Government Kilpauk Medical College Research Articles

Comparison of hearing outcome using ossiculoplasty with autologous incus versus titanium prosthesis

<p><strong>Background: </strong>The aim of the study is to compare the efficacy of autologous incus versus allogenic titanium prosthesis in terms of anatomical results, hearing gain after surgery, operative course and complications.</p><p><strong>Methods:</strong> This is a prospective interventional study of 20 patients out of which 10 underwent autologus incus and 10 underwent titanium prosthesis ossiculoplasties performed between April 2018 To April 2019 in Government Kilpauk medical college and hospital, Chennai after ethical clearance. The postoperative improvement of mean air-bone gap and air conduction over same frequencies between the two groups were studied. A improvement in pure tone average more than 10 dB was considered successful.</p><p><strong>Results:</strong> In current study, 10 patients underwent ossiculoplasties using titanium ossicular replacement prosthesis and 10 patients underwent ossiculoplasties using autologous incus. 5 of the patients in each group underwent canal wall up and 5 underwent canal wall down procedure. The average ABG closure was 9.30 dB in incus group and 15.22 dB in titanium group.</p><p><strong>Conclusions: </strong>Titanium ossicular prosthesis ossiculoplasties provide a significant hearing gain and are advantageous because of the easy insertion with pre-sculpted structure yet the cost is a concern. Better results were noted in canal wall up procedures more than canal wall down procedures.</p>

Comparative study on surgical outcome for benign vocal cord lesions by conventional method versus coblation

<p><strong>Background: </strong>Benign<strong> </strong>vocal cord lesions are common laryngeal pathology found in routine clinical practice.microlaryngeal surgery is useful in excision for pathology. Coblation assisted microlaryngeal surgery is a new technique for the vocal cord lesions</p><p><strong>Methods:</strong> Current study was conducted in Government Kilpauk medical college hospital and Government Royapettah hospital from the period of 2018 to 2019 in 40 patients with benign vocal cord lesion. The objectives of current study were to assess the voice handicap Index before and after surgery, to assess the surgical benefits and ease in doing the procedure intraoperatively and to assess the postoperative recovery in conventional micro laryngeal procedure.</p><p><strong>Results:</strong> The overall analysis shows coblation being an evolving technique has advantages over the conventional cold knife method. Blood loss and the surgery duration was less in coblation. But the assessment tools of both voice handicap index, voice analysisand GRBASscore favours conventional micro laryngeal surgery with reduced scores and improvement in performance with statistically significant values probably due to minimal tissue handling and decrease in post op scarring in conventional micro laryngeal surgery.</p><p class="abstract"><strong>Conclusions: </strong>The overall voice handicap index and voice analysis showed improvement post operatively in both the groups with more favoring response to conventional method with statistically significant values. In the same away the GRBAS score also favors the conventional method. Coblation being a newer technique can be employed for surgical treatment for micro-laryngeal surgery considering its advantages and less time consumption. Stroboscopy and other acoustic analysis along with long term follow up is needed.</p>

Analysis of drug utilization in government tertiary care institution of South India

Background: Drug is an active chemical molecule used for diagnosis, prevention, and treatment of a disease. Drug utilization study is a potential tool in the evaluating the health-care system of a country since drug therapy accounts for major health expenditure. These studies also facilitate rational use of drugs among people of various age groups. Aims and Objectives: This study aims to analyze the utilization pattern of drugs in the pediatric outpatient department (OPD) and also to analyze drug prescribing indicators of the World Health Organization. Materials and Methods: A prospective observational study was conducted in the pediatric outpatient department (OPD) of Government Kilpauk Medical College Hospital, Chennai for one month during October 2014. A total of 600 prescriptions were collected. Patient-related information and drug-related information were analyzed. Drug prescribing indicators of the World Health Organization were also analyzed. Results: The most common age group was 1–6 years. Average number of drug per prescription was 1.96. Antimicrobial agents were most commonly prescribed drugs. About 93.6% of them were generic drugs. About 90.33% of drugs were from National Essential Medicine List 2011. Conclusion: This study helps us to identify potential targets so as to make improvement in prescribing and dispensing policies of drugs in the hospital.

Respectful maternity care initiative-beneficiaries interview-in KMC hospital Chennai

Background: Facility-based care for childbirth is one of the key strategies to reduce maternal and perinatal morbidity and mortality. Various policies have been put in place by different governments and health systems such as use of incentives, education and community mobilization to increase facility births. However, many women decide not to seek facility-based care for childbirth, despite recognizing the associated health benefits. This decision is often based on their previous experiences of poor quality care, including poor treatment, abuse, discrimination and neglect while in facilities. Aims & Objectives: To review available standards for Respectful Maternity Care (RMC) and adapt them in the Indian context by evaluation of Antenatal, Labour ward and Postnatal women from Govt. KMC Hospital. Methodology: In The intervention phase, all the beneficiaries of the department were administered with a questionnaire consists of the above broad parameters. Earlier from the pilot study, the Cronbach's alpha reliability of the questionnaire found(>0.8). It was good reliability. Results and Conclusion: The above analysis clearly indicates the health providers are maintaining RMC care different domains in a uniformed manner and no patients were not satisfied. This shows overall respectful maternity care was well maintained from Government Kilpauk Medical College Hospital. due to the sensitizing of RMC and the LaQshya programme.

RECENT TRENDS IN THE HISTOLOGICAL SPECTRUM OF GASTROINTESTINAL POLYPS

INTRODUCTION: Polyps are projections or elevations from the surface of mucosa. Histopathological examination of polyps is very important because of the risk of malignancy associated with certain polyps. The aim of this study is to analyse spectrum of polyps in different locations of Gastrointestinal tract. MATERIALS AND METHODS: This is a descriptive study conducted in Department of Pathology, Government Kilpauk Medical College for a period of 3yrs. 156 cases were included. Polyps were analysed based on age, sex, location, endoscopic appearance and histologic findings. RESULTS: Gastrointestinal polyps are most common in males(61.5%) and in age group of 46.60years(37.8%). Most of the polyps are sessile(73.1%) and occur in the large intestine(41.6%). The most frequent polyps based on locations are Squamous papilloma in esophagus , hyperplastic polyp in stomach, inflammatory polyp in small intestine and adenomatous polyp in large intestine. DISCUSSION AND CONCLUSION: The results were compared with other similar studies. Most of the study results correlated with study by Gurung P et al. Esophageal polyps correlated with study by Patit et al. Inflammatory polyps are the predominant Sessile polyps, Hyperplastic polyps are the predominant diminutive polyp and adenomatous polyps are the predominant pedunculated polyps. This study provides information regarding most frequent polyps based on locations and gross appearance and helps to find the changing trends in the incidence of polyps.

A study on perinatal outcome in oligohydramnios

Background: In Normal Pregancies, the volume of amniotic fluid increases to about one litre at 36 weeks maximum level. Amniotic fluid volume rises progressively during gestation until 36 weeks, the mean amniotic fluid volume relatively consistent in the level of 700-800ml. After 40 weeks there is a progressive decline of amniotic fluid volume at a rate of 8% per week, with amniotic fluid volume averaging about 400ml at 42 wks. The clinical picture of reduced amniotic volume is termed oligohydramnios. This present study is undertaken to asses the perinatal outcome in Amniotic fluid index of 5 cm or less (oligohydramnios) in term pregnancies.Objective: To determine the perinatal outcome in term pregnancies with Amniotic fluid index 5cms was carried out in, Government Kilpauk Medical College Hospital during the period of February 20016 to January 2017.Sample Size: About 150 cases in AFI < 5cms (Study Group) And 150 Cases in Control Group (AFI > 5cms).Results: In this study perinatal outcome in AFI 5cm or less compared with control group. About 150 cases were studied in each group. 87% in study group & 93% in control group were in the age group 20 - 30yrs.Conclusion: Oligohydramnios with reactive NST is associated with good prognosis (Good apgar, decreased NICU admission & neonatal death).Oligohydramnios with non reactive NST needs careful monitoring and eventuates in early delivery. It increases the incidence of caesarean delivery for fetal distress, NICU admission, low apgar at 5 mins and Neonatal death.Oligohydramnios associated with IUGR carries a poor perinatal outcome (Increased neonatal death, NICU admission, increased rate of CS for fetal distress, very low birth weight) Hence they need good neonatal care.

A study of screening echocardiography in asymptomatic pregnant women

A study of screening echocardiography in asymptomatic pregnant women - IJOGR- Print ISSN No: - 2394-2746 Online ISSN No:- 2394-2754 Article DOI No:- 10.18231/j.ijogr.2019.096, Indian Journal of Obstetrics and Gynecology Research-Indian J Obstet Gynecol Res

Impact of maternal anaemia on cord blood haemoglobin

Background: Anaemia during pregnancy is associated with serious maternal and fetal complications. Cord blood hemoglobin of the newborn is an important indicator of anaemia in newborn at birth. So, this study is done to assess the impact of maternal anaemia on cord blood hemoglobin levels of neonates.Methods: It is a cross sectional study done at government Kilpauk medical college and hospital in the department of paediatrics in year 2016.400 pregnant mothers attending the labour room in Kilpauk medical college were included and cord blood haemoglobin of their babies were collected. Mean cord blood haemoglobin of new-borns born to anaemic mothers (mild, moderate and severe) were compared with cord blood haemoglobin of new-borns born to non-anaemic mothers.Results: Out of 400 mothers,192 mothers were anemic, and 208 mothers were non anemic. The mean maternal hemoglobin among non-anemic mothers was 16.37±0.85 and among the anemic mothers it was 15.03±1.04. The mean cord hemoglobin of neonates born to anemic mothers among the three groups (mild moderate severe) were compared with mean cord hemoglobin of the non-anemic group. The difference between groups were statistically significant with P values &lt;0.05,0.01 and 0.05 respectively.Conclusions: In present study maternal anaemia affects the cord blood haemoglobin of neonates. Present study infers that anaemic mothers deliver babies with lower haemoglobin compared to non-anaemic mothers. Authors have found a linear relationship between maternal haemoglobin and cord blood haemoglobin of the new-borns.

Evaluation of Effect of Yoga on Pulmonary Functions and Hand Grip Strength in College Students

Yoga is an ancient Indian philosophical discipline designed to bring balance and health and to increase longevity. To assess the beneficial effect of yoga to cope up with stress and to improve the overall health and performance of students, the present study has been carried out. The study design was a cohort study. The study was conducted in the Department of Physiology, Government Kilpauk Medical College, Chennai. 52 students in the age group of 17-22yrs were given yoga training for 4 weeks. 52 age and gender matched students formed the control group. Breath Holding Time (BHT), Forced Vital Capacity (FVC), Peak Expiratory Flow rate (PEFR) and Hand Grip Strength (HGS) were done for both study and control groups at baseline and at the end of 4 weeks. Statistical analysis was done using the paired student's “t” test. There was statistically significant improvement of Breath Holding Time (BHT), Forced Vital Capacity (FVC), Peak Expiratory Flow Rate (PEFR) and Hand Grip Strength (HGS) in the study group (group I) following 4 weeks of yoga practice (p < 0.01) while there was no significant change in these parameters in the control group (group II). The study concludes that regular yoga practice can improve the pulmonary functions as well as skeletal muscle strength of young individuals and this positive change could persist into their adulthood.

A comparative study on women empowerment in urban and rural setting in Tamil Nadu

Background: Women empowerment is vital for decision making on nutrition, health-seeking, family planning and economic issues for the family as a whole. In reality, there is prevalence of unequal gender norms among the women in India in urban and rural area. The objective of the study was to compare the empowerment of women in urban and rural setting in Tamil Nadu.Methods: A cross-sectional study was conducted in Nandivaram (RHTC) and Shenoy Nagar (UHTC) attached to Government Kilpauk Medical College among 200 married women of age 15-49 years with a semi-structured questionnaire during June 2018. Data was entered and analyzed in SPSS 16. Chi Square test and logistic regression was used for statistical analysis.Results: Mean age in rural group was 26.74±6.45 years and 30.4±7.35 in urban. Illiterates were 27% in rural and 14% in urban. About 67% were homemakers in rural vs. 43% in urban. About 33% were BPL in rural vs. 21% in urban. Decision making regarding household decisions, about73% in rural vs. 87% urban had participated. In health seeking behavior, 77 % in rural had no say while only 45% in urban. For Family planning, 33% in rural vs. 74% in urban had decision making which were statistically significant. Only 33% contributed to family income in rural vs. 47% in urban.Conclusions: Women empowerment is better in urban setting than rural setting. There is a strong need to create awareness and training in rural setting for better productive life.

Evaluation of Effect of Yoga on Pulmonary Functions and Hand Grip Strength in College Students

Yoga is an ancient Indian philosophical discipline designed to bring balance and health and to increase longevity. To assess the beneficial effect of yoga to cope up with stress and to improve the overall health and performance of students, the present study has been carried out. The study design was a cohort study. The study was conducted in the Department of Physiology, Government Kilpauk Medical College, Chennai. 52 students in the age group of 17-22yrs were given yoga training for 4 weeks. 52 age and gender matched students formed the control group. Breath Holding Time (BHT), Forced Vital Capacity (FVC), Peak Expiratory Flow rate (PEFR) and Hand Grip Strength (HGS) were done for both study and control groups at baseline and at the end of 4 weeks. Statistical analysis was done using the paired student's “t” test. There was statistically significant improvement of Breath Holding Time (BHT), Forced Vital Capacity (FVC), Peak Expiratory Flow Rate (PEFR) and Hand Grip Strength (HGS) in the study group (group I) following 4 weeks of yoga practice (p < 0.01) while there was no significant change in these parameters in the control group (group II). The study concludes that regular yoga practice can improve the pulmonary functions as well as skeletal muscle strength of young individuals and this positive change could persist into their adulthood.

English

BACKGROUND : Tuberculosis ranks alongside Human Immunodeficiency Virus as a leading cause of death worldwide. Psychiatric disorders in chronic medical illnesses have been found to be associated with poor compliance in previous studies. Poor compliance in tuberculosis can have drastic consequences including emergence of drug resistance. In this study, we have attempted to study the prevalence of psychiatric disorders in tuberculosis at a tertiary care centre in Chennai. AIMS & OBJECTIVES : 1. To assess the prevalence of psychiatric illnesses in people undergoing treatment for tuberculosis. 2. To assess the association between psychiatric comorbidity and different sociodemographic factors (age, gender, education) and tuberculosis disease related factors. 3. To assess the relationship between psychiatric co-morbidity and negative behavioural factors like history of defaulting. METHODS : Ours is a cross sectional study conducted at the Department of Thoracic Medicine in Government Kilpauk Medical College, Chennai. A total of 106 patients were interviewed and examined. RESULTS : We observed that 61.32% of the patients had at least one psychiatric illness. When alcohol and substance use disorders were included, the prevalence was 84.90%. About 62.6% had depressive disorder. Anxiety disorders were found in 23.5%, alcohol dependence syndrome in 59.43%, and nicotine dependence syndrome in 40.59%. We also found significant relationships between the following: male gender and presence of psychiatric illnesses, joint family and presence of psychiatric illnesses, dyspnoea grade 3 or more and presence of psychiatric illnesses, AUDIT score of 8 or more and presence of psychiatric illnesses, and, dyspnoea grade 3 or more and severity of depression. CONCLUSION : Effective identification and management of the highly prevalent psychiatric illnesses and substance use disorders can help improve the tuberculosis services.

The use of locking plates in proximal humerus fractures-functional outcome based on age and fracture pattern

Background: Proximal humerus fractures accounts for 4-5% of all fractures. This is the third most common fracture in the elderly population. Surgical treatment is advised for displaced proximal humerus fractures. This study was done to evaluate the functional outcome of fractures operated with locking plates and to evaluate any significant difference of outcome present between age (< 60 years and > 60 years) and fracture pattern (AO Type A, B, C). Materials and methods: This is a Prospective study conducted at Government Kilpauk Medical College Hospital. 25 cases of proximal humerus fractures operated with proximal humerus locking plates. Post operatively functional outcome was evaluated with Constant Murley Shoulder score and radiological followup. Results: In our study, 14 cases were < 60 years and 11 cases were > 60 years. The mean constant score was 86.75 and 67.1 for < 60 and > 60 years respectively and it was statistically significant. The difference in the functional outcome of three fracture types was statistically significant with a p value of 0.048. Conclusion: Proximal Humerus Locking Plate is the implant of choice for treating displaced proximal humerus fractures. It provides stable internal fixation, allows early mobilisation and prevents secondary loss of fixation. The functional outcome was decreased in elderly individuals when compared to younger individuals. More complex initial fracture patterns have decreased functional outcome postoperatively, hence adequate stable fixation and appropriate physiotherapy and rehabilitation protocols should be followed to achieve optimal functional outcome.

A prospective study of sexual dysfunction in patients with benign prostatic hyperplasia

Background: Benign prostatic hyperplasia (BPH)/ lower urinary tract symptoms (LUTS) patients have been found to be more prevalence of sexual dysfunction than in men with no BPH/LUTS. In this study, the authors aimed to evaluate the prevalence of sexual dysfunction in the BPH patient to see the correlation between BPH and sexual dysfunction.Methods: All patients who attended Urology outpatient department or admitted in Government Kilpauk Medical College and Hospital and Government Royapettah hospital during October 2013 to October 2014 for symptoms of BPH were enrolled for the study.Results: The prevalence of sexual dysfunction in patients with LUTS is70%. The severity of sexual dysfunction correlates with severity of LUTS. Ejaculatory function deteriorates after treatment of LUTS/BPH.Conclusions: Though the sample size is small and the follow up is limited, it can be suggested that treatment of sexual function should be combined with management of sexual dysfunction for better patient satisfaction.

Comparison of efficacy of different concentration of bupivacaine in ultrasound-guided transversus abdominis plane (TAP) block for postoperative pain relief in lower segment cesarean section

Comparison of efficacy of different concentration of bupivacaine in ultrasound-guided transversus abdominis plane (TAP) block for postoperative pain relief in lower segment cesarean section

Role of Magnetic Resonance Imaging in the Diagnosis and Management of Pelvic Floor Dysfunction

ABSTRACT Aim To study the effect of age and parity in pelvic floor anatomy in women with pelvic floor dysfunction and the changes in pelvic floor anatomy after a course of pelvic floor exercises. Design A prospective study at Government Kilpauk Medical College (KMC), Chennai. Materials and methods Patients with pelvic floor dysfunction are subjected to clinical examination and magnetic resonance imaging (MRI). The changes in anatomy are analyzed in terms of levator hiatus dimension and descent of the pelvic organs. Substratified analysis is done and mean diameters in each degree of prolapse are identified (Chi-square tests using cross tables). Patients with cystocele, rectocele, or enterocele are also compared in both clinical examination and MRI and the degree of correlation is measured (inter-rater kappa). The changes in pelvic floor anatomy in terms of H line, M line, and levator plate angle with respect to age and parity are studied. In patients with lower degrees of prolapse, the changes in anatomy in terms of H line, M line, and levator plate angle are studied after a course of pelvic floor exercises (post hoc tests and paired t-tests). The area under curve of receiver-operating curve in each degree of prolapse is seen and the critical cut-off value of the various anatomical parameters above which a patient develops a prolapse is calculated. Results Ninety patients with symptoms of pelvic floor dysfunction were studied with clinical examination and MRI. Levator hiatus width cut off at rest above 5 cm and at straining above 5.8 cm develops clinical first-degree prolapse. Levator plate angle of more than 44.4° develops a clinical first-degree prolapse. With increasing age there is an increase in mean values of levator hiatus width at straining, levator plate angle, and descent of various organs. With increasing parity, there is an increase in mean values of levator hiatus width at rest and straining and increase in descent at straining. Conclusion Magnetic resonance imaging should be considered as a pretreatment planning tool when the physical findings are equivocal. How to cite this article Shankar P, Gunasingh S. Role of Magnetic Resonance Imaging in the Diagnosis and Management of Pelvic Floor Dysfunction. J South Asian Feder Obst Gynae 2017;9(3):250-254.

A prospective study on functional and radiological outcome of proximal humeral fractures treated with locking compression plates

Fractures of proximal humerus account for about 4 to 5% of all fractures. It is the third most common fracture after hip fracture and colles fracture in elderly patients. In this study we have analysed 20 cases of proximal humeral fractures treated surgically using (PHILOS) proximal humerus locking compression plates admitted at Department of Orthopaedics and Traumatology, Government Kilpauk Medical College and Hospital, Chennai from April 2013 to November 2013. The aim of the study was to analyze the functional and radiological outcome and to assess the complications of proximal humeral fractures treated using locking compression plates. Patients with proximal humerus fractures, who are skeletally mature and age more than 18 years satisfying Neer s criteria for operative displacement were selected. The patients were operated by the standard anterior deltopectoral approach or deltoid splitting approach using proximal humerus locking plates. All the patients were reviewed at two weeks interval, for first three months and later every month, Radiological evaluation of fracture union was observed by serial X rays. Constant and Murley’s score was used to assess the functional outcome of our patients. The average constant score in our study with 20 patients was 82.4. Finally we concluded that displaced proximal humeral fractures when treated surgically produce greater range of movements (ROM), less pain and less stiffness.

Perioperative intra-abdominal pressure monitoring in emergency laparotomy

Background: The aim of present study is to evaluate the perioperative monitoring of intra-abdominal pressure and abdominal compartment syndrome and its association with the postoperative morbidity in terms of kidney function and pulmonary atelectasis and mortality of the patients undergoing emergency laparotomy.Methods: A prospective study was done in 100 patients undergoing laparotomy. The study was conducted in the department of general surgery, Government Kilpauk medical college and hospital for the period of six months from January 2015 to June 2015. The study group of 100 patients was divided into 2 groups, each group containing 50 patients. The first group containing 50 patients having increased intra-abdominal pressure undergoing emergency laparotomy and second group containing 50 patients undergoing elective laparotomy. The post-operative morbidity in terms of kidney function by means of urea, creatinine and urine output and pulmonary atelectasis with the help of chest x-ray and mortality analyzed compared in between the two groups.Results: By comparing the two groups, the group undergoing emergency laparotomy with increased intra-abdominal pressure had increase in the incidence of postoperative morbidity and mortality than the elective laparotomy group without elevated intra-abdominal pressure.Conclusions: Thus, the perioperative monitoring of intra-abdominal pressure is highly useful in diagnosing intra-abdominal hypertension and abdominal compartment syndrome and thereby helps in minimizing the post-operative morbidity and mortality in emergency laparotomy patients.

Analysis of Referral Pattern in Burns to a Tertiary Burn Care Centre in India

&lt;em&gt;Government Kilpauk Medical College Hospital in Chennai has a tertiary burn care centre with an exclusive new building catering to the needs of burn victims. This burn unit was started by PadmashreeDr.Mathangi Ramakrishnan in the year 1981. All types of burns in all age groups are treated here. Management of a burn patient involves multimodal approach and involves the contribution of various specialists. These patients require multiple stages of medical and surgical managements thus prolonging the duration of hospital stay. Though the treatment to the patient is provided free in the government hospital, the relatives or care takers have to spend money for their food and daily needs. Most patients come from lower socioeconomic background and depend on their daily wages for survival making the problem more complex. Burn survivors are scarred and have some physical disability which persists, creating a sense of depression or loss. Major burn victims have a high mortality even in specialized units. Thus ultimately most of the victims and their care givers are not satisfied in the end&lt;span style="font-size: 8.33333px;"&gt;.&lt;/span&gt;&lt;/em&gt;

Geriatric Burns- A Study- In a Tertiary Burn Care Centre

&lt;div&gt;&lt;p&gt;&lt;em&gt;With increased life span there is an increase in ageing population, who are brought for management of burn injuries to the tertiary burn centre in Government Kilpauk Medical College Hospital in Chennai, Tamilnadu. The special care needed in managing these patients have been analyzed and presented in this study.&lt;/em&gt;&lt;/p&gt;&lt;/div&gt;