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.

1-7

Authors: Bharat Lochan, K. Babu Raj

Background: Myocardial Infarction accounts for 20% of all medical emergency admissions and has the highest risk for adverse effects and deaths. Risk of CAD could be prevented by various strategies and most of the developed countries could reduce the incidence and mortality related to CAD especially Myocardial Infarction by various preventive methods. Cystatin-C thus acts as an independent risk factor for Myocardial Infarction and heart failure. Aim and objective: To estimate the Serum level of Cystatin-C in Acute Myocardial Infarction with normal renal function Materials and methods: The study included 40 patients admitted in the medicine ward of RMMCH. The study period was from February 2018- July 2018. Patients with acute coronary syndromes were identified over a period according to the criteria and were included in the study. Primary complaints like angina, dyspnea, symptoms of cardiac failure were recorded. Risk factors for coronary artery disease like diabetes mellitus, systemic hypertension, smoking, hyperlipidemia, renal failure, and other complaints if any were noted. Clinical examination included a detailed general examination including vital signs and systemic examination of cardiac, respiratory, gastrointestinal, and nervous systems. 2 ml of blood was withdrawn from all patients within 12 hours of onset of symptoms for measuring Cystatin-C. Results: The common age was 52 to 59 years (47.5%) and 45 to 51 years (45.0%). The mean age of the study patients was 51.10 ±5.47 years. The majority of the patients had ST-elevated MI (N=27, 67.5%). Among STEMI, 14 patients were AWMI (N=14, 51.9%) IWMI- STEMI was identified in 18.5% patients. Likewise, posterior wall MI-STEMI was the diagnosis for 18.5% and Inferior-lateral-STEMI was the feature for 11.1%. The mean Cystatin-C for STEMI was 1.24 + 0.26 whereas it was 1.38 ± 28 for NSTEMI. The difference was statistically insignificant (t=1.46, p=151). The overall Cystatin-C Mean was 1.29 ± .27, which was higher than the normal level. The correlation of Cystatin-C with LV function is poor (r = .181, p=26). The relationship was weakly positive and insignificant. That was when Cystatin ‘C’ was more, LV function was less and vice-versa. The correlation of Cystatin-C with TIMI was negative i.e. when Cystatin was more, TIMI was less and vice-versa but the relationship was poor (r=.126, p = .44) and insignificant. Conclusion: Cystatin-C plays an important role in the pathogenesis of Acute Myocardial Infarction, and one of the mechanisms is thought to be that Cystatin-C facilitates the progress of atherosclerosis by regulating inflammation. Cystatin-C is less influenced by age, gender, and muscle mass and thus may be a better indicator of cardiovascular risk especially Myocardial Infarction.

16-22

Authors: Janak Chokshi, Kothi Zuber Suleman, Bhavikkumar Prajapati

Background: In developing countries, the widespread use of organophosphorus compounds (OPCs) has been accompanied by increasing incidence of poisoning with these agents, both suicidal and accidental. This is attributed mainly to their easy availability, indiscriminate handling, storage and lack of knowledge about the serious consequences of poisoning. Of the various substance used for suicidal attempts in India, OPCs form a significant group. Since the clinical manifestation of OPC poisoning is diverse ranging from mild symptoms to fatal complications in the course of time, we need proper management of the situation. Materials and methods: We studied 50 patients of organophosphorus poisoning. We checked vital parameters, general examination and systemic examination. We also checked for various parameters on like cholinesterase level, complete blood counts, renal function test with electrolytes, liver function test. Results: In this study majority of patients fell in 20-30 years of age group with male predominance from lower and middle socio-economical class and most common reason was suicidal. Precipitating event were domestic problem, marital friction and financial problem. Most common clinical features were vomiting, miosis and giddiness. Majority of the patients belonged to mild grade. The average S.cholinesterase level was low as severity increases. More doses of PAM and atropine are required in severe poisoning. Most common complication was respiratory paralysis. Death was more in severe poisoning. Conclusion: OPC is one of the most common poisoning in India. Reason for poisoning is most commonly suicidal. It is common in male with low socio-economical class mainly due to domestic problems, financial issue and unhappy married life. In patients of OP poisoning presenting symptoms and S.ChE level directly correlated with severity. Therapeutic required dose of PAM and atropine are different in different grade of severity. Survival amongst patients is definitely better if atropine and PAM are being given with Mechanical ventilator support in cases of respiratory insufficiency.

30-34

Authors: Nageshwari A, G. Kavitha

Background: Hypothyroidism is the most common pregnancy-related thyroid disorder, affecting 3–5% of all pregnant women. Pregnant women are often iron deficient, and iron deficiency has adverse effects on thyroid metabolism. Impaired maternal thyroid function during pregnancy may cause neurodevelopmental delays in the offspring. Iron deficiency is frequent during the first trimester of pregnancy and associated with a higher prevalence of thyroid autoimmunity, higher serum TSH and lower fT4 levels. Anemia is a decrease in the number of red blood cells (RBC's) or less than the normal quantity of hemoglobin in the blood. Anemia can have several reasons, such as abnormality of the formation and reduction on the half-life of the red cells. Aim of the study: To evaluate the thyroid status in second-trimester antenatal cases. Materials and methods: Totally 60 female patients were included in the study. Group-1(30) pregnant women with hypothyroidism. Group -2(30) pregnant women without hypothyroidism. The study was conducted from July – November 2018 over a period of 6 months at OG Department of DSMCH, perambalur. Ferritin levels were estimated in 60 female patients newly diagnosed patients of hypothyroidism using chemiluminescence technique (advia centaur cp). Total T3 and T4 levels were estimated using radioimmunoassay. Free T3, T4, and thyroid-stimulating hormone (TSH) levels were estimated using chemiluminescence. These were then compared with age- and sex-matched healthy controls. Results were correlated statistically. Results: Serum ferritin levels were found to be significantly reduced in pregnant women with hypothyroidism compared to normal pregnant women (p < 0.001). Conclusion: Complications that may occur during pregnancy and delivery could be due to low thyroid function, but was not able to be clearly proven in this study. Although prior or early-pregnancy testing for iodine level and thyroid function can help early identify iodine deficiency and thyroid disorder, justifying a general screening will require further studies with multicentre-recruitment and ante-natal clinics involvement.

41-47

Authors: Sharanabasappa Algoodkar, Sunitha G

Background: The most serious and frequent mental disorders worldwide is depression. Depression is also known for second major cause of morbidity after cardiovascular disease throughout the world by 2020 as predicted by the World Health Organisation. Various treatment options are available for treating depression which includes pharmacological and non-pharmacological. Non-pharmacological treatment options like yoga, meditation and music therapy are gaining importance. Objectives: To assess the efficacy of music therapy in reducing the severity of depression using 10-item, clinician administered Montgomery-Asberg Depression Rating Scale (MADRS) among depression patients. Materials and methods: Music therapy was administered to depression patients weekly two sessions for one hour duration over a period of 2 months. The impact of this was measured by using MADRS rating scale. Results: The mean score of depression as assessed by MADRS was reduced significantly from 32.90±14.16 to 2.00±1.76 (P<0.05). Conclusion: Music therapy with Indian classical music is beneficial in alleviating the severity of symptoms of depression among depression patients.

58-64

Authors: Kiran Grandhi, Kokiwar PR

Background: Studies are required to establish the utility and safety of use of the procedure of the flexible bronchoscopy under various circumstances and the various settings. Aim: To study outcome of pediatric non resolving pneumonias with the aid of pediatric flexible bronchoscopy Material and Methods: Present study was hospital based prospective study. We selected 100 cases in 1 year to 8 years age group, with radiological features persisting after 3 weeks of optimal antibiotics, their sputum for AFB, and gastric lavage for AFB was negative, sputum culture was sterile. We did pediatric flexible bronchoscopy (Olympus BF3C30, outer diameter of 3.2 mm), under short general anesthesia. All the procedures were uneventful, no reported morbidity or mortality after the procedure, Followed after the procedure till radiological shadows disappear. Results: The most common finding of the flexible bronchoscopy was normal airway anatomy – with thick mucopurulent secretions was found in 55% of the cases. In the normal airway anatomy – with thick mucopurulent secretions, 20 showed TB gene positive. In the normal airway anatomy with thick mucus plug obstructing total lumen of affected air way was sterile in all 18 cases. Foreign body impacted in bronchus in 12 cases. Mediastinal lymph node compressing main stem bronchus was identified in 6 cases. Conclusion: Paediatric flexible bronchoscopy is very useful investigation in non-resolving pneumonias.

70-75

Authors: R Abraham Jebakumar, Sriramchristopher M

Background: Perforation of terminal ileum is a cause for obscure peritonitis with severe toxic state, there may be obscured clinical features with resultant delays in diagnosis and adequate surgical intervention. The objective of this study was to evaluate the clinicopathological characteristics in Ileal perforations because of confusion and controversy over the diagnosis and optimal surgical treatment of terminal Ileal perforation -a cause of obscure peritonitis. Materials and methods: Patients underwent emergency explorative laparotomy for hollow viscus perforation surgery in general surgery department was included in present study. Edge biopsy specimen was sent to histopathological examination. All patients were tested for widal positivity and were started on anti- salmonella treatment if it was positive. Based on intra- operative finding and histopathological reports, ATT was started for those who are positive for tuberculosis. All patients were monitored in the post-operative period for complications. All patients were followed up for a period of six months. Results: A total of 60 patients with Ileal perforation were included in the study of which 50 were males and 10 were females accounting for 83.33% and 16.67 % respectively. The most common symptom was pain abdomen which was present in all the patients (100%). The next common symptom was vomiting seen in 44 out of 60 patients (73.33%) followed by fever seen in 38 out of 60 patients (63.33%). Absent bowel sounds was found in 36 out of 60 patients (60%). Air under diaphragm on erect X-ray abdomen was found in 56 patients (93.33%). Conclusion: Bacterial culture and tissue histopathology though confirmatory are time consuming, and immunological tests are expensive. And administration of ATT helped to treat the patients successfully. A high index of suspicion for intestinal tuberculosis is needed in patients who are on immunosuppression.

83-88

Authors: Kiran Grandhi, Jayasri Helen Gali, Kokiwar PR

Background: To obtain the good amount of specimen by biopsy for proper diagnosis, thoracoscopy is a very good tool. Using thoracoscopy the diagnostic accuracy can reach 100% whereas the diagnostic accuracy of the closed pleural biopsy is around 51-79%. Aim: To study role of thoracoscopic pleural biopsy in low Adenosin DeAminase pleural effusions. Material and Methods: A hospital based cross sectional study was carried out among 50 study subjects aged > 45 years. All were cases of pleural effusion. Thoracoscopic pleural biopsy was performed in all cases. The samples were sent for histopathology after biopsy. Results: Majority of the study subjects were found to be in the age group of 45-55 years i.e. 60%. Males outnumbered females as the pleural effusion may be more common in males above the age of 45 years than among the females. Tuberculosis was more in females (60%) than males (40%). But malignancy – adenocarcinoma spreading to pleura was more common in males (90.5%) than females (9.5%). Only one female was found to have Meigs syndrom (ovarian tumor with secondaries pleura). Mesothelioma was seen in three cases and all of them were males. Normal histopathology finding was seen in five cases and all of them were males. It has been documented that pleural effusion due to tuberculosis was more common in females in the present study. Conclusion: Thoracoscopic pleural biopsy diagnostic yield is high. Low ADA level in pleural fluid does not rule out kochs, incidence more in females.

96-102

Authors: Sasi Kumar Jonalagadda, Subith Kumar Kilari, Srilakshmi, Ramakrishna Reddy YV

Introduction: It has been scientifically established that α1-adrenergic antagonists cause inhibition of the basal tone, peristaltic frequency, and contractions in the lower ureter. Earlier studies have shown promising results with Tamsulosin (α1-adrenergic antagonist) helping in spontaneous passage of Ureteral stones. Hence this prospective randomized double-blind placebo-controlled study is taken up to establish the real impact of Tamsulosin a specific alpha blocker (α1-adrenergic receptors) in expelling distal ureteral stones. This study aimed to include 80 patients with ureteral stones of less than 5 mm and more than 5 mm in size located in the distal ureter. Materials and methods: In the Present study, informed consent was obtained from all 80 patients and the study was conducted after institutional ethical committee approval. Patients are randomized to two groups to receive Tamsulosin and placebo along with analgesics whenever required. Patients were followed up for a period of one month to study the stone expulsion rate, drug side effects and pain episodes. Results: All 80 patients complied with prescribed treatment schedules except 4 patients in placebo group and 2 in study group who were lost to follow up. At the end of 4 weeks, stone expulsion was seen in 30 out of 38 (79% patients in study group and 20 patients out of 36 (56%) in placebo group. The stone expulsion time was shorter in the study group (6.2±3.2 days) and in 9.67±5.4 days for placebo group. No significant impact on the expulsion rate was seen in relation with age, gender and ureteric stones present either in right side or left side. The frequency of pain episodes was almost same and mild in both groups. Conclusion: Tamsulosin is safe and effective drug to enhance spontaneous passage of smaller stones present in distal ureter.

109-111

Authors: S. Vijayalakshmi, V. Katheresan

Background: Acute intestinal obstruction is an enigma with its versatile presentation and wide spectrum of management options available. It presents a constant challenge to the surgeon both in diagnosis and in judgment as regards the line of management for that specific patient, for those specific parameters and for that specific moment in the course of the disease. Materials and methods: This was a facility based retrospective study involving all patients diagnosed as intestinal obstruction clinically, radiologically, and pathologically. The relevant data shall be collected by using detailed case history/previous surgery, symptoms, signs, investigations like complete hemogram, liver function test, radiological, and intra operative findings. Results: In our setup, there was higher incidence of intestinal obstruction among males (28 – males, 12 – females). As far as age distribution was concerned the age range was 14-72 years and most common occurrence between 30 to 60 years. Most common cause of intestinal obstruction was band/adhesion followed by irreducible hernias (inguinal/ umbilical/ incisional/ epigastric)/ malignancy etc. Commonest symptom in our study was pain followed by vomiting, distension, and constipation. Abdominal tenderness, tachycardia, with hyper dynamic or absent bowel sounds was the commonest signs. Conclusion: Acute intestinal obstruction is one of the most common emergencies requiring surgical intervention. A proper and complete bedside clinical examination by the surgeon is more superior to investigational procedures. In our study, Adhesions /bands were found to be the commonest cause for obstruction.

118-127

Authors: Sameena Anjum, T. Suchetha Lakshmi

Background: Intrauterine growth restriction remains a leading contributor to perinatal mortality and morbidity. There is no cure, management is reliant on a structured antenatal surveillance program with timely intervention. Recent advances in ultrasound and Doppler have elucidated several mechanisms of evolution of disease and prediction of threat of intrauterine hypoxia and acidaemia well in advance of other surveillance tests. Materials and methods: This prospective study was conducted in 110 high risk pregnant women attending OPD, admitted in antenatal wards and labor room at Government General Hospital, Siddipet, over a period of 2 years from October-2016 to September 2018; Ultrasound examination was done for interval growth, AFI, placental pathology. Fetal well-being was assessed with Doppler studies of UA and MCA, daily fetal movement count, NST, BPP. Results: In the present study, PIH was found to be the commonest (50.9%) cause of IUGR. Abnormal Doppler Indices in Umbilical and MCA correlated statistically with lower birth weight, higher rates of caesarean delivery, oligohydramnios, lower Apgar scores, perinatal death, and higher admissions to NICU. AEDF/REDF was associated with highest perinatal loss, poor perinatal outcome. Cerebroplacental ratio < 1 (C/U<1) had 100% specificity and 100% PPV. Conclusion: Doppler technology enables a better understanding of the hemodynamic changes in the fetus. It can help in identifying the changes in the fetal circulation well in advance of other surveillance tests, thus identify the truly hypoxic fetus. Interval changes in Doppler indices are useful in determining monitoring frequencies and optional time for delivery.

1-6

Authors: Vijaya Nirmala B, Ramana P.V.

Back ground: Pancytopenia is a common haematological finding in clinical practice. It is a striking feature of many serious and life-threatening illnesses, ranging from simple drug-induced bone marrow hypoplasia, megaloblastic anaemia to fatal bone marrow aplasias and leukaemia. The severity of Pancytopenia and the underlying pathology determine the management and prognosis. Thus, identification of the correct cause will help in implementing appropriate therapy .Pancytopenia is a common haematological finding for which bone marrow aspiration is conducted. Aim: To study the bone marrow aspiration smears in Pancytopenia cases and correlating with peripheral smear and clinical findings to arrive at a diagnosis. Materials and methods: This was a study conducted at Department of Pathology, Gandhi Medical College on 148 cases of Pancytopenia presenting over a period of 2 years. Clinical findings, complete blood counts and peripheral smear findings were recorded and Bone marrow aspiration was done. Smears were stained with Leishman stain. Perls’ stain was done in all cases. Special stains like MPO, PAS, Reticulin staining was done if needed. Results: Out of 148 cases of Pancytopenia 67 cases were males and 81 were females. Most of the cases were in the age group of 10-20 followed by 20-30. Megaloblastic Anaemia was found to be the most common cause of Pancytopenia followed by hypoplastic marrow. Conclusion: A thorough Evaluation of bone marrow smears can diagnose underlying pathology in most cases of Pancytopenia. Correlating bone marrow features with clinical and haematological findings aid in diagnosing and management of most cases of Pancytopenia.

14-20

Authors: K. Babu Raj, R. Prabhakaran

Background: The etiology of diabetes in India is multifactorial and includes genetic factors coupled with environmental influences such as obesity associated with rising living standards, steady urban migration, and lifestyle changes. It is a chronic disease, and as it prolongs it has many serious effects on multiple organs of the body. Keeping a view of the above-said problem, there arises a need for rigorous control of diabetes mellitus. However, rigorous control of diabetes leads to more incidence of hypoglycemia in elderly diabetic patients. Hypoglycemia has serious complications leading to various morbidity and mortality. Aim and objective: To study the risk factors associated with the development of hypoglycemia in elderly diabetic patients, to study about the symptoms occurring during the hypoglycemic episodes. Materials and methods: The study included 100 patients: Group –A 50 diabetics and Group B controls. Age and sex-matched diabetic patients >60 years admitted during the same period in RMMCH. Details of the hypoglycemic episode (symptoms, severity, glucose level, risk factors identified, treatment and outcome), comorbidities, polypharmacy, alcohol use and assessment of functional status Assessment of the functional status was done using Katz score. Results: Functional status of patients were assessed with KATZ index only 10 out of 50 study patients had poor (Katz score=0) functional status. 52% patients had their episodes during night time. 34 patients (68%) had come to the hospital with hypoglycemia and the rest of the patients developed hypoglycemia in-hospital stay. 70% of patients had symptoms and 30% had no symptoms. Neuroglycopenia was predominant in most patients. Conclusion: Asymptomatic hypoglycemia was common in the elderly diabetics. In symptomatic patients, neuroglycopenic symptoms were more commonly encountered than autonomic symptoms. The mean duration of diabetes mellitus was longer in the group of study patients with no symptoms of hypoglycemia as compared to patients who were symptomatic for hypoglycemia.

28-33

Authors: K. Babu Raj, B. Nageswaran

Background: The etiology of posterior circulation ischemia has been thought to be primarily due to local arterial atherosclerosis (large artery disease) and penetrating artery disease (lacunes). However, there is increasing evidence that cardiogenic embolization is more common than previously suspected and is responsible for 20-50% of posterior circulation strokes. Aim and objective: To study the clinical manifestations, risk factor profile, and prognosis in this sample of patients. Materials and methods: 54 cases of posterior circulation strokes, admitted to the Department of Medicine, Rajah Muthiah Medical College, and Hospital, Chidambaram, during the period from September 2016 to October 2017, who fulfilled the inclusion criteria, were taken up for the study. Results: Out of 54 patients, 48.1% had hypertension, 37.0% had diabetes, 37.0% had tobacco abuse, 37.0% had alcohol abuse, 40.7% had dyslipidemia, 7.4% had TIA/Stroke, 11.1% had RHD, 27.8% had IHD and 7.4% had MVP as predisposing factors. Majority of the patients had hypertension as a risk factor followed by dyslipidemia. Many patients had multiple predisposing factors. 46.3% had their consciousness impaired, 59.3% had speech disturbances, 13.0% had cranial nerve involvement, 55.6% had motor disturbances, 13.0% had sensory disturbances, 48.1% had cerebellar signs, 37.0% had nystagmus and 44.4% had fundal changes. Majority of the patients had speech disturbances on clinical examination. Conclusion: Majority of the patients had Hypertension (48.1%) as a risk factor followed by Dyslipidemia (40.7%). Many patients had multiple predisposing factors. There is an increased association between coronary artery disease and posterior circulation strokes in our study (27.8%). Infratentorial lesions (50%) were more common than supratentorial lesions (38.9%) and both combined (11.1%). The mortality associated with posterior circulation strokes in our study is 16.7%. Majority of the patients had no disability (22.2%) or slight disability (18.5%).

39-43

Authors: V. Sivangagai Lakshmi

Background: Smoking harms nearly every organ of the body and diminishes a person’s overall health. Millions and millions of peoples have health problems due to the habit of smoking. It is now a burden worldwide because smoking addiction of teenagers increasing immensely. Globally, smoking is not only a leading cause of cancer as well as various heart diseases. Smoke contains several carcinogenic pyrolytic products like Polycyclic Aroma0tic Hydrocarbons (PCAH), acrolein etc. are irreversible binds to DNA, causes genetic mutation and cancer. Aim: To evaluate the effect of smoking on Blood biochemistry parameters. 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 during the 2016-2017 period of around one year. biochemical parameters such as blood glucose, blood urea, and lipid profile were analyzed using standard methods. Results: While comparing the mean Blood sugar, Serum Cholesterol, Triglycerides, HDL, and LDL values, it was found to be more in smokers compared to that of non-smokers and this was significant at 5% level for Blood sugar and at 1% level for other values like cholesterol, TGL, HDL, and LDL. The mean Blood urea value had no significant association with smoking. Conclusion: Subchronic and acute exposure to tobacco smoke and various tobacco smoke constituents have been shown to elicit a wide variety of cardiovascular effects in animal models. These effects include decreased oxygen-carrying capacity, resulting in ischemia, platelet activation, endothelial damage, altered lipoprotein levels and increased arterial wall thickness which can promote atherosclerosis, and thrombosis. Ischaemia, atherosclerosis, and thrombosis increase the risk of myocardial infarction and other serious cardiovascular effects.

48-53

Authors: Mirunalini S

Background: Perinatal asphyxia is a major cause of acute mortality and chronic neurologic disability amongst survivors, and is a complication that occurs between 2-10% of deliveries. No single parameter can define perinatal asphyxia, rather a combination of parameters like fetal distress, meconium-stained liquor, low Apgar score, umbilical cord blood pH and clinical features of hypoxic-ischemic encephalopathy (HIE) can predict it. Aim: To study the correlation between nucleated red blood cell count (NRBC), fetal acidosis and clinical markers of asphyxia. Materials and methods: 52 pregnant women with fetal distress as a study group and 51 pregnant women without distress as a control the ed group were selected and their cord blood was analyzed for pH and nucleated RBCs. The results were analyzed. Result: Higher NRBC count was detected in the study group with signs of asphyxia (Thick MSAF, Non-Reassuring FHR Pattern, Low APGAR score). Conclusion: NRBC count is a simple bedside test to diagnose fetal asphyxia. Since it is cost-effective and does not require any special expertise or any high-tech facilities, it may be a useful, reliable, inexpensive and easily available markan er to evaluate perinatal asphyxia, especially in a resource-poor country like ours, where blood gas analysis facilities are not available in the majority of place.

58-62

Authors: R. Manimozhi Malathi, S. Ramesh, D. Rajkumar

Background: Malnutrition is an important factor that influences the course of pregnancy and fetal development. It is a serious international problem which leads to a deficiency of metals, trace elements, vitamins, and proteins. Much attention has been given to the effects associated with protein deficiency. Nowadays the effects due to the deficiency of trace elements have been given much importance. Trace elements are essential for life. Deficient intake- leads to impairment of some functions. The impairment may be corrected by intake of the element in physiological amount. With the deficiency of these elements, the organisms can neither grow nor complete its life cycle. Death of an organism results when there is an absolute deficiency. Aim: To compare serum iron and zinc level 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). Serum iron and zinc level were estimated by standardized technique. The results are analyzed accordingly. Results: The estimated mean iron value for the term babies was found to be 114.34 μg/dl with the standard deviation of 34 μg/dl. In case of preterm babies, the estimated mean value for iron was found to be 97.35 μg/dl with the standard deviation of 46 μg/dl. The mean zinc value of term babies was found to be 76.26 μg/dl with the standard deviation of 23 μg/dl. For preterm babies mean zinc value was found to be 56.53 μg/dl with the standard deviation of 29 μg /dl. Conclusion: Preterm birth deprives the fetus of a significant accumulation of iron in storage that occurs beyond 32nd week, total body iron deposits in tissues, Hb and zinc are low in premature babies. Iron deficiency affects perinatal growth, maturation, and function of multiple organ systems including the heart, skeletal muscle, gastrointestinal tract, and brain. Anemia of prematurity has been defined as low hematological constant levels of hemoglobin (Hb), hematocrit (Ht), serum iron, number of erythrocytes, the reticulocytes.

67-73

Authors: M. Agila Saravanan, S. Geetha

Background: Reduced production of thyroid hormone is the central feature of the clinical state termed Hypothyroidism. Hypothyroidism is associated with bradycardia, a decreased cardiac output, increased vascular resistance and perhaps a decreased sensitivity of the sympathoadrenal system. Aim and objective: To assess the cardiovascular functions in diagnosed hypothyroidism patients. Materials and methods: A total number of 70 hypothyroid patients were enrolled in this study. The clinical features, cardiovascular manifestations were studied by ECG, ECHO, chest X-ray lipid profiles. Results: Most of the cases fell in the age group of 31-40 years at a percentage of 52.9%. On analysis of 70 cases, 41% of cases were in moderate hypothyroidism group. On analyzing the pulse rate of 34% of the cases had bradycardia (PR <60/min). Mean BP- 131/84 mm Hg (Range: 118-166/66 – 102 mm Hg). Most of the patients fell into the pre-HT group which was around 66%. 24% of hypothyroid patients were hypertensive (BP >140/90 mm Hg). Lipid analysis in hypothyroid patients showed an increase in total cholesterol. 54.3% of patients had hypercholesterolemia (> 300 mg/dL). On analyzing the ECG changes in hypothyroid patients the most common finding was sinus bradycardia. It was found in 39% of cases. Next was low voltage complex which is around 34%. Normal ECG was found in 14% of patients. Least common findings were ST-T changes, RBBB and LBBB. Out of 70 cases, 12 (17.14%) patient showed enlarged cardiac silhouette (cardiomegaly). 34% of the patients had pericardial effusion. 30 % of the patients had diastolic dysfunction. Systolic dysfunction occurred in 4.3% of them, while IVST and LVPWT were seen in 14.3% and 12.9% respectively. Conclusion: Any unexplained diastolic dysfunction or pericardial effusion should be screened for hypothyroidism. Early detection of hypothyroidism and proper replacement therapy found to reverse the cardiovascular complications and thereby can decrease the morbidity and mortality.

83-90

Authors: E. Rajesh Goud, M. Muralidhar, M. Srinivasulu

Background: The advances in diagnosis and treatment, in the management of breast cancer have led to excellent cure rates for tumors detected in early stage. Even patients with stage III disease have 5 years survival rates in the range of 50-70%. The search for predictive and prognostic factors in breast cancer represents a major challenge. It is important to distinguish prognostic factors from predictive factors. Aim: The aim of the surgery was to compare the immunohistochemical expression of estrogen, progesterone and Her-2 receptor status in breast cancer before and after neo-adjuvant chemotherapy. Materials and methods: In this study, the total of 50 cases of locally advanced breast cancers was included. Cases of carcinoma breast requiring preoperative chemotherapy from January 2015 to January 2017 were recruited in to the study after informed consent. Results: In this study, the total of 50 cases of locally advanced breast cancers was included. Among them most of the cases belonged to the age group of 40 to 60. The extremes of ages (<30 and >60) comprised of only 14 % of the cases. In total of 50 cases 32 patients were pre-menopausal which was accounting for 64% of cases, and remaining patients were post-menopausal. Out of 20 cases of triple negative in this study complete response was seen in 6 cases accounting for about 30%. In our study there were a total of 24 changes in the receptor status post chemotherapy altogether out of which 11 changes were seen in Her2neu group. Changes in the ER and PR group accounted for 8 and 5 cases respectively. Out of 14 cases of ER positive before chemotherapy, conversion was seen in 8 cases accounting for change in ER status of 57%. Similarly 5 changes were seen in PR receptor expression accounting for 62% of change. All the changes found were loss of expression of receptor after NACT means receptor positive cases became receptor negative. Conclusion: Breast cancer subtypes are associat¬ed with the response to NACT. The response rates for the HE and TN subtypes were significantly higher than for the luminal subtypes. So it is mandatory for a patient with breast cancer who is scheduled for NACT should be assessed for the subtype of breast cancer before NACT, by using IHC, for planning treatment. This study also revealed that change in receptor status did occur after neo-adjuvant chemotherapy.

99-104

Authors: Shriraj Kane, Shikhar Bajpai, T K Biswas

Background: Chronic Obstructive Pulmonary Disease (COPD) is defined as a preventable and treatable lung disease with some significant extra-pulmonary effects. Pulmonary component is characterized by airflow limitation that is not fully reversible, usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles and gases. Elderly patients are more prone to COPD due to the reduction in the immune power along with the muscle weakness of the chest wall and bone weakness. Aim and objectives: To study the COPD in elderly with reference to HRCT chest and PFT, to study the pattern of pulmonary involvement in COPD in elderly. Materials and methods: It was Prospective observational study. Study population was elderly patients (age ≥60 years) detected having COPD (both in-patient and out-patient) attending MGM Hospital for treatment. Detailed history was taken from patient, particularly history of symptoms like fever, cough, shortness of breath, weight loss, night sweat etc. Thorough physical examination of all the systems with special emphasis on respiratory system was done. Results: Total 50 patients were enrolled in the study. Majority of the patients (44%) were in the age group of 60-70 years followed by 32% in the age groups of 70-80 years and 24% patients in the age group of >80 years. The mean age of the patients was 72.76±7.58 years. There was male preponderance (72%) in the study. Majority of the male patients were smokers (61%). Dyspnoea (76%), cough (68%), sputum production (64%) were the common symptoms. Centriacinar emphysema (34%) was mostly observed. FEV1/FVC ratio ranged from 38-89% (mean 62.9+/-18.52%) preinhalation, ranged from 45% to 90% (mean 69.26±15.08) post-inhalation. Conclusion: HRCT showed regional assessment of compartment involved and has greater sensitivity than chest radiography in early diagnosis of emphysema.

118-121

Authors: Bhavik Shah, S.S. Goswami

Testicular neoplasms are common cause of morbidity in both pediatric age group as well as adult. In testicular teratomas various types of tissues are present which represent the different germ layers (endoderm, mesoderm and ectoderm).Typically they appear at any age, but are usually much more common in pediatric patients, where they comprise up to 30% of all tu¬mors. In most of the reports, mature testicular teratomas likely to be diagnosed in a younger age group. Here, we report a mature testicular teratoma of the testis in a 55-year-old man which was quite rare especially in old age.

125-128

Authors: Vaibhavi Chaudhari, Jigna Patel

Malignant melanoma is a highly malignant tumor that is derived from melanocytes. The incidence of malignant melanoma has risen markedly over the last decade. Malignant melanoma mostly occurs in the skin, mucous membranes and the choroid. The cases of primary mela¬noma of the breast are quite rare. Observation of the clinical pathological features, immunohistochemical staining methods and tissue origin are required to identify primary malignant melanoma of the breast. This case report of primary malignant melanoma is presented because of its rarity.

133-142

Authors: Latifa Alanazi, Ghada Alhindi, Yara Alanazi, Sarah Alseneidi, Bashayer Alanazi, Dalal Alshagha, Munira Alghufaily

Langerhans cell histiocytosis (LCH), a rare proliferative disorder of cells that share phenotypic characteristics with dermal Langerhans cells, has long been considered an “orphan,” or neglected disease. Prior to its current designation, LCH was known as Hand–Schuller–Christian disease, Letterer–Siwe disease, or eosinophilic granuloma, which was combined under the umbrella designation of Histiocytosis X. The pathogenesis of LCH has remained unclear since the initial reports approximately 100 years earlier, and gene expression studies have demonstrated that these tumors do not originate from dermal Langerhans cells. It remains unclear whether LCH is reactive or neoplastic, although these tumors manifest a unique self-healing phenomenon that is rare among malignancies. The clinical presentation of LCH varies according to the involved organ/system, including common manifestations such as otitis media or pneumothorax or unusual manifestations such as diabetes insipidus. Accordingly, LCH cases are classified according to the number of involved organs/systems and sites, as well as the involvement of so-called “risk organs”. This review aimed to highlight recent insights as a better understanding of LCH will lead to more effective therapies.

1-8

Authors: K. Babu Raj, G. Sivachandran

Background: Cardiovascular disease (CVD) has emerged as the dominant chronic disease in many parts of the world. At the beginning of the twenty-first century, CVD accounts for nearly half of all deaths in the developed world and 25% in the developing world. Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia. Vascular diseases account for most morbidity and mortality in patients with DM. Aim and objectives: To study the clinical profile of type 2 diabetic patients presenting with Acute Coronary Syndrome (ACS) with reference to HbAlc level. Materials and methods: After selecting appropriate samples for the study based on the inclusion criteria, a detailed history was elicited and clinical examination was done as per the proforma. The necessary investigations were done as per the proforma. The clinical profile of these patients was then analyzed and correlated with reference to HbAlc level and statistical analysis performed using paired’ test. Results: The prevalence of microvascular diabetic complications was high with nephropathy amounting to 62% and retinopathy amounting to 58%. Neuropathy was not documented. About 32% of patients were free of microvascular complications. Other macrovascular diabetic complications were not documented. Among complications of ACS, 24% developed hypotension and no other complication was noted. Remaining 76% did not suffer any complications. No mortality was documented. Patients with systolic dysfunction constituted 82% and diastolic dysfunction 66%. The percentage of patients with HbA1c >7% constituted 62% which was very high and only 32% of patients had their HbA1c level in the control range. Conclusion: A majority of diabetic patients developing acute coronary syndrome have poor glycaemic control as reflected by their HbAlc levels. The coronary event is likely to occur sooner after the detection of diabetes if good glycaemic control is not achieved. Exercise, in the form of regular day to day activities, does not achieve satisfactory glycaemic control and cannot prevent the development of adverse complications of diabetes.

17-29

Authors: Maskuri Soujanya, Nama Nagarjuna Chakravarthy, G. Venkateshwarlu

Introduction: Laparoscopic surgery is a routinely performed surgery and it is desirable to have stable intra-operative hemodynamic states by avoiding hypertension and tachycardia. Various drugs have been employed to attenuate this hemodynamic response. No single drug is satisfactory. Thus there is a need to find a simple efficient and reliably consistent method. Aim: The present study was undertaken to evaluate the comparison of Dexmedetomidine and Esmolol on perioperative hemodynamic response during laparoscopic cholecystectomy. Materials and methods: Prospective, randomized, controlled, single blinded trial comparing dexmedetomidine (alpha 2- agonist) and esmolol (beta 1-antagonist) done by allocating into two groups. It was conducted in 60 patients of both sex, belong to ASA I and ASA II of age group 20-60 years admitted for laparoscopic surgery from 2016-2017. They were randomly divided into two groups of 30 patients each. The Heart rate (HR), Systolic blood pressure (SBP), Diastolic blood pressure (DBP), Mean arterial pressure (MAP) were recorded prior to induction, after the induction, after the intubation, 15 min, 30 min, 45 min, 60 min after creation of pneumoperitoneum, post pneumoperitoneum, after extubation. Results: Heart rate and systolic blood pressure were significantly lower in Group A after induction, after intubation, and maintained throughout intraoperative and postoperative period compared to Group B. Diastolic blood pressure were significantly lower in Group A after intubation, and maintained throughout intraoperative period and at extubation compared to Group B. Diastolic blood pressure was not significant after induction, at postoperative period. Mean blood pressure were significantly lower in Group A after induction, after intubation, and maintained throughout intraoperative period and at extubation compared to Group B. Mean blood pressure were not significant at postoperative period. Conclusion: Dexmedetomidine is more effective agent than esmolol in maintaining stable hemodynamics during and after pneumoperitoneum in laparoscopic cholecystectomy.

41-46

Authors: Bhuvanesh Kumar Kahar, Sushma Pandey, Ankush Agrawal, Darab Singh, Ravindra Kumar Sharma

Background: Diabetes mellitus is one of the six primary risk factors identified for MI, others being dyslipidaemia, smoking, hypertension, male gender, and family history of atherosclerotic arterial disease. Diabetics have been shown to have poor outcome after post-thrombolysis in acute STEMI compared to non-diabetics. Objective: To Compare, Post Myocardial Infarction in Hospital Patients Prognosis After Thrombolytic Therapy In Diabetics versus Non-Diabetics. Materials and methods: This was a prospective cross sectional study done at Jhalawar Medical College and Hospital, Jhalawar on 139 patients from October 2016 to September 2017. Consecutive patients with ST segment elevation MI, who were not treated with primary angioplasty, but were thrombolysed with Streptokinase were recruited at the time of arrival in emergency department. ECG was taken at baseline and 2 hour after STK administration. Patients were divided in two groups A) Non-diabetics B) Diabetics. Total 139 patients 85 are diabetics and 54 are non-diabetics. Results: In non-diabetic group (54), ST segment resolution occurred in 77.76 % patients as compared to diabetic group (85) in which only 31.76% patients had ST segment resolution. Diabetics had more complications such as recurrent chest pain, heart failure, arrhythmias, death as compared to non-diabetics. Conclusion: Diabetics with acute myocardial infarction have worse prognosis as predicted by incomplete ST segment resolution in ECG after thrombolysis.

55-63

Authors: Roobal Behal, Suhail Majid Jan, Huda Hussain

Background: Patient compliance plays a decisive role in the outcome of periodontal therapy. Although a number of reports have studied patient compliance and its variables during supportive periodontal therapy, there is a paucity of literature on factors affecting compliance to active periodontal therapy. Moreover, as health beliefs largely stem out of social/religious/ethnic convictions, population specific compliance studies are highly relevant. It is foreseeable, that early identification of compliance-affecting variable will enable institution of a timely and personalized patient education/ motivation programme. Aim: To elucidate factors which affect patient compliance during active periodontal therapy in patients visiting Government dental college and hospital, Srinagar. Materials and methods: 150 patients were included in the study for performance of active periodontal therapy (scaling and root planing) over 3-5 visits every 5 days. They were subjected to pre-validated questionnaire to assess their sociodemographic factors, oral health awareness (OHA) and treatment satisfaction (TS). Results: Sociodemographic factors (education, emplyoyment and gender), OHA and most of all TS were found to influence patient compliance in the given population. Conclusion: Certain sociodemographic factors have a bearing on patient compliance and may be assessed as predictors of compliance to therapy. As treatment satisfaction has a profound effect on the patient’s willingness to return for treatment, it should be an objective of the overall clinical practice. Pertinently, the crucial role of the periodontist in patient education and management should be realized and utilized to achieve predictable compliance.

72-80

Authors: Rahul Sudan, Mehroz Ahmed, Imtiyaz Ahmed Wani, Muzaffar Maqsood Wani, Khurshid Ahmed Banday, Gunjan Gupta

Background: Chronic Kidney Disease (CKD) is one of the most common causes of morbidity and mortality due to renal causes. There are multiple causes of CKD with diabetes, hypertension and chronic glomerulonephritis among the most common causes. All of these causes gradually lead to the final common pathway of End stage renal disease (ESRD). Chronic Kidney Disease (CKD) is defined as Kidney damage for ≥3 months, as defined by structural or functional abnormalities of the kidney, with or without decreased GFR or GFR <60 mL/min/1.73m2 for ≥3 months, with or without kidney damage. Aim: To study the profile of Chronic Kidney disease (CKD) patients presenting in a tertiary care center. Materials and methods: This study was conducted at Sher I Kashmir Institute of Medical Sciences (SKIMS), a tertiary care center in Srinagar, Jammu and Kashmir, India, from July 2013 to January 2016. All the patients of CKD visiting our institute were enrolled in this study. This included patients on follow up at the Out Patient Department (OPD), patients presenting to emergency with complications of CKD, patients referred from other departments who were detected in initial stages of CKD during the routine investigations. A total of 300 patients were enrolled in this study. Results: In our study, a total of 300 patients were enrolled. CKD was more common in males. The most common aetiology of CKD was diabetic nephropathy which was seen in 102 patients (34%) followed by chronic glomerulonephritis seen in 80 patients (27%). Volume overload was the most common cause of morbidity in these patients. Patients in the initial stages of CKD were managed with symptomatic treatment and 230 patients (76.66%) received peritoneal dialysis at some stage of their management. It was in the stage of ESRD that patients were offered some definitive form of renal replacement therapy in the form of renal transplantation or hemodialysis. Out of 160 patients of ESRD, only 12 patients (7.5%) received renal transplantation and the remaining 148 patients (92.5%) were managed with hemodialysis. Conclusion: CKD is one of the leading causes of morbidity and mortality due to renal causes. The early stages of CKD which are managed by conservative methods gradually lead to the development of ESRD. It is therefore necessary to diagnose the patients of CKD in the early asymptomatic stages. At these stages it is feasible to slow down the loss of nephrons by controlling the underlying factors like diabetes and hypertension but once the stage of ESRD sets in, renal transplantation is the preferred modality of renal replacement therapy.

86-92

Authors: Anand Vachhani, Shashvat Modia, Varun Garasia, Deepak Bhimani, C. Raychaudhuri

Background: A solitary pulmonary nodule is defined as a discrete, well - marginated, rounded opacity less than or equal to 3 cm in diameter that is completely surrounded by lung parenchyma, does not touch the hilum or mediastinum, and is not associated with adenopathy, atelectasis or pleural effusion. Aim and objectives: To determine the frequency of single lung metastasis, primary lung cancer and benign lesions in patients with solitary lung nodule and a primary extrapulmonary neoplasm, to evaluate the Chest Radiographs and CT characteristics of solitary lung nodule with a primary extrapulmonary neoplasm, to develop a statistical model to guide clinicians regarding choice of patient for diagnostic biopsy. Materials and methods: A retrospective analysis of CT and Chest Radiographs of 50 patients with an extrapulmonary malignant neoplasm and a solitary pulmonary nodule, done in our Dhiraj General Hospital over a 6 – month period. Results: 50 patients of Extrapulmonary neoplasms were evaluated; out of these patients were diagnosed and evaluated for Primary Bronchogenic Carcinoma, lung metastases, benign nodule. Conclusion: Solitary lung nodule in patients with extrapulmonary malignancies showed a variety of patterns on CT. Nearly half of the non – calcified solitary pulmonary nodules identified in this series were malignant. The likelihood of a spread depends on the histological characteristics of the extrapulmonary neoplasm and the patient's smoking history. Lung cancer was more common than metastatic disease.

100-106

Authors: K. Selvarju, Kondreddi Narayana Prasad, Ajay Kumar Reddy Bobba

Background: Laryngoscopy and endotracheal intubation, which are a basic and integral part of general anesthesia (GA), are associated with reflex sympathetic stimulation, manifested by tachycardia and hypertension. Aim: The aim was to compare the effect of dexmedetomidine and clonidine on the pressor response among patients undergoing tracheal intubation in elective surgeries under general anesthesia. Materials and methods: A prospective and randomized control study conducted in 80 adult patients of age 18-55 years in ASA I and II were included in this study. Patients were divided into Group D and Group C of 40 patients each. Results: Mean SBP, DBP and MAP in the dexmedetomidine group remained close to the baseline throughout the study period showing a significant difference from clonidine groups following the induction interval. In present study after intubation heart rate, SBP, and DBP was increased in all patients but the increase was more in patients of clonidine group when compared to dexmedetomidine group. There was statistically significant difference in heart rate between the two groups at 1, 3 and 4 min interval after intubation (p value<0.05). No significant changes in peripheral oxygen saturation (SpO2) and cardiac rhythm (ECG) were observed in any patients of both groups. Bradycardia (HR<50/min) was observed in one patient of dexmedetomidine group and two patients in clonidine group, five minutes after intubation. Intraoperative hypotension was observed in one patient of dexmedetomidine group and in two patients of clonidine group. Conclusion: Premedication with dexmedetomidine can safely be recommended for attenuation of provided more stable hemodynamics response to endotracheal intubation.

1-7

Authors: Anil Kumar, Madhuri Meena, Y.K. Sanadhya

Background: A simple clinical scale of intracerebral hemorrhage, comprising the Glasgow Coma Scale score, age, Infratentorial origin, ICH volume, and Intraventricular hemorrhage, was recently shown to predict 30-day mortality. We studied how well the original ICH Score would predict morbidity and mortality. Materials and methods: We did a retrospective study, in which records of all the patients with acute intracerebral hemorrhage were reviewed. Components of the ICH Score were recorded along with other clinical characteristics. Outcome was analyzed using modified ranking scale. Results: The mean age was 69  15 years with 45.4% males and 54.6% females. Common risk factors were smoking, diabetes mellitus and hypertension. Supratentorial lesions were 93.25% and Infratentorial lesions were 6.74 %. The overall 30 day mortality rate for ICH was 29.03%. Important predictors of mortality were, GCS score on admission (P<0.0001), hematoma volume >30ml (P <0.0001), Intraventricular extension (P <0.0001), and ICH score (P <0.0001). Conclusion: The study shows ICH score is very useful in prognostication. The overall mortality rate with ICH is similar to the previously published studies.

17-23

Authors: Vigna Sai Potula

Background: Gallstones are one of the commonest medical problems leading to surgical intervention. There is recent rise in the incidence of cases due to westernization of diet. This study intends to know the various modes of presentation, its complications and various treatment modalities with their outcomes. The aim of the study is to study the prevalence of cholelithiasis and to evaluate the advantages and disadvantages of laparoscopic versus open cholecystectomy surgical procedures. Material and methods: This was a prospective study conducted at tertiary care centre for a period of two years. 100 consecutive cases of cholelithiasis were admitted, investigated and operated during this period and results analysed. Results: Cholelithiasis was common in the 4th decade with majority of cases occurring in females. The commonest clinical presentation was pain abdomen. All the cases were diagnosed on ultrasonography abdomen. The diet consumed was mixed diet. Laparoscopic cholecystectomy was done in 72 cases and 28 cases underwent open cholecystectomy. The conversion rate was 4%. The complications were minimal. Mean operating time for open cholecystectomy was 96 minutes and laparoscopic cholecystectomy was 90 minutes. Mean duration of hospital stay was 9 days for open cholecystectomy and 4 days for laparoscopic cholecystectomy. Conclusion: Laparoscopic cholecystectomy is a safe and effective treatment in most of the patients with symptomatic cholelithiasis. In cases of adhesions and inflammation, open cholecystectomy is preferred.

29-32

Authors: A. Usha Murugan

The diabetic foot is a group of syndromes in which ischemia, neuropathy and infection leads to tissue breakdown resulting in morbidity and possible lower extremity amputation. The diagnosis is based on clinical criteria investigations. It is imperative that such patients are managed by a team of Physician, Surgeon, Social care worker, Physiotherapist and a Podiatrist. In this study we included 100 diabetic foot patients in the age group of 30 to 80 years. The study was done for a period of one year. 47% of our patients had Meggit Wagner grade 3 and 10% had grade 5. 27% of the patients had renal failure and 30% had anemia. These patients were subjected to non-enteric culture of blood under sterile precautions. 80% of our patients showed positive culture. The organisms commonly isolated were Staphylococcus aureus, beta haemolytic Streptococcus and Klebsiella pneumoniae. Less commonly isolated were Citrobacter species, Proteus mirabilis and anaerobes. 40% of patients with positive culture went on to have lower extremity amputation. Thus we concluded that non enteric culture in diabetic foot disease has prognostic significance and the spectrum of infection in diabetic foot disease is polymicrobial in nature and at par with the literature.

38-44

Authors: Katadi Venkata Sudha Madhuri, Kolati Srinivas Rao

Background: Abnormal uterine bleeding (AUB) is any heavy or unusual bleeding from the uterus (through your vagina). It can occur at any time during your monthly cycle, including during your normal menstrual period. Aim: This study aimed to compare the accuracy of TVUS and SIS in relation to hysteroscopy in assessing the uterine cavity and in detecting ER and PR in endometrium and their relation with endometrial polyps in women with peri and postmenopausal bleeding. Materials and methods: The present study was a prospective study which included 120 patients with AUB who were attending the department of gynaecology at Gandhi Medical College, Hyderabad from July 2012 to November 2015. Results: 120 patients were selected in this study. Patients suffering from endometrial polyp were 40 (33.34%), endometrial hyperplasia were 25 (20.83%), endometrial atrophy were 19 (15.83%), normal endometrium were 19 (15.83%) and submucous fibroid were 17 (14.17%). Age was shown in mean±SD and p-value was 0.39 and it was statistically non- significant. Parity was shown in mean±SD and p-value was 0.283 and it was statistically non-significant. SIS had 4 false negative results by missing 2 cases with endometrial polyps, 4 false positive result by diagnosing a case of 4 endometrial hyperplasia as polypi. SIS had 8 false negative results (by missing 6 cases), 8 false positive results (3 cases was found to have polypi and 5 cases were normal). Mean endometrial thickness in mm in various diagnosis by TVUS as follows; endometrial polyp had 15.49±10.98, endometrial hyperplasia had 8.19±5.55, endometrial atrophy had 4.55±2.97 and normal endometrium had 12.68±6.80. Conclusion: Especially with intra-cavitary lesions, sonohysterography is superior to ultrasound and very close to hysteroscopy. Hysteroscopy remains the reliable standard for uterine cavity assessment, but cannot replace the histopathology. In the pathogenesis of endometrial polyps and endometrial hyperplasia, the expression of endometrial steroid receptors is crucial.

50-55

Authors: Ayyasami Revathi, Tharmaraj Ramesh Kumar

Background: Gestational diabetes mellitus, as a metabolic disorder affects 1%-28% of pregnancies. History of gestational diabetes is an important predictor of various metabolic disturbances later in life. This study was intended to observe the impact of the various predictors over persistence of abnormal glucose tolerance at post-partum and its association with metabolic risk factors. Materials and methods: This was a prospective study of 216 GDM women diagnosed by 75 g oral glucose tolerance test (OGTT) during index pregnancy attending diabetology OPD in Institute of social obstetrics and Kasturba Gandhi general hospital between January 2016 to March 2018. At 6-12 weeks post-partum, 75 g - 2 hr-OGTT was done to assess their glycemic status. Data for predictors and metabolic risk factors were obtained from history, clinical examination and personal records. Plasma glucose was measured by glucose-oxidase method. The results were calculated using SPSS software and expressed in percentage. Results: Of the 216 women only 173 patients came for postpartum follow up at 6- 12 weeks. Normal glucose tolerance (NGT) was seen in 58.9% and abnormal glucose tolerance (AGT) in 41.1%. The frequency of abnormal glucose intolerance includes IFG: 0.9%, IGT: 24.5%, DM: 15.7%. Gestational age <20 week at detection of GDM, higher parity, insulin use during pregnancy, previous history of GDM, higher glucose levels on the diagnostic OGTT, hypertension were significantly higher in the AGT group. However positive family history of diabetes and BMI showed no statistically significant correlation. Conclusion: It is concluded that advanced age, higher parity, previous history of GDM, earlier gestational age at diagnosis of GDM and use of insulin during pregnancy are important predictors for AGT during post-partum period and hypertension as a metabolic risk factor was strongly associated with AGT. Need for early postpartum screening and implementation of various intervention program to prevent type 2 diabetes in high risk GDM women.

62-66

Authors: R. Maheshwari, Rakesh Fernando

Background: Post-operative complications which follows appendicectomy are not common and it reflect the level of peritonitis that is present during the time of surgery and the diseases which may be predisposed to complications. There are various types of complications that occurred after the appendicectomy surgery. Of them, the commonest complications are fever and surgical site infection. Post-operative complications of appendicectomy have wide range of presentation from fever to fecal fistula. In this study, the patients presenting with features of post-operative complications of appendicectomy will undergo detailed history taking, clinical examination & investigations like complete blood count, blood sugar, urea and lipid profile, serum creatinine, X-ray chest and wound pus culture sensitivity. The study purpose was to assess the age distribution, sex distribution & to discuss various types of complication. Materials and methods: 100 cases that had presented with features of post-operative complications of appendicectomy in the department of surgery, Tirunelveli Medical College and Hospital were evaluated during the study period from April 2012 to October 2013. Results: Our study of 100 randomly selected patients who presented with postoperative complications of appendicectomy. The commonest post-operative complications of appendicectomy were fever (73%), followed by surgical site infection (37%). Most common age group, in which post-operative complications seen, was > 20 years, followed by the 20-30 age group. The surgical site infections were most commonly due to E.coli (64.86%) and Klebsiella species (8.1%). The common day of presentation of fever was 2nd POD with 57.3% cases. In this study 97% case of postoperative complications of appendicectomy occurred after emergency surgeries. Conclusion: Major complications were rare in elective appendicectomies which may reflect the reduced virulence of organisms in those cases.

81-87

Authors: K.B. Chandrabhanu, R. Ashok, K. Haridev Kumar

Introduction: Infective Keratitis is most common cause of corneal blindness in Rural India. Agricultural farmers are more at risk. Fungi and Bacteria are the main cause for this ocular ailment. Early diagnosis and treatment may prevent the corneal blindness. Aim: To evaluate common etiological factors causing Infective Keratitis in the region of Northern Telangana. Materials and Methods: This study was conducted at Tertiary Eye Care Hospital, Regional Eye Hospital, Warangal, Telangana State. Fifty patients were admitted with infective keratitis were clinically evaluated. Each case was analysed and results were recorded as per etiology, clinical symptoms and signs, complications and visual outcome. Results: Age group greater than 40 years (58%) were more common with male predominance (54%) was observed. People living rural area (72%) were affected more than urban areas. Agricultural labour (52%) was mostly seen with infective keratitis. Most of the cases were with trauma (62%) with vegetative matter was mostly seen. Most of the cases were acute (78%) in origin. Fungi were most common organism isolated from the cultures. Staphylococcus and Streptococcus (62%) were common species isolated from bacterial origin and they were antibiotic sensitive (92%). Aspergillous was common fungus isolated Diffuse Corneal ulcer was most common complication. Malnutrition was main cause in systemic illness. Most of the patients before treatment were with no passage of light after treatment visual acuity has prognosis to 6/18 vision. Conclusion: Early diagnosis and treatment may improve the visual prognosis and prevent Corneal blindness due to Infective Keratitis.

94-98

Authors: R. L. Sharma, Rekha Sharma

Hailey–Hailey disease also known as Familial benign chronic pemphigus is a relatively uncommon disease characterized by painful erosions, vesicles, pustules and scaly erythematous plaques on the neck, axillae, groins and perineum. A case of 27 years old male with history of recurrent, itchy, erythematous, papules and vesicles over the groins presented to the dermatology OPD. A clinical diagnosis of Hailey – Hailey disease was made which was confirmed later by histopathological examination. He was treated with tacrolimus ointment and showed a remarkable improvement.