International Archives of Integrated Medicine

7-13

Authors: Priyanka Poonam

Fine needle aspiration of thyroid lesions forms the first diagnostic tool in the preoperative evaluation of thyroid lesions. Thyroid diseases are important as these are curable with medical as well as surgical treatment. Enlargement of thyroid called as goiter is the most common manifestation of thyroid diseases. FNAC forms an important role to determine the nature of thyroid lesion whether benign or malignant. It is simple, safe, accurate and cost effective method. This was a prospective and descriptive study done for the period of 2 years from January 2016 to December 2017 in the Department of Pathology at our tertiary care hospital. A total of 100 patients with thyroid lesions came for FNAC, out of which 50 cases were received for histopathological correlation. There were 39 cases of benign thyroid lesions out of which multinodular goiter were the commonest. Papillary carcinoma was the most common malignant lesion amongst 11 cases. Benign lesions presented in younger age group (20-40 years) whereas malignant lesions had bimodal presentation (20-40 years and 40-60 years). Hereby I have analyzed different types of thyroid lesions in different age groups based on cytological evaluation followed by its histopathological confirmation.

21-27

Authors: A. Valarmathil, R. Aravind Kumar

Introduction: Diabetes mellitus is a group of metabolic disorders characterized by hyperglycemia. This disorder is associated with abnormalities in carbohydrate, fat and protein metabolism. Anemia is a condition in which the hemoglobin concentration in blood is below the expected value, when age, gender, pregnancy and certain environmental factors, such as altitude, are taken into account. There is an increasing number of patients with diabetes who have been found to be anemic without any evidence of any chronic renal disease. The aim of the study: To compare the hemoglobin levels among normal controls and patients with type 2 diabetes, to correlate the levels of hemoglobin with the degree of glycemic control (HbAlc >7 g% vs. HbAlc <7 g%), to detect the unrecognized cases of anemia among type 2 diabetes mellitus patients. Materials methods: The total sample size of the present study is 90 among which, 30 were healthy controls, 30 were better glycemic controlled T2DM patients (HbAlc < 7 g%) and 30 were poorly glycemic controlled T2DM patients (HbAlc >7 g%). Blood samples were collected from all the subjects for the estimation of Hb%, HbAlc, FBS, PPBS, Blood Urea, and Serum Creatinine. Results: There was a significant decrease in the hemoglobin percentage in the diabetic group compared to the healthy controls. Among diabetics, the better glycemic control group had a significantly higher hemoglobin percentage. The Hemoglobin percentage among controls, better glycemic control T2DM patients and Poor glycemic control T2DM patients was 13.44 ± 1.38, 12.27 ± 1.75 and 11.4 ± 1.81 respectively. The HbAlc percentage among controls, better glycemic control T2DM patients and Poor glycemic control T2DM patients was 6.08 ± 0.23, 6.64 ± 0.18 and 8.4 ± 1.21 respectively. There was no significant difference with respect to age, demographic characteristics and renal profile (Blood Urea and Serum Creatinine) among the groups. Conclusion: To conclude Anemia is a common finding in Diabetic patients compared to the general population. Further good glycemic control in T2DM will lead to a better hemoglobin percentage in T2DM patients. Among the diabetic group, the better glycemic control group had a better hemoglobin percentage which was statistically significant.

34-38

Authors: V. Sivangagai Lakshmi

Background: Tobacco cigarette smoking is one of the major leading causes of death throughout the world. Smoking has both acute and chronic effect on hematological parameters. The aim of the present study was to assess the extent of adverse effects of cigarette smoking on biochemical characteristics in healthy smokers. Materials and methods: Totally 68 subjects were included in the study. 34 current smokers who came from in and around Chidambaram to the RMMC and Hospital who fulfilled the inclusion criteria were selected as an experimental group. Another 34 non-smokers of the same age group were included separately in this study as a control group. So a total of 68 respondents were contacted for the study. The primary data were collected for 6 months in the year 2017. Hematological parameters were analyzed using standard methods. Results: The mean Hb level in smokers was less than that of the nonsmokers and it was significant at 5% level (p<0.05). Regarding the differential, count means eosinophil and polymorph values were high in the smokers but the lymphocyte value was less in smokers and these changes were significant at 1% level (p<0.01). The WBC-Total count and the ESR value changes were nonsignificant. Conclusion: Effects of smoking on alterations of the hemostatic and fibrinolytic system, antioxidant status and hematology parameters were extensively studied, but the studies presented inconsistent results. The present study was conducted to compare the effect of cigarette smoking on some hematological parameters between smokers and age-matched non-smoker controls.

44-47

Authors: Mirunalini S

Background: New-born acquires mother’s microbiome from the birth canal during the delivery process and these bacteria then colonize in the gut. Studying the oral microbiome of infants offer a good perspective for us to understand the gut microbiome disruption caused by C-section. A previous study of three-month-old infants reported a higher amount of bacterial taxa of the oral microbiota in vaginally delivered infants than the ones with another birth mode. Aim: Comparison of microflora between the birth canal and the oral cavity of a newborn in Caesarean delivery. Materials and methods: 30 pregnant women selected for the study. Parturient canal samples obtained prior to delivery and infant’s oral cavity oral samples obtained immediately after birth. Samples transported to the lab for microbiological assays and data tabulated and statistically analyzed using Chi-Square Test. Results: E.coli was observed in 21.1% (N=7) in the vaginal swab whereas its occurrence in buccal smear was 10.3% (N=3). The chi-square test of independence was statistically insignificant (p> 0.05). The staphylococcus was observed in 44.8 (N= 13) of vaginal swab and 37.9% (N=11) of buccal smear and again the difference was statistically insignificant. The presence of pus cells was 31% (N=9) in vaginal swab and 10.3% (N=3) in the buccal smear. Conclusion: A significant number of mother-child pairs showed the presence of Staphylococcus aureus, Klebsiella, and E.coli. However, Klebsiella and pus cells were occasionally found.

54-57

Authors: R. Manimozhi Malathi, S. Ramesh, R. Aravind Kumar

Background: Most existing accounts of hemoglobin values in healthy premature infants covering the early weeks of life were written before many of the errors of such determinations were recognized. Because of these limitations, it was decided to review the normal values for the first three months of life. The results were compared with a small series of readings made on a group of healthy, full-term infants. Aim: To compare hemoglobin and packed volume levels in term and preterm babies. Materials and methods: Sixty pregnant women who came from in and around Chidambaram who fulfilled the inclusion criteria during the period from July 2001 to March 2002 were included in this study. Among them, 50 delivered at term (37 to 42 weeks) and the rest delivered prematurely (< 37 weeks). Hemoglobin and packed cell volume as measured by standardized technique. The results were analyzed accordingly. Results: The estimated mean hemoglobin concentration of the term babies was 10.88 gm% with the standard deviation of 1.5 gm%. For preterm babies, the mean hemoglobin concentration was 10.33 gm% with the standard deviation of 2 gm%. The mean calculated packed cell volume (PCV) of the term babies was 34.03% and the standard deviation was found to be 5%. The mean packed cell volume of the premature babies in the present study was found to be 32.75% with the standard deviation of 6.5%. Conclusion: Anemia of prematurity is a multifactorial anemia characterized by low levels of erythropoietin (EPO), iatrogenic blood loss, low circulating blood volume and lack of erythropoiesis. It is a problem due to the high incidence, associated symptoms and increased transfusion requirements. It is a normochromic normocytic anemia hypo-regenerative that occurs between the 2nd and 6th weeks of age in premature infants with gestational age (GA) up to 35 weeks.

63-66

Authors: Balaji Swaminathan, Prem Nivas, Ruta Shanmugam, Shanmugam V.U.

Background: Tympanoplasty refers to any operation involving reconstruction of the tympanic membrane and/or the ossicular chain. Myringoplasty is a Tympanoplasty without ossicular reconstruction. Chronic otitis media is one of the commonest Otological problems among Sudanese, in both adult and children (43%) and they presented with perforation of the eardrum and different degrees of hearing loss. Aim: To evaluate the audiological and surgical results of tragal cartilage graft in myringoplasty for reconstruction of tympanic membrane perforation. Materials and methods: A total of 25 patients in the age group of 16 - 60 years suffering from chronic suppurative otitis media of tubotympanic type, attending the outpatient department at Rajah Muthiah Medical College and hospital and underwent tragal cartilage myringoplasty between October 2015 to August 2017 were included in the study. Results: The mean preoperative pure tone average was 37 and the postoperative pure tone average was 25.80 at 6th week and 15.60 at 10th week. The calculated p-value was less than 0.001 which was statistically significant. Graft uptake was 92% in our study. There was no postoperative retraction. Postoperative reperforation was seen in 2 (8%) patients. Conclusion: Graft takeup in tragal cartilage myringoplasty has been excellent, hearing results are satisfactory and complications are minimal. Immobility of the transplant during the early stages of the healing process is the most important factor for the successful surgical outcome of myringoplasty.

74-82

Authors: V. Suvarna, M. Niharika Reddy

Background: Fetal distress in labour is a common occurrence and is of great concern. Evaluation in early labor which could predict the risk of fetal distress could aid in the management of labour. Aim: The purpose of the study was to determine the value of routine intrapartum amniotic fluid assessment on perinatal outcome. Materials and methods: Study was done on 240 admitted patients in labou. They had an intrapartum AFI determined by four-quadrant technique subsequently these patients delivered during the same hospitalization. AFI determined was graded as Oligohydramnios was defined as AFI ≤ 5 cm (n = 48), Borderline as AFI 5.1- 8 cm (n = 50), Normal as AFI 8.1-24 cm (n = 142) and Women with AFI > 24 cm were not included in the study. The three groups were compared with regard to intrapartum and postpartum variables. Results: In present study, 20% of women were in oligohydramnios group, 21% in borderline group and 59% in normal group. Hence, the cesarean section rate for fetal distress was 54% in oligohydramnios and 28% in borderline group. The incidence of instrumental delivery for fetal distress was 12% in oligohydramnios and 14% in borderline. The incidence of APGAR score < 7 at 1 min and 5 min in oligohydramnios and borderline group were respectively 54%, 35%; and 30%, 14%. The incidence of birth weight <2500 gms in oligohydramnios group was 37% and borderline was 24%. NICU admissions in oligohydramnios group were 40% and 8% in borderline group. The percentage of neonatal deaths among oligohydramnios group was 4.2% and nil in borderline. The efficacy of intrapartum determination of oligohydramnios predicting cesarean delivery for fetal distress gave a sensitivity of 64%, specificity of 89%, positive predictive value of 53% and negative predictive value of 93%. Conclusion: Intrapartum detection of oligohydramnios is a valuable screening test for subsequent fetal distress requiring cesarean delivery.

91-98

Authors: Nived Rao, M. Muralidhar, M. Srinivasulu

Background: Differentiated thyroid carcinoma, arising from thyroid follicular epithelial cells, accounts for the vast majority of thyroid carcinomas. Of the differentiated cancers, papillary cancer comprises about 85% of cases compared to about 12% that have follicular histology, including conventional and oncocytic (Hurthle cell) carcinomas, and <3% that are poorly differentiated tumors. In general, stage for stage, the prognoses of PTC and follicular cancer are similar. The aim of this study is to evaluate the benefit of central compartment lymph node dissection in accurate staging of the disease and plan radioiodine treatment and dosing. And also to assess the morbidity associated with central neck dissection. Materials and methods: This was a prospective clinical study conducted at MNJIO and RCC, Hyderabad. 20 patients with carcinoma thyroid who underwent total thyroidectomy and prophylactic central compartment lymph node dissection from December 2015 to December 2017 were included. The protocol was submitted to the ethics committee at Osmania Medical College and was approved. Results: We analyzed the number of patients of that age in whom the disease stage changed due to the presence of central nodal dissection. Prophylactic CND resulted in upstaging of tumour in 2/20 (10%) patients from stage I to stage II. Also in 4/20 (20%) patients, the evidence of node metastases influenced also the therapeutic strategy because these patients would not have been treated with 131-I if the prophylactic central neck dissection had not been performed. Thus a prophylactic CLND may play an even larger role in determining RAI use. A prophylactic CLND that demonstrates a lack of lymph node metastasis would strengthen the case not to use RAI treatment in a low-risk patient. Conclusion: With the available evidence, we advocate a selective approach to performing prophylactic CND and to be done in high volume centres. Routine prophylactic central lymph node dissection should be avoided in the absence of involved lymph nodes, reserving the procedure to “high-risk” patients as defined by ATA and European Society of Endocrine Surgeons, which include extremes of ages, large primary tumor size, and male gender, which were similar to high risk cases seen in our study.

105-117

Authors: Sreedevi Porika, T. Venkata Naga Lakshmi

Background: Laparoscopic surgeries being minimally invasive surgeries are associated with a relatively minor surgical trauma. Excessive pain, nausea and vomiting and fatigue will delay the discharge. Bupivacaine and Ropivacaine, the long acting Local Anaesthetics when given intraperitoneally provide effective pain relief when the pain peaks within 4-6 hours of surgery. Aim: To compare the efficacy of intraperitoneally nebulised Ropivacaine 0.75% and Bupivacaine 0.5% for postoperative analgesia in Laparoscopic surgeries. Materials and methods: This study was a double blinded randomised controlled trial in ASA grade I and II patients” was conducted in 60 patients of both sexes, of age group 20-45 years. They were randomly divided into two groups of 30 patients each: Group R (Ropivacaine) – received intra-peritoneal nebulization of Ropivacaine 0.75% 4 ml (30 mg) after the placement of umbilical port and Group B (Bupivacaine) – received intra peritoneal nebulization of Bupivacaine 0.5% 4 ml (20 mg) after the placement of umbilical port. Results: There was no significant difference in age and weight between the two groups. Intra-operatively statistically significant differences were observed SBP - At 15 and 30 min post nebulization and at extubation. No significant differences were observed with respect to DBP and HR. Postoperatively DBP and HR differences were found to be statistically significant at 4th post-operative hour. There were no statistically significant differences in SBP and MAP between both the groups. Dynamic VAS scores were statistically significant at extubation and in first 6 hours and not significant at 24 hours between both the groups. Static VAS scores were not statistically significant at all times compared between both the groups. Mean Time for first rescue analgesic requirement was 8.23+0.511 hours in group R vs.7.59+0.52 in group B and was statistically significant (p=0.0001). Mean total rescue analgesic required was 95+33.3 mg Diclofenac in group R vs. 112.6+38.4 in group B with 26% of group R requiring 2nd dose of rescue analgesic and 50% of patients in group B required 2nd dose and was not statistically significant. Mean time for unassisted ambulation was 12.8+0.61 hours in group R vs.13.16+0.6 hours in group B which was not statistically significant (p=0.52). Conclusion: From the present study, it is concluded that both Bupivacaine and Ropivacaine are safe and similarly efficacious in reducing postoperative pain following intra-peritoneal nebulization in laparoscopic surgeries.

122-124

Authors: Mirza Asif Ali Beigh

Unusual root canal anatomy always poses challenge in successful endodontic management. One such case report is of S-shaped or Bayonet shaped root canal. It is always demanding to manage root canal with double curvature. The study is an attempt to focus on the significant work involved to manage root canal with double curvature.

129-132

Authors: Payal Desai, Swapan Goswami, Chandani Krishnani

Endometrial uterine sarcoma is a very rare tumour of the uterine cavity with an incidence of 1-2 cases per 100,000 women. Low grade Endometrial stromal sarcoma (LGESS) is an occasional diagnosis in a patient presenting as leiomyoma uterus. The symptoms are nonspecific, mostly abnormal uterine bleeding in perimenopausal women. Clinically and radiologically it is difficult to diagnose this entity. Histopathological examination and immunohistochemistry confirmed the diagnosis of LGESS. In addition of surgery chemotherapy, radiotherapy and immunotherapy treatments will be quite useful in all cases of LGESS. This case report of Low grade Endometrial stromal sarcoma (LGESS) is presented here because of its rarity.