International Archives of Integrated Medicine

1-5

Authors: Goud AA, Nikhade NS

Background: The elderly population is large in general and growing due to advancement of health care facilities. These people are faced with numerous physical, psychological and social role changes that challenge their sense of self and capacity to live happily. Many people experience depression in old age, either as a result of living alone or due to lack of close family ties and reduced connections with their culture of origin, which results in an inability to actively participate in the community activities. Aim: To find out prevalence of depression in older adults living in old age homes. Materials and Methods: A cross sectional study was carried out in two old age home in Ahmednagar district, Maharashtra. Eighty participants living at old age home in the age group of 60 to 85 years were included in this study. The elderly persons were contacted personally and the Geriatric Depression Scale (GDS) questionnaire was administered in their local language. Results: The prevalence of depression in older adults living in old age home was 53.75%. An increase in depression cases was found as the age increases e.g. Young old (47.92%), Mid old (57.69%) and Old old (83.33%). Percentage of depression in females (58.82%) was more than men (44.83%). Percentage of depression according to marital status was found higher in widows/ widowers (67.57%) followed by divorcee/ separated (63.63%) than in people living with spouse (33.33%) and never married (40%). Conclusion: The prevalence of depression was higher in elderly living in old age home. Percentage of depression in females was more than men and found to be increasing with increase in age.

15-19

Authors: Rathod GB, Alwani M, Patel H, Jain A

Introduction: Pancytopenia is condition in which there is reduction of all the 3 peripheral blood lineage and must be suspected on clinical grounds when a patient presents with unexplained pallor. Careful examination of a blood film is important if reason for the pancytopenia is not apparent from the clinical history. If this does not reveal the cause, bone marrow aspiration and trephine may be needed. Aim: To study the profile of pancytopenia in hospitalized children. Materials and methods: This retrospective study was carried out in Dhiraj General Hospital from January 2014 to December 2014. All the Pediatric patients were included for the study. Complete blood count, peripheral smear (PS), bone marrow aspiration and bone marrow trephine biopsy were performed. Results: Among 200 studied Pediatric cases, maximum number of patients (39%) was in the age group of 6 month to 5 years. In the present study, megaloblastic anemia (26.5%) was the most common cause of pancytopenia followed by Aplastic anemia (20.0%) while leukemia was found in 17.5% of cases. The most common symptom was pallor in 163 (81.5%) cases and fever in 130 (65%). Conclusion: The megaloblastic anemia is most common cause of pancytopenia in our study followed by aplastic anemia and acute leukemia.

26-34

Authors: Shinde S, Bakshi AP, Shrikhande AV

Background: Infections are the most frequent complications in individuals with sickle cell disease. Infection is a significant contributor to morbidity and mortality in sickle cell disease. Materials and methods: A prospective study was carried out in a total of 100 patients to study prevalence and type of infections in homozygous sickle cell disease patients in both sexes and all age groups at Department of Pathology of our institute. All homozygous (SS) sickle cell disease patients with high grade fever of temperature > 101˚F (38˚C) from all age groups and both sexes were included without administration of first antibiotic dose. The identification of the infecting organism was done by staining, and culture studies. Results: The results were analyzed using standard microbiological techniques. In present study, maximum cases were seen in 0-5 years of age group, the cases of infection were more in males (62%) than in females (38%) with M: F ratio of 1.63:1. In the present study, respiratory tract infection was present in 37% cases. The positivity of blood culture was 27% (27 out of 100). Out of 27 blood culture positive cases, Gram negative organisms isolated were Klebsiella (51.55%), Escherichia coli (14.81%), Salmonella (7.40%), Acinetobacter (3.70%) and Gram positive isolates were Enterococcus ( 7.40%), Staphylococcus aureus (11.11%), Streptococcus Pneumoniae (3.70%). Therefore this study was conducted out to assess the patterns of morbidity and mortality due to infections in sickle cell disease and to implement various measures of preventive care and treatment in future. Conclusion: The incidence of infection was more common in age group 0-5 years. The incidence of infection was more common in males as compared to females. Respiratory tract infection was the most common infection. Gram negative organism - Klebsiella pneumoniae was the most common organism isolated followed by E. coli, Salmonella and Acinetobacter. Among Gram positive organism - staphylococcus aureus, enterococcus, Streptococcus pneumoniae were common bacterial isolates. Among non-bacterial causes - Malaria was common infection.

39-45

Authors: Acharya A, Lakhpati G

Computerized Tomography of the Para Nasal Sinuses (CT PNS) is mandatory for endoscopic nasal surgery. Study of CT PNS is absolutely essential for undertaking this surgery. The surgeon has to have a plan for reading the CT PNS. Patients undergoing nasal surgery by endoscopic approach are subjected to CT PNS. Patients with nasal symptoms like nasal obstruction discharge from the nose and epistaxis, watering from the eyes undergo imaging of the para nasal sinuses by CT. The points of study of CT PNS are highlighted which are of importance to the surgeon to do safe surgery and prevent complications to the underlying and neighboring important structures. Changes of mucosa, erosion of bony walls and expansion of the sinuses and encroachment into the surrounding areas are noted and are kept in mind while doing surgery to prevent complications and doing safe surgery.

52-56

Authors: Patel P, Patel P, Parmar H

Background: An incisional hernia is a bulge or protrusion that occurs near or directly along a prior abdominal surgical incision. Various surgical techniques including Open tissue repair, double breasting, darning, open and laparoscopic meshplasty have been used to repair the incisional hernias. In this era, we have selected topic ‘Pre-peritoneal versus on-lay meshplasty in incisional hernia repair’ to focus on advantage and disadvantage of two methods of hernia repair and to provide information regarding indications and benefits of one over another. Material and methods: 77 cases of ventral hernia were taken in On-lay and Pre-peritoneal group. Observations were made with regards to duration and ease of operation, wound complications, hospital stay, morbidity and recurrence. Study profile: group (A): On-lay meshplasty (The prosthetic mesh placed between the subcutaneous tissues of the abdominal wall and the anterior rectus sheath e.g. on the rectus sheath) group (B): Pre-peritoneal meshplasty (The prosthetic mesh placed in the pre-peritoneal plane e.g. Sub lay/ Retro-muscular plane). Results: Mean age in On-lay group is 47.96 year. While in Pre-peritoneal group mean age is 48.66 year. Results showing pain is not making difference between two methods in post operative period 6th day onwards. The duration of hospital stay was comparable and mean duration in On-lay is 3.51 day and in Pre-peritoneal is 3.9 day. In both this method, out of 50, in 37 patients 15X15 cm prolene mesh (cost Rs. 1800) was used and in 13 patients 10X10 cm prolene mesh (cost Rs. 1000) was used. In both cases hospital spend around Rs. 1500 – 2000 average on hospital stay, drugs, food. General anesthesia used cost around Rs.2000 each patient as compare to spinal anesthesia used in other which cost for Rs. 250 each patient. It showed that Pre-peritoneal method required more time than On-lay. In this study, 6/33 patients develops seroma in on-lay method, while 1/44 patients develops seroma in Pre-peritoneal method in post operative period. P value <0.05, the difference is statistically significant. In this study, 2/33 patients develops wound infection in on-lay method in post operative period, while 0/44 patients develops wound infection in pre-peritoneal method in post operative period. P value <0.05, the difference is statistically significant. Conclusion: In view of less post-operative complications like seroma, wound infection, mesh removal and early returns to routine work and less recurrence; pre-peritoneal meshplasty is better repair for incisional hernia compared to on-lay meshplasty.

64-66

Authors: Mahawer J, Patel K, Kavad M, Patel M, Gandhi D, Shah V

Electrical alternans is a broad term that describes alternate-beat variation in the direction, amplitude and duration of any component of the ECG waveform. The presence of electrical alternans has no clinical manifestation outside those present from underlying cause of association. Thus searching for underlying cause is necessary. Here we have reported a case of 8 years old male child who presented with cough and increase respiratory rate following electrical shock and ECG showed electrical alternans in QRS complex.

71-73

Authors: Gopagoni S, E.A. Ashok Kumar

We have described here a new variant of life-threatening organophosphate toxicity syndrome, which produces a brief vocal cord paralysis. A 18 years old male patient with recent ingestion of unknown quantity of Organophosphorous poison, presented to our hospital with acute symptoms of profuse sweating, increased salivation and lacrimation for the first 12 hours. Later on he developed quadriparesis-lower motor neuron (LMN) type - Acute polyneuropathy-myelinopathy. He developed hoarseness of voice and regurgitation of fluids with both 9 and 10 cranial nerve palsies. The patient had developed acute Organophosphorous poison toxicity initially, followed by Intermediate Syndrome after 24 hours of ingestion with vocal cord palsy.

78-81

Authors: Chaurasia IK, Dubey K, Rajiwate F, Sharma D, Jadhav A, Kalyanshetti A, Koshariya M

Migration of orthopedic fixation pins into the thoracic cavity can result in perforation of pulmonary vasculature, aorta, bronchus, atrium, or ventricle. Prompt diagnosis and treatment is of paramount in preventing devastating consequences. A patient who had fixation of a right humerus fracture weeks later had intra thoracic migration of a fixation pin, found on radiographic examination. Patient was attempted and the K Wire was removed by VATS thoracoscopic procedure. The foreign body was retrieved successfully without intra operative or postoperative complication.