Care Hospital In Puducherry Research Articles

Study of Prevalence of Campylobacter Gastroenteritis among Pediatric Population Using a Multiplex PCR in a Tertiary Care Hospital in Puducherry, South India

Study of Prevalence of Campylobacter Gastroenteritis among Pediatric Population Using a Multiplex PCR in a Tertiary Care Hospital in Puducherry, South India

A Clinical Retrospective Study on the Transmission of COVID-19 From Mothers to Their Newborn and Its Outcome.

IntroductionIndia is the second most populated country in the world. The declaration of the COVID-19 pandemic has caused significant morbidity and mortality in pregnant women and newborns. Due to the decreased lung volume and immunocompromised state, pregnant women are more prone to rapid clinical deterioration. Regarding the transmission of COVID-19 infection to newborns, there is no clear-cut evidence regarding the intrauterine or vertical transmission of COVID-19 from the affected pregnant women to their neonates.AimThis study aimed to assess the outcome of neonates born to mothers with COVID-19 in a tertiary care hospital in Puducherry, India.MethodsThis retrospective case record-based study was conducted among all neonates born to COVID-19-positive mothers at a tertiary care institution in Puducherry from April 2020 to June 2020. All the newborns born to COVID-19-positive mothers during the specified period of time were included in the study.ResultsA total of 98 COVID-positive mothers were included in the study. Of these, 13.27% showed mild upper respiratory infection, and one had a moderate category. The mean gestational age was 38.4+1.12 weeks. About 53.06% of COVID-19-positive mothers had C-sections, 45.92% had a normal vaginal delivery, and only one had an instrumental vaginal delivery. All the mothers gave birth to singleton neonates; of 98 newborns, 51 were female, and 47 were male with the mean birth weight of 3.1 ± 0.4 kg. Among the 98 neonates, only six developed COVID-19 infection. Among the six, four acquired infections during the first to second week of the postnatal period and two acquired infections during the fourth week. Three neonates born by normal vaginal delivery only had a fever; two neonates manifested fever, cough, and increased respiratory rate; and only one neonate developed hypoxia.ConclusionThe study showed that vertical transmission from the mother to the newborn is extremely minimal. In our study, six neonates acquired infection mostly due to the close contact of the newborn with the mother during rooming-in and breastfeeding.

Seroprevalence and risk factors for Hepatitis C virus among maintenance hemodialysis patients at a Tertiary Care Hospital in Puducherry, India

Background: Hepatitis C virus (HCV) infection is a serious public health problem and the most significant cause of liver disease in patient receiving dialysis for a long term. The prevalence of HCV infections among dialysis patients varies markedly from country to country. Tight infection control measures implemented in developed countries have minimized the transmission rate, while the prevalence still remains high in the developing world. The aim of this study is to estimate the prevalence rate of HCV infection in hemodialysis patients, to describe demographic characteristics of individuals infected with HCV and to determine whether HCV-polymerase chain reaction (PCR) testing identifies HCV infections not detected by anti-HCV testing. Methods: This retrospective record-based study was carried in Aarupadai Veedu Medical College and Hospital, a Tertiary Care Center in Puducherry, A total of 258 chronic renal failure patients on hemodialysis were studied and tested for anti-HCV antibodies by 4th generation HCV TRIDOT ELISA and real time-PCR. Results: Anti-HCV antibodies were positive in 34 (13.2%) patients, comprising 27 (79.4%) males and 7 (20.6%) females. The majority of patients were found to be positive; between 41 and 60 age 24 (70.5%). HCV RNA was detected in 38 (14.72%) patients. The mean age of patients undergoing dialysis was 45 years. 12 (35%) had raised aspartate transaminase (AST) levels and 14 (41%) had raised alanine transaminase (ALT) levels. Gamma-glutamyl transferase was found to be raised in 25 (73.5%) of the subjects. All the 34 HCV seropositive patients were hypertensive and 33% had diabetes mellitus. 23 (67.6%) patients had undergone dialysis in more than one center. Conclusions: Regular screening of patients for HCV is absolute necessity for early detection of HCV infection that could result in better management of patients and also stresses on the importance of HCV RNA detection by PCR. Strict adherence to universal precautions, the use of dedicated machines along with regular surveillance for HCV in HD units will dramatically decrease the risk of transmission of HCV.

Seroprevalence of transfusion-transmitted infections among blood donors in a tertiary care hospital in Puducherry

Seroprevalence of transfusion-transmitted infections among blood donors in a tertiary care hospital in Puducherry

Breastfeeding Positioning and Attachment among Postnatal Mothers: A Mixed Methods Study in a Tertiary Care Hospital in Puducherry, South India.

Introduction:Proper positioning and attachment play a key role in exclusive breastfeeding. Whereas incorrect breastfeeding techniques lead to poor milk transfer and early discontinuation of breastfeeding.Objectives:1. To assess the breastfeeding techniques among postnatal mothers and to identify the factors associated with improper positioning and poor attachment. 2. To prioritize the action points to improve the poor breastfeeding practices according to the viewpoint of the staff nurses.Materials and Methods:A hospital-based mixed-methods study was carried out in Puducherry for 6 months. In quantitative phase, 99 postnatal mothers were interviewed consecutively and breastfeeding techniques were observed based on Baby Friendly Hospital Initiative and Integrated Management of Neonatal and Childhood Illness guidelines. In qualitative phase, 45 staff nurses ranked the action points to improve the poor breastfeeding practices. Bivariate and multivariate analyses were employed. Mean rank and Kendalls' Concordance Coefficient were calculated for the ranked data.Results:About 28.3% and 27.3% of mothers demonstrated improper positioning and poor attachment, respectively. Young mothers, housewives, <10 days old infants, and failure to receive breastfeeding counseling were associated with poor breastfeeding techniques. Poster displays, healthcare workers' training, targeted counseling, and assistance were the priority action points suggested by the staff nurses.Conclusion:Maternal age, maternal occupation, infants' age, and breastfeeding counseling influenced breastfeeding techniques. The prioritized action points need to be implemented to achieve the level of Baby Friendly Hospital.

Antinuclear antibody patterns by indirect immunofluorescence test: An experience from a rural tertiary health centre of Puducherry, South India

Anti-nuclear antibodies (ANA) are known to be associated with autoimmune diseases and most commonly with connective tissue diseases (CTD). Screening for ANA is the first investigation of choice in the diagnosis of autoimmune diseases and indirect immunofluorescence (IIF) test using Hep-2 cells has been considered the gold standard method. The prevalence of autoimmune diseases and hence the ANA positivity and ANA IIF patterns differ in various geographical regions. This study was aimed to estimate the ANA positivity rates among patients with suspected or confirmed auto immune diseases and to determine the common ANA IIF patterns in the positive samples.: This is a retrospective study including 235 patients with either clinical suspicion of, or suffering from autoimmune diseases attending a tertiary health care hospital in Puducherry, South India, between November 2018 and April 2020. ANA IIF test (Hep 20-10/ primate liver, Euroimmun, Germany) was performed with 1:100 dilutions of patient serum.The ANA positivity rate was 14.5% (34 out of 235 samples were positive). ANA was positive in 10 (13.3%) males and 24 (15%) females. The mean age of ANA positive patients were 43.4 years.The most common pattern was nucleus fine granular (n=8) followed by cytoplasm fine granular (n=7) and centromere (n=4).A significant ANA positivity rate was found in our study and a detailed clinical study has to be conducted to draw further conclusions.

A study of association between serum zinc and HbA1c in type2 diabetic patients in a tertiary care hospital in Puducherry, Tamilnadu

Background: Diabetes currently affects more than 66.8 million people in India which has become a major health care problem, representing the largest number of any country in the world. Reduced concomitant intake of Zinc studies proved to be associated with risk of increased HbA1c percentage in individuals with Type 2 Diabetes patients.&#x0D; Aims and Objective: The current study was designed to assess serum Zinc level in Type 2 Diabetes patients and to find out the correlation between serum Zinc and HbA1c level in Type 2 Diabetic patients.&#x0D; Materials and Methods: One hundred patients were included in the study and they were divided into two groups like Group I (50 patients): Type 2 Diabetic patients with HbA1c more than 7 percent. Group II (50 patients): Type 2 Diabetic patients with HbA1c less than 7 percent (50). Estimation of blood glucose (Fasting and post prandial), Glycated haemoglobin (HbA1c) and serum Zinc was done. Statistical Analysis: The data is collected, recorded and analyzed statistically to determine the significance of different parameters by using SPSS package for windows version23.0.&#x0D; Results: The mean value of serum zinc was lower in the diabetic group whose HbA1c more than 7 (p value – 0.001) when compared to the diabetic group whose HbA1c less than 7.&#x0D; Conclusion: Estimating the level of serum zinc becomes important to know the status of insulin in diabetic patients and correlating the levels of HbA1c and Serum zinc in Type 2 DM patients, can monitor the levels of glycemic control and prevent the risk of development of complications.

Assessment of ten-year risk of cardiovascular event using WHO/ISH risk prediction chart among adults in a tertiary care hospital in Puducherry, India

Context: The changing trends have revealed that cardiovascular disease (CVD) has evolved as prime cause of mortality globally, and predicting this prior is of utmost interest in patient management. Objective: To assess the ten-year risk of fatal or non-fatal cardiovascular event using World Health Organization/ International Society of Hypertension (WHO/ISH) risk prediction chart among adults. Material and methods: A cross sectional study was conducted among 226 general medicine Outpatient Department (OPD) attendees of a tertiary care hospital. Their risk of encountering a major cardiovascular event such as myocardial infarction or stroke ten year later was assessed using the WHO/ISH risk prediction charts. Appropriate tests of significance were employed. Results: Among 226 study subjects, 174 (76.9%) at low risk, 36 (15.9%) at moderate risk and 16 (7.0%) were at high risk of developing major cardiovascular event in the next ten years. Risk factors such age above 50 years, male gender, presence of hypertension or diabetes and smoking were found to be significantly associated with increased risk of the predicted major cardiovascular event. Conclusions: WHO/ISH chart is a useful tool in identifying individuals at high-risk of cardiovascular disease (CVD) and could help in planning appropriate strategies to mitigate the estimated CVD burden in future.

A bacterial and fungal profile of sputum samples in a tertiary care hospital in Puducherry

The microscopic examination of gram stained sputum sample aids in diagnosis of patients with lower respiratory tract infections. Gram stain plays the key role in deciding the appropriateness of the quality of the sputum sample received in the laboratory for culture. It helps to determine the represent ativeness of the sample for the site of collection intended. This study was done to correlate gram stain findings with culture and to assess the use of Gram stain in sputum examination in diagnostic microbiology. During 2017 (July to December) a total of 133 sputum samples were quality assessed using Bartlett’s grading system. The total scoring was done and sample showing score of 1 and above were cultured and identified based on colony characteristics, gram staining morphology and biochemical reactions. One hundred and thirty-three sputum samples were collected from patients with suspected lower respiratory tract infection. Of the 133 samples, 110(79%) were accepted and 23 (21%) were found to be unacceptable by Bartlett criteria. Potential pathogens were grown in 84 samples in the acceptable category. Normal respiratory flora were grown in 26 samples. Out of 84 samples, 63 samples were positive for bacterial growth and 21 showed fungal growth. Out of 63 bacterial growth, 44 were from in-patients and 19 were from out-patients. Among these bacterial isolates, 23 isolates were followed by 16 isolates were , 10 isolates were , 6 isolates were Staphylococcus aureus, 2 isolates were species, 3 isolates were and 3 isolates were Serratia marcesens. All the sputum samples should be subjected to gram staining before culture to differentiate true pathogens from contaminating flora on culture.

Seroprevalence of transfusion transmitted infections in healthy blood donors in a tertiary care hospital in Puducherry

Introduction: Blood transfusion is both a life saving measure in many medical and surgical emergencies and a source of transfusion transmitted infections. So a provision for strict criteria in recruitment and deferral of blood donors may improve safe transfusion practice. The aim of the study was to estimate the trend in seroprevalence of TTI s among blood donors of both voluntary and replacement donors at a tertiary care teaching hospital in Puducherry, India. Material and Methods: A retrospective study was performed from January 2010 to December 2019 in a blood bank of a tertiary care hospital. A total of 21147 blood units which were collected from both voluntary and replacement donors during the study period were included. Data was analyzed from blood bank records, pertaining to all donors who were screened for HBs Ag, Hepatitis C virus and HIV by using appropriate methods. Results: Out of 21147 blood donors, 514 were positive for TTI s. The overall prevalence of HIV, HBV, HCV and Syphilis was found to be 0.04%, 1.88%, 0.06% and 0.42% respectively. The highest percentage of prevalence was observed for HBV, followed by syphilis, HCV and HIV. Conclusion: Adhering the strict donor eligibility criteria and high sensitive screening methods with effective counselling can decrease the prevalence of TTI’s and help in preventing further transmission of infections in the community.

Patients’ satisfaction survey on healthcare services among non-communicable disease patients at a tertiary care hospital in Puducherry

Background: Patient satisfaction is a scale to assess the services offered by the healthcare system. Patient’s feedback is necessary to identify problems that need to be resolved in improving health services. Aim &amp; Objective: Keeping this in view, the present study is an initiative to estimate the patient’s satisfaction in service provision among NCD patients at a tertiary care hospital of Puducherry. Settings and Design: A Facility-based descriptive cross-sectional study was conducted among NCD patients attending General medicine OPD of a tertiary care hospital of Puducherry between April-June 2019. Methods and Material: Assuming 50% satisfaction level among study participants and 5% non-response rate, the sample size was estimated as 404. The NCD register maintained at the General medicine OPD was considered as the sampling frame &amp; systematic random sampling was applied, so that every 5th patient satisfying the inclusion criteria will be included. A standardized patient satisfaction questionnaire with 31-items (4 domains) which is validated for Indian setting (Cronbach’s alpha 0.96) was used. Statistical analysis used: Data capture was done using Epicollect-5 android application and analysed using SPSS version 16.0. Results: Among the 404 NCD patients, the mean age was 56 ± 11.8 (SD) years and 60.6% were females. One in four patients felt poor in reception, doctor-patient relationship and dispensary services. The overall satisfaction of study subjects categorized as good, satisfactory, poor was 6%, 86% and 8% respectively. Conclusions: Majority of the study participants were satisfied with the service provision of the health facility. Still, there is a scope for improvement in dispensary, doctor-patient relationship and registration services.

Cross-sectional study to assess the awareness about personal hygiene and food borne diseases among food handlers in a tertiary care hospital in Puducherry

Background: Food handlers play an important role in ensuring food safety throughout the chain of production, processing, storage and preparation. Mishandling and disregard of hygienic measures by food handlers may lead to food contamination and cause illness among the consumers. This study was undertaken to determine the knowledge, attitude and practice towards food-borne diseases and personal hygiene among food handlers in a tertiary care hospital and to assess their morbidity status.Methods: A cross-sectional study was conducted among the food handlers working in the food establishments within the campus of Pondicherry Institute of Medical Sciences (PIMS), Puducherry. Total 51 food handlers consented and participated. Participants were explained about the purpose of study and written informed consent was obtained. Data was collected using a pre-tested pre-validated questionnaire. Data was analyzed using SPSS version 17.0. Institutional ethics committee approval was obtained for the study.Results: Overall the average score for knowledge, attitude and practices was good among the food handlers. There was statistically significant association between the lesser attitude &amp; practice scores and the history of gastrointestinal morbidity among the participants. There was positive correlation between the years of work experience and the mean knowledge, attitude and practice scores.Conclusions: Although knowledge, attitude and practices of the food handlers working in the tertiary care hospital was good but periodic health education and awareness will contribute in maintaining and reinforcing the existing knowledge and practices so as to prevent any food contamination and potential outbreak of food borne illness.

Knowledge, attitude, and practice of pharmacovigilance among health-care professionals of a tertiary care hospital in Puducherry - A questionnaire-based study

Background: An efficient pharmacovigilance (Pv) system of any country improves patient care and safety. Lack of awareness among health-care professionals (HCPs) is cited as one of the main reasons along with underreporting of adverse drug reactions (ADRs). Knowledge, attitude, and practice (KAP) studies can help understand various issues and improve Pv system. Hence, this study was designed to assess the KAP of the HCPs in a tertiary care hospital and also to explore reasons for underreporting of ADRs. Aim and Objective: The aim of the study was to evaluate the KAP of the HCPs in a tertiary care hospital and also to explore reasons for underreporting of ADRs. Materials and Methods: A cross-sectional self-administered questionnaire-based study was conducted among 500 HCPs. A pre-validated questionnaire was used containing a total of 20 questions about KAPs toward Pv along with one question to identify the reasons for underreporting of ADRs. Data obtained were analyzed using descriptive statistics. Results: About 59.6% knew what is the definition of Pv. About 63% had knowledge on existence of national Pv program in India. A significant number of participants (>70%) felt that there should be an ADR monitoring center in every hospital and also that its necessary to report ADRs. Even though, more than >60% participants had undergone training in Pv and had experienced ADR in their professional practice only 39.6% of participants reported an ADR. Lack of time (43.4%) was found to be the single most important reasons for under-reporting. Conclusion: Most of the participants did realize the importance of Pv system but were lacking in practice. Hence, regular awareness program and training in ADR reporting could help in bridging this gap.

Correlation of the severity of obstruction in coronary arteries with serum free testosterone level

Background: Coronary artery disease (CAD) is the leading cause of death in India. There was increased incidence and prevalence of CAD in males than in females. There have been several studies going on across the globe to find a similar equation in males between testosterone and CAD. This study aimed at correlating the serum free testosterone level in CAD patients with the severity of obstruction of the coronary arteries proven by coronary angiogram. This was the first study in South India to correlate the serum free testosterone levels with the severity of obstruction of coronaries. Objective: This study was designed to correlate the serum free testosterone level in male patients above 40 years with proven or newly diagnosed CAD with the severity of obstruction of coronary arteries as evidenced from coronary angiogram. Materials and Methods: This was a hospital-based cross-sectional study conducted from November 2015 to August 2017 in a rural-based teaching tertiary care hospital in Puducherry, India. The sample size was 40, calculated using the formula n = 4 × σ2/d2 from the previous study of serum free testosterone in men with coronary artery atherosclerosis done by Lucyna Sieminska et al. Results: Of 40 patients in the study group, 30% had CAD, 20% had hypertension (HTN), 45% had diabetes mellitus, 45% were smokers, 37.5% were alcoholic, and only 5% had family history of (H/o) CAD. In the study, ejection fraction was

Seroprevalence of cytomegalovirus among blood donors at a tertiary care hospital in Puducherry, India. Is testing donated blood for cytomegalovirus a viable option?

Seroprevalence of cytomegalovirus among blood donors at a tertiary care hospital in Puducherry, India. Is testing donated blood for cytomegalovirus a viable option?

A study on malassezia species causing superficial infections among patients attending a tertiary care hospital in Puducherry

Introduction: Malassezia are normal resident flora in humans and are opportunistic in nature. Superficial infections caused by Malassezia include pityriasis versicolor, pityriasis capitis (dandruff), seborrheic dermatitis and folliculitis. Though the manifestations due to Malassezia are trivial, chronicity and recurrence of lesions are associated with social embarrassment and decreased self-esteem. Aims and Objectives: The primary aim of the study was to detect the prevalence of Malassezia among superficial skin and scalp lesions. It also aims to compare Wood’s lamp examination, KOH mount examination and culture for the diagnosis of Malassezia and study the percentage of various species of Malassezia responsible for superficial infections of skin and scalp. Materials and Methods: One hundred samples collected from patients attending the Dermatology outpatient room with superficial infections of skin and scalp. Patients attending Dermatology outpatient room with complaints of hypopigmented / hyperpigmented / erythematous, scaly skin patches and patients attending Dermatology OP with complaints of itchy / non itchy scaly flakes of scalp (dandruff) were included in the study. Results: Among the 100 samples, 77% were Wood’s lamp positive, 64% were KOH positive and 59% yielded growth of Malassezia in culture. Overall prevalence of Malassezia in our study was 59%. In our study, M. globosa was the commonest species (57.62%) followed by M. furfur and M. sympodialis. Conclusion: Prevalence of Malassezia was 59% in our study. Wood’s lamp examination and KOH mount showed more positivity than culture. M. globosa was the most common species in the study. Wood’s lamp and KOH mount can be used for diagnosis of Malassezia in resource poor settings. But culture and speciation should be performed wherever possible to avoid treatment failure and recurrences. Keywords: Culture, Malassezia, Potassium hydroxide mount, Skin scrapings, Wood’s lamp.

A study on knowledge, attitude and practice of biomedical waste management among health care workers in a Tertiary Care Hospital in Puducherry

Introduction: Health care workers (HCWs) are constantly associated with generation, segregation and disposal of biomedical wastes (BMW). Knowledge, attitude and practice (KAP) of BMW management among HCWs are the three determinants used to evaluate the effective functioning of BMW management system of the Institution. Aims: This study aims to detect the degree of knowledge, attitude and practice of BMW management among HCWs in a tertiary care hospital. Materials and Methods: This study included 150 HCWs from five groups (postgraduates, interns, nurses, technicians and sanitary staffs), each group comprising of 30 individuals. They were instructed to tick their response in the questionnaire containing 30 questions (10 questions about each parameter) and were graded as good, average and poor based on individual score. Results: Order of decreasing knowledge and practice seen among the five groups was postgraduates followed by laboratory technicians, interns, nurses and sanitary staffs. Decreasing order of attitude was postgraduates, interns and laboratory technicians with same score, followed by nurses and sanitary staffs. In our study, 81.33%, 86.7% and 69.33% of participants had above average KAP values respectively. Conclusion: Postgraduates and interns had better understanding of BMW management than other groups. Laboratory technicians were better than nurses and sanitary staffs. Sanitary workers were highly ignorant regarding BMW management. So a continuing medical education program on BMW management should be conducted on yearly basis to train and update newly appointed as well as existing HCWs. Keywords: Attitude, Biomedical waste, Knowledge, Practice, Questionnaire.

Pathways to care and diagnostic delay among cervical cancer patients attending a tertiary care hospital in Puducherry: a cross-sectional study

Background: The high mortality among cervical cancer patients in India can be attributed to presentation at advanced stages. The varied and lengthy pathway taken up to diagnosis could be a major reason for advanced stage at presentation. Hence, we aimed to describe the care pathways and diagnostic delay among cervical cancer patients.Methods: A hospital-based cross-sectional study was conducted among 101 cervical cancer patients attending a cancer clinic at a Regional Cancer Center. The histo-pathologically confirmed cases of cervical cancer, who registered in July to October 2018 were approached. Data were collected through personal interviews using a semi-structured questionnaire. Descriptive statistics were used to describe the number of providers visited and diagnostic delay.Results: The median (range) number of providers visited by the patients up to diagnosis was 2 (1-5). As the first point of care, 14% of participants approached sub-center or primary care facilities, 27% approached secondary care facilities, 49% participants approached tertiary care facilities and 11% came directly to a regional cancer center. Diagnosis was made only in 24% of participants at secondary and tertiary care levels. The median (IQR) number of days to get diagnosed was 66 (30-130) days and three fourth of the patients had a diagnostic delay.Conclusions: The diagnostic delay was higher among patients who consulted multiple providers. Implementing a protocol to be followed at all three levels of health care delivery system may enhance the early diagnosis.

Expression levels of candidate circulating microRNAs in pediatric tuberculosis

ABSTRACT Tuberculosis (TB) is a preventable and curable disease, but increased mortality and morbidity associated with TB is one of the leading causes of deaths worldwide. MicroRNAs (miRNAs) are small, non-coding RNAs known to regulate the host immune response against TB. We investigated the expression profile of candidate circulating miRNAs, which could be used as a blood biomarker for the effective diagnosis of pediatric tuberculosis. A cross-sectional comparative study was conducted, including 30 children with active-TB and 30 healthy controls (HC) in a tertiary care hospital in Puducherry. We used the SYBR green-based miScript qRT-PCR assay to analyze the expression levels of miRNAs in plasma. Further, we used the receiver operating characteristic curve (ROC) to evaluate the diagnostic value of miRNAs. Active-TB included 25 (83.3%) pulmonary TB and 5 (16.7%) extrapulmonary TB cases. We found a significant upregulation of miR-21, miR-29a, miR-31, miR-155, and downregulation of miR-146a in children with active-TB compared to HC. The ROC analysis showed an excellent diagnostic value of miRNAs as follows: miR‑31> miR‑155> miR‑146a with AUC of (95% CI) miRNAs 0.978, 0.953, and 0.903, respectively. Altered circulating miRNA expression levels could be involved in the dysregulation of the host immune response to TB. The ROC analysis indicated that miRNAs miR-31, miR-155 and miR-146a could be effective diagnostic biomarkers for the detection of active-TB in children.

A study of prognostic significance of serum magnesium concentration in type ii diabetes mellitus in a tertiary care hospital in Puducherry

A study of prognostic significance of serum magnesium concentration in type ii diabetes mellitus in a tertiary care hospital in Puducherry