International Archives of Integrated Medicine

8-15

Authors: Varun Aggarwal, Rachna Dhingra, Gurpal Singh, Shamim Monga, Anuj Jain, Vivek Bansal, Shivani

Backround: The patho-physiology of anal fissure is thought to be related to trauma to the anoderm from any cause. A tear in the anoderm causes acute pain, which results in spasm of the internal anal sphincter and decreased blood supply to the anoderm. Aim: To comparative evaluation of topical 0.2% Glyceryl trinitrate ointment and topical 2% Diltiazem ointment in anal fissure and to evaluate the role of topical 0.2% Glyceryl trinitrate ointment and topical 2% Diltiazem ointment in healing of anal fissure as compared to prevalent conservative treatment i.e. topical anaesthetics. Material and methods: The study was conducted on the patients of anal fissure reported in outpatient department of General Surgery at Guru Gobind Singh Medical College and Hospital, Faridkot including 60 patients which randomized in 3 groups, group A, group B and group C. The data was statistically analyzed using the SPSS version 16. Results: Improvement in constipation after 8 weeks of treatment were 85%, 85% and 80% in Group A, B and C respectively and p value was non-significant (0.887). Improvement in bleeding after 8 weeks of treatment were 90%, 90% and 85% in Group A, B and C respectively and p value was non-significant (0.851). Healing was 78.57%, 92.31% and 46.15% in Group A, B and C respectively. Conclusion: Topical 2% Diltiazem and 0.2% Glyceryl trinitrate ointment are equally effective in healing of chronic anal fissure. However, early pain improvement and fewer side effect profile of Topical 2% Diltiazem ointment; this study suggests it as first line treatment of chronic anal fissure.

22-26

Authors: Deepashri M, Vijayshri Deotale, Bhakti Patil

Dermatophytosis is common fungal infection of human being. To diagnose dermatophytic infections microscopic examination should be followed by culture which is essential step. Many times fungus may fail to grow on culture even after direct microscopy is positive due to non-viability of fungus. In such cases, neutral red staining helps us to know about non-viability of fungus and it has been revealed that trypsinization enhances the rate of isolation of fungus on culture. Therefore, the study was undertaken with an aim to look for the viability and yield of dermatophytes on neutral red staining and trypsinization respectively.

34-38

Authors: Harsha B.R., Chandrashekar K.T., Dakshayani K.R.

Background: Aim of the present study was to observe the measurements of posterior papillary muscles present in tricuspid valve of human heart. Measurements of posterior papillary muscles in tricuspid valve gains utmost importance in cardiac surgeries because they are the causes of myocardial infarction in recent times because of its variations and detection of these causes by advent in modern technologies which will help in treatment of tricuspid valve diseases. Material and methods: This study was carried out on 96 normal formalin fixed human heart specimens. Dissection was performed according to standard techniques. Posterior papillary muscles were observed and length, width and thickness of each muscle were measured and documented. Results: In the present study, numbers of posterior papillary muscles were present with a frequency of 0-7, with most common appearance of 2 muscles in 38 hearts (39.6%) and least common incidence of 0 muscles in 1 heart (1%). Posterior papillary muscles were present in 95 hearts, with maximum number of 7 muscles in 1 heart (1%) and minimum number of 1 muscle in 27 hearts (28.1%). In measurements of papillary muscles, posterior papillary muscle mean height was 1.05±0.37 cm, mean width was 0.63±0.17 cm and mean thickness was 0.5±0.11 cm respectively. Conclusion: This study serves to understand the morphometry of posterior papillary muscles better and can help in various surgical procedures and cardiac treatment done on tricuspid valve.

46-51

Authors: Abdul Rahim, Mukesh Tiwari

Plantar fasciitis is the most common cause of heel pain which seems difficult to treat in its most chronic and severe forms. Earlier treatments, including orthoses, non steroidal anti-inflammatory drugs, and steroid injections are paucity of supportive clinical evidence but carry the potential for serious complication and permanent disability. Platelet-rich plasma (PRP) has recently been demonstrated to be helpful in managing chronic severe plantar fasciitis when other techniques have failed. The purpose of this study was to assess the safety and preliminary clinical results of platelet-rich plasma injections for treating chronic plantar fasciitis. 163 consecutive patients with chronic plantar fasciitis receiving injections of PRP and 158 patients for steroid injections into the plantar fascia were assessed 12 months after the procedure. The visual analogue scale (VAS) for pain was used to evaluate the clinical results. According to criteria VAS score, at 12 months of follow-up, results were rated as excellent in all PRP injected patients, good and poor in steroid injected patients. In PRP injection, VAS (mean) for pain was significantly decreased from 8.6 before treatment to 0.3 at the last follow-up. PRP injection has safety and efficiency as treatment for plantar fasciitis with no side effects and complications.

62-70

Authors: Jayant L. Pednekar, Sachin Patil, Sangeeta Pednekar

Introduction: Bedside Index of Severity in Acute Pancreatitis (BISAP) is a simple bedside tool which helps in early identification of risk of higher mortality in acute pancreatitis. Objectives: Our aim was to study clinical and laboratory profiles of patients with acute pancreatitis presenting to a tertiary care hospital in Mumbai, India and to stratify patients according to their risk of mortality by applying the BISAP score and its correlation with Computed Tomography Severity Index (CTSI). Material and methods: Patients who came to Lokmanya Tilak Municipal Medical College (LTMMC) and General Hospital, Mumbai with definitive features of acute pancreatitis from January, 2013 to April, 2013 were prospectively observed for 24 hours and their clinical information was collected. CT abdomen was used as the gold standard for the diagnosis of acute pancreatitis. Descriptive analysis for various patient variables was performed using SPSS. Results: Alcoholism was the most common etiology; 97% patients presented with abdominal pain. Higher serum amylase, lipase and blood urea nitrogen levels, hypocalcemia, presence of systemic inflammatory response syndrome and bilateral pleural effusion were found to significantly associate with mortality. There was a statistically significant trend for increasing mortality with increasing BISAP score (p<0.001). However, no significant correlation between BISAP score and CTSI was found [(p = 0.101), Pearson’s correlation coefficient = 0.168]. Conclusion: Traditional severity indices have not been clinically useful since they require collection of huge amount of clinical and laboratory data over time. In such circumstances, BISAP score can predict patients who are at higher risk of mortality.

77-83

Authors: Vandana Jain, Sheenu Malik Suri, Arvind Jain

Background: Despite enormous volume of research devoted to the skeletogenous and to the quantitative studies of the developing and mature skeleton, the growth of skull in respect to its surface area is still never been comprehensively studied. Since classical study of Streeter reported gestational age estimation from crown-rump length (CRL), numerous investigators have studied and reported various measures of fetal growth during pregnancy such as biparietal diameter, diaphyseal length of long bones and even cephalometric growth analysis. Present study was done in dried fetal skull bones by calculation of their external surface area and estimation of linear correlation with crown-rump length and hence determination of gestational age. Aim: To establish the correlation between the external surface area of right parietal bone and crown-rump length, to predict fetal age from crown-rump length and calculation of growth rate of right parietal bone. Material and methods: Fifty apparently normal fetuses ranging from 12 cm – 42 cm CR length of both sexes were obtained from the Department of Obstetrics and Gynecology, of our native hospital. After measuring crown-rump length of each fetal skull after removing brain tissue via foramen magnum was then kept for maceration in running tap water. After complete maceration and separation of right parietal skull bone, measurement of external surface area of right parietal skull bone was obtained using wet cotton cloth, marker pen and graph paper. Results: The regression values were plotted in the graph and these values were found to cluster around the standard straight line and are in hand with the straight line indicating highly significant results. Conclusion: In the present study, CR length was estimated from external surface area of right parietal bone. A definite correlation was observed between external surface area of right parietal bone and CR length.

90-93

Authors: Usha Kataria, Dinesh Chhillar, Hitender Kumar, Pankaj Chhikara

Background: Diabetes Mellitus can be complicated by a variety of cutaneous manifestations. Good metabolic control may prevent some of these manifestations and may support cure. Almost all diabetic patients eventually develop skin complications from long term effects of Diabetes Mellitus on the microcirculation and skin collagen. Cutaneous infections are more common in type 2 diabetes. Patients, who had diabetes for many years, tend to develop the most devastating skin problems. Aim: To evaluate the pattern of cutaneous manifestations in Diabetes Mellitus in controlled and uncontrolled State. Material and methods: Two hundred patients with the diagnosis of diabetes mellitus type-II (100 controlled and 100 uncontrolled) attending the outpatient departments of dermatology and medicine of B.P.S. Govt. Medical College, Khanpur Kalan, Dist. Sonepat were studied. Results: Among the cutaneous disorders commonly associated with diabetes, infections (49%) were the most prevalent. Conclusion: One should be vigilant enough for the cutaneous manifestations as they are the window to the systemic illness.

100-107

Authors: T.D. Thimmappa, Amith P, M. Nagaraj, Harsha, K.S. Gangadhara, Prabhudev M.H., Moiza Nazam

Endonasal dacryocystorhinostomy (DCR) addresses the obstruction of lacrimal secretion at the level of lacrimal sac and nasolacrimal duct. It facilitates direct drainage of lacrimal fluid into nose eliminating pooling of tears in lacrimal sac. Endoscopic approach has its many advantages compared to external DCR. This study was done in a tertiary teaching hospital where 210 patients underwent endoscopic DCR, were reviewed for results and complications. The advantages with endonasal DCR were established with few complications and recurrence rate of 8% at the end of one year follow up.

113-118

Authors: Sumana Prudhivi, Satya Prabhakara Rao Yadluri, Prabhakar Rao Yella, Pasha Arif Shaik

Mucormycosis is a devastating infection caused by fungi from the order Mucorales. Rhino-orbital (RO) and Rhino-cerebral (RC) are two forms of the disease which are uncommon, acute, and aggressive infections caused by these fungi occurring in several immune - compromised states including diabetes which is the most common (60-80%) predisposing factor. Because of its rapid progression and high mortality, early recognition and aggressive treatment offer the only chance to increase the survival rate. We reported a case of Rhino-Orbital Mucormycosis (ROM) caused by Rhizopus oryzae (R. arrhizus) that developed in a 39 years old male patient with type II diabetes mellitus (DM) and pyomyositis. He was successfully managed with liposomal amphotericin B, nasal endoscopic surgery and correction of underlying predisposing factors.

123-128

Authors: Rajharsh D. Hanmante, Prabha S. Mulay, Pankaj N. Kadam, Shubha A. Deshpande

Periarticular nodules have the variety of differential diagnosis including inflammatory to neoplastic conditions. Amongst these, gouty tophus is an important differential diagnosis. Fine needle aspiration cytology (FNAC) is a valuable diagnostic tool for the diagnosis of periarticular nodules. We presented here a case of 48 years old male with multiple soft tissue nodules in extremities. Case was evaluated clinically and FNAC was advised. Fine needle aspiration revealed chalky white aspirate. The case was studied and data was collected in month of October 2013. After staining the smear with Hematoxylin and Eosin (H&E), needle shaped crystals were seen in amorphous granular debris. Diagnosis of gouty tophi was made. On further workup, serum uric acid levels were found to be high and a diagnosis of gout was established. FNAC is an easy, minimally invasive and cost effective procedure for diagnosing gouty tophus and is replacing biopsy for the diagnosis of gouty tophus.

133-137

Authors: Disha Singla, Gunvanti Rathod

Fine needle aspiration cytology (FNAC) under radiologic guidance for diagnosis of renal cell carcinoma is well established and is increasingly utilized. Guided FNAC is very helpful for diagnosis, grading and determining operability of renal tumors in adults. Ultrasonography (USG) guided percutaneous fine needle aspiration cytology of renal masses was first reported by Kristensen, et al. The exact diagnosis is possible due to the characteristic cellular features of renal cell carcinoma (RCC). Here, we presented a case of 45 years old female patient, who had retroperitoneal mass diagnosed as renal cell carcinoma on USG guided percutaneous fine needle aspiration cytology.

143-147

Authors: Sushma R Kotian, Billakanti Prakash Babu, Jitendra Singh Yadav

The skin on the dorsum of the foot is innervated by the superficial peroneal, deep peroneal, sural and saphenous nerves. Most of the dorsum is supplied by the superficial peroneal nerve. Here we report a variation in the sensory innervation of the dorsum of the left foot in a 52 years old male cadaver. The skin of the first inter-digital cleft i.e., the cleft between the great and second toes which is normally innervated by the deep peroneal nerve was also supplied by the superficial peroneal nerve. A communication between the superficial and the deep peroneal branches were also observed prior to innervation. In addition, the fourth inter digital cleft i.e., cleft between the fourth and fifth toes which is normally innervated by the superficial peroneal nerve was supplied by the sural nerve. Cutaneous nerves on the dorsum of foot are at risk for iatrogenic damage while performing arthroscopy, local anaesthetic block, and surgical approach to the fibula, open reduction and internal fixation of lateral malleolar fractures, application of external fixators, elevation of a fasciocutaneous or fibular flaps for grafting, surgical decompression of neurovascular structures, or miscellaneous surgery on leg, foot and ankle. Therefore a detailed knowledge about the variations in the pattern of cutaneous innervation of dorsum of foot may decrease the damage to these nerves during operative procedures.

152-160

Authors: Sujit B Koshire, Vishnu P Joglekar

Ayurveda has its own unique way of approach towards the management of visha, and is discussed with the concepts of current science. Snake bite remains an underestimated cause of accidental death in India. Estimates of snakebite mortality in India vary from approximately 1,300 to 50,000 annually. Considering this, World Health Organization added snake bite to their list of neglected hot diseases and designed an exclusive protocol for its management. Acharya Charaka has given 24 Upakramas to counter the cases of poisoning, including Mantras. These can be categorized into different sets of sub divisions for easy and scientific understanding. In the current attempt, efforts were made to provide certain justifications to these classical remedial measures with special emphasis on the measures that restrict the entry of poison into systemic circulation.

165-168

Authors: Neetha J Shetty

The periodontally accelerated osteogenic orthodontic (PAOO) technique combines selective decortication facilitated orthodontics with periodontal regeneration in order to create rapid orthodontic tooth movement (OTM). This reduces potential side effects like root resorption, tooth devitalization, relapse, inadequate basal bone and bacterial time-load factors like caries and periodontal infection. Tooth movement can be achieved with increased alveolar volume providing for a more intact periodontium, decreased need for extractions, degree of facial remodelling and increased bone support for teeth and overlying soft tissues, thus, augmenting gingival and facial esthetics. With an increasing number of adults considering orthodontic treatment, with a propensity for periodontal problems, PAOO technique can be a powerful and attractive treatment option in dental treatment.