International Archives of Integrated Medicine

8-13

Authors: Aasim Farooq Shah, Manu Batra, Vikram Aggarwal, Subha Soumya Dany, Prashant Rajput, Tushika Bansal

Introduction: Dental caries is also one of the major issues which interfere with the healthy life of an individual, especially in children. Due to its high prevalence worldwide, caries in children has often been described as a ‘pandemic’ disease. In preschool age children, this disease is called Early Childhood Caries (ECC), but is commonly known as “baby bottle tooth decay” or maxillary anterior caries. About 90% of school children worldwide experience dental caries with the disease being most prevalent in Asia and Latin American countries and least prevalent in African countries. This study was undertaken with the aim of assessing prevalence of ECC among preschool children of low socioeconomic status in Srinagar city. Material and methods: A cross-sectional study, approved by the institutional Ethical Committee was designed. Children were selected from various Anganwadi centres in Srinagar city, Jammu and Kashmir, India. All children 24–59 months old, attending the selected Anganwadi centres, forming a total of 466 were selected. Clinical examination was carried out at Anganwadi centres or concerned schools by a single calibrated examiner. Data was analysed using SPSS version 16.0 software. Results: Out of the 466 children examined, 229 (49.1%) were boys and 237 (50.9%) were girls. The prevalence of ECC was 39.9% (186 out of 466) out of which 102 (54.8%) were boys and 84 (45.2%) were girls. Whereas prevalence of ECC was significantly higher among 36–47 months old children as compared with other groups (χ2 = 14.03, P = 0.001). The overall mean deft for ECC was 1.80 ± 3.18 ranging from 0 to 17 teeth. Mean deft was significantly higher in 36–47 months age group as compared with others (F = 10.89, P = 0.000). Conclusion: There is an urgent need to implement Preventive and Curative Oral Health Programs for children. As Anganwadis are run by State Government, a public–private partnership between the government, Private Dental Colleges, and Non-Government Organizations (NGOs) would prove useful toward providing oral health care to these children.

21-27

Authors: Manjeet Singh Dhanda, Anurag Ambroz Singh, Manpreet Kaur, Abhishek Singh, Yogesh Kumar, Avinash Surana, Anu Bhardwaj, Sanjeet Panesar, Setu Satani, S. S. Qadri

Background: The need for research into bed sores in orthopedic patients is evident from the increased number of beds they occupy and the considerable morbidity from pressure sores in orthopedic wards. Objective: To analyze and ascertain the prevalence and clinical evaluation of Pressure Ulcers from orthopedics wards of a tertiary care teaching hospital. Material and methods: The present prospective study was conducted by the Department of Orthopedics of a tertiary care teaching hospital from July 2009 to August 2014 among 228 patients seeking care for trauma to proximal femur, hip joint, pelvis and undergone elective surgery or surgery for removal of old implants. Braden scale was used for predicting pressure ulcers in the study subjects. All patients showing the potentiality of developing clinical signs of bed sores were selected and put on the study list. Patients aged ≥ 80 years, sick patients due to terminal illnesses and the worst pressure sores were excluded from the study. Results: Out of total 228 study subjects, 61 subjects developed pressure ulcers giving a prevalence of 26.75%. According to Braden Scale, 16.39% of patients were at high risk for developing the pressure ulcers. 68.85% of ulcer patients were treated for trauma mostly for fracture hips, pelvis or proximal femur or spine. Majority of patients (60.66%) developed pressure ulcers after the second week of admission. The lengths of stay of patients with bed sores exceed the stay of non sores patients on orthopedic wards by several times. Sacrum was the most commonly affected part of body. Conclusion: The findings of the current study highlight the multi-factorial etiology of pressure ulcers and they are preventable. Its prevention would require multidimensional approach including the collaboration of all the nursing and surgical staff. Frequent patient turning, close monitoring and frequent skin checks would delay the onset of pressure ulcers.

40-46

Authors: Anna Todorova, Antoaneta Tsvetkova, Silvia Mihaylova

Over the last few years, bronchial asthma morbidity in pediatric patients has been constantly rising. Asthma is considered the most common disease in adolescents. Our survey was focused on two age groups of pediatric patients: 6 to 12 years old and 13 to 16 years old. It encompassed the period from 2008 to 2013. We examined the use patterns of LTRA (montelukast) and its substantial share of the overall use of asthma controller medications. The results revealed a distinctive upward trend in the use of LTRA (montelukast) in both age groups. The mean absolute growth of montelukast (5 mg) in the group of 6 to 12 years old was 521.6 packs, and the mean growth rate was 333.9%. In the age group of 13 to 16 years old, the mean absolute growth of montelukast (5 mg and 10 mg) was 226.8 packs, and the mean growth rate was 341.3%. Both the drug profile and physicians’ propensity to prescribe innovative medicines promote the use of LTRA (montelukast) as an asthma control drug for childhood patients.

54-56

Authors: S. Chaitra

Background: Diagnosis of acute appendicitis is challenging particularly in pediatric age group even in the hands of experienced surgeons. Acute appendicitis can be atypically presented in children with non specific abdominal symptoms. In addition, there is increased incidence of perforation within pediatric age group of about 20-50%. Hence, finding cheap, quick and reliable investigatory tool is mandatory. White blood cell count (WBC) is elevated in an inflammatory conditions including appendicitis. Therefore it can be used to support the clinical diagnosis of acute appendicitis. Therefore Gronroos, et al. suggested that we can totally avoid 25% 0f negative appendicitis by measuring WBC level in patient clinically suspected appendicitis. Material and methods: The present study was conducted in 50 pediatric age patients at the hospital who have been clinically diagnosed by surgeons as having acute appendicitis and posted for emergency appendicectomy. Pre-operatively blood was sent for WBC estimation, after operation all specimen were sent for histopathological examination (HPE), results of WBC were correlated with HPE reports to evaluate their role in diagnosis of acute appendicitis. Results: In present study, WBC has highest sensitivity and specificity of 90% and 85% with positive predictive value of 90%. Hence, it has proved that WBC level can be used to rule out negative appendicitis, so that surgery can be deferred in them and to reduce the rate of negative appendicectomies. Conclusion: WBC can support the clinical diagnosis of acute appendicitis especially in pediatric age in reducing the negative appendicectomy rate drastically. Hence it is recommended to get WBC level done in all pediatric age patients with suspected appendicitis.

68-72

Authors: Ashwini Narayan K, Manjunath MR, Kusuma KN

Background: Blood is considered to be the most common trace evidence obtained from the scene of crime. Blood grouping reveals vital information regarding identification, in relation to crime investigation. With this respect contamination with dust, rust, bacteria and detergent will have any effect on blood grouping was studied. Material and methods: Randomly A, B, AB, Rh positive samples were taken in duplicates and were added with rusted pins, dust particles, detergent, staphylocopcci bacteria and without any addition one tube was kept in room temperature. Controls were kept in refrigerator at 4-8 ˚C to compare the results. Results: There were lots of changes in blood groups after 10 days of incubation in all tubes with contamination. Blood samples in dust after 10 days incubation had changed from A, B, AB to O blood group with Rh negativity. Blood samples in rust had retained with original ABO group but Rh positives were converted to Rh negative. Detergent tubes had also changed Rh positives to negatives retaining original ABO. There was no change in either ABO or Rh blood groups in tubes with Staphylococci bacteria. Conclusion: Stains contaminated with common agents like dust, rust, bacteria and detergent give inconclusive results by mixed agglutination method with passage of time. The results may be accepted with caution, as the opinion might be medico legally significant.

79-86

Authors: Prashant J Patil, Sarika P Patil, Vilas G Jaltade, Satishkumar S Gupta

Background: Medical equipments are necessary to effectively monitor, treat and support the care of patients by doctors in the management of their medical conditions. Proper maintenance affects the performance and safety of equipment. As equipments are part of health care provision in hospital, it is necessary to have well planned and managed equipment maintenance system in the organization. Aim: The study revealed the medical equipment maintenance system in Physiology Department of tertiary care government teaching institute. Material and methods: A retrospective observational study, during February to June 2014 of fifty-two equipments costing more than 10,000 rupees was done for their maintenance system in the department. Information about equipment was collected by onsite inspection and departmental equipment records in structured proforma. Results: In the study, 45 mechanical and 7 electrical equipments costing less than 100,000 rupees were evaluated. It was found that 94.2% equipments did not have any service contract. From time of installation in the department it was found that most equipment i.e. 53.8% had crossed the life period of 15 years. Maximum i.e. 85.7% electrical equipments had crossed their average life period. There was no proper maintenance of logbook and non availability of the user manual by the side of 84.6% of the equipments in department. Service history in worksheet of all 52 instruments was not recorded, post warranty maintenance in all equipments was by local personals only which was needed in 90.4% equipments. Out of equipments needing the maintenance and repair, it was corrective type in 98.2% times and reactive type in 1.8% times. There was no special training of the technicians about the maintenance of equipments. 73.1% equipments were working while 21.2% were awaiting repair. The procedure of ‘maintenance request’ was noted in log book for all equipments. 3 of the equipment were having the long down time period above 5 years. Non functional equipment with long down time period was due to non availability of the spare parts in 21.2% equipment and vendor was not responding for maintenance in 5.7% equipment. Conclusion: There was need of proper equipment maintenance system in department. The long down time period of equipment was due to old technology, non-availability of parts and non-responding vendors.

96-102

Authors: R. Subhashini, N. Uma

The study conducted in retrospective manner in 150 bedded Government Victoria Hospital; a Maternity Hospital affiliated to Andhra Medical College, Visakhapatnam, Andhra Pradesh. The rates and indications of primary and repeat Cesarean sections (CS) were analyzed among 8121 live births during the year 2014 and present Cesarean section rate was compared with 2004 and 2009 Cesarean rates. In our study, the Cesarean section rate was 25.66%. There is an increase in the CS rate over last decade from 16.14% in 2004, 20.33% in 2009 to 25.66% in 2014. The main contribution to this rise in CS is due to increase in numbers of repeat sections. CS becomes increasingly the procedure of choice in high risk pregnancies to prevent perinatal morbidity and mortality. This has become possible due to improved patient care, availability of effective antibiotics, blood transfusion services, safer anesthesia, improved surgical technique and sophisticated neonatal care services.

108-118

Authors: B. Bheeshma, V. Geetha, Jay Raju, Sandhya Manohar

Cardiac deaths account for 50% of all deaths in developed and 25% in the developing world. One-sixth of world’s population lives in India and heart disease accounts for 24% of all deaths. Sudden death accounts for two-thirds of all autopsies in Forensic Medicine. Actual detection of histological sequence of the infected myocardium will develop only after significant time of, between onsets of myocardial infarction (MI) in death. Cardiac Troponin-T is not normally present in serum unless cardiac necrosis has occurred therefore cardiac Troponin levels act as a specific and sensitive indication of myocardial infarction. The present study was conducted on cases coming for medico legal autopsy to the Forensic Medicine Department at Gandhi Medical College/Hospital, Hyderabad, Andhra Pradesh, India for a period of 1 year from January 2014 to December 2014. Total 12 cases with 6 controls were analyzed. Cardiac Troponin-T Level was markedly elevated >2.000 ng/ml in all except one case of suspected MI. Sensitivity was found to be 91.66% and specificity 66.66%.

126-133

Authors: Mushtaq Ahmad Mir, Mohammad Akbar Bhat, Farooq Ahmad Ganie, Ghulam Nabi Lone, Hafeez ulla Lone

Background: Patients with normal pulmonary function tolerate removal of an entire lung without respiratory problems. In patients with impaired pulmonary function, post resectional function is of importance for the assessment of surgical risk. This necessitates the ability to measure the relative contribution of the parenchyma to be resected to the total lung function and the predicted postoperative lung functions. Objective: To determine preoperative lung functions as assessed with split lung functions and correlates with postsurgical lung functions and to determine the effect of lung resections on spirometric lung function. Material and methods: All those patients planned for lung resection surgery were included in the study. Predicted postoperative FEV1 and FVC were calculated. Preoperative spirometry was performed within a week before surgery. Predicted postoperative values were calculated. Postoperative spirometry was performed at the end of first month, third month, and sixth month for each patient. The relationship between potential predictors and postoperative complications were assessed. The predicted values were correlated with measured values (actual values) during the postoperative follow up. Results: Lobectomy was done in 64 persons. The predicted postoperative FEV1 and FVC correlated well with observed FEV1 and FVC in lobectomy (p<.05). The mean preoperative FEV1/L were 1.8 and the mean predicted postoperative (L) FEV1 were 1.4. The mean FEV1 at 1 month follow up were 1.6 and the mean FEV1 at 3 month follow up were 179.8. Conclusion: Our study showed that simple calculations based on preoperative pulmonary function studies correlated well with the actual postoperative FEV1 and FVC for patients undergoing lobectomy. This calculation, however, underestimates the actual postoperative FEV1 and FVC by 230 ml in lobectomy.

142-145

Authors: Mahendra G, Ravindra S. Pukale, Vijayalakshmi S, Priya

“Couvelaire uterus” or “Utero-placental apoplexy” is a rare complication of severe forms of placental abruption. It occurs when vascular damage within the placenta causes hemorrhage that progresses to and infiltrates the wall of the uterus. We presented here rare case of 23 years old female with Couvelaire uterus.

151-154

Authors: BG Jayawickrama, WMASB Wasala, MVG Pinto, KB Galketiya

We have presented here a case of a twenty three year old male who successfully recovered of a massive right lung injury by rapid transport, insertion of inter costal drain, emergency thoracotomy for resection of upper and middle lobes and post operative intensive care.

161-164

Authors: Usha Kataria, Dinesh Chhillar

Epidermal nevi are congenital hamartomas of embryonal ectodermal origin classified on the basis of their main component. The component may be sebaceous, apocrine, eccrine, follicular or keratinocytic. An estimated 1/3 of individuals with epidermal nevi have involvement of other organ systems; hence this condition is considered to be epidermal nevus syndrome. Solomon defined epidermal nevus syndrome as a sporadic neuro-cutaneous linkage of congenital ectodermal defects in the skin, brain, eyes and skeleton, now also referred to as Solomon syndrome. The syndromes are uncommon. Mortality and morbidity are associated with systemic anomalies.

169-174

Authors: Manu Rathee, Priyanka Boora, Poonam Malik

Achieving excellence in aesthetics and preservation of remaining structure is the ultimate goal in preventive prosthodontic. Overdenture is a conservative and preventive approach and is essentially a preventive prosthodontic concept as it endeavours to preserve remaining teeth and thus found to be eminently suitable for treating patients with few remaining natural teeth. This case report discusses the merits of using selectively retained roots and abutments to minimize alveolar ridge resorption underneath the complete denture fabricated as maxillary overdenture and mandibular fenestrated denture.

179-182

Authors: J. Abirami Krithiga, S. Jeyakumar, R. Jaivinod

We have reported here a case of thoraco diaphragmatico biliary fistula in a 24 years old male who was managed conservatively with antibiotics and tube thoracostomy and had complete radiological clearance. Thoracobiliary fistulas (TBF) (bronchobiliary and pleurobiliary) are rare complications of thoraco-abdominal trauma. Owing to their rarity, there is little consensus on the optimal management. The diagnostic suspicion however must be considered and it's important the correct selection of diagnostic imaging techniques.

188-192

Authors: Kandukuri Mahesh Kumar, Ch. Krishna Reddy, T. Divyagna, R. Swarupa, Chintakindi Sravan, K. Shashi Kiran

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. Most of the cases are located in the stomach followed by the small intestine. They arise from the interstitial cells of cajal, which are located in the wall of the intestine. Malignant GISTs are rare type of tumors in GIT. Small intestine GIST is more likely to be malignant compared to stomach. Here we reported such a rare case of malignant GIST in a 54 years old female patient who came to the hospital with complaints of pain and mass in abdomen. Ultrasound revealed a mass originating from the duodenum. Provisional clinical diagnosis of duodenal carcinoma was considered preoperatively. Patient underwent complete surgical excision of the tumor. Histopathological examination confirmed the diagnosis of malignant GIST. As the recurrence rate for malignant GIST is high, patient was kept on follow up.

197-202

Authors: Ch. Krishna Reddy, Kandukuri Mahesh Kumar, T. Divyagna, Chintakindi Sravan, R. Swarupa, K. Shashi Kiran

Fibroadenomas are the most common benign tumor of the breast. It can occur in women of any age, but the peak incidence seen in young adolescent women during the second and third decades of life. Fibroadenoma is a biphasic tumor, composed of an epithelial and a stromal component. Even though they are solitary lesions, multiple fibroadenomas can also occur especially in the older age group. Breast fibroadenomas seemed to display a wide spectrum of proliferative and non-proliferative histologic changes. Of all these changes, carcinoma arising from fibroadenoma is a rare occurrence. Here, we have presented such a rare case of carcinoma in situ arising from the long standing multiple fibroadenoma in a postmenopausal women. Clinical and radiological features are not helpful in identifying carcinoma arising from fibroadenoma. Histopathological examination of the excised specimen should be done for the confirmation of the diagnosis.

206-210

Authors: Navneet Kumar Kaushik, Anup Aggarwal, Mohita Singh, Shelja Deswal, Priyanka Kaushik

Recently, vegetarian diets have experienced an increase in popularity. A growing body of scientific evidence indicates that wholesome vegetarian diets offer distinct advantages compared to diets containing meat and other foods of animal origin. A vegetarian diet may be adopted for various reasons that can include ecological, economic, religious, ethical, and health considerations. In the latter case they arise from the desire to lose weight, in tackling obesity, improving physical fitness and/or in reducing the risk of acquiring certain diseases. It has been shown that properly applied vegetarian diet is the most effective way of reducing body mass (expressed as BMI), improving the plasma lipid profile and in decreasing the incidence of high arterial blood pressure, cardiovascular disease, stroke, metabolic syndrome and arteriosclerosis. In addition, improved insulin sensitivity together with lower rates of diabetes and cancer has been observed. Some studies have however found that a vegetarian diet may result in changes adversely affecting the body. These include: hyperhomocysteinemia, protein deficiency, anemia, decreased creatinine content in muscles and menstrual disruption in women who undertake increased physical activity. Some of these changes may decrease the ability for performing activities that require physical effort. Nevertheless, on balance it can be reasonably concluded that the beneficial effects of a vegetarian diet significantly, by far, outweigh the adverse ones. It should also be noted that the term ‘vegetarian diet’ is not always clearly defined in the literature and it may include many dietary variations.