Soriani et al examined the clinical pro ﬁ les of 83 pediatric ISH cases. They reported that some ISH patients had (1) a history of symptoms suggesting the presence of cyclic vomiting syndrome or abdominal migraine or migraine equivalent and (2) associated symp- toms such as photophobia and nausea. 3
Walkers with backpain may adopt a strategy whereby they modify their pattern of muscular activity in an attempt to reduce the sensation of pain, thus they exhibiting abnor- mal gait pattern, characterized by shorter stride length, greater step width.Thus they adopt a ‘protective guarding’ or ‘splinting’ strategy by restricting movements of the spine and also they exhibit poorer motor control, and suffer from reduced proprioception, which limits their ability to adapt their gait pattern to changing circumstances.As a result, the walkers compensate for their poorer motor control by deliberately adopting a slower and less flexible gait . The abdominal drawing-in maneuver has been described as the best way to activate the Transverse abdominis and is often a fundamental exercise in a traditional stabilization program for Low backpain . The Abdominal drawing in maneuver is an inward movement of the lowerabdominal wall in which the patient is instructed to draw the umbili- cus toward the spine while maintaining a normal lumbar lordotic curve along with relaxation of the more superficial musculature. It was found to be associated with an uncon- scious co-contraction of the lower lumbar multifidi. This co-contraction of the Transverse abdominis and the Multi- fidi increased stability of the lumbar spine. The abdominal drawing in maneuver is often used to facilitate the re-edu- cation of neuromuscular control mechanisms provided by the local stabilizing muscles . The transverse abdominis muscle is an important unconscious motor activity to pro- vide a stabilizing force which increases intra-abdominal pressure and, through its insertion into the thoracolumbar fascia, resulted in increased stiffness of the lumbar spine . This training of the transverse abdominis has been shown to improve pain and the lower extremity function in patients with chronic low backpain by improving stabil- ity of the spine . Aim of the study is to know the effect of abdominal drawing in maneuver on gait parameters and pain reduction in patients with chronic low backpain. METHODOLOGY
This study is the first in China to investigate the correl- ation between the self-reported academic pressure that Chinese adolescents face currently and the prevalence of chronic pain (headache, abdominalpain, NSP, and LBP) using cross-sectional analysis. The survey results showed that the prevalence rates of headache, abdominalpain, NSP, and LBP in ordinary high school students in Shanghai China were 30.3, 20.9, 32.8, and 41.1 %, re- spectively, which might be higher than the results of international research surveys in spite of different defini- tions about pain and chronic pain [8, 14]. The high prevalence of chronic pain may be related to the current state of high school education in China, with character- istics such as prolonged study time, a heavy burden of learning, and huge pressure. Chinese students experi- ence similar levels of academic pressure regardless of gender. However, the prevalence of chronic pain was ele- vated in female students compared to male students, which was consistent with the results of previous cross- sectional studies [14, 15]. The reasons for this phenomenon might include the following: (1) Compared to males, female adolescents are more emotionally sensi- tive  and feel fatigued more easily . In addition, although we claim the difference between chronic pain and menstrual pain, it’s still difficult for them to distinct the two types of pains. Besides, primary dysmenorrhea is rather common among female adolescents. Therefore, female adolescents are more readily affected by academic pressure and complaining about pains. (2) Females have lowerpain thresholds and tolerance levels than males of the same age [18–20]. Therefore, the symptoms of chronic pain are more likely to manifest in females . The study also shows a correlation between many work- ing hours and chronic pain, but only if the working Table 2 Direct indicators of burden of learning
our conclusions. Additionally, other fac- tors not captured in the data set, for example duration of pain, previous sur- geries, or past medical history, may have in ﬂ uenced the evaluation and man- agement of individual patients. Overall, 70.5% of children during the study period had some form of imaging. Other institutions may have higher or lower rates of utilization. These data were drawn from a single center and re ﬂ ects the local standards and coding habits of those physicians. Our facility had no “ abdominalpain pathway ” during the study period; evaluation and management was at the discretion of the treating provider. Although we be- lieve our conclusions re ﬂ ect the gen- eral practice nationally, we cannot de ﬁ nitively prove this.
3. The presence of alarm symptoms or signs, includ- ing but not limited to involuntary weight loss, deceleration of linear growth, gastrointestinal blood loss, significant vomiting, chronic severe diarrhea, persistent right upper or right lower quadrant pain, unexplained fever, family history of inflammatory bowel disease, or abnormal or unexplained physical findings, is generally an in- dication to pursue diagnostic testing for specific anatomic, infectious, inflammatory, or metabolic etiologies on the basis of specific symptoms in an individual case. Significant vomiting includes bil- ious emesis, protracted vomiting, cyclical vomit- ing, or a pattern worrisome to the physician. Alarm signs on abdominal examination include localized tenderness in the right upper or right lower quadrants, a localized fullness or mass ef- fect, hepatomegaly, splenomegaly, costovertebral angle tenderness, tenderness over the spine, and perianal abnormalities.
ISH has been defined as a rare form of headache, with a prevalence of about 2.0%  in the general adult population. Recently, however, a study that specifically investigated the very brief, short pain paroxysms reported a prevalence of 35.2% in the general population . The authors of this study explained that this wide difference is probably due to the fact that the first study was designed more appropriately for major headache forms and did not completely detect less frequent headaches. To the best of our knowledge, there are no prevalence studies on ISH in the pediatric population. In the only extensive clinical study by Soriani et al. , and in another study , the prevalence of IHS among headache patients was 3.35% and 5.1%, respectively, similar to that found by Rasmussen and Olesen in adults . In our study the prevalence was 3.57%, similar to the two other pediatric studies. Yet, we agree with Sjaastad et al.’s opinion  that ISH is underestimated in the general population and also in the juvenile age. In fact, in our population, as in Soriani et al.’s , ISH was the main cause for referral, while in the general population ISH can fail to be noticed because of the low frequency as well as the brief duration of attacks which do not cause a severe morbidity in comparison with other primary headaches. Moreover, not all such patients are referred to neurological services and the diagnosis may be ignored because of the poor knowledge of the disorder.
Between July 2014 to July 2016, 501 patients with acute lowerbackpain were referred from orthopedic outpatient to the MRI unite at AL-Diwaniya teaching hospital. The mean age 33.49+8.38 range (20-70), 229 male and 272 female. The history was taken from every one of them, the data collected include, age, sex and duration of pain (all had pain for1 to 2 wks. only). We exclude all patients with history of trauma, patients with previous attack of backpain, patients with lumbo-sacral spine diseases and patients with neurological diseases. The MRI exam was done by using Siemens Avanto (1.5 tesla) apparatus putting the patient on supine position, the time of examination (10 minute), an ordinary sequences was done, T1 and T2 weighted image sagittal views, T2 weighted image axial view ( 4mm slice thickness ) and MRI myelography.
tirizine treatment in 12 367 patients (in- cluding 760 children # 12 years old) during 2-month therapy. Upper respira- tory tract infections, drowsiness/sedation, and headaches were the most commonly reported adverse events and occurred more frequently in the ﬁ rst month of therapy. However, both headaches and drowsiness/sedation were uncommon during treatment ( . 0.1%, , 1%). Usually drug-induced headaches are not characteristic. They are dull, diffuse, and of moderate to severe intensity. In the present case, the type of headaches ex- perienced by the girl were characteristic, which led us to adopt a diagnosis of primary stabbingheadache and to as- sume that the headaches were probably aggravated by the antihistaminic drug.
Gary is a full-time shop owner. The role involves prolonged sitting and standing and also involves moving and sorting heavy deliveries. He has a history of lowerbackpain but 6 weeks ago his symptoms altered fol- lowing an incident at work lifting heavy boxes. Previously he com- plained of a constant, but variable, ache across the lumbar region and buttocks, affecting daily activities. Since the recent injury he reports unre- mitting pain in the lowerback (Gary indicates this to be in the L4–L5 region). He also complains that he has a ‘numb bum’ with pins and needles in the right leg.
Functional assessment involves observing the child’s activity while undertaking tasks, but, in preparation for this, useful information can be gleaned by watching the child undress, including their dexterity with buttons and laces and how much help they require or are given. Useful observations are those of gait (walk and run), hopping, toe and heel walk, getting up from squatting and cross legged sit, looking up to the ceiling and over shoulders, hands above head, scratching small of back, holding arms out stretched, pronation, supination, ‘saying prayers’, and flexing fingers. The examination should include growth and general examination and specific examination of locomotor system and central nervous system. 15
Primary stabbing “ice-pick” headache is a primary head- ache syndrome characterized by transient, sharp, stabbing pains that occur within a small area of the scalp for seconds . The pain tends to occur in the distribution of the first division of the trigeminal nerve, including the orbital, temporal, or parietal regions . Its prevalence in children is estimated at 3-5% and it usually appears by age 10 years . In a large sample of children affected, this type of headache usually was not associated with other primary headache syndromes .
of the DS and ten items of the SS. As the HAMD was not designed for the evaluation of somatic symptoms, the DSSS was used as the main scale to evaluate depression and somatic symptoms. Among the ten items of the SS, five items were for pain symptoms (headache, backpain, chest pain, neck or shoulder soreness, and muscle soreness), which constituted the pain subscale (PS); five items were for nonpain somatic symptoms (chest tightness, muscle tension, dizziness, short- ness of breath, and palpitation), which constituted the nonpain somatic subscale (NPSS). In developing the DSSS, the ten items of the SS were selected based on: 1) somatic items that could reflect the severity of depression, predict the prognosis of depression, or have significant impacts on clinical practice; and 2) somatic symptoms that were common in previous stud- ies for depression. The DSSS and its subscales are sensitive to pharmacotherapy and are significantly correlated with the HAMD. 16 The DS and SS are significantly correlated with
nociceptive processing is imaginable, leading to the per- ception of pain in the affected overactive muscles. It is assumed that continuous muscular contraction associated with dystonic muscular disorders induces a severe chronic pain syndrome . Various disorders are often associ- ated with painful sensations in the head and neck area [3,6-12] such as cervical dystonia, spasticity, hemifacial spasm, blepharospasm, temporomandibular joint syn- drome or masseteric hypertrophy. The mechanisms of this phenomenon are poorly understood. The positive phar- macological effect could be thought to be achieved by var- ious mechanisms: 1) blockage of cholinergic transmission and interruption of muscle contractions , 2) decom- pression of vascular nociceptive neurons, 3) normaliza- tion of muscle spindle activity (inhibition of γ motor endings ), or 4) modulation of central mechanisms with regard to neuropeptides and neurogenic inflamma- tion .
Introduction: Lowerbackpain impacts almost 80% of the population. A lower back’s is taken as non-specific when there is not a closed clinical diagnosis. This paper compared the outcomes with the segmental stabilization and the Aussie current’s usage in an isolated and joint form for the treatment of lowerbackpain. Materials and Methods: This is an analytical clynical trial, with a control group which was a subproject of the research named "Physiotherapeutic performance in orthopedic and sports dysfunctions" endorsed by the opinion of number 2,418,872. The sample was comprised by 24 assessed subjects, before and after interventions, through the Visual Analogue Scale and the Start Back and Rolland Morris questionnaire. Afterwards, they were shared among the treatments’s protocol with (1) isolated segmental stabilization, (2) Aussie isolated current, (3) segmental stabilization + Aussie current, and (4) control group. The data analysis was done by the Statistical Package for the Social Sciences program 22.0 version with the paired t-Student test, Wilcoxon and Kruskal Wallis. The level of confidence was 95% (p<0,05). Results: It was noticed that the Aussie current, in an isolated way (p = 0.027) and / or incorporated with the segmental stabilization (p = 0.047) led to greater outcomes. Conclusion: It was settled that the Aussie current was seen as the a better option to decrease pain.
In Ayurveda, the diagnosis & treatment of Krimiroga described in details in all Samhita. In human body there are two types of Krimi – Sahaj & Vaikarik Krimi. Among them, Vaikarik Krimi is harmful to human being. It is said that Krimi may be one cause for Kushtha, Pandu, Grahani, and Karshyata. Aims & Objective: To evaluate the efficacy of Khadiradi kashaya in Purishaj krimi & its co-relation with worm infestation through Ayurvedic & modern texts. Material & Methods: The clinical study of this work was carried out in the Department of Kayachikitsa. Patients were selected as per selection criteria from OPD & IPD of the Kayachikitsa department of the hospital. Discussion: It is observed during study that many patients are coming with complaints of recurrent cough and cold, headache, urticaria, abdominalpain and diarrhoea which are relating to worm infestation also. Modern medicine is mainly focused on bacteria, virus, parasites in comparison with krimi however it is a quite neglected in Ayurveda as it mainly focus on balance of doshas & agni not krimi. Conclusion: Khadiradi kashaya used in this study proves very good utility in the management of Purishaj krimi; it has very appreciable result in 7 main symptoms of Purishaj krimi.
Hestbaek et al. , analysed participants according to any positive answers to headache regardless of aetiology (migraine, headache with nausea, headache with photo- phobia/phonophobia, severe ocular pain). Schur et al.  asked if participants had a doctor’s diagnosis of headache, the authors here also explained why they used a self-reported method rather than diagnostic criteria, as validated measures were too lengthy and diagnostic cri- teria were not agreed upon. Hartvigsen et al. [15, 16] asked participants in a survey whether a physician had ever told them they suffered from various diseases (out- come reported as migraine headache in results), answers were taken as valid if participants confirmed that a diag- nosis was made by a physician. Therefore, whether par- ticipants are truly reporting migraine or another type of headache is unclear [15, 16].
Our case showed several unusual and unique clinical features: multiple lesions, fast growing, and associated with sharp needle-stabbing like headache. The nature of the headache was atypical for a vascular tumor, and as a result, it was misdiagnosed as herpes zoster infection. The underlying causes of headache was un- clear, but likely a result of vasospasm, secon- dary infection, bleeding, and ulceration of the scalp lesion. Up to now, only one case in the reported RH patients presented with a rapidly growing lesion ; one case with multiple le- sions located on trunk and extremities; and an- other case with a single lesion on the scalp re- ported  . In our patient, although it is not clear if
All patients were followed by telephone interviews six weeks and three, six, nine and 12 months after their collision. In the current study, we restricted our ana- lyses to data collected up to the six-month follow-up because it corresponds to the period where maximal clinical improvement is expected . The follow-up interviews provided information on self-rated recovery, pain location, pain intensity, disability, health-related quality of life, exercise, activity limitation, health care provision, depressive symptoms and work status. We used self-reported recovery from WAD as our outcome, measured with the global recovery question: “How well do you feel that you are recovering from your injuries”? Patients answering “All better (cured)” or “There has been quite a bit of improvement” were defined as
Our study highlights several important issues in the management of fibromyalgia. First, fibromyalgia drugs ap- pear to have little effect on reducing health care utilization by patients with fibromyalgia, as seen in previous studies of pregabalin, duloxetine, and TCAs [10-13]. Whether the lack of effect on health care utilization is due to inad- equate benefits or concurrent benefit with new side effects of treatment is unclear. It is also difficult to determine whether the use of health care was inappropriately high or clinically necessary. Second, discontinuation rates are high across all study drugs. In previous studies, researchers have found that the effectiveness of these medications is limited , and many patients discontinue these medica- tions due to side effects . Third, pharmacologic treat- ment alone may not be effective in fibromyalgia . Prior meta-analyses of various nonpharmacologic treatments such as massage therapy, aquatic physical therapy, balneo- therapy, and hydrotherapy showed mixed results on fibro- myalgia symptoms [25-28], although beneficial effects of aerobic exercise and cognitive behavioral therapy on pain and mood were consistently noted [29,30]. Nonetheless, in future longitudinal study, investigators should explore the utility of multifaceted approaches to the treatment of Table 2 Patients ’ continuation of fibromyalgia treatment a