Effectiveness Of Cervical Stabilization Exercises With Feedback On Respiratory Status In Chronic Neck Pain Patients With Forward Head Posture

Background: Chronic neck pain is observed to be commonly kindred with forward head posture (FHP). Rib cage mechanics is found to be altered that decreases thoracic mobility. This reduced mobility of thorax reduces the effectiveness of diaphragm, intercostals, and abdominal muscles in terms of ventilation. Therefore this study was done to evaluate the effectiveness of exercises meant for enhancing the stability of the neck with feedback on neck stabilization exercises with feedback in improving the respiratory status. Methods: This was an experimental study. Based on inclusion & exclusion criteria, 100 subjects (54 males and 46 females) enrolled for the study, which was further allotted into Experimental and Control groups. The experimental group was given Cervical Stabilization Exercise with feedback in addition to routine Physiotherapy treatment. Control group was given only regular Physiotherapy treatment for six weeks. The digital camera assessed the FHP by measuring of Craniovertebral Angle (CVA). Spirometry assessed pulmonary function (FEV1) and Micro RPM assessed inspiratory muscle strength (PImax). All measurements were taken on the day of study, on 3rd and 6th week Results: Significant reduction in forward head posture measured by improvement in Craniovertebral angle, improvement in Inspiratory muscle strength (PIMax) and pulmonary functions (FEV1) were found in the group that received cervical stabilization exercises with feedback along with the conventional Physiotherapy (p< 0.05). Therefore it is suggested that cervical stabilization exercises correct the head posture and helps to improve the biomechanics of respiratory muscles. Conclusion: Cervical stabilization exercise is an effective approach to correct the forward head posture, and it should be included in the intervention measures of patients with forward head posture.

Study of Patient Dissatisfaction in Government Hospital.

The present study was conducted to know the various reasons for patient dissatisfaction at various places and explanations of service providers for patient dissatisfaction. 400 patients selected from all departments and key service providers at Government Medical College Hospital, Miraj. 364 (91%) patients had one/ more dissatisfaction/s to report. Of the 37 types of dissatisfaction reported, 10 were found to be of serious nature viz. cursory clinical examination (56%), lack of counseling (40%), inadequate privacy during clinical examination (14.28%), lack of explanation regarding drug schedule (43%), unsatisfactory emergency management (32.95%), occurrence of post-operative surgical complications (28.82%), discharged without relief (6.18%) and illegal demand of money, etc. Most of these were ‘acts of omission’ on part of service providers. In terms of legal liability, the ‘service-provider’ constitutes a ‘collective responsibility’ with respect to application of law.

Epidemiological Assessment of Goiter.

Research Question: 1. What is the magnitude of problem of Goiter? 2. What is the level of iodised salt consumed by school children at school & home? Objectives: 1. To find out incidence of Goiter. 2. To find out level of iodised salt consumed by school children at school & home. Study Design: Cross-sectional study. Settings: School & houseto- house survey of urban & rural area of Raichur district. Participant: School children & general population of both sexes. Sample size: 45173. Statistical analysis: Proportion & Chi-squared test. Results: Total population covered 45173 in five talukas. Males were 23463 & females 21730, adult population 16404, children more than 15 yrs were 28769 & school population was 24984. School boys were 14269 & girls 10715. Highest prevalence of goiter found in Raichur taluka i.e. 5.68% and lowest in Lingsur taluka i.e. 0.86%. Over all prevalence of Goiter among surveyed villages is found to be 3.19 % (1439 cases). Higher prevalence has been reported among females in age group of 10- 14 yrs 5.25% & 15-19 yrs 4.66% compared to other age groups of village population. School children in Raichur district revealed the prevalence of Goiter 3.66%. Conclusion: Prevalence of Goiter among surveyed villages is found to be 3.19 % (1439 cases), which is less compared to the National figures. The people are consuming the iodated salt and ban on non-iodated salt may be effectively implemented in study region.

Predictors of Aggressive Behaviours in Drug De-Addiction Centre.

Aim: Associations have been reported between aggression and psychoactive substance use. This study aimed to assess the prevalence and nature of aggressive incidents and to examine the factors associated with aggression in patients in a drug de-addiction unit. Method: Forms of aggression and their severity were assessed based on questions of Overt Aggression Scale (OAS). Data were collected from inpatients about the nature of their aggressive incident during a 12-month period. The characteristics of those patients involved in aggressive incidents were compared with those of others who had not been aggressive. Results: Fifty out of 83 patients admitted during this period were involved in some form of aggressive behaviour. Pattern of aggressive behaviour exhibited by patients were in the form of verbal aggression 60.24% (N=50); Object aggression 28.9% (N=24); Aggression toward other 32.53% (N=27) and Aggression toward self 2.41% (N=2). There were high correlations of one form of aggression in presence of other forms. Most common diagnosis was alcohol dependence. On the whole aggression was found to be higher in the alcohol withdrawal with delirium group. While all other forms of violence showed increase with past histories, statistical significance was there only in aggression towards others (p=0.043). Aggressive behaviours generally reported less in voluntarily admitted patients. Comparison of aggressive behaviour in relation to family type, locality, religion, family history of violence did not yield any significant variation. Conclusion: Like weather forecasting, predictions of future violence will not always be correct. However, in order to prevent aggressive incidents, present study revealed that particular attention and increase support required in patients living in the nuclear family, unwilling for admission, past history of aggressive incidents and diagnoses of alcohol withdrawal. Verbal aggression could be considered as strong predictor for other type of assault.

Evaluation of EEG in Child Guidance Clinic.

Background: Electroencephalographic (EEG) abnormalities occur in patients with various idiopathic psychiatric disorders. Among the psychiatric patients, children have shown more EEG abnormalities as compared to the adult cases. The present study therefore examined the pattern of EEG abnormalities in children’s attending child guidance clinic of psychiatry department. Method: Electrodes were positioned according to the 10 – 20 system, using a common reference electrode. EEG recordings from 138 hospitalized psychiatric patients were graded blind to diagnosis and treatment for type of EEG abnormalities. Types of clinical diagnosis were evaluated for association with pattern EEG abnormalities. Results: EEG abnormalities occurred in 53.62% (N = 74) subjects, whereas 46.38% (N = 64) showed no abnormality in EEG record. Generalized abnormalities was observed in 37.84% (N = 28) subjects. EEG abnormality in clinically diagnosed epilepsy were commonest 64.62% (N = 42), followed by dissociative (conversion) vs. epilepsy 62.5% (N = 5), pervasive developmental disorder (PDD) 56.67% (N = 17), and mental retardation with epilepsy 28.57% (N = 10). Conclusions: EEG abnormality risk varied widely among children’s with different diagnoses referred/attending Child Guidance Clinic of psychiatry department. Risk was particularly high in clinically diagnosed epilepsy.

Non Cerebral Activity in Patients of Schizophrenia: EEG Study.

Non Cerebral Activities (NCA) can mimic almost any kind of cerebral electrical activity and lead to serious misinterpretation if artefact periods remain in the recording. We focused on NCA detection in EEG of Patients with Schizophrenia. Out of 35 schizophrenia patients the presence of muscle and eye blink artefacts were higher in there percentages i.e. 86% and 92%. Fifteen patients (42.8%) reported as EEG of doubtful significance, which is higher in psychiatric patient’s then general population of epileptics.

Conversion Disorder: Socio-demographic and Psychosocial correlates of patients presenting with Nonepileptic events.

Objective: To study the socio-demographic and psychosocial correlates in patients with conversion disorder presenting with nonepileptic events and discuss its interventional implication. Material and Methods: This cross-sectional descriptive study was carried out in a tertiary care centre of eastern India from September 2008 to February 2009. 151 consecutive patients with conversion disorder satisfying the inclusion and exclusion criteria were selected. They were interviewed using semi-structured socio-demographic profile proforma, Holmes and Rahe stress scale for the exploration of psycho-social stressors. The data were entered on MS excel, analyzed by SPSS-version 16.0. Results: The psychosocial stressors were clearly identified in all patients. Almost ninety five (94.70%, n=143) out of the total 151 subjects had a history of stressors, while in the rest 4.95% no stressors could be established. The commonest stressors were Troubles with in-laws (26.49%), Death of close family member (11.92%) and Increase in argument with significant others (10.59 %). Conclusion: Significantly higher number of the patients presented with the stressor of troubles with in-laws, when assessed on the Holmes and Rahe Social Readjustment Rating Scale. Detection of exact nature of correlates has immense potential for therapeutic as well as preventive field.

Geriatric Mental Health in a Tertiary Care Centre: Socio-Demographic and Clinical variables.

Background: Nearly 50% of the aged have some physical ailment and are in need of active health care. Geriatric psychiatry is a sub-specialty of psychiatry, which deals with psychopathology occurring in the elderly and the various aetiological factors which cause the mental disorders in old age. Method: This is a descriptive study with sampling in a tertiary centre where the diagnoses were made based on the tenth edition of the International Statistical Classification of Diseases and Related Health Problems (ICD- 10) and were evaluated for sociodemographic and clinical variables as well as general medical conditions. Results: Mean age of the patients was 69.81 years, male constituted 73.58% and female 26.42%, Hindu were 56.60% and Islam 43.40%. Mean duration of stay in psychiatry ward was 5.7 days. 77.36% of patients were discharged on advice, 15.09% were transferred to another department, 1.89% absconded, 1.89% referred to another hospital and 3.77% referred to another department. 9.62% patients had general medical conditions alone and 40.38% had psychiatric disorders alone while 50% had combined psychiatric disorders with general medical conditions. 42.31% patients had organic, including symptomatic, mental disorders; 3.85% had mental and behavioural disorders due to psychoactive substance use; 26.92% had schizophrenia, schizotypal and delusional disorders; 28.85% had mood [affective] disorders; 5.77% patients had neurotic, stress-related and somatoform disorders. Conclusion: Within the limitations of nongeneralizability of findings, present study throws light in important areas of geriatric mental health including general medical conditions.

EEG Study in Excellent and Poor Achiever Students.

Objective: To assess the EEG amplitude and frequency of poor and excellent achievers. Method: The 15% highest achieving students and the 15% lowest achieving students from the three faculties were selected to be included in the study sample. EEG was carried out according to the 10–20 system, using a common reference electrode. The Bipolar recording of 10 minutes of two runs i.e. anterior, posterior and transverse has been taken into account for the analysis of data. Results: There are significant differences in the amplitudes of certain lobes of both hemispheres of poor and excellent achievers. Particularly, poor achievers have higher amplitudes. The frequency of excellent achievers of certain lobes is found to be significantly higher than those of the poor achievers. Conclusion: The relationship of amplitude and frequency with academic achievement are inconclusive, nothing can be said with confidence about the role played by the amplitude in determining the academic achievement of poor achievers. It is difficult to understand the specific roles played by the frequencies of the different lobes in determining the academic achievement of excellent achievers. Hence, further researches should be undertaken to study the cause and effect relationship between amplitude and frequency of the different lobes and academic achievements of’ students.

Problems in Disposal of Long Staying Criminal Psychiatric Patients in Mental Hospital, Varanasi.

Aim – The purpose of the study was to assess, the problems in disposal of long stay criminal mental patients, from mental hospital Varanasi, despite of their improvements and types of crime. Method – In this study 202 criminal mental patients taken from the mental hospital Varanasi. Those patients were admitted between years of 1948-2002. Out of 202, 193 were male criminal patients and 9 were female. Patients were divided into two groups, convicted and nonconvicted. The patients were analysed on the basis, of duration of stay in hospital, despites of their fitness, types of crime, time of discharges and types of mental disorders. Results –The incidence of crime committed were significantly higher in male patient in the age group of (18-40) years 75%, nearly 53%, patients committed crime below 30 years and, 5% crime committed above the age of 50 years. Similar finding reported as (Gluecks 1943, Baldev et al 1970). 75% patients were suffering from Schizophrenia. 67% patients stayed in the mental hospital less than 5 years but remaining patient stayed more than 6 years. 2% patient stayed more than 45 years. Conclusion – A part of criminal patient stayed in the mental hospital because of legal, administrative, medical, and communication problems with respective jails.

Determinants of Acute Dystonia in First Episode of Psychotic Patients Treated with Haloperidol and Centbutindole.

Objectives: To assess the factors affecting of acute dystonia in first episode psychotic patients taken haloperidol and centbutindole Method and Procedure: Total 54 patients (Schizophrenia, manic, psychotic) taken for the study from the psychiatry O.P.D. K.G.M.C Lucknow. The age group of patients were between the 17 to 55 years. This study was double blind and prospective. Patients were randomly administered Holoperidol (5 mg) TDS or Centbutindole (1.5 mg) TDS. The total period of study was 2 weeks, if any abnormal movements developed during this period the criteria for acute dystonia was applied. Tools: Semi structured proforma, International Classification of Disease — 10. Diagnostic and research criteria for neuroleptic induced acute dystonia, Scale for assessment of torsion dystonia. Beck and Refaelsen Mania Rating Scale: for manic patient only, Brief Psychiatric Rating Scale: On all patients was used. Result: The results show that acute dystonia was higher among the manic patients, younger age, married, male between the age group 17-25 year and duration of illness 1-3 months. It was also higher among those patients who have psychiatric family history.

Removal of fluoride by thermally activated carbon prepared from neem (Azadirachta indica) and kikar (Acacia arabica) leaves.

The present investigation deals with fluoride removal from aqueous solution by thermally activated neem (Azadirachta indica) leaves carbon (ANC) and thermally activated kikar (Acacia arabica) leaves carbon (AKC) adsorbents. In this study neem leaves carbon and kikar leaves carbon prepared by heating the leaves at 400 degrees C in electric furnace was found to be useful for the removal of fluoride. The adsorbents of 0.3 mm and 1.0 mm sizes of neem and kikar leaves carbon was prepared by standard sieve. Batch experiments done to see the fluoride removal properties from synthetic solution of 5 ppm to study the influence of pH, adsorbent dose and contact time on adsorption efficiency The optimum pH was found to be 6 for both adsorbents. The optimum dose was found to be 0.5g/100 ml forANC (activated neem leaves carbon) and 0.7g/100 ml forAKC (activated kikar leaves carbon). The optimum time was found to be one hour for both the adsorbent. It was also found that adsorbent size of 0.3 mm was more efficient than the 1.0 mm size. The adsorption process obeyed Freundlich adsorption isotherm. The straight line of log (qe-q) vs time at ambient temperature indicated the validity of langergren equation consequently first order nature of the process involved in the present study. Results indicate that besides intraparticle diffusion there maybe other processes controlling the rate which may be operating simultaneously. All optimized conditions were applied for removal of fluoride from four natural water samples.

Consumer grievance reporting in G.M.C. Hospital, Miraj.

A cross-sectional study conducted among 400 'consumers' at G.M.C. Hospital, Miraj revealed 91% consumers had one/more grievance/s. Higher grievances reported in illiterates, lower social class, indoor patients, surgical patients. Lower grievances reported in age < 15 yrs and 31-45 yrs, rural dwellers. Sex and new / old status of patients not affected grievance- reporting. 10 grievances out of 38 were found to be of serious nature. Some grievances (e.g. post-operative complications, discharge without clinical relief, absence of counselling, cursory clinical examination etc.) might have potential as possible medical negligence.

Effect of adenotonsillitis on peak exploratory flow rate in children.

Peak Exploratory Flow Rate (PEFR) is a simple, economical, reproducible, non-invasive test, which can be quickly performed with ease. PEFR was assessed in 36 children with adenotonsillar enlargement with mean age 10.75 years and equal number of age and sex matched normal children who acted as controls. PEFR was found to be 250. 61 +/- 66.92 lt/min in controls and 216.85 +/- 59.76 lt/min in children with adenotonsillar enlargement signifying impairment of PEFR in children in the second group.

Urinary fluoride levels and prevalence of dental fluorosis in children of Jhajjar District, Haryana.

A study was conducted in the Jhajjar district of Haryana to assess the fluoride excretion in the population exposed to environmental fluoride and efforts were being made to correlate the results with dental fluorosis. The mean fluoride concentration in drinking water samples of Bahadurgarh, Beri, Jhajjar, Matanhail and Sahalawas blocks of Jhajjar district were 2.05 mg/L, 2.14 mg/L, 2.05 mg/L, 2.14 mg/L and 1.93 mg/L respectively. The mean urinary fluoride concentration was 1.58 mg/L in Bahadurgarh, 1.48 in Beri, 1.50 in Jhajjar, 1.51 in Matanhail and 1.56 in Sahalawas. The mean prevalence of fluorosis on the basis of stage of dental fluorosis was highest of yellowish brown type and on the basis of TSIF score, score 4 type fluorosis was highest in most of the blocks of Jhajjar district. The study revealed that more than 50% of the individuals were found to be affected with flurosis in this district.

A study on plasma selenium level among pregnant women at Rohtak, Haryana.

Selenium is an important trace element for human health. Selenium levels in mothers may have significant effects on fetal and neonatal nutrition. In a cross-sectional study undertaken in Rohtak, Haryana, plasma selenium level in mothers was investigated at the time of delivery. The mean plasma selenium level in full term mothers (n=82) was 70.63 +/- 1.62 ppb and in preterm mothers (n = 58), it was 63.28 +/- 2.31 ppb. The difference was statistically significant (p < 0.05). These levels were, however, below the reported normal level of 75-120 ppb in adults. Rura/urban stay, parity, maternal age, socio-economic and literacy status etc. did not influence the selenium level of mothers in either of the groups.

Efficacy of Fipronil and Propoxur in the control of German cockroaches (Dictyoptera: Blatellidae).

A field trial for comparative evaluation of chemicals Fipronil gel, Propoxur spray and bait was carried out. The results in the Fipronil treated area indicate a reduction of 89%, 100% and 98% in cockroach infestation by days 7, 30 and 60, whereas the reduction in Propoxur spray treated area during the same period was 88%, 91% and 87% respectively. Propoxur bait was not found to be effective in reducing the cockroach infestation; rather a build up of the cockroach infestation was noticed in the treated site. The study reports the efficacy of Fipronil gel treatment over conventional insecticidal formulations in the control of cockroach infestation in cookhouses of urban households.