Government Vellore Medical College (GVMC) or Government Vellore Medical College Hospital (GVMCH) is a Medical Council of India (MCI) recognised medical college located at Adukkamparai, Vellore city in Tamil Nadu. It is about 8 km from Vellore Town Bus Terminus. Established in 2005, it is a relatively new medical college in Tamil Nadu offering an MCI recognised Bachelor of Medicine, Bachelor of Surgery (MBBS), General Medicine MD, and General Surgery MS courses., MS Obstetrics and Gynaecology, MD Anaesthesiology, MD Pediatrics.
Background: Tapentadol is a centrally acting opioid analgesic with m-opioid receptor agonism and norepinephrine reuptake inhibition. Although approved for the management of moderate to severe pain, emerging reports suggest increasing misuse of tapentadol in India, particularly through tampering of oral tablets for intravenous use. Limited data are available regarding the clinical profile and complications associated with this pattern of use. Case series: We describe 13 treatment-seeking young adults with intravenous tapentadol abuse who presented to a tertiary care center between January and December 2025. All patients were male, aged 16–29 years, and from rural backgrounds. The duration of intravenous tapentadol use ranged from 6 months to 6 years, with maximum daily doses ranging from 500 mg to 4000 mg. Alcohol (46.2%) and cannabis (38.5%) were the most common primary substances used before tapentadol initiation. Eight patients fulfilled the ICD-10 criteria for opioid dependence syndrome, while five had harmful opioid use. At presentation, Clinical Opiate Withdrawal Scale (COWS) scores ranged from 12 to 30, indicating mild-to-moderately severe withdrawal. Patients also exhibited psychiatric features, including low mood, aggressive behavior, suicidal ideation, and deliberate self-harm behavior. Injection-related complications, including abscess, cellulitis, and thrombophlebitis, were observed in three patients, while four patients tested positive for hepatitis B. Conclusion: Intravenous tapentadol use among young adults from rural backgrounds represents an emerging public health concern in India. Early identification, harm-reduction strategies, and strengthening of regulatory measures are essential to address the growing misuse of prescription opioids.
Background: Serum ferritin, an indicator of body iron stores as well as an acute-phase reactant, has been investigated as a potential prognostic biomarker in acute ischaemic stroke (AIS). This study evaluated the prognostic relevance of serum ferritin, its association with functional outcome using the modified Rankin Scale (MRS), and its relationship with established vascular risk factors in patients with AIS. Methods: This prospective observational study was conducted in the Department of General Medicine, Government Mohan Kumaramangalam Medical College Hospital, Salem, between November 2018 and August 2019. Sixty patients with AIS presenting within 48 hours of symptom onset were enrolled after informed consent. Baseline demographic, clinical, and laboratory characteristics were recorded. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) at admission, and functional outcome was evaluated using the mRS at 4 weeks. Serum ferritin was measured at admission. Results: The mean age was 59.68 ± 10.12 years, and 70% were men. At 4 weeks, 33.3% had good (mRS 1–2) and 66.7% had poor (mRS 3–6) functional outcomes. Mean serum ferritin was 229.71 ± 132.02 ng/mL. Ferritin correlated weakly with age (r=0.309, p=0.016) but not with hypertension, diabetes mellitus, dyslipidaemia, smoking, or alcohol use. Ferritin was significantly higher in patients with poor than good outcome (266.2 ± 131.0 vs. 156.8 ± 103.5 ng/mL; p=0.002). Every 50 ng/mL ferritin increase independently increased the odds of poor outcome by 38% (aOR 1.38; 95% CI: 1.05–1.82; p=0.021). ROC analysis showed an AUC of 0.758; a ≥205 ng/mL cut-off provided 75% sensitivity and 70% specificity. Conclusion: Higher admission serum ferritin was independently associated with poor 4-week functional outcome in AIS and demonstrated moderate predictive ability, supporting its potential role as an adjunctive prognostic marker.
Abstract Background Understanding antimicrobial use and factors driving it in communities is essential to devise its stewardship and reduce emergence of antimicrobial resistance. Objectives To study the intersectional influence of socioeconomic status, migration and place of treatment on antimicrobial use in a semi urban area in Tamil Nadu, India. Methods We conducted a cross-sectional survey among systematically sampled 525 adult men and women from three villages in a semi-urban area in Tiruvallur district. We collected data through structured interviews on incidence of infections in the past 3 months, treatment seeking behaviour, and audited the antimicrobial prescription or empty packs of medicines used. We analyzed the data using R statistical software and performed a multilevel analysis of individual heterogeneity and discriminatory accuracy to study intersectional effects. Results We found that the incidence of infection syndrome was 37% with a majority of them being acute respiratory infections. 143 of them sought treatment, with 40% going to a private general practitioner. People belonging to middle class had a 3.7 times greater odds of going to private sector compared to lower class. Twenty eight (19.6%) of those who sought treatment received an antimicrobial prescription. Sixty percent of them belonged to Access group, 35.7% Watch and 3.6% Restrict group. There was a significant intersectional effect showing middle class- non migrant – private care seekers having 22% probability of antimicrobial use versus lower class – migrant – government care seekers having 16% probability. The variance partition coefficient was 2.6% showing a small by significant portion of the variance contributed by intersectional identities. Conclusion Antimicrobial use in the community is significantly shaped by the intersection of socioeconomic status, migrant status and place of seeking care for the infection. Regulation of private sector prescription patterns and improving access to health care for migrants are key policy interventions.
Background: Diabetes peer support groups help improve adoption of self management behaviours and improvement of glycemic control. Objectives: To evaluate the effectiveness of community based diabetes peer support groups plus diabetes self management education using mobile phones compared to diabetes self management education alone in adoption of self management behaviours, reduction of diabetes distress and improvement in glycemic control, blood pressure, and weight among patients with type 2 diabetes in a rural community in Tamil Nadu, India. Methods: We conducted a cluster randomized controlled trial with homogeneous clusters of 10-12 participants, randomized to intervention and control arms. We formed 29 intervention clusters with 223 participants, and 21 control clusters with 266 participants. The intervention included monthly peer support group meetings. In addition, we developed 24 short videos and shared them through mobile phone and distributed printed pamphlets to all the participants to provide diabetes self management education. We measured the summary diabetes self care activities score, diabetes distress score every 3 months, weight every 6 months and HbA1c at baseline and endline. Linear Mixed Models were fit for all the hierarchical clustered data using R software. Results: Out of a total of 489 participants randomized to the two arms, 121 (24.7%) dropped out of the study during the 2 years. There was no statistically significant effect of peer support on overall self management, diabetes distress, blood pressure, glycemic or weight control. However, peer support had a significant small, time dependent effect beyond 12 months in diet (b=0.01; p<0.001) and foot care behaviours (b=0.02; p<0.01). A significant dose response relationship was also observed with each additional group meeting attended leading to 0.8 (p<0.001) units greater improvement in self management scores. Conclusion: Diabetes peer support may have a small, delayed and dose dependent impact on certain diabetes self-management behaviours.
Background: Tapentadol is a centrally acting opioid analgesic with m-opioid receptor agonism and norepinephrine reuptake inhibition. Although approved for the management of moderate to severe pain, emerging reports suggest increasing misuse of tapentadol in India, particularly through tampering of oral tablets for intravenous use. Limited data are available regarding the clinical profile and complications associated with this pattern of use. Case series: We describe 13 treatment-seeking young adults with intravenous tapentadol abuse who presented to a tertiary care center between January and December 2025. All patients were male, aged 16–29 years, and from rural backgrounds. The duration of intravenous tapentadol use ranged from 6 months to 6 years, with maximum daily doses ranging from 500 mg to 4000 mg. Alcohol (46.2%) and cannabis (38.5%) were the most common primary substances used before tapentadol initiation. Eight patients fulfilled the ICD-10 criteria for opioid dependence syndrome, while five had harmful opioid use. At presentation, Clinical Opiate Withdrawal Scale (COWS) scores ranged from 12 to 30, indicating mild-to-moderately severe withdrawal. Patients also exhibited psychiatric features, including low mood, aggressive behavior, suicidal ideation, and deliberate self-harm behavior. Injection-related complications, including abscess, cellulitis, and thrombophlebitis, were observed in three patients, while four patients tested positive for hepatitis B. Conclusion: Intravenous tapentadol use among young adults from rural backgrounds represents an emerging public health concern in India. Early identification, harm-reduction strategies, and strengthening of regulatory measures are essential to address the growing misuse of prescription opioids.
