International Archives of Integrated Medicine

1-4

Authors: Usha Kataria, Sunita Siwach, Dinesh Chhillar

Background: Vaginal discharge is a common symptom of genital infection in woman. Identifying its source can be challenging as large number of pathogens causes vaginal and cervical infection and several other infections may coexist. Aim: To find out the possible causes of vaginal infection in sexually active woman. Material and methods: One hundred sexually active females in the age group of 20-45 years with complaints of vaginal discharge were selected for the study. A detailed clinical history and a thorough clinical examination were carried out. After making the clinical diagnosis appropriate test for diagnosing candidiasis, trichomoniasis, gonorrhea and bacterial vaginosis were done. Results: The present study showed 34% incidence of bacterial vaginosis, 30% vulvo-vaginal candidiasis, 14% trichomoniasis, 2% gonorrhea, 2% normal physiological discharge and 18% non specific urogenital infections. Conclusion: Every patient, who complains of vaginal discharge, should be thoroughly interrogated, examined and investigated properly.

11-16

Authors: Alpesh B. Amin, Rajesh D. Patel, Chirag Doshi, Amit V Bhuva

Objective: To compare the effectiveness of conservative medical treatment versus minimal invasive surgical techniques like percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) in the management of liver abscess. Material and methods: All patients with liver abscess who were admitted in Surgery from October 2013 to June 2014 were included in this study and were exposed to four different treatment modalities. The patients were first treated with combination of medicine (Option - A). If they failed to respond to this treatment then they were subjected to ultrasound guided aspiration (Option - B). If Option - B failed they were exposed to pig tail catheter placement (Option - C). Final option was surgical drainage (Option - D) if it was rupture liver abscess and if the patient presented with co morbid conditions like septicaemia and peritonitis. PNA was repeated every third day if the cavity size had not declined to 50% of the original for up to three times. Persistence of cavity or of clinical symptoms was considered failure of treatment. Results: Out of 51 patients, 14 patients responded to drug therapy alone. 34 patients required ultrasound guided aspiration and Pig tail catheter placement and 3 patients required open surgical drainage. A combination of drug therapy and ultrasound guided needle aspiration was effective for majority of 83% patients Duration of hospital stay was similar in the two groups. Conclusion: Minimal surgical interventions like PCD and PNA are better than conservative treatment for the management of liver abscesses of size >5 cm, in terms of duration to attain clinical relief and duration for which parenteral antibiotics are needed. Pyogenic liver abscess are less common than amoebic liver abscess. Right lobe of the liver is most commonly involved in both types of abscesses. Radio-imaging techniques like ultrasonography (US) and computerized tomography (CT) are the modalities of choice for investigation purposes. Treatment modalities of these abscesses, first emphasizes on medical treatment, but if it is unsuccessful then only the surgical intervention should be taken up. Laparotomy and Drainage or Laparoscopic Drainage remains the standard of care for ruptured liver abscess.

27-33

Authors: M S Sulakshana, S M Ahmed, A R Raghupathi

Aim: To study the bone marrow changes in elderly patients (above 60 years of age). Material and methods: Bone marrow records from the pathology laboratory in the Department of Pathology, Bangalore Medical College, Bangalore, from March 2012 to June 2013, were searched, and cases from all patients at least 60 years old at the time of bone marrow study were retrospectively reviewed. Results: During the 16 months period, 164 bone marrow examinations were performed, and out of these, 50 patients were at least 60 years old. The age range of the patients was 60 to 82 years, 27 were males and 23 were females. 47 cases (94%) yielded specific diagnosis. 27 cases (54%) had nutritional anemia, 6 cases (12%) were diagnosed as myeloma, 3 cases (6%) had aplastic anemia, 3 cases (6%) had chronic lymphocytic leukemia/ small lymphocytic leukemia infiltrating the bone marrow; 2 cases (4%) had acute myeloid leukemia, 2 cases (4%) had hypocellular marrow with myelofibrosis - grade 3, 2 cases were diagnosed to have monoclonal gammopathy of undetermined significance (4%), 1 case (2%) had metastatic deposits from prostatic carcinoma and 1 case (2%) had metastatic deposits from renal cell carcinoma - clear cell variant; 1 case (2%) of myelodysplastic syndrome - refractory cytopenia with multi lineage dysplasia and ringed sideroblasts was diagnosed. Conclusions: In this study we found that after nutritional anemia, plasma cell dyscrasias were the most common findings in bone marrow studies in elderly patients. Diagnosis of plasma cell dyscrasias prompt for early institution of treatment resulting in reduced morbidity and mortality in such patients.

39-51

Authors: M.S. Siddegowda, Mahadeva Nayaka, S. Shivakumar

Introduction: Thyroid lesions are rare in children and youth. Compared to adults, they show high malignancy rate. Peak incidence is between 20 to 24 years of age. Objectives: To evaluate the utility of Fine Needle Aspiration Cytology (FNAC) of thyroid lesions in children and youth by “The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC)”. Materials and Methods: A prospective study was conducted over a period of 18 months. FNAC was performed on 106 children and youth of 1 year to 24 years age and classified according to TBSRTC. Results: Median age was 18.9 years. Majority (57.5%) were females in 20 years to 24 years age group. Out of 106 patients, 4.7%, 85.8%, 4.7%, 1.9%, 0.9% and 2% were distributed among diagnostic categories I, II, III, IV, V and VI of TBSRTC respectively. Six (5.6%) patients underwent surgery and histopathological study was done. The sensitivity, specificity and accuracy rates were 100%, 97.8% and 98% respectively. Conclusion: TBSRTC for FNAC of thyroid is a definitive diagnostic test to triage patients on the requirement of surgery and to differentiate malignant from non-malignant lesions in children and youth.

57-63

Authors: Manpreet Kaur, Manjeet Singh Dhanda, Abhishek Singh, Bikramjeet Singh, Pooja Goyal, Shewtank Goel, Avinash Surana, Sanjeet Panesar, Anurag Ambroz Singh, Richa Chaturvedi, Lalit Kumar Singh

Background: Voluntary eye donation depends on the awareness levels of various stakeholders in the community. Today’s medical students are tomorrow’s stakeholders of the community. Medical professionals can enhance eye donation rates by educating and motivating the relatives in case of patient's death. Aim: Hence the present study was undertaken with an objective of assessing the promoting factors for eye donation among medical students. Material and methods: The present descriptive cross sectional study was carried out among undergraduate students of a medical college in western Uttar Pradesh in the month of February 2014 using pretested self administered questionnaire. Results: 77% students knew about eye donation. 51% of them were willing to donate their eyes. Only 39% students knew that the ideal time for eye donation is within 6 hours of death. 64% had knowledge about vitamin A’s important role in prevention of childhood blindness. TV, newspaper or other media were the most important channels of getting information for majority (60%) of the students. Regarding perceived promoting factors for eye donation by them, noble cause (57%), pleasure to help the blind (51%) and inspired by advertisement on television (42%) were 3 top most promoting factors. Conclusion: Inclusion of different preventive and promotive aspects of corneal blindness along with basic eye health care into the course curriculum is the need of the hour.

70-77

Authors: Junu Devi, Kunja Lal Talukdar

Background: Accounting for less than 2% of all human neoplasms, salivary gland tumors are relatively uncommon and it comprises a morphologically diverse group of rare tumors. FNAC has been employed in pre-operative diagnosis of salivary gland tumor as essential diagnostic tool to diagnose swelling in major and some minor salivary glands. Superficial locations of salivary glands make them suitable for FNAC. Objectives: To find out the frequency of different types of salivary gland tumors in a hospital based samples and make clinicopathological correlation. Material and methods: FNAC of all 84 patients was done using 22 gauge needle and 10 ml syringe applying negative pressure, smears were either wet fixed or air dried and stained by Papanicolau and Giemsa stains respectively. Histopathological examination was done whenever available and was compared with FNAC diagnosis. Results: In this study, overall male predominance with male to female ratio was 1.4: 1. Maximum number of cases of salivary gland neoplasms occurs in 3rd decade of life. Incidence of malignant and benign parotid neoplasms was 32.14% and 67.86% respectively. Parotid was the most commonly affected salivary gland. Benign tumors were more common in parotid gland however, malignant tumor were more common in submandibular gland. Pleomorphic adenoma (60.71%) was most common benign tumor and mucoepidermoid carcinoma (22.02%) was the most common malignant tumor. Conclusion: FNAC is a simple quick inexpensive and minimally invasive technique to diagnose different types of salivary gland tumor. It could easily differentiate benign from malignant neoplasms and can be helpful for management of patient. Thus, FNAC can be recommended as first line of investigation in the diagnosis of salivary gland tumors.

83-89

Authors: Shama Prakash, Manpreet Kaur, Bikramjeet Singh, Abhishek Singh, Pooja Goyal, Avinash Surana, Shewtank Goel, Sanjeet Panesar, Anurag Ambroz Singh, Richa Chaturvedi, Lalit kumar singh

Background: Identification of factors affecting utilization of primary eye health services would help the government and other eye care providers to address inequity issues in their eye care program. Aim: Therefore this study was planned to find out barrier to utilization of eye health services among people living in rural western Uttar Pradesh. Material and methods: The current community based cross-sectional survey which involved both qualitative and quantitative methods, was conducted among the residents. A total of 216 study subjects participated in the study. Factors in the supply side influencing utilization of eye health services by people from the community were sought through Focus Group Discussion (FGD) and Key Informant Interview (KII). Results: Almost 80% of the respondents had agriculture as their major occupation and > 1/4th were from lower caste community. Regarding the seeking of eye care services, 52.4% respondents who gave a positive history of an eye problem in the family told they attended the nearest health facility; CHC, PHC or SC while 19.2% did actually go to the eye health center. Only 4.8% respondent did not seek any service. Among 112 respondents who were aware of one or other eye diseases, 74.6% identified dirty things fallen into the eyes as the cause of an eye problem followed by 50.3% of the respondents who pointed out injury to the eyes as the culprit. For emergency problem in the eyes 79.2% respondents told that they sought services from health facilities without delay, while 15.4% gave priority to starting household treatment. Conclusion: Raising awareness of the community about eye diseases and the services available together with strengthening of primary eye health services available at the local health facilities could help bring eye health services in closer proximity to the rural population.

96-113

Authors: Mahim Koshariya, M.C. Songra, Rohit Namdeo, Arpan Chaudhary, Sumit Agarwal, A. Rai

Hospital-acquired urinary tract infection (UTI) is the most common infection acquired in hospitals. Up to 25% of hospitalised patients undergo urinary catheterisation, a similar proportion of patients cared for in residential homes will have long term indwelling catheters. Although often necessary intervention, indwelling urinary catheters are a leading cause of nosocomial infections and have been associated with both morbidity and mortality. The urinary tract accounts for more than 40% of total number of nosocomial infections. Most nosocomial infections associated with urinary tract follow instrumentations, usually with the catheter. Results of several studies demonstrated that this antibiotic drug prophylaxis has increased the rate of isolation of resistant organisms. To ensure appropriate therapy, current knowledge of organisms that cause UTI and the antibiotic susceptibility is mandatory. The aim of present study was to assess the bacterial profile for catheter associated UTI and the antimicrobial sensitive to most commonly used antibiotics, used in the therapeutic or prophylactic settings before the results of the urine culture are available. In our study, the incidence of infection in catheterized patients was found to be 27% which was low but comparable to studies done in India and Western studies. E. coli was the most common cause of catheter associated infection and highest sensitivity was found to Amikacin.

119-125

Authors: Madhureema Das, Aparajita Dasgupta

Introduction: Unregulated fertility not only has adverse impact on the health of a woman and her child but also disrupts the economy of society and nation. Thus appropriate knowledge and practice of contraception by couples can help in reducing population burden in a major way and thus markedly improve both health and economy of the nation. Aim: This study was undertaken to determine the knowledge and practice of contraception among married women in rural West Bengal and association of practice with female literacy. Material and methods: A cross-sectional, clinic-based study was conducted using a pre-designed semi-structured questionnaire on 104 married women in the reproductive age group, attending the outpatient department of a rural health centre at Singur block, West Bengal. Pregnant women were excluded from the study. Results: Majority of the women had knowledge about permanent methods (99.03%), oral pills (95.19%) and condoms (94.23%) but very few knew about emergency contraceptives (8.65%) and none about female condoms, diaphragms and implants .Social circle (41.3%) and health personnel (31.7%) served as the major sources of information. 85.57% were currently using some form of contraception. Most of the current users (49.04%) had undergone tubal ligation but none adopted male sterilization. Completion of family was the main reason of usage (57.3%) and fear of side effects (46.7%) and desire for children (40%) were the main reasons behind non usage. Husbands mostly decided the method of contraception (64.04%). Education served as a significant determinant of contraceptive use. Conclusion: Elimination of stigma related to vasectomy and women empowerment and literacy will improve contraceptive use.

137-152

Authors: Rajeev R. Shah, Meeta Gupta

Background: AIDS emerged as one of the most important public health issues of the late twentieth and early twenty-first centuries. The AIDS epidemic has prompted wide-reaching changes in public health, clinical practice, and scientific research, and has had a great impact upon societies throughout the world. Aim: This article gave an insight into beak up of mode of transmission seen in our studied area of Gujarat, which highlighted in which area one should focus more at least to control the prevalence of HIV. Material and methods: In the present study, 961 HIV sero-positive patients (T group) were screened with respiratory tract infections and more 300 HIV sero-positive patients but without respiratory tract infections (C2 group) had been inquired and collected their information about mode of transmission and other demographic characters like age, literacy, financial status, gender etc. Results: The highest patients had acquired HIV by hetero-sexual mode of transmission. In T group it was found to be in 773 (80.43%), while in C2 group it was seen among 257 (85.67%) HIV infected patients. But when both groups are merged which we consider TC2 group, this hetero-sexual mode of transmission was noted in 1030 (81.68%) HIV infected patients, followed by mother to child transmission (MTCT) which was found in 101 (10.51%) patients of T group while MTCT was seen in 29 (9.67%) HIV infected patients of C2 group. Conclusion: If anybody knows exact percentage of acquiring HIV in the particular area, one can work on this direction, to reduce that particular mode of transmission so that at least prevalence of HIV could certainly be decreased tremendously in that particular area, state, country and ultimately from globe. Minimum transmission of HIV can be achieved by widespread of ABC (Abstinence, behavioral change, condoms) policy and with additional maximum and quick implementation of TasP (Treatment as prevention), PrEP (Pre-exposure prophylaxis) and PEP (Post exposure prophylaxis) as and when required in the all ART Centres of our country.

156-160

Authors: J Janardhan, P Venkateshwar, K Sreedhar Rao

A 10 years prepubertal age girl presented with huge 17 X 14 cm painless breast lump of four months duration. Based on the cytological, imaging and clinical findings a preliminary diagnosis of benign proliferative breast lesion closest to giant fibroadenoma was offered. Giant fibroadenomas are rare in young girls and are difficult to differentiate from low grade phylloides tumor by cytology/ imaging. Giant fibroadenomas have to be differentiated from phylloides tumor by the lack of leaf-like structures and stromal cell atypia and from the breast hamartoma and asymmetric breast hypertrophy in girls by the lack of mammary lobules. Giant fibroadenoma should take its due place in the diagnostic algorithm of the breast tumors. Marginal excision with nipple areola sparing and close follow up should be the standard of treatment in young girls.

166-169

Authors: Annie Jain, Gunvanti Rathod

Oncocytomas are benign salivary gland tumors composed of oncocytes, cuboidal to columnar epithelial cells with abundant eosinophilic cytoplasm secondary to the accumulation of excessive number of mitochondria. In 1894, the German pathologist Hurthle first described these granular cells in normal canine thyroid glands, while the term "Oncocyte" was coined by Hamperl in 1931. Fine Needle Aspiration Cytology (FNAC) has increasingly been used as a primary screening tool for salivary gland lesions with high levels of sensitivity and specificity. However, caution should be exercised when interpreting aspirates with predominant oncocytic population. Final diagnosis is assisted by CT and/or magnetic resonance imaging (MRI) of the neck and histopathologic examination.

175-178

Authors: Nataraj Naidu R, Shreeharsha Mallappa Awati

A 32 years old healthy male, married for 6 years presented with infertility. Clinical examination revealed normal external genitalia with underdeveloped empty scrotum. Radiological investigations reported bilateral intra abdominal testis with left testis showing features of teratoma. Intra-operative findings showed bilateral intra abdominal testis along with uterus and fallopian tube and left testis with features of teratoma. Histopathology confirmed the presence of uterus, cervix, right adnexa with atropic testis with tube, seminal vesical, epididymis, and left adnexa ovotestis with mature teratoma, tube and epididymis. Cytogenetics reported 46, XY karyotype. This case is rare presentation of combination of male phenotype true hermaphrodite with presence of teratoma.

182-186

Authors: Nupur Singla, Gunvanti Rathod, Disha Singla

Adenoid cystic carcinoma (ADCC) is a relatively rare malignant salivary gland tumor comprising less than 1% of all malignancies of head and neck. It can arise in any salivary gland site, but approximately 50–60% develops within the minor salivary glands. On fine needle aspiration cytology (FNAC), hyaline globules surrounded by neoplastic cells forming a cell ball are the diagnostic. Adenoid cystic carcinoma, being rare, was not suspected at the first instance. The final diagnosis was made from the cytological, radiological, and histopathological reports.

190-194

Authors: Meraj Rentia, Krunal kalaria, Himanshu Singla, Shreedevi Patel, B.N. Patel

Slipped capital femoral epiphysis is a disorder of the hip that affects children in late childhood and early adolescence, characterized by medial and posterior displacement of the proximal femoral epiphysis on the metaphysis. Although the diagnosis and treatment of slipped capital femoral epiphysis have been well described, the search for its cause and a method of early identification continues. We have reported here an interesting case of a bilateral slipped capital femoral epiphysis as an unusual presentation in one family - father and two siblings, had no record of any hormonal imbalances or endocrine abnormalities; had good nutrition; and presented with atypical characteristics of slipped capital femoral epiphysis.

199-202

Authors: Vani D, Giri Punja M, Geetanjali S, Bharathi M, Dayananda TR

Syringocystadenoma papilliferum, a distinct dermatologic entity, is an exceedingly rare benign skin neoplasm and seems to have arisen from apocrine or eccrine adnexal structures. The diagnosis is clinically suspected and histologically confirmed due to its non-distinct clinical findings and varied presentations. Since it usually appears at birth or during puberty and adolescence, it is called as Childhood tumor. Complete surgical excision is the treatment of choice followed by detailed histologic examination, to avoid the risk of malignant degeneration. Herein, we have reported a rare case of Syringocystadenoma papilliferum of eyelid in an adolescent female.

207-210

Authors: Mahim Koshariya, Vivek Sharma, Arvind Meravi, Krishna Kanwar, Shivang Saxena, S. Shukla, M.C. Songra

A hemangiopericytoma is a rare tumor that originates in the pericytes in the wall of capillaries. It is usually benign in nature and is located in the soft tissues. These tumors can originate anywhere in the body where there are capillaries. The most common locations reported are the brain, lower extremities, pelvic area, head, and neck and abdominal cavity. We have reported here a case of hemangiopericytoma in inguinal region in a 70 year old male patient, who presented with right inguinal mass, which was masking the occurrence of right indirect inguinal hernia and diagnosed as hemangiopericytoma by histopathology.

217-222

Authors: Malay Kumar, Akhtar Riaz, Pushpam Dwivedi, Thippeswamy SH, Abhisheik Khare, Renuka Verma

The practice of placing a small amount of chewing tobacco or snuff in the oral cavity and leaving it in place for extended periods of time appears to be finding its way into young and middle aged adults as a socially acceptable and popular habit. Cancer development at the site of placement and other oral mucosal lesions caused by these products has been described from several population groups. As the composition and the pattern of use of the product vary, evaluation of each type of smokeless tobacco (ST) has to be undertaken with caution. This review thus, highlights the use of ST and its significance as the causative for oral cancer.