Background Long-term postdiscectomy degenerative disc disease and low back pain is a well-recognized disorder; however, its patient-centered characterization and quantification are lacking. Questions/purposes We performed a systematic literature review and prospective longitudinal study to determine the frequency of recurrent back pain after discectomy and quantify its effect on patient-reported outcomes (PROs). Methods A MEDLINE search was performed to identify studies reporting on the frequency of recurrent back pain, same-level recurrent disc herniation, and reoperation after primary lumbar discectomy. After excluding studies that did not report the percentage of patients with persistent back or leg pain more than 6 months after discectomy or did not report the rate of same level recurrent herniation, 90 studies, which in aggregate had evaluated 21,180 patients, were included in the systematic review portion of this study. For the longitudinal study, all patients undergoing primary lumbar discectomy between October 2010 and March 2013 were enrolled into our prospective spine registry. One hundred fifteen patients were more than 12 months out from surgery, 103 (90%) of whom were available for 1-year outcomes assessment. PROs were prospectively assessed at baseline, 3 months, 1 year, and 2 years. The threshold of deterioration used to classify recurrent back pain was the minimum clinically important difference in back pain (Numeric Rating Scale Back Pain [NRS-BP]) or Disability (Oswestry Disability Index [ODI]), which were 2.5 of 10 points and 20 of 100 points, respectively. Results Systematic Review The proportion of patients reporting short-term (6-24 months) and long-term ([ 24 months) recurrent back pain ranged from 3% to 34% and 5% to 36%, respectively. The 2-year incidence of recurrent disc herniation ranged from 0% to 23% and the frequency of reoperation ranged from 0% to 13%. Prospective Study At 1-year and 2-year followup, 22% and 26% patients reported worsening of low back pain (NRS: 5.3 ± 2.5 versus 2.7 ± 2.8, p \ 0.001) or disability (ODI%: 32 ± 18 versus 21 ± 18, p \ 0.001) compared with 3 months. Conclusions In a systematic literature review and prospective outcomes study, the frequency of same-level disc herniation requiring reoperation was 6%. Two-year recurrent low back pain may occur in 15% to 25% of patients depending on the level of recurrent pain considered clinically important, and this leads to worse PROs at 1 and 2 years postoperatively.

Introduction COVID19* is a new disease with significant mortality risk. Because of the scarcity of the study on factors associated with the mortality in Tamil Nadu present study was done to determine the factors associated with the outcome of the COVID19 patients admitted in a tertiary care hospital, Madurai. Method ology : 4530 lab confirmed COVID19 patients admitted from March to August 31st , 2020; excluding the non-responders or who gave incomplete information were included in the study. Data retrieved from Case Investigation Forms *filled through telephonic interview. Chi -square test, Univariate and multivariate logistic regression were used to find out the association between the factors and risk of death(outcome). Results Out of 4530 COVID19 positive patients 381(8.4%) died and 4149(91.6%) were discharged. Using multivariate logistic regression* following were the factors predicted to be associated with mortality:Age group <17yrs(PR = 4.12),30–44yrs(PR = 2.28),45–59(PR = 3.12),60–69(PR = 4.26) and ≥ 70(PR = 7.05); male gender(PR = 1.26); breathlessness at the time of admission(PR = 7.05); with 1symptom (PR = 2.58), 2symptoms(PR = 3.16) and ≥ 3 symptoms(PR = 2.45); chronic kidney disease(PR = 3.07), malignancy(PR = 2.39); other chronic diseases(PR = 1.89); having only diabetes(PR = 1.58); diabetes with hypertension (PR = 1.70); diabetes with heart disease(PR = 1.94); Hypertension with heart disease(PR = 2.30); diabetes with hypertension and heart disease(PR = 1.58). Survival probability* was more than 90% when patient gets admitted within a week after symptom onset,<80% for between 7 and 10 days and declines thereafter. Conclusion Early insights into factors associated with COVID-19 deaths have been generated in the context of a global health emergency *which may help the treating physician.

Background: Chronic obstructive pulmonary disease (COPD) is a major public health problem with increasing prevalence especially in developing countries. Burden of disease estimation is important for decision making, planning, prioritising and allocating funds. It has been found that the recent data on prevalence of COPD is less in south India, especially Tamil Nadu. Hence this study was undertaken in order to estimate the prevalence of COPD in Madurai among adults and its association with socio demographic variables. Methods: This is a community based cross-sectional study done in Kallendiri block of Madurai district with adults aged >30 years of both the sexes as study population. Sample size was 480. Using cluster sampling method, study participants were interviewed with semi-structured questionnaire and peak expiratory flow rate was measured using peak flow meter. Results: Prevalence of COPD was 22.1% among the study population. Males (39.2%) had higher prevalence than females (12.2%). COPD prevalence was significantly higher among increasing age, male sex, illiteracy, low BMI, smokers, inadequate ventilation and those using biomass fuels for cooking. Conclusions: This study has established the fact that COPD is highly prevalent among adults in rural area. For practitioners, the results call for a high index of suspicion of COPD among >30 years with substantial exposure to risk factors. For health policy makers, the results of the current study urge for the development of COPD prevention programs failing which the burden of COPD might result in increased mortality, morbidity and economic burden.

Background COVID-19 pandemic causes major impact on economic, physical, mental well-being of people all over the world. Doctors are working in stressful, unprepared, limited resource setting, and they are under the continuous threat of getting infection. Managing mental health of these warriors is great importance. Hence the present study to estimate the psychological impact of COVID-19* and factors associated with it among doctors in tertiary care hospital, Madurai. Methods A Cross-sectional study was conducted during October–November 2020 using a pre-designed semi structured questionnaire and DASS-21 scale which were sent through Google form to doctors who were in their quarantine period after the COVID duty. Totally 292 responses were received. Descriptive statistics done to find frequencies and percentages. Correlation for continuous variables; Univariate and multivariate regression for categorical variables were used to predict the factors influencing the psychological impact. Results In our study, 42.1% doctors were depressed, 43.8% were stressed and 50.7% had anxiety. Depression*, anxiety*, stress* scores were positively correlated with number of COVID duties(r 2 0.163,0.138,0.133), number of elderly persons(r 2 0.188,0.169,0.188) in their family and negatively correlated with sleep duration(r 2 –0.219,-0.281,-0.239), attitude of study participants(r 2 -0.319,-0.274,-0.291). Multiple logistic regression showed that disturbed sleep(odd'sratio = 3.931,2.734,3.420) and poor quality of sleep which affect the next day function(odd'sratio = 3.470,2.968,3.122) were significant predictors for all three psychological impacts. Conclusion High prevalence of psychological impact estimated, ensures the requirement of early screening with timely psychological intervention and establishment of guideline policies to support mental health of healthcare workers* for maintaining the functionality of healthcare system.

Background COVID-19 is a new pandemic disease. This disease course and its effect on pregnancy is little known due to limited available data. The objective of this study was to describe the demographic profile of COVID-19 positive mothers admitted in Government Rajaji hospital, Madurai in terms of time, place and person and to assess the general and pregnancy outcome of study population. Methods This cross-sectional study was done among 381 COVID-19 positive mothers* admitted during March 22 – August 31, 2020 in dedicated COVID-19 hospital, Madurai. Data was collected using Case Investigation Form (CIF) as a part of Rapid Response Team*(RRT) by Community Medicine* Department and analysed using SPSS version 21. Descriptive statistics done; Chi-square test & Fischer exact test was done to find out association between patient profile and outcomes. Results Out of 381, 154 (40.4%) belonged to 21–25 years, 192 (50.4%) to rural area, 318 (83.5%) to 3rd trimester,189 (49.6%) Primi gravida. 125 (32.8%) were symptomatic and 153 (80.8%) had at least one comorbidity. Death as general outcome was 3 (0.8%), all of them were referred cases and had comorbidity like GDM/PIH. 10 (2.62%) had abortion or perinatal death, 14 (3.77%) had preterm delivery , 99 (25.98%) babies were born small for gestational age. Increased maternal age had more death but was not statistically significant; All symptomatic mothers (p = 0.000),1st & 2nd trimester (p = 0.000) mothers had statistically significant poor pregnancy outcome*. Conclusion COVID positive mothers with increased age, symptomatic, 1st & 2nd trimester were significantly associated with poor outcome, requires special attention. Early referral must be emphasized to mitigate maternal death.