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Mohanraj S.,Velammal Medical College Hospital and Research Institute | Karthikeyan A.,Velammal Medical College Hospital and Research Institute
National Journal of Physiology, Pharmacy and Pharmacology | Year: 2017

Background: Reaction time is the time between presentation of a stimulus and the appearance of appropriate voluntary response in the subject. The measurement of visual reaction time (VRT) is used to evaluate the processing speed of central nervous system and co-ordination between the visual sense and motor system. Refractive errors were proved to affect the accommodation reaction. Defocusing was known to affect the VRT. However, the influence of the refractive error on VRT was not clearly documented. As blur, defocus, illumination affect lot of psychomotor skills like driving, refractive errors also expected to affect the psychomotor skills. Aims and Objectives: This study was undertaken with a purpose to measure and compare the VRT in myopic subjects with and without correcting the refractive error with that of VRT of emmetropic subjects. Materials and Methods: The study was carried out among 112 first year medical students in the age group 18 to 20. 60 emmetropic subjects and 52 myopic subjects were involved in the study. The study was carried out with the help of discriminatory and choice reaction time apparatus. VRT was measured in milliseconds. For myopic subjects, VRT was taken before and after correction of their refractive error. Subjects were presented with two visual stimuli, red and green. Result: VRT is found to be significantly more in uncorrected myopic subjects as compared to emmetropic subjects for both red and green light stimuli. VRT is found to be significantly less in emmetropic subjects as compared to myopic subjects even after correcting the refracting error. Conclusion: The myopic people have greater reaction time than emmetropic people even though when their refractive error is corrected. This adds refractive error as a new member in the row of factors that affects the VRT. © 2016 Saravanan Mohanraj and Aravindan Karthikeyan.


PubMed | MarksMan Healthcare Solutions LLP and Velammal Medical College Hospital and Research Institute
Type: Review | Journal: Perspectives in clinical research | Year: 2016

Randomized controlled trials (RCTs) are the gold standard for measuring the safety and efficacy of drugs. However, they are being challenged by payers and health care providers since they are looking for real world evidence (RWE) to validate whether the new intervention provides similar safety and efficacy as reported in RCT data. RWE uses real world data (RWD) to generate insight, foresight, and explorative findings on diseases, products, and patient populations. There are varied sources of RWD such as administrative data, large pragmatic trials, registries, electronic health records, and health surveys. RWE approaches are increasingly becoming the normal practice in developed countries to bring a product to the healthcare market and to ensure its significance in clinical practice. The Indian healthcare sector is growing at a brisk pace and is grasping up with the principles of health economics and outcome research, thereby exhibiting the value of real-world insights in healthcare decision. India has taken a step toward RWE by developing a framework to assist health care providers in harmonizing RWD for economic, clinical, and humanistic outcome.


PubMed | Institute of Cytology and Preventive Oncology ICMR, World Health Organization, Velammal Medical College Hospital and Research Institute, Healis Sekhsaria Institute for Public Health and U.S. National Cancer Institute
Type: | Journal: Tobacco control | Year: 2016

To systematically review and meta-analyse the studies investigating the association between smokeless tobacco (SLT) use and all-cause mortality and cause-specific mortality outcomes among adult users of SLT and estimate the number of attributable deaths worldwide.Random-effects meta-analysis was used to estimate the pooled risk of death due to SLT use. Population attributable fractions were derived and used to calculate the number of attributable deaths. Observational studies published upto 2015 were identified through MEDLINE, IndMED, Google Scholar and other databases. Data on the prevalence of SLT use was obtained from latest reports or national surveys. Data on the disease burden were obtained from the Global Burden of Disease Study. Hospital-based or community-based case-control and cohort studies that adjusted for the smoking status were included.16 studies that provided estimates for mortality due to all cause, all cancer, upper aerodigestive tract (UADT) cancer, stomach cancer, cervical cancer, ischaemic heart disease (IHD) and stroke were included. A significant association was found for mortality due to all cause (1.22; 1.11-1.34), all cancer (1.31; 1.16-1.47), UADT cancer (2.17; 1.47-3.22), stomach cancer (1.33; 1.12-1.59), cervical cancer (2.07; 1.64-2.61), IHD (1.10; 1.04-1.17) and stroke (1.37; 1.24-1.51). Subgroup analysis showed major regional differences. Globally, the number of attributable deaths from all-cause mortality was 652494 (234008-1081437), of which 88% was borne by the South-East Asian region.SLT is responsible for a large number of deaths worldwide with the South-East Asian region bearing a substantial share of the burden.


Shewade H.D.,Indira Gandhi Medical College and Research Institute | Shewade H.D.,Qutub Institutional Area | Palanivel C.,Indira Gandhi Medical College and Research Institute | Palanivel C.,Jawaharlal Institute of Postgraduate Medical Education & Research | Jeyashree K.,Velammal Medical College Hospital and Research Institute
Family Medicine and Community Health | Year: 2016

Objective: Family medicine, epidemiology, health management and health promotion are the core disciplines of community medicine. In this paper, we discuss the development of a community posting program within the framework of community medicine core disciplines at a primary health centre attached to a teaching hospital in Puducherry, India. Methods: This is a process documentation of our experience. Results: There were some shortcomings which revolved around the central theme that postings were conducted with department in the teaching hospital as the focal point, not the primary health centre (PHC). To address the shortcomings, we made some changes in the existing community posting program in 2013. Student feedback aimed at Kirkpatrick level 1 (satisfaction) evaluation revealed that they appreciated the benefits of having the posting with PHC as the focal point. Feedback recommended some further changes in the community posting which could be addressed through complete administrative control of the primary health centre as urban health and training center of the teaching hospital; and also through practice of core disciplines of community medicine by faculty of community medicine. Conclusion: It is important to introduce the medical undergraduates to the core disciplines of community medicine early through community postings. Community postings should be conducted with primary health centre or urban health and training centre as the focal point. © 2016 Family Medicine and Community Health.


Sinha D.N.,World Health Organization | Suliankatchi R.A.,Velammal Medical College Hospital and Research Institute | Amarchand R.,Velammal Medical College Hospital and Research Institute | Krishnan A.,All India Institute of Medical Sciences
Nicotine and Tobacco Research | Year: 2016

Background: Tobacco control is an important strategy to reduce the disease burden caused by several noncommunicable diseases. An in-depth understanding of the sociodemographic variations in tobacco use is an important step in achieving effective tobacco control. Aims: We aimed to estimate the age-standardized prevalence of any tobacco use and dual tobacco use and determine their association with sociodemographic variables in six countries (Bangladesh, Indonesia, India, Maldives, Nepal, and Timor Leste) of the WHO South-East Asia Region. Methods: The main outcome variables "any tobacco use" and "current dual use" were created from the latest available Demographic and Health Surveys data for each country. The prevalence estimates were weighted using sample weights and age standardized using the WHO standard population. Associations between the sociodemographic variables and tobacco use were calculated by performing multivariable logistic regression analysis. Analyses were performed in Stata 12 using "svyset" and "svy" commands. Results: The highest prevalence of any tobacco use among men was in Indonesia (76.4%) and among women in Nepal (15.7%). Also, Nepal had the highest prevalence of dual tobacco use in both men (17.9%) and women (1.5%). With regard to sociodemographic determinants, despite the inter-country variations, any and dual tobacco use were significantly associated with age, higher education, greater wealth, rural residence, and ever-married marital status. The poor and uneducated had a higher odds ratio for these practices. Conclusion: Prevalence of dual tobacco use and its underlying socioeconomic disparities should be taken into account for the planning of tobacco control activities in the region. Implications: The dual tobacco use phenomenon is being increasingly recognized as a distinct entity in the fight against tobacco addiction. When compared with single product users, dual users have a greater risk of developing tobacco related diseases and are less likely to quit their habits. However, this phenomenon has not been studied adequately in the South-East Asia region. In this context, this study has provided a detailed and comprehensive view of dual tobacco use and its sociodemographic determinants in six countries of the region. This study recommends that tobacco control interventions should be targeted specifically at the disadvantaged sections of the society, such as the poor and the uneducated, who are more likely to engage in "dual" as well as "any" tobacco use. This study could prove as an important reference and tool for policy making in the South-East Asia region. © The Author 2016.


Suliankatchi R.A.,Velammal Medical College Hospital and Research Institute | Sinha D.N.,World Health Organization
Journal of Obstetrics and Gynecology of India | Year: 2016

Background: In India, smokeless tobacco (SLT) use among pregnant women is high and its adverse effects on pregnancy outcomes have not been properly documented in. Objectives: To collate available evidence on the association between SLT use and three adverse pregnancy outcomes, i.e. low birth weight, preterm birth and stillbirth among women in India. Search Strategy: A systematic search was conducted in MEDLINE, IndMed, Web of Science, Google Scholar and major journals. Two authors independently reviewed the studies and extracted data. Selection Criteria: Inclusion criteria were English articles published till December 2014, case control, case cohort or cohort, and exposure and outcome variables meeting predefined criteria. Exclusion criteria were case series, case reports, cross-sectional designs, risk estimate not restricted/adjusted for smoking with or without adjustment for other factors and duplicate data. Qualitative synthesis was followed by meta-analysis. Attributable burden was estimated using the population attributable fraction method. Main Results: Pooled odds ratio was significant for all three outcomes: low birth weight (1.88, 95 % CI 1.38, 2.54), preterm birth (1.39: 1.01, 1.91) and stillbirth (2.85: 1.62, 5.01). We found that 0.87 million low birth weight babies, 0.19 million preterm births and 0.12 million stillbirths occurring annually in India could be attributed to maternal SLT use. Conclusion: There was a suggestive evidence of SLT use associated with adverse pregnancy outcomes among women in India. Further studies in this field are required to generate more conclusive evidence. © 2016 Federation of Obstetric & Gynecological Societies of India


Jeremiah S.S.,Velammal Medical College Hospital and Research Institute | Balaji V.,Christian Medical College | Anandan S.,Christian Medical College | Sahni R.D.,Christian Medical College
Indian Journal of Medical Microbiology | Year: 2014

Context: The modified Hodge test (MHT) is widely used as a screening test for the detection of carbapenemases in Gram-negative bacteria. This test has several pitfalls in terms of validity and interpretation. Also the test has a very low sensitivity in detecting the New Delhi metallo-β-lactamase (NDM). Considering the degree of dissemination of the NDM and the growing pandemic of carbapenem resistance, a more accurate alternative test is needed at the earliest. Aims: The study intends to compare the performance of the MHT with the commercially available Neo-Sensitabs-Carbapenemases/Metallo-β-Lactamase (MBL) Confirmative Identification pack to find out whether the latter could be an efficient alternative to the former. Settings and Design: A total of 105 isolates of Klebsiella pneumoniae resistant to imipenem and meropenem, collected prospectively over a period of 2 years were included in the study. Subjects and Methods: The study isolates were tested with the MHT, the Neo-Sensitabs-Carbapenemases/MBL Confirmative Identification pack and polymerase chain reaction (PCR) for detecting the blaNDM-1 gene. Results: Among the 105 isolates, the MHT identified 100 isolates as carbapenemase producers. In the five isolates negative for the MHT, four were found to produce MBLs by the Neo-Sensitabs. The Neo-Sensitabs did not have any false negatives when compared against the PCR. Conclusions: The MHT can give false negative results, which lead to failure in detecting the carbapenemase producers. Also considering the other pitfalls of the MHT, the Neo-Sensitabs-Carbapenemases/MBL Confirmative Identification pack could be a more efficient alternative for detection of carbapenemase production in Gram-negative bacteria.


PubMed | World Health Organization, Velammal Medical College Hospital and Research Institute and Healis Sekhsaria Institute for Public Health
Type: Journal Article | Journal: International journal of cancer | Year: 2016

The International Agency for Research on Cancer (IARC) has concluded that there is sufficient evidence in humans for the carcinogenicity of smokeless tobacco (SLT) for mouth, oesophagus and pancreas, based largely on Western studies. We wanted to confirm this by conducting a systematic review using Indian studies because India faces the biggest brunt of SLT-attributable health effects. A systematic search was conducted for published and unpublished studies. Two authors independently reviewed the studies and extracted data. Summary odds ratio (OR) for each cancer type was calculated using fixed and random effects model. The population attributable fraction (PAF) method was used to calculate the attributable burden of incident cases. A significant association was found for oral-5.55 (5.07, 6.07), pharyngeal-2.69 (2.28, 3.17), laryngeal-2.84 (2.18, 3.70), oesophageal-3.17 (2.76, 3.63) and stomach-1.26 (1.00, 1.60) cancers. But in random effects model, laryngeal-1.79 (0.70, 4.54) and stomach-1.31 (0.92, 1.87) cancers became non-significantly associated. Gender-wise analysis revealed that women had a higher risk (OR = 12.0 vs. 5.16) of oral but a lower risk (1.9 vs. 4.5) of oesophageal cancer compared with men. For oral cancer, studies that adjusted for smoking, alcohol and other factors reported a significantly lower OR compared with studies that adjusted for smoking only or smoking and alcohol only (3.9 vs. 8.4). The annual number of attributable cases was calculated as 49,192 (PAF = 60%) for mouth, 14,747 (51%) for pharynx, 11,825 (40%) for larynx, 14,780 (35%) for oesophagus and 3,101 (8%) for stomach.


PubMed | World Health Organization and Velammal Medical College Hospital and Research Institute
Type: Journal Article | Journal: Journal of obstetrics and gynaecology of India | Year: 2016

In India, smokeless tobacco (SLT) use among pregnant women is high and its adverse effects on pregnancy outcomes have not been properly documented in.To collate available evidence on the association between SLT use and three adverse pregnancy outcomes, i.e. low birth weight, preterm birth and stillbirth among women in India.A systematic search was conducted in MEDLINE, IndMed, Web of Science, Google Scholar and major journals. Two authors independently reviewed the studies and extracted data.Inclusion criteria were English articles published till December 2014, case control, case cohort or cohort, and exposure and outcome variables meeting predefined criteria. Exclusion criteria were case series, case reports, cross-sectional designs, risk estimate not restricted/adjusted for smoking with or without adjustment for other factors and duplicate data. Qualitative synthesis was followed by meta-analysis. Attributable burden was estimated using the population attributable fraction method.Pooled odds ratio was significant for all three outcomes: low birth weight (1.88, 95% CI 1.38, 2.54), preterm birth (1.39: 1.01, 1.91) and stillbirth (2.85: 1.62, 5.01). We found that 0.87 million low birth weight babies, 0.19 million preterm births and 0.12 million stillbirths occurring annually in India could be attributed to maternal SLT use.There was a suggestive evidence of SLT use associated with adverse pregnancy outcomes among women in India. Further studies in this field are required to generate more conclusive evidence.


PubMed | World Health Organization, Velammal Medical College Hospital and Research Institute and All India Institute of Medical Sciences
Type: Journal Article | Journal: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco | Year: 2016

Tobacco control is an important strategy to reduce the disease burden caused by several noncommunicable diseases. An in-depth understanding of the sociodemographic variations in tobacco use is an important step in achieving effective tobacco control.We aimed to estimate the age-standardized prevalence of any tobacco use and dual tobacco use and determine their association with sociodemographic variables in six countries (Bangladesh, Indonesia, India, Maldives, Nepal, and Timor Leste) of the WHO South-East Asia Region.The main outcome variables any tobacco use and current dual use were created from the latest available Demographic and Health Surveys data for each country. The prevalence estimates were weighted using sample weights and age standardized using the WHO standard population. Associations between the sociodemographic variables and tobacco use were calculated by performing multivariable logistic regression analysis. Analyses were performed in Stata 12 using svyset and svy commands.The highest prevalence of any tobacco use among men was in Indonesia (76.4%) and among women in Nepal (15.7%). Also, Nepal had the highest prevalence of dual tobacco use in both men (17.9%) and women (1.5%). With regard to sociodemographic determinants, despite the inter-country variations, any and dual tobacco use were significantly associated with age, higher education, greater wealth, rural residence, and ever-married marital status. The poor and uneducated had a higher odds ratio for these practices.Prevalence of dual tobacco use and its underlying socioeconomic disparities should be taken into account for the planning of tobacco control activities in the region.The dual tobacco use phenomenon is being increasingly recognized as a distinct entity in the fight against tobacco addiction. When compared with single product users, dual users have a greater risk of developing tobacco related diseases and are less likely to quit their habits. However, this phenomenon has not been studied adequately in the South-East Asia region. In this context, this study has provided a detailed and comprehensive view of dual tobacco use and its sociodemographic determinants in six countries of the region. This study recommends that tobacco control interventions should be targeted specifically at the disadvantaged sections of the society, such as the poor and the uneducated, who are more likely to engage in dual as well as any tobacco use. This study could prove as an important reference and tool for policy making in the South-East Asia region.

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