International Archives of Integrated Medicine

5-10

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

Eight patients of advanced ovarian cancer were treated with monthly cycles of Ifosfamide, Adriamycin and Carboplatin. Debulking surgery was done in 7 cases. None of the patients had complete response. All eight patients had partial response. The follow-up was for 36 months. The present protocol appears to have an influence on initial control of disease but relapse continue to occur following the treatment. Cytoreductive surgery before or after three cycles of chemotherapy may have favourable influence on disease free survival (DFS). Second, third, fourth look surgeries have good results in many centers, which is not routinely practised at this center, might be the main reason for the poor outcome. Prolonged follow up along with second, third, fourth look surgeries will be necessary to determine the overall influence on long term survival.

21-27

Authors: S Kalaichelvi, Kiruthika Somasundram

Background: Liver is the major site for carbohydrate, protein and lipid metabolism. In liver cirrhosis, derangements in metabolic functions can happen. Liver cirrhosis can lead to insulin resistance then impaired glucose tolerance and finally diabetes. The occurrence of insulin resistance in cirrhosis has definite clinical implications like rapid progression to fibrosis and increased risk of gastrointestinal haemorrhage and hepatocellular carcinoma. Objectives: This study was done to find the prevalence of insulin resistance in patients with cirrhosis in Government Royapettah Hospital due to varied etiology. Materials and methods: It was a cross sectional study done on 50 subjects in Government Royapettah Hospital. Patients were selected according to the inclusion criteria. A detailed history was taken, and a thorough clinical examination was done followed by further investigations, all of which were recorded in a pre-designed, structured proforma. Insulin resistance was assessed using three indices: HOMA1 IR, HOMA2 IR calculator and TyG index. Results: The mean age of the population was 46.18± 9.78 years. 94% of patients were males and 6% were females. Among the fifty subjects included, 34% had insulin resistance according to HOMA 1 IR (p 0.024) and 28% with HOMA2 IR (p 0.002). Insulin resistance using both HOMA 1 and 2 was significantly increased in Child Turcott Pugh C (p <0.001 for both). Insulin resistance was not demonstrated in any of subjects using TyG index. There was positive correlation between insulin resistance and fasting glucose and insulin. Conclusion: Insulin resistance is demonstrated in liver cirrhosis which is increased with advancing disease. It can be concluded that regular monitoring of glycemic status is mandatory in these patients who would have definite bearing upon treatment strategy.

36-41

Authors: Venkata Anantha Lakshmi Manabala, Sunil Kumar Keerthi

Background: Blunt injury abdomen due to trauma is one of the most common surgical emergencies all over the world due to increased incidence of accidents. Intestine is the third most common injured organ following blunt injury abdomen. Aim: To study the clinical presentation, management and outcome of intestinal injuries following blunt abdominal trauma. Materials and methods: It was a prospective study of 60 patients who presented with intestinal injury due to blunt injury abdomen to our hospital. The study period was from January 2014 to December 2015. All the patients who underwent laparotomy and were diagnosed to have bowel injuries like intestinal perforation, transection, mesenteric injury leading to gangrene secondary to trauma were included in the study. Patients with simple mesenteric injuries without intestinal injury and simple serosal tears were excluded. Results: 44.8% patients had perforations which were less than 1.5 cm in diameter. 34.4% patients had perforations which were more than 1.5 cm in diameter. 20.6% patients had complete transection. 6 patients had gangrene.4 patients had multiple perforations. Conclusion: Males are more commonly affected than females and age group of 20 – 35 years are affected. Small intestine is the most commonly injured part of bowel. Fixed portions of bowel to the parietes are more commonly injured.

50-58

Authors: Pokalkar D

Background: Cases of quadriplegia, oculobulbar palsy and fasciculations are reported to two tertiary teaching hospitals of Hyderabad during monsoon season. Objective: To describe the clinical and electrophysiological features of cases of acute quadriplegia with oculobulbar palsy, fasciculations and myokymia reported during monsoon season. Materials and methods: All the patients with presentation of overnight onset rapidly progressive quadriplegia admitted in both teaching hospitals of Hyderabad, over the period of 11 years. All patients were subjected to routine biochemical tests and Electrodiagnostic tests. Patients were treated symptomatically along with invasive ventilator support when required. Results: A total of 97 such patients were identified. The clinical features observed were bilateral ptosis, external ophthalmoplegia, bulbar, facial, masticatory, axial and proximal muscle weakness. There were extensive fasciculations and myokymia. Respiratory insufficiency occurred at nadir of weakness. The electrodiagnostic tests showed normal motor, sensory conduction studies without any decrement on repetitive nerve stimulation tests. Concentric needle EMG showed fasciculation, fibrillation potentials and repetitive discharges with normal interference pattern. All patients made total functional recovery in a week time. Mortality was due to respiratory paralysis and its related complications. Conclusion: These unusual cases with typical clinical and electrophysiological features are not reported in the literature and might constitute “Monsoon Fasciculation - Paralysis Syndrome” possibly a new myasthenic syndrome of unknown etiology.

66-71

Authors: G. J. Vani Padmaja, S. S. S. Quadri, O. Shravan Kumar

Background: Hemoglobinopathies are genetically acquired diseases. When present in new-born and in children they need to be treated and can be life threatening many a times. In the adults they can be asymptomatic and can manifest as disease during stress. They may present with other signs and symptoms not related to hemoglobinopathies. Aim: To perform Hemoglobin (Hb) Electrophoresis to detect Hemoglobinopathies in patients not presenting with hematological problems coming to the Medical OPD at Gandhi Hospital. Materials and methods: 3 ml Ethylene Diamine Tetra Acetic Acid (EDTA) whole blood was collected from cubital fossa from patients and Hb Electrophoresis was carried out on BIORAD - D10 Results: Hb Electrophoresis of a total of 464 patients were carried out over a period of six months (July to December 2015) and14 cases of Sickle Cell Trait, 16 cases of Thalassemia Trait, 1 case of Hb E trait , 1 case of sickle cell disease and 1 case of sickle cell disease with low Hb A2 levels were identified. Conclusion: Hemoglobinopathies can present themselves in the adults without symptoms related to red blood cell disorders. So when Patients present themselves with other symptoms and are not being relieved of their complaints by the conventional treatment, Hb Electrophoresis can help in identifying the hemoglobinopathies, especially when the Hb is normal or near normal for that age and sex of the patient.

77-86

Authors: N. Sreemani Kumari, Annapoorna Sireesha, K. Jayashree, O. Shravan Kumar

Introduction: Adrenal gland is a bipartite endocrine gland divided into cortex and medulla. As their developments are different, a wide range of tumours are encountered. We have presented here adrenal tumors of varied histomorphology, in one year study from August 2013 to July 2014, at Gandhi Hospital, Hyderabad. Aim and objectives: To study the spectrum of adrenal tumors diagnosed at Gandhi hospital for over a period of one year, correlation with clinical features and an overview of the pit falls encountered. Materials and methods: All the adrenal gland specimens submitted to the Department of Pathology, Gandhi Hospital, Hyderabad, from August 2013 to July 2014 were included in the study. These specimens were subjected to routine processing and ancillary techniques were used to arrive at final diagnosis. Results: A total of 8 cases were encountered in the present study. Majority of the tumors were seen in the age group of 20-40 years with female preponderance and only 37.5% were detected co-incidentally on imaging. Pheochromocytoma was the commonest tumor encountered (50%). Conclusion: We encountered a total of 8 cases of Adrenal gland tumours, including almost one from each category of the WHO classification. Majority of the tumors were seen in the age group of 20-40 years with female preponderance. Pheochromocytoma was the commonest tumor encountered (50%).

93-114

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

Background: Intra cerebral hemorrhage accounts for 10-15% of all cases of stroke and is associated with highest mortality rate, with only 38% of affected patients surviving the first year. Materials and methods: All cases of cerebro vascular accident (CVA) presented to Gandhi Hospital, Musheerabad, were considered, and the cases of CVA with intra cerebral hemorrhage evidenced by lumbar puncture and CT scan brain were prospectively studied at Department of Medicine, Gandhi Hospital Muheerabad, between May 2002 and April 2004. Results: Out of 63 cases, 22 cases were with non-diabetic normotensive, and non-risk factors; and 41 cases were with non-diabetic hypertension; two groups of cases were studied separately and the comparison was made. Total number of 254 Cerebro Vascular Accident (CVA) cases was presented to Gandhi Hospital, Musheerabad. Cerebral thrombosis were 171, Cerebral embolism were 20, and intra cerebral hemorrhage were 63. Out of 63 intra cerebral hemorrhage cases, 41 were hypertensive and 22 were normotensive. Out of 41 hypertensive patients, 23 died and 18 survived; out of 22 normotensive patients, 3 died and 19 survived. All cases were given broad spectrum antibiotic (inj. Ampicillin 500 mg IV 6th hourly, Inj. Flagyl 500 mg IV 8th hourly and Inj. Gentamycin 80 mg IV 12th hourly), Inj. Mannitol 100 mg IV 8th hourly, tablet Nimodipin 30 mg 8th hourly, proper care was taken and appropriate physiotherapy was given. Conclusion: It is useful to identify the risk factors for intra cerebral hemorrhage in normotensives, because the cause was identified in 5 cases, 4 cases with aneurysm, one case with arterio venous malformations (AVM’s) and most of the cases who belong to 5th and 6th decade, the cause for intra cerebral hemorrhage was not known. Nimodipin was used in all the cases as initial medical treatment, with good results, when compared to 50% mortality in other studies where Nimodipin was not given.

120-131

Authors: Sridevi V, Vinit Anand, Mahendrappa S.K

Background: Estimation of low density lipoprotein cholesterol (LDL-C) is crucial in management of coronary artery disease patients. There are many homogenous assays currently available for the estimation of serum LDL-C. Most clinical laboratories determine LDL-C (mg/dl) by Friedewald’s formula (FF). Recently Anandaraja and colleagues have derived a new formula for calculating LDL-C. This formula needs to be evaluated before it is extensively applied in diagnosis. Aim: The aim of this study was to compare the results obtained by direct homogenous assay for LDL-C to those obtained by Friedewald’s and Anandaraja’s formulas with the assumption that the results obtained by direct assay are the most accurate. Materials and methods: We measured Lipid profile (TC, TG, HDL-C, D-LDL-C) by direct homogenous method in 715 fasting samples. Simultaneously Friedewald’s and Anandaraja’s formulas were also used for calculation of LDL-C (FF-LDL-C and AR-LDL-C, respectively). Results: The mean LDL-C levels were 117.78 ± 13.797, 115.51 ± 12.854 and 112.93 ± 11.671 mg/dl for D-LDL-C, FF-LDL-C and AR-LDL-C respectively. There was a statistically significant difference between the results (P ˂ 0.001) obtained by calculation formulas compared to the measured LDL-C. There was underestimation of LDL-C by 2.27 mg/dl and 4.85 mg/dl by Friedewald’s and Anandaraja’s formulas respectively. In this study, the Pearson’s correlation between FF-LDL-C and D-LDL-C was 0.881 and that between AR-LDL-C and D-LDL-C was 0.880. Bland–Altman graphs showed a definite agreement between mean and differences of the calculation formulas and direct LDL-C with 95% of values lying with in ±2 SD limits. Conclusion: The results of our study showed that FF is better in agreement with D-LDL-C than Anandaraja’s formula for estimation of LDL-C by calculation though both lead to its underestimation.

137-149

Authors: Jain R, Gupta P, Jain V

Background: PCEA (patient controlled epidural analgesia) is a safe and effective technique for post-operative analgesia on routine surgical wards. Use of the epidural catheter as part of a combined epidural-general anesthetic technique results in less pain and faster patient recovery immediately after surgery than general anesthesia followed by systemic opioids does. Aim: In this prospective, randomized, double – blind study, we compared the analgesic effectiveness, hemodynamic changes and other side effects of epidural analgesia with drug combination – bupivacaine with fentanyl and ropivacaine with fentanyl in different concentrations. Material and methods: It was a prospective, randomized, double – blind study. Sixty patients of ASA I-II and age group 18-65 years divided in four groups 15 patients in each group (Group B1 bupivacaine 0.1%; Group B2 bupivacaine 0.05%; Group R1 ropivacaine 0.1%; Group R2 ropivacaine 0.05% with fentanyl 5micrograms/ml in each groups). After taking consent from patients epidural catheter was placed and study drugs were given to every patient. Visual analogue scale, heart rate, blood pressure, sedation score, modified bromage scale and other side effects were noted for the next 48 hours. Statistical analysis was done by using Medcalc 12.2.1.0 version statistical analysis software. Results: All four groups were comparable in terms of analgesia but group B1 patients had significant decrease in blood pressure at all time intervals. This group also had loss in motor power of lower extremity p value 0.020 than all other three groups. Conclusions: We concluded that ropivacaine 0.1% with fentanyl 5 µg/mL after major abdominal surgery provides optimal dynamic analgesia without significant adverse effects.

159-165

Authors: G.V. Manoharan, C. Balamurugan, S. Shanmugam

Background: Acute pancreatitis refers to an acute inflammatory process of the pancreas, usually accompanied by abdominal pain and elevations of serum pancreatic enzymes. This syndrome is usually a discrete episode, which may cause varying degrees of injury to the pancreas, and adjacent and distant organs. Acute pancreatitis is a serious disease with high morbidity and mortality rates some 80% were mid attack which recovers rapidly with conservative management. The rest of 20 % were severe, with protracted course that needs intensive care and specialized management. Materials and methods: It was a prospective study. First 50 patients attending the surgical emergency ward with clinical features of Acute Pancreatitis were evaluated clinically and subjected to laboratory and radiological investigations as per the designed Performa. Data pertinent to the scoring systems were recorded within 24 hours of admission to the hospital. For each of 50 patients included in the study, BISAP and MCTSI scores were calculated by the manner described by Knaus, et al. and Cardinal Health Database system. Results: BISAP and MCTSI was correlated well for mortality with high positive value of 0.904 which was highly significant (0.01). The ROC analysis for Mortality showed BISAP score had AUC of 0.904, P value (0.001) which was more than MCTSI score which had AUC of 0.845, P value (0.007). So BISAP was highly accurate with P value (0.001) and confidence interval of 0.873. BISAP score was highly sensitive (100%), specificity (60%) at score more than 3.5. MCTSI score sensitivity was 85%, specificity was 77% at score more than 7. Conclusions: BISAP score was found to have more sensitivity, specificity and Diagnostic accuracy than MCTSI score in prediction of assessing the severity of acute pancreatitis. Hence, BISAP score found to predict more number of patients and likelihood of progressing to severe disease. Larven, et al. stated the same in their study 42. Hence, BISAP is considered as better available score for assessing the severity than MCTSI score.

171-180

Authors: Chityala Jyothi, T. Divyagna, V. Vijaya Sreedhar, M. Narsing Rao, M.N.P. Charan Paul, Kandukuri Mahesh Kumar

Background: Colorectal diseases are frequently encountered in clinical practice. They range from minor problems causing minimal discomfort to potentially serious diseases causing much morbidity and mortality. Clinically most of these disorders present with non-specific symptoms like altered bowel habits, diarrhea, bleeding per rectum either melaena or fresh hemorrhage; thus causing much delay in drawing attention. Early detection and proper management are essential to reduce the morbidity and mortality. Various diagnostic tools are developed in the recent past, improving the detection and assessment of these lesions. Objectives: To study the profile of various non-neoplastic colorectal lesions and to know the relative frequency of various diseases, and to know the age and sex incidence of the non-neoplastic colorectal lesions. Materials and methods: This study was carried out in the Department of Pathology, NRI Medical College, Chinakakani, Guntur district. The present study comprised a total of 507 cases of colorectal lesions which were received in the department of pathology as colonoscopic biopsies and resected specimens. Out of 507 cases, 187 cases were neoplastic and 320 cases belonged to the non-neoplastic group. The present study was done on the non-neoplastic colorectal lesions over a study period of 5 years, i.e. from June 2008 to May 2013. Results: The present study comprised a total of 507 cases of colorectal lesions over a study period of 5 years, i.e. from June 2008 to May 2013; which included 405 (79.88%) cases of colonoscopic biopsies and 102 (20.12%) cases of resected specimens. Out of the total 507 colorectal lesions, there were 320 (63.12%) cases of non-neoplastic lesions and 187 (36.88%) cases of neoplastic lesions. Out of 320 cases of Non-neoplastic lesions, 211 (65.94%) cases were Males and 109 (34.06%) cases were females; the predominant lesion was chronic non-specific colitis constituting 187 (58.44%) of cases and next to it is the Inflammatory bowel disease which included ulcerative colitis constituting 40 (12.50%) of cases and 10 (3.12%) cases of Crohn’s disease. Conclusion: Colorectal lesions are one of the common causes of morbidity. In routine clinical practice, histology is often considered as the gold standard when compared with other tests. Biopsy provides an excellent opportunity for the clinician and histopathologist to correlate, colonoscopic findings and pathological features.

187-195

Authors: Rana-Khara R, Lakhani SJ, Vasava S, Shah K, Panjwani D

Background: Staphylococci are ubiquitous being the normal inhabitants of the skin and mucous membranes and the most common cause of human infections all throughout the world, both the community acquired as well as nosocomial infections. Objectives: Objectives of this study were to determine the prevalence of methicillin resistant Staphylococcus aures (MRSA) and detection of emergence of resistance to vancomycin among the Staphylococcus aureus (S. aureus) isolates. Materials and methods: Thus hundred S. aureus isolated from various clinical samples were tested for methicillin resistance by cefoxitin disc (30µg) and vancomycin resistance using Ezy MIC – Vancomycin E-test. Results: The MRSA prevalence was found to be 52%. Of the total MRSA (n=52) 32 were obtained from male and 20 from female; and 36.54% from blood, 28.55%, 15.38%, 11.54% and 3.85% from pus, urine, sputum and body fluids respectively. The MRSA (n=52) were found to be resistant to antibiotics tested routinely but susceptible to levofloxacin (86.54%), doxycycline (92.31%), linezolid (96.15%) and vancomycin (100%). Inducible clindamycin resistance amongst MRSA was found to be 25%. All strains i.e.100% were sensitive to vancomycin indicating zero resistance to vancomycin. Conclusion: Though we did not find any resistance to vancomcyin in our setup, the prevalence of MRSA is high in our set up and calls for strict implementation of hospital infection control measures to prevent the spread of this organism and infections due to it. In this study E-test proved to be useful for detection of vancomycin resistance.

203-210

Authors: Panjwani DM, Lakhani SJ, Lakhani JD, Khara R, Vasava S

Introduction: Acinetobacter spp. is an emerging important nosocomial pathogen. This opportunistic bacterium is quickly becoming resistant to commonly prescribed antimicrobials. Emergence of MBLs and ESBLs is becoming a therapeutic challenge as these enzymes leads to degradation of higher generation antibiotics. Aim and Objectives: The study aimed at identification and antimicrobial resistance pattern of the common Acinetobacter species prevalent in our setup and to correlate with different clinical conditions. Materials and methods: All the specimens received in a Clinical Microbiology Laboratory for bacterial culture processed to obtain Acinetobacter during period of June 2014 to May 2015. Identification and species differentiation of Acinetobacter was done by different biochemical tests. They were performed according to standard procedures. Antibiotic susceptibility test was done by Modified Kirby Bauer disk diffusion technique. The ESBL production was examined by phenotypic confirmatory disk diffusion method (PCDDT) and phenotypic expression of MBL was examined by combined disc diffusion test (CDDT). Results: All the clinical samples received in Clinical Microbiology Laboratory for bacterial culture were included in our study. These samples were processed to obtain Acinetobacter during period of June 2014 to May 2015. A total of 64 Acinetobacter were identified from 360 non-lactose fermenting bacteria isolated from various specimens. Out of 64 isolates, 61 were A. baumannii, 2 were A. lwoffii and 1 was A. calcoaceticus. Most of the isolates were resistant to Cefuroxime (96.87%) followed by Amoxicillin-clavulanic acid (95.31%), Amikacin (93.75%), Cefoxitin (93.75%), Ciprofloxacin (90.62%), Cefepime (90.62%), Cefotaxime (90.62%), Co-trimaxazole (90.62%) and Gentamicin (78.12%). Isolates showed minimum resistance of 37.5% against Imipenem. In the present study 12% Acinetobacter were found to be MBL producer and 8% were found to be ESBL producer. Conclusion: In the present study, Out of 64 Acinetobacter spp. 53.12% were from medical wards including ICU. While surgical wards contributed for 20.31% rest from other wards. Most common infective site for Acinetobacter infection was respiratory followed by operative and urinary tract. However maximum Acinetobacter isolated from Pus sample. The incidence of isolates possessing MBL activity in the present study represents an emerging threat of higher resistance to carbapenems and other commonly prescribed drugs among Acinetobacter spp. in India.

216-221

Authors: T. K. V. Sharavanan, K. B. Prasanna, S. Ekanthalingam, A. Sundaram, E. Premalatha, Balaji Arumugam

Background: A high prevalence of cardiac failure has been reported in diabetes mellitus. Worldwide, this represents a major burden to the health care systems. The association of cardiovascular events and diabetes mellitus emphasizes the need for a screening test like echocardiography to gain knowledge about the cardiac status in diabetic patients. Materials and methods: The present study conducted in a tertiary care hospital over a period of 2 months was designed to determine the prevalence of diastolic dysfunction in type 2 diabetes mellitus and also to assess the risk factors contributing to its cardiovascular complications. A total of 120 patients of both sexes with type 2 diabetes mellitus of any duration were included in the study. Echocardiography was used to investigate for diastolic dysfunction. Results: A total of 66 diabetic patients were detected with diastolic dysfunction among the 120 subjects under study. Highest prevalence of left ventricular diastolic dysfunction was observed in the female population and in the individuals belonging to the age group of more than 45 years. Statistical analysis revealed a significant association between the glycosylated hemoglobin and diastolic dysfunction in diabetic patients with a P-value of 0.001. Conclusion: Cardio vascular disorders accounts for major morbidity and mortality in patients with diabetes mellitus, which may predispose to the development of diabetic cardiomyopathy leading to congestive cardiac failure. Prompt diagnosis and treatment prevents the progression of heart failure in insulin resistance.

228-232

Authors: Tukaram Kishanrao Pandve, P. Samuel Rajkumar, G. Nagaiah, Sayyad Tajmul, Bansode Arun, NS Inamdar

Background: The concept that eventually became unmet need of family planning was explored in 1960 when data from surveys of contraceptive KAP shoed a gap between some women’s reproductive intention and their contraceptive behavior. Aim: Objective of study was to estimate the socio economic and demographic patterns associated with the secondary infertility among those eligible couples who are in need of second child i.e. unmet need of family planning and to suggest remedial measures and advice to meet the needs of 2nd child. Materials and methods: The eligible couples are those, who are married, living together, having marital life and the age of the wife is in between 15 – 49 years. Simple random sampling technique was used to select 20 secondary infertility eligible couples from 450 ECs by making house to house survey. Results: The study results show that the upper middle and middle socio economic status is associated with the secondary infertility which is an obstacle to meet the needs of second child among the study group of eligible couples. Conclusion: the upper middle and middle socio economic status is associated with the secondary infertility which is an obstacle to meet the needs of second child among the study group of eligible couples.

239-244

Authors: P. Samuel Rajkumar, Tukaram Kishanrao Pandve, G. Nagaiah, Sayyad Tajmul, Bansode Arun, NS Inamdar

Background: Lymphatic filariasis caused by nematode parasite is a public health problem in India. Filariasis in man manifests as acute and chronic lymphangitis, elephantiasis of genitalia arms, legs, hydrocele in males and lymphadenitis. The Government of India incorporated initial National Filaria Control Programme under the National Vector Born Disease Control Program (NVBDCP) with a goal of eliminating the disease as Public Health Problem by targeted date of year 2016. Aim: Aim of the study was to test the hypothesis that reducing “MICRO FILARAEMIA” in humans to <1% will stop transmission by mass administration of two drug for more than 5 Annual rounds with 65% coverage of total population. Materials and methods: The study was retrospective prospective analytical study from 2010 to 2014 (from coverage evaluation reports) of Medak dist. There is need to enhance community participation to cover more than 65% of total population for future 5 years. Results: The distribution of the drugs was carried to 68% of rural population and 18% of urban population. The effectiveness was only 57.7% of rural and 16% of urban population. The drug compliance was 81% in rural and 87% in urban respectively. The coverage of the population for MDA by using DEC plus Albendazole tabs was 74.7% and 15.3% in rural and urban areas of Medak district respectively. But the actual effectiveness was observed 68% in rural and 15.3 % of urban population. However the drug compliance was found 91% of total population. 79.3% of respondents were aware of MDA trough banners / posters only. All other available Medias were found to be non-functional. Conclusion: MDA coverage was more in rural population in comparison with urban population. Major reasons for noncompliance having some underlying disease (40%), fear of side effects (18%) which can be overcome by intensification of IEC activities. In order to achieve the goal of elimination of lymphatic filariasis there is need to intensify IEC activates about modes of transmission and methods of prevention at community levels by all modes of communication so as increase the coverage with drugs.

250-254

Authors: Parmar P, Rathod GB

Background: Negligence is defined as doing something which reasonably competent people not suppose to do or not doing something which reasonably competent persons suppose to do. Materials and methods: Present study was undertaken with aim to assess knowledge and awareness of general population towards medical negligence at Valsad. Total 100 people from general population were subjected to pre-tested and pre-validated questionnaire related to medical negligence after obtaining their informed written consent. Questionnaire contain 10 questions related to medical negligence with responses based on Likert’s scale varied from strongly disagree to strongly agree. Responses obtained were tabulated in MS Excel sheet and analyzed via SPSS software. Results: Out of 100 participants, 37% were between 31-40 years age group, 65% were male and 73% were married. Total 55% were agreed upon that failure to maintain a medical record by hospital is negligence. 33% were not sure about that doctor, nurse and management staff of hospital – anyone can be liable for negligence. 71% were agreed upon that performing operation without informed written consent is negligence. 31% were agreed upon that treating a patient without his consent is negligence. 48% were strongly agreed upon that carelessly leaving an instrument in patient’s body after operation is negligence. 31% were disagreed upon that refusing to attend patient in emergency is negligence. 36% were agreed about that performing or helping for euthanasia is negligence. 72% were agreed upon that death due to negligence is punishable by court. 44% were agreed upon that compensation for negligence can be claimed in consumer court. 55% were agreed about that wrong diagnosis followed by wrong treatment is considered as negligence Conclusion: Present study reflected that general population has quite a good knowledge regarding medical negligence which may increase gradually over a period of time due to news papers, internet and other resources. Training programs should be conducted for them to bring true knowledge and awareness regarding medical negligence which indeed helps to them as well as practitioners.

260-266

Authors: P. G. Anandhi, V. N. Alagavenkatesan, Venkateshwara Yadav, Shanmugam

Introduction: With the advancement of technology and development of new teaching and training methods, the role of age old teaching methods like anatomy dissection is being increasingly debated. Many western universities have increased the curriculum space for these new teaching methods, at the cost of dissection. There are no data from India on perceptions and utility of anatomy dissection from the student’s perspective. The current study is aimed to assess the student preferences regarding the learning methods of human anatomy and to analyze the perceptions of the medical students on human anatomy dissection Materials and methods: The study was a cross sectional study of 480 randomly selected medical students, conducted across six medical institutions in Tamil Nadu. The sampling method used was multistage simple random sampling. Results: Out of 480, 463 students consented to participate in the study, with a response rate of 96.45%. The mean age of the participants was 17.79 (±0.83) years. Males constituted 49.02% of the study population. Dissection was ranked as the most preferred method by 244 (52.7%) of the students, followed by computer assisted learning 65 (14.0%) and Demonstration (9.7%). Strong positive agreement was displayed by the students for items describing that dissection may help in dealing with patients comfortably in future (51.40%) and dissection makes them feel different and special from other peers (64.14%). Conclusions: Human anatomy dissection is still the preferred method of anatomy learning among the medical students. Human touch, perceptions and aura associated in the family members and friends in other specialties are the most important factors fostering positive attitude towards dissection.

274-280

Authors: Rajakeerthana, Swarnapriya, Vasantha N Subbiah

Background: Hypertension is the most common problem facing by pregnant women. Nowadays in developing countries one of the major causes for maternal and fetal mortality is gestational hypertension disorders. Even though most of the existing studies were concluded that ABO blood groups of mother have an association with PIH but its etiology is still uncertain. The objective of the present study is to assess the association of ABO and RhD blood groups and gestational hypertensive disorders. Material and methods: The study was a case control study undertaken in the Department of Obstetrics and Gynecology of a tertiary care teaching hospital in Chennai from July 2015 to April 2015. All the pregnant women diagnosed with gestational hypertensive disorders in the study setting were the cases. Antenatal women without gestational hypertension were the control group. Results: A total of 183 participants were included in the final analysis. 83 were pregnant women with gestational hypertension and 100 normal controls. Among 83 PIH cases majority were having pre-eclampsia (38.25%). 9 cases have severe eclampsia (4.91%), only 1 case (0.005%) with eclampsia and 3 cases were with chronic hypertension (0.016%). There was no statistically significant association of PIH and maternal age, gravida, para. Non O-blood groups have high risk of PIH than O-blood group (P=0.639) and RhD positive pregnant women have high risk of PE than the RhD negative mothers (P=0.153). Conclusion: Among ABO blood groups non O- blood groups have high risk of gestational hypertensive disorders than O blood group. RhD positive pregnant have significantly higher risk PIH than RhD negative mothers. Other factors like maternal age, gravida, para are not significant association with gestational hypertension disorders.

287-296

Authors: Balan B, Shetty SK, Shetty A, Chandran R, Mathias LJ

Introduction: With various options available like unipolar, bipolar hemiarthroplasty or total hip arthroplasty, it would be wise to choose hemiarthroplasty as it is a procedure with a short operating time with lesser morbidity for elderly patients with displaced intra-capsular neck femur fractures .This study is aimed primarily at comparing the functional results obtained after a hemiarthroplasty using Austin Moore’s prosthesis and cemented modular bipolar prosthesis and studying the associated complications in these cases. Materials and methods: A total of 68 elderly patients who had fulfilled the inclusion criteria were enrolled for this prospective, randomized, comparative study between 2 groups labeled as group A (Austin Moore’s prosthesis) and group B (bipolar prosthesis). Out of total 68 patients, 4 patients from group A were lost to follow up and 2 patients from group A died. Similar surgical approach, perioperative and follow up protocol were followed for both groups. Functional outcome measured using Harris hip score. Statistical comparison of functional outcome and clinic-radiological assessment were done for each patient at 3 months, 6 months and 1 year. Results: The average age of the patient was 73.0 years in Group A and 76.0 years in Group B. After the end of 12 months, mean score was 86.50 in Group A which was comparable to 89.56 in Group B subjects. After duration of 12 months 94.1% of the subjects in Group B had excellent to good treatment which was more compared to 78.6% of the cases in Group A, but the difference was not significant. Incidence of superficial infection and dislocation of prosthesis was equal in both groups. Complications rate were also comparable between the two groups. Conclusion: Primary Hemiarthroplasty is an efficient way for treatment of displaced intra-capsular neck femur fractures in the elderly patients more than or equal to 60 years. Percentage of patients achieving excellent to good outcome at the end of 1 year are more in group B. Long term studies are needed to compare complications with hemiarthroplasty using 2 different prostheses.

302-309

Authors: S. Thirumuruganand, S. Chelladurai, S. Mathan Sankar

Background: Intestinal obstruction is one of the most frequently encountered problems in surgical emergency. Intestinal obstruction is one of the major causes of morbidity and mortality Aim: Acute intestinal obstruction is one of the most common surgical emergencies. The objective of this paper was to identify various causes of intestinal obstruction, mode of presentation, hemodynamic status, importance of early intervention and importance of viral markers in emergency procedures. Influence of factors like age, sex, previous surgeries in the pathogenesis of intestinal obstruction and complications in acute intestinal obstruction were also discussed. Materials and methods: The materials for our retrospective study of acute intestinal obstruction were collected from the medical record department of various surgical units in department of general surgery, Stanley medical college. Totally 50 cases were taken for this study with exclusion of age less than 12 years (Pediatric age group). The study was divided into clinical presentation, investigation, management and complications. The results were analyzed based on the following factors like age, sex, symptoms, signs, investigation, probable causative factor, operative findings, procedure and complications. Results: The study group consists of 50 cases of acute intestinal obstruction in adult age group from 12 years. The common age group was 31-40, common sex was female, commonest cause of acute intestinal obstruction in this study was post operative adhesions (48%) followed by obstructed hernia (18%). The other causes are malignancy (10%), ileo-caecal tuberculosis (8%), intussuception(6%), volvulous (4%), mesenteric ischemia (4%), meckel’s band obstruction (2%). Conclusion: Our study observed still post operative adhesions is the most common cause of acute intestinal obstruction followed by obstructed hernia. The success in the treatment of intestinal obstruction depends upon early diagnosis and early intervention as well as the patients’ hemodynamic status. Lastly this study highlights the importance of using universal precaution in the emergency setting because of the ever increasing number of HIV and HBsAg in our country.

314-320

Authors: Usha Rani, B Vijaya Laxmi

Background: Partogram is a graphic record of progress of labour and fetal condition during labour. The main parameter for recording progress of labour is the rate of cervical dilatation. Aim and objectives: To determine if routine partographic monitoring of spontaneous labour will optimize the maternal and fetal outcome. Materials and methods: This study involved a detailed prospective workup of 200 women all term gestation patients for vaginal delivery, from 37-42 weeks at term with vertex presentation, spontaneous onset of labour and those who had singleton pregnancy were included. Results: This was a prospective study conducted on 200 patients. The WHO partogram was used which is similar to Philpott and Castle's original description, retaining the Action Line in the active phase drawn four hours to the right of, and parallel to the Alert Line. The central feature is the cervicograph in which cervical dilatation is plotted against time. The study divided the patients into three groups and the partogram into three zones: Group A: Safe zone: Patients who deliver before the alert line is reached. Group B: Observation Zone: Patients who deliver after the alert line but before the action line is reached. Group C: Intervention zone: Patients who deliver after the action line is crossed. In the present study, the mean age of the patients was 22.54 years. Most of the cases went into spontaneous onset of labour. Maximum numbers of deliveries were FTND, i.e., 67%, outlet forceps 18% and LSCS rate was 15%. Significant association was found in relation to station of head at admission and mode of delivery where majority of LSCS had -2 station. The majority of FTNDs had -I and 0 stations. The patients having a favorable partogram, i.e. group A, had a high incidence of FTND. The incidence of intervention was found to be more in Group B, while the majority of patients in group C were at risk and required operative intervention. Mean birth weight in the study was 2861g. Majority of babies were delivered at term. The number of babies having an APGAR between 7-8 at one minute and 9-10 at five minutes was more. 96.5% of the patients had no complication. 12.5% of the babies had complication. Conclusion: It is evident that the routine use of the partogram is helpful in detecting abnormalities in the progress of labour and permits early corrective therapy. The key to early diagnosis and detection of disorders in labour progression is by following the evolution of characteristic patterns of cervical dilatation and fetal descent.

327-333

Authors: G. Obulesu, Animireddy Kishore, Madan Mohan Rao

Introduction: Intra venous therapy for infusion of blood products, fluid and electrolytes, parenteral medications, hemodynamic monitoring, and for total parenteral nutrition (TPN) has become an essential feature of modern medical care. However, this is associated with the significant risk of infection of blood stream. Material and methods: Intravenous cannulae with complaint of shooting pain and tenderness associated with cannulae were chosen as subjects of study. Tips of the cannulae were cultured using the semiquantitative method described by Maki. Results: Among them, 32 (32%) cannulae were infected. Among the blood samples of these patients cultured, 14 (14%) were positive and 86 (86%) blood samples were sterile. Fourteen were Coagulase negative Staphylococci, ten were Coagulase positive Staphylococci and five were Micrococci. The others were Corynebacterium jeikeium (4), Candida parapilosis (2), Candida glabrata (2), Klebsiella pneumonia (2) and Pseudomonas aeruginosa (2). Conclusion: There is no significant increase in the percentage of positive cultures with increase in duration of intravascular stay of the cannulae, after 24 hours. Majority of isolates from both cannula and blood are Coagulase negative Staphylococci (34.14% and 35.75% respectively). Majority of blood culture isolates are sensitive to Vancomycin.

345-352

Authors: Chimata T, Tirumuru D, Chowdary NL

Introduction: Globally cataract is the major cause for blindness. About 75% of cases preventable causes of blindness in developing countries are attributed to cataract. As per available literature so many studies are available to study how to control the surgically induced astigmatism in variety of cataract surgeries. In the current study we aimed to focus on the effect of factors like wound modulation, and also role of superior or temporal scleral tunnel incisions on the post-operative astigmatism. Objective: To study the effect of wound modulation on postoperative astigmatism following manual small incision suture less scleral tunnel cataract surgery by either superior or temporal incision. Materials and methods: The study was a hospital based quasi experimental study, conducted in the department of ophthalmology at NRI Medical College and General Hospital, Chinakakani, Andhra Pradesh state from August 2014 to August 2015. A total of 100 randomly selected subjects undergoing cataract surgery by suture less non phaco small incision sclera tunnel technique were included. Results: 36% of the patients included in this study for superior small incision sutureless non phaco cataract surgery pre operatively had with the rule astigmatism and 42% had against the rule astigmatism and no astigmatism is seen in 22% of cases. Pre operatively 34% of the patients included in this study for temporal small incision suture less non phaco cataract surgery had with the rule astigmatism and 48% had against the rule astigmatism and no astigmatism is seen in 18% of cases. In cases subjected to superior small incision suture less non-phaco cataract surgery showed against the rule astigmatism and in 72% and with the rule in 20% and no astigmatism in 4% of cases. In cases subjected to temporal small incision suture less cataract surgery had surgically induced astigmatism of with the rule in 84% and only 8% had against the rule and no astigmatism was found in 8% of cases. At six weeks 86% of cases subjected to superior small incision suture less non –phaco cataract surgery had surgically induced astigmatism of against the rule type and in 12% with the rule type and 2% had no astigmatism. In cases subjected to temporal small incision suture less non-phaco cataract surgery there was surgically induced astigmatism of with the rule type in 86% of cases ad 8% of against the rule type and 6% had no astigmatism. In cases subjected to temporal suture less non –phaco small incision cataract surgery induced astigmatism by 3 weeks was 0.69D in with the rule type and 0.31D in against the rule type and the average total was about 0.66D. By 6 weeks the mean surgically induced astigmatism in superior SICS was 0.71D in with the rule type and 1.51D in against the rule type and an average of 1.01D in total. In cases subjected to temporal SICS it was 0.69D in with the rule type and 0.33D in against the rule type and a total of 0.66 D by 6 weeks. Conclusion: Temporal small incision cataract surgeries shows less induced astigmatism whereas superior small incision cataract surgeries higher SIAS values.

358-361

Authors: S. Thirumuruganand, S. Chelladurai

Hydatid cyst of spleen is a rare condition compared to hydatid cyst of other organs. It ranges from 0.5-4.0 % of abdominal hydatid cyst. The most common sites for hydatid cyst are the liver (60-70%) and lung (10-40%). The first filter of hydatid cyst is liver followed by lung which acts as a second filter. The other rare sites of hydatid cyst are spleen, thyroid, gall bladder, central nervous system, kidney, psoas muscle and retroperitoneum. Splenic hydatid cyst is uncommon, because cyst embryos are trapped by liver and lungs. In this case report, a 54 year old female admitted with complaint of left upper abdominal pain for 15 days duration with splenomegaly. With relevant investigations patient was diagnosed as isolated hydatid cyst of spleen and underwent open splenectomy. This case presented as a case for its rarity.