International Archives of Integrated Medicine

1-8

Authors: Akpan Sylvia Iquoabasi, Megbelayin Emmanuel Olu

Background: World sight day is marked yearly and provides the opportunity to create awareness about eye health. The global event can also serve as an avenue to appraise impacts of health promotions and interventions on blindness prevention. Aim: To determine the prevalence of blindness and common ocular conditions among the studied population. Materials and methods: It was a cross-sectional study involving workers at Uyo Mechanic Village and University of Uyo Teaching Hospital. Instrument was developed in line with study’s objectives. Subjects’ responses to questionnaires and ocular assessment formed the core of data generated which was analyzed by Statistical Package for Social Sciences (version 20.0) Observation: A total of 121 males and 280 females with a ratio of 1:2.3 were analyzed. Age range was from 18 years to 66 years with a mean of 39.8+9.2 years. Prevalence of blindness was 1%. Intraocular pressure, indicated in 81 subjects, ranged from 11 to 33 mmHg with a mean of 16.2+4.8 mmHg. Absolute glaucoma was recorded in 5 patients (1.2%), 71 patients (17.7%) were glaucoma suspects and 19 patients (4.7%) had glaucoma. Refractive error 167 (41.6%) was the commonest finding. Statistical analysis of data revealed no significant relationship between sex and diagnoses (p value = 7.967, X2= 0.826, 95% CI = 0.821-0.836) or age and diagnoses (p value = 509.522, X2= 0.601, 95% CI = 0.591-0.510). Conclusion: Refractive errors were the commonest ocular finding in the population studied.

14-19

Authors: K N Prasad, M Kamali, S Kanimozhi, G Kanmani, M Kannan, A Karthikeyan, R Kaviyarasi

Introduction: Food intake is diminished among old age people due to ill health, disability, co-morbid condition. Hence the quality of life of elderly affects nutrition & protein deficiency contributes to high percentage of DALY. Objectives: To know the calorie deficiency and nutritional status among elderly people Material and methods: This was a cross sectional and community based study done on 300 elderly people among 17079 in rural village of Puducherry during March and April 2015. Data were collected by two methods (questionnaire, basic anthropometry measurement) at their residence. Data was analysed for calorie deficiency and body mass index. Results: There were equal number of men and women. Sixty percent of the subjects were aged between 60-70 years and 7% were aged more than 80 years. Caloric deficit was more in males than females and 35% of them were either overweight or obese according to body mass index. Conclusion: There were no serious micro nutrient deficiency individuals but more than 35% are already obese/ overweight and 50% are suffering from age related problems. The rehabilitation service of old age group is strongly recommended in order to give quality of life.

28-39

Authors: Prakash Gurudevarahalli Madegowda, Sanju R

Background: Stroke is a leading public health problem, it is second to heart disease as a worldwide cause of death and a leading cause of long term disability. The treatment for patients with ischemic stroke is still not very effective and prevention of stroke is a better option. The incidence of stroke can be reduced by adequate control of risk factors. Aim: To evaluate the risk factors in patients with ischemic stroke. To find out the prognosis of ischemic stroke with reference to risk factors. To identify the patients having modifiable risk factors so that preventive care can be taken to improve the prognosis and prevent recurrences. Materials and methods: 65 patients with ischemic stroke who met the inclusion criteria were evaluated with a comprehensive clinical history and detailed physical examination and relevant investigations. Their prognosis during the hospital stay was also determined. Results: At the end of the study it was noted that the incidence of stroke in males was 58.46%. 50.9% of stroke occurred in people aged above 60 years. The most common risk factors were smoking (46.2%), hypertension (38.46%), dyslipidemia (18.46%), alcohol consumption (15.39%), diabetes mellitus (13.09%), heart diseases (10.7%), tobacco chewing (9.23%), history of recent delivery (1.6%) and family history of stroke (1.6%). It was also noted that 72.3% of patients had multiple risk factors of which 7% had complete recovery while 22.2% of patients with single risk factor had complete recovery. Conclusion: It was found that stroke was more common in males when compared to females and increasing age (>60 years) was associated with increased incidence of stroke. Most common modifiable risk factors were smoking, hypertension, dyslipidemia, alcohol consumption and diabetes mellitus. The most common non modifiable risk factors were increasing age, male sex and family history of stroke. Prognosis depends on the number of risk factors present. It was also found that increasing age, hyperglycemia and multiple risk factors were associated with poor prognosis.

47-53

Authors: Gulamus sibtain asad, Himanshu Singla, Ankit vasoya, P. J. Jhala

Aim: To evaluate the features, pattern and extension of the different pathologies affecting the knee joint with help of MRI scans. Materials and methods: This study was performed using MRI scan 1.5 tesla of knee joint in 65 patients. Routine blood investigations were documented in all patients. Results: Distribution of pathologies according to patient’s age, sex, site of involvement and etiology was observed and p-value of knee joint tears by using MRI as gold standard was calculated. Conclusion: MRI scans have proved to be successful modality in evaluating the knee joint; MRI results increased the physician’s confidence in the diagnosis. MRI is an excellent noninvasive modality in imaging of the knee and a noninvasive replacement for arthrography and non-therapeutic arthroscopy.

64-68

Authors: Dharita Manubhai Khatri, Neeta Jayprakash Vyas, Megha Sandeep Sheth

Introduction: Knee osteoarthritis (OA) is a major public health problem. Knee OA leads to impaired balance and reduction in speed of walking, which is accentuated under dual-task conditions. Walking relies on continuous visual processing to obstacles as one navigates through a visually defined environment. Objectives: The study aimed to compare the speed of walking with and without visual distraction in subjects with OA knee and with normal individuals. Material and methods: Fifteen subjects with OA knee and 15 without OA knee of same age and gender were selected. Subjects were selected according to inclusion and exclusion criteria. Experiment was carried out over straight path of 50 m length and 2.5 m width. Subjects walked on two consecutive days at preferred speed 3 times back and forth covering total distance of 300 m. Charts were shown on either of the two days. Subjects passed 12 times through charts of various objects held by two assistants. Some objects were kept upright or inverted and subjects needed to reply by saying ‘yes’ or ‘no’. Charts of various colors were also shown and they were asked to identify them. The speed was noted. They also walked same distance without distraction. Level of significance will be kept at 5%. Results: Wilcoxon test was used for within group analysis for speed of walking with and without distraction. Significant difference was seen for both subjects with OA knee (W=-2.897, p=0.004) and normal subjects (W=-3.266, p=0.001). Mann Whitney U test was used for between groups analysis. With distraction groups showed significant difference (W=-2.219, p=0.026). But there was no significant difference in analysis in between groups without distraction (W=-1.701, p=0.089). Conclusion: Visual distraction leads to reduction in speed of walking in subjects with OA knee as compared to normal subjects.

77-82

Authors: Anupsingh Dhakre, Harshin Nagori, Harsh Shah, Anil Rathwa, Chinmay Parikh, Dhara Patel

Background: To recognize different pathologies affecting the shoulder joint with the help of ultrasound and MRI scans and to evaluate the features, pattern and extension of the different pathologies affecting the shoulder joint with help of ultrasound and MRI scans so as to help the clinician for further management. Aim: To estimate role of ultrasound and MRI in examination of shoulder joint. Material and methods: Study comprised of an observational hospital based study. Out of 65 patients, 20 underwent only ultrasound investigation, 25 underwent only MRI scans whereas 20 patients were evaluated by ultrasound and MRI. These were performed by 3-5 MHZ curvilinear probe and 8-10 MHZ linear probe on HD 7 and HD 9 Philips ultrasound machines and 1.5 T Philips MRI machine. MR arthrography was performed as a follow up in some of the patients in outside centre. Results: USG study also showed that the most commonly occurring rotator cuff tears were supraspinatus tears whereas alone infraspinatus and subscapularis tears were very rare. MRI study showed supraspinatus tears were the most frequently occurring in the rotator cuff whereas subscapularis and infraspinatus tears were rare. MRI is 100% confirmative in almost all cases of Rotator cuff tears but may sometimes need extra imaging by MR arthrography in partial bursal tears. Conclusion: Rotator cuff tears are the most common pathologies affecting the shoulder joint according to this study. It was proved that, there is no evident difference in the accuracy of ultrasound and MRI in detecting this pathology, even though MRI has proved to be more accurate in evaluating almost all other pathologies as compared to ultrasound.

91-97

Authors: Parikh Hemant Chimanlal

Introduction: Happiness is a very subjective feeling and may mean absence of sorrow to indefinite pleasure; to different persons! Material and methods: We derived happiness index of teenagers by asking them 20 questions having score of 1 – 5. We measured happiness amongst teenagers studying I year M.B.B.S., I year B.Sc. nursing and I year physiotherapy. Comparison of happiness levels, was done between these groups. Results: Many of the physiotherapy students were happy with their present. Nursing students were the least happy with present day turmoil. Medical students had reasonably good count on many criteria. However they were involved in lowest social activity. Conclusion: 32 – 40 percent individuals in our study had happiness index less than 73. They were given tips for happiness enrichment.

108-115

Authors: Jai Krishna, G. Chitti Babu, Shewtank Goel, Abhishek Singh, Aakansha Gupta, Sanjeet Panesar, Avinash Surana, Deepak Pathania, Lalit Kumar Singh

Background: The wide and indiscriminate use of drugs has increased the incidence and the modes of presentation of cutaneous drug reaction. Understanding the nature of ACDRs may help narrow down the search for the offending agent. Aim- The study aimed to evaluate incidence, assessment of causality, severity and preventability of Adverse Cutaneous Drug Reactions as a part of Pharmacovigilance from a rural northern Indian medical school. Material and methods: The current survey was executed by the department of Pharmacology in collaboration with Department of Dermatology, MSDS Medical College, Fatehgarh among 7692 patients attending Dermatology OPD during March-December 2014. CDSCO ADR Reporting Form, WHO causality assessment scale, Hartwig and Siegel’s Assessment scale and Modified Schomock and Thronton’s preventability assessment scale were used as study tools. All the doctors, residents, interns and students were encouraged to notify any suspected ACDRs. Patients were screened and recruited if they presented with visible skin lesions suspected to be drug related. As per Modified Schumock and Thornton Scale, 43.5% of ACDRs were ‘Definitely preventable’ followed by ‘Probably preventable’ (30.4%) and ‘Not preventable’ (26.1%). Results: 23 patients (0.3%) were detected to have one or other type of ACDRs. Fixed drug eruption was most common form (34.8%) of ACDRs followed by Acneform eruption and Urticaria in 21.7% and 13% respectively among study subjects. The most common drugs responsible for ACDRs were prednisolone, betamethasone and isoniazid for Fixed drug eruption, while metronidazole, cotrimoxazole and paracetamol for acneform eruption. Antimicrobials, other steroids and NSAIDs were responsible for other spectrum of ACDRs. On assessment of Causality of ACDRs, it was noted that more than half (52.2%) of them fall under probable category. Severity assessment of ACDRs revealed that majority (65.3%) of them was moderate in nature. Conclusion: Awareness on part of the physician can help in timely detection of cutaneous reactions, thereby restricting damage from them. Pharmacovigilance activity is significantly effective in increasing the reporting of ADRs. Study with long-term follow-up and monitoring of the patients with bigger sample size is warranted.

123-135

Authors: Nirav Patel, Niket Domadia, Konark Sarvaiya, Anil Rathwa

Background: Diagnosis of abdominal trauma is a real. Diagnostic tools that help the treating doctor in optimum management of abdominal trauma include; Focused Assessment with Sonography for Trauma (FAST), Diagnostic peritoneal lavage (DPL) and CT scan. Objectives: The aim of this communication was to define the recent role of FAST and CT scan of the abdomen in the diagnosis of abdominal trauma. Material and methods: This study aimed at evaluating patients who came to the Radiology Department of Dhiraj General Hospital, by using USG and CT scan. This study comprised of 50 patients. Results: Out of 50 patients of abdominal trauma, 12 patients (24%) were in age group 21-30 years with male to female ratio of approximately 5.2: 1. The commonest mode of trauma was road traffic accident according for 54% of total cases. Spleen and liver were the most common organs injured, followed by kidney. USG showed overall sensitivity 57.48%, specificity 97.77%, positive predictive value 88.9125, negative predictive value 97.185 and accuracy of 90.75%. CT scan showed highest sensitivity of 95.35%, specificity of 100%, positive predictive value of 100%, negative predictive value 77.78% and accuracy 96%. Conclusion: FAST is useful as the initial diagnostic tool for abdominal trauma to detect intra abdominal fluid. With proper training and understanding the limitations of ultrasound, the results of FAST can be optimized. DPL is indicated to diagnose suspected internal abdominal injury when ultrasound machine is not available, there is no trained person to perform FAST, or the results of FAST are equivocal or difficult to interpret in a hemodynamically unstable patient. In contrast, in hemodynamically stable patients the diagnostic modality of choice is CT with intravenous contrast. It is useful to detect free air and intra peritoneal fluid, delineate the extent of solid organ injury, detect retroperitoneal injuries, and help in the decision for conservative treatment. Helical CT is done rapidly which reduces the time the patient stays in the CT scan room. Furthermore, this improves sagittal and coronal reconstruction images which are useful for detecting ruptured diaphragm.

145-150

Authors: Meeravali SK, Dasaraiah CV

Background: Study was designed to analyze the effects of surgical management of fractures of both bones of forearm with dynamic compression plate with screw fixation. Material and methods: From August 2008 to October 2010, data from 56 patients with fractures of both the radius and ulna were collected and evaluated retrospectively. Patients were managed with early surgical debridement, open reduction and internal fixation with a DCP. All patients had complete functional and radiographic assessments. Results: Patient regained full range of movements within 6-8 weeks. At 12-14weeks check X-ray showed good radiological union. In this series out of 56 cases 42 (75%) cases are graded excellent, 7 (12.5%) cases are graded good, fair 5 (9%) cases and poor 2 (3.5%) cases. Conclusion: Our study has proven that open reduction and internal fixation of diaphyseal fractures of radius and ulna can be best done with dynamic compression plating technique which has given a good result. The technique of DCP fixation is a simple procedure which can be done by the junior orthopedic surgeon with an excellent result.

160-171

Authors: Eyad AlShammari, Rafia Bano, Shahida Banu, S. Bushra Fatima, Asma Sattam

Objectives: Adequate nutrient intake during pregnancy is important to fetal and maternal health. The purpose of this study was to investigate the factors affecting pregnancy outcome and to provide basic data to promote more favorable pregnancy outcomes. Material and methods: Data were collected from 100 pregnant women at two hospitals in Hail region of Saudi Arabia. Demographic characteristics, anthropometric measurements and health related habits were obtained using a questionnaire at the hospital visit soon after the delivery. Data on pregnancy outcomes, including birth weights and gestational ages, were obtained from hospital records. Birth weights were divided into three groups, a low birth weight group (birth weight <2.5 kg), a normal birth weight group (2.5 - 3.9 kg) and a high birth weight group (≥4 kg). Results: The Socioeconomic status was significantly with the birth weight (p<0.05), with high birth weight group babies belonging to high income group and low birth weight babies from lower income groups only. Weight and BMI of the mothers before pregnancy, total weight gain during pregnancy and hemoglobin levels were found to be significantly correlated with the birth weight.(p<0.05). Few health related habits and risk factors were significantly different among the three groups. Birth weight or sex of the baby was not significantly affected by gestational age. Conclusion: Birth weight remained an important factor affecting the neonatal infant and childhood mortality and morbidity. Low birth weight babies are more likely to have disabilities in four of developmental delay, poor growth and mental disabilities. For reducing the prevalence of low birth weight, public health strategy needs to focus attention on better maternal nutrition and education.

183-191

Authors: Ishita Sarkar, Aparajita Dasgupta

Background: Declining sex ratio is an issue of major concern. In spite of legal rules and regulations prenatal sex determination and sex selective abortion is going on in this country. The root of the problem is male child preference and unawareness about the rules forbidding prenatal sex determination. Aim: To elicit the gender preference and perception regarding prenatal sex determination among rural ever married women and to find out the contextual factors influencing the perception. Material and methods: This community based cross-sectional study was undertaken under the rural field practice area of All India Institute of Hygiene and Public Health, Kolkata. All ever married women in that area was line listed out of which the required number of women (i.e. 96) was selected by simple random sampling. A predesigned and pretested semi structured schedule was used for data collection. Firstly a univariate analysis was done. The variables which were found to be significant were entered into the multiple logistic regression model. P value of <0.05 was considered significant. Results: 90.6% of the study population felt that at least one male child is necessary in a family and 59.37% agreed with prenatal sex determination. Multivariate analysis showed that women with higher education had better perception of prenatal sex determination techniques and the PNDT Act with Adjusted Odds Ratio (Confidence Interval) 19.25 (5.58-66.34). Conclusion: Intensive IEC campaigns to increase awareness and enforcement of law are the need of the hour to check this social problem.

197-204

Authors: Tejal C Nalawade, Shyam D Ganvir

Background: Postural control involves controlling body’s position in space for dual purpose of stability and orientation. Postural stability or balance is defined as the ability to maintain the projected Center of motion (COM) within the limits of Base of Support (BOS). During quite stance there is a separate Center of Pressure (COP) under each foot. The net center of pressure lies between the feet and depend on each limb support. Normally no one stand erect, instead the body sways in small amount, mainly forward and backward. Thus quite stance is characterized by small amount of spontaneous postural sway. The device (sway meter) consists of inflexible 40 cm long rod with vertically mounted pen at its end. The rod was mounted 20 cm wide metal plate which will be fitted at the level of PSIS (Posterior superior iliac spine) over lower back region of participants by firm belt. A low tech Sway meter was designed to address the needs of clinicians and researchers with limited resources (e.g. no access to force plates or motion laboratories). It is a useful field test, as it is compact, lightweight, has short administration and data processing time. Unlike other lightweight and easily applied systems, such as accelerometers and gyroscopes, the Sway meter involves no electronics or computer processing. Thus, assessment can be conducted in a variety of community settings and health care facilities. Several research groups have found the Sway meter to be feasible for use in different populations of young and older people. The Sway meter has been used in numerous studies of balance as well as retrospective and prospective investigations of falls risk in older people. The purpose of study was to find out normative data of postural sway by using sway meter in among young adults and the validity of the Sway meter against the floor and foot print. Aim and objectives: To study the normative data of postural sway by using sway meter among young healthy adults, to study the normative data of postural sway by using sway meter among young healthy adults with eye open and eye close, to study the normative data of postural sway by using sway meter compare with the normal values of the lord’s and Sherrington’s study. Material and methods: The subjects were instructed to keep their hand by their sides during standing. Subjects were informed about procedure before starting. Duration of each trial was 30 second. A starting point was marked on the graph paper. At end of the 30 seconds, the rod of the sway meter was taken away from the graph sheet. 5-10 seconds rest was given during trial, but they were not allowed to move away from the foot print. The procedure was repeated for each trial. A total of six trials were taken including, 3 trial with eyes opened and 3 for eyes closed. Maximum duration for all trial was 6-7 minutes and maximum deviation in 3 trials was taken for analysis. Results: In eye open condition, in anterior direction, total 60 (100%) subjects are had sway in 0.1 to 2 cm. In Posterior direction, total 60 (100%) subjects are had sway in 0.1 to 2 cm. In right lateral direction, total 59 (98%) subjects had sway in 0.1 to 2 cm; remaining 1 (2%) subject had sway in 2.1 to 3 cm. In left lateral direction, total 56 (95%) subjects had sway in 0.1 to 2 cm; remaining 2 (3%) subjects had 2.1 to 3 cm sway and 2 (2%) subjects had 3.1 to 4 cm sway in left side. In eye closed condition, in anterior direction 57 (95%) subjects had 0.1 to 2 cm sway in anteriorly, but remaining 2 (3%) subjects had 2.1 to 3 cm sway, and 1 (2%) subject had 3.1 to 4 cm sway. In posterior direction 59 (98%) subjects had 0.1 to 2 cm sway in posterior; rest 1 (2%) subject had nil sway in posterior. In right lateral direction 56 (93%) subjects had 0.1 to 2 cm sway, and rest of the 2 (4%) subjects had nil sway, and 2 (3%) had 2.1 to 3 cm sway in right direction. In left lateral direction 57 (95%) subjects had 0.1 to 2 cm sway, and 1 (2%) subjects had nil sway, rest 2 (3%) subjects had sway in 2.1 to 3 cm. Conclusion: It has been concluded that this study support the self constructed sway meter as a clinical tool for identifying sways in various directions (anterior, posterior, right lateral and left lateral). Similarly 100% of sway was seen in anterior and posterior direction with eye open.

210-213

Authors: Makhela J, Kaushal K, Choraria S, Ranka M, Patel S B

The mucopolysaccharidoses (MPS) are a group of inherited metabolic disorders that result in widespread skeletal, visceral, and mental abnormalities. A defect in metabolic degradation leads to the storage of mucopolysaccharide macromolecules in the nervous system and other body tissues. The MPS are classified into various types, and there are additional diseases, such as the mucolipidoses and a gangliosidosis, that demonstrate similar clinical and radiologic findings. We hereby present 3 cases of Hurler Syndrome, Type I mucopolysaccharidoses, and enumerate there radiological characteristic radiological findings.

220-222

Authors: Jacob K J, Mini K, Sreeja K.R.

Twin pregnancy with a complete mole and a coexisting healthy fetus is a rare condition. There is increased risk of developing severe complications and development of persistent trophoblastic disease. A 28 years old 2nd gravida, with 1st vaginal delivery reported to the hospital at 20 weeks gestation as a case of dichorionic twin pregnancy. On routine USG, it showed a complete mole with a coexisting live fetus. The patient had features of anemia and severe preeclampsia. After explaining the risk to the patient and bystanders, they requested to terminate the pregnancy. She was induced for the same and delivered a normally appearing fetus. This was accompanied by evacuation of the mole. Diagnosis of complete mole was confirmed by histopathology. Twin pregnancy with a complete mole and a coexisting healthy fetus is a rare condition. The decision regarding management of this condition is difficult due to the various complications associated especially development of choriocarcinoma.

227-231

Authors: Ashish Devgan, Amit Batra, Shivani Dua, Vivek Bansal, Sudhir Punia, Shubham Joshi, Harnam Singh Madan, Vinit Verma, NK Magu

Patellar tumors are rare and are usually benign as opposed to malignant tumours. The most frequent benign lesions of patella are giant cell tumor (common in adults), chondroblastoma and osteoid osteoma. A solitary exostosis is the most common benign bone tumor which occurs around the growth plate of long bones. The treatment of choice is extra periosteal resection of exostosis and ensuring complete removal of cartilaginous cap. Indications of surgery are when the exostosis is interfering or disturbing the growth of extremity, malignant transformation, presence of bone erosion, neurovascular compression, interference with joint motion, bursitis, fracture through the stalk and cosmesis. We report a rare case in an adult patient with an extra-articular skeletal osteochondroma of the patella located antero- superiorly which presented as an enlarged bursa and a bony swelling over knee joint.

236-239

Authors: TH Kalidas Singh, Gunvanti B. Rathod

Fine needle aspiration (FNA) of the breast has gained significant credibility in the diagnosis of breast diseases especially malignancy. Fat necrosis of the breast is a phenomenon that occurs within breast adipose tissue following exposure to trauma. It can mimic breast cancer clinically or radiologically. FNA of fat necrosis is a useful tool in directing management and treatment of the patients and avoiding unnecessary surgeries although histopathological examination is the gold standard for the final diagnosis.