Sri Manakula Vinayagar Medical College Research Articles

Correlation between HbA1C and CCT in T2DM

Abstract An observational cohort study of central corneal thickness (CCT) in type 2 diabetes mellitus (T2DM) patients in hyperglycemic and euglycemic states. Context: To assess the significance of glycemic control in CCT measurement. Aims: The main aim was to assess the change in CCT with the change in glycemic state by following them after 3 months. Settings and Design: This study was carried out in the department of ophthalmology, SMVMCH, Pondicherry. Materials and Methods: This is an observational cohort study carried out at Sri Manakula Vinayagar Medical College and Hospital after obtaining ethics committee clearance. Fifty-six T2DM patients with HbA1C >7 were included in this study with informed consent. Clinical history with complete ophthalmic examination done, CCT was measured using ultrasonic pachymetry (UP) along with blood samples to measure their blood sugars and HbA1C values. They were advised to follow up on the treatment given by the medical department. Patients were reviewed after 3 months to measure the CCT and blood sugar values. Statistical Analysis: Done using STATA software 16.0. Continuous data and categorical data were assessed using paired t-test and Chi-square test, respectively. Normality of data using Shapiro–Wilk normality test. Statistical significance was adopted with P < 0.05. Results: In our study, the initial mean HbA1C was 9.4 ± 1.9 and mean CCT was 552.6 ± 40.6 μm, whereas follow-up mean HbA1C was 7.1 ± 1.2 and mean CCT was 548.5 ± 38 μm which shows statistical significance. Conclusion: Diabetics present with thicker corneas and there is a decrease in thickness once glycemic control has been achieved. Keeping this in mind, we suggest assessment of CCT in all diabetic patients during clinical work-up.

Community-based Advocacy Communication Social Mobilization (ACSM) intervention by empowering key community leaders: Evaluation using the RE-AIM framework.

Based on the theme of World Tuberculosis (TB) Day 2018-"Wanted Leaders for TB free world," various studies and country-level project have witnessed how training leaders on TB has helped enhance TB awareness in the community. This study was conducted to evaluate the effectiveness of Advocacy Communication and Social Mobilization (ACSM) intervention strategy through key community leaders, using Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. This study was undertaken by the Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital (SMVMCH), Puducherry, in the field practice area of Primary Health Centre (PHC), Thirubuvanai. The STOP TB, ENGAGE-TB, and National TB Elimination Program (NTEP) guidelines were used for interventions. Key community leaders (KCL) list (N = 117) was obtained from Mannadipet commune panchayat and PHC. The study was conducted in four phases: phase 1 (baseline): quantitative data: proportion of presumptive TB cases from notification register; phase 2 (intervention): training program for staff nurses, auxiliary nurse midwife (ANM), Accredited Social Health Activist (ASHA), and Anganwadi workers (group activity), participatory rural appraisal (PRA) activity for self-help group (SHG) leaders, and health education session for religious leaders and ex-panchayat leaders; phase 3: strengthening of ongoing activity: health education session and active case finding for TB; and phase 4: end line: outcome of the intervention, evaluated using the RE-AIM framework. As an outcome of the intervention, there was a marginal increase (21 cases) in the proportion of presumptive TB cases when comparing before (2018) and after (2019) intervention. The proportion of presumptive TB cases identified and referred by KCL was 312. A total of 77 presumptive TB cases were identified through community-based active case finding (ACF). Two sputum samples (on the spot early morning) were collected and sent for Cartridge-based nucleic acid amplification testing (CBNAAT), of which three cases were positive. This study was community led and involved leaders from diverse backgrounds, optimizing the chance of success. For sustainability, we have initiated TB support group.

A COMPARATIVE STUDY TO ASSESS THE LEVEL OF DEPRESSION AMONG THE ELDERLY LIVING IN OLD AGE HOMES AND COMMUNITY, PUDUCHERRY

Depression is a state of mental illness. It is characterized by deep, long lasting feelings of sadness or despair. Depression can change an individual’s thinking/feelings and also affects his/her social behaviour and sense of physical well-being. It can affect people of any age group, including young children and teens. It can run in families and usually starts between the ages of 15 and 30 years. Women and elderly people are more commonly affected than men. There are several types of depression such as major depression it is a change in mood that lasts for weeks or months. It is one of the most severe types of depression. Dysthymia is a less severe form of depression but usually lasts for several years. Psychotic depression a severe form of depression associated with hallucinations and delusions .Seasonal depression, occurring only at certain time of the year usually winter, also known as winter blues’. Some of the common factors that may cause depression are genetics , trauma and high levels of stress, mental illnesses such as schizophrenia and substance abuse, postpartum depression (women may develop depression after the birth of the baby), serious medical conditions such as heart disease, cancer and HIV, use of certain medications, alcohol and drug abuse, individuals with low self-esteem, trauma and high levels of stress due to financial problems, breakup of a relationship or loss of a loved one. The signs and symptoms of depression include feeling of sadness and loneliness, loss of interest in activities once found enjoyable, feeling of hopelessness, worthlessness or excessive guilt, fatigue or loss of energy, sleeping too little or too much, loss of appetite, restlessness and being easily annoyed. Diagnose the depression based on the detailed history and sign and symptoms of the individual. Laboratory tests such as blood tests to screen for alcohol/drugs in blood. Psychological evaluation of the individual’s thoughts, feelings and behaviour patterns. The most common treatments of depression are Counselling & Psychotherapy, Medication, Electro convulsive therapy. Medications such as anti-depressants are given to help balance chemicals in the brain known as ‘neuro transmitters’. Electroconvulsive therapy (ECT) is carried out in case the treatment with other therapies such as medications has failed. Preventive measures include regular exercise, healthy diet and stable relationships. Statement Of The Problem: A comparative study to assess the level of depression among the elderly living in old age homes and community, Puducherry’’. Objectives: To assess the level of depression among the elderly. • To compare the level of depression among elderly residing in old age home and those living in community. • To associate the level of depression among elderly with their selected demographic variables. Materials and Methods: The investigator obtained formal permission from Hospital authority and Institutional Ethical Committee of Sri Manakula Vinayagar Medical College and Hospital. The study was conducted at help age India old age home and thirubhuvanai community area, Puducherry. The period of data collection was four weeks .The study was conducted quantitative research approach ,descriptive research design and convenient sampling technique was used to select the sample .The sample size was 60 elderly depression patient, 30 were inmates of old age home and 30 were living in community. The investigator explained the procedure to the clients and assessed level of depression among elderly people’s. After obtaining oral consent primarily the demographic data was obtained from the samples. Standardized Hamilton depression rating scale prepared by the investigator was used to assess the level of depression among the elderly living in old age homes and community. This scale consists of 17 items. The data variables were collected from the elderly residing at help age India and thirubhuvanai community area .This was continued for 15-20 minutes in a day. Sample is reassessed to analyze the intervention on depression. Data analysis was done using descriptive and statistical analysis. Result: The findings shows that, the mean score of the level of depression among the elderly living in the old age homes was 16.47 ± 4.637 and the community was 12.73 ± 6.341.The calculated independent ‘t’ test value of t = -2.603 shows statistically significant difference between Comparison between the level of depression among the elderly living in old age homes and community respectively. Conclusion: Out of 60 samples in Frequency and percentage wise distribution of level of depression among the elderly living in old age homes and community .In old age homes, Majority of the elderly10 (33.3%) had moderate level of depression, 9 (30%) had severe level of depression, 8 (26.7%) had mild level of depression, 2 (6.7%) had extremely severe level of depression and 1 (3.3%) had normal level.

Role of Diffusion-weighted Magnetic Resonance Imaging in Differentiating Cholesteatoma from Chronic Suppurative Otitis Media: A Cross-sectional Study

Introduction: Radiological imaging, such as High-resolution Computed Tomography (HRCT) of the temporal bone, has always held significant importance in diagnosing and staging Chronic Suppurative Otitis Media (CSOM). In preoperative cases of CSOM and cholesteatoma, HRCT describes the disease’s extent to aid in surgical approach, while diffusion-weighted Magnetic Resonance Imaging (MRI) sequences can differentiate cholesteatoma from other common inflammatory middle ear diseases. Aim: To determine the role of Diffusion-weighted Magnetic Resonance Imaging (DW-MRI) in differentiating between granulation tissue and cholesteatoma using histopathological findings as a reference standard. Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Radiodiagnosis, Sri Manakula Vinayagar Medical College, Puducherry, India, from November 2018 to April 2020. A total of 40 patients who underwent HRCT of the temporal bone for preoperative evaluation of CSOM underwent diffusion sequence MRI, and their findings were compared with intraoperative and postoperative histopathological results. Findings such as soft-tissue masses with scutum and erosion of ear ossicles were analysed in HRCT, while diffusion restriction was observed in DW-MRI in cases of cholesteatoma. Data were collected using a prescribed proforma and analysed using Statistical Package for Social Sciences (SPSS) software version 24.0. Results: The mean±Standard Deviation (SD) age of the patients was 43±20.41 years (27 males, 13 females). The most common presentations in this study were mucopurulent discharge and conductive hearing loss (20 out of 40 patients). Among the 16 patients diagnosed with cholesteatoma through histopathological examination, all (100%) were reported to have diffusion restriction present in the MRI. The sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of DWI were all found to be 100% in diagnosing cholesteatoma. The sensitivity of HRCT was 81.25% and the specificity was 83.3%. Conclusion: High-resolution computed tomography provides a surgical roadmap indicating the extent of involvement and bony structures, while DW-MRI imaging helps in differentiating cholesteatoma from CSOM. A combined preoperative approach using HRCT and DW-MRI imaging can aid in diagnosing cholesteatoma effectively.

Diathermy versus Scalpel Skin Incision for Open Inguinal Hernia Surgery: An Interventional Study

Introduction: Inguinal hernia is one of the most encountered surgical-related problems worldwide. For years, there has been debate among surgeons about which type of skin incision to use: cutting with electrocautery or the traditional method of a surgical scalpel. Aim: To compare the skin incisions made with electrocautery versus traditional scalpel incisions in terms of incision time, blood loss, postoperative pain, and scar evaluation. Materials and Methods: A hospital-based prospective interventional study was conducted at the Department of General Surgery, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India, from November 2019 to September 2021. Written informed consent was obtained from 130 consecutive cases scheduled for open inguinal hernia surgery. Patients were alternately assigned to undergo incision with electrocautery (group A) or a conventional steel scalpel (group B), with each group comprising 65 patients. Bilateral hernia cases were treated as separate entities. Data analysis was performed using Microsoft Excel and Statistical Package for Social Sciences (SPSS) software version 24.0, employing the Student’s t-test and Chi-square test. A p-value of <0.05 was considered statistically significant. Results: The age distribution in group A was 49.69±15.74 years and in Group B was 52.81±14.25 years. The time taken for incision in the electrocautery group was much shorter at 12.57±11.55 seconds than in the scalpel group at 20.63±2.99 seconds, with a p-value of <0.001. The average amount of blood loss in group A was 1.02±0.35 mL and in group B was 2.03±0.32 mL, with a significant p-value of <0.001. The postoperative pain, calculated by the Visual Analogue Scale (VAS), showed a significant difference in the early postoperative period at 6 hours after surgery in Group A at 6.58±0.9 compared to group B at 7.05±1, with a p-value of 0.005. However, no significant difference was noted between the two groups at 12, 24, and 48 hours after surgery. There was no significant difference in scar evaluation between group A and group B at 12 weeks, with a p-value of 0.673 for the patient score and 0.189 for the observer score. Conclusion: Electrocautery can be recommended for hernia skin incision due to its advantage of shorter incision time, minimal blood loss, and less early postoperative pain.

A Descriptive Study to Assess the Knowledge on Stress Management among Staff Nurses at Sri Manakula Vinayagar Medical College and Hospital Kalitheerthalkuppam

Stress is a physical or emotional state of response always present in a personal as a result of living it is intensified in a non specific response to an internal or external environmental change or threat. stress is frequently described as “ the black plaque of the eighties or the modern epidemic has become an important feature and major problem of everyday life threatening individual organization and social health. Numerous studies have indicated that job stress is significant in nursing, it was found that job stress brought about hazardous impacts not only as nurses health but also their abilities to cope with job demands. this will seriously impair the provision of quality care and efficacy of health services delivery further more professional stress has been found to be one of the major work related health problems. Therefore it is important to understand how work associated stress affects nurses and what factors in their working environment cause the greatest burden. it is also of great importance to gain more knowledge of nurses working condition, occupational stress it management, knowledge that might be used to decrease nurses. professional stress and increase their stress managing abilities.

Effectiveness of NTEP training program in the improvement of knowledge of medical interns

Objectives: Compulsory Residential Medical Interns (CRMI) is being a part of health-care professionals they have a role and responsibilities for counseling the patients on tuberculosis (TB). The objective of the study is to assess the awareness about National Tuberculosis Elimination Programme (NTEP) among CRMI and determine the effectiveness of the training program in the improvement of knowledge of CRMI. Material and Methods: It was a pre-test and post-test design conducted among CRMI posted in the Department of Community medicine, Sri Manakula Vinayagar Medical College and Hospital in Villupuram district of Tamil Nadu. A total of 600 CRMIs from 2014 to 2022 were trained in batches. The training program was conducted as per NTEP guidelines released by Central TB division guidelines. At the end of the session, feedback was obtained. Pre- and post-test data were entered and analyzed in Epi_Info software. The paired test was used to test the statistical significance. Results: It was found 57.8% improvement in the knowledge of the participants about TB after the training program. In the analysis of feedback, the consensus score for all the responses was above 83%. Manual content analysis of the open-ended feedback was done. Conclusion: Health education dissemination strategies (e.g. campaign to end TB) on TB needs to be continuously done at the community and health facility level by trained CRMI.

Mobile phones and children: exposure and pattern of usage of mobile phones among children - a descriptive cross-sectional study

Background: Mobile phone as an invention of the modern world has managed to penetrate not only the most distant parts of the world but also various age groups in a person’s life. There is a need to evaluate the children’ interactions with these modern devices as they might have a significant effect on their behavior, sleep patterns, and psychological addiction. Objectives of the research were: to study the socio demographic characteristics of children using mobile phones, to determine the average time duration of exposure to mobile phones, and to determine the age of initial exposure to mobile phones. Methods: It was a descriptive cross sectional observational study. The study was conducted at Sri Manakula Vinayagar Medical College and Hospital. All the children between the age group of 0-12 years visiting the pediatric outpatient department fulfilling the inclusion criteria were enrolled in the study. Results: Of the 248 children enrolled in the study mobile phone exposure was found in 143 (57.66%) boys and 105 (42.34%) girls. 67.74% of the parents agreed that the mobile phones were being used by their children just for fun without any intended or specific use. 26% of the times it was used to engage the children when the parents were busy. 30.24% of the kids had a screen time of less than 30 minutes on a daily basis. 23.39% of the children were used to the screen for more than 2 hours in a day, on a cumulative basis. It was noted that more than 50% of children were exposed to mobile phones within 1 year of age. The earliest age of exposure to mobile phone was 2 months of age. Conclusions: Regardless of the socioeconomic status the accessibility and the owning of the mobile phones is same across the socioeconomic strata. The need of the hour is to raise awareness among the parents regarding the excessive use of mobile phones among children and their possible adverse impacts on physical and psychosocial health.

Newborn care practices in rural Puducherry; a peek into the harmful practices-a cross sectional study

Background: Immediate care of the newborn is vital not only for the survival but for the growth and overall development of the child. Owing to regional customs and practices, various traditional practices are followed during the neonatal period. There are many beliefs that have developed around those practices and the same has been passed on from one generation to the other. There is a need to understand the dynamic factors which are contributing to the potentially harmful practices and the role the family plays Methods: This was a cross sectional hospital-based study. The study was conducted in Sri Manakula Vinayagar medical college and hospital, tertiary care centre catering to the nearby rural population in Puducherry, India. Results: There was a practice of kajal application to the babies by the care, 606 (89.1%) mothers had the habit of applying kajal to the babies. Care givers also had the practice of instilling oil in either the ear or nose of the babies in order to cure any ailments related to the nose or ears, 277 (40.73%) of them had the habit of oil instillation. Pre-lacteal or extra lacteal feeds which included cow’s milk, buffalo or goat’s milk, water, honey, sugar water was given among 588 (86.4%) babies. In 55% of them some herbal medicine or over the counter medicines given as they believed that it would help in the digestion of the baby and would decrease the excessive crying in baby. Conclusions: Every country owing to its geography cultural variations has their unique traditional rituals and practices. The good practices followed in the community must be motivated and reinforced at the same time all the family members must be made aware of the practices that are detrimental to the health of the baby, such practices must be discouraged. There is a need to plan for a culturally acceptable and scientifically appropriate practice of neonatal health care.

Public visibility of tuberculosis diagnosis and treatment facilities in rural Puducherry, mixed method design

Objectives: To study the specific issues on the diagnosis and treatment to be addressed in TB advocacy, communication and social mobilization activities. Early diagnosis and initiation of appropriate treatment is the mainstay in the prevention and control of tuberculosis (TB). We present findings from an operational research study on visibility of TB diagnosis and treatment among people in rural Puducherry. Materials and Methods: Study area and study setting: The present study was undertaken in the villages of Thirubhuvani Primary Health Center (PHC) in rural Pondicherry by the Department of Community Medicine, Sri Manakula Vinayagar Medical College. Study design: An exploratory sequential mixed method design where qualitative methods (Focus Group Discussion [FGD]) followed by quantitative methods (Community-based cross-sectional survey) were used. Sample size and sampling: Qualitative: FGD was conducted to assess the perceptions and practices of rural people related to TB. We conducted eight FGD, four each with men and women. It was held with the purposively selected men and women (8−12 members) from different socioeconomic strata. Quantitative: Probability proportional to size method was used to select 30 clusters from the villages of Thirubhuvani PHC. In each cluster, 12 households were selected by random walk method and head of the family who is assumed to act as decision maker in that household was interviewed using pre-designed and pre-tested questionnaire. However, we could study the required sample as calculated, the final sample studied was 348. Results: Qualitative: As per the responses emerged from the FGD, four categories are symptoms and mode of transmission, treatment, problems faced, and others. The 12 codes emerged are symptoms, mode of spread, risk factors, availability, effect home remedies health system related, family and community, financial, advantages at government hospitals, media for awareness, and recommendation. Quantitative: Among the 348 people studied, 203 were male and 145 were female. The major source of information of TB received by the community was from family, friends, neighbors, and colleagues. We found that majority of them have correctly responded that weight loss (97.1%) and cough that lasts longer than 2 weeks (27.5%) as the symptoms of TB. However, they have also commented wrongly that rash as one the symptom (76.1%) of TB, the measures for preventing TB are by avoiding hand shaking (26.4) avoid sharing foods (74.7). Smokers and alcoholic are at-risk for TB infection. Most of the participants expressed that they will feel fear (95.1), sadness or hopelessness (94.8), embarrassment (96.8), shame (89.6), and surprise (65.2) if they have contacted TB. The participants also reported TB diagnosis and treatment are free of cost (95.1) and will approach health facility (96.8) if they had symptoms of TB. The 95% of them have informed that TB is curable and treatment is available at government hospital (97.7) and available free of cost (92.2). Conclusion: Hence, a strategy for wide, consistent, and regular dissemination of information on TB is needed for better public visibility of TB diagnosis and treatment facilities in rural Pondicherry.

Diagnostic Accuracy of Computed Tomography by Fungal Sinusitis: A Case-control Study

Introduction: Recent decades show a considerable increase in fungal infections, hence can lead to fungal sinusitis. Immunosuppression, post organ transplant, diabetes mellitus, and Human Immunodeficiency Virus (HIV) infection have led to a rise in the incidence of fungal infections. Recent advances in nasal endoscopy, Computed Tomography (CT), and Histopathological Examination (HPE) Techniques have led to better detection of fungal aetiology. Aim: To determine the most significant CT findings in fungal sinusitis or combination of findings in comparison to HPE. Materials and Methods: This retrospective case-control study was done at Sri Manakula Vinayagar Medical College and Hospital, Puducherry from January 2017 to December 2020. Total number of patients were 90. Total 50 cases of fungal sinusitis confirmed with histopathological confirmation and available non contrast CT Paranasal Sinus (PNS) images where time interval between CT and Functional Endoscopic Sinus Surgery (FESS) not exceeding ten days were included. The control group had 40 patients with chronic sinusitis with HPE negative results. CT PNS were performed on PHILIPS 16 slice scanner without contrast administration. Data was entered into Microsoft excel and analysed using Statistical Package for the Social Sciences (SPSS) 22.0 version software. Results: Mean age of the cases (fungal sinusitis) were 46.7±17 years and 39±13.1 years of controls. Of the total 90 subjects, heterogeneous mucosal thickening was seen in 41 (45.6%), intrasinus hyperattenuation in 36 (40%), bone sclerosis in 44 (48.9%), bone erosion in 36 (40%), sinus expansion in 23 (25.6%) subjects. Fungal sinusitis patients had more proportion of these findings when compared to control group and hence p-value was significant. Conclusion: The CT diagnostic features of the fungal sinusitis are heterogeneous mucosal thickening, intrasinus hyperattenuation, bone sclerosis, bone erosion and sinus expansion which were significant. These findings help to differentiate fungal sinusitis from non fungal sinusitis.

Effect of Rosuvastatin and Glibenclamide in Alone or in Combination on Glucose Homeostasis in Diabetic Male Albino Wistar Rats: An Observer-blinded Experimental Interventional Study

Introduction: Metabolic Syndrome (MetS) is a complex of metabolic disorders which include obesity, insulin resistance, hyperglycaemia, hypertension along with dyslipidemia. It is not clear whether rosuvastatin is having role in new onset diabetes. Aim: To assess the effect of rosuvastatin in comparison to glibenclamide on blood sugar levels and insulin resistance in diabetic rats. Materials and Methods: This experimental study was carried out at Sri Manakula Vinayagar Medical College and Hospital, Kalitheerthalkuppam, Puducherry on 42 adult male Wistar rats, for 8 weeks. Diabetes was created by feeding rats with High Fat and High Sugar (HFHS) diet over a period of 8 weeks. In total, 42 rats were allocated to in 7 groups, consisting of 6 animals per group. Group I -vehicle treated animals (control), group II - HFHS diet animals (Diabetic Control- DC), group III- glibenclimide (G) (5 mg/kg) + HFHS, group IV-rosuvastatin (R) (5 mg/kg) + HFHS, group V-R (10 mg/kg) + HFHS, group VI-G (5 mg/kg) + R (5 mg/kg) + HFHS diet, group VII-G (5 mg/kg) + R (10 mg/kg) + HFHS diet continued for 4 weeks. Rosuvastatin and glibenclamide were dissolved in distilled water and 95% ethanol respectively, and were given orally daily for 4 weeks after induction of diabetes. Data were subjected to one-way ANOVA using Statistical Package for the Social Sciences (SPSS) version 24.0 followed by non parametric test with significance level set for p-value<0.05. Results: By end of 8th week, on comparison of control group with HFHS diet and glibenclamide treated group, there was significant rise in body weight, serum Low Density Lipoprotein (LDL), in addition to Very Low Density Lipoprotein (VLDL) and Triglycerides (TG) levels. Glibenclamide treated (group III) animals on comparison with groups IV, V, VI, VII revealed reduction in body weight, serum LDL, VLDL and TG levels (p <0.001). Glibenclamide treated (group III) on comparing with groups IV, V, VI, VII, there was significant high serum HDL level (p<0.001). By 8th week, significant decrease in serum insulin and HOMA-IR level was observed when glibenclamide group III was compared with groups IV to VII treated animals (p <0.001). Conclusion: The study results indicate that the combination therapy of rosuvastatin and glibenclamide demonstrate beneficial effects on weight reduction, lipid profile and insulin resistant.

Assessment of Superficial Fascia and Abdominal Fat of Anterior Abdominal Wall using Computed Tomography: A Retrospective Study

Introduction: The advancements in technologies have created new promenade pertaining to the anatomy of the anterior abdominal wall and body contouring surgery. This kindle the anatomist and surgeon to redefine the anatomy of the anterior abdominal wall. Anterior abdominal wall was routinely tutored as two layers, but the controversy regarding the existence and extent prevails. From the literature search, it was evident that preservation of Scarpa’s fascia is the pivot in determining the outcome of abdominal surgeries. Aim: To document the existence and extent of the Membranous Fascia of Scarpa (MFS) and compare the abdominal fat between age and sex-matched Computed Tomography (CT) images at 3 levels i.e., i) L1 vertebrae, ii) umbilicus and iii) anterior superior iliac spine and also to compare the distribution of abdominal fat. Materials and Methods: This retrospective cross-sectional study was conducted in collaboration with the Department of Radiology at Sri Manakula Vinayagar Medical College and Hospital, Puducherry, from November 2019 to December 2020. A total of 60 CT images, that were age and sex matched were collected from the Medical Records Department. Data were analysed using Statistical Package for Social Sciences (SPSS) version 24.0 for windows. Types and extent of fascia were expressed in percentage, fat distribution as mean. The difference in mean between two and three independent groups was made using the Student’s t-test. The statistical tests applied were two tailed and p-value<0.05 were considered significant. Results: Single layer of the MFS was observed with 93.3%, 76.7% at level 1; 53.3%, 66.7% at level 2, 70%, 63.3% at level 3, among CT images of male and female respectively. The findings supported the presence of MFS on the entire anterior abdominal wall and 8 different patterns of MFS were observed. The anterior abdominal wall showed three layers of superficial fascia, with superficial fatty, MFS, and deep fatty zone. On comparing the abdominal fat, superficial fat was significantly high among females at all three levels. However, the deep fat though high among females in all the three-level; it was significantly high only at levels 1and 2 among subgroup 1 (p-value=0.003 and 0.001 respectively) and level 1 of subgroup 3 (p-value=0.01). Conclusion: The study decipher 3 layer theory of superficial layer of the anterior abdominal wall and superficial fat was significantly high among females, supporting that gender to be high-risk for surgical intervention. Redefining anatomy would guide for better and fruitful outcomes in surgical interventions.

A STUDY TO ASSESS THE LEVEL OF STRESS AMONG THE PATIENTS WITH CHRONIC DIABETES MELLITUS ADMITTED IN SELECTED HOSPITALS

Introduction: Diabetes mellitus is a disease which must be controlled over the lifetime of a patient. The diagnosis and presence of a chronic disease may be considered a difficult and stressful situation in life, a situation in which coping mechanisms are psychological processes developed at a conscious level to manage these situations. Methodology: Quantitative Research Approach and Descriptive Research Design were adopted for this study. The setting of the study was Sri ManakulaVinayagar Medical College and Hospital at Puducherry. Totally 200 Chronic Diabetes Mellitus Patients who were attending Medical and Surgical OPD and Inpatients department in selected hospital were selected as sample. Purposive Sampling technique was used to select the samples for this study. Results: Regarding level of stress majority of them 168(84%) were in severe stress, 24(12%) were in moderate stress level, Only 6(3%) of them are having extremely severe stress and only one (0.5%) of them were in normal and mild level of stress. There is significant different between level of stress with selected demographic variable such as religion. There is no significant difference between level of stress with selected clinical variables. There is significant difference between the level of stress with psychosocial variable such as type of diet, socio economic status and nature of work. Conclusion: The results of the present study highlights the majority of diabetes patients had severe stress.

Correlation of Serum Uric Acid and Urine Uric Acid in Patients with Type 2 Diabetes Mellitus and Hypertension

Aims and objectives: To estimate the proportion of Hyperuricemia in patients with type 2 Diabetes Mellitus and Hypertension patients and to assess the correlation of serum uric acid and urine uric acid. To assess the relationship between Urine Uric acid/ Creatinine ratio and subclinical Renal damage among these patients. Materials and methodology: This cross-sectional study was conducted in Sri Manakula Vinayagar Medical College and Hospital Puducherry during a period of 6 months. Adults more than or equal to 18 years of age with Type 2 Diabetes Mellitus and Hypertension were included and a total of 56 patients were recruited. Patients were randomly included based on the inclusion and exclusion criteria Results: Patients with Subclinical Renal damage were categorized and constitutes around 53.7%. Odds ratios on comparing the duration of Diabetes and Hypertension, shows inverse correlation with eGFR of both SRD and non-SRD patients (0.469,0.449 respectively) and with Urine Uric acid/ Creatinine ratio was found to have positive correlation (0.108 and 0.085). On comparing eGFR and Urine Uric acid/ Creatinine ratio of SRD and non-SRD patients, it showed positive correlation with value of 0.336. Conclusion: Lower eGFR was associated with higher levels of Serum Uric Acid and Fractional excretion of uric acid (FEUA), but lower uUA/Cr levels. Thus this study suggests that urinary Uric Acid excretion was significantly associated with the risk of Subclinical Renal Damage and Urinary Uric acid can be used as a simple, noninvasive marker for early detection of decreased renal function in otherwise healthy subjects. Keywords: Subclinical Renal Damage, Urinary Uric Acid, Fractional Excretion of Uric Acid

Histopathological Study of Endometrial Changes in Hysterectomy Specimens with Cystic Lesion of Ovary

Introduction: Some of the ovarian lesions become functional and secrete hormones that bring endometrial changes like hyperplasias and polyps. This study aimed to find endometrial changes associated with different types of cystic lesions of the ovary. Materials and Methods: A histopathological study done from 2010 -2013 on all the total abdominal hysterectomy specimens with bilateral oophorectomy having cyst size more than 3cms, with a detailed clinical history received in the Department of Pathology, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry. A total of 112 cases were collected analyzed and statistically correlated. Results: Out of the 112 cases of cystic lesions of the ovary 67% showed endometrium within normal limits, 33% of cystic lesions of ovary showed polyps, simple hyperplasia without atypia, complex hyperplasia without atypia. Among non-neoplastic lesions, follicular cyst produced the most endometrial changes, followed by benign surface epithelial lesions. Granulosa cell tumor was found to induce polyp as well as simple hyperplasia without atypia. Two out of three malignant lesions showed endometrial changes followed by benign lesions. The majority of the cystic lesions of the ovary encountered are non-neoplastic lesions (59%) and follicular cysts were more common (97%). Endometrial hyperplasia of both simple and complex types without atypia was found with serous cystadenoma. Conclusions: From the current study it implicates the necessity of assessing cystic lesions of the ovary like a follicular cyst, luteal cyst, granulosa cell tumors as they can become functional leading to endometrial changes that can form a fertile ground for carcinomas.

An Interesting Presentation of Carcinoma Lung-Case Report

Associative Journal of Health Sciences An Interesting Presentation of Carcinoma Lung-Case Report Dr A Nirmal kumar*, Dr A Arunkumar, Dr Javid Raja and Dr Rajkumar Assistant Professor, Sri Manakula Vinayagar Medical College & Hospital, India *Corresponding author: A Nirmal kumar, Assistant Professor, Department of CTVS, Sri Manakula Vinayagar medical college & hospital, Puducherry, India Submission: July 01, 2021;Published: August 17, 2021 DOI: 10.31031/AJHS.2021.01.000518 ISSN:2690-9707 Volume1 Issue4

English

Third molar extraction remains one of the most common surgical procedures performed in dentistry either by intra-alveolar or trans alveolar methods; yet such a common surgical procedure sometimes results in relatively rare complications. The incidence of complications can be reduced by proper preoperative planning, knowledge of the surgical anatomy, good surgical technique and recognition of complications. Sub conjunctival haemorrhage after maxillary third molar extraction is one such complication, which till now not more than three cases of similar findings have been reported in the literature. The purpose of this article is to present a rare case of sub conjunctival haemorrhage after maxillary right third molar extraction in a 56-year-old female reported at The Department of Oral and Maxillofacial Surgery, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, India.

A comparison of hemodynamic profile of intraperitoneal instillation of ropivacaine versus bupivacaine in laparoscopic surgeries

Inadequate pain relief in the postoperative phase is a well-known problem world-wide. Aside from the suffering caused by insufficient pain relief, this is an issue with potential adverse physiological and psychological consequences for patients in addition to financial draw backs for caregivers. Poorly managed pain may interfere with postoperative complications, cause patient suffering and prolong recovery. Patients may anticipate future medical interventions with greater anxiety if pain has not been managed effectively in the past. To assess postoperative hemodynamics of intra peritoneal instillation of Ropivacaine and bupivacaine in Laparoscopic surgeries. The present study was conducted at Sri Manakula Vinayagar Medical College and Hospital, Pondicherry in the Department of Anaesthesia. The double blinded randomized experimental study was conducted from October 2017 to May 2019.The sample size of 50 study subjects was selected using the mean pain score at 3.6 with 80% power and 95% confidence interval. In each of the group 25 study subjects were allotted based on randomization. All patients were instilled with 30 ml of solution in a standardized manner by the operating surgeon under vision before removal of trocar at the end of the surgical procedure. Group R received 30 ml (0.2%) ropivacaine and group B received 30 ml (0.25%) bupivacaine. The drugs were prepared and given to the investigator who was blind to the identity of drugs. The heart rate was found to be comparable between two groups at 10 min, 30 Min, 60 Min, 120 Min, 4 Hrs, 8 Hrs, 12 Hrs and at 24 hrs and the p value was found to be non-significant. The Systolic Blood pressure was found to be statistically significant between the two groups at 10 Min, 30 Min, 60 Min, 120 Min, 4 hrs, 8 Hrs and 12 hrs. Whereas at 24 hrs the difference of Systolic Blood Pressure was found to be non-significant. Heart rate was similar in both the study groups at various time intervals. Systolic blood pressure and diastolic blood pressure was significantly high among patients in Bupivacaine group measures in most of the time intervals, while mean blood pressure differences were inconsistent over the follow up period.

Anticonvulsant Effect of Nebivolol alone and in Combination with Phenytoin against Maximal Electroshock-Induced Seizures in Mice

Introduction: Phenytoin is widely used in treatment of generalised tonic clonic seizures but its adverse effects make its usage limited. Hence forth, there is a need for newer antiepileptics. Studies have shown antiepileptic property for nebivolol in combination with phenytoin hence, reducing the dosage of phenytoin and its adverse effects and toxicities. Aim: To evaluate the anticonvulsant property of nebivolol alone and in combination with phenytoin against Maximal Electroshock Seizures (MES) in a mouse model. Materials and Methods: This was an experimental animal study on total of 36 swiss albino male mice were randomly assigned to six groups with six animals in each group in December 2019 at Sri Manakula Vinayagar Medical College and Hospital. Group 1 was considered as normal control, Group 2 received Phenytoin 25 mg/kg Intraperitoneal (IP); Group 3 & 4 received Nebivolol 0.25 mg/kg oral & 0.50 mg/kg oral, respectively; Group 5 received 12.5 mg/kg IP and nebivolol 0.25 mg/kg oral; Group 6 received Phenytoin 12.5 mg/kg IP and nebivolol 0.50 mg/kg oral. Anticonvulsant effect of the drugs nebivolol and phenytoin was elicited in mice by MES test. After induction following parameters were recorded for onset of Tonic Hind Limb Extension (THLE), duration of clonus, duration of THLE, number of jerks, recovery time. Statistical analysis was done by ANOVA followed by post-hoc Dunnett t-test. Results: Significant reduction in duration of THLE (p<0.01) and clonus (p<0.001) was observed in the group treated with phenytoin (12.5 mg/kg) and nebivolol (0.50 mg/kg). Conclusion: The present study concludes that the lower dose of phenytoin in combination with nebivolol can reduce seizures induced by MES in mice model.