Sri Muthukumaran Medical College Research Articles

Maternal and Fetal Outcome in Early Onset Severe Pre-eclampsia

Background: Hypertensive disorders of pregnancy are among the most common medical problems in pregnancy with an incidence of between 5-10%.1 The incidence varies amongst different hospitals, regions and countries. Hypertensive disorders in pregnancy are a major cause of maternal and perinatal morbidity and mortality worldwide. Methods: This prospective observational study was conducted by the department of OBG at Sri Muthu Kumaran medical college hospital and research institute, Shikkaraya puram Chennai from December 2019 to May 2020. Results: Out of 100 subjects enrolled into the study, Primigravidas constituted for 66% of pregnancies and multigravidas constituted for 34% of pregnancies. Maximum cases 60 (60%) were in the age of 25-30 yrs followed by 22 (22%) in the age group <20 years. The mean age of the patients was 24.57(SD 6.54) years. Caesarean was the most common mode of delivery constituting for 70% of deliveries where as vaginal delivery constituted for 30% of cases.

Perinatal Outcome in Twin Pregnancy According to Chorionicity

Background: Multiple pregnancy is defined as pregnancy with 2 or more fetuses. It is termed as twins for 2 fetuses, triplets for 3 fetuses, Quadruplets for 4 fetuses, Quintuplets for 5 fetuses, Sextuplets for 6 fetuses and Septuplets for 7 fetuses and so on. The incidence of multiple pregnancies varies significantly. In several overview studies (since the early 1970) it was found that natural twinning rates were less than 8 twin births per 1000 births in East Asia and Oceania, 9-16 per 1000 births in Europe, USA and India and 17 and more per 1000 births in African countries. Methods: This prospective observational study was conducted by the department of OBG at Sri muthukumaran medical college hospital and research institute, Shikkarayapuram, Chennai from December 2019 to May 2020. Results: Primigravidas constituted for 43% of pregnancies and multigravidas constituted for 57% of pregnancies. The maximum cases 42 (42%) were in the age of 25-29 yrs followed by 31(31%) in the age group 21-24 years. The mean age of the patients was 26.87 (SD 9.67) years. The discordant growth constituted for 12% of pregnancies in both monochorionic and dichorionic twins where as it was absent in 88% of cases.

Is Sacralization Associated with occurrence of Back pain - A Cross Sectional Study.

Background: The sacralization of the lumbar vertebra could be one of the cause for back pain. Though the relationship between Lumbosacral Transitional Vertebrae and low back pain was described a century before several contrast findings were also noted in the literature. Hence this study was conducted to assess the impact of sacralization on low back pain. Methods: This retrospective cross-sectional investigation, which used lumbo-sacral X-rays taken at Sri Muthukumaran Medical College Hospital and Research Institute, was carried out in the orthopaedics department. The study contained 514 lumbrosacral X-rays in total. The Institutional Ethics Committee provided its ethical approval. Descriptive statistics, Chi square test was employed in SPSS version 19 to examine the relationship between sacralization and back discomfort. Results: Prevalence of sacralisation was 10.1% with predominant complete sacralisation. Strong association was noted between sacralisation and lower back pain however sacralisation was not associated with age, gender and BMI. Conclusion: As there is a association noted between sacralisation and back pain, early identification of LSTV could help in early lifestyle changes and routine exercise, which can help prevent additional issues including disc degeneration of the vertebrae above the LSTV.

A study on clinical profile and laboratory parameters of dengue fever patients in Chennai, Tamil Nadu, India

Introduction: Dengue fever is the most important mosquito-borne viral disease, found to be endemic in tropical and subtropical countries. In recent decades, the incidence of dengue infection has increased around the world and has become a major public health concern. Materials and Methods: The prospective study was conducted during the period from July 2018 to December 2020 at Sri Muthukumaran Medical College, Hospital & Research Institute, Chennai, India. All the Serum samples were collected with clinically suspected cases of Dengue and then it was confirmed by (NS1 antigen, IgM & IgG antibody) rapid serological test kit. All the clinical details & Hematological parameters were also recorded. Result: During the study period, a total of 434 patients were suspected to have the Dengue infection. Majority of the cases were males 268 (62%) rather than Females 166 (38%). 146 (34%) samples were found to be positive for Dengue viral infection. Fever is the most common clinical presentation which was found in all the patients, followed by headache (56%), vomiting (52%), body pain (33.2%), Myalgia (32%), Joint pain (31.5%), Dry cough (29%), Nausea (22%), Abdominal pain (20%), Diarrhea (13%), Retro orbital pain (10%), Burning Micturition (8.2%), Hemoptysis (2.7%), and Rashes (0.2%). Hematological parameters such as Thrombocytopenia were 36 (24%), followed by Leucopenia 16 (11%), and raised Hematocrit 11 (7.2%). Conclusions: Study has revealed that clinical manifestation is varied considerably from fever, myalgia to life threatening situations like dengue hemorrhagic fever or dengue shock syndrome if not treated on time. Therefore, early recognition and prompt management is required to decrease the morbidity and mortality of illness. Keywords: Clinical profile, Dengue fever, Laboratory parameter.

English

BACKGROUND Cluster headache is an unusual but particularly painful and crippling primary headache disorder with a prevalence of 1 in 1000 making study of the disease process a difficult task to master. These headaches are always unilateral characterised by recurrent short-lasting attacks of 15 - 180 minutes associated with ipsilateral autonomic signs. The diagnosis is mainly clinical, and it continues to be managed sub optimally as the chance of coming across such a condition is few and far between. This study was conducted to determine the incidence of cluster headache in a hospital population and study its association with age, gender and triggers. METHODS This is a cross sectional study of a total of 100 patients attending our Otorhinolaryngology department from June 2017 to June 2018 at Sri Muthukumaran Medical College Hospital & Research Centre with primary complaints of headache. Prior ethical committee clearance was obtained. Patients with chronic debilitating illness, chronic rhino sinusitis, headache following trauma or the presence of fever or any other acute illness were excluded from this study. The results were interpreted using Statistical Package for Social Sciences (SPSS) version 17. RESULTS Out of the total number of 100 patients with headache, only one patient, a 40-yearold male was diagnosed with cluster headache. CONCLUSIONS Hence, we conclude that the incidence of cluster headache in the total of 100 patients is only 1 % which makes it a quite rare condition. Diagnosis is clinical, hence effective history taking is mandatory. KEY WORDS Cluster Headache, Primary Headache, Trigeminal Autonomic Cephalgia, Cluster Attacks

Efficacy of haemorrhoidectomy versus haemorrhoidectomy with internal sphincterotomy in treatment of haemorrhoids: a retrospective randomized controlled trial study

Background: Role of internal sphincterotomy along with hemorrhoidectomy in reducing the pain among the cases with hemorrhoids is still a debate among most of the surgeons. Hence this study was conducted to compare the efficacy of haemorrhoidectomy with or without internal sphincterotomy in reducing the post-operative pain among the patients with haemorrhoids. Methods: A hospital based randomized controlled trial study was conducted among the patients with haemorrhoids undergoing surgical intervention for the same in department of general surgery in Sri Muthukumaran Medical College Hospital and Research Institute, Chennai, during the study period from July 2017 to December 2019. A total of sixty cases with haemorrhoids were included in the study. Patients in group A (n=30) underwent haemorrhoidectomy alone and group B (n=30) underwent haemorrhoidectomy along with internal sphicterectomy. Data entry was done using Microsoft excel and data was analyzed using Statistical Package for Social Sciences (SPSS) version 17. Results: In the present study, mean pain scores on first three post-operative days and the duration required to resume the normal activities was found to be low in the group who underwent haemorrhoidectomy with internal sphincterectomy compared to the group who underwent haemorrhoidectomy alone. Duration of surgical procedure and the complications were found to be similar in both haemorrhoidectomy with internal sphincterectomy group and haemorrhoidectomy alone, group. Conclusions: Haemorrhoidectomy with lateral Internal Sphincterotomy is better in terms of less pain but the complications were similar in both groups.

Conventional versus small incision appendectomy: a retrospective randomized controlled trial study

Background: Open appendectomy is practiced for more than a century and in the recent times small incision appendectomy is also practiced frequently. The efficacy of conventional appendectomy and small incision appendectomy in terms of pain, operating time and duration of hospital stay and have produced conflicting results. Hence this study was conducted to assess the same. Methods: A hospital based randomized controlled trial study was conducted among the patients with appendicitis undergoing surgical intervention for the same in department of general surgery in Sri Muthukumaran Medical College Hospital and Research Institute, Chennai, during the study period from January 2017 to December 2019. A total of eighty cases with acute appendicitis were included in the study. Group A (n=40) includes conventional open appendectomy cases and group B (n=40) includes small incision open appendectomy cases. Data entry was done using Microsoft excel and data was analyzed using SPSS version 17. Results: Blood loss, post-operative pain scores on day 1 and day 2, duration of hospital stay were found to be reduced in Small incision open appendectomy group compared to conventional open appendectomy group. Duration taken to resuming the normal activities and the complications were found to be similar in both conventional and small incision appendectomy group and small incision open appendectomy group. Conclusions: Small incision open appendectomy is superior to conventional open appendectomy in terms of length of hospital stay, return to normal activity, blood loss and postoperative pain scores, which are considered the major advantages of minimally invasive surgery.

Ocular morbidity during nationwide lockdown among patients attending ophthalmic department in a tertiary care center

During this pandemic times majority of the people with ocular complaints were either scared to approach health facility, fearing the chances of contracting the disease, COVID -19 or due to lack of regular functioning of ophthalmic clinics. Hence it is important to understand about the pattern of ocular morbidity during this phased relaxation of lock down. This cross sectional hospital based study was conducted in the outpatient department of Ophthalmology at Sri Muthukumaran Medical College Hospital and Research Institute, Chennai, from September 2019 to November 2019. A total of 234 patients were included in the study. Data analysis was done using SPSS version 18. Common ocular morbidity reported was refractive errors (35.9%) followed by cataract (20.1%), pseudophakia (11.1%), conjunctivitis (9%), age related macular degeneration (7.3%), blepheritis (5.6%), foreign body (5.6%), retinopathies (4.7%), glaucoma (3%) and corneal opacity (2.6%). Also 17.5% of cases reported that they had ocular complaints during the complete lock down. Pattern of ocular morbidity during the lock down was found to be similar to the pattern prevailed before the pandemic COVID 19. Considerable proportion of cases reported ophthalmic complaints during the nationwide lockdown and hence policies should be made in such a way that during these unexpected circumstances also, the essential ophthalmic care centers should be functional with easy access to the population.

Awareness and Knowledge about glaucoma among the cases attending Ophthalmology outpatient department in a Tertiary care center

Awareness and knowledge about glaucoma plays a major role is changing the people’s health seeking behavior for regular eye checkups which in turn leads to early detection and treatment of glaucoma and other ophthalmic disorders also and thus this study was planned. This cross sectional hospital based study was conducted in the outpatient department of Ophthalmology at Sri Muthukumaran Medical College Hospital and Research Institute, Chennai, from September 2019 to November 2019. A total of 220 patients were included in the study. Data analysis was done using SPSS version 18. Awareness about glaucoma was reported among 21.4% of participants and among them only 40.4% had knowledge that increased intraocular pressure (IOP) is the cause for glaucoma. Also 31.9%, 40.4%, 44.7%, 2.1%, 14.9% and 34% of participants reported that obesity, diabetes mellitus, hypertension, steroids, alcohol and smoking and family history of glaucoma were the risk factors of glaucoma. Degree holders and employed participants were found to be significantly associated with better awareness of glaucoma. Awareness about glaucoma in this study was poor and knowledge is still worse. This shows that we are in high time to health educate the people especially the target population about glaucoma, which causes preventable blindness.

Antimicrobial resistance profile in clinical isolates of Pseudomonas aeruginosa producing Extended-spectrum beta-lactamase (ESBL) at a teaching tertiary care hospital, Tamilnadu

The spread of extended-spectrum betalactamase (ESBL)-producing clinical isolates of P. aeruginosa has dramatically increased worldwide and frequently reported in India. The present study was undertaken to identify the prevalence of ESBL producing Pseudomonas aeruginosa and its antimicrobial resistance profile. This prospective study was conducted at Clinical microbiology Laboratory of Sri Muthukumaran Medical college hospital and research Institute for a period of 9 months.. P. aeruginosa isolates from all samples were identified by standard protocols. Antibiotic sensitivity testing for all isolates was done using Kirby-Bauer disc diffusion method. Disc potentiation test was performed to detect ESBL production. ESBL producing pseudomonas aeruginosa(16/69) in this study was 23.18%. Prevalence rate of ESBL isolates among the MDR strains was 41.17%.We observed ESBL isolates with high resistance rate to tested antipseudomonal antibiotics than Non ESBL. All ESBL isolates were sensitive to Polymyxin and Colistin. This study gives an alarming sign towards high prevalence of cephalosporins due to ESBL emphasizes the need for early detection to prevent therapeutic failure. In addition ,our study results would be useful to formulate antibiotic policy and its compliances for effective infection control practices.

Electronystagmographic analysis of peripheral vertigo

<p class="abstract"><strong>Background:</strong> Examination of the vestibulo-ocular reflex is still the investigation of choice for evaluating the vestibular function to rule out peripheral causes. Aim and objectives were to compare the electronystagmographic changes of all peripheral forms of vertigo and to highlight its significance in the diagnosis and management of the same.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study done after obtaining ethical committee approval in a total of 100 patients attending the ENT OPD at Sri Muthukumaran Medical College Hospital & Research Institute with chief complaints of vertigo. Patients diagnosed with chronic suppurative otitis media, hypertensive patients, h/o seizures, recent cardiac illness or patients on cardiac investigations, psychotic disorders, documented CNS lesions, cervical spondylitis, h/o recent eye/ ear surgery are excluded from this study. ENG analysis includes occulomotor testing, positional testing and caloric stimulation. Evaluation of gait and balance is done followed by maneuver induced vertigo testing (dix hallpike and fistula test) along with PTA. Statistical analysis was done using independent sample t test and chi square test to check the hypothesis using statistical package for social studies SPSS version 17. </p><p class="abstract"><strong>Results:</strong> The observations of ENG like spontaneous nystagmus and bi-thermal caloric test responses are represented on a claussens butterfly chart and the corresponding bar codes were obtained. The inferences for different forms of vertigo were studied.</p><p class="abstract"><strong>Conclusions:</strong> ENG is now an accepted routine and basic investigation in the management of all patients suffering from equilibrium disorders. Management consists of diagnosing the underlying pathology and treatment of the same.</p>

Serum vitamin D3 deficiency among cases with extensive tinea corporis infection

<p><strong>Background:</strong> Abnormal serum vitamin D3 levels have been implicated as risk factors for development of various skin disorders. Hence this study was planned to assess the prevalence of vitamin D3 deficiency among patients with <em>Tinea corporis</em> who were attending outpatient department of dermatology in a tertiary care centre.</p><p><strong>Methods: </strong>The cross sectional study was conducted by the department of dermatology, venereology and leprosy, at Sri Muthukumaran Medical College Hospital and Research Institute, among the patients attending the outpatient department, during the month of June to August 2019. A total of fifty cases with extensive <em>Tinea corporis</em> infection were included in the study. The study was conducted using a proforma with the detailed clinical history and also patients underwent skin scrapping for KOH mount and serum vitamin D3 analysis. Data was entered in Microsoft excel and data analysis was done using Statistical Package for Social Sciences (SPSS) version 17.</p><p><strong>Results: </strong>Among the cases with extensive <em>Tinea corporis</em> infection, only 20% of cases were found to have normal levels of serum vitamin D3 whereas 48.3% of cases were found to have serum vitamin D3 insufficiency and 31.7% of cases had deficiency of serum vitamin D3</p><p><strong>Conclusions: </strong>Screening for vitamin D3 deficiency for all cases with extensive <em>Tinea corporis</em> infection can be recommended. Further large scale clinical trials are needed to assess whether vitamin D3 deficiency has any role to play in pathogenesis and treatment of extensive <em>Tinea corporis</em> infection.</p>

Pattern of skin disorders among pediatric age group cases attending a tertiary health care center

<p class="abstract"><strong>Background:</strong> Skin diseases among the pediatric age group people are more common and it contributes to significant burden to health sectors. Also, the pattern of skin diseases changes consistently with reference to place and time. Hence the present study was conducted to assess the pattern of skin diseases in pediatric age group patients attending a tertiary care hospital.</p><p class="abstract"><strong>Methods:</strong> The cross-sectional study was conducted by the department of Dermatology, Venereology and Leprosy at Sri Muthukumaran Medical College Hospital and Research Institute, among the pediatric age group patients attending the outpatient department, during the month of October to December 2019. A total of 412 pediatric age group patients with skin disorder were included in the study. The study was conducted using a proforma with the clinical history and diagnosis of the participants. Data was entered in Microsoft excel and data analysis was done using SPSS version 17.<strong></strong></p><p class="abstract"><strong>Results:</strong> The common skin disorders reported in this study includes infections (34.7%) followed by dermatitis (32.3%), infestations (11.4%), miliaria (8.3%), popular urticaria (7.5%) and urticaria (6.1%). Among the infections fungal, bacterial and viral pathogens contributes to 16.3%, 10.9% and 7.5% of cases, respectively. Also 11.2% of cases were found to be infested with scabies (9.2%) and pediculosis (2.2%).</p><p class="abstract"><strong>Conclusions:</strong> Skin disorders in the pediatric age group are common and showing increasing trend. Hence health education of the parents and the school children about good nutrition, hygiene practices, and proper hydration of skin can be promoting in order to reduce the burden of skin disorders.</p>

A demographic study of a series of eosinophilic appendicitis and its correlation with the clinicopathological profile in a tertiary care hospital-a 3-year study

Introduction: Acute eosinophilic appendicitis (AEA) is a rare variant of inflammation of the appendix. The histologic hallmark of this entity is the infiltration of eosinophils in the musularis layer of the appendix with edema separating the muscle fibers with very few or no neutrophilic infiltration. A retrospective study was done to determine their demographic profile, morphological diagnosis, and clinical correlation. Materials and Methods: All cases of Acute appendicitis reported at the histopathology department of Sri Muthukumaran Medical College and Research Institute, a teaching hospital from the year of Jan 2017 to Dec 2019 were included in this study. Histopathological examination is the gold standard for the diagnosis of acute appendicitis. Hence, Formalin-fixed paraffin-embedded tissue which was stained with Hematoxylin and Eosin were retrieved and used for routine morphology and diagnosis. Results: Out of 419 cases of appendicectomies studied, 27 (6.49%) cases were found to be acute eosinophilic appendicitis, 265 (63.7%) cases were acute appendicitis, 30 (7.2%) cases were reported as acute suppurative appendicitis with periappendicitis most of which showed infiltration of eosinophils along with other inflammatory cells and 97 (23.3%) cases were reported as appendix with reactive lymphoid hyperplasia. Most of the acute appendicitis showed gross edema and congested blood vessels on the serosal surface. Enterobius vermicularis worm infestation was noted in 7 (25%) cases reported as acute eosinophilic appendicitis and in 20 (7.5%) cases of acute appendicitis. Conclusion: It was inferred that the acute eosinophilic appendicitis is a condition which could be an allergic response and an early event in the evolution of acute phlegmonous appendicitis.

Design and evaluation of faculty development workshop for teaching, learning and assessment using E-resources in an Indian Medical School

Introduction: E learning can enhance educational reform for the computer literate learners by the ease of access to learning material any time and helping them pace their learning curve. It also offers educators a new paradigm based on adult learning principles. We hypothesised to develop, implement and evaluate an E learning Project in Sri Muthukumaran Medical College Hospital &RI,Chennai, for which Faculty development was crucial. Hence, we designed, implemented and evaluated a capacity building E learning Workshop for faculties of Sri Muthukumaran Medical College Hospital & RI, Chennai. Methodology: The Workshop on “Teaching, learning and assessment using online Resources” was conducted by an External Faculty Expert and 17 Medical Education Unit (MEU) members were participants, who were trained on various aspects of E learning. They developed E resources for implementation of E learning in Sri Muthukumaran Medical College Hospital & RI, Chennai. Pre and post tests were conducted. Evaluation of the Workshop was through written feedback obtained from the participants. Result: Using Wilcoxon singed rank test, there was statistically significant difference between pre and post test score at p Conclusion: The authors conclude that Faculty development Workshops are effective in enabling faculties to develop feasible E learning projects for introduction of E learning for educational reforms.

Hyperuricemia among hypertensive and normotensive individuals: a case control study

Background: The depth of association between hypertension and serum uric acid remains a mystery. In order to know the exact association between hypertension and serum uric acid, authors intended to investigate the serum uric acid levels among hypertensive and non-hypertensive patients and, authors assessed whether hyperuricemia increases with increasing duration of hypertension and severity of hypertension.Methods: This case control study was conducted among hypertensive (Cases) and non-hypertensive patients (Controls) attending outpatient and inpatient department of general medicine in Sri Muthukumaran Medical College and Research Institute during January 2019 to March 2019. A total of hundred patients were included in this study with fifty cases and control each. Data was conducted using a proforma, covering particulars related to hypertension and the levels of serum uric acid were also noted in the same. Data analysis was done using SPSS.Results: Hyperuricemia among cases and control was found to be statistically significant association with odds ratio of 3.7. Also, the study showed that the serum uric acid levels were significantly increased in patients with Stage 2 hypertension compared to stage 1 hypertension. Also, cases with longer duration of hypertension had significantly raised serum uric acid levels compared to cases with lesser duration of hypertension.Conclusion: Assessment of serum uric acid may be recommended for all the hypertensive cases.

Prevalence of Horseshoe Kidneys by Multidetector Computed Tomography in a Tertiary Care Hospital in South India

Introduction: Horseshoe Shaped (HSK) Kidneys are often asymptomatic and are frequently diagnosed incidentally. The prevalence varies from approximately 1 in 400 to 600 with preponderance in males (male: female ratio of 2:1). This abnormality can affect the drainage of the kidney leading to Pelviureteric Junction Obstruction (PUJO), renal calculi, urinary tract infections and some renal cancers. The superficial location also makes it more vulnerable to injury during trauma or surgical procedures. Aim: To assess the prevalence of HSK and report their morphological features as evidenced following examination with a 64-slice Computed Tomography of the Kidney and Urinary Bladder (CT KUB). Materials and Methods: A retrospective study was conducted in the Department of Radiology, Sri Muthukumaran Medical College and Hospital & Research Institute, Chennai from January 2017 to December 2018. The study included 861 patients who underwent 64 slice CT KUB during that period and review of both plain and contrast enhanced CT KUB examinations were done. For deciding the fusion site, the isthmus, the authors measured a maximum diameter of the outline of the HSK on the axial image and decided the center of the kidneys. The HSK was classified based on fusion site and type of isthmic tissue connecting two kidneys. Results: HSK was found in 4 (3 male and 1 female) out of 861 patients examined. Thus, the prevalence of HSK in the study population was 1 in 215 (0.46%). Two patients with a thick isthmus and anteriorly facing, pelvises had PUJO and urolithiasis. Variant vascular anatomy was found in all four patients. No crossed fused ectopia was found in this study. Conclusion: This study showed that HSK is the most common congenital fusion anomaly and is more common in males. It also demonstrated that patients with a thick isthmus and associated anteriorly facing renal pelvis were more prone to develop PUJO and renal calculi.

A comparative study on knowledge and perception of vector borne diseases among rural and urban population in Tamil Nadu

Background: Vector-borne diseases (VBD) remain a major public health challenge, in India. Knowledge about VBD, social, demographic and environmental factors strongly influence the vector transmission and results in major outbreaks. Hence this study was conducted to assess knowledge and practice along with environmental conditions prevailing in both rural and urban areas.Methods: Cross sectional study was conducted in rural and urban field practice area of Sri Muthukumaran Medical College and Research Institute, Chennai, during June 2018 to December 2018. A total of 472 participants with 236 participants from each urban and rural area were included. Data was collected using proforma and analysis was done using SPSS 16.Results: Knowledge about VBD like dengue was 63.6% and 76.7% among rural and urban population, respectively. Similarly malaria was known by knows 59.3% and 68.2% of rural and urban participants. Japanese Encephalitis was the least known mosquito borne disease in both the groups. (p=0.0136). Common breeding sites addressed by the rural population were artificial collected water (36.9%) and urban population was dirty water (42.8%).Conclusions: Knowledge and practice of preventing vector borne disease is still lacking among both rural and urban participants. Spreading knowledge about VBD is a part in effective vector borne disease control which can be achieved by community education alone rather than insecticides and sprays.

Sexual Dimorphism in the Mandibular Canine-A Study in South Indian Population

Introduction: Teeth are found to be a very useful tool for forensic investigations because of their nature, exhibiting the least turnover of natural structure and effective resistance to mechanical, chemical, physical or thermal destructions. In addition, teeth are readily accessible structure for examination. Amongst all the teeth, the mandibular canine found to exhibit greatest sexual dimorphism. Considering the fact that there are differences in odontometric features in specific populations, the present study was taken up to investigate whether Mandibular Canine Width (MCW), Inter-Canine Distance (ICD) and Mandibular Canine Index (MCI) can be used as a tool for sex determination in South Indian Population. Materials and method: ‘The present study was carried out on 60 apparently healthy individuals from students of Medical college who are origin of south India whose ages ranged between 17-21 years in the Department of Forensic Medicine and Dentistry in the Sri Muthukumaran Medical College Hospital and Research Institute to establish significance of sexual dimorphism in the mandibular canine. Results: The present study confirms that, the means of mandibular canine width and an inter-canine distance were higher in males than in the females and difference is statistically significant. (P 0.05) and overall accuracy of predictive value in respect to sex determination from MCI is only 47.08%. Further we observed whenever mesio-distal canine width less than 6.88 mm, the probability of sex being female and if width is more than 7.4 mm the probability of sex favored towards male. Conclusion: Our study provides a conclusive proof of mandibular canine width and Inter-canine distance exhibits great potentiality of sexual dimorphism. However, MCI per se has limited value and can use as adjunct with other parameters.

Immediate clinical outcome of newborns with meconium stained amniotic fluid

Background: The detection of meconium-stained amniotic fluid during labour often causes anxiety in the delivery room because of its association with increased perinatal mortality and morbidity. The aim of the study is to determine whether meconium staining of amniotic fluid had an influence on the neonatal outcome and the factors responsible for meconium-stained amniotic fluid.Methods: This case-control study was done between March 2015 to October 2017 in the Department of Paediatrics, Sri Muthukumaran Medical College, and RI. 217 newborns who had meconium staining of the amniotic fluid were taken into the study. For each case, two controls were taken. Mode of delivery of baby noted with the grading of meconium either thin or thick meconium. Type of resuscitation done for these babies was noted. Those newborns who were admitted in the newborn unit were followed up till discharge and type of management of these babies were monitored. The outcome of seizures, air leak, MAS etc., were looked for. For each MSAF baby, two newborns without MSAF were recruited and looked for maternal and fetal risk factors.Results: Incidence of MSAF is 16.9%. Among 217 cases of MSAF, thin meconium constituted 141 cases (64.97%) and thick meconium 76 cases (35.02%). The incidence of thin meconium is more when compared to thick meconium. Of the 217 cases of meconium-stained liquor, 170 (78.7%) cases are vigorous babies and 47 (21.6%) are non-vigorous. Out of 47 babies who were non-vigorous, most of them (70.2%) had thick meconium stained liquor. Most of them, 172 cases (79.2%) required only routine resuscitation, whereas BMV with tracheal toileting required in 18 cases (78.3%) of thick MSAF when compared to 5 cases (21.7%) of thin MSAF.Conclusions: MSAF is associated with morbidity and mortality when associated with factors like maternal PIH, anemia, oligohydramnios, IUGR babies and CTG showing FHR variability. The majority of which are thick meconium suggesting that consistency of meconium had a direct bearing on the neonatal outcome.