National Journal of Medical and Allied Sciences

3-7

Authors: Rafi M, Kumar K, Muthiah J, Swadique M.

Introduction: There are various techniques available for securing limbal conjunctival auto graft in the treatment of primary pterygium. purpose of this study to compare the surgical outcome and cost effectiveness of a new techniqueautologous blood with electrocautery pen and current standard of fibrin glue. Materials and methods: This retrospective study was carried out in 76 patients presented with primarypterygia who underwent pterygium surgery using autologous blood with ecp (36 eyes) and fibrin glue (40 eyes). all patients were followed up post operatively on 1stday, 7thdayand 6th month. during follow up,patients were assessed for graft displacement or loss and comfort. cost of the surgery was also compared. Results: No intraoperative complications occurred in either group. out of 36 patients, 4 graft dislodgements occurred in autologous blood with ecp group on the immediate post-operative day. while none in fibrin glue group. during the 6 months follow-up, 6 eyes in group i (16.7%) and 1 eye in group 2 (2.5%) developed recurrence. Conclusion: Autologous blood with ecp in conjunctival autografting is as effective as fibrin glue in terms of graft adherence and post-operative patient comfort. however, this method is 3 times cost effective than the commercially available fibrin glue.

14-19

Authors: Safarulla MA, Rajesh P, Kumar A, Swadique M

Introduction: Thickness of RNFL around the different quadrants of the optic disc margin progressively increases. Macular fibers occupying the lateral quadrant are the most resistant to glaucomatous damage and explain the retention of the central vision till end. This study was undertaken to determine the age related changes in the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) in a group of normal subjects. Material and Methods: This prospective cross sectional hospital based study consisted of 150 healthy eyes of 75 subjects whom underwent ONH measurement using the Optovue optical coherence tomography (OCT) and examined the result of optic nerve head parameters and RNFL. Results- Mean cup disc ratio was found to be higher with increasing age. And the average RNFL thickness was found to decrease with increasing age. Conclusion: There are changes in optic disc parameters and RNFL with increasing age and the changes were measurable and significant.

25-29

Authors: Rajesh P, Safarulla MA, Saad M, Kumar A.

Introduction- Patients undergoing cataract surgery develop astigmatism based on location of incision. This retrospective study investigated the “Pre & post operative astigmatism after cataract surgery based on incision”. Purpose of this study was to compare astigmatismobtained in temporal & superior incision. Material and Methods- Out of 50 cataract patients collected, 25 patients were in the temporal incision PHACO group and 25 were in the superior incision PHACO group. Corneal astigmatism and corrected visual acuity were assessed 30 and 90 days after cataract surgery. Results- against the rule astigmatism is more common after superior incision cataract surgery and with the rule astigmatism is more common after temporal incision cataract surgery. Conclusion: The study reveals temporal incision, increase with the rule & superior incision increase against the rule and also concluded astigmatism is least in temporal incision.

36-40

Authors: Manjunath Rajashekharaiah M, Ghanate AN, Verma P, Ram D

Introduction: Suicidal behaviour is common in bipolar disorder. This is especially true in anxious patients or comorbid anxiety disorder. The effect of subsyndromal anxiety in this group of patients in India needs to be assessed. This study was undertaken to assess comorbid anxiety in patients of bipolar disorder with and without suicidal behavior and to study the relationship of co-morbid anxiety with suicidal behavior in patients with bipolar disorder. Material & Method: 60 bipolar disorder patients in remission coming to the Central Institute of Psychiatry diagnosed as per DSM IV-TR (American Psychiatric Association, 2000) criteria, 30 with suicidal ideation and 30 without suicidal ideation were taken in the study. Co-morbid conditions other than anxiety were ruled out. They were further assessed on Hamilton Rating Scale for Anxiety. Results: The suicidal group was significantly more depressed than the Non-suicidal group with p < 0.001. Statistically significant positive correlation was found between General Somatic Symptoms (Muscular) item and duration of illness (r=0.481, p<0.01). Statistically significant positive correlation were found between the item anxious (r=0.380, p<0.05) and BSI scores. Statistically significant positive correlation were found between the item tension (r=0.435, p<0.05) and BSI scores. Statistically significant positive correlation was found between depressed mood (r=0.368, p< 0.05) and age of onset. Statistically significant positive correlation was found between General Somatic Symptoms (Muscular) (r=0.434, p< 0.05) and age of onset. Conclusions: Suicidal patients were significantly more depressed than the non suicidal patients. Within the suicidal group it was noted that patients who were more anxious and had more tension had higher scores on the suicidal ideation scale. These two items may be taken as indicators of higher suicidal tendencies in patients of bipolar disorders. Also, somatic symptoms were related to duration of illness. Within the Non-suicidal group, age of onset was related to depressed mood and somatic symptoms.

45-49

Authors: Rajashekharaiah M, Ghanate AN, Verma P, Ram D

Introduction: Most patients with bipolar disorder also exhibit suicidal behaviour. Early onset of illness and male preponderance have been noted in Indian population. There was no recent literature with regard to socio-demographic and clinical variables among suicidal behaviour in Indian population except a few earlier ones. This study was undertaken to find out the relationship of socio-demographic and clinical variables with suicidal behaviour in patients with bipolar disorder. Method: 60 bipolar disorder patients in remission coming to the Central Institute of Psychiatry diagnosed as per DSM IV-TR (American Psychiatric Association, 2000) criteria, 30 with suicidal ideation and 30 without suicidal ideation were taken in the study. Their sociodemographic and clinical data were collected. Results: The mean age of onset of the illness in the suicidal group (19.10±5.27 years) was significantly less than the mean age of onset of the illness in the non-suicidal group (23.33±7.56 years). Females were found to have higher BSI scores (mean = 8.20±8.88) than males (mean = 3.40±2.01). Most of the patients had a history of prior hospitalization and most of them had a manic episode as the most recent episode. Females were found to have higher BSI scores (mean = 8.20±8.88) than males (mean = 3.40±2.01). Positive history of prior hospitalization (mean=4.29±4.30) was associated with lower BSI scores as compared to higher scores of that without a positive history (mean=11.33±12.74). Conclusions: Suicidal patients had earlier age of onset of illness than non suicidal patients. Females were found to have higher suicidal ideation than males. Hospitalization can reduce the suicidal ideation in patients.

54-58

Authors: Selvara J, Jeevaraman S, Shankar R.

Introduction: Infections among the diabetic patients play a vital role in the morbidity and to an extent mortality of the diabetic patients. Among the bacteriology of diabetic foot ulcers which had been documented by various researchers mixed aerobic - anaerobic microbes seems to be more common. Fungal infections among immunocompromised patient’s particularly diabetic patients are one of the major health concern in the world today. Very few studies in India was previously done on assessing the magnitude of fungal infections in diabetic foot ulcers particularly among the rural patients. This study was undertaken to assess the prevalence of infections among the diabetic patients with foot ulcers and see for the presence of fungal infections and to describe the spectrum of those fungal infections. Material and Methods: A prospective study was carried out on diabetic patients with foot ulcer during the period of 1 year from June 2014 – May 2015 at Thanjavur medical college. A total of 100 cases with diabetic foot ulcers were included for the study. The power of the study was kept as 89.7%, which was calculated by using the formula of Z power = test statistics/ S.E – 1.96. Where the test statistics was taken as 0.2and the SE was taken as square root of 0.5/n and where n= 100. Specimens (pus, wound, exudates or tissue biopsy) for microbiological studies were obtained from the ulcer region. All the 100 specimens were immediately transported to the microlab for further processing, culture and isolation. Identification of the microorganisms were done according to the standard microbiological procedures. Results: Among the study subjects males constitutes to 83% and females 17%. The mean random blood sugar among the subjects was 316.35±54 mgs/dl. The average duration of the foot ulcer among the study subjects was 13±7.58 months. Of the various microorganisms which was found in the foot ulcer bacterial agents were present in almost 100% of the patients. The fungal growth was seen in 29% of the patients with foot ulcers. The most common fungus identified were Aspergillus flavus (17%), Aspergillus fumigates (5%), Candida albicans (6%) and Mucor (1%). Conclusions: The present study insists on the evaluation of fungal pathogen for long standing diabetic foot ulcers even after effective treatment with antibacterial agents.

64-69

Authors: Shivde R, Patel K, Mittal S, Prasla S

Introduction: Tuberculosis is a major health problem in developing countries. Abdominal tuberculosis is not an uncommon manifestation of extra pulmonary tuberculosis. Recognition of its usual and unusual findings is important for diagnosis of the disease. Material and Methods: This retrospective study involved 150 abdominal tuberculosis patients over a period of 5 years in rural & urban population of Nashik district in Maharashtra. Abdominal ultrasound using Siemens (Accuson X500) and Philips HD 11 with convex & linear probes was done to find out the intestinal and extraintestinal disease involvement and appearances. Results: Abdominal tuberculosis was found to be more common in rural population and had a slight female predominance. In extraintestinal involvement; ascites was found in 44% cases, peritoneal thickening was found in 15 % cases, tubercles were found in 5% cases and thick swollen mesentery in 7% cases. Lymphadenopathy was seen in 47% cases. In intestinal involvement, isolated bowel wall thickening (30%), bowel ulceration (3%), bowel lump with pseudo kidney appearance (11%), matting and clumping of bowel loops (16.5%) and complex bowel mass (8.5%) were seen. Some of the unusual patterns like “club sandwich appearance” (11%) and “multilayered sandwich appearance”(2%) were also seen. Conclusion: Because of nonspecific symptoms abdominal Tuberculosis is mostly under diagnosed or misdiagnosed for chronic acidity, gastritis /colitis or chronic appendicitis. Knowledge of both usual and unusual findings is essential to diagnose abdominal tuberculosis. Hence abdominal ultrasound should be used as a primary cost effective screening modality for diagnosis which helps in management of abdominal tuberculosis.

76-79

Authors: Nigam S, Debbarma S, Barman SK, Midha T

Introduction: According to the 2009 Global Health Risks report, substance abuse is one of the top 20 factors for death and disability worldwide. Globally, there is an increasing trend for people to use multiple substances, either together or at different times, which is likely to further increase the risks. This study was undertaken to know out the prevalence of substance abuse among male undergraduate students and to find out any influencing factor. Material & Methods: The cross-sectional study was conducted among male undergraduate students of G.S.V.M Medical College, Kanpur, Uttar Pradesh in 2015. Data was recorded in a pre-designed and pre-tested questionnaire and analyzed using standard statistical tools Results: Nearly 40.5% of students accepted substance abuse. Peer pressure (41.97%) and anxiety or stress (37.03%) were the commonest reasons for initiation. Substance abuse by parents was found to be significantly associated with substance abuse by students (P<.001). Conclusion: Substance abuse is prevalent among male medical undergraduates. Peer pressure followed by anxiety or stress were the commonest reasons for initiation. Substance abuse by parents increases the likelihood of substance abuse by students.

84-90

Authors: Yadav AK, Gupta P, Shrivastava MR, Prakash D, Yadav KK, Srivastav S.

Introduction: In India, report says that we failed to achieve the Millennium Development Goals. The maternal mortality rate and infant mortality rate in developing regions are approximately 15 times higher than developed countries. Hence safe delivery and essential newborn care, besides neonatal care in domestic setting and timely referral for cases unmanageable are important areas to be addressed. This study was aimed to assess the current pattern of utilization of maternal and neonatal care services in rural areas of Lucknow. Material and Method: This community based cross sectional study was conducted in between August 2014 to July 2015. Study site was rural area of Lucknow. The study unit was a recently delivered woman, defined as a woman who gave live birth in last one year. A multi stage random sampling technique was used. We uses SPSS version 17 for our statistical analysis. Results: We interviewed 368 RDWs and found that 10.6 % of RDWs did not visit even once to health care facility and almost 62% of registered RDWs were registered early. About 70% RDWs completed at least three ANC visits, 67.7% received complete course of tetanus toxoid and 79.1% received at least one hundred of iron and folic acid (IFA) tablets. Approximately 90% deliveries were conducted by qualified physicians in government institution. There was a clear reduction in facilitating services by health care workers before and after delivery. We found that age less than 30 years, higher socioeconomic strata, educational level higher than matriculation of RDWs were likely to complete their ANC cares and these associations were statistically significant. Conclusion: We are still far away from health for all. To achieve SDG, a multi prong approach is need of hour.

97-102

Authors: Agrawal A, Sharma MK, Agrawal S, Arora V, Somvanshi R.

Introduction: Cleft lip/palate are the most common craniofacial anomalies in children, with an incidence of CLP worldwide is 1 in 700 live births. The risk factors are considered as Family history etc. Anaesthesia during cleft lip and palate surgery carries a high risk and difficult airway management in children. Because of other associated congenital anomalies, the anaesthetic management becomes more complicated. Flexometallic endotracheal tubes, PVC macintosh tube, RAE tube are have their own risks and benefits when compared with each other. This study was undertaken to compare ease of intubation ,ease of ventilation ,intra operative maintenance of respiratory parameters ,intra-operative airway complication, post extubation complication by using 3 different types of tubes (1) RAE (Ring Adair Elwyn) tube (2) flexometallic tube (3) PVC ( Polyvinyl Chloride) macintosh tube in pediatric cleft palate surgeries. Material & Methods: A randomized controlled trial was conducted on 90 ASA I and ASA II pediatric patients of age group 9 month to 5 years undergoing cleft palate surgeries. Patients were randomly allocated in three groups of 30 each. Group 1: intubated with R A E endotracheal tube, Group 2:intubated with flexometallictube and Group 3: intubated with P V C macintosh endotracheal tube. The power of study on choosing such sample size was found to be at 90% level. Time taken for intubation, No. of attempt taken for intubation, Monitoring of capnography, SPO2, pulse rate and mean airway pressure every 15 minutes during the surgical procedures, Endobronchial intubation, Inadvertent extubation, Ease of passing of suction catheter after application of dingman retractor and Post extubation cough and croup was observed. Results: The significant differences were observed in stylet used, ease of passing suction catheter and post extubation cough and heart rate after retractor among the groups (p<0.05). All other differences were found to be insignificant. Conclusion: RAE tube provides a good approach for airway management in routine cleft lip surgeries. It possesses advantage over flexometallic tube and PVC tube. As it is a preformed tube passing suction catheter is technically difficult.

109-111

Authors: Gautam R. Ikram A, Nath D, Omhare A

Introduction: Blood disorders are very common among dif¬ferent age groups. They usually range from anemias to advanced hematological malignancies. Material and Methods: The present observational study was conducted in the Department of Pathology, M.L.B. Medical College, Jhansi to find out the incidence of different hematological disorders. marrow examination was done. SPSS software was used for data analysis. Results: Hematological disorders were more common among males (63.55%) and among those aged Bone between 21-30 yrs (27.1%). Anemia was the most common diagnosis in 49 cases (41.52%) followed by leukemia in 16 cases (13.56%). Thirteen cases (11.02%) were diagnosed as malarial parasite positive in bone marrow examination. Conclusion: Bone marrow examination is a useful test in reaching the final diagnosis

120-124

Authors: Safarulla MA, Rajesh P, Kumar A, Swadique M

Conjunctivochalasis is an ocular condition that is usually missed, unless specifically looked for. It is defined as a redundant loose non edematous inferior bulbar conjunctiva. Though generally asymptomatic, It may also present as dryness and foreign body sensation. Various grading systems like Mirmura ((based on Lid-parallel conjunctival folds), Mellers (based on lid-parallel conjunctival folds, punctual occlusion and conjunctival fold changes during down gaze and digital pressure) and Zhang’s based on conjunctival folds, dryness, foreign body sensations, epiphora symptoms, punctual occlusion, tear meniscus height, tear film break-up time (BUT), and conjunctival fold changes during down gaze) system has been outlined. Various etiological aspects like dissolution of the Tenon’s Capsule and role of expression of matrix metalloproteinase-1 (MMP-1) and matrix metalloproteinase-3 (MMP-3) has been dealt in detail. Different surgical approaches like paste-pinch-cut conjunctivoplasty and their steps are specified. Conjunctivochalasis has to be understood in a wider depth and more research work is required to understand CCh in better detail so that preventive steps can be implemented with regard to secondary causes.

132-139

Authors: Safarulla MA, Hussain S, Rajesh P, Swadique M

Infectious keratitis is an important problem in the Indian context, and epidemiological studies suggest a higher prevalence of disease as compared to the developed world. Various aspects of the problem, including the host defence, ocular and systemic risk factors and microbial mechanisms that enhance pathogenesis have been discussed. The clinical and microbiological approach to the infected eye and patient and the relevant tests have been outlined. The major classes of medications that are used the methods of delivery are specified. Finally, the approach to patients with non-responsive keratitis that requires surgical manoeuvres is also highlighted. Clinical experience is important in distinguishing an infective from an inflammatory corneal pathology. The role of an experienced microbiologist is inevitable, for good clinical outcome. Therapeutic keratoplasty has to be done at the right time for better clinical outcomes.

143-147

Authors: Ashraf M, Khan MA, Jabr IA

Introduction -Cosmetically acceptable surgical results are the demand of this modern era. Aesthetic facial look has lots of impact on financial, social and personnel life. Material and Methods- A total of twenty cases were studied in the Department of ENT at Hind Institute of Medical Sciences (HIMS), Barabanki, Uttar Pradesh. FNAC, USG and CECT were done and only benign lesions were selected which could be approached intraorally. Results-There were 20 patients aged between fifteen years to sixty years. There were ten cases of submandibular swellings, four cases of sebaceous cyst, three cases of lipoma and two cases of parapharyngeal space swelling and one case of plunging ranula. The mean operation time of the IOA group was significantly longer than that of the TCA group, but decreased gradually with surgical experience. The mean hospital stay of the IOA group was significantly shorter than that of the TCA group. Conclusions-The innovative surgical approaches were studied and meticulous, cosmetically acceptable results which were highly appreciated by the patients and their attendants were achieved. The stay in the hospital and complication rates were also quite low in intraoral approach than conventional external approach. Hence, intraoral approaches should be used for benign lesions which are amenable to surgery.