International Archives of Integrated Medicine

6-10

Authors: T. Babu Antony, S. Krishna Bharath

Background: Laparoscopic hernia repair has been in use for some time now and has been found to cause lesser postoperative pain and earlier recovery when compared with open methods of hernia repair although they are associated with higher costs and a steep learning curve. The various complications associated with laparoscopic hernia repair needs to be studied and compared with open methods. Aim: The aim of this study was to understand the intraoperative and postoperative complications of laparoscopic inguinal hernia repair and formulate methods to prevent them. Materials and methods: This is an observational study consisting of 50 patients who underwent laparoscopic inguinal hernia repair (TEP, TAPP) in our institution from September 2014 to March 2016. Intra operative and postoperative complications were documented. The following factors were considered: Type of hernia, Type of hernia vs complications, Operation time, Operation time vs complications, Post-operative hospital stay. Results: The mean operative time was 66.8 min. There were no major complications. There were 4 minor complications namely – surgical emphysema, groin pain, shoulder pain, scrotal pain. Surgical emphysema (21 patients, 42%) depends upon operation time. Groin pain (11 patients – 22% all are indirect) depends upon type of hernia mainly in indirect type, because of the dissection carried out for separating indirect sac. Shoulder pain (6 patients, 12%) is directly proportional to the time of surgery (all were >90 min) probably due to retention of CO2 which lead to diaphragmatic indentation. Scrotal edema (6 patients, 12%) depends upon the type of hernia as it occurred only in indirect hernias due to the dissection for indirect sac. All these minor complications subsided with supportive care without any surgical intervention. Mean postoperative hospital stay - 2.6 days. Laparoscopic hernia repair has a steep learning curve and time consuming initially Conclusion: Laparoscopic hernia repair has a steep learning curve and fearsome complications but once mastered, it is a safe and effective technique with early postoperative recovery. In our study we encountered only minor complications all those complications were managed conservatively.

16-20

Authors: T. N. Tamilselvam, Malarvizhi

Back ground: The joint hyper mobility syndrome is a condition that features joints that easily move beyond the normal range expected for that particular joint. Hyper mobility joints tend to be inherited. Symptoms of the joint hyper mobility syndrome include pain in the knees, fingers, hips, and elbows. Often joint hyper mobility causes no symptoms and requires no treatment. Treatments are customized for each individual based on their particular manifestations. Aim of the study: To assess the biochemical changes that occur in patients with Benign Hypermobility Syndrome in a rheumatic clinic in south part of Chennai. Materials and methods: The study was conducted from January 2016 - May 2016. Totally 50 young adults of age range between 17-34 who attended the rheumatic clinic with polyarthralgia and low back pain along with various other symptoms are included in the study. Detailed clinical history such as type of pain, duration of pain, musculoskeletal pain on various regions after activities of daily living are monitored and presence of BHMS was recorded using Modified Beighton Criteria. Biochemical investigations such as complete blood count thyroid profile, lipid profile, C - reactive protein, rheumatic factor were analyzed. Results: Totally 50 patients were included in the study. Among the 50 patients, 23 were male and 27 were female. The age was around 17-35 yrs. ESR was found to be increased in 42patients. Fasting blood glucose was found to elevated in 12 patients. Hypothyroidism found in 3 patients. C-reactive protein found to be normal. Conclusion: Asymptomatic biochemical abnormalities are not uncommon in patients with Benign Hyper mobility. These asymptomatic abnormalities pose a challenge to the general practitioners. Dyslipidemias could occur and decreased HDL cholesterol could partly attributed to decreased physical activity due vague aches and pains. Surprisingly elevated ESR warrants further evaluation to rule out relevant causes. Decreased physical activity may contribute to obesity.

26-34

Authors: Patel D, Kataria L, Bhardwaj R, Tanna K

Introduction: Coping responses are being targeted in psychological interventions as they have the capacity to distinctly influence the illness course. Identifying the coping strategies in patients of Bipolar Mood Disorder thus becomes essential part for treatment design, due to differential coping preferences having etiological and clinical implications. Most studies till date have focused on bipolar I disorder, the current study examines the cognitive coping profiles in both bipolar I (BD I) and bipolar II mood disorder (BD II) patients, and compared them. Aim: To examine the cognitive coping strategies in Bipolar I and Bipolar II patients and how they differ from each other. Material and methods: A total of 100 participants were segregated using MINI and divided into groups based on DSM-IV TR. Participants (62 BD I patients and 38 BD II patients) were analyzed for preferential cognitive coping strategies using the Cognitive Emotion Regulation Questionnaire. Results: BD I patients scored significantly higher on most adaptive coping subscales of CERQ as compared to BD II patients. Conclusion: BD I patients used more adaptive coping strategies as compared to BD II patients.

42-52

Authors: Pathak S, Yadav T, Joshi C, Sharma N, Gulabani S, Gandhi D

Background: Nearly half of all deaths in children under 5 are attributable to under nutrition. Under nutrition puts children at greater risk of dying from common infections, increases the frequency and severity of such infections, and contributes to delayed recovery. The WHO recommends the use of Z scores or standard deviation score (SDS) for evaluating anthropometry, so as to accurately classify individuals with indices below the extreme percentile. In India most paediatricians use IAP classification to classify malnutrition. The aim of the study is to assess the nutritional status of children between 6 months to 5 years of age attending tertiary rural hospital according to WHO criteria and to compare the result of this study with IAP classification for grading malnutrition. The objectives of the study is to assess the knowledge of mothers regarding feeding practices among these children particularly below 2 years of age and to observe associated clinical problems and state of other nutrient deficiencies. Materials and methods: A cross sectional and observational study of 200 children admitted in pediatric ward and NRC (nutritional rehabilitation centre) of Dhiraj Hospital were taken for the study, Piparia, Waghodia, Vadodara. Study was carried for a period of 18 months from April 2015 to September 2016 to assess the nutritional status of children according to WHO criteria and to compare it with IAP classification. Assessment of the nutritional status was done by clinical examination and anthropometry. Interrogation was done with children’s mothers in the language they understood regarding young children feeding practices and accordingly their knowledge was assessed. Data was compiled, categorized and analyzed by appropriate statistical method in consultation with a statistician. Results: Total 200 patients were taken in the study. Result shows that out of 200 patients 108(54%) were males and 92(46%) were females. The distribution of patients was more in age group between 13 and 36 months with 86(43%), of which distribution of males more than females were. Distribution of patients according to SAM and MAM (WHO classification) shows 127(63.5 %) fall under SAM and73 (36.5%) fall under MAM. Distribution of patients according to SAM and MAM (WHO classification) was studied. Result shows that out of 200 children taken in the study 127(63.5 %) fall under SAM and73 (36.5%) fall under MAM according to WHO classification. Distribution of children according to IAP classification in the present study interprets that 103 (51.5%) of the total children came under grade II of IAP classification. WHO classification detected more children with malnutrition than IAP classification, which was true for both boys and girls. Comparison of MUAC (WHO) with WHO (SAM and MAM) of children taken in the present study interprets that 67 (33.5%) had SAM and 95 (47.5%) had MAM according to MUAC criteria, remaining 19% did not fall under SAM and MAM. Comparison of MUAC (SAM) with WHO (SAM) of children in present study interprets that only 67 (52.75%) children came under SAM according to MUAC criteria out of the 127 children of SAM according to WHO classification. Comparison of MUAC (WHO) and IAP classification of children in the present shows that 67 children had MUAC <11.5 cm, out of 67 children (with SAM according to MUAC criteria) 28 (41.79%) came under grade II and 21 (31.3 %) came under grade III of IAP classification. Out of 95 children (MUAC between 11.5 cm and 12.5 cm) 18 (18.94%) came under grade I and 58 (61.05%) came under grade II of IAP classification. Associated co morbidities among children in the present study shows that among 200 patient 152 (76%) had anaemia, 44 (22%) had diarrhoea, 14 (7%) had pedal oedema, 12 (6%) had vitamin A deficiency, 44 (22%) had URTI and 24 (12%) had LRTI. Knowledge Aptitude and Practice study was done among 50 mothers and the result shows that mothers had less knowledge regarding what to be given in complementary feed, importance of immunization, birth spacing interval, and danger signs indicating illness. Conclusion: The present study shows that WHO classification detected more children with malnutrition than IAP classification, which was true for both boys and girls. There was also disparity among results of WHO criteria IAP classification and MUAC classification. Single criteria can’t be justified in assessing malnutrition. KAP study reveals that mother’s knowledge is important in combating malnutrition.

60-63

Authors: Niket Domadia, Harshit Bheda, Shashvat Modiya, Chandra Raychaudhari

Background: HELLP syndrome is life threatening condition. Diagnosis of HELLP syndrome plays an important role in assessment of complication. It can be done by USG and CT scan. Objectives: The aim of this study was to define role of CT scan in assessment of HELLP syndrome. Materials and methods: A case report aimed at evaluation of patient who came with sign and symptoms of HELLP syndrome to Radiology Department of Dhiraj Hospital by using CT scan. Results: A 30 year old patient presented in post-partum state with fever, rigor, nausea and tenderness in the right hypochondrium. Case history showed patient had suffered from pre-eclampsia during childbirth. The Patient had undergone ultrasonography which gave a diagnosis of hepatomegaly with liver abscess. Her Blood investigation showed total count of 22700 with predominant polymorph of 70%, Hb- 4.7 gm, SGPT was 234, Patient has thrombocytopenia with platelet of 1.5 lac. She was subjected to pre and post contrast CT scan in Dhiraj general hospital which showed hepatosplenomegaly, multiple ill-defined hypodense lesions in both lobes of liver (HU value = 52-70) with perilesional oedema, suggestive of multiple liver hematomas with rupture of hematoma into the peritoneal space. Conclusion: CT scan plays the key-role in assessment of complications in pre-eclamptic postnatal patient with HELLP syndrome which may be missed by USG. There by helping in patient management and prognosis.

68-73

Authors: Rafiya Nazir Khan, Suhail Majid Jan, Tahira Ashraf, Rashidat-Ul-Khairat

Bisphosphonates, synthetic (Non-biodegradable) analogues of pyrophosphate, were initially used in industry as water softening agents in irrigation systems and lateron discovered as bone loss inhibitors. Bisphosphonates inhibit bone resorption by being selectively taken up and adsorbed to mineral surfaces in bone, where they interfere with the action of the bone-resorbing osteoclasts. Thus, they have been proposed in the management of periodontal diseases by inhibiting the osteoclastic bone resorption and hence are used as a host modulating factor for prevention of bone loss. The other indications being Osteoporosis , Paget’s disease, Malignant hypercalcemia , Bone metastasis, Multiple myeloma etc. Gastro intestinal intolerance, Renal and hepato-toxicity, Hypocalcaemia, Osteonecrosis of jaws seen especially after invasive dental treatment (called as Bisphosphonate related osteo-necrosis of jaw, BRONJ) are the main side effects of bisphosphonate therapy. To overcome such effects during dental management of patients, the recommendations focus on conservative surgical procedures, proper sterile technique, appropriate use of oral disinfectants and the principles of effective antibiotic therapy. The dentist should retain in his/her file the acknowledgment and consent for the treatment.