Scientific Research Journal of India SRJI Volume-1 Issue-3 Year-2012 Full Journal

7/31/2019 Scientific Research Journal of India SRJI Volume-1 Issue-3 Year-2012 Full Journal

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Vol.1 No.3 2012 Scientific Research Journal of India 1

http://www.srji.co.cc

About Us:

Scientific Research Journal of India(SRJI) is the official organ of Dr.L.Sharma Medical Care

and Educational Development Society. It was founded by Dr. Krishna N. Sharma. It is fundedby the Dr. L. Sharma Medical Care and Educational Development Society. It is a

Multidisciplinary, Peer Reviewed, Open Access Journal of science. The intended audiences of

this journal are the professionals and students. The scope of journal is broad to cover therecent inventions/discoveries in structural and functional principles of scientific research.

The Journal publishes selected original research articles, reviews, short communication andbook reviews in the fields of Botany, Zoology, Medical Sciences, Agricultural Sciences,

Environmental Sciences, Natural Sciences, Anthropology and any other branch of related

sciences.

Frequency:

The issues will be regularly published quarterly.

Special Issue:

Special issue based on specific themes may be published at the suggestion of the executive

committee of Dr. L. Sharma Medical Care and Educational Development Society and themembers of editorial of SRJI.

Disclaimer:

Information provided on the site is meant to complement and not replace any advice or

information from a health professional.

We do not make claims relating to the benefit or performance of a specific medical

treatment, commercial product or service.

All the papers published are claimed to be original by the authors. The editors,

publisher, and reviewers will not be responsible for plagiarism.

Contact Us:Scientific Research Journal of India,Dr.L.Sharma Campus, Muhammadabad Gohana,

Mau, U.P., India. Pin- 276403

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Cont: +91-9320699167, 8822485959, 9305835734


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Index

Editorial Dr. Popiha Bordoloi 5

Perception of students for laptop

ergonomics and its use in the learning

centre of Sheffield Hallam University,

U.K.

Mayank Pushkar,

Shobhit Sagar

Physiotherapy

7

Effectiveness of Educational Sessions on

Reducing Diabetes in Women with

PCOS A Pilot Study

B. Sharmila,

B. Arun23

Efficacy of McKenzie Approach

combined with Sustained Traction in

improving the Quality of life following

low Back Ache A Case Report

A.Sridhar,

S.Vimala34

Diagnosis of Human Brucellosis by

Laboratory Standardized IgM and IgG

ELISA

Rajeswari Shome, M.

Nagalingam,

K. Narayana Rao,

B.Jayapal Gowdu, B.

R. Shome,

K. Prabhudas

Microbiology 40

Study of Non-Isothermal Kinetic of

Austenite Transformation to Pearlite in

CK45 Steel by Ozawa Model Free

Method

Mohammad KuwaitiMetallurgical

Engineering53

Face Exposure Technology Thanigaivel.V

Computer

Technology

60

Recovery of Decayed Species through

Image Processing

K.Priyadharsan,

S.Saranya70


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Editorial

Dear Readers,

I am very pleased to present the third issue of the Scientific Research Journal

of India (SRJI). This multidisciplinary and open access Journal of science is the

official organ of Dr. L. Sharma Medical Care and Educational Development Society.

The previous issues had covered three disciplines of science Physiotherapy,

Agriculture, Anthropology and Computer science. In this current issue we are

covering two new branches of science- Microbiology and Metallurgical engineering.

I would like to mention that this journal is intended to publish selected original

research articles, reviews, short communications and book reviews etc. in the various

fields of science like Botany, Zoology, Medical Sciences, Agricultural Sciences,

Environmental Sciences, Natural Sciences, Anthropology and any other branch of

related sciences and well be more than happy to recognize any of your works in

these field too.

Your comments and suggestions are very valuable for us.

Happy Reading.

Regards,

Dr. Popiha Bordoloi,

Editor in Chief


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Perception of students for laptop ergonomics and its use in the learning

centre of Sheffield Hallam University, U.K.

Mayank Pushkar. BPT, MSAPT (Musculoskeletal)*, Shobhit Sagar. BPT, MSAPT (Musculoskelatal)**

Abstract: Background and purpose: Laptop ergonomics is one of the most

concerned topics which result in high number of symptoms. The aim of this study is to

find out students perception about laptop ergonomics and how to make the learning

centre more laptop friendly. Methodology: A Qualitative survey with questionnaire

consisting of both open and close ended questions was used. 80 volunteer

participants participated in this study. Convenience Sampling was used for the

selection of participants. Qualitative Content Analysis has been used for the analysis

of the data.Results: It was observed that most of the students use laptop but they also

get musculoskeletal problems (Laptopitis) because of the extended use and adopting

improper posture while using laptop. Poor adaptation of posture was mainly because

of unawareness about laptop ergonomics and also because of poor set-up in the

learning centre. Conclusion: Laptop can be used in more friendly way without

causing any discomfort if both the factors (awareness and ergonomics setup) will be

considered. Also the awareness about the laptop ergonomics and proper posture

should be spread among student populations as most of students from other faculties

(0ther than related with health faculty) was not aware about the proper posture and

ergonomics.

Keywords: Laptop Ergonomics, Library Setup, Workplace Ergonomics, Laptopitis/

Laptop Related Injury


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INTRODUCTION

Now a days, technological advances such as

use of personal computers directly affect the

life of people1. As per the National Centre

for Education Statistics (2000), the number

of students using computers has increased

by more than 50% between 1985 and 1999

in the United Kingdom alone. With 98% of

universities having internet facilities, the

number of students opting for use of laptops

to conduct their activities is also

increasing2.In fact, 80% of British students

own a laptop in which 40% spends 3 4

hours daily on internet3. Laptops are widely

being used by professionals who need to

travel and work in different places like

office or college4. This phenomenon is

occurring largely because of the many

benefits accruing from laptops. Laptop

offers high technology performance in a

compact, light, portable and self-sufficient

with battery provided2.

It may be noted though, that the laptop was

not configured for long or constant use

2

.However, since they are increasingly

replacing desktops, students do use them for

extended periods of time. This has resulted

in a series of illnesses affecting different

parts of the body which include pain in the

neck, upper back, hands and wrists,

numbness, swellings, and tingling

sensation5

.Laptops induced injuries have

become so common that an all-

encompassing term has been used to refer to

them as Laptopitis, which includes

musculoskeletal and vision related

disorders6. Laptops construction and usage

result in users assuming improper posture

resulting in body discomfort, visual and

mental strains2. Moreover, workstations

configured for laptop computers, unsuitable

furniture faulty lightings, further contribute

to the physical injuries resulting from use of

laptops5.

Hence, there is a great need to study the

ergonomics of laptops. Laptop ergonomics

is a sub discipline under the broad umbrella

of ergonomics that postulates the optimal

manner of working on laptops and the

design of workspaces, where they are used

in order to keep related injuries to a

minimum and optimize performance7. This

study is focused on the views of students

about the laptop ergonomics and how tomodify or redesign the learning centre, so

that laptops can be used in their preferred

way in the learning centre for extended

periods of time without causing any

physical discomfort or injury.


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LITERATURE REVIEW

Few studies have been previously

undertaken on ergonomics related to the use

of laptops or computers. This report has

tried to discover the perception of

participants about laptop ergonomics and

their views about the lack of resources in

learning centre for use of laptop in

ergonomic way.

Straker and Harris (2000) have completed amixed study with both qualitative and

quantitative data in order to establish the

physical ergonomics issues associated with

the use and carry of laptop computers by

school children. In total 314 participants

aged between 10 and 17 years participated,

and filled the questionnaire in phase 1 of the

study and 20 participants were observed

using the laptop in various locations in

second phase of study. The result found that

the participant's discomforts were resulted

from using the laptop in a variety of non-

traditional work postures and also depend

on the model of laptop they use and carry.

The study identified the potential physical

implications associated with the use of

laptops.

Straker et al. (1997a) had studied the

adoptive posture while using laptops and

desktops. The study was a cross-over study

with 16 participants, who were government

employers. It was found that laptop users

adopt a posture with increased neck,

shoulder and elbow flexion but the

difference was not significant as compared

to desktop users. Similar results were

observed by Harbinson and Forrester (1995).

The study concluded that laptop users

required an increased forward head

inclination in order to operate the laptop due

to lack of its adjustability.Gold et al. (2011) quantitatively studied

postural characterisation in Laptop users in

non-desk setting with 20 asymptomatic

right-hand dominant participants aged

between 18 and 25. The selected

participants were assessed in 3 postures

with two minute typing task followed by 5-

minute editing task on laptop. The study

has used MaxMATE motion data analysis.

It was found that subjects reported greater

intensity of discomfort while using laptop in

prone lying.

Price and Dowell (1998) conducted a

quantitative study on 14 volunteer

participants to evaluate the effect of laptop

configuration and external input device on

posture and comfort of laptop users. Each

participant was asked to work on 6 different

computer configuration and anthropometric

data and baseline Nordic Discomfort Scale

was completed before the start of the task.


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The study concluded that use of extra

peripherals in laptop seems to be more

comfortable and thus decrease the

discomfort associated with laptop usage.

Kumari and Pandey (2010) have conducted

a cross-sectional study to analyse the health

problems associated with computer usage

and role of ergonomic factors. A total of

200 participants were selected by stratified

random sampling from different ITindustries. Close ended questionnaire were

used as data collection tool. The analysis of

the data was done by using SPSS software.

A standardized Nordic Questionnaire was

use to assess musculoskeletal problems and

Zungs self-rating scale was used to assess

depression. The study concluded the various

problems associated with laptops or

desktops use and also the effects of

underlying factors like- environment,

lighting and setup of the work place on

laptop ergonomics.

Several studies on ergonomic research with

desktops while the same cannot be said for

laptops, through some studies have

indicated the development of physical

symptoms associated with laptop use. Few

of the researches have been done, which

found the symptoms associated with the use

of laptop2,4,5

. As per the researchers

knowledge till now none of the studies tried

to find out the solution so that people can

use laptop in more comfortable and in their

preferred way for prolonged time without

causing any discomfort. Hence, this study

aims to focus on the ergonomics of laptops

and what modification can be done in the

learning centre of Sheffield Hallam

University, so that students can use their

laptop in learning centre in their preferred

way without any discomfort.Ethical approval was obtained from

Dissertation Management Group (Sheffield

Hallam University). Participants were given

the information sheet and completion of an

anonymous questionnaire was considered as

consent from the participants.

METHODOLOGY

Research Design

A Qualitative study design with

questionnaire survey was used to obtain the

student's perception about laptop

ergonomics. A qualitative research is the

best means of generating in-depth ideas and

developing hypothesis which may

eventually decide to test quantitatively8. As

the main aim of this study was to gather in-

depth information and generate ideas so the

design of the study was chosen as a

qualitative study.


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Sampling

A total of 80 participants were selected

based on inclusion criteria by convenience

sampling as it was not possible to approach

all the student population in Sheffield

Hallam University. It is practically easy and

fast method of sampling if the population is

very large9. Convenience Sampling is said

to be more appropriate for the study in

which the aim is to get in-depth

information10

.

TABLE 1- INCLUSION AND EXCLUSION CRITERIA:

INCLUSION CRITERIA EXCLUSION CRITERIA

Students of Sheffield Hallam University.

Students who were using Laptop/ Desktop for

their course work.

Students who knew English Language.

Students who were not using laptop/Desktop.

Students who were not student of Sheffield Hallam

University.

Data collection:

The data was collected through the survey

method by using a tool called a

questionnaire as it is the essential form of a

survey to a large sample population11

. A

questionnaire is an important method of

survey to a large sample population11

. The

questionnaire consisted of both close and

open ended questions. Close ended

questions were objective and unambiguous.

Open ended questions were used for

collection of larger amounts of information.

The questionnaires were developed on the

basis of Environmental and Occupational

Health and Safety Service (EOHSS)

Computer Workstation Ergonomics

Questionnaire. Prior to the implementation

of questionnaire, they were circulated

among the colleagues to check for content

validity and suggestions were considered

while reframing the questionnaire. The

questionnaire was pilot tested with 7

participants and the information was taken

into consideration while making final

questionnaire. Changes were made in 7

questions after piloting of the study. The

evidence suggested that, for the

questionnaire to be valid and reliable, it

should go through the formal pilot of the

questionnaire by the same sample

population12.

Data Analysis:

The main purpose of data analysis is to

identify what the texts of participants talk

about. The qualitative content analysis is


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used to process and analyse the information

given in text format or from an open ended

questions13. The data gathered was more

descriptive, hence it was suitable for

qualitative content analysis14

.

Hence, the qualitative content data

analysis15

was used for data analysis, which

involves the following steps:

1. Prepare the data: Present all the

data collected in a chart format.2. Identifying the unit of analysis:

Identify the different

Units/keywords from the text.

3. Developing categories and a

coding scheme: It can be derived

from three sources: the data,

previous related studies, and theories.

4. Code testing on a sample of text: It

is used for the clarity and

consistency of category definitions.

5. Code all the text: Involves coding

all the data which have been.

Different units/keywords with

similar sense were given single code

6. Assess coding consistency: This

step involves rechecking the

consistency of coding.

7. Draw conclusion from the coded

data: This step involves making

sense of themes and identified theirproperties.

Rigour of analysis was enhanced by a

several-stage process of defining and

refiningthemes, by constant comparative

analysis between scripts and themes until

final themes were developed. This analysis

produced 7 key themes, which are listed

with their definition in Table 2.

TABLE- 2: Main Themes from Data Analysis.

THEMES DEFINITION

Factors which facilitates the use of

LC.

Reasons because of which students use

LC.

Preference of use of Laptop/Desktop in

LC

Whats the reason for preference of

using Laptop/Desktop.

Symptoms faced while

using Laptop/Desktop

Which all symptoms the participants

suffer and whats its cause?

Posture Awareness Awareness about the posture in

participants.


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Environment/ Infrastructure of LC How is the environment and setting of

LC for the use of laptop.

Interference with extra

Computer-accessories.

How does the extra computer-accessories

interfere the level of comfort and increase

the work efficacy.

Recommendation to Improve LC What changes can be done to improve the

LC for the use of Laptop.

RESULT:

The questions which were related were putinto similar themes and then the results

were presented on the basis of sub-themes.

Factors that facilitates use of Learning

Centre

Almost all participants were using the

learning centre for their course work

because of better facilities or resources like-

"Books, Journals, area, IT

equipment/resources, caf etc.", while many

participants said that they prefer Learning

Centre because they like the environment of

Learning Centre as it is "Quite place and

easy to concentrate for the study". Some of

the participants use Learning Centre

because of the convenience and comfort,

like- they can "use leisure hours between

the lecture, the convenient opening and

closing hours of Learning Centre and group

study/work". Few of participants said about

psychological motivation they get in

learning centre for study.

Preference of use of laptop or desktop in

learning centre

When the participants were asked whether

they use laptop or desktop in learning centre,

42 participants said that they use desktop as

they feel it convenient and comfortable.

They said that they "do not have to bring

laptop and it is easy for them to use desktop

than laptop". Some of them said that, they

"prefer desktop because of big screen of

desktop and also there is less space and

plug points for laptop in learning centre".

Few of the participants said that it is "easy

to work on desktop as the desktop is fast

and more comfortable" and also they "can

use it for prolonged period of time". Only

11 participants said that they use laptop in

learning centre because they "prefer to use

laptop" and also it is "convenient for them

to save their data". Some of the participants


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said that they use laptop as they "can use it

anywhere in learning centre, comfortable,

easy to use and it is more portable" .

Problems or symptoms faced by

participants while using laptop or desktop

From the result it was observed that, the

most experienced symptoms were Tight,

sore neck and shoulder muscles, followed

by Pain or aching in wrists, forearms,elbows, neck, or back followed by

discomfort, and then General fatigue or

tiredness, then Blurred or double vision.

Also it was found that, the least faced

symptom was Swelling or stiffness in the

hand or wrists.

Most of the participants said that, these

symptoms are because of their bad or poor

posture like- (Keeping laptop on knee, using

laptop while lying down, Slouched posture

etc.), continuous position such as: (Sitting

for prolonged, focusing on small screen for

long period, no interval between work etc.),

and ergonomics setup like- (Desks and

chairs not adjusted, Too close to screen for

long period etc.). Some of the participants

said that there might be some other reasons

for the symptoms like- (weak joint, poor

posture throughout the day, Back and neck

pain from exercise).

Posture Awareness

Out of 80 participants, 55 participants stated

a positive response and defined posture in

their own words, while 25 participants have

given negative response as they were not

aware with the correct position or posture

for the use of laptop. The participants who

were not aware about the posture were

mainly from the faculty other than health

related courses such as: Criminology,Events management, Information system

management, Law etc. Most of the

participants said, usually posture means: sit

straight, back support, hip and knee flexed,

and screen at eye level. Some of the

statements given by the different

participants to define posture for laptop are

presented below:

Screen in line with eyes, elbow flexed to

90, knee at 90, hip at 90, shoulder flexed.

(2)

Back support, Hip + Knee supported,

Appropriate Height. (39)

Sit erect, avoid neck flexion, sitting at

comfortable distance, and avoid excessive

elbow bending. (62)


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Environment or Infrastructure of

Learning Centre (LC)

More than half of participants found

environment of learning centre to be

comfortable for the use of Laptop.

Participants found environment of learning

centre comfortable because of different

resources like- Tables, adjustable chairs,

more space for laptop, plug points, proper

lighting and easily accessible resources.While less than half of the participants

found the environment of Learning Centre

is not comfortable for laptop use.

Participants said that, there is less space,

less number of tables for laptop, tables and

chairs are not setup at proper height or not

adjustable, and also there is less charging

plug/points for laptop use.

When asked about the infrastructure/ setting

of Learning centre, most of them said that

the environment of learning centre is

comfortable because of tables and

adjustable chairs, proper lighting and quite

area. While one quarter of participants did

not find the infrastructure of LC to be

comfortable because of different difficulties

such as: Limited space around the table,

uncomfortable chairs, cold environment,

chairs do not have armrest, very much

crowded. Some of them said that there are

fewer resources such as: Area, less table

and chairs, less space around the table.

Interference with extra computer-

accessories like- keyboard and mouse on

laptop work

Out of 80 participants, some of the

participants answered that, use of extra

equipment like- mouse and keyboard could

provide more comfort and can work withgreater ease. Participants answered that use

of extra equipment can provide more

comfort, free movement and also they can

modify their position accordingly. Some of

the participants said that mouse is better

than touchpad and they can work faster

and in more comfortable way. Few

participants answered that use of keyboard

and can provides more comfort to them

and they do not have to negotiate with

posture. While more than half of

participants answered that, they do not find

any difference in comfort level with the use

of extra keyboard and mouse in the Laptop.

Some of them said that they do not want to

carry keyboard and mouse and also they

can manage fine without it.

Recommendation to improve Learning

Centre for use of Laptop


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Major number of participants have

suggested with different recommendation

for the use of laptops in learning centre so

that laptop can be used for extended period

of time. Most of them want proper

ergonomic setup for laptop users, more

laptop area, more spacious table,

comfortable chairs with neck and back

support, and plug points for laptop

changing. Some of the participants havesuggested for the Laptop stand, specific

type of table for laptop and dock station for

laptop. Few of the participants said that

there should be more tables for laptop in

silent area and also individual/ separate

booth/ room for laptop users.

DISCUSSION

This qualitative study obtained students

perception about laptop ergonomics and its

use in the learning centre of SHU. Almost

all participants use learning centre for their

course work because of the better

environment and different types of

resources available. The environment of

learning centre provides more comfort and

motivation to the students for the study,

because the setup of the environment is

study oriented. It has also been shown that

hot and noisy environment directly affects

the work productivity and ergonomic

condition16

. Student population use laptops

in the learning centre because of the many

benefits of the laptop. It is easy to carry and

use laptop as the participants can save their

data17

.

It was observed that most of the participants

experienced some of the symptoms while

using either laptop or desktop. From the

data gathered by questionnaire, it was found

that the participants faced problems relatedto neck, shoulder, hand, back and eyes. The

most common symptoms were Pain or

aching in wrists, forearms, elbows, neck, or

back followed by discomfort (42%) and

eye strain (42%). Similar type of results was

found by Kumari and Pandey (2010) and

said that the common causes of these

symptoms were sitting for prolonged in

awkward or poor posture (Fig-1). Also the

literature suggested that the participants

should take eye break every after 20 min to

reduce strain on eye while working on

laptop18. It was also found that participants

who use laptop faced more symptoms than

the one who use desktop. This could have

been in order to adjust the posture to use

desktop and laptop in more comfortable

position3. Even evidence proves that

participants adopt poor posture because of

the lack of adjustability of the laptop as the

screen and keyboard are attached2. This was


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supported by another study by Straker et al.

(1997a), they have suggested that usually

laptop users tried to assume posture that

would compromise their posture by

increased neck, shoulder and elbow flexion.

They adopt this posture in order to see a

lower screen and reach a higher keyboard.

The main factors judged by the participants

as cause of their symptoms while using

laptop or desktop were Sitting in sameposture for continuous long hours,

Awkward and poor posture, and the

setup for laptop which was not

ergonomically correct.

As the height of table in the learning centre

is not appropriate, and also some of the

communal table which are being used for

laptop use are of very low height so it is

difficult to adjust the chairs accordingly. As

the evidence by Straker and Harris (2000)

suggested that the participants experienced

physical discomfort because of the physical

ergonomic issues as they use the laptop in

poor posture. This was supported by Moffet

et al. (2002) in their study; evaluated the

impact of two work station (desktop andlaptop) on neck and upper posture, muscle

activity and productivity. The study said

that the workstation setup influenced the

physical exposure variable while working

on laptop.

Fig-1: Shows the poor and good posture for Laptop.

Some of the participants who were not

related with health course, they did not

know about the correct position or posture

for the use of laptops. They have not

defined the posture. This might be because

of lack of awareness about ergonomics

among that students population. So the

participants adopt the poor posture while

working on laptop, because it has been

found that lack of knowledge about posture


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can leads to symptoms as they do not adopt

the proper posture while working on

desktop or laptop5.

From the result it was also found that use of

extra computer- accessories can provide

more comfort, and can ease the symptoms

and increase the work efficacy of the

participants. This is because the extra

equipment provides the adjustability

according to the posture and the users donot have to compromise with the posture.

This was supported by a study done by

Kumari and Pandey (2010) found that the

use of various computer accessories like-

adjustable keyboard tray, foot rest, best-fit

computer mouse design, task lighting and

docking station can help in preventing the

health related symptoms. Even some of the

participants have suggested for the use of

laptop stand or docking station (Fig-2). It

might be helpful because they can fix the

laptop and can use it in ergonomic way sothat the symptoms can be prevented.

Fig-2: Show the ideal Laptop stand/Docking station for laptop.

According to the ergonomic advice by

Stanford University, Environment Health

and Safety, the laptop workstation has been

suggested, so that the laptop could be used

as workstation if working for long hours

and the symptoms can be minimized.

Moffet et al. (2002) have given some

advices to prevent pain while using laptop.

The study has suggested the use of docking

station, so that the subjects do not have to

adopt the poor posture and can use laptop in

effective way.

The study had several limitations. Many of

the participants have not answered all the

questions which might be because of lack of

interest, lack of time or the structure of the


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questions. All the analysis and calculations

were done manually so there might be some

chances of manual error. It was not possible

to explore in-depth perception of

participants as the method of data collection

was questionnaire. The sample size (n=80)

in the study was relatively large, which was

the strength of the study. The participants

were from different faculties, which might

have result in variable data as the studentsfrom different course have different

perception about the ergonomics. Rich

informative data were gathered through the

open-ended questionnaire, which was one of

the aims of qualitative research.

CLINICAL IMPLICATION:

Laptop ergonomics is very applicable for all

who use laptops. The result of this study

might help not only the student populations

but also the general population who use

laptop. As it was found that there is lack of

awareness about the proper posture for

laptop use among students, so the measure

should be done to spread the awareness.

Mainly the student population, who are not

from health related courses, should be

focussed. It might be very helpful if there

should be some induction about the posture

for the student population before start of the

course. Awareness about the posture can be

spread though the means of Poster,

distributing leaflets, and induction or

seminar. The findings about the

recommendation in improving learning

centre can be given into the notice to the

learning centre authority Dept., so that they

can use the finding as feedback in

improving the learning centre for better use

for students and staffs. And also the

students will be benefited by these changesand they might be able to use learning

centre in more efficient way.

The data of this study also has a further

clinical relevance; Symptoms are mainly

because of poor posture and wrong setup of

workstation of laptop, so in order to prevent

those symptoms, both the factors should be

corrected.

FURTHER RESEARCH:

As this was the first study to researcher's

knowledge done on the student population

in SHU about laptop ergonomics, so an

obvious need for more research in this area

is observed. More research should be done

in order to find out the actual ergonomic

setup of the working environment in the

learning centre.Also a quantitative study

could be suggested as further research in

order to find out the effectiveness of

ergonomics training program on posture


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while working on laptop. Looking to the

current scenario it seems that in coming 10

years laptop or i-pad or tablet will be

replacing the desktop so the study should be

conducted in order to find out how the

learning centre should be designed

ergonomically for laptop or i-pad or tablet

use.

CONCLUSION:

From the research done, it can be seen that

students population prefer to use learning

centre because of the different facilities and

environment. But they also get symptoms

by using the resources like- desktop or

laptop, which is because of wrong posture

they adopt while working. So these

resources should be set-up on the basis of

ergonomics way and awareness about the

posture should be spread among students.

REFERENCES:

1. Gulek, J. C. and Demirtas, H. Learning

with technology: The impact of laptop use

on student achievement. Journal of

Technology, Learning, and Assessment,

2005;3(2).

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Physical Ergonomics Issues Associated with

School Childrens Use of Laptop

Computers.International Journal of

Industrial Ergonomics, 2000;26;337-346.

3. Thrasher, M. and Chesky, K. Medical

Problems of Clarinetists. Results from the

UNTMusician Health Survey. Texas Music

Education Research. 1998. Last Accessed

19th Dec 2011 at

http://www.tmea.org/080_College/Research

/thr1998.pdf.

4. Moffet, H. et al. Influence of laptop

computer design and working position on

physical exposure variables. Clinical

biomechanics, 2002;17(5):368-375.

5. Kumari, G. and Pandey, K.M. Studies on

health problems of software people: A case

study of Faculty of GCE and GIMT

Gurgaon, India. International Journal of

Innovation, Management and

Techonology,2010;1(1):388-397.

6. Blome, M., Johansson, C. R. and

Odenrick, P. Visualization of ergonomic

Guidelines A comparison of two computer

aided systems to support vehicle

design.International Journal of Industrial

Ergonomics,2005.


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7. Szeto, G. and Lee, R. An Ergonomic

Evaluation Comparing Desktop, Notebook,

and Sub-Notebook Computers. Arch. Phys.

Med. Rehabilitation, 2002;83: 527-532.

8. Kumar, R. Research Methodology, A

step-by-step guide for beginners. 1st edn.,

SAGE,London, New Delhi, 2005.

9. Marshall, M.N. Sampling for qualitativeresearch. Family Practice,1996;13: 522-525.

10. Patton, M.Q. Qualitative evaluation and

research methods. SAGE Publications.

Newbury Park London New

Delhi,1990:169-186.

11. Paul, H.P., Yeowa, Rabindarnath, and

Sen. Quality, productivity, occupational

health and safety and cost effectiveness of

ergonomic improvements in the test

workstations of an electronic factory.

International Journal of Industrial

Ergonomics,2003; 32: 147163.

12. Williams, A. (2003). How to write and

analyse a questionnaire. Journal of

orthodontics,2003;30:245-252.

13. Kondracki, N. L. and Wellman, N. S.

Content analysis: Review of methods and

their applications in nutrition education.

Journal of Nutrition Education and

Behavior, 2002;34: 224-230.

14. Ffiman, A., Ebbeskog, B. and Klag,

B.Wound care in primary health

care:district nursesneeds for co-operation

and well-functioning organization. J.

Interprof Care,2010; 24: 9099.

15. Mayring, P. Qualitative content analysis.

Forum: Qualitative Social

Research,2000;1(2).

16. Ashraf, Shikdar, Naseem, and Sawaqed.

Worker productivity, and occupational

health and safety issues in selected

industries; Computers & Industrial

Engineering, 2003;45( 4): 563-572.

17. Shears, L. and McDonald. Computers

and Schools. Victoria. Australian Council

for Educational Research.1995.

18. Ergonomic Recommendations for

Laptop Computer Use. Stanford University

Ergonomic program.[Online]. Last assessed

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eral/ergo/documents/laptop_guide.pdf


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and Safety Service (EOHSS). Computer

workstation Ergonomics Questionnaire.

Last Accessed 19th Dec, 2011 at

http://www.umdnj.edu/eohssweb/publicatio

ns/directory.htm#Office

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posture and comfort in laptop users in non-

desk settings. Applied ergonomics,2012;43(2): 392-399.

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Configuration in office: Effects on posture

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ergonomics,1997a;28(4): 263-268.

ACKNOWLEDGMENT:

A special thanks to my family and friends for their continuous support. Also thanks to the

management of Sheffield Hallam University for giving me opportunity to complete my study.

CORRESPONDENCE:

* Sheffield Hallam University, United Kingdom. Email: [email protected] **Sheffield Hallam

University, United Kingdom


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Effectiveness of Educational Sessions on Reducing Diabetes in Women with

PCOS A Pilot Study

B. Sharmila, BPT, MSc (Yoga)*, B. Arun, MPT**

Abstract: PCOS (Poly cystic ovarian syndrome) is one of the common syndromes in

females, around 10 % of females in world having PCOS. PCOS have a strong link on

Diabetes. Study is a descriptive study to find out the effect of educational session on

diabetes for women who has PCOS. Around 20 females with PCOS were selected, an

Educational session was conducted for duration of 4 weeks, and Diabetic

Questionnaire was given to analyze the knowledge of diabetes. Following the 4 weeks

of educational sessions, all participants have gained a good knowledge on PCOS and

Diabetes. This study concludes that educational session is very important for the

management of Diabetes and especially for females who has PCOS.

Key words: Type II diabetes, PCOS, Educational Session, Diabetic Questionnaire.

INTRODUCTION

Diabetes is one of the most common health

problems in the world. India is the capital of

diabetes. Many studies conducted in India

showed that prevalence of type 2 diabetes

was more and it is increasing in urban

populations1, 2

. Diabetes exerts a significant

impact on the lives of individuals and their

family members due to the constant need

for decision-making and actions to promote

good glycemic control, an outcome

acknowledged as the foremost goal in

diabetes care and treatment3.

The burden of diabetes on women is unique,

because the disease can affect both mothers


25/81



and their unborn children. Diabetes can

cause difficulties during pregnancy such as

a miscarriage or a baby born with birth

defects. Women with diabetes are also more

likely to have a heart attack and at a

younger age than women who do not have

diabetes. Type 2 diabetes is strongly

associated with Women who suffer from

PCOS (Poly cystic ovarian syndrome).

PCOS is a leading cause of menstrualirregularity and female infertility. The

Statistical links between diabetes and PCOS

are very strong about 5%--10% of

reproductive age women have PCOS and 50%

--70% of women with PCOS also

experience insulin resistance and 20%--40%

obese women with PCOS may have insulin

resistance and diabetes.

Polycystic ovary syndrome (PCOS) is a

common endocrine disorder, affecting

women in reproductive age, characterized

by chronic anovulation and

hyperandrogenism. The etiology of PCOS is

still unknown. However, several studies

have suggested that insulin resistance plays

an important role in the pathogenesis of the

syndrome. The risk of glucose intolerance

among PCOS subjects seems to be

approximately 5 to 10 fold higher than

normal and appears not limited to a single

ethnic group. Moreover, the onset of

glucose intolerance in PCOS women has

been reported to occur at an earlier age than

in the normal population (approximately by

the 3rd-4th decade of life). However, other

risk factors such as obesity, a positive

family history of type 2 diabetes and

hyperandrogenism may contribute to

increasing the diabetes risk in PCOS4.

Dr.Geoffrey Redmond said that There is

no question about the association one ofthe problems is that people havent put the

pieces together He added that there is a

strong association between PCOS and

Insulin resistance. While focusing the

infertility and menstrual changes, health

care professionals should also look for the

chance of diabetes, and screening of

diabetes is much desirable.

Women with polycystic ovary syndrome

(PCOS) are insulin resistant, have insulin

secretory defects, and are at high risk for

glucose intolerance. PCOS women are at

significantly increased risk for IGT and type

2 diabetes mellitus at all weights and at a

young age, The prevalence rates are similar

in 2 different populations of PCOS women,

suggesting that PCOS may be a more

important risk factor than ethnicity or race

for glucose intolerance in young women,

and the American Diabetes Association

diabetes diagnostic criteria failed to detect a


26/81

Vol.1 No.3 2012

significant number of P

diabetes by post challenge

Type 2 Diabetes h

produces little or no insuli

struggles to keep up wit

for more insulin, excessiv

and insulin build up in

often leading directly to

Certain factors that figur

PCOS are also imdevelopment of Type 2

abdominal fat, high L

cholesterol and low HDL

high levels of triglyceride

(high blood pressure).

Although PCOS is m

gynecological disorder b

fertility and can cause ir

no periods at all. Evide

PCOS is more of a disord

system with gynecologica

Diabetes Prevention

2001, study shows that

associated with Ins

Polycystic Ovarian Syn

Diabetes are interrelated.

of exercise worsen In

which then has a negati

lipid production, increas

low-density lipoprotein),

(low-density lipoprotein

Scientific Research Journal of Indi

OS women with

glucose values5.

as pancreas that

n. As the pancreas

the body's need

levels of glucose

the blood stream,

Type 2 Diabetes.

e in the onset of

licated in theiabetes: excessive

L "bad" blood

"good" cholesterol,

and hypertension

uch perceived as

ecause it impairs

regular periods or

nces suggest that

r of the endocrine

l consequences.

Program study

all of the factors

lin Resistance,

drome and Pre-

Obesity and lack

sulin Resistance,

e effect on blood

ing VLDL (very

LDL cholesterol

- the "bad"

cholesterol) and t

blood stream, as

cholesterol (high-

"good" cholesterol.

While there i

number of steps

complications. Re

5-7% of body fat

activity by taking

week can reduce rDiabetes by almost

DIABET

CELL

STIMULATSECRET

HYPE

HORMO

INSULI

EXCESSIVE

25


riglyceride levels in the

well as decreasing HDL

ensity lipoprotein - the

)

s no cure for diabetes, a

an be taken to prevent

earch showed that losing

and increasing physical

a brisk walk 4-5 times a

isk of developing Type 260%.

S PCOS LINK

IABETES

DYSFUNCTION

THE PANCREAS TOMORE INSULIN

INSULINEMIA

AL IMBALANCE

N RESISTANCE

PCOS

NROGEN SECRETION


27/81



Need for the study:

It's important to understand the distinction

between Insulin Resistance and Type 2

Diabetes. Type 2 Diabetes is one of the topfatal disorders in the World. In 2000, it was

the sixth leading cause of death and has

been associated with long term

complications affecting almost every part of

the body, including blindness, heart and

blood vessel disease, stroke, kidney failure,

amputations and nerve damage. Obese

women are particularly susceptible to PCOS

and Type 2 Diabetes. A vicious cycle

quickly forms because these conditions, in

turn, put women at dramatically increased

risk of Cardiovascular Disease, as well as

the development of many other serious

health conditions, including stroke, kidney

damage and blindness. Overweight women

do not, however, have a monopoly of

Polycystic Ovarian Syndrome and its

related disorders because females of normal

weight and even lean women are also prone

to these conditions.

Insulin Resistance occurs when the body

produces enough insulin but its cells lack

enough receptor sites to allow the

absorption of insulin at a cellular level.Type 2 Diabetes develops when the body

either doesn't produce enough insulin or it

can't process the insulin that is produced.

Aim of the study:

Study Objectives:

To educate the patient about disease (PCOS)

and teach on link between PCOS and

Diabetes

To make the patient learn about the

preventive methods

To reduce the risk of getting diabetes

To make patient to understand the

importance of Diet, Exercises etc.

METHODOLOGY:

The study is a descriptive study design, 100

women with PCOS were examined by the

Gynecologist and 20 women were selected

for the study. The subjects were selected

based on age group of 2533years,

PCOS

INCREASE PRODUCTION OFANDROGEN

STIMULATE THE PANCREAS TOSECRETE MORE INSULIN

HIGH SUGAR IN BLOOD

INSULIN RESISTANCE


28/81



Married females, Married within 2 years,

Obese or female in Borderline obesity. No

history of conception, No other

gynecological problems like irregular

menstrual periods or small uterus. No other

relevant medical problems. Before initiating

the study Blood test was conducted to check

their random blood sugar levels. Clear

instructions were given to all the

participants. The educational class is for 4weeks of duration and the Diabetic educator

role is to make all participants attending all

the sessions. Prior to the class a Diabetic

knowledge Questionnaire was distributed to

all individuals and to find out how much

knowledge on Diabetes and PCOS. The

questionnaire was a single paged one which

includes the questions about the knowledge

on diabetes and the knowledge on PCOS.

The participants were asked to fill up the

questionnaire with Yes or No. Questions are

valued as 1 point for Yes and 0 point for No.

Educational Classes conducted on Every

Sunday Morning (10 am 1 pm). The

content of the Classes include 1) What is

PCOS 2) What are the Causes 3) Symptoms

of Diabetes with PCOS 4) Diabetes Link

with PCOS 5) Prevention Methods. The

questions asked by the women participants

were clarified. At the end of the programme

all participants were instructed to fill up the

questionnaire and their performance was

assessed. At the end of the 4 week class the

questionnaire was repeated and assessed the

knowledge on diabetes for women with

PCOS.

RESULTS:

The demographic data about the subjects

were mentioned in Table 1.

Table 1Demographic Data

Age Group2527 2830 3133

7 6 7

Figure 1

The Table 2 shows the result using students t test.

Groups

Pre

Testmean

Post

Testmean

S.D

Paired t

Value

3.8 7.85 0.28514.19

(P


29/81

Vol.1 No.3 2012

Figure 2

Table 2 shows the paired t v

Questionnaire. This shows

programme has shown pos

participants attitude. It also s

significant improvement on

diabetes mellitus.

DISCUSSION:

Women with PCOS

Overweight or Obese. B

they have more chance of

Usually women with PC

regular check up on diab

for diabetes is very impo

of diabetes. A root ca

Ovarian Syndrome (P

linked Insulin Resistance

increase the risk of devel

and Type 2 Diabetes. All

may result in Cardio

leading to a heart attack

self awareness in people

important, so that the Ty

0

50

100

150

200

Pre

76


alues of the Diabetic

that the educational

itive effect on the

ows that there was a

the knowledge on

are generally

ecause of obesity

insulin resistance.

OS dont have a

tes. But screening

tant in prevention

use of Polycystic

COS) is obesity-

which can also

ping Pre-Diabetes

are disorders that

vascular Disease

r stroke. Creating

ith PCOS is very

e 2, diabetes can

be prevented as

complications foll

Women with PC

Syndrome) who

experience more

general populatio

diabetes, pregnan

pressure, miscar

delivery.

Polycystic ovarycommon endocri

women in reprod

by chronic

hyperandrogenism.

still unknown. H

have suggested th

an important role i

syndrome. The ris

among PCOS

approximately 5

normal and appea

ethnic group. M

glucose intoleranc

been reported to o

in the normal pop

the 3rd-4th decade

risk factors such

family history o

hyperandrogenism

increasing the diab

ost

157

28


well as prevent the

wing diabetes.

OS (Polycystic Ovarian

become pregnant may

ealth problems than the

n, including gestational

cy-induced high blood

riage and premature

syndrome (PCOS) is ane disorder, affecting

ctive age, characterized

anovulation and

The etiology of PCOS is

owever, several studies

t insulin resistance plays

n the pathogenesis of the

k of glucose intolerance

ubjects seems to be

to 10 fold higher than

s not limited to a single

oreover, the onset of

e in PCOS women has

cur at an earlier age than

lation (approximately by

of life). However, other

as obesity, a positive

type 2 diabetes and

may contribute to

etes risk in PCOS


30/81



The link of PCOS with insulin resistance

was subsequently established by clinical

studies characterizing the profound insulin

resistance in obese and lean PCOS patients.

Insulin resistance, hyperinsulinemia, and

beta-cell dysfunction are very common in

PCOS, but are not required for the diagnosis.

Polycystic ovary syndrome (PCOS) is a

major risk factor for impaired glucose

tolerance (IGT) and type 2 diabetes mellitus(T2D). Several studies have examined

possible mechanisms related to glucose

metabolism and insulin secretion that may

be responsible for the high prevalence of

disorders of glucose metabolism in women

with PCOS. The actual pathogenic

mechanisms appear to be complex and

multifactorial, possibly characterized by the

lack of uniformity between patients, thus

reflecting the heterogeneity of PCOS.

Impaired insulin action and/or beta-cell

dysfunction and/or decreased hepatic

clearance of insulin have been implicated so

far.

The overall risk of developing diabetes

mellitus and glucose intolerance seems to be

higher in women with polycystic ovary

syndrome (PCOS) than in healthy women.Limitations of this study include, no control

group, it was a pilot study; need a bigger

study to evaluate the effectiveness of the

programme. Blood report investigations can

show some reliable information. Efficacy of

the treatment can also be evaluated through

objective methods.

REFERENCE:

1. Mohan V, Shanthirani S, Deepa R,

et al. Intra urban differences in the

prevalence of the metabolic

syndrome in southern India - The

Chennai Urban Population Study

(CUPS). Diabet Med 2001; 18; 280-

287

2. Misra A, Pandey RM, Rama Devi J,

et al. High prevalence of diabetes,

obesity and dyslipidaemia in urban

slum population in northern India.

Int J Obes 2001; 25: 1-8.

3. Brown S: Studies of educational

interventions and outcomes in

diabetic adults: a meta-analysis

revisited. Patient Educ Counsel

16:189215, 1990.

4. Pelusi B, Gambineri A, Pasquali R..

Type 2 diabetes and the polycystic


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ovary syndrome. Minerva Ginecol.

2004 Feb;56(1):41-51.

5. R. S. Legro et al. Prevalence and

predictors of risk for type 2 diabetes

mellitus and impaired glucose

tolerance in polycystic ovary

syndrome: a prospective, controlled

study in 254 affected women, The

Journal of Clinical Endocrinology

and Metabolism, vol. 84, no. 1, pp.

165169, 1999.

6. Alberti KG, Zimmet PZ: Definition,

diagnosis and classification of

diabetes mellitus and its

complications. Part 1: diagnosis and

classification of diabetes mellitus

provisional report of a WHO

consultation. Diabet Med 15:539

553, 1998

7. American diabetic association

(1999), American association guide

to medical notional therapy and

diabetes.

8. Balkau B, Charles MA: Comment

on the provisional report from the

WHO consultation. Diabet Med

16:442443, 1999

9. Canadian Diabetes Association.

(1998). 1998 clinical practice

guidelines for the management of

diabetes in Canada. Canadian

Medical Association Journal, 159,

S1-S29.

10.Chobanian AV, Bakris GL, Black

HR, Cushman WC, Green LA, Izzo

JL, Jones DW, Materson BJ, OparilS, Wright JT, Roccella EJ: The

seventh report of the Joint National

Committee on Prevention, Detection,

Evaluation, and Treatment of High

Blood Pressure: the JNC 7 report.

JAMA 289:25602572, 2003

11.Codner E etal., 2006, Diagnostic

criteria for Polycystic ovarian

syndrome and ovarian morpholly in

women with Type II diabetes,

Endocrine Med : Jun 91 (6): 2250-6.

12.Isomaa B, Almgren P, Tuomi T,

Forsen B, Lahti K, Nissen M,Taskinen MR, Groop L:

Cardiovascular morbidity and

mortality associated with the

metabolic syndrome. Diabetes Care

24:683689, 2001


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13.Kitzinger C, Willmott J: The thief

of womanhood: womens

experience of polycystic ovarian

syndrome. Soc Sci Med 54:349361,

2002

14.Lakka HM, Laaksonen DE, Lakka

TA, Niskanen LK, Kumpusalo E,

Tuomilehto J, Salonen JT: The

metabolic syndrome and total andcardiovascular disease mortality in

middle-aged men. JAMA 288:2709

2716, 2002

15.Legros RS et al., PCOS prospective

controlled study in 254 affected

women, J clin endocrine metan:

84:165169.

16.Pouliot MC, Despres JP, Lemieux S,

Moorjani S, Bouchard C, Tremblay

A, Nadeau A, Lupien PJ: Waist

circumference and abdominal

sagittal diameter: best simple

anthropometric indexes of

abdominal visceral adipose tissue

accumulation and related

cardiovascular risk in men and

women. Am J Cardiol 73:460468,

1994

17.Reaven GM: Banting lecture: Role

of insulin resistance in human

disease. Diabetes 37:1595 1607,

1988

18.Sarah Wild, Mb Bchir, Phd, Gojka

Roglic, Md, Anders Green, Md, Phd,

Dr Med Sci, Richard Sicree, Mbbs,

Mph, Hilary King, Md, Dsc, Global

Prevalence Of Diabetes, DiabetesCare 27:10471053, 2004

19.Taylor AE, 2000, Insulin Lowering

medications in Poly cystic ovarian

syndrome. Obstet gyneol Clin north:

Apr 27: 583595.

20.The Expert Committee on the

Diagnosis and Classification of

Diabetes Mellitus: Report of the

Expert Committee on the Diagnosis

and Classification of Diabetes

Mellitus. Diabetes Care 20:1183

1197, 1997

21.WHO Study Group Report.

Prevention of Diabetes Mellitus.

Geneva: World Health Organization;

1994. WHO Technical Report series

no. 844.


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APPENDIX I

DIABETIC QUESTIONNAIRE

Name : Date :

Age :

Occupation :

Address :

Weight :__________ Kgs.

Height : __________CMS

BMI :

Do you have Diabetes : YES / NO

If YES, How long :___________ Months/ Years.

Are you in medications for Diabetes : YES / NO

If YES, Specify medicines : ________, ___________, ___________

Do you have PCOS : YES / NO

If YES, Since when : ____________ Months / Years

Are you in medications for PCOS : YES / NO

If YES, Specify medicines : ________, ___________, ___________

Please fill up the given statement with Yes or No.

S.No STATEMENT Yes No

1. Do you know symptoms of Diabetes

2. Do you know about PCOS

3. Do you know Obesity may cause Diabetes

4. Do you know Obesity may cause PCOS

5. Do you know relation between PCOS & Diabetes

6. Do you know the Risk factors for Diabetes

7. Do you think it is good to do Exercises regularly

8. Do you think intake of Rice may cause Diabetes

9. Do you think you can get Diabetes

10. Do your Parents or Relative have Diabetes

Signature of the Participants Signature of the Assessor


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CORRESPONDENCE:

*Physiotherapist, K.M.C.H Hospital, Coimbatore. Email: [email protected]. **Physiotherapist, K.G.

Hospital, Coimbatore.


35/81



Efficacy of McKenzie Approach combined with Sustained Traction in

improving the Quality of life following low Back Ache A Case Report

A.Sridhar MPT (Neuro)*, S.Vimala BPT**

Abstract: Objective: To evaluate the effectiveness of traction combined with

McKenzie approach for the sub acute low back ache (LBA) patient and evaluating the

quality of life post treatment. Design: Single Case Report Setting: PSG Hospitals

Participant: A 45 years old female with the complaint of LBA with 6 month duration,

gait problem, participatory problem in social activities and also with the impairment

of function. Intervention: One hour session of physiotherapy including traction and

McKenzie exercises interrupted with rest period. Outcome Measures: Visual

Analogue Scale (VAS) (Pain), Quality of life (QOL) (American chronic Pain

Association). Result: There is a significant reduction of pain and improvement of

quality of life after one month of treatment. Conclusion: McKenzie exercises

combined with traction plays a major role in reducing pain and improving the quality

of life following Low Back Ache patient.

Key words: LBA, McKenzie, Traction, Quality of Life, Visual Analogue Scale.

INTRODUCTION

LBP affects 7080% of adults at some point

in their lives, with peak prevalence in the

fifth decade. The drastic increase in LBP in

the past two to three decades. Low back

pain is a common disorder. Nearly everyone

is affected by it at some time. The acute low

back pain may develop to chronic pain and

disability. The treatment of low back pain


36/81



remains as controversial today as it was

fifty Years ago. Over the years the medical

profession used a wide range of treatments,

such as heat or cold, rest or exercise, flexion

or extension, Mobilization or

immobilization, manipulation or traction.

Nearly always drugs were prescribed, even

when the disturbance proved purely

mechanical in origin. Amazingly, most of

the patients recovered, very often inspite oftreatment rather than because of it. But

McKenzie approach in LBA is on

mechanical basis and he assessed the

movements of spine and also the treatment

is based on the patient complaints of pain

whether in flexion or extension or lateral

flexion. So we had tried to apply this

technique coupled with traction for LBA

patient.

METHODOLOGY:

Case History:

A 46 years old female came with the

complaints of pain in the bilateral lower

limb, difficulty in walking, getting up from

the floor, and toileting activities for 6 month

duration. But she doesnt complaints of any

sensory loss over the bilateral lower limb

and also in anal area.

Basically she is from rural area and there is

no facility for her to go for hospitals. But

she went to nearby physician and she got

some pain medications and tropical

ointments for pain relief. As time goes on

she is complaining of severe pain in the

back and unable to walk for even 10

minutes continuously. She feels weakness

of bilateral lower limb and restricted her

participation in the social activities and alsoreducing the usual work what she is doing

regularly. She could not do even carrying

the drinking water from a distance place as

their primary need.

Misdiagnosis:

After she felt more discomfort she went to

various hospitals and diagnosed as GBS,

and someone diagnosed as disc herniation

and advised her to go for surgery. She was

confused and she refused to undergo

surgery. Finally she came to our hospital

and she got medications. In the mean time

we send her for the neuro consult but the

neurologist also advised her to take MRI

and after the he also advised her to go for

surgery.

Being a low economic status she could not

spend more money and she refused for

surgery and come back to our hospital with

the reports.


37/81



Our Views:

As we (Physician, Junior Doctors and

Physical therapist Team) read the MRI and

also observed her complaints of pain. We

taught that she does not need surgery at this

stage and we make her bed rest for one day

and we started our own assessment and

treatment procedures.

We underwent observational, palpation, andexamination of various movements

including reflex, muscle strength, balance,

coordination and Activities of daily living.

We came to the conclusion that she had a

derangement syndrome one with complaints

of symmetrical pain across L4, L5, no

radiating pain and no deformity so it comes

under the first type of derangement so we

decided to treat her with McKenzie

approach and traction. As McKenzie

exercises are very much appreciated in

treatment of lower back ache population in

world wide. we tried our traditional

approach of traction and McKenzie

approach

Outcome Measures:

1. Visual Analogue Scale (VAS).

2. Quality of Life (QOL).

Visual Analogue Scale:

Its is widely used to measure the severity of

pain from patient feeling of pain. Zero

indicates no pain and 10 indicate severe not

tolerable pain.

Quality of Life:

American Chronic Pain Association created

this measure with the following explanation.

Pain is a highly personal experience. The

degree to which pain interferes with thequality of a persons life is also highly

personal. The American Chronic Pain

Association Quality of Life Scale looks at

ability to function, rather than at pain alone.

It can help people with pain and their health

care team to evaluate and communicate the

impact of pain on the basic activities of

daily life. This information can provide a

basis for more effective treatment and help

to measure progress over time.

Scoring system zero indicates non

functioning and ten indicates normal quality

of life.

Treatment protocol:

Traction:

Sustained Traction

This term denotes that a steady amount of

traction is applied for periods from a few

minutes up to hour. This shorter duration


38/81

Vol.1 No.3 2012

is usually coupled with s

This method is most wid

and much of the literatur

applications of sustained

traction is sometimes re

traction. As per the pat

applied 15kg of lumbar st

minutes.

McKenzie Exercises:This is a set of exercises

for 30 min.

1. Prone Lying.

2. Extension in prone

support).

3. Extension in prone lyi

4. Extension in prone

fixation.

5. Sustained extension in

6. Extension in standing.

7. Extension Mobilizatio

passively)

RESULT AND INTERP

The assessment is taken

2nd week, 3rd week,

According to McKenzie

time of disease the p

exercise may worse the c

assessed her at one week i


tronger poundage.

ly used in Europe

describes various

raction. Sustained

erred to as static

ients weight we

atic traction for 30

e asked her to do

lying (forearm

ng ( hand support).

lying with belt

tilt bed.

n (Therapist doing

RETATION:

on the first visit,

and 4th week.

approach at any

rticular form of

ndition so we are

nterval.

Table 1.1 Co

scale on th

Visual Ana

1st visit 2nd We

9 7

Graph 1.1 comp

an

Initially wh

complaints of pai

week she compla

normal.(table 1.1)

Table 1.2

scale on th

Quality of Li

0

2

4

6

8

10

1st visit 2nd

Visual

37


mparing the visual analogue

first visit and 4th

week

ogue Scale (Pain)

k 3rd Week 4th Week

4 0.5

ring the values of visual

logue scale

n we assess in VAS she

as nine and at the end of 4th

ints of 0.5 which means near

(graph 1.1)

omparing the quality of life

first visit and 4th

week

fe ( American chronic Pain

Association)

Week 3rd Week 4th Week

nalogue Scale (Pain)


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Vol.1 No.3 2012

1st

visit

2nd Week 3r

1 4

Graph 1.2 comparing the

Life Sc

Initially when we asse

complaints of 1, and at th

she complaint of 9 whic

work for 8 hours a

participate in famil

activities.(table 1.2) (grap

From the above mentioneits clearly seen that patien

and her quality of life is i

Thereby this case re

recommending that tract

McKenzie exercises are

in treating the disc herniat

0

1

2

3

4

5

6

7

8

9

10

1st Visit 2nd Week

Quality of Life ( Am

Assoc


d Week 4th Week

8 10

values of Quality Of

ale

ss in QOL she

e end of 4th week

h means she can

nd she actively

y and social

1.2)

d table and graphts pain is reduced

proved a lot.

ort is strongly

ion coupled with

ery much helpful

ion condition.

DISCUSSION:

There are various

widely used in tre

reviewing 21 pape

was found to be of

high quality, Van

inferences could b

A trial by Cherki

compared three

manipulation, M

education leaflet.

difference among

regard to pain rec

The chiropracti

significantly bett

intervention groupmonths and the

complaints of the

the technique and

and assess the pa

the knowledge of

features. This cas

for the new p

procedures widel

patients and there

condition. Static l

for this patient as

disc space, after a

be a reduction of

McKenzie had cla

3rd Week 4th Week

erican chronic Pain

iation)

38


treatment procedures are

ating the LBA cases. On

s in 1995, only one paper

er Heijden concluded no

drawn(Phys Ther 1995).

n (N Eng J Med 1998)

groups: chiropractic

cKenzie exercise, vs

He did not find any

the three groups with

rrence or days off work.

c group performed

er than the minimal

at 4 weeks, but not at 31-year. But as per the

atient we have to choose

apply with precautions

ients periodically to get

patients pain and related

report is a eye opening

hysio to apply these

for most of the LBA

y improving the patient

umbar Traction is useful

there is narrowing of the

plying traction there will

the nerve impingement.

ssified the low back pain


40/81



in 3 categories viz. dysfunction, postural

and derangement syndrome. As this patient

had complaint of derangement symptoms so

we applied the treatment protocol for

derangement syndrome one.

Conclusion:

This case report supports that traction

combined with McKenzie exercises plays a

major role in reducing pain and improving

the quality of life.

ACKNOWLEDGEMENT

Thanks to my client & PSG Hospitals and

also to our superintendent and deputy

superintendent for having confident with us

in treating the patients who need physical

therapy.

REFERENCES:

1. Lumbar spine, mechanical diagnosis and

therapy,(1981) R.A. McKenzie, pages

122-150

2. Orthopaedic rehabilitation, assessment

and enablement , John C.Y.Leong et al.

pages 481-488.

3. Low Back Pain, royal college of

practitioners pages 3-39.

4. Lumbar traction, journal of orthopaedic

and sports therapy 1979, H.duane

saunders pages 36-40

CORRESPONDENCE

*Neurophysiotherapist- TLM Naini, UP. [email protected] Cont: +91-8765152734. **Physiotherapist

Trainer- TLM Naini, UP.


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Diagnosis of Human Brucellosis by Laboratory Standardized IgM and IgG

ELISA

Rajeswari Shome*, M Nagalingam*, K. Narayana Rao*, B.Jayapal Gowdu**, B. R. Shome*

and K. Prabhudas*

Abstract:

Brucellosis is a zoonosis caused by facultative intracellular bacteria of the genus

Brucella, which are capable of surviving and multiplying inside the cells of

mononuclear phagocytic system. ELISA is rapid, robust, coast effective and is most

commonly used diagnostic technique for brucellosis. Our present research

communication deals with optimization of IgM and IgG antibodies for diagnosis ofbrucellosis in human beings. In the present investigation, out of the 179 sera samples

from risk groups screened for brucellosis, 10(5.58%) and 4(2.23%) were positive for

anti Brucella antibodies by RBPT and STAT respectively. Seropositivity by IgM and

IgG ELISAs were 2.23% (4/179) and 17.3% (31/179) respectively. In case of blood

donors, out of 123 serum samples 1.62% and 4.87% were positive by RBPT and IgG

ELISA respectively. No antibodies were detected by STAT and IgM ELISA in blood

donors. Among serum samples from Pyrexia of Unknown Origin patients tested, 7. 61%

(15/197) by RBPT, 1.01% (2/179) by STAT and 0.5% (1/197) by IgM ELISA and

11.67% (23/197) IgG ELISA respectively were found positive.

INTRODUCTION

Brucellosis is a zoonosis caused by

facultative intracellular bacteria of the

genus Brucella, which are capable of

surviving and multiplying inside the cells of

mononuclear phagocytic system and are

widely distributed in both humans and


42/81



animals1. Human brucellosis varies from an

acute fabrile illness to chronic, low grade ill

defined disease. It is a systemic disease

characherized by pausity of signs

accompanied with nocturnal sweating,

malaise, fatigue and backache2. The disease

can be a very debilitating, despite the fact

that the fatality rate is generally low. It

often becomes sub-clinical or chronic,

especially if not diagnosed early andproperly treated. The incidence in humans

ranges widely between different regions,

with values of up to 200 cases per 100,000

populations with high prevalence in Middle

East, Mexico, Central and South America

and the Indian subcontinents2, 3

. High-risk

groups include those exposed through

occupation in contexts where animal

infection occurs, such as slaughterhouse

workers, hunters, farmers and veterinarians.

The diagnosis of brucellosis can be

challenging, and its diagnosis demands

epidemimology, clinical and laboratory

information. Its routine biochemical and

hematological laboratory tests also overlap

with those of many other pathogens such as

Salmonella, Yersinia, and Vibrio4. Many

tests are reported for diagnosis of Brucella,

ranging from microbilogical culture to

serodiagnostic tests such as slide or tube

agglutination, indirect coombs test, enzyme-

linked immunosorbent assay (ELISA) and

indirect fluorescent assays, to the recent

molecular techniques such as polymerase

chain reaction (PCR) are available.5, 6, 7

.

Isolation from blood, bone marrow and

other tissues of suspect is classical

diagnostic (gold standard) method for

brucellosis. However, this microbiological

technique is having the draw back of time

consumption as the organism is havingincubation period of 6 weeks and possibility

of contamination to personnel cannot be

avoided8. Rose Bengal Plate test (RBPT) is

commonly used for the screening of

brucellosis however results may at times

inconclusive9. In standard tube

agglutination test (STAT), interpretation of

the result is difficult due to false positive

reaction with Salmonella, Yersinia and

Vibrio species. Further PCR is the

molecular technique which is employed for

the detection of brucellosis, but the

technique is uneconomic and poorly suited

for the laboratory with limited resources. In

view of these limitations, robust , coast

effective and rapid ELISA has been found

an ideal tool for the diagnosis .

In brucellosis, titre of IgM usually raises

from day 5 to 7 with peak titre and IgG

starts to appear from day 14 to 21, reaching

peak during next 2 to 3 weeks in the


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infected individuals. Clinical applications

of IgM and IgG ELISA in human disease

have been reported10, 11. This manuscript

deals with the study on diagnosis of

Brucella infection by laboratory

standardized IgM and IgG ELISA protocol

and its comparison to conventional

serological tests.

Materials and methods:Collection of sera samples

During the course of the study, 2 ml of

blood samples without anticoagulant was

collected aseptically in vaccutainers. The

samples were sourced from risk group

(veterinarians, para veterinarians, farm

workers, animal-handlers and farmers),

blood donors and patients with pyrexia of

unknown origin (PUO). The pyrexia may be

due to systemic cause of rheumatic fever,

jaundice, C reactive protein, hepatitis etc.,

The samples were allowed to clot,

transported to laboratory immediately at

4C. The serum was separated by

centrifuging the sample at 2500 r.p.m for 5

min and stored at 20C for further use.

Rose Bengal Plate Test (RBPT) and

Standard Tube Agglutination Test (STAT)

Sera samples received were initially

subjected to rapid screening RBPT

according to standard procedures12

. Briefly,

for the RBPT , undiluted serum sample (30

l) was mixed with an equal volume of

colored antigen on a glass slide. The results

were rated negative when agglutination was

absent and 1+ to 4+ ratings as positive,

according to the strength of the

agglutination within 1 to 3 min.

RBPT positive samples were further

evaluated by STAT and 2ME STAT by

preparing two-fold serial dilutions of the

serum samples starting at a dilution of 1:20

in the test tube and the addition of an equal

volume of plain antigen according to

Weybridge te

Scientific Research Journal of India SRJI Volume-1 Issue-3 Year-2012 Full Journal

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