Private practitioners`use of exercise therapy in lower back pain

Introduction: Lower back pain (LBP) is a common problem treated by physiotherapists.  Recent research confirms the need for a more dynamic approach, to the management of this condition and includes progressive activity and exercise.  The current use of exercise therapy for people with LBP and the implementation of evidence based practice in this field in South Africa, is unknown.  As 80% of physiotherapists in South Africa offer services in private sector, the purpose of the study was to determine the use of this modality by physiotherapists.  The specific aims were to determine how many physiotherapists utilise exercise therapy, how much therapy time is spent on it and how the modality is applied.  This information can determine whether there is a need for continuing professional development in this area.Method: A stratified random sample of 489 South African physiotherapists was selected to take part in a survey by means of a questionnaire.  Data was analysed descriptively and relationships between categories were analysed using Chi-square tests (p<5).Results: A response rate of 85% was reached.  All but one physiotherapist used exercise therapy however, only 16% of the physiotherapists spent more than half of the course of treatment on exercise therapy.  Most respondents (96%) specified dosages, 95% progressed exercises, but only 46% alwaysre-assess exercises at follow-up visits.  Homeexercises are often prescribed, but group exercises are seldom used.Conclusion: South African physiotherapists in private practice use exercise therapy as a treatment modality for  people with LBP.  Inconsistencies concerning the implementation and time spent on exercises, suggests the need for continual professional development in this area

The chronic colitis developed by HLA-B27 transgenic rats is associated with altered in vivo mucin synthesis

HLA-B27 transgenic rats spontaneously developing a chronic inflammation mainly involving the colon are recognized as a powerful animal model for IBD. We investigated the mucin production in 6-month-old HLA-B27 rats by measuring in vivo fractional synthesis rate (FSR) and expression of mucins. In the inflamed colon of HLA-B27 rats, the mucin FSR was stimulated by 75% compared to F-344 controls, while MUC2,3 mRNA expression was unchanged. A local depletion in mucus-containing goblet cells was observed, suggesting a rapid mucin production/release and/or a real global decrease in goblet cell number. In the noninflamed jejunum of HLA-B27 rats, the mucin FSR was reduced by 35% compared to controls, while MUC2,3 mRNA expression was unchanged. Different alterations in mucin metabolism and expression are observed between HLA-B27 rats and a model of chemically induced chronic colitis (DSS-treated rats), suggesting that mucin alterations may be dependent on the animal model and colitis underlying mechanism.

Vulvar cicatricial pemphigoid of childhood

We report a 9-year-old girl with a vulvar autoimmune bullous dermatosis. A diagnosis of localized bullous pemphigoid or cicatricial pemphigoid was made on the basis of immunohistologic data. Since the lesions were unresponsive to topical corticosteroids but healed completely on dapsone at a dosage of 1.5 mg/kg/day, we favor the diagnosis of vulvar cicatricial pemphigoid. Only two such cases have been reported thus far. The diagnostic criteria and therapeutic modalities are discussed.

Mucin production and composition is altered in dextran sulfate sodium-induced colitis in rats

We evaluated the small and large intestinal mucin production in a rat model of human ulcerative colitis by measuring the in vivo fractional synthesis rate (FSR) and the expression of mucins. A chronic colitis was induced by oral administration of 5% dextran sulfate sodium (DSS) for 9 days followed by 2% DSS for 18 days. DSS-treated rats showed increased colonic MUC2,3 mRNA levels compared pair-fed controls. The mucin FSR was unaffected while mucin-containing goblet cells were depleted in the vicinity of lesions. In the small intestine, no inflammatory lesions were observed but ileal MUC2 mRNA levels and mucin FSR were decreased by 46% and 21%, respectively. Finally, DSS-treated rats showed a marked decrease in mucin's threonine + serine content all along the gut, which may lead to a reduction of potential O-glycosylation sites. Our data indicate that the chronic colitis may impair the mucus layer protective function all along the gut.

[Acquired zinc deficiency in a breast-fed premature infant]

Symptomatic zinc deficiency can occur in exclusively breast-fed infants. We report a case in a preterm infant.

CASE REPORT

A 3-months-old exclusively breast-fed premature infant presented with peri-orificial and acral eczematoid lesions. Laboratory investigations revealed lowered zinc levels in the infant's serum and in her mother's milk. A rapid healing occurred after oral zinc supplementation.

DISCUSSION

Zinc deficiency in breast-fed infants is a rare disease caused by a low level of zinc in mother's milk. The clinical features resemble those of acrodermatitis enteropathica. Oral zinc supplementation is required until weaning.

Physiotherapy students’ perceptions of an innovative approach to clinical practice orientation

The transition from the classroom to clinical practice is stressful for many students. In the current situation in South Africawith the shortages of clinicians’ posts in hospitals, this transition is evenmore difficult given the reduced time that clinicians have for supervisingundergraduate students. The University of Stellenbosch initiated structured peer-led introduction to clinical education (SPLICE), duringwhich senior physiotherapy students orientate second year students toclinical practice.The aim of this study was to investigate the perceptions of all of thesecond, third and fourth year students who took part in these SPLICEsessions. This information was captured using a questionnaire with open and closed questions. The response of all of the students was extremely positive. Common to all cohorts of students was the opinion of themotivational benefits of the sessions as well as the opinion that their confidence increased. Students in the variousyears of study differed in the ways in which they felt more confident. Closely linked were those comments referring to a sense of increased preparedness for clinical practice and a positive learning environment. A positive change inattitude towards clinical practice was also noted in many second year students.Further research is needed into the effect that SPLICE might have had on the second year students when they enterclinical practice as third year students. The role and opinions of patients during these sessions, and indeed during anyclinical education sessions, including clinical examinations, needs further investigation.

[Familial hyperchylomicronemia with a new mutation of the lipoprotein lipase gene]

INTRODUCTION

Familial hyperchylomicronemia is a rare autosomal recessive disease caused by lipoprotein lipase deficiency.

CASE-REPORT

A nine month-old girl presented with eruptive xanthomas revealing a familial hyperchylomicronemia. No lipoprotein lipase activity was found. DNA analysis revealed a novel homozygous non-sense mutation of the lipoprotein lipase gene at the codon 288. The parents were heterozygous carriers.

DISCUSSION

Familial hyperchylomicronemia usually presents with eruptiva xanthomas, abdominal pain, pancreatic manifestation and lipemia retinalis. Papulo-nodular xanthomas occur more frequently in children as in our case. Eighty lipoprotein lipase gene mutations have been recorded to date. The gene locates on chromosome 8. Only 9 non-sense mutations have been described which lead to a truncated protein. In our case, no enzymatic activity was detected probably due to an absence of secretion of the enzyme, even though catalytic activity persisted. The homozygous carrier status leads to hyperchylomicronemia whereas the heterozygote status may lead to mixed hyperlipidemia with an increased risk of atherosclerosis. The screening of lipoprotein lipase gene mutations should be carried out in all families with hyperchylomicronemia, regardless of the presence or absence of xanthomas.

Comparative morphology and paleobiology of Middle Pleistocene human remains from the Bau de l'Aubesier, Vaucluse, France

The discovery of later Middle Pleistocene human remains from the Bau de l'Aubesier, France reinforces an evolutionary model of the gradual accumulation of Neandertal-derived facial and dental features during the Middle Pleistocene of the northwestern Old World. The pronounced maxillary incisor beveling of Aubesier 4 helps to extend the antiquity of nondietary use of the anterior dentition. The interproximal "toothpick" groove on the Aubesier 10 molar increases the sample for these lesions. The pathological loss of the mandibular dentition of Aubesier 11 indicates advanced antemortem masticatory impairment, at a level previously undocumented before the Late Pleistocene. These remains support a view of later Middle Pleistocene humans able to support debilitated individuals despite the considerable use of their bodies to accomplish routine activities.

Suppression of Ras-mediated tumorigenicity and metastasis through inhibition of the Met receptor tyrosine kinase

Mutations in the Ras family of GTP binding proteins represent one of the most frequently observed genetic alterations in human cancers. We and others have recently demonstrated that expression of Met, the tyrosine kinase receptor for hepatocyte growth factor/scatter factor (HGF/SF), is significantly up-regulated in Ras-transformed cells. Because HGF/SF-Met signaling is proposed to play a prominent role in tumor development and progression, we assessed the possible requirement for Met during Ras-mediated tumor growth and metastasis. To disrupt endogenous Met signaling, we constructed dominant-negative mutants of both human and murine Met and showed that these can inhibit HGF/SF-mediated Met signaling and cell invasion of ras-transformed cells in vitro. Moreover, ectopic expression of dominant-negative Met mutants reduced the s.c. tumor growth of ras-transformed cells and dramatically suppressed their ability to form lung metastases in vivo. Our data demonstrate that Met plays a prominent role during Ras-mediated tumor growth and metastasis, and further suggest that agents that inhibit HGF/SF-Met signaling may represent an important therapeutic avenue for the treatment of a variety of malignant tumors.