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> en-US (Dr. Chinmay shah) (Mr Bhavesh Bhoj) Fri, 01 Oct 2021 09:45:12 +0000 OJS 60 COVID 19: Respiratory Management by Non Invasive Ventilation <p>Background: During this long COVID-19 pandemic outbreak, continuous positive airway pressure (CPAP) and non invasive ventilation (NIV) are being widely used to treat of NIV in COVID-19 acute respiratory distress syndrome (ARDS) are lacking, and for this reason it is extremely important to accurately determine the outcomes of this strategy. This study aimed to evaluate clinical data and outcomes of NIV in patients with COVID-19 ARDS. Material And Methods: This is retrospective observation study conducted at government hospital during April 2020 to July 2020. The study was approved by local ethical committee. We analyzed patients with the laboratory confirmed case of COVID-19 infection admitted in intensive care unit who require positive pressure ventilation and perfusion which are not able to maintain on simple O2 masks/ nasal cannula /NRBM. Data related to clinical features and co-morbidities were recorded at admission and clinical laboratory data were recorded at start of NIV and respiratory parameter were recorded at the time of admission, start of NIV and at the time of weaning or shift to invasive ventilation. Result: Out of 119 patients 42 patients were successfully weaned off from non invasive ventilation while remaining were shifted to invasive mechanical ventilation. The patients who were shifted to invasive ventilation were all died. Low P/F ratio, high CRP, high D-dimer, high LDH and high ferritin levels were related to conversion to invasive ventilation and high mortality among the group. Conclusion: Although there is a role for non-invasive respiratory therapies in the context of COVID-19 ARF, more research is still needed to define the balance of benefits and risks to patients. Indirectly, non-invasive respiratory therapies may be of particular benefit in reducing the risks to healthcare workers by obviating the need for intubation, a potentially highly infectious procedure. [Shah M A Natl J Integr Res Med, 2021; 12(4):1-7]</p> Dr. Meera Shah, Dr. Urjita Modi, Dr. Mehul Gajjar, Dr. Kishor Kalsaria, Dr. Shreya Pathak, Dr. Bhavesh Jarwani Copyright (c) Wed, 01 Sep 2021 00:00:00 +0000 A Study Of Paranasal Sinus Complications In Post Covid Patients At A Tertiary Care Centre <p>Background: Paranasal sinus complications in patients recovering from COVID 19 is on the rise. This study is to evaluate the clinically suspected cases of Post Covid Sinusitis patients. Material And Methods: Total 200 cases of Post Covid Sinusitis patients were included in this study. The demographic profile, clinical and radiological presentation, underlying immunocompromised status, laboratory results and treatment outcome of the patients was analysed. Result: Post Covid Sinusitis was observed mainly in the fifth and sixth decade of life with a male predominance. Most common associated disease was diabetes mellitus (77%). Laboratory analysis revealed infection with Mucor and Aspergillus species most commonly. Sino-nasal, orbital, cerebral, palatine and skin involvement found in 100%, 40%, 12.5%,37% and 2.5% of patients, respectively. Symptoms and signs are headache (62.5%), cheek swelling(40%),and decreased vision(26.5%). All patients were treated by surgical debridement, antibiotics and antifungal medications. Overall survival rate was 87.5%. Conclusion: Clinical suspicion and early diagnosis in post covid patients followed by surgical debridement of diseased tissue, antifungal and antibiotic medications are crucial for better prognosis and improved survival rates. [Daymakumar A Natl J Integr Res Med, 2021; 12(4):8-13]</p> Dr. Andalib Daymakumar, Dr. Yadukrishnan MU, Dr. Sushil G Jha Copyright (c) Wed, 01 Sep 2021 00:00:00 +0000 Study Of Fetomaternal Outcome In Indoor Booked And Emergency Patients <p>Background: In current maternal mortality situation in India, it is pertinent to determine the relationship between booking status of mother and maternal and fetal outcomes. Material And Methods: In present study 1500 patients were studied from July 2019 to June 2021 in department of Obstetrics and Gynaecology Smt. S.C.L general hospital, Ahmedabad. Amongst these 1000 were booked (&gt;= 3 antenatal visits) and 500 were emergency (unbooked) cases (&lt;3 antenatal visits). Result: Majority of patients was between 21 to 30 year age group, lower socioeconomic class and from urban area. In booked patients incidence of Antepartum, Intrapartum, Postpartum complications, medical complications, blood transfusion requirement, rate of caesarean section, incidence of Preterm babies, low birth weight babies, NICU admission, perinatal mortality and maternal mortality was less. Conclusion: In booked cases fetomaternal outcome was good. Hence targeted, integrated, patient friendly, affordable, accessible health services need to be delivered in an equitable manner and through routine screening, monitoring and follow up complications, mortality and morbidity can be reduced. [Rathod D Natl J Integr Res Med, 2021; 12(4):14-18]</p> Dr. Digita Rathod, Dr. Harsh Patel, Dr. Satishchandra Kadikar, Dr. Raxita Patel, Dr. Bhavna Mewada Copyright (c) Wed, 01 Sep 2021 00:00:00 +0000 Proportion of Genu Valgum and Genu Varum in Students Aged 19-25 Years <p>Background: Knee joint mal alignments are divided into genu valgum and genu varum. The presence of these mal-alignments leads to complications like tibio-femoral osteoarthritis, compensatory changes in ankle/foot, etc. Taking a community of physiotherapy students, the proportion of genu varum, genu valgum and its association with body mass index (BMI) and foot posture index (FPI) was investigated. The aim of the study was to evaluate the proportion of genu valgum and genu varum in subjects aged 19 -25 years. Materials and Methods: The data was collected from D.Y. Patil University, Navi Mumbai. A consent form and a validated proforma was used. Age, BMI, FPI, IKD (Inter-knee distance), IMD (Inter-malleolar distance) and Q-angle was recorded, and the data was statistically analysed. Results: 45 out of 100 females had genu valgum which was found to be associated with higher BMI and pronated feet. 9 out of 100 females had genu varum which was found to be associated with lower BMI. Chi-square test was done to find out these associations. Conclusion: Awareness of the proportion of angular mal-alignment in knee would increase the recognition of this problem among the individuals and doctors for better execution of strategies that can help avoid these mal-alignments. [Jain U Natl J Integr Res Med, 2021; 12(4):19-25]</p> Dr. Urvisha Jain, Dr. Ajit Dabholkar Copyright (c) Wed, 01 Sep 2021 00:00:00 +0000 Comparison Of In-Hospital Mortality Of COVID-19 Patients Between Those Who Were Vaccinated And Who Were Not <p>Background: We compared the mortality rate of patients with moderate to severe COVID-19 who were vaccinated and who were not. Material And Methods: In this retrospective observational study, we collected data of patients who were admitted with moderate to severe COVID-19.The vaccination status and co morbidities of the patients were documented. The incidence and in-hospital mortality of COVID-19 patients was assessed. Univariate analysis was performed to determine the risk factors of in-hospital mortality.Result: Of 294 patients, 5.1% (n=15) received Covaxin™ and 26.5% (n=78) received Covishield™; 68.4%(n=201) patients were un vaccinated. Of patients who were vaccinated and contracted COVID-19, 24.8%(n=73) had taken the first dose and 6.8%(n=20) had taken the second dose of either vaccine. The in-hospital mortality rate was 13.6% (n=40). No significant association was found with the type of vaccine and the in-hospital mortality (p=0.23). Significant associations with in-hospital mortality were found with the interval before COVID-19 disease and vaccination (OR, 3.02; p=0.01); and the presence of diabetes mellitus (OR, 2.13; p=0.02), cardiovascular diseases (OR, 2.11; p&lt;0.001), and malignancy (OR: 2.33; p=0.0325). Conclusion: The mortality rate of unvaccinated patients with moderate to severe COVID-19 was high. There was no significant difference in the effectiveness of Covaxin™ and Covishield™ in terms of the incidence of COVID-19 and in-hospital mortality. Diabetes mellitus, cardiovascular diseases, and malignancies had a significant association with in-hospital mortality in patients with moderate to severe COVID-19. [Guha A Natl J Integr Res Med, 2021; 12(4):26-28]</p> Dr. Abhraneel Guha, Dr. Subhrojyoti Bhowmick, Dr. Aritra Chakrabarti, Dr. Subhrojyoti Bhowmick, Dr. Saibal Das, Dr. Rahul Khandelwal, Dr. Aditya Singh, Dr. Ajoy Krishna Sarkar, Anupam Das, Dr. Krishnangshu Ray, Dr. Sujit Kar Purkayastha Copyright (c) 2021 Wed, 01 Sep 2021 00:00:00 +0000 A Retrospective Study Of Pre And Post Treatment OCT( Optical Coherence Tomography)In Patients Of BRVO (Branch Retinal Vein Occlusion)With Macular Edematreated With Intravitreal Injection Bevacizumab(1.25mg/0.05ml) Attending Ophthalmology Department Of Ter <p>Background: Retinal vein occlusion (RVO) is the second most common sight threatening retinal vascular disorder after diabetic retinopathy. Retinal vein occlusion is a common form of retinal vascular disease, especially in middle-aged and older individuals. Occlusion results due to thrombotic effect on the retinal vein . BRVO is classified according to the anatomical location as major or macular. Major BRVO refers to occlusion of a retinal vein that drains one of the quadrants. Macular BRVO refers to occlusion of a venule within the macula. BRVO is further classified into perfused (non-ischemic) or non-perfused (ischemic). Ischemic BRVO is defined as &gt; 5 disc diameters of nonperfusion on fluorescein angiography (FA).<br>Objectives: To study pre and post treatment (Intravitreal Bevacizumab 1.25mg/0.05ml)OCT in patients with macular edema secondary to BRVO. Material And Methods: 30 Eyes of 30 patients of BRVO with macular edema were studied retrospectively who attended eye opd during Sept-2012 to Aug-2014 according inclusion and exclusion criteria After routine ophthalmic examination with slit lamp biomicroscopy and dilated fundus examination with indirect ophthalmoscope and preop OCT done for CFT(central foveal thickness)patient underwent intravitreal injection anti VEGF. Post treatment OCT of these patients were reviewed after 1 week and 1 month retrospectively. Result: Significant improvements in CFT were observed in these patients after treatment. Results were analyzed based on the duration Of the treatment given, after 1 week and after 1 month.Conclusion: Early diagnosis &amp; treatment of the pathology contributes to the better visual outcome. [Prajapati V Natl J Integr Res Med, 2021; 12(4):29-33]</p> Dr. Vipul Prajapati, Dr. Bhargavi Parth, Dr. Margi Panchal, Dr. Rima Sith, Dr. Sipra Engineer Copyright (c) 2021 Wed, 01 Sep 2021 00:00:00 +0000 Introduction Of ‘Case Based Discussions’ In Teaching Biochemistry And Its Impact On Learning Of Students <p>Background: When topics of clinical importance are taught by didactic lecture, knowledge gained is hardly retained till the clinical teaching starts in the later years. So, we introduced ‘Case Based Discussions’ while teaching Biochemistry. Material And Methods: Students of II semester were divided in three groups- Group A and B was taught ‘Liver function tests’ by Didactic Lectures. Group B and C were further subdivided and taught through Case Based Discussions in which students collaborated in a small group environment to work through paper-based cases. Students’ understanding of the topic was assessed using a test paper and written feedback was collected from the students in first year to know their perception towards two methods of teaching and then in final year to know if CBD sessions were helpful in clinics. Result: Mean total marks obtained by students of Group B were higher than those obtained by group A and C. Students perceived CBD sessions more stimulating educationally than traditional lectures and also found them helpful in clinics. Conclusion: Traditional teaching along with CBD resulted in significantly better test scores of students and promoted a deeper understanding of the basic concepts of Biochemistry to relate and link to patient cases in clinics. [Jain V Natl J Integr Res Med, 2021; 12(4):34-39]</p> Dr. Vaishali Jain, Dr. Vandana Agrawal, Dr. Yashdeep Das Copyright (c) Wed, 01 Sep 2021 00:00:00 +0000 Beyond Creatinine - A Focus on Mineral Bone Disease <p>Background: Chronic kidney disease (CKD) is a term that encompasses all degrees of decreased renal function, from damaged–at risk through mild, moderate, and severe chronic kidney failure. CKD is now a public health problem affecting an estimated 10-13% of the world population. The Kidney disease: Improving global outcomes (KDIGO) define CKD as either structural or functional kidney damage or a decreased glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m2 for at least 3 months. CKD-mineral and bone disorder (CKD-MBD) is a broader, newly defined term to define the mineral, bone, hormonal, and calcific cardiovascular abnormalities occurring in CKD. Ours study aims to evaluate the prevalence CKD-MBD in CKD stages 3, 4 and 5. Material And Methods: Ours is a retrospective observational study involving Patients &gt;18 years known cases of CKD as per KDIGO guidelines with a minimum follow up duration of 3 or more months. Result: Our study population had a mean age of 52.8 years with male preponderance (72%). All of the patients had some form of MBD present. Conclusion: Our study was able to demonstrate a very high prevalence of CKD-MBD in patients of CKD indicating a need for better understanding the factors behind MBD in Indian patients and the need to emphasize on preventing and treating MBD in patients.[Shah S Natl J Integr Res Med, 2021; 12(4): 40-44]</p> Dr. Sneha S. Shah, Dr. Surbhi Garg, Dr. Monila N. Patel, Dr. Ruchir B. Dave Copyright (c) Wed, 01 Sep 2021 00:00:00 +0000 A Descriptive Observational Study of Effect of Covid-19 Pandemic on Routine Immunization in Children at Tertiary Health Care Centre <p>Background: Immunization has crucial role in protecting a child from vaccine preventable infections. But during last year 2020, Due to COVID-19 pandemic, Routine&amp; supplementary immunization and the surveillance of vaccine-preventable diseases have been impacted in many countries. This may lead to the resurgence of vaccine-preventable diseases. So, we have opted this study to see impact of Covid 19 on routine immunization at vaccination centre of a tertiary care hospital. Aims: To assess effect of covid 19 pandemic on routine immunization. Material And Methods: This study was retrospective observational study, conducted at vaccination centre of tertiary care hospital of Ahmedabad. Data was retrieved from January 2019 to December 2020 from register of vaccination centre and entered in excel sheet and analysed individual month and vaccine wise. Result: Number of immunised children was lower in 2020 as compared to 2019. The result was significant at p&lt;0.05 by Mann Whity test. Inj Td of 10 year was most affected and OPV0 &amp; BCG was least affected. Maximum reduction in percentage was seen in May month and least in February. Conclusion: Health system should design strategies for catch-up vaccination to prevent surge of vaccine preventable disease. [Prajapati V Natl J Integr Res Med, 2021; 12(4):45-50]</p> Dr. Vaishali J. Prajapati, Dr. Shraddha V. Halpara, Dr. Pankti D. Desai, Dr. Mitesh H. Kakkad, Dr. Labdhi M. Sanghvi Copyright (c) Wed, 01 Sep 2021 00:00:00 +0000 Norms Of Prone Plank Testing For Isometric Endurance Assessment In Indian Healthy College Aged Individuals - An Observational Cross Sectional Study <p>Background: Assessment of Musculoskeletal performance is crucial to analyze for development and improvement of required goals and reducing risk of injuries. Isometric endurance assessment of core, as a part of this analysis is often done with techniques that are valid. Objective: To develop normative percentile separated by gender of hold time of prone plank in Indian college aged individuals, investigate effect of habitual physical activity along with reason for test termination and effect of BMI with hold time of testing. Material And Methods: 206 individuals meeting the inclusion criteria performed the prone plank test as long as they can and time was noted. Result: Males produced significantly longer test duration than females and BMI is inversely proportional to hold time. Conclusion: These normative percentiles for abdominal endurance suggest that the abdominal plank test can now be used as an alternative to other abdominal assessments in Indian college students. [Pandit Y Natl J Integr Res Med, 2021; 12(4): 51-55]</p> Dr. Yashshree Pandit, Dr. Richa Bisen, Dr. Khyati Kalra Copyright (c) Wed, 01 Sep 2021 00:00:00 +0000 Proving Of Bacopa Monniera (BRAHMI) <p>Background: Brahmi has been used by Ayurvedic medical practitioners in India for almost 3000 years. The earliest chronicled mention is in the Ayurvedic treatise, the Charaka Samhita (100 A.D.), in which Brahmi is recommended in formulations for the management of a range of mental conditions including anxiety, poor cognition and lack of concentration. According to the Charaka, Brahmi acts as an effective brain tonic that boosts one's capabilities to think and reason. The Sushruta Samhita 6 (200 A.D.) attributes the plant with efficacy in maintaining acuity of intellect and memory. The Bhavprakasha Nighantu, commonly known as the Indian Materia Medica (1500 A.D.), cites the plant as a brain tonic that is effective in maintaining vigor and intellect. Material And Methods: Method for the study has been selected as placebo controlled “Double Blind Method”. Result: In drug proving out of seventeen provers sixteen manifested the symptoms consequent upon the administration of drug. There is a drop of one prover due to death of near one on the 5th day of phase-I. One prover got the typhoid fever so he was continued on abstinence of medicine because of the symptoms persisted till the completion of phase-II. Conclusion: This drug is initially used clinically in mother tincture form and not proved completely on the principles laid down in Organon of medicine. I have taken this drug to prove it in 30c &amp; 200c potency. For the study placebo control “Double blind method” is been selected. [Gupta V Natl J Integr Res Med, 2021; 12(4):56-61]</p> Dr. Vivek Gupta, Dr.Pranav Shah, Dr. Girish Patel Copyright (c) Wed, 01 Sep 2021 00:00:00 +0000 Clinical Trial Of Homoeopathic Genus Epidemicus 'Arsenic Alba' As A Prophylactic During Pandemic Of Covid 19 In India At Dr. V. H. Dave Homoeopathic Medical Collage <p>Background: The objective was to assess the usefulness of Homoeopathic genus epidemics (Arsenic alba 30C) for the prevention of Covid 19 during its pandemic outbreak in the state of Gujrat District Anand, City Anand, India. Materials and Methods: A non- randomized, clinical trial was conducted in Anand city for prevention of Covid 19 during the pandemic outbreak in June 2020 to December 2020. Arsenic alba 30C was randomly administered to 1133 participants. Healthy participants (absence of fever, runny nose, cough etc., but comorbidity like DM &amp; HTN included) were eligible for the study (Arsenic alba 30 C n =1133). Monthly follow-up was done for 6 months. Infection rate in the study groups was analyzed and compared by use of cluster analysis. Results: The findings showed that only 4 persons out of 1133 persons of Arsenic alba 30 C group suffered from Covid 19. Cluster analysis showed significant prevention during Pandemic without any vaccine or other medications. [Incidence rate = 0.35%]. Conclusion: Arsenic alba 30C as genus epidemics is much better in decreasing the incidence of Covid 19 in cluster in Anand. The efficacy of genus epidemicus needs to be replicated in different areas. [Dhighe L Natl J Integr Res Med, 2021; 12(4): 62-65]</p> Dr. Leena Dhighe, Dr. Poonam Prajapati, Dr. Neha Patel, Dr. Jingal Kukadiya Copyright (c) Wed, 01 Sep 2021 00:00:00 +0000 Efficacy Of Low Dose Doxycycline In The Treatment Of Periodontal Disease - A Systematic Review <p><u>Background:</u> Periodontal instrumentation is accessible to a certain limit, as subgingival calculus is difficult to remove completely in cases of deep pockets and furcation defects. Host modulating agents aim to inhibit arachidonic acid pathways, modulate MMPs, bone remodeling, and regulate immune and inflammatory responses. This systematic review aims to find the effects of Low Dose Doxycycline (LDD) as local drug delivery systems and sub-antimicrobial dose doxycycline for the treatment of periodontal disease. <u>Material And Methods:</u> Electronic database searched were: Pubmed, Medline, Scopous and Ebsco was performed using MeSH terms: low dose doxycycline, subantimicrobial dose doxycycline, chemically modified doxycycline, doxycycline, doxycycline hyclate, atridox and periostat. Articles published between years 2008-2019 were reviewed. <u>Result:</u> A Systematic review methodology was followed and database searching was done which yields 422 records. Records from year 2008 – 2019 were taken into consideration. After inclusion and exclusion accordingly, A total of 10 studies were systematically reviewed. Non surgical or surgical periodontal therapy is more effective in reducing periodontal disease when low dose doxycycline is used as an adjunct either locally or systematically delivered. <u>Conclusion:</u> Subantimicrobial Dose Doxycycline (SDD) is commonly accepted as a host response modifier and it Subantimicrobial Dose Doxycycline (SDD) which down regulates the activity of MMPs. Also, doxycycline provides long-term post-treatment effects. Based in the inference drawn from this systematic review, non surgical or surgical periodontal therapy is more effective in reducing periodontal disease when low dose doxycycline is used as an adjunct, delivered either locally or systematically. [Slim L Natl J Integr Res Med, 2021; 12(4): 66-72]</p> Dr. Lukram Slim, Dr. Sachit Anand Arora, Dr. Fatima Gilani Copyright (c) Wed, 01 Sep 2021 00:00:00 +0000 Treatment Of Bilateral Gingival Recession Using Coronally Advanced Flap And Amniotic Membrane On One Side And Coronally Advanced Flap And PRF Membrane On Other Side: A Case Report <p>Gingival Recession is a common, complex, and unpleasant clinical condition. It is more commonly associated with root hypersensitivity, impaired esthetics and root caries. Successful treatment outcome becomes challenging in such cases. Coronally advanced flap for root coverage is most commonly used technique. Combination of biological membranes derived from human body itself along with coronally advanced flap yields better results. This case report describes a case of bilateral Class I gingival recession treated with amniotic membrane on one side and PRF membrane along with Coronally advanced flap on other side. [Gandhi R Natl J Integr Res Med, 2021; 12(4): 73-78]</p> Dr. Riddhi Gandhi, Dr. Pathik Dholakia, Dr. Anuj V. Mansata, Dr. Jalpa Patel, Dr. Priyank J. Karkar Copyright (c) Wed, 01 Sep 2021 00:00:00 +0000 Persistence Of RTPCR Positivity Of Sars-Cov2 Virus In A Asymptomatic Patient <p>.</p> Ashna Bhasin, Sulmaz Reshi, Abha Sharma, Poonam Loomba, Bibhabati Mishra Copyright (c) Wed, 01 Sep 2021 00:00:00 +0000