International Archives of Integrated Medicine

1-5

Authors: T. Bhuvaneswari

Introduction: The application of epidemiology to the study of DM has provided valuable information on several aspects of this disease such as its natural history, prevalence, incidence, morbidity, and mortality in diverse populations around the world. Identification of the cause of the disease and the possible preventive measures that could be instituted to arrest or delay the onset of this disease which has reached epidemic proportions in both the developed and the developing nations. Unfortunately, the improvement in outcomes for individual patients with diabetes has not resulted in similar improvements from the public health perspective. The aim of the study: The purpose of this study was to evaluate pulmonary functions in patients with type 2 diabetes mellitus and to determine their correlations with an anthropometric profile, glycemic control, and duration of diabetes. Materials and methods: The present case-control study was carried out in the Department of Diabetology, Melmaruvathur Adiparasakthi Institute of Medical Sciences and Research during the period of 2015. The study included previously diagnosed type 2 diabetes mellitus cases and healthy controls as not having diabetes. In this study, there were a larger number of females than males (66.2% vs. 33.8%). The probable cause for this discrepancy was the fact that many males were excluded Test (VPFT) were studied in all participants. FVC, FEV1 and FEV1% were selected for the study on account of their smoking history, alcohol intake, irresponsible behavior, busy working schedule while female diabetics were mostly eligible on account of their being non-smokers and other favoring factors. 60 age and sex-matched healthy subjects served as controls. Forced expiratory spirograms were recorded by RMS medspiror Ventilatory Pulmonary Function. Results: A total of 30 previously diagnosed Type 2 Diabetes Mellitus patients (cases) and 30 healthy controls were recruited during the study period. Cases and controls were matched according to their mean age, sex, height, weight, body mass index (BMI). Diabetic patients showed a greater decline in FVC, FEV1, FEF 25-75%, PEFR and increase in FEV1/FVC ratio which is statistically significant, suggesting restrictive lung disorder. Conclusion: The pattern of abnormal pulmonary function observed in our study, low FVC and preserved FEV1/FVC ratio, is suggestive of the restrictive type of lung disease among type 2 diabetics. Diabetic patients showed impaired lung function independent of smoking. Although it was not associated with severity duration of DM affect FVC and FEV1. Lungs are indeed affected in patients with diabetes and pulmonary function testing should be mandatory for diabetics in order to prevent complications thereby improving quality of life.

14-17

Authors: Lincey Alexida, Frederick M. Tiesenga

Background: Biliary dyskinesia is a condition where the gallbladder motility is seen as abnormal. Diagnostic imaging studies for biliary dyskinesia usually include a negative or inconclusive abdominal ultrasound or computed tomography followed by a hepatobiliary iminodiacetic acid (HIDA) scan. The HIDA scan is used to visualize the gallbladder and access its motility. The motility is reported in the form of an ejection fraction (EF). Billiary dyskinesia is diagnosed if the EF is less than 35%. However, there are many patients with an EF of greater than 35% but are exhibiting all the signs and symptoms for biliary dyskinesia. Aim: This study evaluated the efficacy of laparoscopic cholecystectomy as a treatment modality in symptomatic patients diagnosed with biliary dyskinesia with three distinct HIDA scan EF results. Materials and methods: They were a total of 654 verified case of laparoscopic Cholecystectomy done between January, 2013 and December 2016 at Westlake and West Suburban Hospital. A total of 163 cases out of the 654 had HIDA scan with calculated EF, therefore meeting the criteria to be included in this study. The patients pre and post-operative course was reviewed from their medical records and resolution of symptoms was determined by in phone interview. Results: A total of 29 (18%) patients were lost to follow up. Out of the 99 cases interviewed in the first group (EF <35%) 91 (92%) cases reported complete symptom resolution post cholecystectomy. Out of the 18 cases interviewed in the second group (EF between 35%-50%) 13 (72%) cases reported complete resolution post cholecystectomy. Out of the 17 cases interviewed in the last group (EF> 75%) 11 (65%) cases reported complete resolution of their symptoms Conclusion: Our study indicates that patient suffering with symptomatic biliary dyskinesia and has a HIDA with EF less than 50% or EF greater than 75% will most likely benefit from laparoscopic Cholecystectomy and could be a reasonable option to offer symptomatic patients.

27-36

Authors: Swetha Ambati, Mukesh Kumar B

Background: Various adjuvants that can be added to local anesthetics and administered in central neuraxial blockade are Opioids, α2 agonists, benzodiazepines. Knowledge and use of adjuvant drug therapy has rendered neuraxial analgesia more effective in the management of both acute and chronic pain conditions. α-2 adrenergic agonists have both analgesic and sedative properties when used as adjuvant in regional anaesthesia. Aim: To study the effects of intrathecal dexmedetomidine added to ropivacaine for surgeries under spinal anesthesia. Materials and methods: Clinical study conducted on 50 patients of ASA PS 1 and 2 in the age group of 18-50 years of either sex posted for elective lower limb orthopaedic and lower abdominal surgeries under spinal anaesthesia. Results: Subjects among the age groups and the mean age of study population was 40 years (SD: ±11.5). 66% (n=33) of study population were male and 34% (n=17) were female. Most of the study population had healthy BMI. 76% (n= 38) of subjects belonged to ASA grade 1 and 34% (n=12) subjects belonged to ASA grade 2. The average duration of surgery was 94.4 min ± 34.4 min. Level of sensory block was T6 in 24 (48%) of subjects, T4 in 17 (34%) of subjects, T8 in 6 (12%) and T2 in 3 (6%) of subjects. The mean duration for onset of Sensory block was 4.12 minutes (SD: ± 1.69) and the mean duration for onset of motor block was 10.12 minutes (SD: ± 2.89). Hypotension was observed in 3 patients after SAB (Fall in SBP > 20%) after 4 to 6 min. The mean RSS was 2.08 with SD 0.27. Side effects observed were mainly hypotension, nausea and shivering. Conclusions: 5 microgram dexmedetomidine is alternative as an adjuvant to spinal ropivacaine in surgical procedures. It has excellent quality of postoperative analgesia with minimal side effects.

47-51

Authors: T. Bhuvanenswari, B. Devaraj

Introduction: A number of systems or alerts are implemented in the ED to identify and bring resources to patients with traumatic injuries, ST-elevation myocardial infarctions, or acute strokes, but there is currently no system that we are aware of directed toward vital sign abnormalities. Rapid response teams (RRT) or medical emergency teams were created in many in-hospital settings as an effective mechanism to get physicians and nurses to the bedside of patients with acute changes in clinical stability. They were based on physiological criteria as well as a change in clinical status. The aim of the study: To determine whether modified shock index (MSI) is associated with mortality that is superior to heart rate, blood pressure, or the shock index (SI) in emergency patients. Materials and methods: The study was conducted on 80 patients who presented to Saveetha Institute of Medical Science and Hospital, Emergency Department from March to August 2017. We gathered data of the patients on age, gender, vital signs, levels of consciousness, presenting complaints, and SI and MSI were calculated for all patients. Results: After adjustments for differences in the other vital signs, comorbidities, gender and age the following vital signs were independently associated with1-day mortality: oxygen saturation, systolic blood pressure, temperature, level of consciousness, respiratory rate, pulse rate, and age. The highest odds ratios were observed when comparing unresponsive to alert patients (OR 31.0, CI 16.9 to 56.8), patients ≥ 80 years to <50 years (OR 35.9, CI 10.7 to 120.2) and patients with respiratory rates <8/min to 8–25/min (OR 18.1, CI 2.1 to 155.5). Conclusion: MSI is a clinically significant predictor of mortality in emergency patients. It may be better than using heart rate and blood pressure alone. SI is not significantly correlated with the mortality rate of the emergency patient. MSI is an important predictor of mortality in patients presenting to the emergency department and it may be better than blood pressure and heart rate. SI is not significantly correlated with the mortality of emergency patients. When a patient with normal vital signs on the triage desk, MSI can be calculated to decide whether the condition of the patients is critical. Since this is a retrospective study, a prospective study is needed to confirm the result.

61-75

Authors: Nazia Afreen, Humera Sultana, Rubina Affreen

The syndrome of cervical incompetence is characterized by spontaneous painless passive dilatation of cervix followed by expulsion of an immature foetus. The subject has been subjected to increasing controversy in recent years. The wide variations in the incidence of cervical incompetence arise because there are no standard criteria for the diagnosis of cervical incompetence. The certain way of diagnosing a case of cervical incompetence is by history and vaginal examination. The introduction of transvaginal ultrasonographical examination into the obstetrics diagnosis has created further possibilities in recognition of isthmico – cervical insufficiency. The present study was conducted for a period of 18 months with gestational age between 14 to 26weeks and was aimed to evaluate the efficacy of transvaginal sonography and to know the incidence of cervical incompetence in this area. 50 pregnant women at high risk of pre-term delivery were taken in to the study. 36 out of 50 cases (72%) met the criteria and they were managed surgically and had a cervix length < 2.5 cm. 14 (28%) cases had cervix length. > 2.5 cm at the initial transvaginal sonographic evaluation. 40 out of 50 (80%) delivered at around term. Though the diagnosis of cervical incompetence is based primarily on past obstetric, gynaec history and clinical findings, but transvaginal sonographic surveillance of the cervix helps us to use the cervical cerclage more selectively i.e., when the cervix length i.e, < 2.5 cm, internal os open or close with funneling of cervical canal.

85-89

Authors: Manjusha Martin, A. Hameedullah, Sneha Priya M

Background: Melasma is a common, acquired, recurrent and chronic disorder of hypermelanosis. It is distributed symmetrically and affects the sun-exposed areas mainly the face (forehead, cheeks, upper lip and chin), and manifests as light to dark brown patches of hyperpigmentation. The objective of this study is to identify the major predisposing and aggravating factors of melasma. Materials and methods: This was an observational, cross-sectional study, conducted in the Dermatology OPD of Meenakshi Medical College, among 100 patients with melasma for a period of 18 months. Melasma was diagnosed clinically and using Wood’s lamp examination. Factors such as the age at presentation, gender, duration of sun exposure per day, family history, intake of precipitating drugs and systemic diseases were assessed. Results: Most of the patients were in the age group of 36-45 years and the majority of patients were females. Sun exposure for >2 hours was observed to be an important triggering factor. Positive family history was present in 46% patients, 12 patients had a history of intake of precipitating drugs and 30 patients had systemic diseases. Conclusion: It can be concluded from this study that the above factors play a significant role in the development and prognosis of melasma. Sun exposure for longer duration was observed to be a very important factor, especially because of the climatic conditions prevailing here. So elimination of the exacerbating factors and treatment of associated systemic conditions are important in the management along with the therapeutic agents.

99-105

Authors: Jagadish Chandra Mishra, Pradip Kumar Maharana

Background: One of the most suitable modality of anaesthesia for lower abdominal surgeries is spinal anaesthesia. The relatively short duration of action of local anaesthetics necessitates the supplementation of local anaesthetics with adjuvants which help to reduce the dose of local anaesthetic, minimize side effects and prolong the duration of anaesthesia at a relatively lesser cost to the patient. Aim: To evaluate the characteristics of subarachnoid block, the postoperative analgesia and side effects of intrathecal buprenorphine 150 µg when used as adjuvant to 0.5% bupivacaine, for vaginal hysterectomy. Materials and methods: After approval from the hospital ethical committee and informed consent from the patients a prospective pilot study was undertaken to evaluate the efficacy of intrathecal buprenorphine when used as an adjuvant to 0.5% bupivacaine. All patients belonged to American Society of Anesthesiologist’s Physical status I and II and aged between 33 and 60 years. Patients were allocated into two groups. Group A were to receive 0.5% bupivacaine 2.5 mL. Group B were to receive 0.5% bupivacaine 2.5mL with buprenorphine 150 µg. It was observed that most of group A patients had to receive general anaesthesia in addition to subarachnoid block due to inadequate pain relief. The data of group B patients were analysed. Results: Of the 49 patients analyzed, 13 patients had pain free interval which lasted more than 24 hours. Twelve patients who received a single dose of diclofenac 75 mg intravenously before the onset of pain had a pain free interval which lasted more than 24 hours. The average duration of analgesia of 37 patients was 1027 minutes ± 706.662. Conclusions: A single dose of intrathecal buprenorphine 150 µg added to bupivacaine may provide analgesia for a significant length of time in patients who have undergone vaginal hysterectomy without significant side-effects.

115-121

Authors: B Saravanakumaran, S. Sudhakaran

Introduction: Chronic unrelieved pain is not only a major drain on scarce health care resources, but it is the cause of needless suffering of millions of people worldwide. The direct palpable costs to these patients and their families include loss of job, loss of income, loss of savings, and loss of self-esteem. Clearly, the consequences of intractable pain in respect to both its impact our society is staggering. Finding a solution should be a high priority for healthcare intermediaries and health care workers. Abandoning patients when less costly and less invasive intervention does not work to relieve pain is unethical. The neuropathological effect of glycerol was discovered accidentally' and rapidly led to its use as a neurolytic agent in the management of facial pain. Pathology includes numerous inflammatory cells, myelin swelling and axonolysis. As with all neurolytic injuries, lipid droplets can be seen in the cytoplasm of Schwann cells, in phagocytic cells, and in perineal cells, where these droplets accumulate as a nonspecific manifestation of tissue injury. The aim of the study: Aim of the study was to compare the two approaches namely anterior and posterior for neurolysis of coeliac plexus for intractable pain in pancreatic malignancy and chronic pancreatitis. Comparison between the two approaches is ease of technique, accurate placement of needle tip at the coeliac plexus and complications. Materials and methods: Totally 40 patients with diagnosed unresectable pancreatic malignancy and chronic pancreatitis with intractable pain who attended the surgical gastroenterology department of Govt. Stanley Hospital, Chennai during the period of May 2010 to November 2010 were selected for neurolytic coeliac plexus block with 100% Alcohol. They were grouped randomly into two comprising 20 each 1. Group A: ultrasound guided neurolysis of coeliac plexus through an anterior approach. Group P: fluoroscopy guided neurolysis of coeliac plexus through a posterior approach.on the day of the procedure, the patient was kept fasting for four hours intravenous access secured with 18g venflon approach to celiac plexus was chosen randomly. During the procedure, the patients' vitals were monitored. After the procedure, the patients were kept in ICU for one day for monitoring. The next day, if stable, discharged from the hospital. They were followed by phone about the intensity of pain and any complications like diarrhoea. They were instructed to attend the SGE department at 1, 4 and 8 weeks for assessment of pain relief. Results: 34 patients with pancreatic malignancy and 6 patients of chronic pancreatitis with pain scores of 8 to 10 were taken up for the study. They were allocated randomly into 2 equal groups of 20 each. Group A underwent celiac plexus neurolysis through anterior approach with ultra-sonogram guidance. Group P underwent celiac plexus neurolysis through a posterior approach with fluoroscopic guidance. All the patients received the same amount of neurolytic agent and were followed for 8 weeks. Pain intensity was less after 1 week in group P when compared to group A. At the end of 4th and 8th week, the pain intensity in both the groups was not statically significant of p-value (0.875) assessed by Wilcox son sum test. Patient discomfort score was more in group A when compared to group P which was statically significant of p value<0.001). In our study group P (19) patients were more prone for hypotension when compared to group A (18) which was found to be less significant of p-value <0.005. In our study group P (17) patients had diarrhoea when compared to group A (13) which was found to be less significant of p-value <0.005. In our study group P (19) patients had a backache when compared to group A (2) which was found to be more significant of p-value <0.001. Conclusion: Both the groups reported a similar incidence of pain while injecting alcohol and complications like diarrhoea and hypotension, which was not significant. Patients in group P reported a significant a backache up to 2 weeks which required painkillers. So the study demonstrates both the techniques are similar in successfulness of the block, but the anterior approach is easier to perform with less discomfort to the patients.

128-136

Authors: Debashis Roy Burman, Dibyendu Goutam

Though incidence of Colorectal carcinoma is relatively less in consideration of world wide data, Indian scenario differs in higher incidence of Grade 3 carcinoma with signet ring cell component. We tried to find association between intercellular adhesion and propagation of cancer cell in Adenocarcinoma of Colorectal region. E-cadherin (ECAD) is the strongest intercellular adhesion molecule of epithelial cells and Autocrine Motility Factor (AMFR) is known propagator of cancer cell. We studied simultaneous immunohistochemical expression of these two molecules in 92 already diagnosed cases that were treated surgically by Colectomy or Abdomino Pelvic Resection. Normal Colorectal mucosa reacted strongly with ECAD and weakly with AMFR. With increasing dedifferentiation of the tumor, reversal manifested- more aggressive grades showed varied expression in comparison to its less aggressive type. Gastric3 adenocarcinoma show weak ECAD (83% vs. 35%) and more AMFR (93.% vs. 35%) expression in comparison to Grade1.Weak ECAD and strong AMFR was also associated with increase in depth of tumor invasion. As ECAD and AMFR is at least partially responsible for varying histologic grade and behavioral pattern of colorectal adenocarcinoma, simultaneous evaluation of both parameters is helpful to understand pathway of progression of such cancer cell.

144-152

Authors: M. Krishna Naik, Md. Yousuf Khan, D. Prathima Raj, D. Venkatesh, Krishna Kumar T V

Background: Hyponatremia is a common electrolyte disturbance in the hospitalized elderly sick patients. Objectives: To study etiology, clinical features and outcome following treatment of hyponatremia in elderly hospitalized patients. Materials and methods: All elderly patients being admitted to ICU were screened for hyponatremia and 100 patients with severe hyponatremia (<125 meq/L) were included in this study, these patients were investigated as per the protocol and were treated as per the standardized regimen. Results: 100 patients with severe hyponatremia (<125 mEq/L) were studied. There was female preponderance of cases (55%). The common causes of hyponatremia were SIADH (30%) and drugs (24%) of which diuretics (79%) was a major chunk. The common CNS symptoms were drowsiness, lethargy and irrelevant talk. The common co-morbid conditions were hypertension (62%) and diabetes mellitus (51%). Females tolerated hyponatremia better than males with mortality of 9.09% in females and 33.33% in males (p=0.0026). 20 (20%) patients succumbed to their primary illness with a possible contribution attributable to hyponatremia or its treatment. Conclusion: Hyponatremia is common in females and they seem to better tolerate it than their male counterparts. Early detection, strict adherence to treatment protocol is required. Diuretics should be used with caution in elderly.

160-171

Authors: Merugu S

Background: Acute kidney injury (AKI) refers to a syndrome encompassing kidney damage from mild injury to total loss of function that seriously disturbs the homeostasis of fluid and electrolyte balances. Materials and methods: All patients admitted in Medical intensive care unit of Mahatma Gandhi Memorial Hospital, Warangal from 1st January 2016 to 30th June 2016, who fulfilled the inclusion criteria, are included in this study. Patients admitted in medical intensive care were included in the study and patients admitted in surgical and obstetric intensive units are not included. Results: We included all patients above 18 years of age in our study. The mean age for development of AKI was 49.2 years (SD = 18) (Range 18-89 years). Most of the patients belonged to 61-70 years (21.4 %) age group. 97 patients in elderly age group (>65 years) had AKI. Sepsis is responsible for 84 (24%, n= 350) cases of AKI. 67% of the study population had co morbidities in our study; most patients had more than one co-morbidities. Oliguria (52.8) is the most common presenting feature followed by Hyperkalaemia (48%) in our study. There is a significant (p= <.0001) association between presence of oliguria and stages of AKI. There is a significant association (p = <.0001) between need for RRT and KDIGO stages of AKI. Outcomes of AKI were put into three categories in our study. Of the 324 patients in whom outcomes were analysed 204 patients had complete recovery. They were discharged in stable condition with normal or near normal serum creatinine values. Conclusion: Sepsis is the most common cause of AKI in MICU and is associated with significant mortality. Early and aggressive management of sepsis is required to prevent progression of AKI in MICU.

177-181

Authors: Tahira Ashraf, Suhail Majid Jan, Roobal Behal, Rafiya Nazir, Abhima Kumar

Introduction: Periodontitis a chronic inflammatory disease results in the destruction of tooth supporting tissues, eventually progresses to tooth loss. Non-surgical periodontal therapy in form of scaling and root planning although considered as a gold standard, does not completely eradicate periodontal pathogens. Limitation of access and bacterial invasion of periodontal tissues being the main reason and hence the demand for an adjunctive measure is necessitated. Sub gingival irrigation interferes with various plaque components predominantly anaerobic bacterial flora which is known to initiate and perpetuate periodontal destruction. The aim of this study is to investigate the effect of sub gingival irrigation with 3% H2O2 compared to normal saline. Material and methods: 20 patients were taken for the study. After scaling and root planing, quadrants in each patient’s mouth were randomly treated two with 20 ml 3% H2O2 sub gingival irrigation and the other two with normal saline. Sub gingival irrigation was performed at baseline and after 1 and 2 weeks. The clinical parameters were recorded at baseline at the end of week 3 and at the end of week 5. Results: Results showed that sub gingival irrigation with 3% H2O2 produced a significant reduction in gingival bleeding, pocket depths and a significant gain in clinical attachment level compared to the control. Conclusion: The results of the present study conclude that that sub gingival irrigation with 3% H2O2 results in inflammation control manifested as decreased gingival bleeding, reduction in pocket depth and gain in relative attachment levels.

187-192

Authors: Siddharth Goel, Sansar Chand Sharma, Harnam Singh Madan

Introduction: For bridging gap in bone defects created by tumor excision, trauma or as sequelae to infection, various treatment modalities are described including iliac crest graft, cortical tibial graft, allograft, bone transport using the principles of Ilizarov, fibula as an intercalary bone graft and vascularized fibula. Various implants used for fixation are wires, screws, plates, and ring or monorail fixator. Free non vascularized fibula is a popular substitute for this method because of its easy accessibility and minimal donor site morbidity. It has the advantage of being a much simpler procedure and avoids the use of costly implants making it a more feasible and practical solution for bone defects in developing countries. The present study was aimed at finding the results of it in bone gap created after debridement of radius/ulna following chronic osteomyelitis in pediatric population. Material and methods: 12 children of age 4-13 years with diagnosis of chronic osteomyelitis of forearm bones were included in the study. In first stage adequate bone and soft tissue debridement was done. In radial chronic osteomyelitis, to maintain radial length and DRUJ, distractor application was done. Distractor was removed after about 3 weeks and then, “press fit” free non vascularized fibular graft was applied and fixed with intramedullary K wire. The limb was immobilized in plaster till union of fibula at both ends. Results: The average per operative gap at time of grafting was 7 cm (range 4-8 cm). Union was achieved at both ends in all cases in 12-18 weeks with no major complication. One ulnar osteomyelitis case had delayed union at one site which gradually healed. At about 1 year children had good forearm range of motion. Conclusion: Non-vascularized fibular grafting is a good option for bone defects in paediatric population provided adequate debridement, fixation and immobilization has been done.

196-201

Authors: E. Dinesh Kumar, Thumjaa Annamalai

Introduction: Simple febrile convulsion is the most common central nervous system disease seen in children. There are hypotheses that thresh hold of neuron excitation may be affected by iron deficiency anemia. Febrile seizures are convulsions that occur in a child who is between six months and five years of age and has a temperature greater than 100.4ºF (38ºC). The majority of febrile seizures occur in children between 6 months to 3 years of age. The aim of the study: The purpose of this study was to determine the association between iron deficiency and febrile seizures in a large cohort of children who are admitted to the paediatric ward. Materials and methods: The study was conducted in 100 children those concerned parents who are willing to participate in the study at Sree Balaji medical college and hospital, Chennai. Children were categorized into 2 groups. Group, I control group (n=50) admitted with febrile illness (fever duration < 3 days) including respiratory infections or acute gastroenteritis but without seizures and without iron supplements. Group II case group (n=50) admitted with febrile illness (fever duration < 3 days) including respiratory infections or acute gastroenteritis but with seizures and with iron supplements. Both the genders are in taken for the study. Parameters such as height, weight, BMI, body temperature, Hb, MCV, serum ferritin were analyzed using standard techniques and results were analyzed accordingly. Results: The age group, height, and weight didn’t show any specific variations which were found to less statically significant of p value<0.005. The mean hemoglobin level, MCV, MCH, serum ferritin level was found to be more in of Group I control group when compared to Group II case group of p-value <0.001**which was found to be more statically significant. Conclusion: Children with febrile seizures are almost twice as likely to have iron deficiency anemia as compared to children with febrile illness without seizures. Iron deficiency anemia can be regarded as a modifiable risk factor that predisposes to febrile seizures in children between 6 months to 5 years. Early detection and timely correction of iron deficiency may help in preventing simple febrile seizures in children of this age group.

207-213

Authors: Saranya S, D. Aishwarya

Introduction: Birth weight is an important indicator of a child's vulnerability to the risk of childhood illness and chances of survival. LBW results in a corresponding perinatal mortality. The identification of factors contributing to LBW is therefore of paramount importance. Low birth weight is a term used to describe babies who are born weighing less than 2,500 grams (5 pounds, 8 ounces). In contrast, the average newborn weighs about 8 pounds. Over 8 percent of all new-born babies in the United States have low birth weight. The primary cause is premature birth, being born before 37 weeks gestation; a baby born early has less time in the mother's uterus to grow and gain weight, and much of a fetus's weight is gained during the latter part of the mother's pregnancy. Another cause of low birth weight is intrauterine growth restriction. This occurs when a baby does not grow well in utero because of problems with the placenta, the mother's health or birth defects. The aim of the study: To study the prevalence of low birth weight babies and to study the various socio-demographic factors associated with low birth weight. Materials and methods: The present cross-sectional study was undertaken at Sree Balaji Medical College and Hospital in the year of 2015- 2016. Totally 100 babies were selected. In this study, all singleton new-born having a weight of <2.5kg was included as a case (n=50) and a weight of ≥2.5kg was included as a control (n=50). The relation of birth-weight to few maternal factors such as age, socio-economic status and occupation were studied. Results: Our Study showed that the greatest number of mothers having LBW newborns was in the age group of 23 to 27years belonged to the low socio-economic group. The study finding showed maternal age, fetal sex, parity, number of antenatal care, gestational age, birth order, and history of abortion had an insignificant association with low birth weight (P-value <0.05). It was found that 70% of LBW babies were born to mothers who belonged to the labour class by occupation. Conclusion: This study depicted that low birth weight is a public health problem in the study area. Hence, attention should be given to increase community awareness of antenatal care service, access to family planning, prevention of abortion and community mobilization to prevent early pregnancy. This study concluded with the findings that maternal factors like age, socio-economic status, religion and occupation of the mothers were related to LBW of the new-born improving the socio-economic status (SES) of people and providing better working.

220-228

Authors: Sathyan Natarajan, Karthikeyan G, Murugan T

Introduction: Pain in the postoperative period is the distressing period after any surgeries particularly in the first 24 hours. Postoperative pain is associated with an increase in sympathetic activity leading to increases in heart rate, blood pressure, respiratory rate and even delirium and myocardial insults. Opioids and NSAIDS are very commonly used in the postoperative period in spite of their known adverse effects. So there is a need for a study to find a drug which prolongs the duration of analgesia in the postoperative period without many side effects so that usage of opioids and NSAIDS drugs in the first 24 hours can be decreased. The aim of the study: To compare during supraclavicular brachial plexus block, the single perioperative dose of intravenous Dexamethasone and perineural Dexamethasone effects on onset and duration of sensory and motor blockade ; quality of analgesia and reduction in the dose of opioids in first 24 hour. Materials and methods: A Randomized, Triple-Arm, Double-Blind, Placebo-Controlled Trial. Totally 90 patients were recruited in the study patients undergoing upper limb surgeries under supraclavicular block at govt. Kilpauk medical college hospital and govt. Royapettah Hospital from December 2015 to May 2016 were included in the study. After obtaining written informed consent patients were divided into three groups of 30 in each group. Group A local anesthetics and perineural dexamethasone Group B local anesthetics & intravenous dexamethasone, Group C local anesthetics only. Results: The Sensory and Motor block onset time between the intervention groups group A VS group B and group A VS group C were found to be statistically significant (p < 0.05) and the association between group B VS group c was found to be not statistically significant (p>0.05) as per unpaired t-test. The sensory & motor block duration time showed statistical significance in group A VS group C, group B VS group C (p < 0.05) but group A VS group B had no statistical significance( p > 0.05) as per unpaired t-test. The association of Visual Analog Scale between the intervention groups (group A Vs group C and group B VS group C) and VAS scores at 6, 12 and 24 hours postoperatively were found to be statistically significant since p < 0.05 as per unpaired t-test. The number of doses of opioid required in 24 hours was considered to be statistically significant since p < 0.05 as per unpaired t-test between the intervention groups (group A VS group C and group B VS group C). Conclusion: Systemic Dexamethasone is equally effective as perineural Dexamethasone in providing the significant duration of sensory, motor blockade and quality of analgesia. We come to a conclusion that Dexamethasone consistently decreases the postoperative pain scores and decrease the early & number of doses of opioid consumption (48 hours).

241-249

Authors: Tailam Tanmayee, P. Raghunath, D. Anuradha, R. Pandu Naik

Background: Knowledge and use of adjuvant drug therapy has rendered neuraxial analgesia more effective in the management of both acute and chronic pain conditions. α-2 adrenergic agonists have both analgesic and sedative properties when used as adjuvant in regional anaesthesia. Aim: To study the effects of intrathecal dexmedetomidine added to ropivacaine for surgeries under spinal anesthesia. Materials and methods: This clinical study was conducted on 50 patients of ASA PS 1 and 2 in the age group of 18 -50 years of either sex posted for elective lower limb orthopaedic and lower abdominal surgeries under spinal anaesthesia after taking informed consent, study done over a period of 12 months. Results: All demographic details are insignificant. Average duration of surgery was 94.4 min ± 34.4 min. 76% (n= 38) of subjects belonged to ASA grade 1 and 34% (n=12) subjects belonged to ASA grade 2. Mean duration for onset of Sensory block was 4.12 minutes (SD: ± 1.69) and the mean duration for onset of motor block was 10.12 minutes (SD: ± 2.89). Pulse rate in all the patients was maintained in normal range during the observation period. Mean pulse rate was 76 ±4.3 beats per min. average mean systolic pressure was 117.7 ± 14.3 mm Hg and diastolic pressure 68.7± 4.6 mmHg. Mean values of SBP and DBP were maintained in the study population. However, when considered individually, Hypotension was observed in 3 patients after SAB (Fall in SBP > 20%). The hypotension was mainly observed after 4 to 6 min after SAB. The mean Ramsay sedation scale was 2.08 with SD 0.27. Side effects observed were mainly hypotension, nausea and shivering. Conclusion: To conclude, 5 microgram dexmedetomidine seems to be an attractive alternative as an adjuvant to spinal ropivacaine in surgical procedures, especially those requiring long time. This combination (ropivacaine and dexmedetomidine) provides very good quality of haemodynamic stability. It has excellent quality of postoperative analgesia with minimal side effects.

259-263

Authors: Mangane M, Reddy V, Reddy R

Background: Chronic dacryocystitis is the commonest cause of lacrimal passage obstruction indicates inflammation of lacrimal sac. Dacryocystorhinostomy (DCR) is the preliminary choice of surgical procedure in which lacrimal sac is connected with nasal mucosal flap by bypassing nasolacrimal duct. Objectives: This comparative study described and evaluated the effectiveness of conventional D.C.R method and D.C.R implant method in chronic dacryocystitis cases. Materials and methods: The present comparative study consisted of 200 patients with complaint of watering, pus discharge and diagnosed as chronic dacryocystitis. Out of which 160 cases were followed up for a period of 3-6 months. Study cases were operated by using “Pawar implant”. Results: Bleeding occurred during operation was much more in conventional D.C.R. (53.3%) method than D.C.R. implant method (7.7%). Complete patency of nasolacrimal duct was observed in 125 cases i.e. 76 cases in D.C.R. implant method, 35 cases in Conventional D.C.R. method and 14 cases in D.C.R implant after D.C.T done. Partial patency of naso lacrimal duct was observed in 22 cases and failure of patency was seen in 11 cases. Conclusion: D.C.R implant (Pawar Implant) method is secure, minimal time consuming, needs little incision, little bony ostium and less painful surgical modality for chronic dacryocystitis than conventional D.C.R method.

269-274

Authors: Suhail Bin Ahmed, Ather Akhtar Pasha, Yogita Singh Thakur

Background: Diabetic nephropathy (DN) is a progressive kidney disease caused by the damage to the capillaries in the kidneys’ glomeruli. Uric acid is the end product of purine catabolism and is excreted in the urine. Uric acid can serve as an inflammatory factor and is attributed to bring about endothelial dysfunction. The causal role of uric acid in the development of diabetic nephropathy is unknown. This study aimed to evaluate the association of serum uric acid level and low levels of estimated glomerular filtration rate (eGFR) which is an indicator of renal disease progression in patients with Type II (T2D) diabetes mellitus. Methods: A cross sectional analytical observational study was conducted on 150 patients with T2D. Since the study was an observational study it involved no medical intervention. Venous blood samples were obtained in fasting state for determination of random blood sugar, serum creatinine, uric acid, (HbA1c) hemoglobin A1c (reference range 3.8-5.5%); and blood urea nitrogen (BUN). Using MDRD formula eGFR was calculated as = 186 x [serum creatinine]-1.154 x [Age] -0.203 x 0.742. The association of renal disease with T2D and the grading of the patients into different stages of renal failure was analysed by eGFR values. Results: Hundred and fifty diagnosed cases of T2D were included in the present study. The mean age of the study population was 63 ± 12.2. No significant age and gender related variation in serum uric acid level was noted in the study population. The prevalence of Hyperuricemia was 19.33%. The mean BMI was significantly higher among hyperuricemic subjects in comparison with normouricemic patients. Hyperuricemia was evident in 75% (n=18) of the subjects with diabetic nephropathy. Stage IV and stage V patients were associated with significantly very high (p < 0.01) uric acid levels. Conclusions: Serum uric acid has a significant positive association with diabetic nephropathy ultimately resulting in end stage renal disease. Treatment intervention is out of the scope of this study.

281-284

Authors: Meenu Rani, Gursatinder Kaur

Primary cancer of the fallopian tube is very rare. An average of 20 to 30 new cases are reported each year. The incidence of this cancer varies from 0.14 to 1.8% of all Gynecological cancers. It is possible that the true incidence of PFTC has been underestimated because PFTC may have been mistakenly identified as ovarian tumors during initial surgery and/or during microscopic examination by a pathologist, as the histological appearance of these tumors are identical. Here in we report a classic case of PFTC in 40 year old female.