International Archives of Integrated Medicine

8-13

Authors: P V Praveen Kumar, P. Archana

Background: In contributing the patient care, Anaesthesia and endotracheal intubation have become a core part of anaesthesiologists. Via nose or mouth, the trans-laryngeal placement of endotracheal tube into the trachea is called endotracheal intubation. Aim: To compare responses of lignocaine and diltiazem and combination of both on cardiovascular endotracheal intubation in healthy, normotensive patients. Materials and methods: This was a prospective randomised study, 80 patients were scheduled for tubectomy, cholecystectomy, appendectomy, abdominal and vaginal hysterectomy. These patients were divided into four groups, 20 in each group. Group I received normal saline, Group II received lignocaine and normal saline, Group III received diltiazem and normal saline, Group IV received diltiazem and lignocaine. Results: Males were 12, 60% and females were 8, 40% in group I, males were 12, 60% and females were 8, 40% in group II, males were 12, 60% and females were 8, 40% in group III and males were 10, 50% and females were 10, 50% in group II. Most of patients were aged between 21-40 years, group I (90%), Group II (82%), Group III (86%) and Group IV (75%). The mean age of group I was 33.98±8.05, group II was 38.78±9.26, group III was 31.87±5.29 and group IV was 35.68±7.89. The attenuation was maximum in Group IV followed by group II and group III, with respect to heart rate and systolic blood pressure. Conclusion: In normotensive patients, the combination of diltiazem and lignocaine were more effective than when they were administered diltiazem and lignocaine individually for attenuating hemodynamic changes to laryngoscopy and tracheal intubation.

22-29

Authors: P V Praveen Kumar, G Madhavi

Introduction: Caudal block is one of the most popular and commonly used regional anaesthetic procedures in paediatric patients for most surgeries below the umbilicus. Because of the short duration of analgesia with bupivacaine alone various additive have been used to prolong the action of bupivacaine. Aim: The present study was aimed to evaluate the analgesic effect of tramadol or fentanyl added to bupivacaine for infraumblical surgeries in pediatric patients. Materials and methods: It was a prospective study, 80 patients randomly selected belonging to American Society of Anesthesiologist physical status I-II, in the age group of 1-12 years, of either sex undergoing infraumblical surgery under general anesthesia were divided into two groups. Group BT received 1 ml/kg of 0.25% bupivacaine with tramadol 2 mg/kg in normal saline and Group BF received 1 ml/kg of 0.25% bupivacaine with fentanyl 2 mg/kg in normal saline with maximum volume of 12 ml in both groups. All patients were assessed intraoperatively for hemodynamic changes, pain score and sedation score. Results: The mean duration of analgesia was 10-18 h in Group BT while in Group BF it was 7-11 h. The postoperatively period up to 10 h, Group BF had higher sedation score up to two as compared to that below one on Group BT. Conclusion: Caudal tramadol compared to caudal fentanyl significantly prolongs the duration of analgesia without any side effects.

36-39

Authors: K. Surendar Reddy, J. Sowmya, Bhaskar, Pradyut Waghray

Background and objectives: The objective of the present study was to study the the clinico-pathological profile of the lung cancer in Mahabubnagar. Materials and methods: We performed a retrospective analysis of histopathologically proven cases of bronchogenic carcinoma admitted in our hospital from January 2011 to May 2016. Results: Our study included 67 patients with confirmed cases of lung cancer. Male to female ratio was 1.7:1. The common age group was 40-60 years (52.2%). The most common histopathological type was Adenocarcinoma (38.8%) followed by Squamous cell carcinoma (31.4%). Endobronchial biopsy has more yields in squamous cell carcinoma 8 cases (38.1%), CT Guided biopsy has more yields in Adenocarcinoma 14 cases (53.8%), Small cell carcinoma 4 cases (66.7%), and in carcinoma in situ 6 cases (55.4%), pleural biopsy has highest yield in the diagnosis of malignant mesothelioma 1 case (100%). Among all the procedures CT Guided biopsy has the highest diagnostic yield 29 cases (43.2%). Conclusion: CT guided biopsy has the highest yield for the diagnosis of lung malignancies especially if the tumour is peripherally located.

52-58

Authors: Mudumala Issac Abhilash, NL Varun Mai, Shravan Kumar, Uma Devi

Introduction: Studies of renal perfusion when kidney function tests are still normal could be useful in understanding the pathophysiology of functional kidney impairment in cirrhosis. Kidney functional failure in cirrhosis is considered as a consequence of active renal vasoconstriction. The same have been studied by invasive and non-invasive methods. The present study is aimed at non-invasive assessment of renal artery resistance in patients of cirrhosis of liver. Materials and methods: The present study included 30 cases, patients with different stages of cirrhosis, who were clinically stable, while those with major complications like hepatic encephalopathy, major bleeding etc were excluded. All patients were evaluated clinically and a series of laboratory investigations were done. The resistance in the renal artery was calculates as Resistivity index, by using a color Doppler ultrasonography. Results: In our study, we found the main resistivity index was higher in cases with MELD >20. There was further increase in resistivity index as a severity of the cirrhosis increases. Similarly the MDRD EGFR was decreasing as the severity of cirrhosis was increased. Conclusion: Within limitations of the present study, we conclude that the estimation of the resistivity index in the kidney appears to be a sensitive and easy method for studying the early renal hemodynamic alterations in cirrhotic patients and thus by better understanding the Pathophysiology of hepatorenal syndrome.

67-71

Authors: Vani Chappidi, Pradeep Koppolu, Lingam Amara Swapna, Sridhar Reddy Erugula, Krishnajaneya Reddy Pathakota

Background: The localized inflammatory reaction to periodontal pathogenic bacteria or bacterial products is characterized by penetration of the periodontal tissues by inflammatory cells. Recent studies demonstrate the relation between periodontal disease (PD) and hyperlipidemia, which influence the likelihood of PD as an underlying factor for hyperlipidemia. Aim: The aim of this Randomized, case-control type of study was to elucidate the association between serum lipid parameters in periodontally diseased patients with healthy individuals. Material and methods: A total number of 44 subjects were segregated into two groups Group A (Control) Group B (Test). Periodontal parameters including Oral hygiene Index-Simplified (OHI-S), Gingival Index (GI), Probing Depth (PD) and Clinical Attachment Level (CAL) were recorded. Lipid profile comprising of Serum cholesterol, Triglycerides, HDL- Cholesterol and LDL was assessed and co related with periodontal parameters. Results: The results of the present study demonstrated a positive correlation between GI, PD, OHI-S and CAL with serum cholesterol, TG and LDL. The Serum cholesterol, Triglycerides and LDL levels between both the groups showed statistical significance. But the serum HDL levels when compared between both the groups were not statistically significant. Conclusion: The present study showed a definitive positive correlation between PD and increased lipid levels.

77-86

Authors: P. Divya Daniel, D. Anupama

Introduction: Hysterectomy is a very common surgery and can be performed by abdominal, vaginal or laparoscopic method though the abdominal route is more popular. Vaginal hysterectomy has distinct health and economic benefits. We designed this study to compare the outcomes in TAH and non-descent vaginal hysterectomy and to determine which route of hysterectomy is superior, safe and effective. Aims of the study: To determine the safety and effectiveness of abdominal hysterectomy versus non descent vaginal hysterectomy and to compare both in terms of duration of surgery, blood loss, intra operative complications, postoperative complications and duration of hospital stay. Materials and methods: This was a prospective, study done on total of 100 patients were divided randomly into two groups. One group underwent total abdominal hysterectomy and the other underwent vaginal hysterectomy. Both groups were compared for patient demographics, indications for surgery, size of uterus, duration of surgery, blood loss, need for blood transfusions, complications and duration of hospital stay. Results: Fibroid was the most common indication in both the groups. Most of the patients had 6 – 8 weeks size uterus. Mean intra operative blood loss in TAH group was slightly more than NDVH group. The need for blood transfusion was similar. The mean duration of surgery was 100.2 minutes in TAH group and 83 minutes in NDVH group. Fever was the most common complication in both groups. Abdominal wound infection and secondary suturing was seen in TAH group. The mean postoperative stay was 8.1 days in TAH group and 5.8 days in NDVH group. Conclusion: NDVH is associated with less duration of surgery, less blood loss, less postoperative stay than TAH. There was no difference between the need for blood transfusion between the two groups. Therefore, vaginal hysterectomy is safe and feasible in most of the women requiring hysterectomy for benign conditions and should therefore be attempted.

93-96

Authors: N. Sathish Kumar, D. Sundararajan, S. Veluchamy

Background: Myopia is a common pathologic change of the eye, especially in Asian countries undergoing rapid development. It is known that Asian people have a higher prevalence of myopia. High levels of myopia are associated with increased risk of cataract, posterior vitreous detachment, retinal tears and retinal detachment, increased risk of choroidal neovascularization, and myopic macular degeneration. Aim: To describe the corneal endothelial density and morphology in patients of low and moderate myopic in rural south Indian population and the relationship between endothelial cell parameters and other factors. Materials and Methods: Totally 100 patients were included. Noncontact specular microscopy was performed after taking a history and testing the visual acuity, intraocular pressure measurement, Schirmer’s test and routine eye examination by slit lamp microscope. The studied parameters included mean endothelial cell density (MCD), the coefficient of variation (CV), and percentage of hexagonality. Results: In low myopic eyes the MCD was 2892. 0±146.2/mm2, the mean CV was 38.4± 0.4 and the mean hexagonal appearance of the cell was 53.9± 0.9%. In moderate myopic eyes, the MCD was 35716± 142.0 mm2, the mean CV was 37.9± 3.4% and mean the hexagonal appearance of the cell was 59.83± 3.6. There were statistically significant differences in MCD (p<0.000) and hexagonal appearance of the cell (p<0.005) between low and moderate myopic eyes. Conclusion: The normative data of the corneal endothelium of eyes indicated that statistically, MCD decreased significantly with age. Previous studies have reported no difference in MCD, the percentage of CV, and percentage of hexagonality between genders. Nevertheless, significantly different percentages of CV between genders were presented in this study.

105-110

Authors: Deepikadevi SN, Sundararajan D, Namitha Bhuvaneshwari K, Murali Krishnan

Introduction: Refractive error is the most common visual impairment seen worldwide. This is one of the main cause for which patients come to ophthalmologist. This can occur at any age of the patient. Automated refractometer has become popularised method for doing refraction because of the busy practise of ophthalmologist and due to heavy patients load in screening camps. It is an easy method to learn, to operate and also time saving procedure. Patients are also very comfortable with it because of this easy procedure done in short time. But Streak retinoscopy which is considered as a Gold standard technique for refraction, has some difficulties like time consuming, dilatation of pupil and discomfort to the patient. Aim: Comparing the effect of the conventional method of refraction with computerized automated refraction in various refractive error patients. Materials and methods: It was an observational, cross-sectional study done in a 50 refractive error patients who attend Department of Ophthalmology OPD. Results: According to the statistical analysis done to compare the refraction values of the auto refractometer and streak retinoscopy with the patient's acceptance value, results came as streak retinoscopy values had no significant difference with the patient's acceptance value. This study also shows males were more affected by refractive errors than females and the mean age of affection in myopia was 19- 20 years and hypermetropia is 33-36 years. Conclusion: Since reteak retinoscopy values are accepted well by the patients, it is the better method for refrection than auto refractometer.

117-122

Authors: S. Sujatha, V. Srinivas Kumar, K. Durga

Background: Autopsy serves as a gold standard for the clinical diagnosis of cardiac arrest, which is important for quality assurance. Materials and methods: 44 medico legal cases of suspicious/ sudden deaths were examined by using various dissection techniques of the heart to identify the cause of death in a 2 year period. The main objective was to know the cause of death by correlating with the past history by the previous reports of the patients, the clinical diagnosis, photographic records, gross study of the heart and Histopathological examination and confirmation. The various methods used are inflow-outflow method; short axis method; window method; Valve plane method; Four chamber cut methods, etc. Different methods are used for different conditions of the heart, e.g., cardiomyopathy, valvular diseases, ischemic heart diseases etc. Results: In the present study males outnumbered the females constituting 26 and 18 respectively. At autopsy majority of the cardiac deaths were confirmed as ischemic heart disease by the short axis dissection method. One case of myocarditis identified with Inflow-Outflow method, one case of restrictive cardiomyopathy dissected with four chambered cut method. 1 case of replaced prosthetic valve dissected with valve-plane method. In three cases cause of death is not identified. Conclusion: Cardiac autopsy is backbone in diseases like Ischemic heart disease and cardiomyopathy etc. Its role in medico-legal case importance cannot be excluded.

128-132

Authors: Singh R, Mahanti M, Kumar N, Sen A

Vermiform appendix is one of the most variable organs inside the abdomen. Unusual positions pose diagnostic and surgical challenges. The present study was conducted on 38 cadavers in Narayan Medical College and Hospital to find the morphological variations of vermiform appendix and caecum. It was seen that the most common position of appendix was retrocaecal (61%) while second most common position was pelvic (21%). Mean length of appendix was found to be 5.98 ± 1.67 cm. Mean outer girth was 2.87 ± 0.36 cm. Mean distance of Vermiform Appendix from ileocaecal junction was found to be 2.58 ± 0.46 cm. Adult type is the most common shape (71%) followed by exaggerated one (18%). Mean length of caecum was 7.61 ± 0.80 cm. and mean width being 8.49 ± 0.88 cm. Knowledge about morphological pattern of appendix and caecum is helpful in proper clinical management.

137-142

Authors: S. Sujatha, V. Geeta, V. Srinivas Kumar

Background: Meningiomas are common CNS tumors arising from the meningothelial cells and usual sites are intracranial, followed by intra spinal. WHO 2007 has categorised meningiomas into 3 grades. This grading helps in predicting their behaviour and treatment. Aim and objectives: To study the frequency, clinical details, histological typing of meningiomas in comparison with squash cytology (intra operative diagnosis) and Histopathological examination post operatively. Materials and methods: The present study was a prospective study conducted from May 2015 to April 2017 in the Department of Pathology, Gandhi Hospital. We received 50 clinically as well as radiologically diagnosed cases of meningiomas, which were compared with squash cytology and Histopathological examination. Results: In our study, meningiomas constituted 15% of all CNS tumors received from the Neurosurgery Department in a period of 2 years. In the present study, the number of Meningiomas was 50. Females outnumbered males (36 out of 50). Common site was intracranial (45), followed by intra spinal-thoracic (5). The commonest sub type was meningothelial variant of meningioma (12), followed by transitional variant (11). Squash cytology matched with the Histopathological examination in 91.15% cases. Conclusion: Meningiomas are predominantly occur intra cranially with female preponderance, majority were of benign grade I neoplasms. Squash cytology plays a major role in their intra operative diagnosis.

151-156

Authors: M Balasundaram, Reny Jayaparakas, Subith P Bhaskar

Background: Breast cancer patients with the same stage of disease can have markedly different treatment responses and overall outcome. The strongest predictors for metastases (for example, lymph node status and histological grade) fail to classify accurately breast tumors according to their clinical behavior. The discordance in estrogen receptor (ER), progesterone receptor (PgR) and human epidermal growth factor receptor 2 (HER2) status between primary and recurrent breast cancer are being intensively investigated and a large amount of data have been produced. Aim: To study the epidemiological and clinical profile of carcinoma breast with analysis of receptor status. Materials and methods: A descriptive study of 40 cases of carcinoma breast with receptor analysis, in Vinayaka Missions Medical College, Karaikal, from June 2015- June 2016 was done. Detailed history, clinical examination, and investigations were done, after staging, patients were treated with a suitable type of mastectomy, chemotherapy, radiotherapy and hormonal therapy as indicated. Cases were followed up for one year, data thus obtained was analyzed and results compared. Results: All our cases were unilateral- 26 (65%) right breast and 14(35%) left breast. Majority of the cases had lump measuring >5cm –30 (75%). 23 (57.5%) of cases had a tumor in the upper outer quadrant, followed by other locations. Most of the cases were stage III- 27 (67.5%), 3 (7.5%) had metastasis at the time of presentation. The predominant histological type was infiltrating ductal carcinoma 31 (77.5%). There was a predominance of ER+/PR+24 ( 60%), followed by ER-/PR-, ER+/PR- then ER-/PR+. Conclusion: Majority of the cases belonged to stage III, with a predominance of infiltrating ductal carcinoma. Reporting to the hospital in earlier stages of the disease is lacking in the study population and highlights the need for public education and screening methods. It also emphasizes to analyze hormone receptor status in patients, as receptor positive status significantly reduces recurrence if hormone therapy is initiated.

165-172

Authors: B. Kalyan Kumar, Ravi Kumar, J. Venkateshwar Rao

Background: There are very few published studies of heart disease in HIV infected children. The incidence of cardiovascular disease reported among HIV infected children ranges from 72% to 90%. Cardiac disease was primary cause of death in 25% of HIV Positive patients. Studies carried out in Indian subcontinent have demonstrated the presence of systolic and diastolic dysfunction on 2D Echo in HIV infected patients. Objectives: To determine the prevalence, and describe the type of heart disease among children with HIV attending an ART centre in Gandhi hospital and centre of excellence Niloufer hospital in collaboration Department of Cardiology, Gandhi Hospital. Materials and methods: 100 HIV infected children in age group of 1-18 years attending an ART centre in Gandhi hospital and centre of excellence Niloufer hospital from December 2011 to August 2013 were evaluated clinically, and investigated by chest X-ray, electrocardiography and 2D-echo.
 Results: Heart abnormalities were detected in 48 children (43 by 2D-echo, 4 by ECG, 1 by chest X-ray). The abnormalities included left ventricular systolic dysfunction (16%), left ventricular dilation (8%), left ventricular hypertrophy (11%), Pulmonary artery hypertension (11%), tricuspid regurgitation (14%) pulmonary regurgitation (4%), mitral regurgitation (4%), sinus tachycardia (4%), cardiomegaly on chest X-ray 1 of total 100 children taken for study. Conclusions: Heart abnormalities were common especially in HIV infected children. Clinical examination, chest radiograph and ECG may pick up manifest cardiac disease. Sub-clinical manifestations such as left ventricular dilatation hypertrophy and decrease systolic dysfunction can be detected only by echo cardiography. Annual echography and ECG examination is recommended to evaluate the progression of cardiac disease and treat the same before it become irreversible in HIV infected children.

181-187

Authors: S. Sukumar

Introduction: Acts of self-injury and self-poisoning that have not resulted in death are described by various terms such as attempted suicide, parasuicide, and deliberate self-harm. Due to the wider utility in various studies, the term attempted suicide is used in this study also. While suicide attempt is defined as intentional self-inflicted poisoning, injury or self-harm which may or may not have a fatal intent or outcome the term attempted suicide is used here for patients who have completely recovered from their attempt and referred for psychiatry opinion. Aim: Aim of the study was to evaluate the socio-demographic factors, methods of the attempt, psychiatric morbidity, and other causes of attempted suicide. Materials and methods: Victims of attempted suicide who were treated and referred from general medicine inpatient care for a regular psychiatric opinion were selected for this study. In the planned period of 3 months span 102 consecutively referred individuals were assessed. Through unstructured, comprehensive clinical interview individuals were evaluated and psychiatric diagnoses were made by using ICD-10-criteria. Datas were entered in a self-structured proforma, results were analyzed. Results: Women (63%), less than 30 years of age (74%), married persons (66%), studied up to secondary and higher secondary education (62%), rural population (80%), semi-skilled workers including housewives (60%), outnumbered others. 21% had a family history of suicide. 13% have attempted in the past. 56% have attempted through organophosphorus and natural plant poisoning. 39% had psychiatric morbidity. Depressive, alcohol, personality disorders were common. 57% of suicidal attempts have resulted from Dysfunctional family living in the form of Interpersonal conflicts and quarrels. Conclusion: Although identifying and treating the psychiatric condition is an immediate need, addressing the Healthy family functioning through school level educational and community level programmes would have long term impact on preventing suicidal attempts.

194-202

Authors: Sreenath S, Santhosh Kumar T.S., Parthiban, Jasen Joseph, Ratheesh Kumar V.R.

Background: Stroke is a major health problem in India. Stroke burden has been rising in India as compared to the developed countries. Recent studies have shown that high serum cholesterol is associated with clinically less severe ischaemic strokes and better outcome. Aim: The primary objective of the study was to compare the outcome of patients with ischaemic stroke to their cholesterol levels and to correlate the cholesterol levels to the stroke outcome. Materials and methods: This hospital based prospective follow-up study was conducted in 140 patients admitted with ischaemic stroke in the medical wards of Medical College hospital, Trivandrum. Patients were divided into 2 groups based on cholesterol levels as <160 mg/dl and >160 mg/dl. Their clinical severity at presentation was calculated by Scandinavian stroke scale (0=worst, 58=best) and outcome of these patients at the end of 1 year was measured by Modified Rankin scale (0=best, 6=worst).Serum cholesterol was measured using enzymatic method. Results: Mean age of 140 patients of at presentation was 63.4±11.9 years of which 53.5% (n=75) males, the mean Scandinavian stroke scale (SSS) being 28.3±12.5. The mean SSS score of high cholesterol group was 39.6 whereas 17 in the low cholesterol group (p<0.001). Similarly, the size of infarct in CT brain, outcome variables of modified Rankin scale and mortality were statistically significant between these groups (p<0.001). Bivariate correlation analysis showed that increased serum cholesterol level is associated with increased SSS score (positive correlation) with high statistical significance (p<0.001). Logistic regression adjustedwith other risk factors showed high cholesterol levels are associated with better outcome and decreased mortality, which is supported by Kaplan-Meier survival analysis. Conclusion: Hypercholesterolemia is associated with clinically minor strokes and better outcome, whereas major strokes are commonly seen in patients in the low cholesterol group. Hence post stroke outcome is inversely related to serum cholesterol levels in ischaemic stroke patients.

209-215

Authors: Nitin Kumar Singh, Himanshu Jain, Sonal Garg, Sachin Yadav

Background: Hip fractures in older patients are associated with impaired mobility, excess morbidity and mortality, and loss of independence. Objectives: To determine whether total hip arthroplasty is associated with lower reoperation rates, mortality, and complications, and better function and quality of life than hemiarthroplasty for displaced fractures of the femoral neck in older patients. Materials and methods: We prospectively as well as retrospectively studied 46 patients treated with total hip replacement or hemiarthroplasty. Pain, range of motion, hip function, haris hip score and complications were assessed clinically while hip stability, femoral anteversion, acetabular cup inclination and acetabular erosions were assessed radiographically. Results: In our study according to Harris hip score, group A (hemiarthroplasty group) showed 58.33% excellent to good result whereas 33.34% shows fair to poor result. In group B (total hip replacement group) 90.91% showed excellent to good result and 9.08% showed fair to poor result. In this study, the overall Harris hip score was 76.33 with SD±19.091 in hemiarthroplasty group and 86.45 with SD±6.363 in Total hip replacement group with p-value 0.0224(<0.05). Conclusion: So we concluded in our one year of study that total hip replacement had better functional outcome in fracture neck of femur in elderly treated by either hemiarthroplasty or total hip replacement and total hip replacement is less painful than hemiarthroplasty.

221-229

Authors: M Manjusha, B. Manoj Kumar, N. Venkat Rajaiah, P. Narayana

Background: Pericardial effusion in clinical practice is commonly under diagnosed or missed especially minimal to moderate effusion. Aim and objectives: To study the clinical and etiological profile of pericardial effusion and to recognize radiological, electrocardiographic and echocardiographic features that are characteristic of pericardial effusion and to analyze pericardial fluid in various etiologies. Materials and methods: It was prospective study in patients presenting with pericardial effusion in department of Medicine and Cardiology. Total of 30 patients who presented with pericardial effusion based on clinical criteria and confirmed by echocardiography were included in the study. Results: The causes of pericardial effusion in this study were Tuberculosis (33.33%), Uremia (20%), Viral /Idiopathic (16.67%), Bacterial (10%), Malignancy (10%), Hypothyroidism (3.33%), and post MI with ischemic cardiomyopathy (3.33%), SLE (3.33%). 3 cases (10%) were HIV positive among viral causes,1 patient had tuberculous pericarditis. ECG findings of low voltage complexes were present in 90% of patients and electrical alternans was seen mainly in tamponade cases. Chest X-ray finding of cardiomegaly was present in 90% patients with pleural effusion in 13.3% patients. ADA levels elevated in all 10 patients of tuberculous effusion with 100% sensitivity and among them smear for AFB was positive in 3 patients. Increased levels of ADA>60U/L was associated with increased incidence of effusive constrictive pericarditis in TB effusion. Pericardial fluid IFN-ᵞ increased greater than 200 pg/L, tuberculous etiology showed 100% sensitivity and specificity. In all 10 patients of 2Dimensional echocardiographic findings of right atrial, right ventricular collapse and left atrial collapse was seen predominantly in tamponade cases. Pericardiocentesis showed hemorrhagic effusion in malignancy and uremia, serous and serofibrinous in tuberculosis and purulent in pyogenic effusion. In 3 cases of pyogenic effusion, culture revealed Staphylococcus aureus in 2 patients and Klebsiella pneumonia in 1 patient. Among 3 cases of HIV, one patient had ADA >40 and smear for AFB positive suggesting tuberculous etiology and other 2 cases were directly due to HIV. In HIV with tubercular effusion the patient presented with cardiac tamponade. Conclusions: ADA>40U/L is diagnostic of tuberculous effusion which showed 100% sensitivity and specificity. Increase of ADA>60 U/L is associated with effusive constrictive pericarditis which has poor prognosis. IFN-ᵞ is increased >200pg/l in all patients of tuberculous etiology showing 100% sensitivity and specificity.

236-249

Authors: Ashwini Devarashetty, Humera Sultana, G. Nikhat Parveen, Yasmin Iqbal

Background: Infertility is a complex disorder with significant medical, psychosocial and economic aspects. Infertility causes great distress to many couples, causing increased numbers of them to seek specialist fertility care. Objectives: To measure the success rate of combined clomiphene citrate and gonadotropin therapy in anovulatory infertile patients overcoming the drawbacks of clomiphene alone treatment. Materials and methods: In this observational analytical study, total of 100 anovulatory infertile patients were selected for Combined Clomiphene Citrate and Human Menopausal Gonadotropin (CC – hMG) regime and maximum of three treatment cycle were given. Results: Out of 100 patients in present study, 46 patients became pregnant. Primary infertility was seen in 81 patients (81%) and secondary infertility in remaining 19(19%) of patients. Polycystic ovary disease (PCOD) was the commonest cause of anovulation seen in 62% of patients. Miscarriage was seen in 3 patients (3%). Multiple pregnancies were observed in 8 patients (8%). Number of patients conceived after 1 cycle was 12 (26%), 2nd cycle was 20 (43.47%), 3rd cycle was 14 (30.43%). Conclusions: Present study shows the success rate of 46% with CC-HMG combined regimen. Sequential clomiphene/ HMG regimen appears to be an effective protocol for controlled ovarian stimulation in infertile women who are resistant to clomiphene alone which has drawback of poor endometrial quality. It is easy to administer, requires less intense monitoring, fewer medications, and is cheaper without sacrificing efficacy, in other words it’s a cost effective technique in the management of infertile patients.

258-261

Authors: S. Uma Ganesh, Krishnapriya R, R. Srinivasan

Scleroderma is a chronic systemic autoimmune disease of unknown origin characterized by excessive collagen deposition and autoantibodies. Patients with autoimmune diseases are known to develop infections like tuberculosis due to the disease per se and also secondary to immunosuppressive treatment. Mycobacterial infections are also known to induce the development of autoantibodies. We present a case of simultaneous occurrence of interstitial lung disease and pulmonary tuberculosis (BAL positive for AFB) in a patient with features of systemic sclerosis. Antibody profile was done were found to be positive for ANA. She also had most of the classical features of scleroderma on clinical examination thus confirming the diagnosis. A detailed history, clinical examination, radiological examination, bronchoscopy and immunological test helped in the diagnosis of the patient. We highlight the importance of suspicion, careful general examination, radiological assessment and screening tuberculosis patients for autoantibody profile in presence of a multisystem involvement.