International Archives of Integrated Medicine

1-7

Authors: Prabhakaran R, Marannan N, Ponnusamy Kumar, Vijayakumari Vrinda

Background: Poisoning with organophosphorous substances is the commonest cause of inpatient mortality among all poisonings in developing countries like India. This study is undertaken with an aim of assessing simple parameters like GCS and QTc (marker of ventricular arrythmias) in predicting the outcome and complications of organophosphate compound poisoning considering the mortality and sufferings of Organophosphorous poisoning patients. Aim: To assess the utility of GCS score and QTc interval in predicting prognosis in patients who had consumed organophosphate and carbamate poisoning and to assess whether the above parameters helps to identify the high risk groups requiring mechanical ventilation. Materials and methods: This study was conducted among 200 organophosphate and carbamate poisoning patients who were admitted at Government Rajaji Hospital, Madurai from February 2014 to September 2014. After taking detailed history and physical examination and investigations the Glasgow coma scale score and QTc interval at the time of admission was calculated. Patients with GCS score < 13 and QTc interval > 0.44s in males and 0.46s in females as poor outcome. Results: There was a linear relation with QTc interval and severity of Organophosphorous poisoning i.e. as the QTc interval increases the severity of poisoning increases. There was an inverse relationship between the GCS score and severity of Poisoning, .i.e. as the GCS decreases the severity of poisoning increases. Conclusion: Our study showed that respiratory failure in patients with OP compound poisoning can be predicted at admission by simple parameters like lower GCS and prolonged QTc interval in ECG.

13-19

Authors: Anupama Priyadarshini N

Background: Succinylcholine remain unsurpassed in providing ideal intubating conditions in the shortest time among all available neuromuscular blocking agents hence is advocated as the drug of choice for rapid sequence endotracheal intubation. Aim: Study compared the effects of succinylcholine and rocuronium bromide on intraocular pressure. Materials and methods: Study was done in 30 samples of ASA physical status 1 and 2 were selected through simple random sampling technique. All patients were scheduled for elective non-opthalmologic surgery for which general endotracheal anesthesia at various intervals at various intervals intraocular pressure changes, pulse rate, systolic and diastolic blood pressure were recorded at each of the above periods. Results: Intraocular pressure was elevated after giving succinylcholine high above the baseline values while in rocuronium group the intraocular pressure reduced below the baseline values. Though in both the groups IOP rose after intubation and decreased after three and five minutes after intubation, in group S it remained above the baseline after five minutes where as in group R it remained below the baseline value. Increasing after intubation nearing baseline value after five minutes after intubation. Conclusion: To conclude rocuronium in a dose of 0.9 mg/kg provides good to excellent intubating conditions comparable to that succinylcholine. It is a suitable agent for tracheal intubation in patients undergoing elective and emergency ophthalmic surgery where raise in intraocular pressure is undesirable.

26-30

Authors: G. Indumathi, M. Arivumani

Introduction: Ingestion of oleander seeds results in a clinical picture similar to that of digoxin overdose. Severely poisoned patients may die in dc shock resistant ventricular fibrillation. It can lead to severe Hyperkalaemia is a marker of a poor outcome in cardiac glycoside poisoning, which may worsen further toxicity and lead to serious Arrhythmias. Aim: To analyse Clinical Profile, ECG Changes, Electrolyte Status among the patients with acute yellow Oleander seed Poisoning. Materials and methods: All patients admitted with consumption yellow oleander poison within 48 hours was studied. The study was carried out over a nine-month-period beginning June 2016. Clinical parameters, CBC, Blood sugars, Serum Urea, Creatinine, Serum Na+, Serum K+, LFT, ABG, ECG, and Gastric aspirate analysis were done to analysis the changes on hourly basis. Results: Among the 72 patients, the significant ECG abnormalities were found in 45(62.5%), 37.5% had normal rate and rhythm. No significant abnormalities were found in Renal and Liver functions. No significant change in Serum Sodium level was noted. But significant change in the Serum Potassium levels was noted in 28.1% of patients. In this 19.7% had Hyper-Kalemia and 8.4% had Hypo-Kalemia. Conclusion: Oleander seed is still used as a suicidal agent. Oleander plant is easily available as an ornamental plant in urban, semi-urban and rural areas. ECG abnormalities were found in majority of the individuals. Prognosis was poor among those who presenting with Hypo-tension, Electrolyte disturbances especially those with Hyperkalaemia, and complex Arrhythmias.

38-44

Authors: Yashvardhini Siddareddy, Himabindu Sangabathula

Introduction: Mid-trimester termination of pregnancy is one of the most controversial areas of gynaecological practice. It has moral, emotional, social and technical issues. There is continuous need for termination of pregnancy in second trimester, more recently due to increase in the use of antenatal diagnostic procedures. The objective of the present study is to compare acceptability, safety, efficacy, complications and induction-abortion interval of ethacridine lactate with vaginal misoprostol versus vaginal misoprostol alone for mid trimester abortion Materials and methods: This was a comparative study s200 women of 13-20 weeks pregnancy were randomized in two groups. Out of these 100 patients were selected at random for intravaginal misoprostol 400 μg stat followed by 200 μg misoprostol P/V 4th hourly and 100 cases for extra amniotic ethacridine lactate instillation with tablet misoprostol 400 μg Stat followed by tablet misoprostol 200 μg 4th hourly. The relative efficacy, induction- abortion interval, complications of each was studied. Results: The patients studied belong to all categories of marital status, married, and unmarried, widowed. The age ranged from 15-34 years. The gestational age from 14-20 weeks most of them were primi para. Mean induction abortion interval with misoprostol is 15.2 hours while that of emcredil with misoprostol is 16.44 hours. Success rate with misoprostol is 94% while that of emcredil with misoprostol is 95%. Incomplete abortion with misoprostol 2% while that of emcredil with misoprostol 1%. No major complications are noted in both the methods. Conclusion: Misoprostol is safer, more effective and acceptable than ethacridine for mid trimester termination of pregnancy.

51-54

Authors: Theerupally Jaya, Pottekula Sridevi

Background: Aim of the present study was to assess the technical difficulties and complications of double puncture laproscopy in camp setup in urban areas. Materials and methods: Laproscopic sterilization camps are held in the urban area (Hyderabad) from April 2014 to March 2016 a total of 7112 cases were done. The technical difficulties and complications are analyzed. Results: Failure to do the operation was technical failure mainly due to adhesion followed by pelvic inflammatory disease. The most common complication encountered was bleeding from the port site and infection at the port site. No major morbidity or mortality was reported. Conclusion: Laproscopic sterilization by Falope rings is very popular as it has very few complications and large number of patients can be operated in a day by an experienced laproscopic surgeon and safe alternative to modified Pomeroy’s technique.

60-63

Authors: P. S. Rani, P. Sasikumar

Introduction: The incidence of diabetes in India is 3.8%34. It is well known that diabetes is a systemic disease; it affects almost all organ systems. Non-alcoholic fatty liver disease (NAFLD) is being increasingly recognized today as a potentially serious complication of diabetes, especially type 2. The spectrum of NAFLD extends from simple steatosis or steatosis with mild inflammation to severe non-alcoholic steatohepatitis (NASH). Aim of the study: The Aim was to analyse the prevalence of Fatty Liver (Non Alcoholic Fatty Liver Disease) in Patients with Diabetes. Materials and methods: The study was to be conducted in Government Dharmapuri Medical College Hospital, Dharmapuri, and Tamil Nadu. It was an observational type of study. Interview technique was used to collect information on a predesigned proforma. All diabetes patients both type 1 and type 2. Both male and female patients were included in the study. Results: Among the 75 diabetics who were studied, fatty liver was found in 31patients (41.33%). No. of patients with fatty liver was 31. No. of patients without fatty liver was 44. The number of males with fatty liver were 2 (2.6%) and females 29 (38.6%). The number of patients with fatty liver who had central obesity (waist hip ratio >1) was 23 (74.19%). All the patients with fatty liver had central obesity (waist hip ratio >1 in males and >0.85 in females). Conclusion: The prevalence of non-alcoholic fatty liver disease was 41.3% and it was present mainly in patients with type 2 diabetes mellitus. It occurred more commonly in women (38.66%) than men.

71-74

Authors: K. Sureshkumar, P. S. Rani

Introduction: Heart failure is the end stage of all diseases of the heart and is a major cause of morbidity and mortality. Since 1970s the treatment of CHF has been transformed, resulting in major benefit to patients. This advance has been the consequence of better understanding of the pathophysiology, investigations, the introduction of newer drugs and cardiac transplantation. Aim of the study: To find out the prevalence of congestive heart failure among the patients admitted in the hospital and to analyse their presenting features and precipitating factors. Materials and methods: A total of 196 cases that satisfied the inclusion and exclusion criteria stated above were taken up for subsequent study. Results: During the study period, 6072 patients were admitted in the medical wards. Out of them 196 satisfied the inclusion criteria. So the prevalence was 3.2 % (196/6072). Among the 196, 7 were expired, thus case fatality rate was 3.5% (7/196). Conclusion: The prevalence of congestive heart failure among hospitalized was 3.2 %Congestive heart failure was common among the age group of 45 – 65 years. Drug intake mainly Non-steroidal anti-inflammatory drugs, anaemia and infections were the most common precipitating factors.

82-87

Authors: Patel S, Vachhani A, C. Raychaudhuri

Background: The thymus is a central lymphoid organ that plays a vital role in the development and maturation of the immune system during childhood, the thymus appears as a bilobed triangular structure located in the anterior mediastinum. Aim and objectives: To provide radiologists a comprehensive understanding of Recognition of the variable appearance of thymic lesions and evaluation of thymic lesions on different radiological modalities like X-Rays and CT-scan for early diagnosis as well as management. Materials and methods: 10 cases of either strong suspicion or symptoms related to thymic lesion were evaluated who came to Dhiraj Hospital with different radiological modalities (X-ray, CT-scan). Results: Out of total no. of 10 patients who were diagnosed and evaluated with thymic lesion on X-rays and CT-scan are: Thymic Hyperplasia, Thymic Cyst, Thymic Lymphoma, Thymoma, Benign Teratoma, Malignant Teratoma. Conclusion: CT Imaging remains the ideal scanning modality to evaluate Radiologists play a major role in differentiating normal thymus from its variants, various thymic lesions and tumor. But common associated radiological modality used along with CT scan done is X-ray.

93-98

Authors: Santosh Kumar, Monika Padwal, Nirali Naik, Harshal Panchiwala, Raghav Pandya, Dhrupad Patel

Background: Hypertension is the one of the important disease of the world and increases the risk of coronary heart disease (CHD), ischemic heart disease (IHD), stroke, peripheral vascular disease, and renal failure etc. Aim: To study the Epidemiological and clinical profile of hypertensive patient came in Dhiraj General Hospital, Vadodara. Materials and methods: This was a descriptive cross sectional study of the patients who came in medicine OPD of Dhiraj General hospital in a period from Janurary 2017 to April 2017. Data related to patients were collected with standard questionnaire performa and blood pressure was measured twice during medical visit with the help of manual mercury column sphygmomanometer. Information of patients relating to epidemiological features (age, sex, place of residence), blood pressure levels, cardiovascular risk factors (diabetes, dyslipidemia, family history of early coronary heart disease, smoking, alcoholism) were noted. Results: There were total 175 patients registered, out of these 124 (70.85%) were male and 51 (29.14%) were female. The age range was 18 years to 100 years. Out of 175 patients, 6.85% were professionals, 32.57% were belonging from low social class. In 175 patients 8.9% had diabetes, 16% had dyslipidemia, 12.5% smoked cigarettes, 15.4% had history of tobacco abuses and 7.45% had given a history of alcohol intake. Family history was present in 19.42% cases. Conclusion: Hypertension is a significant health problem in our society and more common low socioeconomic class. Effort should be made to create hypertension awareness; life style changes, de-addiction and need for regular blood pressure check up should be emphasized in society tries to keep a good control on hypertension through regular and adequate medication through medical advice.

102-104

Authors: R. Abraham Jebakumar, P. Ezhil

Background: Delayed wound healing is a significant health problem, particularly in older adults. In addition to the pain and suffering, failure of the wound to heal also imposes social and financial burdens. Vacuum-assisted closure (VAC) therapy has been developed as an alternative to the standard forms of wound management, which incorporates the use of negative pressure to optimize conditions for wound healing and requires fewer painful dressing changes. Aim: To assess whether the management of non-healing wounds using VAC therapy will result in improved efficacy and safety outcomes compared with conventional methods. Materials and methods: Present prospective, time bound study was done for 1 year from January 2016 to December 2016 over 50 subjects (25 cases and 25 controls). Details of cases were recorded including history and wound characteristics. Routine investigations were done. Follow up with size of wound, appearance of granulation tissue after day 0, 3, 6, 9, 12 and so on dressings were done. Results: Patients managed with VAC had increased rate of r epithelialization and fewer patients required repeat split thickness skin graft to the same site. VAC was more effective at treating various chronic and complex wounds, as there was a significantly greater reduction in wound volume, depth and treatment duration. Conclusion: VAC results in better healing than standard methods, with few serious complications. More rigorous studies with larger sample sizes assessing the use of VAC therapy on different wound types are required.

109-124

Authors: Muley P, Odedara T, Memon R, Sethi A, Gandhi D

Introduction: Tuberculosis (TB) remains a major public health problem, despite noteworthy socio-economic development and advances in medical science. It is a curable disease but still millions of people suffer every year and a number of them die from this infectious disease, resulting in devastating social and economic impact. TB treatment requires several months of swallowing a combination of 3 to 4 drugs every day. Patients often forget to take their medicines or stop taking them when they start to feel better. The Revised National TB Control Programme (RNTCP), based on the internationally recommended Directly Observed Treatment Short-course (DOTS) strategy was launched. Studies of paediatric TB are scantily available both in global and national context. Reliable data on the treatment of paediatric TB and its follow up are not available. Hence, a study of paediatric TB is designed to evaluate the clinical profile of childhood tuberculosis and following up the treatment outcome upto 6 months Materials and methods: The study was carried out in the Department of Pediatrics at Dhiraj Hospital, Piparia. Recruitment took place from February 2014 to February 2015. The clinical profile of 71 patients was studied. Results: There was preponderance of males (60.56%, n=43) in study population as compared to females (39.44%, n=28). Most of the patients were belonging to age group of <6 years (32.4%, n=23) and >10 years (38.0%, n=27). Among 6 to 10 years, 21 (29.6%) patients were included in study. Most common form of TB was extra-pulmonary TB (60.56%, n=43) followed by pulmonary TB (39.43%, n=28). Non-specific symptoms like fever (82.5%, n=66) was the commonest presenting symptoms. Other symptoms included cough (33.8%, n=24), altered sensorium (19.71%, n=14), swelling (15.5%, n=11). From all, the patient with follow up (n=50), 44 (88.0%) were cured, 3 (6.0%) patients expired during the course of treatment, 3(6.0%) patient showed no improvement. Conclusion: Diagnosis of paediatric tuberculosis still continues to be a challenge. In the study TB was more common in extra-pulmonary than pulmonary forms in our setting. Diagnosis was based on a combination of epidemiological and clinical suspicion supported by results of various investigations. Presence of paediatric TB is an indication of prevalence of TB in that community. As the source of transmission of TB to children is usually an adult, control of tuberculosis in adult is necessary to decrease the prevalence of TB in children. DOTS is an effective strategy for treatment of TB.

132-135

Authors: Shaik Sulaiman Meeran, Paranthaman Poongavanam, Subashri Mohanasundaram

Poisoning is one of the commonest health problems in patients who present to Emergency Department, causing significant morbidity and mortality in them. The present study is aimed at assessing the incidence, clinical profile and outcome of poisoning patients admitted during a 2- month period of December 2016 - January 2017 in Government Royapettah Hospital, Chennai. 132 cases of acute poisoning in adults due to drugs and chemicals were included. Data on age, sex, type of poison, route of exposure, associated co-morbid conditions and outcome of poisoning were recorded and analysed by descriptive method. Among 132 cases, 90 cases were of intentional poisoning and 42 cases were of accidental poisoning. In all the cases the route of exposure was oral. The percentage of poisoning patients was equal in both males & females. Peak occurrence was in the age group 21-30 years. Rat killer was the commonest toxic agent. Associated comorbidities were found in 11 patients. The incidence of acute poisoning, morbidity and mortality can be substantially reduced by implementing effective strategies that prevent the easy availability of pesticides & over-the-counter medications.

144-148

Authors: Srivastava N, Yadav A

Background: The purpose of present study was to know the relation between the four blood groups (A, B, AB, and O) and high academic scores among students of Government medical colleges of North India. Materials and methods: Study was conducted in Department of Physiology, Dr BSA Medical College, Delhi and UCMS, Delhi on 247 medical students both males and females of age group 18-20 years. Blood groups were collected from past medical records during the time of admission and Confirmation was done during the blood grouping practical classes. Blood group, completion test marks, internal assessment marks (theory, practical and viva-voce) in percentage were tabulated. Statistical analysis was done by SPSS 16.0 software. Results: Out of 247 students 98 students were B group, 76 students were O group, 57 students were A group and 16 students were AB group. Total number of Blood group B students (N=22) who scored high marks were more than the other blood group students. While the %age of students of A blood group (29.8%) were more than other blood groups. Conclusion: Though our study showed that there was a variation in the academic scores between the blood groups A, B, O and AB, there was no significant association (p < 0.05) found between any blood group and academic scores. So, the conclusion of our study was that there was no real correlation between blood groups and academic scoring.

157-169

Authors: G. Thulasikumar, Vijayasarathy S

Introduction: The association of peripheral arterial disease in diabetic foot ulcer is an emerging risk factor for accelerated limb amputations. Presence of ischemia delays the wound healing increasing the likelihood of limb loss. Most amputations can be prevented and limbs salvaged through a multimodal treatment of infection control, wound debridement and revascularization procedures. Materials and methods: This was a prospective study which involved type 2 diabetic patients with isolated foot ulcer (DFU). WIFI- G score was incorporated in the wound assessment. A total of 100 patients were evaluated in this study. Once diagnosed with PAD, patients underwent vascular surgery consultation and were put on appropriate treatment. The patients were followed up for a period of 3 months from definitive procedure to assess the ulcer healing and limb salvage. Results: There was significant association of PAD with high WIFI index. Osteomyelitis was strongly associated with PAD (59%, p=0.003). PAD was associated with higher amputation rates (53.8%, p=0.003). Of minor lower limb amputations, only 47% were associated with PAD whereas of all major amputations, 87% were associated with PAD (p= 0.002). Also higher amputation rates correlated with a high WIFI score (p<0.0001). Conclusion: Revascularization limits the level of amputation and facilitates healing of stump. Major amputations were reduced to half with revascularization. Revascularization if indicated should be done at the earliest onset to attain the benefit of limb salvage.

175-180

Authors: Chinta Vittal Prasad, Nagababu Pyadala

Background: This study focused on introducing MRI into the diagnostic pathway for suspected scaphoid fracture management. In discussion with our musculoskeletal radiologists, we implemented new guidelines to standardize management of our patients with scaphoid fracture and now report our findings. Materials and methods: A consecutive series of 104 patients referred to the orthopedic department with clinically suspected scaphoid fracture but normal series of plain radiographs were prospectively followed up over a three-year period. We implemented the use of early MRI for these patients and determined its incidence of detected scaphoid injury in addition to other occult injuries. We then prospectively examined results of these findings on patient management. Results: 25 (24%) MRI examinations were normal with no evidence of a bony or soft-tissue injury. Soft-tissue injury was diagnosed in 45 patients (43.3%). Of those, 32 (30.8%) were triangular fibro cartilage complex (TFCC) tears and 13 (12.5%) were intercarpal ligament injuries. Bone marrow oedema with no distinct fracture was discovered in 35 (33.6%) cases. In 12 (11.5%) cases, this involved only the scaphoid. In the remainder, it also involved the other carpal bones or distal radius. Fracture(s) were diagnosed on 27 examinations (25.9%). Conclusion: MRI should be regarded as the gold standard investigation for patients in whom a scaphoid fracture is suspected clinically. It allows the diagnosis of occult bony and soft-tissue injuries that can present clinically as a scaphoid fracture; it also helps exclude patients with no fracture. We believe that there is a need to implement national guidelines for managing occult scaphoid fractures.

187-191

Authors: Santosh Prasad, Sarbil Kumari, Jairam Singh, Laxman Kumar

Hypertension is major risk factor for many illnesses. Studies have shown that burden of hypertension in children is increasing. Hence, this study was conducted to find distribution of blood pressure and correlates among School Going Children of Nalanda District. Mean SBP was 107.1±7.8 mm of Hg and mean DBP was 71.0±4.4 mm of Hg. It was seen that mean SBP and DBP were higher for males as compared to females (p=0.00) and higher age (p<0.05) and not related to religion (p>0.05) and socioeconomic status (p>0.05). Routine BP measurement in children is vital.

196-200

Authors: Sandhya Kumari Suman, Binod Prasad

Adolescence is the most crucial period for establishing healthy practices. Menstrual hygiene is effective in preventing RTIs and promoting reproductive health. The present cross-sectional descriptive study was conducted to find the menstrual profile and knowledge and practices regarding menstrual hygiene among adolescent girls of RHTC, ANMMCH, Gaya and included 213 school going girls. It was found that 80.8% thought menstruation to be normal, 78.9% knew the correct periodicity of menstruation and 87.3% the correct duration. 43.2% thought that menstrual blood comes from uterus and 50.7% to be coming from vagina. 23% respondents used sanitary napkins, 89.2% took regular bath and 34.7% cleaned their genitalia regularly. 79.4% disposed it with domestic waste or reused while 11.7% threw it at roadside. Proper awareness and promotion of hygienic practices will be helpful in promoting reproductive health.

204-208

Authors: Priyanka Poonam

Takayasu arteritis also known as Aortic Arch Syndrome or Pulseless disease is an uncommon condition mainly affecting aorta and its branches. It is chronic inflammatory disease of unknown cause, so also called as non- specific aortoarteritis. Though it is rarely seen in children, I am hereby presenting a case of 8 year old girl presenting with constitutional symptoms, claudication of lower limbs, anasarca altered sensorium and decreased urinary output.

213-216

Authors: Priyanka Poonam, Navin Kumar Bariar

Adenoid Cystic Carcinoma is a rare malignant salivary gland tumor comprising <1% of all malignancies of head and neck and 10-15 % of the malignant tumors of salivary glands. Most of it arises in minor salivary glands nearly about 60%. Intraorally, about 50% of adenoid cystic carcinomas occur in the palate. Here by, we present a case of adenoid cystic carcinoma affecting the left maxillary antrum and palate on the same side in 30 years old male along with a brief review of literature.