, exercises and advice to stay active, in the management of cervico-brachial pain, resulted in less pain at 6-month follow-up. For patients with neuropathic pain the positive effect was more pronounced. Adding NM as an adjunct to usual care is effective to improve pain for patients with cervico-brachial pain especially for those with a neuropathic pain component. The presence of neuropathic pain and catastrophising resulted in poor pain-related outcomes. / MT2017

This set of experiments evaluated the physiological responses of intensively managed ostriches to L-carnitine. In experiment 1, 32 female and 16 male Zimbabwean Blue Neck and South African Black Neck breeders (n=48 of each sub-species; eight years old), were investigated in 16 breeder units of two females and one male (Trio), in a completely randomised design within four treatments and four replicates over an 8-month period during the breeding season. The same basal diet was fed supplemented with 0 (T0, control), 125 (T125), 250 (T250) or 600 (T600) mg/kg L-carnitine. T600 improved the egg production percentage, egg fertility percentage and the hatchability of set eggs for Black-Necks and Blue-Necks, respectively, and the hatchability of fertile eggs in Black Necks. L-carnitine did not affect egg shape index, defective eggs, egg weight, embryonic and post-hatch mortality. In experiment 2, 12 Black Neck males (5.5 years old) were allocated to three treatments (T0, T250 and T500) and four replicates. Semen samples were collected once a month over three months. L-carnitine had a significant effect on semen volume, sperm motility, live sperm percentage and sperm count, but had no significant effect on abnormal sperm percentage. In experiment 3, 32 day-old Black Neck ostrich chicks were allocated to treatments T0, T125, T250 and T600 with four replicates of two chicks. Chicks were vaccinated against inactive Newcastle Disease (ND) vaccine at day 30 as primary, and at day 51 as booster immunisation. ND antibody responses in the sera were monitored over three phases at 51, 70 and 80 days. Anti-NDV antibodies were detected using a modified chicken anti-NDV enzyme-like immunosorbent assay (ELISA). The treatments and the time periods and their interactions influenced ND antibody responses. T125 and T250 had the highest level of ND antibody response compare to the other groups. There were no differences in ND antibody response between T0 and T600 as well as T125 and T250. The highest ND antibody responses were recorded at day 70. Experiment 4 was designed the same as 3, to determine chicks’ growth responses over the 60-day period. Live weight and live weight gain values of T125 and T250 did not differ from those of T0. T600 had the lowest feed conversion ratio (FCR) during the total period. Feed intake (FI) was reduced in the T125 and T600 treatments compared to T0 and T250 over the total period. T125 gave the lowest FI and FCR responses over the total period, whereas there was no difference between T0 and T250. These results suggest that dietary T600 can have a beneficial effect on egg production, fertility and hatchability in the Black and Blue Neck breeders and T250 might improve sperm quality in males. In ostrich chicks T125 and T250 had positive effects on immune responses and T125 can improve the performance by decreasing the FCR. In contrast, the suppressive effect of a high inclusion level (T600) might indicate that ostrich chicks are sensitive to high inclusion levels that could cause adverse effects. / gm2013 / Animal and Wildlife Sciences / Thesis (PhD)--University of Pretoria, 2013. / Unrestricted

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / Shoulder pain was constantly reported as a problematic symptom causing dysfunction and quality of life interference after neck dissection in head and neck cancer patients. Due to a lack of conceptual framework and inconsistency of instrument selection, a comparison among previous studies was almost impossible, making it difficult to understand the phenomenon. The current study applied the University of California, San Francisco School of Nursing Symptom Management Model. The purposes of the study were to (a) describe the symptom experience of shoulder pain at 1 month after neck dissection, (b) describe the relationships among symptom experience of shoulder pain, functional status, and quality of life, and (c) identify the contextual variables, concurrent symptoms, and/or adherence predicting symptom experience of shoulder pain, functional status, and/or quality of life. This was a descriptive study with a convenience sample of head and neck cancer patients. The data were collected via a medical record review, a self-administered survey, and a physical examination. The data from 29 patients were entered for descriptive statistics, Pearson correlations, and multiple regressions. At 1 month after surgery, 62% of patients reported they had shoulder pain at some point within a week. Their shoulder pain was from mild to moderate. Fifty-nine percent complained that shoulder pain bothered them about the moderated level. In the final model, symptom experience, shoulder pain, was significantly correlated with one outcome, active shoulder abduction, but not the other, total quality of life, generic quality of life, and head and neck quality of life. Active shoulder abduction was significantly correlated with three quality of life measures. Adding significant predictors of symptom experience and outcomes into the final model, there is a potential that the model would be useful to guide treatment strategies. Treatment for myofascial pain of the levator scapulae could relieve shoulder pain after neck dissection and improve head and neck quality of life. Those with level V dissection were high risk populations of developing shoulder pain. Risk factors of quality of life, which were depression, loss of sensation, and radiation would describe how an intervention could change or unchange the patient’s life.

Objective: To investigate the potential etiology of a loss of neck control injury in female standard ballroom dancers. The median frequency (MF) as measured by electromyography (EMG) of the left upper trapezius (UT), left splenius capitius (SPL), and right sternocleidomastoid (SCM) of injured dancers was compared to non-injured dancers. This comparison was performed to identify whether dancers with a history of loss of neck control have a greater amount of fatigue than those with no history of this particular injury. Design and Setting: A 2 x 6 factorial design was used for this investigation. The independent variables were group (injured vs. non-injured) and time (before and after the three rounds of dancing). The dependent variables were MF as measured by EMG, range of motion, and neck length. All testing was performed at the university biomechanics laboratory and ballroom dance studio. Subjects: Twenty female subjects (10 injured group {mean height 167.40 ± 4.12 cm and weight 59.30 ± 5.41 kg}, 10 non-injured group {mean height 166.76 ± 4.62 cm and weight 58.93 ± 5.30 kg}), with at least one year experience in competitive ballroom dancing, in the standard division participated in this study. All subjects competed at a Dancesport competition either in the novice, pre-championship, and/or amateur standard classifications. Inclusion criteria for the injured group included female ballroom dancers who had a loss of neck control episode. Measurements: Surface EMG activity was recorded from the left UT, left SPL, and right SCM muscles before and after dancing the five standard dances. Results: The decrease in EMG MF was not significant between groups. There was no difference in neck lengths from the external occipital protuberance to inferior angle of the scapula between groups. There were also no significant differences in range of motion of left and right lateral flexion and extension in either group from pre to post dancing. Conclusions: Based on the results of this study, subjects with a history of neuromuscular neck injury did not appear to have acute fatigue of the three muscles studied here following the routine used in this study.

Necrotizing fasciitis (NF) is a critical and rapidly progressive infection of the skin and soft tissue, and it is associated with a high mortality rate. NF of the cervicofacial region is uncommon due to the rich vascular supply of the head and neck, which promotes an efficient immune response to infection. Patients who are immunocompromised or have comorbidities affecting the vasculature, such as diabetes mellitus or peripheral vascular disease, are at an increased risk of more severe disease and outcome. Cervicofacial necrotizing fasciitis (CNF) is most frequently attributed to mucosal damage, such as those related to dental infections or local trauma including medical procedures. Due to its ability to quickly spread to the neck and mediastinum, CNF must be diagnosed and treated expeditiously. In this report, we present a case of a 28-year-old female with a past medical history significant for obesity and tobacco abuse who presented to the emergency department (ED) with fever, left-sided facial pain, cervical pain, and swelling. She had worsening symptoms despite current treatment with clindamycin for a dental abscess. A CT scan of the head and neck revealed an odontogenic abscess complicated by CNF. Intravenous antibiotics were initiated and she underwent prompt surgical intervention. She remained nasally intubated following her surgery due to concern for postoperative edema leading to airway compromise. Following extubation, she experienced an uncomplicated recovery. This case demonstrates that NF is a complication of dental infection that may occur even in young and relatively healthy patients. Additionally, due to the swiftly destructive nature and high mortality rate of CNF, early diagnosis and aggressive medical and surgical therapy are essential to reduce morbidity and mortality.

Background: In recent years, students' screen time has increased, especially during the corona pandemic. As increased prevalence of neck pain and decreased physical activity (PA) have been reported during this period, it is of interest to study the relationship between these variables. Aim: To examine screen time, neck pain and the level of PA and the relationship between these variables in students studying full-time at Uppsala University. Method: A quantitative, descriptive and correlational cross-sectional study. PA was measured with the International Physical Activity Questionnaire, neck pain in days, and intensity with the Numeric Pain Rating Scale (NRS), and screen time in hours, for the past week. The data was collected using a web survey.   Results: Ninety-eight students answered the survey. Fifty-four percent of participants reported neck pain the past week. On average, students spent 18.5 hours on screen studies, and 41.3 hours on total screen time. The PA level averaged 2438 Metabolic Equivalent of Task in minutes. Median neck pain was one day with NRS 1. A low significant correlation was seen between: screen studies and number of days neck pain (r = 0.23; p = 0.028); total screen time and neck pain (r =0.26; p = 0.012); studies at screen and neck pain intensity (r = 0.23; p = 0.024); total screen time and neck pain intensity (r =0.26; p = 0.011). A low, non-significant correlation was seen between screen studies and total screen time and PA (r = 0.04/0.02; p = 0.713/0.881). Conclusion: Students spend a lot of time in front of screens and a majority of students reported low-intensity neck pain the past week. However, there was only a low correlation between screen time and neck pain, and between screen time and FA. / Bakgrund: Under de senaste åren har studenters skärmtid ökat, inte minst under corona-pandemin. Då ökad prevalensen av nacksmärta och minskad fysisk aktivitet (FA) har rapporterats under denna period, är det av intresse att studera sambandet mellan dessa variabler.  Syfte: Undersöka skärmtid, nacksmärta och nivån av FA och samband mellan dessa variabler hos studenter som studerar heltid på Uppsala universitet.  Metod: En kvantitativ, deskriptiv och korrelerande tvärsnittsstudie. FA mättes med International Physical Activity Questionnaire, nacksmärta i dagar, och intensitet med Numeric Pain Rating Scale (NRS), och skärmtid i timmar, för senaste veckan. Datan insamlades med en webenkät. Resultat: Nittioåtta studenter besvarade enkäten. Femtiofyra procent av deltagarna rapporterade nacksmärta senaste veckan. I genomsnitt spenderade studenterna 18,5 timmar på studier vid skärm, och 41,3 timmar på total skärmtid. Nivån FA var i genomsnitt 2438 Metabolic Equivalent of Task i minuter. Medianen för nacksmärta var en dag med NRS 1. Ett lågt signifikant samband sågs mellan: studier vid skärm och nacksmärta i antal dagar (r = 0,23; p = 0,028); total skärmtid och nacksmärta (r =0,26; p = 0,012); studier vid skärm och nacksmärtans intensitet (r = 0,23; p = 0,024); total skärmtid och nacksmärtans intensitet (r =0,26; p = 0,011). Ett lågt icke signifikant samband sågs mellan studier vid skärm respektive total skärmtid och FA (r = 0,04/0,02; p = 0,713/0,881).  Konklusion: Studenter spenderar mycket tid framför skärm och en majoritet av studenter rapporterade lågintensiv nacksmärta under senaste veckan. Dock förelåg enbart ett lågt samband mellan skärmtid och nacksmärta, samt mellan skärmtid och FA.

Cancer is a major cause of morbidity and mortality with increasing incidence worldwide. Early detection of cancers and better treatments would improve the outcome for patients. The overall 5-year survival rates of head and neck squamous cell carcinoma have not improved in the past several decades due to diagnosis at advanced stages and recurrent disease. Early detection and improved chemotherapy drugs are two key areas that are required to help to improve the prognosis for this disease. This thesis focuses on the enzyme telomerase which is known to contribute to one of the hallmarks of cancer (immortality). Elevated telomerase activity has been observed in the majority of cancer cells but not in most normal human cells so there is an opportunity to use telomerase as a biomarker for disease. This first part of this study assessed telomerase activity in saliva and tissues of head and neck squamous cell cancer patients. The Telomerase PCR-ELISA kit was used to assess telomerase activity in the saliva of patients with confirmed oral carcinomas and its expression was analysed in paraffin embedded tissue using immunohistochemistry (IHC). Whilst telomerase was detected in cell lines, no telomerase activity was detected in saliva samples from patients but was detectable in IHC specimens. The second part of the study focused on the pharmacological evaluation of a series of small molecule G–quadruplex DNA binding agents as potential telomerase inhibitors. A total of 19 telomerase inhibitors were identified but of these, only 4 were specific inhibitors of telomerase. These compounds also caused toxicity to cell lines following a 2 hour drug exposure at doses that also inhibit telomerase activity. Further studies are required to explore these compounds further. In conclusion, the results of this study have demonstrated that detection of telomerase activity I the saliva of patients with oral cancers is unlikely to be useful in terms of detecting oral cancers before symptoms of the disease are clinically manifest. A series of novel and specific inhibitors of telomerase have been identified and further studies are required to develop these compounds further.

Background: About five to 10% of cancers in the head and neck region are neck squamous cell carcinoma of unknown primary (NSCCUP). Their diagnosis and treatment are challenging given the risk of missing occult tumors and potential relapse. Recently, we described human papillomavirus (HPV)-related NSCCUP-patients (NSCCUP-P) as a subgroup with superior survival. However, standardized diagnostic workup, novel diagnostic procedures, decision-making in the multidisciplinary tumor board (MDTB) and multimodal therapy including surgery and post-operative radio-chemotherapy (PORCT) may also improve survival. Methods: For assessing the impact of standardized diagnostic processes simultaneously established with the MDTB on outcome, we split our sample of 115 NSCCUP-P into two cohorts treated with curative intent from 1988 to 2006 (cohort 1; n = 53) and 2007 to 2018 (cohort 2; n = 62). We compared diagnostic processes and utilized treatment modalities applying Chi-square tests, and outcome by Kaplan–Meier plots and Cox regression. Results: In cohort 2, the standardized processes (regular use of [18F]-FDG-PET-CT imaging followed by examination under anesthesia, EUA, bilateral tonsillectomy and neck dissection, ND, at least of the affected site) improved detection of primaries (P = 0.026) mostly located in the oropharynx (P = 0.001). From 66.0 to 87.1% increased ND frequency (P = 0.007) increased the detection of extracapsular extension of neck nodes (ECE+) forcing risk factor-adapted treatment by increased utilization of cisplatin-based PORCT that improved 5-years progression-free and overall survival from 60.4 and 45.3 to 67.7% (P = 0.411) and 66.1% (P = 0.025). Conclusions: Standardized diagnostic workup followed by ND and risk-factor adapted therapy improves survival of NSCCUP-P.

No description available.