International Archives of Integrated Medicine

1-9

Authors: SORO Tianga Yaya, MIAN Jean Claude, COULIBALY Sirabana, NENE-Bi Semi Anthelme, TRAORE Flavien

Daniellia oliveri is a common plant in Africa and widely used by the population. It is found in the wooded savannahs as well as in dry forests. The medicinal properties of Daniellia oliveri are attributed to its different parts. Thus the leaves are used to treat various diseases such as inflammation, fever and pain. The comparative study of the aqueous extract of leaves Daniellia oliveri and the indomethacin (INDOCID) on inflammation induced by carrageenan on the right hind paw of the rats showed anti-inflammatory properties of this extract. The phytochemical analysis of the aqueous extract of leaves Daniellia oliveri showed the presence of flavonoids which could cause anti-inflammatory properties of this extract. The toxicological study of aqueous extract of leaves of Daniellia oliveri allowed to determine an LD50 = 436.51 mg/kg body weight. According Classification of Diezi this plant is toxic. These results justify the traditional use of leaves of Daniellia oliveri as anti-inflammatory.

18-24

Authors: Ray S, Patel M, Parmar H

Background: The term acute abdomen designates symptoms and signs of intraabdominal diseases usually treated best by surgical operation. Many diseases, some of which do not require surgical treatment, produce abdominal pain, so the evaluation of patients with abdominal pain must be methodical and careful. The proper management of patients with acute abdominal pain requires a timely decision about the need for surgical operation. The term “acute abdomen” should never be equated with the invariable need for operation. The abdomen has been referred to as Pandora’s magic box. Very often an accurate diagnosis cannot be made without surgery and many wonders are revealed on opening the abdomen. So it is often the last court of appeal in investigating abdominal cases. The general rule can be laid down that the majority of severe abdominal pains that ensue in patients who have been previously well, and that last as long as six hours, are caused by conditions of surgical import. Materials and methods: The present study was a study of 110 patients presenting with acute abdominal pain. Out of these, 100 patients were managed surgically and 10 patients were kept conservatively. Sampling frame was done to study the incidence of non-traumatic, acute abdominal emergencies. Inclusion criteria were patients willing to participate in the study, patients with history of acute onset of pain in abdomen, positive findings in USG and X-ray abdomen standing. Results: From 61-70 years of age, 11 total cases were reported, out of which 5 were due to perforated duodenal ulcer, 2 each due to ileal perforation and gastric perforation, and 1 each for acute intestinal obstruction and acute pancreatitis. Out of 110 cases of acute abdomen, 42 were caused by acute appendicitis and hence it forms the major reason among the causes of acute abdomen. While comparing duration of pain and acute abdomen with its management, it was found that when the pain was less than 8 hours long, the final diagnosis of acute abdomen was obtained in 21 patients out of a total of 110. This formed 19% of the total cases. A Maximum of 15 cases of complications were seen in acute intestinal obstruction with 6 wound infections, 5 pulmonary complications , 2 cases of septicemia and 2 cases of skin excoriation. Also death of a patient was seen. This disease forms 13% of the total cases. Conclusion: Acute abdomen is often a surgical emergency and a challenge to any surgeon. Rigorous approach to diagnose is mandatory. Acute appendicitis was the most common cause of abdominal surgical emergency.

31-40

Authors: Patel VP, Patel P, Mehta SS, Rathod GB

Background: The international association for the study of pain has defined pain as unpleasant and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Spinal anesthesia was first produced by Corning in 1885 and first used deliberately by Bier in 1898. Glucose containing solution for spinal anesthesia was introduced by Barker in 1907. Since then hyperbaric solutions are in use for spinal anesthesia. All these advantages of spinal anesthesia are offset by complain of postoperative pain when effect of local anesthesia wears off due to relatively shorter duration of action of local anesthetic drug. Aim: The present study was designed to evaluate the effect of intrathecal bupivacaine 0.5% heavy 3.0 ml (15 mg) with neostigmine 5 mcg and bupivacaine 0.5% heavy 3.0 ml (15 mg) with neostigmine 5 mcg and nitroglycerin patch (5 mg/24 hour) in various surgeries divided 2 groups, 25 patients in each group. The objectives of study were to observe onset and duration of sensory and motor blockade, to observe duration of post operative analgesia, to observe perioperative hemodynamic stability, to observe perioperative complications. Materials and methods: The study was conducted by taking 50 randomly selected patients for various surgeries. Patients belonged to ASA Grade I/II aged 18 to 60 years were included. Patients were divided into 2 groups. Group - A: 0.5% heavy bupivacaine 3 ml (15 mg) + preservative free neostigmine 5 mcg. Group - B: 0.5% heavy bupivacaine 3 ml (15 mg) + preservative free neostigmine 5 mcg + transdermal nitroglycerin patch (5 mg/24 hours), applied on a non anaesthetised area after 20 minutes. All the patients were evaluated preoperatively and those having history of allergy to any drug, having any contraindications to spinal anesthesia, any neurological disorder and psychiatric illness were excluded from the study. Detailed preoperative history of past and present illness was taken. Systemic and general examination was done and back of patients were examined to rule out any spinal deformity and infection at local site. Patients were investigated for laboratory investigations like complete blood count, blood Sugar, renal function test, serum electrolytes, serum bilirubin and chest X-Ray, ECG were reviewed. Results: In our study of 50 patients we observed that intrathecal neostigmine 5 mcg with bupivacaine 15 mg with transdermal nitroglycerin patch (5 mg/day) markedly prolong duration of post operative analgesia than intrathecal neostigmine with bupivacaine alone. Intra-operative complication like bradycardia do occur but it was not significant, and other complication like hypotension occur with both groups but more in group B which requires monitoring . Conclusion: Transdermal nitroglycerin patch increases post-operative analgesia of low dose intrathecal neostigmine with bupivacaine in spinal anesthesia with less side effects.

45-50

Authors: Todorova A, Gugleva V, Georgieva L

Background: Despite the wide variety and the increasing number of industrially manufactured pharmaceuticals in recent years, extemporaneous medications are still often prescribed and prepared. Materials and methods: The purpose of this study was to analyze doctors` points of view on pharmacy compounding and to characterize advantages and disadvantages, associated with extemporaneous prescribing and dispensing. We performed a direct anonymous survey among general practitioners and medical specialists in the Northeastern Bulgaria. Results: Our study findings showed that extemporaneous medications are still preferred by physicians to meet the need of a tailored approach to specific patient and to provide individualized drug dosing. The role of extemporaneous compounded medicines is significant in the field of dermatology, due to the possibility of combining different ingredients in order to achieve better therapeutic action and also to serve as an alternative when there are no available market preparations. Conclusion: The prescribing and compounding drugs is a possibility for ensuring optimal therapeutical success in a certain patient. The advantages of extemporaneous medicines define their important role in the personalized therapeutic approach. The question about the perspectives and the future of compounded drugs is complex and depends not only on the number of prescribed prescriptions, but also on the pharmacists’ willingness to dispense them, becoming equivalent partners of doctors in general treatment process.

60-68

Authors: D. Srinivasa Naik, K. Ravi Kumar, Surendra Babu, R. Pandu Naik

Aim: To evaluate the effects of Dexmedetomidine to reduce the intra ocular pressure and sedation in day care cataract surgeries. Materials and methods: This study was conducted in 50 patients of either sex, belonging to 40 – 60 years of age, ASA grade I and II admitted for cataract surgeries. Patients were randomized into two groups of 25 each. Group D received 1 mcg/mg of Dexmedetomidine as IM route, Group P received placebo as IM and intra ocular pressure changes, hemodynamic parameters, sedation levels and SPO2, anxiolysis and pain were monitored. Results: There was a statistically significant difference in group D before and after premedication in terms of intra ocular pressure reduction. This was not seen in placebo group. Systolic blood pressure, diastolic blood pressure and heart rate in the study was a statistically difference in group D before and after premedication. There was no statistically significant difference in group P before and after premedication. There was a statistically significant difference (P<0.05) between the group D and group P in terms of sedation. Oxygen saturation observed in group D and group P at intervals of 0, 10, 20, 30, 40, 50, 60 min showed no statistical significance (P>0.05). There was a statistically significant difference (P<0.05) between the group D and group P in terms of pain relief and anxiety after premedication. Conclusion: Results suggested that Dexmedetomidine produces sedation and a reduction of intra-ocular pressure with minimal hemodynamic side effects when given intramuscularly as premedication before cataract surgery under regional anesthesia.

74-78

Authors: Bharpoda NY, Leuva BR, Patel U, Patel SG, Srikranthi, Kothari A

Introduction: India is facing a double burden of under nutrition and underweight on one side, and a rapid rise in obesity and overweight, particularly in the urban settings on the other side. The aim of the present study was to examine the association of the maternal Body Mass Index (BMI) and the obstetric and the perinatal out comes in singleton pregnancies. Materials and methods: A total number of 100 cases were taken. All the cases were primigravida with singleton pregnancy and were booked. Patients with preterm delivery or any medical disorder like cardiac disease, hypertension, chronic renal diseases and endocrinal dysfunctions, pre eclampsia, eclampsia, gestational diabetes mellitus were excluded from the study. Patients with their BMI calculated in first trimester delivering in Dhiraj General Hospital were taken. Mode of delivery, birth weight of babies, APGAR score were noted. Results: In present study, we found that maternal BMI showed association with the birth weight of their babies. We found direct linear correlation between maternal BMI and perinatal outcome. We found no association between maternal BMI with mode of delivery and APGAR score Conclusion: It can be concluded from our study that mother’s with low BMI tend to give birth to babies with lower birth weight and mothers with higher BMI, in absence of complications, tend to give birth to babies of higher birth weight.

88-91

Authors: Vohra A

Introduction: The ideal bone graft substitute should provide osteogenetic cells to facilitate bone regeneration, osteoinductive factors to induce bone formation and an osteoconductive matrix to directly stimulate bone deposition. The present study was conducted to radiologically assess the regenerative potential of hydroxyapatite with collagen and to evaluate the clinical usefulness of these materials to enhance bone healing. Materials and methods: Orthopentomogram (OPG) were taken after extraction in the control group and after extraction but before graft placement in study group and post operatively after 8 weeks. Each image was analyzed for bone density of the post-extraction sockets through ‘densitometric analysis’ software in the OPG program. Chi-square test was applied to find the correlation. Results: Post-operative mean measurement for study group was 108.72±22.54 after extraction and was 136.59±23.20 after 8 weeks with significant p value (0.00). The value for control group was 119.69±18.41 after extraction and was 121.39±14.21 after 8 weeks with insignificant p value (1.96). Conclusion: Grafting of the surgical site results in faster regeneration of tissue and computer assisted image analysis software is an important aid in assessing the bone density changes at the surgical site.

98-103

Authors: Shankar O, Balraj N, Rakesh G

Background: Hashimoto’s thyroiditis, a well known condition affecting the thyroid gland is often under diagnosed due to its wide spectrum of clinical manifestations. As such it could present as a Multi Nodular Goitre, Diffuse Goitre or Solitary Nodule with features of Hypothyroidism, Hyperthyroidism or Euthyroid state. Materials and methods: Total 120 patients with Hashimoto’s Thyroiditis were studied with history, clinical signs and symptoms, recorded in the format and were subjected to hormonal assay, FNAC. Results: Out of 120 cases, 117 were females and 3 were males. All the 120 patients presented with complaint of swelling in the front of the neck, most of the patients presented within 6 months after noticing the swelling. Consistency of the gland was firm in all cases. 75 patients were Multi Nodular Goitre (62.5%), 42 were Diffuse Goitre (35%) and 3 were solitary nodule (2.5%). 57 patients were Hypothyroid (47.5%), 42 patients were Euthyroid (35%) and 21 patients were Hyperthyroid (17.5%). FNAC was positive in 111 patients (92.5%). Antibodies were positive in 105 patients (87.5%). 105 patients were treated conservatively and monitored regularly every 3 months. Conclusion: In Hashimoto’s thyroiditis, the hyperthyroid patients showed high positivity to Anti TPO Antibody, the hypothyroid patients were highly negative to Antibodies, and the Euthyroid patients responded well to Thyroxine therapy. Surgery was mostly required for patients presented with symptoms and signs of obstruction. Incidence of Lymphoma in patients with Hashimoto’s Thyroiditis was usually high.

114-118

Authors: Ramamurthi R, Kavitha G, Pounraj D, Rajarajeswari S

Background: Infertility rates were highest in women living in urban areas and increases proportionately with level of education. The social consequences due to infertility affect the women more often. It is necessary to identify and treat the amount of stress and various coping methods by infertile women population. We have evaluated psychological impact of infertility and coping strategies employed in women population attending infertility OPD at department of obstetrics in a tertiary care teaching hospital in Tamil Nadu. Material and methods: This was a hospital based cross sectional study done in 150 women attending infertility OPD at a tertiary care hospital in Tamil Nadu for a period of 12 months from January 2014 to December 2014. A structured and validated proforma was designed for the purpose of data collection. The tool was validated by including the inputs from five experts in the subject area. Categorical variables were presented as frequencies and percentages. Quantitative variables were presented as mean and standard deviation. IBM SPSS version 21 was used for statistical analysis. Results: Majority of the study subjects belonged to 21 to 25 years of age group 35.7% and 45.5% of the women had recent onset infertility. 17% women had difficulty in falling asleep was reported. 58.9% of the women reported with high levels of anxiety. 26% women have decrease in weight was noticed. Whereas 48.2% women reported feeling guilt and 35.7% women reported feeling of pessimism and suicidal tendency.16.28% women participants reported to have immersing in household activities followed by 13.95% with hobbies and 11.63% with crying spells. Conclusion: Our study revealed that infertile women experienced high levels of anxiety, guilt, feeling of pessimism and suicidal tendency. The coping strategy adopted by majority of the women was engaging in household activities and hobbies. There should be parallel psychological counselling should be advocated strongly to all women with infertility taking treatment along with family members.

129-135

Authors: Kar K, Sinha S

Background: Pregnancy induced hypertension may complicate to preeclampsia and eclampsia. The pathophysiology of the former is still confusing, many authors suggested different opinions, and indicated different parameters for the prognosis of this. Aim: To evaluate serum HDL and LDL cholesterol, alkaline phosphatase, ionized calcium in pregnancy induced hypertension patients. Materials and methods: We had selected normal non-pregnant females (Group 0), pregnant normotensive females (Group I) and pregnancy induced hypertensive females (Group II). All the above mentioned parameters were estimated in them. Statistical analysis was done by SPSS 17 software; ANOVA and post hoc Bonferroni analysis were used to compare them. Results: Significant increase of LDL and alkaline phosphatase as well as significant decrease of HDL and ionized calcium were found in Group II females. Conclusion: HDL and LDL cholesterol, alkaline phosphatase, ionized calcium can indicate the severity of gestational hypertension. Normalization of those parameters can prevent the complications like preeclampsia and eclampsia.