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Objectives: The morphometric changes in the vertebral artery are essential for various interventions. Inadequate details about it can lead to risk of vertebral artery injury and other complications. This study explains the normal anatomical course of V2 segment of vertebral artery which is more prone for iatrogenic injury. Materials and Method: 25 adult patients with symptomatic neck pain were involved in the study. Various measurements were made from seventh cervical vertebra (C7) to the third cervical vertebra (C3) that included Distance from midline to VA, Distance from medial margin of Longus Colli to VA, Perpendicular distance from anterior margin of transverse process to center of VA, Horizontal distance from anterior tubercle to VA, sagittal and coronal diameter of the transverse foramen and vertebral artery. Result: Distance from midline, Distance from medial margin of Longus Colli, Perpendicular distance from anterior margin of transverse process to center of VA and Horizontal distance from anterior tubercle were increased towards right compared to left side. The sagittal and coronal diameter of the transverse foramen and vertebral artery decreased from C6 to C3 vertebra. Vertebral artery dominance was seen on left side in all cases. Conclusion: Preoperative assessment by computed tomography angiography helps to know the course of the vertebral artery, understand its patterns and assess various abnormalities thereby aids in preventing complications in future surgeries.

Background: Total knee arthroplasty being the definite procedure in degenerative arthritis of the knee is associated with a high cost that includes the cost of implants & in-hospital length of stay (LOS). Incurring such high costs will put a burden on the patients economically, so the goal being the reduction of LOS yet improving the functional outcome with better patient satisfaction. The purpose of this study is to identify the perioperative risk factors increasing the LOS of patients, by quantifying them, efforts can be done to manage those risks providing better satisfaction to patients.Materials and Methods: The study design is a retrospective analysis of 1022 patients of primary elective total knee arthroplasty, performed in our institution. The potential factors recorded were: age, sex, hemoglobin levels, albumin levels, BMI calculated with patients height and weight, ASA grading, smoking alcohol status, diagnosis for which TKA was done and comorbids were analysedResults: We looked at 1022 patients and found the average length of stay is 6 days, with age, comorbids, BMI, ASA, Diagnosis, blood transfusion, hemoglobin and albumin all played a role to influence Length of stayConclusion: Our study showed that LOS after TKA is multifactorial. Various risk factors are present at the time of presentation, some of which are modifiable and some non-modifiable. It is important to acknowledge all the factors that increase the in-hospital LOS & to do one's uttermost use of medical resources.

The mechanism by which circulating ox-LDL and inflammatory indicators such as high sensitivity C-reactive protein may exert their impact on the development of CHD is still poorly understood. The study aims to measure the levels of circulating oxidized LDL and high sensitive C - reactive protein in CHD subjects. This cross-sectional study was conducted in the Department of Cardiology, General Medicine, and Master health check-up OP of SRM Medical college hospital and research centre, Tamil Nadu, India. A total of 182 subjects in which 91 CHD subjects and 91 healthy control in the age group of 30 to 55. ox-LDL and hs-CRP were measured by ELISA method and Lipid Profile is measured using Auto Analyzer AU480. Statistical analysis was done using the student ‘t’ test and Pearson correlation analysis was done for the comparison between two groups. The mean level ox-LDL and hs-CRP in CHD were elevated and statistically significant (p-value

Background: Periodontal disease is a major oral health problem, which approximately affects 15–17% of the adult population. However, the periodontal disease not only affects the supporting structures of the oral cavity, but also has a negative impact on the oral health-related quality of life. Aim: the aim of the study was to assess the association between oral health status and quality of life among a selected South Indian population. Materials and Methods: The present study was conducted among 150 outpatients who reported to the Department of Periodontics, Saveetha Dental College and Hospitals, Chennai, India. Based on the periodontal status of the patients, patients were categorised as follows: Group 1 - Clinically healthy (50 patients); Group 2 - Gingivitis (50 patients); Group 3 - Periodontitis (50 patients). To measure patient based outcomes, Oral Health Impact Profile-14 (OHIP-14) item questionnaire was used. The OHIP-14 questionnaire consists of seven divisions and the patients were asked to rate each item on a 5-point scale. The OHIP-14 score is the sum of responses and ranges from 0 to 56. The data was analyzed using Statistical Package for Social Sciences (SPSS Software, Version 23.0). The association between oral health status and quality of life was done using Chisquare test. The level of significance was set at p

BACKGROUND New corona virus respiratory syndrome is a health emergency due to high infectivity and high case fatality in patients with comorbid conditions like ischemic heart disease. The diagnostic methods of corona virus disease (Covid-19) are still in experimental stage. Hence, a sensitive and specific disease progression marker of Covid-19 is needed. CRP (C-reactive protein) is synthesised by liver. It is elevated in infection and inflammatory conditions as it is an acute phase protein. The purpose of this study was to evaluate CRP as a promising marker for predicting severity of Covid-19 in ischemic heart disease patients and to correlate the impact of CRP with other circulating cardiac biomarkers in different age groups and both sexes. METHODS This is a cross sectional study done among south Indian population mostly from Tamil Nadu and Andhra Pradesh. 232 cases were selected and divided into two groups based on age, sex and confirmed Covid-19 positive cases by RT-PCR (Reverse transcription-polymerase chain reaction), admitted and treated in Rajiv Gandhi Government General Hospital, Chennai. RESULTS In this study, CRP levels were elevated in the age group of 50 - 70 years (66.96 ± 70.09 mg/dL) than CRP levels of age group 30 - 50 years (82.31 ± 90.23 mg/dL) and P value was found to be significant in the age group of 50 - 70 years. Lactate dehydrogenase (LDH) levels were elevated in the age group of 30 - 50 years (380.77 ± 252.23 U/L) than the LDH levels of age group 50 - 70 years (393.53 ± 206.83 U/L) and P value was found to be significant in the age group of 30 - 50 years. Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and creatine kinase (CK) levels are the additional cardiac enzymes found to be elevated in this study. CRP showed a positive correlation with LDH (r = 0.221 P < 0.001) in both males (r = 0.06 and P < 0.001) and females (r = 0.45 and P < 0.001) with a significant P value. Receiver operating characteristics (ROC) curves for CRP Vs age group shows a sensitivity of 91.15 % and specificity of 92.52 % and area under curve of 0.556. CONCLUSIONS CRP can be used as a promising marker for early detection and timely intervention of ischemic heart disease in Covid-19 patients especially in the age group of 50 - 70 years and thereby reduces the mortality. KEYWORDS Biomarkers, Heart Disease, Mortality, Prognosis

Introduction The philtral ridges form a prominent visual landmark in the upper lip. An aesthetically pleasing cleft lip repair should restore this preferably without any scars cutting across it. Although there are several scientific publications on morphology of this structure and its variations, very few studies on the Indian population have been published. Aim To study the morphology of the philtral ridges and their relationship to the columellar base in normal Indian children and its significance in cleft lip repair. Methods 115 normal healthy children from southern India aged between one and 12 years were studied based on direct observation of the relationship of the superior end of the philtral ridge to the columellar base and nasal sill. In type A, the philtral ridge terminates at the nasal sill just lateral to the columellar base, and in type B, it either reaches or fades before reaching the columellar base. All observations were performed by the first author by examining standardized two-dimensional (2D) photographs of the upper lip-nose complex. Results In this study, 74% of the subjects had the philtral column extending lateral to the columellar base. Conclusion These finding assume a significance since, in a substantial proportion of the studied population, techniques of cleft lip repair such as the rotation advancement method, place a scar that crosses the upper third of the philtral ridge which may be undesirable.

BACKGROUND The association between orofacial cleft and parental age is evident. This study focuses on paternal age playing a vital role in the birth of children with orofacial clefts. We wanted to assess the role of paternal age as a factor in the development of congenital anomalies in this study. METHODS A case control study was performed on 1000 cases and 250 controls in Mangalore. The parents were interviewed regarding their age at the time of conception. RESULTS 46.4 % of fathers of the cleft children belonged to 30 - 34 years of age group and 25 % belonged to 25 - 29 years of age group at the time of conception. In the control group, 38 % belonged to 30 - 34 years of age group and 24.8 % belonged to 25 - 29 years of age group. CONCLUSIONS Paternal age in the age group of 30 - 34 years has significant contribution in the birth of orofacial children with cleft deformities. KEY WORDS Orofacial cleft, Paternal Age, Congenital anomalies

Background: The humerus can be broken down into four segments. If the humerus is found in its entirety, then its length can be used to estimate stature. However, if only segments of the humerus are recovered then a combination of segments can be used to estimate stature. To estimate the stature using Humerus length among adult population in South India. Materials and Methods: A Cross sectional study was carried out using purposive sampling among Medical Students at CIMS, Chamarajanagar. Study duration was 6 months from July 2019 to December 2020. 100 Male and 100 Female Medicos were included in the study after taking informed consent. Differently abled adults were excluded from the study to reduce the error. Structured questionnaire was used to collect the data such as age, gender, height, arm length or Humerus length and distance between medical and lateral condyle. Results: In the study among males there was significant positive correlation between Humerus length and height and distance between medial & lateral epicondyle among females there was negative correlation between Humerus length and age Among Males equation for estimation of height using Humerus length = 103.1 + 1.903 x Arm length. Among Females equation for estimation of height using Humerus length = 108.34 + 1.608 x Arm length. Conclusion: As a result, these measurements may help to indicate the characteristic morphological features of humeral segments in south Indian population and also help the orthopedic surgeon to place the various implants in the reconstruction of humeral fractures. Keywords: Humuerus, Age estimation, Stature, Forensic, Regression

BACKGROUND Failure in managing the airway is the most important cause of death in patients undergoing general anaesthesia (GA). For effectively preventing airway catastrophe it is essential to have a meticulous airway assessment pre-operatively. Many methods are in use to predict difficult airway like Mallampati, Wilson’s scoring, percentage of glottic opening (POGO) scoring, Cormack - Lehane classification, thyromental distance, mandibular hyoid distance, atlantooccipital joint extension etc. In this study, we compared between two popular methods of airway assessment, upper lip bite test (ULBT) and height to thyromental distance ratio (RHTMD) to predict the difficulty in tracheal intubation. METHODS This descriptive study was conducted at Government Medical college, Thrissur, over a period of one year , on 76 patients of American society of Anaesthesiologist (ASA) - PS l - lll, requiring general anaesthesia. ULBT and RHTMD were used to assess the patient’s airway. It was correlated with Cormack - Lehane classification during direct laryngoscopy. The data was analysed using Fisher exact test (P < 0.05) and Kappa statistics. RESULTS Out of the 76 patients, 41 (53.9%) were women 35 were men (46.1 %). ULBT predicted 89.6 % [25 + 43] belonging to class 1 and 2 as easy, while 10.5 % [8] of class 3 as difficult. RHTMD predicted 35 patients (46 %) as easy (grade 1) and 41 patients (54 %) as grade 2. Using ULBT, of the 8 patients predicted to have difficult intubation (Class 3), 2 were found practically difficult and 6 were easy. In remaining 68 patients, 23 patients had difficult view and 45 had easy view. According to Cormac and Lehane, among 41 patients who predicted difficult by RHTMD, 19 patients were practically difficult and 22 were easy. Of 35 patients, 6 patients were difficult and 29 were easy. CONCLUSIONS The RHTMD is more sensitive compared to ULBT in predicting difficult intubation. As assessed by Cormack - Lehane classification. KEYWORDS Difficult Intubation, Ratio of Height to Thyromental Distance, Upper Lip Bite Test

Context Progressive supranuclear palsy (PSP) is a neurodegenerative disorder which comes under Parkinsonism plus syndrome. As this spectrum of disease has many overlapping clinical as well as imaging findings, some quantitative parameters like magnetic resonance Parkinsonism index and midbrain/pons ratio are useful to differentiate PSP from other PD patients. Aims The study aimed to detect sensitivity and specificity of magnetic resonance Parkinsonism index in differentiating PSP from PD. Settings and Design It was a retrospective case–control study conducted in Sri Manankula Vinayagar Medical College, Puducherry, during the period of January 2018 to June 2019. Materials and Methods The 87 subjects, who were diagnosed and grouped into three categories (PSP, PD, and control) after performing magnetic resonance imaging brain, were reviewed. The parameters like the area of Pons and midbrain, width of MCP and SCP, P/M, M/P, and MRPI were calculated. Statistical Analysis One-way ANOVA and Chi-square test was used. The sensitivity, specificity, diagnostic accuracy, and cut-off values obtained with receiver operating characteristic curve analysis were determined. Results The mean age of presentation was approximately 75 years with male predominance. The cut-off value of MRPI obtained in this study was 13.4 with 100% sensitivity and specificity. Even though M/P ratio was found to be statistically significant among PSP patients; cut-off value was not obtained. Conclusion MRPI was concluded as the better tool in diagnosing PSP compared with the M/P ratio. Hence the combined qualitative as well as quantitative measurement of MRPI will increase the diagnostic accuracy of PSP.

BACKGROUND Appendicitis is a common clinical condition but sometimes diagnosis is delayed when appendix is found at a rare location. The present study was conducted to find out various clinical presentations of appendicitis, to evaluate its various positions in South Indian population and compare the same with western population. METHODS The cross-sectional study was conducted among a total of 1000 patients (631 males and 369 females) taken from Government Stanley Medical College and Hospital, Tamil Nadu, India, from 2018 to 2019 with an age range of 18 to > 60 years of both sexes. The clinical symptoms were recorded, demographic details were collected. RESULTS The present study included 631 (63.1%) male and 369 (36.9%) female patients including the age category 18 to > 60 years old patients. The anatomical locations of the appendix which were as follows: retrocecal in 860 individuals (86%), pelvic in 110 patients (11%), postileal in 10 (10%), preileal in 10 (10%), subhepatic in 8 individuals (0.8%), paracolic and subcaecal in 1 person respectively (0.1%). In our study, the mean distribution of gender by age in the study population was 157.75 males and 92.25 females. Length of appendix > 119 mm was found in total individuals (32.9%) i.e., maximum than other studies. These results showed an extreme statistically significant P value. CONCLUSIONS The present study successfully compared south Indian population with western population. The clinical symptoms were recorded, details of demography, age and sex were collected successfully. KEYWORDS Anatomical Locations, Appendix, Appendectomy, South Indian, Western Population

Background: Atopic Eczema (AE) is a specific chronic relapsing dermatitis with varied presentations. The etiopathogenesis of AE is largely speculative and over years has led to origin of various criteria like Hanifin, Rajka’s criteria (HRC), United Kingdom working party’s diagnostic criteria (UKWPDC) and millennium diagnostic criteria (MDC). These have originated in western countries and is used among Indian population without much validation studies. Objective: To validate HRC, UKWPDC and MDC in the diagnosis of AE among Indian population. Materials and Methods: A case-control study including 50 cases of AE and 30 age matched controls who are presenting to the DVL OPD of a tertiary teaching hospital. Defined case proforma was prepared highlighting the criteria’s of HRC, UKWDPC and MDC posing as a questionnaire to the cases/subjects. Total Serum IgE levels were estimated. Sensitivity, specificity, Positive predictive value (PPV), Negative predictive value (NPV) and Relative value were calculated for all criteria. Results: The Sensitivity, specificity, PPV and NPV was 100% for HRC and UKWPDC whereas there was a compromise in the specificity (32.5%) and lower relative value of (22.5%) for MDC. Some minor features of HRC and MDC criteria showed lower validity compared to major features. Conclusions: Though many upgradations are going on in HRC, UKWPDC it could still be considered and used as a diagnostic criterion considering the high sensitivity, specificity and accuracy for diagnosis of AE. Keywords: Atopic Eczema, Total serum IgE, Hanifin & Rajka criteria, UK working party diagnostic criteria, Millennium diagnostic criteria.

Introduction Basal angle, Boogaard’s angle, and clival angle are frequently used in diagnosing the craniometric angle malformations either on radiography or now more on MRI. But anatomic and clinical studies have used varied terms for these parameters. We aimed to look for these parameters among a normal south Indian adult population to standardize the measurements and their terminology. Materials and Methods One hundred MRI images (50 males and 50 female) were studied retrospectively. MRI images that were reported as normal by neuroradiologist were taken up for the study. Mean and the standard deviation of males and females were calculated for basal angle, Boogaard’s angle, and clival angle, separately. Unpaired t-test was used to analyze the significant difference (p < 0.05) between the genders. The intraclass coefficient correlation was used to analyze the interobserver variability. Results The mean value of basal angle in males and females are 113°and 114°, respectively. The mean value of Boogaard’s angle in males and females are 120°and 121°, respectively. The mean value of clival angle in males and females are 157°and 155°, respectively. There was no statistically significant difference (p > 0.05) between males and females in all three angles. Conclusion Knowledge about the normal angles will be an important tool in understanding the normal and abnormal skull base. Since the type of skull varies in accordance with race, the normal craniometric angle also varies in accordance with race. The present study tried to standardize the parameters of normal skull base angles for appropriate correction of the anomalies and uniform usage of terminology.

Hypocalcaemia being one of the most common complications after total thyroidectomy may not be avoidable in all cases. This study evaluated the effectiveness of intact Parathyroid hormone (iPTH) measured at 1-h after total thyroidectomy in predicting postoperative hypocalcaemia in early postoperative period in South Indian population. Patients who underwent total thyroidectomy in our institute from 2016 to 2018 were included. Preoperative calcium and iPTH levels were measured. Patients’ iPTH level was measured 1 h after surgery and serum calcium level was measured at 24 h after surgery. Patients were also monitored clinically for any symptoms and signs of hypocalcaemia. A total of 57 patients were studied. The malignant causes accounted for 75.4% with papillary carcinoma thyroid being the most common cause. 65.7% of patients who underwent total thyroidectomy and 100% of patients who underwent total thyroidectomy with neck dissection developed hypocalcaemia. 70% of patients with low iPTH developed hypocalcaemia and none of the patients who had normal iPTH developed hypocalcaemia. This relation was statistically significant with p value of 0.018 (

Introduction Diabetes risk-screening tools are validated and implemented across various countries. There is a need for improvement in these risk scores with suitable modifications so as to make them more sensitive, specific, and suitable to the local population. Objectives The aim of this study was to evaluate and compare the diagnostic accuracy and clinical utility of the Indian diabetes risk score (IDRS), the American diabetic association (ADA) risk score, and the Finnish Diabetes Risk Score in healthy subjects of South Indian origin in predicting the risk of diabetes and to correlate these risk scores with the blood glucose and hemoglobin A1c (HbA1c) levels in the study population. Materials and Methods A total of 160 subjects attending the master health checkup/outpatient department of a tertiary care hospital were included in the study. Each subject was asked to fill a questionnaire. Details obtained using the questionnaire were assessed as per the three diabetic risk scores. Fasting blood sugar/random blood sugar and HbA1c were estimated. Statistical Analysis Used Data analysis was done using SPSS 22/23. Pearson correlation was used to compare continuous variables, with p < 0.05 considered statistically significant. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and Mitchell’s clinical utility indices were calculated for each risk tool. Results We found the prevalence of diabetes to be 11.9%. ADA risk score was the only risk score that showed a statistically significant difference (p-value = 0.05) between the low- and high-risk subjects. Conclusions ADA or IDRS risk scores can be used for screening diabetes in the South Indian population. We suggest that inclusion of the history of gestational diabetes and hypertension in the IDRS risk score might improve its sensitivity as a screening tool in our local population.

Naveen Kumar Challa,1,2 Waleed M Alghamdi1 1Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia; 2Lotus Eye Care Hospital, Coimbatore, IndiaCorrespondence: Naveen Kumar ChallaQassim University, P.O. Box: 1162, Buraidah, Saudi ArabiaTel +966531177518Fax +966(16)3800050Email N.challa@qu.edu.saAim: To determine the absolute and relative ocular protrusion values in normal south Indian population, and its relation to age, gender and type of refractive error.Methods: A total of 387 subjects aged 7– 70 years were included in this study. Both right and left absolute ocular protrusion values were measured by a single physician using Luedde exophthalmometer in primary gaze. Right eye ocular protrusion data were used for reporting the absolute ocular protrusion values, and difference between right and left eye absolute ocular protrusion values of the same individual was used to report the relative ocular protrusion values. Subject age was grouped as decades. Measurement values were evaluated by descriptive and inferential statistics.Results: The mean absolute ocular protrusion of right eye was 14.67 ± 1.70 mm and left eye was 14.32 ± 1.75 mm. The mean right absolute ocular protrusion values from 1st to 7th decade were 12.73 ± 1.21 mm, 14.8 ± 1.25 mm, 15.79 ± 1.31 mm, 15.77 ± 1.36 mm, 15.87 ± 1.28 mm, 15 ± 1.03 mm and 14.36 ± 0.88 mm respectively. One-way analysis of variance showed that there was a significant difference in the ocular protrusion among the age groups (p < 0.005). The mean relative ocular protrusion was 0.35 ± 0.64 mm. The type of refractive error (up to ± 6.00D) has no significant effect on the absolute ocular protrusion values and showed a weak correlation between magnitude of myopia and hyperopia on absolute ocular protrusion. There was a statistically significant difference in absolute ocular protrusion among the female and male subjects.Conclusion: Age and gender seems to significantly influence the absolute ocular protrusion and need to be considered for clinical evaluation of bilateral proptosis. The refractive error up to ± 6.00D seems to have no significant effect on the absolute ocular protrusion.Keywords: absolute, relative, ocular protrusion, exophthalmometer, refractive status, proptosis

Missing teeth impair the quality of life. It interferes with the process of mastication, aesthetics and other functions of the oral cavity. The presence of teeth in the oral cavity is a major consideration for the evaluation of the oral health of an individual. The aim of this study is to evaluate tooth loss and edentulism among the south Indian population. This is a retrospective study. Data of the patients who visited Saveetha Dental College between September 2019 and March 2020 were collected and searched for those who underwent full mouth extraction. The data was tabulated using the parameters of age, gender and the reason for edentulism (dental caries, periodontitis, others). All the data were tabulated and analysed with the use of the statistical software IBM SPSS version 20.0. Statistical analysis of the data was done using Chi square test. Within the limits of the study, it is proven that the prevalence of total edentulism is observed in the population above the age of 50 years. Total edentulism shows a male predilection where the main causes for tooth loss in an individual is the presence of dental caries and periodontal diseases.

Objective: The main objective of the present study was to perform the knowledge, attitude and perception of metabolic disorders (Hypothyroidism and Type II DM) in South Indian population. Methods: A prospective observational study was conducted in the city of Vijayawada, South India to assess the KAP of the individuals towards the common conditions of Hypothyroidism and Type II DM using standard questionnaire and procedure. Results: A total of 980 houses were screened in a span of 1 year, resulting in 187 people living with thyroid disorders and 735 with Diabetes Mellitus. After passing through the selection criteria, we are left with 130 of Hypothyroid (H) and 456 of T2DM alone patients. Out of whom 55 were lost during follow-up. Statistical analysis was performed using SPSS 16 version by using Chi-square test. Conclusion: Knowledge and perception of the individuals regarding the T2DM was found to be good compared to the Hypothyroidism. However, practicing them in their daily life is often found missing due to the rapid urbanization and less awareness created by counseling.

Introduction: The greater palatine foramen (GPF) is located in the posterior part of the hard palate between the articulations of hard palate with the maxilla. GPF continues posteriorly and upwards as greater palatine canal (GPC) which opens in to the inferior wall of pterygopalatine fossa. Exiting the foramen rotendum, maxillary nerve enters the pterygopalatine fossa where it can be blocked. The intraoral route of GPF approach can be preferred for maxillary nerve block because of its low incidence of complications and high success rate. For achieving a painless intra operative period in procedures involving the maxillary region and for tooth extraction achieving a perfect maxillary nerve block is of at most importance. Our present study is aimed at correctly locating the position of GPF, its shape and patency in south Indian population which will be helpful for the intra oral approach of maxillary nerve block through the GPF Materials and Methods: The study was conducted in 30 dry adult skull bones of both sex. The molar relation, shape and the patency of the GPF were observed, the readings were obtained, statistically analyzed and compared with other studies. Results: In our observation on both side of skull, it was noted that GPF was located opposite to the 3rd molar in 90% of cases. Oval shaped GPF is most commonly found in our study which accounts to 53.35% and the overall patency rate for GPF was 95% in our study. Conclusion: Analysis and comparison of data has proven that the position, shape and patency of GPF may vary according to different races. This study has also confirmed that the maxillary nerve block via GPF is relatively safe and easier due to the consistency of the position, shape and the patency of the GPF in south Indian population. KEY WORDS: Greater palatine foramen, maxillary nerve block, regional blocks, Greater palatine canal, pterygopalatine fossa, Maxillary nerve.

OBJECTIVE: Currently no standardized tools are available in the Indian languages to assess changes in cognition. Our objectives are to culturally adapt the Alzheimer’s disease Assessment Scale – Cognitive Subscale (ADAS-Cog) for use in India and to validate the Tamil version in an urban Tamil-speaking older adult population. METHODS: Two panels of key stakeholders and a series of qualitative interviews informed the cultural and linguistic adaptation of the ADAS-Cog-Tamil. Issues related to levels of literacy were considered during the adaptation. Validation of the ADAS-Cog-Tamil was completed with 107 participants - 54 cases with a confirmed diagnosis of mild-moderate dementia, and 53 age, gender, and education matched controls. Concurrent validity was examined with the Vellore Screening Instrument for Dementia (VSID) in Tamil. Internal consistency using Cronbach’s alpha, sensitivity, and specificity data using the Area Under the Receiver Operating Characteristics (AUROC) curve values were computed. Inter-rater reliability was established in a sub-sample. RESULTS: The ADAS-Cog-Tamil shows good internal consistency (α=0.91), inter-rater reliability, and concurrent validity (with VSID-Patient version: r=-0.84 and with VSID-Caregiver version: r=-0.79). A cut-off score of 13, has a specificity of 89% and sensitivity of 90% for the diagnosis of dementia. CONCLUSION: ADAS-Cog-Tamil, derived from a rigorous, replicable linguistic and cultural adaptation process involving service users and experts, shows good psychometric properties despite the limitations of the study. It shows potential for use in clinical settings with urban Tamil speaking populations. The English version of the tool derived from the cultural adaptation process could be used for further linguistic adaptation across South Asia.

Background: Huge easy nerve limb flaw connecting higher and mid-3rd remains a therapeutic challenge. The objective of this study was to evaluate the effectiveness and versatility gastrocnemius myocutaneous flap cover for post traumatic large defect of greater and mid-3rd of leg. Materials and Methods: As accomplished cadaveric partition in twenty legs to copy the place of the proximal and distal greatest perforators rising since the sural, peroneal and later tibial blood vessel on the later feature of the leg spreading since the intercondylar streak upon eight cm centre of the body to the middle n adjacent a bony projection with a shape likened to a hammer head. The part of middle stomach of gastrocnemius through the end-to-end later tibial a nerve was selected as the mid lap & the area ended adjacent stomach of gastrocnemius with together peroneal a nerve was elected as adjacent flap. Results: In the area definite as the middle flap we originate a regular of 2.4 a nerve arising since the middle sural blood vessel & 1.8 rising since the later tibial blood vessel. In the mid flap the distal greatest a nerve was the later tibial sept cutaneous a nerve, such as a regular 23.2 cm since the notch separates the condyles of the femur line, about 6.8 cm beyond away since the distal greatest mid sural a nerve. Cutting-edge the side fold area, as originate a regular of 1.8 adjacent sural a nerve alongside by 1.6 peroneal blood vessel forming a connection between a deep system and a superficial one. In this lappet the distal greatest blood vessel forming a connection between a deep system and a superficial one was the peroneal septocutaneous, at a normal space of 23.2cm distal to the notch separates the condyles of the femur streak and at a normal of 7.3cm additional missing since the distal greatest adjacent sural blood vessel forming a connection between a deep system and a superficial one. Conclusion: At the time of inspection of the functional base of mutual mid and adjace

Aims: The aim of the study is to investigate the association between ocular dominance and central corneal thickness (CCT) among normal eyes. Settings and Design: A cross-sectional study was conducted in the outpatient department of a tertiary care center in Southern India. Subjects and Methods: Participants of the study included 87 outpatients and volunteers with bilateral nonpathological eyes. This study was performed according to the tenets of the Declaration of Helsinki. To determine the dominant eye, hole-in-card test was utilized. Masked of the ocular dominance result, an independent observer measured CCT at the visual axis with specular microscopy (CEM-530, Nidek, Canada) by noncontact modality. Three readings were obtained from each eye. The right eye was first examined. Average of the three CCT readings was used for analysis. Statistical Analysis Used: Statistical methods included paired t-test (for comparison of eyes within patient) and Chi-square test to assess the association between ocular dominance and CCT. A P < 0.05 was considered statistically significant. Results: The 87 volunteers studied were aged 37.6 ± 14.8 years and 62.1% were female. CCT was 525.5 ± 28.4 μm in the right eye and 534.8 ± 29.8 μm in the left eye. Right eye was dominant in 63 (72.4%) patients. CCT in the dominant eye was 528.0 ± 29.5 μm and was significantly thinner (P < 0.001) than the nondominant eye (532.2 ± 29.3 μm). This was true in 69.0% of the patients. However, thinner cornea in a person was not indicative of a dominant eye (P = 0.535). Conclusions: As with other populations, right eye dominance was seen in South Indian population among nonpathological eyes. CCT is predominantly thinner in the dominant eye. Yet, this result cannot be applied to an individual by labeling the eye with thinner cornea as dominant with precision.

Over time and with the advancement of dental materials, a shift in the paradigm of how lost tooth structure can be restored has occurred. It is not very surprising to notice that many of the traditional amalgam restorations have been replaced with dental composites in the name of aesthetics. The factors that usually contribute to the failure of the composite restorations are secondary caries, pulpal irritation, post-operative sensitivity and marginal discoloration, all indicating microleakage being the cause. Microleakage, in turn, is caused by polymerization shrinkage, which is inherent to the material because of its composition. Amongst a few strategies to minimise polymerization drinking shrinkage is the use of the incremental technique. The aim of the present study was to evaluate and compare the number of increments of composites used for restoring disto-occlusal cavities of maxillary and mandibular molars in the South Indian population. It is a retrospective analysis. Data from 86,000 patient records were sieved and a total of 101 case sheets that presented with disto-occlusal composite restorations in maxillary and mandibular molars were included. The number of increments used to restore the cavity was assessed and tabulated in Microsoft Excel along with details like age, gender and tooth number. Frequency analyses and Chi-Square test was performed. Two increments of composite resin were reported to be used maximum in the restoration of the DO cavities in molars. The association of the number of increments to tooth number is found to be significant (p

Introduction: Childhood obesity is one of the global public health challenges of the 21st century,affecting every country in the world. Globally, in just 40 years the prevalence of obesity has raisedmore than 10-fold from 11 million to 124 million school-age children. Material and Methods: Thisstudy is a school-based cross-sectional study. The study population is 150 children from 11-14 yearsold school children from a selected private school in urban Pondicherry. Result: In the present studyit was observed the prevalence of overweight and obesity shows that the prevalence of overweight is18% (N=27) and Obesity is 6% (N=9) based on BMI. Overweight and Obesity is an emerging majorhealth problem in school children in our Country. Conclusion: In the present study, there is anincrease in the prevalence of overweight /obesity in school children.

Background: Knowledge of the branching pattern of arch of aorta is important in avoiding surgical and accidental injuries during aortic instru- mentation, thoracic and neck surgeries. Subjects and Methods: The present study is based on dissections that were performed on 50 properly embalmed human cadaver specimens. The anatomical variations of arch of aorta and its branches, diameter of its branches at site of origin and distance of each branch from the point of origin to median plane were measured. Results: The usual three branched pattern of arch of aorta was found in 36 specimens (72%). The common trunk for both brachiocephalic trunk and left common carotid artery was present in 10 specimens (20%). In 2 specimens (4%), the arch gives four branches, left vertebral artery being additional branch. In 1 specimen (2%), the arch gives three branches namely; common trunk for brachiocephalic trunk and left common carotid artery, left vertebral artery and left subclavian artery. In 1 specimen (2%), the arch gives three branches namely; brachiocephalic trunk, left common carotid artery and common trunk for left vertebral artery and left subclavian artery. Conclusion: The results in this study provide significant information vital for anatomists, cardiovascular surgeons and radiologists.

Diabetes mellitus and hypertension co-exists in many individuals as the pathogenic relationship between diabetes mellitus and hypertension is actually bidirectional. Extraction of teeth is a common procedure performed in Dentistry and the Co-existence of these systemic diseases in dental patients can cause many complications like delayed wound healing, infection or bleeding during dental extractions. The aim of the present study was to assess the prevalence of hypertension among dental patients with diabetes mellitus in south Indian population. A retrospective study was conducted from the data of 6682 dental patients who visited the outpatient Department of Oral and Maxillofacial Surgery, Saveetha Dental College, Saveetha University, Chennai, for dental extractions due to various reasons during the time period from June 2019 – to March 2020. Patients data was retrieved from the institutional digital data registry and statistically analysed. Among 6682 patients who underwent extractions, 904 [13.5%] patients had diabetes mellitus. Among 904 patients with diabetes mellitus, 419 [46.3%] patients had hypertension. Prevalence of hypertension was more in males than females and the results were statistically not significant [p=0.062, (>0.05)]. Prevalence of hypertension was more in 41-50 years age group and the results were statistically significant. [p

Mandibular first molars are amongst the most common teeth requiring endodontic treatment due to their early emergence in the oral cavity and subsequent caries. Proper knowledge and understanding of the root canal morphology and anatomy of mandibular first molars, will help the clinician in developing a proper and standard treatment protocol by predicting possible variations that potentially challenge the treatment outcome. The main objective of the present study was to know the prevalence of canal variations in mandibular 1st molar among the South Indian population and its association with age and gender. All the patients who reported during June 2019 to March 2020 for mandibular 1st molar endodontic therapy were chosen for the study. Information was collected from the dental hospital record system and the resulting data was tabulated in excel and imported to SPSS for correlation and association. Within the limits of the study, the results obtained are: prevalence of canal variations is 7.6% and 2.2% in single and multi visit root canal treatment respectively with a higher incidence among the male patients and it is primarily seen in the age group of 21 to 40 years. This knowledge about the canal variations in the South Indian population will be helpful to the clinician to look for any unusual anatomy while performing endodontic therapy which will prevent any unwanted procedural errors. It necessitates the careful negotiation and cleaning of all accessible canal spaces.

Introduction: Uterine Fibroids are common growth of female reproductive tract in women of reproductive age group. So this prospective observational study was conducted to evaluate the effect of low dose Mifepristone treatment for 6 months on the outcome of fibroid size and related symptom. Materials and Methods: The study was a prospective observational study conducted at Tertiary care Hospital, Tamil Nadu during the period of July 2016 to June 2017. Forty five patients with symptomatic fibroid, aged between 24-45 years were recruited for the study. Baseline data regarding fibroid volume, Hb value, PBAC (Pictorial Blood Assessment Chart) & VAS (Visual analogue Scheme) score were recorded. The follow-up data regarding above parameters again collected at the end of 6 months of therapy. All patients received 25mg mifepristone daily and comparison was made between pre and post treatment symptoms and leiomyoma volume. Results: After therapy with Mifepristone there was a significant reduction in mean volume of fibroid, menorrhagia and pain related symptoms. The mean leiomyoma volume was reduced from 104.3mm3 to 56.8 mm3 by the end of 6 months of mifepristone therapy. Similarly, at the end of six months of therapy mean hemoglobin value was also raised by 2.8gm/dl from the baseline mean value of 7.9gm/dl. There were no major side effects observed during the course of the study and the drug was well tolerated. Conclusion: Mifepristone is effective against low size uterine leiomyoma and can decrease its associated symptoms among women with symptomatic fibroids. Keywords: Mifepristone, Leiomyoma, Clinical treatment, Menorrhagia, Dysmenorrhea, Uterine fibroid, Volume of fibroid, Leiomyoma.

Introduction: Cholecystectomy specimens are frequently received specimens. The number of cholecystectomy has increased more than 50% in the last decade, a vast majority performed annually for gallstone related diseases. Present study was done to study the morphological features of cholecystectomy specimens & to compare the spectrum of gallbladder diseases in both the populations in North Indian as well as South Indian populations. Materials and Methods: A total 800 cholecystectomy specimens (400 cases each from North India & South India) were studied at Kasturba Medical College, Mangalore and Postgraduate Institute of Medical Sciences & Medical Research and associated Dr. Ram Manohar Lohia Hospital, New Delhi. Results: Gender distribution (M:F) in North India was 1:4.88, whereas in South India it was 1:1.33. Chronic cholecystitis was significantly higher in North Indians (84%) as compared to South (66.75%). Gallbladder carcinoma was more common in North India (2%) as compared to South (1.25%). Dysplasia associated with cholecystitis was more common in North India (2.50%) as compared to South (1.75%). Associated cholesterolosis was significantly seen in North Indian study group (17.75%), whereas no case was seen in South. Keywords: Cholecystitis, Metaplasia, Dysplasia, Carcinoma, Gallbladder, Indian population.

Purpose: To study correlation between central corneal thickness (CCT) and intraocular pressure (IOP) in the primary open angle glaucoma (POAG) suspects and to assess the importance of the local population reference CCT in pachymetry adjusted IOP. Design: Prospective, cross sectional study. Materials and Methods: A total of 100 patients aged 40-70 years of age diagnosed as POAG suspects were included. CCT measurements using ultrasound pachymetry and IOP measurement with Goldmann applanation tonometer (GAT) was done. IOP was corrected to the local south-Indian baseline CCT and also to the International CCT and comparison was done. Results: The study included 100 patients (58 male and 42 female) with mean age of 51.7 ± 6.1 years. The mean CCT was 518.91 ± 24.26 mm, 522.19 ± 21.56 mm among females, males respectively. The mean uncorrected IOP (GAT) was 19.50 mmHg, 20.14 mmHg (right, left sides). Significant, moderate positive correlation between CCT and IOP was observed. The two groups i.e mean IOP corrected for South-Indian CCT (Mean_CX_IOP) versus IOP corrected for CCT international (Mean_CX_INT_IOP) showed significant difference. The mean IOP in Indian CCT corrected group was 19.76 ± 2.81 mmHg and in international CCT group was 21.51 ± 2.83 mmHg. Levene’s test indicated significant difference in mean IOP of 2 groups (p=0.000). Conclusions: CCT is an important parameter in glaucoma management and known to vary in different ethnic groups. Local ethnicity specific CCT should be used in IOP correction with the help of anthropologists. Keywords: Corneal anthropology, Central corneal thickness, Glaucoma suspects, Intraocular pressure.

Patients with a vertical growth pattern have a tendency for a long face and gummy smile due to the clockwise rotation of the mandible and ensuing divergence of maxillary bases. A patient can be said to have a gummy smile when there is gingival exposure of 3mm or more while smiling. A gummy smile is unaesthetic and warrants correction. The common treatment modalities employed for correction are dental intrusion and surgery. The study aimed to determine the number of patients with leptoprosopic facial patterns having gummy smiles and the various treatments for its correction. The objective of this study was to determine whether all leptoprosopic patients have a tendency towards gummy smiles and the treatment plan most commonly used for its correction. Records from the Department of Orthodontics were retrieved and searched for the patients with leptoprosopic facial type. Only 42 patient records were eligible according to the selection criteria of which (n=22) were females and (n= 20) were males. Selection criteria included patients who had a long face with facial index between 90-94%, on cephalometric evaluation female patients with upper dental facial height >27.4+/-1.7 mm and male patients >30.5+/-2.1. The results showed that the patients with leptoprosopic facial patterns had a tendency towards gummy smiles and the treatment plan most commonly used for its correction in the Department of Orthodontics in Saveetha dental college was skeletal intrusion using dental mini implants and IZC. Other treatment modalities included Le-Fort Superior Impaction of maxilla in severe cases. Association between gender the various treatments employed for gummy smile correction was statistically insignificant. (p>0.05). We can conclude that gummy smile and facial patterns have a positive correlation.

Background: Lumbar disc herniation is a common orthopedic challenge warranting surgery in special situations. Lumbar discectomy is said to provide considerable relief when performed in early stages of the disease. The present study was carried out to evaluate the outcomes of lumbar discectomy based on duration of sciatica in a single institution setting among south Indian population. Methods: In this prospective study, 50 patients with lumbar herniation were divided into 3 sub cohorts accordingly to the duration of sciatica. All these 50 patients were analysed clinically and the diagnosis confirmed with MRI and underwent laminectomy and discectomy. They were scored with ODI questionnaire preoperatively and postoperatively on 10th day, 3rd month, 6th month and 1 year. Results: Patients in all the sub cohorts showed improvement following the surgery but patients with duration of sciatica less than 12 months showed significant improvement than patients with duration of sciatica more than 12 months. As the duration of sciatica increases the functional outcome of the surgery reduces. Conclusion: The duration of sciatica has a significant predictive value on the functional outcome of laminectomy and discectomy. If the duration of sciatica increases the surgical outcome is poor. There are complications associated with surgical intervention which has to be emphasised while selecting the patient for the same. In view of the favourable natural course of herniation of lumbar disc and possible complications associated with surgery, most authors recommend a minimum period of conservative management for 2 months. We recommend not to exceed 12 months of conservative management as the risk of poor functional outcome increases significantly after that.

Aim: We undertook this study to determine the average valgus cutting angle of distal femur in South Indian population since most of the studies are on western population and very few studies in Indian population and particularly South Indian population. Methods: We did a study femoral valgus angle of 174 knees in 87 patients with full length CT scannograms in our radiology department. Results: The average Femoral valgus angle was found to be of 6.51 ± 0.76 and there was no statistically significant difference between male and females or between both the sides. There was a strong correlation between the two sides(0.971) and weak correlation with regards to age(.003).

Background: Lumbar disc herniation is a multi-factorial problem and its etiology is still an enigma. Patients with lumbar disc herniation are commonly seen in day to day clinical practice and it has been suggested that the probability of symptoms resolving with conservative treatment decreases progressively with time. The present study was carried out to clinically evaluate the pattern of presentation of lumbar disc herniation. Methods: This cross sectional study was carried out among 50 patients diagnosed with lumbar disc herniation based on symptomatology and clinical evaluation. Radiological confirmation of the diagnosis was made. The participants were grouped into three categories based on the duration of illness. Results: Majority of the participants belonged to the age group of 36.89 years. The duration of symptoms was 12 months of symptoms. At all times of clinical presentation, L4-L5 segment were commonly involved. Conclusion: The present study has documented increase in the complications like sensory and motor deficits with prolonged duration of symptoms. It is therefore essential that due awareness be created among the occupational sections so as to minimize the need for surgical interventions.

Aim: To determine the average acetabular antiversion angle in south Indian population, for ideal acetabular cup position in Total Hip Arthroplasty. Background: Abnormal acetabular anteversion of the hip, has been from many years the etiogenesis of early hip wear and tear leading to osteoarthritis [1]. In this era the demand for total hip replacements has increased worldwide and in India as well. The acetabular anteversion angle plays a very important role in terms of longevity of the implant and cup positioning. Since studies on acetabular anteversion are very few compared to western and Asian studies hence, the purpose of this study is to find out the acetabular anteversion angle for south Indian population. Materials and Methods: A retrospective study of 250 CT scans of hips where collected from 2017 to 2020 and the mean acetabular anteversion angle was measured which was compared with Asian and western population. Results: The average acetabular anteversion angle is 20.9±3.19 there was no statically significant difference between male and female population, as with the side, left and right side (p=0.02). There was a significant 2 to 3 degree increase in acetabular antiversion compared to US, European and Asian studies. Conclusion: The average acetabular anteversion angle 20.9 ±3.19 was significantly higher when compared to the western population due to the habitual cross legged sitting and squatting since childhood, hence this should be taken into consideration when designing and positioning acetabular cups during total hip arthroplasty.