Shri Sathya Sai Medical College Research Articles

Application of Compensation Rules in the Four-quadrant Graphical Tool for Arterial Blood Gas Interpretation: A Cross-sectional Study

Introduction: Arterial Blood Gas (ABG) interpretation plays an indispensable role in emergency medicine and the care of intensive care patients, yet it remains a challenging task. Although several graphical methods exist for ABG interpretation, they are not commonly used at the bedside. The existing graphs are complicated, difficult to understand, and unable to diagnose many disorders. In previous research articles, the current author developed and published a four-quadrant graphical tool for ABG interpretation. The tool incorporates compensation rules, which are crucial for identifying changes resulting from compensations or the presence of a second primary acid-base disorder. Aim: To develop a method for applying compensation rules in a four-quadrant graphical tool to interpret ABG reports for complex acid-base disorders in clinical practice. Materials and Methods: This cross-sectional study was conducted at Shri Sathya Sai Medical College and Research Institute, Chennai, Tamil Nadu, India, from November 2022 to April 2023. A total of 232 ABG samples were utilised, and the values of pH, pCO2, HCO3, Standard HCO3, and Standard Base Excess (SBE) were recorded. These values were classified according to different acid-base disorders. Three derived ratios were calculated using the values of pCO2, bicarbonate, and standard bicarbonate, as these ratios change in various acid-base disorders and provide clues for differentiating between different acid-base disturbances. A four-quadrant graph method was constructed using the values of SBE, pCO2, and these ratios. Subsequently, compensation rules were applied to this graph method. Results: The four-quadrant method facilitated the easy identification of different acid-base disorders, and the application of compensation rules further simplified the identification of mixed or compensatory acid-base disorders. Conclusion: The application of compensation rules in this four- quadrant graphical tool for ABG interpretation distinguishes this tool as a unique method among existing approaches. This tool offers an optimal and simplified approach for interpreting ABG results for complex acid-base disturbances, making it highly suitable for clinical practice at the bedside.

Comparative Study of Postoperative Macular Thickness Following Uncomplicated Cataract Surgery – Diabetic versus Nondiabetic Patients in a Tertiary Care Center at Chengalpattu District

Background: Cataracts are the most common cause of blindness in the world. This study aims to determine whether cataract surgery has an effect on the progression of macular thickness in nondiabetic and diabetic patients, specifically in the absence of pre-existing diabetic retinopathy (DR) changes. Methods: It is a prospective cohort study carried out between January 2022 and September 2022 at Shri Sathya Sai Medical College, which is a Tertiary Health-care Center situated at Chengalpattu district in Tamil Nadu, after obtaining ethical clearance from the Institutional Review Board. A total of 72 patients posted for cataract surgery were divided into two groups each group of 36 patients, Group 1 well-controlled diabetics without DR planned for cataract surgery and Group 2 nondiabetics. The patients underwent cataract surgery by small incision cataract surgery/phacoemulsification method based on the staging of cataract and also the surgeon’s choice and cataract surgery was done by the same surgeon and the patients were implanted with rigid/foldable intraocular lens. Results: Out of 72 patients analyzed in both the groups, 37 were male patients and 35 were female patients in the age group commonly 50–65 years. The mean age group in the diabetes group was 57.19 ± 9.18 and the normal group was 61.67 ± 7.73. The mean foveal thickness of the DR group was higher than that of the control group, but the difference was not statistically significant. At the end of the 3rd month, the mean foveal thickness returned to near-normal range. Conclusion: The thickness of the fovea is increased after cataract surgery in the 1st week postoperatively in both diabetic and nondiabetic groups and returns to near-normal preoperative value in both the groups at the end of 3 months postoperative period.

Comparision of intravenous iron sucrose and intravenous ferric carboxymaltose for treatment of iron deficiency anemia in pregnant women: in a tertiary care hospital in Chengalpattu district

Anaemia is the most common manageable problem among pregnant women worldwide, which contribute to maternal and perinatal mortality.The aim is to compare the efficacy, safety and compliance of intravenous ferric carboxymaltose with intravenous iron sucrose in the treatment of iron deficiency anaemia in pregnancy. It is a randomized prospective study conducted in department of obstetrics and Gynecology at Shri Sathya Sai Medical College, constituting of 100 pregnant women. 50 pregnant anemic patients were treated with intravenous ferric carboxymaltose and other 50 patients were treated with intravenous iron sucrose. Hemoglobin, packed cell volume and blood indices were measured before and 3 weeks after treatment. The efficacy and safety of both intravenous compounds were studied.Anaemia in pregnancy was more prevalent among 20-24 years of age groups, it is more common in multigravida in 22-28 weeks of gestational age. The mean difference of hemoglobin 3 weeks after treatment was 2.34 g/dl for ferric carboxymaltose and 1.32g/dl for iron sucrose. The other parameters also increased significantly for ferric carboxymaltose than iron sucrose.: ferric carboxymaltose is an efficient and better alternative in iron deficiency anaemia in pregnancy with fewer side effects and has the added advantage of single dose regime.

Efficacy of N acetylcysteine vs metformin on biochemical and clinical parameters in women with polycystic ovarian syndrome in a tertiary care hospital

: Ovarian dysfunction syndrome, or PCOS, is characterised by hyperandrogenism, enlarged cystic ovaries, and persistent anovulation in women of reproductive age. These coexist with insulin resistance, dyslipidemia, and obesity. To enhance menstruation pattern, insulin sensitivity, and treat dyslipidemia, a metformin replacement that has few side effects is required.: To study the effects of N acetyl cysteine in women with PCOS in and compare with commonly used Metformin. : To evaluate if N acetyl cysteine can substitute Metformin in treatment of women with PCOS in clinical parameters like BMI, menstrual pattern and biochemical parameters like FBS and lipid profile.: A prospective randomized control study was conducted in Obstetrics and Gynaecology department in Shri Sathya Sai medical college. 60 women (diagnosed by Rotterdam criteria) of age group 18 to 45 were included in this study. Subjects were randomly assigned into 2 groups. Group M received Metformin 500mg TDS and group N received N acetylcysteine 600mg TDS. Clinical and biochemical parameters contributing to metabolic syndrome such as menstrual pattern, BMI, Fasting blood sugars and lipid profile were noted before and after completion of the study along with side effects of the drugs.: 30 women in metformin group and 30 in NAC group completed study. A statistically significant decrease in BMI, Waist hip ratio was noted in both metformin and NAC groups. The mean difference post treatment was (3.63 vs 4.16) in BMI and (0.014 vs 0.017) in waist hip ratio. Both treatments led to significant improvement in menstrual pattern, FBS and lipid profile. Group N showed statistically better results compared group M. : Metformin and N acetyl cysteine were efficient in improving BMI, menstrual pattern and the metabolic parameters. However, decrease in BMI, WHR, FBS, lipid profile and menstrual pattern were statistically more significant in NAC compared to metformin.

Efficacy of tablet metronidazole and clindamycin in management of bacterial vaginosis in a tertiary care hospital in Chengalpattu district

BV is a common disorder, yet poorly understood poly-microbial vaginal infection. It is more commonly seen in women in reproductive age group. It has high prevalence in African women specially those in sub-Saharan Africa. Approximately 50-69% of women with BV are not symptomatic and women who presents with symptoms varies from Gray-white offensive vaginal discharge intensified after sexual intercourse and during menstruation, lower abdominal pain and dyspareunia. BV is diagnosed by two different criteria such as Amsel’s and Nugent’s. After the diagnosis according to the above criteria, CDC & ACOG recommended either orally or Intravaginally Metronidazole or Clindamycin is given to treat BV. To study the effectiveness of Clindamycin on Bacterial Vaginosis and compare with commonly used Metronidazole. A randomized control study was done after approval from Institute Ethical committee on patients who came to Gynaecology OPD in Shri Sathya Sai Medical College and Research Institute after taking written and informed consent.All study subjects were examined in the OPD. Under aseptic precautions a high vaginal swab was taken and sent to microbiology lab for culture and sensitivity and using the criterias mentioned below such as Amsel’s and Nugent’s, diagnosis will be noted and treated accordingly.Clindamycin is better than Metronidazole with respect to Amsel’s criteria and Nugent’s after treatment (P<0.05) and with respect to the culture results after treatment (P<0.05).Oral Clindamycin may be preferable to Oral Metronidazole because of its broader spectrum of activity.

OBSERVATION OF THE NORMAL DEVELOPMENTAL PATTERN OF FETAL CEREBRAL SULCI BETWEEN 18 TO 32 WEEKS OF GESTATIONAL AGE BY USING ULTRASONOGRAPHY - A CORRELATIONAL STUDY BETWEEN TWO MATERNAL AGE GROUPS

Background: Anomalous or absent fetal sulci and gyri may be associated with abnormal brain development and increased incidence of the neurological and psychomotor problems like refractory epilepsy or developmental delay, later in the infant life. Lissencephaly, is a condition with "smooth brain," with the absence of normal convolutions (folds) in the cerebral cortex. Neuronal migration disorders result when the post mitotic neurons fail to migrate from the ventricular zone to the cortical plate, resulting in a wide spectrum of cortical malformations. The most common clinical manifestations include severe psychomotor retardation, developmental delay, refractory seizures, and failure to thrive.
 Aim. The research aims at observing normal developmental pattern of fetal cerebral sulci between 18 to 32 weeks of gestational age by using ultrasonography.
 Material and Methods. This is a Cross-sectional observational study, performed among 110 antenatal women investigated under the Department of Radio Diagnosis, Shri Sathya Sai medical college and research institute, Ammapettai. The appearance and complete formation of sulci and fissures such parieto-occipital sulci, cingulate sulci, calcarine sulci and convexity sulci and also the insula/sylvian fissure were identified.
 Results and Discussion. Parietooccipital fissure wass identified as dot pattern by 18-19 weeks and complete by 24 weeks. Calcarine fissure identified as dot pattern by 18 -19 weeks and almost complete by 22 weeks. Cingulate sulci were identified as dot pattern by 23-24 weeks, with Y pattern appearing by 27-28 weeks and complete by 31-33 weeks. By 19-20 weeks Smooth surface Sylvian fissure was present and predominant till 20-21 weeks. By 22-23 weeks Obtuse angle Sylvian fissure was predominant and by 29-30 weeks Acute angle Sylvian fissure was complete. Convexity sulci was absent till 23 weeks 6 days and started appearing after 24 weeks. The Convexity sulci fully appeared after 28 weeks. The mean Period of Gestation (weeks) of the appearance of Dot, V and Y patterns of each fissure and sulci between the mother of below and above 35 years were not statistically significant.
 Conclusion. Parietooccipital fissure, Sylvian fissure and Calcarine fissure started appearing by 18-19 weeks, and complete by 24 weeks (except Sylvian fissure which was complete by 30 weeks). Convexity and Cingulate sulci started appearing early by 23 weeks, complete by 28 weeks and 33 weeks respectively.

An evaluation of lipid profile in patients with metabolic syndrome at a tertiary care teaching hospital based in Tamilnadu

Background: Metabolic risk factors contributing are abdominal obesity, dyslipidemia, hypertension, elevated plasma glucose, pro-thrombotic state and proinflammatory state. Diabetes mellitus (DM), a metabolic disorder caused by impaired insulin secretion, peripheral insulin resistance or both, has become a major public health problem in India. Aims and Objectives: To evaluate the lipid profile in patients with Metabolic Syndrome at a tertiary health care centre Tamilnadu. Materials and methods: This is a cross-sectional study carried out in the Department of Medicine, Shri Sathya Sai Medical College and Research Institute in Patients diagnosed with Metabolic syndrome were identified and randomly selected in all age groups. 50 metabolic syndrome patients (Cases) and age matched 50 normal patients (Controls) were enrolled into the study with written explained consent. All patients underwent lipid profile testing and fasting and post -prandial sugar level as per standard protocol. Statistical analysis was done with unpaired t-test and chi-square test using SPSS version 19 software. Results and Observations: our study contains that the majority of the patients were in the age group 61-70y – 42%, 50-60y.29%, >70y 13% similarly controls were also 60-70y- 38%, 50-60y -29%, >70y were 8% and hence both the cases and controls were comparable with age (p>0.05).

Assessment of risks with acute ischemic stroke in association with CRP levels

Background: There is growing evidence of the prognostic importance of C-reactive protein (CRP) in ischemic stroke. However, the independent value of CRP at different stages after stroke has not been established. Therefore, we assessed the prognostic values of CRP in ischemic stroke. C- reactive protein (CRP), an acute phase reactant and a marker for underlying systemic inflammation has been reported to be elevated in acute coronary syndromes. It has been reported that concentrations of C-reactive protein is directly correlated with the presence and severity of atherosclerosis and are predictors of coronary events and mortality in patients with acute coronary syndromes. Aims and Objectives: The primary aim of this study was to systematically and critically review the relationship between CRP and long-term functional outcome in ischemic stroke patients to evaluate the current state of the literature and also risks involved in it. Materials and methods: This is a prospective study carried out in the Department of Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Chengalpet, Tamilnadu. Personal history regarding dietary habits, smoking, alcohol consumption and tobacco chewing were noted. NIH Stroke Scale was assessed in all patients to assess the neurological disability and its prognosis.

Comparison Between Epidural Bupivacaine with and without Magnesium Sulphate in Patients Undergoing Elective Total Abdominal Hysterectomy: A Double-blinded Randomised Clinical Trial

Introduction: The effectiveness of a local anaestheticis increased by the addition of an adjuvant. Magnesium sulphate along with bupivacaine is effective in reducing the pain and extending the analgesia period. Aim: To compare the duration of analgesia among subjects receiving plain bupivacaine and bupivacaine with magnesium sulphate among patients undergoing total abdominal hysterectomy. Materials and Methods: This double-blinded randomised clinical trial was conducted in Department of Anaesthesiology at Shri Sathya Sai Medical College and Research Institute, Ammapettai, Tamil Nadu, India, (tertiary care center) between November 2019 and October 2021. The study was done among 50 subjects undergoing elective total abdominal hysterectomy. The subjects were divided into two groups, one group received only bupivacaine while the other group received bupivacaine with 500 mg magnesium sulphate. Onset and duration of blocks were observed. Haemodynamic parameters were monitored intraoperatively and postoperatively. Data was analysed using Chi-square test, Fischer’s exact test. Results: Demographic variables like age (p-value=0.17), height (p-value=0.62), weight (p-value=0.14) and BMI (p-value=0.24) were comparable between the two groups. The mean duration of analgesia was significantly more among the bupivacaine and magnesium sulphate group (416.72±93.6) in comparison to the bupivacaine alone group (204.56±71.25). The bupivacaine and magnesium sulphate group required two doses of rescue analgesia in 24 hours, while the other group required four doses of analgesia. Significantly more side-effects were noted among the bupivacaine alone group (12 vs 6) (p-value=0.04). Conclusion: The study showed that bupivacaine and magnesium sulphate group showed less intraoperative side effects, reduced postoperative VAS score increased duration of analgesia, decreased requirement of analgesia required in 24 hours and reduced postoperative side-effects.

Fetal and neonatal outcomes in early onset versus late onset pre-eclampsia-a comparative study

Background: Pre-eclampsia is typed as two different entities: early-onset preeclampsia occurring at less than 34 weeks of gestation, and late-onset occurring at 34 or more weeks of gestation. The aim of this study is to compare the fetal and neonatal outcomes in early versus late onset preeclampsia.Methods: 208 patients diagnosed with pre-eclampsia in Shri Sathya Sai medical college and research institute over a period of three years (From January 2016 to January 2019) were retrospectively studied. Patients were classified as early onset and late onset pre-eclampsia based on the gestational age of onset. Data on fetal and neonatal outcomes were collected and analysed using Chi square and Fisher’s test and compared.Results: Early onset and late onset pre-eclampsia were 34.6% and 65.3%. The incidence of oligohydramnios, SGA, low APGAR at 5 minutes of birth were high in early onset type. 64.9% of early onset type required NICU admission whereas only 38.23% new born of mothers with late onset type required NICU admissions.10.8% of babies of patients with early onset type were still born. The incidence of NICU admissions, requirement of respiratory support, duration of NICU stay were significantly high in early onset type.Conclusions: Patients with early onset pre-eclampsia are found to have higher rates of specific fetal and neonatal morbidity when compared to the late onset type. Prudent and close scrutinizing and follow up and delaying delivery in stable and appropriately selected patients with pre-eclampsia would be advantageous for neonates.

English

BACKGROUND Hand size measurements are commonly used references when instruments are not available and still practiced in rural and even in urban areas of Tamil Nadu. Ancient literature evidences have adequate support for their usage. We wanted to correlate hand span length, hand breadth, and hand length with the stature of an individual. We also wanted to compare the level of correlation of hand span length between males and females. METHODS 214 students were recruited for this study as a convenient sample size. Male students were 122, females were 92. They were aged between 18 - 23 years of Shri Sathya Sai Medical College and Research Institute. Hand span is the distance between tips of the casually extended pollex and minimus. RESULTS The results of Pearson’s correlations were moderately significant between height and the hand breadth (0.315), between height and weight (0.340), and between height and hand length (0.387). The extent of correlation was significant between height and the hand span (0.954) in case of males. In case of females, value of the correlation was also moderately significant between height and the hand breadth (0.619), between height and weight (0.392), between height and hand length (0.515) and between height and the hand span (0.973). CONCLUSIONS The stature was reliably estimated from the hand span length, and the same could be applied for the medicolegal, and forensic purposes. KEY WORDS Hand Span, Stature, Medico Legal, Anthropometry

Self-reported, self-care activities among type 2 diabetic patients in rural areas of Kancheepuram district, Tamil Nadu: a cross-sectional study

Background: Diabetes is a chronic condition. The burden of diabetes is, expected to rise to 592 million by 2035. Diabetes self-care activities can have a dramatic impact on lowering glycosylated hemoglobin levels. Hence, this study has been planned to assess the self-care activities among the type 2 diabetes patients in rural areas of Kancheepuram district, Tamil Nadu.Methods: A cross-sectional study was conducted among type 2 diabetic patients residing in rural field practice area of Shri Sathya Sai Medical College and Research Institute, Kancheepuram district during May 2019 and June 2019. Personal interview using semi-structured questionnaire including summary of diabetes self-care activities- revised version was conducted.Results: Majority of the study participants were female and 46.2% were above 51 years of age. Majority had diabetes mellitus for 1-5 years. Of the diabetic self-care activities 68.5% had healthy eating 2-4 times/week. About 33.2% of the participants were not indulged in physical activity as well as high-intensity exercises even for a single day; about 33% had not tested their blood sugar level for even a single time and only 1.5% had checked their feet on all days during the previous week. Higher food scores were found significantly associated with availability of family support for self-care activities (p value 0.020).Conclusions: Of the diabetic self-care activities the healthy dietary component was followed satisfactorily but exercise, foot care and testing of blood sugar were followed poorly by the study participants.

Anatomical variations in patients with chronic sinusitis

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">C</span><span lang="EN-IN">hronic sinusitis is repeated bouts of acute infection or persistent inflammation of the sinuses. The range of anatomic variants that can interfere with the mucociliary drainage of osteomeatal complex including concha bullosa, deviated nasal septum, uncinate process variations, ethmoid bulla, paradoxical middle turbinate, agger nasi and Haller cells. This is also important in surgeon point of view to know about detail knowledge of lateral nasal wall, paranasal sinuses, surrounding vital structures and anatomical variation. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Observational case series study in which 90 cases of chronic rhinosinusitis patients attending the ENT outpatient department from November-2015 to November-2016 in Shri Sathya Sai Medical college and Hospital, who had chronic sinusitis for more than three months duration not responding to the medical line treatment and who are willing to undergo functional endoscopic sinus surgery are studied and statistically analysed. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">In our study we found anatomical variation in 93% of chronic sinusitis patients. In our study it was observed that 52% of patients with two anatomical variation, 41% patients presented with single anatomical variation and 7% patients presented with no anatomical variation. In our study deviated nasal septum was the most common anatomical variant noted followed by unilateral concha bullosa, medialized uncinate process, paradoxical middle turbinate, haller cell and agger nasi. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">In our study it was concluded that presence of anatomical variations is common in patients with chronic sinusitis. Presence of more than one anatomical variations significantly contributes to disease process.<strong> </strong>Deviated nasal septum is the most common anatomical variation in our study followed by concha bullosa, medialized uncinate process.</span></p>

Incidence of accessory ostia in patients with chronic maxillary sinusitis

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Chronic maxillary sinusitisis is one of the most frequent diseases presenting in ENT out patient department seeking medical attention<sup>.</sup><strong> </strong>Defects in the fontanelle region of the lateral nasal wall have been described as accessory ostia. The presence of AMO in both pre and post operated cases of chronic maxillary sinusitis can cause recirculation of mucus leading to recurrences. In the present study we will investigate the incidence of accessory ostia in patients with clinical and radiological signs of chronic maxillary sinusitis. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">The study included 100 patients visiting the out patient department of Shri Sathya Sai Medical College and Research Institute selected according to inclusion criteria with a clinical diagnosis of chronic rhino sinusitis which was confirmed by high resolution CT scan and those patients were subjected to diagnostic nasal endoscopy under local anesthesia. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The study group consisted of total 100 patients among whom 56 were male patients and 44 were female patients. Accessory maxillary ostia were detected in 23% of the cases and in rest of the 77% cases it was absent. Among the 23 cases in 35% cases accessory ostia were found to be bilateral and in 65% cases it was found to be unilateral. Among the cases where accessory ostia were seen, in 39% cases only accessory ostia were found. Where as in 17.39% cases it was associated with concha bullosa, in 65.2% cases there was deviated nasal septum and in 8.7% cases paradoxical middle turbinate were found to be present. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">To conclude, the present study revealed close association of accessory ostia with chronic maxillary rhino sinusitis. It was also found that majority of the cases accessory ostia were found to be unilateral and were frequently found in the posterior fontanelle region.</span></p>

A STUDY ON THE LEVEL OF DRUG COMPLIANCE AMONG THE OUTPATIENTS WHO ARE ON A LONG-TERM DRUG THERAPY IN A TERTIARY CARE TEACHING HOSPITAL AT KANCHEEPURAM DISTRICT IN TAMILNADU

ABSTRACTObjectives: To evaluate the drug compliance level among the patients attending the outpatient department of Shri Sathya Sai Medical College Hospitalusing Morisky 8-item drug compliance questionnaire and to determine the factors which hinder them from adhering to physician’s prescription.Methods: 100 patients who were on long-term drug treatment on outpatient basis were selected. Following that, Morisky 8-item drug compliancequestionnaire, a self-reported scale of medication adherence was used. Along with the mentioned questions, a few questions to assess factors causingnoncompliancy and their knowledge on drug compliance were included. Data were collected and based on the scale, the level of compliance, i.e., low,medium or high was estimated. Patients found noncompliant, factors hindering them from being noncompliant were assessed.Results: Among the 100 patients, 33% belonged to low adherence group, 44% to medium adherence group, and 23% to high adherence group.Patients belonging to low and medium adherence group were segregated and their individual questionnaire was assessed and reason for beingnoncompliant analyzed. The majority of the low adherence group said that they discontinue treatment once they feel that their symptoms were undercontrol.Conclusion: Drug noncompliance is an important factor for treatment failure. The importance of medication adherence was re-emphasized to thosepatients who belonged to low/medium adherence group.Keywords: Morisky, Drug compliance, Shri Sathya Sai, Low adherence.

Vitamin D status in children with cerebral palsy

Background: The aim of the study was to find the prevalence of vitamin D status - vitamin D deficiency and insufficiency in children with cerebral palsy and to compare them with normal children. To identify the risk factors associated with vitamin D deficiency in these children.Methods: A prospective case control study was done in 200 children in Shri Sathya Sai Medical College and Research Institute, Ammapettai, Thiruporur, Tamil Nadu, India over a period of one year from December 2014 to December 2015 after obtaining approval from institutional ethical committee. Study group contained 100 children with cerebral palsy. 100 Age and sex matched children were taken as controls. Children included in the study were between 1 to 12 years. All children were subjected to the following investigations: serum calcium-total, serum phosphorus, serum alkaline phosphatase (SAP) levels. These were determined by an automated analyzer. The 25OH vitamin D levels were estimated by CLIA (chemi luminescence immunoassay) method. Results: Vitamin D deficiency was observed in 32 (32%) and insufficiency in 61 (61%) of children with cerebral palsy in case group. Similarly, vitamin D status studied in control children was found that majority of them 49 (49%) was normal. While 38 (38%) were vitamin D insufficient, 13 (13%) showed deficient levels (p <0.0000001).Conclusions: The presence of feeding difficulties, poor sunlight exposure, poor nutritional status, and the use of antiepileptic drugs, type of CP and the functional grade of CP had statistically significant association with Vitamin D deficiency in these children.

Pre-hospital care among victims of road traffic accident in a rural area of Tamil Nadu: A cross-sectional descriptive study.

Background:The World Health Organization has estimated that globally almost 1.24 million people die annually on the world's roads. The aim of the study was to assess the attributes of pre-hospital care in road traffic accidents (RTAs) victim brought to the health care establishment and to evaluate the pre-hospital trauma care provided in the rural areas of Kancheepuram district of Tamil Nadu.Materials and Methods:A cross-sectional descriptive study of 3 months duration (June 2014 to August 2014) was conducted in the Shri Sathya Sai Medical College and Research Institute, Kancheepuram. The method of sampling was universal sampling and all RTA victims satisfying the inclusion criteria were included in the study. During the entire study duration, total 200 RTA victims were included. A pre-tested semi-structured questionnaire was used to elicit the desired information after the victims of RTAs are stabilized. Ethical clearance was obtained from the Institutional Ethics Committee prior to the start of the study. Written informed consent was obtained from the study participants (patient/guardian of children) before obtaining any information from them. Data entry and statistical analysis were done using SPSS version 18. Frequency distributions and percentages were computed for all the variables.Results:Majority of the RTA victims 158 (79%) were from the age-group of 15-45 years. Most of the accidents were reported in night time [77 (38.5%)], on week-ends [113 (56.5%)], and involved two-wheelers [153 (76.5%)]. Almost 66 (33%) of the victims were not aware of the existence of emergency ambulance services. Also, only 15 (7.5%) victims were brought to the hospital in the emergency ambulance, of which only 3 victims were accompanied by a doctor.Conclusion:To conclude, the study indicates that a significant proportion of people were unaware about the emergency trauma ambulance services and the existing pre-hospital care services lack in multiple dimensions in a rural area of South India.

Offering a ray of hope for the mentally-ill and differently-abled individuals

Offering a Ray of Hope for the Mentally-ill and Differently-abled Individuals Mentally-ill/challenged and differently-abled persons constitute a significant proportion of global population the health care and social welfare needs of which can neither be ignored nor be neglected. In the global effort to ensure accessibility, availability and affordability of the primary health care services to all segments of people including the mentally-ill and disabled individuals, Shri Sathya Sai Medical College & Research Institute (SSSMC & RI), Kancheepuram district, Tamil Nadu has extended the wide scope of preventive, curative and psychologically rehabilitative services to the inmates of a Special school and home for the mentally ill / challenged and multiple-disabled individuals named Anbagam. To conclude, in rural areas and in low-resource settings which usually lack the geographical accessibility and availability of medical personnel and paramedics, the extension of health care services by SSSMC & RI for the welfare of mentally ill, disabled and community in general is definitely a stepping stone towards improving the quality of life of the community and health indicators of the region in general.

English

IntroductionEnterococci are part of the normal intestinal flora of humans and animals but have also emerged as important pathogens responsible for serious infections in hospital and community acquired infections. According to recent surveys, Enterococci remain in the top 3 most common pathogens that cause nosocomial infections. AimTo process all the clinical samples from various departments in our hospital, for the isolation of Enterococci sp. To speciate the isolates & to have the resistance pattern of the isolates to Vancomycin Methods and MaterialA total of 928 samples were collected from both out patients and in patients in all clinical departments and transported to microbiology laboratory. Specimens were processed by inoculating on to Mac Conkeys agar, blood agar, nutrient agar and Pfizer selective media and incubated at 370C for 24 48 hours. Enterococci were identified by their typical arrangement in Gram stain, Bile esculin test and salt tolerance test. Speciation was done by subjecting the isolates to a battery of biochemical tests. Antimicrobial susceptibility patterns were determined by performing Kirby-Bauer disc diffusion method and Minimum Inhibitory Concentration (MIC) values were identified by Tube & Agar dilution method. ResultsA total of 928 samples. Among these, 647 (69.72%) were culture positive with different isolates and 281 (30.28%) were culture negative. Among 647 culture positive cases, 100 (15.46%) were Enterococcus faecalis. Antimicrobial susceptibility & MIC done as per standard protocols. The E. Faecalis showed 99% sensitive to Vancomycin. The resistance to Vancomycin was further confirmed by MIC both Agar &Tube dilution methods, in which the MIC was: 32μg/ml in one isolate. ConclusionsSpecies level identification of Enterococcus is not only important for epidemiological study, but also for analysing the drug resistant pattern. Effective detection of Vancomycin resistance in laboratory helps in reducing the morbidity and mortality due to VRE in hospitalized patients. Key wordsBlood agar, Mac Conkeys agar, Bile esculin, Vancomycin resistant Enterococci, Minimum inhibitory concentration. International Journal of Medical and Clinical Research ISSN:0976-5530 & E-ISSN:0976-5549, Volume 3, Issue 4, 2012 Citation: Sunilkumar Jada and Karthika Jayakumar (2012) Prevalence of Enterococcus species from various clinical specimens in Shri Sathya Sai Medical College & Research Institute with special reference to speciation and their resistance to Vancomycin. International Journal of Medical and Clinical Research, ISSN:0976-5530 & E-ISSN:0976-5549, Volume 3, Issue 4, pp.-154-160. Copyright: Copyright©2012 Sunilkumar Jada and Karthika Jayakumar. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited. Introduction Enterococci are part of the normal intestinal flora of humans and animals but have also emerged as important pathogens responsible for serious infections in hospital and community acquired infections. The genus Enterococcus includes more than 17 species, but only a few cause clinical infections in humans [1]. Enterococci were originally classified as enteric gram-positive cocci and later included in the genus Streptococcus. In the 1930s, with the establishment of the Lancefield serological typing system, Enterococci were classified as group D streptococci and were differentiated from the non-Enterococcal group D streptococci such as Streptococcus bovis by distinctive biochemical

Vulnerability to disasters: Are we moving ahead?

DEAR EDITOR Strong and effective emergency disaster management has been a felt need in all corners of world. India is vulnerable to a variety of natural and man‐made disasters. Management of disasters require collaborative and systematically planned efforts of existing administrative set up, civil society, and its various institutions. Effective policies play a vital role in mitigating impact of disasters and reducing likely losses of life/property. It has been observed that in times of disaster, apart from lack of resources, lack of coordination among various agencies, and an absence of role clarity amongst various stakeholders pose serious challenges. Each disaster highlights that government agencies are either not prepared or ill prepared for next crisis. It is, therefore, important to identify factors that make a critical difference in effective policy outcomes. In a study to assess hospitals preparedness for disaster in Indore, it was observed that only one hospital had adequate infrastructure for management of disaster. In another study to evaluate staff knowledge and perceptions in disaster preparedness, it was revealed that there were no specific national standards/guidelines through which individual hospitals can develop their capabilities in disaster preparedness. Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, Tamil Nadu, India Correspondence to: Dr. Saurabh Rambiharilal Shrivastava, 3rd floor, Department of Community Medicine, Shri Sathya Sai Medical College & Research Institute, Ammapettai village, Thiruporur Guduvancherry Main Road, Sembakkam Post, Kancheepuram 603108, Tamil Nadu, India. E-mail: drshrishri2008@gmail.com