Background: Cardiovascular diseases (CVD) are among the leading causes of morbidity and mortality globally. Previous studies conducted in India showed that more than 45% suffers from pre-hypertension. Persons with systolic blood pressure of 120-139 mm Hg or diastolic blood pressure of 80-89 mm Hg are defined as having “prehypertension”. Subjects with pre-hypertension have a greater risk of developing hypertension, myocardial infarction and coronary artery diseases later in life. Adopting preventive measures such as lifestyle modification, yoga, and meditation may be helpful for prehypertensives in preventing the progress and complication. Dyslipidaemia is abnormal lipid profile. The prevalence of dyslipidaemia is increasing worldwide. One of the causes of dyslipidaemia is obesity. Dyslipidaemia is a major risk factor for atherosclerosis also which contribute to cardiovascular complications. In medical profession fast food consumption is one of the major cause of obesity. Methodology: This study was conducted at Aarupadai Veedu Medical College and Hospital of Puducherry, India. A total of 300 medical students of first to final year MBBS (18-23 years) were selected randomly. Each participant's data was collected by questionnaire methodfollowed by anthropometric measurements of height and weight. BMI was calculated. To measure the blood pressure a mercury sphygmomanometer was used. The mean of three readings, recorded 5 min apart was taken. Blood samples were collected after an overnight fast. Fasting plasma glucose, serum cholesterol, triglyceride and HDLc, were estimated by using commercially available kits in autoanalyzer. Serum LDLc, and VLDLc (very low density lipoprotein-cholesterol) were calculated. All the data were analysed by using SPSS-16 software. Results: Out of 300 students 160 (53%) were males and 140(47%) were females. The overall prevalence of PHT was 38%. Prevalence of prehypertension is more in females. BMI of Pre-hypertensive were significantly (p<0.001) more than the normotensive students. Among the lipid parameters, prehypertensives showed significant increase in TC, TG, LDLc than normotensive students. TC, TG, LDLc were high for female students than male students. Total prevalence of dyslipidaemia was 17.4 % (14.9% hypercholesterolemia, 8.15% hypertriglyceridaemia, 5.6% high LDLc level and 10.4% low HDLc level). So prevalence of hypercholesterolemia is more followed by low HDLc level. Conclusion: In conclusion, our study among healthy medical students found a prevalence of prehypertension of 38% and this was associated with a higher BMI. Prevalence of dyslipidemia is 17.4%. Hypercholesterolemia is more prevalent. Students should change their life style. They should do yoga, meditation regularly to cope with stress. They should avoid oily foods to decrease cholesterol level.

Introduction: Good prescribing practices form essence of drug therapy for better patient care. Major aim of better prescribing is to improve rational prescribing process. The study was aimed to explore attitude and beliefs of deprescription among patients & their primary carers in a tertiary health care facility. Material and methods: Cross-sectional, questionnaire-based prospective study done for two months. Attitude towards deprescription was assessed by using validated rPATD. Analysis of correlation between participant characteristics and their responses determined using gamma/kappa rank correlation, Mann-Whitney U test & chi-square test. Results and discussion: 312 patients and primary carers participated in the study. Among 156 patients, 25.6% were hypertensives & 21.2% had diabetes. 41.7% were between 36-50 years of age. Only 16.7% belongs to elderly age group. 43.6% of patients and 62.2% of primary carers were female. 51.3% of the patients were willing to stop one or more of their regular medicine(s) under the advice of treating physician but 62% were satisfied with their current medicine(s). 33.4% were reluctant to stop medicines taking for a long time. Conclusion: Deprescription gained momentum in recent decade. In our more than 50% of people and their caregivers were willing to try medication cessation under their physician recommendation. There was moderate agreement between patients and their primary carers in trial of medication cessation. Thus, results obtained from this study may help towards improving rationalized prescribing practices in institutional setup.

Introduction: Bi-directional screening for Tuberculosis and Diabetes, has emerged as a key healthcare strategy. Diabetes and Latent Infection in Household Contacts can syngertistically lead to TB Infection. In recognition of strong interaction between NCDs and infectious diseases especially TB, there is a consequential need to explore common platforms/approaches to maximize detection and Prevention. Hence, the study was carried out among adult (>18 years) household members of those registered for tuberculosis treatment in Urban Puducherry a) to determine the risk for Diabetes and the associated socio-demographic, behavioral and clinical factors, b) to assess awareness and risk perception of TB and Diabetes and c) to determine the level of uptake of preventive measures for Diabetes and TB. Methodology: This Pilot study included 77 household members (aged > 18 years) of 29 TB patients undergoing treatment during June - September 2017 in the urban health-training center of the institute after written informed consent. The study utilized modified STEPS Instrument for NCD Risk Factors, modified WHO Stop TB Partnership ACSM tool for TB Awareness, Diabetes Awareness Questionnaire based on ICMR INDIAB Study, questionnaire for uptake of preventive steps and clinical profile. Physical Measurements included Anthropometry and Blood Pressure. Fasting Blood Glucose and Total Cholesterol Levels were estimated. Results: Prevalence of Common Four NCD Behavioral Risk Factors among household members: smoking or smokeless forms of tobacco - 11.6%, alcohol consumption including in the past - 18.2%, No Fruit and Vegetable Intake - 50.6% and 2.6%, Addition of Salt before eating food - 32.4%, Physical Inactivity at Recreation/Leisure - 97.4%.Prevalence of NCDs among them were: Known Hypertension 11.7%, Prehypertension - 46.2%, Hypertension - 14.7%, Known Diabetes - 9.1%, Diabetes 13% and Impaired Fasting Glucose - 6.5%.Key action related attributes of Awareness about Tuberculosis and Diabetes ranged from 5% to 99%, while individual initiative to undertake preventive steps for TB and NCD ranged from 2.6% to 42%. Conclusion: Diabetes/NCD Screening among Household members of the TB patients can be beneficial. However, larger and further studies are required.

Introduction: Escherichia coli are organisms with the ability to colonise and persist in numerous niches. They are usually commensals, but can also take on a more pathogenic nature, causing infections of the blood stream, intestinal tract and the urinary tract among others. Uropathogenic E. coli (UPEC) are the primary cause of about 70 - 95% of community acquired urinary tract infections and recurrence is usually a major problem in many individuals. There are several virulence factors associated with UPEC like Iron acquisition systems, fimbriae, secreted toxins like ? - hemolysin, biofilm formation etc. Virulence factors among various types of UPEC have been poorly studied. This study aims at comparing the presence of some common virulence factors among UPEC isolated from patients with urinary tract infection (UTI). Materials and methods: This study was done between June - July 2017 on patients presenting with symptoms of UTI. Clean catch mid-stream urine samples were collected from these patients and 91 cases who had E. coli grown from the urine were included in the study. Urine samples were examined microscopically for presence of pus cells, RBC's and other structures. It was cultured using the semi quantitative method on CLED and MacConkey agar. After overnight incubation growth on the plates were quantified and E.coli identified using biochemical tests. Antibiotic susceptibility testing was done for these isolates. The organisms were further analyzed for some virulence factors like Hemolysin production, Biofilm formation, and gene coding for Type 1 pilus (FimH). A correlation between the presence of these virulence factors and clinical picture was done. Results: The prevalence of UPEC during the study period was 25%. Sixty two cases were inpatients and 29 were out patients with maximum number of cases in the 61 - 70 age group. Mucoid organisms accounted to 9.8% of the total and 32.9% were hemolytic. Strong biofilm production was seen in 6.5% of the strains. Multi - drug resistance was seen in 38.4% of the strains and 35% were ESBL producers. Fim H gene was detected in 8 out of the 20 strains tested for the presence of the gene. Conclusion: This study found the presence of all the virulence factors detected. Hence it would be worthwhile to look at other markers of virulence especially the genetic markers, as the presence of these could predict the outcome of the infection particularly in patients who are debilitated. MDR strains were encountered in the study and Pan resistant strains were also found. Hence studies on the phenotypic and genotypic characters with susceptibility pattern of these organisms will go a long way in understanding the outcome of these infections.

Background: In India, nearly, 1, 30, 000 Indians are dying due to tobacco related cancer. Identifying smokers, detecting intense nuclear damage by genetic tests like micronucleus test, counseling them about the ill-effects of smoking related cancer are the only hope in reducing the burden of this disease. Thus, the aim of the study was to compare the chromosomal alteration in the exfoliated cells from the buccal mucosa of smokers based on their smoking index and their control counterparts to verify the genotoxic effects of the cigarette smoke and the utilizing the findings to facilitate early diagnosis and subsequent disease management tailored to the individual patient. Methods: This is a descriptive and analytical study which was conducted at MGMC&RI, Pondicherry, a rural tertiary care hospital. The study includes thirty smokers belonging three groups of 10 each based on their smoking index (SI), as follows: Group I: SI < 150, Group II: SI 150-300, and Group III: SI > 300. SI was calculated using the formula as given by Srinivasan et al.5: SI = Numbers of cigarettes/bidis/cigars per day × total duration of smoking in years. Exfoliated buccal cells smears on the subjects and controls was done to study Micronucleus, the cytogenetic parameter to access nuclear damage following standard protocol. Results: The mean value of MN in smokers, increased significantly with increase in the smoking index. In the case-control studies, the mean value of MN, of the study group was significantly higher than their control counterparts. Conclusion: Thus, in an event of tobacco related genotoxicity, genetic instability appeared to exist in smokers belonging to any groups of smoking index than the controls, signifying that MN test play a key role in the evaluation of mutagenicity and primary prevention to any smoking related cancer in the future.

Introduction: Nasal septal surgery is one of the commonest surgeries performed in Otolaryngology practice. Post-operative pain is a major concern and a multitude of medications are available for its management, but they have a lot of side effects and are costly. Therefore we planned to evaluate the efficacy of music therapy on pain and anxiety in patients undergoing nasal septal surgery. Methodology: In this randomized study, patients admitted in the ENT department for nasal septal surgery were divided two study groups. Group A received routine postoperative care and analgesics. Group B received routine postoperative care and analgesics along with music therapy for 30 minutes session twice daily for two postoperative days. Patients were evaluated for pain score by VAS scale on postoperative day 0, 1, 2 and by GAD7 scale for anxiety score before and after surgery. Results: The decrease in the post operative pain in the music group was found to be statistically significant as compared to the control group on post operative day 0 (p<.001), 1 (p<.001) and 2 (p<.001). The difference in the preoperative (6.73 ± 2.32 and 3.14 ± 1.71, p <. 0001) and postoperative anxiety scores (8.93 ± 2.20 and 2.86 ± 2.33, p<. 0001) in both the groups was statistically significant with reduced anxiety in the music therapy group. Conclusion: Music therapy is an effective, safe and easy to comply with adjunctive modality in the management of pain and anxiety in patients undergoing nasal sepal surgery

Introduction: Achieving informed consent is a core clinical procedure. In addition to routine consent process patients are invited to watch the video of therapeutic/diagnostic procedure to gain knowledge of perspective what is involved and assessed its impact on patient satisfaction. Methodology: True experimental post test only design was used for this study and sample size was 80 with 40 each in control and experimental group. The samples were selected by using simple randomized sampling technique. The data was collected by using structured questionnaire and standardized validity tool by experts for a period of two months. Major Findings: The mean value for knowledge was 3.52 with standard deviation of 0.99 in control group and mean value was 17.8 with standard deviation of 0.84 in experimental group. The mean value for satisfaction was 19.55 with standard deviation of 14.5 in control group and mean value was 57.93 with standard deviation of 0.83 in experimental group. The improvement was tested by paired\'t\' test which was found significant at p< 0.001implicating the effectiveness of video assisted informed consent. Conclusion: Levels of satisfaction from the patient's necessitate the adoption of video assisted informed consent for invasive therapeutic/diagnostic procedure in this technological era.

Introduction: Hearing loss is one of the most common sensory impairment affecting the elderly. With increase in life expectancy globally, presbycusis has become a major problem. The hearing loss can affect the social, emotional, psychological and functional wellbeing of an individual. Understanding the impact of hearing loss in various aspects of health can help us in understanding their needs better. Methodology: The study was conducted in 100 people more than 60 years of age with hearing loss. Hearing was assessed using pure tone audiometer. Pure tone average was calculated. HHIE questionnaire was used to calculate the handicap scores from which the degree of handicap was assessed. The severity of handicap was correlated with the degree of hearing loss. Results: From the study it was found that hearing loss in elderly people causes significant handicap (69%). There was statistically significant correlation between the degree of hearing loss and the severity of handicap (p=0.00). Conclusion: From the findings in the study it can be concluded that hearing loss in older adults significantly impairs their quality of life. Any worsening in hearing will further impair the social and emotional aspects of life.

Introduction: WHO defines that child sexual abuse or maltreatment constitutes all forms of physical and emotional ill treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power. The growing complexities of life and the dramatic change brought about by socio-economic transitions in India have played a major role in increasing the vulnerability of children. The main aim of the study was to evaluate the effectiveness of information bundle on knowledge regarding child protection against sexual abuse among school children. Methodology: Quasi-experimental one group pre and post- test research design was adopted. 30 students were selected by simple random sampling techniques, by using semi-structured questionnaire. After the pre-test the information bundle was given on knowledge regarding child protection against sexual abuse. Result: The result shows that the group had adequate knowledge. The improvement of knowledge statistically tested by paired t-test which was found to be highly statistically significant at (p<0.0001) level. It indicates that teaching programme was effective to improving the knowledge regarding child protection against child sexual abuse among school children. Conclusion: It concludes that the majority of school children had adequate knowledge regarding child protection against sexual abuse. It reveals that the information bundle was very effective to improve the knowledge level of school children's on child protection against sexual abuse.

Aim: To highlight the endovascular glue embolisation of bleeding gluteal Arterio-Venous Malformation and management strategies of bleeding peripheral Arterio-Venous Malformations. Materials and methods: Check A 45 year old male patient presented to our institute with active bleeding from pre-existent right gluteal swelling after having penetrating trauma. CT angiogram was done, which showed Arterio-Venous Malformation nidus at the subcutaneous plane of right gluteal region with active extravasation of contrast; feeding arteries were from dilated right inferior gluteal artery and venous drainage was seen into right internal iliac vein. This was followed by emergency Digital Subtraction Angiography (DSA) via left common femoral artery approach, which showed findings similar to CT. Two of the major feeding vessels of right inferior gluteal artery were super selectively catheterized using guide catheter & micro-catheter system with micro-catheter tip placed close to the AVM nidus. 33% glue-lipiodol mixture was injected via micro-catheter into the nidus. Angiogram showed opacification of small residual nidus, which was successfully embolised with 33% glue by direct percutaneous puncture under ultrasound guidance. Entire nidus was excised next day by vascular surgeon. Results: Patient improved symptomatically. Follow up CT angiogram was done after 6 months which showed complete resolution of lesion without any residual nidus. Conclusion: Extra cranial AVMs are far less common than intra cranial AVMs. Less than 2% of total AVMs involve pelvis. Transarterial embolisation is the preferred method in the management of bleeding peripheral AVMs as done in our case.

Background: Raising special child gives unique set of challenges to their parents. These parents needs to adopt coping strategies that help to eliminate, modify, or manage a stressful event or crisis situation. Hence the current study was conducted among the parents of the child with special needs - to determine the various problems faced and the coping strategies adopted by them. Methodology: A cross-sectional study with quantitative and qualitative components was conducted in the selected special schools of Puducherry. The study duration was May 2017 to June 2017. The sample size was calculated to be 187. Quantitative component included interviews among the parents of special child using pre -tested semi structured and self-reported F-COPES (Family Crisis Oriented Personal Evaluation Scale) questionnaire after obtaining the informed consent. Qualitative data regarding their problems and use of different coping strategies was collected in the form of focus group discussions (FGDs). Data was entered in EpiData 3.1 and analyzed using EpiData 2.2.2.182 software. Results: Among 187 participants, 70.6% were mothers and 29.4% were fathers. Majority of them reported problems like depression (69%) followed by economical issues (26.7%) and emotional disturbances (23.5%). Coping strategies used by the parents were having the strength within the family to solve problems (80.2%), accepting that difficulties occur unexpectedly (78.6%), having faith in God (77%), believing we can handle our own problems (75.4%), and accepting stressful events as a fact of life (74.9%). Conclusion: The present study concluded that, feeling depression was one of the major problems faced by them. Reframing and spiritual support are the coping strategies used the most by them. More counseling sessions by psychologist and motivational speech for the parents can boost the moral.

Background: Intrauterine growth restriction is a common risk factor for perinatal morbidity and mortality. Early diagnosis of IUGR during the antepartum period is of significance to reduce the incidence of preterm delivery and still birth and would lead to better management of neonatal health. The present study investigated the urinary and blood levels of inflammatory and oxidative stress markers in women with intrauterine growth restriction. Methodology: The study included 23 pregnant women with IUGR and 30 healthy pregnant women. Detailed history, gestational age and demographic data were obtained. Biochemical parameters such as total protein, albumin, urea and creatinine were assessed. Neopterin, total anti- oxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) were estimated in the blood and urine of women with and without IUGR. Results: Urinary TOS (20.4 ± 4.4, P < 0.05) and OSI (5.4 ± 1.2, P < 0.05) were significantly increased in pregnant women with IUGR. Reduced urinary TAS and increased urinary neopterin levels were found in pregnant women with IUGR, but these results were not statistically significant. Receiver operating curve analysis of urinary oxidative stress index showed reasonable cut off values for the diagnosis of IUGR. Conclusion: Maternal inflammatory response and oxidative stress is positively associated with the development of IUGR in pregnant women. Estimation of these parameters in serum and urine could serve as screening tool for the early prediction and diagnosis of IUGR which will further aid in the better management of neonatal health.

Background: Cytochrome P450 oxidoreductase (POR) supports reactions of microsomal cytochrome P450 which metabolize various drugs and steroid hormones. The principal function of POR is to transfer electrons from reduced NADPH through FMN which then associates with Cytochrome P450 thereby permitting catalysis of the reactions. Polymorphism of POR*28 gene was found to be associated with endocrinological abnormalities, alteration to various drugs, cholesterol metabolism and many other CYP450 metabolizing enzyme activities. The frequency of POR*28 has been studied in various populations like Swedish, Korean and Chinese with varying results. Methodology: This study is a genetic epidemiological study conducted on healthy volunteers. Genomic DNA was isolated from the blood sample using QIAGEN Blood DNA isolation kit. Genotyping of the DNA samples for POR*28 polymorphism was done using TaqMan assay kits in Real Time PCR platform. Results: The results in our study showed a Genotype frequency of Wild type - CC of 41.7% Heterozygous -CT of 47.2% and Mutant - TT of 11.1%. The Allele frequency was C - 65.3% and T - 34.7%. Conclusion: From this study we have identified the genotype and allele frequency of POR*28 gene and the minor allele frequency of POR*28 gene in south Indian population was found to be 34.7%.

Background: pain is a complex multidimensional experience, for many people it is a major problem that causes suffering and reduces the quality of life. Comfort is an important need and ensuring a patient's comfort is a major nursing responsibility. The intramuscular injection is one of the most frequent procedure done almost every day. If there is a technique, by which the nurse can provide painless injections that will be great relief for those clients who are afraid of needles. Objective: The main objective of the study was to correlate the level of pain among patients during intramuscular injection in pin-prick technique versus routine technique. Materials and Methods: Quasi experimental (post test only design) design was adopted for the study. Total of 60 samples were selected by convenient sampling technique, 30 in each group (Group I Experimental and Group II comparison). Pin-prick technique was given only to the experimental group while administrating intramuscular injection. Pain perception was assessed for both groups by using numerical pain rating scale. Results: The result revealed that in group I 26(86.7%) had mild pain (4-6) and four (13.3%) had moderate pain (1-3) and in group II 14 (46.7%) had mild pain, 15(50%) had moderate pain and one (3.3%) had severe pain. The post test median value for group I was 4, and group II it was 2. The obtained Mann-Whitney Test value was -4.72. It was statically significant at p <0.001 level. It indicates there was variation in the level of pain perception was reduced in group I than group II. Conclusion: The study concludes that Pin- prick technique was very effective on reduction of pain perception during intramuscular injection.

Background: India moving towards a cashless economy. Digital transaction brings in better transparency, scalability and accountability. The rural people have less knowledge on digital payments on mode of transaction using Banking Cards, Unstructured Supplementary Services Data, ADHAAR Enabled Payment System, Unified Payment Interface, Mobile wallets, Banks Pre - Paid Cards, Point of Scale Machines, Internet Banking, Mobile Banking, Med Health cards and E - Coupons. The researcher felt the need of imparting knowledge regarding cashless digital transaction among rural people. Objectives: To assess the level of knowledge regarding cashless digital transaction. To evaluate the effectiveness of video assisted demonstration on knowledge regarding cashless digital transaction. To associate the level of knowledge regarding cashless digital transaction with selected demographic variables. Methods: Pre - experimental, one group pre test - post test design was adopted. 60 rural people in Pillaiyarkuppam, Puducherry, selected using convenient sampling. Data collection was done before and after the video assisted demonstration using structured questionnaire which consists of 25 questions. Results: The result of the study showed that the mean value of 60 samples 7.45 pre test, 20.95 post test level of knowledge. The P value was <0.001 which was significant implicating effectiveness of video assisted demonstration on knowledge regarding cashless digital transaction among rural people. Conclusion: This study revealed that video assisted demonstration is effective in enhancing the knowledge among rural people regarding cashless digital transaction. The study helps to rural people on utilization of digital payments to make cashless India.

Introduction: The effect of immobilization leads to many complication related to different systems in our body. The goals of orthopedic surgery procedure are as follows to improve the patient's body function's to recover their movement and stability and to alleviate pain and disability and to improve the sleep. Hence this study was undertaken to assess the effectiveness of passive range of motion exercise on sleep among patients undergone orthopaedics surgery in MGMCRI at Puducherry. Objectives: To assess the level of sleep among patient undergone orthopaedics surgery. To assess the effectiveness of passive range of motion exercise on sleep among patient undergone orthopaedics surgery. To associate the level of sleep among patient undergone orthopaedics surgery with their selected demographic variables Methodology: The study was adopted with quantitative research approach and use pre-experimental (one group pretest & post-test) design, 30 patients undergone orthopaedic surgery was selected from MGMCRI at Puducherry by using purposive sampling technique and the data were collected by using demographic variables. The assessment of quality of sleep was done by using Graningen Sleep Quality Score respectively as pre-test and post-test with intervention of passive range of motion given to the patients undergone orthopaedics surgery. Results: The level of sleep among patients undergone orthopaedics surgery during pre-test and post-test were assessed. In pre-test among 30 patients 15(50%) were having poor sleep and 13(43.3%) were having moderate sleep. In post test 28(93.3) were having good sleep and 2(6.7) were having moderate sleep. The effectiveness of passive range of motion exercise on sleep among patient undergone orthopaedics surgery in the pre-test and post-test mean sleep level was 9.63 and 3.33. the improvement was statistically tested by paired t- test which was found to be highly statistically significant at p <0.001 level it indicates that passive range of motion exercise was highly effective to improve the sleep among patients undergone orthopaedics surgery. Conclusion: Passive Range of Motion Exercise is highly effective to improve the sleep and easily can do and which is very beneficial for all patients undergone orthopedics surgery.

Introduction: American Diabetes Association guidelines recommend early recognition and treatment of DAN among diabetics to reduce life threatening complications. Hence, a study was carried out among diabetics of selected PHCs in Puducherry using non-invasive, validated symptom based scale called COMPASS -31; a) to determine the proportion with DAN b) to assess the factors associated with DAN. Methods: A cross-sectional analytical study was conducted in the service area of Kirumampakkam and Thavalakuppam PHCs. Diabetes patients were selected using simple random sampling from the list obtained from PHCs. The investigator visited the diabetes patients at their residence and interviews were conducted after obtaining informed consent. The information on socio-demographic details, morbidity details and behavioural risk factors were elicited using semi-structured interview schedule. The COMPASS-31 questionnaire was used to assess DAN. The individual with score greater than 16 was considered to have DAN. The data was captured using EpiCollect mobile app and analysed using Stata 12.0 software. The proportion of DAN was expressed as percentage. The association between independent factors and DAN was assessed using multivariate generalized linear models. Results: In total 303 diabetes patients participated in the study. The mean (SD) age of the study participants was 49.1 (10.5) years and majority (51.5%) were females. Of the total 303 participants, 32 (10.6% (95% CI: 7.3% - 14.6%)) were screened positive for DAN. The number of individuals with diabetes who needs to be screened (NNS) for DAN was 10. The individual level factors like female gender (PR-10.6 (5.2-21.8)), being unemployed (PR-3.0 (1.8-5.0)) and class IV SES (PR-1.3 (1.2-1.3)), duration of disease for more than 10 years (PR-1.3 (1.1-1.5)), having hypertension (PR-2.2 (1.1-4.6)) and having BMI in underweight range (PR-2.8 (1.6-4.8)) and alcohol use (PR-5.0 (4.4-5.7)) were independently associated with screening positive for autonomic neuropathy. Conclusion: On screening ten diabetes patients, one individual with autonomic neuropathy can be picked up using COMPASS-31 scale. With good yield, DAN can be included in the comprehensive care package provided to diabetes patients in the PHC.

Introduction: Supra clavicular brachial plexus block (SCBPB) is considered the best alternative for general anaesthesia for upper limb surgeries. Mixture of local anaesthetics (LA) are commonly used to have a faster onset while also prolong the duration of action. We hypothesized that when the LA is deposited very close to neural elements using Ultra Sound Guidance (USG), the onset of action of bupivacaine will not be significantly prolonged compared to the commonly used bupivacaine-lignocaine combination. Methodology: After getting hospital ethical committee approval, 25 - ASA 1 and 2 patients undergoing elective elbow or below elbow surgeries were recruited. In Group LB, SCBPB was performed with 10 ml of 2% lignocaine with adrenaline + 10 ml 0.5% bupivacaine and in Group B with 20 ml of 0.5% bupivacaine. Onset of complete sensory and motor blockade in all 4 major nerve distributions (Median, Ulnar, Radial and Musculocutaneous) and duration of analgesia were noted by a blinded observer. Result: Demographic data were comparable between the two groups. With 20 ml of LA volume, there were no failed blocks in either group. The mean time to complete sensory block was 59 (55 -63) minutes in group LB and 19 (11 - 27) minutes in group B, p = 0.000. The mean time to complete motor block was 50 (40 - 61) minutes in group LB and 19 (12 - 27) minutes in group B, p = 0.000. The mean duration of analgesia was 16 (13 -18) hours in group B and 7 (6 - 9) hours in group LB, p = 0.000. Conclusion: We concluded our study stating that a mixture of lignocaine - bupivacaine produced a significantly shorter onset than bupivacaine alone in US guided SCBPB (19 min vs 59 min). The duration of analgesia was significantly prolonged in the bupivacaine group (16 hrs vs 7 hrs) than the combination group.

Background: Subclavian-vein(SCV) cannulation is associated with lowest incidence of catheter-related bloodstream-infection. Ultrasound- guidance has become the standard of care for central venous access. But the clavicular acoustic-shadow limits visibility of proximal part of SCV. Hence we designed this study to test the hypothesis that abduction of the arm to 90¿ would improve the sonographic-visualization and cannulating SCV in mechanically-ventilated patients. Methodology: After Ethical-committee approval, sixty patients having BMI <30, elective surgery ¿GA were recruited and informed-consent obtained. SCV size, depth & posterior relation measured at three different points, medial part of SCV visualization near clavicular acoustic-shadow in adducted-arm(Point-A) or abducted-arm(Point-B) and at same point-A with abducted-arm(Point -A\'). The distance between Point-A&B over the skin and cephalic movement of the clavicular acoustic- shadow from Point A-A\' were noted. Then they were randomized into two groups namely, Group-A(adducted-arm) and Group-B(arm-abducted, shoulder-90¿) by sealed enveloped technique. Anaesthesiologist with an experience of more than 20- ultrasound guided SCV cannulation performed the procedure in strict aseptic precautions by out of plane approach with Seldinger's-technique. If any malposition of guidewire was noted and cannulated after redirecting into right atrium. Attempt, first-pass success, failure and complications noted. Results: In abducted-arm position from Point A-A\', the clavicular acoustic-shadow moved in cephalad-direction by 2¿0.4cm, enabled the proximal scanning of SCV from Point-A to Point-B by 2¿0.6cm. During proximal scanning from Point A-A\'-B, SCV becomes smaller(12¿5, 10¿5, 10¿4mm2;P=0.00), closer to skin (19¿5, 20¿5, 17¿4mm;P=0.00) and distance to pleura was 3mm deeper in Point-A\'(6¿2, 9¿6, 5¿2mm;P=0.00). The first-pass success rate was 80% in Group-B(P=0.552) and the number of attempts in two groups was comparable(P=0.752). Conclusion: Abduction of arm moves away the clavicular-acoustic shadow cephalad by 2cm to enable easier visualisation and cannulation of SCV under USG guidance. The point of entry where the subclavian artery disappears under the clavicular shadow in abducted-arm seems to more ideal for cannulation. This described point is more medial and the SCV becomes more superficial with only rib as its common posterior structure. The complication rate is very minimal in experienced hands.

Background: Recent studies on several video laryngoscopes had demonstrated their superiority over conventional orotracheal intubation techniques. However very few studies have been conducted to evaluate their suitability for nasotracheal intubation. The Truview laryngoscope is one that has studies demonstrating its suitability for both oral and nasal intubations. Another relatively newer device, the King Vision video laryngoscopes has fewer studies supporting its suitability for oral intubations, however its suitability as a nasal intubating device has not yet been evaluated. Aim: To perform a randomized comparison of the Truview and King Vision video laryngoscopes for performing successful nasotracheal intubation. Methodology: We evaluated the performance of the Truview PCD and King Vision video laryngoscopes on 80 patients undergoing various elective surgeries that required nasotracheal intubation between January 2016 and June 2017. On receiving approval from the institutional ethical committee, 80 patients fulfilling the inclusion criteria posted for various elective surgeries that required nasal intubation, were sequentially selected and assigned to two groups of forty patients each. Patients under ASA I and II, aged 18-50 years, with a mouth opening of more than three centimetre were recruited in the study. All patients were subjected to a standardized anaesthesia protocol. Patients were randomized by a sealed envelope technique to Group T where they were intubated using Truview PCD or to Group K who were intubated with the non-channelled King Vision video laryngoscope. Our primary outcome was the single successful nasotracheal intubation without the use of any additional manoeuvres. The time taken for intubation and the use of pre-defined additional manoeuvres along with Cormack Lehane grading and hemodynamics were collected and analysed. All data were documented by a non-participating anaesthesiologist not involved in the study. Results: 71 patients (88.75%) were successfully intubated in a single attempt i.e. 35 patients (90%) in Group K and 36 patients (87.5%) with in Group T. Intubation time (Mean ± SD) was 67.9 ± 24.1 seconds in Group T and 64.9 ± 20.0 seconds in Group K where comparison was not statistically significant (p = 0.5). The additional manoeuvres (p = 0.2) and hemodynamics were also analysed which did not show any statistically significant difference between the two groups. Minimal bleeding was noted only in eleven cases and twelve cases in Group T and Group K respectively which was self-limiting. Post-operative sore throat was observed in 4 cases in Group T and 3 cases in Group K who were intubated with Macintosh laryngoscope was assisted with Magill forceps due to failed video laryngoscope assisted intubation. Conclusion: Based on the results and the methodology employed, we concluded that both Truview and King Vision video laryngoscopes are suitable intubating devices for achieving successful nasotracheal intubation; however our study has not demonstrated the superiority of any one device over the other. Hence, King Vision video laryngoscope is just as effective as Truview PCD video laryngoscope for successful nasotracheal intubation.

Introduction: The costoclavicular approach to the brachial plexus block has shown to produce consistent blockade of all four terminal nerves of the brachial plexus. But the incidence of phrenic nerve paresis is unknown. Hence, we designed this study to analyse the hemi-diaphragmatic function following two different ultrasound guided techniques of the brachial plexus block namely Supraclavicular and Costoclavicular approach. Methods: Forty patients posted for right upper limb surgery were randomized into two groups (Group SC: Supraclavicular, Group C: Costoclavicular). Total 20 ml of equal mixture of 0.5% bupivacaine and 2% Lignocaine with adrenaline were used by multi point subfascial injections. Ultrasound guided diaphragmatic excursion (normal and deep breathing, sniff test) and Peak expiratory flow rate (PEFR) were measured before block and 30 minute after block. Result: Number of patients who had > = 50% reduction diaphragmatic excursion (Normal breathing; P=0.018, Deep breathing; P=0.003) and paradoxical movement on sniff test (P=0.018) were more in Group SC. While reduction in PEFR (>=25%) were comparable (P=0.058). There was no incidence of block failure and respiratory compromise in either group. Conclusion: Considering > =50% reduction in diaphragmatic excursion on deep breathing, incidence of phrenic nerve paresis was 5 % in ultrasound guided Costoclavicular approach while 45 % in Supraclavicular approach.

Introduction: Epidural analgesia is the most effective technique of labour analgesia. However increase in instrumental delivery is one of the hindrance factor in practise of epidural labour analgesia. Our previous study on labour analgesia with 0.1% Levobupivacaine showed 32% instrumental delivery and none in 0.1% Ropivacaine group. We hypothesized that 0.08% Levobupivacaine with fentanyl may reduce the incidence of instrumental delivery similar to 0.1% Ropivacaine with fentanyl and provide better maternal outcome. Hence, we decided to compare the effectiveness of 0.1% Ropivacaine and 0.08% Levobupivacaine with fentanyl 2 g/ml as an adjuvant for epidural labor analgesia in terms of mode of delivery, onset, duration and quality of analgesia. Methods: 70 nulliparous parturient with singleton uncomplicated pregnancy, who requested labour analgesia were recruited by convenient sampling. They were randomized into two groups to receive 0.08% of Levobupivacaine (n=35) in Group L or 0.1% of ropivacaine (n=35) in Group R with 2 g/ml fentanyl as intermittent epidural bolus. The epidural analgesia was initiated with 12 ml of study drug solution in active stage of labour (cervical dilation > or = 3cm). Further analgesia was maintained by repeated demand bolus (12ml of the same study drug solution) whenever the VAS score was > 3. Onset, duration and quality of analgesia, degree of motor blockade was analysed. Maternal outcome was evaluated in terms of mode of delivery, duration of labour and assisted vaginal delivery and the neonatal outcome by APGAR score. Results: Demographic characteristics were comparable between the two groups. In Group L, out of the 31 vaginal deliveries, two had instrumentation (6.45%) whereas in Group R, out of the 22 vaginal deliveries, one underwent instrumentation (4.54%) which was statistically not significant (p=0.739). When comparing the mode of delivery, in Group L (n=35), 4 parturients underwent caesarean section (11.4%) and in Group R (n=35), 13 underwent caesarean section (37.1%) which was statistically significant (p=0.012**). Mean onset of analgesia in Group L was 22.43 2.6 min and in Group R was 21.00 2.5 min which was clinically and statistically not significant (P=0.37). Duration of analgesia in Group L was 67.2 9.7 min and in Group R was 66.09 12 min which was clinically and statistically not significant (P=0.66). More than 80% of parturients had excellent pain relief in both the groups. Conclusion: We conclude that 12ml of intermittent epidural boluses of 0.08% Levobupivacaine and 0.1% Ropivacaine with 2 g/ml fentanyl provided equal and effective analgesia during labour without any motor blockade in nulliparous women and had similar incidence of instrumental vaginal delivery which is not related to epidural analgesia.

Introduction: The ability of local anaesthetic to block a nerve depends on the length of the nerve exposed, the diameter of the nerve, the presence of myelination and the local anaesthetic used. Studies have suggested that current perception threshold involves quantification of sensory threshold to transcutaneous electrical stimulation and therefore has been explored as a technique to evaluate the effectiveness of peripheral nerve blockade. This study is designed to quantify the intensity of sensory blockade by assessing whether a double point injection would give a more intense blockade than a single point injection using a peripheral nerve stimulator. Material and methods: Sixty patients posted for foot surgeries under ultrasound guidance sciatic nerve block were recruited by random selection and enrolled into 2groups -single point group received a single injection of 20ml of 1.5 % of lignocaine with adrenaline just proximal to the sciatic nerve bifurcation and double point group received one injection of 10ml of 1.5% lignocaine with adrenaline at the point similar to that in group SP and a second injection of 10ml of the same at a point 6cms above the first point. The sensory blockade onset, the time to complete sensory blockade, the time to complete motor blockade, the exposed nerve length, the analgesia duration were evaluated. Observations and results: Double point technique showed a significantly faster time to complete loss of motor blockade and a significantly longer length of nerve exposed and longer duration of analgesia when compared to the single point technique. The sensory blockade onset, the time to complete sensory blockade were not statistically significant different between the two groups. Conclusion: Double point technique was found to be superior when compared to single point technique in terms of length of nerve exposed, completeness of motor blockade and duration of analgesia.

Background: Obesity, is an important public heath burden is characterized by an excessive accumulation of fat mass in adipose tissue. White adipose tissue is the most vital site of chronic inflammation in obesity as indicated by the expression of proinflammatory cytokines and infiltration of various immune cells. Circulating high levels of free fatty acids (FFAs) contribute to inflammation and oxidative stress, thus leading to the production of free radicals. Aim: To profile saturated and unsaturated free fatty acids on inflammatory markers of adipocytes and macrophages. Methods: 3T3-L1 adipocytes and RAW 264.7 macrophages were incubated for 24, 48, 72 hrs with the following FFA: monounsaturated fatty acid (Oleic acid), saturated fatty acid (Palmitic acid, Stearic acid and Myristric acid) at the concentration of 500 ?M and the mRNA expression of cytokines and chemokines was determined by Real time PCR. Results: The results showed that the conditioned media of differentiated 3T3-L1 cell were subjected to RAW264.7 cells exploring the resident macrophage expression in adipocytes that are prone to inflammation. Hence, the pro-inflammatory cytokines in the in vitro conditions mimics obesity, thereby contributing to macrophage infiltration. Conclusion: Pre-adipose 3T3-L1 cell line, a convenient model to establish the molecular mechanisms for adipogenesis has been studied. During adipogenesis, high levels of free fatty acid (FFA) contribute to inflammation and oxidative stress, thereby leading to the production of free radicals. Our results indicate that saturated and unsaturated FFA's may induce AT inflammation through proinflammatory stimulation of macrophages.

Background: Cerium oxide or ceria (CeO2), a rare earth metal oxide. CeO2 nanoparticles (CNPs) have received much attention in nanotechnology due to their useful applications as catalysts, fuel cells and antioxidants in biological systems [1]. CNPs, exhibit biomimetic properties depending on their size, ratio of valency on their surface, and the ambient physico-chemical properties. Aim: To evaluate the. cytotoxic effect of CNPs on U251 cells at pH 7.4 under normoxia (physiological) and pH 6.5 under 1.5% physiological hypoxia (tumor micro-environment) conditions. Methods: The CNPs were synthesized at 6nm (CNP-6) and 12nm (CNP-12) sizes, characterized and glioma cell lines were treated with these CNPs at varying concentration. The cytotoxicity assay was performed (MTT assay). Then IC50 value was determined and the GBM cells were treated with CNP-6 and CNP-12 under physiological and tumor micro-environment. Total RNA was extracted, converted to cDNA and Real-time PCR was done to determine the gene expression pattern of several metabolic genes. Results: These CNPs also had a modulating effect on metabolic gene (GLUT 1, 3, 4, PKM, PFKP, MCT1, 4) expression. In addition, The CNPs also exhibited peroxidase-like activity thus sensitizing the tumor cells towards chemotherapy, thus suggesting a promising tool for cancer therapy.

Background: Advances in the field of dermatology have led dermatologists perform office surgery procedures almost every day. Anxiety that accompanies minor procedures may be relieved by introducing music intervention with no risk or side-effect. Music is a simple, inexpensive, safe and effective adjunct to office surgery which promotes psychological and physiological health. Objectives: This study aims to explore the effect of music listening on state anxiety and physiological parameters in patients undergoing dermato-surgery under local anesthesia. Methods: Study design - Hospital-based randomised control trial, Setting- Department of Dermatology, Venereology and Leprology (DVL) in collaboration with the Department of Psychiatry and Center for Music Therapy Education and Research (CMTER) in a tertiary care centre in, Puducherry) Subjects- Male and Female patients aged 12 years and above undergoing invasive dermato-surgery procedure (IDL) under local anesthesia (LA) were taken up for this study. Procedure - All consecutive patients posted for dermato-surgery procedures like Electro Cautery, Intralesional steroid injection, Skin Biopsy and various other procedures done under local anesthesia, in a DVL OPD were approached for the study. After obtaining a written informed consent/assent from the participants they were randomly divided into two groups - experimental (music listening group) and control (non-music listening group). The experimental group listened to music during the dermato-surgery procedure while the control group did not. Subjects in the experimental group where rated using Interest In Music scale (IIM). Anxiety was assessed at baseline, 10 minutes after the start of procedure and 20 minutes post procedure in both the groups using a single item Likert scale. Blood pressure, heart rate and respiratory rate were also assessed at these three points of time in both the groups. Results: Out of the total of 150 patients, 75 were in the experimental (music listening group) and 75 were in the control (non-music listening group). The age of study participants ranged from 15 to 70 years. The mean age of total sample was 36.8±13.2 years. Mean age was 35.1±13.4 years and 38.7±12.9 years in experimental and control group respectively. There were 42 men and 33 women in the experimental group and 40 men and 35 women in the control group. The gender distribution in the experimental and control group did not vary significantly (p=0.87) Majority of the participants in experimental group 62(82.6%) preferred Tamil film music. The mean duration of music listening was 41.73±5.89 minutes. The mean anxiety scores showed a trend to decrease from baseline to 20 minutes within the two groups. Post hoc analysis revealed that the difference in anxiety from baseline to 10 minutes; 10 minutes to 20 minutes and baseline to 20 minutes were statistically significant in both experimental and control groups (p=0.000) Anxiety levels at baseline between both the groups were significantly different with the control group having higher anxiety score. But anxiety at 10th minute after the start of procedure and 20th minute post procedure did not show any statistical significance between the two groups. In both the groups, SBP, DBP, HR and RR all showed a trend to increase at 10th minute of start of procedure and then decreased when measured at 20 minutes post procedure but statistically significant difference was present only in SBP and HR in music listening group; and SBP and RR in non- music listening group. Comparison of systolic blood pressure, heart rate and respiratory rate between the two groups showed a statistically significant difference at baseline. But no statistical difference was observed at 10th minute of start of procedure and 20 minutes post procedure between the two groups. There was no statistically significant difference in diastolic blood pressure at all the three point of time between experimental and control group. There was a negative correlation found between anxiety and scores of interest in music domains (music activity & emotional engagement with music and Social avoidance through music) during music listening, suggesting that higher interest in music lowers anxiety. Conclusion: The results of this study indicated that though there was no statistically significant difference of anxiety levels between the two groups, there was a positive trend towards reduction in anxiety levels within the two groups from baseline to 20 minutes post procedure which was statistically significant. Hence we conclude that music listening may not have contributed to significant reduction in anxiety levels because of short duration of dermato-surgery procedure and music listening. We feel that future studies should be taken up after addressing the limitations of the study to understand the relationship between music listening and anxiety levels in subjects undergoing similar procedures.

Background: As every other organ, skin is invariably affected in most patients with diabetes. It cannot be ignored owing to the fact that skin is the largest organ of the body. In some of them, skin manifestation can be the presenting sign. The purpose of this study was to analyse the various dermatoses pertaining to Type 2 Diabetes Mellitus. Materials and Methods: This is a descriptive study, conducted in the Department of Dermatology, Venereology and Leprosy, Mahatma Gandhi Medical College and Research Institute. Data collection was done prospectively in a pre-written proforma, in which history and clinical findings were noted. Results: 100 diabetic patients with mucocutaneous manifestations were studied. Out of them, 64% were males and 36% were female diabetics. Most of them were in 5^th and 6th decade of life. 31% of them gave a positive family history. 76% had more than a single feature in them. There was no statistically significant correlation between the duration of diabetes and clinical manifestations. The most common among all the findings were xerosis/ichthyosis which was seen in 46% of the patients. This was followed by cutaneous infections (44%), acanthosis nigricans (27%), acrochordons (25%), and diabetic dermopathy (20%). Seborrheic keratosis/DPN was seen in 24% of them. The less common features which we came across were psoriasis, ulcer, melasma, amyloidosis, xanthomas, perforating dermatoses, lichen planus, vitiligo, scleredema diabeticorum, diabetic rubeosis and gangrene. Conclusion: Skin involvement in Type 2 diabetics is common. Suspecting the disease from the particular manifestation can be possible, when we can intervene earlier and prevent the possible complications, thereby increasing the quality of life of patients.

Background: Oral mucosa reflects the general health of an individual. Clinically/symptomatically in certain systemic diseases oral cavity may be affected first. In dermatological practice certain diseases have mucocutaneous presentation, and so the reason why examination of skin is never complete without the examination of other mucosae. Aims and objectives: To find out the frequency and diversity of oral mucosal lesions in patients attending DVL OPD. Methods: This is a hospital based observational study, 100 patients with oral mucosal lesions fulfilling the inclusion & exclusion criteria were enrolled in the study. Detailed history, physical examination, clinical photographs and investigations if required were recorded for all the patients. Results: The prevalence oral mucosal lesions among dermatological patients is 1.04% with a female predilection and the mean age was 38.44±17.30. Majority of the patients belonged to the age group of 31-60 years. Established risk factors for developing oral lesions like tobacco and beetle nut use was found in only 24% and 16% of the patients respectively.21% of the patients were diabetic and the commonest oral lesions in them were oral candidiasis, mucosal vitiligo and leukoplakia18% of the patients presented with only oral complaints, while 82% of patients came with skin complaints and their oral lesions were incidental findings. Out of 82 patients with dermatological diseases specific mucocutaneous diseases were seen in 44% of patients. Most common dermatological diseases seen were infections followed by vitiligo, lichen planus and pemphigus vulgaris. Majority of patients (91%) had single oral lesion and the commonest among them were oral candidiasis followed by mucosal vitiligo, lichen planus, aphthous ulcers and vesiculo bullous disorders. Conclusion: There is enough evidence that oral cavity can provide early and sometimes the only clues to diagnosing certain systemic diseases. Many oral diseases with potential to turn malignant can be caught early if the clinician takes a few minutes to examine the oral cavity in all patients that he attends to.

Introduction: Around the globe, the most common fungal agents which have been linked with superficial infections of the skin are Dermatophytes. With changing weather conditions, socio-demographic profile of the populations and the economic conditions and occupational profile of the population, the profile of the dermatophyte infections is also a constantly changing phenomenon. Understanding these changing profile is highly important for health care practitioners at different levels to be able to treat them effectively. Also a good understanding of the profile of patients affected by these agents may enable the clinicians to plan appropriate preventive measures in high risk groups. This understanding is highly essential in resource poor settings like India, where the diagnostic facilities to isolate fungi may not be available at all levels of healthcare and a major proportion of these cases are treated empirically. Aims and Objectives: To find out the prevalence of various clinical pattern of dermatophytosis and correlate the clinical diagnosis with KOH positivity and fungal culture positivity. Materials & Methods: The current study was a prospective observational study. Conducted in the department of dermatology Mahatma Gandhi Medical College & Research Institute, Pillaiyarkuppam Pondicherry. the study population included patients presenting to the dermatology outpatient department, with skin lesions suggestive of dermatophyte infections All patients who are clinically diagnosed to have dermatophytosis between January 2016 to July 2017at department of DVL OPD in MGMCRI were included. Results: The mean age of the patients affected by dermatophyte infections was 33.65 ± 11.61 years, with the majority belonging to 16 to 30 years of age group. There was a high Male preponderance, as 72% of the affected population were males with a male: female ratio of 2.57: 1. The most common clinical diagnosis was Tinea corporis seen in 47.50% of the population, followed by tenia Ungum in 28% and tenia cruris in 19.50%. KOH positivity was seen in 86 (43%) out of 200 cases in the study population. The culture was positive in 55 (27.50%) of the study population. The most common organism isolated in culture was Trichophyton mentagrophyte (10%), followed by Trichophyton rubrum (9.5%) and Trichophyton tonsurans (5.5%). KOH positivity was highest in 46 to 60 years of age (50%). It was more in males as compared to females (47.91% Vs, 30.35%, P-value 0.446) but the difference was statistically not significant. Among the study population, 55 (27.5%) of the people had both culture and KOH positive. Among 31 (15.5%) people KOH was positive but culture was negative. None of the subjects had KOH negative status when culture was negative in the study. Neither KOH nor culture was positive in 114 (57%) patients Conclusions: Dermatophyte infections commonly affect the young and economically productive population in 16 to 30-year age group, with high male preponderance. Tinea corporis was the most common clinical form and Trichophyton mentagrophyte was the most common organism. KOH tends to show a higher proportion of positivity as compared to culture.

Background: Traditionally over decades, myringoplasty was done using an operating microscope. Earlier endoscopes were used for diagnostic and documentation purposes only. Currently they are becoming popular in otological surgeries. Hence the aim of this study is to compare the outcome of endoscopic myringoplasty and microscopic myringoplasty in patients with inactive mucosal type of chronic otitis media. Methodology: Prospective comparative study done in a rural tertiary health care centre from November 2015 and October 2017 after obtaining clearance from the Institutional Human Ethics Committee. Eighty patients underwent myringoplasty; they were block randomised into forty each for microscope and endoscope assisted. Results of surgery were compared at the end of six months post surgery. Results: The hearing gain between the two study groups was not significant (p=0.36). The average duration in microscopic myringoplasty was 82.25±10.8 minutes and in endoscopic myringoplasty was 56.43±8.6 minutes and this difference was significant (p=0.00). The graft success rate in both the groups was the same. The post-operative complications both groups was not significant (p=0.49). Conclusion: Endoscopic myringoplasty is more advantageous than microscopic myringoplasty in terms of duration of surgery, cost of the instrument and better magnification. As it is a one-hand held technique and requires experience, microscopic myringoplasty is still the most accepted procedure performed. Hence, both microscopic and endoscopic myringoplasty is equally effective in treatment of chronic otitis media.

Aim: This study aimed to determine the incidence of hearing loss in healthy newborns thus assessing the effectiveness and utility of OAE as a screening tool to detect hearing impairment in newborns. Study design: Prospective cross sectional study Methods: Over a period of 18 months, all healthy neonates delivered in a rural tertiary care centre were included in the study. Neonates with congenital malformations of the external ear were excluded from the study. All candidates underwent hearing screening in a sound treated room in the department using Distortion Product Otoacoustic Emissions (DPOAE) test at 24-72 hours of life. For cases failing the test, the test was repeated immediately. Those infants failing the second test were re-screened at 30 days of life. Infants failing the third OAE test then underwent BERA testing after 3 months to confirm hearing loss. Results: 3121 neonates were included in the study, of which 689 (22.07%) failed the initial screening, 84 (2.69%) failed the second OAE, 59 (1.89%) failed the third OAE and 32 (1.03%) neonates were diagnosed with hearing impairment using BERA. Risk factors which had significant correlation with hearing screening failure included male gender (p=0.01), low gestational age (p=0.01), birth weight <2500 gm (p=0.01), maternal age (p=0.01), multiple gestation (p=0.01), consanguineous parents (p<0.01), Caesarean section (p=0.03), family history of hearing loss (p=0.01). Conclusion: The prevalence of impaired hearing in the population of Pondicherry appears to be higher than the global average and may be related to local risk factors such as high prevalence of consanguinity. The three staged screening protocol with DPOAE is a useful protocol in detecting hearing loss in newborns and should be implemented as a national programme.

Background: The association between diabetes and depression is well known. They may have a bidirectional association though the exact mechanism is still not clear. Many of the current literature regarding the intertwined nature of Diabetes Mellitus (DM) and depression are cross-sectional in nature. There are not many longitudinal or prospective studies to determine the association between DM and depression in Indian scenario. Our study was mainly intended to find out the prevalence of depression in diabetic individuals and its impact on diabetes. Objective: To study the prevalence of depression in diabetic patients, its impact on the clinical course of diabetes and to study the association between clinical courses of depression and diabetes. Methods: Sample size was taken as 30 in each group. All patients who fulfilled the inclusion exclusion criteria were taken up for the study. A semi structured data collection proforma was used to record the socio demographic details. (SCIP) Standard for clinicians interview in psychiatry, a screening tool was administered to screen for various mental health problems. Those who were screened positive for depression were further assessed using PHQ9 questionnaire. After that patients were referred to psychiatry for further management. Diabetic patients were screened for depression till the study sample size of 30 was reached in the group with depression. From the total number of diabetic patients screened, the prevalence of depression was calculated. Equal number of T2DM patients who were screened negative for psychiatric disorders and who consented for 3 months follow up were taken as control. Appropriate treatment for diabetes and depression were administered to subjects of both the groups, in accordance with standard & contemporary practice guidelines. PHQ-9, FBS, PPBS, HbA1c were measured at baseline and repeated at 3rd month of follow-up, to monitor the clinical courses of diabetes and depression. Results: It was observed that 40% of participants with DM and depression were in the age group of 51-60 years. Among 30 participants in DM with depression 56.6% female participants had depression as compared to 43.4% male participants. Majority of the subjects in both the groups were from rural area and most of them were housewives. There was no statistical significance in age, gender, education, occupation, domicile, socio economic status between two groups. It was also observed that 30% subjects with DM and depression having diabetes duration 11-15 years had significant depression, implying that longer the duration of DM, the greater is the chances of developing depression. There was statistically significant fall in PHQ 9 scores from baseline when compared to follow up showing significant improvement in depression. In our study the prevalence of depression among diabetic individuals was found to be 15%. There was no statistically significant difference in FBS, PPBS and HbA1c between the two study groups, both at baseline and also at follow up. The difference in FBS, PPBS and HbA1c among subjects with mild, moderate and severe depression was found to be statistically significant. It implies that severe the depression, worser the glycemic control. Among the study participants of DM with depression group, those from urban domicile, co-morbidities, higher baseline FBS, PPBS and HbA1c levels had severe depression when compared to those with mild and moderate depression. The difference in improvement of HbA1c from baseline to follow up was statistically significant when compared between groups having mild, moderate and severe depression, with maximum fall of HbA1c in the group with severe depression. This implies the positive effect of treating depression on glycemic control. Conclusion: In our study the prevalence of depression among diabetic individuals was found to be 15%. Among the study participants of DM with depression group, those having higher baseline FBS, PPBS and HbA1c levels had severe depression when compared to those with mild and moderate depression implying a negative impact of depression on glycemic control. There was statistically significant improvement in severity of depression on intervention. There was no statistically significant difference in FBS, PPBS and HbA1c between the two study groups, both at baseline and also at follow up. But the fall in HbA1c from baseline to follow up was statistically significant in the group having severe depression showing the positive effect of improvement in depression on glycemic control.

Introduction: Type 2 diabetes mellitus (t2dm) is the most prevalent form of diabetes seen in India. Patients with BMI <18.5kg/m2 were termed as lean type 2 diabetes mellitus (t2dm). Lean t2dm differs from classical obese type 2 diabetes. They have moderate to severe basal hyperglycaemia with low levels of plasma insulin. They have normal c-peptide levels indicating good beta cell function. The present study attempts to analyze the clinical profile, complications and type of treatment needed in these patients. Methodology: This was a prospective, descriptive study on 50 patients with T2DM and BMI<18.5 kg/m2. History taking, physical examination and Anthropometric measurements on all selected patients were done and investigations were done and recorded to find the etiology according to proforma. Results: T2DM with BMI<18.5kg/m2 were studied. There is a male preponderance in the study with a male to female ratio 5:2, majority of the patients were in the age group of 31-70 years. Majority are from middle socioeconomic class. Almost 76% patients responds to oral hypoglycaemic agents and 12% to insulin. They have a high prevalence of peripheral neuropathy and infection. Conclusion: T2DM with BMI<18.5kg/m2 were as termed as lean T2DM. Males are more affected than females. Peripheral neuropathy and infection are common complication in lean T2DM. Prevalence of macro vascular complication like IHD and PVD are low. Majority of patients responds to oral hypoglycaemic agents with adequate calorie intake without emphasis on weight loss.

Introduction: Lipid abnormalities are common among patients with Chronic kidney disease (CKD) and it tends to persist/worsen even after initiating treatment. The cardiovascular mortality and morbidity remains significantly high in this population. Aim: The present study was carried out to assess the effect of yoga therapy on fasting lipid profile in CKD patients. Materials and Method: It was an interventional case control study on CKD patients with and without yoga in a tertiary care hospital. About 30 adult male and female CKD patients aged > 18 years were enrolled in Group 1 who underwent yoga therapy. Group 2 consisted of 30 CKD patients who did not do yoga and they served as controls. Serum lipid profile, RFT and BP were estimated among all patients of both groups. Chi-square test, Paired and unpaired t test, mean and delta change were used for comparing parameters. A p-value of <0.05 was considered statistically significant. Results: Out of 60 patients, males were predominant. There was significant reduction in Triglycerides, LDL and VLDL in the yoga group. Total cholesterol also reduced but was not statistically significant. HDL also increased but insignificant statistically. There was also significant reduction in BP in the yoga group. Conclusion: Yoga can reduce the lipid levels and Blood pressure in CKD patients. It can reduce the cardiovascular mortality and morbidity.

Background: Stroke is one of the leading cause of death and long term disability. Records shows one life is lost in 10 seconds due to stroke and an incident of stroke occurs every ½ second worldwide. Platelet indices are potentially useful markers for the early diagnosis of thromboembolic diseases. Mean platelet volume (MPV) and platelet distribution width (PDW) can be used to predict impending ischemic stroke. Aims and objectives: To study the significance of mean platelet volume and platelet distribution width in acute ischemic stroke. To compare the MPV and PDW in acute ischemic stroke and control. Assessment of ROC to assess the cutoff point of MPV and PDW in predicting stroke. Methods: This study was a hospital based case control study, done from Jan 2016 to May 2017 at MGMC&RI in Pondicherry. The study was carried out among 40 patient with acute ischemic stroke compared with controls (patients without ischemic stroke). In all patients MPV and PDW was compared between the two groups. Results: There was statistical difference in MPV and PDW between the two groups (p=< 0.001).The MPV in acute ischemic stroke patients was 12.9 ± 1.8 fl was increased compared with controls who had 8.1 ± 1.8fl. The PDW in acute ischemic stroke was 18.1 ± 2.4 % was increased compared with control who had 11.7 ± 1.7 %. The area under curve for detecting the acute ischemic stroke based on MPV and PDW is 0.98 and 0.97 respectively with 95% CI (0.94-1.0) which was statistically significant. Conclusion: In acute ischemic stroke patients, MPV and PDW was more compared with controls. Thus MPV and PDW can be used as laboratory marker for predicting acute ischemic stroke.

Introduction: Pre-diabetes is a mounting health problem occurring worldwide. Microvascular complications are prone to occur during this stage. Early diagnosis & treatment delay progression to type 2 diabetes & microvascular complications. Aims & Objectives: To determine the prevalence of microalbuminuria, c-peptide & fundal changes in pre-diabetics Methodology: 125 pre-diabetic patients those who visited MGMCRI General Medicine OPD & admitted in medical wards were taken into the study after fulfilling the inclusion & exclusion criteria. Those entire study participants's urine & blood sample were sent for analysis of microalbuminuria & C-peptide respectively. Fundus was examined to look for retinopathic changes. Results: Among 125 prediabetic participants, prevalence of microalbuminuria was 12.8%, c-peptide levels was elevated in 46.4 %, but none of the study participants had fundal diabetic retinopathy changes. Conclusion: The microvascular complications like microalbuminuria starts in the pre-diabetic stage itself. Increased c-peptide levels are an important marker of prediabetes & a risk factor for diabetes. Prevalence of increased c-peptide levels & microalbuminuria was more in individuals who had both IFG & IGT

Background: ACS is a life threatening manifestation of CAD. It warrants an early risk stratification and timely intervention. Recently, Haematological indices, have gained attention because of their significant associations in predicting outcomes of CAD. We carried out a prospective cross-sectional study among ACS patients to find the association of Red Cell Distribution Width (RDW), Haemoglobin Corrected RDW (HbCRDW), Red Cell Width Volume Index (RWVI), Neutrophil/Lymphocyte Ratio (NLR) and Platelet Distribution Width (PDW) with in-hospital Major Cardiac Adverse Events (MACEs) (Recurrent Angina, Clinical LVF, LV Dysfunction by Echocardiogram, Arrhythmias and Death). Methods: 100 ACS patients admitted in our hospital were enrolled for the study. The significance of association between the haematological parameters with the MACEs were found using Fisher Exact Test. Results: Frequency of occurrence of In- hospital MACEs were 17% Recurrent Angina, 42% Clinical LVF, 57% LV Dysfunction, 18% Arrhythmias and 10% Mortality. Using Fisher-Exact test, although indices had no significance with mortality, RDW (>15%) had a significant association with Recurrent Angina (P=0.012) and LV Dysfunction (P=0.09). Higher tertiles of HbCRDW & RWVI had significance in predicting Recurrent Angina with P values of 0.013&0.043 respectively. Higher tertiles of NLR (>3.75) was significant in predicting Clinical LVF (P=0.086) and Arrhythmias (P=0.080). Conclusion: RDW and its derived indices HbCRDW, RWVI are strong predictors of in-hospital Recurrent Angina among ACS patients. In addition, Higher values of RDW are also useful in predicting LV dysfunction. PDW had no significance with MACEs, yet NLR is found significant in predicting clinical LV failure and arrhythmias.

Introduction: Type 2 Diabetes Mellitus (DM), is characterized by a relative insulin deficiency or insulin resistance associated with a cluster of metabolic abnormalities. India leads the world with largest number of diabetic patients and is often referred to as the diabetes capital of the world. The estimated number of patients with diabetes in India was 62.4 million in 2011 which is projected to rise to a staggering 101.2 million by 2030. The lipoprotein abnormalities commonly present in type 2 diabetes, include hypertriglyceridemia, increased VLDL, LDL-C, decreased HDL-C & delayed chylomicron clearance and remnant accumulation but its pattern is also influenced by patient ethnicity. Diabetes and dyslipidemia commonly coexist in India there is a lack of country wide data to understand the pattern of dyslipidemia and to accurately assess the control of lipids in this population in a real world setting. The main aim of our study is to analyze fasting and post prandial lipid profile (by OFTT) in type 2 diabetic patients; (b) compare fasting lipid profile with post prandial lipid values and (c) motivate patients for exercise therapy and to analyze the lipid profile after three months of follow up. Methodology: The present study was initiated with 100 in- patients who were screened to short list those based on the inclusion criteria i.e Type 2 diabetic mellitus between age groups of 30 - 60 years on statin therapy and newly diagnosed with Dyslipidaemia. After sampling on fasting for analysis they were provided with standard meal (devised in this research study) of 4 slices of bread with 30 gms butter and 250ml of milk. Post-prandial readings were taken at 3 hours and 6 hours. Based on these three sets of data one at fasting and 2 at post prandial period, about 25 per cent (24 patients) study populations with deranged lipid profile who were already on statins and those newly diagnosed in this study recommended for statin therapy were followed up after 3 months with exercise - aerobic. Results: The finding reveals that none of the factors could be correlated with age, occupation and gender except the TGL, VLDL and HDL. The levels of TGL, VLDL and HDL after meal were increased and statistically significant compared to corresponding fasting lipid values. Meal did not affect the HDL concentration in this group and remained nearly same. Patients who were encouraged to do exercise exhibited no statistical significant changes in their fasting and post post-prandial TGL level. However, although the levels of VLDL and HDL after meal were increased and their changes were statistically significant. Conclusion: Postprandial lipid abnormalities are profoundly significant in Type 2 diabetic individuals especially TGL and VLDL which increases the risk factor for developing CVD. Also exercise has an affect but in our study it didn\'t significantly alter the lipid parameters.

Introduction: CAIMT measurement in hypothyroidism will help assess the progression of atherosclerosis and timely intervention may prevent vascular complications. Aim: The aim of our study was to assess the carotid artery intima media thickness (CAIMT) in patients with clinical and subclinical hypothyroidism and the effect of thyroid replacement therapy after 4 months on CAIMT. Materials and Method: This study included 30 clinical hypothyroid, 30 subclinical hypothyroid and 30 controls. As per procedure, informed consent was taken from the patients in prescribed formats before their participation in the study. Patients were divided into 3 groups of CH, SCH and Controls after obtaining the TFT values. CAIMT on the right side was measured in the three groups for comparison. Other parameters included age, sex, height, weight, BMI and lipid profile. After 4 months of levothyroxine therapy, CAIMT and lipid profile were reassessed. Results: The CAIMT was increased in CH and SCH group when compared to euthyroid individuals. The mean CAIMT in CH group was 0.60 ± 0.009 cm, in SCH group it was 0.055 ± 0.010 cm and in controls it was 0.047 ± 0.006 cm. After 4 months of levothyroxine therapy, there was no change observed in the mean CAIMT values. Conclusion: CAIMT levels are increased in CH and SCH group when compared to euthyroid controls. After 4 months of levothyroxine therapy there was no regression in CAIMT.

Background: Thyroid disorders are common throughout the world including in India. Rapid and accurate intraoperative diagnosis of thyroid lesions helps in deciding the plan of management and spares the patient the additional expenses and morbidity of a second surgery. Aim of the study: To assess the role of imprint cytology in diagnosis of thyroid lesions in consecutive thyroidectomy specimens at Mahatma Gandhi Medical College and Research Institute, Pondicherry. Materials and Methods: Study design: Cross sectional study Place of study: Mahatma Gandhi Medical College and Research Institute, Pondicherry. Study period- November 2015 to July 2017. 60 consecutive thyroidectomy specimens were subjected to touch imprint cytology by the same pathologist who was blinded of the prior fine needle aspiration cytology reports and the results of imprint cytology and fine needle aspiration cytology were compared with the final histopathological examination report. The data obtained were entered in MS Excel sheet and analysed. Results: A total of 60 consecutive thyroid specimens from the departments of General Surgery and ENT were studied. Thyroid lesions showed a female preponderance (female: male ratio of 13:1) with maximum incidence in the fourth decade of life. Colloid goitre was the most common benign lesion and papillary carcinoma was the most common malignancy accounting for 43.3 and 18.3 % of the study population. Imprint cytology had a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 61.5%, 97.9%, 88.8%, 90.1% and 90% respectively which was found to be better compared to fine needle aspiration cytology. Conclusion: Imprint cytology is a simple, cheap and reliable intraoperative diagnostic technique for thyroid lesions. It has high specificity, positive predictive value, negative predictive value and accuracy. Though other intraoperative diagnostic methods like frozen section remain an option, the lack of uniform availability and expense remains a limiting factor. The diagnostic indices of imprint cytology were found to be comparable to that of frozen section in various other studies.

Background: Urinary iodine excretion is a measure of iodisation. With the advent of Universal Salt Iodisation (USI), a lot of conflicting reports are available that implicate excessive iodisation in both hypo and hyperthyroidism. Urinary iodine reflects iodine status in the given population. Pondicherry population is unique since it is a mixture of urban, semi-urban and rural. Hence, the study was undertaken. Methodology: Urinary iodine was measured by the state-of-the-art Hplc procedure with electrochemical detection- a highly sensitive and specific analytical procedure. Thyroid hormones were quantitated by automated chemiluminescence method. The sensitivity and specificity of urinary iodine was related to thyroid hormone levels by keeping the cut-off for the former at 200micrograms per dl. Results: USI leads to excessive iodisation as exemplified by the mean urinary concentration values for various thyroid pathology including hypothyroidism, hyperthyroidism, nodular goitre, and hyperplastic thyroid nodule. Conclusion: Mean urinary iodine concentration and its magnitude can be used in providing a preliminary insight into different thyroid pathology. USI contributes to excessive iodine that is equally dangerous like iodine deficiency diseases.

Background: Ulcers form a significant proportion of cases encountered by the general surgeon on a daily basis. Even though this may seem to be a simple problem, approximately 81% of cases with non-healing extremity ulcers undergo amputation owing to faulty wound healing. Many methods have been used to treat non healing wounds and their merits and demerits well documented. Autologous Platelet-rich plasma (PRP) is a product derived from the patient's own blood through the process of gradient density centrifugation. The use of autologous Platelet-Rich Plasma in promoting wound healing has been studied for over 30 years. Despite this, PRP dressings are infrequently used by the general surgeon to treat non healing ulcers in everyday clinical practice. This study is intended to assess the feasibility of autologous PRP dressings for non-healing ulcers, in terms of efficacy, safety and as a natural alternative to other modalities of treatment including surgery. Materials and Methods: Patients admitted with a diagnosis of chronic ulcer and fell under the inclusion criteria were selected for the study. Consent was obtained from the patients to be included in the study after explaining the nature of study, investigations involved. Those patients who were willing to undergo PRP dressings were included in the test group and patients who consented for conventional dressing were included in the control group. The PRP group had 50 patients, with various etiologies of chronic ulcers and were treated with autologous PRP dressings, which were applied twice weekly. The CONTROL group included 50 patients, who were treated by daily dressing which involved cleaning the wound with normal saline, and then Povidone iodine and covering by sterile dressing. Both groups were studied for reduction in ulcer size, quality of granulation, type of discharge from wound, change in pain score, peri-lesional changes and microbiology of the wound. Results: The mean ulcer size in PRP group on initial measurement was 13.66cm.sq and in CONTROL group was 13.65cm.sq. The mean reduction in ulcer size on day 7 in PRP group was 2.47cm.sq and that in CONTROL group was 0.84cm.sq; this was statistically significant with a p value of 0.006. The mean reduction in ulcer size on day 14 in PRP group was 4.84cm.sq and that in CONTROL group was 1.51cm.sq; this too was statistically significant with a p value of 0.004. The quality of granulation improved significantly in PRP group on day7 and 14 as compared to CONRTOL group. This improvement was noted in all etiological sub-groups studied. There was a statistically significant reduction in discharge from wound on day 7 and day14 in PRP group compared to CONTROL. There was no statistically significant improvement in pain reduction following PRP application on day7. Significant reduction in pain score was only observed on day 14 in PRP group when compared to CONTROL. Conclusion: Autologous PRP is effective in reducing ulcer area in chronic ulcers, it improves the quality of granulation tissue, it decreases discharge and pain from ulcerand can be safe alternate to conventional dressing. As an autologous product PRP does have a risk of transmissible disease. Application of PRP requires minimal training and can be performed easily by those trained in wound care.

Background: Transgenders, a unique group of people, experience mismatch between their assigned sex and gender identity. A person's distress in accepting their biologically assigned sex is called Gender identity disorder or Gender dysphoria. All surgical procedures that a patient wishes to receive to resemble the opposite genders appearance is called Gender reassignment surgery which is indicated for treating gender dysphoria. The literature on Transgenders and GRS is limited in India. In this study, we present psychological aspects, chromosomal analysis, surgical procedure, its outcome with post-operative complications and satisfaction levels in Male to Female GRS. Methods: This is a retrospective and prospective study on transgenders who volunteered to undergo GRS MTF from March 2015 to August 2017 and demographic profile along with surgical outcomes and complications were registered and analysed. Results: During the study period, a total of 62 GRS MTF was performed. Major complications like rectovaginal fistula, pulmonary embolisms and deep venous thrombosis were not observed. The most common complications were wound infection and reactionary bleeding from the urethra. Conclusions: Gender reassignment surgery plays a pivotal role in relieving the psychological discomfort of Gender Dysphoria individuals. GRS MTF can be performed with a low rate of complications. The collaborative effort between the surgeon, behavioural scientist, and a medical physician responsible for hormonal therapy is recommended for a desirable outcome. Surgical expertise is the key factor to minimize the psychological burden of a transgender throughout their post operative life.

Introduction: The Lichtenstein technique is currently the first choice to repair unilateral primary groin hernias. Many methods have been used recently for mesh fixation in Lichtenstein mesh repair to prevent mesh dislocation and recurrence. In contrast to penetrating fiixation known to cause acute chronic pain, adhesive fiixation is becoming increasingly popular as it reduces markedly the risk of injury and chronic pain. Synthetic glue (N-butyl 2 cyanoacrylate) have been used in the mesh fixation since it does not interfere with normal wound healing and does not produce local thermal injury. Aim: To compare the effectiveness of synthetic adhesive sealing (n-butyl-2- cyanoacrylate) for mesh fixation with polypropylene suture material in Linchtenstein inguinal hernioplasty. Methodology: 60 patient diagnosed to have unilateral inguinal hernia have been included in this study from august 2015 till july 2017.Initially patients were grouped into two groups randomly. One group (group A) have undergone mesh fixation with polypropylene suture material and another group (group B) with synthetic glue (N-butyl 2 cyanoacrylate). Operative time have been noted for both groups. Prospective observation was done on regular intervals of 12 hrs, B) 24hrs, 72hrs, 7 days and 14 days to assess the post operative pain and post operative complications in both groups. Time to get the normal activity have also been compared between both groups. Results: The study showed shorter operative time for mesh fixation with synthetic adhesive glue when compared to conventional mesh fixation with polypropylene material. post operative pain was significantly low in group B. One surgical site infection was reported in the group A. Time taken to get back to the normal activity was same for the both groups. Based on this data, mesh fixation with synthetic glue is more effective than polypropylene suture material.

Introduction: SSI of the third most common nosocomial infections occurring worldwide. They are accounted for about a quarter of all nosocomial infections. The main objective was to know the incidence of SSI in clean surgical procedures carried out in the institute of MGMCRI and to determine various pathogens causing SSI. Subjects and methods: This was a projective observational study done on 100 patients in Department of Genera l Surgery in MGMCRI, Puducherry from a period of June 2015- August 2017 who underwent clean surgical procedure on elective basis. Preoperatively single done of injection cefazolin 1gm intravenous preparation was given 30 minus before the skin incision and patient were observed and followed up meticulously for the incidence of SSI and to determine the bacterial flora in the event of SSI. Results: In our study a total of 100 patients were included out of which 64 were males and 36 female among the study population. In our study a total of three out of 100 patients developed SSI which is around 3%. Out the 3 patients who had SSI all of male gender which is around 4.6% in our study. In relation to the distribution based on the age group more than 50 year of the age of the patient are most frequently associated with SSI in our study. The bacterial flora includes staphylococcus aureus which was isolated from one patient and klebsiella pneumonia isolated from two patients who had surgical site infections. Conclusions: This study concludes that single dose pre operative antibiotic which injection cefazolin has advantage in prevention of SSI and it is cost effective for patient who undergoing clean elective surgery.

Background: Perineal trauma following vaginal birth is associated with significant short term and long-term morbidity. Our aim in this study was to investigate whether perineal massage during second stage of labour as a perineal protection technique could decrease perineal trauma in form of episiotomy and perineal tears. Objectives: To compare the incidence of episiotomy in labouring women undergoing perineal massage with the control group (no perineal massage). To compare the incidence and type of perineal tears in both groups. Materials and methods: A randomized controlled study was conducted on 150 term primigravida admitted in Mahatma Gandhi Medical College and Research Institute, Puducherry to evaluate the efficacy of perineal massage in reducing incidence of episiotomy and perineal tears in the second stage of labour. 150 term antenatal women in labour were randomly assigned to two groups, one group of 75 received perineal massage and another group of 75 received routine care during second stage of labour. The frequency of episiotomy, perineal tear, intact perineum, degree of perineal tear, duration of second stage of labour and perineal pain after 24 hours was compared between the two groups. Results: Baseline demographic characteristics were similar in both groups. In this study the incidence of episiotomy in massage group was 80% and in control group it was 93%(Relative Risk-0.857, P value-0.016). The incidence of perineal tear in massage group was 16% and in control group it was 9.4% (p-0.220). Among the massage group, 6.7% had first -degree perineal tear, 9.3% had second-degree perineal tear and no participant had third or fourth degree perineal tear. Among the control group 1.3% had first-degree perineal tear, 4% had second-degree perineal tear, 4% had third degree perineal tear and no participant had fourth degree perineal tear. There was no significant difference between the frequency of perineal tears among the groups. In massage group 4% had intact perineum after delivery, whereas none had intact perineum in control group. The mean duration of second stage of labour in massage group was 41 minutes in control group it was 51 minutes, which was significantly shortened by 10 minutes. The mean pain score was assessed 24 hours after delivery was significantly reduced in massage group. Birth outcomes with respect to Apgar score, NICU admission was similar in both groups. Conclusion: Perineal massage was found efficient in reducing the incidence of episiotomy, duration of second stage of labour and perineal pain assessed 24 hours after delivery. While frequency of perineal tear, intact perineum did not differ significantly between groups. Perineal massage was protective against the severe forms of third and fourth degree perineal tear.

Introduction: Hysterectomy is the most common gynecological procedure performed worldwide. It is a routine practice to catheterize and pack the vagina following vaginal hysterectomy with or without pelvic floor repair to prevent urinary retention and reactionary hemorrhage. There is a controversy about the ideal time for removal of catheter and vaginal pack. Traditionally it was 24 -48 hours, which is associated with high incidence of urinary tract infection. The present study was undertaken to compare post-operative morbidity in early & late removal of Foley's catheter and vaginal pack. Aim: To compare post-operative morbidity in early and later removal of Foley's catheter and vaginal pack following vaginal hysterectomy. Objectives: To assess febrile morbidity, urinary tract infection, recatheterization, pain perception, voiding difficulty, vaginal bleeding and duration of hospital stay. To compare the incidence of the complications in the two groups of women in whom the urinary catheter and vaginal pack are removed after 6 hours and 24 hours postoperatively. Subjects and methods: This was a prospective randomized study conducted from December 2015 to January 2017 in a tertiary hospital, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India. Ethical committee approval was obtained. Sample size of 100 women who were undergoing vaginal hysterectomy with or without pelvic floor repair and fulfilled the inclusion criteria. Informed written consent was obtained from all the women. They were assigned to 6 hours Foley's catheter and vaginal pack removal group (group I, n=50) or 24 hours Foley's catheter and vaginal pack removal group (group II, n=50) based on computer generated randomization. Parameters used to assess were urine routine and microscopy, urine culture and sensitivity on post-operative day 2, incidence of symptoms of urinary tract infections, need for recatheterization and repacking, febrile morbidity, ambulation, vault infection and post operative hospital stay duration were analyzed in both groups. Results: Most of the women were in the age group of 48-50 years and 49% were post menopausal. Common incidence for VH was fibroid uterus and pelvic organ prolapse. Febrile morbidity was found in 6% and 8% of patient in group I and group II. Positive urine culture was found in 10% and 20% of group I and group II respectively. Escherichiacoli was the commonest organism in both the groups. Rate of recatheterization was 10% in group I and none in group II. 6% had vaginal bleeding after pack removal and needed repacking in group I. All of them had pelvic floor repair. None had in group II. Hospital stay was less in group I. Conclusion: Delayed removal of Foley's catheter and vaginal pack was associated with higher incidence of urinary tract infection, with no recatheterization and no repacking where as early removal was associated with less incidence of urinary tract infection and increased rate of recatheterization and repacking. Needs larger comparative studies to support the practice of early removal.

Introduction: Physiological changes that take place in uterus in early pregnancy play an important role in labour and delivery. The chances of preterm delivery and prolonged pregnancy are related to the length of the cervix measured during mid-pregnancy at around 20-24 weeks. There is a strong association between preterm delivery and short cervix. Similarly, long cervix in mid-pregnancy may be associated with risk of post dated pregnancy or caesarean section due to poor progress of labour among primigravidae. This study is based on the assumption that mid-pregnancy ultrasonographic measurement of cervical length can be a predictor of timing and mode of delivery. Aims and Objectives: 1) To determine the association between cervical length at mid-pregnancy and timing of delivery. 2) To determine the usefulness of mid-pregnancy ultrasonographic cervical length measurement in predicting mode of delivery. Materials and Methods: This study was done in primigravidae with singleton pregnancy with no comorbidities. Transvaginal sonography was done to measure the cervical length between 20-24 weeks of gestation. These patients were followed till delivery. Those who developed complications like GDM, GHTN, malpresentation or who required induction of labour before 40 weeks for other complications were excluded from the study. Measured cervical length was not revealed to the obstetrician conducting delivery. Timing of delivery whether preterm, term upto 40 weeks or post dated (after 40 weeks till 41+6 weeks) was observed. And also mode of delivery whether vaginal or caesarean section was observed and these results were correlated with mid trimester cervical length. Results: Totally 237 patients were studied, of which 173 satisfied inclusion criteria. Out of 15 patients with cervical length less than 3cms, 14(93.33%) had preterm delivery. Post dated pregnancy was observed in 46(92%) out of 50 patients with cervical length more than 4cms. In cervical length less than 3 cms group, 12 (80%) delivered vaginally. Among cervical length more than 4 cms group 24(48%) required caesarean section. Conclusion: It is concluded from the study that cervical length of less than 3cms measured between 20-24 weeks is associated with preterm births and favours vaginal birth. Whereas, cervical length of more than 4cms is associated with post dated pregnancy and increased risk of caesarean section.

Background: Gestational diabetes mellitus is a common medical disorder associated with pregnancy, leading to adverse perinatal outcome. Lipid profile abnormality in GDM patients is a contributing factor for adverse perinatal outcomes. Aim of the study is to evaluate the effect of lipid profile on GDM. Objectives of the study was to find out the proportion of GDM having abnormal lipid profile and to compare the mode of delivery and birth weight among patients with normal and abnormal lipid profile. Subjects and methods: This study was done in Mahatma Gandhi Medical College in the department of Obstetrics and Gynecology from November 2015 to April 2017, lipid profile was done in all gestational diabetes mellitus patients who were fitting into the inclusion criteria from 28 to 32 weeks of gestation. The variables studied were total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, VLDL cholesterol and the results were analyzed. Mode of delivery and birth weight was compared between the patients with normal and abnormal lipid profile. Results: 219 GDM patients were taken for the study, among them 185 (84%) patients were having either single or multiple lipid parameter abnormality with mean total cholesterol, triglyceride and HDL value of 222.2±14 (mg/dl), 181.7±28(mg/dl) and 49.2±7.4(mg/dl) respectively. 34 (16%) patients were having normal lipid profile with mean total cholesterol, triglyceride and HDL value of 150.1±27 (mg/dl), 95.2±28 (mg/dl) and 65.7±7.2 (mg/dl) respectively. Comparing the mode of delivery among the groups, cesarean section was done in 7 (20.6%) patients with normal lipid profile, but cesarean section was done in 84 (45.4%) patients with dyslipidemia. None of the patients with normal lipid profile had instrumental delivery, but 9 (4.9%) patients in dyslipidemic group had instrumental delivery. Mean birth weight of 3.2±0.5 (kg) was noted in dyslipidemic group, whereas; mean birth weight in normal lipid profile group was 3.0±0.5 (kg). Conclusion: Majority of the GDM patients may have abnormal lipid profile and this abnormal lipid profile may lead to increased operative interference and higher birth weight in comparison to GDM with normal lipid profile. Hence, performing lipid profile in GDM patients may be useful in predicting additional adverse obstetric outcomes.

Background: Caesarean section is the most performed major surgical procedure in obstetrics. But it is also associated with a great deal of maternal and perinatal morbidity. This study aims at comparing maternal and perinatal outcome in emergency and elective caesarean section and identifying preventable risk factors where ever possible. Materials and Methods: This is a prospective comparative study done on 370 women who underwent caesarean section and who fulfilled the inclusion criteria in the Department of Obstetrics & Gynaecology, MGMCRI from November 2015 to April 2017. After taking consent, patients were identified into two groups based on the type of caesarean section that is elective or emergency. Continuous variables like age, period of gestation and Apgar score were summarized as mean and standard deviation. Categorical variables like intra and post-operative complications were summarized as proportions. Comparison of proportions between the emergency and elective CS was done using chi-square test or fisher's exact test depending upon the expected cell counts. Comparison of continuous variables between the two groups was done using independent samples t test. Results: Elective caesarean section group 158 women were studied whereas in emergency caesarean section group 212 women were studied. Intraoperative complications for elective CS group were 10 (6.3%) versus emergency CS group 44 (20.8%). Postoperative complications in elective CS group were 22 (13.9%) compared to emergency CS group 71 (33.5%). Adverse perinatal outcome was higher in emergency CS group in terms of low Apgar score, RDS and NICU admissions. Conclusion: Adverse maternal and perinatal outcome was found to be more in emergency caesarean section compared to elective caesarean section. Inducing labour with proper indication, assessment of cephalopelvic disproportion and intrapartum monitoring using partogram are some of the preventable factors identified to reduce adverse outcome.

Aim: Comparison of peribulbar anaesthesia with sub-Tenon's anaesthesia in manual small incision cataract surgeryin relation totime of onset of akinesia, extraocular movements, and pain at the time of administration. Methodology: Arandomized comparative study of 113 patients of which 57 patients received peribulbar anaesthesia and 56 patients received Sub- Tenon's anaesthesia. Results: The average time of onset of akinesia with sub-Tenon's anaesthesia was 2.78±0.958minutes and peribulbar anaesthesia was 9.96±2.141minutes. The difference was statistically significant (p=0.00). Peribulbar anaesthesia ranked higher on pain score (5.12±1.255) at the time of administration compared to Sub Tenon's anaesthesia (3.77±1.716), the difference being statistically significant (p=0.00). Conclusion: Sub-Tenon's anaesthesia is a safe and effective substitute for peribulbar anaesthesia.

Aim: To determine correlation between the retinal nerve fibre layer thickness (RNFL) and central corneal thickness (CCT) in patients with ocular hypertension (OHT). Methodology: This was a prospective, observational study, done between January 2016 and June 2017 at a rural tertiary care eye centre. All patients diagnosed with OHT, defined as an intraocular pressure of 21 mm Hg or higher, with normal optic disc and visual field, in the absence of any other ocular disease, were included in the study. Patients with OHT were sub-divided into thin (CCT ?555μm) and thick (CCT > 555μm) corneas. RNFL was measured with spectral domain optical coherence tomography and CCT with ultrasound pachymetry. Results: We examined 65 eyes of 35 OHT patients with a male: female ratio of 3:4. The mean age was 45.4 ± 12.21 years. The mean age in males and females were 44.47 ± 10.93 years and 44.14 ± 13.15 years, respectively, and the difference was not significant (p-value=0.93). The mean intra-ocular pressure (IOP) was 23.48±2.47 mmHg (range: 21 to 30 mm Hg; 95% confidence interval [22.88, 24.08]). The mean CCT was 553.81±38.3μm and the mean RNFL was 102.12±12.28μm. Mean RNFL in thin corneas was 101.14±10.68μm and in thick corneas was 103.21±13.92μm. There was no significant difference in the average (p-value=0.502) or quadrant-wise (superior, nasal, inferior and temporal) RNFL, between the two groups (p=0.247, 0.882, 0.897, 0.551). Conclusion: There is no correlation between central corneal thickness and retinal nerve fibre layer thickness in patients with ocular hypertension.

Background: Diabetic maculopathy is the major cause for visual impairment in type 2 diabetics. Slit lamp biomicroscopy with +90 D lens has been the traditional method for diagnosis. Neurodegenerative changes precede clinical retinopathy. Optical coherence tomography (OCT) is a newer tool for diagnosis of such subtle changes in the macula. The purpose of this study is to assess the central macular thickness (CMT) in type 2 diabetics without clinical retinopathy. Methods: Prospective cross-sectional study was done at a rural tertiary care centre from January 2016 to June 2017 after obtaining clearance from the Institutional Human Ethics Committee. CMT was measured using Spectral Domain SLO/OCT [Opko/OTI, Inc., Miami, Florida] among the type 2 diabetics without clinical retinopathy. Results: This study included 104 patients (44 males, 60 females). Mean age of males was 53.66±10.85 years and females were 48.63±7.09 years. Duration of diabetes ranged from newly diagnosed to 15 years. Mean HbA1c was 8.99±2.51%. The average CMT among type 2 diabetics without retinopathy was 199.10±17.78μm. The CMT among male diabetics was thicker (208.35±16.14μm) than female diabetics (192.33±15.85μm) (p=0.00). CMT did not correlate with duration of diabetes (r=0.047) or with the glycemic control (r=0.107). Conclusion: Among type 2 diabetics without clinical retinopathy, males had thicker CMT than females. CMT did not correlate with duration of diabetes or with the glycemic control.

Background: Cataract surgery in pseudoexfoliation syndrome remains a challenge due to poor pupillary dilatation and increased risk of intraoperative complications. Aim: To study the clinical profile and immediate surgical outcome of patients with pseudoexfoliation syndrome (PXF) following manual small incision cataract surgery (MSICS). Methodology: A prospective observational study of patients with cataract and PXF was conducted between November 2015 and April 2017. A complete ophthalmic examination was done followed by MSICS in a tertiary care hospital. Results: 80 operated eyes of 80 patients were studied. Mean age was 62.51±8.91 years. 52% had bilateral presentation. PXF material on pupillary margin (96%) was the most common finding followed by PXF on anterior lens capsule (62%) and Bull's eye pattern (27%). 73% patients had hard cataract. Poor pupillary dilatation was noted in 16% patients. Posterior capsular rent was noted in 15% and zonular dehiscence in 10% patients. Postoperatively, significant corneal edema was seen in 26% and significant iritis in 38% patients. Good visual acuity on POD 1 was seen in 51% patients. Conclusion: Pseudoexfoliation syndrome was seen in 9.75% of the patients who underwent cataract surgery. Patients with pseudoexfoliation undergoing cataract surgery have poor pupillary dilatation and higher rate of posterior capsular rent. After cataract surgery 51% patients with PXF had good visual outcome. Proper preoperative assessment and planning is desirable in pseudoexfoliation syndrome.

Background: Pregnancy is associated with a lot of physiologic changes in the body. A standout amongst the most essential pathologies going with pregnancy is the preeclampsia-eclampsia disorder. Preeclampsia-eclampsia influences all organs and the eyes. The change seen in the vasculature of the eye can be extrapolated with other vasculature in the body which can influence the morbidity and mortality associated with PIH. The aim of this study was nothing the ocular changes in pregnancy. Methods: This is a prospective case control study in which 120 pregnant women are divided into two groups: 60 new onset hypertension of pregnancy and 60 Normal pregnant women as controls. Results: Our study showed that severity of hypertension was similar in each group irrespective of age. Retinal changes have been reported to occur in 42.45% of the subjects with PIH. Our study showed that 20% of the subjects had retinal changes due to PIH. This difference may be due to large number of patients with mild hypertension in our study group. Conclusion: Though PIH is an important cause of maternal and childhood mortality and morbidity, the changes in the eye are very minimal. But a clear monitoring of all cause of PIH is a necessity.

Background: Pseudoexfoliation syndrome (PXS) is an age related microfibrillopathy characterized by deposition of whitish flaky material over various ocular tissues. PXS is known to have thinner corneas. The purpose of this study was to find if any diurnal variation exists in central corneal thickness (CCT) and intraocular pressure (IOP) in eyes with pseudoexfoliation syndrome (PXS) without glaucoma and the relationship between them. Methodology: Prospective observational study was done on 141 eyes of 85 patients with PXS without glaucoma. CCT and IOP were measured at 4 times in a day by Ultrasonic pachymeter and Goldmann applanation tonometry respectively. Results: There was a significant variation in the CCT and IOP (p=0.00) during the day, CCT ranged from 517.14±36.027 to 507.23±36.238 μm in right eye and 515.32±34.273 to 504.36±35.095 μm in left eye, IOP ranged from 14.68±2.458 to 13.26±2.356 mmHg in right eye and 14.64±2.497 to 13.10 ±2.398 mmHg in left eye and there was a significant correlation between them (p<0.05). Conclusion: A single CCT reading is not adequate to correct the IOP as variation exists in CCT, which could lead to an over or an under estimation of IOP. So for every IOP reading a subsequent CCT should be done and IOP should be corrected based on that.

Background: Rotator cuff tendinopathy is the leading cause of shoulder pain. Tendinopathy if untreated, leads on to cuff tear which needs surgical intervention. PRP is a cellular component, obtained by centrifuging whole blood and has high platelet concentration. PRP injection into lesion sites has gained popularity in the treatment of tendinopathies. Numerous clinical studies which have been published with favorable results with the use of PRP, a few randomised clinical trials have reported controversial results. We decided to study the effectiveness of PRP injection in the management of chronic rotator cuff tendinopathy. Materials and Methods: In our interventional descriptive study. 30 patients with rotator cuff tendinopathy, who presented to Dept. Of Orthopaedics, Mahatma Gandhi Medical College & Research Institute, Puducherry, were treated with Platelet Rich Plasma injection in subacromial space of the affected shoulder. Patients were selected based on inclusion and exclusion criteria. Inclusion criteria were 1) Rotator cuff tendinopathy as diagnosed by clinical examination, ultrasound and MRI. 2) Pain more than three months refractory to conservative treatment. 3) Age between 18 - 70 years 4) Normal complete blood count and coagulation profile. 5) Patients who gave consent for treatment with PRP as per our protocol. And exclusion criteria were 1) Tendinopathy with Rotator cuff tear. 2) Arthritis and bony lesions of the Shoulder. 3) Patient with systemic inflammatory disease - Rheumatoid and Coagulopathy. 4) Local Pathologies - Skin lesion and infection. After preinjection evaluation, 5 ml of PRP was injected into the subacromial space and patients were followed up at 3^rd, 6^th and 12^th week clinically. Pain and functional outcome was assessed using VAS, SPADI (shoulder pain and disability index) and Constant & Murley scores. Data obtained were arranged in tables and statistical analysis was done using mean, chi- square test, kruskal-wallis test. Results: Majority of the patients were 30 to 50 years (43.3%). Most of the patients were male (56.7%). Mean VAS score improved from 7.4 to 1.9, the mean SPADI score improved from 73.33 to 18.1 and the mean Constant & Murley score improved from 39.57 to 86.47. Which was statistically significant (p<0.001). No complication like infection, inflammation, needle breakage seen except for pain in injected site in some patients for 24 to 48 hours. We had a excellent results in majority of our patients. Conclusion: Platelet Rich Plasma injections in our study showed good to excellent results, in patient with rotator cuff tendinitis with improvement in VAS, SPADI and CONSTANT & MURLEY scores. Platelet Rich Plasma can be recommended for patient with rotator cuff tendinopathy not responding to physiotherapy.

Introduction: The uterus is a specialised fibromuscular organ composed of the upper corpus which is muscular and the lower cervix which is fibrous and continues down into the vagina. Occurance of corpus pathologies differ among different geographical regions. Aims and Objectives: To study the gross and microscopic appearances of different uterine corpus lesions. To find the occurrence of various neoplastic and non-neoplastic lesions. To analyse the occurrence of uterine corpus lesions with age predilection. To access the types of hysterectomies done for various uterine corpus pathologies. Materials and methods: The specimens received through resection of uterus reported in MGMCRI in a period starting November 2015 to May 2017 were studied. Results: Majority of the uterine corpus lesions were seen among reproductive age group (76.82%) followed by menopausal age-group (18.9%). Total abdominal hysterectomy (57.9%) was the most commonly performed surgery for uterine corpus lesions. The occurance of myometrial lesions was higher (59%) compared to the endometrial lesions (41%). Non-neoplastic endometrial lesions constitute about 76.4% of the total endometrial lesions while the neoplastic lesions constitute only 23.52%. The occurance of villoglandular variant of endometrioid carcinoma was higher (35%). Adenomyosis (82.1%) was the most common non-neoplastic myometrial lesion. Leiomyoma was the most common myometrial lesion. Conclusion: Totally 338 hysterectomy specimens were received. The occurance of uterine corpus lesions were common in the reproductive age-group. Leiomyoma was the most common non-neoplastic myometrial lesion. Stromal nodule was the common neoplastic myometrial lesion. This database from our study may help gynecologists to modify their treatment options.

Introduction: Breast carcinoma is associated with high mortality and morbidity. The overall patient survival is determined by prognostic factors. HER2/neu status is an important immunohistochemical evaluation and is related to high grade tumor and poorer prognosis but favourable response to monoclonal antibody therapy and disease survival. Hence the present study investigates correlation between presence of HER2/neu and various clinicopathological parameters in primary breast carcinomas at our institution. Methods: Clinical data was obtained from hospital records. The gross details were noted upon arrival of specimens in our department. The sections of carcinoma breast cases were subjected to immunohistohemistry study of HER2/neu. HER2/neu status was correlated with various clinicopathological parameters. Results: There was a significant statistical association between HER2/neu expression with clinical stage (p= 0.029), histological grade (p= 0.038) as well as lymph node involvement (p= 0.022). Expression of HER2/neu expression was increased in tumour size of more than 2 cms (72.46%), higher tumour grade (87.03%) and lymph node metastases (89.47%). The major histological subtype was Infiltrating duct carcinoma and 35.18% of them showed HER2/neu expression. All the other histological subtypes were negative for HER2/neu. Meanwhile there was no significant association of HER2/neu expression with age, clinical stage, tumour size. Conclusion: The study indicates that HER2/neu is a powerful predictor of poor prognosis due to its association with prognostic parameters like tumor size, high mitotic grade, tumor grade, lymph node enlargement and clinical stage.

Introduction: Anaemia is one of the preventable diseases worldwide, especially in countries like India. Iron deficiency is the most common cause of Anaemia. Age, sex, geographical and comorbid factors play important roles in the morphological patterns of anaemia. Anaemia, if undetected can cause morbidity and mortality, which can be prevented. Aims and objectives: To study the morphological patterns of Anaemia in patients of all age groups and correlate the findings of automatic hemoanalyser, peripheral smear and biochemical parameters like Iron studies, vitamin B 12 and folic acid. To find the distribution of Anaemia on the basis of age, sex and morphological type and to find out the commonest pattern. Materials and methods: The study comprised of 300 Anaemic patients over a period from December 2015 to July 2017 in Mahatma Gandhi Medical College and Research Institute, Pondicherry. Results: Out of 300 cases, majority were adults and female predominance was seen and majority(68.3%) showed severe degree of Anaemia. Microcytic Hypochromic Anaemia was the commonest in all age groups (66%). All the Microcytic Hypochromic Anaemic cases showed reduced levels of serum Iron, ferritin and increased levels of TIBC. Among 23% patients with Dimorphic Anaemia, 76.4% patients showed reduced levels of serum Iron and ferritin with increased TIBC, 7.3% showed reduced levels of vitamin B 12, 10.2% showed reduced folate levels and 5.8% showed normal levels of vitamin B 12 and folic acid. Among 8% patients with Macrocytic Anaemia, 80% patients had both vitamin B12 and folate deficiency, 12% had folate deficiency alone and 8% patients showed normal vitamin B 12 and folate levels. Normocytic Normochromic Anaemia accounted to 3%, out of which 5 cases showed reticulocytosis, indicating Hemolytic Anaemia. Conclusion: In our study, Microcytic Hypochromic Anaemia was the most common morphological type of Anaemia and all were Iron deficiency Anaemia. Thus, Complete blood count, Peripheral smear study and biochemical studies proved to be definitive in diagnosis of Anaemia. Thus facilitating the further management of patients suffering from Anaemia. This holistic approach towards diagnosis of Anaemia will reduce the morbidity and mortality associated with it.

Background: Despite the increasing prevalence of overweight, obesity, and its related comorbidities among children and adolescents over the last two decades there is a paucity of comprehensive studies in obese children in our region. Hence this study was conducted to find out the prevalence of obesity and its risk factors among children, and to estimate the burden of comorbidities among school children in Puducherry. Methods: 1020 children, in the age group 6-12 years, were selected from three semi-urban schools of Puducherry, after obtaining adequate consents. The children and their parents were interviewed using a structured proforma and subjected to anthropometric measurements. Data regarding their physical activity, duration of sleep and dietary habits were recorded. For those diagnosed as obese, blood pressure was measured, and blood tests were done to screen for certain comorbidities. They were also screened for signs of depression. Results: The prevalence of obesity and overweight among the study children was found to be 15.1% and 14.5% respectively. Reduced physical activity, increased screen viewing time and increased consumption of junk food were found to be associated in more than 85% of obese children. Comorbid dyslipidemia and hyperglycemia were observed in 40% of obese children whereas hypertension was observed only in 2.4%. Around 65% of the obese children had associated depression. Applying WHR adult standards for the diagnosis of obesity, it was found to have a sensitivity of 69.2% and a specificity of 92.7%. Conclusion: The prevalence of overweight and obesity among school children in Puducherry has significantly increased reflecting the regional and global trend. The results of our study can be used for planning interventions aimed at reducing the burden of overweight and obesity in this region.

Introduction: Mechanical ventilation has become a cornerstone in neonatal intensive care unit. Along with improving the outcome, morbidity and long term sequelae also has been a burden both for the parents and medical professionals. Hence it becomes necessary to evaluate the indications of ventilation, complications, outcome and long term comorbidities. Objectives: This study was undertaken to find out the indications, complications, and outcome of neonates requiring assisted ventilation. Methodology: It was a prospective observational study conducted at MGMCRI Hospital, Pondicherry - a tertiary care centre over a period of 1 year 9 months from October 2015 to July 2017. All the neonates who received Mechanical Ventilation in the Neonatal Intensive Care Unit (NICU) during the study period were included. We excluded the neonates with major congenital malformations, surgical conditions. Data were entered in a pre-designed proforma and morbidity and mortality were analyzed. Results: Among 80 ventilated neonates, Hyaline Membrane Disease 28(35%) and birth asphyxia 27(33%) were the commonest indication followed by Meconium Aspiration Syndrome (22.5%). Female babies had a better survival rate (96%) compared to male babies (76.4%). Ventilated associated pneumonia was the commonest complication, followed by sepsis, shock, pulmonary hemorrhage, pneumothorax, bronchopulmonary dysplasia. Mortality in ventilated neonates was 17.5%. Conclusion: In our study, the survival rate of ventilated babies was 82.5%.Hyaline membrane disease was the commonest indication of mechanical ventilation. Pulmonary hemorrhage, PPHN and IVH were significantly associated with a poor outcome.

Introduction: This study aimed to assess the prevalence of hearing loss using OAE in newborns admitted in the NICU and to determine the risk factors predictive of hearing impairment in high risk newborns. Methods: Over a period of 18 months, a prospective cross sectional study of all neonates admitted for more than 48 hours in the NICU of a rural tertiary care centre was done. Neonates who died during the study period were excluded from the study. All candidates underwent hearing screening in a sound treated room in the department using Distortion Product Otoacoustic Emissions (DPOAE) test at the time of discharge from the NICU. Babies who failed this initial screening underwent another OAE test within 1 month after discharge, and those who failed the test again were be referred to an Otologist for comprehensive audiological assessment at 3 months. Results: 200 neonates were included in the study, of which 101 (50.5%) failed the initial screening, One neonate (0.5%) failed the second OAE screening and moderate hearing screening was diagnosed in this child using BERA. Risk factors which had significant correlation with hearing screening failure included Mechanical ventilation (p=0.01), prematurity (p=0.01), low Apgar scores (p<0.01) and multiple gestation (p<0.05). Other conditions predominating in neonates who failed hearing screening included TTN, MAS, LBW and neonatal jaundice. Conclusion: Newborn infants admitted to the NICU are exposed to multiple risk factors putting them at a higher risk for hearing impairment. The two staged screening protocol with DPOAE is a useful protocol in detecting hearing loss in newborns and should be implemented as a national programme.

Background: The burden of mental disorders has been increasingly recognised. Successful screening increases possibility of identifying those in need & appropriately treating them. However, research is scarce with regard to mental health screening in the context of “preventive health care” in India. Thus, we studied the psychiatric morbidity and quality of life among subjects attending the Preventive health care unit (PHCU) of a tertiary hospital. Methods: Cross-sectional study conducted in PHCU, in a tertiary hospital in Puducherry. All consecutive subjects (>18 years) attending PHCU on a specified day of the week were included in the study. Standard for Clinicians\' Interview in Psychiatry (SCIP) - Screening module, DSM-5 Level-1 Cross- Cutting Symptom Measure, Mini-Cog and Quality of Life Enjoyment and Satisfaction Questionnaire was administered. Relevant diagnostic modules of SCIP were applied to subjects who screened positive on SCIP. Results: Mean age of subjects was 43.38 ± 13.99 years. Of 203 subjects, 57 (28.1%) screened positive & 53 (26.1%) were confirmed to have psychiatric disorder. 4% screened positive for cognitive impairment. Most commonly diagnosed disorders were alcohol use disorder (9.9%) & major depressive disorder (6.4%). Prevalence of depressive disorder was higher in subjects with physical disorder. However did not reach statistical significance (x²=8.449; p=0.076). Subjects with psychiatric disorder alone or with both psychiatric & physical disorders had significantly poorer quality of life (F=27.132; p<0.001). Conclusion: One-fourth of the subjects attending PHCU were found to have psychiatric disorders. Presence of psychiatric disorder was associated with significantly poorer quality of life. This underscores the importance of routine mental health screening in PHCU.

Background: Tuberculosis being a systemic disease and has a capacity for wide spread dissemination, it can affect various endocrinological organs like adrenals, pituitary, thyroid, pancreas and gonads. Among which thyroid dysfunction among new smear positives pulmonary tuberculosis was least studied. Aim: This study aims to identify the effects of antituberculous treatment on thyroid profile in new detected smear positive pulmonary tuberculosis cases. Study and design: This study was a prospective study done in a tertiary care hospital in Pondicherry. Materials and methods: This study was conducted among 60 new smear positive pulmonary tuberculosis cases attending pulmonary medicine OPD from May 2015 to April 2017.Thyroid function test in the form of free T3, free T4 and TSH was measured before initiating Anti tuberculosis treatment (ATT), at 3 months and at the end of treatment. Results: Out of 60 patients enrolled in our study, majority were males with male: female ratio of 3.2:1 and mean age was found to be 49 years. Diabetes mellitus was found to be the major co morbidity in 50% of patients. During the study all patients was initially euthyroid before iniating ATT. Sick euthyroid was found in 75% of patients at the end of 3 months. Hypothyroidism was found to be increasing during the study from 16% at the end of 3 months and 63% at the end of 6 months. Among the thyroid function test, free T3 and T4 was found to have decreasing trend however TSH was found to have increasing trend during the study. Conclusion: New smear positive pulmonary tuberculosis cause thyroid dysfunction leading to hypothyroidism and sick euthyroid syndrome at various stages of treatment with highest incidence of sick euthyroid syndrome at 3 months and hypothyroidism at the end of 6 months. Sick euthyroid syndrome was found to be a temporary reversible condition which disappeared 6 weeks after stoppage of treatment. We recommend thyroid function test to be done in all cases of smear positive pulmonary tuberculosis before initiating treatment, during the course of treatment and 6 weeks after the stoppage of treatment to avoid unnecessary treatment of thyroid dysfunction. We also recommend that all these patient should be reassessed after 6 weeks of stopping treatment with thyroid function test to confirm the need of thyroid supplements and for further work up which is beyond the scope of this study.

Aims and objective: To evaluate placental thickness with respect to gestational age and fetal weight by using ultrasonography. To correlate placental thickness with respect to gestational age and fetal weight. To derive normogram of placental thickness in comparison with fetal gestational age. Materials and method: This was a prospective comparative study, which was conducted at the Mahatma Gandhi Medical College and Research Institute Hospital, a rural tertiary care hospital over one-year period from December 2015 to November 2017 until we enrolled pregnant women between 11-40 weeks of gestation. The grey scale real time ultrasonographic examinations were performed using a MINDRAY DC-8 machine and the probe used for the study was 3.5 MHz convex curvilinear transducer. Hard copies of the cases were acquired using the thermal printer and photographs. Results: Placental thickness has positive correlation with gestational age. The gestational age and placental thickness increases in a linear manner from 16-36 weeks of gestational age and then decreases by 1-3mm after 36 weeks. Conclusion: Fetal weight increases in relation with the placental growth and placental thickness is an indicator of the fetal growth..Placental thickness can be used as an additional tool to be routinely carried out during the anomaly scan.

Aim & Objectives: To assess the carotid intima-media thickness (CIMT) between hypertensive and normotensive patients using high resolution B mode Ultrasonography. To compare the CIMT between hypertensive and normotensive population. To quantify IMT as an early marker of Atherosclerosis Materials and Methods: This study included 50 hypertensive and 50 age and sex matched normotensive patients. Brief history was taken and general physical examination of the subjects was done. All patients had their blood pressure levels checked. Examination of the CIMT was done using 12.0 MHz linear transducer MINDRAY DC-8 ultrasound scanner. CIMT was measured in the far wall 1 cm proximal to the carotid bulb on both CCA. The mean value was calculated and values greater than 0.7 mm were considered to be abnormal. These values of hypertensive patients were compared with that of normotensive subjects. Results: The systolic & diastolic BP(150/92mmHg) was significant(p=0.0001) in hypertensive patients when compared to the normotensives (119/79mmHg). The average CIMT for hypertensive was 0.8mm and 0.74mm on the right and left side respectively. Whereas in normotensives, average CIMT was 0.58mm and 0.61mm. The odds of developing abnormal CIMT among hypertensive patients was 11 fold more when compared to normotensive individuals(odds ratio=11.96).CIMT was more on the right side when compared to the left side. BMI was significantly increased in hypertensive group when compared to normal group. Conclusion: This study proved that CIMT was significantly increased in hypertensive patients when compared to the normotensive subjets. CIMT is a surrogate marker of atherosclerosis. Hence B mode ultrasound is invaluable in predicting vascular complications in hypertensive patients.

Introduction: Anatomical variations of nose and paranasal sinuses is important in patients who are undergoing CT for various rhinological reasons. CT PNS provides us excellent anatomical soft tissue and bony details. Surgical complications like damage to vital structures could be reduced and helps to determine the predisposing variants to the diseases. Aims and Objective: To study the prevalence of anatomical variations in computed tomography of nose and paranasal sinuses in patients with symptoms of sinonasal diseases. To study the anatomical variations that are present and their association with sinonasal disease. Materials and methods: This prospective observational study was conducted in Department of Radio-diagnosis, MGMC & RI, Pondicherry over a period of two years from December 2015 to September 2017 in 100 patients with complaints of sinonasal diseases, who needed further CT evaluation was included in this study. All patients were subjected to CT (GE 660 optima 128 slice CT machine) followed by reconstruction done using the same machine. Results: Out of the 100-sample size, 58 were male and 42 females. The variants noted were nasal septal deviation in 68%, 50% had agger nasi cells, 45% had concha bullosa, onodi cells and haller cells were noted in 21% of patients, large ethmoid bullae was seen in 13% of patients, frontal sinus hypoplasia in 16% and hyperplasia in 4%, maxillary sinus hypoplasia was noted in 5% and hyperplasia in 4%, superior turbinate pneumatization was noted in 5%, paradoxical middle turbinate was noted in 14%, pneumatized crista galli was seen in 1%, pneumatized uncinate process was seen in 5% patients, pneumatization of pterygoid process in 3% and anterior clinoid process in 5%. Out of these 100 clinically significant patients with anatomical variants, the most common pathology seen is sinusitis which was noted in 66% of patients and the commonly involved sinus is maxillary sinus. Conclusion: Based on the results and methodology employed, we have concluded that: Deviation of nasal septum is the most common anatomical variation seen in clinically significant patients with nose and PNS pathology and few uncommon variations were also seen which are paradoxical middle turbinates, pneumatization of crista galli, uncinate process pneumatization, superior turbinate pneumatization and pneumatized pterygoid and anterior clinoid process. Sinusitis is the most common pathology noted in patients with anatomical variants and maxillary sinus is the most common sinus which is involved predominantly.

Background: Stroke is one of the most common debilitating diseases with a huge burden related to both mortality and morbidity. Ischemic stroke is far common compared to haemorrhagic stroke and it is also associated with significant carotid stenosis. Hence this present study is carried out to evaluate all the aspects of this disease. Objectives: To Evaluate stroke and TIA patients with carotid ultrasound Doppler to look for Intima Media thickness, presence of plaque and characterization of plaque (type, surface and site), spectral waveform analysis and percentage of stenosis. To find out the prevalence of carotid artery stenosis in stroke patients and TIA patients. Observation/Correlation between percentage stenosis (carotid USG) and infarct size on CT. To find out if there is any association between carotid artery lumen IMT and stenosis with age, hypertension and diabetes. Design: Cross sectional single centre study. CT-scan and Carotid Doppler studies on patients admitted into our institution with signs and symptoms of stroke. A detailed and thorough history, physical examination and investigations were performed, studied and noted. Results: Out of 75 patients who are clinically diagnosed to have stroke, 55 patients showed small infarcts and 20 showed large infarcts in the CT-Scan. 75 patients underwent Doppler Ultrasonography of the Carotid Arteries. The prevalence of the carotid stenosis in this study is 38.7% (29 out of 75 had stenosed carotids). In this study, 90.5% of patients with <50 % stenosis had small infarct on CT head, while only 9.5% of these patients had large infarct.62.5% of patients with > 50% stenosis had large infarct on CT scan head, just 37.5% of these patients had small infarct. Conclusion: Carotid stenosis is one of the common causes of ischaemic stroke. 38% of ischaemic stroke patients had carotid stenosis in our study. -The prevalence of carotid stenosis increases with increase in age, male gender, diabetes mellitus and Hypertension. A simple, non-invasive screening procedure like Doppler sonography of the carotid arteries in high risk individuals could therefore have profound diagnostic and therapeutic implications in predicting and preventing a potentially fatal and devastating stroke. The present study has shown that Carotid Doppler is an important non invasive diagnostic tool. It can be used for screening in high risk asymptomatic patients, patients with history of cerebrovascular events and for determining treatment protocol. Thus it should be used as a first line investigation in these patients supplemented by Magnetic Resonance Angiography whenever required and angiography should be used only in equivocal cases.

Aim: To assess the role of ultrasound (US) in assessing rotator cuff (RC) tears and to enumerate the associated findings. Materials and methods: 40 consecutive patients who were referred to department of Radiology for MRI shoulder with suspected musculotendinous pathology, at our institute were prospectively included in the study. All the patients underwent an initial MRI examination, followed by US which was performed by an examiner who was blinded to the MRI results. According to the findings obtained in US and MRI, the tendons of supraspinatus, infraspinatus and subscapularis were classified into full thickness tears, partial-thickness tears, or intact. Associated findings like bursal fluid and joint effusion were also recorded. Results: Diagnostic accuracy of US for full-thickness RC tears was high with sensitivity and specificity of 100% & 96.77% respectively. For partial RC tears, US showed an overall sensitivity and specificity of 71.43% & 92.31% and for tendinopathy it was 88.24% & 78.26% respectively. There was significant agreement between US and MRI in detecting RC pathology with a p value of <0.001. Conclusion: US can be used for the initial detection of RC tears. MRI can be reserved for cases when the US results are inconclusive or when sonographically inaccessible areas such as labrum or deep parts of ligaments are to be evaluated.

Introduction: The incidence of Urological Malignancies has been increasing globally as well as an increase in the number of patients being diagnosed with Metabolic Syndrome. Patients with type 2 diabetes mellitus suffer from a significantly higher risk of urological malignancies and Ca bladder. The mechanisms of such an increased cancer risk in the diabetic patients may be related to insulin resistance, hyperinsulinemia, proinflammatory status and increased oxidative stress Smoking, obesity, dyslipidemia, hypertension have been identified as potential risk factors for renal malignancy [4, 5, 6]. In diabetics, cancer contributes 13% to mortality and high rates of cancer recurrence [7]. Lack of neonatal circumcision, poor genital hygiene, phimosis, human papilloma virus infection and smoking are all risk factors for invasive penile cancer Increasing BMI was associated with higher risk of developing invasive penile cancer. The use of tobacco in any form is a risk factor for penile carcinoma. Materials & Methods: This was a prospective study of 49 patients with Urological Malignancy between January 2016 and June 2017. Individuals with the following Urologic Malignancies were included in this study: RCC, TCC Bladder & Upper Tract, Ca Penis, Ca Prostate. Following Criteria was used for the clinical Identification of the Metabolic Syndrome - (Any 3 of the Following), Abdominal obesity * Waist circumference, Triglycerides, HDL cholesterol, Blood pressure, Fasting glucose. Results: Of the total 49 patients 22(44.8%) were Diabetic, 26(53%) were Hypertensive and 18(36.7%) were both. Out of the 49 patients 23(46.9%) were Obese. Among the total 49, 28(57.1%) were Smokers, 28(57.1%) were Alcoholic and 19(38.7%) were both. The alverage waist circumference was noted to be the highest in the RCC group. The average S. Triglyceride levels were found to be highest in the Ca Bladder group. The average S. HDL levels were found to be highest in the Ca Bladder group 18(36.7%) of the 49 patients were found to fulfil the criteria for Metabolic Syndrome. The highest incidence of Metabolic Syndrome was noted in the Ca bladder group 8(50%) of the 16 cases and the least in the RCC group 1(20%) out of the 5 cases. Conclusion: Many adverse health consequences result from Metabolic Syndrome including the increased risk for several cancers. Our study shows a high incidence of Metabolic Syndrome in patients with Urological Malignancies. Most factors responsible for metabolic syndrome are modifiable hence greater emphasis on lifestyle modification and control of comorbid conditions like DM and HTN may be beneficial in reducing the incidence of urological malignancies

Introduction: Transurethral Resection of Prostate (TURP) is gold standard for management of Benign Prostatic Hyperplasia. Technological advances and refinements in this procedure have contributed to improving safety and reducing morbidity and faster recovery. Here we compare the safety, efficacy and complications of Monopolar vs Bipolar Transurethral Resection of Prostate (TURP) in patients with prostate gland larger than 50CC. Methodology: Patients with enlarged symptomatic Prostate more than 50CC were randomized into Monopolar or Bipolar group. The patients were evaluated with pre-operative and post- operative Haemoglobin (Hb) and Sodium. Duration of resection, volume of Irrigation fluid used, weight of gland resected and post-op Visual Analog Scale(VAS) score were noted. International Prostate Symptom Score (IPSS), maximal flow rate(Vmax) and residual urine volume(PVR) were observed pre-operatively and at 1 month following surgery. Complications if any, were noted. Results: Of 52 patients included in the study, 26 (50%) underwent Monopolar TURP (M-TURP) and 26 (50%) underwent Bipolar TURP (B-TURP). There was no significant difference in age, prostate volume, International Prostate Symptom Score(IPSS) and post-op VAS score between the 2 groups. The mean duration of resection and volume of irrigation fluid used were similar. In the Monopolar group 1 patient required blood transfusion and another had TUR Syndrome. The duration of catheterisation and hospital stay, post-op improvement in PVR and Vmax were similar between the 2 groups. Conclusion: M-TURP and B-TURP groups showed similar outcomes. Bipolar TURP is slightly safer than Monopolar as Bipolar TURP minimizes the risk of TUR syndrome compared with Monopolar TURP.

Background: Glaucoma is one of the leading causes of irreversible blindness worldwide. Elevated intraocular pressure is the only known risk factor for the disease as a result of which considerable interest has been generated in identifying the other potential risk factors. Of these diabetes is of special interest given both its high prevalence and its modifiable nature. Objective: To study the association between diabetes mellitus and primary open angle glaucoma (POAG). Materials & Methods: This case control study was conducted in an institutional setting and included POAG patients as cases and age and gender matched individuals as controls. Patients with a family history of glaucoma, media opacities and those with underlying pathologies that could alter intraocular pressure were excluded from the study. Relevant history was taken regarding course of glaucoma, diabetes and hypertension. In the case group this was followed by a thorough ophthalmic evaluation including dilated fundus examination and intraocular pressure measurement. Fasting blood glucose levels and HbA1c levels measured in the six months prior to the study were obtained from records. The prevalence of diabetes and hypertension was compared between both the groups. P value less than 0.05 was considered statistically significant. Results: A total of 144 cases and 586 controls were included in the study. The demographics were comparable between both the groups. The prevalence of diabetes was higher in the case group with an adjusted odds ratio of 2.47 (95% CI=1.58-3.88, p= 0.001). The prevalence of hypertension was found to be lower in the case group. No significant correlation was found between fasting blood glucose levels, HbA1c levels and intraocular pressure, cup disc ratio and mean central corneal thickness. Conclusions: Type 2 diabetes mellitus is a risk factor for primary open angle glaucoma, signifying the need for screening of the same in this subset of patients.

Background: Headache among people living with epilepsy (PWE) is classified as pre- ictal, ictal, post-ictal and inter-ictal. Inter-ictal headache differs from the other three in having no definite relationship with seizures. There is hardly any systematic study on antiepileptic drugs (AEDs) associated headache other than a few case reports and mention in the package inserts. Objective: To assess prevalence of headache in epileptic patients using Carbamazepine compared to other AEDs. Materials and methods: 2000 epileptic patients on AEDs were screened, out of which 165 patients having headache were identified. Eight patients were excluded due to co morbid illnesses, which could potentially contribute to headache. Finally 157 patients were recruited as cases. 157 age and sex matched epilepsy patients on AEDs, without headache were recruited as controls. Headache questionnaire based on ICHD-II criteria was used to classify primary headaches such as migraine and tension-type headache. Results: 157(7.8%) out of around 2000 epileptic patients had some form of new onset interictal headache. 71 (45%) of our patients with headache had migrainous character out of whom 23 (14.6%) had migraine without aura. In multivariate analysis, lower seizure frequency and lower EEG abnormalities were found to be independent predictors of headache. Conclusions: CBZ was not found to have any predilection for headache compared to other AEDs. Lower frequency of seizures and EEG abnormalities in patients with headache may suggest that seizures contribute less to the development of headache and further may support the hypothesis that antiepileptic drugs may be significant contributing factors for the development of headache.

Introduction: Supraclavicular block being the most preferred route, due to the greatest likelihood of conduction blockade at the level of the trunks of brachial plexus has the highest success rates for analgesia in upper limb surgeries. Many additives are used with the local anaesthetics during the supraclavicular block to enhance the effect of analgesia in the patients. A drug which can be used to obtain a rapid onset and prolonged duration of the effect of local anaesthetic used for the block providing hemodynamic stability with no complications is yet to be described. Therefore, this study is aimed at comparing the efficacy of dexamethasone; onset and duration of the block, intraoperative hemodynamics and postoperative complications, if any, when used as an adjuvant in supraclavicular block perineurally and intravenously. Materials and methods: Study population: Patients admitted to PIMS for elective upper limb surgeries (forearm and hand). Type of study: Randomized control double blind study. Number of groups: 3 Sample size: 90 (30 in each group) Results: Onset of sensory and motor blockade (8.00 ± 3.107 min) and (10.50± 3.309min) was statistically significantly faster after taking the perineural dexamethasone compared to the intravenous dexamethasone (11.83 ± 5.167 min, p =0.003) and (14.83± 4.997min, p =0.001) respectively. The duration of sensory and motor blockade was statistically significantly longer after taking perineural dexamethasone (14.37± 1.974hours) and (12.92 ± 1.89 hours) compared to the intravenous dexamethasone (11.60± 1.694hours, p<0.001 and (10.30 ± 1.622 hours, p<0.001) respectively. There were no statistically significant hemodynamic changes in both the groups intraoperatively and no complications were noted in both the groups postoperatively. Discussion: Anaesthesia to the restricted portions of the body, preserving consciousness in the patients and avoidance of interfering with the vital centers of the body marked the beginning of brachial plexus block in clinical anaesthesiology. Addition of various adjuvants in the local anaesthetic mixture, to reduce the volume of local anaesthetic, fasten the onset and prolong the duration has made its use almost inevitable in most peripheral nerve blocks. The mechanism and site of action for dexamethasone is not well understood. It is being used both peripherally and centrally for management of chronic pain. In this study, the efficacy of dexamethasone was studied when given though two different routes. Conclusion: Dexamethasone as an adjuvant to local anaesthetic mixture in supraclavicular block speeds the onset and prolongs the duration of the sensory and motor blockade when given perineurally when compared to the intravenous route.

Background: An accurate estimation of fetal gestational age is the cornerstone for the management of all pregnancies, especially necessary for determining the fetal viability, involving obstetric interventions terminating pregnancies and assess and predict fetal outcome. The clinical estimation of gestational age (GA) typically depends on the clinical history followed by confirmation by physical examination and signs and symptoms. Calculation of exact gestational age by LMP is very difficult in some situations. Ultrasound gave clinicians a method to estimate gestational age, growth and accuracy by measuring fetal biometry.⁽¹⁾A variety of ultrasonographic biometric parameters are used to date pregnancy, each have their own limitations^(2). However, non-biometric parameters such as Transcerebellar diameter (TCD) and Foot length (FtL) can be reliably used as surrogate parameters in those situations. Aim: To evaluate the accuracy of estimation of fetal gestational age by Ultrasound assessment of TCD and FtL. Material and methods: This study is a hospital based prospective cohort study on 100 consecutive pregnant women with reliable dates between 18 and 36 weeks of gestation attending antenatal OPD in Aarupadai Veedu Medical College Pondicherry over the period of two year from February 2016 to July 2017 were recruited in the study. These women were subjected to trans-abdominal USG and measurement of TCD and FtL with BPD, HC, AC and FL was done. Results: In our study, we found strong correlation of GA and TCD and FtL with r = 0.946 and 0.769 respectively. TCD in mm from 19 to 30 weeks is equal to gestational age and FtL corresponds to gestational age in mm between 19 to 24 weeks. Conclusion: Estimation of gestational age by TCD and FtL is a reliable and cost effective tool and significantly correlates with gestational age. TCD and FtL has a linear progression with advancing gestational. These are valuable tool that can be used as an independent parameter to assess fetal growth especially in cases of IUGR and unknown dates.

Introduction: Distal 1/3rd extra- articular tibia and fibula fractures account for 10% of fractures of lower limb. Most of the time it requires surgical intervention. Proximity of this fracture to the ankle joint, less blood supply and subcutaneous nature of this bone makes treatment more complicated. Intramedullary nailing and plating are the two standard commonly carried out procedures for the treatment of distal tibia and fractures. Methods and materials: This was a prospective (October 2015 and January 2017) and retrospective study(January 2010 to June 2015) to analyse and compare the functional and radiological outcome of extra-articular distal tibia and fibula fracture treated with closed reduction intramedullary with interlocking nailing and, open reduction internal fixation with plating at Department of Orthopaedic Surgery, Pondicherry Institute Of Medical College, Pondicherry. Functional outcome was assessed using KOOS(Knee Injury and Osteoarthritis Outcome score) and AFAS(American Foot and Ankle Score). Radiological union was assessed using RUST(Radiological Union Scale for Tibia) We studied total of 57 patients of which 34 patients were treated with closed reduction intramedullary interlocking nailing and 23 patients were treated with open reduction and internal fixation with plating. Results: Knee function assessed by KOOS score was higher in plating group than nailing group and was statistically significant(p=0.01), Where as Ankle function assessed by AFAS score was higher in nailing group than plating group and was statistically significant(p=0.01). Radiological union assessed by RUST, though score is better in nailing group it was not statistically significant(p=0.376). Conclusion: In our study, we conclude that nailing had better clinical outcome as compared to plating at the ankle as compared to knee, where the plating had no role. Nailing had a better patient compliance and fewer complications than plating. Hence, nailing is our procedure of choice for extra-articular distal tibia fractures.

Background: Periodontitis is a chronic inflammatory disease characterized by increase in pathogenic bacterial microflora, resulting in destruction of bone and soft tissue. Periodontitis is associates with various systemic disease one of which is PCOS. PCOS is a genetically complex endocrinopathy of uncertain etiology affecting women of reproductive age group which results in most common cause of anovulatory infertility, menstrual dysfunction and hirsutism. PCOS have close association with cardiometabolic risk profile, insulin resistance (IR), hyperinsulinemia, central obesity, dyslipidemia and increase prevalence of cardiovascular risk factors. The common pathway is the chronic low grade inflammation which is constituted by proinflammatory cytokine IL-6. Aim: To compare salivary IL-6 levels among Polycystic ovary syndrome (PCOS) patients with and without Chronic Periodontitis. Materials and methods: Newly diagnosed PCOS patients were selected for the study and the periodontal Parameters were recorded. Group A consist of 42 patients of PCOS with Periodontitis & Group B consist of 42 patients of PCOS without Periodontitis. Salivary samples were collected in a 15 ml sterile container. Then salivary samples are stored in stored in -40?C. The samples were then centrifuged at 3000 RPM for 15 mts. supernatant saliva is collected through the micropipette and collected in 1.5 ml vial. Salivary levels of IL-6 was compared between the two groups, and was assessed by Enzyme Linked Immuno Sorbent Assay (ELISA) kit (Bioassay). Results: In our study, group A has mean age of 24.88± 3.2 years from reproductive age group between 18 - 30 years and group B has a mean age of 24.09 ± 2.9 years. On comparing age between group A and group B the values were not statistically significant. (p = 0.24). BOP in group A was 1.40 ± 0.40 and in group B it was 0.91.± 0.18, PPD in group A was 4.23 ± 0.134 and in group B it was 1.30 ± 0.06, CAL in group A was 4.87 ± 0.124 and in group B was 1.30 ± 0.06. The values were statistically significant (p= <.001). IL-6 level in group A is 102.59 ± 18.2 and in group B it was 51.3 ± 25.3. Which implies there is an increase salivary IL-6 level in group A (PCOS with Periodontitis) than group B (PCOS without Periodontitis). Conclusion: Salivary IL-6 levels shows a double fold increase in Group A (PCOS with Periodontitis) than in group B (PCOS without Periodontitis).

Aim: The aim of the study was to compare the plaque microbiota around prosthesis on natural tooth and on implants in healthy oral cavity. Materials and Methods: 15 participants with prosthesis on natural tooth and 15 participants with prosthesis on implants were enrolled based on the inclusion and exclusion criteria. Plaque samples were collected and transferred to 100?l of a universal bacterial lysis buffer containing 36% to 50% guanidine hydrochloride and stored in the refrigerator at 4°C until being processed for DNA extraction. Following the collection of the 30 samples, they were transported for the 16S rRNA amplification and sequencing. The sequenced data was then compared with reference bacterial gene sequences deposited in Human Oral Microbiome Database (www.homd.org) using Blast N program. Finally, bacterial gene sequence having higher identity with the reference gene sequence was identified in both the groups and phylogenetic tree was drawn to compare the bacterial profile around prosthesis on natural tooth and on implants. Results: In the present study, the microorganisms dominated around prosthesis on natural tooth were Streptococcus sp., Fusobacterium sp., Corynebacterium sp., Micrococcus sp., Aeromonas sp., Leptotrichia sp., Dechloromonas sp. and around implants Streptococcus sp., Fusobacterium sp., Corynebacterium sp., Prevotella sp., Eikenella sp., Nisseria sp., Rothia sp., Aeromonas sp., Leptotrichia sp., Actinomyces sp. were identified. Conclusion: Our results suggest that while comparing the plaque profile around prosthesis on natural tooth and on implants, even in healthy oral conditions with plaque score of 0 - 1.9, the bacteria around implants tends to be of pathogenic in nature and hence the participants with implants are more likely susceptible to periodontal breakdown. This illustrates the need for supportive periodontal therapy and periodontal interventions at the earliest in patients with implants.

Aim: To evaluate the kinetic fictional resistance in conventional bracket and passive Self ligating bracket system by passing 19x25 SS rectangular wire in wet and dry conditions. Materials and Methods: conventional brackets such as Metal bracket, Ceramic brackets and Synergy brackets and Self liagting brackets such as Smart clip, Empower and Damon Q brackets were procured 36 each. 19x25 SS rectangular straight length wire were passed through the brackets and frictional characteristics were evaluated in Instron universal testing machine for both wet and dry conditions. Results: The results obtained for Group A1 when evaluated for frictional characteristics in dry medium were 4.99N and in wet condition was 5.83N. For Group A2 values in dry medium was 5.83N and in wet condition was 8.24N. values obtained for Group A3 in dry condition was 4.75N and values in wet condition was 5.82N. Group B1 values in dry medium obtained was 4.41N and values in wet condition was 5.16N. For Group B2 frictional characteristics in dry medium was 3.49N and in wet condition was 4.24N. Group B3 when evaluated for frictional characteristics in dry medium exhibited frictional values of 1.46N and in wet condition which is 2.34N. Conclusion: Damon Q showed least frictional characteristics followed by Empower Self ligating bracket, then Smart clip self ligating bracket followed by Synergy brackets, Metal brackets, ceramic brackets in both wet and dry conditions. Synergy even though a conventional bracket, exhibited superior frictional characteristics when compared with other conventional brackets in both wet and dry conditions

Introduction: Early detection of carious lesions paves way to preservation of tooth structures by remineralization strategies. Visual examination using ICDAS II has been validated with gold standard of histological classification. Fluorescence camera is yet another diagnostic aid for early detection of carious lesion based on the auto fluorescence of the enamel and dentin. This study was done to evaluate the validity of the fluorescence camera (Soprocare, Acteone) in detecting the early carious lesion. Material & Methods: 690 occlusal surface of non-cavitated premolars and molars were examined by Examiner 1 & 2 trained in ICDAS II grading system. The photographs of the occlusal surface and the fluorescence images, which was taken using Soprocare (Acetone) intraoral camera were examined by Examiner 3 &4. The scoring were tabulated and correlated. Results: The kappa values for, inter examiner reproducibility of indirect visual was 0.841 (good) and his and fluorescence camera was 1.00 which is very good. The correlation analysis revealed that there was higher correlation between direct visual and indirect visual for both the examiners when compared to direct and fluorescence camera. There was a positive relationship between indirect visual and fluorescence camera for both the experimenter). Indirect visual method for detection of carries has high sensitivity and specificity irrespective of the examiner. Examination by fluorescence camera has a low sensitivity and high specificity. Conclusion: The specificity of the caries detecton method by indirect visual examination based on ICDAS II coding that of Soprocare fluorescence camera were consistent and reliable where as indirect visual examination had a high sensitivity for detecting ICDAS code 1, 2. Soprocare showed a very low sensitivity in detecting ICDAS code 1, 2 lesions.

Introduction: Smoking is the predominant etiological factor for the development of potentially malignant disorder and Oral Leukoplakia is the most common potentially malignant disorder seen in the oral mucosa. Tobacco smoking is identified as one among the common cause for both oral leukoplakia and acetaldehyde production in the human body. Acetaldehyde not only is toxic but also is a known to dissolve in the saliva during smoking and act as a local carcinogen in the human upper digestive tract. Aims and objectives: To estimate salivary acetaldehyde levels in smokers and compare the acetaldehyde levels between smokers with leukoplakia and smokers without leukoplakia. Materials and method: A Total of 126 subjects with the habit of smoking were included in the study. Smokers with leukoplakia Group A (n 63) and without Leukoplakia the Group B (n 63). Unstimulated whole saliva was collected from the cases and controls. Salivary acetaldehyde level was estimated using Head space Gas chromatography mass spectrum. Independent t- test was used to compare the difference of salivary acetaldehyde between two groups. One Way ANOVA to compare the salivary acetaldehyde level between three histopathological grading while the average salivary acetaldehyde value of the two groups and their measure of dispersion from the mean values using arithmetic mean and standard deviation. Results: Smokers with leukoplakia had significantly higher level of acetaldehyde (155.10±9.59μl) in comparison to the Smokers without leukoplakia (116±4.8μl). (P<0.001). Conclusion: We inferred from our study that smoking is one of predominant etiology in increasing salivary acetaldehyde levels. Salivary acetaldehyde levels are higher in smokers with oral leukoplakia but do not show a statistically significant correlation with the histopathological grading of Oral Leukoplakia.

Aim: The aim of the study is to evaluate and compare both the attractive and repulsive force values in Neodymium iron boron magnets and Samarium cobalt magnets of different sizes at various distances. Materials and Methods: For this study 168 magnets each of NdFeB and SmCo of cylindrical shape were procured. The NdFeB magnets were grouped as Group I and was further subdivided into GROUP IA for 10x3mm size, GROUP IB for 6x3mm size, GROUP IC for 4x4mm size depending on size. The SmCo magnets were grouped as Group II and was further subdivided into GROUP IIA for 10x3mm size, GROUP IIB for 6x3mm size, GROUP IIC for 4x4mm size) depending on size. The force of attraction and repulsion was measured using the Instron Universal testing Machine. Results: The attractive and repulsive test for both the groups were performed at all the nine specified distances and the readings were recorded and statistically analysed using unpaired t test. The obtained results were tabulated depending on the distances maintained. Both the SmCo and NdFeBo magnets of 4x4mm size at 10mm to 20mm distance apart with 2.5mm intervals could not generate any force levels suggesting lacking in ability to generate any force at that distance and above. Conclusion: The study showed that NdFeB magnets had higher force values than SmCo magnets. The forces generated for NdFeB and SmCo magnets ranged from 943.01-24.13gms and 738-11.39gms respectively for different sizes and distances all of which can be used for orthopaedic correction or orthodontic tooth movement.

Introduction: Glass Carbomer is a new generation of restorative material developed from Glass Ionomer Cements with possibility of gradual mineralization into fluorapatite. The aim of this clinical trial was to compare and evaluate the clinical performance of Glass Carbomer cement over a period of one year, with that of Resin-Modified Glass Ionomer Cement in Non-Carious Cervical Lesions. Methodology: Thirty - three subjects (30-60 years) with NCCLs of not more than 2mm depth in premolars were recruited. Fifty- six NCCLs were restored with RMGIC (Group 1) and another 56 NCCLs with Glass Carbomer (Group 2). Single blind evaluation of clinical parameters was performed at the 3 ^rd, 6 ^th and 12^th month using modified USPHS criteria. The intragroup comparison at various intervals was evaluated using the McNemar test and the intergroup comparison using the Fishers Exact tests. Results: Recall rate was 73.2% for one year. Group 1 had 94.6% retention rate whereas Group 2 had 86.5%. There was statistically significant decline after 12 months for marginal integrity (p=0.008), anatomic form (0.002) and colour match (p=0.0003) for Group 2. Group 1 restorations showed statistically significant better results in terms of retention, marginal integrity (p=0.005), colour match (p< 0.0001), wear (p =0.0311), recurrent caries (p =0.0228), marginal staining (p =0.0086), fracture (p =0.0054) and post-operative sensitivity (p =0.0574) after one year of clinical service. Conclusion: Clinically, RMGIC (Group 1) showed an overall better performance than Glass Carbomer (Group 2).

Background: Loss of adhesion between acrylic teeth and denture base is a commonly occurring clinical challenge. Studies that have evaluated that detachment of resin denture teeth from the base is the common reason for repairs. Methodology: A total of 90 maxillary central incisors artificial denture teeth were selected and divided into three groups namely Acryrock (I), Acrylux (II) and Acryplus (III). All teeth of each group were trimmed to a specific thickness using a custom-made metal jig. All teeth were mounted to the acrylic cuboidal block. The shear bond strength was calculated using an INSTRON universal testing machine and the force was applied at the junction of the denture base resin and acrylic resin teeth. And statistical analysis was done using ANOVA. Results: The trimmed teeth showed significantly higher shear bond strength (p = < 0.05). On comparing the groups, Acryrock & Acrylux and Acrylux & Acryplus showed significant difference (p = <0.001) but while comparing Acryrock and Acryplus no statistically significant variations were found (p = 1.000) in both trimmed and untrimmed variants. Conclusion: Trimmed acrylic teeth showed higher shear bond strength than untrimmed teeth. And there was no difference in the shear bond strength of untrimmed and trimmed of Acryrock to Acryplus but the shear bond strength of untrimmed and trimmed of Acryrock and Acryplus to Acrylux was higher.

Introduction: Oral squamous cell carcinoma (OSCC) is the most common histological type of cancer of the oral cavity, and has an important and well-established pattern of dissemination to cervical lymph nodes. Tumor thickness (TT) has been shown to be one of the most important features in predicting lymph node metastases in oral cancer. Malignant tissues, as a consequence of abnormal morphogenesis, have structurally abnormal blood supplies. Color Doppler Ultrasonography (CDUS) has been widely used to detect blood flow signals. Low-impedance tumor vessel flow is helpful differentiating malignant from benign tumors. Hence, this study is designed to assess the usefulness of CDUS in quantifying (OSCC) vascularization and correlating it with occurrence of local metastasis. Aim: To assess the hemodynamic parameters of OSCC and correlating it with the TT and the occurrence of local lymph node metastasis. Methods: A case control study was conducted in which; 90 subjects were enrolled. Group A constituted 45 cases diagnosed with OSCC and Group B constituted 45 healthy controls. Intraoral US was performed using a high-frequency CDUS probe (14 MHz), to determine the Resistive Index (RI), Pulsatile Index (PI), Peak Systolic Velocity (PSV), End diastolic velocity(EDV) and TT. Results: The mean values for RI was 0.46 ± 0.10, PI was 0.94 ± 0.29, PSV was 24.18 ± 4.52, EDV was 12.88 ± 3.60 in Cases (Group-A) and in controls (Group - B) the RI was 0.84 ± 0.08, PI was 2.11 ± 0.62, PSV was 39.03 ± 7.96, EDV was 5.76 ± 3.44. A very high significance (p = 0.000) difference was noted on comparing the intra-lesional vascular indices in cases and controls. Using Pearson Correlation, it was also observed that TT is inversely related (- 0.68) to RI, which was statistically significant (p = 0.000). Conclusion: Although Color Doppler evaluation cannot replace the histopathological procedure, it plays a definite role as an adjunct to the clinical evaluation of OSCC and proves its value as an important investigation. CDUSG should be used as the first modality for investigation in OSCC prior to biopsy as a routine protocol

Back ground: The human oral cavity harbors hundreds of different microbial species amongst which Candida albicans is the most common fungal pathogen. This commensal inhabitant assume a pathogenic role when there is impaired local and/or general health. Increased incidence in resistance, adverse effects to conventional anti-fungal agents has led to the search for alternative medicines. Aim: To Compare the efficacy of 0.1% Tea Tree Oil Oral rinse with 1% topical Clotrimazole in patients with Oral candidiasis by assessing candida colony forming units in saliva and candidial hyphae in cytosmear. Methods: 50 patients who visited the Department of Oral Medicine and Radiology with Oral Candidiasis were included in the study. Patients were divided into two groups by randomization. Cytosmear was made from the lesion site for the identification of candidal hyphae and saliva was collected for assessing candida colony forming units. Group 1 was treated with 0.1% tea tree oil oral rinse and group 2 with 1% topical clotrimazole. Subjects were recalled after 2 weeks and same procedures were repeated to asses post treatment candidal load. Statistical analysis: Unpaired t test and paired t test was done to compare two groups. Pearson correlation analysis was done to correlate candida colony forming units and candidial hyphae and results were obtained. Results: Group 1 and group 2 showed 80.9% and 67.7% reduction in colony forming units respectively; 84% and 82.6% reduction in candidal hyphae was seen in the two groups after therapy. Conclusion: 0.1% TTO being nontoxic, economical, and compliable, is an alternative to 1% clotrimazole in the treatment of oral candidiasis. A longer duration of treatment of more than 2 weeks is recommended for complete elimination of candidal load.

Introduction: Probiotics as live microorganisms, on early administration can reduce S.mutans level, thereby reducing the risk of dental caries. Lozenge is an easy and acceptable vehicle for ingestion of probiotics in children. Therefore thisstudy was planned to assess the variations in the levels of S.mutans and its serotypes e, f, k in saliva before and after a short term daily intake of Probiotic lozenge. Methodology: A double blind randomized controlled trial was conducted among 6-12 years old children from Udhavikarangal Orphanage. A total of 60 children were included in the study, 30 each in placebo group and Testgroup, who were given lozenge containing probiotic bacteria, twice daily after brushing for one monthand a 6 month followup was done. Using PCR and gel electrophoresis the prevalence of S.mutans serotypes, the pre and post levels of S.mutans on the collected saliva samples was evaluated. The data obtainedwas subjected to statistical analysis using ANOVA, Post - Hoc, Chi-square, Mann Whitney test and T-test. Results: The prevalence of serotypes e, k was found to be 5%, 12% with the absence of serotype f. In probioticgroup, there was asignificant reduction in S. mutans level (p = 0.00) at one month intervention. Comparing one month intervention with 6 months follow up there was onlya marginal increase in the levels of S.mutans. Conclusion: Probiotic lozenge can be used as an adjunct for the prevention of dental caries as an oral supplement in children at varying risk for dental caries.

Aim: The aim of this study is to evaluate the shear bond strength of stainless steel brackets and radiance plus ceramic brackets by curing it in various distances of 0mm, 5mm, 10mm using 3M ESPE light cure unit and also to evaluate the adhesive remnant index (ARI) scores to find the site of bond failure. Material & Methodology: 120 premolars were procured. 60 stainless steel brackets and 60 radiance plus brackets were referred to as group A and group B respectively. Group A consisting of stainless steel bracket which were subdivided into group A1, group A2 and group A3 based on the light curing distance of 0mm, 5mm and 10mm, and similarly group B were subdivided into group B1, B2 and B3 based on the curing distances. The brackets were bonded to the tooth surface after etching the enamel with 37% of phosphoric acid (D-tech) and using Transbond XT adhesive. The brackets were bonded to the tooth surface. Curing was done using 3M ESPE ELIPAR light curing unit of 1200millwatt/cm sq intensity. Debonding was done using Instron Universal Testing Machine to check for the shear bond strength (SBS). The debonded brackets were subjected to stereomicroscope of 20X magnification to check the Adhesive Remnant Index (ARI) and the results obtained were tabulated and statistical analysis was done. Results: The shear bond strength (MPa) for group A1, group A2, group A3 were 23.06±1.83, 20.56±2.13, 14. 09±2.52 respectively and for group B1, B2, B3 were 31.38±1.54, 28.29±1.36, 24.46±2.03 respectively. It was found that group B has superior bond strength compared with group A at all distances and it was statistically significant. According to the ARI evaluation, at 0mm distance the bond failure for both the groups were observed at bracket adhesive interface and at 5mm and 10mm distances the bond failure was observed at the enamel adhesive interface. Conclusion: The shear bond strength (SBS) of radiance plus bracket was found superior than the stainless steel brackets, and the bond strength obtained at all three distances for both the brackets were clinically accepted. The ARI at 0mm exhibited bond at enamel adhesive interface for both brackets and at 5mm and 10mm, it exhibited bond at bracket adhesive interface.

Introduction: A sound knowledge of root canal anatomy and its variations is essential for treatment planning and executing root canal procedures so as to reduce the chances of missed root canals and procedural errors thus increasing the success rates. Mandibular II molar usually has two roots and three canals. Few common variations include - combinations of one or two roots with one, two, three or even four canals and the C-shaped canals. In today's technological advancement Cone Beam Computed Tomography (CBCT) has become a successful tool to explore the root canal anatomy. Hence, the purpose of this study is to investigate the variations in root canal anatomy of south Indian population. Materials & Methods: Total of 354 freshly extracted human mandibular 2nd molar was selected based on the inclusion & exclusion criteria. the 4samples were mounted in a modeling wax & scanned using CBCT with Voxel size is 90μmx90μmx90μm. The image was analysed & anatomical features namely (Incidence of C-shaped canal, Root canals configuration based on Vertucci classification, Isthmus configuration, Number of roots and root canals, Level of bifurcation or convergence - Apical, middle or coronal.) C-shaped canals was categorised using Modified Melton's Classification. The data was recorded & the incidence of anatomical variations was noticed. Results: According to the present study, the Incidence of C-shaped canal was found to be 8.4% and 6.2% showed fused root. Incidence of two rooted second mandibular molar was found to be 98%. On further classification of root morphology based on Vertucci classification, mesial roots showed an incidence of 27% of type 3canals, 25% of type 2 canals, 20 %for type1 canals and for the distal roots showed the incidence of 75% for type 1canals. Incidence for Isthmus configuration of mesial root found for type 3-26.5%, for type 5- 24%, for type 1-20.6% and for distal root found for type 1-33.8%, for type 3-27.9%.incidence in the level of bifurcation at the apical level was found to be 64.1%. Conclusion: The most common morphology in Indian mandibular second molars was the two-rooted teeth with three canals (two mesial and one distal). C-shaped canals were found in 8.4% of the teeth, in that C2canal were found to be the most at 3.3% the canal shape resembled a semicolon resulting from the discontinuation of the “C”. The observations made in this study show that mandibular second Molars among Patients Reported to Private Clinics in Vellore District, South India exhibited both Mongoloid and Caucasian traits.

Introduction: Early childhood caries (ECC) presents its first clinical manifestation as a white spot lesion (WSL). Preventive strategies if implemented at the earliest reverses these lesions, thus inhibiting caries progression. Fluoride varnishes are recommended in children as it remineralizes WSL. Since no clinical research has assessed the efficacy of combination varnishes, this present study was planned to assess the remineralising efficacy of fluoride and its combination varnishes on white spot lesion in children with ECC. Methodology: In a single blinded randomized clinical trial, sixty children with active WSL on primary maxillary anterior teeth were randomly selected. At baseline, the WSL activity was evaluated using ICDAS II (LAA) and its dimensions through photographic method. They were allocated to Group 1 (5% NaF), Group 2 (5% NaF with ACP) and Group 3 (5 % NaF JJ with CPP-ACP). First, Oral hygiene instructions and diet counselling were given followed by application of fluoride varnishes in their respective groups. The same parameters were recorded at follow up of 2, 4, 12 and 24 weeks intervals. Data was collected and subjected to statistical analysis using Friedman Chi-square and Mann Whitney tests. Results: From the overall results, Group 3(MI varnish) showed statistically significant reduction in the dimension of WSL from baseline to 24 weeks, when compared to other 2 groups. Although MI varnish changed all active WSL to inactivity, statistically the results were insignificant. Conclusion: Combined fluoride varnish with CPP-ACP would be an effective preventive strategy in reversing WSL in children with early childhood caries.

Aim: To correlate the levels of salivary Retinol Binding Protein-4 with BMI in patients with Chronic periodontitis. Materials and Methods: Ninety-one systemically healthy non - smoking participants with chronic periodontitis were enrolled. Patients ? 30 years of age were selected. Periodontal parameters such as bleeding on probing, periodontal probing depth and clinical attachment loss were recorded. Body Mass Index and Waist-to-Hip ratio was recorded. Unstimulated salivary samples were collected and the samples were assayed for RBP4 using human RBP4 ELISA kit. Results: Salivary RBP4 does not correlate with BMI and waist to hip ratio and no significant correlation between RBP4 and periodontal parameters was also found. The only correlation was observed was between BMI and bleeding on probing. Conclusion: Our results suggest that while correlating RBP4 with BMI in chronic periodontitis, no possible association between RBP4 and BMI was found. This illustrates that in this present study, RBP4 may not be a potential marker in chronic periodontitis.

Background: Elastomeric impression is used for making final impression in fixed partial denture and for various purposes in Prosthodontics. Accuracy of VPES and Addition Silicone might alter on delayed pouring when it is involved in saliva, blood etc., However, literature lacks in prospective randomised controlled trials in this topic to define the accuracy of both materials using monophase impression technique. Methodology: In this parallel group randomised controlled trial 64 impressions were made in partially edentulous patients were assigned randomly to groups 1 and 2 through simple randomization. After making final impressions, presence/absence of tear and voids was evaluated using magnification loupes (3x). 128 casts obtained were evaluated using Vernier Caliper (linear dimensional accuracy) and also using stereomicroscope (Axio vision rel.48 software) in dies of distal abutment (accuracy of dies). Evaluation was done by two different independent (blinded) observers who knew to operate the instrument. Values were tabulated and statistical analysis was done using unpaired t- test using SPSS20 Software. Results: Accuracy of dies showed statistically significant (p=0.001). Linear dimensional accuracy was statistically not significant. Tear and Voids - VPES showed absence of tear in 100% than Addition Silicone which shows 15.6%. VPES showed presence of voids is 6.3% which is minimal when compared to Addition Silicone which showed 9.4% and it showed slight difference between the groups. Conclusion: Overall accuracy is maintained between VPES and Addition Silicone even after storage for 7days using monophase impression technique, so both materials are clinically acceptable for making final impression in FPD.

Background: Elastomeric impression materials used in fixed prosthodontics are expected to yield highly precise impressions with good handling properties. The dimensional accuracy of elastomeric impression material being a crucial property, it is affected more by the impression technique than by the chosen material. Methodology: According to the standard design specifications, a master cobalt chromium metal die of a mandibular molar was milled using CAD software. The custom trays were fabricated and impressions of the metal die were made using three different elastomers - namely Polyether, VPS, and VPES (heavy body, medium body and light body consistencies) and named as group I, II and III respectively under one step and two step impression techniques which was grouped as 1 & 2 for each impression material. N= 10, a total of 60 samples under the groups were studied. The dimensional accuracy was evaluated by superimposing the 3D images of gypsum dies against that of metal master die and the mean deviation values were calculated. Results: When comparing the accuracy among three materials using one step and step two impression techniques, there was no statistical significant difference among Polyether, VPS and VPES[p>0.05]. But Polyether was a statistical significant difference among the two techniques for one step and two step techniques (p= 0.001). Conclusion: Though Polyether showed statistical significant difference among the two techniques but was not clinically significant. Within the limitations of the study it was concluded that the dimensional accuracy of all three impression materials were clinically acceptable under the two techniques.

Background: Smear layer produced during instrumentation of root canal prevents the penetration of irrigants and intracanal medicaments into dentinal tubules and compromises the fluid tight seal in root canal obturation. The combinations of irrigants used currently Sodium Hypochlorite (NaOCl), EDTA, MTAD remove smear layer but are not without disadvantages such as eroding dentin, causing chemical burns and tissue necrosis. Passion fruit extract (PFE) irrigant, a herbal alternative has been found to possess antimicrobial properties. This study aims to assess its smear layer removing ability and erosive capacity. Materials and method: 35 single-rooted premolars were divided into 5groups: 30% passion fruit extract, 17% EDTA, 17% EDTA + 5.25% NaOCl, 30% passion fruit extract+17% EDTA and saline. Following irrigation with the above irrigants each tooth was split into two halves and examined and scored (modified Torabinejad's criteria) for smear layer removal and erosion (modified Torabinejad's criteria) using Scanning Electron Microscope. Kruskal - Wallis and Mann-Whitney U test were used for statistical analysis. Results: 30% PFE produced less erosion and statistically significant smear layer removal in coronal and middle third of the root. When combined with 17% EDTA smear layer removal was effective in all the three thirds of the root. Erosive potential of 30% PFE+17% EDTA was less when compared to 17% EDTA + 5.25% NaOCl. Conclusion: Owing to reduced erosive potential and comparable smear layer removal capacity 30% PFE along with 17% EDTA can be a promising irrigant in endodontics.

Background: The simple insertion of a needle has been shown to be one of the most frightening and distressing medical procedures for hospitalized children. Buzzy device (cold and vibration) is one of the non-pharmacologic methods used and acts through local skin desensitisation according to gate-control theory which reduces the pain associated with Intravenous cannulation. Hence, the investigator was interested to do this study to put instant Pain Management in the hands while performing IV cannulation. The main aim of the study was to determine the effectiveness of Buzzy Technique on pain level during IV cannulation among children. Materials and methods: Quantitative Research approach and a Quasi Experimental Non Equivalent Control Group Post Test only design was adopted. A total of 60 samples in the age group between 6- 12 years (30 in experimental and 30 in control group), were selected based on inclusion criteria. Children belonging to the experimental group were applied the Buzzy, during IV Cannulation, while Children in the control group received the routine care. The Pain level was assessed by Wong's Baker Pain scale. Descriptive and inferential statistics were used to analyze the data. Results: The post test mean score for experimental group was 2.6 with a standard deviation of 1.9 and post test mean score for control group was 7.6 with a standard deviation of 2.13. The obtained Mann Whitney test value was 6.103 which was found to be statistically significant at p<0.001 level, which attributes to the effectiveness of Buzzy device in reducing pain. Conclusion: Non- pharmacological methods used for alleviating pain during painful procedure is part of our Nursing care. As Buzzy is found to be highly effective in reducing pain among children, it can be used as an instant pain among Children, it can be used as an instant pain reliever for Children during IV Cannulation.

Background: Cancer is the second most serious health problem and the second leading cause of death in human. Now a days the cancer patient face physical, social and emotional issues. These have many problems in that most people have stress, anxiety and depression occasion for most people. Progressive Muscle Relaxation Technique is a relaxation exercises, you tense up particular muscles and then relax them, then you practice this technique consistently to reducing muscle tension were used to reduce the stress, anxiety depression, pain among the patient and normal people. Aims & objectives: The aim of this study was to determine the impact of progressive muscle relaxation technique on the levels of stress, anxiety and depression among the cancer patients. Methodology: A quasi-experimental study was conducted at the Puducherry Cancer Trust Hospital & Research Centre, Puducherry. Totally 60 Cancer patients who undergoing treatment were taken for the study. Progressive muscle relaxation technique was given to cancer patient. The pretest and posttest level of stress, anxiety and depression were measured using Depression, Anxiety Stress Scales - 21 (DASS-21). The data analysis done by the Descriptive and inferential statistics. & Results: At the end of the study, 100% of the patients were completed the study respectively. The study result shows that there were significant improvements in anxiety, stress and depression (p<0.001) of the cancer patient those receiving progressive muscle relaxation technique. It indicate that there was a effectiveness in the level of stress, anxiety and depression in the cancer patient. Conclusions: The improvement in stress, anxiety and depression showed the potential of PMRT in the management of cancer patients. Future studies should be carried out over a longer duration to provide stronger evidence for the introduction of relaxation therapy among cancer patients as a coping strategy to improve their stress, anxiety and depression.

Introduction: Autism spectrum disorder is a serious neuro developmental disorder that impairs a child's ability to communicate and interact with others. Each child with Autism spectrum disorder is likely to have a unique pattern of behaviour and level of severity - from low functioning to high functioning. Parents are usually the first to notice unusual behaviours in their child, although they may not realize the specific nature or degree of the problem. Knowledge, attitude and practice of parents/primary care givers towards children with autism spectrum disorder are important factors in promoting health and wellness of children. Objectives: To assess the level of knowledge, attitude and practice among primary caregivers regarding care of children with autism spectrum disorder and to evaluate the effectiveness of video assisted teaching regarding care of children with autism spectrum disorder on knowledge, attitude and practice among primary care givers. To associate the level of knowledge, attitude and practice regarding care of children with autism spectrum disorder with selected demographic variables. Methodology: Pre experimental research design with one group pre-test post-test was adopted. Sixty primary caregivers were selected through purposive sampling. Video assisted teaching was given to primary caregivers. Data collection was done before and after the video assisted teaching programme using structured questionnaire which consists of 57 questions. Results: The result of the study showed that the post test level of knowledge (16.67±1.79) attitude (16.57±4.16) and practice (29.5±6.04) among primary caregivers of children with autism spectrum disorder was significantly high (p=0.001) when compared to pre test level. Conclusion: This study revealed that video assisted teaching is effective in enhancing the knowledge of primary caregivers about autism spectrum disorder. The study helps to make a positive attitude among primary caregivers towards caring the children with autism spectrum disorder.

Background: There are an estimated 15 million preterm birth across the world each year. In India 3.5 million, accounted for the most preterm births in the world. Most premature babies(>80%) are between 32 and 37 week of gestation, and many die needlessly due to lack of mother's knowledge regarding care of preterm. Video assisted teaching programme will improve the mother knowledge on aim of the study to find of effectiveness of video assisted teaching on knowledge and practice regarding care of preterm babies among postnatal mother. Materials and methods: Pre experimental research design with one group pre-test post -test was adopted. Fifty postnatal mother were selected through purposive sampling. Video assisted teaching was given to postnatal mothers. Data collection was done before and after the video assisted teaching programme using structured questionnaire and 5 point likert scale. RESULTS: The result of the study showed that the posttest level of knowledge (17. 18± 1.79) and practice(73.12± 1.31) which found to be statistically significant at (p<0.0001) level. When compared pretest level. CONCLUSION: This study revealed that video assisted teaching is effective in enhancing the knowledge of post natal mothers about care of preterm babies. The study help to make a positive attitude among post natal mothers in taking care of preterms.it also helped to promote good practice among post natal mothers in caring the preterm babies.

Background: Thoppukaranam is the practice of ear piercing too has its real reasons being the stimulation of the pituitary and pineal glands, due to the effect of the pressure in the ear lobes. The main benefit of Thoppukaranam is a simple, fast and effective technique used to promote proper functioning of the brain, greater intelligence and creativity. Each and every performance followed by some scientific truth. Thoppukaranam\' activates the acupuncture points at right and left ears thereby activating the right and left brains. The main aim of the study was to evaluate the effectiveness of Thoppukaranam on Academic Performance of school going children. Material and methods: Quantitative research approach and True experimental research design was used for this study. Total 120 school going children from Government Higher Secondary School, Nonankuppam and Dr. Ambedkar Higher Secondary School, Kirumampakkam, Puducherry, were selected by using simple random sampling technique. The group A (n= 60) received Thoppukaranam for 10 times in morning and the group B (n = 60) had normal daily routine activity. The Academic Performance was recorded from the academic total marks secured by the students in their midterm exams. Results: The results revealed that Thoppukaranam was effective on academic performance in group A was better than group B, which was statistically significant at p <0.001 by paired t test. Conclusion: The study concluded that Thoppukaranam is effective on academic performance among school going children.