International Archives of Integrated Medicine

10-17

Authors: Kamalakar Karampudi, J Ashwin

Background: Spinal anesthesia is oldest and all over the world till date one of the most frequently employed methods of regional anesthesia. The addition of opiates like the lipophilic opioid Fentanyl to local anaesthetics produces many of its clinical effects very early after intrathecal administration. Aim: The study was designed to compare the efficacy of intrathecal Fentanyl along with Bupivacaine and Bupivacaine alone and their effect on prolonging the duration of postoperative analgesia in lower segment caesarean section without any adverse effects. Materials and methods: Fifty ASA physical status I and II patients scheduled for elective lower segment caesarean section surgery were studied. Patients were randomly divided into two groups i.e., group FB and group B consisting of 25 patients each. Patients in group FB were given 8.5 mg of 0.5% hyperbaric Bupivacaine plus 25 µg of Fentanyl (0.5 cc) and group B received 8.5 mg of 0.5% hyperbaric Bupivacaine plus 0.5 cc of normal saline to adjust the final volume to 2.2 cc. Results: It was found that addition of 25 µg of Fentanyl to 8.5 mg of 0.5% hyperbaric intrathecal Bupivacaine had no effect on the onset of analgesia to pin prick, maximum level of analgesia and time to achieve maximum level. Fentanyl did not prolong the Bupivacaine sensory block but there was a significant prolongation of postoperative analgesia with addition of Fentanyl. Fentanyl 25 µg did not enhance the onset and duration of sensory block produced by 8.5 mg of 0.5% hyperbaric intrathecal Bupivacaine. Fentanyl however, prolonged post-operative analgesia and lowered the incidence of shivering. The incidence of pruritus was high, but it was usually mild in Fentanyl 25 µg along with 8.5 mg of 0.5% hyperbaric Bupivacaine. Conclusions: Intrathecal Fentanyl with Bupivacaine is very much safer than other opioids like morphine which has more postoperative complications like intense, intermittent respiratory depression.

27-35

Authors: Sethi P, Betkerur J, Sethi P, Adhlakha B, Kulkarni M, Murthy KC

Background: Primary pyodermas are one of the most common dermatological diseases. Staphylococcus aureus (S. aureus) is frequently isolated. It has developed resistance to many antimicrobials and Methicillin Resistant Staphylococcus aureus (MRSA) is a major problem. The precipitous usage of topical antimicrobials especially Mupirocin and Fusidic acid has increased the development of multi-resistant strains of S. aureus and in India, few studies have shown susceptibility profile to these drugs. Aim: This study aimed at the clinical and bacteriological profile in primary pyoderma patients, prevalence of MRSA and the resistance pattern of S. aureus to Mupirocin and Fusidic acid. Materials and methods: Patients with primary pyodermas from community were recruited. Gram stain and culture sensitivity was done with swabs taken from the lesions. Antibiotic susceptibility for S. aureus was tested using VITEK- 2. Mupirocin and Fusidic acid susceptibility was determined by E-strip method. Observations: A total of 107 patients of primary pyodermas were included. Pyoderma were common in young age group (P = 0.001). Poor hygiene was the main predisposing factor. Furunculosis (45.8%) was the most common pyoderma followed by impetigo and folliculitis (16.8% each). Culture was positive in all except 3. S. aureus was isolated in 61.7% and polymicrobial flora in 13.1%. Prevalence of MRSA was 39.5% (P= 0.066). All strains of S. aureus demonstrated 100% susceptibility to Mupirocin and Fusidic acid. Conclusions: Furunculosis still has the highest incidence in adult population with a high prevalence of MRSA (39.5%). Despite extensive usage of Mupirocin and Fusidic acid, no resistance was found in this part of India.

46-53

Authors: Kontham Praveen, Farida Begum, Kandukuri Mahesh Kumar

Introduction: Gastro Intestinal Tract (GIT) is an important site for wide variety of lesions which include congenital, inflammatory, neoplastic conditions. The invention of flexible fiber-optic endoscope is a very good achievement towards the diagnostic field. With the use of this facility direct vision of diseased mucosa and biopsy of mucosal lesions, therapeutic induction and photographic visualization of the lesions are made possible. Aim: Aim of this study was to know the incidence of Gastro intestinal lesions with reference to age, sex and site and to study the histopathological types of Gastro Intestinal lesions. Materials and methods: The present study included 180 GIT biopsies (gastro intestinal biopsies) between the period August 2013 to August 2015 .Clinical details and case histories were obtained from the patients presented to the gastroenterology department. Biopsies were obtained by the gastroenterologist with fiber optic forward viewing endoscope. Results: Among all the GIT biopsies, esophageal biopsies were 11 (6.11%), gastric biopsies were 31 (17.22%), gastro esophageal junction 4 (2.22%), and small Intestinal 67 (37.22%) and 67 (37.22%) was from large intestine. Conclusion: Endoscopy and subsequent biopsy for histopathology can detect early malignant lesions. In the absence of endoscopic screening, detection of these lesions may be missed. Such patients may present with advanced stage of disease in later life. In endoscopic biopsy only mucosa is seen, the level of invasion cannot be ascertained.

61-68

Authors: Sreenivasaiah Bharathi, Kotte Chiranjeevi

Background: Various studies have shown the correlation between Magnesium, Zinc and Copper levels in Serum and Cerebrospinal fluid (CSF) and occurrence of Febrile Convulsions. Hypomagnesaemia is characterized by hyper excitability of the central nervous system leading to convulsions. Hence the study is undertaken to find out the Serum Magnesium levels and its correlation with febrile convulsions. Aim: To Study the Serum levels of Magnesium in children: 6 months - 5 years of age with febrile convulsions and to establish the correlation between serum Magnesium levels and febrile convulsions. Materials and methods: This study was done in the Department of Pediatrics, Gandhi Medical College, Secunderabad from July 2015 to July 2016. It was an Observational Prospective study. A total of 120 children 6 months to 5 years of age admitted with history of fever and convulsions diagnosed as febrile convulsions were included in the study. Serum Magnesium levels were measured using catalyst method by Synchron CXR systems. Informed Consent was taken from Parents of all the children. Detailed Clinical History was taken along with thorough Clinical examination. Complete Blood Counts, Serum Magnesium levels, Serum Electrolytes, Blood Glucose and Serum Calcium levels were done. CT scan brain was done wherever required Results: Out of 120 total cases: 104 (86.67%) were Typical Febrile Convulsions. 16 (13.33%) were Atypical Febrile convulsions. Hypomagnesemia was seen in 19 (16%) children. Out of these, 9 (47.36%) cases were Males and 10(52.64%) cases were Females. Out of 104 Typical Febrile convulsions: 17 cases were shown hypomagnesemia, 87 were shown Normal magnesium levels. Out of 16 Atypical Febrile convulsion cases: Only 2 cases were having hypomagnesemia and 14 were having Normal Magnesium. Conclusion: No association was found with Gender, Age, and Temperature of the patient and subtype of febrile convulsions. Statistically significant association was found with hypomagnesemia and ‘Typical Febrile convulsions’. No such association was found with Atypical Febrile convulsions. Therapeutic value of administration of Magnesium in children with febrile convulsions associated with hypomagnesemia to be established. This requires further interventional studies. Larger clinical studies are required to establish the association of hypomagnesemia and febrile convulsions. Further studies are suggested to determine the effect of Magnesium administration for the prevention of febrile convulsions.

78-82

Authors: Sabhnani G, Tomar S

Giant peptic ulcer perforation is a life threatening surgical emergency with high mortality rate. This study compares two different surgical techniques Omentopexy and Omental plugging for the treatment of giant peptic perforation. A prospective non-randomized study of 36 patients with giant peptic perforation (>=2 cm in diameter) was carried out over a period of 24 months .The highest incidence was seen in males over 50 years of age. Biliary leak rates were 22.22% in the omentopexy group compared to no leak in the omental plugging group. This rate when calculated on standard error of proportion was significant at 5% level (p<0.05).Mortality rate was higher in omentopexy group compared to omental plugging group.

88-93

Authors: C. Amulya, T. Sasikala, V. Poornima

Background: Hypertensive disorders complicate 5-10% of all pregnancies and together they form one member of the deadly triad, along with haemorrhage and infection that contribute greatly to maternal morbidity and mortality rates. Materials and methods: Antihypertensive drugs taken into the study were Tab. Labetolol, 100-300 mg three times a daily, max dose 2400 mg per day and T. Nifedipine, 10 mg three times a day, max dose 120 mg per day. The study was a randomised control clinical trial, the study period started from Nov 2014 to June 2016, in the Department of Obstetrics and Gynecology, KGH, Andhra Medical College, Visakhapatnam, India. Results: Age distribution, Gravidity, Gestational age at the time of admission, Distribution of cases as per type of hypertension, Duration of therapy before delivery in study group, Changes in blood pressure, Maternal side effects in the study group, Mode of delivery, APGAR score of the babies at the time of delivery were tabulated. Conclusion: Labetolol gave good control of BP with single agent, when the dose was titrated appropriately, till the BP was controlled. The control of BP was consistent with labetolol, and also could be used for longer duration without any additional therapy whereas with nifedipine, control of BP was inconsistent and required additional medication for proper control of BP.

103-111

Authors: PSV Rama Rao, M. Vijayakanth, Mohammad Feroz

Introduction: Pain is one of the most important factors that is responsible for many adverse outcomes during surgery and in postoperative period. Effective pain control can also facilitate rehabilitation and accelerate recovery from surgery. Aim: To compare ultrasound-guided TAP block versus patients receiving no Transverse abdominis plane (TAP) block as regards the degree of pain relief in patients undergoing laparoscopic appendectomy. Materials and methods: Prospective single blinded randomized control study. Patients were randomly allocated (computer coded sealed envelopes) to receive either TAP block or no TAP block with regular analgesia. Patient will be observed for 24 hours post operatively. 60 patients divided equally into 2 groups cases were TAP (transverse abdominis plane block) group (n =30), Control group (n= 30). Results: The age between the two groups was analysed using student-t-test , the average age group in control group was found to be 32.64 years and TAP group 29.4 years. There was no significant difference in age between the two groups. The percentage of Males in TAP group was more when compare with Control, whereas in Control group the females were more but the difference was not statistically differ. Pain score between two groups was analysed using Maan-Whintney U test. The p-values of the Mann-Whitney U-test for the 2nd, 6th and 12th hours showed significant (p value – 0.000), which revealed that the mean rank for the pain scores of Control group was significant greater than the TAP group. Whereas for the 24th hour the mean rank for the pain score for both the groups were almost similar. Conclusions: Ultrasound guided TAP block with 0.375% ropivacaine bilaterally can be used effectively for post operative analgesia for patients undergoing laparoscopic appendectomy.

118-128

Authors: Ramulu Pulimaddi, Amruth Rao Parveda, Dhanunjaya Dasari

Introduction: Non-alcoholic fatty liver disease (NAFLD) is a condition characterized by excess accumulation of fat in the liver occurring in people who consume little or no alcohol. This study was aimed at estimating the prevalence of fatty liver in type 2 diabetic patients using ultrasonography and to also to study the correlation between coronary risk factors, coronary artery disease and fatty liver. Materials and methods: This was a cross-sectional study conducted on 150 patients above the age group of 30yrs who were already diagnosed of type 2 diabetes mellitus and on treatment for T2DM were recruited according to inclusion criteria Results: In the present study it was observed that 54 % of the diabetic patients had fatty liver and 46 % had no fatty liver disease on ultrasonography. Out of the 81 diabetic patients who had fatty liver, grade I fatty liver or mild steatosis was observed in 69.1 % cases while 44.9% of cases with no fatty liver disease and 49.4% of cases with non-alcoholic fatty liver disease and were in the age group of 51- 60 yrs with male predilection. 88 patients out of 150 were hypertensive, in patients with no fatty liver disease 59.4 % patients presented with hypertension and 58% hypertensive patients with non-alcoholic fatty liver disease. Mean BMI, waist circumference, HBA1c and liver enzymes (AST and ALT) were significantly higher in patients with fatty liver than in patients without fatty liver. The mean total cholesterol levels (178.18), the mean triglyceride levels (154.9) and mean LDL cholesterol (103.8) were significantly higher in patients with fatty liver when compared to those without fatty liver. Mean HDL cholesterol in patients with fatty liver was 43.3 which were significantly lower than mean HDL cholesterol of 46.21 in patients without fatty liver. The prevalence of metabolic syndrome (66.7%) and CAD (59.3%) were significantly higher in the NAFLD subgroup. Conclusion: The prevalence of NAFLD in type 2 diabetics is very high. NAFLD is associated with higher prevalence of metabolic syndrome and coronary artery disease. There is clustering of traditional coronary risk factors in patients with NAFLD.

136-142

Authors: Joshi K, Bhatt M, Saxena R

Background: Thyroid dysfunction is the second most common endocrine disease in pregnant women. Hypothyroidism is a more common dysfunction encountered in pregnancy. Aim: To study the incidence of thyroid dysfunction in antenatal cases and its effect on fetomaternal outcome. Materials and methods: Total 50 cases of pregnancy with thyroid disorder were selected. Detailed history was taken and full clinical and general examination was performed using a predesigned proforma including clinical feature suggestive of thyroid dysfunction. Serum TSH, T3, T4, fT3, fT4 was measured by CLIA (Chemiluminescence Immunoassay) in all the cases as initial hormonal screening investigations. Results: The overall percentage in our study was 15.97% and out of this 74% was without any symptom i.e. subclinical and only 26% had symptoms. Caesarian section rate was (30% v/s 0%), 18% with subclinical hypothyroidism were detected. In controls, 9% with subclinical hypothyroidism were detected. The most common complication associated with hypothyroidism was abortion (14%) and PIH (16% v/s 56%) hyperemesis gravidarum (9% v/s 3%) and hemorrhage in early pregnancy (22% v/s 8%) We also observed that hypothyroidism is associated with more complications even if it is subclinical (42%). Conclusion: The study concludes that thyroid dysfunction in pregnancy is often significantly associated with maternal complications most commonly abortions, anemia, preterm labour and abruption. Higher caesarean rates are also observed among hypothyroid mothers. Low Apgar scores, increased NICU admissions, low birth weight mainly due to prematurity are usually noted in the neonate. The early administration of treatment and maintenance of a normal level of thyroid hormones significantly minimize the risk of maternal and fetal complications.

151-153

Authors: Rathva A, Jaiswal SK, Gupta K, Zala S

Hydatid involvement of the kidney accounts for only 2–4% of all cases of hydatid disease it is very rare and again primary involvement of the kidney without involvement of liver parenchyma or lung parenchyma that makes it extremely rare. The purpose of this article is to review the imaging features of hydatid disease of the kidney and thus show the role of radiography, excretory urography, sonography, CT, and MRI in the diagnosis of Hydatidosis. Hydatiduria accompanies only 10 to 20 % of all cases of renal Hydatidosis and usually microscopic ,here we are reporting a 65 years old female with abdominal lump in right hypochondriac region with pain on USG finding suggestive of hydatid cyst of liver with indentation and possible involving right kidney but MDCT suggest it is a primary right renal hydatid large exophytic cyst having multiple daughter cysts involving upper pole of kidney with breech in the cortex and it extends to involve right renal pelvis which indenting to inferior surface of liver.

164-170

Authors: Neki NS

Salivary diagnostics is an emerging field that has progressed through several important developments in the past decade, including the publication of the human salivary proteome and the infusion of federal funds to integrate nanotechnologies and microfluidic engineering concepts into developing compact point-of-care devices for rapid analysis of this secretion. In this article, we discuss some of these developments and their relevance to the prognosis, diagnosis and management of periodontitis, as an oral target, and cardiovascular disease, as a systemic example for the potential of these biodiagnostics. Our findings suggest that several biomarkers are associated with distinct biological stages of these diseases and demonstrate promise as practical biomarkers in identifying and managing periodontal disease, and acute myocardial infarction. The majority of these studies have progressed through biomarker discovery, with the identified molecules requiring more robust clinical studies to enable substantive validation for disease diagnosis. It is predicted that with continued advances in this field the use of a combination of biomarkers in multiplex panels is likely to yield accurate screening tools for these diagnoses in the near future.