International Archives of Integrated Medicine

1-7

Authors: Amrit Kejriwal, Arpan Singh Chouhan, Jaishree Ghanekar

Background: Hematocrits have always been helpful to doctors as they are important parameters used on a daily basis. With the latest technology one can measure different indices of platelets mainly Plateletcrit, PC, MPV, PDW. Aim and objectives: To study the role of platelet distribution width as a prognostic factor of outcome in hemorrhagic stroke. Materials and methods: This study included 35 patients of hemorrhagic stroke coming to MGM hospital, Kamothe. Results: The study contained of 13 females and 22 male patients. Group A consisted of 5 patients. As the patients expired within 24 hours, only a single value of PDW was available in these patients. The mean of the PDW of these patients was 16.92 with a SD of 1.22. Conclusion: PDW may act as a prognostic factor of mortality in hemorrhagic stroke.

15-22

Authors: G. Indhumathi, K. Suresh Kumar

Introduction: Sedentary lifestyle, low fiber, high fat and energy-rich foods have penetrated even the rural India in the name of globalization. All these will come not without cost. India is now facing the paradox of malnutrition on one hand and epidemic of obesity on the other. Indians three times higher risk of developing Coronary Artery Disease (CAD) compared to Chinese and are 20 times more likely to die due to CAD compared to native black or white South Africans. The aim of the study: To find out the prevalence of Central Obesity, Hypertension, Impaired Fasting Glucose or Diabetes mellitus, Hypertriglyceridemia and low HDL cholesterol and to analyze the differences in their prevalence among the age groups, sex, social class and chronic and acute coronary syndromes. Materials and methods: All patients belonged to a low socioeconomic group attended medical outpatient department or those who were getting admitted medical ward of Govt. Dharmapuri Medical College, Dharmapuri with coronary artery disease (CAD) were included. Results: Mean of age for males (CI: 55.49± 22years) and females (CI: 51.87±24.7years) lied within one standard deviation from the sample mean. 59 patients (52.2%) had central obesity. 64.2% patients in age group <40 years, 41.4% in age group 40-60 years and 72.4% in age group >60 years had central obesity. This increase in the prevalence of central obesity among younger (<40 year) and older age group (>60 years) was significant. 84 patients (74.34%) had hypertension. 71.43% patients in age group <40 years, 77.14% in age group 40-60 years and 68.96% in age group >60 years had hypertension. There was no significant difference in prevalence of hypertension among age group.57 patients (50.44%) had diabetes or IFG. 50% patients in age group <40 years, 40% in age group 40-60 years and 75.86% in age group >60 years had diabetes or IFG. This increase in the prevalence of Diabetes and IFG among younger (<40 year) and older age group (>60 years) was significant. 48 patients (42.48%) had hypertriglyceridemia. 50% patients in age group <40 years, 32.86% in age group 40-60 years and 62% in age group >60 years had hypertriglyceridemia. 54 patients (47.78%) had metabolic syndrome. 50% patients in age group <40 years, 37.14% in age group 40-60 years and 72.41% in age group >60 years had metabolic syndrome. This increase in the prevalence of metabolic syndrome among younger (<40 year) and older age group (>60 years) is significant (X2- 10.25, p=.006). Conclusion: The result of the present study suggests that in urban patients who live below poverty line with symptomatic coronary artery disease there in the increased prevalence of metabolic syndrome, central obesity, hyperglycemia, hypertension, and dyslipidemia. The higher prevalence particularly noticeable in those with the premature coronary artery disease and that might have resulted in earlier onset of CAD in them.

30-33

Authors: Ganesamoorthy Karupasamy, K. Karthick

Introduction: In 20 to 40% of all diabetes mellitus patients some abnormalities of autonomic function is present. Diabetic autonomic neuropathy can involve both sympathetic and parasympathetic nervous system. Parasympathetic abnormalities appear earlier and sympathetic innervations may remain intact even in presence of severe Parasympathetic damage. The aim of the study: To determine the various aspect of autonomic neuropathy in the diabetic population using series of standardized test, to interpret the different type of presentation of autonomic neuropathy in diabetes mellitus. Materials and methods: Sixty patients with mean age of 57.7% who had non-insulin dependent diabetes mellitus, varying from one year to fifteen years duration with normal 12 lead electrocardiograph were selected for the study. With standard autonomic function test procedures for both sympathetic and parasympathetic were done with suitable inclusion criteria. Results: Peripheral neuropathy was observed in 40% (24/60) of patients. In 46.6% (28/60) patients Pupillary changes were observed. In patients with peripheral neuropathy, 95.8% (23/24) had Pupillary changes. Postural hypotension was observed in 36.7% (22/60). The results of various tests of autonomic function are as follows. While interpreting the results all borderline cases were considered as normal. The rise of heart rate less than ten was observed in 40% of study group with mean of6.94.Among the patients, 36.7% (22/60) had fallen in blood pressure of more than 30millimeter of mercury. Conclusion: Newer drugs have to be tried for comforting many diabetics with clinical autonomic neuropathy afflicted with this condition in that at least the quality of life of with diabetic neuropathy will improve.

44-54

Authors: Giridhar Bellamkonda, Sri Kavya

Background: Cataract surgery and intraocular lens implantation restores near normal visual acuity in otherwise healthy eyes, safe surgery, postoperative emmetropia and early resuming of normal activities are three major considerations of present day cataract surgery. Aim: To evaluate and compare surgically induced altered refractive status following superior versus temporal incision in small incision cataract surgery. Materials and methods: 100 cases of cataract surgery were selected for study of post-operative refractive status in superior versus temporal incision in cataract surgery. A complete ocular examination including anterior and posterior segment examination and general physical examination was performed in all cases. Results: Majority (75%) of patients of the present study who underwent cataract extraction belonged to age group of above 50 years with maximum preponderance in the age group of between 61-70 years. The minimum amount of astigmatism one week after surgery in Group – 2 was 0.5D and the maximum amount was 6.0D. The average amount of astigmatism one week after surgery in Group – 2 was 2.75D. The minimum amount of astigmatism 6 weeks after surgery in Group – I was 0.25D and maximum amount was 4.0D. The minimum amount of astigmatism 6 weeks after surgery in Group – 2 was 0.25D and maximum amount was 2.0D. The complications were seen in early postoperative period more in superior incision group than in temporal group. Astigmatism was cleared in temporal group when compared to superior incision group. After 6 weeks of postoperative follow-up, visual acuity of every patient was recorded after giving proper pseudophasic correction. Temporal Incision had 92% 6/6 -6/9 and 6/12-6/18 visual acuity. Conclusions: Amount of astigmatism was less in temporal incision SICS than superior incision SICS. The postoperative refractive status, is also good in temporal incision SICS than superior incision SICS.

60-70

Authors: Muath Aleid

Clinically, six minute walk test (6MWT) is the most common exercise test. It is used to estimate the level of physical fitness among patients. The aim of this research to measure the beat by beat heart rate slopes instead of depending on the covered distance to predicate and estimate the level of physical fitness during 6MWT. Seventy (70) healthy adult male students aged between 18 to 27 years were recruited randomly from the general Saudi population in Riyadh. 6 MWT using 50 meter corridor was performed according to standardized American Thoracic Society (ATS) guidelines. Mean distance walked in 6 minutes (470.5±64.6 meters) and beat by beat heart rate (HR) was calculated by heart rate monitor. In addition Body mass index (BMI), Body surface area (BSA), Borg Rating of Perceived Exertion (BRPE) and Maximum predicted heart rate percentage (MPHRP) was also calculated. A stepwise regression equation was used to predict six minute walk test distance (6MWTD), six minute walk test slope (6MWTS) and recovery slope. There was a significant correlation between 6MWTS and the recovery slope (r= -0.460, p <0.001), 6MWTS with 6MWTD (r= 0.264, p<0.05) and recovery slope with 6MWTD (r= -0.249, p <0.05). In conclusion, both 6MWTS and recovery slope can predict the 6MWD.

77-87

Authors: Shadab Maqsood, Tasaduq Ahmad Khan, Shaafiya Ashraf

The challenge in the imaging of abdominal trauma is to accurately identify injuries that require early exploration and at the same time avoid unnecessary operative intervention in cases that can be managed conservatively. To ascertain degree of trauma, a rapid, cost effective, safe and reproducible investigation used is ultrasonography. However limited information by USG limits its role in trauma. The advent of Multi Detector Computed Tomography (MDCT) is a major advancement in evaluation of patients of abdominal trauma by offering decreased scanning time, increased resolution owing to thinner collimation and reduced partial volume and motion artefacts. The aim of the present study was to assess role of Multi detector computed tomography (M.D.C.T) in evaluation of patients of blunt abdominal trauma and to assess the utility of multi planar reformations (MPR), maximum intensity projections (MIP) and 3-D reconstruction in patients of blunt trauma abdomen. At the outset of the study, a detailed history was taken, general physical examination and relevant local examination findings were recorded. Relevant laboratory examination findings were recorded. The most common mode of injury was road traffic accident (RTA) accounting for approximately 69.5% (32/46) of cases Pattern of the injuries showed that the liver was the most commonly injured organ accounting for 34.78% (16/46) of injuries The management plan of the patients prior and after MDCT examination which was guided by demographic profile like age, clinical status of the patients; time elapsed since injury and initial sonographic findings if done was studied. The use of multi detector CT in initial triage of clinically stable patients with blunt abdominal trauma results in reduction in number of unnecessary laparotomies by 91% and helps guiding initial management in emergency department in virtually every patient with high success rate of around 95%. The MDCT grade of solid organ injury does not correlate with management plan in patients with blunt abdominal trauma. The high resolution MPR, MIP, 3-D volume rendered images not only helped in displaying complex injuries but also increased diagnostic capabilities, accuracy and shortened the reporting time. The high resolution MIP and 3-D volume rendered images gave quick and prompt diagnosis of associated vascular and bony injury.

97-105

Authors: K. Sharada, Hema Warrier, Ajay Kumar Reddy, P. Thulasi

Background: Induction of labor is defined as the process of artificially stimulating the uterus to start labor. It is usually performed by administering oxytocin or prostaglandins to the pregnant woman or by manually rupturing the amniotic membranes. Objective: Main objective of the study was to find out are there any differences in maternal and neonatal / fetal outcomes after induction labor with misoprostol and oxytocin beyond 37 weeks of gestation. Materials and methods: This was a hospital-based study carried out in 431 inductions of labor during the study period. Total 327 women met the criteria and were enrolled into study. Misoprostol of 25 μg was inserted in posterior fornix of vagina or oxytocin infusion was started from 2.5 units on whom induction was decided. Maternal and fetal/ neonatal outcomes were observed. Collected data were analyzed using SPSS and MS Excel. Results: Analysis of onset of labor led to the finding that mean onset of labor was much rapid in oxytocin (7.2 h) than misoprostol (12.7 h). However, there is similarity in induction–delivery interval in both groups. Overall, the rate of normal delivery and caesarean section was found to be 64.8% and 38.2%, respectively. Fetal distress was found as the most common reason for caesarean section. The overall occurrence of maternal complication was found to be similar in misoprostol and oxytocin groups, nausea/vomiting being the most common complication followed by fever. Besides this, the most common neonatal complication found in overall cases was meconium stained liquor. Conclusion: It was found that misoprostol was used most frequently for induction of labor compared to oxytocin. The onset of labor was found to be rapid in oxytocin than misoprostol. However, the occurrence of side effects was found to be similar in both misoprostol and oxytocin groups.

113-119

Authors: Mohanakrishna Meka

Background: This study was to show the advantage of Honey dressing over conventional saline dressing in the management of chronic non healing ulcer. Materials and methods: This was an open study comparing conventional normal saline dressing and honey dressing in the management of chronic non healing ulcers done during July 2014 to June 2015 in general surgical wards of government TD medical college, Alappuzha. Results: Factors assessed include average hospital stay, culture sterility pre and post dressing, their outcome plan (discharged, amputated or grafted), whether diabetes and vascular compromise has altered the results in two groups etc. As in evidence with ancient literature and studies in modern literature it was proved that irrespective of age, sex, distribution of diabetes and vascular compromise in Doppler; honey dressing was significantly advantageous over conventional normal saline dressing in terms of culture sterility, better outcome plan as well as less stay in hospital. Conclusion: The honey dressing is a better alternative to conventional normal saline dressing which can also pave way for decrease in antibiotic resistance.

124-127

Authors: Saba Khan, Meenu Rani

Thyroid malignant tumors are rarely associated with hyperfunctioning thyroid. The incidence of this co-incidence is highly variable. Here we report a rare case of papillary thyroid cancer associated with hyperthyroidism with brief literature review. 34 years-old female, presented with palpitation, excess sweating and weight loss for two months duration. There was asymmetrical swelling of the neck, more on left side which moves with deglutition. The result of histopathological examination confirmed papillary thyroid carcinoma. Literature review has showed an increasing number of papers reporting the association of high level of thyroid function tests and thyroid malignancy. Although the coexistence of them is rare, thyroid malignancy should be put in the differential diagnosis of hyperthyroid goiter and we can conclude that histopathology is the gold standard for the confirm diagnosis.