Efficacy of cervical spine mobilization versus peripheral nerve slider techniques [neurodynamics] in cervicobrachial pain syndrome

The objective of this study was to compare the efficacy of cervical spine mobilization versus peripheral nerve slidertechniques [neurodynamics] incervicobrachial pain syndrome. The study design was arandomized interventional study. This study was conducted at the Armed Forces Institute of Rehabilitation Sciences [AFIRM], Rawalpindi from August 2014 to January 2015. Forty patients [n=40] were included by using purposive sampling technique. Patients of Age 30 to 60 years with Radiating neck pain, Limited ROM of neck and Pain persisting for more than 2 months, were included in study. Then randomly divided into two groups, each group contains 20 participants. One group was treated with neck mobilization and other was treated with neurodynamic treatment protocol. Pain and Active Range of Motion [AROM] was measured by Visual analog scale [VAS] and Inclinometer respectively. Neck Disability Index was also used. Patients were assessed before and after six week intervention. Data was analyzed on SPSS 20 and Independent t Test was used to compare the results of two groups. Pain was measured on VAS, the mean of Mobilization and Neurodynamics were [2.0+1.892 vs.4.8+2.397] respectively. There is significant [p<0.05] difference between two groups. There is also significant [p<0.05] difference for Range of Motion between two groups. The mean value for NDI of both groups were [14.5+7.564 vs 26.80+11.484]. It also shows better treatment is mobilization. The results of this comparison between two single interventions indicate that cervical mobilization treatment in neck pain is more useful than anneurodynamic treatment. For daily practice, we can recommend treatment according to the expert guidelines investigated

Depression; prevalence among amputees

Depression has been estimated to have an increased prevalence amongst all population and particularly among diseased population. To determine prevalence of depression among amputees after major traumas by using Beck Depression Inventory [BDI], in different hospitals of Rawalpindi and Islamabad. A descriptive Cross sectional survey was done with a sample of 110 amputees of age between 15-60 years, in different hospitals of Rawalpindi and Islamabad. The study duration was completed from 1[st] June 2013 to 1st January 2014. Details of data were collected through structured questionnaire. Questionnaire contained causes responsible for this depression and Beck's Inventory Score to measure level of depression. According to the data analyzed results shows that out of 110 amputees 28[25.5%] were having no depression, 35[31.8%] were mildly depressed, 16[14.5%] were borderline depressed, 14[12.7%] were moderately depressed, 8[7.3%] were severely depressed and 9 [8.2%] were extremely depressed according to BDI. The current study suggests that amputees in sample have mostly mild mood disturbance BDI, as they were following rehabilitation and using assistive devices which reduces the impact of disability and dependency and helps coping with depression. Sample selection was from those hospitals of Rawalpindi and Islamabad where a proper Rehabilitation setup was working and a lot of emphasis was laid on the Rehabilitation regime after Amputation. So on the whole mostly patients were mildly depressed according to BDI

efficacy of Rib Cage Mobilization on lung function in COPD patients

To determine the efficacy of rib cage mobilization on lung function in COPD patients. This randomized control trial was carried out at Department of Physical Therapy and Rehabilitation, Fauji Foundation Hospital, Rawalpindi and Railway General Hospital Rawalpindi, Pakistan from sep. 2010 to sep. 2011. Sixty two patients were randomly placed into two groups, 35 in group A and 27 in group B. The inclusion criteria was at least one year history of COPD, altered Dyspnea index, and decrease FEV1/FVC ratio and the exclusion criteria was less than one year history of COPD, normal Dyspnea index and no change in FEV1/FVC ratio. All the patients were treated for three weeks and rib cage mobilization was applied in group A and deep breathing exercise in group B. The rib cage mobilization was applied in sitting and side lying position for 10[th] to 2[nd] ribs and in supine position for 1[st] rib. The Dyspnea index and FEV1/FVC ratio were used as assessment tools, and were calculated before and after the therapy intervention. The data was analyzed by SPSS v 20 and paired t- test was applied to calculate the probability at 95% level of significance. The rib cage mobilization increased FEV1/FVC ratio and Dyspnea index significantly [P=0.004, P=0.006] in group A, as compared to the deep breathing exercise in group B [P= 0.073, and P=0.083]. We conclude that rib cage mobilization had very effective role in increasing rib cage mobility and improve lung function in COPD patients

Changes in intraocular pressure following phacoemulsification

To observe the difference in IOP that occurs before and after phacoemulsification surgery. A six month study was conducted at Department of Ophthalmology, Unit A, Khyber Teaching Hospital/ Khyber Medical College, Peshawar. Total number of 38 eyes were operated upon. Intraocular pressure was recorded using a Goldmann tonometer. One reading was taken one day before the scheduled operation and the second reading a day after. Universal II model from Alcon[registered sign] Surgical was used in the trial. Types of viscoelastic and IOL were also noted. Based on preoperative [pre-op] and postoperative [post-op] intraocular pressure, they were placed in 2 groups Within the 2 groups, the increase in IOP was statistically significant 24 hours after surgery. Between the groups, the difference was highly significant [P =.003], as determined by Pearson's Correlation test. The increase in IOP was higher in the Viscoat group, 14.28%, as compared to the Hydroxypropyl methylcellulose [HPMC] group, 7.14%. Mean IOP was 14.71 mmHg after surgery as compared to 12.42 mmHg preoperatively. Out of 38 patients 4 [10.5%] had pressures above 20 mmHg. The transient increase in post-op IOP was highly significant 24 hours after surgery in cases where HPMC and Viscoat were used. In cases where Provisc was used no significant elevation of IOP was noted

Clinical indications of enucleation surgery

Purpose: To determine the clinical indications of enucleation surgery at Al-Shifa Trust Eye Hospital Rawalpindi

Participants and Methodology: An observational case series was carried out for the study being conducted at Al-Shifa Trust Eye Hospital, Rawalpindi in which 60 new cases undergoing enucleation during 6 months were included by non probability convenience sampling

Results: There were 31[51.7%] male and 29 [48.3%] female patients with a mean age of 23.51[SD 19.546] years. Malignant tumours [41.66% eyes] were the most common indication of enucleation followed by phthisis bulbi [23.33% eyes] and trauma [16.7% eyes]. Retinoblastoma [RB] was found to be the most common malignant tumour diagnosed in 20% eyes. Students comprised 28.33% of the cases followed by farmers / laborers [23.33%] and housewives [13.33%]. In terms of socioeconomic status 37 [61.66%] patients belonged to lower class

Conclusion: Advanced ocular malignancies, phthisis bulbi and traumatically shattered eye globes are the major indications for enucleation in our country. Protective measures from trauma, early detection of tumours and creating awareness at various levels can decrease the incidence of enucleation

Role of intravitreal bevacizumab [avastin] in the treatment of clinically significant macular edema

To determine efficacy of single intravitreal injection of bevacizumab [Avastin] for treatment of clinically significant macular edema [CSME]. A quasi experimental month study was carried out at the retina clinic of Al Shifa Trust Eye Hospital, Rawalpindi from 1[st] January 2010 to 31[st] December 2010. A total 107 patients with CSME were included in this study. All patients were evaluated for visual acuity, anterior and posterior segment while central macular thickness was documented through optical coherence tomography. A single injection of bevacizumab was administered in all the patients. Outcome measures [improvement in BCVA and decrease in central retinal thickness] were evaluated at 2 weeks, 1 month and 2 months. All except one patient completed 2 months of follow-up. At baseline mean BCVA +/- SD was 0.967591 +/- 0.3705 log MAR of Snellen letters, which significantly improved to 0.808525 +/- 0.3260 at 2 weeks, 0.65581 +/- 0.36078 at 1 month, and 0.6319 +/- 0.3900 at 2 months [for each, p-value < 0.05]. The mean central retinal thickness +/- SD was 502.60 +/- 81.622microm at baseline and significantly decreased to 307.69 +/- 82.306 microm at 2 weeks, 235.75 +/- 63.162 microm at 1 month, and 237.58 +/- 64.230 microm at 2 months [for each, p-value < 0.05]. Primary single intravitreal bevacizumab injection in a concentration of 1.25mg / 0.05ml in patients with CSME resulted in significant improvement in BCVA and central macular thickness as early as 2 weeks after injection, and this beneficial effect persisted for up to 2 months