National Journal of Integrated Research in Medicine <p>This is an Open access official publication of <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 for access of article.</strong></p> Association of Health Professionals and Health Educators en-US National Journal of Integrated Research in Medicine 2230-9969 The A2DS2 Score As A Predictor Of Pneumonia In Acute Ischemic Stroke <p>Background: Stroke is the second leading cause of death worldwide. In the acute phase, stroke patients are susceptible to complications like chest infections, cardiac dysfunction, and urinary tract infections. Globally, the incidence of pneumonia among stroke patients is estimated to be around 14%. The A2DS2 score (age, atrial fibrillation [AF], dysphagia, sex, and stroke severity using the National Institutes of Health Stroke Scale [NIHSS] score) is a simple scoring system to find risk of stroke associated pneumonia (SAP). Here our aim is planned to assess the risk of SAP in patients with acute stroke using the A2DS2 score.<br>Material And Methods: This prospective observational study was conducted on patients with Ischemic stroke, time from symptom onset within 7 days and Age &gt; 18 years admitted in tertiary care hospital. NIHSS score and A2DS2 score were calculated on admission. Follow up of all the patients was done during their hospital stay and those who fulfilled Mann’s diagnostic criteria for pneumonia were diagnosed as SAP. Result: Out of 110 patients (M:60, F:50, Mean age 60.37+7.07), the commonest comorbidity was Hypertension (85, 77.27%) and the commonest symptom was Facial Asymmetry (73, 66.4%). Among these, 19 (18.8%) patients developed SAP. Patients with SAP had higher mean age, male preponderance, commonest symptom dysphagia, higher NIHSS score and higher A2DS2 score. Patients with acute ischemic stroke who had high A2DS2 scores (5-10) higher risk of developing SAP and worse outcome (P &lt;0.05). Conclusion: In conclusion, patients in the high A2DS2 score group had higher incidence of SAP and non-favourable outcome compared to patients with low A2DS2 scores who had more favourable outcomes [Vyas C Natl J Integr Res Med, 2022; 13(1): 01-08, Published on 26/01/2022]</p> Dr. Chintal Vyas Dr. Hemang Suthar Dr. Nachiket Parmar Copyright (c) 2022-01-26 2022-01-26 13 1 01 08 Study Of Visual And Refractive Outcomes In Patients Undergoing Limbal Relaxing Incision During Clear Corneal Phacoemulsification Surgery With Foldable Intra Ocular Lens <p>Background: Phacoemulsification requires a smaller incision, few or no stitches are needed and the patient's recovery time is usually shorter when using a foldable IOL. Limbal Relaxing Incisions, or LRIs, are partial thickness corneal incisions strategically placed to reduce or eliminate pre-existing astigmatism during cataract surgery or refractive lens exchange surgery. Present study was aimed to evaluate the visual and refractive outcome in patients undergoing limbal relaxing incision during clear corneal phacoemulsification surgery with foldable intra ocular lens. Material And Methods: Present study was single-center, prospective, observational study, conducted in patients of age more than 18-75 years, with clear cornea and regular astigmatism on keratometry, with preoperative astigmatism more than or equal to 0.5D on keratometry, fit for phacoemulsification cataract surgery with foldable IOL. Result: A total of 44 eyes of 44 patients who for cataract phacoemulsification surgery, mean age of the patient was 56.98 ± 05.98 years. Refractive acceptance preoperatively was 0.50 D to 2.0 D. On slit lamp examination showed most common Cataract Nucleus grade is NS 3 with PSC preoperatively. We observed improved diopteric difference by automated keratometry on postoperative 90th day as compared to preoperative values. Majority of patients had Preop Keratometric Difference (K1-K2) of 1.5 D, all required LRI Incisions length of 4 clock hours (60°).The difference between the visual acuity preoperatively and post operatively was found to be statistically significant with a p&lt;0.01 by employing the statistical test Analysis of Variance (ANOVA). Visual outcome a change after limb relaxing incisions statistically significant. Keratometry changes preop and postop is statistically significant with p value &lt;0.001. Conclusion: Visual and refractive outcome changes as improved best corrected visual acuity (BCVA), decrease in Corneal Astigmatism was noted in patients undergoing limbal relaxing incision during clear corneal phacoemulsification surgery with foldable intra ocular lens [Sahare H Natl J Integr Res Med, 2021; 12(6): 09-15, Published on 26/01/2022]</p> Dr. Harshal D. Sahare Dr. Sujit M. Murade Dr. Kalyani D. Narote Dr. Anamika H. Agrawal Dr. Akshay M. Jadhav Copyright (c) 2022-01-26 2022-01-26 13 1 9 15 Corneal Endothelial Cell Density Changes In Diabetic And Non-Diabetic Eyes In Grade 2 And Grade 3 Nuclear Sclerosis Undergoing Phacoemulsification <p>Background: Corneal endothelial cells are susceptible to mechanical trauma from ultrasound energy during phacoemulsification. Several studies have reported various results of phacoemulsification effect on corneal endothelial cells between diabetic and non-diabetic patients due to stressful events. Present study was aimed to evaluate corneal endothelial density, hexagonality and Central Corneal Thickness (CCT) changes between diabetic and non-diabetic patients at early postoperative period and 1 month after phacoemulsification. Material And Methods: Specular microscopy examinations prior to phacoemulsification and at early postoperative period and 1 months after phacoemulsification were performed on diabetic and non-diabetic groups in grade 2 and grade 3 nuclear sclerosis. Later the changes in endothelial density, the percentage of hexagonality, and Central corneal thickness were evaluated. Result: Mean age of 120 study sample was 58.45 years (standard deviation – 8.498 years), with the highest 74 years and lowest 43 years. There were 53 (44%) females and 67 (56%) males in the study. 42 (35%) samples were from 51-60 years age group followed by 37 (30.83%) subjects in 61-70 years age group. Mean corneal endothelial cell density decreases after cataract surgery in comparison with pre-operative density among study samples. Mean pre-operative corneal endothelial cell density was lower in diabetics in comparison with non-diabetics, and the difference was statistically significant. Cell density count decreases after cataract surgery in both groups with significant difference between two groups. Mean corneal endothelial cell morphology (hexagonal cell percentage) decreases after cataract surgery in comparison with pre-operative density among study samples. Central corneal thickness increases in early postoperative period followed by normalisation at day 30. Conclusion: Diabetic group showed greater hexagonality decrease compared to non-diabetic group at 1 month after phacoemulsification. It is suggested that diabetic corneal endothelium requires additional care and protective measures during cataract surgery to minimize surgical trauma. There were no statistically significant differences in the endothelial loss and Central corneal thickness changes between the diabetic and non-diabetic group at 1 month follow up after phacoemulsification. [Sarate K Natl J Integr Res Med, 2022; 13(1): 16 -22, Published on 26/01/2022]</p> Dr. Krushnadas M. Sarate Dr. Darshana B. Rathod Dr. Harshal D. Sahare Copyright (c) 2022-01-26 2022-01-26 13 1 16 22 A Study Of Perioperative Cardiovascular Events In Non-Cardiac Surgery <p>Background: Perioperative evaluation is an important step before considering a patient for surgery to deal with cardiovascular risk factors. The aim of the study is to evaluate the risk of cardiovascular events during perioperative period in non-cardiac &amp; non-vascular surgery, even in patients with no previous evidence of cardiac disease. Material And Methods: All patients admitted in Orthopaedic, Surgery, Gynaecology department were evaluated clinically as well as with laboratory and radiological investigation. All patients with age &gt; 40 years were subjected to electrocardiography. All the data was collected &amp; recorded in standard Proforma. Clinical evaluation was done preoperatively &amp; 24 hour post operatively. In patients developing cardiovascular complications, additional evaluation was done on the basis of need. Result: Highest number of patients undergoing elective non-cardiac surgery belonged to the younger age group. General surgery had the highest number of patients 45.3%, followed by Orthopaedics (36%), Gynaecology (18.7%). In view of surgery done by 3 above-mentioned surgical branches, there was not much difference in the rate of risk of cardiovascular events. Diabetes mellitus, hypertension, and cardiac diseases were found as frequent risk factors (44 (29.3%), 52 (34.6%), 26 (17.3%) respectively.) Postoperative cardiovascular complication rate was most commonly seen in cardiac diseases, which were 8 (30.7%) patients. The incidence of perioperative cardiac complication in our study was 8.7% with 4% mortality. Conclusion: The incidence of complication was highest in patients undergoing high risk surgeries like intraperitoneal surgery. The RCRI classification was a good preoperative tool for risk stratification of patients undergoing non-cardiac surgery. [Bhansali P Natl J Integr Res Med, 2022; 13(1):23 -26, Published on 26/01/2022]</p> Dr. Prashant Bhansali Dr. Ashish Patel Dr. Anjali Oza Copyright (c) 2022-01-26 2022-01-26 13 1 23 26 Duration Of Diabetes Mellitus And Vascular Complications <p>Background: Type 2 diabetes mellitus (DM) is associated with disabling and potentially life-threatening micro-vascular and macro-vascular complications. Common risk factors for vascular complications in people with type 2 diabetes include hyperglycemia, insulin resistance, dyslipidemia, hypertension, tobacco use and obesity. This study aimed to determine the incidence of macro- and micro-vascular complications and risk factors among patients with type 2 diabetes mellitus. Material And Methods: 100 Patients with type 2 DM attending the medicine opd at Shardaben General Hospital, were included in this observational study who fulfilled inclusion criteria. Detailed history of all patients was recorded including the duration of DM, risk factors for DM and complications of DM. Result: Incidence of DM was higher in males (56%). Maximum patients with diabetes were between 51 - 70 years. 31% patients were newly diagnosed having DM, 36% had DM of &lt;5 years, 24% had DM duration of 5- 10 years and 9% had DM duration of &gt;10 years. Mean fasting Blood sugar was 186mg/dL. 78% had one or more micro vascular complications. Retinopathy was the most common micro-vascular complication (35%). The most common macro-vascular complication was coronary artery disease (44%). Conclusion: Retinopathy was the most common micro-vascular and coronary artery disease is most common macro vascular complication. Incidence of micro-vascular complication increases with duration of diabetes, while macro-vascular complications doesn’t correlate with the duration of diabetes mellitus. [Chauhan H Natl J Integr Res Med, 2022; 13(1): 27-30, Published on 26/01/2022]</p> Hetal B Chauhan Divyang H Makwana Breej B Karamata Copyright (c) 2022-01-26 2022-01-26 13 1 27 30 Assessment Of Knowledge Regarding COVID-19 And It’s Preventive Protocol Among Dentists Of North Gujarat <p>Background: The World Health Organization (WHO) had declared the Novel Coronavirus as a Pandemic in March, 2020. As dentists are at an increased risk due to the aerosol transmission, it is extremely important for them to understand the virus spread. Objectives: To assess the knowledge and attitude of the dentists of north Gujarat population towards the novel Coronavirus and their knowledge regarding the spread of their infections. Material And Methods: A descriptive, cross-sectional study was conducted among 274 dentists including post graduate and undergraduate dental students, faculty members and private practitioners of North Gujarat. A Questionnaire was circulated using the Google forms, consisting of two parts: first – consisted of demographic details and the second part consisted of 25 questions regarding knowledge of dentists towards the COVID-19 and its impact on their dental practice. The level of significance was set at ≤0.05. Result: The study participants were well aware about the COVID-19 prevention protocols. Majority of the participants 59.5% agreed that elective dental procedures needed to be postponed for at least 3 weeks. Also 73% stated that 90GSM of PPE kit was considered appropriate to protect from cross-infection. The results were statistically significant. Conclusion: The study concluded that dentists had sufficient knowledge regarding COVID-19 protocols but same was not implemented in their practices. Dentists should have proper knowledge regarding the transmission and prevention of infection from the virus as they are at high of developing an infection. [Attur K Natl J Integr Res Med, 2022; 13(1): 31-36, Published on 26/01/2022]</p> Kailash Attur Nikibahen Modi Kiran Vachhani Manjusha Rawtiya Switibahen Soni Pawan Gurjar Copyright (c) 2022-01-26 2022-01-26 13 1 31 36 Psychological Effect Of Chemosensory Deficits In COVID-19 Patients <p>Background: Mental health was broke greatly in this COVID-19 pandemic. Objective: This study aimed to detect the effect of chemosensory deficits from deadly pandemic COVID-19 on mental health. Material And Methods: A survey questionnaire was used to detect the level of psychological problems in this cross-sectional observational study in sample size of 200 COVID-19 positive patients. Result: The findings shows that there is increase in prevalence of psychological problems which affects mental health drastically like isolation, anxious, afraid of failure to recover back which hampering their quality of life. Conclusion: This study emphasizes on the importance and prevention of psychological problems as well as role of counselling &amp; treatment. [Panchal F Natl J Integr Res Med, 2022; 13(1): 37-41, Published on 26/01/2022]</p> Dr. Panchal Fairy Dr. Kagathara Jaydeep Dr. Patel Vilaschandra Copyright (c) 2022 2022-01-26 2022-01-26 13 1 37 41 Coblation Tonsil Resection (TR): Our Experience For A Powered Instrument Feasibility With Advantages And Disadvantages <p>Background: Tonsillectomy is one of most commonly performed surgical procedure in otorhinolaryngology. In past, various surgical techniques for tonsillectomy have been developed. And coblation tonsillectomy is one of the latest techniques developed. We carried this study to check feasibility of powered instrument (coblator) in view of patient and surgeons benefit with advantages and disadvantages for tonsillectomy. Material And Methods: We carried out this study in randomly selected total 125 patients who presented to our ENT department with chief complain of recurrent tonsillitis. All patients underwent coblation techniques and were analysed for total time consumption during operation, amount of blood loss during operation, immediate postoperative pain, postoperative haemorrhage whether primary or secondary, time needed to return back to the normal activity and diet ,total percentage of healing post operatively. Each patient had preoperative blood investigation to exclude any coagulation disorder and anemia. Postoperative analgesics and broad spectrum antibiotics were administered. Result: Mean operation time was 12±2.45 minutes in coblation group. Intraoperative blood loss turned out to be 20.00±5.0 ml for the coblation. Mean return to normal diet period was significantly shorter (5.00±1.50). Otherwise, return to normal behaviour was significantly earlier with coblation(10.50±2.00 ). Postoperative we have not seen any case of primary hemorrhage or secondary hemorrhage in our study. Conclusion: We found that coblation technique for tonsillectomy offers considerable advantages in the operation time and intra operative blood loss. Coblation is related with timely return to routine activities and normal adequate diet. To endorse its significance over conventional tonsillectomy warrants further study. [Patel N Natl J Integr Res Med, 2022; 13(1): 42-48, Published on 26/01/2022]</p> Dr. Nehal R. Patel Dr. Alpesh V. Patel Dr. Payal R. Vadher Dr. Kinnari K. Rathod Copyright (c) 2022-01-26 2022-01-26 13 1 42 48 A Study Of Clinical Profile And MRI Findings Of Patients Admitted In LG Hospital With New Onset Generalized Tonic Clonic Seizures <p>Background: Seizure is defined as a paroxysmal event due to abnormal, excessive, hyper synchronized discharge from central nervous system neurons. A generalized tonic clonic seizure is involuntary movements of all limbs that have a tonic phase followed by clonic muscle contraction. It has various underlying etiologies. It is a major public health concern in terms of burden of disease, nature of illness, and its impact on individual, family, and community. Objective: This study was performed to evaluate clinical profile and MRI findings of patients admitted in LG Hospital with 1st episode of generalized tonic clonic seizures (GTCS). Design: The study was cross sectional study conducted over a period of 1yr in AMC MET medical college, Ahmedabad. Material And Methods: The clinical profile and MRI findings of 50 patients with 1st episode of GTCS admitted in the medicine department of our hospital were analysed. Result: The most common age group affected was 18-30 yrs (56%), more commonly affecting males (54%). The most common presenting symptoms are uprolling of eyes (90%), followed by frothing from mouth (80%) and tongue bite (78%). Among MRI findings, the majority of patients (78%) had normal MRI followed by infarct (8%) and tuberculoma (4%). Conclusion: The onset of GTCS occurs most commonly in early adulthood and both male and female genders are almost equally affected. The most common presentation is tonic clonic type of convulsion with uprolling of eyes, frothing from mouth and tongue bite. Majority of patients didn't have any co-morbidities and also had normal laboratory parameters and normal MRI findings. In patients with metabolic precipitating factors; most common was alcohol withdrawal, while in those with CNS cause, the most common MRI finding was infarct. [Rathod S Natl J Integr Res Med, 2022; 13(1): 49-53, Published on 26/01/2022]</p> Dr. Sangita Rathod Dr. Bij Javia Dr. Zalak Gadani Copyright (c) 2022-01-26 2022-01-26 13 1 49 53 A Comparative Study Of Endoscopic And Microscopic Type-1 Tympanoplasty <p>Background: Chronic suppurative otitis media tubotympanic type is a common pathology for which tympanoplasty is done. The decision to decide the approach for tympanoplasty depends upon multiple factors like extent of disease, site and size of perforation, size of external auditory canal and surgeon’s own expertise and preference. This study was undertaken to compare endoscopic and microscopic approach for type-1 tympanoplasty. Material And Methods: This study data was collected from 50 patients who underwent tympanoplasty in our department in our hospital from July – 2017 to November 2019.Patients above 15 years of age with inactive chronic otitis media tubotympanic type operated for type-1 tympanoplasty. Pre-operative, intra-operative and post-operative data collected as per performa and evaluated. Result: Equal (25) number of cases underwent microscopic and endoscopic type-1 tympanolasty. As far as graft taken up is concern both approaches have good and comparable result. Hearing gain is almost similar in both approaches - Endoscopic approach- 10.80 dB; microscopic approach-11.23 dB. Both methods do not have any major complications. Endoscopic approach has advantage of depth and angled vision. Endoscopic approach (57.2 min.) also saves surgical time than microscopic approach (89.4 min.) and comparatively good cosmetic result. Microscopic approach has upper hand over endoscopic approach in having two handed surgery with magnified surgical view. Patient compliance and satisfaction is more with endoscopic approach. Conclusion: Both microscopic and endoscopic methods are excellent for type-1 tympanoplasty with advantage and limitation of each method. A careful selection of patient is necessary for endoscopic approach. [Patel K Natl J Integr Res Med, 2022; 13(1): 54-60, Published on 26/01/2022]</p> Dr. Khyati Jayantkumar Patel Dr. Saurabh Gandhi Dr. Swati Chaudhari Dr. Sanket Alkeshkumar Shah Dr. Vishalkumar Pratapbhai Solanki Copyright (c) 2022-01-26 2022-01-26 13 1 54 60 Study Of 215 Patients Who Required High Flow Nasal Cannula During Corona Virus Epidemic <p>Background: High flow nasal cannula is a newer modality of treatment for hypoxemic respiratory failure. Present study is conducted to evaluate demographic characteristics, co-morbidities and outcome parameters of patients on High flow nasal cannula. Material And Methods: In retrospective observational study all patients on High flow nasal canula with covid-19 were evaluated for demographic characteristics and outcome with comorbidities during study period. Result: Maximum number of patients belongs to age group 51-60 years. Highest mortality was in the age group of 61-70 years. Conclusion: The High flow nasal cannula therapy may provide important newer modality and helpful in patients with respiratory failure. [Shah V Natl J Integr Res Med, 2022; 13(1): 61-63, Published on 26/01/2022]</p> Dr. Viral Shah Dr. Mehul Gajjar Dr. Sanjay Tripathi Copyright (c) 2022-01-26 2022-01-26 13 1 61 63 Comparison Of Pulse Rate Variability Among Type 2 Diabetics And Normal Individuals <p>Background: Cardiac autonomic dysfunction is one of the most common and serious complication of type 2 diabetes mellitus (DM). Pulse rate variability (PRV) is a simple and non-invasive indicator of cardiac autonomic functions. Aim: To assess and compare the cardiac autonomic functions using PRV in type2 diabetes patients and normal individuals. Material And Methods: The study included 38 type2 diabetic individuals and 37 healthy controls. Five minutes PRV was recorded in all the subjects. PRV indices, namely standard deviation of Normal to Normal (SDNN), root mean square of successive differences (RMSSD), total power (TP) and ratio of low to high frequency power of PRV, were calculated. Result: All parameters were summarised using median and inter quartile range. Mann-Whitney U test was used to compare median differences in all the parameters between the two groups. Statistically significant differences (p˂0.05) were found in SDNN, RMSSD, TP, low frequency (LF) and high frequency (HF) parameters. Median SDNN of controls was 91.8ms with an inter quartile range of (58.03 – 236.55)ms and in diabetics median SDNN was 21.15ms with an inter quartile range of (16.07 – 26.92)ms. In controls median total power was 3904ms2 with an inter quartile range of (3267 – 5370 ) ms2. In cases median total power was 1025.50ms2 with an inter quartile range of (492 – 1250) ms2. Conclusion: Decrease in PRV indicates the presence of cardiac autonomic dysfunction in diabetics. Therefore PRV can be used as a simple, non-invasive method for assessing cardiac autonomic function in diabetic individuals. [Saha S Natl J Integr Res Med, 2022; 13(1): 64-68, Published on 26/01/2022]</p> Dr. Satabdi Saha Dr. Vijaya Das Copyright (c) 2022-01-26 2022-01-26 13 1 64 68 Comparative Evaluation Of The Efficacy Of Pocket Debridement With Diode Laser And Periodontal Open Flap Debridement <p>Background: In the last decade, the use of lasers (light amplification by stimulated emission of radiation) has occupied part of the dialogue within periodontology and oral surgery because of several proposed advantages. Laser uses produces less postoperative swelling, reduces inflammation and is also relatively painless. In the arena of periodontology, laser use as an adjunct to non-surgical therapy was demonstrated to enhance periodontal health. The present study was done to highlight these facts and to add over the previous researches. Material And Methods: A total of 50 patients with generalized chronic moderate to severe periodontitis with pocket probing depth (PD) ≥5 mm were selected for a split-mouth study. Flap surgery with adjunctive diode laser irradiation was performed in the test quadrant while routine OFD was done in the control quadrant. Clinical parameters including PD, plaque index, and gingival index were recorded at baseline, 3 months and 6 months following treatment. Result: All clinical parameters significantly improved after therapy without any statistically significant difference between the two groups for any of the parameters. The results of the present study indicate that diode laser used as an adjunct to in OFD did not significantly enhance the treatment outcome. Conclusion: Since there was a significant clinical improvement in case of gingival inflammation, it can be safely and effectively used to achieve the same and can aid in tissue healing. [Pandya D Natl J Integr Res Med, 2022; 13(1): 69-74, Published on 26/01/2022]</p> Dr. Dhara Pandya Dr. Jigna Shah Dr. Mayur Mishra Dr. Mandeepsinh Gohil Copyright (c) 2022-01-26 2022-01-26 13 1 69 74 Pattern Analysis Of Genetics Animations Using Mayer’s Principles And Its Implications For MBBS Students <p>Background: MBBS students access online animation videos to understand complex concepts. However, multiple studies have raised concerns regarding quality of online educational videos. Animations designed using Mayer’s principles have been shown to improve learning outcomes. In this study, we analysed pattern and design quality of online genetics animations using Mayer’s principles. Material And Methods: In this cross-sectional study, we analysed 59 online genetics animations chosen from MBBS 1st year Biochemistry syllabus. These animations were shortlisted through systematic search on and These were analysed using Mayer’s multimedia learning principles that manage extraneous processing. Result: 54% (33) of the animations complied with all the multimedia learning principles that manage extraneous processing. However, 44% (26) animations violated multimedia learning principles in various combinations. Amongst the animations that violated multiple principles, combination pattern of Signalling +Spatial Contiguity +Temporal Contiguity was most common (7 out of 26 animations). Conclusion: Majority of the animations follow all the Mayer’s multimedia principles that manage extraneous processing. However, significant portion of animations violated multimedia leaning principles in various combinations and their use may result in poor learning outcomes. By adopting a few easy to implement measures, teachers can increase their effectiveness as visual learning aids for MBBS students. [Ravi Kishore Polepalli Natl J Integr Res Med, 2022; 13(1): 75-80, Published on 26/01/2022]</p> Dr. Ravi Kishore Polepalli Copyright (c) 2022-01-26 2022-01-26 13 1 75 80 Effect Of Covid 19 Pandemic On Anatomy Teaching Learning Methods: Students’ Perspective <p>Background: In comparison to other basic subjects in medical sciences, learning Anatomy online was felt difficult. With the emergence of Covid 19 pandemic, the teaching and learning method entirely shifted to online classes. So, the present study aimed to compare the effectiveness of teaching learning in the subject of Anatomy by online teaching learning methods with that of traditional classroom teaching learning methods by students’ perspective. Material And Methods: The study was done using predesigned multiple-choice questionnaire among the first MBBS students. The opinion about effectiveness of traditional classroom teaching learning methods and online teaching learning methods were anonymously retrieved through Google forms. Result: 80.2% students opined that traditional classroom teaching learning method is better. Conclusion: Classroom teaching is far better than online teaching. [SP Fulari Natl J Integr Res Med, 2022; 13(1): 81-84, Published on 26/01/2022]</p> Dr. Fulari S.P. Dr. Masaram N.B. Dr. Doijad V.P. Copyright (c) 2022-01-26 2022-01-26 13 1 81 84 How Difficult Is It To Implement A Competency-Based Medical Education In India: The Next Steps? <p>Background: Medical Council of India is in the revamping mode to align the medical curriculum to the emerging health care needs of the society, by introducing Competency-Based Medical Education (CBME). This new medical curriculum intends to impart the competencies that are needed to produce medical graduates who would function efficiently as Physicians of first contact or basic doctors in the community. The ECE program would enhance the knowledge, skills, and attitude of the medical graduates if it is implemented. We conducted this study to assess the challenges currently faced by faculties for the implementation of this new curriculum. Material and Methodology: It is a cross-sectional study conducted at NC Medical College, Israna during the study period was July 2021 to November 2021. The study team regularly scrutinized the data collection process and met periodically to review the study conduct and computing of data. At the end of the study period, the consolidated data were analyzed using IBM SPSS version 22. Result: A total of 50 teaching faculties, we acknowledged 48 questionnaires that were complete. 96% faculties showed positive and opportunistic behaviour towards the new curriculum of CBME with constructive ideas but 4% faculties declined. Conclusion: CBME is the paradigm shift in the teaching and learning approach of medical education. Most of the medical faculty members are aware of the need and have attained a positive attitude for the application of CBME. However significant barriers do exist in the form of manpower, new time mapping and resources which need to be addressed. [Tewari R Natl J Integr Res Med, 2022; 13(1): 85-90, Published on 26/01/2022]</p> Dr. Reshu Tewari Dr. Deepika Dalal Dr. Anurag Bajpai Dr. Ashish Kumar Malik Dr. Veena Singh Ghalaut Dr. P. S. Ghalaut Copyright (c) 2022-01-26 2022-01-26 13 1 85 90 Study Of Febrile Seizure In Pediatric Patients <p>Background: Febrile seizures are among the leading cause of pediatric emergency hospital admission and affect 2% to 5% of pediatric population1,2 and are by far the most common type of seizure in childhood. Various risk factors are said to play a role in aetiology of FS are gender, developmental delay, maternal history of smoking, family history, bacterial and viral infections, certain vaccinations and iron deficiency, low serum sodium at the time of presentation. Preventive measure to remove such risk factor could lead to lower the incidence of febrile seizure. Objective: To study occurrence of predictive risk factors like gender, age, low birth weight in children with febrile seizure. To study fever and seizure pattern in above children. To observe positive family history pertaining to febrile seizure. Material And Methods: An observational prospective study was conducted in the tertiary care hospital over a 2 year period. Children aged 6 months to 60 months diagnosed as febrile seizure and admitted at pediatric ward were included in the study. A total of 69 patients were enrolled in the study. All information was collected from parents and indoor case sheets after taking verbal consent. Data was entered in Microsoft excel and analysis was carried out using SPSS version 21. Result: Gender wise a male predominance was seen. Younger age group is a risk factor. Majority of children (92.8%) presented with simple FS with seizure duration less than 5 minutes. Majority (82.6 %) had fever for &lt; 24 hour prior to FS. Positive family history of FS is observed in 20.2% children. Conclusion: Identification of predictive risk factor will help clinician to educate and counsel parents regarding seizure recurrence, prophylactic use of antipyretic and measures during seizure activity. [Patel S Natl J Integr Res Med, 2022; 13(1): 91-96, Published on 26/01/2022]</p> Dr. Sweety M Patel Dr. Bijal S Shah Dr. Aasheeta S Shah Dr. Himanshu M Shah Dr. Arshiya Bai Copyright (c) 2022-01-26 2022-01-26 13 1 91 96 A Study On The Morphological Variations Of The Human Liver And Its Clinical Implications In Gujarat Region <p>Background: liver is a soft, friable and largest gland in the body, occupying the upper part of the abdominal cavity just beneath the right diaphragm. The greater part of it is situated under cover of the ribs, extending to the left to reach the left diaphragm. Objective: to determine gross anatomical variations of liver and their clinical and surgical implications. To study variations in lobes, fissures and accessory lobes were observed. Material And Methods: a total of 50 formalin-fixed adult human livers, irrespective of the sex, were studied over a period of three years from Dr M K shah medical college. These livers were specifically observed for any variant or anomalous surface morphology. Result: out of 50 specimens, 16 were considered normal without any ac-accessory fissures, lobes, or presence of a pones hepatis. 34 livers had one or more morphological variations. 14 liver has accessory fissure, 10 liver are present with riedel’s lobe present in liver, 10 liver are present with pons hepatic. Conclusion: liver being the largest abdominal organ, the knowledge of its normal and variant morphology is essential for the clinicians. In general, accessory hepatic fissures/sulci are potential sources of diagnostic errors during imaging. On ultrasound or computerized tomography, any collection of fluid in these fissures may be mistaken for a liver cyst, intrahepatic hematoma, or liver abscess, which would require further radiologic workup. [Chaudhari M Natl J Integr Res Med, 2022; 13(1):97-100, Published on 26/01/2022]</p> Dr. Manisha Chaudhari Dr. Bhadreshkumar Prafulbhai Vaghela Dr. H R. Jadav Copyright (c) 2022-01-26 2022-01-26 13 1 97 100 A Study Of Electrolyte Abnormalities In Acute Exacerbation Of Chronic Obstructive Pulmonary Diseases <p>Background: Chronic obstructive pulmonary disease / COPD is a multifactorial disease involving various electrolyte abnormalities. This study aimed at evaluating serum electrolyte levels in patients with acute exacerbation of COPD. Material And Methods: This study aimed at evaluating serum electrolyte levels in patients with acute exacerbation of COPD. This study included 100 cases &amp; 100 controls with acute exacerbation of COPD admitted in intensive care unit. All the patients from the cases group were screened for Ca+2 &amp; Mg+2 abnormalities during their intensive care unit stay. In group 1 (cases) correction for abnormal electrolytes were given on the day of admission. Treatment, antibiotics selection, metabolic parameters correction &amp; acid base correction were considered equally in both the groups as per GOLD (Global initiative for chronic obstructive lung disease) guidelines. Symptomatic patients after 48 hours of intensive care unit admission were screened for calcium &amp; magnesium levels &amp; prevalence of hypocalcemia &amp; hypomagnesemia was calculated. Result: It was found out that average duration of intensive care unit stay was reduced significantly in group 1 (cases) in whom the correction of electrolyte imbalance was considered at the time of admission. Also, in the control group, who were still symptomatic after 48 hours of intensive care unit treatment, a significant proportion was found to have hypocalcaemia and hypomagnesaemia (Electrolytes measured after 48 hours). Conclusion: In stable COPD patients there are abnormal serum electrolytes that may get further deranged during acute exacerbations. Thus serum electrolytes level should be monitored routinely in these patients &amp; an attempt should be made to correct them at the earliest to avoid poor outcomes. [Bhansali P Natl J Integr Res Med, 2022; 13(1): 101-104, Published on 26/01/2022]</p> Dr. Prashant Bhansali Dr. Bharat Sukhmani Dr. Rujul Shastri Copyright (c) 2022-01-26 2022-01-26 13 1 101 104 A Study On Impact Of Online Education And Traditional Anatomy Teaching On Student <p>Background: The emergence of corona pandemic situation in india during april 2020 forced the institutes to send students to their respective hometowns. Faculty had no option but to continue teaching online in such situation. In comparison to other basic medical science subjects, learning anatomy online was felt difficult as the students were unable to understand the three dimensional structures in human body. Rising concerns among students urged to evaluate strength and weakness of ongoing online teaching and learning methods. Aim: To compare the effectiveness of teaching anatomy subject online anatomy theory and practical online teaching. Material And Methods: Study is conducted on 2019-2020 first MBBS batch 100 student participate in it from my collage. A cross sectional study was conducted among 100 MBBS first year medical students from Dr. M K. Shah medical college and research centre, Chandkeda, Ahmedabad. Informed consent was obtained from all the students prior to the start of the study. The online classes were conducted due to covid-19 lockdown in our institution from April 2020 as per the guidelines from government. The study was conducted by taking feedback from the students in the form of pre-formed questionnaire regarding the online classes in Google forms for 1st year MBBS students. Questionnaire consisted of information related to difficulties encountered by students during online class and understanding of subject during online class. Result: A 60% students agree that lectures are effective to understand in online teaching. 76% student use mobile for attend online lecture. 50% student disagree that dissection in anatomy can effective by online teaching. Online lecture on zoom is accepted method for online teaching by 78% of student. 69% students attend 30 minute online class out 60 min class. 90% student recommends that for dissection teaching in dissection hall is more effective. Again 75% student offline class for demonstration class is effective. 61% student facing internet issue during online class. Conclusion: Students preferred classroom teaching over online teaching for anatomy subject. Between the platforms used in online teaching, google meet has an edge over google classroom in terms of learning. [Chaudhari M Natl J Integr Res Med, 2022; 13(1): 105-108, Published On 26/01/2022]</p> Dr. Manisha Chaudhari Dr. Bhadreshkumar Prafulbhai Vaghela Dr. H R. Jadav Copyright (c) 2022-01-26 2022-01-26 13 1 105 108 A Prospective Observational Study To Evaluate TOPS Score As An Outcome Predictor In Extramural Referred Neonates Admitted At A Tertiary Care Center <p>Background: The neonatal period is the most vulnerable time for a child's survival. As survival perspective of extramural neonates significantly relies on the state of neonate at admission, various survival scores like CRIB, SNAP, MINT, TRIPS, TOPS etc. are designed to prognosticate the outcome of neonate at admission. This study was designed to delineate correlation of TOPS score with outcome of referred neonates. Aims And Objectives: To recognise correlation of TOPS score with outcomes of extramural neonates. Material And Methods: It was prospective observational study conducted from September 2019 to February 2020 at nicu of tertiary care hospital. Clinico-demographic characteristics and TOPS score were documented in a pre-designed proforma. Hypothermia, Hypoxia, prolonged CRT and Hypoglycemia were defined as&lt;36.5C, &lt;90%, ≥3 secs and &lt;40mg/dl respectively. Each parameter was assigned a score of ‘1’ if abnormal and ‘0’ if normal. Neonates were treated as per standard protocol and their outcome was recorded as survived or expired. Result: Out of 239 neonates 140 (58.6%) were males and 99 (41.5%) were females. The area under the ROC curve (AUROC) for TOPS Total predicting Outcome: Expired vs Outcome: Survived was 0.932. At a cut-off of TOPS Total ≥2, it predicts Outcome: Expired with a sensitivity of 83% and a specificity of * The relative risk (95% CI) for Outcome: Expired when TOPS Total is ≥2 was 25.68. Hypothermia (Chi-squared test, χ2 = 38.462, p = &lt;0.001), hypoxia (Fisher's exact test, χ2 = 122.636, p = &lt;0.001), poor perfusion (shock) (Fisher's exact test, χ2 = 103.563, p = &lt;0.001) are found to be significantly associated with poor outcome. Conclusion: TOPS score is an easy, reliable and applicable tool for outcome prediction of transported neonates. [Halpara S Natl J Integr Res Med, 2022; 13(1): 109-114, Published on 26/01/2022]</p> Dr. Shraddha Halpara Dr. Pankti Desai Dr. Vaishali Prajapati Dr. Bhavi Modi Dr. Zarna Shah Copyright (c) 2022-01-26 2022-01-26 13 1 109 114 Implant Supported Overdenture - A Review <p>Background: Traditional complete dentures were the most common treatment option for patients with edentulous arches. However, the initiation of implant-supported overdentures has substituted orthodox dentures as an improved standard for restoration. Careful case selection is important criteria for improving success rate of implant supported over denture. Lower arch implant-supported overdentures have a better success percentage than upper arch implant-supported overdentures. Upper arch implant-supported overdentures are simulating a form of “salvage treatment,” rather than being the primary modality of treatment for patients with completely edentulous upper arch. [Shah J Natl J Integr Res Med, 2022; 13(1): 109-116, Published on 26/01/2022]</p> Dr. Jill J. Shah Dr. Divya Mehta Dr. Darshalkumar D. Panchal Siddhant Kulmendra Taneja Dr. Anuj Vasantray Mansata Copyright (c) 2022 2022-01-26 2022-01-26 13 1 115 122 10.53551/njirm.v13i1.3412 Periarticular Infiltration (Bupivacaine, Adrenaline, Magnesium Sulphate And Dexmedetomidine) For Postoperative Analgesia In Total Knee Arthroplasty- A Cases Series Study <p>Background: Total knee arthroplasty is a major surgery associated with severe pain and delayed rehabilitation. Good quality analgesia with minimum side effects is required for post-operative rehabilitation and influences overall outcome of patients. Material And Methods: All patients were given spinal anaesthesia. Intraoperatively, all patients received periarticular infiltration with solution of bupivacaine, adrenaline, dexmedetomidine and magnesium sulphate and normal saline. Post-operatively all patients received intravenous diclofenac sodium 75 mg 12 hourly. Postoperative pain using VAS score, sedation using Ramsay sedation score and hemodynamic parameters were observed. Result: The mean VAS score for pain was &lt;2 during the first 48 hours and provided good analgesia to the patients. During the post-operative period hemodynamic parameters remained comparable to baseline and all patients were co-operative, oriented and tranquil. None of the patient developed any side effects. Conclusion: Local infiltration with bupivacaine, adrenaline, dexmedetomidine and magnesium sulphate can be used along with intravenous diclofenac sodium in patients undergoing total knee arthroplasty and is effective, safe and reliable multimodal pain regimen. [Mehta H Natl J Integr Res Med, 2022; 13(1): 117-122, Published on 26/01/2022]</p> Dr. Harsh Mehta Dr. Bansari Kantharia Copyright (c) 2022 2022-01-26 2022-01-26 13 1 123 128 10.53551/njirm.v13i1.3413 Esthetic Root Coverage Of An Isolated Gingival Recession By Lateral Pedicle Graft Technique: A Case Report <p>Background: Gingival recession is the one of the widespread mucogingival deformity and should be treated at its most primitive recognition. Exposed root surfaces are more likely to develop root sensitivity, root caries, cervical abrasions and post esthetic problems. Amid innumerable procedures, laterally positioned pedicle graft (LPG) is extensively used efficaciously to conceal recession defects. The main advantages of the laterally positioned pedicle graft is, it produces excellent esthetic results as it has good vascularity of the flap and ability to cover the denuded surfaces. Thus, the present case report describes the use of lateral pedicle graft technique in an isolated gingival recession on mandibular incisor. [Dholakia P Natl J Integr Res Med, 2022; 13(1): 123-126, Published on 26/01/2022]</p> Dr. Pathik S. Dholakia Dr. Jill J. Shah Dr. Pooja Thumar Dr. Alankrita Singh Chouhan Dr. Anuj V. Mansata Heer T. Bakshi Copyright (c) 2022 2022-01-26 2022-01-26 13 1 129 132 10.53551/njirm.v13i1.3414