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Chronic kidney disease (CKD) is a public health problem, which has a prevalence of 17.2% in India. As kidney function decreases, there is a gradual deterioration in the regulation of bone mineral homeostasis. Vitamin D is recognized as the central player in the maintenance of bone health in CKD. Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines suggest that vitamin D supplementation should be given to all CKD patients with serum 25-hydroxy vitaminD (25(OH)D) level 30 ng/mL. Hence we undertook this study to evaluate the vitamin D status in South Indian patients with CKD.Fifty-nine non-dialysis CKD patients of stage 3 and 4 were recruited and screened for 25(OH)D deficiency. Circulating levels of 25(OH)D were measured using chemiluminescence immunoassay. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology (CKD-EPI) equation. Serum calcium, phosphorous, creatinine and alkaline phosphatase levels were measured spectrophotometrically by an autoanalyzer.Contrary to published literature, 75% of South Indian CKD patients had normal 25(OH)D (≥30 ng/mL), 15% of them had insufficient (20-29 ng/mL) and 10% had 25(OH)D deficiency (20 ng/mL). Alkaline phosphatase levels were found to be increased in only 20% of cases. Calcium1 levels were normal in all CKD cases and hyperphosphatemia was observed in 5% of CKD patients.We found that most of our CKD patients (75%) had normal vitamin D levels. This paradoxical finding could be explained by the fact that most of them gave a history of intake of vitamin D and calcium supplements, as advised by their doctors before coming to our institute. Hence we conclude that before prescribing vitamin D or calcium supplements to CKD patients, their 25(OH)D status should be ascertained to prevent hypervitaminosis D and its complications.

Aim: Global health care is experiencing an unprecedented surge in the number of critically ill patients who require mechanical ventilation due to the COVID-19 pandemic. The requirement for relatively long periods of ventilation in those who survive means that many are considered for tracheostomy to free patients from ventilatory support and maximise scarce resources. COVID-19 provides unique challenges for tracheostomy care: health-care workers need to safely undertake tracheostomy procedures and manage patients afterwards, minimising risks of nosocomial transmission and compromises in the quality of care. Conflicting recommendations exist about the timing and performance of tracheostomy and the subsequent management of patients. This is due to a number of factors including prognosis, optimal healthcare resource utilisation, and safety of healthcare workers when performing such a high-risk aerosol-generating procedure.Methods: MEDLINE (accessed from PubMed) from 6 august 2019 to 7 august 2020 were systematically searched using: “COVID 19” OR “CORONAVIRUS” OR “SARS COV-2” AND “TRACHEOSTOMY” with filters as ‘2020’ year of study, English language, full article available on 7/08/2020 at 11.30 Am.Results: Total of 56 articles were obtained on search and the final 15 articles extracted based on our selection criteria were reviewed. A synthesis of the current international literature and reported experience is presented with respect to timing of tracheostomy, ideal place for tracheostomy, staff safety, procedure modification and post tracheostomy care thus leading to a pragmatic recommendation that tracheostomy is not performed until at least 14 days after endotracheal intubation in COVID-19 patients and if indicated should be done in negative pressure isolated ICU room with full PPE protection with some modification during procedure.Conclusion: In selected COVID-19 patients, there is a role for tracheostomy to aid in weaning and optimise healthcare resource utilisation. Tracheostomy can be performed safely with careful modifications to technique and appropriate enhanced personal protective equipment.

Chronic kidney disease (CKD) is associated with increased cardiovascular (CVD) morbidity and mortality. Hence, this study was carried out to assess the biomarkers of endothelial dysfunction and inflammation as predictors of CVD risk in Indian patients with CKD. In this case control study, we recruited 43 patients with CKD and 43 healthy control volunteers. Circulating levels of endothelial dysfunction markers [asymmetric dimethylarginine (ADMA), angiopoietin-like protein-2 (ANGPTL2), matrix metallopeptidase 9 (MMP-9)] and systemic inflammation [high-sensitivity C-reactive protein (hs-CRP)] were assessed in the study population. All study participants underwent brachial artery flow mediated dilation (FMD) to estimate endothelial dysfunction. Disease severity (e-GFR) was assessed by a nephrologist. CKD patients showed markedly elevated levels of ADMA, ANGPTL2, MMP-9, and hs-CRP. FMD and eGFR were significantly decreased in cases, as compared to the controls. ADMA, ANGPTL2, MMP-9 and hs-CRP showed significant positive correlation with one another and significant negative correlation with FMD and disease severity. We also observed a significant negative correlation of FMD with disease severity and duration of CKD. In the multiple linear regression model, ADMA and ANGPTL2 were found to be independent predictors of FMD. In CKD patients, there is significantly increased endothelial dysfunction and systemic inflammation, which showed a positive correlation with disease severity. Thus, the markers of endothelial dysfunction such as ADMA and ANGPTL2 can be used as predictors of CVD risk in CKD.

Background Psoriasis is a T helper cell-mediated chronic immune-mediated inflammatory disease affecting mainly the skin, although systemic pathological effects are also observed. Cytokine-mediated interaction between T lymphocytes and keratinocytes lead to excessive proliferation of keratinocytes, which in turn leads to formation of a proinflammatory milieu and finally to psoriatic plaque formation. Aim To measure interleukin (IL)-9, IL-17 and vascular endothelial growth factor (VEGF) levels in patients with psoriasis compared with controls, and to evaluate the effect of methotrexate (MTX) monotherapy on the aforesaid cytokine levels in psoriasis. Methods This cohort study included 54 patients with psoriasis and 54 age- and sex-matched healthy controls (HCs). IL-9, IL-17 and VEGF levels were measured by using commercially available ELISA kits. Patients with psoriasis who were on MTX monotherapy were followed up for a period of 3 months. Results Patients with psoriasis had increased levels of IL-9, IL-17 and VEGF at baseline, compared with the HC group. After 3 months of MTX monotherapy, Psoriasis Area Severity Index (PASI), Dermatology Life Quality Index (DLQI) and levels of cytokines (IL-9, IL-17 and VEGF) were significantly decreased compared with baseline. PASI and DLQI at baseline also showed a positive correlation with IL-9, IL-17 and VEGF. Conclusion Our results suggest the existence of a proinflammatory milieu in psoriasis, with increased levels of IL-9, IL-17 and the proangiogenic growth factor VEGF, showing an increasing trend with increasing disease severity and impaired quality of life (QoL). MTX treatment helps to reduce levels of IL-9, IL-17 and VEGF, thereby limiting disease progression and improving QoL in psoriasis.

Background: Preterm birth is one of the important causes of perinatal mortality and morbidity in developed countries after congenital malformations. Postponement of delivery plays essential role in preventing such incidences by allowing fetal lung maturity. Methods: This is a prospective study conducted over a period of 20 months among the patients admitted for preterm labour with gestational period between 27 to 36 weeks. After the patients obeyed all the inclusion criteria, they were administered terbutaline 250 µg subcutaneously every 8th hourly followed by 5 mg tablet orally twice daily till contractions ceased. The patients were analysed for gestational period at which they presented with preterm labour contractions, associated risk factors, response to terbutaline, and gestational period at delivery, perinatal complications, neonatal and maternal outcomes. The data obtained were analysed by descriptive analysis. Results: There were 1,678 deliveries during study period, out of which 207 (12%) presented with preterm labour and 20 (~10%) patients received terbutaline. Idiopathic (50%) and vaginal infections (25%) were common causes of preterm labour among the patients who received terbutaline. The labour was prolonged by 3 - 5 days among 8 patients, 7 - 15 days in 9 patients and 15 - 30 days in 3 patients. Common maternal side effects were nausea and tremors. Neonatal outcome was good in most of the cases except in 5 (25%) neonates who required NICU admission but they all recovered well without any morbidity. Conclusions: Administration of terbutaline prolonged labour without any serious maternal complications and better neonatal outcome as 90% of the neonates were born without any complications. Hence, terbutaline can be used as a safe and effective tocolytic agent among patients presenting with preterm labour.

Background: Tympanoplasty is a surgical procedure for closing the tympanic membrane perforation and reconstructing the tympanic membrane and hearing, commonly after trauma and chronic otitis media. The aim of the study was to compare the clinical and audiological outcomes of tympanoplasty with or without anterior tucking.Methods: In this prospective study, 50 patients with chronic otitis media (COM) were divided into two groups. Group 1 underwent type 1 tympanoplasty with anterior tucking method, and group 2 underwent type 1 tympanoplasty without anterior tucking. The result was measured on graft uptake and hearing outcome at 6 months postoperatively by performing pure tone audiometry. Results: The hearing improvement was almost the same in both the groups. Graft uptake was good in type 1 tympanoplasty with tucking (96%) when compared to without tucking tympanoplasty (92%). Complications like residual perforation were seen in both groups equally. Anterior marginal blunting was noted (8%) in type 1 tympanoplasty with tucking.Conclusions: The hearing improvement of type-1 tympanoplasty with anterior tucking and without anterior tucking is the same. Type-1 tympanoplasty with anterior tucking has a better graft acceptance. The only disadvantage of type-1 tympanoplasty with anterior tucking is anterior marginal blunting.

Background: Pulmonary tuberculosis being the predominant manifestation of the disease Extra-Pulmonary sites can also involve as a result of dissemination from a chief focus. The present study aims to determine the presentation and outcome of patients with extra-pulmonary tuberculosis treated with category I DOTS and to identify the incidence and pattern of ADRs caused by anti-tubercular drugs and to assess the causality and severity of the reported ADRs. Methods: Data was collected from cases of Tuberculosis patients diagnosed and treated under category I DOTS at Sri Siddhartha Medical College for the period of one year (during 2015). These patients were monitored for ADRs during OPDs and hospital stay. Any Adverse effects observed were recorded in ‘Adverse Drug Event Reporting Form’ prepared by the CDSCO, Govt. of India. The data were evaluated for patient demography, types of TB, incidence of ADRs, onset and outcome of the ADRs. ADRs were also assessed for their causality and severity by using WHO-UMC criteria and Hartwig’s scale. Results: Extra-pulmonary cases accounted for 32.2% of total TB cases. Among 224 cases of extra-pulmonary TB studied, 136 (60.7%) were males and 88 (39.3%) were females. Among these patients 82.2% completed treatment, 7.5% were defaulted, 9.9% died and 0.4% treatment failure. The most common reason for default was irregular treatment (29.5%) followed by alcohol abuse (23.5%). Among 224 patients of EPTB who were started on ATT as per DOTS, we noted ADR in 52 patients and 73 ADRs. Gastritis was the most common ADR (25%) followed by anorexia (14%) and skin reactions (9.6%) and multiple drug therapy was the major predisposing factor for these ADR’s. Conclusions: Extra-pulmonary Tuberculosis accounts for 32.2% of the total cases studied. Treatment irregularities and alcohol abuse are the two most common reasons for default. On evaluation of the causality of ADRs, majority of them were found to be ‘possible’ by WHO-UMC and Naronjo’s causality assessment scale. The severity assessment of ADRs showed that 42% reactions were moderate and 58% were of the ‘mild’ nature.

Background: CSOM is one of the most common ear diseases in developing countries. Lack of an aerating mastoidectomy at the time of the initial tympanoplasty may be a significant source of failure in patients with chronic non-cholesteatomatous otitis media so cortical mastoidectomy along with tympanoplasty has for long been considered the surgical procedure of choice. The purpose of our study is to ascertain the effectiveness of tympanoplasty with or without cortical mastoidectomy.Methods: Our study was carried out in the Department of Otorhinolaryngology, Aarupadai Veedu Medical College, Pondicherry. It included 50 patients of CSOM tubotympanic type of age between 15 years to 45 years and of either sex who were diagnosed and treated in E.N.T Department during the study period October 2016 to August 2018. Out of 50 patients who underwent surgery in 25 cases tympanoplasty with mastoidectomy was done and tympanoplasty without mastoidectomy was performed in 25 cases. Results: Commonest age group was 15-19 years. Male to female ratio was 1.6:1. In x-ray bilateral mastoids Schuller’s view, 24 patients (48%) had sclerotic mastoids and 26 patients (52%) showed pneumatic mastoids. Clinical improvement, graft uptake and postoperative hearing improvement was similar in both the groups.Conclusions: Most common age group of presentation with CSOM tubotympanic type is 15-25 years. CSOM tubotympanic type appears to be more common in males. Hearing improvement following tympanoplasty alone and tympanoplasty with mastoidectomy were comparable in both the groups. Mastoidectomy with tympanoplasty does not give additional benefit in terms of hearing improvement.

Background: Tympanoplasty is a surgical procedure performed to reconstruct hearing mechanism with or without reconstruction of tympanic membrane perforation. Cartilage shield tympanoplasty was first reported in literature by Duckert et al in 1995.The purpose of the present study was to prepare the cartilage shield graft and to evaluate its effect on the success rate of tympanoplasty.Methods: In this study 70 patients who presented to ENT OPD of Aarupadai Veedu medical college, Puducherry, with chronic otitis media (COM) mucosal type, who were treated during the period between December 2016 to April 2018 were enrolled. Patients with COM mucosal type, with mild to moderate conductive hearing loss, dry or moist ear were included in the study. Detailed history was taken in the selected patients including a thorough otological examination and blood investigations required for surgery. Results: In the present study male to female ratio was 1.6:1. 30% patients were in the age group between 20-24years. In our study 33% patients had pre-operative airbone gap in the range of 31-40 dB and post-operative improvement in airbone gap was in the range of 0-10 dB in 49% patients.Conclusions: Conchal cartilage shield tympanoplasty is an effective technique in tympanic membrane reconstruction and shows no detrimental effect to the hearing outcome. Conchal cartilage is preferred graft as it can be harvested from same incision. The graft uptake rates are excellent with this technique.

Background: Benign lesions of the nasal cavity represent a diverse group of pathologies. Furthermore, each of these disorders may present differently in any given patient as pain and discomfort, epistaxis, headaches, vision changes, or nasal obstruction.Methods: This study was carried out in a tertiary care center in India from October 2016 to March 2018. A total of 80 patients of age 10 years to 80 years were included. Detailed history and complete ENT examination including radiological studies was done. Patients were subjected to diagnostic nasal endoscopy and biopsy followed by histopathological examination. Depending on the diagnosis, medical or surgical treatment or combination of both was administered. Results: In present study the commonest presenting complaint was found to be nasal blockage found in 76% of cases, followed by rhinorrhea in 40%, nasal mass in 30%, epistaxis in 16%, cheek swelling in 5%. Out of 80 benign lesions, polyp was noted in 65 cases, hemangioma in 8 and inverted papilloma in 3 cases. Out of 65 cases of polyps, 52 were antrochoanal, 10 ethmoidal and 3 maxillary. Medical treatment was given in ethmoidal polyp cases, out of which 5 were cured. Most common surgery was polypectomy. Lateral rhinotomy was done in 6 casesConclusions: Patients with benign lesions of the nose commonly presented in the second and third decade with slight male preponderance.Antrochoanal polyps are most common. Medical treatment works to a certain extent in patients with ethmoidal polyposis and surgery is the mainstay of treatment in the benign lesions of the nose.

AIMS: The purpose of the study is to determine the prevalence of Hypomagnesemia among patients presenting with acute exacerbation of asthma and during its standard treatment and to know its clinical significance. SETTINGS AND DESIGN: This is a prospective study done on inpatients admitted with acute exacerbation of asthma. METHODS: A total of 50 patients admitted with acute asthma were enrolled in the study with random selection. Treatment started according to GINA (Global Initiation of Asthma) protocol. Serum Magnesium levels were measured at intervals of 0 min, 90 minutes and 180 minutes and 24hrs after starting nebulization. STATISTICAL ANALYSIS: The Excel and SPSS 10.5 (SPSS Inc, Chicago) software packages were used for data entry and analysis. The student 'T' test was used to differentiate gender parameters Proportions were compared using Chi-square test. One-way analysis of variance was used to test the difference between groups. RESULTS: Hypomagnesemia at the time of admission (0 min) was found in 15(30%) subjects and it increased to 22(44%), 16(32%) and dropped to 7(14%) at 90min, 180min and 24 hours respectively after starting treatment. Maximum drop in magnesium level was noted at 90min (by 0.162 mg/dl). Severity of asthma was statistically and clinically significant with hypomagnesemia (P=0.04). CONCLUSION: As Hypomagnesemia was significantly associated with severe asthma attack, an effort should be made to check and correct serum magnesium level during admission and at least after 2 hours of nebulization.

Background: Atrophic rhinitis is a chronic nasal disease characterized by progressive atrophy of mucosa and underlying bone of turbinate’s.1 Disease is also referred to as dry rhinitis, rhinitis sicca, open-nose syndrome, or ozena. It is classified into 2 types viz., primary and secondary. The cause of primary atrophic rhinitis is unknown. Histopathologically, primary atrophic rhinitis is characterized by squamous metaplasia and two characteristic types of vascular involvement (Type I and Type II). Type I is common (50-80%) where endarteritis obliterans, periarteritis and periarterial fibrosis of the terminal arterioles is seen. These patients benefit from the oestrogen therapy. Type-II is less common (20-50%) and is associated with capillary vasodilatationMethods: This study was carried out in the Department of Otorhinolaryngology, Aarupadai Veedu Medical College and hospital, Puducherry between October 2015 and July 2017.51 patients of atrophic rhinitis of age 12 years to 95 years were included. Detailed history and complete ENT examination was done in all patients. Results: In the present study atrophic rhinitis cases formed 0.34% of the total OPD attendance. Maximum number of patients belonged to the age group of 51-60 years (33.3%) followed by 61-70 years (27.5%). Disease was found to be more common in females (82.4%) female to male ratio was 4.7:1. Most common complaint of the patients was nasal crusting (96.1%) followed by nasal fetor (92.2). In present study, most of the patients had chronic symptoms for the past 1-5 years (45.1%) and 6-10 years (29.4%). 35 patients i.e. 68.6% showed bilateral atrophic rhinitis and 16 patients i.e. 31.4% showed unilateral atrophic rhinitis. In the present study, majority of patients belong to class V of Modified B G Prasad scale (47.1%). Severity of the disease was classified into 3 stages, that is, early, advanced, and late advanced, according to the findings in the nasal cavity as recommended by Ssali. The majority of patients 36 (70.5%) were in the advanced stage. Partial squamous metaplasia and total squamous metaplasia, were seen in 35.7% and 42.9% of patients respectively, denuded epithelium were noted in 9 patients i.e. 21.4%.Conclusions: Incidence of atrophic rhinitis is in a decreasing trend. Females and people of age group 51-60 years are commonly affected. Bilateral atrophic rhinitis is more common. Lower socioeconomic status is a predisposing factor due to hygiene issues. Our institution being a tertiary care centre most patients presented with advanced stage of disease. Total squamous metaplasia is the commonest histological finding in patients with atrophic rhinitis.

Background: Sudden sensorineural hearing loss (SNHL) is sensorineural hearing loss of 30 dB or more over at least three contiguous audiometric frequencies that develop over a period of few hours to three days. The purpose of study is to make a protocol for treatment.Methods: 30 cases of sudden SNHL who presented to OPD of Government Medical College, Miraj between December 2015 to April 2017 were included. Detailed history taking and ENT examination was done. All patients were admitted and started on intravenous methylprednisolone. If hearing improvement was not observed, intratympanic methylprednisolone (ITS) was administered. Results: 50% patients had recovery with intravenous Methylprednisolone and 50% had no recovery. “No recovery” patients were subjected to ITS, of which 20% had complete, 30% partial and 50% no recovery. Among no recovery patients of ITS, 10% had hearing loss greater than 90 dB with improvement rate of 0%; 40% had hearing loss of 90 - 50 dB with improvement rate of 50%; 50% had hearing loss of 50-30 dB with improvement rate of 60%. Among 15 cases of ITS, mean number of days between onset of symptom and starting ITS was 13 days for complete recovery patients; 17.3 days for partial or slight recovery; 20.6 days for no recovery.Conclusions: Hearing loss less than 90 dB and earlier ITS has positive influence on hearing recovery. Systemic steroids are currently the mainstay of initial treatment. ITS is an effective treatment modality for patients who fail to respond to systemic steroids.

Background: Chronic suppurative otitis media (CSOM), tubotymapanic type, despite a commonly encountered disease in otorhinolaryngology has many controversies involved. This study was aimed at bringing few of these aspects to limelight. Methods: The study was conducted in Otorhinolaryngology department, Aarupadai Veedu Medical College and Hospital, Pondicherry, India between September 2015 - August 2016. Total of 207 ears of 180 patients with CSOM tubotympanic type were included. Selected patients were subjected to ENT examination and pure tone audiometry after obtaining history. Results: In this study 35.9% patients belonged to 4th decade and 29.4% to 3rd decade. Among patients with discharge for more than 30 years, 68.8% had moderately-severe hearing impairment and those with discharge for less than 10 years, 60.2% had mild hearing loss. Among patients with large central perforation, 51.4% had moderately-severe hearing loss and those with small central perforation, 68.4% had mild hearing loss. Hearing loss was nearly same in anterior and posterior perforations. On chi square test p value was 0.0874 i.e. >0.05, difference insignificant. Conclusions: In our study most patients were in 4th decade, incidence is equal in both genders. Hearing loss is directly proportional to disease duration and perforation size. Site of perforation does not influence hearing loss.

Background: Pulmonary tuberculosis being the predominant manifestation of the disease extra-pulmonary sites can also involve as a result of dissemination from a chief focus. Extra- pulmonary tuberculosis is more common in HIV cases. The present study aims to determine the presentation and outcome of patients with extra-pulmonary tuberculosis treated with DOTS and to assess any difference in outcome of treatment in HIV positive extra-pulmonary tuberculosis. Methods: Data was collected from cases of tuberculosis patients diagnosed and treated under DOTS at Sri Siddhartha Medical College for the period of one year (during 2015). We evaluated extra-pulmonary cases and recorded sites of involvement in order of frequency. We also studied treatment outcome by recording as per definitions given by the WHO and also evaluated any difference in outcome of extra-pulmonary tuberculosis disease with HIV co-infection. Results: Extra-pulmonary cases accounted for 30.5% of total TB cases. Among 224 cases of extra-pulmonary TB studied, 136 (60.7%) were males and 88 (39.3%) were females. Most common site of extra-pulmonary tuberculosis was pleura (29.9%) followed by meninges (22.5%), abdomen (19.6%) and lymph node (10.7%) tuberculosis. Among these patients 82.2% completed treatment, 7.5% were defaulted, 9.9% died and 0.4% treatment failure. The most common reason for default was irregular treatment (29.5%) followed by alcohol abuse (23.5%). Among 8 HIV reactive patients, 5 patients completed treatment and the remaining 3 patients died during the course of treatment. Conclusions: Extra-pulmonary Tuberculosis accounts for 30.5% of the total cases studied. Pleura is most common site of extra-pulmonary TB in our study. Treatment irregularities and alcohol abuse are the two most common reasons for default. Co-infection with HIV seems to have a poor outcome on patients with extra-pulmonary TB and needs to be studied in large number of samples.

Background: The objective of the study was to assess the awareness of P- drug selection among rural general practitioners’s (GP) for common medical conditions.Methods: Fifty general practitioners in Tumakuru district were provided with proformas for selection of P- drugs for mild to moderate hypertension, diabetes, upper respiratory tract infections and acid peptic disease based on safety, affordability, need, and efficacy (SANE criteria).Results: Forty one GP’s responded by completing the proformas. Seventeen of them were aware of the concept of P- drug selection. In hypertension, beta blockers followed by Angiotensin Converting Enzyme (ACE) inhibitors were most commonly preferred. In diabetes, biguanides followed by sulfonylureas were preferred as oral hypoglycemic agents. Ampicillin, Ciprofloxacin and Cotrimoxazole were the commonly used antibiotics for upper respiratory tract infections. Ranitidine and antacids were preferred for acid peptic disease. Affordability followed by efficacy was the deciding criteria for P- drug selection.Conclusions: There is lack of awareness of P- drug selection among many rural GP’s. Therefore, there is necessity to create awareness about P- drug selection through continued medical education for rational use of drugs.