Table of Contents : Journal of clinical and diagnostic research : 2026 - November - 20

Netter’s: Anatomy that Fits Your Pocket

Surraj Susai, Daisy Loyola Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X

Hepatocellular Carcinoma Presenting Clinically as a Scapular Mass: A Case Report

Payal Arvind Chawhan, Upinderjeet Singh, Alfa Shamim Saifi, Divesh Jalan, Priyadharshini Bargunam Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Hepatocellular Carcinoma (HCC) is an aggressive malignancy with a strong propensity for vascular invasion and distant metastasis, although presentation with isolated bone lesions remains uncommon. The diagnosis of metastatic HCC can be challenging in patients lacking underlying liver-related symptoms or known chronic liver disease. In this report, authors present an exceptionally rare case of a 70-year-old male presenting with right scapular pain and swelling as the primary manifestation of HCC with bone metastasis. Because appendicular skeletal involvement is rare-with fewer than 10 cases of scapular metastasis documented-and patients frequently lack abdominal symptoms, initial misdiagnosis is common. Given the highly vascular nature of HCC metastases, these lesions carry a significant risk of acute vascular complications. This case emphasises the importance of including HCC in the differential diagnosis of atypical osteolytic lesions. A multidisciplinary approach integrating advanced imaging, histopathology, and immunohistochemistry is essential for timely diagnosis and appropriate management.

Rosai-Dorfman Disease Presenting as a Primary Mesenteric Mass in an Elderly Patient: A Rare Case Report

Kanthilatha Pai, Pratik Bhat, Brij Mohan Kumar Singh, Veena Raghavan Varier, Debyani Kishore Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Rosai-Dorfman Disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is a rare benign non-Langerhans cell histiocytic proliferative disorder that commonly presents with painless cervical lymphadenopathy in young adults. Extranodal involvement occurs in nearly 40% of cases; however, isolated abdominal disease is exceptionally uncommon and may mimic neoplastic lesions radiologically. This case report describes a rare case of mesenteric RDD presenting as an abdominal mass clinically and radiologically suggestive of a Gastrointestinal Stromal Tumour (GIST). A 66-year-old male presented with a 2-week history of abdominal pain and dysuria. Imaging revealed a progressively enhancing soft-tissue mass in the left lumbar region supplied by the superior mesenteric artery, favouring a diagnosis of GIST. Surgical exploration identified a highly vascular mesenteric mass attached to the small bowel. Histopathological examination showed marked lymphoid follicular hyperplasia with sinusoidal proliferation of large histiocytes exhibiting emperipolesis. Immunohistochemistry demonstrated positivity for S100, CD68, and Cyclin D1, while CD15 and CD30 were negative, excluding Hodgkin lymphoma. These findings confirmed the diagnosis of mesenteric RDD. This case highlights the diagnostic challenge posed by isolated abdominal RDD due to its non-specific clinical and radiologic features. Recognition of characteristic histopathological findings and immunophenotypic profile is essential for accurate diagnosis and appropriate management. RDD should be considered in the differential diagnosis of unexplained abdominal masses to avoid misdiagnosis and unnecessary aggressive treatment.

Quadriplegic Cerebral Palsy with Infantile Spasm and Lissencephaly: An Unusual Case of Neurological Convergence

Krupa Bhanushali, Revat Meshram, Amar Taksande, Aditya Jain Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Cerebral palsy is a clinically defined symptom complex applied to individuals with a static, non progressive motor impairment of early onset, cerebral in origin. It is an aetiologically heterogeneous condition with multiple causes that feature an aberration or injury to the maturing central nervous system. Lissencephaly is a rare congenital condition that causes the developing brain to appear smooth, rather than the normal sulci and gyri. Here is a case of a 7-month-old female child with features like microcephaly, hypertonia and atypical movements, suggestive of quadriplegic cerebral palsy. The child also had multiple infantile spasms and was managed for the same. On Magnetic Resonance Imaging (MRI) studies, features of lissencephaly with Dandy-Walker malformation were noted. While a child with cerebral palsy can be diagnosed with anatomical malformations of the brain as well as seizures, the convergence of lissencephaly and infantile spams in a child with diagnosis of cerebral palsy is a rare phenomenon. Hence, the need to do a comprehensive workup of a child with cerebral palsy is critical to not miss the associated conditions. The present case highlights the importance of a comprehensive workup for a child with cerebral palsy to address correctable issues and improve quality of life.

Infantile Nephropathic Cystinosis Presenting as Bartter-like Syndrome in Infancy: A Case Report with CTNS Gene Variant

Elakeya Elumalai Saraswaty, Shivaashankari Dharmalingam, Shanmugam Muthukrishnan, Ajay Subramanian Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Nephropathic cystinosis is a rare autosomal recessive lysosomal storage disorder caused by mutations in the CTNS gene, leading to cystine accumulation and multiorgan involvement. It typically presents with features of proximal tubular dysfunction; however, atypical presentations may pose diagnostic challenges. In the present case, a male infant, aged 11 months, who was born out of a non-consanguineous marriage was brought to the hospital with a history of failure to thrive, polyuria, and polydipsia. Both his height and weight were below the third percentile. Bartter syndrome like tubulopathy was suggested by hypokalaemia, and elevated renin levels. Following initiation of Indomethacin therapy for suspected Bartter’s syndrome, there was partial clinical improvement in symptoms. The results of the ocular examination were normal. Whole exome sequencing identified a mutation in the CTNS that causes infantile nephropathic cystinosis. This case highlights that infantile nephropathic cystinosis should be considered in infants presenting with hypokalaemia, persistent polyuria, polydipsia, failure to thrive, and elevated plasma renin, even in the absence of classical Fanconi syndrome or corneal cystine crystals.

Atypical CHARGE Syndrome with Auditory Neuropathy and Vestibulocochlear Nerve Aplasia: A Case Report

S Sweatha Shree, Sree Divya Mohan, Sundari Subramanian Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X The CHARGE syndrome represents a rare congenital disorder characterised by a constellation of ocular, auditory, vestibular, craniofacial, and developmental anomalies, most commonly linked to pathogenic variants in the CHD7 gene. The phenotypic spectrum is notably wide, and advances in molecular diagnostics have increasingly revealed incomplete and atypical presentations. This report describes a 17-month-old male child presenting with developmental delay, ocular coloboma, inner ear malformations, vestibulocochlear nerve aplasia, and Auditory Neuropathy Spectrum Disorder (ANSD), alongside absence of choanal atresia, cardiac, or renal anomalies. Whole exome sequencing identified a pathogenic CHD7 mutation, confirming atypical CHARGE syndrome. This case is notable for the rare coexistence of ANSD with unilateral vestibulocochlear nerve aplasia in genetically confirmed atypical CHARGE syndrome. The absence of classical features such as choanal atresia, cardiac, and renal anomalies further emphasises the expanding phenotypic spectrum. Radiological-audiological discordance underscores the importance of detailed neuroimaging in children with unexplained hearing loss. This report highlights the critical role of whole exome sequencing in diagnosing incomplete presentations of CHARGE syndrome and guiding multidisciplinary management.

Perioperative Anaesthetic Management of Ludwig’s Angina with Awake Fibreoptic Intubation and Ultrasound Guided Cervical Plexus Block: A Case Report

Ajinkya Akulwar, Neeta Chaudhary, Amreesh Paul Francis Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Ludwig’s Angina (LA) is an acute infection associated with the deep cervical region that can rapidly lead to airway obstruction. Unique problems arise in airway management due to trismus, an elevated floor of the mouth, abnormal airway anatomy, and sudden airway obstruction at the time of induction of anaesthesia when such infections are present. This report describes the perioperative management of a 46-year-old male who presented with progressively worsening submandibular swelling, dysphagia, and restricted mouth opening due to an odontogenic infection. He was scheduled for an urgent incision and drainage of a submandibular abscess. Given the anticipated difficult airway, the patient was intubated awake using a nasal fibreoptic technique while receiving dexmedetomidine sedation and nebulised lignocaine for airway topical anaesthesia, with spontaneous ventilation maintained throughout the procedure. Following successful airway management, he was subsequently given General Anaesthesia (GA) and a Superficial Cervical Plexus Block (SCPB) (performed by ultrasound guidance) to provide perioperative analgesia. Upon completion of the surgical procedure, the patient required elective postoperative ventilatory support due to airway swelling and was subsequently extubated with relative ease after demonstrating clinical stability. This case illustrates the significance of complete airway planning, maintenance of spontaneous ventilation during airway procedures, and the benefits of utilising several anaesthetic techniques to ensure the safe provision of required perioperative anaesthetic care for patients with LA.

Therapeutic Role of Repeated Shodhana (Virechana) in Management of Plaque Psoriasis (Kitibha Kushta): A Case Report

Sonali D Konkeri, Basavaraj R Tubaki, Aayushi U Soni, Bawadkar Prasad Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Psoriasis is a chronic inflammatory skin disorder characterised by well defined erythematous plaques with silvery scales, pruritus, and pain. Hereby, the authors present a case of 49 year old male present-ed with indurated plaques affecting the limbs and back for four years, diagnosed as plaque psoriasis (Kitibha Kushta in Ayurveda). Management involved repeated Virechana procedures over 31 months. Each cycle began with Deepana Pachana (Chitrakadi Vati, Hingwashtaka Choorna), followed by Snehapana (Tiktaka Ghrita) and Virechana (Trivrita Lehya), along with Samsarjana Krama for post purification recovery. Internal medications included Aarogyavardhini Vati and other supportive formulations, while external care comprised Cutisora ointment and medicated oils (tailas). Clinical outcomes demonstrated sustained improvement: the Psoriasis Area and Severity Index (PASI) decreased from 12.9 to 6, and the Dermatology Life Quality In-dex (DLQI) improved from 19 to 5. No adverse effects were reported. The decision to employ repeated Virechana was based on the chronicity of disease, bahudosha avastha (multi dosha involvement), and initial non responsiveness to therapy. This approach resulted in progressive and sustained clinical benefit.

Reconstruction of the Lower Lip and Oral Commissure Using a Composite Radial Forearm Free Flap with Palmaris Longus Tendon Following Resection of Well-Differentiated Squamous Cell Carcinoma: A Case Report

Imran Salim Solanki, Rajanikanth Kambala, Nitin Bhola, Parmarth Sonpal Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Well-Differentiated Squamous Cell Carcinoma (WDSCC) of the lower lip is managed by complete oncologic excision with safe margins, appropriate assessment of regional neck, and immediate reconstruction aimed at restoring oral competence, speech, swallowing, and facial symmetry. For extensive lower-lip defects involving the commissure, local flaps may be inadequate because they can cause microstomia or insufficient sphincter support. A 49-year-old male with a 20-year history of kharra/tobacco chewing presented with a painful ulceroproliferative lesion of the lower lip extending to the left oral commissure and gingivobuccal sulcus. Clinical examination showed a 4×3.3×2 cm lesion with restricted mouth opening and no palpable cervical lymphadenopathy. Incisional biopsy confirmed WDSCC. Contrast-enhanced computed tomography was used for locoregional assessment, after which wide local excision with left modified radical neck dissection type I and right supraomohyoid neck dissection levels I-III was performed. The ablative defect was reconstructed using a composite radial forearm free flap incorporating the palmaris longus tendon as a sling to recreate lower-lip support. Histopathology confirmed WDSCC with negative mucosal, skin, and deep margins, Depth Of Invasion (DOI) of 15 mm, positive skin involvement, no lymphovascular or Perineural Invasion (PNI), and 0/15 metastatic lymph nodes, corresponding to pT4aN0Mx. Postoperative recovery was uneventful. At six months of follow-up, the patient had a mouth opening of approximately 40 mm, with satisfactory restoration of oral competence and facial aesthetics. No evidence of recurrence was observed during the follow-up period. The case report provides further evidence in documenting single stage commissure and near total lower lip reconstruction using a tendon incorporated radial forearm flap in a nutritionally vulnerable, medically comorbid patient.

Endodontic Management of C-shaped Canals Configuration in Taurodontic Teeth: A Report of Two Cases

Vaishnavi Jemini Kasat, Anita Tandale, Manasi Vaidya Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Taurodontism represents a rare morpho-developmental dental anomaly characterised by apical displacement of the pulpal floor and an enlarged pulp chamber. It presents serious endodontic and diagnostic difficulties when combined with abnormal canal shapes like C-shaped canals. Besides advanced imaging aids like Cone-Beam Computed Tomography (CBCT) along with magnification and illumination, irrigation activation with NaOCl are helpful in managing these cases. This report describes the endodontic treatment of two mesotaurodontic teeth with different C-shaped canal anatomies. A mandibular second molar in Case 1 exhibited a C2-type canal configuration whereas in Case 2, mandibular second premolar had a C4-type pattern. CBCT along with magnification was essential in defining the interior anatomy and directing the course of treatment. Enhanced irrigation activation was employed for effectively disinfecting the uninstrumentable intercommunications, apical splits, and ramifications in conjunction with a modified hybrid rotary technique for cleaning and shaping. Obturation was modified in both the cases and was accomplished by combining calcium silicate based sealer with lateral compaction and resin based sealer followed by thermoplasticised gutta-percha technique to ensure three-dimensional sealing of the intricate canal system. Over the course of the 12-month follow-up period, both cases showed good healing and remained asymptomatic. The successful therapy of taurodontic teeth with C-shaped canals highlights the critical role that CBCT plays in diagnosis along with the use of magnification. To overcome the anatomical complexities associated with such morphologies, a customised biomechanical, chemical and obturation procedure is essential.

Therapeutic Outcome of Krimi Chikitsa (Anti-parasitic Protocol) in Intestinal Amoebiasis w.s.r. to Pureeshaja Krimi: A Case Report

Meghana Daivat Liman, Snehalata Shivajirao Pawar, Bhavya Khurana, Manisha Mukesh Thakare Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Amoebiasis, caused by the protozoan Entamoeba histolytica, remains a significant global public health concern, contributing to considerable morbidity and mortality. A 35-year-old male presented with altered bowel habits, including semi-solid stools with mucus discharge, mild lower abdominal pain and distension, a sensation of incomplete evacuation, anal itching, and loss of appetite for one month, along with emaciation. He was diagnosed with Pureeshaja krimi. Treatment was planned according to the krimi chikitsa protocol, which includes Apakarshana (elimination of parasites) through Yoga basti (a structured 8-day course of Anuvasana Basti 80 mL (oil enema) and Erandamooladi Niruha Basti 510 mL (decoction enema)), Prakriti vighata (disruption of the parasite-supportive environment), and Nidana Parivarjana (elimination of causative factors) through dietary and lifestyle modifications. The patient reported absence of Entamoeba histolytica on stool examination, with regular bowel habits and no mucus, and complete resolution of abdominal pain, distension, and anal itching and no recurrence over three months of follow-up. This structured classical krimi chikitsa provides evidence for the potential role of the krimi chikitsa protocol in managing amoebiasis by addressing both disease pathology and the host environment. However, this is a single case report; larger controlled clinical studies are required to standardise the treatment protocol.

Management of Refractory Pemphigus Vulgaris through Ayurvedic Shodhana Therapy: A Case Report

Vyom Upadhyay, Mujahid Khan Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Pemphigus Vulgaris (PV) is a chronic autoimmune blistering disorder characterised by painful mucocutaneous erosions. Standard management relies on systemic corticosteroids and immunosuppressants; however, many patients experience relapses when doses are tapered, leading to refractory disease. Present case report is of a 36 year old female with extensive erosions (60% body surface area) and recurrent “rebound flares” despite prolonged steroid therapy. Seeking a steroid sparing alternative, she underwent a structured Ayurvedic Shodhana (bio purification) protocol comprising Vamana (therapeutic emesis), Virechana (therapeutic purgation), and adjunctive Jalaukavacharana (leech therapy), along with supportive internal and external care. Over 12 weeks, progressive improvement was observed, with near-complete clinical remission with full re-epithelialisation of cutaneous and mucosal lesions. While this case highlights the potential role of Ayurvedic detoxification therapies in refractory PV, the absence of standardised scoring indices and immunopathological confirmation limits generalisability. Larger, controlled studies are warranted to objectively evaluate efficacy and long term outcomes.

Non-extraction Camouflage of Class II Malocclusion Using Forsus Fatigue Resistance Device in a Late Adolescent: A Case Report

Tejaswi Kamble, Ranjit Kamble, Srushti Atole, Ashray Nimje Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Management of Class II malocclusion in late adolescents pose a therapeutic challenge due to the limited growth potential and the need to achieve balanced occlusal correction with facial aesthetics. While fixed functional appliances such as the Forsus Fatigue Resistance Device (FRD) are widely used during active growth phases, literature describing their application in growth-limited individuals is comparatively limited; particularly in patients with a horizontal growth pattern, where vertical control is critical. The present case presents a detailed description of a 19-year-old female patient with Class II malocclusion and its management by non extraction approach using Forsus FRD. Growth assessment was performed using cervical vertebral maturation indicators, confirming minimal residual growth potential. The present report focuses on treatment planning considerations, appliance selection and role of dentoalveolar camouflage in achieving functional occlusal correction, when growth modification is no longer possible. The case highlights the role of controlled biomechanics and torque management in achieving predictable dentoalveolar camouflage while minimising undesirable effects in late adolescent patient. Forsus FRD was delivered after alignment and levelling on a rigid stainless steel archwire with emphasis on incisor torque control. Active Forsus therapy was carried out for seven months, contributing in correction of molar and canine relationships and reduction in overjet. The total treatment duration was 24 months. Post-treatment results demonstrated achievement of bilateral Class I molar and canine relationships, improved facial profile, and satisfactory occlusal stability. Follow-up at six months showed stable results. The present case report addresses the limited evidence on the use of Forsus FRD in late adolescents with minimal growth potential and horizontal growth pattern.

Multidisciplinary Management of a Combined Endodontic Periodontal Lesion in a Young Adolescent: A Case Report

Rijuta Gujar, Punit Fulzele, Nilima Thosar, Ishani Rahate, Anjori Raut Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Endodontic-periodontal lesions are a group of lesions involving both the pulp and periodontal tissues due to the close anatomical and vascular inter-relationship between them. These lesions can present a diagnostic challenge because of their similar clinical manifestations and complex pathogenesis. Early diagnosis and prompt multidisciplinary management are particularly important in adolescents to preserve the natural dentition, to maintain supporting periodontal structures, and ensure proper oral function and aesthetics. This case report describes the successful management of a combined endo-perio lesion in a 13-year-old adolescent patient using a multidisciplinary approach involving endodontic therapy, periodontal therapy, Advanced Platelet-Rich Fibrin (A-PRF), and bone grafting. The patient presented with pain, swelling, deep periodontal pocketing, and radiographic evidence of extensive periapical and periodontal bone loss associated with a permanent mandibular molar. After thorough clinical and radiographic evaluation, a combined endodontic-periodontal lesion was diagnosed. Conventional root canal treatment was initially performed to eliminate the pulpal infection, followed by periodontal surgical intervention. Regenerative therapy was carried out using A-PRF combined with a bone graft to promote healing and regeneration of the lost periodontal structures. Postoperative follow-up demonstrated satisfactory clinical and radiographic healing, reduction in probing depth, improved periodontal attachment, and significant bone fill. This case highlights the importance of accurate diagnosis, interdisciplinary treatment planning, and the regenerative potential of A-PRF and bone grafts in managing endo-perio lesions in young patients, thereby improving prognosis and preserving the natural tooth.

Iatrogenic Methotrexate Toxicity Leading to Acute Oral Mucositis: A Rare Case Report

Saini Koner, Rudra Prasad Chatterjee, Sudeshna Bagchi, Sangeeta Sinha, Mousumi Pal Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Methotrexate (MTX) is a folate antagonist extensively employed in oral metronomic chemotherapy and the management of various autoimmune disorders. Despite its established therapeutic efficacy, its narrow therapeutic index predisposes patients to severe adverse effects following dosing errors or inappropriate administration. Oral mucositis represents one of the most debilitating manifestations of MTX toxicity and may be accompanied by significant haematological and cutaneous complications. This report describes a rare case of iatrogenic MTX toxicity in a 56-year-old male who inadvertently consumed MTX 7.5 mg daily instead of the prescribed mirtazapine for 10 consecutive days. The patient presented with extensive painful pan-oral ulcerations, purulent discharge, haemorrhagic crusting of the lips, de-papillated erythematous tongue, restricted mouth opening, and multiple necrotic cutaneous lesions involving the extremities and trunk. Haematological evaluation revealed severe anaemia, while peripheral blood smear, exfoliative cytology, and histopathological examination demonstrated features consistent with MTX-induced cytotoxic mucosal injury accompanied by chronic inflammatory cell infiltration. Following prompt recognition of the medication error, MTX was discontinued and supportive management comprising folic acid supplementation, haematinic therapy, topical corticosteroids and anti-inflammatory oral rinses was instituted. Progressive clinical improvement was observed within two weeks, culminating in complete resolution of oral and cutaneous lesions with normalisation of haematological parameters at two months. The present case highlights the potential for severe mucocutaneous and haematological toxicity even with short-term inadvertent exposure to low-dose MTX. Furthermore, it underscores the critical importance of medication reconciliation, patient education, attentive clinical observation and early recognition of oral manifestations to prevent avoidable iatrogenic morbidity and improve medical safety.

Multiple Neodymium Magnet Ingestion Causing Multisegment Bowel Entrapment in a Toddler: A Case Report

Jevina Daphne Winnifred, Jayatheertha Joshi, Kishan B Shetty, Leo Francis Tauro Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Ingestion of multiple high-powered neodymium magnets is a uniquely dangerous paediatric emergency. When distributed across non-contiguous bowel segments, transmural magnetic attraction causes progressive vascular compression, ischaemia, necrosis, and perforation. The incidence has risen sharply over the past decade, driven by the widespread availability of neodymium magnetic bead toy sets. Diagnosis is frequently delayed because children are often asymptomatic initially, creating a deceptive window during which bowel injury silently advances. A three and a half-year-old presented with bilious vomiting and fever without a reliable ingestion history. Plain radiograph revealed the stacked magnet sign across multiple abdominal quadrants. Conservative management failed the six-hour non-progression threshold, necessitating laparotomy. Magnets in the stomach, proximal jejunum, and transverse colon were drawing all three loops into stacked apposition with near-full-thickness ischaemia at each contact site. All were retrieved via gastrotomy and enterotomies; primary two-layer closure was performed. Recovery was uneventful. The stacked magnet sign mandates immediate surgical consultation. Adherence to the six-hour non-progression rule enabled timely laparotomy before frank perforation, which was directly responsible for the favourable outcome.

Cholestatic Liver Injury following Re-initiation of Carbimazole in a Patient with Graves’ Disease: A Case Report

S Meenatchi Sundaram, M Sukrit Nanda, N Srihari, N Jayaprakash, S Mohammed Thaha Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Carbimazole is a commonly used Antithyroid Drug (ATD) for the treatment of Graves’ Disease (GD). Although generally well tolerated, it can rarely cause drug-induced liver injury, typically presenting with a cholestatic pattern. Carbimazole-induced cholestatic liver injury is an uncommon and often underrecognised complication that may pose a diagnostic challenge. In this case, a 46-year-old man presented with jaundice for one month, along with pruritus, nausea, anorexia, weight loss, palpitations, heat intolerance, and tremors. He had GD and had been off treatment for nearly one year before restarting carbimazole 10 mg twice daily two months before presentation. The patients had symptoms of hyperthyroidism and jaundice. Laboratory tests showed conjugated hyperbilirubinaemia with a cholestatic pattern of liver injury and preserved liver synthetic function. Thyroid function tests confirmed thyrotoxicosis, and positive thyroid autoantibodies were consistent with GD as the underlying aetiology. Viral markers and autoimmune liver tests were negative. Imaging ruled out biliary obstruction, and liver biopsy showed cholestatic injury with canalicular bile plugs, consistent with carbimazole-induced cholestatic liver injury. Carbimazole was stopped, and two cycles of low-volume plasma exchange were performed. Thyrotoxicosis was controlled with Lugol’s iodine, dexamethasone, and propranolol, followed by total thyroidectomy. This case highlights that even late presentation and toxicity following re-initiation of carbimazole should be considered in patients presenting with cholestatic liver injury.

Ionised Hypocalcaemia as a Compounding Factor in Refractory Seizures During Opioid-benzodiazepine Withdrawal: A Case Report

Mittal Rohan Sindhav, Ronak Shah Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Concurrent opioid and benzodiazepine dependence is common in clinical practice, and abrupt cessation of either agent can independently precipitate withdrawal seizures that are frequently refractory to standard treatment. Ionised hypocalcaemia is a less widely recognised and potentially reversible contributor to seizure threshold lowering in this setting, and can be overlooked when only total serum calcium is measured. Hereby, the authors present a case report of a 28-year-old male with a 6-to-7-year history of polysubstance dependence, involving codeine-containing cough syrup, alprazolam, tobacco, gutkha, and intermittent methamphetamine use, in whom this compounding metabolic factor was identified during combined opioid-benzodiazepine withdrawal. He presented to the Emergency Department with altered sensorium and cluster tonic-clonic seizures approximately 48 hours after abrupt cessation of all substances. On arrival, the Glasgow Coma Scale (GCS) was 7 of 15, and arterial blood gas analysis showed a critically low ionised calcium of 0.56 mmol/L (reference range 1.12 to 1.32 mmol/L), while total serum calcium checked the following day was normal (10.4 mg/dL), illustrating that total calcium can be misleadingly reassuring when ionised calcium is critically low. Six further cluster seizures occurred in the Emergency Department despite prior benzodiazepine loading at a referring hospital, and management required intravenous sodium valproate, lorazepam, naloxone for diagnostic clarification of possible opioid co-ingestion, thiamine, intravenous calcium gluconate correction, and intensive-care-level monitoring with neurology and psychiatry co-management. Seizure frequency decreased progressively, with improvement in sensorium and correction of ionised calcium, and the patient was discharged on a structured benzodiazepine taper together with naltrexone for relapse prevention. The present case illustrates that combined opioid and benzodiazepine withdrawal can produce seizures resistant to initial benzodiazepine monotherapy, and that severe ionised hypocalcaemia should be actively sought and corrected as a potential contributing factor in withdrawal-associated seizures, particularly when radiological and cerebrospinal fluid evaluation are not feasible and other causes cannot be fully excluded.

Double Cortex Syndrome in an Adolescent Female with Refractory Epilepsy and Consanguineous Parentage: A Case Report

Paruvada Monika, PS Arthi, Paleti Tejo Varshini, Preethi, Nirmala Devi Chandrasekaran Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Double cortex syndrome, also known as Subcortical Band Heterotopia (SBH), is a rare X-linked dominant neuronal migration disorder caused by mutations in the Doublecortin (DCX) gene located at Xp22.3. It almost exclusively affects females, who present with variable degrees of epilepsy, developmental delay, and intellectual disability. We report an 18-year-old female born of second-degree consanguineous parentage who presented with multiple generalised tonic-clonic seizures and transient loss of consciousness. She had achieved normal developmental milestones until five years of age, when speech regression became apparent, followed by progressive learning difficulties and poor concentration during schooling. Physical examination confirmed global developmental delay. Electroencephalography (EEG) demonstrated epileptiform abnormalities. Computed Tomography (CT) of the brain revealed an abnormal band of grey matter deep to and paralleling the cortex bilaterally, raising the diagnosis of double cortex syndrome. Magnetic Resonance Imaging (MRI) of the brain confirmed bilateral symmetric subcortical grey matter bands isointense to normal cortex on all sequences, with frontoparietal cortical thickening and a thin intervening white matter layer creating the characteristic double cortex appearance. Antiepileptic therapy was initiated with referral for genetic counselling. This case underlines the critical role of MRI in the diagnosis of cortical malformations and the need for early genetic testing to guide management and family planning.

Diagnostic Challenges in Seronegative Autoimmune Limbic Encephalitis Presenting as Faciobrachial Dystonic Seizures: A Case Report

Tejo Varshini Paleti, Srija Sura, Shivam Gupta, Sagar Ashok Patil, Nirmala Devi Chandrasekaran Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Faciobrachial Dystonic Seizures (FBDS) are sudden brief seizure-like episodes, which are highly characteristic for Autoimmune Limbic Encephalitis (AIE), mostly associated with Voltage-gated Potassium Channel (VGKC), classically Leucine-Rich Glioma Inactivated-1 (LGI1). Timely diagnosis in seronegative patients poses a big challenge, often leading to delay in intervention, causing irreversible neuronal damage. A 66-year-old male with a history of hypertension for seven years on regular medications presented to neurology Outpatient Department (OPD) with one week history of recurrent brief involuntary dystonic movements involving left face and upper limb, along with neuropsychiatric manifestations. Initial assessment revealed mild hyponatraemia. Cerebrospinal Fluid (CSF) analysis, Magnetic Resonance Imaging (MRI) and Electroencephalogram (EEG) were unremarkable. Fluorodeoxyglucose-Positron Emission Tomography Computed Tomography (FDG PET-CT) revealed hypermetabolism in right mesial temporal cortex, bilateral caudate nuclei and putamen. Despite the fact that antibodies were absent in CSF, patient was still started on pulse intravenous corticosteroid therapy and Anti-Seizure Medication (ASM) along with immunotherapy resulting in significant improvement of the patient. The present case highlights the limitations in presently used diagnostic criteria, which rely heavily on MRI and CSF analysis. Advanced imaging techniques like FDG PET-CT are more sensitive, and hence support the diagnosis, when diagnostic criteria are not fulfilled. Timely initiation of immunotherapy based on strong clinical suspicion and advanced imaging is very important to prevent irreversible cognitive impairment.

Purple Urine Bag Syndrome as a Clinical Indicator of Bacteraemic Urosepsis Caused by Extensively Drug-resistant Escherichia coli: A Case Report

Mittal R Sindhav, Ronak Shah, Parth Shah Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Purple Urine Bag Syndrome (PUBS) is an uncommon but clinically informative finding in catheterised patients, arising from bacterial enzymatic conversion of urinary indoxyl sulphate to indigo and indirubin within alkaline drainage tubing. Although usually benign in isolation, PUBS can signal severe underlying infection, constipation, alkaline urinary pH, and renal impairment. We report a 77-year-old man with diabetes mellitus and Chronic Kidney Disease (CKD stage 4) who presented with fever, dysuria, and altered sensorium. Following urinary catheterisation, purple-violet discolouration of the drainage tubing developed within six to eight hours, confirming PUBS on bedside assessment; the finding prompted urgent urine microscopy. Urine and blood cultures grew Extensively Drug-Resistant (XDR) Escherichia coli with an identical antibiogram, resistant to carbapenems, colistin, and the empirically administered antibiotic, with susceptibility retained only to fosfomycin and nitrofurantoin. He was treated with oral fosfomycin trometamol under nephrology guidance and discharged on day five with clinical resolution and improved renal function. Paired photographs documented the discolouration and its complete resolution within 24 hours. To our knowledge, this is the first photodocumented report of PUBS associated with bacteraemic XDR E. coli with concurrent carbapenem and colistin resistance from an emergency department in a low- and middle-income country setting. The case illustrates the value of PUBS as a bedside alarm sign that can accelerate recognition of severe multidrug-resistant sepsis, and underscores the importance of pre-antibiotic culture collection and prompt antimicrobial stewardship in catheterised elderly patients with systemic illness.

Rhino-Orbito-Paranasal and Cavernous Sinus Mucormycosis Presenting with Extensive Cranial Nerve Palsies in a Patient with Diabetes Mellitus: A Case Report

Harsh Kansagara, Anil Wanjari, Tushar Sontakke, Nayan Mundhada, Rushikesh Dhondge Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Rhino-orbito-paranasal and cavernous sinus mucormycosis is a rapidly progressive angioinvasive fungal infection caused by moulds of the order Mucorales. It occurs predominantly in patients with poorly controlled diabetes mellitus and carries high mortality when diagnosis is delayed, particularly in South and South-East Asia. Here, the authors report a case of 56-year-old male with long-standing poorly controlled type 2 diabetes mellitus (Glycated Haemoglobin (HbA1c) 13.6%) and a prior episode of myocardial infarction presented with one month of progressive left nasal obstruction. Over the next two months, he developed complete left visual loss, total external ophthalmoplegia, proptosis, ptosis, trigeminal sensory loss involving branches V1-V3, and ipsilateral lower motor neuron facial nerve palsy. Histopathology of nasal crusting showed broad pauci-septate hyphae consistent with Mucorales, and fungal culture grew Rhizopus species. Magnetic Resonance Imaging (MRI) orbit demonstrated involvement of the left frontal, ethmoidal, sphenoid, and maxillary sinuses, with extension into the superomedial extraconal orbital space, orbital apex, and left cavernous sinus. Associated oedema of the extraocular muscles and pterygoid muscles, diffuse thickening of the left optic nerve, and mild proptosis were also noted. The patient was treated with left functional endoscopic sinus surgery, medial orbital decompression, and liposomal amphotericin B 250 mg daily for 21 days. The present case represents an unusually extensive pattern of cranial nerve involvement in Rhino-Orbito-Cerebral Mucormycosis (ROCM), affecting cranial nerves II-VII, and highlights the need for early tissue diagnosis, prompt antifungal therapy, and multidisciplinary management.

Right-sided Aortic Arch with Aberrant Left Subclavian Artery Arising from a Kommerell Diverticulum: A Case Report

Ankit Gandhi, Shashank M Hiremath, Aditya Hadole, Asif Tamboli, Amol Bhoite Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Right-sided aortic arch with an Aberrant Left Subclavian Artery (ALSA) arising from a Kommerell diverticulum is a rare congenital anomaly of the aortic arch system. A 58-year-old male presented with progressive exertional breathlessness and intermittent dysphagia. Contrast-enhanced CT aortography with multiplanar and three-dimensional reconstructions demonstrated a right-sided aortic arch with sequential branching of the left common carotid artery, right common carotid artery, right subclavian artery, and an ALSA arising from a Kommerell diverticulum. The aberrant vessel followed a retro-oesophageal course, causing indentation of the oesophagus, explaining the patient’s dysphagia. Mild fusiform dilatation of the aortic arch was also observed without evidence of dissection or rupture. This case highlights the importance of multidetector CT angiography in the diagnosis and anatomical characterisation of rare aortic arch anomalies. Early recognition of Kommerell diverticulum is important for appropriate clinical management, surveillance, and prevention of potential vascular complications.

Zinner Syndrome Presenting with Chronic Pelvic Pain in a Middle-aged Male: A Case Report

Ankit Gandhi, Shashank M Hiremath, Aditya Hadole, Asif Tamboli, Amol Bhoite Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Zinner Syndrome (ZS) is a rare congenital anomaly of the mesonephric (Wolffian) duct characterised by the classical triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ejaculatory duct obstruction. A 45-year-old male presented with chronic pelvic pain of two to three months duration associated with intermittent dysuria. Computed Tomography (CT) of the abdomen and pelvis demonstrated absence of the right kidney consistent with right renal agenesis and a large cystic lesion in the right seminal vesicle region. Dependent calcific foci within the cyst suggested inspissated secretions related to chronic ejaculatory duct obstruction. Magnetic Resonance Imaging (MRI) of the pelvis further characterised the lesion, revealing a well-defined cystic mass measuring approximately 9.7×8.1×17.5 cm located posterior to the urinary bladder. The lesion appeared hypointense on T1-weighted images and hyperintense on T2-weighted images with mild peripheral enhancement and no diffusion restriction. The cyst produced mass effect on adjacent pelvic structures while maintaining preserved fat planes. The imaging findings confirmed the diagnosis of ZS. The present case is distinguished by an unusually giant (17.5 cm) seminal vesicle cyst with dependent calcific/inspissated secretions, imaging features that are rarely reported in ZS. Recognition of these characteristic findings facilitates accurate diagnosis and appropriate management.

Urachal Cysts: A Report of Two Cases Highlighting Histopathological Diagnostic Challenges

Sathiya Murthy Divyasree, J Thanka, Vinutha Gali, K Anbukkarasi Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Urachal cysts are rare congenital anomalies arising from the incomplete obliteration of the urachus, an embryonic allantoic remnant that connects the foetal bladder dome to the umbilicus during 4-12 weeks of gestation. While the urachus normally involutes into the median umbilical ligament, failure of mid-urachal obliteration results in a cyst, which often predominates near the bladder due to gravity-dependent mucin accumulation. Although easily identified in infants via umbilical discharge, up to 35% of adult cases present as “silent” or enclosed cysts that mimic acute abdominal or urological pathologies. This case report highlights the diagnostic challenges through two adult cases, one was a 21-year-old male presenting with symptoms of lower abdominal pain and other was, a 49-year-old female presenting with symptoms of lower abdominal pain, burning micturition, and urinary frequency mimicking a urinary tract infection. Pathological examination in the latter revealed an urachal cyst with extensive granulomatous cystitis. This inflammation, featuring epithelioid granulomas and Langhans-type giant cells, presents a significant diagnostic pitfall, as it mimics genitourinary tuberculosis despite negative stains for acid-fast bacilli. Because these “diagnostic chameleons” can simulate conditions ranging from appendicitis to bladder malignancy, a high clinical suspicion and thorough histopathological evaluation are vital. Recognising urachal remnants in adults with atypical lower abdominal pain or recurrent urinary symptoms is essential to avoid diagnostic delays or unnecessary, long-term antitubercular therapy.

Autologous Platelet-rich Plasma in the Conservative Management of a Traumatic Foot Injury with Impending Gangrene in a Pregnant Patient: A Case Report

Ansh Khanduja, Sanjay V Deshpande, Krishna Sambare, Dev Pandhi Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Musculoskeletal trauma during pregnancy presents a dual challenge, as both the maternal management and foetal safety should be balanced together. This condition presents a challenge in the use of ionising imaging, anaesthesia and operative fixation. Autologous Platelet-Rich Plasma (PRP) can present as a better alternative for wound management in these conditions. This is a case of a 34-year-old female with 31-week gestation presented to the casualty department for the management of an incomplete traumatic amputation of the little toe of the left foot and a laceration over the dorsum. The distal part of the toe was dusky and poorly perfused, consistent with impending gangrene. Radiographical assessment (abdominal lead-apron shielding) showed a comminute fracture of the head of the fifth metatarsal and a fracture of the distal phalanx of the fifth toe.The wound was cleaned, debrided, with stay sutures placement followed by the initiation of the autologous PRP therapy. The initially non-viable-appearing wound demarcated and granulated over the PRP course, and the toe was salvaged; the wound subsequently healed completely by secondary intention under topical recombinant human epidermal growth factor and mupirocin dressings. She delivered a healthy female neonate at term. Follow-up at one year showed a gradual foot healing and weight-bearing. Autologous PRP combined with meticulous wound care might be associated with salvage of a devascularised digit with impending gangrene in pregnant females with non-feasibility of operative fixation. Hence, it can be recommended as a low-risk adjunct for wound healing in pregnant patients with limited surgical options.

Ridge Splitting with Simultaneous Implant Placement in the Atrophic Posterior Mandible: A Case Report

Prajwal Ramesh Shet, Srinidhi Bhat, Pratiksha Telsang Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Dental implant therapy effectively replaces missing teeth, but a narrow alveolar ridge can hinder optimal implant placement. The Alveolar Ridge Split Technique (ARST) is a minimally invasive approach that allows for ridge expansion and concurrent implant placement. The present case report discusses the treatment of a 28-year-old male with a narrow mandibular ridge using the OSSTEM™ ESSET (easy split and expansion of the narrow ridge) kit. Cone-Beam Computed Tomography (CBCT) indicated a ridge width of 4.2-4.3 mm with sufficient vertical bone height. Ridge splitting and the placement of three implants were performed. At three months post-treatment, CBCT showed an increase in ridge width to 7.1 mm at site 34 and to 6.6 mm at sites 35 and 36. Resonance frequency analysis indicated stable implant integration with values above 74. Ridge splitting with simultaneous implant placement effectively enhanced ridge width and facilitated successful rehabilitation for this patient.

Benign Mesothelial Cyst of the Spermatic Cord Presenting as a Giant Scrotal Swelling: A Case Report

Eeshansh Khare, Avani Shrivastava Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Large cystic lesions of the scrotum may include hydrocele, encysted hydrocele of the cord, dermoid cyst, hydatid cyst, and mesothelial cyst. A 55-year-old patient presented with a huge swelling in the scrotum and was diagnosed clinically as a case of right-sided vaginal hydrocele. However, preoperative radiological investigation (ultrasonography of the scrotum) suggested a large, well-defined anechoic cystic lesion in the right scrotal sac with post-acoustic enhancement, with inferiorly displaced right testis, and scrotal exploration was done and intraoperatively unilocular cystic swelling of size 15×12 cm surrounding the whole of right testis with a clear fluid in situ was found leading to diagnosis of a large spermatic cord cyst. However, the final histopathological report of the cystic wall suggested a benign mesothelial cyst. Patient was doing well on six-month follow-up with no recurrence. Though rare, spermatic cord mesothelial cyst should always be kept in the differential while making a clinical diagnosis of large scrotal swellings.

Nodular Malignant Melanoma Presenting as a Rapidly Growing Pigmented Skin Lesion: A Case Report

Deepali Trilokkumar Shukla, Manan Nilesh Bhensadadiya, Vidhi Jayprakash Jain, Khusbu Chhaya Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Nodular variant of malignant melanoma is a highly aggressive neoplasm arising from melanocytes, accounting for the majority of skin cancer related deaths despite its relatively low incidence. Hereby, the authors present a case of a 68-year-old male patient presented with 10 months history of pigmented nodule with ulceration over left supraclavicular region which gradually increasing in size. There was no any positive family history of similar lesion. Routine haematological and biochemical reports did not show any significant abnormality. Contrast-enhanced Computed Tomography (CT) scan of the thorax revealed a well-defined irregularly marginated heterogeneously enhancing soft-tissue lesion measuring 2.7×1.7×1.6 cm approximately involving left supraclavicular region. For the present particular case, the patient did not undergo prior biopsy procedure. Patient had a wide local excision and condition was determined to be nodular type of malignant melanoma after histopathological examination. Histopathological examination showed high breslow thickness, microsatellitosis, tumour infiltrating lymphocytes, high mitotic rate, focal regression. In the absence of histological confirmation of distant metastasis, the pathological primary tumour category was assigned as pT4b based on the primary tumour characteristics. Following surgical excision, the patient was referred to a tertiary oncology centre for B-Raf proto-oncogene, serine/threonine kinase (BRAF) V600 mutation testing and further oncological management. Given the high-risk pathological features, adjuvant anti-PD-1 immunotherapy was considered. As Nodular Malignant Melanoma (NMM) is a malignant neoplasia with high rate of mortality and bad prognosis, prompt diagnosis is paramount for physicians to start an aggressive treatment. The present case showed the highly aggressive nature of NMM demonstrating multiple adverse prognostic features.

Identification of Enterobius vermicularis in a Cervical Specimen from a Woman with Heavy Menstrual Bleeding: A Case Report

Shiny Jasmine, J Thanka, Lakshmi Priya Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Enterobius vermicularis, commonly known as pinworm, is an intestinal nematode that rarely involves the female genital tract. Cervical identification of this parasite is particularly uncommon and may pose a diagnostic challenge because the precise relationship of the organism to the cervical tissue may not always be established. A 41-year-old married, premenopausal woman presented with a six-month history of prolonged heavy menstrual bleeding. The patient’s menstrual cycles were regular, with bleeding lasting approximately eight days and requiring approximately six pads per day. Papanicolaou smear examination revealed atypical glandular cells of endocervical origin, not otherwise specified. Pelvic Magnetic Resonance Imaging (MRI) demonstrated findings suggestive of adenomyosis, along with a bulky cervix with multiple nabothian cysts. Histopathological examination of endometrial, endocervical and cervical specimens revealed disordered proliferative endometrium and a parasitic structure morphologically consistent with E. vermicularis in the cervical specimen. The organism appeared to be situated within a luminal/tissue space rather than unequivocally embedded within the cervical stroma, and there was no prominent inflammatory or granulomatous tissue response. Therefore, secondary migration or luminal contamination could not be completely excluded. The clinical significance of the parasitic finding in relation to the patient’s heavy menstrual bleeding also remains uncertain, particularly in view of the coexisting disordered proliferative endometrium and MRI findings suggestive of adenomyosis. The present case highlights the importance of careful histopathological evaluation, recognition of parasitic morphology and clinicopathological correlation when E. vermicularis is identified in an unusual cervical specimen.

Diabetic Ketoacidosis as the Presenting Feature of Type 3C Diabetes: A Case Report of Missed Chronic Calcific Pancreatitis

Ronak Prakashkumar Shah, Mittal Sindhav, Parth Rohitkumar Shah Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Type 3C Diabetes Mellitus (T3cDM), also termed pancreatogenic or pancreatic diabetes, arises from exocrine pancreatic disease, yet remains widely underdiagnosed and misclassified as Type 2 Diabetes Mellitus (T2DM). This misclassification carries significant therapeutic consequences, as standard oral hypoglycaemic regimens used in T2DM are often inappropriate or contraindicated in the setting of pancreatic exocrine failure. We report a 38-year-old male driver with a five-year history of diabetes mellitus managed on tablet metformin 500 mg and glimepiride 1 mg twice daily, who presented with epigastric pain, low-grade fever, and incidental post-varicella cutaneous lesions. Investigations revealed metabolic acidosis with an elevated anion gap consistent with mild Diabetic Ketoacidosis (DKA), hyponatraemia, hypokalaemia, and a markedly elevated C-Reactive Protein (CRP >300 mg/L). Retrospective analysis confirmed that this patient had been inappropriately treated with oral hypoglycaemic agents contraindicated in pancreatogenic diabetes. In-hospital management included intravenous fluid resuscitation, broad-spectrum antibiotics, continuous actrapid insulin infusion, and subsequent initiation of basal insulin glargine once the metabolic acidosis resolved. The case highlights prolonged misclassification of T3cDM as T2DM, atypical DKA presentation, and the diagnostic limitation of normal-to-low pancreatic enzymes.

First-trimester Detection of Isolated Unilateral Complete Radial Aplasia during Nuchal Translucency Screening: A Case Report

Vignesh Kumar Mohan, Hitha Almengada Ravi, Kohila Kalimuthu, Karthik Krishna Ramakrishnan, Paarthipan Natarajan Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Radial ray defects are congenital upper-limb anomalies involving the radius, radial carpal structures and thumb. We report a 24-year-old primigravida in whom left-sided complete radial aplasia with radial club hand and absent thumb (Bayne-Klug Type IV) was identified at a routine first-trimester nuchal translucency scan at 13 weeks six days of gestation. Detailed sonographic examination showed no other structural anomaly or soft marker. Chorionic Villus Sampling (CVS) was performed at 14 weeks one day for conventional karyotyping, with foetal DNA stored for possible future testing. The couple elected medical termination without awaiting the result. Expulsion followed mifepristone and misoprostol and was complicated by retained placenta requiring emergency suction evacuation and transfusion of one unit of packed red cells. Karyotyping was subsequently reported as normal. Postexpulsion radiography confirmed complete absence of the left radius with a bowed ulna and absent thumb. Chromosomal microarray and exome sequencing were not performed and no autopsy was undertaken; the defect was therefore described as apparently, rather than truly, isolated.

Young-onset Chronic Kidney Disease with Biopsy-proven Chronic Tubulointerstitial Nephritis and a Rare REN Variant, with Coincident Drug-related Erythrocytosis: A Case Report

Sai Sanketh Nethula, Rama Venkateshprasad, Manikantan Sekar, Subalakshmi Balasubramanian, Aalaya Haridas Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Chronic Kidney Disease (CKD) in a young adult with a bland urinary sediment should prompt consideration of a monogenic tubulointerstitial disorder. Autosomal Dominant Tubulointerstitial Kidney Disease (ADTKD) is an under-recognised genetic cause, and in ADTKD due to REN the phenotype depends on where the variant lies in preprorenin. This report describes a 23-year-old man with six months of frothy urine who had young-onset CKD (estimated glomerular filtration rate 47-54 mL/min/1.73 m²) with sub-nephrotic proteinuria, hyperuricaemia and a negative immunological screen. He also had absolute erythrocytosis (haemoglobin 20.1 g/dL, packed-cell volume 60.1%) that was JAK2 V617F- and exon-12-negative with a normal erythropoietin and normal oxygen saturation, attributed to prior anabolic-androgenic (“testosterone-boosting”) agents and resolving after a single therapeutic venesection and cessation. Renal biopsy showed chronic tubulointerstitial nephritis with negative immunofluorescence, and whole-exome sequencing identified a heterozygous REN variant, c.708A>T (p.Gln236His), in the mature-renin domain - a region associated with later onset and absence of the anaemia that characterises signal-peptide variants. The variant is currently of uncertain significance and family segregation is advised. The case illustrates genotype-phenotype nuance in ADTKD-REN and the value of separating two coincident haematological and renal processes.

Management of a Transaxillary Metallic Rod Impalement Injury without Neurovascular Deficit: A Case Report

Ayush Gandhi, Pooja Batra, Raju Shinde, Sanjeev Gianchandani Gyani, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Transaxillary impalement injuries are known to be rare and potentially life-threatening due to their close proximity of major neurovascular structures within the axillary region. The present case reports a 35-year-old male who sustained a through-and-through metallic rod impalement injury extending from left axilla to the superior aspect of the shoulder following accidental fall from a tree. On presentation, the patient was haemodynamically stable with preserved distal pulses as well as intact neurological examination of the left upper limb. Radiographic evaluation showed a linear metallic foreign body traversing soft-tissues without associated bony or thoracic injury. The patient underwent emergency surgical management under general anaesthesia with controlled removal of the rod, tract irrigation, debridement and delayed wound closure. The postoperative period was uneventful, and the patient demonstrated preserved functional outcome without neurovascular deficit at six-month follow-up. The present case highlights the importance of meticulous neurovascular assessment, controlled operative extraction, and multidisciplinary management in achieving favourable outcomes despite hazardous injury trajectory.

A Case of Peripancreatic Tuberculous Lymphadenitis Mimicking Pancreatic Malignancy: Diagnosis by Endoscopic Ultrasound-guided Core Biopsy

Sai Divija Kanuri, Shanmughanathan Subramanyam, AK Koushik, Srinivas Gridhati, Ramanjaneya Reddy Medagam Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Pancreatic and peripancreatic Tuberculosis (TB) are uncommon and may closely resemble pancreatic malignancy on imaging. The authors report a 65-year-old immunocompetent male who presented with epigastric pain, weight loss of 5-6 kg, and malaise. Contrast-Enhanced Computed Tomography (CECT) of the abdomen showed a 2.5×1.9×1.7 cm hypoenhancing lesion in the pancreatic head with multiple enlarged peripancreatic lymph nodes showing central necrosis, raising suspicion of pancreatic malignancy. Positron Emission Tomography-Computed Tomography (PET-CT) showed an Fluorodeoxyglucose (FDG)-avid necrotic lesion adjacent to the pancreatic head and neck, along with multiple FDG-avid necrotic peripancreatic lymph nodes and mildly FDG-avid mediastinal and right hilar lymph nodes. Endoscopic Ultrasound (EUS) demonstrated conglomerated peripancreatic lymph nodes measuring approximately 3×1 cm with central calcification. EUS-guided core biopsy showed necrotising granulomatous inflammation, and GeneXpert performed on the tissue was positive for Mycobacterium tuberculosis. The patient was started on anti-tubercular therapy and showed significant clinical improvement, with complete resolution of the lesions on follow-up PET-CT after six months. The present case illustrates the difficulty in distinguishing peripancreatic tuberculosis from pancreatic malignancy based on imaging alone and highlights the importance of EUS-guided tissue acquisition with molecular testing in establishing the diagnosis and guiding appropriate treatment.

Intraoperative Acute Bronchospasm Mimicking Acute Chest Syndrome in a Patient with Sickle Cell Disease Undergoing Laparoscopic Cholecystectomy: A Case Report

Nikita Sareen, Jayashree Sen, Monika Sareen, Manoj Sareen, Dhwani Sheth Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Sickle Cell Disease (SCD) is associated with significant perioperative morbidity due to an increased risk of hypoxia, acidosis, dehydration, and stress-induced vaso-occlusive crisis. Laparoscopic procedures may further exacerbate these risks through pneumoperitoneum-induced respiratory and haemodynamic alterations. Intraoperative bronchospasm in patients with SCD is uncommon and may mimic or precipitate Acute Chest Syndrome (ACS), creating diagnostic and therapeutic challenges for the anaesthesia team. The present case is of a 59-year-old female with known SCD who presented with abdominal pain and was diagnosed with cholelithiasis, choledocholithiasis, a probable benign distal Common Bile Duct (CBD) stricture, and mild hepatosplenomegaly. Preoperative optimisation included correction of anaemia, Endoscopic Retrograde Cholangiopancreatography (ERCP), and CBD stenting. She subsequently underwent elective laparoscopic cholecystectomy under general anaesthesia. Shortly after Carbon Dioxide (CO2) insufflation and placement in the head-low position, she developed a sudden rise in End-Tidal Carbon Dioxide (EtCO2), increased peak airway pressures, and bilateral wheezing, consistent with severe intraoperative bronchospasm. Prompt management with bronchodilators and ventilatory optimisation was initiated; however, owing to persistent respiratory compromise, the procedure was converted to open cholecystectomy. The patient recovered uneventfully with postoperative supportive care, underwent successful CBD stent removal and transfusion, and was discharged in stable condition. This case is unique because severe intraoperative bronchospasm occurring during laparoscopic cholecystectomy in a patient with SCD closely simulated complications such as ACS and vaso-occlusive events. The report highlights the importance of early recognition, prompt airway management, careful intraoperative monitoring, and multidisciplinary collaboration to ensure favourable outcomes in this high-risk patient population.

A Case of Common Carotid Artery Pseudoaneurysm Repair: An Anaesthetic Challenge

Malavika Nambiar, B Kala, Dipika Balasubramanian, Akash Babu Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Pseudoaneurysms of the extracranial common carotid artery are rare but potentially life-threatening vascular lesions that may present with airway compromise, embolic events, cranial nerve palsy or rupture. Surgical repair is technically challenging because of maintenance of cerebral perfusion during carotid cross clamping. The present study describes the successful management of a patient undergoing repair of a giant common carotid artery pseudoaneurysm. A 56-year-old male patient, known hypertensive and chronic smoker was planned for surgical repair of pseudoaneurysm of left common carotid artery. Extracranial carotid artery pseudoaneurysms are uncommon but potentially catastrophic because they may rupture, embolise, or compress the airway and adjacent cranial nerves. Aetiological factors like mycotic pseudoaneurysms, fibromuscular dysplasia and Behçet’s disease (triad of mouth, genital ulcers and relapsing iritis) have also been reported. Histologically aneurysms have been divided into two types: True aneurysms and pseudoaneurysms. Pseudoaneurysms are more common and develop when entire arterial wall is lacerated and surrounded by a haematoma. Large pseudoaneurysm may produce vascular impairment to the head and neck and airway distortion. The neck swelling was impinging upon and displacing the trachea. The huge neck swelling and tracheal deviation poses challenges to anaesthesiologists in airway management. The affected carotid artery was clamped during the repair. The present case highlights the precautions taken, the detection and the strategies for preventing the impending cerebral insult during such surgeries whenever the carotid artery is clamped. The present case is distinctive because a giant pseudoaneurysm causing airway displacement and vocal cord palsy was successfully repaired despite coexisting ventricular dysfunction and anaemia, using controlled airway instrumentation, short shunt-supported carotid clamping, and immediate neurological assessment.

Anti-NR1 Autoimmune Encephalitis with Burst-suppression-Resistant Non Convulsive Status Epilepticus: A Case Report

Anupama K George, Kevin J Porunnolil, Amarsinha Fulchand Kakade, Shivam Gupta, Nirmala Devi Chandrasekaran Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Anti-N-Methyl-D-Aspartate Receptor (anti-NMDAR) encephalitis is the commonest autoimmune encephalitis and among the most misdiagnosed conditions, particularly in young men who lack the classical ovarian teratoma trigger. When seizures resist both conventional anticonvulsants and pharmacologically induced coma, the physician faces a crisis that only targeted immunotherapy can resolve. The authors report a 21-year-old male admitted to the Neurology Intensive Care Unit (ICU) with subacute encephalopathy and new-onset seizures. A 14-target Film Array Meningitis/Encephalitis (ME) panel on CSF was entirely negative. Magnetic Resonance Imaging (MRI) brain showed only non specific bifrontal Fluid-Attenuated Inversion Recovery (FLAIR) foci. Serial lumbar punctures demonstrated persistent and worsening lymphocytic pleocytosis despite empirical antimicrobials-a pattern pointing to autoimmune rather than infectious inflammation. CSF cell-based indirect immunofluorescence assay returned a moderately positive Anti-NR1 antibody with all other panel antibodies negative. Electroencephalogram (EEG) progressed from diffuse delta slowing to frank electrographic non convulsive Status Epilepticus (NCSE). A 48 hours of propofol-induced burst-suppression failed to extinguish seizure activity, confirming pharmacologically refractory NCSE. Echocardiography excluded endocarditis. Rituximab was commenced as second-line immunotherapy on day 8. The present case demonstrates that negative imaging and infectious workup should not deflect from an autoimmune diagnosis when the clinical trajectory is wrong. Burst-suppression failure signals antibody-driven receptor pathology-not a sedation problem-and mandates urgent immunotherapy escalation.

Cutaneous Small Vessel Vasculitis Complicating Sepsis and Inflammatory Bowel Disease in an Older Adult with Chronic Kidney Disease: A Case Report

Kaviya Sree Vairamuthu, Vignessh Raveekumaran Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Cutaneous Small Vessel Vasculitis (CSVV) is an immune-complex-mediated dermal vasculitis associated with infections, medications, and systemic inflammatory diseases. A man in his 70s with Chronic Kidney Disease (CKD), diabetes mellitus, and hypothyroidism presented with abdominal pain, diarrhoea, vomiting, Acute Kidney Injury (AKI), and palpable purpura involving all four limbs after receiving an undocumented parenteral drug. Investigations revealed Enterococcus faecalis Urinary Tract Infection (UTI), elevated inflammatory markers, severe renal dysfunction, and negative antineutrophil cytoplasmic antibodies. Skin biopsy confirmed Leukocytoclastic Vasculitis (LCV). Colonoscopy with histology and markedly elevated faecal calprotectin confirmed Inflammatory Bowel Disease (IBD), while renal biopsy showed Acute Tubular Injury (ATI) with class III diabetic nephropathy. Sepsis-associated CSVV was considered most likely, with IBD-related immune activation and drug-induced vasculitis as alternative contributors. Management prioritised infection control, pathogen-directed antibiotics, haemodialysis, and delayed corticosteroid therapy after microbiological control was achieved. The patient improved clinically but was discharged against medical advice at his own request before completion of the planned course of treatment, with scheduled outpatient follow-up and long-term outcome information was unavailable.

Severe Hypotension with Neuraxial Fentanyl in Patients with Low Cardiac Reserve: A Case Report

KP Rishanth, Srinidhi, Pranjali Kurhekar, Yasmin Mariam Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Neuraxial opioids, when added to Local Anaesthetic (LA) agents in small recommended doses, can hasten the onset of sensory and motor block, improve quality of block and peak sensory level without resulting in haemodynamic instability. With this knowledge, doses of LA are reduced and opioids are added to achieve adequate neuraxial anaesthesia without much haemodynamic disturbance. However, higher concentrations of neuraxial fentanyl per millilitre may negate these expected benefits. A 76-year-old male with low Ejection Fraction (EF) who depended on venous return for cardiac pumping developed episodes of hypotension with high concentrations of neuraxial opioids with LA, whereas the patient remained haemodynamically stable with only LA without opioids. The present case highlights an important and underreported clinical concern that may have implications for drug concentration strategies in neuraxial anaesthesia, particularly in patients with limited cardiac reserve. To the authors’ knowledge, no previous reports have described hypotension associated with the administration of high-concentration epidural fentanyl.

In-vitro Exflagellation of Plasmodium vivax Microgametocytes: A Case Report

Sahil Paul, Arnav Kr Roychoudhury, Sahil Chhabra, Arun Puri Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X The diagnosis of malaria is typically established through Peripheral Blood Smear (PBS) examination, which reveals ring forms (trophozoites), schizonts, and gametocytes. Exflagellation of microgametocytes, a sexual stage of the malarial life cycle, is exclusively observed in the mosquito gut and rarely reported in human peripheral blood. A 40-year-old man presented with a three-day history of high-grade fever with chills and rigors. Haematological workup showed a total leukocyte count of 9,700 cells/μL and mild thrombocytopenia (platelet count 1.1×105/μL). PBS stained with Leishman stain revealed ring forms (trophozoites) of Plasmodium vivax. In addition, multiple clusters and individually scattered thin, filamentous structures measuring 10-15 μm in length with an oval-shaped nucleus were identified- consistent with exflagellated microgametes of P. vivax. The blood sample had been collected in an Ethylenediaminetetraacetic Acid (EDTA) vacutainer and kept at room temperature (20-23°C) for approximately 1.5 hours before smear preparation, with no exflagellation seen on fresh finger-prick smears prepared immediately after collection. The patient was treated with chloroquine and primaquine and recovered uneventfully. Exflagellation in human peripheral blood is an in-vitro phenomenon driven by EDTA anticoagulation, prolonged sample storage, and exposure to atmospheric air leading to a rise in pH. Recognition of this morphological rarity is essential to prevent misidentification as Borrelia, Trypanosoma, or staining artefacts. This case underscores the critical importance of pre-analytical variables in PBS interpretation.

Blood Culture-negative Infective Endocarditis with Fatal Ischaemic Hepatitis in a Patient on Antitubercular Therapy: A Case Report

Mittal Sindhav, Ronak Shah, Parth Shah Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Infective Endocarditis (IE) in patients receiving Antitubercular Therapy (ATT) is easily missed, because rifampicin can sterilise blood cultures and blunt the febrile and inflammatory response, delaying recognition until multiorgan failure is already established. The present case report is of a 45-year-old male in the fourth month of HRZE (isoniazid, rifampicin, pyrazinamide, ethambutol) ATT for pulmonary tuberculosis who presented afebrile with a two-day history of dyspnoea and haemodynamic collapse. Emergency physician bedside Point-Of-Care Ultrasound (POCUS) showed a collapsible Inferior Vena Cava (IVC), an ejection fraction of 35%, a thickened calcified aortic valve with a mobile vegetation, severe aortic regurgitation, and moderate functional mitral regurgitation. Initial Arterial Blood Gas (ABG) showed pH 7.19 and lactate 15 mmol/L; over the next five hours the acidosis worsened (pH 7.12) although lactate was 12.8 mmol/L, despite initial supportive measures. Following IVC-guided fluid resuscitation, vasopressor optimisation, and Intermittent Haemodialysis (IHD) from day 3, lactate improved to a nadir of 5.1 mmol/L on day 3 before re-rising to 8.9 mmol/L by day 5, paralleling progressive multiorgan failure. Serum Glutamic-Oxaloacetic Transaminase (SGOT) was 7,279 IU/L (182 times the upper limit of normal) at presentation, indicating pre-arrival ischaemic hepatitis, and exceeded 20,000 IU/L by day 2. Two pre-antibiotic blood culture sets remained negative for growth at 96 hours (Day 4) of incubation, consistent with probable rifampicin-associated blood culture-negative endocarditis. The patient died on day 5 after a cardiac arrest unresponsive to resuscitation. This case demonstrates that IE on a tuberculosis-predisposed calcified valve can present afebrile with extreme hyperlactataemia and established ischaemic hepatitis, and that an early lactate-clearance response does not preclude terminal re-deterioration once hepatic and multiorgan failure are structurally established.

Markedly Prolonged Activated Partial Thromboplastin Time without Bleeding in Factor XII Deficiency: A Case report of Clinical-laboratory Paradox

S Nahveena, A Ashwin, R Niranj Rathan, M Sampath Kumar, R Krishnamoorthy Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Factor XII deficiency is an uncommon inherited coagulation disorder characterised by a markedly prolonged activated Partial Thromboplastin Time (aPTT) in spite the absence of a bleeding tendency. As affected individuals are usually asymptomatic, the condition is most often discovered incidentally during routine preoperative coagulation testing rather than after a bleeding episode. Awareness of this discordance between laboratory findings and clinical presentation is important to prevent unnecessary postponement of surgical procedures and inappropriate therapeutic interventions. A 58-year-old male, a known case of type 2 diabetes mellitus, was admitted because of an infected, non-healing diabetic ulcer involving the left foot and planned for a below-knee amputation. Routine preoperative investigations revealed an isolated prolongation of aPTT (61.5 seconds; control: 27.2 seconds), while the Prothrombin Time (PT) and International Normalised Ratio (INR) remained within the normal range. A 1:1 mixing study completely corrected the prolonged aPTT, indicating an underlying coagulation factor deficiency rather than the presence of an inhibitor. Subsequent coagulation factor assays demonstrated severe Factor XII deficiency, with FXII activity below 1%, whereas Factor VIII activity was 153%, thereby excluding haemophilia A. The patient had no previous history of excessive bleeding, nor was there any family history suggestive of a hereditary bleeding disorder. The planned surgery was performed under general anaesthesia. Fresh frozen plasma was administered intraoperatively to manage significant blood loss during the procedure as per the institutional practice and was not intended as treatment for the FXII deficiency. No excessive perioperative or postoperative bleeding was observed, and the patient recovered without complications. This case highlights the well-recognised lack of correlation between markedly abnormal coagulation test results and clinical haemostasis in severe Factor XII deficiency. When an isolated prolonged aPTT corrects on mixing studies in a patient without a bleeding history, FXII deficiency should be considered in the differential diagnosis. Early recognition of this entity facilitates appropriate interpretation of coagulation test abnormalities, helps avoid unnecessary delays in surgical management, and reduces the inappropriate use of blood components. Bleeding is uncommon in this condition, though thrombotic history in such patients still warrants careful, individualised evaluation, and coagulation results should always be interpreted alongside the clinical picture.

Crohn’s Disease Masquerading as Carcinoma of the Caecum: An Uncommon Cause of Acute Large Bowel Obstruction

Shalini Singh, G Murlidharan Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Crohn’s Disease (CD) is a chronic, relapsing inflammatory bowel disease characterised by transmural inflammation that may involve any segment of the gastrointestinal tract. Although abdominal pain, chronic diarrhoea, weight loss, and fatigue are considered classical manifestations, a small proportion of patients may remain clinically silent until complications develop. Acute large bowel obstruction as the initial presentation of CD is uncommon and may mimic colorectal malignancy, making the diagnosis challenging. A 53-year-old woman presented to the Emergency Department with abdominal pain for one week and vomiting and abdominal distension for two days. She also reported intermittent pain in the right iliac fossa for the preceding one year. Clinical examination revealed abdominal distension and a palpable right iliac fossa mass. Abdominal radiography demonstrated multiple air-fluid levels with dilated bowel loops, suggestive of intestinal obstruction. In view of complete intestinal obstruction with clinical suspicion of carcinoma of the caecum, emergency exploratory laparotomy was performed. Intraoperatively, a caecal mass was identified, and right hemicolectomy with ileocolic anastomosis was performed. Histopathological examination demonstrated transmural chronic inflammation, non caseating granulomas, fissuring ulcers, fibrosis, and lymphoplasmacytic infiltration without evidence of malignancy, confirming CD. The patient recovered uneventfully and was referred for long-term gastroenterological management. CD should therefore be considered an important differential diagnosis in obstructing ileocecal masses, even in patients lacking classical gastrointestinal symptoms. Histopathological examination remains essential for establishing the definitive diagnosis, while timely surgical intervention and multidisciplinary postoperative management are important for achieving a favourable outcome.

Advocating Hand Mirror Therapy for a Unique Case of Chronic Inflammatory Demyelinating Polyneuropathy-induced Hand Weakness with Hemispatial Neglect

Abha Khisty, Jyotsna Bhatia, Tushar Palekar Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) refers to a significant neuromuscular illness that manifests chronically and worsens over a period of more than eight weeks. The precise triggering event is still unknown despite enormous advancements in understanding illness pathophysiology. As per understanding of the diagnosis and treatment of CIDP and its variations grows, so does the potential for detection and care. There was an incidental reporting of a 59-year-old female patient with CIDP-induced left hand weakness with a novel presentation of Hemispatial Neglect (HN) of same side with no history of right hemisphere stroke. Magnetic Resonance Imaging (MRI) confirmed an old lacuna 20 years back with no signs of hemiplegia or hemiparesis infarction in internal capsule and thalamus however no obvious pathology pertaining to hemispatial neglect was reported. HN was evaluated entirely by physiotherapeutic assessment tools. The readily available methods to address CIDP-induced weakness are plenty however the challenge was to address concurrent same side hemispatial neglect. Mirror therapy has profoundly improved the spatial orientation and voluntary control in various neurological patients. Therefore, in the present case we administered 5 weeks Physiotherapy exercises along with mirror therapy to address combined deficits of CIDP-induced weakness of left-side and same side hemispatial neglect. The post-intervention analysis revealed significant improvement of 90% on upper extremity functional scale and increase in muscle strength of hand muscles.

Human Amnion Grafting for Vaginal Agenesis in Mayer-Rokitansky-Kuster-Hauser Syndrome: A Case Report

Hemant Deshpande, Shriraj Katakdhond, Abira Ghosh Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Vaginal agenesis is a congenital condition of the female genital tract. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a disorder characterised by agenesis of Mullerian structures, including the uterus and upper two-thirds of the vagina, with normally developed secondary sexual characteristics. The author presents a case of a 21-year-old married woman with primary amenorrhoea diagnosed with type 1 MRKH syndrome. The patient underwent the modified McIndoe vaginoplasty procedure with the use of a human amnion as a graft for creating a neovagina. The patient was discharged fifteen days postsurgery with training on the use of vaginal dilators. The patient was followed up weekly to assess vaginal patency. At the end of three months, the patient had approximately 7 cm of neovaginal length.Sexual intercourse was recommended thereafter.Modified McIndoe vaginoplasty with a human amnion graft is an effective, simple, safe procedure with high acceptability and a good enough functional vagina in women with MRKH syndrome.

Lessons from a Challenging Case: Bilateral Valgus Knee

Yogeshwar Agharkar, N Sachin Nishanth, Anurag Choudhary Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Osteoarthritis (OA) of both knees with fixed valgus deformity presents a surgical challenge during Total Knee Arthroplasty (TKA) because of lateral soft-tissue imbalance, bone loss, and patellofemoral involvement. A case of a 66-year-old man with severe bilateral knee OA with fixed bilateral valgus knee deformity treated with staged bilateral TKA is described, with objective assessment using clinical valgus angle, Range of Motion (ROM), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. At 3-month follow-up, objective improvement was demonstrated with correction of the clinical valgus alignment to near neutral alignment, increased ROM from 10°-90° right and 5°-95° left preoperatively to 0°-115° right and left, and decreased total WOMAC score from 73 immediately postoperatively to 18 at three months. The importance of careful preoperative assessment, sequential lateral soft-tissue release, appropriate posterior-stabilised implant selection and structured rehabilitation in fixed valgus knees is highlighted.

Spontaneous Intracranial Hypotension with Bilateral Subdural Haematomas and Posterior Cerebral Artery Infarcts with Delayed Epidural Blood Patch Response: A Case Report

Virendra Kumar Meena, Sakshi Singhal, Renu Khamesra, Ravinder Kumar Kundu Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Spontaneous Intracranial Hypotension (SIH) is a rare but treatable cause of orthostatic headache due to spontaneous leakage of Cerebrospinal Fluid (CSF). A 48-year-old male presented with orthostatic headache with bilateral subdural haematomas. The patient was found to have bilateral subdural haematomas with mass effect on Brain Magnetic Resonance Imaging (MRI), and a cervical dural tear with active CSF leakage on contrast-enhanced MR myelography, suggestive of SIH. The late diagnosis was complicated by progressive mass effect and infarcts involving the bilateral posterior cerebral arteries. A delayed Epidural Blood Patch (EBP) had favourable clinical and radiological outcomes. Early diagnosis and prompt EBP were needed to avoid neurological sequelae.

Ocular Inflammation as a Diagnostic Clue to Systemic Autoimmune Disease: A Report of Two Cases

Hetaj Sheth, Kshama Popat, Karan Maniar Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Ocular inflammatory disorders may represent the first manifestation of systemic autoimmune disease or, less commonly, prompt reconsideration of an existing diagnosis. Two cases are reported below in whom ophthalmic findings played a pivotal role in establishing or revising the underlying rheumatological diagnosis. A 29-year-old female presented with Peripheral Ulcerative Keratitis (PUK) complicated by a 3×3 mm corneal perforation with iris prolapse. Detailed systemic evaluation, prompted by severe ocular disease, revealed previously unrecognised Mixed Connective Tissue Disease (MCTD). The patient underwent tectonic penetrating keratoplasty with amniotic membrane transplantation and temporary tarsorrhaphy, along with systemic immunosuppressive therapy, resulting in successful globe preservation and a clear graft with a Best-Corrected Visual Acuity (BCVA) of 6/24 at long-term follow-up. The second patient, a 43-year-old male receiving treatment for Rheumatoid Arthritis (RA), developed recurrent anterior scleritis. Persistent ocular inflammation prompted repeat autoimmune evaluation, which demonstrated Proteinase 3-Anti-Neutrophil Cytoplasmic Antibody (PR3-ANCA) positivity, leading to reclassification of the diagnosis as Granulomatosis with Polyangiitis (GPA). Escalation of systemic immunosuppressive therapy with intravenous cyclophosphamide achieved satisfactory control of ocular inflammation with residual scleral thinning. These cases highlight the crucial role of ophthalmologists in recognising ocular manifestations that may establish a previously undiagnosed systemic autoimmune disease or necessitate re-evaluation of an existing diagnosis. Early multidisciplinary collaboration and timely systemic immunosuppression are essential to optimise both ocular and systemic outcomes.

Opioid-sparing Ultrasound-guided Regional Anaesthesia for Acute Pain Management and Bedside Procedures in the Emergency Department: A Case Series

Abhay Kumar Nahar, Revant Agarwal, Shuchita Vaya, Avniendra Bharadwaja, Pritish Sharma Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Acute pain is one of the most common reasons for Emergency Department (ED) visits. While systemic opioids remain common, they carry risks of respiratory depression, sedation, and delayed care. Ultrasound-guided Regional Anaesthesia (UGRA) provides targeted, opioid-sparing analgesia and facilitates bedside procedures. This descriptive case series evaluates 10 adult patients who received emergency physician-performed UGRA for acute traumatic and non traumatic pain. Serial pain scores on the 11-point Numeric Rating Scale (NRS at baseline, 15, 30, and 60 minutes), post-block rescue opioid requirements in Morphine Milligram Equivalents (MME), block-to-analgesia time, and block-to-procedure time were recorded. The median patient age was 29 years (range: 20–50 years; eight men, two women). The median baseline NRS decreased from 10 (range: 8-10) to 1 (range: 0-4) at 15 minutes and 0 (range: 0-1) at 60 minutes. The median block-to-analgesia time was 11 minutes (range: 5-30 minutes), and the median block-to-procedure time was 20 minutes (range: 10-30 minutes). Half of the patients (50%) required no post-block rescue opioids median rescue consumption was 2.5 MME (range: 0-25 MME). All 10 procedures were completed without procedural sedation. No complications occurred. Emergency physician-performed UGRA provides rapid pain relief, reduces rescue opioid use, and allows definitive bedside procedures without procedural sedation.

Feasibility and Safety of Total Intravenous Anaesthesia and Target-Controlled Infusion for Detethering Surgery in Tethered Cord Syndrome: A Case Series

Keerthana Kalaiselvan, V Rajesh Kumar Kodali, Thamaraiselvi Krishnasamy, SM Niranjan, Divya Velusamy Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Tethered Cord Syndrome (TCS) is a critical congenital spinal dysraphism that necessitates surgical detethering to arrest progressive, irreversible neurological deterioration. These complicated neurosurgical procedures require robust Intraoperative Neuromonitoring (IONM) utilising multimodal Somatosensory Evoked Potential (SSEPs) and Motor Evoked Potentials (MEP) to protect neural tissue. Anaesthetic management is challenging because neurophysiological signals are vulnerable to anaesthetic-induced depression. Total Intravenous Anaesthesia (TIVA) with propofol and opioids is preferred over volatile drugs to reduce signal suppression, however manually controlled weight-based infusions can introduce intraoperative pharmacological fluctuation. Target-Controlled Infusion (TCI) titrate anaesthetic drugs to effect-site concentration using population-specific pharmacokinetic and pharmacodynamic models. TCI reduces false-positive neuromonitoring alerts, optimises spinal cord perfusion pressure, and facilitates predictable emergence for immediate postoperative neurological assessment. Incorporating TCI to neuroanaesthetic procedures provides a repeatable, stable neurophysiological substrate for accurate IONM interpretation and improved patient safety during complex spinal dysraphism repairs. This case series describes four paediatric patients with TCS who underwent detethering surgery using TIVA or TCI-guided propofol anaesthesia with entropy-guided depth monitoring. Reliable SSEPs and MEPs were successfully maintained throughout surgery in all patients without significant signal attenuation attributable to anaesthetic technique. Haemodynamic parameters remained stable with minimal requirement for vasoactive support, and no episodes of intraoperative awareness or major anaesthesia-related complications were observed. All patients had preserved postoperative neurological function with uneventful recovery. The uniqueness of this series lies in demonstrating the feasibility and effectiveness of TIVA and TCI-based anaesthesia in paediatric detethering surgeries requiring multimodal neuromonitoring.

Scrotal Defect Reconstruction using the Anterolateral Thigh Perforator Flap: A Case Series

Prashant Bahirani, Durga Karki, R Chandan Kumar, Sunil Sharma, US Varshetha Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Infection, trauma, and burns are significant causes of large peno-scrotal defects. Peno-scrotal defects resulting from these causes may pose a major challenge for management and reconstruction. During treatment, multiple debridements may be required, often resulting in significant soft-tissue loss that requires reconstruction. In this case series, 10 patients underwent reconstruction of large penoscrotal defects using a perforator-based Anterolateral Thigh (ALT) flap. All flaps survived well without any major complications. All patients had satisfactory aesthetic outcomes on follow-up. Three patients experienced complications: two had venous congestion managed with leech therapy, and one had wound dehiscence managed with secondary suturing. The pedicled perforator-based ALT flap appears to be a reliable option for reconstruction of large scrotal defects, providing satisfactory aesthetic outcomes with acceptable donor-site morbidity.

Clinical and Radiological Spectrum of Angiomatoid Fibrous Histiocytoma of the Musculoskeletal System: A Case Series

Jessica Vaddeswarapu, Benjamin Barsouma Mathew, Vineeth Joseph Abraham, KT Joseph, Madhavi Kandagaddala Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Angiomatoid Fibrous Histiocytoma (AFH) represents a rare and clinically deceptive mesenchymal neoplasm that primarily affects children and young adults. Currently, classified by the World Health Organisation (WHO) as a tumour of intermediate malignant potential, AFH is frequently characterised by an indolent clinical course; however, it presents a formidable diagnostic challenge due to its profound clinical and radiological heterogeneity. The Magnetic Resonance Imaging (MRI) features described are multiple internal blood-fluid levels, a T2-hypointense fibrous pseudocapsule, focal nodularity along the cyst wall, and the double rim sign. Definitive diagnosis rests upon histopathological confirmation and molecular testing for the pathognomonic EWSR1-CREB1 fusion. The primary management strategy is centred on wide local surgical excision. In this series, authors describe a heterogeneous group of clinical and radiological presentations of this entity within bone and muscle, ranging from superficial, well-circumscribed soft-tissue masses to aggressive, bone-eroding lesions. These varied cases highlight the absolute necessity of maintaining a high-index of clinical suspicion for AFH when evaluating any recurrent or atypical cystic musculoskeletal lesion.

Effect of Uttarbasti Combined with Ayurvedic Oral Medicines in Women with PCOS Associated Anovulation and Thin Endometrium: A Case Series

Varsha P Jadhao, Pooja Shrivastava, Pratiksha Rathod, Pradip M Adhav Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Polycystic Ovary Syndrome (PCOS) affects 8-13% women of reproductive age and is responsible for 80% cases of anovulatory infertility. The presence of thin endometrium (<7 mm) in PCOS patients is another challenging co-existing pathology along with anovulation to achieve implantation successfully. This case series included 13 patients aged 18-35 years with Rotterdam criteria-confirmed PCOS, Endometrial Thickness (EMT) <7 mm and anovulation. Management consisted of 3-months of oral Ayurvedic medicines and monthly Uttarbasti, followed by 3-month follow-up. Primary outcomes were ovulation, EMT ≥7 mm, and menstrual cycle regularisation. Secondary outcomes included conception rate. All 13 patients completed the treatment protocol. Promising improvements were noted in all primary outcomes from start to end point of treatment. The mean follicle grade increased from 0.00±0.00 to 2.38±1.04 (p=0.001, Wilcoxon signed-rank test), the mean EMT grade improved from 1.00±0.00 to 2.23±0.83 (p=0.004), and the mean menstrual regularity grade enhanced from 1.77±0.73 to 0.54±1.05 (p=0.005). After the end of the study 69.2% patients achieved ovulation, EMT improvement of ≥7 mm was attained by 76.9% patients, and menstrual cycles was regularised in 76.9% patients. No serious adverse events or treatment discontinuation occurred. The treatment protocol showed a satisfactory safety profile with minimal adverse effects with encouraging results in conception. This case series suggests that Uttarbasti with oral Ayurvedic medicines may improve ovulation, EMT, and menstrual cycle regularity in women with PCOS-associated anovulation and thin endometrium. Large scale randomised controlled trials are necessary to support these findings.

Polymastia: Bilateral Accessory Breast in a Young Female

Yashasvi Trivedi, Rajesh Gattani, Shraddha Gajbhiye, Nitish Reddy, Saurabh Gawand Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X

Distinctive Dysmorphism: Clinical Imaging Perspectives in Kabuki Syndrome

Namrata Sant, Tanaya Rajesh Jadhav, Prashansa Kasat, Chitwan Agrawal Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X

Bifid Middle Turbinate Associated with Unilateral Nasal Obstruction and Discharge

Saurav Shah, Shraddha Jain, Dhwani Sheth Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X

Clinical Image of Amniotic Band Syndrome: A Rare Congenital Limb Deformity

Sunny Prakash Khule, Renu Bharat Rathi Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X

Prevalence and Clinical Profile of Intrauterine Foetal Death: A Retrospective Observational Study from Odisha, India

Deepak Kumar Tripathy, Sachin Ramesh Rawal, Amrut Suresh Chothe, Sandeep Arjunrao Dhore Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Intrauterine Foetal Death (IUFD) remains an important obstetric problem in developing countries. High-risk pregnancies are commonly referred to tertiary care hospitals, where facility-based research is needed to describe the true clinical burden of IUFD. Aim: To describe the obstetric profile, associated maternal and foetal clinical factors, and outcomes of women managed for IUFD. Materials and Methods: This was a retrospective observational study of women with a confirmed diagnosis of IUFD managed over a six-month period (July-December 2025) in the Department of Obstetrics and Gynaecology, DH Jharsuguda, Odisha, India. As no comparison group of live births was available, data were summarised descriptively as frequencies, percentages, and mean±standard deviation, no inferential statistical testing was performed. Results: Fifty-three women with IUFD were identified among 1,822 total deliveries, giving an institutional prevalence of 29.1 per 1,000 deliveries (56 foetuses, including 3 twin pregnancies). Mean maternal age was 25.5±4.3 years; 32 (60.4%) were multigravida and 11 (20.8%) had a previous caesarean section. The most common associated maternal conditions were hypertensive disorders (19, 35.8%), anaemia (12, 22.6%), and placental abruption (11, 20.8%); no maternal cause was documented in 13 (24.5%). Mean hospital stay was 5.8±2.7 days; 47 (88.7%) had a routine discharge and 5 (9.4%) left against medical advice. No maternal deaths were recorded. Conclusion: IUFD accounted for an institutional prevalence of 29.1 per 1,000 deliveries over the study period. Hypertensive disorders, anaemia, and placental abruption were the most common associated clinical conditions among women with IUFD.

Comparative Efficacy of Three Different Toothbrush Types in Plaque Removal and Gingival Health: A Randomised Clinical Trial

Ganganapalli Reddy Sravya, SVSG Nirmala Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Effective plaque control in adolescence is crucial for gingival health. Conventional toothbrushes are technique-sensitive, while modified designs aim to simplify brushing; however, comparative clinical evidence in children is limited. Aim: To compare the plaque removal efficacy and gingival health outcomes of three different types of toothbrushes in children aged 12-15 years. Materials and Methods: This randomised clinical trial was conducted in Radhika EM High School, Kadapa district under the institutional affiliation of Narayana Dental College and Hospital, from July 2025 to September 2025. A total of 75 healthy children aged 12-15 years meeting the inclusion criteria were included in the study. Participants were randomly allocated into three groups (n=25 each) using the sealed envelope method: Group-1- Ultra-soft single-headed toothbrush (Modified Bass technique), Group-2- T-shaped toothbrush (Vertical brushing technique), and Group-3- Triple-headed toothbrush (simultaneous brushing). Baseline demographic parameters such as age and gender were recorded. Professional oral prophylaxis was performed at baseline, followed by standardised oral hygiene instructions. Plaque and gingival status were assessed using the Silness and Löe Plaque Index and the Löe and Silness Gingival Index at baseline, two weeks, one month, and three months. Statistical analysis was performed using SPSS software; intragroup comparison was done using repeated measures ANOVA and intergroup comparison using One-way ANOVA with post-hoc Tukey test, with significance set at p<0.05. Results: All three groups demonstrated a statistically significant reduction in plaque and gingival scores over the study period (p<0.05). Intergroup comparison revealed no significant differences at baseline, two weeks, or one month (p=0.464, p=0.587, and p=0.875, respectively). However, at the 3-month follow-up, a statistically significant difference was observed in plaque scores (p=0.040) with the triple-headed toothbrush group showing the greatest reduction, followed by the T-shaped toothbrush group. Although gingival scores showed a greater reduction in the triple-headed toothbrush group, intergroup differences were not statistically significant (p=0.101). Conclusion: Modified toothbrush designs, particularly the triple-headed toothbrush, was more effective in improving plaque control and gingival health in children compared to a T-shaped and conventional ultra-soft single-headed toothbrushes. These designs may be considered beneficial aids for enhancing oral hygiene in adolescents.

Trends in Blood Culture Contamination in a Specialised Oncology Hospital: A Five-year Retrospective Observational Study

Ankita Chaurasia, Rahul Sarode, Sujit Bharti, Vijeta Bajpai Batra, Anwita Mishra, Devesh Rai, Om Prakash Gupta, Karishma Ambure Satale Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Bloodstream Infections (BSIs) are a major source of morbidity and mortality in cancer patients who are immunocompromised. While blood culture remains the gold standard for BSI diagnosis, contamination during collection can result in false-positive results, leading to unnecessary antibiotic use, prolonged hospitalisation, and increased healthcare costs. Aim: To analyse Blood Culture Contamination (BCC) rates over a five-year period in a tertiary care cancer hospital. Materials and Methods: A retrospective observational study was conducted from January 2019 to December 2023. All blood culture specimens received in the Department of Microbiology, Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi, Uttar Pradesh, India were analysed. Contamination rates were analysed annually, department-wise, and by collection site i.e., (blood collected from peripheral vs central line). Data were represented as frequencies and percentages to determine the annual contamination rates over the months. Statistical analysis was performed using the Chi-square test, with p-value <0.05 considered statistically significant. Results: Of the 2,651 positive cultures, 761 (28.7%) were identified as contaminants, corresponding to an overall contamination rate of 3.11%. Coagulase-Negative Staphylococci (CoNS) represented the predominant contaminants, with a statistically significant upward trend (p-value =0.047). A similar increase was observed for Micrococcus spp. (p-value <0.001). Higher contamination rates were observed in specimens collected from peripheral sites, particularly in the paediatric haemato-lymphoid, adult haematology, and uro-oncology departments, with statistically significant variation across the study years (p-value <0.001, p-value <0.001, and p-value =0.030, respectively). General wards: 513/13542 (3.79%) and chemotherapy: 97/3474 (2.79%) showed higher contamination rates compared to specialised units like bone marrow transplant: 12/886 (1.36%). Conclusion: Although overall contamination rates remained close to the acceptable threshold set by the Clinical and Laboratory Standards Institute (CLSI) (<3%), significant variation was observed across departments and collection methods. Targeted training, strict adherence to aseptic techniques and continuous surveillance are essential to minimise contamination, improve diagnostic accuracy, and optimise patient outcomes. BCC remains a key challenge in accurately diagnosing BSIs among oncology patients.

Association Between Maternal Blood Group and Anaemia in First-trimester Pregnancy: A Cross-sectional Study from Tamil Nadu, India

Sharumathi Palaniappan, R Jasmine, KA Arul Senghor, VM Vinodhini, P Renuka Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Iron Deficiency Anaemia (IDA) is a significant public health concern among first-trimester pregnant women in India, particularly in Tamil Nadu. Given the dual burden of maternal anaemia and the potential role of blood group as a biological determinant, exploring this relationship is essential. Elucidating such relationships may strengthen antenatal care by enabling risk based screening, improved antenatal care practices, personalised interventions, and ultimately better maternal and neonatal outcomes. Aim: To assess the association between maternal blood group and iron deficiency anaemia among pregnant women in their first trimester attending a hospital in Tamil Nadu, India. Materials and Methods: This hospital-based, cross-sectional study was conducted at the Department of Obstetrics and Gynaecology of SRM Medical College and Hospital, Faculty of Medicine and Health Sciences, S.R.M. Institute of Science and Technology, Kattankulathur, Chengalpattu, Chennai, Tamil Nadu, India, for six months, from July 2025 to December 2025, among 280 pregnant women in their first trimester. Initial obstetric evaluation included basic analytes such as iron, Transferrin Iron Binding Capacity (TIBC), % Transferrin Saturation (TSAT), haemoglobin and blood group. Iron profile was evaluated in a Beckman Coulter DXC700 analyser. Subjects were categorised as Group A with mild anaemia, Group B with moderate anaemia and Group C with severe anaemia. Normality of the variables was evaluated by applying the Shapiro-Wilk test, and it was demonstrated as skewness, non parametric methods were employed. Descriptive statistics were expressed as median values with interquartile ranges, while categorical variables were summarised as frequencies and percentages. Results: A total of 280 women in the first trimester of pregnancy were enrolled in this study. The mean age of the participants was 26.86±4.52 years. The distribution of ABO blood groups among participants was as follows- group O- 120 (43%), Group A- 53 (18.92%), group B- 92 (33%), group AB- 15 (5.36%). This distribution highlights the predominance of group O, followed by group B, consistent with population level data. Out of 280 participants, the majority of participants were Rh positive 246 (87.86%), while a smaller proportion were Rh negative 34 (12.14%). The AB+ group had the lowest median haemoglobin concentration among the blood groups studied; however, between-group statistical comparisons were not performed/reported. Participants with Hb less than 11 g/dL were 131 (46.78%), and haemoglobin levels more than 11 g/dL were 149 (53.22%). About 3 (2.29%) had severe anaemia with Hb less than 8 g/dL, 58 (44.27%) had moderate anaemia with Hb levels ranging between 8 and 9.9 g/dL and 70 (53.44%) had mild anaemia with Hb levels between 10 and 10.9 g/dL. Conclusion: Blood group typing may serve as a supplementary biological marker for identifying vulnerable populations, but effective prevention and management should prioritise evidence based strategies with routine iron supplementation, early haematologic screening, and structured nutritional education to reduce the burden of anaemia, particularly in pregnancy.

Assessment of Nutrition, Anthropometry, and Electrolyte Balance in Patients with Perforation Peritonitis: A Prospective Observational Study

Rasika Nitin Pathak, Surekha Tushar Nemade, Shubhangi Dinesh Wankhade, Nutan Bharat Ahire, Nitin Eknath Bagal Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Perforation peritonitis is a severe abdominal emergency associated with systemic inflammation, catabolism, and significant nutritional and biochemical disturbances. Early postoperative assessment is vital to guide nutritional and electrolyte correction. Aim: To analyse changes in nutritional biomarkers (Serum total cholesterol, Serum triglyceride total protein, Serum albumin) anthropometric indices and electrolyte balance from the preoperative period to Postoperative Day 5 (POD5) in patients undergoing surgical management of perforation peritonitis. Materials and Methods: This prospective observational study was conducted at Dr Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik, Maharashtra, over five years, from May 2021 to May 2025. The study included 110 patients who underwent emergency laparotomy for perforated peritonitis. Nutritional parameters (serum cholesterol, serum Triglycerides, serum total protein, serum albumin), anthropometry {weight, Body Mass Index (BMI), mid-arm thickness, triceps skinfold}, and electrolytes (sodium, potassium) were recorded preoperatively and on POD5. Statistical analysis was done using paired t-tests. (p<0.05 was considered significant). Results: A total of 110 patients (83 males and 27 females) in the age group of 25-60 years (47.1±9.10 years) were included in the present study. Serum cholesterol and serum triglycerides showed a significant postoperative decline in values, indicating altered metabolism, reduced intake, and also an acute-phase response. Serum total protein and serum albumin were found to be decreased, suggesting inflammation. Reduced nutritional intake and catabolism can be the reason for this. Electrolytes remained stable, indicating adequate postoperative fluid and electrolyte management. Anthropometric markers, mid-arm thickness (p=0.0614) and triceps skinfold thickness (p=0.2903), were not statistically significant. Reduction in weight and BMI is statistically significant (<0.0001), which indicates early postoperative nutritional deterioration. Conclusion: Early postoperative deterioration of nutritional and anthropometric measures was evident. These findings collectively highlight the importance of early nutritional assessment and timely postoperative nutritional intervention in patients with perforation peritonitis.

Anatomical Variations in the Intratemporal Course of the Facial Nerve in Wet Temporal Bones: A Cross-sectional Study

Mayur Ingale, Sarthak Gupta Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: The Facial Nerve (FN) has a complex intratemporal course within the temporal bone and maintains close anatomical relationships with middle ear and mastoid structures, rendering it particularly vulnerable to iatrogenic injury during otologic surgery. Anatomical variations in its course, including facial canal dehiscence and Oval Window (OWL) overhang, may significantly increase surgical difficulty and risk of FN injury. Aim: To study the anatomical variations in the intratemporal course of the FN in wet temporal bones and correlate them with mastoid pneumatisation patterns. Materials and Methods: The present cross-sectional study was conducted in the Department of Otorhinolaryngology in the temporal bone dissection laboratory at Dr. D.Y. Patil Medical College and Research Institute, Pune, Maharashtra, India, over 18 months from March 2024 to June 2025. Fifty wet cadaveric temporal bones were dissected under an operating microscope. Mastoid pneumatisation patterns were recorded, and the lengths of the tympanic and mastoid segments were measured. Second Genu (SG) angle, depth from mastoid cortex, degree of descent, facial canal dehiscence, OWL overhang, lateral hump, and key anatomical distances were recorded. Statistical analysis was performed using a Chi-square test. Results: The majority of specimens showed a pneumatised mastoid pattern 39 (78%), followed by diploeic 6 (12%) and sclerotic 5 (10%) mastoids. Facial canal dehiscence was identified in 6 (12%) specimens, OWL window overhang in 8 (16%), and lateral hump at the SG in 6 (12%). The mean tympanic and mastoid segment lengths were 9.18±1.044 mm and 13.89±1.297 mm, respectively. A statistically significant association was found between mastoid pneumatisation and oval window overhang (p=0.005). Conclusion: Clinically, significant variations such as facial canal dehiscence, oval window overhang and lateral hump occur in a considerable proportion of cases.

Prevalence and Antimicrobial Susceptibility Patterns of Multidrug-resistant Organisms: A Retrospective Observational Study from a Tertiary Care Hospital

Charmi Mangal, Payal Khant, Kairavi Passwala, Rachana Solanki, Mahendra Vegad Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Antimicrobial Resistance (AMR) has emerged as a major threat to effective clinical care, significantly limiting therapeutic options and worsening patient outcomes. Tertiary care hospitals represent high-risk environments for the emergence and dissemination of Multidrug-Resistant Organisms (MDROs), particularly among critically-ill patients exposed to broad-spectrum antimicrobial therapy. The increasing prevalence of multidrug resistance across key hospital pathogens highlights a concerning shift toward difficult-to-treat infections, underscoring the need for institution-specific surveillance data. Aim: To evaluate the prevalence and antimicrobial susceptibility patterns of MDROs in a tertiary care hospital. Materials and Methods: This retrospective observational study was conducted from January to June 2025 at the Department of Microbiology, Dr. M.K. Shah Medical College and Research Centre, Ahmedabad, Gujarat, India. A total of 530 non-duplicate bacterial isolates from clinical specimens were included. Isolates were identified using colony morphology, Gram staining, standard biochemical tests, and/or the VITEK 2 Compact system. Antimicrobial Susceptibility Testing (AST) was performed by the Kirby–Bauer disk diffusion technique and/or the VITEK 2 Compact system, with interpretation in accordance with Clinical and Laboratory Standards Institute (CLSI) M100 Ed35 2025 guidelines. Data were analysed using WHONET 2024. Statistical analysis was performed using appropriate statistical methods. Categorical variables were summarised as frequencies and percentages. Associations between categorical variables were assessed using the Chi-square test. A p-value of <0.05 was considered statistically significant. Results: Of 530 bacterial isolates, 320 (60.4%) were identified as MDROs. The MDRO distribution was dominated by carbapenem-resistant Enterobacterales (CRE) 108 (33.75%), followed by ESBL producers 77 (24.06%) and Carbapenem-Resistant Acinetobacter Baumannii (CRAB) 70 (21.88%), with lower proportions of Methicillin-Resistant Staphylococcus aureus (MRSA) 40 (12.5%), carbapenem-resistant Pseudomonas aeruginosa 24 (7.5%), and VRE 1 (0.31%). MDROs were more frequent among inpatients, 291 (90.94%), particularly in intensive care units 127 (39.7%), and showed higher prevalence in older age groups ≥60 years (53.13%). Wound 101 (31.56%) and respiratory 99 (30.94%) specimens constituted the major sources of isolation. Conclusion: The present study demonstrates a concerning institutional multidrug resistance landscape that compromises the effectiveness of commonly used antimicrobials. The institution-specific resistance patterns generated in this study support a data-driven recalibration of empirical antimicrobial therapy, while reinforcing the need for sustained antimicrobial stewardship and strengthened infection prevention measures.

Retinal Nerve Fibre Layer Thickness Analysis using Spectral-domain Optical Coherence Tomography in Normal Eyes, Ocular Hypertension, Glaucoma Suspects, and Early Primary Open-Angle Glaucoma: A Cross-sectional Comparative Study

Deeksheka Donthiboina, Lily Daniel, R Kalpana, S Sushritha Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Structural alterations of the Retinal Nerve Fibre Layer (RNFL) are among the earliest detectable manifestations of glaucomatous optic neuropathy and may precede measurable visual field defects. Spectral Domain Optical Coherence Tomography (SD-OCT) enables objective quantification of these changes and facilitates early detection of glaucoma. This study compared RNFL thickness among normal eyes, ocular hypertensives, glaucoma suspects, and eyes with early Primary Open-Angle Glaucoma (POAG). Aim: To compare retinal nerve fibre layer thickness using spectral-domain optical coherence tomography among normal eyes, ocular hypertensive eyes, glaucoma suspects, and early primary open-angle glaucoma eyes, and to evaluate its association with intraocular pressure. Materials and Methods: This hospital-based cross-sectional study was conducted at the Outpatient Department (OPD) Ophthalmology of a Tertiary Care Hospital in Tamil Nadu, India, from August 2024 to October 2025. This study included 120 consecutively recruited participants categorised into normal eyes (n=30), ocular hypertension (n=30), glaucoma suspects (n=30), and early POAG eyes (n=30). All participants underwent a comprehensive ophthalmic evaluation, including intraocular pressure measurement by Goldmann applanation tonometry, gonioscopy, Humphrey visual field analysis, optic nerve head assessment, and spectral-domain optical coherence tomography-based RNFL analysis. Average and quadrant-wise RNFL thicknesses were compared among the groups using One-way Analysis of Variance (ANOVA). Receiver Operating Characteristic (ROC) analysis was used to evaluate the diagnostic performance of OCT-derived RNFL parameters. Results: Average RNFL thickness showed a significant progressive decline from normal eyes (102.9±5.6 μm) to ocular hypertensives (95.8±5.9 μm), glaucoma suspects (82.0±6.2 μm), and early POAG eyes (72.1±6.1 μm) (p<0.01). Quadrant-wise analysis showed more pronounced RNFL reduction in the inferior and superior regions than in the nasal and temporal quadrants. OCT demonstrated high diagnostic accuracy, with area under the curve values of 0.96 for average RNFL thickness and 0.97 for inferior quadrant RNFL thickness. Conclusion: Spectral-domain OCT-derived RNFL thickness may serve as a useful structural biomarker for early glaucomatous damage and may aid in risk stratification and early glaucoma detection.

Association of Serum Phosphate Levels with Disease Severity and Clinical Outcomes in Patients with Community Acquired Pneumonia: A Hospital-based Prospective Observational Study

Krunal Jayeshbhai Vaghani, Sonipriya Pazhani, Viknesh Prabu Anbalagan Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Community Acquired Pneumonia (CAP) remains a major cause of morbidity and mortality worldwide. Early identification of patients at risk of severe disease is essential for timely intervention. This prospective observational study evaluated the prognostic significance of serum phosphate levels in hospitalised CAP patients. Aim: To evaluate the association between serum phosphate levels, CURB-65 (Confusion, Urea, Respiratory rate, Blood pressure, and Age 65 or older) score, Intensive Care Unit (ICU) admission, and mortality in hospitalised patients with CAP. Materials and Methods: This hospital-based prospective observational study was conducted between May 2022 and October 2022 at Government Royapettah Hospital and Government Kilpauk Medical College Hospital, Chennai, Tamil Nadu, India after Institutional Ethics Committee approval. A total of 79 patients diagnosed with CAP were enrolled. Serum phosphate levels were measured at admission and on day 3 of hospitalisation. Disease severity was assessed using the CURB-65 score, and early ICU admission was defined as transfer within 48 hours. Data were analysed using Student’s t-test, Chi-square test, Analysis of Variance (ANOVA), and Kendall’s Tau correlation, with p-value <0.05 considered statistically significant. Results: Serum phosphate levels demonstrated a significant inverse correlation with CURB-65 scores at admission (τ=-0.273, p-value=0.001) and on day 3 (τ=-0.456, p-value <0.0001). Lower serum phosphate levels were significantly associated with higher CURB-65 scores, increased ICU admission rates, and poorer clinical outcomes (p-value <0.0001). Conclusion: These findings suggest that serum phosphate, an inexpensive and routinely available laboratory parameter, is associated with disease severity in patients with CAP and may serve for identifying high-risk patients and guiding clinical management in CAP.

Clinical and Angiographic Profile of STEMI-Equivalent Electrocardiographic Patterns in Acute Coronary Syndrome: A Prospective Observational Study

Utkarsh Gaur, Charuta Gadkari, Aditya Pundkar, Gajanan Chavan Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Prompt diagnosis of acute coronary occlusion plays an important role in lowering deaths in patients suffering from Acute Coronary Syndrome (ACS). Although ST-Elevation Myocardial Infarction (STEMI) forms the basis of reperfusion therapy, there are many high-risk non ST-segment elevation electrocardiographic presentations of ACS known as STEMI equivalents, which represent acute coronary occlusion but are frequently under-recognised. Aim: To determine the incidence of STEMI-equivalent presentations among ACS patients, describe their clinical and angiographic characteristics, and compare in-hospital outcomes based on reperfusion strategy. Materials and Methods: The present prospective observational study was conducted in the Emergency Department of a tertiary care teaching hospital, Datta Meghe Institute of Higher Education and Research, in Wardha, Maharashtra, India, over 24 months from August 2022 to August 2024, involving 120 patients diagnosed with ACS. Baseline demographics, including age, gender, Body Mass Index (BMI), and cardiovascular risk factors such as hypertension, diabetes mellitus, and thyroid disorders, were recorded. The clinical presentation, Electrocardiogram (ECG) findings, biochemical parameters, echo parameters, angiographic findings, reperfusion strategy, and clinical outcome were also recorded. Subjects were divided into a classical STEMI group and STEMI-equivalent groups, and comparisons were made among them and among groups based on reperfusion strategy. Continuous variables are represented as mean±Standard Deviation (SD) and were analysed using unpaired Student’s t-test, while categorical variables were represented as frequency (%) and analysed using Chi-square or Fisher’s exact test. A p-value of <0.05 was accepted as significant. Results: Among 51 STEMI-equivalent patients, males constituted 33 (64.7%). The most common patterns were left bundle branch block (20, 39.2%) and Wellens’ syndrome (19, 37.3%). Among STEMI-equivalent patients, the prevalence of multivessel coronary artery disease was 47.1% (24/51), compared with 30.4% (21/69) in classical STEMI patients. Similarly, reduced left ventricular ejection fraction (<50%) occurred in 54.9% (28/51) of STEMI-equivalent patients, compared with 43.5% (30/69) in classical STEMI patients. In-hospital mortality was highest in the de winter pattern (3/6, 50%) and aVR ST elevation (1/3, 33.3%); however, these estimates were based on small subgroup sizes. Survival was significantly higher in patients undergoing primary Percutaneous Coronary Intervention (PCI) than in those receiving thrombolysis (94% vs 78.1%, p=0.042). Conclusion: A significant proportion of ACS has STEMI-equivalent patterns and is associated with poor outcomes. Prompt diagnosis and early primary PCI dramatically improve survival.

Cerebrospinal Fluid Levels of Brain Derived Neurotrophic Factor in Children with Acute Encephalitis Syndrome: A Prospective Observational Study

Shiv Kant Prakratyansh, Chandrakanta, Manisha Verma, Neeraj Anand, Shailendra K Saxena Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Acute Encephalitis Syndrome (AES) is a severe neurological condition affecting children, characterised by acute onset of fever, altered consciousness, and seizures, often leading to long-term complications or death. Brain Derived Neurotrophic Factor (BDNF) is a neurotrophin involved in neuronal survival, development, and repair, as well as in the brain’s response to injury and inflammation. Although BDNF has been studied in other neurological conditions, its role in AES remains largely unexplored. Aim: To assess BDNF in the Cerebrospinal Fluid (CSF) of children diagnosed with AES to explore its potential role in disease pathophysiology. Materials and Methods: This prospective observational study was conducted at the Department of Paediatrics at King George’s Medical University, Lucknow, Uttar Pradesh, India, from October 2022 to April 2024. Children aged six months to ≤12 years diagnosed with AES as per World Health Organisation (WHO) criteria were enrolled in the study. A detailed history, demographic data and examination, including blood investigations and neuroimaging {Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) Brain} were performed as needed for patients. CSF BDNF levels were measured using Enzyme Linked Immunosorbent Assay (ELISA). Outcomes were categorised as good or bad based on clinical status at discharge. Data were entered into a Microsoft Excel spreadsheet and were analysed using the statistical software Statistical Package for the Social Sciences (SPSS) version 23.0. For the comparative data, t-test and Chi-square test were applied. The difference in p-value<0.05 was considered statistically significant. Results: The present study evaluated 80 paediatric cases of AES with a mean age of 7.95±3.59 years, of which 48 cases (60%) had an unknown aetiology, 25 cases (31.25%) had bacterial infections, and 7 cases (8.75%) had viral infections. No significant differences were found in clinical symptoms, laboratory investigations, or CSF BDNF levels across the groups. Although most children had favourable outcomes (71.25%), there were minor differences in neurological signs, such as absent deep tendon reflexes in bacterial cases. The duration of hospital stay and recovery, as reflected by GCS scores, was similar across all groups. Conclusion: The present study found no significant difference in BDNF levels across different AES aetiologies or clinical outcomes. However, BDNF's potential as a neuroprotective agent in AES remains promising, warranting further research to explore its therapeutic applications.

Ayurvedic Management of Hypersensitive Reactions to Insect Bite (Keeta Visha): A Case Report

SK Venkateshperumal, K Jayadeep, Mahesh P Savalagimath Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Insects are common in tropical countries like India, and their bites often cause allergic reactions ranging from local irritation to severe hypersensitivity. Common ants can trigger these reactions through protein allergens, resulting in symptoms like urticarial rashes, angioedema, and anaphylaxis. Agadatantra (Ayurvedic toxicology) focuses on managing these conditions, offering an alternative to modern drugs that may have adverse effects. A case study of a 22-year-old male with extensive erythematous rashes, severe itching, and facial swelling demonstrated the effectiveness of Ayurvedic treatments, which led to a rapid resolution of symptoms.

Role of Amniotic Fluid to Umbilical Cerebral Ratio for Anticipation of Perinatal Outcome in Appropriate for Gestational Age Foetuses at Term: A Prospective Observational Study

Manju Lata Verma, Hina Prakash, Uma Singh, Amita Pandey, Pushp Lata Sankhwar Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: The role of amniotic fluid in embryonic development is crucial. Amniotic Fluid Volume (AFV) is maintained by physiological processes that vary with gestational age. Either oligohydramnios or polyhydramnios, a variation from the normal volume, may be related to maternal and foetal problems. Hence, considering the importance of amniotic fluid, combining Doppler with the amniotic fluid deepest vertical pocket as a ratio, for foetal wellbeing assessment might be helpful. Aim: To study the role of Amniotic Fluid to Umbilical Cerebral Ratio (AUCR) in prediction of perinatal outcome in Appropriate for Gestational Age (AGA) foetuses at term. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, King George’s Medical University, Lucknow, Uttar Pradesh, India from May 2021 to May 2022. Foetal Doppler ultrasound examinations, which included Umbilical Artery (UA) Doppler (systolic diastolic ratio (S/D), Pulsatility Index (PI), Resistive Index (RI)), and Middle Cerebral Artery (MCA) Doppler (S/D, PI, RI). AUCR was calculated as the ratio of Single Deepest Pocket (SDP) to Umbilical Cerebral Ratio (UCR= UAPI/MCAPI- UA PI/MC PI). Beyond this Cerebroplacental Ratio (CPR=MCAPI/UAPI- MC PI/UA PI was done. Caesarean Delivery (CD) and Operative Vaginal Delivery (OVD) due to foetal distress had been collectively termed as “OI due to foetal distress”. Also, Apgar scores and neonatal unit admissions were noted. Results: Total 112 term AGA pregnancies were followed in the present study. The age range was 18–40 years with a mean age of 26.34 years and the mean Body Mass Index (BMI) was 24.88 kg/m2. Out of 112 term pregnancies, 56 foetuses had foetal distress, of which five had Operative Vaginal Delivery (OVD) by outlet forceps and 51 patients had Lower Segment Caesarean Section (LSCS). Ten newborns needed Neonatal Intensive Care Unit (NICU) a admission. For predicting operative intervention (adverse perinatal outcome), the Cerebroplacental Ratio (CPR) demonstrated the highest diagnostic accuracy with an AUC of 0.801 (p-value<0.001), followed by MCA PI (AUC 0.781) and AUCR (AUC 0.72). Conclusion: Inclusion of amniotic fluid in the ratio in the form of AUCR has moderate predictive ability for the prediction of poor outcome in AGA foetuses.

Early Exposure to Artificial Intelligence in Medical Education: A Knowledge, Attitude and Practice Study among Preclinical Medical Students from Mangaluru, India

Md Aayan Afroz, Suriyan S Nair, Manjula Shantaram Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Artificial Intelligence (AI) is the study of machines that learn from collected data and use human-like reasoning. AI applications are already used in healthcare, and there is a need to understand the need for AI training in the medical curriculum. Aim: To assess the Knowledge, Attitudes, and Practices (KAP) related to AI among first- and second-year MBBS students. Materials and Methods: This cross-sectional study was conducted at AJ Institute of Medical Sciences and Research Centre, Mangaluru, Karnataka, India from April to May 2026, among first- and second-year MBBS students via an online questionnaire; the sample size was 327. Based on existing KAP studies, the questionnaire collected data on AI knowledge (e.g., AI/ML concepts and applications), attitudes (e.g., beliefs about fostering AI knowledge despite its future application), and AI application. Categorical associations were analysed using Chi-square tests. Statistical significance was set at p-value <0.05. Results: Of 327 survey participants, 204 (62.39%) were first-year medical students. Most reported at least basic knowledge of AI; however, few had prior training {26 (7.95%) attended AI workshops, and 41 (12.54%) received curriculum training}. Most students believed medical schools should teach AI concepts (269, 82.26%) and supported incorporating AI into the curriculum (193, 59.02%). ChatGPT was the most popular AI tool, used by 315 (96.33%) respondents, primarily for exam preparation and studying, with other uses less frequent. The key obstacles included insufficient knowledge/lack of proper training in AI (222, 67.89%) and concerns about data privacy and ethical issues (157,48.01%). Conclusion: Despite extensive exposure to AI (as most students used AI tools), students had limited knowledge or training in it. Students were optimistic about AI in healthcare and strongly supported AI education. These results suggest incorporating AI training into the medical curriculum to bridge knowledge gaps and meet learners’ needs.

Types of Treatment and Early Clinical Outcomes in Breast Cancer Patients: A Retrospective Cohort Study

Abhishek Basu, Saikat Sheet, Ipsita Palui Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Breast cancer is the most commonly diagnosed malignancy among women worldwide and remains a major contributor to cancer-related mortality, particularly in low- and middle-income countries. However, data describing stage distribution, treatment delivery, radiotherapy utilisation, and early clinical outcomes of breast cancer patients treated in public-sector tertiary care institutions remain limited. Aim: To describe the clinicodemographic profile and treatment patterns of breast cancer patients managed at a tertiary care centre. Materials and Methods: This retrospective cohort study was conducted at the Department of Radiotherapy, Midnapore Medical College, West Bengal, India. The present study included 152 histologically confirmed breast cancer patients managed between January 2023 and June 2025 and followed up till 31st December 2025. Patients with newly diagnosed metastatic disease at presentation were included. Data regarding age, residence, socioeconomic status, presenting symptoms, tumour characteristics, stage at diagnosis, type of surgery, systemic therapy, radiotherapy utilisation, duration of hospitalisation, and early clinical outcomes during follow-up were extracted from hospital records and analysed. Associations between categorical variables were assessed using the Chi-square test. Fisher’s-exact test was used when expected cell frequencies were small. The Chi-square test was used to evaluate associations between disease stage and duration of hospitalisation, type of surgery and radiotherapy utilisation, and disease stage and radiotherapy utilisation. Age and duration of hospitalisation were analysed as continuous variables where appropriate and were additionally categorised for descriptive and categorical analyses. No multivariable analysis was performed because the study was primarily descriptive and exploratory, and the sample size and number of outcome events were limited. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) software, version 24.0. A two-sided p-value <0.05 was considered statistically significant. Results: Breast cancer constituted 31.8% of all cancer registrations. Majority were aged ≤50 years and from lower socioeconomic strata. Stage-II disease was most common. Adjuvant radiotherapy was administered in 85% of patients. A significant association was observed between disease stage and hospital stay (p<0.001), type of surgery and radiotherapy utilisation (p<0.001), and radiotherapy utilisation with disease stage (p<0.001). Conclusion: Advanced-stage disease remains prevalent and is associated with increased healthcare utilisation. Integration of radiotherapy and early detection strategies are essential to improve outcomes.

Antimicrobial Activity of Gunjadya Taila (oil): An In-vitro Study

Gunja Kiran Dahikar, Sandip Bhimrao Kamble, Bharat Jagdish Rathi, Supriya Jagdish Meshram, Suvidha Pazare Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Physicians are facing many challenges in treating various bacterial and fungal infections due to obstacles such as resistance development, side-effects, patient affordability, etc. Gunja mentioned in Ayurvedic texts can be an ideal substitute for the treatment of various infectious diseases. Gunja is a well-known herbal semi-poisonous plant reported to contain various medicinal properties used in various formulations after a proper purification process. These formulations are indicated for preservation of health and cure of a variety of disease conditions Gunjadya Taila is one of the formulations prepared from Shuddha Gunja and other ingredients. This medicine is used topically in different dosage forms suited for the patient and the disease condition. In the current scientific work, the effect of Gunjadya Taila is assessed for antimicrobial effect on Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae and Candida albicans hence to evaluate both antifungal and antibacterial activity against gram-positive and gram-negative bacteria this study is undertaken. Aim: To assess the antimicrobial activity of Gunjadya Taila. Materials and Methods: In-vitro (antibacterial) study was carried out in JNMC, Sawangi (M), Wardha, Maharashtra, India. The duration of the study was from April 2022 to August 2023. The in-vitro antibacterial study of Gunjadya Taila was performed on three bacteria and one fungal strain. Gunjadya Taila was prepared in three batches in Laboratory of Rasashastra Department. The in-vitro antibacterial activity was evaluated by the Agar well diffusion method at 100 μL, 150 μL and 200 μL concentration and their results were compared with a broad spectrum and most commonly used antibiotic. The test for statistical analysis used was ANOVA at all three concentrations. The software used for statistical analysis was SPSS and 27.0 version. The set level of significant p-value was <0.05 for the antibacterial study. Results: It is observed that Murchchhita and Amurchchhita Gunjadya Taila both sensitive against Staphylococcus aureus, E. coli and Candida albicans. Conclusion: Gunjadya Taila shows antimicrobial activity against Staphylococcus aureus and Escherichia coli. It also shows limited antifungal activity against Candida albicans, although this was inferior to that of the positive control.

Prevalence of Selfitis and Its Association with Anxiety, Loneliness and Sleep Disturbances Among Urban College Students in Chennai District: A Mixed-methods Study

Tharani Vasudevan, G Shiny Chrism Queen Nesan Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Selfitis is not formally recognised as a disorder in the World Health Organisation (WHO) International Classification of Diseases, 11^th Revision (ICD-11). In research, it is operationally defined as excessive or compulsive selfie-taking and posting behaviour, measured using the Selfitis Behaviour Scale (SBS). College students, as a digitally active population, represent a group in whom selfie-related behaviour may overlap with anxiety, loneliness and sleep disturbance. Aim: To estimate the prevalence of selfitis and assess its association with anxiety, loneliness and sleep disturbances among undergraduate students aged 18-21 years from arts colleges in urban Chennai, with a qualitative strand exploring the perceived reasons for selfie-taking behaviour. Materials and Methods: A mixed-methods study was conducted by the Department of Community Medicine, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, among undergraduate students from arts colleges in Chennai district, Tamil Nadu, India over a period of six months (July 2025 to December 2025) among 268 undergraduate students selected through convenience sampling from arts colleges across urban zones of Chennai district. The quantitative strand was an analytical cross-sectional study using SBS, Generalised Anxiety Disorder-7 (GAD-7), the 10-item University of California, Los Angeles (UCLA) Loneliness Scale and a modified six-component Pittsburgh Sleep Quality Index (PSQI). The qualitative strand employed In-Depth Interviews (IDIs) with a subsample of 18 students who consented from the 26 students approached, continued until thematic data saturation was achieved; the IDI sample size was determined by saturation and not by statistical power, as is standard in qualitative research. Non parametric tests, Chi-square tests (with Monte-Carlo exact estimation for sparse tables) and Holm-corrected significance testing were used for analysis Results: Among 268 students, 187 (69.8%) had moderate selfitis and 26 (9.7%) had severe selfitis. Moderate anxiety was observed in 112 (41.8%) and severe anxiety in 39 (14.6%) students; high loneliness in 125 (46.6%) and poor sleep quality in 232 (86.6%). Male students had significantly higher SBS scores than female students (p=0.036). Selfitis severity was significantly associated with anxiety category (p<0.001) and loneliness category (p=0.006), but not with sleep quality (p=0.812). Year of study was significantly associated with sleep quality (p=0.003; Holm-adjusted p=0.045). Qualitative findings revealed seven themes need for social validation (88.9%), emotional coping and loneliness (83.3%), self-presentation and identity formation (77.8%), peer influence and social media pressure (72.2%), sleep disturbance and night-time phone use (66.7%), anxiety and appearance concern (61.1%), and perceived need for digital well-being (55.6%). Conclusion: Moderate selfitis was common among urban arts-college students and showed significant associations with anxiety and loneliness. Poor sleep quality was highly prevalent. Campus-based digital well-being interventions addressing anxiety, loneliness, sleep hygiene and responsible social media use are recommended.

Prevalence and Phenotypic Detection of ESBL-producing Escherichia coli and Klebsiella Species: A Cross-sectional Observational Study

Sagnik Bhattacharjee, Jayanta Debnath, Pradip Kumar Das, Debosmita Paul Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Extended-Spectrum b-Lactamase (ESBL)- producing Enterobacterales have emerged as a major public health concern because of their ability to confer resistance to extended-spectrum cephalosporins and their frequent association with Multidrug Resistance (MDR). Early detection and continuous surveillance are essential for appropriate antimicrobial therapy and infection control. Aim: To determine the prevalence and phenotypic detection of ESBL-producing Escherichia coli and Klebsiella species. Materials and Methods: A cross-sectional observational study was conducted in the Department of Microbiology, Tripura Medical College and Dr BR Ambedkar Memorial (BRAM) Teaching Hospital, Agartala, Tripura, India from March 2025 to February 2026. A total of 324 clinical isolates of Escherichia coli, Klebsiella pneumoniae, and Klebsiella oxytoca were included. Isolates were screened for ESBL production using third-generation cephalosporins and confirmed by the Combined Disc Test (CDT) and ESBL E-test. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 26.0. Associations were evaluated using the Chi-square test or Fisher’s exact test, as appropriate, with a p-value <0.05 considered statistically significant. Results: Of the 324 isolates tested, 106 (32.7%) were confirmed as ESBL producers. ESBL production was highest among E. coli 58/155 (37.4%), followed by K. pneumoniae (46/156, 29.5%) and K. oxytoca 2/13 (15.4%). A significant association was observed between age group and ESBL production (p-value =0.007), whereas gender showed no significant association (p-value=0.901). ESBL-positive isolates showed high resistance to cefuroxime (100% in both K. pneumoniae and E. coli) and third-generation cephalosporins, with cefotaxime resistance of 45/46 (97.8%) and 57/58 (98.3%), ceftriaxone resistance of 45/46 (97.8%) and 55/58 (94.8%), and ceftazidime resistance of 43/46 (93.5%) and 56/58 (96.6%) in K. pneumoniae and E. coli, respectively. Amikacin showed comparatively lower resistance, particularly among ESBL-positive E. coli 9/58 (15.5%). CDT showed excellent agreement with the E-test, with sensitivity, specificity, and accuracy of 97.2%, 99.5%, and 98.8%, respectively. Conclusion: ESBL-producing E. coli and Klebsiella species constitute a proportion of clinical isolates and exhibit substantial antimicrobial resistance, particularly to cephalosporins. The CDT showed high diagnostic accuracy compared with the ESBL E-test, supporting its utility as a reliable phenotypic method for routine ESBL detection.

Association of Admission Fibrinogen-to-Albumin Ratio with Angiographic Severity of Coronary Artery Disease in Patients with ST-Segment Elevation Myocardial Infarction: A Cross-sectional Study

Janga Namratha, Bhargav Kiran Gaddam, RM Anitha, Buchipudi Sandeep Kumar Reddy Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: ST-Segment Elevation Myocardial Infarction (STEMI) involves intense thrombotic and inflammatory activation. Fibrinogen rises during coagulation and acute-phase responses, whereas albumin may decrease during inflammation; the Fibrinogen-to-Albumin Ratio (FAR) integrates these pathways and may reflect coronary atherosclerotic burden. Evidence relating FAR to angiographic severity in STEMI remains inconsistent. Aim: To assess the association between admission FAR and Coronary Artery Disease (CAD) severity quantified by the Gensini score. Materials and Methods: This hospital-based cross-sectional study included 87 consecutive adults with confirmed STEMI at a tertiary care teaching hospital in Puducherry, India, during August 2024 to January 2026. Admission fibrinogen and albumin were measured before coronary angiography. CAD was classified by Gensini score as mild (1-19), moderate (20-79), or severe (≥80). Spearman correlation, Kruskal-Wallis with Dunn-Bonferroni comparisons, ordinal logistic regression, and Receiver Operating Characteristic (ROC) analysis were used. Results: Mean age was 58.34±12.91 years and 61 (70.1%) participants were male. Mean FAR was 95.33±31.46 mg/g and mean Gensini score was 50.28±37.06. FAR correlated strongly with Gensini score (ρ=0.903; p-value <0.001) and increased from mild to severe CAD (71.56±10.09, 99.86±11.03, and 143.85±16.44 mg/g; p-value <0.001). FAR remained independently associated with higher CAD severity (adjusted OR 1.331; 95% CI 1.208-1.466; p-value <0.001). ROC AUC for severe CAD was 0.996; a FAR cut-off of 124.0 mg/g yielded 95.0% sensitivity and 98.5% specificity. Conclusion: Higher admission FAR was strongly associated with greater angiographic CAD severity in this single-centre STEMI cohort. External validation is required before clinical cut-offs are adopted.

Sociodemographic Factors and Supplementation Practices Associated with Hypovitaminosis D in Infants: A Prospective Observational Study

Richa Bhatt, Jagruti Rathva, Shilvi Shah, Urvish Joshi, Halak Vasavada, Vaidehi Godbole, Pankti Desai, Aadya Vyas Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Vitamin D deficiency remains highly prevalent among infants in low- and middle-income countries. Maternal health-seeking behaviour, urbanisation, and seasonal variations are emerging as key factors associated with infant vitamin D status. However, hospital-based data evaluating adjusted associations among these factors and infant vitamin D status remain scarce. Aim: To determine the prevalence of hypovitaminosis D among hospitalised infants and identify sociodemographic and supplementation-related practices independently associated with the deficiency. Materials and Methods: A hospital-based prospective observational study was conducted in the Department of Paediatrics at Narendra Modi Medical College, LG Hospital in Ahmedabad, Gujarat, India, from July 2023 to December 2024. The study was conducted among 183 hospitalised infants (1-12 months) with acute medical illnesses. Sociodemographic variables, seasonal admission, maternal/infant supplementation practices, feeding types, and nutritional status were recorded. For the present study, hypovitaminosis D was operationally defined as serum 25-hydroxyvitamin D [25(OH)D] concentration <20 ng/mL. Univariate analyses and multivariable binary logistic regression were performed to calculate Unadjusted Odds Ratios (UOR) and Adjusted Odds Ratios (AOR) with 95% Confidence Intervals (CI). A p-value <0.05 was considered statistically significant. Results: The cohort comprised 183 infants (mean age 5.4±3.2 months; 63.9% male). The prevalence of hypovitaminosis D was 54.1%. In unadjusted analyses, urban residence, lower Socioeconomic Status (SES), winter season, and low parental education were significantly associated with deficiency (p<0.05). In multivariable binary logistic regression, the lack of maternal antenatal supplementation (AOR 2.95; 95% CI 1.40–6.10, p=0.004) and lack of infant supplementation (AOR 4.00; 95% CI 2.00-8.15, p=0.0001) demonstrated statistically significant independent associations with deficiency. Infants presenting with acute respiratory infections had higher unadjusted odds of hypovitaminosis D than those with non respiratory diagnoses (UOR 2.55; 95% CI 1.40–4.64; p=0.002). Conclusion: Hypovitaminosis D was highly prevalent among hospitalised infants. Lack of maternal and infant supplementation showed the strongest adjusted associations with hypovitaminosis D. These findings should be interpreted within the hospital-based observational design.

Motivation across Academic Performance Groups among First-year Undergraduate Physiotherapy Students in Mumbai, Maharashtra, India: A Cross-sectional Study

Pothiraj Pitchai, Bhavana Gadhavi, P Antony Leo Aseer, Dipali Suvarna, Dhvani Shah, Sandesh Sakpal, Bhavana Mohota Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Physiotherapy education in India is transitioning to a competency-based curriculum that emphasises self-directed learning. Academic motivation is a key learner-related factor that influences academic outcomes. However, evidence on motivational profiles across academic performance groups remains limited, especially among physiotherapy students. Understanding these differences may facilitate targeted educational support to improve academic outcomes. Aim: To assess academic motivation and compare advanced, average, and Slow Performers (SLP) among undergraduate physiotherapy students. Materials and Methods: The present multicentre cross-sectional study was conducted from March 2025 to December 2025 in private physiotherapy colleges affiliated with Maharashtra University of Health Sciences located in Mumbai and Navi Mumbai, Maharashtra, India. A complete enumerative sampling technique was used to recruit 509 eligible first-year physiotherapy undergraduates. Students who took the first formative exam were included. Based on exam scores, students were classified as advanced (top 20%), average (middle 60%), or SLPs (bottom 20%). Data were collected using the Academic Motivation Scale via Google Forms and Analysed applying the Mann-Whitney U test and Kruskal-Wallis H test with Bonferroni correction (p<0.017). A p-value of <0.05 was considered statistically significant. Results: A total of 450 participants were included for the final analysis, comprising 74 males (16.44%) and 376 females (83.56%). Significant differences were observed among the three academic performance groups for intrinsic motivation to know (H=13.25, p=0.001) and amotivation (H=13.97, p=0.001). Post-hoc analysis showed significant differences in intrinsic motivation to know between advanced and SLPs, and between average and SLPs, while amotivation differed significantly between advanced and SLPs. Conclusion: The findings of the present study demonstrate that advanced performers exhibited higher intrinsic and lower amotivation than SLPs, although the differences were small. Moreover, extrinsic motivation types did not differ. Integrating early assessment of academic motivation and autonomy-supportive learning environments may help reduce amotivation and enhance learner engagement.

Comparison of Dexmedetomidine and Fentanyl-propofol Infusions for Perioperative Haemodynamic Stability and Postoperative Analgesia in Supratentorial Tumour Surgery: A Randomised Clinical Trial

AS Sai Saran, Naseema V Kanase, Vishwas M Joshi Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Supratentorial tumour surgeries are associated with sympathetic responses during airway manipulation and surgical stimulation. Maintenance of haemodynamic stability is essential to preserve cerebral perfusion and provide favourable neurosurgical conditions. Aim: To compare dexmedetomidine with a fentanyl-propofol supplementary infusion for perioperative haemodynamic profile and postoperative analgesic outcomes. Materials and Methods: This single centre, parallel group, randomised clinical trial was conducted in the Department of Anaesthesiology, Krishna Hospital and Medical Centre, Krishna Institute of Medical Sciences, Karad, Maharashtra, India, from May 2024 to September 2025 and the study included 100 adults undergoing supratentorial tumour resection. Group-D (n=50) received dexmedetomidine 1 μg/kg over 10 minutes then 0.5 μg/kg/hour; Group-FP (n=50) received 2 mL/hour of a 50 mL mixture containing fentanyl 100 μg and propofol 100 mg. Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) were measured serially. Postoperative Visual Analogue Scale (VAS), rescue analgesia, adverse events and hospital stay were compared. Continuous outcomes, including haemodynamic variables, VAS scores, analgesic requirements and hospital stay, were compared between groups using the independent-samples Student’s t-test. Categorical variables, including rescue opioid use and adverse events, were compared using the Chi-square test or Fisher’s-exact test, as appropriate; p<0.05 was considered statistically significant. Results: Mean age was 45.2±12.1 years versus 44.7±11.8 years and Body Mass Index (BMI) 25.7±4.5 kg/m² versus 25.2±3.8 kg/m² in Groups D and FP, respectively. HR was lower in Group-D from three minutes (71.9±7.6 versus 77.9±6.6 beats/min; p<0.001); MAP was lower from 5 minutes (93.2±4.8 versus 99.1±7.8 mmHg; p<0.001) and at the recorded postoperative time point (88.1±5.6 versus 90.9±6.3 mmHg; p=0.019). VAS at 24 hours was lower in Group-D (1.5±1.1 versus 2.9±1.1; p<0.001). Time to rescue analgesia was longer (277.5±73.6 versus 200.2±63.7 minutes; p<0.001), tramadol use was lower (36.0±37.9 versus 73.0±56.4 mg; p<0.001), and hospital stay shorter (5.9±1.6 versus 6.8±2.1 days; p=0.019) in Group-D. Adverse events were comparable. Conclusion: The fentanyl-propofol regimen maintained comparatively higher HR and arterial pressures, which may be useful when avoidance of hypotension and bradycardia is prioritised. Dexmedetomidine provided superior postoperative analgesia with reduced analgesic requirement.

Emotion Regulation and Coping Styles in Bipolar Mood Disorder: A Cross-sectional Study

Dhawalkumar D Patel, Lakhan Kataria, Samant Singh Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Specific coping mechanisms utilised by Bipolar Mood Disorder (BD) patients are increasingly recognised as stable, trait-like prognostic markers. However, foundational regional data from the Indian subcontinent remains largely unexplored compared to advanced global literature. While international research mapped coping deficits to neurobiological vulnerabilities and functional decline, no comparable cross-sectional studies originated from the Indian subcontinent. Aim: To assess coping profiles and emotion regulation strategies in an Indian euthymic BD cohort. Materials and Methods: The present cross-sectional study was conducted at the Smt. Bhikhiben Kanjibhai Shah Medical Institute and Research Centre (SBKSMI&RC), Sumandeep Vidyapeeth, Vadodara, Gujarat, India, between June 2015 and August 2016 and assessed 200 participants (100 euthymic BD patients, 100 matched healthy controls). Diagnoses were confirmed through detailed, semi-structured clinical interviews conducted by a consultant psychiatrist applying strict DSM-IV-TR criteria. Coping profiles were evaluated using the Brief Coping Orientation to Problems Experienced (Brief COPE) Inventory, Cognitive Emotion Regulation Questionnaire (CERQ), and Coping Inventory for Prodromes of Mania (CIPM). All participants provided informed consent for the use of anonymised data. Data were analysed using Statistical Package for the Social Sciences (SPSS) software. Descriptive statistics (mean, standard deviation) were utilised for sociodemographic variables. Results: The clinical cohort revealed BD patients relied significantly more on maladaptive strategies including self-blame, rumination, and catastrophising (p<0.001), while underutilising positive reappraisal and active coping (p<0.001). Conclusion: Euthymic BD patients exhibit profound, trait-like vulnerabilities in their coping profiles. Persistent regional literature gap highlights an urgent need to incorporate culturally-adapted cognitive restructuring into standard psychiatric care.

MED-AI Summit 2026

Vijayashree Raghavan Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Abstract Proceedings

In-vitro Evaluation of 3D Bioprinted Alginate Membranes for Periodontal Regeneration: Mechanical Properties, Biocompatibility and Drug Release Analysis

Shirley Joshini Samvel, Supraja Ajitkumar, SK Balaji Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Alginate-based hydrogel membranes are commonly used in periodontal applications due to their biocompatibility. Rosuvastatin (RSV), a lipid lowering drug is known for inducing osteoblastic differentiation by several studies. Aim: To assess the physical properties {using Scanning Electron Microscope (SEM), Fourier Transform Infrared (FTIR), surface roughness, and contact angle} and drug release behaviour (via Franz Diffusion Method) of alginate-based 3D bioprinted membranes, with and without 1.2% RSV. Materials and Methods: This in-vitro study was conducted in Department of Periodontology, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India from September 2025 to November 2025. Two bioinks, including one with 1.2% RSV and other premade bioink CELLINK BONE®, were 3D printed into 10 mm × 10 mm × 1 mm membranes. Each bioink was incorporated with RSV calcium (18 mg - CELLINK BONE® and 12 mg - 6% Alginate). Membranes were printed in rectilinear and honeycomb patterns and crosslinked using 0.5% Calcium chloride. Physical properties, haemocompatibility and drug release were then evaluated. Results: SEM and FTIR analysis validated the formation and typical morphology of the 6% alginate membranes. The membranes were hydrophilic and haemocompatible, while the one with RSV had sustained drug release. However, the CELLINK BONE® membrane loaded with RSV was not structurally stable as it disintegrated after processing. Conclusion: The results indicate that both membranes are promising for their use in Guided Tissue Regeneration (GTR), serving as scaffolds as well as local drug delivery systems.

Comparison of Incidence and Severity of Post-dural Puncture Headache After Caesarean Section Using 25G versus 27G Quincke Spinal Needles: A Randomised Controlled Trial

Renuka Patond, Nikhil Bhalerao Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Post-dural Puncture Headache (PDPH) is a frequent occurrence after spinal anaesthesia, especially in obstetric patients for caesarean section. It is described by the headache that aggravates with upright posture and is usually accompanied by photophobia, nausea, and stiff neck. It has marked effects on maternal recovery, neonatal care, and hospital stay. The design and size of the spinal needle are important predictors of PDPH, and thinner gauge needles with atraumatic bevels are perceived to minimise Cerebrospinal Fluid (CSF) leak and the risk of headache. Aim: To evaluate the incidence and severity of PDPH in patients for elective caesarean section under spinal anaesthesia with 25G and 27G Quincke spinal needles. Materials and Methods: This was a double blinded, randomised controlled trial conducted at the Department of Anaesthesia, Jawaharlal Nehru Medical College (JNMC) and Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, Maharashtra, India, from June 2023 to October 2024. A total of 120 pregnant women aged 18-35 years, with American Society of Anaesthesiology (ASA) physical status II, scheduled for elective caesarean section under spinal anaesthesia, were enrolled. Participants were randomised into Group A (25G Quincke) and Group B (27G Quincke), receiving 1.8 ml of 0.5% hyperbaric bupivacaine. The postoperative period involved observing the occurrence, intensity, onset, and side-effects of PDPH. The Chi-square test was used for comparison of categorical data, and the Independent-samples t-test for continuous data. The number of attempts at insertion was also recorded and analysed statistically, with significance set at p-value <0.05. Results: A total of 120 pregnant women aged 18-35 years (mean age 27.6±8.3 years), with a mean height of 163.0±7.6 cm, mean weight of 60.1±6.3 kg, and mean Body Mass Index (BMI) of 22.8±3.3 kg/m2, were enrolled and randomised equally into the 25G and 27G Quincke spinal needle groups. PDPH occurrence was significantly less in the 27G group (5%) compared to the 25G group (20%) (p-value <0.05). The 27G group mostly experienced mild headaches, whereas the 25G group had significantly more cases of moderate to severe headaches. Additional attempts were required to successfully puncture the dura with the 27G needle. Adverse effects, including nausea and vomiting, were not significantly different among groups. Conclusion: The 27G Quincke needle decreases the occurrence and intensity of PDPH significantly compared to the 25G needle in elective caesarean deliveries. Despite technical problems, the thinner needle gives better comfort to the patient, and is therefore recommended for obstetric spinal analgesia.

Prevalence and Characteristics of Atopic Dermatitis-related Symptoms among School Children in Al-Baha Province, Saudi Arabia: A School-based Cross-sectional Study

Hasan S Al-Ghamdi, Nada Khader Mohammed Alghamdi, Atheer Mohammed Saad Al-Ghamdi, Raghad Ahmed Saeed Alghamdi, Nouf Ahmed Ali Alghamdi, Ahlam Saud Hussain Alabbad, Sarah Adel Abdullah Alharbi, Sarah R Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Atopic Dermatitis (AD) is a chronic, relapsing inflammatory skin disorder that can impair sleep, learning and family wellbeing. Epidemiological evidence from Al-Baha Province remains limited, despite marked climatic contrasts between the mountainous Al-Sarah and coastal Tihamah. Aim: To estimate the prevalence of AD-related questionnaire indicators, describe symptom characteristics (age at onset, clearance and nocturnal waking), and explore differences in recurrent itchy rash and eczema according to demographic, educational and geographical characteristics. Materials and Methods: The present school-based cross-sectional study included children aged 6-15 years attending primary and intermediate schools in Al-Baha Province, southwestern Saudi Arabia, between February 2023 and February 2024. Parents of pupils across educational levels and ecological zones completed an Arabic questionnaire incorporating the validated Arabic version of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase I eczema module. AD symptoms were defined by a recurrent itchy rash for at least six months, occurrence of the same rash during the preceding 12 months, and previous involvement of a characteristic site. Lifetime history of eczema (‘eczema ever’) and parent-reported physician-diagnosed AD were assessed separately. Analyses used item-specific denominators, Wilson 95% Confidence Intervals (CIs) and chi-square or exact tests. Results: The final analysis included 978 children with a mean age of 10.22±2.97 years; 514 (52.6%) were female. Recurrent itchy rash was reported by 312 children (31.9%; 95% CI: 29.1%-34.9%); 236 children (24.1%; 95% CI: 21.6%-26.9%) reported the same rash during the preceding 12 months. AD symptoms were reported in 213 children (21.8%; 95% CI: 19.3%-24.5%). Eczema ever was reported by 316 (32.3%), whereas parent-reported physician-diagnosed AD was reported by 330 (33.7%). Among children with follow-up data, rash onset before two years of age was reported in 147/236 (62.3%), complete clearance during the preceding year in 169/234 (72.2%), and nocturnal waking at least once per week in 54/230 (23.5%). Recurrent itchy rash was more common among females and intermediate-school pupils, whereas eczema ever was more common among intermediate-school pupils and Al-Sarah residents. Conclusion: AD symptoms were reported in 213 (21.8%) children. Recurrent itchy rash was more frequent among females and intermediate-school pupils, whereas eczema ever was more frequent among intermediate-school pupils and among residents of higher-altitude Al-Sarah than among residents of coastal Tihamah. Among children with nocturnal-waking data, 23.5% were awakened by the rash at least once per week. These findings require cautious interpretation but support greater awareness within schools and appropriate clinical assessment, while also underscoring the need for rigorous probability-based surveys using weighted, cluster-adjusted analyses.

Intraoperative Morphology-based Laparoscopic Ovarian Drilling in Women with Polycystic Ovary Syndrome: Technique and Reproductive Outcomes

Sneha Aramandla, Surakshith Battina, Sarat Battina, Nandhana Venkateswaran, Khush Shah Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Polycystic Ovary Syndrome (PCOS) is a common cause of anovulatory infertility. Although Laparoscopic Ovarian Drilling (LOD) is an established second-line treatment, conventional techniques typically employ a fixed number of punctures irrespective of ovarian morphology and ovarian reserve. This study describes an intraoperative morphology based LOD technique tailored to ovarian characteristics and evaluates its reproductive outcomes and perioperative safety. Aim: To evaluate the technique of LOD employed in the study, among women with PCOS and determine the reproductive outcomes after LOD. Materials and Methods: This was a retrospective study conducted at Indigo Women’s Center, Chennai, Tamil Nadu, India from September 2025 to February 2026. Data was obtained from past clinical records, extended from June 2022 to May 2024 (a total duration of two years). The number of ovarian punctures was individualised according to ovarian morphology and ovarian reserve parameters. Operative characteristics, perioperative safety, and reproductive outcomes were analysed using descriptive statistics. Results: A total of 152 women underwent LOD. The median number of punctures performed per ovary was 10 (IQR: 7-13), with a mean operative time of 20±10 minutes. No intraoperative or postoperative complications were recorded. During six months of follow-up, 60 women (39.5%) achieved pregnancy, of whom 56 (36.84%) had live births, three (1.97%) experienced miscarriage, and one (0.66%) had an ectopic pregnancy. Women who did not conceive within the first three months subsequently received Ovulation Induction (OI) with letrozole as part of routine clinical management. Conclusion: LOD, employing an individualised technique, in this study of 152 women with PCOS, using a monopolar electrode was associated with favourable reproductive outcomes and an excellent perioperative safety profile in women with PCOS. The procedure was completed within a relatively short operative time, including diagnostic hysteroscopy and chromopertubation, supporting its feasibility as a safe surgical option for OI.

Validity and Reliability of the Kannada Version of the Pain Catastrophising Scale in Individuals with Knee Osteoarthritis: A Cross-sectional Study

Aparna Dinesh Shetty, Prashant Mukkannavar, Pooja Motar Sublok, Kartik B Patil, Shivashri Math Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Pain catastrophising (PC) involves reacting to pain with an exaggeratedly negative mindset. For individuals suffering from Knee Osteoarthritis (KOA), a higher level of catastrophising correlates with more pain, restricted activity, and a diminished Quality of Life (QoL). Although, the Kannada-Pain Catastrophising Scale (K-PCS) is available in Kannada, its reliability and validity for KOA individuals have not been confirmed, so it needs to be tested specifically for this group. Aim: To evaluate the structural validity, construct validity and reliability of the K-PCS and to determine whether it validly and reliably assesses PC in individuals diagnosed with KOA. Materials and Methods: The present cross-sectional psychometric validation study was carried out in the Department of Physiotherapy, at JGMM Hospital and Medical Research Centre in Hubballi, Karnataka, India, from April 2026 to June 2026. The K-PCS was administered along with the Visual Analogue Scale (VAS), World Health Organisation QoL (WHOQOL-BREF), and Knee Injury and Osteoarthritis Outcome Score (KOOS). Internal consistency was evaluated using Cronbach’s alpha. Test-retest reliability was assessed with the Intraclass Correlation Coefficient (ICC) in 30 participants after seven days. Structural validity was explored using Exploratory Factor Analysis (EFA) followed by a preliminary Confirmatory Factor Analysis (CFA) of EFA derived model, while construct validity was measured using Spearman’s correlation coefficient (ρ). Additionally, Composite Reliability (CR) and Average Variance Extracted (AVE) were estimated. Results: EFA identified a two-factor model consisting of pain reflection and helplessness. A subsequent of CFA of the EFA derived model performed on the same sample, showed good apparent model fit (RMSEA=0.00, SRMR=0.039, CFI=1.00, and TLI=1.00); these findings were considered preliminary. Cronbach’s α showed excellent internal consistency (0.964), with test-retest reliability evidenced by an ICC of 0.988. The K-PCS positively correlated with pain intensity (VAS; ρ=0.813, p<0.001) and negatively with knee function (KOOS; ρ=-0.666 to -0.787, p<0.001) and QoL (WHOQOL-BREF; ρ=-0.774, p<0.001). Conclusion: The findings provide preliminary evidence supporting the K-PCS as a valid and reliable instrument for assessing PC in Kannada-speaking individuals with KOA.

Telemedicine Utilisation, Perceived Benefits, Barriers, and Patient Experiences among People with Parkinson’s Disease in Tamil Nadu, India: An Exploratory Cross-sectional Study

Ramakumar Nagarajan, Saravanan Chinnaiyan, Bharathi Palanisamy Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Parkinson’s Disease (PD) is a chronic neurodegenerative disorder that requires continuous medical monitoring and multidisciplinary care over the long term. Telemedicine has emerged as a promising modality for improving healthcare access among persons with chronic neurological conditions, particularly in settings where specialist availability is limited. Aim: To assess telemedicine utilisation and patient experiences among persons with PD in Tamil Nadu. Materials and Methods: The present exploratory cross-sectional study was conducted among 57 patients with clinically diagnosed PD attending two movement rehabilitation centres in Chennai, Tamil Nadu, India, conducted between March 2025 and April 2025.. Participants aged 50 years and above were recruited by convenience sampling. Data were collected through face-to-face interviews using a semi-structured questionnaire covering sociodemographic characteristics, disease profile, healthcare accessibility, telemedicine awareness and utilisation, patient perceptions, and barriers to adoption. Descriptive statistics were used to summarise the data using Statistical Package for the Social Sciences (SPSS) version 24.0. Results: The mean age of participants was 69.5 years, and the majority were male 44 (77.2%). Telemedicine awareness was reported by 87.7% of participants, and 75.4% had used telemedicine for PD management. The most commonly reported benefits were reduced travel burden 42 (97.7%), faster access to specialists 39 (90.7%), and lower cost relative to in-person visits 32 (74.4%). More than half of the participants 30 (52.6%) preferred telemedicine over in-person consultations, and 93% rated the quality of remote care as comparable to or better than conventional care. The most commonly reported barrier was difficulty operating digital technology due to Parkinson’s-related motor symptoms 27 (47.4%) followed by lack of access to appropriate technology 11 (19.3%) and poor internet connectivity (14.0%). Conclusion: The present study findings suggest that remote healthcare services may help address healthcare access challenges among patients attending specialised rehabilitation centres. Addressing technological barriers, strengthening digital infrastructure, and integrating caregiver-assisted service models are necessary steps toward broader adoption of telemedicine in chronic neurological care.

Microneedling with Vitamin C, Soft-tissue Laser and Scalpel Technique in the Management of Gingival Pigmentation: A Prospective Interventional Study

Sakshi Singh, Kanishk Gupta, Kumar Saurav Singh, Kriti Agarwal, BG Priyadarshini, Shweta Bali, Tanya Sahai, Divjot Kaur Narula Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Gingival hyperpigmentation is a common aesthetic concern caused by excessive melanin deposition in the gingival epithelium. Various treatment modalities have been proposed for depigmentation, including conventional scalpel surgery, soft-tissue lasers, and newer minimally invasive approaches such as microneedling with topical agents. Microneedling combined with vitamin C has recently gained attention for its potential to enhance drug delivery, promote healing, and reduce recurrence. Aim: To comparatively evaluate the clinical efficacy of gingival depigmentation using microneedling with a derma pen and topical vitamin C, soft-tissue laser and the conventional scalpel technique. Materials and Methods: The present prospective interventional study was conducted in the Department of Periodontics and Oral Implantology at Santosh Dental College and Hospital, Ghaziabad, Uttar Pradesh, India, from October 2024 to November 2025, with follow-up assessments at 24 hours, one week, one month and six months. Eleven systemically healthy patients, predominantly females, aged 18-40 years with physiologic gingival hyperpigmentation participated in the study. Of 23 patients screened, 33 hyperpigmented gingival sites in these 11 patients were included and randomly allocated to three groups: Group 1 (conventional scalpel technique), Group 2 (soft-tissue laser), and Group 3 (microneedling with derma pen and topical vitamin C). Clinical parameters-Dummett Oral Pigmentation Index (DOPI), Takashi’s Oral Pigmentation Index (TOPI), Visual Analogue Scale (VAS) for pain, and Wound Healing Index (WHI)-were recorded at baseline, 24 hours, one week, and six months, as applicable to each parameter. Intergroup comparisons were performed using one-way Analysis of Variance (ANOVA), and intragroup comparisons across time were performed using the paired t-test. Results: All three techniques produced a significant reduction in gingival pigmentation from baseline (DOPI and TOPI, p<0.001 within each group), with pigmentation scores falling to near zero in all groups by one month. By six months, however, a significant intergroup difference emerged for DOPI (p=0.013), with pigment recurrence in the scalpel (0.909±0.944) and laser (0.727±0.786) groups, whereas the microneedling group maintained a complete absence of pigmentation (0.000±0.000). Postoperative pain at 24 hours (VAS) was significantly higher after scalpel surgery (3.636±0.924) than after microneedling (1.364±0.505) or laser (0.273±0.467; p<0.001). Wound healing at one week was most favourable in the microneedling group (1.000±0.000, uneventful in all cases) compared with laser (1.545±0.522) and scalpel (1.818±0.405; p<0.001). Conclusion: Microneedling with derma pen and topical vitamin C achieved depigmentation outcomes comparable to laser and scalpel techniques, with the least postoperative discomfort, the most uneventful early wound healing, and the greatest resistance to pigment recurrence at six months-supporting its use as a minimally invasive alternative for gingival depigmentation.

Coronary Artery Disease among Patients Undergoing Valve Replacement Surgery: A Retrospective Study of Angiographic Profiles and Predictors at a Southern Indian Tertiary Care Centre

Gailin Sebastian, Yokesh Madhavan, Venkatesh Babu, Kiron Sukulal, Jai Arthe, Arya Rajesh, Shreya Gailin, Krishna Viju Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Coronary Artery Disease (CAD) frequently co-exists with Valvular Heart Disease (VHD). In developing countries like India, the shifting epidemiology from rheumatic to degenerative VHD alters this association. Concomitant CAD drastically dictates surgical strategies, yet local angiographic profile data remains scarce. Aim: To determine the angiographic profile and clinical predictors of CAD in patients undergoing Coronary Angiography (CAG) prior to valve replacement surgery at an Indian tertiary care centre. Materials and Methods: The present retrospective study was conducted at Sree Mookambika Institute of Medical Sciences, Kanyakumari, Tamil Nadu, South India, and analysed data of 200 consecutive patients undergoing preoperative CAG before valve replacement surgery. Demographic profiles, cardiovascular risk factors, echocardiographic parameters, and angiographic findings were reviewed. Patients were stratified into CAD and non CAD cohorts. Obstructive CAD was defined angiographically. Statistical analysis utilised Chi-square and Student’s t-tests. Results: The cohort’s mean age was 55.6±9.3 years; 127 (63.5%) were males (63.5%). Prevalences of hypertension, diabetes mellitus, dyslipidaemia, and tobacco use were 71 (35.5%), 64 (32%), 30 (15%), and 15 (7.5%), respectively. Patients with CAD were significantly older (mean age: 59.2±8.5 vs 53.8±9.1 years; p<0.001) and predominantly males (72 (73.5%) vs. 55 (53.9%); p=0.005). Increasing age and diabetes mellitus emerged as independent predictors of CAD in multivariate analysis (OR 1.09, 95% CI 1.05-1.13; p<0.001 and OR 2.49, 95% CI 1.10-5.63; p=0.028, respectively). No statistically significant association was observed between CAD status and valves involved namely, Mitral Valve Disease (MVD), Aortic Valve Disease (AVD) and combined valve disease or valve surgery performed. AVD showed a non significant trend toward higher prevalence in the CAD group (p=0.11). Left Anterior Descending (LAD) artery was the most frequently diseased vessel {49 (50%)}. Left Ventricular Ejection Fraction (LVEF) was marginally lower in the CAD arm (54.2±12.4% vs 57.1±11.3%; p=0.05), while Atrial Fibrillation (AF) lacked statistical correlation (p=0.89). Conclusion: The CAD in Indian valve replacement candidates was independently associated with advanced age, diabetes mellitus, and standard atherosclerotic risk factors. There was no statistically significant association between presence of CAD and the underlying valve pathology, or the type of surgery performed. Preoperative angiographic screening is critical for precise surgical planning, which should be dictated not only by age but by the presence of cardiovascular risk factors.

Clinical Profile of Echocardiographically Estimated Pulmonary Hypertension in Patients with Non Dialysis-dependent Chronic Kidney Disease Stages 3-5: A Cross-sectional Study

Gunishetti Adithya, RM Anitha, Buchipudi Sandeep Kumar Reddy, Bhargav Kiran Gaddam, Hemachandar Radhakrishnan Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Pulmonary Hypertension (PHTN) is increasingly recognised as a clinically significant complication of Chronic Kidney Disease (CKD), even before initiation of dialysis. However, the clinical profile, echocardiographic pulmonary pressure estimates, and biochemical correlates of PHTN in Non Dialysis-Dependent CKD (NDD-CKD) stages 3-5 remain incompletely characterised. Aim: To describe the clinical profile of elevated pulmonary pressures in NDD-CKD stage 3-5, estimate Pulmonary Artery Systolic Pressure (PASP) by echocardiography and to determine PHTN prevalence and severity, and explore correlations between biochemical parameters and PHTN severity. Materials and Methods: The present hospital-based cross-sectional study enrolled 84 NDD-CKD stage 3-5 patients at a tertiary care centre, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, India. PASP was estimated by transthoracic echocardiography and mean Pulmonary Artery Pressure (mPAP) was derived using the Chemla formula (mPAP=0.61×PASP+2). Elevated pulmonary pressure was defined as mPAP ≥20 mmHg and categorised as mild (≥20-40 mmHg), moderate (>40-55 mmHg), or severe (>55 mmHg); values <20 mmHg were considered normal. Demographic data, co-morbidities, CKD stage, and laboratory investigations were measured. Non parametric stage-wise comparisons with Bonferroni correction, Spearman correlations, ordered-stage trend analyses, and binary logistic regression were performed using Statistical Package for the Social Sciences (SPSS) version 24.0. p-value of <0.05 was considered statistically significant. Results: Mean age was 48.18±14.07; 49 (58.3%) were male. Hypertension (HTN) was present in 70 (83.3%) participants, Diabetes Mellitus (DM) in 37 (44.0%), and smoking in 45 (53.6%). Mean mPAP was 36.29±16.68 mmHg; Elevated pulmonary pressure was present in 59 (70.2%) participants, comprising mild elevation in 20 (23.8%), moderate elevation in 24 (28.6%), and severe elevation in 15 (17.9%). mPAP increased significantly across CKD stages (p=0.006), with an increasing ordered-stage trend (p=0.0006) and rising PHTN severity (rs=0.288; p=0.007). mPAP correlated positively with serum urea (rs=0.335; p=0.001) and creatinine (rs=0.332; p=0.002), and negatively with estimated Glomerular Filtration Rate (eGFR) (rs=-0.339; p=0.001)-all surviving Bonferroni correction. HTN was an independent predictor of PHTN on both univariate (OR 4.157; 95% CI 1.263-13.680; p=0.019) and multivariable analysis (adjusted Odds Ratio (aOR)=5.425; 95% CI=1.416-20.783; p=0.014). Conclusion: PHTN burden is high in NDD-CKD stage 3-5 and increases with declining renal function. HTN independently predicts PHTN, highlighting the importance of left-heart-mediated mechanisms. Structured cardiopulmonary evaluation is warranted in advanced pre-dialysis CKD.

Computed Tomographic Evaluation of Nasal Septal Deviation According to Mladina Classification: A Cross-sectional Study

Pratixa Elaviya, Meghana Joshi, Hetal Vaishnani Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Nasal Septal Deviation (NSD) is one of the most common anatomical variations of the nasal cavity and may contribute to nasal obstruction, impaired airflow and sinonasal diseases. Computed Tomography (CT) provides accurate assessment of septal deformities and associated anatomical variations. The Mladina classification is a widely accepted system for categorising different types of NSD. Aim: To evaluate the distribution of NSD according to the Mladina classification on CT scans and to assess its distribution with respect to age and gender. Materials and Methods: A cross-sectional study was conducted at Kiran Multi Super Speciality Hospital, Surat, Gujarat, India. A total of 180 patients aged 10-80 years undergoing CT of the paranasal sinuses or CT brain were included. CT images were evaluated using Digital Imaging and Communications in Medicine (DICOM) software, and NSD was classified according to the Mladina classification. Data were analysed using Jamovi version 2.7.27.2. Categorical variables were presented as counts and percentages. Results: Age-wise, the largest proportion of participants belonged to the 21-40-year group (38.6%), followed by the 41-60-year group (31.9%), with Types I-III predominating across these age groups. Of 180 participants, Type-I deviation was most frequent, occurring in 56 (31.1%), followed by Type-II in 49 (27.2%), Type-III in 44 (24.4%), Type-V in 15 (8.4%), and Type-IV in 6 (3.3%). No Type-VI or Type-VII deformities were identified, while 10 (5.6%) participants had no septal deviation. Type-I was the most common pattern in both males {28/90 (31.1%)} and females {28/90 (31.1%)}. Conclusion: Type-I was the most frequently observed Mladina pattern in this CT-based study, followed by Type II and III. The findings describe the morphological distribution of NSD in the study population and demonstrate similar predominance of Type-I among males and females.

Comparative Evaluation of Pegcetacoplan and Placebo on the Progression of Geographic Atrophy in Dry Age-related Macular Degeneration: A Systematic Review and Meta-analysis of Randomised Controlled Trials

PA Abhisek, Deepak Choudhury, Shweta Supriya Pradhan, Rishi Sharma, Nikita Dash, Binaya Kumar Bastia Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: As a late-stage dry Age-related Macular Degeneration (AMD), Geographic Atrophy (GA) historically, has had few effective therapeutic options, but pegcetacoplan (marketed as Syfovre) was recently approved by the Food and Drug Administration (FDA) for this indication in 2023. Pegcetacoplan inhibits C3 component of the complement system and reduces downstream inflammation and damage to the retina. Aim: To examine the efficacy and safety of pegcetacoplan, a complement C3 inhibitor, in slowing GA progression by targeting complement dysregulation, compared with placebo. Materials and Methods: The present systematic review and meta-analysis were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024625783). A systematic search of MEDLINE, EMBASE, Scopus, Web of Science, ProQuest and Cumulative Index to Nursing and Allied Health Literature (CINAHL) from inception to December 2024 was conducted. Randomised controlled trials (RCT) in English language evaluating intravitreal pegcetacoplan in GA secondary to dry AMD were included. Eligibility criteria for screening were RCTs of pegcetacoplan versus placebo/sham reporting efficacy {change in GA area and Best-Corrected Visual Acuity (BCVA)} and safety outcomes {Treatment-Emergent Adverse Events (TEAE), Serious Adverse Events (SAE), and Macular Neovascularisation (MNV)}. Data were extracted and risk of bias was assessed independently by two reviewers, using the RAYYAN tool and the Cochrane Risk of Bias 2 (RoB 2) Tool and any disagreement on study inclusion was resolved through discussion and consensus with a third author. We quantitatively combined studies with similar participants, interventions, outcomes and methods using meta-analysis. Mean Differences (MDs) and Odds Ratios (OR) with 95% Confidence Intervals (CI) were computed using fixed and random-effects models in RStudio (v4.2.1) with the meta package, while heterogeneity was assessed using Cochran’s Q (Chi-squared), Tau-squared and I² statistic. Results: Seven eligible publications were included in the systematic review. Pegcetacoplan significantly slowed GA progression compared to placebo at 12 months (MD: -0.199; 95% CI: -0.372; -0.026; p=0.0236) and 24 months (MD: -0.760; 95% CI: -1.014; -0.507, p<0.001) respectively. No significant improvement in BCVA was observed at 12 and 24 months. Pegcetacoplan was associated with a 36% increase in TEAEs (OR: 1.36; 95% CI: 1.03; 1.81; p=0.03) and 53% increase in TEAEs (OR: 1.53; 95% CI: “1.04; 2.26”; p=0.03) at 12 months and 24 months respectively. No significant differences in SAEs at 12 months. Pegcetacoplan was associated with an approximately three-fold higher odds of MNV at 12 months (OR: 2.99; 95% CI: “1.12; 7.96”; p=0.029) and 24 months (OR: 3.17; 95% CI: “1.50; 6.73”; p=0.0026), respectively. Conclusion: Pegcetacoplan considerably slows the progression of GA at 12 and 24 months in patients with dry AMD, but no significant improvement in visual acuity was observed. Treatment was associated with increased risk of TEAEs and MNV, but not SAEs, supporting a favourable but carefully balanced benefit-risk profile that merits further long-term evaluation. The magnitude and long-term durability of treatment effects should be interpreted with caution given the evidence available is based on a small number of underlying trial cohorts and further independent studies are warranted.

Undergraduate Nursing Students’ Experiences and Perceptions of Virtual Reality-based Clinical Skills Training in Saudi Arabia: A Qualitative Study

Amal A Alfouzan, Ahmed S Alsadoun, Fahad Alharbi, Albaraa N Aloudah, Yazan A Alghamdi, Yahia Aldhamri Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Virtual Reality (VR) is increasingly used in nursing education to support clinical skills through immersive and interactive learning. Although evidence of its educational benefits is growing, qualitative research exploring nursing students’ experiences of VR-based learning in Saudi Arabia remains limited. Aim: To explore nursing students’ experiences and perceptions of VR-based clinical skills training at King Saud University, Riyadh, Saudi Arabia. Materials and Methods: A qualitative study was conducted with 11 undergraduate nursing students who had participated in VR-based clinical skills training at King Saud University, Riyadh, Saudi Arabia. Participants were recruited based on predefined eligibility criteria. Data were collected through individual semistructured interviews via Zoom and analysed using Braun and Clarke’s reflexive thematic analysis. Results: Four main themes were identified: VR as an immersive and engaging learning environment; building confidence and clinical readiness; comparing VR with traditional clinical skills training; and challenges and future directions for VR-based nursing education. Participants reported that VR increased engagement, improved their understanding of clinical procedures, and strengthened confidence, clinical judgement, and readiness for practice. They valued repeated practice in a safe environment but emphasised that VR could not reproduce the relational and emotional dimensions of real patient care. Participants therefore preferred a blended approach combining VR with traditional clinical training. Reported challenges included initial unfamiliarity with the technology, occasional temporary dizziness, and the limited range of clinical scenarios available. Conclusion: Nursing students perceived VR-based clinical skills training as a valuable educational approach that supported learning, confidence, and clinical preparedness. VR may be most beneficial when used as a complementary tool alongside traditional simulation and clinical education rather than as a replacement for direct clinical experience.

Effects of Virtual Yoga on Functional Balance and Limits of Stability in Adults with Diabetic Peripheral Neuropathy: A Randomised Controlled Trial

Dipali Khade, Chaitali Shah, Sandesh Sakpal, Pothiraj Pitchai, Dhvani Shah Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Diabetic Peripheral Neuropathy (DPN) is a prevalent consequence of Type 2 Diabetes Mellitus (T2DM) that severely impacts balance, postural control, and functional mobility. Virtual yoga has been proposed as a potential rehabilitation approach that anybody can use, although there is not much information addressing how it affects measurable outcomes related to balance in patients with DPN. Aim: To determine the effects of an eight-week virtual yoga program on functional balance and Limits Of Stability (LOS) in middle-aged persons with DPN. Materials and Methods: A single-blinded randomised controlled study was conducted among 50 adults aged 40-59 years with DPN. Participants were randomised into the virtual yoga group (n=25) or conventional physiotherapy group (n=25). Both groups received supervised interventions for eight weeks, three times per week. Outcome measurements comprising Single Leg Stand Test (SLST), Four Square Step Test (FSST) and LOS parameters included Reaction Time (RT) and Directional Control (DCL). Baseline and post-intervention assessments were conducted. For intragroup comparisons, either the Paired T-Test (PTT) or the Wilcoxon Signed Rank Test (WSRT) was employed and for intergroup comparisons either the Independent samples t-test (ITT) or the Mann-Whitney U Test (MWUT) was utilised, depending on the distribution of the outcome variable. Results: Significant intragroup improvements were observed after intervention in both groups (p <0.05). However, the virtual yoga group revealed significant improvement in SLST, FSST, LOS RT, and DCL in most directions (p<0.05) with moderate-to-large effect sizes compared with the conventional physiotherapy group. Conclusion: An eight-week virtual yoga program significantly improved functional balance and LOS in middle-aged persons with DPN. Virtual yoga may be a useful supplemental home-based rehabilitation technique to improve balance and stability in this group.

The Risk of Disordered Eating Attitudes among University Students in the Northern Border Region of Saudi Arabia: A Cross-sectional Study

Mohamed M Abd El Mawgod, Awwad Alenezy, Abdulaziz Saleh Abdullah Alomaym, Fahad Shayish Naha Alanazi, Sultan Mohammed Madullah Alanazi, Basil Hamdan Yatim Alanazi, Fahad Suliman Hamuod Alsagri Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Eating Disorders (EDs) cause serious health issues, and adolescents are prone to these nutritional disorders.They are psychological and nutritional problems marked by the disruption of eating habits. ED are characterised by an unusual attitude toward food that leads to changes in one’s eating habits and behaviours. Aim: To evaluate the risk of disordered eating attitudes and the socio-cultural attitudes on appearance among university students at Northern Border University, Saudi Arabia. Materials and Methods: A cross-sectional study was conducted among students at Northern Border University, Arar, Saudi Arabia between May 2025 and April 2026. The survey included 424 respondents. A self-administered questionnaire was used for data collection and included three sections. The first part was the socio-demographic data of the participants. The second section was the Eating Attitudes Test (EAT-26), and the last section included the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4). The Chi-square test was applied to find relationships across categorical variables. A p-value <0.05 was considered significant. Results: The mean age of the participants was 22.1±2.1 years; slightly more than half were female, 216 (50.9%). More than Nearly two-thirds, 273 (64.4%), of the participants were classified as at high risk of EDs. In terms of Societal attitudes regarding appearance, media pressure was the most significant influence, followed by peer and family factors. Conclusion: This research indicates that the risk of disordered eating attitudes is very common, with over 60% of students testing positive on the EAT-26. The finding points to a serious, generally underestimated public health problem. Media pressure has the most significant influence on socio-cultural attitudes on appearance, followed by peer and family pressures.

Awareness of Iodinated Contrast Media Reactions and its Management among Healthcare Personnel: A Cross-sectional Descriptive Study

Samadhan Bade, Kalyani Agale, Sainik Choure, Amita Digambar Dabholkar, Shreya Gujar Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Iodinated Contrast Media (ICM) are important drugs that play a significant role in radiologic investigations such as Computed Tomography (CT) and X-rays. Although important in practice, the administration of ICM is associated with the risk of adverse effects ranging from mild reactions like nausea and urticaria to severe anaphylaxis that can be fatal. Aim: To evaluate the level of knowledge among healthcare professionals on the adverse reactions of ICM and their management at Radiology Department of a Tertiary Care Hospital. Materials and Methods: The present cross-sectional descriptive study that involved 60 healthcare professionals who were recruited at the Department of Radiodiagnosis, Dr. D.Y. Patil Medical College, Hospital and Research Centre (DYPMC), Pimpri, Pune, Maharashtra, India. The study was conducted over a period of five months, from 1st November 2025 to 31st March 2026. Purposive sampling method was employed. The participants responded to a validated questionnaire that was analysed using descriptive statistics in WinPepi Software Version 11.65. Results: The majority (60.0%) of respondents belonged to the age group of 25-30 years; 91.7% had received contrast reaction training earlier. The strengths of the present study include high recognition of mild reactions (98.3%) and knowledge about pre-procedural renal function tests (91.7%). Important gaps have been found: only 40.0% gave the correct name of the first-line drug for anaphylaxis (epinephrine against 55.0% of those who picked antihistamines), only 26.7% knew the right route of drug application (intramuscular injection), and only 3.3% knew that there is no need for breastfeeding interruption following ICM administration according to current American College of Radiology (ACR) guidelines. Conclusion: Though overall awareness was found satisfactory, dangerous pharmacological and guideline knowledge gaps remain. Simulation-based training of radiology staff in accordance with current ACR and European Society of Urogenital Radiology (ESUR) guidelines is highly recommended.

Prevalence and Imaging Patterns of Cystic Duct Variants on Magnetic Resonance Cholangiopancreatography in Patients with Cholelithiasis: A Single-centre Retrospective Observational Study

Sakthi Ganesh Subramonian, Satti Keerthi Charitha, Abdul Samad Abdul Kareem, Paarthipan Natarajan Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: The Cystic Duct (CD) shows considerable variation in its length, course and site of insertion into the Extrahepatic Bile Duct (EHBD). Unrecognised variants are an important contributor to iatrogenic bile duct injury during surgical, endoscopic and percutaneous biliary procedures. Magnetic Resonance Cholangiopancreatography (MRCP) demonstrates CD anatomy non invasively. Aim: To determine the prevalence and imaging patterns of CD insertion and course variants on MRCP in patients with cholelithiasis at a tertiary-care centre in Southern India. Materials and Methods: This retrospective observational study was conducted in the Department of Radiodiagnosis of a tertiary-care teaching hospital in Chennai, Tamil Nadu, India. MRCP examinations demonstrating cholelithiasis, performed for routine clinical indications between January and June 2025 on a 1.5-Tesla scanner (Philips Multiva, Philips Healthcare), were identified from the institutional Picture Archiving and Communication System (PACS). Data were analysed after institutional ethics approval was obtained. Two radiologists blinded to clinical data independently classified each CD into one of six patterns, namely normal (lateral aspect of the middle third of the EHBD), high insertion, low medial insertion, posterior insertion, spiral course and parallel course. Inter-observer agreement was assessed using Cohen’s kappa. Results: A total of 168 patients were included, comprising 104 (61.9%) females and 64 (38.1%) males, with a female-to-male ratio of 1.6:1 and a mean age of 45.1±13.4 years (range 19-79 years). The CD was confidently traced in 152 of 168 patients (90.5%). A normal lateral insertion at the middle third of the EHBD was seen in 89 patients (58.6%), while a variant pattern was present in 63 patients (41.4%). High insertion (9.2%) and spiral course (9.2%) were the commonest variants, followed by posterior insertion (8.6%), low medial insertion (7.9%) and parallel course (6.6%). Variants were more frequent among females as compared to males (43.8% versus 37.5%), although the difference was not statistically significant (χ²=0.57, p-value=0.45). Conclusion: CD variants were common among patients with cholelithiasis, occurring in over 40% of cases. MRCP can delineate clinically relevant CD anatomy and may aid pre-procedural recognition of variants.

Immediate Effect of Dry Needling of Tight Hamstrings on Chronic Non specific Low Back Pain and Lumbar Range of Motion: A Quasi-experimental Study

Simran Shiv Thapar, Rupali Sameer Shevalkar Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: The lumbar spine provides both stability and mobility while also protects neural structures. Chronic Low Back Pain (CLBP) is commonly associated with postural dysfunction and reduced core stability, increasing mechanical stress on the lumbar region. Dry Needling (DN), involves insertion of fine needles into myofascial trigger points and is widely used for managing musculoskeletal pain. It helps reduce muscle tension, improve circulation, and modulate pain. Thus, it may be an effective adjunct in the management of CLBP. Aim: To study the immediate effect of DN of tight hamstrings on chronic non specific low back pain and lumbar range of motion. Materials and Methods: The present one-group pretest post-test quasi-experimental study was conducted in the Department of Musculoskeletal Physiotherapy of KJ Somaiya College of Physiotherapy, Mumbai, Maharashtra, India from September 2022 to March 2024. Individuals with chronic non specific Low Back Pain (NSLBP) (Numeric Rating Scale (NRS) 4 to 7) and hamstring tightness {>20* on Active Knee Extension Test (AKET)} in the age group of 18 to 45 years were included in the study using purposive sampling. Pre-treatment assessment was done using Numerical pain rating scale for low back pain, Measuring tape for range of motion (modified Schober’s test) of back and universal goniometer (AKET) for hamstring flexibility. DN was administered to the hamstring muscles at the predetermined treatment points. Following the intervention, post-treatment assessment was performed using the same outcome measures as those employed during the baseline evaluation. Following the post-treatment assessment, participants were prescribed a conventional exercise program. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) software version 24. Data normality was checked using Shapiro-Wilk test. For the data that passed normality, paired t-test was used and for the data that did not pass normality Wilcoxon signed-rank test was used Level of significance p-value=0.05. Results: The mean age group of subjects was 25.3±5.8 years. There were 12 males and 29 females included in the study. It was noted that there was an immediate and significant reduction in low back pain levels (p<0.001) and a significant increase in the hamstring muscle extensibility (p<0.001) was seen but no changes were seen in the lumbar range of motion (p=0.131) on DN the hamstring muscles. Conclusion: An immediate and significant reduction in low back pain and a significant increase in hamstring muscle extensibility Bilateral (B/L) were seen but no changes were seen in the lumbar range of motion post DN the hamstring muscles.

Effectiveness of a Combined Back Massage and Affirmation-based Relaxation Intervention on Breastfeeding Outcomes among Post-Caesarean Section Mothers: A Quasi-Experimental Study

Tity Jose, Koyeli Girigoswami, Lt. Col. Sarvjeet Kaur, PC Indu, Sabu K Ulahannan Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Breastfeeding adequacy following caesarean section is often compromised due to physiological and psychological stressors that disrupt early lactation. Conventional interventions primarily focus on technical and educational support, with limited attention to psychophysiological processes influencing milk ejection. Aim: To assess the effectiveness of combined back massage and affirmation-based relaxation intervention on breastfeeding adequacy among post-caesarean mothers. Materials and Methods: A quantitative evaluative approach using a quasi-experimental two-group pre-test–post-test design was employed to conduct the study in the Obstetrics and Gynaecology wards of a secondary-level hospital in Uttar Pradesh, India, from October 2022 to March 2023. Among 220 post-caesarean mothers in a secondary-level hospital in India. Post-caesarean (n=220) mothers were allocated to experimental (n=110) and control (n=110) groups. The intervention consisted of structured back massage combined with guided affirmation relaxation, administered four times daily over three days. Primary outcomes included let-down reflex and breast milk secretion, while secondary outcomes comprised proxy indicators of breastfeeding adequacy (urination, stool frequency, satiety, and breastfeeding behaviour). Data were analysed using non parametric tests, ordinal logistic regression, and Analysis of Covariance (ANCOVA). Results: The intervention group demonstrated substantially greater improvements in let-down reflex (?=2.60 vs. 1.19) and breast milk secretion (?=5.81 mL vs. 3.01 mL) compared to controls (p<0.001). Secondary outcomes also improved significantly, indicating enhanced feeding adequacy. Adjusted analyses (ordinal regression and ANCOVA) further strengthened these findings, supporting an association between the intervention and improved lactation outcomes beyond baseline differences. Improvements occurred concurrently across physiological and functional domains, supporting a psychophysiological pathway of lactation response. The overall pattern is consistent with a psychophysiological mechanism linking maternal stress modulation and lactation response. Conclusion: A structured psychophysiological intervention is associated with improved breastfeeding adequacy among post-caesarean mothers, providing evidence for integrating psychophysiological approaches into postnatal lactation care. Its feasibility, low cost, and compatibility with nursing care highlight its potential for integration and scale-up in routine postnatal settings.

Cosmetic Product Usage and Cosmetovigilance Awareness among Healthcare Students in a Tertiary Care Centre: A Quasi-experimental Study

Jeevitha Ramu, Parimala Kathirvelu, Shanmugapriyan Sivaraman, Lokeshkumar Samy Sankaran, Ganeshkumar Dayalan, Hafeeza Shaikh Abdul Latiff Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Cosmetic products are used almost universally by young adults, yet cosmetovigilance, the systematic surveillance of Adverse Cosmetic Reactions (ACRs) remains poorly recognised among healthcare students, who will later identify and report such reactions in clinical practice. Aim: To assess cosmetic product usage patterns among healthcare students and to evaluate the effect of a structured educational intervention on their cosmetovigilance knowledge, practice intentions and attitudes. Materials and Methods: A single group quasi-experimental pretest–post-test study was conducted between July and September 2025 among healthcare students (MBBS, Nursing and Allied Health Sciences) at a South Indian tertiary care teaching institution. A self-administered questionnaire covering demographics, usage patterns, knowledge, practice intentions and attitudes was administered through Google Forms before and after a structured cosmetovigilance seminar. Pretest and post-test records were linked by respondent e-mail identifier and analysed as matched pairs using the paired t-test in Statistical Package for Social Sciences (SPSS) version 21, with p<0.05 taken as significant. Results: Of 339 pretest and 334 post-test responses, 302 formed complete matched pairs. The cohort was predominantly female (178; 58.9%) and mainly MBBS students (192; 63.6%). Daily cosmetic use was reported by 150 (49.7%) participants, chemical based products predominated (105; 34.8%) and online platforms were the commonest source of purchase (128; 42.4%). All seven knowledge items improved significantly: awareness of the term cosmetovigilance rose from 25.5% to 90.1%, knowledge of where to report from 25.5% to 86.8% and knowledge of the patch test from 45.0% to 89.4% (all p<0.001). Confidence in recognising ACRs rose from a mean of 3.24 to 3.67, and intention to report an ACR to a healthcare provider from 66.2% to 88.7% (both p<0.001). Cautious product selection (p=0.587), skin monitoring (p=0.069) and the belief that marketed cosmetics are completely safe (p=0.824) did not change. Conclusion: A single structured seminar produced large, statistically significant gains in cosmetovigilance knowledge and in reporting related attitudes, but did not alter established preventive behaviours or product safety beliefs. Cosmetovigilance merits formal inclusion in undergraduate healthcare curricula, delivered as reinforced rather than one off teaching.

Bioequivalence of a Hydroxyurea Oral Suspension (100 mg/mL) and Xromi® 100 mg/mL Oral Solution (100 mg Hydroxycarbamide) under Fasting Conditions: A Randomised, Open-label, Single-dose, Two-period Crossover Study

Sunil Jaiswal, Arun Chaudhary, Mamta Sharma, Mansingh Rajput, Badrinath Sangle, Kamlesh Londhe Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Hydroxyurea oral suspension is approved as an adjunctive treatment for Sickle Cell Disease (SCD) and Myeloproliferative Disorders (MPD). Oral liquid formulations ensure accurate dose administration, improve ease of use in patients with difficulty swallowing solid dosage forms, and may be administered with or without food. As patient-friendly formulations are increasingly needed, there is growing demand for a bioequivalent alternative to the marketed reference hydroxyurea oral solution. Aim: To evaluate the bioequivalence of hydroxyurea oral suspension (100 mg/mL) compared with the reference product, Xromi® (hydroxycarbamide oral solution 100 mg/mL), under fasting conditions. Materials and Methods: This open-label, two-treatment, two-period, two-sequence, single-dose crossover bioequivalence study was conducted under fasting conditions over six days at Vivotech Research Lab Pvt., Ltd., Navi Mumbai, Maharashtra, India. Healthy subjects were randomised to receive a single oral dose of 500 mg hydroxyurea as either the Test (Hydroxyurea Oral Suspension 100 mg/mL) or the Reference (Xromi®, Hydroxycarbamide Oral Solution 100 mg/mL), with a 3-day washout period. Plasma hydroxyurea concentrations were measured up to 24 hours using a validated Liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. Pharmacokinetic parameters (Cmax, AUC0-t, and AUC0-8) were summarised using descriptive statistics and analysed by Analysis of Variance (ANOVA) on log-transformed data. Bioequivalence was assessed using geometric mean ratios (Test/Reference) and corresponding 90% confidence intervals (90% CIs). Results: Twenty-eight subjects completed both study periods and were included in the pharmacokinetic analysis. The geometric mean ratios (test/reference) and corresponding 90% CIs were 100.57% (93.49-108.18) for Cmax, 97.87% (93.82-102.09) for AUC0-t, and 97.85% (93.84-102.02) for AUC0-8. The 90% CIs for all three primary bioequivalence parameters were within the predefined bioequivalence acceptance range of 80.00-125.00%, demonstrating comparable rates and extents of absorption between the test and reference formulations. Both formulations were well tolerated, and all Adverse Events (AE) were mild and transient. Conclusion: Hydroxyurea oral suspension (100 mg/mL) was bioequivalent to the reference product, Xromi® (Hydroxycarbamide Oral Solution 100 mg/mL), under fasting conditions. Both formulations were safe and well tolerated, supporting the oral suspension as an effective alternative for patients requiring a liquid oral dosage form.

Comparison of Intravenous Magnesium Sulphate and Dexmedetomidine for Attenuation of Cardiovascular Stress Response during Laryngoscopy and Endotracheal Intubation: A Double-blinded Randomised Clinical Trial

Praneetha Vijayan, Thounaojam Dinesh Singh, Kajal Momin Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Laryngoscopy and intubation provoke sympathetic tachycardia and hypertension. These transient changes may precipitate adverse effects in patients with undiagnosed co-morbidities. Magnesium sulphate and dexmedetomidine attenuate this response, but direct comparisons at clinical doses remain limited. Aim: To compare magnesium sulphate 30 mg/kg and dexmedetomidine 1 μg/kg for attenuating cardiovascular responses to laryngoscopy and endotracheal intubation. Materials and Methods: This double-blind, randomised clinical trial was conducted at Shija Hospitals and Research Institute, Imphal, Manipur, India from May 2021 to May 2022. A total of 80 adults with American Society of Anaesthesiologists physical status (ASA PS) I or II were randomly allocated equally to receive intravenous magnesium sulphate (30 mg/kg) or dexmedetomidine (1 μg/kg), infused over 10 minutes, beginning 15 minutes before intubation. The parameters assessed included demographic characteristics, haemodynamic variables including Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP), recorded at baseline, after drug infusion, after induction and at 1, 5, 10 and 15 minutes after intubation, and postoperative adverse events categorical variables were analysed using the Chi-square test, while quantitative variables were compared using Student’s t-test. The p-value <0.05 was considered statistically significant. Results: The two groups were comparable at baseline. The mean age was 34.80±10.16 years in Group A and 38.55±10.77 years in Group B (p-value =0.113). Group A included 19 males and 21 females, compared with 18 males and 22 females in Group B. The distribution of ASA PS was also similar between groups, with 29 and 31 patients classified as ASA PS I and 11 and nine patients as ASA PS II in Groups A and B, respectively. HR was lower with dexmedetomidine at all postinduction time points at T2 (p-value=0.004), T3 (p-value=0.036), T4 (p-value=0.043), T5 (p-value=0.002). At 15 minutes, Group A versus Group B values were: HR, 78.70±16.50 versus 68.83±11.37 beats/min (p-value=0.003); SBP, 116.15±13.77 versus 114.05±17.61 mmHg (p-value=0.550); DBP, 72.50±14.60 versus 72.65±13.55 mmHg (p-value=0.962); and MAP, 87.20±19.67 versus 86.48±14.00 mmHg (p-value=0.851). No clinically significant bradycardia, hypotension or postoperative adverse effects occurred. Conclusion: Both drugs effectively attenuated the haemodynamic response to intubation. Dexmedetomidine provided better control of HR than magnesium sulphate. Blood Pressure (BP) responses were comparable between the two groups. Neither drug caused clinically significant adverse effects.

Effect of Lower Limb Weighted Treadmill Training on Strength and Range of Motion in Children with Spastic Diplegia: A Randomised Controlled Trial

Shravya, Rakesh Krishna Kovela Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Children with spastic diplegia commonly present with reduced muscle strength and limited joint mobility, particularly in the hip and ankle, which adversely impacts gait efficiency and functional mobility. Although treadmill training is widely utilised in paediatric neurorehabilitation, incorporating additional resistance through Lower Limb (LL) weights may enhance the muscular engagement. However, evidence supporting its effectiveness in improving strength and Range Of Motion (ROM) remains limited. Aim: To determine the effectiveness of LL weighted treadmill training on hip flexor and ankle dorsiflexor muscle strength and joint ROM in children with spastic diplegia. Materials and Methods: This randomised controlled trial was conducted at the outpatient Department of Paediatric Physiotherapy Unit, Justice KS Hegde Charitable Hospital and Kapikad Community Rehabilitation Centre, Mangaluru, Karnataka, India from March 2025 to March 2026. A total of 26 children with spastic diplegia were randomly allocated to an intervention group and a control group. The intervention group received treadmill training with added LL weights in addition to conventional physiotherapy, whereas the control group underwent conventional physiotherapy alongside treadmill training without additional weights. The intervention was carried out over six weeks. Outcome measures included assessment of hip flexor and ankle dorsiflexor muscle strength and joint ROM using dynamometer and goniometer respectively. A paired t-test was utilised to evaluate significant changes between pre- and post-test measurements within each group, while an unpaired t-test was used to determine significant differences between the two groups. The level of significance was set at p-value <0.05. Results: Both groups showed improvements following the intervention. However, the intervention group demonstrated greater improvement in muscle strength (p-value <0.05) and active ROM (p-value <0.05) compared to the control group. No statistically significant changes were observed in passive ROM in either group. Conclusion: The LL weighted treadmill training combined with conventional physiotherapy significantly improved muscle strength and active ROM in children with spastic diplegia. This combined approach may serve as an effective adjunct to rehabilitation strategies aimed at optimising functional abilities.

Effectiveness of Novel Oral Microencapsulated Ferric Saccharate Strips versus Colloidal Elemental Iron Oral Supplementation in Iron Deficiency Anaemia: An Open-label Randomised Controlled Trial among Children

Kag Rakesh Choudhary, Tanmaya Metgud, Deepti M Kadeangadi Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Iron Deficiency Anaemia (IDA) is a major public health problem in children, particularly in low- and middle-income countries. Gastrointestinal intolerance and poor palatability of conventional oral iron often compromise adherence. Microencapsulated ferric saccharate (MFS) oral strips are a novel formulation designed to improve bioavailability and tolerability. Aim: To compare the effectiveness, tolerability, adverse effects and treatment compliance of MFS oral strips with Colloidal Elemental Iron (CEI) in children aged 4-18 years with IDA. Materials and Methods: This open-label randomised controlled trial was conducted at KLE Dr. Prabhakar Kore Hospital and Medical Research Centre, KAHER, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India, from September 2024 to October 2025. A total of 60 children aged 4-18 years with IDA were randomised to receive either MFS oral strips or CEI for 12 weeks. Randomisation 1:1 by computer-generated sequence, allocation concealed in sequentially numbered opaque sealed envelopes. Laboratory staff assessing Haemoglobin (Hb) and ferritin were blinded. Deworming with albendazole 400 mg was given to both arms at enrollment before randomisation as per Indian Academy of Paediatrics (IAP) standard care. MFS dose: 27-54 mg/day fixed; CEI dose: 3-6 mg/kg/day (mean 68-139 mg/day based on mean weight 22.8-23.2 kg). Haemoglobin, red cell indices, iron profile, adverse effects and treatment compliance were assessed at baseline and after 12 weeks of therapy. Data were analysed using independent t-test, Chi-square test, Fisher’s exact test, Mann-Whitney U test and Wilcoxon signed-rank test. A p-value <0.05 was considered statistically significant. Results: Sixty children were enrolled, with 30 in each group (MFS=30; CEI=30). Baseline characteristics were comparable, including mean age (8.2±4.1 years vs 8.0±4.3 years) and haemoglobin levels (8.7±0.9 g/dL vs 8.6±0.9 g/dL). At three months, mean Hb rise was significantly higher in the experimental group than the control group (2.7±0.7 g/dL vs 2.0±0.8 g/dL; p-value <0.001). Gastrointestinal adverse effects occurred less frequently with the MFS group, and compliance was significantly better in the intervention group (p-value <0.001). Conclusion: In this small open-label trial, fixed-dose MFS strips showed greater Hb rise, lower GI events and higher adherence compared with weight-based CEI. This reflects combined effects of tolerability and adherence, not equivalent-dose bioavailability. Larger blinded trials with dose-equivalent comparison and cost-effectiveness are needed.

Evaluation of Patellar Indices in the South Indian Population using Magnetic Resonance Imaging: A Retrospective Observational Study

Janani Yoganandham, Teena Kezi Angel, Arathi Mariappan Senthiappan, Sowjanya Bandlamudi Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Being placed subcutaneously, the patellofemoral joint carries a lot of significance and is also prone to a higher risk of trauma. Developmental and degenerative changes in patella are very common, sometimes warranting surgical intervention as well. Surgical procedures like total knee arthroplasty which are being performed across different age groups worldwide, mandating a study to evaluate the morphometric analysis of patella and its indices in different population. Aim: To estimate the various patellar indices like Patellar Angle (PA), Patellar Relative Thickness (PRT), Patellar Facet Thickness (PFT), Patellar Lateral Facet Ratio (PLFR) and Patellar Medial Facet Ratio (PMLR) across both genders and also to compare and contrast them within the same gender by broadly classifying the cohorts into two different age groups. Materials and Methods: A retrospective observational study was conducted in the Department of Radiology over four months, including 324 MRI. Patellar parameters such as height, width, thickness, angle, lateral facet width, medial facet width and indices like PA, PRT, PFT, PLFR and PMLR were measured, and statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) Statistics software, version 22.0. Results: The MRI of 162 males and 162 females were categorically classified into two groups: between 20-40 years and above 40 years. Across genders, strong statistical significance was observed for all parameters, including patellar height, width, angle, thickness, and facet thickness. Type 2 of Wiberg patellar variant was found to be the most commonly observed of the three types:30 (37%) in females of the 20-40 years group, 45 (56%) in females > 40 years group, 43 (53%) in males of 20-40 years group and 49 (61%) in males >40 years group. Conclusion: It was notable that almost all the parameters were statistically significant across the genders, while the significance was notably less when compared across the different age groups.

Morphometry of the Patella and Patellar Ligament for Bilateral Variation and Sexual Dimorphism: A Cadaveric Study from Chennai, India

M Ponmalai, Sankaranarayanan Govindharajan, Sameen Taj, A Arun Suriyan Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: The patella and ligamentum patellae together form a complex structure in front of the knee joint to stabilise it. The patella is a dense, thick bone and is covered by a compact lamina, which helps delay putrefaction or decomposition after death. This characteristic feature significantly affects the estimation of sex, age, and racial features. Variations in patellar and ligament dimensions aid knee replacement surgery, implant design, reconstruction procedures, and sex differentiation. Aim: To evaluate the patella and ligamentum patellae morphometry to assess the differences between the sides and genders and to classify the patellar articular facet according to the Koyuncu classification. Materials and Methods: This cross-sectional morphometric study was carried out at the Department of Anatomy, Saveetha Medical College and Hospital (SIMATS), Thandalam, Chennai, Tamil Nadu, India, from June 2025 to November 2025 on 32 human cadavers (16 males and 16 females) comprising 64 patellae in total. The dimensions such as height, width, thickness, central ridge length, medial and lateral articular facets of the patella, and the length, thickness, proximal and distal width of the ligamentum patellae were measured and compared between the sides and genders. Patellar facets were categorised as per Koyuncu’s categories. A p-value <0.05 was considered statistically significant. An Independent t-test or Mann-Whitney U test was used for continuous variables based on normality using the Shapiro-Wilk test, and the Chi-square test was used for categorical variables. Results: A significant side difference was observed with only one bony parameter (length of the medial articular facet), and all other bony parameters showed no significant difference between the sides (p-value >0.05). The length, thickness and distal width of ligamentum parameters differed significantly between the sides (p-value >0.05). Significant side differences were observed for all measured ligamentum patellae parameters (p<0.05), with higher values on the right side. Most patellar and ligamentum patellae parameters showed significantly higher values in males than females. As per Koyuncu’s classification, predominance in Type B (82.81%) morphology was noted, followed by Type C (12.50%) and Type A (4.69%). Conclusion: All the patella and ligamentum patellae dimensions showed significant sexual differentiation with unilateral imbalance in specific dimensions like the medial articular facet and all ligament parameters. The most prevalent Type B patellar articular facets ensure the importance of population-specificity in implant design, anterior cruciate ligament repair (ACL repair or reconstruction), and forensic tools in sexual differentiation.

Synthesis and Antifungal Activity of N-(3-(4-(1,3-dioxolan-2-yl) phenyl)-1,2,4-thiadiazol-5-yl) Benzamide Derivatives: An in-vitro Study

K Dayana, Raja Mohamed Kamil, MR Manasa, Santhosh M Mathews Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Fungal infections are associated with morbidity and mortality globally and immense economic burden. With the emergence of multidrug resistant fungal strains, it is essential to develop new antifungal drugs. Aim: To synthesize and evaluate the antifungal activity of N-(3-(4-(1,3-dioxolan-2-yl) phenyl)-1,2,4-thiadiazol-5-yl) benzamides against Candida albicans, Cryptococcus neoformans and Aspergillus niger. Materials and Methods: An in-vitro study was conducted in the Department of Chemistry, Islamiah College, Vaniyambadi, Tamil Nadu, India from August 2022 to February 2024. ovel N-(3-(4-(1,3-dioxolan-2-yl) phenyl)-1,2,4-thiadiazol-5-yl) benzamides were synthesized by a simple procedure. Pyridine was added to 3-(4-(1,3-dioxolan-2yl) phenyl)-1,2,4-thiadiazol-5-amine and dichloromethane was added dropwise. The resulting mixture was washed with water, saturated brine solution, dried over anhydrous sodium sulfate and concentrated under reduced pressure. The purification of crude residue was done by column chromatography. Their characteristics were confirmed by 1H and 13C Nuclear Magnetic Resonance (NMR) and Liquid Chromatography- Mass Spectrometry (LC-MS). They were screened for activity against Candida albicans, Cryptococcus neoformans and Aspergillus niger by disc diffusion method. A loopful of cells from fungal stock cultures was added to Sabouraud Dextrose Broth (SDB) containing test tubes and incubated at 25°C for 24 hours. The test compounds were assessed for their antifungal activity. Their activity was compared with fluconazole which was the standard drug. The experiments were conducted with the test compounds and control experiment was done with Fluconazole. The growth inhibition zones around the disks were measured in mm at 28°C after 2-3 days. Results: Twelve N-(3-(4-(1,3-dioxolan-2-yl) phenyl)-1,2,4-thiadiazol-5-yl) benzamides (7a-7l) were synthesized with good yield. Compounds 7c and 7g had good activity against Candida albicans. Compounds 7f and 7g had moderate activity against Aspergillus niger, whereas Compounds 7d, 7f and 7h had moderate activity against Cryptococcus neoformans. Conclusion: A series of N-(3-(4-(1,3-dioxolan-2-yl) phenyl)-1,2,4-thiadiazol-5-yl) benzamides (7a-7l) were synthesized. These compounds have moderate to good antifungal activity against Candida albicans, and moderate activity against Aspergillus niger and Cryptococcus neoformans.

Effectiveness of Gong’s Mobilisation, Angular Joint Mobilisation and Maitland Mobilisation on Physical and Functional Outcomes among Patients with Frozen Shoulder: A Randomised Controlled Trial

KP Sowbhagya, P Sathya, Sathvik Acharya Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Frozen shoulder is a prevalent shoulder condition marked by significant pain and reduced mobility, which substantially compromises good health and well-being frequently among the elderly. Manual therapy techniques such as Gong’s Mobilisation (GM), Angular Joint Mobilisation (AJM), and Maitland Mobilisation (MM) are widely used to improve Range Of Motion (ROM), reduce pain, and restore function. Aim: This study evaluated and compared the effectiveness of three manual therapy techniques GM, AJM, and MM on physical and functional improvements in individuals with Stage II frozen shoulder. Materials and Methods: This study was a single-blinded, three- arm randomised controlled trial conducted at outpatient physiotherapy clinics affiliated with a University, Bengaluru, Karnataka, India, between March 2024 and August 2025. A total of 54 participants aged 40-60 years diagnosed with Stage II frozen shoulder were included based on primary inclusion criteria of shoulder pain and stiffness persisting for 3-9 months with a capsular pattern of restriction. Participants were randomly allocated into three groups (n=18 each): Group-A (GM), Group-B (AJM), and Group-C (MM). Each group received the respective manual therapy intervention along with standardised conventional physiotherapy for six weeks. Demographic parameters including age, sex, and duration of symptoms were recorded at baseline. Outcome measures assessed pre- and post-intervention included Passive ROM (PROM) using goniometry, the PENN Shoulder Score (PSS) (pain, satisfaction, and function), and the Upper Extremity Functional Scale (UEFS). Statistical analysis was performed using appropriate parametric and non-parametric tests, including Kruskal-Wallis test, Wilcoxon signed-rank test and Dunnett’s T3 post-hoc analysis with a p-value <0.05 considered statistically significant. Results: All three interventions showed statistically significant improvements across all outcome measures (p<0.05). Between-group analysis revealed significant differences in post-intervention PENN Total Score, PENN Satisfaction, UEFS, ROM flexion, abduction, and Internal Rotation (IR). Post-hoc comparisons showed AJM provided the greatest pain relief and patient satisfaction. GM demonstrated significantly greater improvement than MM in upper-limb functional ability (UEFS), while AJM demonstrated greater improvements in selected ROM outcomes. Conclusion: GM, AJM, and MM are all effective techniques for treating frozen shoulder. However, AJM demonstrated superior outcomes in pain relief and satisfaction, while AJM and GM were superior in restoring mobility and function. Clinicians should tailor interventions based on individual patient needs and clinical presentation to optimise recovery.

Effect of Foot Muscle Energy Technique on Plantar Pressure in Patients with Diabetic Neuropathy: A Randomised Controlled Trial

Mugdha Pendse, BR Ganesh Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Diabetic Peripheral Neuropathy (DPN) is a common complication of diabetes mellitus, often leading to altered plantar pressure, foot dysfunction, and increased risk of foot ulcers. Physiotherapy interventions such as Muscle Energy Technique (MET) and conventional strengthening and mobility exercises may improve foot biomechanics and functional outcomes in these patients. Aim: To evaluate the effect of Foot MET compared with strengthening and mobility exercises, both combined with sensory integration training, on plantar pressure distribution and foot function in patients with moderate DPN. Materials and Methods: An open-label randomised controlled trial was conducted in the Department of Physiotherapy at Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India, from July 2025 to December 2025, on 24 participants aged 50-75 years diagnosed with moderate DPN. Participants were randomly allocated into two groups: Group-A received MET with sensory integration, and Group-B received strengthening and mobility exercises with sensory integration. Interventions were administered three times weekly for four weeks. Data normality was assessed using the Shapiro-Wilk test. Within-group and between-group comparisons were performed using the Wilcoxon’s signed-rank test and Mann-Whitney U test, respectively. Effect size was calculated using standardised correlation coefficient (r). Results: Both groups demonstrated statistically significant improvements in plantar pressure distribution, pain, disability, activity limitation, and total Foot Function Index (FFI) scores post-intervention (p<0.001). Effect sizes were larger in Group-A, indicating a greater magnitude of improvement. Between-group analysis showed that MET resulted in significantly better plantar pressure redistribution, pain reduction, and overall foot function compared with strengthening and mobility exercises. Conclusion: Both MET and strengthening and mobility exercises with sensory integration effectively improved plantar pressure and foot function in patients with DPN. MET demonstrated superior outcomes and may be considered an effective physiotherapy intervention to enhance foot biomechanics and functional performance in individuals with diabetic neuropathy.

A Comparative Interventional Study on Craniosacral Therapy and Myofascial Release on Pain Intensity and Quality of Life in Patients with Migraine

Mahima Mohan Naidu, KC Vinod Kumar, Siddesh Ganesan Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Migraine is a prevalent neurological disorder that significantly affects an individual’s daily functioning and overall quality of life. Complementary manual therapy techniques, such as Craniosacral Therapy (CST) and Myofascial Release (MFR), have gained growing attention for their potential therapeutic benefits. The present study aimed to compare the effectiveness of CST and MFR in managing migraine symptoms and enhancing the quality of life among affected individuals. Aim: To analyse the comparative efficacy of CST and MFR in reducing pain intensity and improving quality of life in individuals with migraine headaches. Materials and Methods: The present was a comparative interventional study conducted at physiotherapy outpatient clinics, affiliated with the College of Physiotherapy, Dayananda Sagar University, Bengaluru, Karnataka, India from July 2025 to December 2025, spanning a total duration of six months. A total of 36 participants clinically diagnosed with migraine per the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria, aged 18-50 years, with restricted cervical rotation, were randomly assigned to two intervention groups-Group A received CST, while Group B underwent MFR techniques. Each participant received three sessions per week, lasting 30-45 minutes, over six weeks. Demographic parameters including age and sex were recorded at baseline. Pain intensity was assessed using the Numerical Pain Rating Scale (NPRS), headache-related disability with the Headache Impact Test (HIT-6), and quality of life through the Migraine-Specific Quality of Life Questionnaire (MSQOL). Statistical analyses included paired t-tests for within-group pre-post comparisons and independent t-tests for between-group comparisons, with a significance threshold of p<0.05. Results: Both CST and MFR groups demonstrated significant within-group improvements in pain intensity and headache impact after six weeks (p<0.001). In the CST group, NPRS reduced from 5.83±1.38 to 3.11±1.28 (d=2.68), HIT-6 decreased from 60.83±2.46 to 48.17±2.26 (d=10.66), and MSQOL improved from 44.89±4.10 to 63.11±3.97. In the MFR group, NPRS reduced from 5.28±1.57 to 3.11±1.13 (d=3.06), and HIT-6 decreased from 61.22±2.76 to 54.72±3.88 (d=2.82), while no significant improvement was observed in MSQOL (55.22±3.95 to 54.83±4.27; p=0.488). Between-group analysis showed no statistically significant difference in NPRS scores between the CST and MFR groups (p=1.000). However, CST demonstrated greater improvement in headache impact and migraine-specific quality of life outcomes compared to MFR. (p<0.001). Conclusion: CST was found to be more effective than MFR in alleviating pain intensity, reducing headache-related disability, and enhancing the overall quality of life in individuals with migraine.

Ultrasound-guided TAP Block versus Port-site Infiltration for Postoperative Analgesia after Laparoscopic Donor Nephrectomy: A Double-blinded Randomised-controlled Study

Punithavathy D, T Anupriya, Harendra Singh Jat Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Laparoscopic donor nephrectomy is a minimally invasive procedure, with postoperative pain being a major concern, increasing opioid use. The use of opioids is limited due to their adverse effects, and Non-Steroidal Anti-inflammatory Drugs (NSAIDs) are avoided due to their nephrotoxic effects. Aim: To compare the pain control efficacy and opioid-reducing effect of Transversus Abdominis Plane (TAP) block using 0.5% Ropivacaine and port site local infiltration of 0.5% Ropivacaine in patients undergoing laparoscopic donor nephrectomy Materials and Methods: This randomised double-blinded controlled study was conducted among 72 patients who underwent laparoscopic nephrectomy in Department of Anaesthesiology at Kovai Medical Centre and Hospital (KMCH), Tamil Nadu, India, from January 2023 to January 2024. Patients were randomised equally into two groups, 36 each. Group 1 was given port site local infiltration of 0.5% Ropivacaine, and Group 2 received 0.5% Ropivacaine via TAP block. The dose of Ropivacaine varied according to the weight of the patients. All the patients were evaluated a day before surgery, preoperatively. Postoperative pain scores, haemodynamic parameters, and rescue analgesic requirement were assessed. Mean Visual Analogue Scale (VAS) score was compared between the two groups using the Mann-Whitney U test, and the Rescue analgesic requirement was assessed using the Chi-square test. A p-value <0.05 was considered statistically significant. Results: Among the 72 patients who underwent laparoscopic nephrectomy, more than half of the patients were aged 21-50 years with the majority being Females in both groups. The mean postoperative VAS score at extubation was significantly lower in Group 2 than in Group 1 (1.5±0.7 vs. 2.1±0.7; p=0.001). At one hour post-extubation, the mean VAS score was significantly lower in Group 2 than in Group 1 (1.4±1.4 vs. 2.3±1.4; p=0.006). Furthermore, total rescue opioid administration was significantly lower in the TAP block group 14 (38.9%) compared to the port-site group 26 (72.2%), which was significant with a p-value of 0.03. Conclusion: The ultrasound-guided TAP block provides early postoperative analgesia and achieves a highly significant reduction in systemic opioid consumption compared to port-site infiltration. These findings indicate that the TAP block serves as a highly effective, safe regional alternative.

Comparative Evaluation of Apically Extruded Debris Using an Integrated Endomotor and a Conventional Endomotor with Two Different Nickel-Titanium File Systems: An In-vitro Study

Sridivya Kankanala, Anithakumari Rangappa, MS Adarsha, ME Sudhanva, KN Manasa, K Manu Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Apical extrusion of debris during root canal instrumentation is an unavoidable phenomenon that may contribute to postoperative pain, inflammation and delayed periapical healing. The design of endodontic file systems and the type of endomotor used can significantly influence the amount of debris extruded beyond the apex. Accurate working length determination and controlled instrumentation are important factors in minimising apical extrusion during biomechanical preparation. The rationale for the present study stems from the lack of direct comparative evidence on the effect of integrated versus conventional endomotors used with matched file systems on apical debris extrusion under standardised in-vitro conditions. Aim: To assess the apically extruded debris with an Integrated Endomotor (Canal Pro CL2i) and conventional endomotor (Endo-Mate TC2) using two different file systems (HyFlex CM and NT Gold Pro) Materials and Methods: This in-vitro study was conducted at Department of Conservative Dentistry and Endodontics, Vokkaligara Sangha Dental College and Hospital, Bengaluru, Karnataka, India from January 2024 to September 2024. Total 40 extracted human permanent single-rooted premolars were categorised into two groups: Group 1 (Canal Pro CL2i integrated endomotor) and Group 2 (Endo-Mate TC2 conventional endomotor), each subdivided into: Group 1A (Canal Pro CL2i+HyFlex CM), Group 1B (Canal Pro CL2i+NT Gold Pro), Group 2A (Endo-Mate TC2+HyFlex CM), and Group 2B (Endo-Mate TC2+NT Gold Pro). Teeth were prepared to a standardised working length up to file size 30/0.04, and the amount of debris extruded was measured using the laboratory model described by Myers GL and Montgomery S. Statistical analysis was performed using One-way Analysis of Variance (ANOVA) with Tukey’s post-hoc test (p<0.05). Results: The mean weight of extruded debris for canal Pro CL2i integrated endomotor HyFlex CM rotary files was 0.1244±0.0395 g, Canal ProCL2i integrated endomotor with NT Gold Pro rotary files was 0.2126±0.0528 g, Endo-Mate TC2 endomotor with HyFlex CM rotary files was 0.2457±0.0424 g and Endo-Mate TC2 endomotor with NT Gold Pro rotary files was 0.4240±0.0405 g. The difference in mean weight of extruded debris between four subgroups was statistically significant at p<0.001. Conclusion: Canal Pro CL2i produced significantly less apical debris extrusion than the Endo-Mate TC2 across both file systems tested. File system selection also independently influenced extrusion levels; HyFlex CM consistently generated lower debris extrusion values than NT Gold Pro.

Intrathecal Dexmedetomidine versus Fentanyl as Adjuvants to Hyperbaric Bupivacaine for Spinal Anaesthesia in Elective Gynaecological Procedures: A Double-blinded Randomised Clinical Trial

Rutuja Patil Jadhav, Pramod Jamale, Naseema V Kanase Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Spinal anaesthesia is commonly used for elective gynaecological surgery. Hyperbaric bupivacaine provides dependable neuraxial blockade, but postoperative analgesic duration may be inadequate. Intrathecal dexmedetomidine and fentanyl improve block quality and prolong analgesia, although their adverse-effect profiles differ. Aim: To compare intrathecal dexmedetomidine 5 μg with intrathecal fentanyl 25 μg as adjuvants to 0.5% hyperbaric bupivacaine for spinal block characteristics in women undergoing elective gynaecological procedures. Materials and Methods: The present double-blinded randomised parallel-group clinical trial was conducted in the Department of Anaesthesiology, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, Maharashtra, India, from June 2024 to November 2025. The study enrolled 60 women aged 18-60 years with American Society of Anaesthesiologists (ASA) physical status I or II. Eligible participants were randomly distributed into two equal groups. In Group DEX, patients received intrathecal 0.5% hyperbaric bupivacaine 15 mg with dexmedetomidine 5 μg. In Group FEN, patients received intrathecal 0.5% hyperbaric bupivacaine 15 mg with fentanyl 25 μg. Sensory and motor block characteristics, postoperative analgesic profile, haemodynamic changes, and adverse effects were assessed at predefined intervals. Statistical analysis was performed using the independent samples t-test, Mann-Whitney U test, Chi-square test, or Fisher’s-exact test, depending on the type and distribution of data. Statistical significance was set at p<0.05. Results: The mean age was 42.3±9.1 years in Group DEX and 41.7±8.6 years in Group FEN; ASA physical status I/II distribution was 18/12 and 17/13, respectively, with comparable baseline characteristics. Dexmedetomidine produced faster sensory block onset than fentanyl (2.4±0.6 versus 3.8±0.9 minutes; p<0.001) and significantly prolonged sensory and motor blockade. Time to first rescue analgesia was significantly longer with dexmedetomidine (382.7±41.2 versus 261.5±36.8 minutes; p<0.001), with fewer rescue analgesic doses and lower early postoperative pain scores. Haemodynamic effects were clinically manageable in both groups; bradycardia was more frequent with dexmedetomidine, whereas pruritus occurred only with fentanyl. Conclusion: Intrathecal dexmedetomidine 5 μg, when added to hyperbaric bupivacaine, provided quicker establishment of spinal anaesthesia and longer postoperative analgesia than intrathecal fentanyl 25 μg in elective gynaecological surgery. Careful monitoring for bradycardia is required when dexmedetomidine is used.

Amelioration on Mechanical Ventilated Patients in Response to Music Therapy: A Pilot Randomised Clinical Study

KN Ashwini, Larissa Matha Sams Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Mechanical Ventilation (MV) is a crucial, life-sustaining treatment, but it frequently causes significant changes in physiological parameters and may challenge recovery. Research suggests music-based interventions to stabilise vital signs during MV. However, studies investigating specific music therapy techniques addressing physiological well-being in patients on MV are scarce. Aim: To identify the effect of the Nature-based Sounds (NBS) vs Patient Preferred Music (PPM) intervention on physiological parameters in patients under MV support. Materials and Methods: This pilot randomised clinical study was conducted with mechanically ventilated patients admitted to the Intensive Care Unit (ICU) of tertiary hospitals in Mangaluru and Madikeri, Karnataka, India, from March 1 to June 30 2025. A total of 45 patients > 18 years were divided into: (1) Intervention Group 1 (IG1): standard care + NBS; (2) IG2: standard care + PPM; and (3) control group: standard care alone, using simple randomisation following the closed-envelope method for 30 minutes using headphones. The outcome measures assessed were physiological parameters (heart rate, respiration, blood pressure, SpO2, and pain) before the intervention and at the 15th minute, 30^th minute, and after 30 minutes of intervention. Pain was assessed using the Non verbal Pain Scale- Revised (NVPS-Revised). Statistical analysis was performed using Statistical Package for Social Sciences (SPSS), including Analysis of Variance (ANOVA) tests. Results: Both experimental groups exhibited significantly lower mean heart rate, blood pressure, and pain levels alongside the maintenance of normal oxygen saturation in comparison with pre-test values (p<0.001). A progressive decrease in these values at the 15^th, 30^th minutes and 30 minutes post-intervention indicated a cumulative dose effect. Notably, these variations were not evident during between-group analysis. Conclusion: Music of any kind, either NBS or PPM, stabilises physiological parameters and also serves as a distraction from pain in MV patients. This improvement underscores the music effectiveness in addressing problems associated with MV, enhancing adherence to complementary therapy and contributing to safer healthcare delivery and improved patient outcomes.

Patient Satisfaction, Postoperative Symptoms, and Peri-anaesthetic Awareness Following General Anaesthesia: A Prospective Observational Study

Bhavini Shah, Ibrahim Saleem Mainaparambil, Niveditha Kishore Srinivasan, Sakshi Gupta Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: General Anaesthesia (GA) is an integral component of modern surgical care, providing unconsciousness, analgesia, and amnesia during operative procedures. Patient satisfaction has emerged as an important indicator of the quality of anaesthetic care, reflecting the overall perioperative experience, including communication, comfort, symptom management, and recovery. Aim: To assess patient satisfaction, postoperative outcomes, and intraoperative awareness following GA among adult patients undergoing surgery. Materials and Methods: This prospective questionnaire-based observational study was conducted in the Department of Anaesthesiology at Dr. DY Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India, from February 2025 to March 2026. A total of 150 adult patients with American Society of Anaesthesiologists (ASA) physical status I-III undergoing surgery under GA were enrolled. Patient satisfaction, postoperative symptoms, and awareness were assessed using the Bauer Patient Satisfaction Questionnaire and Modified Brice Questionnaire at 1^st, 6^th, 12^th, and 24^th postoperative hours. Data were analysed using IBM Statistical Package for Social Sciences (SPSS) Statistics version 27.0. Continuous variables were expressed as Mean±Standard Deviation (SD), categorical variables as frequencies and percentages. Results: A total of 150 patients were included, 84 (56.0%) males and 66 (44.0%) females. Of the procedures, 104 were elective, and 46 were emergency. Most postoperative symptoms were absent or moderate in severity, with only 7 (4.7%) patients reporting severe pain at the surgical site and 10 (6.7%) experiencing severe Postoperative Nausea and Vomiting (PONV). Satisfaction with perioperative information, recovery from anaesthesia, pain management, and overall care remained consistently high. Among them, 8 patients (5.3%) reported intraoperative awareness, whereas 141 (94.0%) reported no dreams during anaesthesia. The most common last memory before induction was seeing the operating theatre in 98 patients (65.3%), while the first memory after recovery was being in the recovery room in 62 (41.3%). Pain in 63 patients (42.0%) and anxiety in 48 patients (32.0%) were the most frequently reported concerns. Conclusion: GA was associated with high patient satisfaction, favourable perioperative outcomes, low incidence of awareness, and minimal severe postoperative adverse effects. Effective communication, perioperative management, and symptom control contributed to a positive patient experience.

Adjunctive Effect of Buteyko Breathing on Cardiorespiratory Fitness and Physiological Parameters among Recreational Athletes: A Protocol for a Randomised Controlled Trial

Sayantan Patra, Akanksha Saxena, Mandeep Kumar Jangra Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Buteyko Breathing (BB) has shown potential to improve cardiorespiratory endurance in previous studies. The breath-holding effect of BB is the condition of maintaining high carbon-dioxide levels all the time, which can lower blood pH, causing more oxygen to be released into the tissues and increased cardiorespiratory endurance. BB is about slow and shallow nasal breathing, aiming to prevent hyperventilation, which may consequently increase parasympathetic activity. Need of the study: With limited research available on the effects of BB on athletic performance, especially in enhancing VO2 max, Resting Heart Rate (RHR) and Resting Blood Pressure (RBP). This randomised controlled trial aims to fill this gap by providing valuable insights into how BB can improve Cardio Respiratory Fitness (CRF) and physiological parameters. The objective of this study is to see whether daily BB practice over six weeks would increase cardiorespiratory endurance and lower RHR and RBP. Aim: To evaluate the effectiveness of BB on CRF and physiological parameters among recreational athletes. Materials and Methods: A randomised controlled trial will be conducted at Maharishi Markandeshwar (deemed to be university), Mullana, Ambala, Haryana, India, from March 2025 to July 2026. A total of 60 recreational athletes aged 18-40 years regularly engaged in sports for at least two years will be recruited and randomised into an experimental group (Group A), which will receive functional training exercises in combination with the BB exercise, and a control group (Group B) will have only functional training. Normality will be assessed with the Kolmogorov-Smirnov test. Parametric tests (paired t-test, Independent t-test) will be used for normally distributed data, and non-parametric tests (Wilcoxon signed-rank test, Mann-Whitney U test) for non normal data. A value of p<0.05 will be considered statistically significant.

Evaluation of the Predictive Value of a Newer Scoring System (SHUDE Score) for Chronic Endometritis in Women with Previous Reproductive Failure Undergoing IVF Treatment: A Research Protocol

Shuchi Jain, Deepti Shrivastava Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Chronic Endometritis (CE) is a persistent inflammation of the endometrial lining, frequently asymptomatic but associated with Recurrent Implantation Failure (RIF) and Recurrent Pregnancy Loss (RPL) in women undergoing In-Vitro Fertilisation (IVF). Need of the study: Preliminary evidence indicates CE prevalence varies with diagnostic methods, underscoring the need for standardised tools. The SHUDE score could close this gap by offering a structured, accessible approach to CE diagnosis. If validated it may enhance early detection and management of CE, improve IVF outcomes, and serve as a cost-effective option in resource-limited environments. Aim: To evaluate the predictive value of the newer scoring system for diagnosing CE in women with previous reproductive failure undergoing IVF treatment in comparison to the gold standard, i.e., CD138. Materials and Methods: A cross-sectional study will be conducted at the Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College (DMIHER), Wardha, Maharashtra, India, from January 2024 to December 2025. It will involve 121 IVF patients with a history of implantation failure or pregnancy loss. Each participant will undergo hysteroscopy and CD138 IHC testing. SHUDE score will be calculated incorporating the various clinical parameters, hysteroscopic findings and tuberculous molecular testing. The diagnostic accuracy of the SHUDE score in comparison to CD138 will be studied using Statistical Package for Social Sciences (SPSS) version 22.0, and the R package(s) will be used for the Receiver Operating Characteristic (ROC). Diagnostic accuracy, including sensitivity, specificity, predictive values and likelihood ratios, will be assessed. Youden’s Index will be calculated. A p-value <0.05 will be considered statistically significant.

Comparison of Wobble Board and Trampoline Training as an Adjunct on Proprioception, Kinesiophobia and Risk of Fall in Patients with Knee Osteoarthritis: A Randomised Clinical Trial Protocol

Prachi D Pandey, Amita S Aggarwal Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Knee Osteoarthritis (KOA) is chronic degenerative, age-related disorder leading to physical decline, balance and gait disturbance along with deformities. Patients with KOA exhibit impaired joint position sense, fear of movement, poor proprioception and elevated fall risk which contributes to poor postural control, increased sway and higher risk of fall. Need of the study: Proprioception training using unstable surface is essential component of rehabilitation. Wobble board training is commonly used to improve balance and neuromuscular control, whereas trampoline training provides a dynamic, multidirectional challenge which might provide more better functional demand. However, evidence comparing these two modalities as an adjunct in KOA is limited. Aim: To compare the effect of wobble board and trampoline training as an adjunct to conventional therapy on proprioception, kinesiophobia and risk of fall in patients with KOA. Materials and Methods: The present Randomised Clinical Trial (RCT) will be conducted in MM Super Specialty Hospital, Mullana, Ambala, Haryana, India, from March 2026 to March 2027. A total of 36 patients with bilateral KOA of grade 2 and 3 (Kellgren-Lawrence grade) will be recruited based on predefined inclusion and exclusion criteria. Group A will receive wobble board training with conventional therapy, and Group B will receive trampoline training with conventional therapy for three sessions per week for four weeks. Primary outcome measures include knee joint proprioception, Tampa Scale for Kinesiophobia, Fall Efficacy Scale-International (FES-I)and secondary outcome includes Knee injury and Osteoarthritis Outcome Score (KOOS) and Numeric Rating Scale (NRS). A paired t-test will be performed for within group comparison for normally distributed using Independent t-test and Wilcoxon Signed-Rank Test for not normally distributed data.

Effect of Graded Motor Imagery Training in Individuals with Chronic Lumbar Prolapsed Intervertebral Disc: A Research Protocol for a Randomised Controlled Trial

Garima Karra, Mandeep Kumar Jangra, Akanksha Saxena Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Prolapsed Intervertebral Disc (PIVD) causes lumbar pain, altered sensory processing, fear of movement, and reduced function. Chronic conditions disrupt central pain processing, motor planning, and body perception. Graded Motor Imagery (GMI), a recently used neuroscience-based intervention that targets altered central pain processing, cortical representation, and motor planning, has emerged as a promising intervention. Although GMI has demonstrated benefits in several chronic pain conditions, evidence regarding its effectiveness in chronic lumbar PIVD is limited. Need of the study: Chronic lumbar PIVD is associated with pain, disability, impaired lower extremity function, and fear-avoidance behaviours that are not fully addressed by conventional physiotherapy. Although GMI targets altered central pain processing and cortical representation, evidence regarding its effectiveness in chronic lumbar PIVD remains limited. Therefore, the present study calls for a clinical trial to assess the effectiveness of GMI training. Aim: To evaluate the effectiveness of GMI training on pain, lower extremity function, disability, and fear-avoidance in chronic lumbar PIVD patients. Materials and Methods: This protocol describes a two-arm, parallel-group randomised controlled trial, which will be conducted at Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation (MMIPR), Mullana-Ambala, Haryana, from March 2026 to March 2027. A total of 60 participants with chronic lumbar PIVD aged 18-45 years will be randomly allocated into two groups: an experimental group, which will receive GMI training and conventional physiotherapy and a control group, which will receive conventional physiotherapy only, twice a week for four weeks. Pre- and post-intervention outcome measure assessments will be done for pain on the Numerical Pain Rating Scale (NPRS), for Disability on the Oswestry Disability Index (ODI), for fear avoidance on the Fear Avoidance Belief Questionnaire (FABQ), and for lower extremity function on the Lower Extremity Functional Scale (LEFS) at baseline and after the 4-week intervention period. Shapiro-Wilk test for normality, paired t-tests (within groups), independent t-tests (between groups), Wilcoxon Signed Rank and Mann-Whitney U test will be applied. A p-value of <0.05 will be considered statistically significant.

Effect of Tendo-Achilles Stretching on Land versus Water in Non Specific Low Back Pain: A Research Protocol for Randomised Controlled Trial

Dhaval Chivate, Santosh Metgud Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Low Back Pain (LBP) is a prevalent condition affecting people of all ages and is difficult to manage because of its non specific nature. In addition to pain, it can alter muscle function, balance, body awareness, and joint movement. Need of the study: Calf muscle tightness may influence posture, balance, and LBP. Evidence linking Tendo-Achilles tightness with postural control, balance, and Non specific LBP (NSLBP)-especially in aquatic therapy is currently insufficient. Moreover, the objective evaluation of muscle adaptations following targeted stretching is limited. Hence, the present study is essential to scientifically examine the effects of Tendo-Achilles stretching using ultrasonographic assessment in individuals with NSLBP. Aim: To evaluate the effect of three weeks of Tendo-Achilles stretching on land versus water in subjects having NSLBP. Materials and Methods: The present randomised controlled trial will be conducted at KLE University’s Dr Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India, from January 2026 to June 2027. A total of 120 participants with NSLBP of three months to two years duration will be randomly assigned to three groups (n=40 each): Group A-conventional Transcutaneous Electrical Nerve Stimulation (TENS) and exercises, Group B-conventional TENS with land-based stretching, and Group C-conventional TENS with aquatic stretching, for three weeks (three sessions per week). Diagnostic ultrasonography will assess calf muscle length, echogenicity, and cross-sectional area. Calf flexibility, lumbar mobility, lower limb function, dynamic balance, and disability will be evaluated using the Weight Bearing Lunge Test (WBLT), Modified-Modified Schober Test (MMST), lower extremity functional scale, Y-Balance Test, and Modified Oswestry Disability Questionnaire, respectively. Analysis of Variance (ANOVA) and post-hoc Tukey’s test will be used for testing the significance of the hypothesis among groups. Paired t-test or Wilcoxon signed-rank test will be used for within-group comparisons, with p<0.05 considered statistically significant.

Efficacy of Adjuvant Role of Dantimooladi Dhoom versus Levosalbutamol and Ipratropium Bromide (Duolin) Nebulisation with Standard Care in Children with Bronchitis (Kaphaja Kasa): A Randomised Controlled Trial Research Protocol

Mohammad Zafar, Sonamm Kanzode, Atul Andelkar, Prachi Warukar Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Introduction: Kasa (cough), a common paediatric respiratory disorder, is primarily associated with the movement of Vayu and an imbalance of Kapha Dosha, which is predominant in childhood. Need of the study: In paediatric practice, difficulty with the taste or swallowing of oral medicines can reduce treatment compliance. Dantimooladi Dhoom offers a potentially more child-friendly inhalation-based approach, with its action directed toward the respiratory passages. According to Ayurvedic principles, it may help loosen and clear accumulated Kapha (mucus), reduce congestion, and facilitate breathing. This study goal is to scientifically evaluate this classical Ayurvedic therapy in children with Kaphaja Kasa and assess its potential as a safe, practical, and supportive treatment option for childhood cough and bronchial conditions. Aim: To study the comparative efficacy of Duolin Nebulisation versus a modified dosage form of Dantimooladi Dhoom in children with Bronchitis (Kaphaja Kasa). Materials and Methods: A randomised controlled trial will be conducted at Mahatma Gandhi Ayurveda College, Hospital and Research Centre, Salod (H), Wardha, Maharashtra, India from November 2025 to July 2026. A total of 66 patients diagnosed with bronchitis (Kaphaja Kasa) will be enrolled and randomly allocated into two groups. For 15 days, Duolin nebulisation with standard care will be given to Group A in a standard paediatric dose of 0.5 mL of Duolin diluted with 2 mL of normal saline. Group B will receive the same treatment using the modified dosage form of Dantimooladi Dhoom (herbal smoke inhalation) with standard care. The overall assessment will be done using the Bronchitis Severity Score Paediatric version (BSS ped). Outcome measures will be assessed on the 16th day after completion of the therapy. Within-group comparisons will use the paired t-test, between-group comparisons the unpaired t-test, and categorical variables the Chi-square test. A p-value <0.05 will be considered statistically significant.

The Role of Moringa oleifera in the Prevention and Treatment of Periodontal Disease: A Narrative Review

Ehab Azab Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Periodontal disease is an inflammatory condition caused by pathogenic bacteria in dental plaque and dysregulated host responses. Due to the limitations of conventional antiseptics, natural alternatives like Moringa oleifera (MO) have gained interest for managing this condition. The present review examines the potential of MO extract based on literature from PubMed, Web of Science, ScienceDirect, and Google Scholar from January 2014 to May 2026, covering various studies. Findings suggest that MO extract possesses anti-inflammatory, antioxidant, and antimicrobial properties, promotes periodontal tissue healing, bone regeneration and supports implant osseointegration, indicating it may be a promising natural alternative for periodontal disease management. However, further translational studies are necessary to confirm these effects in clinical settings, determine optimal concentrations, and ensure long-term safety.

Efficacy of TECAR Therapy in the Management of Chronic Non-specific Low Back Pain: A Narrative Review

Sarvotam Chauhan, Ranjana Singh Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Chronic Non-Specific Low Back Pain (CNSLBP) is the single largest contributor to years lived with disability worldwide, and a substantial proportion of patients respond only partially to guideline-endorsed first-line care, sustaining interest in adjunctive electrophysical modalities. Transfer of Energy Capacitive and Resistive (TECAR) therapy, also termed Capacitive-Resistive Electric Transfer (CRet), is a non-invasive radiofrequency diathermy that delivers energy at 448-500 kHz to generate endogenous deep-tissue heat, with proposed effects including vasodilation, improved microcirculation, reduced fascial and muscular stiffness, and attenuation of nociceptor sensitivity. This narrative review synthesises the current controlled clinical evidence for TECAR therapy in adults with CNSLBP, drawing on 14 randomised and controlled trials (approximately 700 participants across seven countries, 2016-2025) appraised with the Physiotherapy Evidence Database (PEDro) scale. Across all trials, TECAR was associated with significant short-term reductions in pain, and disability outcomes improved in most studies. Four trials that used a sham comparator demonstrated treatment-specific effects beyond placebo, and studies combining TECAR with exercise, manual therapy or proprioceptive neuromuscular facilitation consistently outperformed the comparator intervention alone, supporting an adjunctive role. Methodological quality was generally good (mean PEDro 7.5/10), although therapist blinding was absent in every trial and the durability of benefit beyond one to three months remains uncertain. TECAR therapy appears to be an effective short-term adjunct for reducing pain and improving function in CNSLBP; adequately powered, sham-controlled trials with standardised dosing and extended follow-up are required to define its long-term value.

Mechanisms and Management of Pneumococcal Meningitis: A Comprehensive Review

Nayakawadi Akhil, Amar Taksande, Revat J Meshram Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Pneumococcal Meningitis (PM) remains a major cause of mortality and long-term neurological complications. Presently, PM pathogenesis is not clearly understood. Infection usually initiates with colonisation of Streptococcus pneumoniae in the nasopharynx, followed with epithelial cellular adhesion, blood invasion, complement activation and coagulation pathways. Inflammatory mediators permit bacterial infiltration of the Blood-Brain Barrier (BBB), leading to bacterial proliferation and immune system activation through antigen-presenting and microglial cells. This facilitates extreme inflammation, neutrophil infiltration, and distinctive PM features. Recently, experimental animal models have progressed understanding of PM pathophysiology, helping in generating novel adjuvant therapies and antimicrobial approaches. A comprehensive literature search was conducted using PubMed, Google Scholar, Scopus and Directory of Open Access Journals (DOAJ), supplemented with relevant reference list screening, focusing on published literature on PM pathogenesis and management approaches. Despite effective antibacterial treatment, many survivors experience severe brain damage and long-term neurological sequelae, including hearing loss, cerebral palsy, seizures, hydrocephalus, or cognitive malformation. The present review explores recent insights into PM pathogenesis and current management approaches.

A Narrative Review on Bridging the Gap in Women’s Health: Self-Help Group versus Accredited Social Health Activist-led Cervical Cancer Screening Strategies in India

Achita Sawarkar, Deeplata Mendhe, Jaya Khandar, Madhuri Shambharkar, Prearna Sakharwade Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X Cervical cancer has continued to be a major public health menace and the leading cause of deaths resulting from cancer among women Low and Middle-Income Countries (LMIC) particularly in India. There are very effective screening methods that include Pap smears and Visual Inspection with Acetic acid (VIA), but cervical cancer screening coverage rates remain at appallingly low levels due to a combination of sociocultural and systemic barriers. The population has inadequate information, suffers from stigmatisation, lacks easy access to healthcare facilities, and does not seek treatment; hence late diagnosis leads to high mortality rates. Community-based strategies have been able to effectively sensitise people and facilitate their screening uptake. Two such grassroots approaches that this paper will attempt to review and comparatively analyse are Self-Help Group (SHG)-based interventions and Accredited Social Health Activist (ASHA)-led awareness drives. ASHA workers are health facilitators appointed by the government, who help greatly with the mobilisation of women and establishment of linkages with the healthcare services whereas in the SHG-based model, peer influence, group dynamics, and participatory learning create behaviour change in a community. Through a synthesis of recent studies and evaluations of programs, the present article rates the relative efficacy, reach, acceptability, and sustainability of both models. Results indicate that though ASHA-led efforts might be critical due to their existence within the healthcare system, SHG-based intervention has a higher possibility of creating long-term impact because of peer trust, empowerment, and community ownership. A hybrid model integrating both strategies can be proposed as a pathway that would work synergistically toward improving coverage for cervical cancer screening in varied Indian settings.

Pathogen Spectrum and Antimicrobial Susceptibility Patterns in Lower Respiratory Tract Infections: Updates from Bronchoalveolar Lavage Fluid Analysis at a Tertiary Healthcare Centre in Central India

Anjali Zoting, Titirsha Kayal, Swati Bhise, Dilip Gedam Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X

Bilateral Cleft Lip and Palate with Facial Nerve Palsy in Goldenhar Syndrome: A Rare and Severe Phenotypic Expression

Samikshsa Tidke, Ranjit Kamble, Tejaswi Kamble Journal of clinical and diagnostic research : 2026 - November - 20:0973-709X