National Journal of Integrated Research in Medicine 2021-01-15T19:37:37+00:00 Chinmay shah Open Journal Systems <p>This is an official publication of&nbsp;<strong>"</strong><strong>Association of Health Professionals and Health Educators".&nbsp;</strong> National Journal of&nbsp; Integrated Research in Medicine&nbsp; will publish article of research in various type of therapy for the benefit of mankind i.e. allopathy, ayurvedic, Homeopathy, Sujok therapy, Unani and Siddha Medicine. All the Content of Journal are Open Access and <strong>can be accessed by all without login or payment . We follow Creative Commons license CC BY-NC-SA for access of article.</strong></p> Determinants of awareness and knowledge about Diabetic retinopathy in long-standing type 2 diabetes mellitus 2021-01-15T19:37:35+00:00 APURVA STHAPAK Dr Rekha R Khandelwal Dr Abhishek Mankar <p><u>Background:</u> Diabetic retinopathy (DR) is a complication of diabetes that affects the eye and is asymptomatic till it reaches advanced stages. The present study was designed to assess the determinants of awareness and knowledge of DR in type 2 diabetic patients. <u>Objectives:</u> To assess the determinants of awareness and knowledge about diabetic retinopathy (DR) in long-standing type 2 diabetes mellitus (DM) patients. <u>Material &amp; Methods:</u>&nbsp;A cross-sectional study was conducted on patients with type 2 DM for two months in a rural-based hospital in Central India. A brief structured open-ended questionnaire was used to collect information about the subjects’ awareness and knowledge about DR. A detailed history of the subjects including demographic details, BMI, socioeconomic status and treatment modalities were also obtained. The ocular examination in detail was performed by a retina consultant to diagnose the stage of DR. <u>Results:</u><strong>&nbsp;</strong>Out of 328 participants, there were 181 male (55.18%) and 147 female subjects (44.81%) in the study. 71.30% of patients were being treated with oral hypoglycemic drugs, 14% with insulin and 9.5% with both. Only 21.7% were aware of the involvement of retina in Diabetes. More than half of the type 2 DM patients (52.4%) were not advised eye examination by the physician. <u>Conclusion:</u><strong>&nbsp;</strong>Awareness and knowledge regarding DR are poor. There is a need to spread awareness about DR in the community to avoid blinding complications. [Sthapak A Natl J Integr Res Med, 2020; 11(6):1-6]</p> 2021-01-14T18:30:33+00:00 Copyright (c) 2020 National Journal of Integrated Research in Medicine A study for evaluation of gap between paediatricians and ophthalmologists for retinopathy of prematurity management in western India. 2021-01-15T19:37:36+00:00 Dr. Kinjal Trivedi Dr. Vipul Prajapati Dr. Hetal Chatbar <p><u>Background:</u> To study gap between paediatricians and ophthalmologists for management of retinopathy of prematurity (ROP) and apply it in better policy makings to prevent irreversible vision loss in the affected preterm babies. <u>Material &amp; Methods:</u> In this cross-sectional observational study,100 paediatricians of western India&nbsp; were asked about educational&nbsp; and&nbsp; practicing&nbsp; profile, knowledge regarding ROP screening&nbsp; guidelines,&nbsp; risk&nbsp; factors and potential outcomes,&nbsp; referral&nbsp; facilities available in their localities&nbsp; and&nbsp; barriers&nbsp; for&nbsp; referral. Chi-square&nbsp; test&nbsp; was&nbsp; used and&nbsp; a&nbsp; P&nbsp; value&nbsp; of&nbsp; &lt;0.05&nbsp; was considered&nbsp; as&nbsp; statistically&nbsp; significant. <u>Results:</u> All (100%) knew about risk factors&nbsp; for development of ROP. Awareness regarding timing of screening was found in 82% urban and40% rural practitioners. 74% urban practitioners knew about treatment modalities but only 50% rural paediatricians were aware about this. Only 14% urban practitioners were facing problem in referral in contrast to 60% rural practitioners. Majority (70%) said unavailability of a trained ophthalmologist was the barrier in the referral. <u>Conclusion:</u>&nbsp; Majority&nbsp; of&nbsp; paediatricians&nbsp; in&nbsp; western&nbsp; zone&nbsp; of&nbsp; India&nbsp; were&nbsp; aware&nbsp; of&nbsp; risk factors but had&nbsp; less&nbsp; information&nbsp; about&nbsp; ROP&nbsp; screening timings&nbsp; and&nbsp; treatment&nbsp; modalities.&nbsp; This&nbsp; suggests&nbsp; need&nbsp; for&nbsp; creating&nbsp; awareness&nbsp; and&nbsp; close&nbsp; coordination&nbsp; between&nbsp; paediatricians&nbsp; and&nbsp; ophthalmologists especially in rural localities. [Prajapati V Natl J Integr Res Med, 2020; 11(6):7-10]</p> 2021-01-14T18:40:42+00:00 Copyright (c) 2020 National Journal of Integrated Research in Medicine Profile & Pattern Of Abdominal Tuberculosis: A Record Based Study 2021-01-15T19:37:36+00:00 Dr. Akash Mukeshbhai Shah Dr. Archana Dalal Dr. Yagnya Dalal Dr. Sandip Patel Dr. Jalay Desai Dr Viraj Patel <p><u>Background:</u> Abdominal tuberculosis encompasses gastrointestinal, peritoneal and visceral forms of tuberculosis. Their clinical presentation and radiological findings are varied and non-specific, often warranting surgical intervention either for confirmation of diagnosis or for definitive management. This study aims to analyse the trend, clinical profile, diagnostic modalities, site of distribution and outcome of Koch’s abdomen in non HIV infected patients. <u>Material &amp;Methods:</u> This is a retrospective study conducted at a tertiary care teaching hospital from January 2012 to December 2019. All serologically HIV negative patients (&gt;12 years age) with diagnosis of abdominal tuberculosis were included. <u>Results:</u> Out of 184 cases of abdominal tuberculosis, 120 patients (65.2%) were managed conservatively while 64 patients (34.7%) had undergone laparotomy. Peritoneal disease was the commonest (33.1%) followed by involvement of ileocaecal region (31.25%), ileum (21.73%), nodal &amp; omental disease (13.58%). Resection &amp; anastomosis was done in 43 (67.18%) patients, adhesiolysis in 13 (20.31%) patients and resection with stoma in 8 (12.5%) patients. <u>Conclusion:</u> Abdominal tuberculosis should be considered in differential diagnosis of the patients with abdominal pain. While majority of such patients can be managed conservatively, some may require surgery. Those requiring emergency surgery are at more risk to develop complications. [Shah A Natl J Integr Res Med, 2020; 11(6):11-16]</p> 2021-01-14T18:52:24+00:00 Copyright (c) 2020 National Journal of Integrated Research in Medicine Students’ and teachers’ perception of Structured Oral Examination 2021-01-15T19:37:36+00:00 Gauri Lele Shailesh Lele <p><u>Background:</u> Conventional Oral Examination entails variability in terms of sampling and scoring. Non uniform time allocation, environment and attitudes of both the examiner and the examinee are the other challenges. Hence, a study was undertaken to introduce Structured Oral Examination (SOE) in the subject of Pedodontics and Preventive Dentistry as formative assessment; and obtaining the teachers’ and students’ perception and acceptance of the same. <u>Material &amp; Methods</u>: Following sensitization of teachers to this method, a protocol for conducting SOE was developed. A pre validated set of questions with scoring criteria was given to examiners, and they were randomly allocated 2/3 students by ‘chit method’. Identical questions were posed in a fixed time frame to 27 student participants from III BDS posted in the department. Feedback was obtained from students and teachers, in the form of a questionnaire. <u>Results</u>:&nbsp; Overall, there was 100% satisfaction on part of students and teachers, with 100% agreement on elimination of bias with SOE. <u>Conclusion</u>: SOE was well accepted by students and teachers. Though this method requires elaborate planning and resources. SOE could be implemented and tested on a larger student/teacher population. [Lele G Natl J Integr Res Med, 2020; 11(6):17-21]</p> 2021-01-14T18:52:46+00:00 Copyright (c) 2020 National Journal of Integrated Research in Medicine Role of ultrasound in diagnosis and early prediction of severity of dengue infection in children 2021-01-15T19:37:36+00:00 Rutvik Parikh Hetal Jeeyani Shivam Badiyani Harsh Muliya Parth Modi <p><strong>Abstract</strong></p> <p><strong>Background and Objectives: </strong>Dengue has become a major health problem worldwide. The main objective of the study was to evaluate ultrasound features in children with dengue and determine its role in early diagnosis and predicting the severity of the disease.</p> <p><strong>Methods:</strong> 113 serology-positive cases from 1month-14years were divided into three clinical groups – dengue fever, dengue fever with warning signs and severe dengue. Ultrasound was performed during the critical phase and features were analyzed. Comparison was done between these groups by applying appropriate statistical analysis.</p> <p><strong>Results and interpretation:</strong> 75(66.3%) were diagnosed as Dengue fever, 16(14.1%) as Dengue with warning signs and 22(19.4%) as Severe dengue. Ultrasound features were, ascites(54,47.7%), gall bladder wall thickening(41,36.28%), pleural effusion(32,28.31%), splenomegaly(28,24.77%) and hepatomegaly(22,19.46%). The ultrasound features like ascites(p&lt;0.05), pleural effusion(p&lt;0.00001) and gall bladder wall thickening(p&lt;0.00001) were significantly higher in Severe Dengue as compared to Dengue fever which suggest that these features predict severity of dengue. Hepatomegaly and splenomegaly showed no significant difference suggesting that it only supports the diagnosis.</p> <p><strong>Conclusion:</strong> Ultrasound can be used as an important supportive modality in early diagnosis of suspected dengue. In an epidemic, gall bladder wall thickening, ascites and pleural effusion favors the diagnosis of dengue fever and predicts its severity by identifying plasma leakage.</p> 2021-01-14T18:56:31+00:00 Copyright (c) 2020 National Journal of Integrated Research in Medicine Positive Predictive Value Of Possum Scoring In Outcome Prediction In Laparotomies 2021-01-15T19:37:36+00:00 Dr Ronak R Modi Dr. Keyur N Surati Dr. Haresh Suthar Dr. Jatin Modi Dr. Harshil Modi Dr. Anuj S Shah Dr. Vikas Khakhariya Dr. Jigar Patel Dr. Monil Patel <p><u>Background:</u> Early prognostic evaluation of laparotomies patients is desirable to select the high-risk patients for a more aggressive treatment. The continuous monitoring and audit of clinical practice is an essential part of making improvements in medical science and enhancing patient care. P-POSSUM remain the most commonly used scoring system in laparotomies for prediction of mortality and morbidity. <u>Material &amp; Methods:</u> 50 Patients undergoing emergency or elective laparotomy were scored according to their physiological pre-op, post-op &amp; intra-operative parameters and findings. And thus, final expected mortality rate and morbidity rate was calculated according to P-POSSUM scoring system. Positive predictable value (PPV) and sensitivity were calculated. <u>Results:</u> In this study, True Positives are 27, False Positives are 12, False Negative is 0 &amp;amp; True Negatives are 11. Sensitivity of the P-POSSUM scoring system is 100%. Positive predictive value is 69.23%. <u>Conclusion:</u> P-POSSUM remain the most commonly used scoring system in laparotomies. POSSUM is subjective scoring system but in actual study morbidity is near or less than expected. It may due to vigorous post-operative management for decreasing morbidity score. It’s a useful tool for clinicians to predict prognosis as well as anticipate development of morbidities. [Surati K Natl J Integr Res Med, 2020; 11(6):28-32]</p> 2021-01-14T19:05:47+00:00 Copyright (c) 2020 National Journal of Integrated Research in Medicine To Study Arterial And Venous Blood Gas Sample For Diagnosis Of Acid Base Abnormality In Patient With Diabetes Ketoacidosis 2021-01-15T19:37:36+00:00 Dr. Gaurav Raiyani Dr. Parshav Patel Dr. Prafful Kothari Dr. Ashok Choudhary <p><u>Background:</u> To study the values of Arterial Blood Gas (ABG) and Venous Blood Gas (VBG) sample for comparison of pH, HCO3 and pCO2 values in patients presenting with Diabetic KetoAcidosis. To determine Degree of Agreement between these values in such patient. To assess whether VBG analysis can replace ABG analysis in initial evaluation of patients presenting with DKA. <u>Material &amp; Methods:</u> The observational comparative study was carried out on 38 patients above the age of 17 years presenting with Diabetic ketoacidosis admitted in Emergency Ward (EW) of medicine department at Tertiary Health Center, South Gujarat. <u>Results:</u> Strong linear correlation was found between Arterial and Venous pH, HCO3 and CO2 values and Venous pH and HCO3 is almost equivalent to that of Arterial, but according to the Degree of agreement Venous pCO2 is not equivalent to Arterial pCO2; so Venous pH and HCO3 can be used in place of Arterial pH and HCO3 in initial evaluation of DKA patient but not Venous pCO2. <u>Conclusion:</u> For initial evaluation of DKA patients (for pH and HCO3 determination), we can use VBGA in place of ABGA, as ABGA is technically more difficult, more painful, and carries higher incidence of complications. [Riyani G Natl J Integr Res Med, 2020; 11(6):33-37]</p> 2021-01-14T19:16:42+00:00 Copyright (c) 2020 National Journal of Integrated Research in Medicine Knowledge & practices of ASHA functionaries in active case detection of leprosy ,Lucknow Uttar Pradesh 2021-01-15T19:37:36+00:00 Dr. Praveer Saxena Dr. Vartika Saxena <p><u>Background:</u> : Leprosy Case Detection Campaign (LCDC) is first of it’s kind initiative taken by Govt. of India for early detection and treatment of Leprosy cases in the community. ASHA functionaries are involved in this campaign to make it successful. LCDC campaign is primarily a door to door search with physical examination &amp; identification of suspects followed by confirmation of diagnosis by Medical officer and free of cost treatment for positive cases. <u>Material &amp; Methods:</u> This was the community based observational study. In this study total 19 ASHA functionaries were involved from two randomly selected Sub-centers&nbsp;&nbsp; Ataria &amp; Kunwarpur out of six Sub-centers attached with Rural Health Training Center Ataria, Lucknow, Uttar Pradesh under department of community medicine of Hind Institute of Medical Sciences Sitapur. All ASHA functionaries were interviewed using semi-structured questionnaire &amp; observed by faculty of department of community medicine during LCDC activity. <u>Results</u>: None of ASHA functionary correctly knew exact cause of leprosy. Only 10% knew mode of transmission, 26% knew complications and 19% knew method of complications prevention. However, most of them knew sign &amp; symptoms (90%) and free of cost availability of treatment in Govt. health centers. During LCDC activity 53% ASHAs were correctly marking the house.90 % ASHA knew their responsibility regarding leprosy case search &amp; treatment. Only 37% knew exact amount of incentives they would get for leprosy case search &amp; treatment. Only 58% ASHA attended the orientation training. Out of them only 27% completed the practical exercises and none of them got IEC material. None of ASHA informed the community before or after starting LCDC activity and same was true for distribution of IEC( Information Education &amp; Communication) material. Only 16% ASHA were working in field from the onset of LCDC activity. Only 53% ASHA correctly filled the tally sheets. 74% ASHA could achieve given target for house to house search. <u>Conclusion</u> –Training quality, organization of IEC activities &amp; supportive supervision are the areas where improvement is needed. [Saxena P Natl J Integr Res Med, 2020; 11(6):38-42]</p> 2021-01-14T19:21:05+00:00 Copyright (c) 2020 National Journal of Integrated Research in Medicine An Evaluation Of The Retention Property Between Cream Type And Strip Type Denture Adhesive With And Without Salivary Substitutes: An In Vitro Study 2021-01-15T19:37:36+00:00 Zalak patel <p>Background: Patients with xerostomia complain of not only dryness of mouth but also discomfort during routine normal oral functions like speaking and swallowing. This complain is worse in individuals wearing removable intraoral dental prosthesis. In such situations, when salivary flow decreases, denture adhesives and salivary substitutes are recommended; which aid in denture retention and improve patient comfort. Method: A total 150 samples were prepared using heat-cure acrylic resin of 30mm×30mm×5mm. All samples were equally divided in A,B,C,D,E groups, wherein Group A was control group with salivary substitutes. Group B was denture adhesive cream without salivary substitutes. Group C was denture adhesive cream with salivary substitutes. Group D was denture adhesive strips without salivary substitutes. Group E was denture adhesive strips with salivary substitutes. The retentive force was measured for all samples using universal testing machine. Results: Data was collected and statistical analysis was done by one-way ANOVA test followed by post hoc test. The significant difference was found between the retentive forces of cream type and strip type denture adhesives with or without salivary substitutes. Conclusion:From this study, it is concluded that denture adhesive will definitely increases the denture retention. The cream type denture adhesive with salivary substitutes has the most retention than among all groups [Shah D Natl J Integr Res Med, 2020; 11(6): 43-48]</p> 2021-01-15T19:24:10+00:00 Copyright (c) 2020 National Journal of Integrated Research in Medicine Post operative complications in Early versus interval laparoscopic cholecystectomy for acute cholecystitis: A one year Eastern Indian experience 2021-01-15T19:37:36+00:00 Mainak Pal Prasenjit Bhattacharya Dibakar Bagchi Sibnath Mandal Subhayan Bera Subhrojyoti Bhowmick <p><strong>Background</strong>: Laparoscopic cholecystectomy is the gold standard method of treatment for acute cholecystitis. Controversy remains regarding its timing. Interval cholecystectomy after 4 to 6 weeks of resolution of acute inflammation was the standard of care but recent trend towards early cholecystectomy within 72 hours of symptom onset. Comparative study between these two approaches is limited from Eastern India private hospitals. The objective of the study is to compare the post operative complications of these two approaches in a tertiary care Hospital in Eastern India.</p> <p><strong>Methods</strong>: A prospective observational study was conducted for one year duration(01.02.2019 to 31.01.2020) at the Department of Surgery, Peerless Hospital, Kolkata with 50 patients divided into 2 groups of surgical intervention (based on admission in even and odd days of week ). Post operative complications were noted at first week and six week follow up. The statistical analysis was performed using SPSS software with a p-value &lt; 0.05 was considered to be statistically significant.</p> <p><strong>Results: </strong></p> <p>2 patients had epigastric pain at port site in both surgical intervention groups. No patients in either group had post operative jaundice. In early group 4 patients (16%) had increased ESR and 3 patients (12%) had increased CRP during the 1<sup>st</sup> follow up visit which became normal in the next follow up. No patients in either group suffered from continuous drainage of bile, blood, wound infection &amp; mortality</p> <p><strong>Conclusion: </strong>Our study clearly depicts no difference in post operative complications between early and interval cholcyestetomy. Early laparoscopic cholecystectomy within 72 hours of symptom onset is the preferred and safe method for treating acute cholecystitis than interval laparoscopic cholecystectomy in Indian patients.</p> <p>&nbsp;</p> <p>&nbsp;</p> 2021-01-14T19:28:18+00:00 Copyright (c) 2020 National Journal of Integrated Research in Medicine Symptomatic assessment of the effectiveness of homeopathic interventions on forty nasal polyp patients: A prospective observational study 2021-01-15T19:37:37+00:00 Dr.Nur-E-Alam Rasel <p><u>Background:</u> Nasal polyp is hypertrophied, pedunculated, loose, fibro-oedematous mucosa of nose and the para nasal air-sinuses. The surface is lined with pseudo-stratified ciliated columnar epithelium. Nasal problems represent a major health problem in developing countries and also a high risk to travellers who visit the cold rich countries. Conservative estimates place the global health problems reveal that 0.1% children and 1% adult population is affected by nasal polyp. Male are more affected by female &amp; chance of developing is 1-20 in 1000, after the age of 60 and has no racial predilection. Nasal polyps are frequently dealt-with cases in day-to-day practice. Among its different varieties, simple mucus polyps are very common. It has two distinct varieties – ethmoidal and antro-choanal polyps. Almost always, an allergic or infectious aetiology is present. Nasal obstruction, rhinitis, headache, loss of smell, snoring, sleep apnoea etc. are some of the very disturbing complaints from which the patients suffer. Appropriate diagnosis, correct general measures and judicious homeopathic approach not only uproot the disease, can also prevent recurrence of Nasal polyps quite effectively and this treatment is more cost effectiveness to other conventional treatment. <u>Material And Methods</u>: Forty Nasal polypus patients were taken up for the study and treated according to symptoms similarity of homeopathic system of medicine with different medicines in different time-period from a non-government OPD homeopathic hospital and four private chambers and clinics. <u>Results:</u> By the end of this study showed, out of 40 cases 77.5% are almost improved, 5% are improving well, 10% cases are not responded well and rest of 7.5% gave up treatment. <u>Conclusion:</u> Almost all of the cases belong to either fundamentally sycosis or dominantly tubercular miasm. This observational study also showed <em>Calcarea Carbonicum</em> was most used as a symptomatic homeopathic intervention that extent to which the observed effects&nbsp; are&nbsp; due&nbsp; to&nbsp; the&nbsp; life-style&nbsp; regulation&nbsp; and&nbsp; placebo&nbsp; or&nbsp; context&nbsp; effects&nbsp; associated&nbsp; with&nbsp; the treatment needs clarification in future explanatory studies. [Resel N E Natl J Integr Res Med, 2020; 11(6): 56-60]</p> 2021-01-14T19:55:21+00:00 Copyright (c) 2020 National Journal of Integrated Research in Medicine Preventive Prosthodontics : Seeing the Unseen 2021-01-15T19:37:37+00:00 Dr. Shruti.P.Mehta Dr. Hitendra Shah Dr. Priyanka.V.Sutariya Dr. Vinita.P.Karia Dr. Viraj.Y.Shah Dr.Tanvi.S.Goyal <p>The aim of Preventive prosthodontics should be an attempt to converge to the dictum of DeVan “Perpetual preservation of what remains, rather than meticulous restoration of what is lost”. Preventive prophylaxis improves the overall prognosis of the stomatognathic system and the quality of life significantly.&nbsp; Moreover, efforts directed toward disease prevention are fundamentally superior to dental rehabilitation due to disease development. With a paradigm shift in dental care practice in progress during the current pandemic situation, preventive dentistry holds the prospects to reduce the treatment needs of the patients. Preventive prosthetic dentistry is the need of the hour.</p> <p>&nbsp;</p> 2021-01-15T19:28:39+00:00 Copyright (c) 2020 National Journal of Integrated Research in Medicine Heparin Resistance in a COVID-19 patient: A Rare Occurrence 2021-01-15T19:37:37+00:00 Dr. Khushali Parikh Dr. Sapna Gupta Dr. Supriya Malhotra Dr. Pratik Patel <p>Coronavirus disease-2019 (COVID-19) in severe cases is associated with marked inflammation in mainly the lungs. Reports suggest a beneficial role of heparin/low molecular weight heparin (LMWH) in reducing mortality and morbidity in such patients. We have summarized potential beneficial, anti-inflammatory mechanisms underlying treatment of COVID-19 patients with heparin/LMWH. Herein, we present a rare case of severe COVID-19 showing Heparin Resistance (HR), which was primarily suspected due to constantly elevated inflammatory markers like CRP, D-dimer, IL-6 and subtherapeutic levels of aPTT when the patient was on Heparin. These parameters showed remarkable changes when Heparin was replaced by LMWH, Dalteparin and eventually the condition of patient ameliorated.</p> 2021-01-15T19:33:14+00:00 Copyright (c) 2020 National Journal of Integrated Research in Medicine PERSPECTIVES ON BIO-MEDICAL WASTE MANAGEMENT EDUCATION 2021-01-15T19:37:37+00:00 Vivek Mishra Mrinal Barua Shelja Sharma Sundip Charmode Suryakanta Seth Subodh Kumar Aroop Mohanty <p>This article describes a novel way of introducing the concept of bio-medical waste management to medical students in their first year of medical education. The bio-medical waste management policies and practice in the department can be utilized as an educational opportunity for formal training of students at no additional cost. We are running an educational program (a practical and hands-on approach) on bio-medical waste management and successfully training a batch of 100 students every year.</p> 2021-01-15T19:36:23+00:00 Copyright (c) 2020 National Journal of Integrated Research in Medicine