Rajiv Gandhi Government General Hospital Research Articles

Automated diagnosis of acute cerebral ischemic stroke lesions from diffusion-weighted magnetic resonance images in assessment with modified Rankin Scale

Purpose: Automated diagnosis of acute cerebral ischemic stroke lesions (ACISL) is an evolving science. Early detection and exact delineation of ACISL automatically from diffusion-weighted magnetic resonance (DWMR) images are crucial for initiating prompt treatment. Thus, this work aims to determine the appropriate slice out of 60 pieces using multi-fractal analysis (MFA) and to segment the lesions in DWMR images using a hybrid optimization method. Features extracted from the segmented images were clinically correlated with the modified Rankin Scale (mRS). Methods: Thirty-one real-time stroke patients’ images were collected from Rajiv Gandhi Government General Hospital, Chennai, India. Multiple MRI slices were taken from each patient and filtered using an anisotropic diffusion filter (ADF). These filtered images were skull-stripped automatically by the maximum entropy thresholding technique incorporating mathematical morphological operations (MEM). The multi-fractal analysis (MFA) identifies the prominent slice with the significant infarct lesion. An isodata algorithm that integrated differential evolution with the particle swarm optimization method based on Kapur’s (IDPK) and Otsu’s (IDPO) approaches was attempted to segment the ACISL. Finally, the geometric and moment features extracted from the segmented lesions categorized the stroke severity and were correlated with the mRS. Results: The findings of the experimental work confirm that the suggested IDPK approach achieved usual normalized values for image similarity indices such as Sokal-Michener Coefficient (98.51%), Roger-Tanimoto Coefficient (90.16%), Sokel-Sneath-2 (91.04%), and Sorenson Index (90.04%) are superior to IDPO. Statistical significance proved that the segmented lesions’ area (r = 0.820, p < 0.0001) and perimeter (r = 0.928, p < 0.0001) were strongly correlated with the mild and moderate criteria of mRS. Conclusion: The proposed work effectively detected ischemic stroke lesions and their severity within the studied image groups. It could be a promising and potential tool to aid radiologists in validating their diagnosis.

Depression and its role in adherence to anti-retroviral treatment in people living with HIV and AIDS in Chennai.

The AIDS epidemic has drastically reduced in India since it was first identified in 1986, largely due to the widespread availability of anti-retroviral treatment (ART). Management of HIV is currently more focussed on long term morbidities, including mental health. Depression is the most common co-morbidity seen in people living with HIV. Depression is found to negatively affect patient adherence to ART. Poor adherence to ART leads to drug resistance and susceptibility to opportunistic infections. The purpose of this study is to find the prevalence of depression among people living with HIV and to study the correlation between depression and adherence to ART. The study was conducted in the ART centre at Rajiv Gandhi Government General Hospital in Chennai, between August and October 2022. Patient health questionnaire-9 (PHQ-9) was used to identify depression, and the Adult AIDS clinical trials group (AACTG) questionnaire was used to identify adherence. Data were entered in MS Excel and were analysed using Statistical Package for Social Science (SPSS) Version 16. The association between categorical data were analysed using Chi-square and Fisher exact test. The correlation between adherence and depression was done using the Spearman correlation. The prevalence of depression was found to be 20.2%. A mild negative correlation was found between depression and adherence. Depression was found to have a significant correlation with women, unemployed, widowed, divorced individuals, and those with diabetes mellitus and tuberculosis. Depression is an important risk factor for adherence to ART. Though severe depression was not found in this study, mild and moderate depression was associated with reduced adherence to ART. Treating depression is likely to improve adherence and the overall wellbeing of patients with HIV and AIDS.

Microsurgical excision of intracranial arteriovenous malformation

Objectives: Brain Arteriovenous malformations are high-flow cerebrovascular lesions with dysplastic vascular nidus, fed by arteries and drained by veins without intervening capillaries. Prevalence is 0.2% and is an important cause of intracerebral haemorrhage in about 38% of young adults. The objective of this study is to analyze surgically managed Intracranial AV malformations with respect to their demographic features, varied clinical presentations, imaging features Spetzler Martin grading and outcome. Methods: A study of 48 patients with Intracranial Arteriovenous malformations who underwent microsurgical excision at the Institute of Neurosurgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai over a period of 5 years from July 2018 to June 2022 and extracted their data including demographic characteristics, clinical presentations, Spetzler-Martin (SM) grades, complications and outcome were assessed. Results: Of the 48 patients treated with microsurgery, the most common 51% belongs to the age group between 21 to 40years, left-sided is slightly more common with headache major symptom, involving Parietooccipital lobe 33% commonly, 28 (62.2%) patients initially presented with haemorrhage. Anterior circulation artery feeders was common 68.8% and mostly drainage involving superficial venous drainage system. Based on the Spetzler-Martin (SM) grading system, the patients were graded as follows: 6(13 %) Grade I, 10(21%) Grade II, 25(52%) Grade III, 3 (6%) Grade IV and 4(8%) Grade V. Overall, 35(73%) patients had a favorable outcome, most commonly seen in Grade I, II and Grade III. Almost complete obliteration of the AVMs were achieved in all favorable outcome cases. Conclusion: Microsurgical excision is the gold standard treatment of choice for low grade AVMs and certain high-grade AVMs with increased risk of rupture. The Spetzler-Martin grading system is a simple and effective method to estimate the risk of surgery and to evaluate the prognosis. Proper patient selection combined with appropriate preoperative evaluation, meticulous surgical technique and postoperative care all lead to reduced mortality and morbidity.

Limb salvage surgery for primary bone tumors: retrospective study in a tertiary care centre

Background: Limb salvage surgery is the standard of care for patients with primary bone tumors. The study retrospectively analyses a single center experience of use of endo-prosthesis for limb conservation in cases of primary bone tumors over a five-year period (2015-2020). Methods: Total of 34 histologically proven primary bone tumor were retrospectively studied which included 25 males and 9 females who received limb salvage surgery for bone tumors at department of surgical oncology, Rajiv Gandhi Government general hospital, Madras medical college, Chennai. Results: Median age at diagnosis was 23 years. Tumor localized to lower limb in 23 patients, and upper limb in 9 patients, pelvic bones in 3 cases. Tumors were malignant in 24 patients (70.4%) and benign in 10 patients (29.4%). The most common diagnosis was osteosarcoma17 patients (50%). The median resection length was 10 cm. High grade tumors (grade 2a and 2b and grade 3) was found in 14 cases (41.1%). 6 patients had prosthesis related complications. The mean follow-up was 5 years (range: 3-7). 27 (79.4%) patients of 34 were alive with the endo-prosthesis at the last follow-up. Conclusions: The custom mega prosthesis favored by us in most of the cases in limb sparing surgery for bone tumors results in satisfactory results in terms of local tumor control and limb function.

Study on knowledge, attitude, and practices of general public toward antimicrobial use and antimicrobial resistance

Background: The World Health Organization (WHO) states that antibiotic resistance (AMR) is a serious public health issue that is only getting worse. Antibiotic misuse leads to serious complications such as prolonged hospital admissions, high death rates, and increased financial load. While a number of factors have been identified as contributing to the development of AMR, inappropriate antibiotic usage has been identified as the primary cause. Taking antibiotics more often than prescribed, not taking them to their full recommended dosage, sharing prescription medications, storing medication for later use to treat the same symptoms, and obtaining antibiotics without a prescription are some of the factors that contribute to antimicrobial resistance (AMR). Aims and Objectives: The aims and objectives of the study are to assess the knowledge, attitudes, and practices of public regarding the use of antimicrobial use and antimicrobial resistance; evaluating potential corrective measures to address the problem; selecting effective communication strategies to raise awareness; and to analyzing the factors associated with a higher level of knowledge about antimicrobial resistance. Materials and Methods: A descriptive cross-sectional study was carried out after obtaining approval from the Institutional Ethics Committee from July 28th, 2022, to September 28th, 2022, with a sample size of 488 voluntary participants from general public visiting outpatient departments (OPDs) of Rajiv Gandhi Government General Hospital (RGGGH), Chennai. The participants’ knowledge, attitude, and practices regarding the use of antibiotics and antimicrobial resistance were assessed through a questionnaire in English and translated into the local language (Tamil). Results: A total of 488 responses were received from patients visiting the various OPDs of RGGGH, Chennai. Among the respondents, the majority were females 257 (52.7%) of age groups, 18–25 years (172, 35.2%). The respondents were also grouped based on their level of education and found that most of them had completed class 12, 218 (44.7%). Previous history of antibiotic use was assessed and found that 417 (85.5%) participants had taken antibiotics within the past 12 months before the study. Our study found that the majority of respondents (280, 57.4%) knew that the full course of antibiotics should be taken as directed. Practices of acquiring antibiotics were also assessed in our study and found that 301 respondents (61.7%) said they have never purchased antibiotics without consulting a doctor. The proper use of antibiotics was another question that participants were asked and 288 (59%) participants answered that they had received this explanation health-care workers. The knowledge about antibiotic use was assessed and found that the majority of participants (368, 75.4%) correctly identify urinary tract infection as a disease that can be cured by antibiotics. Our study also revealed that most of the participants (317, 64.9%) had awareness about the antibiotic resistance from the given list of terms related to issue of antibiotic resistance. Conclusion: The majority of the general people who visited the RGGGH’s OPDs revealed good attitudes and awareness regarding the severity of antimicrobial resistance (AMR) and the significance of using antibiotics appropriately. Their knowledge, attitudes, and behaviors are determined to be highly satisfactory. There were a few minor fallacies, such as the idea that antibiotics work well against colds. To more accurately assess the baseline circumstances of the broader population, there is a greater need for research in this field using multicentric approaches and a modified demographic focus.

Extrapulmonary tuberculosis - A cross-sectional study comparing the utility of Ziehl-Neelsen stain and immunohistochemistry

Background: Tuberculosis (TB) continues to be a significant global health issue despite known causes and effective treatments. Factors such as virulent strains, drug resistance, and the human immunodeficiency virus pandemic, especially in India, contribute to its prevalence. Mycobacterium tuberculosis, the TB agent, can evade immune responses, persisting within host cells. A distinct feature of TB, granuloma formation, can also appear in diseases such as leprosy, histoplasmosis, and non-infectious conditions like Crohn’s disease. Proper diagnosis is vital, as in resource-limited countries, TB treatment often relies on presumptive diagnoses based on imaging and symptoms, leading to high false positive rates. Aims and Objectives: This study aims to compare the utility of Ziehl-Neelsen (ZN) staining and immunohistochemistry (IHC) staining in suspected extrapulmonary TB lesions. Materials and Methods: This is a retrospective cross-sectional study conducted at the Institute of Pathology, Rajiv Gandhi Government General Hospital, Chennai, over a 2-year period from August 2015 to July 2017. Fifty cases out of the 198 suspected extrapulmonary TB lesions were selected for the study. Results: About 12% of cases were positive for acid-fast bacilli by ZN staining, whereas 82% of cases were positive for acid-fast bacilli by IHC staining. P value was found to be <0.001 by McNemar test which was statistically significant. Conclusion: Diagnosing extrapulmonary TB can be challenging because the disease presents with various clinical manifestations and the bacterial load may be low. Immunohistochemistry is superior to ZN staining for localization of the tubercle bacilli and thus can serve as an effective ancillary technique in diagnoses of extrapulmonary TB in formalin-fixed paraffin embedded tissue sections.

Correlation of cardiac autonomic functions with uroflowmetry parameters in Type 2 diabetes mellitus patients – Analytical cross-sectional study

Background: Diabetic autonomic neuropathy can affect the autonomic nervous system (ANS) as a whole and result in a detrimental impact on cardiovascular, gastrointestinal, and genitourinary systems. However, urinary bladder dysfunction is one of the most important complications of long-standing and poorly controlled diabetes mellitus (DM) and often impairs the quality of life presenting as an under-recognized complication of diabetes. Cardiac autonomic functions are also severely affected in DM, leading to cardiovascular autonomic neuropathy (CAN). Hence, the present study aimed at correlating the urinary bladder functions with cardiac autonomic functions in Type 2 diabetic patients. Aims and Objectives: The aim of the study was to assess the cardiac autonomic functions using a cardiac ANS study (CANS study) and correlate it with the urinary bladder functions using uroflowmetry studies in Type 2 DM patients. Materials and Methods: This is an analytical cross-sectional study, with a sample size of 31 Type 2 DM patients recruited from the diabetology ward of Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai. The patients were clinically examined and the history was collected. The Uroflowmetry test was done in the Department of Urology and the CANS study was done in the Department of Diabetology and the parameters were recorded in Microsoft Excel and analyzed using Statistical Package for the Social Sciences software. Results: A majority of subjects had significant severe and definite sympathetic involvement and early and definite cardiac autonomic neuropathy in the CANS study. Subjects with cardiac autonomic neuropathy had a negative correlation with voided volume, maximum flow rate, and average flow rate and a positive correlation with voiding time, and post-voided residual urine volume. Conclusion: According to this study, subjects with uncontrolled diabetes had predominant sympathetic nervous system dysfunction and also early, definite cardiac autonomic neuropathy. Subjects with early cardiac autonomic neuropathy had significant alterations in the uroflowmetry parameters indicating bladder voiding dysfunction in them. Hence, CANS study and uroflowmetry can be used to determine early ANS dysfunction in DM.

Our experience in postoperative management of totallaryngectomy – A case series

Total Laryngectomy (TL) is recommended as a treatment for advanced laryngeal cancers, while salvage totallaryngectomy is performed as a secondary procedure after recurrence following laser surgery, radiation, orchemoradiation. Establishing comprehensive standards of care for patients undergoing total laryngectomy in thepostoperative period has proved challenging. Perioperative care continues to exhibit considerable variability, oftenrelying on anecdotal practices. The objective of this study was to disseminate our knowledge and expertise ona case series of patients who have undergone TL and the challenges we encountered during the postoperativeperiod and to identify postoperative complications risk factors and their management in the perioperative careof total laryngectomy patients. A retrospective analysis of 10 patients who underwent total laryngectomy at RajivGandhi Government General Hospital, Chennai, was included in the study. Four of them were cases of recurrentlaryngeal carcinoma following the initial failure of definitive radiation (RT), either with or without chemotherapy. 4out of 10 patients developed complications. Complications, primarily pharyngocutaneous fistulas were observedin 3 patients, which were managed surgically by flap cover closure. Complications occurred among patientswith risk factors for inadequate wound healing, such as comorbidities like diabetes mellitus and radiation, whichincreased hospital stay, antibiotic duration, and time to initiate oral feeds among reconstructed patients. Thisanalysis contributes insights into postoperative challenges and risk factors associated with complications in TLpatients.

Assessing the Effect of the Anti-tuberculosis Drug Rifampicin on Known Hypertensive Patients With Tuberculosis in a Tertiary Care Center.

Background Epidemiological evidence suggests an indirect link between hypertension and tuberculosis, and several studies have reported that rifampicin has potentially diminished the hypotensive effects of many anti-hypertensive agents by inducing cytochrome P450. This study investigates rifampicin's effect on the target blood pressure in known hypertensive patients whose blood pressure had been previously controlled with anti-hypertensive drugs. Methodology This prospective observational study was conducted at the Institute of Internal Medicine, Madras Medical Collegeand Rajiv Gandhi Government General Hospital, Chennai, from June 2021 to December 2022. A total of 160 patients with known hypertension on anti-hypertensive drugs were recruited for this study. All these patients had been recently diagnosed with tuberculosis and had been treated with rifampicin-based anti-tuberculosis therapy (ATT). Results The maximum number of patients were under 50 years of age and predominantly male (67%). A total of 91 (57%) patients were hypertensive for less than five years, and the remaining patients were hypertensive within 6-10 years or more than 10 years. However, these patients had other comorbidities such as diabetes mellitus (32%) and coronary artery disease (27%). Before ATT, the mean systolic blood pressure (SBP)/diastolic blood pressure (DBP) was recorded to be 130/80 mmHg. The last six months' course of ATT showed mean values around 154/96 mmHg even after adding additional/multiple anti-hypertensive drugs. After discontinuation of ATT, the mean SBP/DBP was effectively 130/80 mmHg at four weeks. Conclusions Rifampicin significantly diminishes the hypotensive effects of many well-established anti-hypertensives such as calcium channel blockers, beta-blockers, and diuretics to maintain blood pressure.

Characterization and Antimicrobial Susceptibility Pattern of Non-fermenting Gram-negative Bacilli and Molecular Analysis of Pseudomonas Species from Respiratory Samples of Intensive Care Unit Patients in A Tertiary Care Hospital

Among patients admitted to the intensive care unit (ICU) the most common cause of infection is lower respiratory tract infections, which account for 4.4% of hospital admissions. Among the non-fermenters, Pseudomonas aeruginosa and Acinetobacter calcoaceticus-baumannii complex, cause many types of nosocomial infections. Ventilator-associated pneumonia is the most common emerging infection among them. The goal of this study was to isolate and speciate non-fermenting Gram-negative organisms from respiratory samples of ICU patients and to detect antimicrobial susceptibility patterns of the isolated non-fermenters. This cross-sectional study was conducted at the Institute of Microbiology in collaboration with Medical Intensive Care units in Rajiv Gandhi Government General Hospital. A total of 200 patients who satisfied the inclusion criteria were included in the study conducted between March 2019 and March 2020. Culture, sensitivity, and anti-microbial susceptibility tests were performed for the respiratory samples collected as per standard protocols. Pseudomonas aeruginosa (49%) was the most commonly isolated non-fermenter followed by Acinetobacter baumannii (24.3%). Among Pseudomonas aeruginosa isolates, the highest percentage were ESBL producers (44.4%). Carbapenem resistance among Pseudomonas isolates was 33%. The study showed increased isolation of MDR non-fermenters from the ICU causing Ventilator-associated pneumonia (VAP). To prevent VAP caused by these MDR pathogens, clinicians should follow strict infection control practices, use invasive devices on a short-term basis, and use antibiotics judiciously.

Prevalence, predictors, and outcome of pulmonary mucormycosis in COVID-19 associated rhino orbital mucormycosis in a tertiary care center in South India.

India witnessed an explosive rise in mucormycosis following COVID-19 infection. Pulmonary mucormycosis closely followed rhino orbital mucormycosis as the most common presentation. The need for advanced resources and lack of clinical suspicion for COVID-19-associated pulmonary mucormycosis led to widespread underdiagnosis and poor response to late therapy. The present study aimed to assess the prevalence of pulmonary mucormycosis in COVID-19-associated rhino-orbital mucormycosis using non-invasive techniques, such as sputum microscopy and chest imaging. A prospective observational study was conducted at the Institute of Internal Medicine, Rajiv Gandhi Government General Hospital in Chennai, India between June 2021 and July 2021. All hospitalized patients with proven rhino orbital mucormycosis with or without cerebral involvement within three months of confirmed COVID-19 infection who had clinical symptoms compatible with pulmonary mucormycosis were included in this study. These patients were screened for probable and possible COVID-19-associated pulmonary mucormycosis using computed tomography (CT) chest imaging and sputum microscopy within 48 h of hospital admission. Based on the findings, 8 (16%) out of 50 patients with rhino-orbital mucormycosis, had associated possible or probable pulmonary mucormycosis. All 8 patients were diabetics and had characteristic CT chest findings while only half of them had positive sputum microscopy. A higher prevalence of probably disseminated COVID-19-associated mucormycosis was noted among 51-60-year-old males with the use of corticosteroids and oxygen for COVID-19 therapy. The mortality rate was 100% in probably disseminated mucormycosis, 50% in possible disseminated mucormycosis, and only 9.5% in isolated rhino-orbital mucormycosis. Non-invasive and feasible methods, such as sputum microscopy and chest imaging can be considered for early screening and intensive management of probably disseminated mucormycosis to improve prognosis.

Diabetes Self-Management Behaviours among Adult Persons with Disabilities – A Systematic Review

International Journal of Medicine and Public Health,2023,13,1,31-36.DOI:10.5530/ijmedph.2023.1.5Published:June 2023Type:Original Article Diabetes Self-Management Behaviours among Adult Persons with Disabilities – A Systematic ReviewRajeswaran Thiagesan, Vijayaprasad Gopichandran, Sudharshini Subramaniam, Sanjai Subha, Kalpana Kosalram, and Hilaria Soundari Rajeswaran Thiagesan1,*, Vijayaprasad Gopichandran2, Sudharshini Subramaniam3, Sanjai Subha4, Kalpana Kosalram5, Hilaria Soundari1 1Centre for Applied Research, The Gandhigram Rural Institute – (Deemed to be University), Gandhigram, Dindigul, Tamil Nadu, INDIA. 2Department of Community Medicine, ESIC Medical College and PGIMSR, Ashok Pillar Main Road, KK Nagar, Chennai, Tamil Nadu, INDIA. 3Institute of Community Medicine, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, INDIA. 4Department of Neurology, Junior Specialist Doctor (Standard), Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UNITED KINGDOM. 5School of Public Health, SRM Medical College and Hospital, SRM Institute of Science and Technology, SRM Nagar, Potheri, Chengalpattu, Tamil Nadu, INDIA. Abstract:Background: Self-management of diabetes is essential for proper control of blood sugars and prevention of complications. Persons with disabilities face challenges in adopting self-management behaviours. Objectives: To assess diabetes self-management behaviours among persons with disabilities. Materials and Methods: We searched PubMed with a comprehensive search strategy to retrieve epidemiological studies that reported the diabetes self-management behaviours among persons with disabilities in English language journals between 1990 – 2022. We did a step-wise screening of the retrieved articles and synthesized the findings of the selected papers. Results: Of the 992 papers that were obtained, 981 did not meet our inclusion criteria and were excluded at the stage of title and abstract screening. Eleven papers were retrieved and read in detail, and 8 of them were excluded at this stage. Finally, three papers two from China and one from Iran were included in the review. The studies revealed poor diabetes self-management behaviours among persons with disabilities, especially in the domains of diet and physical activity. Conclusion: There is a dearth of studies exploring diabetes self-management behaviours among persons with disabilities. Even the few reported studies show low levels of self-management behaviours. Keywords:Diabetes self-management, diet, Disabilities, Exercise, Glycemic control, Medication adherence., MonitoringView:PDF (149.67 KB)

Prevalence and Auditory Characteristics of Auditory Neuropathy Spectrum Disorder in Adult Population with Sensory Neural Hearing Loss: A Hospital Based Study in South India.

Auditory neuropathy spectrum disorder (ANSD) is a heterogenous group of disorder characterized by abnormalities in auditory brainstem responses (ABR) with preserved otoacoustic emissions and/or cochlear microphonics. The aim of the study is to estimate the prevalence and evaluate the audiological characteristics of ANSD in adult population with sensory neural hearing loss. A prospective study was conducted on the adult population (≥ 18 years) attending ENT outpatients clinic at Rajiv Gandhi Government General Hospital, Chennai. All patients reported to the department with auditory and vestibular symptoms underwent case history, otoscopic examination, and routine audiological evaluation (pure tone audiometry, speech audiometry and immittance audiometry). Patients with indications of ANSD in case history and routine audiological evaluation were further evaluated using distortion product otoacoustic emissions and ABR. A total of 8682 adult population was evaluated during the period of 2017 to 2018. Out of 8682 patients, 1343 (15.46%) of them had sensory neural hearing loss of varying degrees. Out of 1343 adults with sensory neural hearing loss, 24 (1.78%) adults were diagnosed as ANSD. The prevalence of ANSD in adult population with sensory neural hearing loss in our study is 1.32% per 1000 adults. The clinical characteristics of ANSD shows impairment in speech perception irrespective of degree of hearing loss, preserved cochlear functions and abnormal ABR. Hence ANSD is not a rare clinical finding in adults with sensory neural hearing loss, but its prevalence was estimated to be lower in Indian population. Often young females are affected causing significant impairment in speech perception and disability.

A case series on post-traumatic facial nerve palsy

Road traffic accidents accounts a for substantial proportion of traumatic facial nerve injuries. Facial nerve paralysis causes considerable facial disfigurement and emotional distress to the patient. It can cause detrimental effect on both voluntary and involuntary actions of facial muscles. Importantly, it can interrupt normal daily functions such as eating and drinking. Therefore, early identification and surgical intervention are of prime importance in the management of traumatic facial nerve palsies, which is described below in this case series. The goal is to find out type of temporal bone fractures in patients with traumatic facial nerve palsy, to find out the common site of facial nerve injury in patients with traumatic facial nerve palsy, and to assess the surgical outcomes in patients who underwent facial nerve decompression. Case series of five patients who are admitted in ENT Wards in Rajiv Gandhi Government General hospital with traumatic facial nerve palsy were included in this study. Thorough history taking, otoscopic examination, audiological evaluation, radiological Imaging (HRCT temporal bone), topodiagnostic tests, and nerve conduction studies were done in all the five cases. All five patients presented with either grade 3/grade 4 facial palsy according to House–Brackmann’s grading system. HRCT temporal bone showed a fracture line in all the five cases. Electroneuronography showed more than 90% degeneration in all the cases. All the patients underwent facial nerve decompression followed by a course of oral steroids and post-operative physiotherapy. All five cases showed remarkable improvement in facial palsy after surgery with leveling up to House–Brackmann grade 2 and grade 1, early identification of facial nerve palsy due to trauma and prompt management by surgical intervention plays a important role in the management of facial nerve palsy.

A case series on allergic fungal rhino sinusitis – variable presentations

Allergic fungal rhino sinusitis (AFRS) is a non-invasive fungal sinusitis resulting from an allergic and immunologic response to the presence of extramucosal fungal hyphae in the sinuses. Defined largely by the presence of allergic fungal mucin, which is a thick, tenacious, and eosinophilic secretion with characteristic histologic findings. To present a case series on the variable presentations in patients diagnosed with AFRS. A retrospective study of 10 cases that presented to Rajiv Gandhi Government General Hospital ENT outpatient department with allergic fungal rhinosinusitis confirmed by diagnostic nasal endoscopy and CT scan who were managed successfully by endoscopic sinus surgery. In our study, out of 10 cases, nine patients had unilateral symptoms, only one patient has bilateral symptoms. Most common presentation was headache, facial pain, nasal obstruction, and nasal discharge. Some patients had variable presentations such as proptosis, oroantral fistula, blurring of vision, watering of eye, and unilateral frontal headache. On diagnostic nasal endoscopy, two patients had nasal polyposis. Complete disease clearance was achieved in nine cases by functional endoscopic sinus surgery. Patients were started on topical and oral corticosteroids, pre/postoperatively. On follow-up, only one patient had recurrence. Preventing and treating the condition, as well as its spread and complications, are greatly aided by early detection and management of AFRS. The key to enhancing the result is surgical intervention (endoscopic sinus surgery) and medical therapy (corticosteroids). Antifungals have limited role in treatment of AFRS. Longstanding unilateral Sinusitis should always raise suspicious of AFRS.

"Caring for the Uncared for": A Novel Initiative of Madras Medical College.

Every society has persons with illness who do not have any family support. Taking care of such uncared-for patients requires a well-structured system providing medical, psychological, emotional, and rehabilitory support. The first ever rehabilitation ward among government hospitals in Tamil Nadu was created at Rajiv Gandhi Government General Hospital (RGGGH), Chennai with the motto of "Caring for the uncared for." This paper highlights the organizational structure, functionality, profile of patients admitted, challenges faced, and the outcome of patients admitted in the rehabilitation ward. A retrospective study was done on the "untended" patients, who were admitted in the rehabilitation ward at Rajiv Gandhi Government General Hospital (RGGGH), Chennai, Tamil Nadu, India from December 2020 to June 2022. Sociodemographic and clinical characteristics and outcome of the patients were analyzed. A total of 201 adults with physical disabilities or mixed physical and psychiatric disabilities were admitted for intensive rehabilitation. Common medical illnesses included orthopedic disorders in 80 (39.8%), followed by neurological illness in 43 (21.4%) patients. The median length of stay was 50 (24.5-103.5) days with longest stay of 447 days. Of those patients who recovered, 54 patients (26.9%) reunited with family and returned home and 125 (62.2%) patients were sent to old age homes/asylums. A dedicated ward for untended patients is the first of its kind in the state of Tamil Nadu, India. Such a venture has proved to be of benefit, considering the positive outcome in a significant proportion of the beneficiaries.

COX-2 Expression as a Prognostic Inflammatory Marker in Head and Neck Squamous Cell Carcinoma: A Cross-sectional Study

Introduction: Head and Neck Squamous Cell Carcinoma (HNSCC) ranks as the sixth leading cause of cancer worldwide. HNSCC is an aggressive neoplasm involving multistep carcinogenesis. As it is associated with an increased risk of recurrence, morbidity and mortality, many studies are being undertaken to understand its pathophysiology at the molecular level, identify newer prognostic factors and develop novel therapeutic agents. Aim: To assess the clinicopathological features of all cases of HNSCC, including age, sex, site and risk factors and to demonstrate the expression of the Cyclooxygenase-2 (COX-2) marker in various grades of the tumour in a subset of cases. Materials and Methods: A cross-sectional study was conducted on HNSCC at the Institute of Pathology, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India for a period of one year from July 2014 to June 2015. A total of 50 cases (representing different grades) were randomly selected, 25 each from the oral cavity/oropharynx and upper respiratory tract. Immunohistochemistry (IHC) was performed using the COX-2 marker and the results were tabulated in an MS Excel sheet to assess the incidence among different age groups, genders, various risk factors, and sites. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) 21.0 software, using the Chi-square test to assess the significant expression of COX-2 in varying grades of the tumour. A p-value <0.05 was considered significant. Results: The study results (total cases=50) showed an increased incidence of HNSCC among males (n=39; 78%) compared to females (n=11; 22%). Additionally, HNSCC most commonly affected patients in the 5th to 6th decade (n=24; 48%) of life. The occurrence was most commonly noted in the tongue (n=8; 16%) and hypopharynx (n=13; 26%) among all Squamous Cell Carcinoma (SCC) cases of the oral cavity and upper respiratory tract, respectively. Out of the 50 cases included to analyse COX-2 expression, 41 cases (82%) of HNSCC showed COX-2 expression, and its association with different grades was evident by a significant p-value of 0.027. Conclusion: This study demonstrated significant expression of COX-2 in all grades of HNSCC, supporting the role of inflammation in multistep carcinogenesis. Furthermore, molecular targeted therapy against COX-2 could be implemented as an adjunctive therapy with chemoradiation to hinder the progression and aggressive behaviour of the tumour.

Clinico-Epidemiological Profile of COVID-19 Patients with Omicron Variant Admitted in a Tertiary Care Center, South India.

Omicron, a variant of SARS COV2, is looming large as a cause of global concern. Its high transmissibility can pose challenges in healthcare allocation in a highly populous country like India. Studying the behaviour of the virus among the Indian population will definitely help in planning for the impending omicron surge, so we conducted a preliminary analysis of the clinical and epidemiological characteristics of the suspected omicron cases in the early part of the surge. The study was conducted in the Rajiv Gandhi Government General Hospital, from 17th December 2021 to 11th January 2022. A total number of 159 consecutive patients ≥18 years of age with the S gene target failure were enrolled and clinically followed up during hospitalisation. Nearly half (n = 79, 49.7%) were aged between 18 and 30 years and the mean (SD) age of the patients was 35.1 (14.9); 52.8% (n = 84) were males and 54.7% (n = 87) were healthcare workers. The NLR ratio and CRP were raised in unvaccinated individuals. Out of 159 patients, only 4 patients required oxygen and all the others showed a mild course of illness and there was no mortality. The clinical course of suspected omicron patients was mild in those who were vaccinated. Unvaccinated individuals with comorbid illness need to be closely monitored for prompt referral for acute care. Further studies are needed in the high-risk group with omicron.

Assessment of Cardiac Autonomic Functions in Prehypertensive Individuals with and without a Family History of Hypertension: A Cross-sectional Study

Introduction: Individuals with prehypertension are at an increased risk of developing hypertension. Family history is one of the paramount non modifiable risk factors for developing hypertension. Hence, it becomes mandatory to assess the cardiac autonomic functions, which play an important role in the regulation of Blood Pressure (BP), in prehypertensive individuals with a family history. Aim: To compare the variations in parameters of cardiac autonomic function tests in prehypertensive individuals with and without a family history of hypertension. Materials and Methods: This cross-sectional study was conducted at the Institute of Physiology and Experimental Medicine, Madras Medical College, Chennai, Tamil Nadu, India from October 2020 to October 2021. The study included 30 prehypertensive individuals without a family history of hypertension and 30 prehypertensive individuals with a family history of hypertension, aged between 20 and 50 years, of both genders. They were recruited from the non communicable diseases Outpatient Department (OPD) at Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India. The prehypertensive range refers to a Systolic Blood Pressure (SBP) of 120-139 mmHg or a Diastolic Blood Pressure (DBP) of 80-89 mmHg. After obtaining informed consent, baseline parameters such as resting Heart Rate Variability (HRV) using AD instruments powerlab recorder, deep breathing test, Valsalva maneuver, isometric handgrip test, and Cold Pressor Test (CPT) were evaluated. The data obtained was statistically analysed using a Student’s t-test. Results: The mean age of prehypertensive individuals without a family history was 36.90±4.6 years, and in prehypertensive individuals with a family history, it was 36.43±5.3 years. The male to female ratio was higher. The resting SBP and DBP, as well as the basal heart rate, were significantly increased in the prehypertensive subjects with a family history. Time domain variables such as the mean RR, Root Mean Square of Successive Difference (RMSSD), and pRR50 were reduced in prehypertensive individuals with a family history. Among the frequency domain variables, the total power was reduced, while the low-frequency component and LF:HF ratio were significantly increased. The E/I ratio and Valsalva Ratio (VR) were also significantly reduced in prehypertensive individuals with a family history. Thus, the results emphasise that there is significant autonomic dysfunction in prehypertensive individuals with a family history of hypertension compared to prehypertensive individuals without a family history. Conclusion: Cardiac autonomic function tests in prehypertensive individuals with a family history indicate a definite sympathovagal imbalance in the form of sympathetic overactivity. This may substantiate the role of genetic predisposition in them. Chronic activation of the sympathetic nervous system makes them more prone to developing early hypertension.

Determination of age by radiological examination of shoulder joint

Aim of the study was to estimate the age of an individual from the fusion of the secondary ossification center of the shoulder joint. The study was conducted on 60 subjects who were randomly selected from various schools as well as the cases attending the outpatient Department of General Medicine, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai. After obtaining written consent from each individual, radiological examination was done. After the statistical analysis it was observed that in the age group 16-17 males, there were no complete union, among females in the same age group. It was 30%, in the age group 17-18, percentage of complete union was 30.76 among males and 40% among females, in the age group 18-19, percentage of complete union was 33.33% among males and 50% among females.It was concluded that the age of complete fusion of epiphysis of the shoulder joint was 17-18 years for males and 16-17 years for females and the earliest union occurred at the age of 15 years in females and 17 years in males which was higher than the previous studies