Abstract: Diabetes is one of the largest health emergencies of the 21st century. In future there will not only be increase in the incidence and prevalence of diabetes but also there will be an increase in economic burden, disability and life years lost due to disease. Microalbuminuria is used as predictor for early micro and macrovascular changes in diabetes. The objectives were to find out the prevalence of microalbuminuria among type II diabetes mellitus patients in urban Chidambaram and to find out the association between albuminuria and age, sex, duration of diabetes.A descriptive cross sectional study was carried out in the urban field practice area of urban health centre between October 2015 and July 2016, among 200 study participants who had type II diabetes mellitus. The prevalence of microalbuminuria among the study participants was 41.5%. All the three risk factors age, sex and duration of diabetes mellitus were found to have significant association with occurrence of albuminuria. As the age increased the probability of being microalbuminuric also increased (P<0.05). Males had 2.9 times the risk of being microalbuminuric than the females. As the duration of diabetes mellitus increased the chance of being microalbuminuric also increased (P<0.05).Life style modifications and other measures which can postpone the age of onset of type II diabetes mellitus can aid in decreasing the mean duration of diabetes mellitus with age.Studies with analytical designs should be performed in the same area for deeper understanding of the role of risk factors for the occurrence of microalbuminuria in the indigenous population.

Abstract: This study sought to determine the average time spent on social media by medical undergraduates in University of Uyo, Akwa Ibom State, Nigeria and to determine the relationship between social media use and disturbances of sleep quality and quantity amongst medical undergraduates in University of Uyo. It was a cross sectional population based study among 208 medical students in University of Uyo, Southern Nigeria. They were randomly selected with a proportionate stratified random sampling method and data collection was done using a self-reporting anonymous questionnaire. Social media use was assessed using multiple items reflecting the frequency, volume, location and platform of social media use. The average time spent on social media by respondents was 1-3 hours. Proportionately, the most time was spent on Facebook. In models that adjusted for all covariates, participants who spent more time on social media per day had significantly greater odds of having disturbance of sleep quality. Compared with those who spent more than 3 hours per day on social media, those who spent 1-3 hours per day had an adjusted odds ratio of 4.59 (95%CI: 4.14-5.48, p value < 0.001) for sleep disturbance. A significant association was reported between volume of social media use and sleep disturbance. This has important clinical implications for the health of young adults. Future work would focus on the interactions on the various social media platforms that make their use significant to young adults.

Abstract: Cataract is a highly treatable condition due to advances in cataract surgery, procedures and intraocular lens design. Currently 90% of the cataract surgeries are performed with intraocular lens (IOL). The aim of cataract surgery to improve visual function which also improves overall quality of life. The objectives were to find out the current visual outcome among subjects of post cataract surgery (IOL) over a period of 3 to 10 years and correlate visual outcome with selected variables. A community based descriptive cross-sectional study was conducted in selected urban field practice area of Rajah Muthaiah Medical College and Hospital from December 2015 to August 2016. Totally 120 subjects underwent cataract surgery were included in the study. The socio-demographic data and details regarding the surgery were collected using a pretested proforma and visual acuity was measured by Snellen’s chart. The visual acuity has been classified namely good, borderline and poor. The majority of the subjects were in the age group of 46-60 years (65%). 87 were females (72.5%) and 49 were illiterate (40.8%). Among these subjects 83 were homemakers (69.2%), 96 (80%) underwent surgery in institution (picked up through camp). 10.8% had complications immediately after surgery, 50% study subjects had a history of chronic diseases, such as DM, HT or both. Visual acuity measured as good vision (6/6-6/18) 54.2%, borderline vision (<6/18-6/60) 33.3% and poor vision (<6/60-unable to appreciate hand movements) 12.5%. 12.5% of the post cataract surgery (IOL) subjects had poor vision. 30% of the subjects those who had cataract surgery (IOL) surgery more than 5 years ago has poor vision.

Abstract: This study is aimed to determine the variations in perihilar branching pattern and extra renal arteries in 25 cadavers at SRM medical college hospital and research center, Chennai, India. Among the 50 kidneys studied, perihilar branching pattern (32%), accessory renal artery (26%), polar renal artery (16%), accessory renal artery & perihilar branching pattern (12%), accessory renal artery & polar artery (10%) and polar renal artery & perihilar branching pattern (4%) were observed in 16, 13, 8, 6, 5 and 2 cases, respectively. The knowledge of these probable variations of renal arteries will be useful for surgical management during renal transplantation, angiographic interventions, urological procedures and repair of abdominal aorta aneurysm.

Abstract: Tolosa-Hunt syndrome (THS) is essentially a clinical diagnosis of exclusion; painful ophthalmoplegia caused by nonspecific inflammation of the cavernous sinus or superior orbital fissure. We reported a 70 year old male with THS who responded to corticosteroids dramatically and made an uneventful complete clinical recovery.

Abstract: Splenic sarcoidosis is a rare clinical entity which can have heterogeneous clinical presentation. We highlight two different clinical encounters of splenic sarcoidosis with coexistent pulmonary sarcoidosis, which needs high degree of clinical suspicion to diagnose in complexed burnt out state and importance of timely diagnosis and early initiation of corticosteroids to minimize disease progression. Case 1; 58 year old previously healthy female presented with marked constitutional symptoms and left side upper abdominal discomfort over 6 months period with unremarkable clinical examination on admission. Her chest X ray on admission simulated the appearance of lymphangitic carcinomatosis, however ultrasound guided splenic tru-cut biopsy confirmed the diagnosis of splenic sarcoidosis and patient responded to corticosteroid therapy. Case 2; 21 year old young male was evaluated for pyrexia of unknown origin for three months. His clinical examination was only significant for bilateral cervical discrete lymph node enlargement and chest X ray on admission showed bilateral hilar enlargement and initial ultrasound abdomen revealed multiple hypoechoiec splenic lesions. Finally brochoscopy guided lung biopsy confirmed the diagnosis and patient was remarkably improved with corticosteroid treatment. Splenic sarcoidosis has heterogeneous clinical presentation. Judicial use of imaging, appropriate tissue biopsy together with correct clinical judgment will enable early diagnosis and early treatment with corticosteroid will have favorable patient outcome.

Spinal anesthesia (SA) is a safe anesthetic technique used for both elective and emergency operations. Shivering is known to be a frequent complication in patients undergoing surgery under neuraxial anesthesia with incidence of 40–70%. SA inhibits tonic vasoconstriction and causes redistribution of core heat from the trunk (below the block level) to the peripheral tissues predisposing patients to hypothermia and shivering. Post spinal anaesthesia shivering (PSAS) is an involuntary, repetitive activity of skeletal muscles as a physiological response to core hypothermia to raise the metabolic heat production. PSAS increases O2 consumption, CO2 production, plasma catecholamines and cardiac output. Shivering may interfere with the monitoring of ECG, blood pressure and oxygen saturation. Te mainstay of prophylaxis and treatment of PSAS remain pharmacological due to inadequate control of central hypothermia by techniques based on physical principles (e.g., intravenous infusion (IVI) of warm fluids and forced air warmers). It appears logical to prevent PSAS rather than to treat it once it develops.

Introduction: Local anaesthetic like bupivacaine is commonly used in spinal anaesthesia, but the duration of spinal anaesthesia may be short and limited, and higher doses of rescue analgesics may be required in the postoperative period. This can be avoided by using higher doses of bupivacaine which again can produce cardiac toxicity. Studies have shown that duration of analgesia due to bupivacaine in spinal anaesthesia can be prolonged by using adjuvants such as midazolam, opioids, neostigmine, dexmedetomidine, and clonidine. Almost all opioids have been used as adjuvants intrathecally. Material and methods: This randomized controlled study was carried out over a period of 6 months, after obtaining approval from the Hospital Ethics Committee and written informed consent from the patients. Ninety-nine patients of Anaesthesiologists Classes I or II of either sex and of age 25-60 years, posted for lower abdominal surgery were randomly divided into 3 groups (n = 33) using computer-generated program. Assigned random group was enclosed in a sealed envelope to ensure concealment of allocation sequence. The anaesthesiologist, who was not involved in the study, opened the envelope in operation theatre and prepared the drug accordingly. The observation was done by the anaesthesiologist who was blinded to the drug. Patients having severe systemic disorders such as diabetes mellitus, hypertension, heart disease, allergy to bupivacaine, spine deformity, increased intracranial pressure, neurological disorders, haemorrhagic diathesis, and infection at the puncture site were excluded from the study. Result: A total of 106 patients initially enrolled in this study, 7 patients had to be excluded because of logistical reasons or other violations of the study protocol. Ninety patients were included and randomly assigned to their treatment groups. Conclusion: Intrathecal clonidine (75 μg) when added to bupivacaine in spinal anaesthesia provides prolonged duration of postoperative analgesia than 25 μg of fentanyl but with higher degree of sedation. Fentanyl (25 μg) may be recommended as a better option when sedation is not desirable. We concluded that intrathecal clonidine 75 𝜇g with bupivacaine prolonged intraoperative anaesthesia and the time to first analgesic request compared to fentanyl, however, the total analgesic consumption in the first 24 h postoperative was similar in fentanyl and clonidine groups following elective lower abdominal surgeries.

Background: Cardiovascular disease (CVD) remains the leading global cause of mortality, and Type 2 Diabetes Mellitus (T2DM) significantly elevates CVD risk through metabolic and vascular complications. Objective: To assess the effectiveness of family medicine interventions in reducing cardiovascular risk factors and events among T2DM patients in Alahsa during the December 2015 to September 2016 period. Method: This retrospective cohort study included 3,000 T2DM patients from Alahsa. Data on glycemic control, lipid profiles, blood pressure, pharmacological adherence, and CVD event rates were analyzed. Patients were grouped into those receiving comprehensive family medicine care and standard care. Statistical comparisons were performed to evaluate outcomes. Results: Among the 3,000 patients, 65% achieved glycemic control (HbA1c <7%) with family medicine-led care, compared to 47% in the standard care group. LDL cholesterol levels reduced by 30%, and HDL levels increased by 18% in patients receiving lipid-focused interventions. Blood pressure control (<140/90 mmHg) was achieved in 78% of hypertensive patients, compared to 61% in the standard care group. Adherence to cardioprotective therapies, including SGLT2 inhibitors and GLP-1 receptor agonists, improved to 88%, resulting in a 25% reduction in major cardiovascular events (from 16% to 12%). Patients receiving family medicine care had a 32% lower relative risk of CVD complications (p<0.01). Conclusions: Family medicine significantly improves cardiovascular outcomes in T2DM patients by enhancing risk factor management and adherence to therapies, highlighting its essential role in primary care.