International Archives of Integrated Medicine

1-11

Authors: Saraladevi R, Nirmala Kumari T, Shreen B, Usha Rani V

Background: Thyroid disorders constitute one of the most common endocrine disorders seen in pregnancy. Maternal thyroid function changes during pregnancy and inadequate adaptation to these changes results in thyroid dysfunction. Aim: A prospective and comparative clinical study to know prevalence of thyroid disorder in pregnancy and pregnancy outcome was done. Materials and methods: This study was carried out in pregnant women during 1st trimester who attended antenatal clinic of maternity hospital to know the prevalence of thyroid disorders in pregnant women living in and around and also to know the outcome of pregnancy in women suffering from thyroid disorders. Results: In this study, prevalence of thyroid disorder was 11.6% with 95% CI of 9.64 to 13.54 which was high when compared to other regions in India and in other parts of Asia. Subclinical hypothyroidism and Overt hypothyroidism was 6.4% and 2.8% respectively. Subclinical and Overt hyperthyroidism was 1.8% and 0.6% respectively. Subclinical hypothyroidism was more prevalent and hidden, leading to the poor obstetrical outcome and fetal complications. Rate of miscarriage was high in overt hyperthyroid patients. Conclusion: Due to the immense impact that the maternal thyroid disorder has on maternal and fetal outcome, prompt identification of thyroid disorders and timely initiation of treatment is essential. Thus, universal screening of pregnant women for thyroid disorder should be considered especially in a country like India where there is a high prevalence of undiagnosed thyroid disorder.

17-24

Authors: E. A. Ashok Kumar, P. Jijiya Bai

The diagnosis of Invasive Pulmonary Aspergillosis (IPA) and therapy with Amphotericin B appear to improve survival, but the early diagnosis is difficult. There are no pathognomonic clinical findings for IPA. The commonest presentation is compatible with any of bacterial, fungal, viral or protozoan infections. In addition, IPA may coexist with or arise during the therapy of other infections in immune compromised patients. It was thought that ante mortem isolation of Aspergillus species from respiratory secretions in pathologically confirmed cases occur infrequently. Demonstration of tissue invasion by fungal hyphae remained the accepted standard for diagnosis of IPA. Sputum culture is regarded as not useful for the diagnosis of IPA. Colonization of aspergillus may occur without invasion, hence, culture of respiratory secretions were not reliable. Aggressive diagnostic methods to establish the diagnosis of IPA are warranted. However there may exist important subsets of patients where sputum culture of Aspergillus may still be diagnostically useful. The underlying disease, i.e. immune suppression, neutropenia/ leukemia is a critical factor in selecting patients where sputum cultures may be useful. The degree of immune suppression increases, the diagnostic specificity of isolation of aspergillus from sputum. In this article, a meta analysis of 21 studies, spanning 27 years, the methods adopted for diagnosing IPA by various authors is analysed and discussed. The detailed pathogenesis of IPA is also discussed.

29-34

Authors: Goyal SK, Chhabra UK, Bansal SK, Choudhary D, Goyal PK, Singal G

Mechanical bowel obstruction presenting acutely is a common surgical emergency and a frequently encountered problem in department of surgery. Intestinal obstruction continues to remain a challenge to surgeons despite advances in field of medicine, pathophysiology, surgical technique and conservative management. This retrospective study in patients operated for acute mechanical bowel obstruction in our department, was intended to highlight the common causes of intestinal obstruction in this geographical location of the study which had suggested measures for prevention and treatment of the condition. 150 patients who underwent exploratory laparotomy for intestinal obstruction were compared in terms of age, sex, symptoms, etiology of intestinal obstruction, site of obstruction, operative procedure performed.

42-47

Authors: Venkat Narsimha Reddy Nandyala

Background: E learning refers to the use of Internet technologies to deliver a broad array of solutions that enhance knowledge and performance. It is more often used by medical educators in basic science courses than in a clinical evaluation. Materials and methods: An observational study was carried out in the Department of General Surgery among undergraduate medical students to know the impact of e-learning in the acquisition of clinical skills required during evaluation of an inguinoscrotal swelling. A total of 60students were divided into two groups of 30 each. Group A students were trained by conducting bed side clinics on patients while students from Group B were trained using You tube videos. Results: At the end of these sessions, all the students were assessed by Objective Structured Clinical Examination on patients presenting with inguinoscrotal swelling with a check list. Out of 20 marks students from group A had a mean of 16.4 and the mean in the E learning group was 14.1 and the P value was .004 which was statistically significant. Conclusion: E learning by using videos cannot substitute traditional bed side teaching but it can impart basic clinical skills to a certain extent in a resource constrained situation.

52-64

Authors: Rathva AM, Singla H

Background: CT has evolved from single–detector row scanners into multi–detector row helical volumetric acquisition techniques, and these advances have had a significant impact on imaging of the urinary tract. Aim and objectives: To evaluate the CTU compare to other imaging modalities for urinary tract abnormalities in light of present knowledge, To study the role of CTU in evaluation of various abnormalities those are not detected by conventional IVP, Benefits of CTU over IVP, To provide information about the extent of the lesions involving kidneys and its relation to surrounding structure and Characterizing the lesions whether they are benign or malignant and helping the surgeons for the further management, Grading the renal injuries. Materials and methods: Data was collected from patients who attended the surgical O.P.D. or emergency of S.S.G.H., Baroda with clinically suspected renal abnormalities. A study was conducted over a period of two years on 50 patients with clinically suspected renal abnormalities. Informed consent was taken from every patient. Patients were evaluated with Multidetector Computed Tomography (G.E. Bright Speed). Results: Our Study included 10 patients of renal stones, 8 patients of renal masses, 3 patients of pyelonephritis, 7 patients of renal injury, 5 patients of PUJ obstruction, 7 patients of ureteric stricture, 5 patients of anomalies, and 5 patients of bladder mass. Among all pathology CT urography is more helpful and gives better imaging findings as compare to conventional urography that helps in better management of patients. Conclusion: CTU gives reliable information not about the extent of lesion but also the characteristics of lesions which makes surgeons to take proper decision aboutthe further management of patients, it also avoids unnecessary laparotomy surgery in case of blunt abdominal trauma patients by giving the precious extent of renal injuries. For all these gold standard benefits of MDCTU over conventional IVP makes MDCTU as “one stop shop” for urinary tract abnormalities and nearly completely replacing the IVP in recent era.

70-75

Authors: Ragi V, Sridevi A

Background: Intertrochanteric fractures are the most commonly treated fractures by Orthopedic surgeon. Many techniques are described in literature but internal fixation with Dynamic Hip screw is most efficient method. Aim: The present study was conducted to compare the results of conservative methods and internal fixation with dynamic hip screw in management of intertrochanteric fractures of the femur. Materials and methods: This study included 40 patients of intertrochanteric fractures of the femur, out of which 30 patients were treated by conservative methods considered as Group I and 10 patients were treated by internal fixation with Dynamic Hip Screw (DHS) considered as Group II. All the results were evaluated by using Kyle’s criteria. Results: In Group I, 4 (13.3%) cases had excellent results, 6 (20%) case had good results, 20 (66.6%) cases had poor results. In Group II, 8 (80%) cases had excellent results, 6 (20%) cases had good results. In Group I, 73.3% of cases had unstable fractures and in Group II, 80% of cases had unstable fractures Conclusion: The quality of results was better with internal fixation with dynamic hip screw (DHS) as compared to conservative methods.

81-86

Authors: N L Eshwar Prasad, V Ravi, P Anuradha

Background: Breast cancer is the most frequent cancer in women globally and represents the second leading cause of cancer death among women. Materials and methods: This study was a retrospective which constituted of 30 cases of breast cancer admitted during the period of 1 year. Investigations were done for confirmation and to know the extent of the disease. Treatment adopted after clinically evaluating and investigating. Post operatively breast with tumor and axillary lymph nodes had been sent for histopathological examination. Results: Incidence of breast carcinoma was highest in the age group of 30-40 years and 51-60 years with 61% of patient in this group. 3.56% patients presented with less than 6 months duration of symptoms. Majority of the patients presented with stage – 2nd and stage – 3rd diseases constituting 73% of the cases. Majority of patients suffering from carcinoma Breast were multiparous, constituting about 60% of total. The duration of the symptoms varied widely from one month to 2 years, with majority 17 patients presenting before 6 months.17 patients out of 30 were prenatal with less than 6 months duration of symptoms, constituting 56.1% of cases. 16 out of 30 patients were presented with N 1 lymph nodal metastasis constituting 60% of cases and 8 patients out of 30 were presented without N0 lymph nodal metastasis constituting 26.6%. Type of surgical treatment adopted for the patient was depending on the stage of the disease. Post operative treatment in the form of radiotherapy, chemo-therapy and Tamoxifen was given for all patients except for stage – 0 and stage – 1 cancer patients. Conclusion: Good disease free survival rate and overall survival improvement neoadjuvant chemoradiation is to be followed.

95-98

Authors: Koramutla Harsha Kumar, Jaya Someswar Narreddy

Background: Clavicle fractures are one of the most common bone injuries seen in adult population. Generally all the fracture clavicles were treated non-surgically by figure-eight bandage and surgical intervention like plating with cortical screws is infrequently required. Non-union rates, strength and endurance deficits are familiar in cases treated conservatively. We evaluated functional and radiological outcomes in non operative versus operative management of fracture clavicle, in patients visiting to orthopedic OPD in a tertiary care hospital in Andhra Pradesh. Material and methods: In a prospective clinical trial study of 80 patients, with displaced mid-shaft fractures of the clavicle were referred to Orthopedic OPD in a tertiary care hospital. These patients were deliberately placed into two treatment groups: non-surgical (with figure-eight bandage) and surgical (with DCR plate fixation). All patients of the surgical group underwent ORIF. Clinical examination, fracture radiography and shoulder scores were recorded for all patients at the end of 12 weeks. Shoulder function is measured by the constant shoulder score which includes the pain score, functional assessment, range of motion and strength measures. Patient satisfaction according to strength, shoulder function and pain was also assessed. Results: There were 32 patients in operative in which 23 males and 9 females whereas in non-operative group (figure of eight) there were 35 males and 13 females. The mean age of the patient was 23±3.4 years in operative and 19±2.5 years in non-operative group. 61 fractures occurred on the right side and 10 on the left side. In the Surgical group mean time to reunion was 8±1.8 weeks where as it was 11.±2 weeks in non surgical group. The overall Constant shoulder score was 93.75% in surgical group where as it was 87.50% in nonsurgical group. Additionally the percentage of patients with excellent results was more in surgical group than non- operative group (figure of eight). Conclusion: In both figure of eight bandage and plating, there was satisfactory union of clavicle but due to appropriate bone proximity in cortical screw and plating, excellent functional outcome in the terms of early mobilization and quick union was much appreciated.

106-117

Authors: E.A. Ashok Kumar, P. Jijiya Bai

Earlier Diabetic nephropathy was thought to be a rare complication in Type II Diabetic patients. The incidence and prevalence of nephropathy in Type II Diabetes have been under estimated in the past probably because most patients with nephropathy succumbed to cardiovascular disease, even before nephropathy could manifest clinically. The current study was done to screen Type II diabetic patients for micro albuminuria and macro albuminuria, to identify the risk factors for development of nephropathy, and to note association of other micro vascular and macro vascular complications, and compare them with diabetics without proteinuria.

123-127

Authors: Naveen Kumar E, Ramesh K, Alugonda Y, Kothapalli J, Goud AK

Background: Negligence is the breach of a legal duty of care. Liability is the responsibility of a person for his acts of commission and omissions. Aim: This study aimed to determine the role of liability in medical negligence in teaching hospital. Materials and methods: A total 36 medical negligence cases reported during the period of 3 years i.e. from July 2011 to June 2014 were gathered from Hospital Case Records, Inquest Reports, Post Mortem Examination Reports, and Forensic Science Laboratory Reports. Results: Among these 36 cases of medical negligence doctors were liable for their negligence in 15 cases i.e. 41.7% and vicariously liable in 3 cases i.e. 8.3%. There was no liability for doctors in 18 cases i.e. 50%. Conclusion: It this study, male and female was equally suffered for medical negligence. Among the females pregnant cases were more common. Most of the medical negligence cases had come to the hospital with major health problem. Health care professionals are increasingly facing complaints regarding the facilities, standards of professional competence and the appropriateness of their therapeutic and diagnostic methods.

134-138

Authors: Saini S, Hasan N

Background: Understanding the future career interests of medical graduates is important, as they are the future workforce of the healthcare profession. Aim: The aim of this study was to determine the career choices and the factors that influence undergraduate medical students to choose a particular medical specialty. Materials and methods: A cross sectional observational study was conducted among ‘300’ undergraduate medical students of Sardar Patel Medical College, Bikaner, Rajasthan between January to March 2014. A self-administered questionnaire was used to collect data and the association between different variables was tested using Chi-square test. Results: Out of total ‘300’ respondents, 84% (n=252) considered post-graduation very important for future career and majority of them (99%) wanted to pursue the same in clinical subject. The most preferred specialty expressed by male students was Medicine, followed by Surgery and Orthopedic, while the female students were more interested in Radiology, Paediatrics and Obstetrics and Gynecology. Little interest was shown in other specialities. Personal interest was found to be the most common factor that influenced the choice of specialization. Conclusion: A variety of factors appeared to inspire medical graduates to opt for a particular specialty. All the substantial factors that influence the medical graduates’ decision should be equally justified and addressed, so that the quantitative and qualitative inequality of specialists can be nullified.

147-157

Authors: Patel P, Patel VP, Patel H, Rathod GB

Introduction: Organophosphorus compound (OPC) poisoning has assumed alarming proportions and it is primarily a problem of the developing countries. Serum cholinesterase levels are easier to estimate and usually depressed after OP poisoning. Peradeniya OP poisoning scale has not been studied much in Indian scenario. So, we decided to have first hand information and hence conducted this study. Aim and objectives: To find out severity of patients with OP poisoning by calculating Peradeniya OP Poisoning score, level of plasma and RBC cholinesterase level of patients of OP poisoning on admission before any treatment, and correlate the level with severity and outcome of patients and requirement of ventilator support with OP poisoning. Material and methods: All patients who presented to emergency department with history of poisoning with known compound were taken as study subjects. A detailed history, clinical examination and relevant biochemical investigations were performed. Peradeniya OP poisoning scale was applied to all study subjects and the severity of OP poisoning was graded as mild, moderate, severe. In all study subjects, 3 ml of plain blood was collected on admission before administration of atropine and plasma cholinesterase and RBC cholinesterase was estimated. Results: Most of the patients consumed poison with a suicidal intent. Majority had consumed poison orally. Most patients had consumed 50 – 100 ml of poison. Quantity of poison consumed did not correlate with severity of poisoning. In this study, requirement of ventilatory support was seen in 16% of patients. Mortality in our study was 9%. Pseudo cholinesterase levels were significantly depressed in patients who required ventilatory support and correlated with mortality. Miosis, Bradycardia, increased respiratory rate, impaired level of consciousness, all correlated well with need for ventilatory support and increased mortality. Peradeniya OP poisoning score of more than 8 correlated in predicting the need for ventilatory support and mortality. RBC and Plasma cholinesterase levels estimation in conjunction with Peradeniya OP poisoning score is a useful parameter for grading severity of OP poisoning and in predicting the need for ventilatory support and mortality. Conclusion: The POP scale and RBC Che and plasma cholinesterase levels both showed a significant association in predicting the need for ventilatory support and outcome. Lower grade of poisoning had a better outcome whereas higher severity of poisoning had a poorer outcome.

163-165

Authors: Raghuram Mohan S, Harika V, Sandhya Anil S, Sandhya Rani H

Fibroadenolipoma is a solid, rare benign tumor. It is a circumscribed lesion composed of fat and other breast tissues which may be normal or which may show various changes. The reported incidence of breast hamartomas is 0.7% of all benign breast tumors in females [1]. Clinical findings resemble fibroadenoma and if there is a palpable mass, the patients may receive an immediate diagnosis. Ductal hyperplasia, apocrine metaplasia, calcification and adenosis may occur within the hamartoma, with rarer instances of lobular or ductal intraepithelial neoplasms.

169-171

Authors: Kolandaivelu PG, Lakshmana R, Balamurugan R, Arun Prasath S

Primary omental torsion occurs when the mobile thickened segment of the omentum rotates around a proximal fixed point in the absence of any association or secondary intra abdominal pathology and is reported rarely in literature. Our patient was a 55 year old postmenopausal woman who presented with acute abdominal pain on the right side for 3 days and was diagnosed to have primary omental torsion.

177-180

Authors: Sharma MK, Joshi N, Yadav ML, Agarwal T

Tuberculosis is an infectious disease that has displayed increasing incidence in the last decades. In the ENT area, the most common onset is cervical lymphadenitis, which accounts for 95% of ENT cases. The posterior pharyngeal wall, tonsillar pillars, sidewalls, soft palate, and tongue are the least probable locations. A 40 year old male presented in the ENT OPD with a growth at base of tongue, involving the lateral sulcus, anterior tonsillar pillar and lower pole of tonsil left side. A biopsy was taken from the same area and sent for histopathological examination with a strong clinical suspicion of squamous cell carcinoma. The final histopathological diagnosis was tuberculosis of tongue. The patient showed good response on ATT.