The Chettinad Health City Medical Journal has taken rapid strides towards establishing itself as one of the top medical journals in the country. The journal is committed to achieving high standards in terms of scientific content, and pubmed indexing in the near future. The increasing proportion of original articles will help in achieving this target.

Due to an aging population needing aortic valve replacements (AVR), there is a growing need for minimally invasive cardiac surgery aimed at reducing operative trauma and peri-operative morbidity. Large case series have reported minimally invasive (MI) AVR to be a good alternative to median sternotomy AVR with faster recovery and reduced morbidity. Our aim is to review our early experiences with MI AVR and compared that to full sternotomy (FS) AVR.

Myocardial ischemia is metabolic phenomenon that occurs in patients undergoing open heart surgery like Coronary Artery Bypass Grafting and Valve surgery due to interruption of coronary blood flow during aortic cross-clamp and reperfusion after aortic cross-clamp release. This myocardial damage leads to hemodynamic instability, arrhythmias, high dose of inotropes, difficulty in weaning of CPB and chance of intra aortic balloon pump use. This study examined the efficacy and safety of Retrograde with Antegrade Cardioplegia comparison with Antegrade approach in valve surgery.

Coronary artery disease (CAD) is the most common cause of mortality in India with 3 million deaths annually. Deaths occurring due to CAD occur 5–10 years earlier in the Indian subcontinent than in Western countries. We studied the risk factors in a semi-urban area of Tamil Nadu with special reference to the conventional risk factors like diabetes, hypertension, hypercholesterolemia, smoking, and family history of coronary artery disease and other modifiable risk factors.

To study the prevalence of Glucose Tolerance Test abnormalities in PCOS women attending the infertility clinic in a tertiary care hospital. Methods: 149 PCOS women who attended the infertility clinic between September 2007 –August 2009, were subjected to Oral Glucose Tolerance Test (GTT) with 75 grams glucose load after ruling out other causes of anovulation. Blood sugar values were categorized as normal, impaired or Type 2 Diabetes Mellitus by WHO 1999 criteria.

Hypo-osmotic swelling (HOS) test was done to assess the vitality of spermatozoa. Sterile water is easily available and inexpensive when compared to HOS reagent. Efficacy of sterile water is checked in comparison with Hypo-osmotic swelling (HOS) Reagent for assessing the vitality of human spermatozoa.

The educational environment is fundamental to effective student learning. It has been shown to significantly impact their attitudes and professional progress and is critical for personal and social well-being. The present survey was conducted among the dental students and interns of Chettinad Dental College and Research Institute to assess their perception about the educational environment in the institution.

A 60 year old male patient was transferred to our hospital with a diagnosis of community acquired lobar pneumonia and scrub typhus. He was a diabetic and hypertensive and was also positive for the HbsAg antigen. He was being treated with mechanical ventilation for respiratory failure and antibiotics for pneumonia and scrub typhus. His general condition, sepsis and respiratory status gradually improved.

Congenital diaphragmatic hernias resulting from the failure of posterolateral diaphragmatic foramina to close, was first described by Bochdalek in 18481 . Presentation in adults is rare, usually they present with mild respiratory or gastrointestinal symptoms1 . We present an adult patient who underwent simultaneous coronary artery bypass grafting and hernia repair through a median sternotomy. There have been no similar reports of combined procedure.

Cor triatriatum sinister is a very rare congenital heart disease, characterized by a division of left atrium into two chambers by a fibromuscular membrane. Usually it presents in early childhood. They may present with features of mitral stenosis or remain asymptomatic un till adulthood.

Synchronous testicular germ cell tumors with discordant histopathology are an uncommon entity. We describe a case in a 39-year-old male who presented with bilateral testicular swelling. Investigations revealed raised tumor markers and bilateral testicular lesions on scrotal Ultra Sound. Histopathology of bilateral orchidectomy showed a right testicular mixed germ cell non-seminomatous tumour comprising of immature teratoma and yolk sac (endodermal sinus) elements and a left testicular of mixed germ cell non-seminomatous tumour comprising of embryonal carcinoma and choriocarcinoma elements. This case is being presented for its rarity and unusual combination of germ cell histological tumours.

A broad range of developmental anomalies and morphological variants may occur in the oral cavity of the newborns. Dental lamina cysts, also known as gingival cysts of the newborn, are benign oral mucosal lesions of transient nature present at birth. Although the prevalence is high, they are rarely seen because of the transient nature of the lesions. They are self limiting and disappear spontaneously a few weeks or months after birth. Hence no treatment is required for such cases. Clinical diagnosis of these conditions are important in order to avoid unnecessary therapeutic procedure.

Alport’s syndrome or hereditary nephritis is a rare genetic disorder of basement membrane, clinically characterized by haematuric nephritis, sensorineural deafness and characteristic ocular manifestations1. We report a case of Alport’s syndrome with unusual ocular presentation featuring bilateral congenital coloboma of optic disc with unilateral pigmentary retinopathy. This is a rare ophthalmological finding in Alport’s syndrome.

Far lateral disc prolapse offers a diagnostic and management challenge. Patient clinically present with radiculopathy of the exiting nerve root at that level. These are being increasingly diagnosed after the advent of Computed tomography (CT) and Magnetic resonanace imaging (MRI). Surgical approach is different from the regular approach to the lumbar disc . This case report highlights the clinical presentation and the use of inter transverse muscle splitting approach for farlateral disc prolapse.

Heart failure (HF) is a leading cause of death nowadays. Heart failure is a pathophysiologic condition that leads to inadequate cardiac performance and is responsible for the heart's inability to increase output. The myocardium responds to the reduced output by compensatory mechanisms of the Frank-Starling relationship.

Publishing in peer reviewed journals is the hallmark of an accomplished doctor. As doctors, we have 3 responsibilities – to our patients by upholding the highest standards of care, to future generations of doctors by teaching them and to our profession by sharing our knowledge and experience. Publication of the results of clinical work and reviewing the results of studies published by others is the result of and proof of critical independent thought. These activities demonstrate that the author who is a doctor is not only capable of following e.g. I do because my chief told me so, but of being a leader – I do because I have analysed the evidence and the evidence shows so. But why is it important to think critically?.

The introduction should be brief and focused and should contain a background to the study in question and hypothesis to be tested with relevant references.

Semen analysis is an important tool in the diagnosis of male infertility. Through its cellular and chemical components, human semen can provide information on the functional properties of the organs producing this fluid i.e., the testis, epididymis, and accessory glands.

Obesity epidemic is taking the globe in its stride with the metamorphosed lifestyle. Obesity prevalence is constantly increasing with over a third of population being overweight or obese in India. It contributes in a big way to pathogenesis of chronic non-communicable diseases. Interventions to reduce burden of obesity, partly depend on detecting and understanding the risks complicating obesity. This article summarizes the need for focused clinical skills on obesity related health risks and vigorous validation of benefits possible through interventions toward weight management in patients.

A heart attack in the 1950s was like a death warrant1. Those who reached the hospital alive would be sentenced by the physician to be confined to bed for six weeks or longer and in spite of this ‘treatment’, nearly a third succumbed. Such devastating effects of Coronary artery disease stimulated physicians to look frantically for treatment. It was a challenging time for clinicians investigating treatment options for Angina Pectoris. Armed only with Electro Cardiograms - ECGs (recorded painstakingly on a drum or photographically to be developed in a dark room), the journey to understand the pathophysiology of Coronary Artery Disease and its treatment had just begun - with no Coronary Care Units, no echocardiography, no biological markers, no nuclear imaging, but just an infectious passion to contain the dreaded killer

‘Genetics’ is a term ‘allergic’ to most of the physicians, but the day has come that they need to understand and make use of it for better patient management. There are many studies in recent times showing unequivocal association of select genes with hypersensitivity to select drugs. One such widely known in the recent times is the ‘Abacavir’, an anti-retroviral drug widely used to treat AIDS patients, and patients with HLAB*57:01 develop severe adverse reactions1. Another sister clade of this HLA, viz B*58:01 has on the other hand been shown to cause severe cutaneous adverse reactions (SCAR) with ‘allopurinol’ treatment of gout patients2 . Hence in the West, clinics have started testing HLA B*57 and 58 status before prescribing these drugs.