International Archives of Integrated Medicine

1-6

Authors: Mayuri Prasad, Toshi, Rajat Sehgal, Manisha Mallik, Aaysha Tabinda Nabi, Sneha Singh

Background: Saliva is complex fluid maintaining microbiological flora and oral hygiene. It has varying composition and has diagnostic and prognostic value. The present case-control study was aimed at finding the association between salivary pH and periodontal disease. Materials and methods: Three groups consisting of persons with healthy gingiva, persons with generalized chronic gingivitis and those with generalized chronic periodontitis were studied. Results: It was seen that the saliva of patients suffering from chronic generalized gingivitis was alkaline in nature while that of patients with chronic generalized periodontitis was acidic when compared with health individuals. The difference between the groups was significant (p=0.00). Conclusion: Salivary pH can have prognostic value for periodontal disease.

13-22

Authors: Kannaiah B, Radha Mohan M, Snigdha, Sharada

Background: Breastfeeding is the healthiest way to feed a baby. Like mothers love there is no substitute for breast milk. Despite of benefits of breast feeding, the breast feeding incidence and the duration of exclusive breast feeding all over world is not satisfactory. In India though breastfeeding is almost universal, the prevalence of exclusive breastfeeding as per WHO recommendation is not up to the expectations. Over one million infants worldwide die every year because they are not breastfed or because they are given other foods too early. The determination of indicators and variables related to exclusive or overall breastfeeding duration can be a valuable instrument when planning local actions and policies aimed at improving breast feeding rates. Aim: To assess the knowledge, attitude and practices of mothers regarding breast feeding and to determine the impact of lactation counseling to mothers around the time of delivery on breast feeding practices. Material and Methods: Our study was a single center cross sectional questionnaire based study conducted in a Teaching Hospital in Telangana state in India. Duration of study was from October 2016 to September 2018. It was conducted upon 600 (n=600) women i.e. Expectant mothers admitted in antenatal wards and mothers in labour room and postnatal wards of our hospital, who were otherwise healthy. These women were randomly divided in to two groups Group A and Group B. Group A (n=300), Women interviewed after delivery with a preset questionnaire which included 22 questions pertaining to knowledge, attitude and practices of breastfeeding. For Group B (n=300), women brief counseling was given just before delivery in the antenatal wards or in the labour room. Counseling was done by women who were appointed as support staffs under NRHM. These women were given basic training on ideal breastfeeding practices as per Infant and Young Child Feeding (IYCF) guidelines by SNCU pediatricians in our hospital. Mothers in Group B were also interviewed with the same questionnaire by the same interviewer after delivery. The data from the questionnaire of the two groups were analyzed and compared using open EPI INFO statistical methods. Results: Early initiation of breast feeding was observed in 88 % (252-mothers) of Group B compared to 67 % (201-mothers) in Group A. Among the literate women 75% (98-mothers) of Group A and 94% (138-mothers) of Group B women followed early initiation of breast feeding where as in illiterate women early initiation was noticed in 31% (92-mothers) of group A and 41%(114-mothers) of group B mothers. Media played minimal role 16% (48 mothers) of group A and 9% (12 mothers) in group B in encouraging breast feeding. Support from family members & hospital staff had positive influencing on breastfeeding in the groups. 71% (213) of Group A and 89 % (254) of Group B mothers felt breast feeding should be continued for two years and beyond. Conclusion: It revealed that mothers, in virtually all cultures and communities, have considerable knowledge and experience related to all aspects of maternal and child development, and that they have a strong commitment to promoting the well-being of children, their mothers, and families. ‘To have enduring effects, interventions must have an impact on social norms’. In particular, in households in traditional societies around the world, older women or grandmothers play a leading role in decision. They also serve as the primary caregivers of women and children and will continue to play-important role in mother and child health. Thus early initiation of breast feeding, antenatal counseling, educating other family members and support of media etc. will have major role in promoting exclusive breast feeding.

28-33

Authors: Sangeetha Meena, Manikandan R.C.

Introduction: The burden of diabetes mellitus (DM) is on the rise especially in developing countries like India. Due to its chronic nature DM tends to cause many debilitating complications and diabetic peripheral neuropathy (DPN) is one of them. The aim of this study is to determine the prevalence of DPN among patients attending a tertiary care hospital and to identify the determinants associated with it. Materials and methods: A cross-sectional study was conducted in diabetic patients attending a tertiary care hospital in Kancheepuram district of Tamil Nadu from May 2018 till September 2018. A total of 203 diabetic patients were asked to respond to the patient history version of Michigan neuropathy screening Instrument and examinations were conducted after obtaining consent from them. The data were analyzed in terms of descriptive statistics as well as bivariate analysis. Results: The prevalence of DPN using the MNSI history version and MNSI examination were found to be 31% and 24% respectively. The major determinants were found to be age more than 50 years (OR: 0.24, CI: 0.123- 0.467), P<0.00001, HbA1C > 6.5 (OR: 0.467, CI: 1.90 – 0.356, P= 0.05). Conclusions: This study showed that the prevalence of peripheral neuropathy among diabetic patients was 41.5% and the major determinants were age more than 50 years and poor HbA1C control. Early detection through routine screening and regular follow up examinations will reduce the burden of disability among diabetics and improve their quality of life significantly.

44-47

Authors: Priyanka Poonam

Background: The pap smear is the screening test for the detection of premalignant lesion of the cervix. It should be done annually in all women of age 35 years and above. Pap smear screening of cervix can significantly reduce the deaths due to cervical carcinoma. Materials and methods: This was a prospective and descriptive study done for the period of 6 months from February 2018 to July 2018. A total of 158 women above the age of 21 years and married were included in the study. A Pap smear test was done after clinical examination in all women and sent to the department of Pathology of our tertiary care centre for cytopathological examination. Results: There were 150 cases with inflammatory smear, 2 cases of ASCUS, 3 cases of LSIL and 3 cases of HSIL. Women who were positive for ASCUS, LSIL and HSIL underwent colposcopy and guided biopsy. Most women with inflammatory smear were of age group 20-40 years, 2cases of ASCUS were of ages 35 years and 38 years, 3cases of LSIL were of age group 35-45 years and 3 cases of HSIL were of age group 45-55years. Conclusion: Thus cervical cancer is a preventable cancer if regular Pap smear screening test is done. It is simple, cost effective, non-invasive and easy to perform screening test for precancerous lesions of cervix.

53-57

Authors: Rajesh Prasad, Kumari Renu, Amit Kumar Anand, Arvind Kumar

Background: Spontaneous bacterial peritonitis is a fatal complication of liver cirrhosis. Ascitic fluid culture is positive in half of the cases. Materials and methods: The present cross-sectional study was conducted upon the patients admitted in Medicine ward of VIMS, Pawapuri. Bacterial examination of ascitic fluid, culture and antibiotic sensitivity was done. Results: 47.2% of SBP cases were culture positive. E. coli (46.2%), Klebsiella (26.9%), Acinetobacter (7.7%) and Pseudomonas aeruginosa (3.8%) were the common organisms isolated. Conclusion: As half of SBP cases have positive culture, ascitic fluid culture and antibiotic sensitivity testing is essential in such cases.

62-68

Authors: Lavanya V, Pavani P, Kailasanatha Reddy B

Background: Vulvovaginal candidiasis is a global issue of concern due to its association with economic costs, sexually transmitted infections, and ascending genital tract infection leading to several complications in both pregnant as well as non-pregnant women. It is second to bacterial vaginosis affecting approximately 50–72% of women of reproductive age group. Resistance to antifungal agents has increased during the last decade. Thus, identification of Candida up to species level and its antifungal susceptibility testing is essential in the management of Candidal infections. Aim: To determine the prevalence of various Candida species among vaginal candidiasis and to determine the antifungal susceptibility pattern of the isolates. Materials and methods: A total of 56 Candida species were isolated from 200 clinical diagnosed cases of vaginitis over 6 months period. Growth on Sabouraud dextrose agar were evaluated according to standard protocol and further processed for Candida speciation on CHROM agar. Antifungal susceptibility testing was performed using the Etest method as recommended by Clinical and Laboratory Standards Institute (CLSI) M27-A3 document. Results: Out of 200 vaginitis patients, 56 were positive for Candida species. All the isolates were speciated comprising four species – C. albicans 24 (42.8%), C. krusei 20 (35.7%), C. tropicalis 7 (12.5%), and C. glabrata 5 (8.9%). Antifungal susceptibility testing result of all Candida isolates were 100% susceptible to amphotericin B, nystatin and voiconazole. C. krusei and C.glabrata isolates were showed 100% resistance to fluconazole and ketoconazole respectively. Conclusion: In the present study, C. albicans was most common species followed by C. krusei. Presumptive identification followed by confirmation of Candida species helps to initiate early appropriate antifungal treatment. The relatively higher resistance shown by Non-abicans Candida species to commonly prescribed antifungals (fluconazole and ketoconazole) emphasizes the need for routine antifungal susceptibility testing of all Candida isolates.

74-78

Authors: Prabhat Ranjan, Md. Arif Ansari

Background: Bowel perforation is an important cause of acute abdomen. It carries high morbidity and mortality. Materials and methods: The present descriptive study included 48 patients with ileal perforation admitted at the department of surgery. Data regarding clinical features, management and complications was noted. Results: Mean age of the patients was 34.4 ± 8.8 years with male preponderance. Abdominal pain and distension (100%) and constipation (87.5%) were the common symptoms seen. Single perforation was commoner (64.6%) than multiple perforations. It was caused by typhoid in 39.6% cases, due to tuberculosis in 16.7%, due to injury in 10.4% and other causes in 33.3% cases. Surgical site infection was the commonest complication. Conclusion: Ileal perforation is caused by typhoid or tuberculosis in majority of the cases and presents with pain abdomen and distension. Rates of infection are high in these cases.

87-95

Authors: Ebenezer Joel Kumar E, Bridgit Merlin J, Anu Asheetha R

Background: The most important duty of an anesthesiologist is to protect the patient’s airway and to provide adequate ventilation. The anesthesiologist should be skilled enough to make decisions at the circumstances of difficult intubations. We compared the success rate of blind tracheal intubation through two different supraglottic airway devices, I-GEL and ILMA using PVC endotracheal tube. We studied the complications in both the techniques. The aim of the study: To compare the advanced I-GEL, to ILMA as a conduit for blind endotracheal intubation for patients posted for elective procedures under general anesthesia. Materials and methods: A Prospective randomized study was conducted in 80 adult patients who undergone elective surgery under general anesthesia. They were divided into 2 groups- each group included 40 patients. Group A - I-GEL, Group B- ILMA. We noted the Ease of insertion, Duration of successful attempts, No. of failed attempts, Total intubation time and First attempt success rate. We recorded Heart rate, Blood pressure, Pulse oximetry, EtCO2 and Complications of I-gel and ILMA insertion. Results: Supraglottic device insertion time (15.62s vs 17.17s) and Supraglottic device removal time (15.82s vs 16.55s) were the least I-GEL group. The first attempt success rate for tracheal intubation (87.5% vs 60%) and Success rate for insertion (95% vs 72.5%) were high in the ILMA group. There was no statistical difference in Total intubation time, Complications, Hemodynamic response to intubation, No. of attempts for supraglottic device insertion and Time for first attempt tracheal intubation. Conclusion: We concluded I-GEL aids easy and rapid insertion as a supraglottic airway device, but when it is used as a conduit for blind endotracheal intubation, the failure rate is high as there is more incidence of oesophageal intubation. On the contrary, ILMA being a gold standard device meant for intubation guide has a high first attempt success rate for blind endotracheal intubation.

102-107

Authors: Mamta Singh, Ila Bhattacharjee

Background: Hypothyroidism is one of the leading endocrine problems worldwide. Prevalence of high rates of subclinical hypothyroidism has been found in hilly areas. It leads increased risk of cardiovascular diseases, dyslipidemia and proneness to fractures. Materials and methods: The present cross-sectional study was conducted upon female patients above the age of 18 years attending OPD and thorough clinical and biochemical evaluation of thyroid disease was done. Results: 67.1% of the females were euthyroid. 27.2% suffered from hypothyroidism of which 9.1% was overt and 18.1% was subclinical in nature. Prevalence of subclinical hypothyroidism was higher when the age advanced. Conclusion: The prevalence of subclinical hypothyroidism is high in this area.

114-120

Authors: Vijaya Kumar Vasa, Sadhna Sharma, Rakesh Nukasani, Srivani Gulleli, Phani Kumar Reddy

Introduction: Pancytopenia is characterized by a decrease in the red blood cells, white blood cells along with the platelet count below the normal levels. It can be due to a number of pathologic mechanisms, depending on the geographic location. Early diagnosis and treatment are crucial in the management of pancytopenia. There are very few studies regarding the clinic-pathological profile of such patients. Materials and methods: A cross-sectional study was undertaken at NRI General Hospital, Chinakakani. All eligible participants more than 13 years of age were included. Data collection was done from August 2016 to August 2018. A thorough history taking along with clinical examination and laboratory investigations were performed among the study population. Data was analyzed using SPSS version 13. Results: The most common finding suggestive of etiology was megaloblastic anemia at 38.4%, which was more common among females. Aplastic anemia was the second most common finding at 24.6%. Other diagnoses included hypersplenism, myelodysplastic syndrome and acute leukemia. Fever and pallor were the most common presenting symptoms. Blood examinations demonstrated anisopoikilocytosis, hypersegmented neutrophils, erythroblasts, macrocytes and reticulocytes, which were found in differing proportions in the various etiological diagnoses. Conclusion: It is noteworthy that megaloblastic anemia, a reversible condition, is common in India compared to the higher occurrence of aplastic anemia and myelodysplastic syndrome in developed nations. Clinical alertness and suspicion can assure early diagnoses and treatment can prevent complications and reduce the burden. The need for more standard management protocols is immediate.