International Archives of Integrated Medicine

6-12

Authors: Nanda GS, Singh H, Sharma B, Arora A

Introduction: Tuberculosis (TB) causes enormous social and economic disruption and hampers nation’s development. DOTS strategy under RNTCP is one of the largest public health programs found to be beneficial against TB. Adverse drug reactions lead to decrease in patient compliance and adherence. Good patient adherence to the treatment regimen is the foundation stone to effective anti-tubercular therapy. Noncompliance is cited as the major problem to the control of the tuberculosis at the level of public health which finally leads to drug resistance in case of TB. Aim and Objectives: To identify the occurrence and pattern of Adverse Drug Reactions (ADRs) associated with anti-tubercular drugs in TB patients under DOTS therapy during Intensive phase of treatment. Materials and methods: A prospective observational study was conducted in 2 randomly selected DOTS centers of Jalandhar. A total of 102 patients of categories I and II who were registered in third quarter of 2014 were selected for study. The follow up period was during the intensive phase of DOTS regimen. All patients on ATT were followed up at the end of 1 week, 1 month and after the completion of intensive phase or if/ when self reporting was done due to adverse drug reactions. Detection and monitoring of adverse drug reaction was done by interviewing patients, consulting with physicians about the patient’s clinical problems, reviewing laboratory test and medical records. The data so collected was entered and analyzed using SPSS 21 software. Results: The Incidence of adverse drug reaction was observed in 20.4% i.e. 21 out of 102 patients. Total number of adverse reactions developed in 21 patients were 31, with most common being GIT system (38.7%), followed by skin problems (29%). History of alcoholism, associated co-morbidities, pulmonary TB and DOTS treatment Category II were found to be significantly associated with occurrence of ADRs. Conclusion: The present study highlighted the importance of developing strategies to ameliorate ADRs both to improve the quality of patient care and to control TB safely. In addition, a proper educational counseling may promote more ADR reporting by patients. These strategies may improve the patient adherence to treatment and therapeutic outcome.

18-23

Authors: Rathod GB, Jain M, Vachhani D, Chandra A, Balar M

Introduction: Cervical cancer is the third most common type of cancer among women worldwide, following breast cancer and colon cancer. The micronucleus test is a simple and widely used technique to evaluate genetic damage due to exposure to carcinogenic or mutagenic agents. We undertook this study to compare the MN (micronucleus) score in the whole spectrum of cervical lesions. Materials and methods: In this retrospective study, we had compared the MN score in the whole spectrum of cervical lesions which comprised of seven different groups like normal (20), inflammatory (30), ASC-US (20), ASC-H (13), LSIL (20), HSIL (10) and IC (19) over a period of 1 year (January 2014 to December 2014) which included a total of 132 cases. Results: In the present study, there was a stepwise gradual increase in MN count from inflammatory to ASC-US to LSIL to HSIL group, followed by a slight increase in IC. The mean MN count was most significant in the LSIL and HSIL group. Thus micronucleated cells as well as the total number of micronuclei show increasing trend towards malignization. Conclusion: Our study showed that MN counting can be a helpful screening tool in conjunction with conventional Pap test for screening of cervical cancer.

29-35

Authors: Pullishery F, Panchmal GS, Siddique S, Abraham A

Introduction: Bio-medical wastes are of great importance due to its potential environmental hazards and health problems. The waste produced in the course of health care activities carries a higher potential for infection and injury than any other type of waste. It is estimated that annually 0.33 million tons of hospital waste is generated in India. The objective of this study is to analyze the medical waste management practices in different health care settings, analyze the risk perceptions of health care personnel and assess the attitude towards the waste management policies. Materials and methods: A cross-sectional study is conducted using a pre-tested questionnaire to assess the awareness, knowledge and practices on medical waste management among health care personnel in different health care settings in Mangalore city. Results: Doctors, nurses, and laboratory technicians have better knowledge than sanitary staff regarding biomedical waste management. Knowledge regarding the color coding and waste segregation was found to be better among nurses and laboratory staff as compared to doctors. Conclusion: The management of hospital waste requires its segregation and removal from the health care establishments in such a way that it will not be a source of health hazards to those who are directly or indirectly related to the hospital environment. The segregation of waste in almost all hospitals is not satisfactory. Proper and judicious handling of Bio-medical waste continues to be a matter of serious concern for health authorities in India.

46-50

Authors: Naik N, Patel G, Parmar H

Background: Acute pancreatitis occurs in only 3-7% of patients with gallstones. But gallstones were implicated in about 27% cases of acute pancreatitis reported in a decade prior to 1980. The relative risk of developing acute pancreatitis varies from country to country, and within a given country it is influenced by socio-economic, ethnic, and cultural factors. The present study evaluated the incidence of the disease, age-sex distribution, clinical manifestations methods, and management of gallstone pancreatitis. Aim and objectives: To diagnose a case of gallstone pancreatitis by various investigations like blood investigations, USG or by CT scan, age-sex distribution, to observe the varied clinical presentations of biliary pancreatitis with regards to symptoms and signs, to study the management protocol of gallstone pancreatitis. Material and methods: 50 cases of gallstone pancreatitis were studied during the period from May 2012 to July 2014, from all surgical units at our institute. Inclusion criteria: All patients admitted in surgical wards in a given particular unit who have diagnosed as having gallstone pancreatitis. Exclusion criteria: Patients having pancreatitis other than biliary cause. This study included all the age groups and both the sex. Results: In our study, most (34%) of male patients at the age group of 50-70 years, biliary pancreatitis was more predominant. Most (34%) of female patients at the age group of 40-60 years had biliary pancreatitis. In our study, most (92%) of the patient’s serum amylase was 3 fold above normal value, alkaline phosphatase was raised in 88% of patients, 68% of them had increased AST, and 22% of them had had elevated serum bilirubin levels. Normal value of serum amylase ranges from 40 to 140 U/L, Alkaline phosphatase from 45 to 115 U/L and AST from 8 to 48 U/L. In our study, out of 50 patients, 28 patients underwent laparoscopic cholecystectomy and 8 patients underwent open cholecystectomy during same admission. In 9 patients endoscopic retrograde cholangiopancreatography (ERCP) plus endoscopic sphincterotomy (ES) was done and remaining patients managed conservatively. Conclusion: Gallstone pancreatitis represents the most severe form of disease. The diagnosis is based in history and physical examination, an elevation of serum amylase 3 fold above the normal level, and ultrasound and CT scans. Endoscopic retrograde cholangiopancreatography is one of the tools in less certain cases of the absence of an agent that can abort progression of the disease; therapy should consist of adequate resuscitation, nutritional support, and careful monitoring to detect early complications.

58-66

Authors: Shukla M, Tyagi S, Agarwal M

Background: Adequate infant and young child feeding (IYCF) practices are essential to ensure optimal survival, health, growth, development and overall nutritional status of children. Objective: The objective of the present study was to assess the IYCF practices among mothers with children aged 0-23 months attending immunisation clinic at a tertiary care hospital of Lucknow, capital of Uttar Pradesh. Materials and methods: A hospital based cross-sectional study was conducted at immunisation clinic, King George’s Medical University from January 2015 to September 2015. Systematic random sampling was used and a total of 240 mothers with children 0-23 months old attending immunisation clinic were interviewed with the help of pre-designed, pre-tested and semi-structured questionnaire. Results: Breastfeeding (BF) was initiated within one hour of birth in 18.3% of children. Early initiation of BF was significantly associated with educational and socioeconomic status of mother and type of delivery. Pre-lacteal feeds were given to 23.4% of the children, children born at government health facility and with birth order ≤2 received pre-lacteal feeds more often. Colostrum was given by 67.9% of the mothers. Children born at private institutions or home were more likely to receive colostrum (p< 0.05). The prevalence of exclusive breastfeeding for at least 6 months was 53.8%. It was higher in children belonging to low socioeconomic group (p< 0.05). Complementary feeding was initiated at 6 months in 32.8% of children. Children of mothers belonging to upper socioeconomic class, nuclear family and delivered at government institution through normal delivery were more likely to be started on timely complementary feeding (p<0.05). Conclusion: The study revealed that inadequate IYCF practices are still quite prevalent in the community and therefore emphasis should be given to IYCF education sessions.

74-84

Authors: Rao PR, Narayana SS

Sexually transmitted diseases (STD) consist of different group of endemic diseases of varying clinical presentation, characterized epidemiologically as sexually transmitted infections. Sexually transmitted diseases in individuals have far reaching health, social and economic consequences. Sexually transmitted infections are very important because of their potential complication and interaction with HIV/AIDS. Recognition of HIV/STI cases has tremendous contribution for targeted intervention in the hospital. By evaluating the HIV/STI cases it will be a signal to know the affected groups and major determinants. In this Paper, the study was conducted to evaluate the clinical, epidemiological and laboratory characteristics of the sexually transmitted diseases (STD) found in the government general Hospital, Nizamabad in the year 2013.

90-96

Authors: Prasanna B, Jhansi CB, Swathi K, Shaik MV

Aim: The present study was designed to study the ectopic pregnancy risk factors and their clinical presentation in ectopic pregnancy attending to a tertiary care center. Material and methods: It was a prospective study with 50 cases of ectopic pregnancy conducted in the Department of Obstetrics and Gynecology, Narayana Medical College and Hospital, Nellore for a period of 2 years were included. Detailed history suggestive of risk factors for ectopic pregnancy, menstrual and obstetric history was taken. General, systemic, abdominal and vaginal examination was done. Results: A total of 2777 pregnancies were confirmed during the study period, of which 50 cases of ectopic pregnancies were diagnosed, giving an incidence of 1.8%. 74% were in the age group of 21-30 years. 84% of women were multigravidae and 16% were primigravidae. 80% of the patients had identifiable risk factors, of which past history of PID in 26%, history of previous abortion in 16%, infertility in 10%, uterine anomalies in 4%, history of previous ectopic pregnancy in 6%, usage of IUCD and OCP in 6% each and tubectomy in 6% were noted. 96% had amenorrhea, followed by pain abdomen in 90%, bleeding PV in 68%, fainting and syncopal attack in 16% of the patients. Pallor in 56% of the cases, 18% presented with shock was noted. Percentage of haemoglobin was <7gm% in 28% observed. Evidence of 41 patients with ruptured ectopic were recorded. 7 were unruptured ectopics and 3 were tubal abortions recorded. Conclusion: Increasing awareness regarding safe sexual practices and contraception decrease abortions and reduces the risk of ectopic pregnancy. All high risk women should be screened at the earliest with serum β-hCG and TVS. The impact on future fertility can be improved by focusing on primary prevention and early diagnosis before rupture.

105-109

Authors: Vasa VK, Chowdary DB, Kalyani OM

Background: Gullian-Barre Syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy (AIDP) with autoimmune background. The clinical management of GBS is by nerve conduction velocity (NCV) and supportive care, intravenous immunoglobulin’s (IVIG) and Plasmapheresis. We have studied the clinical outcome of Gullian-Barre Syndrome patients visiting to the tertiary care hospital in Andhra Pradesh. Material and methods: A cross sectional study was conducted in a tertiary care teaching hospital at Andhra Pradesh in 50 patients over the period of 2 years. Neurological examination like higher mental functions, cranial nerves, motor system, sensory system and autonomic system was done for all patients. Descriptive analysis of clinical presentation, type of GBS, occurrence of complications and final outcome was also done. Results: A total of 50 participants were included in the study. Majority (52%) of the study participants were aged below 40 years. Diabetes mellitus (DM) and hypertension (HTN) were the most common co-existing illnesses reported in 8% and 6% of study population respectively. Conclusion: The majority of the Guillain-Barre Syndrome patients recovered smoothly without going for complications. Prognostic outcome was poor in our study with increasing age and co-existing illness like diabetes mellitus or ischemic heart disease.

116-118

Authors: C. Saritha, B. V. Anuradha Devi, Imran Ali Mohammed, Chandra Sekhar, S. Sandhya Anil, H. Sandhya Rani

Lipomas are most common benign tumours derived from adipose tissue. Lipoma breast is somewhat difficult to diagnose clinically because of fatty consistency of breast. Lipoma breast measuring more than 10 cm in diameter or weighing more than 1 kg is called giant lipoma of breast which is infrequently observed because of rarity in size and location, with only very few case reports available in literature. Here, we have reported a case of this rare entity in 80 years old female who presented with complaints of painless lump in her right breast at our hospital.

122-126

Authors: Dhiman P, Bhatia S

Background: Dengue is the most common arboviral illness in humans. It is transmitted by mosquitoes of the genus Aedes, which are widely distributed in subtropical and tropical countries. The dengue virus has four related but antigenically distinct serotypes: DENV-1, DENV-2, DENV-3, and DENV-4. Many patients with dengue experience a prodrome of chills and facial flushing, which may last for 2-3 days. Other symptoms may include headache, retro-orbital pain, severe myalgias, nausea and vomiting, maculopapular or macular confluent rash over the thorax with islands of skin sparing, weakness, altered taste sensation, anorexia, sore throat, hemorrhagic manifestations (e.g. petechiae, bleeding gums, epistaxis and hematuria) and lymphadenopathy. The incubation period is 3-14 days. Criteria for the diagnosis of dengue hemorrhagic fever, according to the World Health Organization (WHO), are as follows: Fever, Hemorrhagic manifestations (e.g. hemoconcentration, thrombocytopenia, and positive tourniquet test), Circulatory failure, such as signs of vascular permeability (e.g. hypoproteinemia, effusions) and Hepatomegaly. Aim: To know the atypical manifestations of Dengue such as acute liver failure, seizures and encephalopathy. Material and methods: Study material obtained from Columbia Asia hospital Patiala along with all the records and detailed history of the patient. The study was carried out in Intensive Care Unit of the hospital where the patient was admitted. Observation and conclusion: In our case, patient presented with Dengue Hemorrhagic Fever. He developed acute liver failure which was considered to be due to dengue infection as antigen for the same was positive and other viral markers were negative. Acute liver failure manifested in the form of raised liver enzymes, coagulopathy, and encephalopathy. Dengue can lead to mild to moderate elevation of liver enzymes but complication of acute liver failure is rare.

132-135

Authors: Nath AL, Nair S, Pal R, Chakraborty A

A case of Peters anomaly with bilateral post axial polydactyly, convex soles, ocular hypertelorism, a low nasal bridge, retrognathia, undescended testis, microphthalmia and club foot was examined in a neonatal Indian baby girl who had been delivered in the hospital and admitted to the newborn unit. She died aged five days. There were no cases of Peters anomaly recorded in India according to a literature search. In addition, available data point to the majority of the principal associations in Peters anomaly to be genitourinary anomalies, making this case a rare one in its isolated collection of musculoskeletal associations. A Indian baby girl of who was born through a Cesarean section presented in the new born unit of our hospital with bilateral corneal opacities, bilateral polydactyly, camptodactyly and club foot. This is a rare case of Peters anomaly and its association with Patau syndrome makes it special.