International Archives of Integrated Medicine

8-13

Authors: Narendra Kumar Maddur, Surendar Reddy K, Sowmya J, Pradyut Waghray

Background: Automobile exhaust related air pollution have become a major health hazard. Traffic police personnel, due to their continuous and prolonged exposure are likely to be the worst affected group in this regard. Many studies in the past have documented impaired respiratory function among traffic policemen. Studies from India, exploring the relationship between duration of exposure and respiratory function is necessary. Objective: To compare the pulmonary function parameters between controls and traffic police exposed to air pollutants for variable duration Materials and methods: The study was a community based analytical cross sectional study in Telangana state from August 2012 to November 2013. A total of 120 study participants, including 30 controls and 90 traffic police (30 in each of decadal age groups from 21 to 50 years) were studied. Lung functions were measured by Spirowin. FVC (L), FEV1 (L), FEV1 / FVC ratio, FEF 25 - 75 (L/Sec) and PEFR (L/Sec) were measured and compared. Results: The absolute and percentage predicted values of FEV1 were higher in control group, compared to traffic police and they have shown gradually decreasing trend with increasing age band which was statistically significant. The mean FVC value and percentage predicted was highest in 21 to 30 age group traffic police and showed gradually declining trend with increasing age band. The other pulmonary function parameters like FEV1/FVC, FEF 25-75 and PEFR have also shown gradually declining trend with increasing age group among traffic police. Conclusion: The traffic police had poor respiratory function, compared to general population, which declined with increasing age of the individual and increasing duration of exposure.

20-23

Authors: Parmar P, Rathod S, Parikh A

Background: Euthanasia is a matter of debate since its origin and till now. Few countries have proper legislation for the same while in India, the matter is always remain unnoticed. Present study was aimed to analyze perceptions of patients towards euthanasia. Materials and methods: A cross sectional study was conducted among 107 patients after obtaining their informed written consent for participation in the survey regarding euthanasia and its medico-legal perspectives. All patients were subjected to pre-tested and validated questionnaire (Likert type scale) related to euthanasia after obtaining their socio-demographic details. Results: Out of 107 responses, only 100 responses were considered for analysis and rest of 7 were discarded. Out of 100 patients, maximum (33%) were in between 31 to 40 years of age, 66% were male, 82% were Hindu, and 71% were married. 51% were agreed that person should be kept alive as long as possible regardless of his age, disease, disabilities and personal preferences. 40% believed that supporting death with dignity means supporting active and passive euthanasia. 61% suggested that freedom of choice also applicable to freedom of choice to live or die. 55% disagreed that some patients should be allowed to die instead of making heroic efforts to prolong their lives. 73% believed that demanding or helping in euthanasia is crime. 52% were unsure regarding legalization of euthanasia. 78% believed that legalization of euthanasia may create moral and ethical problems. Conclusion: Perceptions of patients were varied but conclusion can be drawn that many of them believed that legalization of euthanasia may create moral and ethical problems.

29-37

Authors: Sirohiya P, Mantan K, Rehman H, Kumari M, Devra V, Singh R

Addition of clonidine to local anesthetics improves peripheral nerve blocks by reducing the onset time, improving the efficacy and extending postoperative analgesia. This study evaluated the effect of Bupivacaine clonidine combination in supraclavicular brachial plexus block for upper limb surgeries. A randomized double-blind controlled trial was performed in 60 patients. Group B (n=30) patients received 25 mL 0.5% Bupivacaine and 0.2 mL of Saline, whereas group C (n = 30) received 25 mL 0.5% bupivacaine and 0.2 mL (30 mcg) clonidine through supraclavicular brachial plexus block. In both groups, differences between age, sex, ASA grades, weight, vital parameters were statistically insignificant. Time of onset of sensory blockade and motor blockade were reduced in group C compared to Group B and were statistically significant. Duration of sensory and motor blockade were prolonged in group C compared to Group B and were statistically significant. Duration of post operative analgesia was prolonged in group C compared to Group B and were statistically significant. Sedation score of patients in group C were higher than those in group C intra-operatively and postoperatively. No clinically significant differences were observed in pulse rate, mean blood pressure and oxygen saturation. Due to its sedative properties, it can reduce patient anxiety and provide optimal intra-operative and postoperative patient comfort.

46-52

Authors: Dutta N, Gupta VK, Shetty R, Roy A, Dani G, Pandey V

Introduction: The HIV pandemic has become a human, social as well as economic disaster, with far reaching inferences for individuals, communities and countries. The distribution of some of the specific oral manifestations is reported to differ between adults and children. Thus, the present study was carried to compare the oral manifestations in HIV positive children and HIV negative children. Materials and methods: The present study comprised a total of 90 subjects, divided into 3 groups, 30 HIV positive pediatric patients with HAART, 30 HIV positive pediatric patients without HAART and 30 healthy controls (HIV negative patients). The present study was conducted in the ART centre in Ranchi, Chattisgarh, India. The details to be taken from these children for subsequent analysis include age, CD4+ T cell count and oral lesions. Chi- square test was used to compare the lesions with P-value of 0.05 or less was considered for statistical significance and a P-value of 0.02 or less was considered for statistical highly significance. Results: Statistical analysis showed that patients with low CD4+ T cell counts (Group IA) had more number of lesions when compared to the patients with higher CD4 T cell count (Group IB). According to individual lesion percentage distribution, it was observed that except hyperpigmentation most of the other lesions where more prevalent in group II than in group I. Mucocele was seen in group III and was not seen in group I and II. Dental caries was prevalent in all the three groups. Conclusion: HIV infected patients receiving HAART, had a significantly lower prevalence of oral lesion as compared to patients without HAART therapy.

58-63

Authors: Sridhar Reddy Erugula, P. Sujatha, Ayesha Sameera, B. Suresh Reddy, Jesudass Govada, G. Sudhakar, Kandukuri Mahesh Kumar

Background: Assessment of nuclear morphology is crucial for the diagnosis of non-Hodgkin's lymphoma. The non-Hodgkin’s lymphomas (NHL) constitute a heterogenous group of lymphoid neoplasms that vary in clinical behavior, histology, immunology and genetic profile. The diversity makes it difficult to diagnose accurately and reproducibly under light microscopy. The nuclear features play a major role in categorizing non-Hodgkin's lymphomas. Materials and methods: The present study was conducted for a period of two years in the Department of Oral Pathology, MNR dental College and Hospital, Sangareddy, Telangana, India. We encountered only three cases of Non-Hodgkin Lymphomas and so we have borrowed the some specimens of NHL from other hospitals in Hyderabad, India. Hematoxylin and Eosin (H and E) stained histological sections were selected and assessed for nuclear area, perimeter and nuclear size of 40 nuclei of tumour cells were measured using the Windows® based image analysis software Results: Total number of cases in our study was 15. The mean nuclear area, perimeter and nuclear size of neoplastic cells were studied. In our study, the mean nuclear area, perimeter and nuclear size of neoplastic cells were significantly high in large cell lymphomas as compared to intermediate cells and small cell lymphoma. P value was significant. Conclusion: Our study supports the assumption that nuclear morphometry offers a more objective and reproducible diagnostic method for subcategorizing lymphoid tumors than is currently possible by conventional histopathological techniques.

74-80

Authors: K. Ramesh, Balaji Prasad Nayak

Background: Cardiac abnormalities associated with hypothyroidism attracted great deal of investigational effort. There are only few studies done in our country to asses CVS parameters in hypothyroid patients. Hypothyroidism is known to cause reversible cardiac dysfunction in humans. Aim: This study was aimed at studying the cardiovascular involvement in hypothyroidism. Materials and methods: The data for this study was collected from 40 hypothyroid patients by clinical examination and by performing ECG and Echocardiogram who came to Malla Reddy Medical College and Hospital, Hyderabad which included both outpatients and inpatients. Results: On systemic examination, diminished heart sound was found in 25 % patients. Lipid analysis showed increase of TOT.CHOL, LDL, VLDL, TGL and decrease of HDL. Normal ECG was found in 30% of patients, Bradycardia was most common finding seen in 16 patients counting for 40%. Low voltage complexes were seen in 35% patients. Echo findings were normal in 32.5% cases. Pericardial effusion was next common finding seen in 11 cases accounting to 27.5%. Diastolic dysfunction was seen in 27.5%, majority of them being mild dysfunction. No cases were found to have severe diastolic dysfunction. IVS thickness was found only in 2 cases. Conclusion: Among 40 new cases of hypothyroidism, pericardial effusion was found in 27.5% patients. Diastolic dysfunction was seen in 27.5 % patients. All the patients diagnosed with hypothyroidism are to be screened for pericardial effusion and other cardiac complications.

85-88

Authors: Joshi V, Shah S

Background: Obesity has become one of the major health issues in India. WHO defines obesity as “A condition with excessive fat accumulation in the body to the extent that the health and wellbeing are adversely affected”. Obesity results from a complex interaction of genetic, behavioral, environmental and socioeconomic factors causing an imbalance in energy production and expenditure. Peak expiratory flow rate is the maximum rate of airflow that can be generated during forced expiratory manoeuvre starting from total lung capacity. The simplicity of the method is its main advantage. It is measured by using a standard Wright Peak Flow Meter or mini Wright Meter. Aim: The aim of the study is to see the effect of body mass index on Peak Expiratory Flow Rate values in young adults. Materials and methods: A correlational study was done 40 healthy individuals with age of 18-35 year old. Subjects having cardio or pulmonary condition were excluded. Then according to body mass index (BMI) normal (group A) and obese (group B) individuals were included. Where, BMI - normal: 18.5-22.9 kg/m2 and obese: 25 kg/m2 onwards. Then in sitting position all the individuals were given three trials for PEFR and best of all was taken. Results: Group A: BMI mean -18.74±1.11and PEFR mean - 395±116.8, Group B: BMI mean -28.7±1.12 and PEFR mean - 309±46.4. According to spearman’s correlation Group A, r= 0.456 and p=0.022 also in Group B r=0.097 and p=0.342. Conclusion: There was weak correlation in between BMI and PEFR.

94-100

Authors: Maanasa T J, Sivabackiya C, Srinivasan B, Shajahan Ismail, Sabari Sridhar OT, Kailash S

Background: Co-occurrence of personality disorders with other psychiatric disorders has also been well documented by many researchers in the past. Diagnosing co occurring personality disorders in psychiatric patients with is of strong clinical significance, considering their association with the duration, recurrence, and outcome of these disorders. They also can have wide range of other adverse health outcomes. However, most of the existing literature regarding the studies related to personality disorders (PDs) in India is confined to community and mental hospitals. Aim: To study the prevalence and factors affecting personality disorders in a general hospital psychiatry unit. Materials and methods: The study was a cross sectional study conducted in a psychiatric unit of a tertiary care teaching hospital in south India. ICD-10, Mini International Neuropsychiatric Interview (MINI) and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV Personality Disorders (SCID-II) were used. Results: A total of 116 participants were included in the study. Majority of the participants were between 26 to 45 years of age. The prevalence of personality disorder was 21.55% (95%CI 14.07 to 29.03) among the study population. The most common type of personality disorder was avoidance (7.7%), followed by anti social (5.17%) and borderline (3.45%) personality disorders. Highest proportion of PD was seen in people with major depressive disorder (35.7%), followed by people with multiple psychiatric illness (31.6%) and Psychotic disorders/mood disorders with psychosis (18.9%). Conclusion: The proportion of personality disorders was highest in 26 to 35 year age group, was higher in males, compared to females. People who studied up to primary school had higher proportion of PD, compared to other educational categories. The proportion was higher in people belonging to higher socio economic strata, people who are separated and people from nuclear family.

106-112

Authors: P. Sujatha, V. Indira, Kandukuri Mahesh Kumar

Background: Leucorrhoea is the clinical evidence of infection and can be treated satisfactorily whenever diagnosed. Occurrence of cervical cancer associated with discharge/leucorrhoea can be easily prevented if detected early. Majority of patients attending hospital present with varying degree of vaginal discharge and cytological monitoring of these subjects is mandatory to know any cellular changes in the cervical epithelium as well as the presence of any sexually transmitted diseases (STD’s) in the genital tract. Materials and methods: This research study was done at Malla Reddy Institute of Medical Sciences (MRIMS), Suraram, Hyderabad, Telangana State, India for a period of 2 years. A total of 500 cases were included in the study with women of age ranging from 20-50 years, complaining of Leucorrhoea. As told by the patients on questioning as a part of clinical history, the Leucorrhoea was found to be of different types white discharge, yellowish discharge, greenish discharge; blood stained and fouls smelling discharge. Smears were taken with a thorough history in particular reference to age at first child birth, parity, personal and genital hygiene, history of husband suffering from any sexually transmitted diseases, vaginal discharge, mass per vaginum, duration of labour and history of sexually transmitted diseases were elicited. Results: In our study of 500 cases, 348 (69.6 %) cases showed reactive cellular changes associated with repair (Inflammatory smear), 56 (11.2%) cases were due to various infectious agents, 32 cases (6.4%) were of Reactive changes with Atrophic vaginitis, Low grade squamous intraepithelial lesion (LSIL) 18 cases (3.6%), High grade squamous intraepithelial lesion (HSIL) 5 cases (1%), Atypical squamous cells of undetermined significance (ASCUS) 4 cases (0.8%), Atypical glandular hyperplasia 4 cases (0.8%),Suspicious of malignancy 9 cases (1.8%),Shift in flora suggesting Bacterial vaginosis 7 cases (1.4%), Normal smear/ Normal study 13 cases (2.6%) ,Unsatisfactory for evaluation as more than 75 % of smear is obscured by blood – 4 cases (0.8%). Conclusion: A Pap test (Pap smear) is a quick and simple test that checks for changes to the cells of your cervix that may lead to cervical cancer. Pap smear reduces the mortality and morbidity with cervical cancer. This cytological screening should gain much popularity and should be accessible to all. It is recommended as part of routine medical examination in gynecological practice.

120-126

Authors: Wulsa N, Divyalasya TVS, Soren G, Pathapati RM, Buchineni M

Background: Measuring blood pressure and detecting hypertension are significant in antenatal monitoring. Most clinicians read blood pressure (BP) only to the nearest 10 mmHg. It is consistently seen in BP records that end digit is rounded off to zero showing end-digit preference (EDP) or terminal digit preference (TDP). Here, we assessed the frequency of EDP/TDP and 110/70 and 120/80 mmHg among BP records. Materials and methods: This was an observational study conducted in the outpatient department of Obstetrics and Gynecology. BP measurements were observed in 200 women. Fifty were healthy and non-pregnant while the remaining 150 were pregnant women, 50 from each trimester. Women between 20 and 30 years were included and those having any organic disease were excluded. Data was collected from10 am to 12 noon. Results: We found an increased frequency of EDP of zero among Systolic Blood Pressure (n=142, 71%) and Diastolic Blood Pressure (n=126, 63%) records and 110/70 mmHg (19.5%) and 120/80 mmHg (23. 5%). The number of patients with110/70 mmHg increased from 1st to 3rd trimester (n=6 in 1st trimester, n=10 in the 2nd trimester and n=17 in 3rd trimester) whereas those with 120/80 mmHg decreased from 1st to 3rd trimester (n=15 in 1st trimester, n=11 in the 2nd trimester and n=5 in 3rd trimester). Conclusion: We observed the higher frequency of terminal digit being zero, 110/70 and 120/80 mmHg in BP measurements. Health care professionals should be well-trained to avoid misinterpretation and misdiagnosis of hypertension, particularly among pregnant women.

133-137

Authors: Lakum S, Anita, Pandya H, Shah K, Lakhani SJ

Background: Infections with pseudomonas have been an important cause of Morbidity and Mortality throughout the history, which makes the treatment challenging every year. The present study was intended to find out the drug resistance pattern of Pseudomonas aeruginosa from various clinical specimens. Materials and methods: The study was conducted during April 2015 to September 2015. One hundred and one strains of Pseudomonas aeruginosa were subjected to antimicrobial susceptibility test by modified Kirby-Bauer disk diffusion method as per CLSI guidelines with Pseudomonas aeruginosa ATCC 27853 as control strain. Results: One hundred and one Strains were isolated from 83 males and 28 females. Majority of the Pseudomonas strains were isolated from ICU (30.63%), followed by Orthopedics (14.41%) and Pediatrics wards (13.51%), Strains were mainly isolated from pus samples (48.65%) followed by urine (20.72%) and sputum sample (13.51%). Majority of the strains were resistant to Aztreonam (70.27%) followed by Ciprofloxacin (54.95%), Amikacin (53.15%), Piperacillin (51.35%), Cefoperazone-sulbactam (50.45%), Gentamycin (49.55%), Cefepime and ceftazidime at 45.95% respectively. While with Piperacillin - Tazobactam we got sensitivity of 63.97% and with Imipenem and Imipenem –EDTA we got sensitivity of 78.38% and 81.08% respectively. Conclusion: We concluded that drug resistance of Pseudomonas was mainly isolated from pus samples of ICU patients, which is therefore an urgent call for the physicians to limit the indiscriminate use of antibiotics. The encouraging finding was its sensitivity to Imipenem and Piperacilin-Tazobactum as an effective antibiotic for the treatment.

146-150

Authors: Lal RZ, Biyani S, Lodha R

Introduction: Measurement of prolactin and thyroid hormones, especially thyroid stimulating hormone (TSH), has been considered an important component of infertility work up in women. Thyroid dysfunctions interfere with numerous aspects of reproduction and pregnancy. Aim: To correlate thyroid hormones level with FSH, LH and prolactin in infertility in the reproductive age group women. Materials and methods: This study includes 100 infertile women who attended infertility clinic of our institute along with 50 fertile women as a control group between age group of 20 to 40 years. Out of 100 infertile women, 70 were of primary infertility and 30 of secondary infertility. Thyroid hormones and infertility hormones level is measured from all participants by chemiluminance immunoassay. Results: Prolactin and TSH were positively correlated with each other. They were also negatively correlated with LH, FSH and T3 in infertile groups. Therefore we can say that hyperprolactinemia and hypothyroidism plays key role in etiopathogenesis of infertility. Conclusion: There was a higher crude prevalence of hypothyroidism and hyperprolactinemia in the infertile women as compared to the fertile ones in the control group.

159-165

Authors: T. Murali Venkateswara Rao, B. Bhaskara Rao, Raghuram Chikkala

Introduction: Malaria has been a major public health problem plaguing India for centuries and about 95% of Indian population is residing in malaria endemic regions. The proportion of the Pf % has gradually increased from 39% in 1995 to 65% in 2014. Periodic clinical profiling studies may help us in understanding of the changing pattern of the disease, complication rate and emerging drug resistance patterns, which can help the clinicians in making better and informed clinical decisions. Objective: To analyze the socio demographic and clinical profile of falciparum malaria cases and to study the incidence and profile of complications of falciparum malaria and their impact on hospital in falciparum malaria. Materials and methods: A prospective observational study was conducted in department of General Medicine of tertiary care hospital from November 2011 to November 2013 among patients diagnosed with falciparum malaria by smear. Patients aged above 18 years, both genders were included in the study. Results: Among 50 study participants, 42% belonged to 26 to 40 years of age and 76% of them were males. Fever was the most common clinical symptom reported by all the patients, followed by chills and rigors (90%), headache (74%), nausea and vomiting (46%). A total of 37 (74%) of the patients had complicated malaria, out of the 37, 17 (45.95%) had single complication and remaining 54.05% had multiple complications. Liver involvement manifested by jaundice was the most common complication seen 51.4% of the subjects, followed by cerebral malaria (48.6%) and anemia (45.9%). None of the patients reported mortality. Conclusions: Males in the age group of 26 to 40 years is the most common population group affected by plasmodium falciparum malaria. The proportion of complicated cases is very high (73%) in the study population and the most common complications include liver dysfunction and cerebral malaria. No mortality was reported in the study probably attributed to early diagnosis and effective management.

174-183

Authors: Viswambhar V, Reddy GMM, Ragulan R, N. Meenakshi, Aruna Shanmuganathan, Krishnaveni R

Background: Asthma is a heterogeneous syndrome with multiple phenotypes, the most prevalent of which is allergic asthma in association with allergic rhinitis. Construction is one of the important industries, which employs a large number of people on its workforce. In India about 340 million (92%) workers are in unorganized sector and about half of them are in construction industry. The construction workers are one of the most vulnerable occupational groups, prone to wide range of illnesses especially to respiratory morbidities like Asthma and allergic rhinitis. Despite this high risk very few studies are available on extent of asthma and AR in construction workers. Objectives: To assess the prevalence and factors influencing allergic rhinitis and bronchial asthma among construction workers and to assess the degree of disease control using CARAT questionnaire Materials and methods: The study was a cross sectional study conducted in sub urban areas of metropolitan city of Chennai. The participants were selected by multistage Cluster random sampling. World Health Organization (WHO)-sponsored Allergic Rhinitis and its Impact on Asthma (ARIA) guideline, Spirometry and CARAT scoring were used in the study. Results: A total of 231 participants were included in the final analysis. The prevalence of any respiratory morbidity was 39% among study population. Out of the diseased 11 (4.8%) had AR alone, 12 (5.2%) subjects had BA alone and remaining 67 (29%) had both AR and BA. The prevalence of respiratory morbidity gradually increased with increasing age and was more in males. Upper airway symptoms were poorly controlled in 100% of the affected patients, this proportion was 66.7% for lower airway symptoms and 83.58% for combined airway score Conclusion: Co-existence of Bronchial asthma and Allergic rhinitis is more common among construction workers compared to general population. Male workers in middle age group are more prone to airway allergy. Bronchial asthma is poorly controlled in workers with coexisting allergic rhinitis.