Government Vellore Medical College

Coronary Artery Bypass Grafting (CABG) and Percutaneous Coronary Intervention (PCI) are standard treatments for Multivessel Coronary Artery Disease (MVD). Their long-term comparative effectiveness remains debated. A systematic review and meta-analysis of randomized and observational studies was conducted, including patients with MVD followed for ≥5 years. Data were pooled using randomor fixed-effects models, depending on the level of heterogeneity. Thirteen studies met the inclusion criteria. CABG was associated with reduced all-cause mortality (RR 0.82, 95% CI 0.72-0.91) and fewer repeat revascularizations (RR 1.98, 95% CI 1.74-2.26) compared with PCI. Stroke risk was slightly higher after CABG. Findings suggest CABG provides superior survival and event reduction in long-term follow-up, particularly in higher-risk subgroups. However, the modestly increased stroke risk highlights the need for individualized decision-making, taking into account patient comorbidities, anatomy, and surgical suitability. CABG offers long-term survival and durability advantages over PCI in MVD, while PCI remains suitable for patients with lower-risk anatomy or when surgery is contraindicated.

Modified P1 zone is defined as the zone related to the recurrent laryngeal nerve(RLN) 1cm proximal to the nerve entry point to the larynx, where the vessels cross the nerve at a vertical plane. RLN injuries are common in this zone during thyroidectomy. This study aims to describe the vascular pattern at the modified P1 zone. This prospective analysis included 131 consecutive subjects who underwent thyroid surgery between October 2023 and June 2024. Various clinical, radiological, histopathological and intraoperative parameters were studied. The study included 212 nerves at risk(NAR). The mean age of the study population was 43 ± 12.6years. Immediate post-operative vocal cord palsy was noted in 3.3% of NAR. 100% of patients had at least one vessel in relation to RLN in the modified P1 zone. The mean number of vessels in this zone was 3 ± 1.2. Type 3 vascular pattern(presence of vessels anterior and posterior to the nerve) was the most common(68.9%). Multivariate analysis showed the presence of Pelizzo grade 2 tubercle of Zuckerkandl (OR 2.4; 95% CI: 1.07-5.37, p = 0.033) and the presence of stage 2 or 3 tumor stage(OR 2.2; 95% CI: 1.10- 4.55, p = 0.026) were independent predictors of the increased number of vessels(> 2 vessels). The study describes the consistent vascular pattern and its relationship with RLN in the modified P1 zone. Awareness of this may help surgeons to prevent RLN injury during thyroid surgery and effectively tackle the vessels in modified P1 zone.

Background Obesity is a major public health challenge worldwide and is strongly associated with cardiovascular diseases, type 2 diabetes mellitus, and metabolic syndrome. Although Body Mass Index (BMI) is widely used for obesity classification, it has limitations in reflecting body fat distribution, particularly central adiposity. Objective To evaluate the effectiveness of selected anthropometric indices in predicting obesity among Indian adults and to determine optimal cutoff values for obesity classification. Methods A cross-sectional study was conducted among 241 adults (133 females and 108 males) at Coimbatore Medical College, Coimbatore, Tamil Nadu, India. Standard anthropometric measurements were obtained, and derived indices, including WHtR, BRI, WHR, and A Body Shape Index (ABSI) were calculated. Pearson correlation analysis assessed relationships between indices, independent t-tests evaluated gender differences, and Receiver Operating Characteristic (ROC) curve analysis determined predictive accuracy and optimal cutoff values. Results WHtR and BRI demonstrated the highest predictive accuracy for obesity classification, each with an AUC of 0.88. BRI showed the highest sensitivity (91%) with 78% specificity, followed by WHtR (sensitivity 87%, specificity 78%). Optimal cutoff values were identified as WHtR ≥ 0.55 and BRI ≥ 4.21. Hip circumference also showed strong predictive performance (AUC 0.89; cutoff 108 cm). Waist circumference exhibited high specificity (92%) with an optimal cutoff of 97 cm but moderate sensitivity (65%). WHR and ABSI were the weakest predictors. Combining indices, particularly waist circumference with BRI, improved classification accuracy (AUC 0.90). Conclusion WHtR and BRI are superior to BMI for obesity classification in Indian adults, offering better reflection of central adiposity and improved risk stratification. Recommendation Waist-to-Height Ratio and Body Roundness Index should be incorporated into routine clinical and community-based obesity screening programs to facilitate early detection and timely intervention.

Abstract Aim This study aims to evaluate the effectiveness of adapted ERAS protocols in patients undergoing emergency abdominal surgeries, focusing on the key outcomes of hospital length of stay, complication rates, and readmission rates. Method In this prospective study, 200 patients requiring emergency abdominal surgery (including appendectomies, cholecystectomies, and bowel resections) at a tertiary care center were enrolled over a period of 12 months. Patients were randomly assigned to two groups: one receiving traditional care (n=100) and the other managed under an ERAS protocol adapted for emergency procedures (n=100). The ERAS interventions included minimal preoperative fasting, goal-directed fluid therapy, multimodal opioid-sparing analgesia, early mobilization, and standardized early postoperative nutrition. Data on length of hospital stay, postoperative complications, and readmissions within 30 days were collected and analyzed using chi-square tests for categorical variables and t-tests for continuous variables, with a significance level set at p<0.05. Results The implementation of the ERAS protocol in emergency abdominal surgeries led to a significant reduction in the average length of hospital stay compared to traditional care (5 days vs. 7 days, p<0.01). Additionally, the complication rate was significantly lower in the ERAS group (15% vs. 30%, p=0.02). There was no significant difference in the readmission rates between the two groups (10% in both), indicating that the reduced hospital stay did not adversely affect patient outcomes post-discharge. Conclusions The study demonstrates that ERAS protocols can be effectively adapted for emergency abdominal surgeries, resulting in shorter hospital stays and reduced complication rates without increasing readmission rates.

PurposeTo estimate the prevalence and determine predictors of lens opacities (LO) among South Asian Indians aged 41–44 years.MethodsThis cross-sectional study included 1080 participants from the Vellore Birth Cohort, Vellore, South India. All underwent anthropometric measurements, detailed ophthalmic examination including assessment of LO by LOCS III classification and biochemical metabolic measurements. ‘Any cataract’ was defined as any opacity type with a score of >2 or evidence of cataract surgery in either eye. Data collected included information on ocular history, life-style factors, socio-economic and educational status, cooking fuel and sunlight exposure. Multivariable logistic regression analysis was used to examine the association between risk predictors and LO.ResultsThe mean age (SD) of participants was 41.8 (1.0) years; 53.8% were male and 50% were rural residents. The overall prevalence of ‘any cataract’ was 13.8% (148/1075, 95% confidence interval (CI) 11.8,16.0). The types of cataract were nuclear 59.1%, cortical 16.9%, posterior subcapsular 4.1%, mixed cataracts 18.9% and pseudophakia 0.7%. Increased risk for LO was observed with a history of asthma (OR 4.51; 95% CI 2.1, 9.7), HbA1C of ≥6.5% (OR 2.29; 95% CI 1.4, 3.7), hypertension (OR 1.73; 95% CI 1.1, 2.7) and, in a subgroup (n = 372), lower 25(OH) vitamin D levels (≤20 ng/dL)(OR 5.56; 95% CI 2.3, 13.2).ConclusionThe high prevalence of LO at a relatively young age in South Asian Indians suggests earlier onset of ageing. History of asthma, higher HbA1C, hypertension and lower 25(OH) vitamin D levels were associated with LO.

ABSTRACTBackground:Medical students often experience high levels of stress, which can negatively impact their mental and physical health. Elevated stress levels activate the hypothalamic–pituitary–adrenal (HPA) axis, leading to increased serum cortisol, a key biomarker of stress. Simplified Kundalini Yoga (SKY) is a holistic practice that incorporates meditation, breathing techniques, and physical exercises, which may help mitigate stress.Objective:This study aimed to evaluate the effects of SKY on perceived stress and serum cortisol levels among medical students.Methods:A quasi-experimental study was conducted among 120 first-year medical students at Government Erode Medical College. Participants were randomly assigned to either the experimental group (n = 60), who practiced SKY for 24 weeks, or the control group (n = 60), who received no intervention. Perceived Stress Scale (PSS) scores and serum cortisol levels were measured at baseline, after 12 weeks, and after 24 weeks. Repeated measures ANOVA was used for statistical analysis.Results:The experimental group exhibited a significant reduction in stress scores, decreasing from 24.47 at baseline to 14.05 after 24 weeks (F = 83.82, P < 0.001), while the control group showed no significant change (F = 0.43, P = 0.65). Similarly, serum cortisol levels in the experimental group decreased significantly from 19.90 μg/dL at baseline to 17.66 μg/dL after 24 weeks (F = 29.24, P < 0.001), whereas the control group showed no significant change (F = 1.132, P = 0.29).Conclusion:SKY effectively reduces perceived stress and serum cortisol levels among medical students, highlighting its potential as a stress-management intervention in medical education. Integrating SKY into medical curricula could enhance students’ mental well-being and resilience. Further research is needed to explore the long-term benefits and broader applications of SKY in stress management.