International Archives of Integrated Medicine

6-11

Authors: Dinesh P, Swetha Raghavan

Background: Postpartum depression (PPD) is a type of clinical depression which can affect woman after childbirth. PPD is very common among women and is a major public health problem. It is estimated that overall 10 to 15% women experience PND while it ranges from 3.5 to 63.3% in Asian countries. But it is one of the most underdiagnosed conditions due to lack of adequate number of studies on the subject. Hence the current study was conducted with an objective of assessing the prevalence of postnatal depression among subjects with normal and cesarean deliveries and to compare the socio-demographic profile between normal and cesarean deliveries. Materials and methods: The study was a cross sectional study, conducted in the Department of Pediatrics, Apollo institute of medical sciences and research (AIMSR), Chittor. The data collection for the study was done between January 2015 to November 2015. The study population included people who were undergoing normal and cesarean deliveries. Post natal depression was assessed by EPDS score. Results: The highest proportion of patients belonged to 21-25 years and 26-30 years age groups in both the study groups Normal delivery and Caesarean delivery, the association of age groups between the study groups was statistically significant (P value<0.001). The maximum proportion of patients were housewives in both the study groups. The rural area patients were more in normal and caesarean deliveries as 44% and 39% respectively, the locality showed statistically significant association with the study groups (P value<0.05). All the individual EPDS scores mean values were high in cesarean group when compared to normal delivery group. The mean Total EPDS score mean in normal delivery patients was 8.85 and in cesarean delivery patients 10.85 with t value=-4.766. The proportion of patients with postnatal depression prevalence was high (30%) in cesarean group where as it was only 15% in normal delivery group. The t value was 6.452. Conclusions: Prevalence of postnatal depression was comparably high in caesarean sections compared to normal deliveries with clear statistics about the same, EPDS scores also reflected the higher risk of depression in caesarean section when compare with normal deliveries knocking the alarm to concentrate on the patients more with caesarean sections by providing good counselling, better medication and positive environment in each stage during and after pregnancy from both the patient’s family side and medical staff side.

20-26

Authors: Sivanoli Ambalavanan, Vimal

Background: Lignocaine has been used for spinal anesthesia since 1948 for many decades without any serious complications. In subjects who were recovering from lignocaine spinal anaesthesia, Transient Neurologic Symptoms (TNS) have been reported. In pregnant women, small doses of spinal anaesthesia are known to produce higher levels of spinal anaesthesia compared to non-pregnant women. The aetiology of TNS is still poorly understood and the incidence of TNS has been reported to be low in pregnancy. Materials and methods: We conducted a randomised controlled clinical trial on 200 subjects who were admitted to Dhanalakshmi Srinivasan Medical College and Hospital. 100 obstetric subjects were randomised to receive either 1.1 ml of 5% lignocaine (Group 1 – OL, n=50) or 2 ml of 0.5% bupivacaine (Group 2 – OB, n=50). 100 non obstetric subjects were randomised to receive either 2 ml of 5% lignocaine (Group 3 – NL, n=50) or 3 ml of 0.5% bupivacaine (Group 4 – NB, n=50). Incidence of Transient Neurological Symptoms was our primary outcome variable. Results: Out of 50 people with OL none had TNS. The proportion of subjects developing TNS was 2%, 4% and 4% respectively in OB, NL and NB groups. None of the factors such as degree of motor blockade, age, weight, occurrence of hypotension, lowest SBP, lowest DBP, lowest heart rate had a significant association with occurrence of TNS. Conclusions: The incidence of TNS in OL group was 0. The occurrence of transient neurologic symptoms with intrathecal lidocaine among obstetric patients in the supine surgical position appears to be infrequent and also without any serious complications.

30-37

Authors: Muath Ibrahim Alsabih, Hussein Saad Amin, Ali Saeed Alrawdhan, Fahad Yousef Alturki, Abdulrahman Mansour Alakeel, Yasser Abdulaziz Alrumih, Ahmed Saleh Allohidan, Ammar Abdullah Naji, Naif Abdulrahman Alarjani

Background: It is assumed that the students of health care colleges have a greater knowledge about healthy lifestyle and dietary habits when compared to other students. The main goal of this study was to determine the prevalence and effect of exercise on the academic performance of the health care students. Materials and methods: This cross-sectional study was conducted on 376 male healthcare students at King Saud University in Riyadh from Colleges of Medicine, Dentistry and Pharmacy in the period from December 2014 until March 2015. The study population was selected by multistage random sampling. A self-administered questionnaire was used for data collection. A pilot study was conducted to test its feasibility. A statistical package for the social sciences (SPSS) version 21.0 was used for data analysis. Results: 56.6% of the subjects were found to be physically active. Those who did not perform exercise, lack of time (55.8%) and lack of interest (36.2%) appeared to be the two most common causes for not exercising. The effect of physical activity on academic performance was found to be statistically significant in only two domains which were being less likely to be being late to the classes (P.026) and relatively better concentration during lectures (P.001). Conclusion: The study included that a significant positive effect of exercise was found on two domains of academic performance, namely better concentration in classes and punctuality in attending lectures, but with no significant effect on GPA of students.

43-47

Authors: S Vijayalakshmi

Background: Seroma formation is a common problem after mastectomy. The incidence varies between 30% to 92%. It is often an ongoing problem after removal of the suction drain, and repeated skin puncture is necessary to remove the seroma. In addition to many ambulatory visits this also leads to an increased risk of infection, and the adjuvant treatment can be delayed for several weeks. Different procedures have been tried to avoid seroma formation. Among these are for examples: immobilisation of the arm and shoulder after mastectomy, different drain regimens, closing of the dead space of the cavity, different chemical substances as thrombin, tranexamacid and fibrin. None of these results has been successful. Seroma formation is most likely the result of the inflammatory response due to wound healing. In the seroma fluid several factors have been detected that support this assumption. These factors are: high levels of IgG, leucocytes, granulocytes, proteinases, proteinases inhibitors, different kinds of cytokines (tPA, uPA,, uPAR, PAI-1, PAI-2, IL-6 og IL-1). On the basis of this, an inhibition of the inflammatory response might result in a decrease of seroma formation, and perhaps improve quality of life after mastectomy. Steroids inhibit the inflammatory response for example by inhibition of the cytokine function. It has been shown that a high single dose of steroid infusion (30 mg/kg solu-medrol) inhibits the normal IL 6 response after colon resection. Newer studies have shown that even at a lower dose the inflammatory response is inhibited. In several studies of head and neck surgery the oedema in surgical area is reduced after a single dose of 125 mg solumedrol. It is precisely this effect of reduced fluid formation we want to obtain in our study. We have therefore chosen to use a single dose of 125 mg of solumedrol in this study. Even at the largest single dose of glucocorticoids there have not been seen any increasing in surgical complications. Aim: The aim of this study was to study the effect of injection methylprednisolone in post mastectomy seroma in patients coming to Govt. Villupuram Hospital. Materials and methods: This was a prospective study consisting of 20 patients diagnosed as carcinoma breast who underwent modified radical mastectomy in our institution. With all aseptic precautions, 125 mg methylprednisolone sodium succinate intravenously as a single bolus before the start of surgery in patients undergoing modified radical mastectomy in case group. Results: Most common age group was 41-50 years of age. In 2 cases seroma aspiration was present. Conclusion: Since Seroma formation is the most common complication of Mastectomy and among the methods used to reduce its incidence, steroid administration seems to be the most cost effective and shows promising results. Its routine use in every case is recommended under good antibiotic cover and wound care.

57-63

Authors: Vidyadhara Rani P, Naveen Kumar S

Introduction: Dengue fever is one of the most prevalent and fastest spreading mosquito borne arboviral infection, occurring in tropical and subtropical regions. They are single stranded RNA viruses and transmitted by Aedes mosquitoes. There are four serotypes of dengue virus DENV 1, DENV2, DENV3, DENV 4. Following an infection lifelong immunity develops against the respective serotype. The clinical spectrum of dengue infection varies from undifferentiated fever, Classical Dengue fever, Dengue hemorrhagic fever, Dengue shock syndrome, Expanded dengue syndrome. Continuous surveillance of dengue fever is important for the proper and timely institution of vector control measures. Aim: The aim of present study was to evaluate the thrombocytopenia with prevalence of dengue infection along with seasonal variation. Materials and methods: The present study was a retrospective study conducted in the Department of Hematology, at Chalmeda Anand Rao Hospital, Karimnagar during the period from 2015 June to 2016 May. Blood samples were collected from 4047 patients presented with acute febrile illness clinically consistent with Dengue infection. Serological confirmation of dengue infection was done using “Rapid Visual test kit” for detection of NS1 antigen and differential detection of IgM and IgG. Platelet count was done on “Automatic cell counter XN1000” which was correlated with manual platelet count in all the serologically positive cases. Results: Out of 4047 suspected cases, 1505 cases were confirmed as serologically positive for dengue infection. Out of 1505cases, 742 samples were positive for only NS1, 70 were positive for only IgM, 361 were positive for only IgG, remaining 332 were positive for more than one serological markers (NS1, IgM, IgG). A majority, 655 (43.52%) of the dengue cases were noted in the age group of 15-30 years, followed by less than 15 years of age. Among the dengue cases, 61.8% were males and 38.2% were females. A significantly higher number of serologically positive cases 1342 (89.2%) were noted in the post monsoon period. Conclusion: Incidence of dengue infection was higher in monsoon and post monsoon period. Thrombocytopenia provide high suspicion of dengue infection, which could be life threatening. Platelet count is an important predictive and recovery parameter of dengue infection.

72-83

Authors: Shweta P. Bijwe, Mithil B. Ghushe

Background: Sickle cell disease is characterized by chronic hemolysis, frequent infections and recurrent occlusions of microcirculations, which causes painful crisis and results in chronic organ damage and failure. Occlusion of microcirculation and infection are important factors that stimulates production of cytokines and acute phase proteins like C- reactive protein. Aim: To estimate serum C-reactive protein levels in cases of painful vaso-occlusive crisis of sickle cell disease, to study correlation of level of serum C-reactive protein with duration of painful vaso-occlusive crisis of sickle cell disease, to study relation between level of serum C-reactive protein and treatment response of analgesic versus analgesic opioid in cases of painful vaso-occlusive crisis of sickle cell disease. Materials and methods: This hospital based observational case control study was carried out at IGGMC, Nagpur, Maharashtra, India. Total 31 cases of sickle cell vaso-occlusive crisis, of age 12 years and above, admitted in hospital and 31 controls included in study. Study protocol was followed in each case. Results: Musculoskeletal, joint pain (83.87%) was most common form of presentation. Exhaustion and severe physical activity (25.80%) was most common precipitating factor. Mean hemoglobin, bilirubin showed statistically significant difference in cases compared to control. Mean CRP on day 1 (40.87±17.22 mg/L) was significantly high compared to control (3.67±0.77 mg/L) with statistical significance p<0.0001. Conclusion: Serum C- reactive protein levels are higher in cases of painful sickle cell vaso-occlusive crisis than control. C- reactive protein levels correlate positively with duration of pain in cases of painful sickle cell VOC. Steady state C- reactive protein level is normal in cases of sickle cell anemia. Cases of painful sickle cell VOC in whom opioid had to be used in addition to NSAIDs for pain management had higher CRP levels than who responded to NSAIDs alone. The cases in whom serum C- reactive protein levels were >33.2mg/L required use of opioid for pain management of sickle cell VOC. However, sample size of the present study is small and will need further prospective study.

94-104

Authors: D. Sampath Kumar, S. Prasanna, P. Sakthi Seethalakshmi

Introduction: Minimal Change Nephrotic Syndrome is the most common type of nephrotic syndrome accounting for 85% of cases. It is the most common primary or idiopathic type of nephrotic syndrome in children. It occurs between 1 to 12 years of age, but most commonly 2 to 6 years. Even though the majority of cases show remission of nephrotic syndrome, the hypocalcemia due to Glucocorticoids are very severe. It reduces the bone mineralization and reducing the bone mineral content and thereby reducing bone density. Aim of the study: To assess the reduction in bone mineral density among children who have completed the first course of steroid therapy for nephrotic syndrome by measuring biochemical markers of bone. Materials and methods: This study was done to find out the reduction in the Bone mineral density among children who completed steroid therapy for nephrotic syndrome, by using bone biochemical markers. This study also helped to assess the side- effect of Glucocorticoids on bone density and to prevent bone demineralization and pathological fractures in children. Results: The results showed there was a reduction in the serum calcium values among children with MCNS. This implied hypocalcemia among children due to GCs and the P value is significant <0.001. This represented the corrected calcium levels among the children after drug effect. It implied the overall the corrected calcium levels at low levels with MEAN=8.34 mg%. The P value was <0.024 Significant. The total proteins were normal among children after completing the glucocorticoid therapy. The P value was <0.001 and was significant. Mean = 5.68. Standard Deviation (SD) = 0.28. The serum phosphorus was almost normal among remission MCNS Children and at higher levels among defaulters, SDNS and SRNS. Conclusion: Glucocorticoids is the drug of choice and standard therapy for Minimal Change Nephrotic Syndrome (MCNS), but the drug-induced hypocalcemia and hypovitaminosis D are assessed by our study. Added to the above, the disease itself characterized by hypocalcemia and hypovitaminosis D. So, all children should undergo this assessment to prevent growth failure and pathological fractures. Nutritional supplements are recommended for the quality of life among children.

111-115

Authors: S. Kalaichelvi, Rohini iyyadurai

Introduction: A peptic ulcer is a sore that forms when digestive juices wear away the lining of the digestive system. A peptic ulcer can occur in the lining of the stomach, duodenum, or lower part of the esophagus. Symptoms can include indigestion-like pain, nausea, and weight loss. It is not uncommon for people to have a peptic ulcer and no symptoms at all. However, one of the most common symptoms of peptic ulcers is an indigestion-like pain. Diabetic shave increased the vulnerability of the gastric mucosa to various ulcerogens such as ethanol, ischemia/reperfusion, stress, and non-steroidal anti-inflammatory drugs. The notable changes that are often observed in patients with chronic diabetes mellitus are decreased gastric secretion (in response to insulin but not to either histamine or pentagastrin) and motility. The aim of the study: To assess the prevalence of gastric ulcer in diabetes mellitus patients who were attended Medicine OPD. Materials and methods: The study was conducted from April to August 2017 to explore the prevalence of peptic ulcer disease among the patients attended the Department of Medicine. Detailed information about the common signs and symptoms of peptic was analyzed with questioner regarding the prevalence of disease. Totally 50 patients with diabetes on medication with prone ulceration symptoms (25 –Group A) and (25-group B) patients with diabetes who were asymptomatic were considered as control group are taken in for the study. Results: After treating symptoms such as abdominal pain, nausea, abdominal bloating were completely relieved for group A subjects except for one case. Among 25 subjects with group B above symptoms were not completed seen. Out of treated subjects in the group A, 21subjects had a good appetite, free from the tar-like stool, abdominal pain, GERD reflex were improved in 22 cases after medication and diet control. Conclusion: The problems of the disease can be tackled through prevention and treatment which includes education, increasing awareness, reducing stress, and smoking and decreased intake of NSAIDs. H. Pylori prevalence was found to be high. Individuals who had a low educational level and NSAIDs consumers were under higher risk of infection than others. H. pylori infection appears not to be associated with diabetes.

124-134

Authors: Nama Nagarjuna Chakravarthy, A Sagar, G. Venkateshwarlu

Background: Epidural opioids have unique advantages over conventional, intermittent IV/ IM administration, in that patients given epidural opioids have fewer respiratory complications and can be mobilized sooner in the postoperative period. Aim: To compare the effects of epidural 0.5%Bupivacaine with nalbuphine and 0.5% bupivacaine with fentanyl in lower abdominal and lower limb surgeries. Materials and methods: This prospective, randomized, single blind study, where in Epidural Nalbuphine (10 mg) with 0.5% bupivacaine and epidural fentanyl (50 g) with 0.5% bupivacaine in lower abdominal and lower limb surgeries. Results: There were statistically no significant difference between mean age, weight, gender, ASA grading, types of surgeries and baseline parameters in both groups. The duration of surgery and time of onset of sensory blockade, motor blockade and peak motor blockade were not statistically significant (p> 0.05). The duration of sensory blockade was highly significant (p < 0.01). Duration of motor blockade was not statistically significant (p > 0.05). Mean heart rates in both the groups were significant only at 6th, 7th, 8th, 9th and 10th hours. Mean arterial pressures in both the groups were significant only at 3rd, 6th, 7th, 8th, 9th and 10th hours. 30% of patients in group A had a pain score more than 4 during 6-12 hours of postoperative period as compared to 80% in group B. The pain scores were similar in both the groups in the first six hours of postoperative period. Number of rescue analgesics required in the first 24 hours of post-operative period in group B were significantly higher (p < 0.01) when compared with group A. 4 patients (13.2%) in Group B experienced respiratory depression which is significant statistically. Conclusions: Epidural Nalbuphine with 0.5%bupivacaine significantly prolongs the total duration of sensory blockade with better postoperative analgesia when compared to epidural fentanyl with 0.5%bupivacaine, with stable hemodynamics and less side effects.

141-149

Authors: Khalid Mohammed Alshahrani, Abdulmonem Alsiddiky, Sultan Mohammed Alamro, Awn Abdulkhaliq Alqarni

Background: Developmental dysplasia of hip (DDH) is a condition in which there is an abnormal relationship between the head of femur and acetabulum. Currently there is no single definition of the disease in the aspect of morphology, clinical, radiological studies. Objective: To know the level of knowledge, attitude and skills among parents with a DDH-diagnosed child, to compare the socio-demographic status between parents and how it affects the disease, to compare attitude between parents with previously diagnosed child with DDH against those who are not. Materials and methods: A cross-sectional study was conducted on a sample of 340 across parents in city of Riyadh, Saudi Arabia. Using the simple random technique with the help of a questionnaire, the data were processed using SPSS version 23 (SPSS Inc., Chicago, Illinois, USA). Results: From a total of 340, only 234 (68.8%) of the participants had a previous knowledge about DDH, while 106 (32.2%) had no idea about DDH. From a total of 72, only 42 (58.3%) of the fathers do know about DDH, while 30 (41.7%) of them do not. From a total of 268, only 192 (71.6%) of the mothers do know about DDH, while 76 (28.4%) of them do not. There is a significant association between being a mother and knowing about DDH (p<0.05). Conclusion: As the DDH awareness level in Saudi Arabia is suboptimal, additional efforts need to be done to ensure the delivery of simple and reliable information regarding this condition through various media portals and campaigns.

160-167

Authors: Rahul Sudan, Mehroz Ahmed, Khursheed Aslam, Irfan Yaqoob, Gunjan Gupta, Shantanu Aggarwal

Background: Ventricular Tachycardia (VT) constitutes an important manifestation of coronary artery disease (CAD). VT can occur in the immediate acute myocardial infarction (MI) period, further complicating the management. VT also occurs after long duration of acute coronary syndrome (ACS) in the healed MI. Aim: The aim of our study was to evaluate the epidemiology, clinical presentation, hemodynamic status, treatment received and finally the outcome of CAD patients manifesting as sustained VT. Materials and methods: This prospective study was conducted at Sher I Kashmir Institute of Medical Sciences (SKIMS), a tertiary care center in Srinagar, Jammu and Kashmir, India, between August 2013 to May 2016. All the cases of definite sustained VT already admitted in the hospital or presenting in the emergency department including those who developed VT during the course of acute MI were evaluated. Results: In our study, a total of 35 patients of CAD manifesting as sustained VT were observed. Majority of these patients were males. The most common presenting symptom was chest pain seen in a total of 14 patients. A total of 23 patients (66%) were hemodynamically stable at the time of VT. A decreased Left Ventricular Ejection Fraction (LVEF <50%) was seen in 18 patients (51%). Monomorphic VT was seen in a total of 28 patients (80%) and the rest of 7 patients showed polymorphic VT. Mortality was seen in 8 patients (23%). Conclusion: Polymorphic pattern of sustained VT, hemodynamic instability at the time of VT and a decreased LVEF are associated with increased mortality in patients of CAD manifesting as VT.

174-180

Authors: Sarbjit Singh, Ram Saroop Sharma

Background: Obesity is a major modifiable cardiovascular risk factor as studied by American Heart Association. Aim of present study was to determine the prevalence of generalised and central body obesity among Medical Students and association of obesity measured by body mass index (BMI) and waist circumference (WC) with health risk factors. Material and methods: The present study was conducted on 200 medical students including 102 males and 98 females in the age group of 18-23 years in the Department of Physiology, Govt. Medical College, Amritsar. For generalised obesity (BMI> 25 kg/m2 and abdominal or central obesity (WC 94>cm in males and 80 >cm in females) were used. Results: The prevalence of generalised obesity in males and females was 75.51% (males 50.0%, females 25.51%) and abdominal or central obesity 82% (males 14% and females 68%). Isolated generalised obesity (BMI increased and WC normal) in males and female was 62.96% and 37.04% and isolated abdominal obesity (WC increased and BMI normal) in males and females 17.28% and 82.72%. Combined obesity (BMI and WC both increased) in males and females 40.12% and 59.88%. Conclusion: Prevalence of combined obesity was found high among both sexes. While isolated generalised obesity was more common in males and isolated abdominal obesity more common in females. However, these prevalence rates vary markedly depending on cut points used. WC is a better marker of obesity related risk than BMI.