International Archives of Integrated Medicine

7-16

Authors: G Ravindra, Dashetwar AM

Background: An Atrial Septal defect is an abnormal hole of variable size in the atrial septum, which generally permits left to right shunting of blood at the atrial level. ASD is one of the most common congenital cardiac anomalies, present in 10-15 percent of patients with congenital heart disease. Aim: To study the clinical profile, diagnostic modalities used, post operative morbidity and mortality of patients operated for atrial septal defect in a major teaching hospital in Telangana. Materials and Methods: This study was based on a patient population of 50, admitted to undergo surgical correction for atrial septal defect. Results: The incidence of ASD is more in females. The male to female ratio was 1:2.1 in this study. The majority of the patients were symptomatic (96%). The commonest symptom was dyspnoea on exertion (76%). Most of the patients were in NYHA class II (62%). Consanguineous marriage of parents was present in 28% of patients. Most of the patients were in sinus rhythm (94%). ASD were of fossa ovalis type (96%). In 74% of the patients, the size of ASD was between 2-4 cm in diameter. 78% of the patients were repaired by direct closure of ASD. Most of the patients (96%) were supported by ventilation, out of which 62% (31/50) of patients were ventilated for 1-6 hours. Patients (70%) were discharged by 9th –12th post operative day. Mortality was 2% in this study. Conclusion: Surgical repair of atrial septal defects is a safe procedure which is associated with excellent results and low morbidity.

21-26

Authors: K. Ravi Sekhar Rao, N. Krishna, G. Vasantha

Background: Refractive errors are one of the known cause of visual impairment and a main cause of blindness worldwide. In children, refractive errors make us learning disabilities and also prevent academic progression. Aim: To study the prevalence of refractive errors in children of school going age. Materials and methods: This was a descriptive study in which children were screened for refractive errors. Children aged 4 to 15 years whose parents were willing to sign the informed consent form. This study was done from 2011 to 2015. Results: Total 531121 children were screened in which 13206 having refractive errors, incidence of 2.4% in the present local area. The most common age group affected is 8-11 years of these were boys 2706 (20.4%) and 3491 (26.4%) girls. Conclusion: The major cause of visual impairment worldwide is refractive errors and have immediate and long term consequences in children.

36-41

Authors: Maratha V,Kapil M,Kumar S, Dhamija A, Manchanda J

Background: One of the indispensable components of spine surgeries is the relieving of post-operative pain. When used as an adjuvant in regional anaesthesia, α2 adrenergic agonists have both analgesic and sedative properties. With the addition of alpha agonist to epidural local anesthestics, the degree of pain relief increases because of their analgesic properties and augmentation of local anaesthetic effects. Hence, we comparatively evaluated the effect of ropivacaine versus dexmedetomidine and ropivacaine in epidural anaesthesia in lower limb orthopedic surgeries. Materials and methods: The present study included 200 patients in the age group of 25 to 65 years. The patients who were scheduled to undergo lower limb orthopedic surgeries under epidural anaesthesia were included for the present study. All the patients were randomly divided into two study groups; Group I and group II with 100 patients in each group. Pre-operatively pulse rate, non-invasive systolic and diastolic blood pressure (DBP) and respiratory rate was recorded. Assessment of sensory block was done was observing the loss of sensation to pin prick in the midline. Assessment of the motor block was done by analyzing the modified Bromage score. Assessment of analgesia was done by analyzing VAS score. Post-operative values of the parameters were also recorded after surgery. Adverse effects and complication like hypotension, bradycardia, headache, dry mouth, nausea and vomiting etc were noted in the first 24 hours after surgery. All the results were analyzed by SPSS software and chi square test was used for assessment of level of significance. Results: Mean age of the patients in group I and II were 40.45 and 41.23 years respectively. No significant results were obtained on comparing the mean age and mean weight of the patients. Majority of the patients in both the groups were males while rest were females. 74 % of the patients in group I belonged to ASA grade 1 while in group II, 69 percent of the patients belonged to ASA grade 2. Conclusion: For shorter surgical procedures, dexmedetomidine may be undesirable as it produces prolonged duration of motor block and sedation.

48-54

Authors: Jain K, Pandey A, Gupta S, Rahul

Introduction: This study was aimed to assess the hearing outcome after type I tympanoplasty using temporalis fascia graft, to assess the factors which influence the outcome and to evaluate the result of our study and to compare our data with similarly published study. Materials and methods: The study was conducted at NSCB Medical College and Hospital, Jabalpur in the Department of Otorhinolaryngology after obtaining approval from the institutional ethics committee, from October 2014 till October 2015. Patients, aged 15 to 45 years, presenting with perforated tympanic membrane were consented. Audiological evaluation was done preoperatively, 1 month and 3 month after tympanoplasty. Results: During the study period 45 type I Tympanoplasty were performed using temporalis fascia as graft, 24 males. 21 cases below the age of 26 years showed graft take up of 84% and the mean hearing gain of 11.37 dB. 77% of those belonging to low socioeconomic group showed graft take up of 76.9% with mean hearing gain of 12.03 dB and 88% of those belonging to high socio economic group showed graft take up of 87.5% with mean hearing gain of 11.14 dB. Out of 21 cases which had perforation size <50% 20 showed graft take up of 95.23% with mean hearing gain of 11.77 dB. Conclusions: Graft uptake is independent of gender, age of the patient. Pre operative dry ear status is directly related to the outcome of surgery. Graft take up is better in perforation size less that 50% but hearing gain will be more in perforation size of more than 50%.

62-69

Authors: M. Virgin Joena, R. Ananda Xavier Pragasam, Benita Florence

Background: Increasingly many studies across the globe in the recent past have documented increase in prevalence of burnout among various cadres of health care professionals at very young age. Even though the burden, influencing factors and adverse consequences of burnout on professional and personal life have been documented by many studies from the west, there are very few studies conducted on the subject in Indian health care providers. The current study has been undertaken to assess the prevalence of burn out and factors influencing it among clinicians in an urban tertiary care hospital in a state of Tamil Nadu. Materials and methods: The current study was a cross sectional of 73 clinicians working in a single tertiary care teaching hospital, who were selected by convenient sampling. Burn out was assessed by Maslach Burnout Inventory scale. Results: The proportion of overall burnout reported in the study was 34.2%. Among the all the potential factors, which were assessed for their association with burnout in the study population, the factors which have shown statistically significant association were experience less than 4 years (Odds ratio 3.24, 95% CI 1.16 to 8.99), Hours of sleep < 6 hours (OR 7.45, 95% CI 4.98 to 9.92) and regular night duties (OR=3.25, 95% CI 1.17 to 9.02). Conclusion: The prevalence of burnouts in south India is around 34.2% is slightly lower compared to the prevalence reported in western studies. Limited experience, regular night duties and sleep duration less than 6 hours were associated with burnout.

74-78

Authors: Khurana E, Oommen ER

Background: Cardiovascular fitness refers to the ability of circulatory system to supply oxygen to working muscles during sustained physical activity. Objectives: To determine the cardiovascular fitness (using predicted VO2 max) among young healthy medical students in the age group of 17-19 years. Materials and methods: On the basis of physical activity performed subject were categorized into 3 category light, moderate, vigorous exerciser. Cardiovascular fitness was assessed by using treadmill exercise as per Bruce protocol. Results: Data were analyzed using the paired t-test.Conclusion.it was observed in the study that vigorous exerciser had better cardiovascular fitness than moderate and light exerciser. Conclusion: Students who had more physical activity were having better cardiovascular fitness. Hence, it is suggested that some physical activity should be mandatory in the curriculum of medical education which would help us to maintain cardiovascular fitness and reduce the risk of cardiovascular morbidity and mortality in the long run of their careers.

87-93

Authors: Rahul, Gupta S, Pandey A, Jain K

Introduction: This study aimed to clinically correlate adenoid facies with various clinical features related to ear, nose and throat and to broadly study the various sequelae of adenoid hypertrophy on the physical, mental as well as the social conditioning of children. Materials and methods: After taking approval of the institutional ethics committee the study was carried out in the department of Otorhinolaryngology and Head and Neck Surgery Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur from January 2012 till December 2012. Patients who presented to the outpatient clinic or were admitted in the indoor ward with adenoid facies were included in the study. After detailed history taking and clinical examination, data was analysed with appropriate statistical methods. Results: 30 patients with adenoid facies of varying degrees were included in the study. Nasal block was the most commonly presenting symptom. Pain in throat was complained of by 66.66% of cases. In 50% of cases the parents complained of irregular dentition. Decreased airflow upon functional examination of the nose was seen to be bilateral in majority of cases. A hitched upper lip was found in 100% of cases. High arched palate was seen in all cases, grade III tonsil enlargement was seen in 63.33% cases while grade II tonsil enlargement was seen in 30%. It was seen that mastoid pneumatization was affected by adenoids, being partial cellular in 48.33% of the cases and sclerosed in 18.33% ears. Conclusions: This study concluded that adenoids affect each part of ear nose and throat system, thus its effect can actually be quite devastating in growing children.

100-104

Authors: S. Dhanraj Reddy, M. Sandhya Rani

Background: Prostatic carcinoma is one of the most important causes of mortality in elderly men mainly because of the late detection despite of the fact that it is a potentially curable disease. Fine needle aspiration cytology (FNAC) is an easy to perform outpatient procedure requiring no expensive equipment or anesthesia. Objectives: The present study was carried out in an attempt to evaluate the fine needle aspiration cytology in the diagnosis of carcinoma prostate. Materials and methods: The present study was performed on 27 patients admitted in the surgical wards, with complaints suggestive of prostatic disease, in whom there was found to be a suspicion of malignancy of the prostate gland. Results: Among 27 patients, 14 patients were diagnosed as prostatic malignancy on per rectal FNAC whereas, 19 patients were confirmed with prostatic cancer histologically. Out of 19 histologically confirmed cancer cases, 16 were also positive on FNAC i.e. 84.21% accuracy of FNAC in detecting prostatic malignancy. Conclusion: Fine needle aspiration cytology is easily available and inexpensive procedure. It is a reliable method in the diagnosis of prostatic cancer. Its positive results are relatively more reliable than the negative ones. It is an effective method in follow up of the cancer cases.

111-116

Authors: P. Renuka, K. Aruna Kumari, Akhila

Background: Obstetric emergencies faced in India are much different from those faced by the western world. Out of them, Abruption leading to hemorrhagic shock is a major obstetric emergency, which requires adequate management to avoid catastrophic events including maternal death. Aim: To assess the various modalities of treatment for abruption and its outcome, to assess maternal and perinatal outcome in patients with abruption, to determine the association and influence of various maternal factors on the outcome of pregnancy. Materials and methods: The study was conducted at GMH, Nayapool which serves as a tertiary referral Center having approximately 18000-24000 deliveries per annum. The study was conducted during June, 2006 to July-2007. During this period there were 18950 deliveries. Out of this 296 cases were selected. Results: Out of 18,000 deliveries, 1.64% (n-296) of the patients were complicated by abruption. The mean maternal age was 22-25 years with maximum incidence in both extremes of age. (20-25 years-64.80%, 31-35 years-28.37%). Multiparous women (83.10%) were more affected compared to primigravida (16.89%). A staggering 89.86% or women had no antenatal care and 91.21% of patients belonged to low socio-economic status. 41.21% of women were in 28-32wks of gestation and 35.81% were in 32- 36 weeks. Bleeding per vaginum was the presenting complaint in 89% of patients. 66.22% of patients came with IUD. Maternal complications were frequent. There were 6 maternal deaths, 4 due to hypovolemic shock, 1 due to DIC, 1 due to status Eclampticus. Duration of time between onset of bleeding and seeking medical advice was significant. 2 patients developed PPH. The average induction-delivery interval was 5.2hrs, 82.43% of patients had vaginal delivery and Cesarean section was done in 17.56% of patients. 62.5% of patients received blood transfusion and 55.74% of patients were given FFP's Maternal mortality rate was 2.36% Perinatal Mortality was 61%. Out of these 66.21% of the patients came with IUD, 7.43% had early neonatal deaths, 7.42% had stillbirths. Conclusion: The possibility of abruptio placentae should be considered by the clinician when managing pregnant women with any of those characteristics. Abruptio placentae should be managed in centers where there is advanced maternal and neonatal facilities.

125-138

Authors: Gummadivandanaushasree, Sreenivasaiah Bharathi, Jampalavenkateshwar Rao

Background: An increasing number of HIV infected children have been reported as spread of HIV in adults are showing increasing trend in India. We reported the clinical manifestation, laboratory parameters and follow up of these children. Aim: To study the clinical profile follow up of paediatric patients admitted with HIV in the age gruop18 months to 13 years for a period of 1 year. Materials and methods: This Prospective study was conducted at tertiary care centre at Gandhi Hospital in association with ART centre, Ganhi Hospital, Secunderabad over a period of one year (January 2013 - December 2013). Over 100 consecutive patients suspected and later confirmed by TRIDOT & HIV EIA COOMB were included in the study after obtaining written consent from guardian of the patients. A detailed history, thorough clinical examination and laboratory investigations were carried out. ART & ATT therapy were given according to guidelines and followed up. Results: Of the 100 cases, 55 were males and 45 were females. Immunization status of these children included 20%completely immunised, 52% partially immunized and unknown in 28. Clinical manifestation like, anemia was seen in 95 cases, 91 cases had PEM with 47.25% were in gr 4, PGL (38), fever (36), respiratory (28), diarrhoea (15). Less commonly seen were CNS and chronic ottorhea. Most common opportunistic infections were tuberculosis (16) and candidiasis (16) with giardiasis (3) and herpes zoster (2). Of the 100 cases enrolled, 11 were lost to follow up and 3cases died. Mean weight gain after 6 months 1.6 SD and 2.8 SD at 12 months. On laboratory investigations 95 cases had Hb <2SD, 21 had mantoux positive (>5 mm), abnormal chest X-ray in 23 cases. Conclusion: Most children were in the age group of 1-5 years with mean age of presentation of 5.5 years. Mild bias towards male patients is noted. Perinatal mode is the only mode of transmission, no other modes noted. Most of the children presented to us in a partially immunized status and others’ status was not known. Common presentations - PEM, anemia, skin manifestations, nutritional deficiencies, prolonged fever, systemic manifestations – PGL; respiratory infections like pneumonia, TB; chronic diarrhoea. CNS manifestations were uncommon and renal problems, malignancies were not noted in our study. Amongst opportunistic infections, TB involving various organs and candidiasis were seen in maximum number of patients. Our study concluded that administration of nevirapine based ART regimes for HIV-1 infected children is feasible in resource limited settings. There was improvement in growth parameters with the use of this therapy and prevention of deterioration in immune status.

146-152

Authors: B. Rekha, J. Rajeshwari

Introduction: The intrapartum assessment of fetal well being has become an integral part of the management of labour. Aim: The objective of this study was to evaluate the predictive value of admission test in detecting fetal asphyxia at the time of admission in labour and to correlate the results of admission test with perinatal outcome in high risk obstetric cases compared with low risk obstetric cases. Materials and methods: This was a prospective observational study conducted in the labour and maternity ward of Govt. Gandhi hospital in Secunderabad, during the period 2012 to 2013 with a sample size 50 high risk obstetric cases and 50 low risk obstetric cases. All women were subjected to an admission CTG, which included a 20 minute recording of FHR and uterine contractions. Results: The majority of women were primigravida in the 18-23 years age group in both high risk and low risk groups. Admission test was reactive in 35 cases (70%) in high risk group, 42 cases (84%) in low risk group where as non reactive in 15 cases (30%) in high risk group and 8 cases (16%) in low risk group. In cases with reactive admission test spontaneous vaginal deliveries were more in low risk group than in high risk group. Operative deliveries were more in high risk group than in low risk group in both reactive and non reactive admission test. Indication for caesarean section in both reactive and non reactive admission test was more in high risk group i.e. 1 case (25%) and 6 cases (66%) respectively. Perinatal outcome was abnormal in high risk groups in both reactive and non reactive admission test. Specificity and Negative predictive value in high risk group is less than that in low risk group. Conclusion: The admission CTG appears to be a simple non-invasive test that can serve as a screening tool in both high-risk and low risk obstetric patients with significant results.

158-161

Authors: Madhu Mohan Reddy B, Rajanikanth Amrutham, Nagababu Pyadala

Background: Acute pancreatitis is an inflammatory disease of the pancreas, develops over a short period of time. Aim: To evaluates the clinical presentation in different age group, gender, aetiology, mortality, morbidity and outcome of management of patients with acute pancreatitis in surgical unit of MNR Teaching Hospital. Materials and methods: A prospective study was conducted in MNR Medical College Hospital over a period of 3 years. Patient details, clinical examinations, laboratory reports, treatment options, complications and mortality rate were recorded during study period. Results: Among 46 patients, 29 (63.04%) were males and 17 (36.95%) were female. Most common age group with acute pancreatitis was 21-30 years (45.65%). All patients had pancreatic oedema. 26.08% acute pancreatitis was due to gallstones, 15.2% had pseudo cyst, 17.4% had ascites and 15.21% had hepatosplenomegaly. Fatality rate was 6.5%. Conclusion: Conventional conservative approach for the management of acute pancreatitis has better outcome.

174-178

Authors: Aasim Farooq Shah

Studies of dietary effects on saliva were common in the early part of this century, but it is now understood that such studies are of little value because the effects of other physiologic variables, such as time of day, were seldom controlled in the experimental design. The main salivary factors that, from theoretical considerations, might be expected to influence the process of caries are flow rate and the concentrations of calcium, phosphate, bicarbonate, hydrogen ions, fluoride, urea, and protein (particularly amylase). As the mankind has evolved, a drastic change has been seen in the dietary fermentable carbohydrate which eventually is associated with increased prevalence of dental caries. Milk is consumed with sugar syrups or honey to add flavor which eventually increases sugar content of milk, putting the children at a higher risk of dental caries. This study was conducted to evaluate and compare the acidogenic potential of milk as compared to milk and sugar at various time intervals. A total of 230 children aged 12 to 15 years were examined, 60 children which equal number of males and females (30 each) who satisfied the inclusion criteria were randomly selected and assigned to two groups, Group I: Plain milk (250 mL) and Group II: Milk and sugar (250 mL + 1 table spoon sugar =12.50 gm). After recording the resting pH, the change in the salivary pH in the respective groups after consuming the test meal was recorded after 5 minutes, 10 minutes, after 15 minutes, after 30 minutes and 120 minutes. The results show that there was no statistical significant difference in pH between the two groups. Statistically significant difference was seen at 10, 15, 30 minutes with highest at 15 minutes (p = 0.001) between plain milk (group I), milk and sugar (group II). The milk group showed a significant decrease in pH at 10 minutes. However, pH returned to normal at 15 - 30 minutes in group II. The study concluded that milk when added with sugar as did not pose a risk of demineralization as there was no decrease of pH below the limit of critical pH of 4.5 to 5.5.

185-191

Authors: Uppala Veeramma, D. Rajeswari, N.V. Sundarachary

Background: Thrombosis of the cerebral venous sinuses (CSVT) is not an uncommon form of stroke. Usually affects young individuals. Aim: To compare the clinical profile of Cerebral venous thrombosis patients. Materials and methods: It was an observational study, comparing the epidemiological and etiological profile of patients with CVT during two time periods Results: This study group consisted of 130 patients, 63 patients in cohort 1 (2013/14), and 67 Patients in cohort 2 (2015-2016), were male noted in 27% and female were noted in 73% in cohort 1 (2013-14. In cohort 2 (2015-2016) male were noted in 39% and female were 61%.The data in rural were 81.5% and urban were 18.5% in cohort 1 and in cohort 2, Rural were noted in 66% and urban 34%.Common risk factors were postpartum status 31 were noted in cohort 1 and 18 were noted in cohort 2. In MRI brain Parenchymal changes cohort 1 consisted 51 and cohort 2 consisted 38. Headache was the common clinical presentation in the patients and next followed by altered sensorium. Time of onset of symptoms in the both cohorts was at 6-10 days in most of the patients, risk factor associated in both cohorts was postpartum status. Conclusion: CSVT is a multi-factorial condition with gender-related specific causes. Fifty years ago, CSVT was a mortal condition, but with the introduction of neuroimaging, the mortality rates have become minimal. CSVT is effective and economical.

199-203

Authors: Devanatha Reddy P, Madan Mohan Rao GV, Nagababu Pyadala

Background: Country like India patellar fractures is more common due to the activity of daily life. 1% of all skeletal injuries due to patellar fracture by direct or indirect mechanism. Aim: This present study focus on advantages and complications associated with fixation technique for the management of patellar fracture. Material and Methods: 50 patients with patellar fractures treated by cannulated cancellous screw with tension band wiring. Result: The most common age group in our study was 41-50 years. Among 50 patients 37 were male and 13 were female. Fracture due to indirect injury was 64% and direct trauma was 36%. Outcome of our study was 90% as excellent, 8% as good and 2% poor. Conclusion: According to our study management and early mobilization of displaced transverse patellar fracture by cannulated cancellous screw and tension band wiring showed better result.

212-220

Authors: C. Venkateshwarlu, B. Praveen Kumar, Md. Yousuf Khan

Background: Recently much of attention is focused on the diastolic function of the heart. Since the systolic performance of the heart in hypertensive patients has been examined so far, but the study of the diastolic function of heart has emerged as a newer mode of study. Aim: To study non-invasively the diastolic function of left ventricle in patients with systemic hypertension. Materials and methods: Twenty patients either admitted or as outpatients in outpatients Department, Gandhi Hospital with isolated systemic hypertension. (HTN) who satisfied inclusion and exclusion criteria were taken up for the study with five age matched individuals who along served as controls assessed by Doppler Echo-cardiography and their findings were compared with five normotensive age matched controls. Results: Bedside post valsalva maneuver, this test was positive in 7 5% of the test subjects. Of the 25% who had a negative test, 40% had evidence of diastolic dysfunction as assessed by pulsed wave Doppler. Left ventricular hypertrophy was present in 55% of the patient subgroup and all (100%) of these patients had significant diastolic dysfunction. The rest of the 45% of the patients did not have left ventricular hypertrophy. 75% of these non-hypertrophic hypertensives had diastolic dysfunction as seen by PWD. Increased left ventricular mass index has been observed in 85% of the hypertensives but has not correlated statistically with either severity of blood pressure or diastolic filling variables or isovolumic relaxation time. The left atrial size an indirect indicator of LV diastolic function was increased in 50% of the hypertensive subjects when compared with the controls but the statistical difference was insignificant. LV diastolic function as assessed by PWD mitral flow velocity profile and isometric volume relaxation time was abnormal in 85% of the hypertensive subgroup and was highly significant statistically (P value <0.005). The deceleration time (MS) was similar in both the controls and the hypertensives making it an insignificant parameter for assessing LV diastolic function. The peak filling rate was reduced in the hypertensive subgroup and was of moderate statistical significance. Conclusion: Doppler Echocardiography, an easily available non invasive technique today, can be utilized for identifying hypertensives with diastolic dysfunction and thus treat this group with specific therapy (Beta Blockers) so as to arrest or reverse the pathological changes produced in left ventricle due to hypertension.

228-234

Authors: S. Sujit, M. Bathragiri, K. Chandra

Introduction: Transplantation returns the majority of patients to an improved life-style and an improved life expectancy, as compared to patients on dialysis; however, careful prospective cohorts studies have yet to be reported. Infection is a leading cause of morbidity and mortality in transplant recipients, with more than 80% suffering at least one episode of infection in the first year. The risk for infection is strongly determined by an interaction between epidemiologic exposures and net state of immunosuppression. Aim and objectives: To study the prevalence of infections in the post renal transplant recipients, to find out the most common cause of infections in post renal transplant patients, to find out the frequency of infections in early and late phase of renal transplantation. Materials and methods: Patients who reached end stage renal disease and who underwent Renal Transplantation in our hospital was prospectively followed up for infections for a period of 1 year. Results: A total of 77 transplant recipients were included in our study. Out of which, 50 recipients (69.44%) had infections during follow up. 32 recipients (64 %) had infections involving more than one system. The infectious were common within the first 6 months of surgery and most of them occurred within the first month of surgery. Conclusions: Urinary Tract infection was the most common confection occurring in the post renal transplant recipients.

239-244

Authors: Rajeshwary P, M. Nagaprasanth, Salma Mahaboob R, G. Obulesu

Reproductive failure is a significant public health concern. Recently, ROS have been shown to have an important role in the normal functioning of the reproductive system and in the pathogenesis of infertility in females. Oxidative stress affects both natural and assisted infertility. Treatment that reduces OS may help infertile women with the disease that is caused by imbalance between free radicals and antioxidants. MDA is an end product of lipid peroxidation which can be used as a biomarker to measure the level of oxidative stress. TAC measures the low molecular weight non enzymatic antioxidants. Increase in MDA and decrease in TAC indicates an increase in oxidative stress. In the present study, it was observed that there was a statistically significant increase in serum MDA levels in female factor infertility and unexplained infertility when compared to controls. There was a statistically significant decrease in serum TAC in female factor infertility and unexplained infertility when compared to controls and statistically significant increase in serum LDH in infertile women with unexplained infertility compared to the control group and female factor infertility signifying the apoptotic damage in the unexplained infertility.

251-258

Authors: Y. Kishore Kumar, Ajay Kumar Basod, G. Obulesu

Background: Hearing impairment is a major problem worldwide, significantly delaying acquisition of speech in children. Unfortunately delayed detection of hearing impairment especially in rural and remote areas, adds a significant burden to the society and the nation. Hence early detection of hearing impairment is imperative and the need of the hour lies in developing an easy, cost effective and reliable method for testing large number of neonates and infants. This study was to assess the effectiveness and utility of Tympanometry as a screening tool for assessment of middle ear pathology in neonates and infants. Middle ear disorders are significantly prevalent in young children. Aim: Investigating and comparing the results of visual inspection of the tympanic membrane to the results of Tympanometry with traditional probe tone (226 Hz) and high frequency probe tone (678 Hz) in” ears without effusion” and “ears with effusion” and to establish their sensitivity and specificity to detect middle ear disorders as a database in clinical practice. Materials and methods: Subjects were evaluated for the stable middle ear/ Eustachian tube function. Ears with no sign of effusion in the middle ear on otoscopy were labeled as “ears without effusion” and those who showed the presence of fluid in the middle ear were labeled as “ears with effusion”. Blinded to otoscopic ear exam results, Tympanometry was conducted with conventional probe tone of 226 Hz and high probe tone 678 Hz by audiologist using standard procedure. Results: Otoscopic examination results of ears for all age groups were evaluated and ears without effusion and with effusion were tabulated. Conclusion: The tympanometric parameters obtained with 226 Hz and 678 Hz probe tones have statistically significant differences in detecting the ears without effusion and with effusion. Compliance values also proved to be statistically different with the different probe tones.

268-271

Authors: B. Madhu Mohan Reddy, Banothu Srinivas

Background: Continued chronic pain after inguinal hernioplasty is the most important current issues. Factor responsible for pain development mechanisms are still unclear. Influence of age as well as other factors is still controvertible. Objectives: To study the incidence of occurrence of postoperative pain in relation to age and duration of hernia. Materials and methods: A cross sectional prospective study includes 220 patients between 18-80 years. Participants willing for scheduled follow up of 7th, 30th, 90th and 180th day were considered for this study. All patients were explained for surgery and probable complications. Results: Study of chronic pain had shown that 12 (10.9%) had mild pain, 2 (1.4%) had mild pain but occasional taking drugs and 2 (1.4%) had moderate pain but not taking any drug on 90th day. On 180th day, 7 (6.4%) had chronic pam of which 6 (5.5%) had mild pain while 2 (0.9%) patients had moderate pain but none of the patients were taking any analgesics. Conclusion: There was significant association between age of the patients and pain. Chronic pain and the severity of pain decrease with advancing age.

280-289

Authors: P. Malathi, D. Anupama, P. Habitha

Background: The achievement of safe child birth by caesarean delivery (CD) was one of the greatest medical advances of the 20th century. Indeed, CD is now the most frequent operation performed, consulting approximately one third of all deliveries annually. Aim: To evaluate the effect of preoperative administration of Injection tranexamic acid on blood loss during and 2 hrs after elective caesarean delivery. Materials and methods: This study was a prospective observational study for a period of 15 months; randomized controlled trial was conducted among 200 women scheduled for elective Cesarean delivery. Results: A comparative study was undertaken to study the effect of inj. TXA on blood loss during and after Cesarean delivery. The mean age in tranexamic group was 23.40±3.06 while in control group was 23.59±3.56. 64% fall in age group 21-25 years. In Gravida Distribution, majority of the patients in both the groups are of Gravida 2 (Group A 65% and Group B 64%). The mean ± SD was 2.17 ± 0.65 in study group and 2.2 ± 0.56 in control group. Comparison of blood loss between two groups, intra-operative blood loss was lower in the study group than in the control group 375±69 vs 410±79.9 and is statistically significant. The mean postpartum blood loss was also in the study group than in the control group 52±30 Vs 131±42 and was statistically significant. Conclusion: Tranexamic acid injection significantly reduces the perioperative blood elective Cesarean section, if given prior to the skin incision, without significant adverse effects.