ANGIOGRAPHIC CORRELATION OF ST ELEVATION IN LEAD AVR DURNG TMT IN PATIENTS WITH LMCA DISEASE

BACKGROUND:Treadmill testing is the most widely used method for evaluating patients with coronary artery disease. Predicting the left main coronary artery disease (LMCA) before invasive procedure is important in risk assessment because of its grave clinical outcome. Lead aVR can be very useful in identifying LMCAobstruction. It is also valuable lead not only in diagnosis but also predicting the prognosis. AIM: To examine whether STelevation in aVR during TMTcorrelates with LMCAdisease in coronary Angiogram METHOD: In this study 100 patients with positive TMT were included. The study group consisted of 60 patients with ST elevation of > 1mm in aVR. 40 patients also have TMT positive but with < 1mm of ST elevation in aVR is the control group. All patients underwent coronary angiography. RESULTS: Coronary Angiography in the study group revealed significant LMCA disease in 36 (63%) patients whereas no LMCA disease in control group 12 (20%) patients had ostioproximal LAD leisions in study group 4 (10%) patients in the control group. Triple vessel disease in 10 (17%) patients in study group 6 (15%) patients in control group. Since the p value was significant, ST Elevation in aVR during TMT strongly predicts the presence of LMCADisease. CONCLUSION: STsegment elevation in aVR > 1mm during Treadmill testing is a strong predictor of LMCAdisease

Inter-rater reliability of a composite health promotion scoring system developed in Singapore

INTRODUCTION@#In view of the important role of the environment in improving population health, implementation of health promotion programmes is recommended in living and working environments. Assessing the prevalence of such community health-promoting practices is important to identify gaps and make continuous and tangible improvements to health-promoting environments. We aimed to evaluate the inter-rater reliability of a composite scorecard used to assess the prevalence of community health-promoting practices in Singapore.@*METHODS@#Inter-rater reliability for the use of the composite health promotion scorecards was evaluated in eight residential zones in the western region of Singapore. The assessment involved three raters, and each zone was evaluated by two raters. Health-promoting practices in residential zones were assessed based on 44 measurable elements under five domains - community support and resources, healthy behaviours, chronic conditions, mental health and common medical emergencies - in the composite scorecard using weighted kappa. The strength of agreement was determined based on Landis and Koch's classification method.@*RESULTS@#A high degree of agreement (almost perfect-to-perfect) was observed between both raters for the measurable elements from most domains and subdomains. An exception was observed for the community support and resources domain, where there was a lower degree of agreement between the raters for a few elements.@*CONCLUSION@#The composite scorecard demonstrated a high degree of reliability and yielded similar scores for the same residential zone, even when used by different raters.

The prevalence of undiagnosed thyroid dysfunction and diagnosed diseases of gallstones

Background: Cholelithiasis is a disease prevalent worldwide because of an imbalance of bile salt and cholesterol concentrations that leads to precipitation inside the gallbladder. Gall stones are the most common biliary pathology both in India and western countries. Recent studies concentrate on gall stones and thyroid hormones – T3 and T4 have an effect on both bile content and bile flow. Patients with hypothyroidism have a serum level of cholesterol approximately 50% higher level than in euthyroid patients and 90% of all hypothyroid patients have elevated cholesterol level. Likewise, low levels of t4 have an effect in relaxing the sphincter of odds, leading to biliary stasis and stone formation. The aim of the study: To check thyroid status in patients who are diagnosed with gallstone disease, thereby dividing into euthyroid, hypothyroid, hyperthyroid and subclinically hypothyroid, correlating the prevalence of subclinical hypothyroidism in patients with cholelithiasis. Materials and methods: This study was conducted in the Department of General Surgery, Government Stanley Medical College, Chennai in 2018. Patients were divided according to history, clinical examination, and USG neck and lab estimation of T3, T4, and TSH. Subclinical hypothyroidism: The symptom-free patient with TSH concentration above the upper limit of normal range and T3/T4or both decrease below normal limit. Clinical hypothyroidism: In which there were symptoms of hypothyroidism with TSH level above the upper limit and T3/T4or both decreases below normal limit. Euthyroid group: Where clinical and lab tests were within normal range. Manimegalai, T. Avvai. The prevalence of undiagnosed thyroid dysfunction and diagnosed diseases of gallstones. IAIM, 2019; 6(3): 231-236. Page 232 Results: The predominant age group was 51-60 years constituting 36.67% of patients. Youngest patient age was 21 years and the oldest was 80 years of age. Of the 60 patients, the majority of patients were euthyroid status 52 (86.67%). 6 (10%) patients were subclinical hypothyroidism, 2 (3.33%) were clinical hypothyroidism. Of the 60 patients, 52 were diagnosed with gallstone only and 8 were diagnosed with gallstone and CBD stones. In this study, hyperlipidemia was present in 7 of the hypothyroidism. Conclusion: There is a relationship between thyroid dysfunction particularly hypothyroidism and gallstone diseases. Hypothyroidism is seen more in GB stones patients compare with CBD stone patients. Subclinical hypothyroidism is more common than clinical hypothyroidism. Hypothyroidism has a higher prevalence in females than males. High cholesterol levels are seen in gallstone disease with thyroid dysfunction.

Comparative study of complications following laparoscopic TEP versus TAPP versus open hernioplasty in inguinal hernia repair

Background: Hernia repairs, both inguinal and ventral/ incisional, are some of the most common surgeries performed in the world. Over the last 5 years, the field of hernia surgery has had a significant transformation thanks to many new and innovative surgical techniques as well as exponential growth in mesh and mesh technology. The aim of the study: To compare the intraoperative complications of TEP vs TAPP vs open hernioplasty in terms of operative time, major visceral or vessel injury and conversion rates. Materials and methods: This study was conducted in the Department of General Surgery, Government Stanley Medical College, and Chennai in 2018. 75 patients (25 cases of open hernioplasty, 25 cases of TAPP, 25 cases of TEP). Post-operative pain was recorded based on Visual Analog Scale and requirement of analgesics. Post-operative complications like urinary retention, wound seroma, wound hematoma, wound infection, port site infection, recurrence, mesh infection, bowel complication was collected with clinical examination and complications recorded. Results: The study involved 75 male patients who satisfied the inclusion criteria. 25 patients were subjected to Lichtenstein tension-free open hernioplasty, 25 treated with TEP, and another 25 subjected to TAPP. Among the 75 cases studied 21 cases were found to have left sided inguinal hernia, whereas 54 cases were having right sided hernia. Intraoperative complications like major vessel injury or bladder injury were observed. No intraoperative complications were encountered Rosy Adhaline Selvi, Manimegalai. Comparative study of complications following laparoscopic TEP versus TAPP versus open hernioplasty in inguinal hernia repair. IAIM, 2019; 6(3): 223-230. Page 224 during the study period in any of the groups. Post-operative urinary retention was found only in two cases of Lichtenstein tension-free open hernioplasty and this required bladder catheterization. All cases of laparoscopic hernioplasty were catheterized intraoperatively and catheter retained till postoperative day 1, hence urinary retention could not be assessed. The post-operative pain was measured using the Visual Analog Scale (VAS) 6 hours after the surgery. The patient was given a dose of Injection Tramadol 100mg in after the surgery. The pain scores were analyzed with Chi-square and the difference found to be statistically significant. Lichtenstein tension-free open hernioplasty was found to have increased postoperative pain when compared to laparoscopic repair. Among the laparoscopic repair, TAPP was found to have increased postoperative compared to TEP. The postoperative hematoma was observed in a single case of Lichtenstein open hernioplasty. The hematoma was in the subcutaneous plain and required drainage. Conclusion: Primary unilateral inguinal hernia without complications can be treated with Lichtenstein tension-free open hernioplasty or laparoscopic transabdominal preperitoneal hernioplasty or laparoscopic totally extraperitoneal hernioplasty. Lichtenstein open hernioplasty has an advantage over laparoscopic repair in terms of shorter duration of surgery and learning curve.

A comparative study between onlay and subway mesh repair in the treatment of ventral hernia

Background: More than 1 million ventral hernia surgeries are done annually in India. Suture repair techniques have dominated ventral and incisional hernia repair over a century. The most popular of these techniques was the Mayo duplication. In larger hernias, suture repair requires the application of tension to the fascia in order to close the orifice. The aim of the study: This study aimed to compare the duration of surgery and postoperative complications of subway and only meshplasty in the treatment of ventral hernias. Materials and methods: This study was conducted in the Department of General Surgery, Government Stanley Medical College, Chennai in 2018. Totally 50 cases were included in the study. Group A (25 Cases- Onlay meshplasty) Group B (25 cases - Sublay meshplasty). All subjects undergoing onlay and sub lay mesh repair for ventral hernias were evaluated intraoperatively for the duration of surgery and postoperatively for complications like surgical site infections, seroma formation, flap necrosis and duration of hospital stay. Results: The most common complication observed was seroma in 6 patients. 1(4%) were in preperitoneal and 4(20%) in the onlay mesh repair group. This complication was managed with seroma drainage. The only technique had more of seroma formation, due to the fact that onlay techniques require significant subcutaneous dissection to place the mesh, which can lead to devitalized tissue with seroma formation or infection. The superficial location of the mesh also puts it in danger of becoming infected if there is superficial wound infection. Wound infection was found in 5 cases. Out of these, 1(4%) were in a pre-peritoneal group and 4(16%) were in onlay group. These patients were Manimegalai, Avvait. A comparative study between onlay and subway mesh repair in the treatment of ventral hernia. IAIM, 2019; 6(3): 217-222. Page 218 treated with appropriate antibiotics and regular dressing. No patient required removal of mesh because the infection was superficial and responded well to antibiotics. Conclusion: Sublay mesh repair is a good alternative to onlay mesh repair that may be applicable to all forms of ventral hernia as the mesh related overall complication rate like a seroma, surgical site infections, flap necrosis, and hospital stay are less compared to onlay mesh plasty.

Scrutiny of extent of axillary node dissection for patients with primary breast cancer

Background: Carcinoma of the breast is the most common of non-skin malignancies in women and is second to lung cancer is a cause of cancer deaths. A woman who lives to age 90 has a one in eight chance of developing breast cancer. It is as ironic and tragic that a neoplasm arising in an exposed organ, readily accessible to self-examination and clinical surveillance, continues to exact such a heavy toll. The aim of the study: To determine, if differences in the extent of axillary node dissection would alter the number of reported positive nodes, to emphasize the presence and importance of dissecting the inter pectoral node (Rotter’s Node) in Modified Radical Mastectomy. Materials and methods: This study was conducted in the Department of General Surgery, Government Stanley Medical College, Chennai in 2018. Patients were evaluated according to NCCN guidelines and were subjected to Modified Radical Mastectomy for whomsoever it was needed. 32 cases underwent Modified Radical Mastectomy with complete axillary dissection (level I/II/III and inter pectoral node) according to the identical procedure. The dissection was carried out in all patients, irrespective of whether they had palpable nodes or not clinically. Results: An average of 13 lymph nodes was examined per case (range: 8−20). Axillary lymph node involvement was found in 56% of the cases (18/32). Of the 18 cases, 83% (n = 15) had involvement of level I/II nodes only, and 16% (n = 3) had positive ALN in levels III and, or, inter pectoral nodes, in addition to the level I/II. Involvement of lymph nodes in level III and inter pectoral nodes without a level I metastasis was not found. By the inclusion of level III to a level I/II dissection, two cases (11%) was converted from one to three positive nodes (pN1) to ≥4 positive nodes (pN2). Involvement Rosy Adhaline Selvi, Manimegalai. Scrutiny of extent of axillary node dissection for patients with primary breast cancer. IAIM, 2019; 6(3): 212-216. Page 213 of lymph nodes in level III was found in 3 cases (16%) 10/32 cases (31%) had ≥4 positive nodes who required adjuvant therapy. Conclusion: Variations in the level of axillary node dissection for breast cancer which includes the inter pectoral and level III nodes can result in significant changes in the number of positive axillary nodes stepping up the pathologic nodal status from pN1 to pN2. This can potentially bias adjuvant therapy recommendations if treatment decisions are based on this prognostic factor.

Age Changes in Human Skin from 3 Years to Years of Age.

Background: Natural aging process is reflected by gradual changes in the structure of the skin. These changes become very marked in old age. The changes in the epidermis and dermis as age advances is reflected externally as wrinkling, dryness, loss of elasticity , thinning and tendency towards purpurae on minor injury. So the aim of this study is to measure the thickness of the epidermis. Materials and Methods: The study was done in skin specimens by grouping the individuals in 4 age groups namely Group A (3-20yrs), Group B (21-50yrs), Group C (51-65yrs and Group D (>65yrs).The specimens were stained with Haematoxylin and Eosin stain and the changes in the thickness of the epidermis was observed. Results: The epidermis was found to be thin in children from 3years of age. The thickness of the epidermis starts increasing in young individuals and is thick till 50 years of age. Then the thickness of the epidermis starts reducing and becomes very thin in older persons. Conclusion: As the average life expectancy is increasing, the aging of skin presents a growing problem for the dermatologists. The computer system for image processing and analysis has made possible, measuring the thickness of the epidermis. Human aging is characterized by a number of disorders like epidermolysis bullosa and phemphigus vulgaris affecting the structure of the skin. So it is necessary to study the normal changes that occur in the skin as age advances which predisposes to various disorders. The study is done among Indian population.

Andersson Lesion in Ankylosing Spondylitis

Andersson lesions are destructive foci that appear at the discovertebral junction in ankylosing spondylitis. We report three cases of ankylosing spondylitis with such lesions. These lesions simulate an infection and in our country, mimic spinal tuberculosis.

Use of Traditional Eye Medicines by corneal ulcer patients presenting to a hospital in South India.

PURPOSE: To investigate the nature and frequency of use of Traditional Eye Medicine (TEM) for corneal ulcer in patients from predominantly rural background. METHODS: We documented the the use of TEM by corneal ulcer patients presenting to a tertiary eye-care centre in South India during two months of 1996. RESULTS: Of 283 patients enrolled in the study, 135 (47.7%) of the patients used TEM. There was no difference with regard to age and sex distribution of patients using TEM and those who did. Patients with history of trauma were more likely to use TEM. Common forms of TEM used were human breast milk 61(45.2%), leafy matter 40(29.6%), castor oil 16 (11.9%), and hen's blood 8 (5.9%). CONCLUSION: Though the awareness of intraocular lens implantation for cataract surgery is very high in this segment of the population, it is still tragic that an awareness of primary eye care following trauma has not been created. Health education is mandatory to prevent this avoidable cause of blindness.

Effect of vitamin-E on high fat diet induced hyperlipidemia in rats.

High fat diet intake in rats resulted in hyperlipidemia which was evidenced by elevated levels of plasma cholesterol, free fatty acids, triglycerides and increased LDLc/HDLc ratio. Vitamin E (400 mg/kg body wt/day) administration for 60 days prevented the elevations in plasma lipid levels. It reduced LDLc/HDLc ratio, lipid peroxide levels and elevated the level of reduced glutathione (GSH) in hyperlipidemic rats. Vitamin-E was non-toxic.

Hormonal influence on epididymal lipids.

Single dose administration of Prolactin(P), Progesterone (PP) and a combination of both (PPP) affected the epididymal lipids considerably. Caput and Cauda showed differential responses. PP and PPP showed significant alterations in Caput epididymis. However, Prolactin was effective in Cauda epididymis. The importance of these changes in relation to physiological functions of epididymis is discussed.