Since the invention of stethoscope by Rene Laennec, auscultation has become sine qua non of clinical examination, especially for cardiovascular system. Many clinical signs are named after the first describer, as a tribute to their efforts. So is true for cardiac murmurs. Sir Graham Steell was a British cardiologist who described the high pitched diastolic murmur of pulmonary regurgitation. Diastolic murmur of severe aortic regurgitation is named after American physician, Austin Flint, who actually disapproved eponyms. American physician Richard Clarke Cabot and his colleague Locke described early diastolic murmur of severe anemia, which is thought to be due to high flow in left coronary artery. The name of Carey Coomb, a British cardiologist, is associated with mid-systolic murmur of mitral valvulitis in acute rheumatic fever. Left anterior descending arterial stenosis sometimes produces an early diastolic murmur and it was first described by American physician William Dock. The machinery murmur of patent ductus arteriosus was first described by George Alexander Gibson. Key-Hodgkin murmur is the diastolic murmur of aortic regurgitation, named after Thomas Hodgkin and Charles Ashton Key. French pediatrician Henri Louis Roger described the holosystolic murmur of ventricular septal defect and his name is also associated with Maladie de Roger. Sir George Frederic Still, an English paediatrician, whose name is associated with juvenile idiopathic arthritis described the innocent functional murmur mostly heard in children. It was Louis Gallavardin, a French physician, who described the phenomenon of dissociation of musical component and noisy component of aortic stenosis. Though the popularity of such eponyms are on wane due to advent of phonocardiography and ECHO Doppler, one hopes some newer descriptions of murmurs due to changing profile of cardio-vascular diseases will emerge in near future.

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Background and Objectives: Urinary tract infections (UTIs) are commonly seen in clinical practice and are most often caused by Escherichia coli (E. coli). To administer appropriate antibiotic therapy and reduce morbidity, it is crucial to know the local resistance patterns of E. coli. This study aims to show long-term changes in the resistance of E. coli to commonly used antibiotics over the past two decades in a hospital in southern India. Materials and Methods: This study was carried out at Dr. Jeyasekharan Medical Trust, a multispeciality teaching hospital in southern Tamil Nadu. It analyzed data from records of all urine samples received, cultured, and tested for resistance in its microbiology laboratory between 1991 and 2012. Results: A total of 44% of the urine cultures grew organisms. E. coli was present in 73% of the positive cultures. A trend of increasing resistance to gentamicin, fluoroquinolones, and cephalosporins was noted over the study period. The development of resistance was faster with the fluoroquinolones and cephalosporins than gentamicin. Chloramphenicol resistance showed a downward trend. Amikacin and nitrofurantoin were the most effective antibiotics with 10% and 28% resistance levels, respectively, over the period that they were used. The levels of resistance to second-line antibiotics did not show any definite trend. Interpretation and Conclusions: This study shows changing patterns of E. coli resistance over a period within an institution. Monitoring urinary cultures and resistance patterns regularly can assist in developing guidelines for selecting appropriate first guess antibiotics, thereby optimizing patient outcome.

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Objective: The aim of the study was to correlate the clinical and radiologic features of the coronary artery anomalies in the Indian subcontinent. Methods: A total of 1000 patients who underwent 128 rows multidetector computed tomography (MDCT) angiography were evaluated for the presence of congenital coronary artery anomalies. Results: Coronary artery anomalies were found in 31 patients; 25 were males and 6 were females with a mean age of 35 years (range 1.9-79 years). The anomaly of origin in 48.3% (n = 15), course in 29% (n = 9) and anomalies of termination and intrinsic anomalies of coronary arteries were found in 12.9% (n = 4) and 9.6% (n = 3), respectively. Atherosclerosis was noted in 16% patients (n = 5). Conclusions: MDCT detects and delineates the complex anatomy of the coronary anomalies, which helps in therapeutic management of the patients. Coronary artery anomalies predispose the vessel to atherosclerotic changes.

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Assessment and optimization of hemodynamic parameters and oxygen delivery may improve outcome in critically ill patients. Optimum fluid management often needs to take hemodynamic parameter in to account. Comorbidity and critical illness during pregnancy contribute significantly to maternal and fetal morbidity and mortality. This article will focus on the role of hemodynamic monitoring in the field of practice of obstetrics, perioperative and critical care management of obstetric patients with current evidence and type of hemodynamic monitoring technique for such patients. PubMed advanced and Google Scholar search with index word "hemodynamic monitoring", "haemodynamic monitoring", "shock", "obstetric", "preeclampsia", "heart disease", "cardiac disease", "hemodynamic monitoring in obstetric", "hemodynamic monitoring in obstetrics", and "haemodynamic monitoring in obstetric" in different combinations to retrieve clinical trials, case series, and review articles for the current literature review.

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Introduction: Syndicate learning is a form of peer learning involving small groups of 5-6 students working in semi-independent groups toward achievement of a collective goal. Methods: Eighty final Bachelor of Dental Surgery (BDS) students were enrolled. Pre-test was conducted for regular batches posted for clinical posting in Oral Medicine and Radiology. Each batch was randomized into two equal sub-groups. Sub-group A and B were exposed to syndicate and traditional learning methods, respectively. Post-test was carried out. Crossover was done. Pre-test was again conducted. Sub-group A and B were exposed to traditional and syndicate learning, respectively. Post-test was again carried out. Results: In round one, scores of post-test were significantly better than pre-test in both subgroups A (pre-test - 2.40 ± 0.98, post-test - 4.45 ± 0.71) and B (pre-test - 2.47 ± 0.96; post-test; 3.57 ± 0.87). In round two after crossover, scores of post-test were significantly higher in both subgroup A (pre-test-2.30 ± 1.09; post-test-3.72 ± 0.84) and subgroup B (pre-test - 2.37 ± 1.12; post-test - 4.50 ± 0.59). Further, when subgroup A was compared with B, scores of post-test were significantly higher in the syndicate group compared with traditional group, before and after crossover. Conclusions: Syndicate groups can make learning experience more interesting; generate many opportunities for creative interchange of ideas and lively, meaningful participations and discussion among students.

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Objective: This prospective study was planned to study the prognostic value of time to presentation to the hospital, clinical scales and examination, hematological and biochemical parameters as predictive factors of mortality in ischemic stroke. Materials and Methods: In this study, 188 consecutive patients of ischemic stroke were included. The patients were subjected to relevant history taking, clinical evaluation, blood investigations (total leukocyte count [TLC], capillary blood sugar, potassium, high-sensitivity C-reactive protein (hs-CRP), troponin I (Trop I)), electrocardiogram (ECG) and neuroimaging. The patients were followed up till their final outcome in the hospital, and patients who expired were grouped as 'Mortality Group' and the rest as 'Discharged Group'. Logistic regression analysis was carried out among the significant parameters to identify independent predictors of mortality in cases of ischemic stroke. Results: After statistical analysis, it was found that late presentation to the hospital, pyrexia (temperature >99°F), low diastolic blood pressure at the time of admission, hypoxia (saturation of oxygen [sPo2] <94%), National Institute of Health Science scale (NIHSS) score >15, modified Rankin score (MRS) greater than 3, Glasgow coma scale (GCS) less than 8, hyperglycemia (random blood sugar >200 mg/dL), raised total leukocyte count and hs-CRP (>10 mg/L), are positive predictive factors of mortality in cases of ischemic stroke. Conclusion: Late presentation to the hospital, pyrexia (temperature >99°F), low diastolic blood pressure at the time of admission, hypoxia (sPo2 <94%), more severe stroke (NIHSS score >15, MRS >3, GCS <8), high TLC estimated at the time of hospitalization, are the most important predictive prognostic factors of in-hospital mortality in cases of ischemic stroke.

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Objective: The objective of the present study was to assess the effect of tobacco chewing on buccal mucosa by using cytomorphometry. Study Design: The study group consisted of 100 subjects divided into 50 tobacco chewer subjects (Group C) and 50 control subjects (Group N) aged between 31 and 80 years. We analyzed and compared the nuclear and cell morphometric features, that is, mean nuclear area (MNA), mean nuclear perimeter (MNP), mean of maximum nuclear diameter (Max-ND), mean of minimum nuclear diameter (Min-ND), mean cell area (MCA), mean cell perimeter (MCP), mean of maximum cell diameter (Max-CD), mean of minimum cell diameter (Min-CD) and nuclear to cell parameter ratio. Buccal epithelial cells of these individuals were collected with a brush and fixed smears were stained with Papanicolaou stain and cytomorphometric analysis performed using Image J image analysis software. Results: The mean of above nuclear and cell morphometric parameters and their ratio were found to be statistically significant by Univariate analysis of variance (ANOVA) being P value < 0.001. Conclusions: There is progressive increase in nuclear parameters, decrease in cellular parameters and increase in ratio of nuclear to cellular parameters in smears from tobacco chewers, as compared with normal subjects. It is possible to conclude that these adaptive changes in the cellular and nuclear parameters tend to be a progression toward dysplastic or premalignant change.

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Introduction: Various studies have reported a higher risk of cardiovascular morbidity in psoriasis but the effect of severity and duration of psoriasis; and gender on cardiovascular risk factors is not yet defined. Material and Methods: The present study included 436 clinically diagnosed patients of psoriasis attending our institution's psoriasis clinic, retrospectively from September 2008 onwards. Details of history, clinical examination and investigations were recorded from the proforma. Age, gender, duration of psoriasis, severity (body surface area [BSA] of involvement <10% - limited and BSA >10% - extensive and psoriasis area severity index), waist circumference, body mass index (BMI), blood pressure and investigations were analysed. Results: There was no significant association of severity of psoriasis with diabetes, hypertension, raised waist circumference, raised triglyceride levels and low high density lipoprotein (HDL) levels. A longer duration of psoriasis was significantly associated with high waist circumference (P = 0.007), high BMI (P = 0.013) and increased prevalence of hypertension (P = 0.002). Obesity (P = 0.003) and high waist circumference (P = 0.00) were significantly more prevalent in females. Conclusion: All patients of psoriasis should be screened for markers of increased cardiovascular morbidity irrespective of gender and severity of psoriasis. Long standing psoriasis and female gender may carry higher risk of development of high waist circumference and obesity.

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Background: Mental health among anaesthesiologists has been studied in India in a limited manner. In this study, we aim to assess the same in a group of trainee anesthesiologists. Methods: A cross sectional study was undertaken among all the anesthesiology registrars doing their post graduation at the Christian Medical College and Hospital, a tertiary care hospital in southern India. The mental health was assessed using General Health Questionnaire - 28 (GHQ 28). Results: 43% of the study group was found to have higher levels of emotional distress. Significant correlation was found for female registrars and those between 20 and 30 years of age. Conclusion: While nearly half of trainee anaesthesiologists were found to have higher levels of emotional distress, the association was most marked among women and, individuals under 30 years of age.

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