Coimbatore Medical College Research Articles

Identification of Risk Factors for Lower Extremity Amputation in Diabetic Foot Ulcer Patients in Coimbatore Medical College: A Prospective Study

Identification of Risk Factors for Lower Extremity Amputation in Diabetic Foot Ulcer Patients in Coimbatore Medical College: A Prospective Study

Study of diagnostic accuracy of non-aspiration cytology in solid tumors

Fine needle aspiration cytology (FNAC) is widely accepted as a primary method for the diagnosis of thyroid lesions. An alternative to FNAC is fine-needle sampling without aspiration (FNNAC). FNAC is easy to perform, quickly and has a high degree of sensitivity and specificity and avoid unnecessary surgery. Hence the present study was performed to study the diagnostic accuracy of FNNAC with FNAC technique in solid tumors.: An observational study was carried out on 325 patients with swellings in the breast, thyroid, and soft tissues and enlarged lymph nodes in the Department of surgical oncology, Regional Cancer Centre, Government Coimbatore Medical college hospital, Coimbatore, India. A single pathologist was responsible for all cytological and histological reports. Slides of both approaches were analysed and compared using Mair et al grading methodology, which depends on five factors. The number of smears with superior quality and diagnostic accuracy is compared and analysed statistically using the 'z' test for two proportions.: FNNAC produced better smears with less haemorrhage in vascular organs like the thyroid. FNAC performed better in breast fibrous lesions such as fibroadenoma and phyllodes tumour. For malignant lumps of breast and lymph nodes, FNAC yields better material than FNNAC.: The current research shows that FNNAC is the superior approach for highly vascular organs such as the thyroid because it yields high-quality smears with less blood admixtures. Although FNAC smears were more often diagnostic, they typically yielded acceptable rather than excellent grade smears.

Brainstem auditory evoked responses in newly diagnosed untreated hypothyroid females

Background: Hypothyroidism stands as a prevalent endocrine disorder, affecting females more than males. Among the array of otolaryngological manifestations linked with thyroid dysfunctions, sensorineural hearing loss emerges as the most frequently encountered issue. Evoked potentials serve as valuable tools extensively utilized in studying brain disturbances. Among these evoked potentials, Brainstem Auditory Evoked Response (BAER) stands out as one of the methods employed for assessing the pathology within the brainstem auditory pathway. Aims and Objectives: The aim of the study is to evaluate the auditory sensory process in the brainstem using BAERs in newly diagnosed untreated hypothyroid individuals. Materials and Methods: Forty newly diagnosed untreated hypothyroid females of 20–50 years were taken as cases and forty age-matched females were considered controls. The hypothyroidism was diagnosed by estimating the serum levels of free T3 (fT3), free T4 (fT4), and thyroid-stimulating hormone. After getting informed written consent, the absolute latencies and interpeak latencies of BAER were recorded using NeuroPerfect EMG 2000 system with installed BAER in the research laboratory, Department of Physiology, Coimbatore Medical College, Coimbatore, and the data were analyzed by student unpaired t-test. Results: The absolute latencies I, III, V and interpeak latencies I- III, III- V, I – V were significantly prolonged in newly diagnosed untreated hypothyroid females (P < 0.0001) and also there was a direct correlation between thyroid profile changes and the BAER latencies. Conclusion: The results of the present study suggest that hypothyroidism impacts the auditory pathway diffusely and early identification of auditory pathway involvement in thyroid hormone deficiency can be achieved using BAER. Prolonged BAER latencies observed in newly diagnosed untreated hypothyroid females are attributed to defective myelination of neural pathways and diminished cerebral metabolism. Hence, integrating BAER recordings into screening protocols could enhance the accuracy and early assessment of neurological involvement in hypothyroid females.

Validity of percutaneous external fixator for calcaneal fractures to allow early weight bearing

Calcaneum, the most common tarsal bone to fracture affecting manual labourers who were sole breadwinners of the family. Generally treated with below knee pop and ORIF, commonly associated with complications and delayed weight bearing. This study analyses functional outcome of early weight bearing with minimally invasive skeletal stabilisation of calcaneal fractures.This study was conducted at Institute of orthopaedics and traumatology, Coimbatore medical college and Meenakshi medical college hospital and research institute, Kanchipuram between July 2019 to October 2021. 15 patients in age group 20-65 years with 19 calcaneal fractures less than 4 weeks duration are included in study.Surgery averaged 1.6 days after injury. Full weight-bearing was achieved in 11.7 days for unilateral calcaneal fractures (range 9 to 15 days) and 43.5 days for bilateral fractures (40 to 49 days). Patients returned to work in 35.6 days on average (range 24 to 52 days). All 19 calcaneal fractures healed in 52.63 days. External fixator removal averaged 56.57 days. Two patients had postoperative pin site infections. No bones were infected. Six-month AOFAS scores averaged 86.15.In our study calcaneal fractures are fixed with mini external fixator percutaneously and it can be used in presence of compound fractures and with skin blisters. Though anatomical reduction cannot be attained completely weight bearing is possible from 2nd day after surgery and full weight bearing was possible in 2nd week. The limitations of our study include a smaller number of cases. A large multi-centric study may be necessary to confirm our results.

Medical teacher in Tamil Nadu government sector: A role model for youngsters in India

Introduction: Government hospitals in India generally have a negative opinion among pubic due to lack of sanitation and facilities but in Institute of orthopaedics and traumatology, Coimbatore government medical college hospital headed by Prof. Dr. S. Vetrivel Cherian is having facilities and patient care in par with corporate hospitals. Aim of the article is to teach and inspire young doctors about the methods and innovations adopted by him for the welfare of patients.Materials and Methods: As a retrospective study from 2000–2022, the efforts of Dr. S. Vetrivel Chezian in the public sector and how he expanded the orthopaedic medical services at Coimbatore Medical College are covered in detail.Discussion: He revolutionized trauma care services by leg bone surgery fracture fixation within 6 hours of admission even during covid 19 pandemic. He established modern lightweight artificial limb centre during covid-19 pandemic for the welfare of differently abled people without direct expenditure to the government under AB PMJAY thus making Coimbatore the first district in India with no waiting list for artificial limbs. He improved new born and children care by prevention and surgical correction of foot deformities (Clubfoot) every Thursday even during covid-19 pandemic and established ward for no attender destitute patients for the first time in India. He upgraded department of orthopaedics to Institute of orthopaedics and traumatology and improved patient care by providing various amenities. He also had passion for teaching which enabled him to publish books and encouraging post graduates by giving medals.Conclusion: Various initiatives taken by Prof. Dr. S. Vetrivel Chezian not only improved the patient care but also changed the perception about government hospitals among public and also his actions serve as a role model for young doctors.

Hemodynamically stable very low birth neonates weight gain is affected by the early initiation of full enteral feedings compared to standard feeding.

Premature babies need to develop similarly to fetuses of the same gestational age. The majority of premature neonates experience a growth-restricted status while in the patent ductus arteriosus (PDA). Extrauterine growth failure is a significant barrier for infants with very low birth weight (VLBW). The study was conducted for six months at the Neonatology Unit, Department of Pediatrics, Coimbatore Medical College Hospital, Coimbatore, Tamil Nadu, India. Neonates with VLBW who met the inclusion criteria were assigned randomly to one of two feeding strategies, that is, full enteral feeding or partial feeding, based on the randomization sequence discovered by opening the sealed cover. The duration of stay, weight variation, neonatal variables, feeding intolerance, necrotizing enterocolitis (NEC), septicemia, apnea, newborn hyperbilirubinemia, PDA, hypoglycemia, intracranial bleeding, and mortality of neonatal recruits were all carefully evaluated. Two thousand two hundred eighty-four neonates were hospitalized throughout the six-month trial period, and 408 had low birth weight. Three hundred forty-two babies were eliminated from the study due to hemodynamic instability, persistent respiratory distress, infections, metabolic issues, and congenital abnormalities. Sixty-six babies met the study's inclusion criteria, and thus participated in the study. Sixty-six newborns weighed between 1.251 and 1.500 kg. Randomly assigning intervention and control groups. Thirty-three newborns were assigned to group A (intervention) and another 33 to group B (control). The study concluded that enteral feeding was effective, inexpensive, secure, and feasible. Early full enteral feeding reduced septicemia and infant hyperbilirubinemia. Thus, we must start enteral feeding as soon as possible to avoid inadequate nutrition in neonates with VLBW during a crucial growth period.

Analysis of Conventional and Nonconventional Risk Factors, Clinical Profile and Angiographic Correlation in Young Myocardial Infarction at Tertiary Care Centre

Background: CAD in the young require special attention as the clinical profile, risk factors and prognosis are different from that in older patients. Method: The present study is an attempt to evaluate acute myocardial infarction in young individuals (<40 years of age) undergoing coronary angiography (CAG). A total of 290 patients aged 40 years or younger who underwent CAG in the Department of Cardiology, Coimbatore medical college hospital between December 2019 to February 2021 were included in this study. Demographic characteristics, risk factor profile, laboratory test results, ECG and echocardiographic findings, CAG findings, and in-hospital mortality were as­sessed. All subjects completed the Hospital Anxiety and Depression Scale (HADS) to assess anxiety levels or presence of depressive symptoms as a potential risk factor among young patients. Results: The mean patient age was 35.6 ± 4.4 years. Men made up 87.2% of the study sample. STEMI was present in 84 % of acute MI while remaining had NSTEMI. CHF (Killip class II or III) was present at hospital admission 14.4% patients. Angiographically normal coronary arteries were found in 4% of patients with the diagnosis of ACS. The most common location of significant atherosclerotic coronary lesions was the left anterior descending artery (60.1%) followed by the right coronary artery (32.4%). The most prevalent were conventional cardiovascular risk factors followed by anxiety/depression, a family his­tory of CAD. The findings showed that 32% of the respondents had anxiety caseness and 40% had depression caseness. Conclusion: Significant risk of CHF on presentation and STEMI most common cases. Modifiable risk factors constitute primary etiology with less commonly evaluated cause as anxiety and depression need to be monitored regularly, provide regular counselling services. 4.0% revealing normal coronaries suggesting microvascular dysfunction important process other than atherosclerosis. Keywords: [young MI, nonconventional risk factors, STEMI, coronary angiogram]

ACUTE MYOCARDIAL INFARCTION IN YOUNG INDIVIDUAL: THE STARTLING REALITY OF CORONARY PROGERIA

Objective: To study the epidemiology and clinical silhouette, risk prole, angiographic patterns, management, and long term outcomes of Corononary artery disease presenting as an ACS(cute coronary syndrome) in young individuals of age less than 40 years presenting to our tertiary care centre. Methods: We incorporated 251 patients aged less than 40 years who presented with ACS (STEMI or NSTEMI/UA) to the department of cardiology Coimbatore Medical College, Coimbatore. Results: 251 young patients aged 40 years or less who presented with ACS were included in the study. Smoking turned out to be the most deadly risk factor and was associated with the most number of cases present in 68% of cases. Next in line was diabetes (54%) and family history (48%) of cases. 54% patients were reported to be having signicant depression.Hypertension (44%)and dyslipidemia (40%) were also seen in a large proportion of cases. Most of the cases presented as STE-ACS (80%) and other presented as NSTE-ACS(20%). Out of 251 patients 178 patients underwent CAG, of all the patients undergoing Coronary angiogram most recurring angiographic prole was that of being Single vessel disease (65%) mostly involving the LAD. There was in-hospital mortality of 4 patients, one of which had presented with concomitant diabetic ketoacidosis. Most common complication of the patients was Cardiogenic shock which occurred in 22% of the patients, while 18% of them had post MI period complicated by Arrhythmias. Conclusions: STE-ACS was the most common presentation of ACS in the young population. Smoking was the most common risk factor. The majority of the patients had single-vessel disease. Our study concluded that modiable risk factors are the most penetrative factors which could be dealt with in an ideational manner to reduce the relative risk of CAD in young

A prospective study on variations in haematological parameters in pulmonary tuberculosis

: In India tuberculosis is a communicable infectious bacterial disease caused by Mycobacterium tuberculosis causing major public health problem. The present study is a prospective study of various haematalogical parameters in sputum positive pulmonary tuberculosis.: The study included thirty patients of fresh pulmonary tuberculosis with sputum positive for acid fast bacilli (AFB). It was conducted for a period of three months in the institution of Coimbatore medical college hospital. The various hematological parameters were analyzed by means of automated cell counter and peripheral smear examination. The smears were stained with Ziehl Neelsen stain used to identify acid-fast organisms mainly mycobacteria. : The study included 30 cases of newly detected pulmonary Tuberculosis patients who were positive for acid fast bacilli out of which 6 were females and 24 were males. Maximum number of cases were found in between 40-60 years of age. The commonest hematological findings were anemia 100% then raised ESR 93.33%, followed by, thrombocytosis 16.66%., neutrophilia 56.66%, leukocytosis 56.66% and lymphocytosis 6.66%. The commonest peripheral smear picture was microcytic hypochromic anemia 63.33% followed by normocytic normochromic anemia 30% then macrocytic anemia 6.6%.Various changes in haematological parameters has been observed in patients with patients who are sputum positive for pulmonary tuberculosis. The present study is being done to evaluate the hematological profile in tuberculosis and analyse the variations in hematological manifestations. These parameters acts as a valuable tool to reduce the morbidity and mortality thus aids in improving then prognosis in patients with pulmonary tuberculosis.

An analytical study on the ocular manifestations of autoimmune blistering skin disorders, in patients attending a tertiary care hospital

Autoimmune blistering skin diseases are a heterogeneous group of diseases that have as their common feature autoantibodies directed against desmosomal structural proteins. They can sometimes affect the eye, with manifestations ranging from mild to potentially vision threatening. To evaluate the spectrum and incidence of ocular manifestations and to analyze whether early ophthalmological examination will be beneficial in reducing ocular morbidity.rn Hospital based analytical study conducted at Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu. This study involved 100 patients diagnosed with autoimmune blistering skin disorder attending Dermatology and Ophthalmology outpatient department and included a comprehensive ocular examination of the patients. The collected data were analysed with IBM.SPSS statistics software 23.0 Version. To find the association of significance in categorical data the Chi-Square test was used. In the above statistical tool, the probability value .05 was considered as significant level. Autoimmune blistering skin diseases were associated with a significant proportion of ocular manifestations, of which in this study, dry eye and conjunctivitis were the most common. Dry eye and conjunctivitis were the most common ocular manifestations in this study. Though none of the patients had vision threatening manifestations, a comprehensive ocular examination and follow up of these patients is necessary.

Significance of HER2/neu Expression in Oesophageal Carcinomas and its Association with the Histopathological Grading

Introduction: Oesophageal carcinomas are one of the most aggressive human malignancies which are associated with a poor prognosis because most of the cases are in stage 2 or 3 at the time of diagnosis with a high frequency of lymph node metastases. It is important to know the prognostic factors can help us on therapeutic decisions and improve the survival of these patients. A member of Epidermal Growth Factor Receptor (EGFR) family, Human Epidermal Growth Factor Receptor 2 (HER-2/neu) is a very useful antigenic marker expressed in oesophageal carcinomas which has increasing evidence of therapeutic significance. Aim: To determine the immunological expression of HER2/ neu in oesophageal carcinomas and associate it with the histopathological grading. Materials and Methods: This cross-sectional study was conducted in Department of Pathology at Coimbatore Medical College, Coimbatore, Tamil Nadu, India, from January 2015 to February 2016. Total 30 cases of histologically proven oesophageal carcinomas were subjected for HER2/neu immunoexpression. Membranous staining was considered as positive and the intensity of staining was scored and compared with various histopathological parameters. The p-value<0.05 using a two-tailed test was taken as level of significance for all statistical tests. Results: Among 30 cases, 24 were squamous cell carcinomas and six were adenocarcinomas. Out of 24 cases of squamous cell carcinomas, there were 20 males and four females. All the six adenocarcinoma cases were males. HER2/neu was positive in 10 cases(41.6%) of squamous cell carcinoma and 4 cases(66.6%) of adenocarcinoma. It was seen in 10% of well differentiated, 60% of moderately differentiated and 80% of poorly differentiated carcinomas. There was significant correlation with staging and lymph node metastases. Higher grade tumours had higher level of expression of HER2/neu. Conclusion: The HER2/neu immunoexpression was significantly higher with progression of tumour grade. Hence, such patients with high grade oesophageal carcinomas and with lymph node metastases could be benefitted with targeted therapy

EPIDEMIOLOGY OF HEAD INJURY- LEVEL 1 TAEI CENTRE STUDY

Introduction: Head injury affects over 60 million people every year which causes mortality and morbidity. Of all the injuries, head injury accounts for most cases of death and disability. Sixty-nine million individuals worldwide sufferred from head injury in 2018. As the time progresses there is observable increase in rates of Head injuries. Hence this study focuses on this aspect of injuries in a level 1 TAEI centre. Research studies from TAEI centre are sparse as of now and this study will be a helpful tool for illumination of further research and development which will be useful in reducing public health burden. TAEI (Tamilnadu Accident and Emergency Care Initiative) : Tamilnadu Government have initiated TAEI centres along the National and major State highways. This is in co-ordination with 108 free ambulance service, Government hospitals and CMCHIS schemed private hospitals. It provides immediate and free treatment to the trauma patients. Aim : To study the Epidemiology of Head Injury in level 1 TAEI centre, Coimbatore medical college and hospital, Coimbatore. Materials And Methods: This study is a prospective study covering all head injury cases admitted from November 2020 - January 2021 in level 1 TAEI centre, Coimbatore medical college and hospital, Coimbatore. The treatment is initiated upon arrival in Zero delay ward and they are triaged by TAEI team. These patients are treated according to the protocol of Department of Neurosurgery. This study covers the management, discharge and follow up of these patients. Results: The admitted head injury patients in TAEI ward are 1319 cases out of 1750 trauma cases. Among them RTA tops head injury mortality and morbidity. Among RTA, Two wheeler associated injuries were most common. Drunken drive, not wearing helmets and protective gears played a vital role in head injuries. Conclusion : The primary prevention can be the key to reduce the national burden of head injuries.

EPIDEMIOLOGY OF HEAD INJURY - A LEVEL 1 TAEI CENTRE STUDY

Head injury affects over 60 million people every year which causes mortality and morbidity. Of all the injuries, head injury accounts for most cases of death and disability. Sixty-nine million individuals worldwide suffered from head injury in 2018. As the time progresses there is observable increase in rates of Head injuries. Hence this study focuses on this aspect of injuries in a level 1 TAEI centre. Research studies from TAEI centre are sparse as of now and this study will be a helpful tool for illumination of further research and development which will be useful in reducing public health burden. TAEI ( Tamilnadu Accident and Emergency Care Initiative ) : Tamilnadu Government have initiated TAEI centres along the National and major State highways. This is in co-ordination with 108 free ambulance service, Government hospitals and CMCHIS schemed private hospitals. It provides immediate and free treatment to the trauma patients. Aim : To study the Epidemiology of Head Injury in level 1 TAEI centre, Coimbatore medical college and hospital, Coimbatore. Materials and Methods : This study is a prospective study covering all head injury cases admitted from November 2020 - January 2021 in level 1 TAEI centre, Coimbatore medical college and hospital, Coimbatore. The treatment is initiated upon arrival in Zero delay ward and they are triaged by TAEI team. These patients are treated according to the protocol of Department of Neurosurgery. This study covers the management, discharge and follow up of these patients. Results : The admitted head injury patients in TAEI ward are 1319 cases out of 1750 trauma cases. Among them RTA tops head injury mortality and morbidity. Among RTA, Two wheeler associated injuries weremost common. Drunken drive, not wearing helmets and protective gears played a vital role in head injuries. CONCLUSION : The primary prevention can be the key to reduce the national burden of head injuries.

Coimbatore model: A role model for other medical colleges in India to start modern light weight artificial limb production centre without expenditure to government under Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana

Introduction: The Common locomotor disability in modern India is due to loss of limb. In India, Most of the people who have lost their limbs are from below poverty line. The primary aim is to start a modern lightweight artificial limb production centre with the available resources without expenditure to the government. Materials and Methods: The lightweight artificial limb production centre was established during Covid-19 pandemic in July 2020 at the Institute of Orthopaedics and Traumatology, Government Coimbatore medical College Hospital, Coimbatore without expenditure to the government. Result: The first transtibial light weight artificial limb prosthesis was fitted to a lady who had lost her limb due to diabetes mellitus on 15th august 2020 under AB PMJAY-TN CMCHIS. The modern light weight artificial limb production centre work was initiated and completed within 60 days during the Covid pandemic. Even during Covid pandemic, 45 beneficiaries enjoyed freedom of living on their own by the dedicated team work under AB-PMJAY. the Coimbatore model is profitable to the government institution. Discussion: Coimbatore is the first lightweight artificial limb production centre without expenditure to the government. The light weight artificial limb prosthesis package is available in AB-PMJAY. Hence the money is generated through their AB-PMJAY package. The generated money is not only useful for recurring expenditure but also used for infrastructure developments and repaying the money to start light weight artificial limb production centre. Conclusion: In Coimbatore model, the so-called expenditure concept is converted into money generation concept which is useful for infrastructure development of Government Coimbatore Medical College Hospital. Hence this model can be taken up as a profitable role model to start light weight artificial limb production centre in other government medical college hospitals in India without expenditure to the government.

Is congenital isolated club foot heritable? A study from India

Background: Club foot is a very common and serious birth defect affecting one of every 1000 live births. Substantial progress has been achieved in the management and diagnosis of limb defects; however, not much is known about the genetic basis underlying talipes equino varus disorder. This study was undertaken to find out the prevalence of single nucleotide polymorphisms in PITX1 gene that are associated with isolated clubfoot babies in Indian population. Materials and Methods: The study was done at Institute of Orthopaedics and Traumatology (IOT), Multidisciplinary Research Unit (MRU) Coimbatore Medical College and Hospital during the period of December 2019 to June 2020 after ethical committee clearance. Fifty isolated clubfoot babies were included in the study group of which 32 were male and 18 were female.23 babies had bilateral club foot, 18 had right sided and 9 had left sided club foot. Results: The Chr5:135031277 C>T type mutation is 2.26 times more likely to happen than the Chr5:135031290 C>T mutation group in Indian population. The z-statistics which tested the odds ratio is 1.992 which is significant as the probability is less than 0.05 (P=0.0463). Conclusion: A larger multicenteric study should be conducted in other regions of India to prepare more specific gene to be associated with club foot. We hope this study will encourage future studies and aid in improving the genetic knowledge of club foot in India. Keywords: Club foot, PITX1 gene, Single nucleotide polymorphism, Talipes equino varus.

Enigma Still Unconquered- Ectopic Pregnancy

Background: A ruptured ectopic pregnancy is a true emergency and remains the leading cause of pregnancy related deaths worldwide. The objective is to study the clinical profile of ectopic pregnancy in a tertiary care hospital. Methods:A retrospective study conducted at Coimbatore Medical College Hospital from Jan 2019 to Dec 2020. A total of 149 patients with ectopic pregnancy were analysed on patient characteristics, risk factors, intraoperative findings and treatment modality. Results: A majority of patients with ectopic pregnancy (64.5%) did not have any risk factors, while 33.5% had predisposing risk factors associated with ectopic pregnancy. Most common presentation was ruptured tubal ectopic and the commonest site was ampulla (85.9%). There was 1 maternal death out of 149 cases reported (0.67%). Conclusion: Ectopic pregnancy still remains one of the major causes of maternal morbidity and mortality. Early diagnosis and referral in hemodynamically stable state along with use of minimal access surgery or medical management can change the scenario of ectopic pregnancy in the developing world.

CORRELATION OF MEAN PLATELET VOLUME WITH GLYCEMIC INDEX IN PATIENTS WITH TYPE II DIABETES MELLITUS – AN OBSERVATIONAL STUDY

Type II Diabetes mellitus (TII DM) is a major global health problem. TII DM is characterized by the prothrombotic state of platelets which owes to the persistent hyperglycemia and insulin resistance, causing injury to pericytes and endothelium. Increased platelet activity is believed to be associated with the development of vascular complications in TII DM. Mean Platelet Volume (MPV), a marker of platelet function which can be used to assess the vascular complications. This is an observational study including 150 TII DM patients attending Diabetology OPD in Coimbatore Medical College& Hospital. MPV, FBS, PPBS, HBA1c were signicantly elevated in TII DM patients. Mean FBS, PPBS, HBA1c, MPV were 188.84±91.50mg/dL, 281.10±104.51mg/dL,8.56±2.25 %,9.66 ± 2.02fL, respectively. MPV showed a signicant positive correlation with FBS, PPBS, HBA1c. MPV showed more strong correlation in patients with HBA1c >7% than in patients with HBA1c ≤7%. Our study showed that in Type II Diabetes Mellitus patients, Mean Platelet Volume (MPV) is increased. MPV is signicantly increased in patients with high HBA1c level. Thus, MPV can be taken as a simple and a cost-effective parameter in assessing the Glycemic control in TII DM patients.

Socio-Demographic Profile of Fatal Poisoning in a Tertiary Care Teaching Hospital of Coimbatore District-A Retrospective Study

Background: Poisoning poses a major public health problem mainly in developing countries. Because ofthe rapid industrialization and advancement in agricultural sector, fatality by poisoning also increases dayby day. The aim of this study is to determine the socio-demographic profile of fatal poisoning in CoimbatoreDistrict. Methods: This retrospective study was carried out in Department of Forensic Medicine, CoimbatoreMedical College, Coimbatore, Tamil Nadu with data obtained from fatal poisoning cases brought forpostmortem examination from January 2016 to December 2016. Identification of specific poisons were donewith chemical examiner’s report. All collected data were analyzed in various possible aspects in the preparedproforma. Results: During the study period the total number of medico legal autopsies conducted were 3675out of which fatal cases due to poisoning were 600(16.33%) cases. The study showed that the incidence ofpoisoning was more common among married men ie.303 cases (50.5%) out of 600 total number of poisoncases. The incidence was more common in the age group 31 – 40 years in males (86 cases) which formed14.3 % and in females it is 21-30 years (65 cases) which formed 10.8%.When we observed the religion wisedistribution, Hindu males out numbered 369 out of 600 cases which formed 61.5%. Conclusion: Morbidityand mortality due to poisoning can be minimized by health education, early referral, establishment oftoxicological units for detection of specific poisons and appropriate guidance for proper management ofpoisoning cases at hospitals and primary health care centers.

Nail Patterns in Papulosquamous Disorders- An Observational Study from Southern India

Introduction: Nail changes are always a cause of physical handicap and psychological stress in this era where utmost importance is given to cosmetic appearance. Other than trauma and infections, Papulosquamous disorders are major contributor to nail changes. Thorough knowledge of their patterns will aid in early detection and treatment before irreversible damage to nails occurs. Aim: To observe the clinical patterns of nail changes in various papulosquamous disorders. Materials and Methods: This observational descriptive cross- sectional study was conducted in a tertiary care set up at Government Coimbatore Medical College, Coimbatore from June 2016 to June 2017. The study group comprised of 104 cases of various papulosquamous disorders. The type of papulosquamous disorder, presence of nail changes, their onset, duration, various patterns and associated co-morbidities were noted in detail. The observed data were entered in Microsoft Excel and data analysis was done in Epi Info system. Results: Out of the 104 cases taken for study 71 (68%) had nail changes. Majority of them were in 31-45 years age group (n=29; 41%). More of males (n=38, 54%) had nail changes than the females (n=33, 46%). Psoriasis (n=47; 66%) was the most common papulosquamous disorder with nail changes followed by lichen planus (n=9; 13%) and pityriasis rubrapilaris (n=7; 10%). Pitting of nails was the most common nail pattern (n=44; 62%), followed by subungual hyperkeratosis (n=24; 34%), thickened nail plate and longitudinal striations (both n=19; 27%). Finger nails were more affected than toe nails. Psoriasis and pityriasis rubrapilaris had 100% nail involvement. The patterns of nail changes were maximum in psoriasis and lichen planus. Beaus lines was observed in most of the papulosquamous disorders except Lichen nitidus and Lichen striatus. The time gap for onset of nail changes was longer for psoriasis (4.2 years) and shorter for pityriasis rosea (two months). In lichen striatus and lichen nitidus, nails were involved only in children. Minimal nail changes were observed in para psoriasis and pityriasis lichenoides. More number of co-morbidities like diabetes, hypertension, atopy and arthritis were seen in psoriasis. Conclusion: In the present study, it was observed that the nail changes were more common in psoriasis, lichen planus and pityriasis rubra pilaris among the papulosquamous disorders. The highly frequent nail patterns were pitting and subungual hyperkeratosis.

Prognostic importance of hyponatremia in acute st- elevation myocardial infarction

BACKGROUND AND OBJECTIVE: Hyponatremia is the most common electrolyte disorder in clinical settings and in hospitalized patients, and is found to be the most important predisposing factor of cardiovascular mortality among patients with heart failure. The fact is that the neuro humoral activation is similar to both acute myocardial infarction and heart failure. So our aim is to investigate the prognostic importance of hyponatremia in acute ST elevation MI and to establish its usefulness in predicting short term survival. MATERIAL: From June 2013 to June 2014, around 100 patients who presented with acute ST-elevation MI admitted in ICCU of Coimbatore Medical College Hospital, Coimbatore was studied. METHOD: 100 consecutive patients who were selected underwent detailed history and clinical examination. Their Plasma sodium concentrations were obtained on admission and at 24, 48 and 72 hours after that. The end point was to find the cause which caused mortality within 30 days following myocardial infarction. RESULTS: The result of this study was found to be that, the proportion of patients who presented with acute ST elevation MI were hyponatremic at the time of admission or developed hyponatremia after admission. The 30 days mortality ratio was found to be high in hyponatremic group than normal group. There was also evidence that the severity of hyponatremia and mortality were having significant linear relationship. Multivariate analysis performed also showed that the significant independent predictor of 30 days mortality was identified as hyponatremia on admission or early development of hyponatremia. CONCLUSION: By this study we conclude that hyponatremia at the time of admission or shortly after that in patient with acute ST elevation MI is an independent predictor of 30days mortality. A simple marker to find patients at risk is Plasma Sodium Levels.