International Archives of Integrated Medicine

1-9

Authors: Emmanuel O. MEGBELAYIN, Yewande O. BABALOLA, Musbahu S. KURAWA, Ibeinmo OPUBIRI, Sunday N. OKONKWO

Background: Satisfaction surveys are periodically necessary to evaluate services rendered to clients/patients as a means of quality assurance and service improvement. Aim: To determine satisfaction to services rendered to ophthalmic patients in an outpatient eye clinic. Material and methods: It was an observational study carried out with validated questionnaires complemented with a focused group discussion. Statistical Package for Social Sciences (version 15∙0) was used for data analysis. Observation: A total of 251 questionnaires were analyzed comprising 139 males and 112 females (M: F= 1: 0∙8). Age range and mean age were 17-92 years and 37∙2 + 15∙6 years respectively. Overall satisfaction with quality of services was 80∙1%. Specifically, 95∙6%, 92%, 80∙9%, 70∙9%, and 59∙8% were satisfied with cleanliness of hospital premises, doctors’ willingness to listen to complaints, nursing care; doctors’ following-up on treatment, and time nurses administered treatments respectively. However, only 37∙8%, 38∙6%, 39∙8%, and 47∙4% were satisfied with drug costs, cost of transportation to hospital, laboratory charges, and record keeping profile respectively. Conclusion: Costs of uptake of eye care services and record keeping profile were key sources of dissatisfaction in this study.

16-20

Authors: Ilhan Ece, Huseyin Yilmaz, Hüsnü Alptekin, Serdar Yormaz, Mustafa Sahin

Background: The laparoscopic approach for the treatment of hepatic hydatid cysts is increasingly gaining importance. The aim of this study was to report a series of 27 patients with hepatic hydatid cyst managed with laparoscopic partial cystectomy. Methods: A retrospective review of patients treated at a university clinic for hepatic hydatid cysts from March 2010 to May 2014 was performed. Operative time, blood loss, length of hospital stay, post-operative complications, and early follow-up outcomes were evaluated. Results: Laparoscopic surgical intervention was performed on 27 patients (17 females and 10 males) who were diagnosed with hydatid cysts by ultrasonography and computed tomography (CT). Except 3 of the cysts, were located in the right lobe of the liver. No mortality was noted during the study. Two surgical site infections were observed and no abscesses developed in the cystic cavity. Recurrence was not noted during the mean follow-up period of 22 months. Conclusion: Laparoscopic partial cystectomy is a safe and effective method for the treatment of hepatic hydatid cyst.

27-31

Authors: O. Gambhir Singh, A. M. Singh

Background: Poisoning cases is a significant contributor to mortality and morbidity all over the world. Acute poisoning cases form one of the commonest causes of emergency hospital admissions. Material and methods: It is a retrospective study of 106 poisoning cases admitted in M.A.P.I.M.S., which is a tertiary health care centre in Tamil Nadu, India from January 2010 to December 2012. Results: The incidence of poisoning was highest in the age range from 20-50 years. Most common poison was insecticide/ rodenticide and cases were mostly suicidal in nature. Conclusion: Trends of poisoning cases in Melmaruvathur region of Tamil Nadu are more or less similar to other parts of India.

42-48

Authors: Deivam S. Gounder, Abirami Dhakshinamoorthy, Prabhu Nagarajan, Balasubramanian Narasimhan

Background: Since the inception of the integrated counselling and testing centre (ICTC) at all teaching reference institutions and associated hospitals, there was very few cases observed on the clinical experiences in HIV/AIDS positive cases in institution. Aim: The aim of this study was to delineate the epidemiological profile of HIV/AIDS seropositive cases and which included to study the number of HIV seropositive patients from February 2013 to June 2014; common signs and symptoms of HIV/AIDS seropositive patients; age and sex distribution of all seropositive cases; mode of transmission of HIV infection; residence and profession profile of seropositive cases and different types of opportunistic infections in these patients. Material and methods: Present study was documental and analytical descriptive and it was conducted at the tertiary care teaching institution and associated hospitals through data collection of 105 records of individual who tested positive for HIV by three rapid test methods using three different antigens at integrated counselling and testing centre (ICTC). Demographic variables such as age, sex and occupation, data on mode of transmission and clinical manifestation were examined together. Results: A total of 105 patients included in which 59 (56.2%) male and 46 (43.8%) females. The peak incidence was found in the age group of 26 to 45 years (62.8%). Majority of HIV positive patients belonged to skilled workers followed by unemployed and agricultural workers. Transmission of infection was through sexual contact and 54.2% expressed that they do not know how they acquire this infection. One case identified that the transmission occur through homosexuals. Vertical transmission and blood transfusion accounted in 0.9% cases. The educational categories were mainly observed among the secondary schoolings (47.6%). Spouse testing also done where 16 subjected were included among them 8 were concordant couples and 8 were discordant. Among the patients attended the ART centers, it was found that 64 out of 105 were under ART treatment and 11 died due to opportunistic infections. Among 105 cases, 55 were symptomatic (6 were having tuberculosis infection) and 50 were asymptomatic. Conclusion: Tuberculosis and candidiasis were common opportunistic infection followed by herpes zoster and varicella. This study highlighted the burden of HIV/AIDS patients in the study place. The results can be useful for various programs in health promotions in patients of HIV/AIDS from this region.

58-62

Authors: Lakshmeesha T, Praveen G

Introduction: Injuries are becoming major public health problem worldwide and since India is also passing through a major socio-demographic, epidemiological and technological transition injuries are coming up as an emerging health problem. This study was aimed at analyzing the morbidities of orthopaedic injuries among patients attending the casualty department in a medical college hospital. Material and methods: The record analysis of injured patients attending the casualty department over a 12 months period from Jan 2013 to Dec 2013 was done. The data was analyzed to know the pattern of orthopedic injuries. Results: A total of 1100 injured patients attended the casualty department were analyzed. Study showed that 880 (80%) of victims were in the age group of 11-45 years. 825 (75%) were males and 275 (25%) were females. Road traffic accident (RTA) was the most common cause of injuries being responsible for 660 victims (60%) followed by fall from height 242 (22%). Study revealed that in 770 (70%) of the victims the most common presentation of morbidity was fracture and the most common site was lower limbs in 378 (49%). Next most common site was upper limbs followed by pelvic fracture, spine fractures, facial fracture & Ribs fracture. 792 (72%) cases had simple fracture. 44 (13%) cases had various dislocations, shoulder dislocation being the most common. Most common visceral injury was head injury 198 (18%). Conclusion: Fractures were the most common pattern of orthopedic injuries, frequently associated with head injuries. Research into appropriate strategies for prevention of injuries, especially RTA is required in medical college hospital.

68-74

Authors: Rippalkumar Bhimani, Gunvanti B. Rathod, Sachin Aggarwal, Rushabh Patel, Rahul Goyal, N.K. Kuchhal

Hemoglobin Q-India (α 64 Asp→His) is an important member of the hemoglobin Q family, molecularly characterized by the replacement of aspartic acid by histidine. The first case of Hb Q-India was reported by Sukumaran in 1972 in a Sindhi family with associated β-Thalassemia. India is known as a country with a high prevalence of α - and β-thalassemia and different types of hemoglobinopathy. Many of these variants are yet to be identified. Here, we are reporting two cases of Hb Q- India diagnosed during premarital thalassemia screening.

80-85

Authors: Deepak Grover, Gurpreet Kaur

The defects of the alveolar ridge can result from various causes, most common being the collapse of alveolar bone during extraction. Localized defects of alveolar crest impair prosthetic rehabilitation due to poor emergence profile of the pontic which in turn adversely affects the aesthetics and function. Several alternatives have been proposed to restore the damaged ridge by hard and soft tissue augmentation. Various soft tissue ridge augmentation techniques have been used to augment alveolar ridge with varying success. The present clinical report describes the “roll technique” as a means of soft tissue ridge augmentation to treat alveolar ridge defects.

91-95

Authors: R. P. Tiwari, S. N. Tiwari, P. K. Mehar, Ramaiah Maddi, Kumari Vaishali

There are so many diseases specially classified for children come under Kaumarabhria treatment as per Ayurveda. Recently many researchers’ works to explore development of treatment of diseases related with childhood. The utilization of traditional system of treatment is well known but now it has been well proved and established also on the basis of scientific study and evidences. Further more research investigation need to be required for the establishment and modernizing of traditional therapy for children disease. This review article summarizes advanced research work of this area. Article involve discussion of traditional Ayurveda text related to the childhood disorders like; Rickets, asthma, constipation, Jwara and krimi etc. Further research and new concepts are utilizing for exploring Kaumarabhria.

100-104

Authors: Takuma Hayashi, Takao Hirano, Toshinori Murata

Although the transcription factor, nuclear factor-κB (NF-κB) is known to regulate cell death and survival, its precise role in cell death within the central nervous system (CNS) remains unknown. We previously reported that mice with a homozygous deficiency for NF-κBp50 spontaneously developed optic neuropathy. We examined the expression and activation of pro-apoptotic factor(s), which mediate optic neuropathy in p50-deficient (p50-/-) mice. Recombination activating gene 1 (Rag1) is known to regulate the recombination of immunoglobulin V(D)J. Experiments with genetically engineered mice revealed the involvement of Rag1 expression in the apoptosis of Brn3a-positive retinal ganglion cells (RGCs), and also showed the specific effects of a p50-deficiency on the activation of Rag1 gene transcription. Furthermore, a genetic analysis of murine neuronal stem-like cells clarified the biological significance of Rag1 in NMDA (N-methyl-D-aspartate)-induced neuronal apoptosis. The apoptotic regulating factors, Bax, and cleaved caspase 3, 8, and 9 were observed in HEK293 cells expressing the external molecule of Rag1, and a human histological examination revealed the expression of Rag1 in RGCs. Recent study indicated that Rag1 played a role in optic neuropathy as a pro-apoptotic candidate in p50-/- mice. This result may lead to new therapeutic targets in optic neuropathy.

1-8

Authors: Seema Zargar

Citrinin is a nephrotoxic mycotoxin produced by several species of the genus Aspergillus, Penicillium and Monascus. Citrinin is generally formed after harvest and occurs mainly in stored grains. The efficacy of different concentrations of aqueous leaf extracts of Aervalanata, Nerium oleander, Rhazya stricta Decne and Cleome amblyocarpa (5 to 10 mg/mL) on growth and citrinin production in two fungal strains Penicillium notatum and Aspergillus niger was investigated. Mycotoxin production and fungal biomass by the isolates was suppressed, depending on the concentration of the plant extract added to culture media at the time of spore inoculation. Citrinin production in fungal mycelia grown for 15 days in culture media containing 5 – 10 mg/mL of the aqueous extracts of A. lanata, N. oleander, R. stricta Decne and C. amblyocarpa showed inhibition of approximately 14.2 to 91.8 % in Penicillium notatum and 13.4 to 90.3% in Aspergillus niger. Among the all four extracts, Rhazya stricta Decne was more efficient than other tested plant extracts in inhibiting the citrinin production ranging from 22.4 to 91.8% in P. notatum and 32.6 to 93.2% in A. niger.

13-17

Authors: Vrinda Hari Ankolekar, Mamatha Hosapatna, Anne D Souza, Antony sylvan D Souza

Introduction: Identification and recognition of the cephalic vein (CV) in the deltopectoral triangle is of critical importance when considering emergency procedures. Therefore, the present cadaveric study was undertaken to identify the CV in the deltopectoral groove and its termination in the axillary vein with respect to the relevant anatomical landmarks. Material and methods: The length of the CV was taken from the lowest limit of the deltopectoral groove to its draining point into the axillary vein. The coracoid process (CP), first costo-chondral junction (CCJ) and the midclavicular point (MCP) were used as the landmarks and their distances from the drainage point of CV into the axillary vein were measured. Results: In all cadavers, the CV traversed the deltopectoral groove and terminated into the axillary vein. The mean length of the CV was 15.46 ± 1.57 cm. The distances of its drainage point from the sternoclavicular joint, midclavicular point, first costo-chondral junction and the coracoid process were 8.26 ± 0.99 cm, 3.51 ± 0.8 cm, 5.66 ± 0.71 cm and 5.16 ± 0.8 cm respectively. Conclusion: The present anatomical study describes the location of cephalic vein in relation to the anatomical landmarks which would be commonly used in the intervention procedures in this region.

27-30

Authors: Ashfaq ul Hassan, Rohul Afza Kaloo, Shifan, Obaid, Nisar Chaudhary, Muneeb ul Hassan

The Liver is commonly injured following penetrating trauma and the second most commonly injured organ following blunt trauma. Due to the soft consistency of the liver parenchyma, the injuries are often minor and can be easily managed. The article pinpoints the various anatomical and surgical characteristics and how they relate to liver injuries and trauma management. We reported here two cases of abdominal trauma where both the patients had liver injuries in the form of lacerations and bleeding within the substance of liver. The first case was of a young patient who had a high velocity road traffic accident and was brought to the casualty in a state of shock. The second patient had a fall from bike and fell on the road by his side.

36-38

Authors: Tariq AL-Johani, Ahmed A. Alhumidi

Pigmented epithelioid melanocytoma (PEM) is a borderline melanocytic neoplasms or a low-grade melanoma which is rare. It affects all age groups. The prognosis is relatively good compared to conventional malignant melanoma. We presented here a case of 3 years old Saudi girl presented with an asymptomatic brown-black lesion on her left forearm. At clinical examination, the lesion had a diameter of 0.6 cm, appeared round, exophytic, and intensely pigmented with well-defined edges and bluish reflections. All features strongly suggested nodular melanoma and the lesion was excised and histopathology showed asymmetrical growth of heavily pigmented atypical epithelioid and spindle cells. A pigmented epithelioid melanocytoma, so-called animal-type melanoma, was diagnosed. The depth of invasion was classified as Clark level IV, with maximum thickness of 3 mm.

44-57

Authors: Harish M. Takarani, Shankul kumar, N.S. Bhajipale

Stem cells are now becoming part of regenerative medicines due to pluripotency, but as some of the major risk factors and ethical considerations; use of amniotic fluid for extracting stem cells have now gained importance in recent years. Much of research is focused on derivatisation of stem cells obtained from amniotic fluid into various organs. Amniotic fluid derived stem cells (AFDSC) are heterogeneous population, devoid of carcinoma development and have no ethical debates. Moreover amniotic fluid (AF) stem cells have high in vitro proliferation potential. AFDSC may guarantee source of stem cell with matching immune profile. AF stem cells may become invaluable source for direct treatment of genetic disorders. The isolation techniques used for AF stem cells extraction got importance for its ease and no need of feeder cells. The work showed use of AF derived stem cells for various organ regeneration like lungs, kidneys, heart muscles, even nowadays scientist have proved its use in Alzheimer’s disease as well and other brain disorders. Use of AF stem cells in hematopoietic system got attention. Recent studies now involve use of AF stem cells for neurotransmitter system also. It is now believed that AF stem cells are most efficient among others stem cells for therapeutic purposes. Risk factors are devoid in case of AF stem cells, moreover, due to plasticity, lack of immunogenicity, lack of tumorogenicity showed AFDSC as safe for therapy and regenerative treatment.

1-8

Authors: Santhrani Thakur, Pradeepthi Chilikuri, Bindu Pulugurtha, Lavanya Yaidikar

The present study aimed to study the preliminary phytochemical analysis, standardisation and in-vitro antioxidant evaluation of Hippophae salicifolia (HS) berries extracts. Briefly, the berries were subjected to alcoholic and aqueous extraction. The preliminary phytochemical analysis was performed for aqueous and alcoholic extracts. The aqueous and alcoholic extracts are standardised for total phenolic, total tannin and total flavonoid content. The extracts were evaluated for its in-vitro free radical scavenging activities against, 2’-diphenyl-1- picrylhydrazyl (DPPH) radicals, hydroxyl radicals, nitric oxide radicals and total antioxidant activity. We found that alcoholic extract showed the presence of alkaloids, phenols, tannins, saponins, flavonoids and aqueous extract showed the presence of flavonoids, tannins, carbohydrates, and phenols. The extracts of HS berries were standardized for their total phenolic, tannin, flavonoid and vitamin-C content. The in vitro antioxidant activity revealed that both the extracts showed significant scavenging activities against free radicals. It can be concluded that both the extracts are effective in scavenging the free radicals. The flavonoids, tannins, vitamin-C and saponins may be attributed to free radical quenching activity of Hippophae salicifolia.

17-22

Authors: Sangita Rathod, Ashish Parikh

Background: Myocardial infarction is one of the most common causes of death in adult and elderly people. Aim and objectives: To study age and sex wise incidence, various risk factors, involvement of anatomical site and mortality in cases of acute myocardial infarction. Material and Methods: The present study included 100 cases of acute myocardial infarction admitted in the intensive coronary care unit of tertiary care hospital, Ahmedabad. Patients with classical ECG changes of hyper-acute or acute MI with transient rise in cardiac enzyme levels and presence of pathological q waves accompanied by elevation of ST segment and symmetrical inversion of T waves with rise in cardiac enzyme levels were included. Results: Maximum MI cases occurred in sixth decade and more common in male. Smoking was the most common risk factor and anterior wall MI was most common. Maximum mortality was found in MI involving anterior wall, inferior wall and right ventricle all together. Conclusion: Study of pattern of myocardial infarction, age and sex wise incidence, risk factors, anatomical site and mortality in cases of myocardial infarction is very useful for the treatment and prevention purposes.

34-43

Authors: Tarjina Begum, Anup K Das

The true incidence of functional physical disorders is higher in general practice including functional bowel disorders. It leads to a high socio-economic burden by way of delayed diagnosis. ROME III criteria are used to diagnose these disorders. Although there are specific clinical diagnostic features, definite diagnostic investigations are unavailable. Recent scientific studies link the mind and body as part of a system where their dysregulation can produce illness and disease where psycho-social factors do play a role in addition to genetic susceptibility and environmental factors. The brain-gut axis is now an area of intense research in studying these functional disorders and psychotherapy, behavioral modification and psycho-pharmacotherapy are becoming increasingly important to manage such disorders.

50-60

Authors: Kishor Bhimrao Rathod, Mohan Ramchandra Joshi, Priyanka Ashok Aher

According to Charaka Samhita, the disease is the state in which both the body and mind are subject to pain and misery. There is need of classification of disease which is caused by exogenous and endogenous factors. Generally, the classification gives the idea about the type and difference between diseases. Classification of disease is very essential for the treatment of the diseased individual. Unskilled physicians, who are unable to identify nature of disease, examine patient by applying sensory organ which provides only superficial knowledge of disease. To know the whole nature of disease, one should know the classification of disease which is based on origin of disease, causative factor, surgical cure or nonsurgical cure, infected organ etc.

1-6

Authors: O. Gambhir Singh, Hemalatha N.

It is a prospective study of 50 fatal head injury cases whose medico legal autopsy was done in the Institute of Forensic Medicine, Madras Medical College and Government General Hospital, Chennai from December 2007 to June 2008. There were total 50 cases of fatal craniocerebral injuries which needed admission either in Intensive Care Unit or neurosurgery. In the present study, male victims (47 cases, 96%) outnumbered female victims (3 cases, 6%) with an approximate male-female ratio of 16:1. Road traffic accidents (RTA) involving mainly pedestrians and two wheeler users were the most common cause of fatal head injury, seen in 43 cases (86%). Out of the total 50 cases of fatal head injury, brain stem injury was seen in 41 cases (82%). Skull bone fracture was found in 26 cases (52%), 11 cases were associated with primary brain stem injury and 15 cases with the secondary brain stem injury. Temporal and parietal bones were the common site of fracture, observed in 17 cases (34%). The range of survival period was wide, spreading from 6 hours to 600 hours; the mean survival period being 73.42 hours. Brain stem injury, which is generally associated with skull base fracture, was found to be the main factor governing the prognosis of the case.

12-17

Authors: Ashish Parikh

Background: Obesity and its associated co-morbidities like hypertension and diabetes is recent out bursting problem all over the world. Aim: To study prevalence of obesity and its relation with hypertension and diabetes. Material and methods: Total 70 patients who came to outdoor patient department of Gayatri Hospital, Gandhinagar from January, 2014 to June, 2014 were included in present study. Body mass index, waist circumference, blood pressure and random blood sugar were estimated in all patients to detect obesity, hypertension and diabetes. Results: Out of 70 subjects, 30 were male and 40 were female. Total 29 subjects were found obese with BMI >25. Out of 29 obese subjects, 18 were hypertensive and 13 were diabetic. Among 19 males with waist circumference >90 cm, total 12 were hypertensive and 4 were diabetic. Among 20 females with waist circumference >80 cm, total 16 were hypertensive and 8 were diabetic Conclusion: General obesity determined by help of BMI is associated with hypertension and diabetes in both males and females while central obesity determined by help of waist circumference is associated with hypertension and diabetes in females only.

26-29

Authors: Hinal Rathod

Evidence based practice, evidence based medicine, evidence based nursing etc. are not new terminology in the recent era. For implementation of evidence based nursing practice, only knowledge is not sufficient among core workers but nursing community must have attitude and intention to practice it by their heart. In current Indian scenario, there are plenty of challenges in integrated evidence based nursing practice. For effective implementation of evidence based nursing practice, a nurse must be able to decide either the evidence is relevant and appropriate for the particular patient or not before its application. All patients must receive safe, effective person centred care, based on the best available evidence is the aim of evidence based nursing and nurses have to play a key role in it.