International Archives of Integrated Medicine

6-10

Authors: Dhingra R, Dhillon V, Monga S, Mehta AS, Kaur G, Kaur M

Introduction: Incidence of chronic suppurative otitis media has been reported varying from 2.55% to 9.25%. CSOM without prompt, proper treatment can progress to a variety of mild to life-threatening complications that can be intra temporal and intracranial. Thus, the present study was conducted to identify sociodemographic factors associated with Chronic suppurative otitis media. Materials and methods: The present study comprised of 100 patients with history of discharge from ear along with perforation. Detailed clinical examination along with history was taken as per proforma. Specific emphasis was given on the sociodemographic factors associated with Chronic suppurative otitis media. Results: The present study found that the majority of cases belonged to lower (poor) socioeconomic status comprising 59% of cases, 74% in study group belonged to rural areas and factors associated with this infection were living in crowded conditions and in large family, unhygienic practices, such as bathing in contaminated ponds and rivers, unsterile ear piercing, leaning ears with aseptic things such as matchsticks, hairpins, pen-refills, etc. Conclusion: Sociodemographic profile and associated risk factors play a significant role in etiopathogenesis of CSOM. Thus, possible preventive strategies and programs to educate patients regarding knowledge of this burden of illness should be planned in developing countries like India.

16-22

Authors: Singh R, Pareek A, Kumari M, Khilji MY, Sirohiya P

Background: Pain is main post operative adverse outcomes causing patient distress, prolonging hospital stay, and increasing the incidence of admissions after surgery. Study was done to assess and compare the post-operative analgesic effects of fentanyl via nebulisation, intranasal and intravenous routes to provide better analgesia, anxiolysis and sedation to the patient. Materials and methods: After approval from ethical committee of SPMC, Bikaner and written informed valid consent from patients, sixty patients of either sex belonging to ASA class I and II, were randomised into three group (Group I - Nebulised Fentanyl, Group II - Intranasal Fentanyl, Group III - Intravenous Fentanyl). With all aseptic precaution, subarachnoid block was instilated via 23/25 gauze spinal needle by injecting sufficient dose of bupivacaine heavy 5% to achieve an adequate sensory and motor block for the proposed surgery. When patient complained pain 1st time, fentanyl was given via nebulisation in group I, intranasal in group II, and intravenous in group III with dose 4 mcg/kg, 1.5 mcg/kg, 2 mcg/kg respectively. Patients were assessed for pain by VAS score. For statistical data, SPSS 10.0 software was used. Results: In present study, Ramsay sedation score, patient satisfaction score and duration of analgesia was better in group II as compared to group I and III. Group III had lesser time of onset of analgesia in comparison to group II and I respectively. Conclusion: On the basis of analgesic efficacy, we concluded that intranasal group was better than nebulisation and intravenous route.

27-31

Authors: Patel R, Sheth M, Vyas N

Introduction: The diaphragm is man's main respiratory muscle. The role of the abdominal muscles is seen in both quiet and forceful breathing. Abdominal muscle function could be affected in subjects with back pain. Few studies are done about the relation between expiratory muscle strength and pulmonary function. So the aim of this study was to evaluate the correlation of abdominal muscle strength with pulmonary function in patients with low back pain. Materials and methods: Sixty subjects with low back pain were included in the study. Subjects with history of acute or chronic respiratory disorders were excluded. Abdominal muscle strength was measured by curl up test and FEV1/FVC and peak expiratory flow rate (PEFR) was measured to assess pulmonary functional. Results: Using Spearman test for correlation between abdominal muscle strength and FEV1/FVC (r= -0.27, p=0.03), and between abdominal muscle strength and PEFR (r=0.34, p=0.007) was seen. Conclusion: There was a weak correlation between abdominal muscle strength and pulmonary function in subjects of low back pain.

42-48

Authors: Tanna K, Oza F

Introduction: According to the American College of Sports Medicine, flexibility is an important component of good physical fitness and health. Therefore, for physical activity programs, muscles stretching exercise is an important component. Sedentary or less flexible subjects may perform the VM during stretching exercises due to difficulty in reaching and sustaining extreme ranges of motion. Materials and methods: 40 participants of age group 18-25 years having either hamstrings or pectorals tightness were included in quasi experimental study by convenient sampling technique. 20 subjects were included in each group: group A hamstrings tightness and group B pectorals tightness. 3 reps of stretching were given with 15 sec rest after each rep. Heart rate and Blood pressure was measured. Results: PNF stretching of hamstrings with VM shows significant increase in HR, SBP and DBP compared to PNF stretching of pectorals. Conclusion: PNF stretching of hamstrings with VM shows significant increase in HR, SBP and DBP compared to PNF stretching of pectorals.

59-64

Authors: R. S. Pushpa Kumari, V. A. Vipula, Jain S

Background: Community acquired pneumonia (CAP) has been recognized as a common and potentially lethal condition nearly two centuries ago. CAP is a spectrum of diseases ranging from a simple febrile respiratory infection to a severe and fulminating illness leading to death. Aim: To obtain comprehensive insight into the mode of presentation, clinical, bacteriological and radiological profile of patients with community acquired pneumonia for the early detection of the disease. Materials and methods: A total 50 patients diagnosed as community acquired pneumonia as defined by MNR Medical College and Hospital were considered and analyzed individual clinical, radiological and microbial status for predetermination of disease. Results: Dyspnoea was significantly dominant in aged CAP patients (p< 0.001) and chest pain was frequent in younger CAP patients (p=0.090). Gram-positive cocci were observed in (70%) and gram-negative bacilli in 26% whereas, mixed cocci were found in 4%. In radiological examination, CAP associated with COPD was constituted 22%. Conclusion: Identification and determining the etiological and clinical patterns of Community Acquired Pneumonia helps in adoption of regionally optimized diagnostic and therapeutic approach.

71-76

Authors: Srinivas B, Shailendra B

Background: As the laparoscopic management in bowel surgeries of abdomen grows as a tool in the armamentarium of the acute care surgeon, it is critical that outcomes are tracked to aid surgeons in making evidence-based decisions with regards to management of their patients. Aim: To study the feasibility of laparoscopy as a diagnostic modality and to assess the feasibility of laparoscopic intervention in various bowel pathologies in comparison to open surgery. To analyse the outcomes of laparoscopic surgery in compared to those treated by open surgery. Material and methods: A total 110 cases (Females 45% and Male 55%) of different Intestinal Pathologies from November 2013 to November 2015 were considered. For laparoscopy 80 Therapeutic cases and 30 diagnostic cases were included. All the cases were undergone for routine blood and urine investigation, ECG, X-ray, USG abdomen and Barium meal. Results: The commonest intestinal pathology in our study was acute Appendicitis (23.6%). Majority of the cases were seen in the age group of 26-40 years (40%). The mean operative time for laparoscopic appendectomy was 23 minutes and 25 minutes in open approach. Conclusion: Laparoscopy is safe and effective in the treatment of Bowels of abdomen. Tertiary centers with adequate minimally invasive skills should establish laparoscopy as the primary surgical technique in the treatment of this condition.

82-87

Authors: Bakkireddy Srinivasulu Reddy, P. Narasimha Reddy

Intravenous regional anesthesia requires a tiny practice to obtain good results and proves economical. We evaluated the efficacy of fentanyl (1 µg/kg) and pancuronium (0.5 mg) in lower doses with 0.25% lignocaine (1.5 mg/kg) for intravenous regional anesthesia for upper limb surgeries for a period not exceeding one hour, additionally we also compared the above study with standard Bier's block i.e. intravenous regional anaesthesia with 0.5% lidocaine (0.5 mg/kg body weight). This study was conducted in a medical college government general hospital, in Andhra Pradesh over the period of 3 years during 2001 to 2004. Fifty patients belonging to ASA grade I and grade II undergoing upper limb surgery were selected. Patients were included if they were undergoing upper limb surgeries for a period not exceeding one hour. These patients were assigned in a randomized, double fashion to two groups: Group A received 0.6 ml/kg of 0.5 % lidocaine (3 mg/kg) and Group B received 0.6 ml/kg of 0.25 % lidocaine (1.5 mg/kg) plus fentanyl (1 µgm/kg) and pancuronium (0.5 mg). The patients were observed for two hours after the release of the tourniquet for any complications like bradycardia, hypotension, and convulsions etc. The present was compared with standard Bier's block, i.e., 0.5% lidocaine (3 mg/kg body weight). Data was presented as Mean±SD, actual numbers and percentages and analyzed using SPSS version 16. In this study, 50 patients undergoing various upper limbs, surgeries were given intravenous regional anesthesia which included 38 males and 12 females. The postoperative analgesia was slightly greater in Group B compared to Group A. The onset of sensory and a motor blockade were earlier in Group A patients when compared to Group B patients. Short delay observed with this new method in the onset of sensory and motor blockade should be noted and the start of surgical procedures delayed until 15-20 minutes after tourniquet inflation. There was no difference in the quality of analgesia and muscle relaxation between two groups. The triple combination of lidocaine, fentanyl and pancuronium can be considered as is safe and effective since the dose of lignocaine can be reduced to a non-toxic level with the same quality of anesthesia. However, the limiting factor in this new technique is a short delay in the onset of sensory and motor blockade compared to standard Bier's block.

93-100

Authors: Datta A, Ray J

Background: An innovative paradigm, of teaching-learning (TL) method, like Case Based Learning (CBL) in a paraclinical subject like Pathology is considered essential, which would bring about learning of pathological and clinical features of diseases in an integrated easy manner, resulting in growing of interest in undergraduate medical students to learn pathology with better retention of knowledge. Aim: To evaluate the efficacy of CBL as a TL method in Pathology and to assess perception of students and teachers to CBL. Materials and methods: Study involved 86 students from 2nd professional MBBS course. Two common diseases viz. microcytic hypochromic anemia and pulmonary tuberculosis were taught in two phases respectively. Students were equally divided into two large groups of 43 each – Didactic lecture (DL) and CBL groups. DL group was taught with conventional DL by Pathology-faculties and CBL group was taught with CBL tool jointly by pathology and relevant clinical faculties. Teaching method was interchanged between large groups for two diseases. Pretest and post-test were conducted before and after intervention (DL/CBL) respectively. In addition, to test for knowledge retention one late post-test was also conducted in 2nd phase. Lastly, students’ and teachers’ feedbacks on perception to CBL were obtained. Results: Significant increase in mean-scores of post-tests than from pretests in both phases was observed with post-test mean-scores of CBL group significantly higher than that of DL group, although the difference in pretest mean-scores of the groups was not significant. Comparison of mean-scores of late post-test and immediate post-test of CBL group in 2nd phase showed no significant difference, whereas the same for DL group showed significantly lower mean-score in late post-test. Feedbacks of students and teachers revealed that they were more satisfied with CBL than DL. Conclusion: CBL is more effective and highly acceptable TL tool than DL in Pathology.

107-112

Authors: Singh M, Khurana I, Kundu ZS, Kaushik NK

Background: Cervical spondylosis is a common progressive degenerative disorder of the human spine often caused by the natural aging process. Osteophytic formations contribute to biomechanical changes that result in neural and vascular compression. The spinal compression of the obliquely passing cervical nerve roots can result in possible autonomic imbalance in the body. Valsalva maneuver is a simple, non-invasive and cost effective means to assess the autonomic activity. The results are appreciably reproducible if done properly under standardized conditions. Valsalva ratio is an important index of the baroreflex-mediated bradycardia and gives a fair idea about the parasympathetic tone. Aim: The aim of our study was to assess the level of autonomic activity by studying the valsalva ratio in patients with cervical spondylosis and to compare it with healthy controls. Materials and methods: This prospective random case control study was conducted at Pt. B. D. Sharma PGIMS, Rohtak. The study sample comprised of group I consisting of thirty randomly selected age and sex matched healthy controls and group II of thirty patients diagnosed with cervical spondylosis (age group 30-60 years of either sex). Results: In our study, valsalva ratio was found to be significantly low (p<0.01) in patients of cervical spondylosis as compared to healthy individuals. Conclusion: Altered parasympathetic tone can predispose the patients to hemodynamic instability leading to adverse cardiovascular implications in the long run.

124-129

Authors: T. Uma Maheswara Rao

Aim: This study aimed to evaluate the role of cefazolin in prevention of various infections after abdominal wall repair by mesh. Materials and methods: This is a prospective study consisted of 300 patients with various kinds of hernia (inguinal, femoral, bilateral, incisional, umbilical and lumbar hernias who were treated for elective mesh repair in from September 2010 to October 2014. Results: In the present study, 300 patients with different kinds of hernia were selected for elective surgery. Of them 200 patients (66.6%) were males and 100 patients (33.4%) were females with mean age of 50-55 years. Patients were assigned into study group and control group. 180 patients (60%) received prophylactic cefazolin, this group was named as study group and 120 patients (40%) were named as control group and did not receive any prophylactic antibiotics. The mean age of patients in control group was 51.5±13.45 years and that in study group was 53.0±15.75 years which was not significantly different. (p =0.05). 22 patients (18.3%) of 120 control group patients had epigastric hernia, 18 patients (15%) had incisional hernia, 46 patients (38.3) had inguinal hernia, 34 patients (28.3%) had umbilical hernia and all these patients were not given any prophylactic antibiotics. 44 patients (24.4%) of 180 study patients had epigastric hernia, 31 patients (17.2%) had incisional hernia, 85 patients (47.2%) had inguinal hernia and 20 patients (11.1) had umbilical and all these patients were given prophylactic antibiotic. One patient who received rives repair in the study group developed deep surgical site infection which necessitated readmission and partial debridement of the mesh without complete excision. Conclusion: This study results did not support the use of cephazolin as a prophylactic for various kinds of abdominal wall hernia repair with mesh.

136-141

Authors: T. Uma Maheswara Rao

Background: Following surgery and anesthesia, post-operative nausea and vomiting (PONV) are two of the most common side effects. Dexamethasone has been reported to be effective in reducing the incidence of emesis in patients undergoing chemotherapy. Aim: The aim of the study was to compare the effectiveness of granisetron and dexamethasone in combination with ondansetron and dexamethasone in combination for prophylaxis after laparoscopic cholecystectomy. Materials and methods: This is a prospective study on patients undergoing laparoscopic cholecystectomy consisted of 200 patients. 164 patients completed the study. 82 patients in group 1 and 82 patients in group 2. Patients were randomised in two groups, namely group 1 received granisetron and dexamethasone while group 2 received ondansetron and dexamethasone. Results: Out of 200 patients who initially signed the informed consent form, 164 patients (82 in group 1 and 82 in group 2) completed the study. In this study, Granisetron + Dexamethasone was found to be as effective as when compared to ondansetron + Dexamethasone as at 0-1 hour, 100% of patients in group 1 had no vomiting and 97.56% of patients had no vomiting in group 2. Total response was present in 97.56% in group 1 and 95.12% in group 2. The percentage of patients who received metoclopramide was 8.53% in both the groups. At 1-7 hour, 97.56% of patients in group 1 had no vomiting and 100% of patients had no vomiting in group 2. Total response was present in 96.34% in group 1 and 93.90% in group 2. The percentage of patients who received metoclopramide was 4.87% in group 1 and 2.43% in group 2. At 7-24 hour, 97.56% of patients in group 1 had no vomiting and 100% of patients had no vomiting in group 2. Total response was present in 95.12% in group 1 and 95.12% in group 2. The percentage of patients who received metoclopramide was 2.43% in both the groups. 4 out of 82 patients complained of dizziness in group 1 and 4 out of 82 patients complained of dizziness in group 2. 6 out of 82 patients complained of headache in group 1 and 6 out of 82 patients complained of headache in group 2 in the post anaesthesia care unit. Pain scores in group 1 were at 0-1 hr was 6±2.4, at 1-7 hour was 5.4±0.7 and at 7-24 hour was 3.5±0.9. Pain scores in group 1 were at 0-1 hr was 7±2.3, at 1-7 hour was 5.9±2.7 and at 7-24 hour was 4.5±0.2. In between the two groups, there was no significant difference in the side effects and pain scores. Conclusion: The combination of dexamethasone with either granisetron or ondansetron after induction of anesthesia in patients undergoing laparoscopic surgery showed no statistically significant difference in antiemetic efficacy with minimal side effects and excellent patient satisfaction.

148-151

Authors: B. Bheeshma, Shyamala Srujana, Padma Sunethri

Background: Construction of a question is a very important step in setting up of a question paper in written assessment of students during II M.B.B.S course. The most important aspect of this assessment is framing the question paper. At present long essay type of questions is one of the methods to assess cognitive skills in examinations. The two major categories of assessment are structured and unstructured questions, each of which serves different purposes to draw inferences about a subject’s capability. Objectives: To evaluate II year M.B.B.S students in answering structured essay question versus unstructured essay question and to compare and assess reliability of the structured essay question in Pathology examinations. Materials and methods: Present study was conducted in Gandhi Medical College, for a batch of 205 students i.e. II year students before University examinations. Students were initially tested with unstructured essay question, and then same group of students subsequently tested after one week with structured essay. Marks were tabulated and analyzed. Mean difference in the score of each answer was calculated by Chi square test. Results: A total of 205 students were evaluated for formative assessment by giving two different types of essay questions in Pathology in pre final examinations. 47.8% of students with unstructured essay question evaluation scored less than 10 marks (74.63%) and only 15.61% of students scored 16 and above marks in this group. In structured essay question evaluation (second phase) had higher percentage of student who scored more than 10 marks (73.17%). More than 38% of students scored 16 and above marks in this group. Conclusion: In this repeated measures study, students administered with structured essay method scored significantly better marks than the unstructured essay method, suggesting a need for introducing structured essay method for better evaluation of students in the examination.

157-163

Authors: Alimelu M, Radha Mohan M., Vindhya Tuladi, Sudhershan Reddy P, Shailaja V.V., Preeti Nagaraj G

Pediatric gastroenteritis is a major cause of childhood mortality and morbidity worldwide, especially in developing countries. Diarrhoea can be caused by a variety of different pathogens including bacteria, viruses and parasites. Among the viruses; Rotavirus has been extensively studied and is responsible for 44% of GE cases. As the Rotavirus vaccination coverage improves, the causative agent’s shift may be more towards the Calciviruses (Norovirus, Sappovirus) and other similar viruses, and consequently the investigations should focus on these viruses in future. This study was conducted in a Teaching hospital, Hyderabad, Telangana State included 118 cases of Gastroenteritis of which 6 cases were positive for Norovirus (NoV) i.e.; 5% of cases were NoV positive by RIDASCREEN EIA and RIDA QUICK, the rapid test for NoV virus. These 6 cases were children between 7 months and one and half year old. The age profile showed a fall in the number of diarrhoea cases as the child’s age increases. 63 (53.3%) were male children and 55 (46.6%) were female children. In children < 2 years (n=83), 22 (26.5%) were breast fed, 30 (36.1%) were bottle fed and 7 (8.4%) were on mixed feeds. Among mothers 25.42% never washed their hands with soap, 60.16% used soap occasionally and only 14.4% always used soap. 43.2 % presented with no dehydration, 27.96% presented with some dehydration and 28.8% presented with severe dehydration. 70.3% of mothers continued to feed during diarrhoea. Regarding the treatment used for diarrhoea before admission in hospital, 42.37% used ORS, 27.11% used both ORS and antibiotics, 55.08% were on antibiotics and 11% took no treatment at all.

170-177

Authors: V. Sakthiv Adivel, S. Appandraj

Background: From the beginning of the AIDS epidemic, it was recognized first at autopsy and later by non-invasive techniques that HIV infection can cause cardiac abnormalities. Aim of the study: To assess the cardiac abnormalities in HIV patients and its relation with CD4 count and risk factors. Materials and methods: A total of 150 patients were divided into two groups depending on the CD4 count. Group I included 51 (34%) patients with CD4 count ≤ 350 cells / mm3 and Group II included 99 (66%) patients with CD4 count > 350 cells / mm3. Among them 62 (41.3%) were males and 88 (58.7%) were females. All patients were subjected to a questionnaire to assess the risks of acquiring HIV, risk factors for cardiac disease. A thorough clinical examination was done. BMI was calculated as per WHO criteria for Asian population.CD4 count, ECG, Echocardiogram were done for all patients. Cardiologic data were correlated with age, sex, BMI, alcohol, smoking and CD4 count. Results: Our study populations mean age was 30.87± 6 years and mean BMI was 20.40 ±3.89 kg/m2. Mean CD4 count was 473.34 ± 223.20 cell/mm3 (Group I - 261.08 ± 83.75 cells/mm3; Group II - 582.69 ± 191.24 cells/mm3). Smokers and alcoholics constituted 7.3% (11 patients) and 8% (12 patients) respectively.Heterosexual was the most common (95.3%) route of infection. Prevalence of cardiac abnormality was 16.7%. Pericardial effusion was the most common abnormality. Conclusion: Cardiac abnormalities were specifically correlated with CD4 count. There was no correlation between age, sex, BMI, smoking and alcohol with cardiac abnormalities.

182-191

Authors: Bachalla N

Synthetic food colors are widely used in different types of food stuffs in India as well as in the world. Changing lifestyles across the globe have transformed food habit patterns. The instant and processed foods (junk foods) are mainly used in a variety of attractive “Synthetic food colors” by its manufacturers. In the present study an attempt has been aimed to study the Extraction, Identification of Synthetic food colors adulteration by Paper chromatography and UV-Visible spectrophotometer in different sweets and jams. In the Institute of Forensic Science and Criminology (IFSC), Bundelkhand University, Jhansi, Uttar Pradesh in 2011.

199-206

Authors: Sidiq M, Lone N, Yousuf A, Shah AF

Background: Nowadays, electronic mass media such as television influence the behavioral patterns of their audiences, mainly children. The study aimed to investigate the extent of effectiveness of health education intervention among 7-14 year old children and their parents regarding the food advertising to children on Indian television Materials and methods: A cross sectional study was conducted among 140 children between 7-14 years and their parents attending Department of Pedodontics, Government Dental College and Hospital, Srinagar. Data was collected by administering a pretested and a validated questionnaire among children and their parents. Oral health education intervention in the form of counselling by power point presentations was provided and pictorial self explanatory pamphlets were distributed among the participants. They were recalled after 3 weeks and the same questionnaire was administered again to evaluate the effect of oral health education intervention. Results: After oral health education intervention regarding the Food Advertising to children and their parents on Indian television, there was a significant reduction (P<0.05) in the attitudes and practices which were detrimental to oral health. Conclusion: Children are exposed to TV advertisements which affect children’s food preferences resulting in consumption of unhealthy foods that are detrimental to the oral health. Oral Health education intervention to parents is necessary for selecting healthy foods.

211-212

Authors: Gupta K, Rathwa AM, Singla H, C. Raychaudhuri

Dorsal pancreatic agenesis is an extremely rare congenital entity. Very few cases have been published in the literature about this congenital anomaly. Agenesis of the dorsal pancreas is associated with various anomalies, such as polysplenia syndrome, wandering spleen, interruption of the inferior vena cava, hemiazygos and azygos continuation, symmetrical liver, anomalous hepatic fissure or lobe, left-sided inferior vena cava, median gall bladder, inverted gallbladder and stomach, and intestinal malrotation. We have reported here an asymptomatic 31 year old male with incidental findings of hypoplasia of pancreatic body and absence of pancreatic tail on contrast enhanced abdominal computed tomography (CT) and similar findings were seen on Magnetic resonance imaging (MRI). Further Magnetic resonance cholangiopancreatography (MRCP) was done on which hypoplastic proximal MPD at body of pancreas with complete absent of MPD at tail region noted. The final diagnosis was dorsal pancreatic agenesis.