Coimbatore Medical College Research Articles

Epidemiological profile of cancer patients attending tertiary care teaching hospital: a record based retrospective study

Background: Cancer, the second leading cause of death worldwide is one of the most dreaded non-communicable diseases. Cancer incidence and demographic data form an important basis for cancer prevention. However, the data available through cancer registries are limited. Thus, the present study aimed to describe the epidemiological profile of cancer patients registered in our hospital.Methods: A record based retrospective study was done assessing the records of the cancer patients, admitted during the year 2017 at Coimbatore Medical College Hospital. The data collected included the epidemiological information like demographic details, place distribution and the type of cancer.Results: A total of 1192 confirmed cases of cancer were studied. Among the study subjects, 1014 (50.9%) patients were male and the age group of 50-69 had the maximum percentage of cancer cases (1121 cases, 56.3%). Most cases came from western Tamil Nadu (1138 cases, 95.5%) and majority of them belonged either to lower (560 cases, 46.6%) or upper lower class (548 cases, 45.9%). The lip, oral cavity and pharynx was the type of cancer having the maximum number of cases (429 cases, 36%) and had high proportion in comparison with world level and national statistics. Nearly 57% cases presented with regional extent of disease.Conclusions: The epidemiological factors leading to high incidence of cancer should be analysed and steps towards cancer prevention should be initiated by altering the associated risk factors.

Evaluating the efficacy of platelet rich plasma injection for the treatment of chronic plantar fasciitis

Background: Plantar fasciitis is a common and recurring cause of heel pain in adults. Platelet-rich plasma (PRP) derived from autologous blood contains a high concentration of growth factors necessary for tissue healing and offer potential treatment for plantar fasciitis. Materials and Methods: The study was conducted in Coimbatore medical college hospital as a day care procedure. Between May and September 2017, 100 patients with chronic plantar fasciitis with a mean age of 40 years were included in this prospective study and were treated with single autologous PRP injection. All patients were assessed for the pain on the visual analog scale (VAS) and the American orthopedic foot and ankle score (AOFAS) both preinjection and postsingle injection of PRP. Results: The average pain perception before injection as assessed using VAS was observed to be 9.1. Before PRP injection, 72% of patients had severe limitation of activities and 28% of patients had moderate limitation of activities. Following the administration of PRP, VAS decreased to 1.6. Eighty-eight patients were completely satisfied; eight patients were satisfied with reservation, whereas four patients were unsatisfied with the treatment outcome. AOFAS improved from 52 to 90, thus establishing its therapeutic efficacy both at 8 weeks and 3 months posttreatment. Conclusion: The results of this study support that injection of autologous PRP is safe, does not affect the biomechanical function of the foot and is efficacious in improving plantar fasciitis.

Role of platelet rich plasma in osteoarthrosis of knee joint among south Indian populaton

Aim: The purpose of this prospective study is to clinically evaluate the efficacy of treatment for knee osteoarthrosis using platelets rich plasma injection. Materials and Methods: This study was performed between January 2018 and June 2018 at the Government Coimbatore Medical College and Hospital as a day care procedure. Eighty patients with knee osteoarthrosis are treated with platelet-rich plasma and studied. Primary data collection was performed using questionnaire tool VAS and WOMAC. Results: All patients in this study completed a questionnaire on pre-injection, 8 weeks post-injection and12 weeks follow up visits using the VAS andWOMAC score. After 3 months the VAS score was 1.8 (p and the WOMAC score improved from 78 to 32 (p Conclusion: This study suggests using platelet rich plasma in osteoarthrosis of the knee joint as a cost effective and less complicated approach to relieve pain and improve day to day activities. Keywords: Knee osteoarthrosis, Knee joint, Platelet rich plasma.

Role of Magnetic resonance imaging in diagnosis, staging and follow up of patients with carcinoma cervix

Materials and Methods: From June 2017 to June 2018, 70 patients (both new and treated) who were histopathologically diagnosed cases of carcinoma cervix and referred to the Department of Radiodiagnosis, Coimbatore Medical College were included in the study. Conclusion: Magnetic Resonance Imaging scored better than clinical techniques and other imaging methods in staging of carcinoma cervix and assessing its recurrence. Hence, Magnetic Resonance Imaging can be used as a single best investigation for local staging in carcinoma cervix, obviating the need for multiple invasive procedures.

Role of MR imaging in diagnosis, staging and follow up of patients with carcinoma cervix

Role of MR imaging in diagnosis, staging and follow up of patients with carcinoma cervix

Impact of Tamil Nadu accident and emergency care initiative (TAEI) programme on orthopaedic emergency fixation: Lesson from Coimbatore for low income countries

Introduction: Tamil Nadu accounted for 10.1% of the road traffic accidents in India. In a view to reduce the mortality and morbidity of trauma patients the Government of Tamil Nadu have come with an innovative idea of “Tamil Nadu Accident and Emergency care Initiative (TAEI)” programme in 2016. This study done at our Institute of orthopaedics and traumatology, Coimbatore medical college hospital analysis the impact of TAEI on various aspects before and after its implementation.Materials and Method: This is a comparative study and the study period was from January 2017 to November 2019. The emergency orthopaedic trauma patients treated before implementation of TAEI in 2017(January –November) was analysed with after implementation of TAEI in 2019(January –November). We also compared the performance of the CMCHIS before and after the implementation of the TAEI programme. Results: The total emergency surgeries done before the TAEI implementation in 2017 were 732 cases and after TAEI implementation in 2019 were 1053 patients. The total number of intramedullary interlocking nailing done in emergency orthopaedic theatre before and after TAEI was 5 and 155 cases respectively. The total number of external fixator done before and after TAEI was 119 and 184 respectively. The total number of beneficiaries from the CMCHIS before TAEI before and after TAEI was 558 and 975 respectively.Conclusion: The TAEI programme is found to have a major impact on the emergency orthopaedic trauma care in various aspects and also helped in generating more fund for the Government of Tamil Nadu.

Comparative anthropometry analysis of the digital X-rays of the right and left hip joints in an Indian population

Background: Population-specific anthropometric analysis of hip joints has vital clinical and surgical implications including adoption of optimal preventive measures and selection of effective prosthesis. Hence, in this study, we determined the anatomical variance between the right and left hip of the patients referred to our orthopedic unit. Materials and Methods: Five hundred patients with a normal hip joint attending the Institute of Orthopedics and Traumatology Unit of Coimbatore Medical College Hospital, Coimbatore, India, were included in this study. Plain radiographs were taken to measure the neck-shaft angle (NSA), head diameter (HD), neck width (NW) of the right and left femur, and the values were compared with data reported in the literature for various other population. Results: The mean value of NSA (134.2°), HD (42.9 mm), and NW (28.2 mm) in the study population differed when compared with data reported in the literature for the Western and other Indian population. Significant changes were also observed between the right and left sides of the hip joint in the study population. Conclusion: This study concludes that significant differences exist between the right and left side of hip joint in the study population. Further the values observed in our study population were considerably different from the values reported in the literature for the Western population.

CONDITIONS FAVORING SUCCESSFUL REINTERVENTION FOLLOWING LOWER LIMB GRAFT THROMBOSIS

16Dec 2019 CONDITIONS FAVORING SUCCESSFUL REINTERVENTION FOLLOWING LOWER LIMB GRAFT THROMBOSIS Elancheralathan K. and Deepan Kumar B Department of Vascular Surgery, Tirunelveli Medical College and Hospital, Tirunelveli Department of Vascular Surgery, Coimbatore Medical College and Hospital, Coimbatore

Morphological spectrum of lesions in renal biopsies with diagnostic role of Immunofluorescence

Background: Renal diseases are common causes of morbidity in clinical practice and their incidence is on rise. Glomerulonephritis constitutes nearly 60% of all non-surgical renal diseases and accounts for a substantial number of cases of end stage renal disease. Objectives: This study was done to analyse the histomorphology of renal diseases. Specific immunofluorescence patterns were also studied as an aid to diagnose various lesions. Materials and methods: This study was done for a period of six months between January 2017 and June 2017. A total of 30 renal biopsies were received in the Department of Pathology, Coimbatore Medical College, Coimbatore. The tissues were subjected to light microscopic examination and immunofluorescence studies. Results: Among the total 30 renal biopsies, the most common age group affected was between 31 years and 40 years. The most common age group affected was between 31 years to 40 years. Females (51.72%) were slightly more affected than males (48.27%). Out of 30 cases, 23 (79.31%) showed primary glomerular lesions, 5 (17.24%) showed secondary glomerular lesion and 2 (3.45%) showed tubulointerstitial nephritis. Diffuse proliferative glomerulonephritis was the most common primary glomerular lesion with a total of 6 out of 30 cases (22.41%). Lupus nephritis was the most common secondary glomerular lesion with a total of 4 out of 30 cases (12.07%). Immunofluorescence studies showed positivity in 21 patients accounting for 72.41%. The predominant pattern was granular glomerular basement membrane which was noted in 9 patients (31.03%). The diagnostic utility of IF was noted in 2 cases (6.90%) whose diagnoses included IgA nephropathy and C1q nephropathy. The IF studies helped in modification of the final diagnosis in 1 case (1.72%) whose final diagnosis was lupus nephritis class I. Conclusion: Immunofluorescence studies have complemented the clinical, histomorphological findings in patients both in primary and secondary glomerular diseases. However, it was even more of diagnostic importance in 5 patients including IgA nephropathy, C1q nephropathy and Lupus nephritis class I where a confident diagnosis could be rendered only because of availability of immunofluorescence studies. Hence, immunofluorescence studies when combined with histomorphologic findings by light microscopy, clinical, biochemical and serological markers can yield a better and precise diagnosis.

The visual outcome and surgical complications in posterior capsular rupture following cataract surgery with scleral fixated intraocular lens in tertiary care centre – A prospective study

Aim: To analyse the complications as well as the long term functional and visual outcomes of anterior vitrectomy with scleral fixated posterior chamber intraocular lens implantation in patients with inadequate posterior capsular support. Settings and Design: This was a prospective study done at Coimbatore Medical College Hospital, Coimbatore during the period of May 2016 to December 2017. Materials and Methods: 30 eyes of 25 aphakic patients and 5 patients who had primary scleral fixated IOL implantation were included in the study. Anterior segment examination with slit lamp, preoperative visual acuity, intraocular pressure, fundus examination and IOL power calculation was done. Results: Scleral fixation of IOL is a safe procedure with a success rate of 93% and most of the intraoperative and postoperative complications were minor. Postoperative best corrected visual acuity of 6/12 and above was seen in 70% of patients. Conclusion: Anterior vitrectomy with scleral fixated IOL implantation is a safe and effective procedure to correct aphakia in eyes without adequate posterior capsular support. Complications seen with anterior chamber IOL are not seen with SFIOL and dreaded complications like retinal detachment, suture lysis and infection were not encountered in our study. However precise determination of small differences in visual outcome and long-term complication rates would require a large prospective, randomized clinical trial. Keywords: Aphakia, Inadequate posterior capsular support, Scleral fixated IOL.

Comparative evaluation of functional outcome of discectomy versus discectomy with posterior lumbar interbody fusion for treatment of lumbar disc herniation

<p class="abstract"><strong>Background:</strong> Lumbar disc herniation is the most common cause of low back pain and significant disability with economic impact too. Management of disc herniation is challenging, often confusing when surgical treatment is considered, because of frequent failures after surgery in many patients to relieve symptoms.</p><p class="abstract"><strong>Methods:</strong> Our study was a prospective study conducted in Department of Orthopaedics, Coimbatore medical college. Thirty six patients operated for intervertebral disc herniation of lumbar spine from March 2015 to February 2017 were included in the study.<strong></strong></p><p class="abstract"><strong>Results:</strong> VAS score was not significant between two groups, at one month, but at 6 months, PLIF group had better VAS score and was statistically significant. ODI scores showed a similar pattern.</p><p><strong>Conclusions:</strong> Discectomy for symptomatic lumbar disc herniation is still the procedure of choice but with any subtle instability, then it should be combined with stabilisation like posterior lumbar interbody fusion.</p>

Analysis of cutaneous adverse drug reactions in a tertiary care teaching hospital

Background: Cutaneous Adverse Drug Reaction (CADR) is considered as one of the reasons for discontinuation of drug as well as medication non-adherence. This study analyses the common drugs causing CADR, clinical spectrum of different types of CADR, causality and drugs causing severe CADR.Methods: This was a retrospective cross-sectional observational study conducted by the Department of Pharmacology, Coimbatore Medical College, Coimbatore, Tamil Nadu, India. The study was conducted using data collected in CDSCO’s ADR reporting forms with CADR from June 2015 to July 2017. Patient’s information, details related to adverse drug reaction, suspected medication details, concomitant medication history, causality and seriousness were recorded.Results: A total of 102 CADR were evaluated in this study. The mean age of sample was 37.21±20.33 years. Maximum number of cases was in the age group of 40-49 years. Male to female ratio was 0.96:1. The commonly incriminated drugs causing CADR were antimicrobial agents. Ciprofloxacin (21.57%), phenytoin (9.8%), diclofenac sodium (6.86%), anti-snake venom (6.86%) and vancomycin (3.92%) were the common drugs implicated in CADR. Maculopapular rash and itching were the most common CADR. Anticonvulsants especially phenytoin was commonly associated with severe CADR.Conclusions: The present study has made an impact on all departments of this institution and awareness has been created about spontaneous reporting of all adverse drug reactions in CDSCO ADR reporting forms to the pharmacovigilance centres. Thus, sound knowledge about the adverse drug reactions may decrease the occurrence of drug induced morbidity and mortality.

Autopsy based analysis of unidentified dead bodies in a tertiary care hospital of South India

Increasing number of the unknown dead body is also described as the silent mass disaster. The identification of cadavers is a key issue in autopsy and equally important for ethical, criminal and civil reasons. This prospective study was conducted during the period from January 2016 to December 2016 at Coimbatore Medical College Hospital. Over 152 cases of unidentified dead bodies, brought for postmortem examination were included in this study. The study observed seasonal variation in the unidentified corpse brought for autopsy, with a male sex predilection. Most of the victims were in the age group of 50 to 60 years with the majority of the cases being reported as road traffic accidents. The cause of death in unidentified dead bodies was highly variable. The most commonly applied method for identification of dead bodies in India is visual and other customary means of identification. Identifying the dead body is the essential criteria in the process of medico-legal autopsy and we are supporting the investigating officers in identifying the deceased by various techniques like fingerprints, superimposition, blood grouping and DNA fingerprinting. Even though the modern and more accurate techniques are available for identification, the usage is limited than the expected outcome because of the limited availability of data for comparison. By improving and increasing the availability of data by means of Aadhar linking or data bank we could ensure that the suffering of a family comes to an end, and for dignified disposal of corpses.

English

BACKGROUND : Diabetes mellitus is a progressive disease, diabetic foot is the major complication of it, and eventually leads to development of gangrene and lower extremity amputation. This study has been carried out to detect the antibiotic sensitivity pattern of the isolates in relation to HbA1C levels. OBJECTIVES : To study the prevalence of diabetic foot ulcers in various age groups and gender. To isolate and identify the bacterial isolates causing diabetic foot infections. To analyze HbA1C levels in relation with Diabetic Foot Infections, bacteriological profile and antibiotic susceptibility pattern. MATERIALS AND METHOD : Pus and wound swabs were collected from around 100 diabetic patients with foot ulcer attending the Surgery Out-Patient Department of Coimbatore Medical College Hospital. The samples received in the Department of Microbiology were processed for aerobic culture and antibiotic sensitivity testing during the study period. Blood samples were collected to analyze the HbA1C levels. RESULTS : Of The 100 cases studied, most of the patients belonged to the 5th and 6th decades of life (37%) and (28%) respectively. Males were more affected compared to females with a ratio of 2.3:1. Maximum number of patients with Diabetic Foot Ulcers were seen in Wagner’s Grade II (40 nos), followed by 38 DFI patients in Wagner’s Grade III. Among Gram positive aerobes, Staphylococcus aureus was the predominant Isolate (18.4%). Among Gram negative aerobes, Proteus spp was the most common isolate (23.2%) followed by E.Coli 16.8% and Pseudomonas 16%. Acinetobacter species was the least common isolate (2.4%). While staphylococcus aureus was the most common among gram positive cocci, Proteus species was the most common isolate among the gram negative pathogens. CONCLUSION : Staphylococci and Proteus were the two most common isolates detected in diabetic foot infections. There was significant association between DFI and higher HbA1C Levels. But no correlation found between HbA1C levels and the polymicrobial nature of infection in DFI.

A tertiary care centre experience of modified early warning score (MEWS) in post-operative patients

Background: The aim of the study is to analyse and implement the modified early warning score (MEWS) in assessment of need of early intervention and surgical intensive care unit (SICU) admission in patients undergoing elective and emergency major surgical procedures.Methods: This prospective study was done in Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu. It included 150 patients who underwent major emergency and elective surgical procedures under regional or general anaesthesia with monitoring of physiological parameters in the P.O period.Results: The predictability of MEWS system was analyzed with the following results: MEWS 1=77 patients were alive (51.3%) of the study population. MEWS 8=3 patients were alive (2.1%) and 7 patients died (100%) of the study population. This indicates that the greater MEWS the mortality of the patient rises, and the lesser MEWS score the chances of mortality in the P.O period is very minimal. In our study, we have derived that MEWS score of 7 or 8 implicates the need for SICU admission and it indicates an increased mortality of the patient in the P.O period.Conclusions: The Modified Early Warning Score (MEWS) is an effective tool in identifying the early deterioration of the patients undergoing major surgical procedures and assessing the need for admission in SICU for further interventions.

The accuracy of free-hand cup positioning: a CT based measurement in a South Indian hospital

<p class="abstract"><strong>Background:</strong> In total hip arthroplasty, the restoration of normal hip center in acetabular reconstruction encourages the normal bio mechanics. The impingement, dislocation, and implant wear have increased the interest in accurate component placement in arthroplasty. This study is to determine the accuracy of the free hand technique in the acetabular cup placement in relation to native acetabulam using CT scan images.</p><p class="abstract"><strong>Methods:</strong> This study was done in the Coimbatore Medical College and Hospital from June 2015 to March 2016. Twenty patients who have undergone total hip replacements were subjected to CT scan of pelvis preoperatively and postoperatively. The acetabular cup version and the inclination were measured and analyzed statistically.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean acetabular version was 17.5◦±6.5◦ and the inclination was 46.6◦±9.3◦ pre operatively. Post operatively the mean acetabular version was 26.3◦±17.3◦ and the inclination was 41.7◦±10.9◦. With reference to the component version it ranged from 12.5˚ of retroversion to 62.5˚ anteversion with a mean of 26.3◦±17.3◦. The component inclination ranged from 15.6◦ to 58.4◦ with a mean of 41.7◦±10.9◦. On combining component version and inclination, only (50%) was within the safe zone.</p><p class="abstract"><strong>Conclusions:</strong> Based on the CT finding acetabular version and inclination differs from individual to individual. During acetabular cup placement in total hip arthroplasty using free hand technique, our study shows that that inclination is better achieved and the anteversion is over targeted in most of the cases.</p>

Fournier's gangrene: prospective study of 34 patients in South Indian population and treatment strategies.

IntroductionFournier's gangrene (FG) is a fulminant necrotizing fasciitis of the perineum and genitalia. The objective of this study was to study the etiology and microbiology associated with FG and to study the debridement and reconstructive procedures required in these patients.MethodsThis was a prospective follow up study conducted from September 2011 to November 2012 at Coimbatore medical college hospital, Coimbatore, India. Patients presenting to the outpatient department and emergency department with the clinical diagnosis of FG were included in the study.ResultsA total of 34 patients were studied in the study period. The mean age of presentation in years was 50±11.13. The male to female ratio was 33:1. The source of the infection was most commonly anorectal. Diabetes mellitus was the most common co morbid factor associated. Most commonly the disease was polymicrobial with escherichia coli being the commonest grown organism. The average number of wound debridement required was 2.9±1.42. Primary closure of the scrotal skin defect was the most common reconstructive procedure performed. Mortality associated with the disease in our series was 11.8%.ConclusionAlthough FG is a relatively rare disease, it is still prevalent in Indian population. Incidence of FG in HIV patients is high, even though it is not the commonest of the co morbid condition. The mortality can be kept to minimal with aggressive medical and surgical management. Extensive raw area following the infection and wound debridement can be managed by simple reconstructive procedures with good outcome.

Clinical and Histopathological Correlation in Hansen’s Disease

AIM OF THE STUDY: To assess, classify and adopt apt treatment protocols based on histopathological evalaution of leprosy (Hansen’s) patients. MATERIALS AND METHODS: The study was conducted on the skin biopsies of 35 patients newly registered at the Department of Dermatology, Venerology & Leprosy and subsequently reported at the histopathology section of the Department of Pathology, Coimbatore Medical College & Hospital, Coimbatore for a period of 18 months from May 2010 to October 2011. Skin biopsies of newly diagnosed, untreated leprosy patients were fixed in 10% formalin and routine histopathological examination done followed by special stain (Fite – Faraco) to evaluate the bacterial index (BI). OBSERVATION AND RESULTS: From the study it was observed that, the commonest age group affected by leprosy was 31 - 50 years, males are 2 times more commonly affected than females. (M : F = 1.9 :1) & the most commonest clinically diagnosed spectrum was tuberculoid leprosy (TT). The commonest histopathologically diagnosed spectrum was IL (34.28%), followed by TT & histoid leprosy. It was observed that there was complete agreement between clinical diagnosis and histopathological diagnosis in 62.85% cases and disagreement was observed in 37.15% cases. CONCLUSION: If there is discrepancy between clinical and histopathological classification, both the findings should be reviewed by independent experienced observers. In case of confirmed discrepancy, the more advanced findings (ie. towards the lepromatous pole) should be given greater weightage and the case is to be classified and treated accordingly. In all cases of leprosy, in order to type the exact spectrum of disease for appropriate treatment, skin biopsy of the lesions with histopathological examination followed by special stain (Fite -Faraco) is recommended.

English

BACKGROUND: Psoriasis is a common genetically determined chronic inflammatory skin disease. It is characterized by well defined erythematous plaque with silvery white scales. It is commonly distributed over the elbow, knee, lower back, nails, scalp, palms and soles. It is associated with varying periods of remission and relapse. Various modalities of treatment have been tried. The main goal of therapy is rapid control of the disease and to maintain a longer duration of remission. Treatment of palmoplantar psoriasis and remission maintenance is very difficult. AIM OF THE STUDY: The aim of the study is to compare the efficacy of topical psoralen and ultraviolet A phototherapy with sequential therapy of topical 0.05% clobetasol propionate ointment and topical 0.005% calcipotriol ointment in palmoplantar psoriasis and to observe the adverse effects, remission maintenance and PASI percentage reduction of more than 50% in both groups. MATERIALS AND METHODS: 50 patients are included in the study. The population for the study included patients attending outpatient Department of Dermatology, Coimbatore Medical College Hospital, Coimbatore. The patients are divided into two groups, group A and group B. The treatment duration was 6 months and the follow up period was 6 months. Each group has 25 patients. Group A patients received topical hand foot PUVA therapy with minimum dose of 1J/cm2 with increment dosage of 0.5J/cm2, in the frequency two times per week and the maximum dose of 24.5J/cm2 in some patients. Eyes were protected by using goggles during treatment. In group B sequential therapy of calcipotriol ointment combinations given in three phases, in phase 1 combination of clobetasol propionate and calcipotriol ointment once a day application in the first month, in phase 2 clobetasol propionate for weekends and calcipotriol for week days once a day application in the second and third month, in phase 3 calcipotriol ointment once a day application in the fourth, fifth and sixth month. PASI score and PASI percentage reduction was assessed at the end of 8th, 16th, 24th weeks. RESULTS: During treatment, 3 patients in group A and 1 patient in group B lost follow up. In both groups none of the patients showed complete clearance of both palms and plantar lesions. In group A out of 22 patients, 20 (90%) showed more than 50% reduction of PASI score. Four patients showed complete clearance of lesion in the palms. Two patients showed complete clearance of lesion in the soles. The average period of clearance of lesions was at 19 weeks. In six months follow up period 3 patients showed relapse after 15 weeks of average period of remission. 4 patients showed adverse effect like erythema and burning sensation. In group B out of 24 patients, all (100%) showed more than 50% reduction of PASI score. Seven patients showed complete clearance of lesion in the palms and five patients showed complete clearance of lesion in the soles. The average period of clearance of lesions was at 20.3 weeks. In six months follow up period 2 patients showed relapse after 20 weeks of average period of remission. 3 patients showed adverse effect like erythema,itching and burning sensation. CONCLUSION: The efficacy of topical calcipotriol ointment and steroid used in sequential manner is better than the topical psoralen ultraviolet A therapy. All the patients (100%) in calcipotriol and steroid combination group showed more than 50% reduction of PASI score. But in PUVA therapy group 90% of patients showed more than 50% reduction of PASI score. On comparing the adverse effects, patients on PUVA therapy group developed more adverse effects than the patients on calcipotriol and steroid combination group. The duration of remission maintenance was long in calcipotriol and steroid combination group when compared to PUVA therapy group. In our study, we arrived at the conclusion that topical therapies used in a sequential manner was more effective and it may be considered as a first line therapy for the treatment of patients with palmoplantar psoriasis.

Serum Magnesium Levels in Acute Myocardial Infarction

BACKGROUND: Magnesium has been implicated in the pathogenesis of acute myocardial infarction and its complication like arrhythmia. Magnesium improves myocardial metabolism, inhibits calcium accumulation and myocardial cell death. It improves vascular tone, peripheral vascular resistance, after load and cardiac output, reduces cardiac arrhythmias and improves lipid metabolism. Magnesium also reduces vulnerability to oxygen derived free radicals, improves endothelial function and inhibits platelet function including platelet aggregation and adhesion. OBJECTIVE: To know the relationship between the serum magnesium levels and arrhythmias in patients with acute myocardial infarction. METHOD: By using simple random method, 50 cases of acute myocardial infarction, admitted in Coimbatore Medical College and Hospital. RESULTS: There is a significant difference in the magnesium levels in patients with arrhythmias and without arrhythmias. CONCLUSION: In acute myocardial infarction, patients with low magnesium levels are more prone to get arrhythmias. So magnesium treatment can be considered in patients of acute myocardial infarction with low magnesium levels.