Table of Contents : Journal of clinical and diagnostic research : 2024 - November - 18

Incorporation of Double Salivary Reservoirs in Maxillary Denture of an Edentulous Patient with Post-mandibular Resection: A Case Report

Amit Hindocha, Mohit Dudani, Anupama Patankar, Tejas Nalawade Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X The treatment of mandibular deviation in a completely edentulous patient (after segmental resection of the mandible) without osseous reconstruction consists of a twin-table maxillary complete denture occluding with a mandibular segmental denture at deviated position. Salivary reservoirs incorporated into the maxillary complete denture provide a potential solution to the ill effects of xerostomia, which is the most common post-irradiation complication. Hereby, the authors presents a case report of 62-year-old male patient with a unique method of incorporating two salivary reservoirs: one in the center of the palatal surface and the second beneath the additional palatal row of prosthetic teeth, with an approximate capacity of 7 mL. The novel design includes a removable silicone lid with an escape hole, allowing the patient’s tongue to control the release of the salivary substitute. It provided ease of removal of the lid, as well as cleaning and refilling of the reservoir. The design allowed area under the second row of teeth was utilised effectively without adding to the bulk of the denture.

Considerations for Optimal Dental Management in a 10-year-old Child with Congenital Heart Disease and Dextrocardia: A Case Report

Sahili Santosh Mungekar, Laresh Mistry, Shrutika Mankar, Snehal Markandey, Punam Patil Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Congenital Heart Disease (CHD) is one of the most common developmental anomalies seen in children and there is an increased risk of developing oral disease and its systemic effects in children with CHD. The present case report highlights the dental management of a 10-year-old boy with CHD and dextrocardia. The diagnosis for the patient included dextrocardia (where the position of the heart is developmentally changed from the left to the right-side), complete atrioventricular septal defect and double outlet right ventricle with pulmonary stenosis. After consultation, diagnosis and treatment planning and upon obtaining consent from the parents and modifying the child’s behaviour, the dental needs of the child were addressed on a visit-by-visit basis. A quadrant approach was adopted to complete the extractions of all retained carious primary teeth, followed by restorative treatment. Oral prophylaxis was performed, followed by topical fluoride application and the patient was then referred to the Department of Orthodontics for treatment of malalignment. This case report focuses on the guidelines followed for antibiotic prophylaxis against Infective Endocarditis (IE) and highlights the importance of maintaining good oral health for this group of patients. The dental management of children with CHD can be complex, as oral health is often neglected by both parents and patients. Cardiovascular problems can significantly impact both the child and the parent, affecting management and financial implications. The dental considerations require early diagnosis of dental problems and prompt treatment to prevent complications and difficulties in implementing treatment due to systemic repercussions. The present case report aimed to improve dental care for children with severe systemic alterations, as there is a lack of scientific literature regarding the dental management of paediatric patients with CHD.

Stress-induced Late Onset Adult Idiopathic Epilepsy after Snakebite: A Rare Case Report

Vignessh Raveekumaran, Elakkian Raj, Sethuraj Selvaraj Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Viper snake bites are associated with haemorrhagic qualities and bleeding disorders, including intracerebral haemorrhage. However, idiopathic epilepsy resulting from viper venom is considered a rare condition. Here is a case of a 30-year-old female who developed idiopathic epilepsy following a snake bite within two hours of the incident. Based on her clinical symptoms and laboratory investigations, the patient was immediately treated with Anti-Snake Venom (ASV) and supportive care. She then experienced an idiopathic seizure upon admission, and her Electroencephalography (EEG) showed generalised epileptiform activity. Subsequently, she was treated with anticonvulsant agents. After being discharged, the patient was readmitted one month later for the same condition, experiencing multiple seizure episodes, each lasting about 40 to 50 seconds. Her MRI of the brain was normal. She was then treated with two anticonvulsant agents and discharged with regular follow-up. This case highlights the importance of maintaining a high suspicion for seizures in patients presenting after envenomation. Early diagnosis and aggressive management may help prevent further neuromuscular damage to the patient.

Valproate-induced Hyperammonaemia in a Bipolar Disorder Patient: A Case Report

Induja Nair, Suvarna Jyothi Kantipudi Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Valproate is a widely used mood stabiliser in neurology and psychiatric practice. It can cause rare but serious adverse effects, including hyperammonaemia. Hereby, the authors present a case report of 40-year-old married male diagnosed with bipolar affective disorder, who presented with manic symptoms and subsequently developed hyperammonaemia after the initiation of Sodium Valproate. Despite normal liver function and no history of substance use, the patient exhibited excessive drowsiness and constipation five days after increasing the valproate dosage to 1500 mg/day. Serum ammonia levels were significantly elevated, prompting the cessation of all psychiatric medications and the initiation of lactulose treatment. Over six days, ammonia levels normalised, revealing the underlying manic symptoms. The patient was transitioned to Lithium for mood stabilisation while Valproate was not reintroduced. The case highlights the potential for hyperammonaemia in patients receiving valproate, even in the absence of liver dysfunction. The mechanisms behind this adverse effect may include Carnitine depletion and toxic metabolite accumulation from valproate metabolism. The report underscores the importance of vigilance in monitoring for hyperammonaemia, particularly in patients receiving rapid dose escalations of valproate. Limitations of the report include the absence of serum Valproate levels at the time of hyperammonaemia, which would have aided in understanding the dose-response relationship. It also highlights the need for early detection of hyperammonaemia and appropriate management.

From Crisis to Diagnosis: A Case of Hypertriglyceridemic Pancreatitis as the First Clinical Presentation of Type 1 Diabetes

Subashini Vadivel, Sheetal Nandha Kishore, Jagannath S Dhadwad, Janvi Panchal Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Acute Pancreatitis (AP) is a prevalent and rapidly progressive inflammatory disorder of the pancreas, often presenting with abdominal pain and elevated serum pancreatic enzymes. The present case report emphasises the crucial need for accurately diagnosing the underlying cause of Hypertriglyceridemic Pancreatitis (HTGP) in patients who present without any pre-existing co-morbidities. A 16-year-old female presented with a three-day history of generalised abdominal pain, vomiting and low-grade fever, with no co-morbidities. Initial clinical assessment revealed signs of dehydration, tachypnoea, tachycardia and diffuse abdominal tenderness. Laboratory workups indicated a significant rise in amylase and lipase, hyperglycaemia, metabolic acidosis and pronounced Hypertriglyceridemia (HTG). Imaging studies corroborated the diagnosis of AP, revealing necrotic fluid collections. The patient was immediately started on plasmapheresis, aggressive intravenous fluid resuscitation, insulin infusion and supportive care, which included electrolyte correction, pain management and vigilant monitoring of vital signs. The autoantibody panel for type 1 diabetes, Antiglutamic Acid Decarboxylase antibodies (GAD) returned positive. Over the following days, the patient exhibited marked clinical improvement, with decreased abdominal tenderness, stabilisation of vital parameters and normalisation of biochemical abnormalities. Subsequent imaging confirmed the resolution of pancreatitis. Upon discharge, the patient was prescribed a regimen of insulin, statins, fenofibrate and saroglitazar for ongoing management of her lipid levels and diabetes. This case underscores that HTG may present as the first clinical manifestation of Type 1 Diabetes Mellitus. It also emphasises the critical importance of prompt and coordinated therapeutic interventions in managing HTGP, where early and effective treatment is crucial for optimising patient outcomes.

Multiorgan-dysfunction Secondary to Glyphosate Poisoning: A Case Report

Pujitha Karlapudi, Viswanathan Pandurangan, Devasena Srinivasan, Divya Joyce Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Globally, glyphosate is the most widely used non selective broad-spectrum herbicide. The uncoupling of oxidative phosphorylation and polyoxymethylene amine-mediated cardiotoxicity are thought to contribute to glyphosate toxicity. Hereby, the authors presents a case report of 54-year-old male with an alleged history of consuming glyphosate, who experienced complications 48-72 hours after ingestion. These complications included acute kidney injury, corrosive injury to the oesophageal mucosa, cardiotoxicity, and Acute Respiratory Distress Syndrome (ARDS). These are rare but severe manifestations of oral glyphosate-Polyoxyethyleneamine (POEA) poisoning. The patient survived due to aggressive supportive therapy, which included renal replacement therapy, non invasive ventilation, and heart failure management. Since, there is no antidote for glyphosate poisoning, exposure to glyphosate can be fatal, necessitating vigorous supportive therapy. Published data indicate that the use of additional therapies, such as intravenous (i.v.) fat emulsion (20% intralipid, 100 mL) and adsorption haemoperfusion cartridge filters, has had limited success.

Dental Management of a Child with Hunter’s Syndrome and Hydrocephalus: A Case Report

Pavithra Suresh, Karthika Devaraj Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Mucopolysaccharidosis (MPS) type II, or Hunter’s syndrome, is an X-linked recessive disorder with a defect in Glycosaminoglycan (GAG) metabolism resulting in a deficiency of the enzyme Iduronate sulfatase. Hydrocephalus (HC) is a condition in which the volume of Cerebrospinal Fluid (CSF) in the cerebral ventricles is abnormally elevated. HC patients may show macrocephaly and delayed development. A Ventriculoperitoneal (VP) shunt is the most commonly used treatment option. Hereby, the authors present a case report of a nine-year-old male child diagnosed with Hunter’s syndrome and HC. The manuscript provides a comprehensive overview of the dental management strategies involving a team of specialists, including a paediatric dentist and a paediatrician. Key interventions included emphasising assessment of oral health issues related to the syndrome and condition, modification of treatment plans like implementation of a tailored oral hygiene regimen and fluoride treatments, use of sedative techniques to manage anxiety and facilitate thorough dental work, regular follow-up appointments to monitor oral health and accommodate the child’s physical and developmental needs, preventive care, modified treatment techniques, and close monitoring of systemic health. Effective dental management of patients with HC and Hunter’s Syndrome requires a comprehensive, multidisciplinary approach. Tailoring dental care to accommodate the unique needs of these patients can lead to successful outcomes and improved quality of life. This case underscores the importance of collaboration between dental and medical professionals in managing complex cases.

Congenital Dermoid Fistula of the Anterior Chest Region: A Case Report

Sanjay M Khaladkar, Sujith Kumar Samudrala Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Congenital Dermoid Fistula of the Anterior Chest Region (CDFACR) is a subcutaneous fistula that ends caudally in the subcutaneous tissue close to the sternoclavicular joint, originating from the skin at the anterior border of the sternocleidomastoid. The fistulous track is lined by keratinised stratified squamous epithelium with hair follicles, sebaceous glands and sweat glands. It presents clinically as a cutaneous pit, sinus, or infected mass. It is rare and can be complicated by recurrent infection and abscess formation. Before surgery, imaging the complete extent of the sinus is essential to prevent recurrence. Authors hereby, report a case of a 20-year-old male presenting with discharge from the anterior chest wall. On radiological and histopathological examination, it was diagnosed as a congenital dermoid fistula. In the present report, authors present a case of CDFACR confirmed through comprehensive evaluation, including sonography, Computed Tomography (CT) sinography, Magnetic Resonance Imaging (MRI) and histopathology. The present case also represents the first documented instance of CDFACR from India, highlighting the importance of multimodal imaging in the diagnosis and management of this rare congenital anomaly.

Management of Vyanga (Melasma) with Vyanganashak Lepa: A Case Report

Mrunal Sunil Bole, Sourabh Deshmukh, Trupti Thakre Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Melasma is a widespread acquired symmetrical hypermelanosis characterised by irregularly shaped but clearly defined dark brownish maculae on photo-exposed areas, particularly the forehead, temples, nose, eyelids, chin, and upper lips. It is a major cosmetological issue that can also affect a person’s psychological well being. Melasma can be correlated with Vyanga in Ayurveda. Vyanga is one of many Kshudra Rogas and Raktapradoshaj Vikaras. According to modern medicine, local application of corticosteroids is preferred for the management of melasma. However, due to the relapse of the disease and the side effects of steroids, an Ayurvedic approach is beneficial. Ayurveda mentions Shaman Chikitsa in the form of Lepa, which has Vatapittahara, Varnya, Twachya, Kushthaghna, and Raktaprasadaka properties as the line of treatment. Hereby, the authors present a case report of a 46-year-old female who reported to the Outpatient Department (OPD) of Kayachikitsa, complained of brownish discolouration on her face for six months, which was diagnosed as Vyanga (melasma). Ayurvedic treatment was planned according to the classical principle of Shaman Chikitsa, with a local application of Lepa containing depigmenting and skin rejuvenating drugs, along with lifestyle modifications. Due to the recurring nature of the disease, a proficient treatment approach was required. Vyanganashak Lepa has skin resurfacing and revitalising properties that act efficiently on the disease. In present case, Vyanganashak Lepa was found to be highly effective and showed remarkable results with continuous usage in a short period.

The Silent Invader: A Case Report of Pulmonary and Cerebral Nocardiosis by Nocardia cyriacigeorgica in a Renal Transplant Recipient

Sanjana Paranji Srirama, Akshen Sundaresan, Palraj Kennedy Kumar, Kopula Satyamurthy Sridharan Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Nocardia species primarily affect the lungs of immunocompromised individuals. The clinical presentation may mimic pulmonary tuberculosis. Accurate identification and high clinical suspicion are crucial for correct diagnosis and treatment, especially in tuberculosis-endemic regions. A prolonged antibiotic regimen with two or more drugs is needed, and non adherence to the treatment protocol can lead to potentially fatal outcomes. A 37-year-old man with systemic hypertension and chronic kidney disease, who also underwent live-related renal transplantation, presented with fever, cough, and weight loss. No other significant complaints were noted. Physical examination revealed elevated body temperature and bilateral basal crepitations. Baseline investigations showed anaemia, leukopenia and elevated renal parameters. A chest X-ray indicated right lower zone opacity. A provisional diagnosis of pulmonary tuberculosis or mycosis was considered. Video bronchoscopy revealed thick mucoid secretions that were collected for staining, culture, and sensitivity testing. Gram stain and modified Acid-Fast Bacilli (AFB) stain showed microscopic features suggestive of Nocardia species, while the colonies that grew on culture were identified as N. cyriacigeorgica. Treatment was initiated with oral cotrimoxazole and intravenous imipenem. After 14 days, he was discharged with a continuation plan but did not adhere to the regimen. The patient eventually presented again 10 days later with seizures and altered sensorium, leading to a diagnosis of cerebral nocardiosis. Despite treatment, he progressed to septic shock and died. Effective treatment of nocardiosis requires a multidrug regimen, typically consisting of cotrimoxazole, amikacin, or imipenem, tailored to the severity of the infection. Early diagnosis, prompt treatment, and strict adherence to protocols are mandatory for successful treatment, as delays or non compliance can lead to fatal outcomes.

Low-dose Fractionated Spinal Anaesthesia for Elective Caesarean Section in a Patient with Large Atrial Septal Defect, Severe Pulmonary Hypertension and Preeclampsia: A Case Report

Lisa Barman, Karishma Dhankhar, Neha Goyal, Anurag Das Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Atrial Septal Defect (ASD) is one of the most common acyanotic heart diseases presented in adults, with a higher prevalence among females. Patients often go unrecognised until middle age, unless complications such as arrhythmias arise. The physiological changes during pregnancy cause significant alterations in maternal haemodynamics. Cardiac valvular diseases, when present in obstetric patients, are among the leading causes of maternal mortality worldwide. These conditions pose a significant and unanticipated anaesthetic challenge, as the shunting of blood from left to right may precipitate hypoxia, hypercarbia, arrhythmias and cardiac failure. The presence of any other co-morbidities further complicates management. Hereby, the authors reported the successful management of a 30-year-old primigravida female at eight months of pregnancy, associated with a large ASD (34 mm), severe pulmonary hypertension, and preeclampsia, who underwent an elective Caesarean section (C-section). She presented at the Obstetric Emergency Department with dyspnoea at rest, which progressively deteriorated from the second month of pregnancy onward. She had no other complaints during her pregnancy. Echocardiography revealed a large Ostium Secundum ASD (OS-ASD) measuring 34 mm, almost leading to a single atrium physiology, with an ejection fraction of 45% and grossly dilated right atrium and right ventricle, as well as, severe Pulmonary Artery Hypertension (PAH). She underwent an elective Caesarean section with minimal haemodynamic alterations under fractionated spinal anaesthesia, with prophylactic adrenaline infusion. The effects were found to be beneficial and safe for the Caesarean section in patients with large ASD and preeclampsia.

Management Challenges of Refractory Immune Thrombocytopenia during Pregnancy: A Case Report

R Akshaya, Aboobacker Mohammed Rafi, Deepak Charles Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Thrombocytopenia, characterised by a platelet count below 150,000/μL, affects 7-11% of pregnancies for various reasons. Immune Thrombocytopenia (ITP), with platelet counts under 100,000/μL, accounts for 1-4% of pregnancy-related thrombocytopenia cases, particularly in the first and second trimesters. Not all pregnant patients with ITP require treatment, but when necessary, corticosteroids and Intravenous Immunoglobulins (IVIGs) are commonly used. This case reports a 25-year-old pregnant female, G3A2, at 27 weeks of gestation with a history of ITP and hypothyroidism. She presented with severe thrombocytopenia (8,000/μL) and a history of petechiae and gum bleeding. Initial treatment included corticosteroids, IVIG, and platelet transfusions, leading to fluctuating platelet counts. Due to refractory ITP, advanced treatments such as rituximab and romiplostim were administered. Despite significant challenges, including an episode of epistaxis and the need for intensive monitoring, the patient delivered a healthy baby via normal vaginal delivery at 35 weeks. The newborn required brief respiratory support and phototherapy for jaundice but had stable platelet counts at discharge. This case highlights the complexity of managing refractory ITP during pregnancy, emphasising the need for a multidisciplinary approach and individualised treatment plans to ensure maternal and foetal wellbeing. Continuous vigilance, adaptive strategies, and the use of multidrug therapy were crucial in achieving a successful outcome, underscoring the importance of tailored protocols and emerging therapies in such high-risk pregnancies.

Radiological findings of Secondary Synovial Chondromatosis of Elbow Joint: A Case Report

Pulkit Kumar Santoshi, Nahid Niaj, Soumyabrata Debnath Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Synovial Chondromatosis (SC), previously known as synovial osteochondromatosis, is usually an uncommonly encountered condition. Pathologically, the condition involves the formation of multiple cartilaginous nodules that arise from the synovium of facet joints and may detach from the synovium to form loose bodies in or around the joint space. While X-rays help in the early detection of loose bodies in SC, advanced diagnostic modalities such as Computed Tomography (CT) scans and Magnetic Resonance Imaging (MRI) aid in preoperative diagnosis and work-up. Authors hereby, report a unique case of secondary SC of the elbow joint in a 50-year-old male patient who presented with complaints of swelling, chronic elbow pain, and joint stiffness with restricted movement following an old traumatic injury. The patient was clinically misdiagnosed as having ‘Myositis Ossificans’ due to the history of massaging the elbow joint following trauma by a local practitioner. However, radiological investigations revealed multiple intra- and extra-articular loose bodies of varying sizes and stages of calcification, leading to a diagnosis of ‘Secondary SC’. SC is a rare entity that is often misdiagnosed during clinical examinations. Therefore, extensive radiological evaluation is necessary for the accurate and early diagnosis of the condition. Early surgical management can restore the Range of Motion (ROM) of the affected joint and prevent secondary osteoarthritic changes.

Rapp-Hodgkin Syndrome: A Case Report on its Clinical and Dental Manifestations

Anwesha Biswas, Kaushik Dutta, Abhishek Khatua, Anwesha Banerjee, Rekha Puttanavar Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Rapp-Hodgkin Syndrome (RHS) is a rare heterogeneous disorder characterised by ectodermal abnormalities primarily affecting the skin, teeth, eyes, hair and appendages. It is a type of Anhidrotic Ectodermal Dysplasia (AED) associated with clefts of the lip, palate and alveolus. Affected areas include the skin, hair, teeth, mouth, jaws, nails, eyes and ears. The authors present a case of RHS in a 13-year-old male who complained of deformed teeth, reduced sweating and heat intolerance. Clinical findings included sparse, thin hair on the scalp and eyebrows, sparse eyelashes, epiphora, discoloured scaly skin, a deformed pinna, microstomia, trismus, a cleft lip scar, hyponychia and a deficient maxilla. Intraoral examination showed oligodontia and misshapen teeth, along with a depapillated tongue. The patient had previously undergone cleft lip and palate surgery, ankyloblepharon release, adenoid surgery, and ear surgery at a younger age. Radiographically, there was evidence of cleft alveolus, retained deciduous teeth, impacted teeth and oligodontia. Although the patient had a normal karyotype, histopathological examination of the skin showed hyperkeratosis, acanthosis, follicular plugging, and increased pigmentation of the basal cell layer. Considering this amalgamation of signs and symptoms, a diagnosis of RHS was made, which necessitates a multidisciplinary approach for treatment. This patient will require a multidisciplinary approach to address his complaints. The authors reported the present case because it represents a rare type of ectodermal dysplasia, which is important for any physician’s knowledge due to its varied presentations.

Intrapleural Fibrinolytic Therapy for Complex Haemothorax in a Patient with Congenital Heart Disease and Eisenmenger Syndrome: A Case Report

Siri Vineeth Anuraag Ganta, Manosri Mandadi, Vishnu Prabhakar Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Haemothorax, characterised by blood in the pleural cavity with a haematocrit greater than 50%, can arise from both traumatic and non traumatic causes. Prompt blood removal is crucial to prevent coagulation and complications like post-traumatic empyema. While tube thoracostomy is the initial management, Intrapleural Fibrinolytic Therapy (IPFT) offers a less invasive alternative when drainage is insufficient. The authors hereby, report the case of a 33-year-old male with congenital heart disease who presented with haemothorax. He exhibited worsening breathlessness, a cough with yellowish sputum and intermittent fever. Examination revealed clubbing, tachycardia, hypotension, tachypnoea and hypoxia. Imaging confirmed a right-sided pleural effusion with septations and severe Pulmonary Arterial Hypertension (PAH). Initial management with a pigtail catheter and antibiotics resulted in minimal drainage. The patient then underwent IPFT, leading to significant fluid drainage and radiological improvement. His clinical condition improved with reduced breathlessness and stabilised vital signs. The present case supports the efficacy of fibrinolytic agents like Streptokinase (STK) in managing clotted haemothorax, particularly in patients with complex medical backgrounds such as congenital heart disease. Early IPFT can enhance pleural drainage and reduce the need for invasive surgery, highlighting its value in similar clinical scenarios.

Notorious Foreign Body in the Cricopharynx with Impending Internal Carotid Artery Penetration: A Case Report

K Gowthame, Raghvi Anand, RB Namasivaya Navin, S Prabakaran, B Sarath Kumar Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X The presence of foreign bodies in the throat is a relatively frequent occurrence in otolaryngology practice. Adults experience foreign bodies in their throats more frequently, with food impaction being the main reason. A 60-year-old female presented with a history of fish ingestion and complaints of Foreign Body (FB) sensation in the throat and painful swallowing. Computed Tomography (CT) of the neck showed the presence of a FB in the hypopharynx, with a possibility of penetration into the parapharyngeal space and the left Internal Carotid Artery (ICA). The patient underwent FB removal under flexible fibreoptic endoscopy with intravenous sedation. Any delay in diagnosis and treatment could lead to the migration of the FB into the carotid artery, resulting in catastrophic bleeding. Hence, every patient who visits the otolaryngology Outpatient Department (OPD) with complaints of FB sensation in their throat needs to be evaluated promptly. Physicians should be particularly concerned if the patient has prolonged clinical symptoms, positive neck radiography, and negative direct laryngoscopy and rigid esophagoscopy. These cases have a high index of suspicion for a migrating FB. Whether to consider segmental resection and end-to-end anastomosis, angioplasty with a saphenous vein or prosthetic patch, insertion of an allograft, Polytetrafluoroethylene (PTFE) interposition graft, or replacement of the injured ICA will depend on the type and extent of the arterial injury.

Moebius Syndrome Misdiagnosed as Duane Retraction Syndrome: A Case Report

Harnoor Kaur, Neha K Sethi, Harsimarpreet Singh Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Moebius syndrome and Duane Retraction Syndrome (DRS) are Congenital Cranial Dysinnervation Disorders (CCDDs) characterised as congenital, non progressive groups of diseases caused by abnormal development of cranial nerve nuclei or their axonal connections. Due to their overlapping features, distinguishing between these disorders can be challenging, leading to potential diagnostic oversights. This is a case report of a 10-year-old female with Moebius syndrome misdiagnosed as DRS. She had 6th and 7th nerve palsies with exposure keratopathy. Probably the cause for misdiagnosis was the presence of an abduction deficit-a characteristic shared by both disorders. Additionally, it is crucial to examine the facial nerve, as it is exclusively affected in Moebius syndrome. DRS is significantly more common than Moebius syndrome; the rarity of Moebius syndrome might contribute to the misdiagnosis. Conducting a thorough examination is essential for differentiating between these conditions, thereby facilitating comprehensive management.

Successful Non Surgical Endodontic Management of Multi-fractured Maxillary Anterior Teeth: A Two-year Follow-up

Aashish Handa, Kanwalpreet Kaur Bhullar, Manpreet Kaur, Roohan Malhar Sandhu, Smiley Goyal Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Traumatic Dentoalveolar Injuries (TDI) refer to injuries to the tooth (crown/root) and/or the tooth-supporting structures (Periodontal Ligament (PDL)/alveolar bone) due to traumatic force. The incidence of trauma to maxillary anterior teeth is very high. Hereby, the authors present a case report of non surgical endodontic management of fractured maxillary anterior teeth in a 19-year-old female at the middle and apical third root levels. Clinical examination of the patient revealed multiple fracture injuries involving the upper anterior teeth. There was no response to the pulp sensibility test concerning teeth 11, 12, 21, 22, 23, and 24. The Conical Beam Computed Tomography (CBCT) results showed apical third root fractures in teeth 11 and middle third fractures in tooth 23. Resorptive abnormalities were visible in the periapical regions of teeth 11, 12, 21, 22, and 24. Root canal treatment was performed using a bioceramic sealer and Mineral Trioxide Aggregrate (MTA). Clinical, CBCT, and radiographic evaluations conducted 24 months after the initial treatment verified total resolution in the periapical areas of the affected teeth. The present case study demonstrated the usefulness of MTA for the rehabilitation of teeth with broken roots and bioceramic sealers in the treatment of resorptive defects in traumatised teeth. Clinical and radiological signs of healing were observed during a follow-up period of 24 months.

Ameloblastic Carcinoma: A Rare Case Report

Sowmya Vimala Nandika, Tatapudi Ramesh, Ravikanth Manyam, Puvvada Divya, Veerakumari Merneedi Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Ameloblastic carcinoma is a rare, aggressive, malignant form of ameloblastoma with a low incidence rate, accounting for 0.3-3.5% of all odontogenic tumours of the jaws and has a poor prognosis. It exhibits a 5:1 mandibular predilection, with the lungs being the most common metastatic site. Clinically, these lesions behave more aggressively than conventional ameloblastomas. The most common sign is an asymptomatic swelling, with less frequent findings of pain, rapid growth, trismus and dysphonia. About 38% of cases may present without typical clinical symptoms or unique clinical presentations. The present case is a rare case report of 40-year-old male patient of ameloblastic carcinoma presenting with a unique clinical manifestation as osteomyelitis. Initially, the patient reported the presence of an unhealed extraction site, followed by gradual swelling with discharge and pain over the past 20 days. After the necessary diagnostic procedures, the case was diagnosed as ameloblastic carcinoma and referred to higher centres for treatment. The lack of typical clinical presentation makes the diagnosis of these cases difficult. To prevent morbidity and mortality associated with these aggressive cases, they must be diagnosed and treated as early as possible.

Non Tubercular Mycobacterial Infection as a Cause of Non Resolving Aspiration Pneumonia in a Case of Achalasia Cardia: A Case Report

Shailesh Bhanudas Meshram, Hiral Gulab Ramnani Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Achalasia is an oesophageal motor disorder characterised by the absence of peristalsis and swallowing difficulties, which results in poor clearance of the oesophagus. The Lower oesophageal Sphincter (LES) fails to relax, either partially or completely, with elevated pressures demonstrated monometrically. Hereby, the authors present an interesting case of a 38-year-old male who presented to a tertiary care hospital with high-grade fever, difficulty in breathing, chronic cough with whitish-yellowish sputum, and generalised weakness for one month. He had made multiple hospital visits for similar complaints and was treated as a case of aspiration pneumonia. Upon admission, he was febrile but otherwise had stable vital signs. Initial investigations revealed bilateral inhomogeneous opacities on chest radiography, a total leukocyte count of 25,000/mm3, and haemoglobin of 7 gm%. He was started on empirical antibiotics and antipyretics, and due to difficulty swallowing, a nasogastric tube was inserted under fluoroscopic guidance. High-Resolution Computed Tomography (HRCT) showed a dilated thoracic oesophagus with mild tracheal and Superior Vena Cava (SVC) compression, bilateral mass-like consolidation, and an air-fluid level, raising suspicions of malignancy or lung abscess. Upper gastrointestinal endoscopy revealed a dilated, tortuous oesophagus with white plaques. A 2D echocardiography showed an ejection fraction of 60% with moderate pulmonary arterial hypertension. Despite initial antibiotic therapy reducing the leukocyte count, his cough and fever persisted. Fiber optic bronchoscopy indicated mild tracheal compression and bilateral mucosal congestion, and a transbronchial lung biopsy was performed. Bronchoalveolar Lavage (BAL) samples tested negative for the Cartridge-based Nucleic Acid Amplification Test (CBNAAT) but showed acid-fast bacilli on Gram and Ziehl-Neelsen (ZN) staining. Repeated sputum samples and CBNAAT tests revealed similar results, confirming the presence of Non Tubercular Mycobacteria (NTM), and appropriate treatment was started. The patient gradually improved, with a reduction in fever spikes over a month. He later underwent laparoscopic Heller’s cardiomyotomy with Dor’s fundoplication, the treatment of choice for achalasia cardia. Currently, patient has completed nine months of treatment for NTM with visible clinical and radiographic improvement.

Management of High-grade Anterior Cruciate Ligament Tear: A Case Report on Integrating Physiotherapy and Ayurvedic Therapy

Mayank Rai, Sadhana Misar Wajpeyi, Reeya Gamne Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Anterior Cruciate Ligament (ACL) tears are frequently managed surgically in conventional medicine; however, some patients seek alternative treatments due to personal preferences or contraindications. This case presents a 55-year-old male who suffered a high-grade complete ACL tear following a road traffic accident and fall. Despite recommendations for surgical intervention from multiple allopathic surgeons based on Magnetic Resonance Imaging (MRI) findings, the patient opted for an integrative approach combining Ayurvedic herbal and Panchakarma therapies with physiotherapy. The Ayurvedic treatment aimed to reduce inflammation, promote tissue regeneration, and enhance joint stability, utilising herbal medicines and therapeutic procedures such as snehana (oleation), basti (therapeutic enema), alepa (external application), and upanaha swedana (poultice). Concurrently, physiotherapy focused on strengthening the surrounding musculature, improving Range of Motion (ROM), and enhancing functional mobility. Over the treatment period, the patient experienced substantial pain relief, reduced knee swelling, and significant improvement in functional ability, enabling a return to daily activities without surgical intervention. This case underscores the efficacy and feasibility of an integrative approach in managing ACL tears, providing a holistic non surgical option for patients who are reluctant or unsuitable for conventional surgical interventions.

Nasal Rhinosporidiosis Diagnosed in Cytology: A Case Report

Yogamaya Pattanayak, Goutami Das Nayak, Ranjan Kumar Mallick, Gouranga Charan Prusty, Lity Mohanty Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Rhinosporidiosis is a chronic granulomatous inflammation of mucosal sites caused by the fungus Rhinosporidium seeberi. The most common site of involvement is the nasal mucosa, followed by the lips, palate, uvula, maxillary antrum, epiglottis, larynx, pharynx and trachea and bronchi. It usually presents as a polypoidal, reddish, friable, painless, pedunculated, hyperplastic soft-tissue mass in the nasal area, typically with an indolent and chronic progression. It can be confused clinically with other benign lesions such as inverted papillomas, primary sinonasal tuberculosis, angiofibromas and malignancies like nasopharyngeal carcinoma. Hence, accurate and final diagnosis is vital, which is achieved through histopathology. This is a case of rhinosporidiosis in a 44-year-old male patient who presented with a polypoidal nasal mass. Cytosmears revealed numerous endospores and few sporangia of Rhinosporidium seeberi, along with inflammatory cells and foreign body-type giant cells. Biopsy highlighted sporangia with endospores in different stages of maturation and thus confirmed the final diagnosis. Although cytology is a simple, preliminary, rapid and inexpensive method, histopathology is the gold standard for a definitive diagnosis. Surgical removal of the lesion with cauterisation of the attachment base is curative in the majority of cases. Recurrence is variable in endemic areas, especially in mucosal sites like the oropharynx and paranasal sinuses. Since there is inadequate literature on the cytodiagnosis of rhinosporidiosis, this case report highlights the significance and utility of cytology in the early diagnosis of nasal rhinosporidiosis.

Effective Troubleshooting of EZ-Blocker™ Endobronchial Blocker Insertion in Minimally Invasive CABG Surgery: A Case Series

Arupratan Maiti, Sreya Moitra, Amrita Guha Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X EZ-Blocker™ is a specially designed semi-rigid Y-shaped Bronchial Blocker (BB) containing two inflatable cuffs. The difficulties and challenges encountered while inserting the Rusch EZ-Blocker™ (Teleflex Life Sciences Ltd., Athlone, Ireland) for isolating the left lung in Minimally Invasive Coronary Artery Bypass Graft (MICS CABG) surgery are numerous and varied. The present case series describes 28 different patients (out of 102 patients with attempted EZ-Blocker™) who faced various difficulties and technical problems while introducing the EZ-Blocker™ and how troubleshooting was performed in those cases with different manoeuvres. The difficulties in inserting the EZ-Blocker™ were due to a variety of reasons such as inadequate space between the carina and bronchus, a prominent right main bronchus at an acute angle compared to the obtuse angle of the left main bronchus, a compressed left main bronchus, deviation of the airway and a deep posterior bronchus. The manoeuvres used to overcome these challenges included controlled pulling of the endotracheal tube upwards, rotation of the head to the right-side with or without direct tracheal manual compression to the right-side, manual widening of the distal Y end of the EZ-Blocker™ and extension of the head in selected cases. Out of 102 attempted cases of EZ-Blocker™, difficulty (insertion time >90 seconds) was noted in 28 cases, which were managed with the different clinical manoeuvres mentioned above. However, in four other cases, the EZ-Blocker™ could not be introduced and the attempts failed. Although the EZ-Blocker™ is a safe and easy alternative to the Double Lumen Tube (DLT), it has not been widely used in India to date. The proposed manoeuvres will surely help clinicians use it more efficiently in cases where they encounter difficulty during insertion.

A Case Series Reflecting Airway Difficulty Challenges: Insights into Intubation and Extubation for Large Retrosternal Goitres

Shilpa Sarang Kore, Supriya B Gholap, Runjhun Jain Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Retrosternal goitres, often due to longstanding thyroid enlargement, can compress critical structures like the trachea and oesophagus, necessitating thyroidectomy. Managing the airway while ensuring patient safety presents a significant challenge for anaesthesiologists. This case series explores the complex airway management in three patients with large retrosternal goitres undergoing total thyroidectomy. The patients, aged 50, 60, and 73, presented with long-standing neck swelling, tracheal deviation and symptoms including breathlessness, dysphagia and hoarseness of voice. The goitres had progressively enlarged over many years, leading to significant tracheal compression and deviation, which posed a high-risk for airway obstruction during surgery. Given these challenges, Awake Fiberoptic Intubation (AFOI) was chosen to secure the airway while minimising the risk of airway loss. AFOI was performed under conscious sedation with dexmedetomidine and local anaesthesia, providing effective intubation with minimal discomfort and stable haemodynamics. This approach was critical in managing the anticipated difficult airway due to the retrosternal extension of the goitres and their impact on surrounding structures. Postoperatively, the patients were kept intubated to prevent tracheomalacia, a potential complication arising from prolonged tracheal compression. Tracheomalacia, characterised by the weakening of tracheal walls, can lead to airway collapse after extubation. To ensure airway stability, extubation was delayed until a satisfactory cuff-leak test was performed 24-36 hours after surgery. This case series emphasises the importance of careful preoperative planning and the use of AFOI in managing patients with large retrosternal goitres to avoid a ‘can’t intubate, can’t ventilate’ situation. The successful management of these cases highlights the effectiveness of AFOI in reducing perioperative risks and ensuring patient safety, particularly in scenarios where difficult airway management is anticipated. By implementing appropriate postoperative protocols, the risk of complications such as tracheomalacia can be significantly reduced, leading to improved surgical outcomes.

Understanding and Managing Thrombocytopenia in Pregnancy: A Case Series

Akshaya Radhakrishnan, A Parimala, K Jayashree Srinivasan, RV Lakshmipriyaa Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Thrombocytopenia, defined as a platelet count of less than 1.5 L/mm3, is a common haematological disorder encountered during pregnancy. It can arise from a variety of causes, including immune-mediated destruction, gestational thrombocytopenia, and underlying medical conditions such as preeclampsia or Haemolysis, Elevated Liver Enzyme Levels and Low Platelet (HELLP) syndrome, with gestational thrombocytopenia being the most common. Hereby, the authors present a case series including six patients with thrombocytopenia in pregnancy. The clinical characteristics, diagnostic work-up, management strategies, and maternal and foetal outcomes in patients with varying aetiologies of thrombocytopenia were described in present series. Understanding the aetiology and management of thrombocytopenia in pregnancy is crucial for optimising maternal and foetal outcomes, and this series contributes valuable clinical insights into this important area of obstetric haematology. It underscores the need for a multidisciplinary approach in managing complex obstetric cases involving thrombocytopenia and other co-morbidities. Effective collaboration among obstetricians, haematologists, physicians, and specialists is essential for addressing the challenges of thrombocytopenia during pregnancy and achieving the best outcomes for both mother and baby.

Topical Sirolimus for Facial Angiofibroma in Tuberous Sclerosis Complex: A Case Series

Gampi ETE, Manjeet Ramteke, Ratnakar R Kamath, Neha Fogla, Aarti V Chavhan Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Facial angiofibromas (FAs) are a distressing manifestation of Tuberous Sclerosis Complex (TSC), often leading to significant physical and psychological burdens. Traditional treatment modalities have limitations, prompting the exploration of alternative therapies. In the present case series, topical sirolimus, a Mammalian Target of Rapamycin (mTOR) inhibitor, was used to manage FAs associated with TSC. Four cases (1 male and 3 female) of FAs in patients with TSC were treated with 0.1% sirolimus ointment applied once daily. The Facial Angiofibroma Severity Index (FASI) was utilised to assess FA severity at baseline and during follow-up visits, which spanned 3 to 12 months. Patient satisfaction and tolerability were also evaluated. Results demonstrated a consistent reduction in FASI scores across all patients, indicating improved FA severity. Patient satisfaction varied, with higher contentment observed in cases where treatment was initiated at a younger age. Importantly, no significant adverse effects were noted, affirming the safety profile of topical sirolimus. These findings underscore the potential of topical sirolimus as a promising therapeutic avenue for FAs in TSC, offering a cost-effective and well-tolerated alternative to conventional treatments. Further research is warranted to elucidate optimal dosing strategies and long-term outcomes, but current evidence supports its consideration as a viable option in the management of FAs associated with TSC.

Complications of Acute Formic Acid Poisoning: A Series of Five Cases

Mukut Debnath, Mahendra Debbarma, Rakesh Chandra Pal, Rudra Pratap Debbarma, Tanmay Chakraborty Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Formic acid poisoning, although uncommon, carries a high-risk of morbidity and mortality. Five cases (one male and four females) of formic acid poisoning were referred to the Emergency Department within a time frame of 60-120 minutes after ingestion. The age range was between 14 years and 70 years. Three patients had accidental ingestion, while two had ingested the substance with suicidal intent. The quantity ingested ranged from 15-30 mL of undiluted acid. Out of the five patients, two had hypertension, one had both hypertension and diabetes mellitus, and the remaining two did not have any co-morbidities. All five patients presented with orofacial burns, upper abdominal discomfort and dysphagia. One patient experienced mild haematemesis, while another had severe haematemesis. Three patients had altered sensorium due to metabolic acidosis. Four patients developed dark, cola-coloured urine and one had gross haematuria. All patients exhibited acute renal toxicity and dyselectrolytemia. Metabolic acidosis was corrected in two patients with a 7.5% NaHCO3 infusion. Four patients improved with haemodialysis and other supportive measures and were discharged within 10-16 days of admission. However, a 60-year-old patient who had gross haematuria and severe haematemesis following the accidental ingestion of 30 mL of acid expired due to severe metabolic acidosis and hypovolemic shock within eight hours of hospital admission.

Chronic Polyarticular Gout at Unusual Sites: A Rare Case

Srilakshminagasaikrishnapraneeth Addagarla, B Vijay Anand, S Karthikeyan, Senthil Kumar Aiyappan Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X A 59-year-old male presented to the orthopaedics department with complaints of pain and swelling in the right knee for one week. The pain was insidious in onset with gradual progression, dull aching, non-radiating, and aggravated on weight bearing and knee movements with no relieving factors. The patient also had a similar history of pain and swelling in both knee joints on and off for the past three years. The patient also gave a history of pain in the neck region radiating to both upper limbs for the past two months. The patient was not a known hypertensive, diabetic, not a smoker or alcoholic. The patient consumed a vegetarian diet. The medical history of the patient revealed chronic gout for four years, diagnosed elsewhere and the patient was on intermittent treatment with allopurinol. The general examination of the patient was unremarkable.

Circinate Balanitis in a Patient with Sexually Acquired Reactive Arthritis: Clinical images

Shivani Deepak Jangid, Bhushan Madke Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X A 37-year-old male patient presented to Dermatology Out Patient Department (OPD) with complaints of multiple hyperkeratotic plaques over his entire body, bilateral palms, and soles for one year. The lesions were associated with low back pain and bilateral knee joint pain. The lesions were also associated with onycholysis and subungual debris in the nails of bilateral hands and feet. The patient complained of occasional dysuria and purulent discharge in urine. The patient also had a history of sexual contact six months before the onset of lesions. On further examination of the genitals, the penile region revealed multiple asymptomatic superficial erosions that coalesce to form a sharply demarcated, serpiginous pattern (Table/Fig 1). Multiple hyperkeratotic papules and plaques with exfoliation of skin were present over the sole, suggestive of keratoderma blennorrhagicum (Table/Fig 2).

Secondary Peritoneal Hydatidosis: A Radio-pathological Correlation of Rare Presentation

Garima Chandrakar, Simran Khan Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X A 36-year-old female patient was referred from a secondary rural hospital to the outpatient department, presented with a gradually increasing lump in the abdomen associated with dull aching pain and discomfort, along with weight loss since three months. Physical examination revealed a palpable diffuse mass of about 14×14 centimeters in the epigastric region extending to the right hypochondrium as well as a mild shift towards the left hypochondrium. Routine haematological and biochemical parameters, including complete blood count, liver function tests, and renal function tests, were normal. Chest radiography was normal.

Situs Inversus Totalis in a Five-month-old Male Child Presenting with Cough: Diagnostic Clinical Images

Sayali Sanjay Borse, Renu B Rathi Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X

Clinical Image of Aphallia: A Rare Congenital Anomaly

Aditya Sriharsha Pedaprolu, Sai Goutham Rekavari Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X A six-year-old boy with a karyotype of 46XY presented to the outpatient department with congenital absence of the penis, known as aphallia (Table/Fig 1). He was born from an uncomplicated pregnancy, with no family history of congenital anomalies or consanguinity. Upon further history-taking and physical examination, it was discovered that he was passing urine from an external urethral opening located in the perineum. A local examination revealed a total absence of the penis, and bilateral testes could not be palpated in the scrotum. Apart from this, there were no other identifiable external abnormalities. An abdominal and inguinoscrotal ultrasound showed left kidney pyelectasis, and the right testis was found to be undescended, located in the inguinal canal, while the left testis was present at the neck of the scrotum. Doppler ultrasound indicated internal vascularity in both testes. Due to these findings, the parents were counselled regarding the nature of the condition, and the patient was ultimately referred to a higher centre for further management by a specialist in Disorders of Sexual Differentiation (DSD) regarding the case of aphallia.

Images of Common Foreign Body at an Uncommon Site

Parindita Sarmah, Sagar Gaurkar, Prasad Deshmukh Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X A 73-year-old male resident of Wardha presented to the Ear, Nose and Throat (ENT) Outpatient Department (OPD) with complaints of a foreign body sensation in his throat for the past eight days. He described ingesting a fish bone a week earlier and experiencing mild throat soreness. Subsequently, it developed into a persistent foreign body sensation in the throat and difficulty in deglutition, which did not subside with the intake of antacids and other throat lubricants. There was no history of fever following this incident. The posterior pharyngeal wall was found to be clear during the throat examination. Indirect laryngoscopy revealed that all hypopharyngeal structures were normal. However, during video [Video-1] direct laryngoscopy, a fish bone was discovered embedded in the lingual surface of the epiglottis (Table/Fig 1). Upon receiving written consent, the embedded fish bone was removed with the help of long artery forceps under the guidance of video direct laryngoscopy (Table/Fig 2). There was no evidence of bleeding, oedema, or congestion after the procedure. The foreign body measured approximately 1.5 cm and was causing the patient immense discomfort (Table/Fig 3). The patient was prescribed a five-day course of antibiotics after the procedure, which included Tablet Amoxyclav 625 mg BD (Amoxicillin plus Clavulanic acid), Tablet Zerodol SP BD (Aceclofenac / Paracetamol / Serratiopeptidase), Tablet Pantop 40 mg OD (Pantoprazole), Tablet Levocet 10 mg HS (Levocetirizine), Syrup Mucaine gel 2 tsp BD (Aluminium hydroxide, magnesium hydroxide, and oxetacaine), and Betadine gargle TDS. He was advised to follow-up after five days to check for any delayed onset of postprocedure complications.

Stem Cells at the Crossroads: Addressing Ethical, Scientific and Regulatory Challenges

Meenakshi Singh, Nidhi Rohan Purandare Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Dear Editor, Stem cell research offers immense potential for regenerative medicine, but its clinical application faces significant challenges. While stem cells can differentiate into various cell types, ethical concerns surrounding embryonic stem cells and the technical complexities of creating patient-specific induced pluripotent stem cells (iPSCs) hinder progress (1). Many countries have imposed restrictions on embryo research, hindering progress in developing treatments for neurodegenerative diseases, cardiovascular diseases, diabetes, and autoimmune diseases (2). In addition to these ethical concerns, translating scientific discoveries into clinical applications requires the establishment of reliable and repeatable mechanisms that ensure both safety and efficacy.

Serum Vitamin D Level in Patients with Sepsis and its Correlation with Sequential Organ Failure Assessment Score: A Cross-sectional Study

Sunita Lamichaney, Priyam Goswami, Monigopa Das, Pranjal Kumar Dutta, Tanvee Yusuf Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Sepsis is a leading cause of morbidity and mortality worldwide, and the Sequential Organ Failure Assessment (SOFA) score is used as a key criterion in diagnosing the sepsis syndrome. Recent studies have also suggested that vitamin D is an important mediator in the immune system and plays an inhibitory role in sepsis. Aim: To assess serum vitamin D levels in patients with sepsis and to investigate the correlation between vitamin D levels and the SOFA score, as well as the outcomes of sepsis. Materials and Methods: This was a hospital-based cross-sectional study carried out on 91 patients diagnosed with sepsis. The SOFA score was calculated within 24 hours of admission and again at 72 hours; however, only the SOFA score obtained on admission (within 24 hours) was used to assess disease severity and to compare with vitamin D levels. Vitamin D assessment was conducted using a competitive immunoassay in the VITROS 5600 fully automated integrated assay system. Pearson’s correlation (r) was used to measure the association between variables. Results: The mean age of the study population was 57.34±16.55 years, with a male to female ratio of 1.17:1. A significant increase in vitamin D deficiency was noted in patients with a SOFA score above 10. There was a negative correlation between serum vitamin D levels and the SOFA score within 24 hours after admission, which was statistically significant (p-value <0.001, r-value -0.420). In the vitamin D deficient group, 65.7% of patients died, demonstrating a significant negative association between vitamin D levels and mortality (p-value <0.001). Conclusion: This study has shown that lower levels of vitamin D are associated with greater severity of sepsis upon admission. Additionally, lower vitamin D levels are linked to a higher mortality rate and poor outcomes. However, larger-scale, intervention-based trials of supplementary vitamin D therapy in the management of sepsis are required to strengthen the evidence of the correlation between these two variables.

Assessment of Oral Hygiene Status by Intergroup Comparison of Three Different Brushing Techniques in Visually Impaired Children aged 6-12 years: A Prospective Interventional Study

Vishal Sharma, Anil Gupta, Shalini Garg, Shikha Dogra, Sakshi Jainer, Lata Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Visually impaired children require a specialised form of dental health education that facilitates the learning process for brushing their teeth correctly using effective techniques. The Braille method is a conventional means of education for children with visual impairments. In contrast, the Audio Tactile Performance (ATP) technique is a uniquely developed method for educating these children and has proven to be effective. Aim: To evaluate the oral hygiene status by comparing the Braille and ATP techniques with the Fones method, as well as ATP with the Modified Bass technique of tooth brushing using a conventional dentifrice in visually impaired children, and to assess its impact on the children’s daily routines. Materials and Methods: A prospective interventional study was conducted by the Department of Paediatric and Preventive Dentistry at SGT University, Gurugram, Haryana, India, involving 300 blind school children aged 6-12 years from New Delhi-National Capital Region (NCR), India over a period of 18 months from November 2018 to February 2020. The Oral Hygiene Index-simplified (OHI-S) scores were recorded pre- and post-operatively among three groups: Group 1 (conventional Braille method), group 2 (ATP technique with the Fones method), and group 3 (ATP with the Modified Bass method). The data were analysed statistically using Statistical Package for Social Sciences (SPSS) software version 21.0. Intergroup comparisons of oral hygiene status were performed using the Post-hoc Bonferroni correction. A p-value of less than 0.05 was considered significant. Results: The study participants comprised 283 males and 17 females, with a mean age of 8.58±1.297 years (Mean±SD). When comparing the three groups, the OHI-S scores at baseline and one month post-examination were found to be statistically insignificant (p-value >0.05). However, at the 6, 9, and 12-month marks, the mean differences between group 1 (Braille) and group 3 (ATP + Modified Bass) and between group 2 (ATP + Fones) and group 1 (Braille) were statistically significant (p-value <0.001). Conclusion: Groups 2 and 3 demonstrated comparable and superior results in reducing the mean plaque scores at the 12-month follow-up compared to baseline when assessed against group 1, indicating the higher efficacy of the ATP technique over Braille instructions. This study also revealed that group 3 had slightly superior results compared to group 2, although this difference was statistically insignificant. The ATP technique proved to be more effective than Braille instruction in raising awareness of oral health education.

Evaluation of Postoperative Pain in Periodontal Flap Surgery with and without Photobiomodulation using Diode LASER: A Split-mouth Randomised Controlled Study

Neeraj Chandrahas Deshpande, Aayushi Shah, Monali Amit Shah Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Flap surgery is used to treat deep periodontal pockets and recent innovations like Low-level LASER Therapy (LLLT), or Photobiomodulation (PBM), help reduce postsurgical pain. LLLT works by emitting red or infrared light at wavelengths between 660 and 940 nm, which penetrates tissues and interacts with cytochrome c oxidase to modulate immune responses, reduce inflammation and ease pain, promoting faster healing. Aim: To evaluate and compare postoperative pain in periodontal flap surgery with and without PBM using a diode laser. Materials and Methods: A split-mouth randomised controlled study was carried out in the Department of Periodontology at KM Shah Dental College and Hospital, Vadodara, Gujarat, India. The study took place from August 2023 to January 2024. Based on the inclusion and exclusion criteria, 14 participants (28 sites) with bilateral pocket probing depths of 5-7 mm diagnosed with generalised periodontitis stage II grade A were treated with open flap debridement. After open flap debridement, the test group (Group A) received PBM using a diode LASER (940 nm in a continuous mode with 0.5 W for 112 seconds) applied with a whitening handpiece at a 3 mm distance to the flap surfaces, whereas the contralateral arch, or control group (Group B), received no LASER treatment. The parameters assessed for postoperative pain following flap surgery included the Visual Analogue Scale (VAS) to track the patients’ pain levels and the amount of analgesics they took throughout the first week following surgery. For inter group comparison of the amount of analgesics taken and assessing the VAS score, the Mann-Whitney U test was used. Data analysis was done using IBM Statistical Package for Social Sciences (SPSS) Statistics 20.0 (IBM Corporation, Armonk, NY, USA), with the level of significance set at p=0.05. Results: The mean age of the participants was 41.14±2.95 years. Patients in the test group had statistically significant differences in their VAS scores from the day of surgery (day 0) to day 7 compared to the control group. The number of analgesics taken on day 1 postsurgery did not show statistically significant results, as the number of analgesics taken was similar in both the control group as well as LASER group (p-value 0.063). However, patients receiving LASER treatment used fewer analgesics on days 2, 3, 4, 5 and 6 than the control group, with a p-value of less than 0.05, indicating statistically significant findings in this regard. Conclusion: Based on the present study’s findings, it can be concluded that the 940 nm diode LASER has the potential to greatly minimise postoperative discomfort and reduce the quantity of analgesics that patients require following flap surgery.

Evaluation of Blood Lactate Level as a Predictor of In-hospital Morbidity and Mortality in Patients Undergoing Surgery for Bowel Perforation: A Prospective Cohort Study

Anish Kumar Singh, Sandeep Kumar, Nityasha, Mamta Jain, Teena Bansal, Amanpreet Singh Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Perforation peritonitis is associated with significant Morbidity and Mortality (M&M). The predictive performance of blood lactate levels and their clearance varies depending on the timing of measurement, and the optimal time for measurement remains unclear. Aim: To evaluate perioperative lactate levels and their clearance as predictors of in-hospital M&M in bowel perforation surgery. Materials and Methods: The present prospective cohort study was conducted in the Department of Anaesthesiology and Critical Care, Pt. BD Sharma PGIMS, Rohtak, Haryana, India, from March 2023 to December 2023. Study was conducted on 40 adult patients undergoing surgery for bowel perforation, and clinical and various laboratory parameters were observed from admission until discharge. Baseline and perioperative lactate levels were recorded up to 24 hours postoperatively. The association of M&M with different scores such as the Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Mannheim Peritonitis Index (MPI), as well as, lactate levels and lactate clearance, was assessed. The diagnostic accuracy of lactate levels and lactate clearance at different time points in the perioperative period to predict M&M was calculated, and finally, the ‘Bidirectional Stepwise Selection’ (BSS) was used to select the most useful predictor of M&M. Results: Total 40 participants were included in the study, of which 34 were males and 6 were females. The overall M&M rates were 50% and 30%, respectively. On univariate analysis, there was a significant difference between non survivors and survivors in terms of age (50.92 vs 38.07 years, p-value=0.004), APACHE II score (10.00 vs 6.46, p-value=0.028), preoperative serum creatinine (1.41 vs 1.13 mg/dL, p-value=0.043), 24-hour postoperative lactate (4.75 vs 1.54 mmol/L, p-value=0.005), and lactate clearance (-28.97 vs 24.83%, p-value=0.03). Patients with or without morbidity showed a significant difference in age (47.7 vs 36.15 years, p-value=0.005), MPI score (22.45 vs 18.6, p-value=0.048), preoperative serum creatinine (1.40 vs 1.03 mg/dL, p-value=0.028), and 24-hour postoperative lactate (3.65 vs 1.35, p-value=0.002). In BSS analysis, age and 24-hour postoperative lactate were identified as good predictors of M&M, with the latter being the best predictor. Conclusion: The incidence of M&M is quite high in perforation peritonitis. Among all predictors, 24-hour postoperative lactate is the strongest predictor of M&M and may be useful in risk stratification and optimising treatment accordingly.

Abbe McIndoe Procedure Vs Singapore Flap for Neovaginal Reconstruction in Mayer-Rokitansky-Küster-Hauser Syndrome: A Prospective Interventional Study

S Arun Prasath, R Santharam, C Balasubramanian Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Congenital uterovaginal agenesis is a condition wherein, although the secondary sexual traits usually develop, the lack of a uterus and vagina leaves the patients unable to conceive and experience sexual fulfillment. A well-done neovaginal repair is essential for enhancing the psychological and social effects on women. Aim: To compare the Abbe McIndoe technique and the Singapore flap, which are frequently used for vaginal reconstruction. Materials and Methods: This prospective interventional study was conducted over three years at the Department of Plastic Surgery, SRM Medical College Hospital and Research Center, Kattankulathur, Tamil Nadu, India. Twelve patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome were included, with six undergoing the Abbe McIndoe procedure and six undergoing the Singapore flap procedure. This study assessed operative time, hospital stay, neovaginal length, complications, mould use, donor site morbidity, and sexual satisfaction. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 26.0, with a p-value of <0.05 considered statistically significant. Results: The mean±SD age of participants was 22.6±4.16 years in both groups. The mean±SD operative time was slightly longer for the Singapore flap (127±8.37 minutes) compared to the Abbe McIndoe procedure (123±13.03 minutes). The Singapore flap group had a more extended hospital stay (11.17±1.32 days vs. 9.17±1.94 days) but achieved a greater mean neovaginal length (9.28±0.25 cm vs. 8.88±0.61 cm). The Singapore flap group experienced fewer complications, with no late complications and only one immediate complication, compared to the Abbe McIndoe group, which had two late and two immediate complications. Mould use was not required in the Singapore flap group, while it was variable in the Abbe McIndoe group. The Singapore flap group had no donor site morbidity compared to four cases in the Abbe McIndoe group. Sexual satisfaction was higher in the Singapore flap group, with five patients reporting ‘good’ outcomes than three in the Abbe McIndoe group. Conclusion: The Singapore flap technique demonstrated superior outcomes in neovaginal reconstruction for MRKH syndrome, with fewer complications, no need for postoperative moulds, no donor site morbidity, and higher sexual satisfaction. These findings suggest that the Singapore flap may be a preferred technique for neovaginal reconstruction in appropriate clinical settings.

Coverage and Effectiveness of Influenza and Pneumococcal Immunization in Autoimmune Inflammatory Rheumatic Disease Patients: A Cross-sectional Study

Shabir Ahmad, Mushtaq A Dangroo, Umer Sharief, Amir Farooq, Roksana Parveen, Jawad Iqbal Rather Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Patients with Autoimmune Inflammatory Rheumatic Disease (AIIRD) are at an increased risk of developing infectious diseases. Vaccination is recommended for these patients by various societies as a preventive strategy. Despite this, the coverage of vaccination is exceedingly low, especially in developing countries. Aim: To estimate the coverage of pneumococcal and influenza vaccinations, as well as Vaccine Effectiveness (VE). Materials and Methods: This was a cross-sectional study conducted over a duration of one year, from December 2021 to December 2022, in the Department of Internal Medicine and Allied Specialties at the Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, India. All consenting AIIRD patients aged over 18 years were enrolled in the outpatient department of Internal Medicine and Allied Specialties at SKIMS, Srinagar, Jammu and Kashmir, India. A history of seasonal influenza and pneumococcal vaccinations was obtained. The coverage of vaccination was determined, and patients were followed-up over a period of one year to assess VE. The Chi-square test was used for comparing categorical values, with a p-value of <0.05 considered significant. Results: This study included 438 patients, of which 348 (79.5%) were females and 90 (20.5%) were males. The mean age of the study population was 38±11.8 years. Out of 438 patients, only 100 (22.8%) were vaccinated against influenza, while a total of 90 (20.5%) patients had received one or more doses of pneumococcal vaccines. The incidence of symptomatic influenza and pneumococcal pneumonia was higher in the unvaccinated groups. Both vaccines were found to be safe and effective, with a VE of 73.21% for the influenza vaccine and 65.26% for the pneumococcal vaccine. Conclusion: Present study reveals an overall low coverage of these vaccinations among patients with AIIRD in the region, which needs to be addressed. The findings indicate that influenza and pneumococcal vaccines are safe and effective for patients with AIIRD.

73137

Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X

Predictive Ability of Interstitial Fibrosis and Tubular Atrophy Scoring in Determining the Severity of Diabetic Kidney Disease: A Cross-sectional Study

Shamantha Gopichand, Sunil Rajanna, Tirthankar Mukherjee, Rakshith Somanahalli Chikkanna, Nalini Modepalli Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Diabetic Kidney Disease (DKD) is a major complication of Diabetes Mellitus (DM). Renal biopsy is the gold standard for the diagnosis and management of many renal diseases. Renal Interstitial Fibrosis and Tubular Atrophy (IFTA), as well as the number of obsolescent glomeruli, are prognostic factors associated with Diabetic Nephropathy (DN). Aim: To describe the renal biopsy profile of patients with DM presenting with renal disease and to determine the significance of IFTA scoring and the number of obsolescent glomeruli in predicting DKD and its severity. Materials and Methods: This cross-sectional study was conducted over a period of three years, from 2019 to 2022, involving a total of 189 patients selected through purposive sampling. Patients with DM who presented with renal disease and required renal biopsy to confirm the diagnosis were admitted to the Department of General Medicine and Nephrology at Kempegowda Institute of Medical Sciences Hospital and Research Centre, Bengaluru, Karnataka, India. The biopsy reports were obtained and analysed. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 20.0 and results were expressed using descriptive and inferential statistics. A p-value of <0.05 was considered statistically significant. Results: The mean age of the participants was 53.02±11.00 years, with an age range from 21 to 81 years. Among the subjects, 78.3% were males and 21.7 were females. Based on the renal biopsy findings, DN was the most common condition, found in 127 subjects (67.6%). Nearly 50.0% of those with DN had Class IV chronic DN, followed by Class III (42.5%). Chronic interstitial nephritis was the most common Non Diabetic Kidney Disease (NDKD), accounting for 24.6% of cases. IFTA scoring was significantly associated with DKD and there was a significant positive correlation between the severity of IFTA scores and the number of obsolescent glomeruli with the class of DKD. A unit rise in the IFTA score and the number of obsolescent glomeruli increased the risk of having severe DKD (Class III and Class IV) by 4.32 times and 1.24 times, respectively, compared to those with less severe forms (Class I and II) (p<0.05). Conclusion: The IFTA scoring and the number of obsolescent glomeruli were found to be significant independent predictors of the severity of DKD.

Evaluation of the Marginal Fit and Fracture Resistance of Polyetheretherketone (PEEK) and Zirconia Copings: An In-vitro Study

Nehal Mahajan, Urvashi Sukhija, Navneet Kukreja, Sandeep Kalra, Sanjeev Mittal, Manumeet Bhathal, Swati Chhabra, Surinder Sachdeva Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: In dentistry, there has been an increasing demand for aesthetics and biocompatible restorations with low plaque affinity. The success of any restoration is based on three main factors: marginal fit, fracture resistance, and aesthetics. Polyetheretherketone (PEEK) is a polymeric material that has emerged as a novel thermoplastic material with wide applications. Aim:To evaluate the marginal fit and fracture resistance of PEEK and zirconia copings fabricated using Computer-aided Design (CAD)/Computer-aided Manufacturing (CAM) technology. Materials and Methods: The present in-vitro study was conducted in the Department of Prosthodontics, MM College of Dental Sciences and Research, Mullana, Ambala, Haryana, India, from November 2022 to March 2024. The present study compared the marginal fit and fracture resistance of PEEK and zirconia copings fabricated using CAD/CAM technology. All-ceramic tooth preparations were performed on extracted maxillary first premolars, and the prepared teeth were scanned. Using three dimensional (3D) printing technology, 20 resin dies were obtained. These dies were divided into two groups: 10 for PEEK and 10 for zirconia. Ten copings for zirconia and PEEK were fabricated using CAD/CAM technology, and two reference points were marked on the copings. The copings were luted with resin cement on the dies, and marginal fit and fracture resistance were recorded. The observations were statistically analysed using a two-way Analysis of Variance (ANOVA) test and a two-sample t-test. Results: The lowest mean marginal discrepancy values (18.469±6.55 μm for the palatal aspect and 17.116±6.34 μm for the buccal aspect) were observed for the zirconia copings. These values were significantly better compared to the PEEK copings (23.941±7.73 μm on the palatal aspect and 22.338±7.89 μm on the buccal aspect). In terms of fracture resistance, PEEK copings demonstrated a higher load-bearing capacity (523.11±117.27 N) and significantly better results compared to zirconia copings (395.4±150.93 N). Conclusion:The results revealed that, when comparing both PEEK and zirconia copings, zirconia copings demonstrated a better marginal fit compared to PEEK copings. However, for fracture resistance analysis, PEEK copings exhibited better load-bearing capacity than zirconia copings.

Detecting Presence of Tarsal Tunnel Syndrome in Type II Diabetic Patients using Clinical, Radiological and Electrodiagnostic Studies: A Cross-sectional Study

Vipul Kumar, Mohammed Alam Parwaz, Surjeet Dwivedi, Shrikant Manwatkar, Shreyansh Chowdhry, Rahul Merkhed, Arvind Kumar, Pallavi Dhanvijay Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Diabetic foot is one of the most devastating complications of diabetes and is the leading cause of lower limb amputations. Patients with a long-standing history of diabetes mellitus often experience symptoms of pain, burning sensation, numbness, and paraesthesia in the heel and feet. These symptoms may be due to compression of the medial plantar nerve, a branch of the tibial nerve, within the tarsal tunnel. Aim: To evaluate the incidence of Tarsal Tunnel Syndrome (TTS) in patients suffering from Type 2 Diabetes Mellitus (T2DM). Materials and Methods: This study was a cross-sectional analysis conducted at the Army Hospital (Research and Referral) in New Delhi, India, from October 2019 to April 2021. A total of 30 consecutive diabetic patients presenting with pain, burning, numbness, and paraesthesia in the heel or feet, with or without ulcers, were included. All patients were clinically evaluated using three-point sensory testing, Tinel’s sign at the tarsal tunnel, and assessment for the presence of ulcers on the foot. All patients underwent Nerve Conduction Velocity (NCV) studies. Imaging studies in the form of Magnetic Resonance Imaging (MRI) were performed for a complete work-up of these patients and further diagnosis of TTS. The incidence of TTS was evaluated using clinical, radiological and electrodiagnostic studies. Results: Of the 30 patients enrolled, 20 were males (66.7%) and 10 were females (33.3%). The incidence of TTS among diabetic patients was found to be 14 (46.7%) based on electrodiagnostic criteria, 22 (73.3%) based on clinical evaluation, and 25 (83.3%) based on radiological findings. The mean HbA1c level was 8.5±1.04%. The most common imaging finding was oedema, observed in 83.3% of patients. Inflammation and ganglion cysts were seen in 13.3% and 10% of patients, respectively. Conclusion: TTS is difficult to diagnose. MRI is a useful imaging modality to support the diagnosis. Electrodiagnostic studies can help confirm the diagnosis.

Comparison of Scrotal Hitch Technique and Conventional Scrotal Dressing in Reducing the Postoperative Scrotal Oedema in Inguinoscrotal Surgeries: A Non Randomised Clinical Study

Balaji Rajavarman, Manigandan Raju, Umesh Raj Somasundaram, AS Sangeethapriya Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Inguinoscrotal swellings, including hernias and hydroceles, are the most common complaints in the surgical outpatient department. Hernioplasty and eversion of the sac are the most common elective procedures for inguinoscrotal swellings. Scrotal oedema is one of the complications following the surgery, which increases the patient’s morbidity. Aim: To evaluate the effectiveness of the scrotal hitch technique in preventing scrotal oedema and postoperative pain after inguinal and scrotal surgeries compared to conventional scrotal dressing. Materials and Methods: This is a non randomised clinical study conducted in the Department of General Surgery at Melmaruvathur Adhiparasakhti Institute of Medical Sciences and Research, Melmaruvathur, Tamil Nadu, India, from September 2021 to December 2023, among 60 patients undergoing inguinoscrotal surgeries. Group-A consists of 30 patients who were given scrotal hitch and 30 patients in Group-B were given conventional scrotal dressing. The outcomes were compared between both groups for scrotal oedema and postoperative pain. Descriptive statistics were presented as mean±Standard Deviation (SD) for continuous variables and frequencies and percentages for categorical variables. Fisher’s-exact test was used as a test of significance for categorical data. Student’s t-test and Mann-Whitney U test were used as tests of significance for continuous data. Results: The mean age of patients in Group-A was 51.7±13.87 years and in Group-B was 53.03±14.22 years. In Group-A, two patients developed scrotal oedema with the scrotal hitch, while in Group-B with scrotal dressing, 11 patients developed scrotal oedema 72 hours postsurgery. In Group-A, the median Visual Analogue Scale (VAS) score at 6, 24, 48 and 72 hours was 6, 3, 1 and 0. In Group-B, the median VAS score was 7, 4, 1 and 0 at 6, 24, 48 and 72 hours. Conclusion: Postoperative pain was found to be lower in the scrotal hitch group compared to patients with conventional scrotal dressing.

Effectiveness of Virtual Reality-based Rehabilitation and High-intensity Exercise Program for Total Knee Arthroplasty Patients: A Randomised Controlled Trial

K Nishitha, A Anitha, D Thaheera Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Progression of articular cartilage loss and wear and strain are the usual causes of Osteoarthritis (OA), sometimes referred to as degenerative joint disease. India had roughly 200,000 knee arthroplasty procedures in 2020 in which nearly 72% were because of OA. Rebuilding the knee joint through knee arthroplasty is a great alternative for treating symptomatic OA in patients who have not responded to conservative treatment. Aim: To determine the effect of Virtual Reality (VR)- based rehabilitation and high-intensity exercise program for Total Knee Arthroplasty (TKA). Materials and Methods: In this double-blinded randomised controlled trial, 36 participants matched the inclusion criteria who underwent Total Knee Replacement (TKR) at the Department of Physiotherapy, Saveetha College of Physiotherapy, SIMATS, Chennai, Tamil Nadu, India. The study was started in the month of October 2023 and ended in January 2024. Then the participants were randomly allotted to an experimental group-VR (n=18) and a conventional group-high-intensity exercises (n=18). Outcome measures used are the Numeric Pain Rating Scale (NPRS) pain scale, knee range of motion, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Timed Up and Go (TUG) test. A paired t-test was utilised to evaluate significant variations between the pre- and post-test measurements. In order to find any meaningful differences between the two groups, an unpaired t-test was employed. Result: The average mean±Standard Deviation (SD) of age and Body Mass Index (BMI) was found to be 51.2±5.2 yearsand 28.3±2.0 kg/m². The experimental group and the conventional group both exhibited notable changes in terms of within-group differences. Numeric Pain Rating Scale (NPRS) significantly showed the same between the groups, but the range of motion showed better output in VR-based rehabilitation than indifferently supporting the pain outcome of the experimental group (p≥0.0001). Balance, gait and functional activities were improved in the experimental group compared to the conventional group and in the VR-based rehabilitation, the functional independence of the patient was achieved in nine weeks compared to the High-intensity (HI) exercises. Conclusion: The VR-based rehabilitation showed better outcomes in pain, range of motion, balance, gait and functional independence than a high-intensity exercise programme.

Prevalence of Sexually Transmitted Infections in Self-reporting Men Who have Sex with Men: A Cross-sectional Study from Chennai, India

R Sowmiya, BT Priya, Ragini Rajan, V Anandan, Ramya Selvaraj Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Men who have Sex with Men (MSM) are at high-risk for acquiring Sexually Transmitted Infections (STIs). The high prevalence of STIs, such as syphilis, Human Immunodeficiency Virus (HIV), genital herpes, genital warts, gonorrhea, and hepatitis B, necessitates regular screening in the MSM group. Furthermore, the presence of these STIs increases the transmission of HIV. Unfortunately, limited data are available regarding STI prevalence among MSM in India. Understanding the prevalence in this high-risk group aids in rapid diagnosis and effective control of infections, thereby reducing their transmission. Aim: To analyse the prevalence of STIs in the MSM group in Venereology Outpatient Department (OPD) in a Tertiary care centre, Chennai, Tamil Nadu, India. Materials and Methods: A record-based cross-sectional study was conducted at a tertiary care centre in Chennai, Tamil Nadu, India over a period of one year (January 2023 - December 2023). The study included 110 men who were brought in by voluntary organisations or who walked in directly to the Venereology department and identified themselves as homosexuals. Their socio-demographic data, detailed contact history, chief complaints, relevant investigations, and treatments provided were recorded and analysed. All data were analysed using Statistical Package for the Social Sciences (SPSS) software. Results: Out of the 110 men enrolled in this study, most were in the 18 to 29 years age group, and a predominant 58 (52.72%) reported engaging in unprotected sexual practices. Specifically, 67 (60.91%) of the men identified themselves as strictly homosexuals, while 43 (39.1%) identified as bisexuals. Further inquiry about their partners revealed that 24 (21.82%) had contact with known partners, while 86 (78.18%) had contact with unknown partners, primarily through dating apps and social media platforms. Among the 42 patients diagnosed with STIs, syphilis was the most common, affecting 15 (13.63%) individuals. The second most common STI was HIV, seen in 10 (9.09%) of which 4 had co-infection with syphilis. The next most common STIs diagnosed were genital herpes in 7 (6.36%), gonorrhea in 6 (5.45%), genital warts in 3 (2.73%), hepatitis B in 3 (2.73%), and genital scabies in 2 (1.81%). Conclusion: The prevalence of STIs in this study was found to be 38.18%. This study underscores the importance of understanding the prevalence of STIs, which may aid in targeted interventions to address STI transmission, particularly among young adults and MSM populations. Efforts should focus on promoting safer sexual practices, increasing access to testing and treatment, and providing education and support to both individuals and their partners.

Comparative Evaluation of Denture Retention Using Three Border Moulding Techniques: A Non Randomised Clinical Study

Anne Mary, Deviprasad Nooji, Suhas K Rao Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: In complete dentures, the final impression plays a pivotal role in the success of the treatment. Advancements in impression materials have been the primary influence on the evolution of complete denture impression procedures. Aim: To compare and evaluate the retention of complete dentures fabricated on resorbed ridges using three different border moulding techniques. Materials and Methods: This non randomised clinical study was conducted in the Department of Prosthodontics and Crown and Bridge at KVG Dental College and Hospital, Sullia, Karnataka, India. The study included 10 patients with resorbed ridges who sought treatment from the Department of Prosthodontics during the period from January 2022 to December 2023. The study participants were selected from Dakshina Kannada and Kasargod, aged between 40 to 70 years, and included both males and females. For each patient, three custom trays were fabricated. The first tray was used for border moulding with putty and light body impression paste recorded using a Transcutaneous Electrical Stimulation (TENS) machine (Group A). The second tray was used for border moulding with putty and light body impression paste (Group B), while the third tray utilised a tissue conditioner as the secondary impression material (Group C). Retention was checked using a force gauge after the secondary impression, and heat-cured dentures were fabricated for each patient. The retention values were statistically analysed using Analysis of Variance (ANOVA), with the significance level set at p≤0.05. Results: The measurements indicated significantly higher mean retentive values in Group-A (2.58±0.56 kgf and 2.49±0.99 kgf for the secondary impression and final denture, respectively) compared to the other two groups (p<0.001). Comfort was reported to be better in Group-B. Both Groups A and B exhibited a good fit for the dentures. Conclusion: Within the limitations of the study, it can be inferred that border moulding with TENS using polyvinyl siloxane putty and light body secondary impressions provided higher retention compared to functional border moulding using tissue conditioner.

Effectiveness of Structured Visual Pedagogy in Improving Knowledge of Nursing Graduates Regarding Oral Healthcare of Children with Special Healthcare Needs: AQuasi-experimental Study

Neil Mahendra Godbole, Aditi Mathur, Sunnypriyatham Tirupathi, Krishnapriya Suhas Nene, Sneha Madhu Nair, Prachi Patil Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Nurses are the primary contact for caregivers of Children with Special Healthcare Needs (CSHCN). Parent counselling and health screening programs are undertaken in which nurses play an important role. Along with this, it is also essential to have knowledge of oral health and the importance of maintaining oral hygiene, especially for CSHCN. Aim: To evaluate the knowledge of nursing graduates regarding oral healthcare for CSHCN at baseline, one week and one month after a Structured Visual Pedagogy (SVP) intervention, and to compare their knowledge scores before and after the intervention. Materials and Methods: This pretest-posttest quasi-experimental study was conducted at Dr. D.Y. Patil College of Nursing, Pune, Maharashtra, India, between February 2023 and June 2023, among 60 nursing graduates. An SVP was curated and delivered to the study population. It was an audio-video discussion-based intervention covering the various domains of oral healthcare for CSHCN, including their oral manifestations, barriers to oral hygiene maintenance, and their management through counselling and timely referrals. Participants completed a pre-validated questionnaire at three intervals: before the intervention, one week after and one month after the intervention, and their knowledge was analysed. The data were analysed using International Business Machines (IBM) Statistical Package for Social Science (SPSS) software version 21.0, USA. Results: The mean age of study group was 21±0.85 years. Among the participants, 52 (86.6%) were females and 8 (13.4%) were males. Between the baseline and the first week of the SVP, as well as, between the baseline and the first month, nursing graduates’ understanding of the oral health requirements of CSHCN increased. The mean knowledge score at the pre-intervention stage was 6.83±2.35; at one week post-intervention, the mean knowledge score was 14.40±1.50; and one month post-intervention, the mean knowledge score was 13.65±1.40. It was observed that there was a statistically significant increase in the mean knowledge score one week, as well as, one month post-intervention compared to the baseline (p-value<0.05). Conclusion: The SVP was highly effective among the nursing graduates, clearly highlighted its use as a training tool for nurses.

Incidence and Outcome of Spontaneous Alveolar Air Leak Events in COVID-19 Pneumonia: A Prospective Cohort Study

Samruddhi Dhanaji Chougale, Anita Tulshiramji Anokar, Amarnath P Prasad, Uma A Deshpande, Sashi Bhushan, Ashish A Dhotre, Kiran Vadapalli Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Coronavirus Disease 2019 (COVID-19) has increased the burden of hospitalised pneumonia cases and related complications. Spontaneous Pneumothorax (PT) and Pneumomediastinum (PM) have been reported in both spontaneously breathing and ventilated patients with COVID-19 pneumonia. Aim: To determine the incidence and outcomes of spontaneous alveolar air leak events in COVID-19 pneumonia. Materials and Methods: This prospective cohort study was carried out from June 2020 to June 2021 at a tertiary care centre in Western India. All incident cases of alveolar air leaks in COVID-19 pneumonia were included. Clinical and demographic data were collected, and statistical analysis was performed. The Chi-square test or Fisher’s exact test were used to assess the differences in subgroup proportions. Results: A total of 79 patients (63 males and 16 females) experienced spontaneous alveolar air leaks in the form of PT, PM (mediastinal emphysema), or Subcutaneous Emphysema (SE), either isolated or in combination. A total of 58 patients (73.41%) had PT, while 8 patients (10.12%) had isolated PM and 2 patients (2.53%) had isolated SE. Of the total events, 35 (44.30%) occurred in spontaneously breathing patients, among them vigorous coughing was an important precipitating factor. At the time of the incident, 1.27%, 21.52%, and 77.21% of the affected cases belonged to mild, moderate, and severe COVID-19 categories, respectively. Male patients (n-63, 79.74%) in the age group of 30-60 years were predominantly affected. A total of 38 events (48.10%) occurred within two weeks (early) of symptom onset. The PaO2:FiO2 ratio at the time of the alveolar leak showed a significant association with the outcome. Patients with PT had a poorer outcome compared to those with other types of alveolar leaks (p-value<0.005). Major bleeding occurred in 2 (3.33%) of the total 60 Intercostal Drainage (ICD) procedures. Prolonged alveolo-pleural fistula healed spontaneously in four out of five cases. The cumulative incidence for air leak events was 1.55%, and for barotrauma, it was 6.47%. The overall mortality in this cohort was 74.68% (n=59), while it was 29.41% (5 out of 17) in the moderate severity group. Patients with late-onset events had a better outcome (p-value<0.005). Conclusion: In this cohort of COVID-19 pneumonia from Western India, the cumulative incidence of spontaneous alveolar air leaks was 1.55%, predominantly affecting males. The early occurrence of PT in severely hypoxic patients on mechanical ventilator was associated with higher mortality.

Evaluation of Serum ApoA1 and ApoB Levels in the First-degree Relatives of Patients with Essential Hypertension at a Tertiary Care Centre in Eastern India: A Cross-sectional Study

Bandana Thakur, Pooja Priyadarsini, Sarada Asis Dash, Sangeeta Sanghamitra Bhanja, Subhashree Ray, Sarthak Ranjan Nayak, Rajlaxmi Tiwari, Prachi Jena Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: An altered serum lipid profile and lipoprotein levels are major modifiable risk factors for hypertension. Apolipoprotein A1 and B100 (ApoA1 and ApoB100) are the chief structural proteins of High-density Lipoprotein Cholesterol (HDL-C) and Low-density Lipoprotein Cholesterol (LDL-C), respectively. The level of ApoB in the serum represents overall atherogenicity, whereas the level of ApoA1 can indicate total antiatherogenicity. Aim: To evaluate the serum levels of ApoA1 and ApoB in the first-degree relatives of individuals with essential hypertension. Materials and Methods: This cross-sectional observational study was conducted in the Clinical Biochemistry laboratory in association with the Department of General Medicine at SCB Medical College and Hospital, Cuttack, Odisha, India, from February 2018 to March 2019. It consisted of 165 participants: group I included hypertensive patients (n=55); group II included first-degree relatives of the above hypertensive patients (n=55); and group III included non hypertensive healthy age-matched controls (n=55). The waist-hip ratio, Blood Pressure (BP), fasting plasma glucose, serum cholesterol, triglycerides, HDL-C, LDL-C, ApoA1, ApoB, and the ApoB/ApoA1 ratio were all measured. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software version 25.0. Results: The mean age of subjects in groups I, II, and III was 49±8.3, 38±5.2, and 37±5.4 years, respectively, with males constituting 56% and females 44% of the total participants. The ApoA1 levels were lowest in group I (104.9±16.3 mg/dL) and highest in group III (117.4±7.3 mg/dL). The serum ApoB levels and the ratio of ApoB/ApoA1 were highest in group I (104.2±14.1; 1.1±0.64 mg/dL) and lowest in group III (60.9±18.2; 0.5±0.15 mg/dL). A highly significant negative correlation (r=-0.40, p<0.01) was found between Systolic Blood Pressure (SBP) and ApoA1. A significant correlation (r=0.26, p=0.04) was observed between SBP and the ApoB/ApoA1 ratio in group III. Conclusion: Serum ApoB levels and the ratio of ApoB/ApoA1 were significantly elevated in the first-degree relatives of hypertensive patients, thus emphasising the importance of screening individuals with a positive family history of hypertension.

Role of Doppler Saline Sonosalpingography in Evaluation of Tubal Factors in Women with Infertility: A Cross-sectional Study

Sonal Sangwan, Bindu Bajaj, Sheeba Marwah, Asmita Saran, Ayushi Jainth Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: The contribution of tubal factors to infertility is up to 30%. One of the tests used to evaluate tubal factor infertility is Doppler saline Sonosalpingography (SSG). The basic principle of SSG is to distend the uterine cavity with isotonic saline, which helps identify the uterine contour, intrauterine pathology, endometrial thickness and the presence of fluid in the Pouch of Douglas (POD). Adding Doppler increases its efficiency and accuracy. Aim: To ascertain the role of Doppler saline SSG in tubal infertility. Materials and Methods: This cross-sectional study was done for 18 months in the Obstetrics and Gynaecology Department of Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India involving 200 women with either primary or secondary infertility. These women were recruited in the mid-follicular phase after obtaining written informed consent. Patients underwent Doppler SSG to assess tubal patency and the findings were compared with Diagnostic Hysterolaparoscopy (DHL). Diagnostic tests were used to calculate sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV). Inter-rater kappa agreement was used to find out the strength of the association between Doppler Saline SSG and diagnostic laparoscopy. A p-value of less than 0.05 was considered significant. The data was entered into an MS Excel spreadsheet and analysis was done using the licensed version of Statistical Package for Social Sciences (SPSS) version 21.0. Results: The mean age and mean duration of infertility were reported to be 29 years and five years, respectively. The sensitivity of Doppler SSG for tubal patency was reported as 85.4%, the specificity as 95.8%, PPV as 95.3%, NPV as 86.8% and the accuracy for tubal patency was 90.6%. Doppler SSG and laparoscopic chromopertubation findings had substantial association (k value -0.62). Conclusion: Doppler SSG is a reliable method for the assessment of tubal factors and can be used as a screening modality with high sensitivity and specificity.

Pharmaceutical Analysis and Evaluation of In-vitro Antibacterial Activity of Gomutra Ghana: A Concentrated and Solidified Form of Cow’s Urine

Payal Ashok Raut, Bharat Jagdish Rathi, Anita Santoshrao Wanjari, Supriya Mukunda Meshram Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Cow’s urine has been described as a highly effective animal-derived substance. Its therapeutic and pharmacological actions make it effective in the treatment of a variety of disorders. One of its notable properties is its antibacterial action, where the drug’s ability to target and inhibit the growth of bacteria. However, due to the pungent odour and taste of cow’s urine, it is difficult to consume in its natural form. Additionally, the collection of fresh cow’s urine can be challenging, especially in urban areas where access to cows may be limited. So, it is important to modify it into a dosage form, like Gomutra Ghana, which improves palatability and shelf life. Aim: To study the pharmaceutical development, quality control assessment, and in-vitro antibacterial activity evaluation of Gomutra Ghana. Materials and Methods: The pharmaceutical and analytical studies were carried out in Mahatma Gandhi Ayurved College Hospital and Research Centre and Dattatraya Ayurved Pharmacy, Salod (H), Wardha, Maharashtra, India. The in-vitro (antibacterial) study was carried out in JNMC, Sawangi (M), Wardha, Maharashtra, India, from April 2022 to August 2023. The in-vitro antibacterial study of cow’s urine and Gomutra Ghana was performed on five bacterial strains. Fresh cow’s urine was collected from a goshala (cowshed), and Gomutra Ghana was prepared in three batches by boiling the cow’s urine to a thicker consistency, then sun-drying it, followed by drying in an electric dryer. The final product was stored in a clean, sealed glass jars. Analytical parameters like pH, loss on drying at 105ºC, total ash, water-soluble ash, acid-insoluble ash, water-soluble extractives, alcohol-soluble extractives, and microbial contamination were studied. The in-vitro antibacterial activity was evaluated using the agar disc diffusion method at concentrations of 5 μL, 10 μL, and 15 μL, with results compared to those of a broad-spectrum and commonly used antibiotic, ciprofloxacin (5 μg). Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 27.0, employing Analysis of Variance (ANOVA) to compare three groups (Ciprofloxacin, cow’s urine, and Gomutra Ghana) at all three concentrations. A significance level was set with a p-value of <0.05 for the antibacterial study. Results: High-Performance Thin-Layer Chromatography (HPTLC) showed a peak from cow’s urine and Gomutra Ghana, with maximum heights of 500.1 and 450.4, which were nearly the same, so they may contain similar constituents. An extra peak was observed in Gomutra Ghana, suggesting the presence of additional compounds formed during its preparation. Gomutra Ghana extract showed the highest zone of inhibition against Escherichia coli. Conclusion: Gomutra Ghana showed antibacterial properties, which warrant further exploration in humans for safety and efficacy in humans.

Alterations in Hand-eye Coordination and Gait in Individuals with Anxiety: A Cross-sectional Study

Shaj Shrestha, Jayesh Chandran, Rakesh Krishna Kovela, Yughdtheswari Muniandy Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: The involvement of the motor system in anxiety is barely addressed and remains under-researched in cognitive theories. Understanding the link between motor impairments and anxiety symptoms can aid in creating personalised treatments for individuals with motor disorders, thereby enhancing their productivity and career prospects. The relationships between hand-eye coordination and gait, respectively with anxiety may be overlooked if the focus is limited to core diagnostic criteria. Therefore, The present study examined how anxiety influences hand-eye coordination and spatiotemporal gait parameters in individuals, highlighting these important yet often neglected aspects. Aim: To investigate alterations in hand-eye coordination and spatiotemporal parameters of gait in individuals with anxiety. Materials and Methods: The present cross-sectional study was conducted at the motion analysis laboratory in the Nitte Institute of Physiotherapy, Mangaluru, Karnataka, India. The individuals were screened for anxiety using the Generalised Anxiety Disorder 7 (GAD-7) and 156 participants were included based on a GAD-7 score of ≥ 8. Participants’ fine and gross motor hand-eye coordination was assessed using the Scale for Handwriting Evaluation (SHE) and the Alternate-Hand Wall-Toss Test (AHWTT), respectively. A 2D gait analysis system was used to assess spatiotemporal gait parameters. The obtained data were analysed using IBM Statistical Package for the Social Sciences (SPSS) software version 29.0.10. The Pearson’s correlation coefficient (r) was utilised to assess the relationship between anxiety and hand-eye coordination, as well as between anxiety and spatiotemporal gait parameters. One-way Analysis of Variance (ANOVA) compared hand-eye coordination and gait parameters across different GAD-7 levels, while Tukey’s test was used for post-hoc analyses. A p-value of less than 0.05 was deemed statistically significant. Results: The average age of the participants was 21.37±2.35 years. The study found weak negative correlations between the AHWTT score (r= -0.358, p <0.05) and the SHE score (r= -0.285, p<0.05) with the GAD-7 score, respectively, but no correlation between the GAD-7 score and gait parameters. Significant differences were found in the AHWTT score, SHE score, walking speed and stride length across anxiety levels. Conclusion: Anxiety levels negatively correlated with hand-eye coordination, with anxious individuals exhibiting poorer performance. However, the relationship between anxiety and gait remained inconclusive.

Efficacy of Dexamethasone versus Dexmedetomidine as an Adjuvant to Bupivacaine for Bilateral Superficial Cervical Plexus Block in Thyroid Surgeries: A Randomised Clinical Trial

Vanishree Deshpande, Vijay Katti, Santosh Alalamath Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Thyroid surgeries are among the most frequently performed endocrine surgeries globally. Pain control is one of the many challenges faced by perioperative physicians in post-thyroid surgery patients; if, left untreated, it can progress to chronic pain. Regional anaesthesia, such as Bilateral Superficial Cervical Plexus Block (BSCPB), can provide excellent analgesia in the initial postoperative period without the side effects of systemic analgesics. Aim: To assess postoperative pain using Visual Analogue Scale (VAS) scores at various intervals upto 24 hours postoperatively and to evaluate the duration of the superficial cervical plexus block. Secondary objectives include assessing intraoperative haemodynamic stability, analgesic consumption, and block-related complications. Materials and Methods: This randomised double-blinded clinical trial was conducted in the Department of Anaesthesiology at a teritary care centre, BLDE (Deemed to be University) Shri BM Patil Medical College, Hospital and Research Centre in Vijayapur, Karanataka, India, from April 2023 to March 2024 on 74 American Society of Anaesthesiologists (ASA) grades I-II patients undergoing elective thyroid procedures were randomly assigned to two groups: Group Dexmedetomidine (DexD) (n=37), which received US-guided BSCPB with 10 mL of 0.5% bupivacaine and 25 mcg of dexmedetomidine on both sides; and Group Dexamethasone (DexA) (n=37), which received US-guided BSCPB with 10 mL of 0.5% bupivacaine and 4 mg of dexamethasone on both sides. Intraoperative blood pressure, Heart Rate (HR), and Mean Arterial Pressure (MAP) were measured at predefined time periods. Postoperative VAS scores were assessed at predefined intervals, along with the time taken for the first analgesic request and the cumulative postoperative analgesic dose consumed. Student’s t-test and Chi-square test were used for data comparison. Results: The mean age in Group DexD was 42.59±8.64 years, and in Group DexA it was 45.40±8.96 years. Group DexD had significantly lower postoperative VAS scores for upto eight hours (2.108 vs. 2.72; p-value=0.0002), and the time before the first rescue analgesia request was significantly longer than that of Group DexA (688.37±55.75 min vs. 593.64±72.56 min; p-value=0.001). The total postoperative analgesic utilisation in the first 24 hours was significantly lower in Group DexD compared to Group DexA (81.08±20.754 mg vs. 104.17±44.921 mg; p-value=0.006). Group DexA experienced a lower incidence of nausea (p-value=0.002) and vomiting (p-value=0.001) in the postoperative period. Conclusion: Dexmedetomidine performed better than dexamethasone when added to bupivacaine for BSCPB for pain management during the postoperative period in patients undergoing thyroid surgical procedures. However, when added, dexamethasone has the advantage of reducing nausea and vomiting in the postoperative period.

Spirometric Evaluation among Individuals Working in Stone Chip Crushing Factories: A Cross-sectional Study

Sujoy Mukherjee, Parthasarathy Sinha, Debalina Sengupta, Sanhita Mukherjee Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Silicosis is still one of the most serious occupational health diseases in the world because of its potential to cause physical impairment. It is a progressive and debilitating occupational lung disease that primarily affects workers in the manufacturing, construction and mining industries. Silicosis is mostly caused by inhaling crystalline silica dust. Still, a substantial study on the lung health of stone quarry workers in Western Part of Bengal are still lacking. Aim: To determine the alterations in pulmonary function status (by spirometry) and evaluate the gender differences in pulmonary mechanics among workers affected by occupational silica dust Materials and Methods: A cross-sectional study was conducted for a duration of three months to analyse the spirometric changes in lung function among 62 workers exposed to occupational silica dust, aged 18 to 60 years (both genders), attending the Department of Physiology at Rampurhat Government Medical College, West Bengal, India. After obtaining anthropometric measurements, including height and weight of the subjects, spirometry was carried out on each patient according to the recommendations of American Thoracic Society (ATS) and European Respiratory Society (ERS) (2005). Patients were grouped into categories of normal, Chronic Obstructive Pulmonary Disease (COPD), restrictive pattern, mixed ventilatory defect, and Small Airflow Obstruction (SAO) based on spirometric values of Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV₁), FEV1/FVC, Forced mid-Expiratory Flow (FEF25%-75%), and Peak Expiratory Flow Rate (PEFR) values. Analysis was performed using GraphPad QuickCalcs software using Chi-square test and Unpaired t-test. Results: The mean age of the subjects was 49.6 years, with 51 (82.26%) males and 11 (17.74%) females among the 62 study subjects. There were 36 (58.06%) smokers and 26 (41.94%) non smokers. The average Body Mass Index (BMI) of the study subjects was 17.268±2.501 kg/m² (underweight category). A significant reduction in spirometric variables was observed below the lower normal limit of percent predicted, including FVC (80-120%), FEV₁ (80-120%), PEFR (>60% predicted value for men; up to 100 L/min lower than predicted for males, and 85 L/min for females), FEF_25%-75% (50%-60% and up to 130% of the average), and Forced Expiratory Time (FET) (6 secs), except for the FEV₁/FVC ratio (70-85%), which was higher than the normal limit. The majority of the study subjects belonged to the mixed ventilatory defect category, comprising 36 subjects (58.06%), 17 (27.42%) had a Restrictive Spirometric Pattern (RSP), while the remaining 9 subjects (14.52%) were classified as normal. Conclusion: Detectable spirometric changes have been observed among stone quarry workers, revealing not only restrictive patterns but also mixed ventilatory defects. Necessary preventive and interventional measures should be taken at an early phase to prevent further progression of lung impairment in such a population.

Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X

Lower Urinary Tract Symptoms and its Impact on Quality of Life among Adults: A Cross-sectional Study from a Tertiary Care Hospital, Mangaluru, Karnataka, India

Jyothi, K Pavithra Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: A collection of clinical symptoms affecting the bladder, prostate, urethra, and urinary sphincter is collectively referred to as Lower Urinary Tract Symptoms (LUTS). LUTS can be categorised into two types: storage symptoms and voiding symptoms. Male individuals experiencing LUTS may have a lower Quality of Life (QoL). Aim: To assess LUTS and its impact on QoL among adults in a selected tertiary care hospital in Mangaluru, Karnataka, India. Materials and Methods: A cross-sectional observational study was conducted at Yenepoya Medical College Hospital in Mangaluru, Karnataka, India, from June 2020 to December 2023. A total of 220 subjects were recruited using a non probability purposive sampling technique. A LUTS questionnaire was used to assess the severity of symptoms, and the World Health Organisation (WHO) QoL Bref tool was utilised to evaluate QoL. The collected data were analysed using descriptive and inferential statistics. The correlation and association between the concepts were analysed using Karl Pearson’s correlation coefficient and the Chi-square test. Results: The majority, 171 (77.7%), of adult males had a moderate level of LUTS, followed by 39 (17.8%) with a mild level of LUTS and 10 (4.5%) with a severe level of LUTS symptoms. The overall QoL was average. There was a positive correlation between LUTS symptoms and QoL (r-value=1.71, p-value=0.01). However, the calculated p-value indicates that there was no significant association between the prevalence of LUTS and demographic variables. Conclusion: In this study, LUTS affects majority of adults aged ≥40 years, and symptoms increase with advancing age. Clinically, this underscores the importance of comprehensive assessments and personalised treatment approaches for LUTS, focusing not only on symptom severity but also on overall QoL.

Efficacy of Infrainguinal vs Suprainguinal Approach to Fascia Iliaca Compartment Block for Postoperative Analgesia in Patients with Proximal Femoral Fracture: A Randomised Clinical Study

K Jubairiya, PK Farha, Neera Valsan, Moona, Paul O Raphael, AJ Sukanya Prince Mary, P Anusree, SM Mohammed Nabeel Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: The Fascia Iliaca Compartment Block (FICB) has been useful in postoperative pain management for surgeries involving the hip joint and femur. Under ultrasound guidance, one can approach this compartment using either the conventional infrainguinal or suprainguinal methods. The suprainguinal approach was expected to be better due to the more proximal placement of the drug. Aim: To compare the suprainguinal and infrainguinal approaches to FICB for postoperative analgesia in proximal femur fractures. Materials and Methods: This unicentric prospective randomised double-blind clinical study was conducted over six months following approval from the ethics committee and in accordance with the Clinical Trial Registry of India (CTRI/2022/12/048121). A total of 60 patients were randomly divided into two groups of 30 using computer-generated random numbers. FICB was performed in the preoperative area with either approach under ultrasound guidance depending on the assigned group. Surgery was performed under a subarachnoid block after 30 minutes. Postoperative pain was assessed using the Visual Analogue Scale (VAS) score. If the VAS score was greater than 4, rescue analgesia was administered with intravenous paracetamol 1 gm infusion. The incidence of postoperative delirium was also recorded. Results: The duration of postoperative analgesia was significantly longer in the suprainguinal group (Group S) (481.7±136.7 minutes) compared to the infrainguinal group (Group I) (385.2±99.39 minutes) (p-value=0.001). The VAS score was similar between the groups at 2, 6, and 12 hours. However, the VAS score was significantly lower in Group S (2.333±0.479) compared to Group I (2.867±1.196) at 24 hours. The incidence of postoperative delirium was comparable in both groups (p-value=0.754). Conclusion: Regarding the duration of analgesia and reduced pain intensity at 24 hours, suprainguinal FICB was more effective than infrainguinal FICB in managing pain. There were no significant differences in overall paracetamol intake and the incidence of delirium between the two groups.

Role of Maternal Anogenital Distance Measurement in Prediction of Perineal Tears during Vaginal Delivery: A Prospective Cohort Study

Karishma Singh, Sandhya Jain, Rachna Agarwal, Bhanu Priya Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Almost 85% of women suffer from perineal trauma during vaginal birth, which can have long-term consequences. Anogenital Distance (AGD) is a novel and useful parameter for predicting perineal tears during vaginal delivery. Aim: To determine the accuracy and cut-off values of AGD in predicting ≥2^nd degree perineal tears. Materials and Methods: A prospective cohort study was conducted in the Department of Obstetrics and Gynaecology at GTB Hospital, New Delhi, India, from January 2021 to April 2022, including 80 patients in group 1 and 80 in group 2. Group 1 consisted of patients who experienced ≥2^nd degree perineal tears during vaginal delivery, while group 2 included patients with an intact perineum or up to 1^st degree tears. Anthropometric data such as Anus to Clitoris Distance (AGDac) and Anus to Fourchette Distance (AGDaf) (anus to fourchette distance), as well as labour parameters like foetal position, duration of the second stage, induction of labour and birth weight, were noted. Receiver Operating Curves (ROC) were plotted to obtain cut-off values for AGDac and AGDaf in predicting ≥2^st degree perineal tears. Unpaired t-tests and Chi-square tests were used to compare quantitative and qualitative parameters, respectively. Results: The mean AGDac (75.99 vs. 77.05) and AGDaf (33.50 vs. 34.52) were lower in group 1 compared to group 2. AGDaf (75%) showed better sensitivity for predicting ≥2^st degree perineal tears and anal sphincter injury compared to AGDac (60%). The specificity of AGDaf (55%) was better for predicting ≥2^st degree perineal tears, while AGDac (51%) was more specific for sphincter injury. Foetal head position (p=0.016) and birth weight (p=0.002) were identified as the strongest risk factors for tears. Group 1 patients reported more bowel (25% vs. 10%) and prolapse symptoms (11.5% vs. 3.75%) compared to group 2 patients at six weeks postpartum. Conclusion: Perineal length, as measured antenatally by AGD (both AGDac and AGDaf), is useful in predicting the occurrence of perineal tears during vaginal delivery. If found to be short, obstetricians can exercise greater caution during delivery, potentially reducing the incidence of anal sphincter injuries and their long-term consequences.

Impact of Body Mass Index on Coordination, Static and Dynamic Balance in Young Adults: A Case-control Study

Ankita Debnath, Manish Kumar, Mamta Dagar, Vishwajeet Trivedi, Ashish Tyagi, AS Moorthy Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Abnormal Body Mass Index (BMI), characterised by a higher percentage of fat mass, has notable effects on postural control, leading to a forward shift in posture that exceeds the Base Of Support (BOS) boundary due to increased segmental mass and a compromised ability to regain stability after a disruption caused by excess adiposity. Aim: To investigate the potential impact of BMI on the coordination, static balance and dynamic balance of young adults. Materials and Methods: The present case-control study was conducted in the Department of Physiotherapy, School of Healthcare and Allied Sciences (SoHAS), G D Goenka University, Gurugram, Haryana, India from November 2023 to April 2024. Study was conducted among 90 subjects from the Delhi-NCR region, aged between 18 years and 30 years and including both genders, were recruited. They were categorised into three groups based on Asian Pacific BMI classifications: 29 subjects in the normal weight group (BMI 18.5-22.9 kg/m²), 26 subjects in the overweight group (BMI 23-24.9 kg/m²), and 35 subjects in the obese group (BMI >25 kg/m²). Body composition, balance tests and coordination tests were assessed for all subjects. The p-value and F-values were calculated to assess group differences using the One-way Analysis of Variance (ANOVA) method, indicating significant results (p-value<0.01) for static and dynamic balance as well as coordination tests. Subsequently, post-hoc tests were conducted to explore specific differences among the groups. Results: The mean ages of the normal weight, overweight and obese groups were 22.10±2.38 years, 21.77±2.90 years and 21.91±2.38 years, respectively. The mean BMI of the normal weight, overweight and obese groups were 20.23±1.30 kg/m², 23.99±0.68 kg/m² and 29.69±3.09 kg/m², respectively. The ANOVA single factor test showed a significant difference between the normal weight, overweight and obese groups in the Single Leg Standing (SLS) test with opened and closed eyes on each leg for static balance; in the Timed Up and Go (TUG) test for dynamic balance; and in sidewalking, tandem walking, and heel walking for coordination at p-value<0.05. The post-hoc test showed a significant difference in all the parameters for overweight and obese groups in comparison to the normal weight group at p-value<0.016. Conclusion: Abnormal BMI affects both static and dynamic balance along with coordination in young adults. Therefore, preventive measures should be considered to normalize BMI to prevent coordination and balance issues in overweight and obese young adults.

Effectiveness of Two Phytochemicals, P-Coumaric Acid and Quercetin in Reducing the Melanin Content of Pigmented Gingival Tissue: An Ex-vivo Study

Shubhangi Behl, Vishakha Patil, Vidya Dodwad Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Pigmented gingiva is an aesthetic concern for many individuals. Various treatment modalities have been developed to address this condition, but each carries certain disadvantages. Recently, the use of herbal products has been considered as a treatment modality, as they are safe and readily available. P-Coumaric Acid (p-CA) and Quercetin are two plant-based chemicals that have shown depigmenting effects on the skin. Given the similar cellular structure of skin and gingiva, the present study aimed to test their depigmenting effects on the gingiva. Aim: To evaluate the effectiveness of two phytochemicals, p-CA (3 μM) and Quercetin (20 μM), in reducing the melanin content of pigmented gingival tissue. Materials and Methods: The study was an ex-vivo study conducted in the Department of Periodontology at Bharati Vidyapeeth Deemed to be University Dental College and Hospital, Pune, Maharashtra, India, from January 2024 to April 2024. A total of 10 patients with a Dummet Oral Pigmentation Index (DOPI) score of two were selected for the study. A surgical depigmentation procedure was performed and the excised tissue was divided into three parts. The first part of the excised tissue served as a control group (Group A), while the second and third parts were treated with p-CA (Group B) and Quercetin (Group C), respectively. Histological analysis was conducted using Haematoxylin and Eosin (H&E) staining and immunohistochemical analysis was performed using the Human Melanoma Black 45 (HMB-45) antibody test. The reduction in melanin content was recorded in all three groups and the results obtained were compared using a t-test. Statistical Package for the Social Sciences (SPSS) version 20.0 was used for statistical analysis, with a p-value of ≤0.05 considered statistically significant. Results: Both p-CA and Quercetin demonstrated a reduction in the level of pigmentation. Comparative analysis indicated that p-CA had a stronger effect than Quercetin. Conclusion: The p-CA and Quercetin can be considered potential depigmenting agents.

Quality of Life of Patients Treated with VenaSeal™ Versus Endovenous Laser Treatment for Varicose Veins: A Retrospective Cohort Study

Kaurabhi Zade, Sarang Ingole, Kshitij Wani, Rahul Arkar Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Endovenous Laser Ablation (EVLT) has been considered the ‘gold standard’ for the treatment of varicose veins for the last two decades. The newer non thermal, Non tumescent treatment modality like VenaSealTM has shown promising results and is now considered non inferior to thermal ablation. Aim: To compare the Quality of Life (QoL) of patients with varicose veins treated with VenaSealTM and EVLT. Materials and Methods: A retrospective cohort study was carried out at the Department of Interventional Radiology of a Sahyadri Super Speciality Hospital, Pune, Maharashtra, India from January 2022 to December 2023. Adult patients (of either gender) with symptomatic venous reflux disease involving the Great Saphenous Vein (GSV) and/or Small Saphenous Vein (SSV) with associated moderate to severe varicosities (C2-C5 stages) were studied. Group I (n=30 limbs) consisted of patients who had already undergone VenaSealTM treatment for varicose veins and group II (n=30 limbs) consisted of patients who had already undergone EVLT for varicose veins. Patients in both groups were assessed before the intervention and at one week, six weeks and six months following the procedure using the 36-item Short Form Survey (SF-36) and the Aberdeen varicose veins Questionnaire (AVVQ). Categorical variables were compared using the Chi-square test. Continuous variables were compared using unpaired t-test or Mann-Whitney U test between the two treatment groups and the Kruskal-Wallis test was used within the two treatment groups. For within-group analysis, the Friedman test was used to compare pre- and postoperative values across all time points-at enrollment, six weeks and six months. A p-value of <0.05 indicates statistical significance. Results: The mean age was 48.70±12.62 years for group I and 50.46±13.00 years for group II. At baseline, no statistical difference was observed in all domains of SF-36 scores between the two groups. At six weeks, group I showed statistically higher scores in the domains of Physical Function (PF), Role limitations due to physical Problems (RP), Energy/Vitality (VT), Social function (SF) and Bodily Pain (BP) domains than group II. At six months again, no statistical difference was observed in all domains of SF-36 scores between the two groups. AVVQ scores were significantly better in the VenaSeal™ group at six weeks, but at six months, no statistical difference was noted between the two groups. Conclusion: VenaSeal™ and EVLT both provide similar QoL improvements in patients with varicose veins at six months of follow-up. VenaSeal™, however, eliminates the QoL limitations experienced by patients in the immediate and early postoperative period.

Effect of Sealing Gel on Bacterial Microleakage at Implant-abutment Junction: A Split-mouth Randomised Controlled Trial

Lavesh Manoj Chopra, Umesh Palekar, Deepak Vikhe, Veena Saraf, Rupal Sarode, Vaibhav Nandkumar Awinashe, Minal Awinashe Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Dental implants are widely used for tooth replacement; however, challenges such as bacterial microleakage at the Implant-abutment Interface (IAI) can lead to complications. Sealing gels have been developed to close this gap and prevent issues like screw loosening and bacterial infiltration, thereby improving implant success. Aim: To compare bacterial microleakage at the Implant-abutment Junction (IAJ) with and without the use of sealing gel (conventional method). Materials and Methods: This Split-mouth randomised controlled study included 30 implant patients who visited the Department of Prosthodontics and the Department of Microbiology at Rural Dental College and Rural Medical College, Pravara Institute of Medical Sciences (Deemed to be University), Ahmednagar, Maharashtra, India, from April 2023 to October 2023. Based on inclusion and exclusion criteria, randomisation was performed using a lottery method, assigning 15 implant samples to each group. Before collecting saline samples, a sterile field assessment was conducted. The sealing gel was injected into the internal compartment of the implant, and a healing abutment was placed in Group A (medical-grade silicone was used as the sealing gel). In Group B, the healing abutment was placed without sealing gel at the IAI. The healing abutment was removed after 15-20 days, and 10 μL of sterile saline was introduced into the internal compartment of the implant using an insulin syringe. The saline was then drawn back up and transferred to the laboratory for microbial assessment to calculate the colony types and the number of colony counts using Colony-forming Units (CFUs). Statistical analysis was performed using the Chi-square test and the Mann-Whitney’s U test. Results: The mean age of the implant patients was 35±1 years, ranging from 20 to 50 years. Bacterial microleakage assessment showed that Group A (with sealing gel) had 100% sterility, while Group B (without sealing gel) exhibited only 4 (26.67%) sterile samples, 7 (46.66%) with Enterococcus growth, and 4 (26.67%) with Gram-positive bacilli growth in terms of colony types. The sterility in the number of colonies corresponded with the types of colonies for both groups. In Group B, there were 250 colonies in 3 (20%) of the samples, 500 colonies in another 3 (20%), and over 1000 colonies in 2 (13.33%) of the samples. There was a statistically significant difference in the number of sterile samples between the groups (p<0.05). However, intragroup analysis in Group B indicated that the difference in the proportion of the number of colonies was not statistically significant (p>0.05). Conclusion: The use of sealing gel significantly reduces bacterial microleakage at the IAI, thus improving biomechanics and extending implant longevity for better oral health outcomes.

Assessment of Electrocardiographic P Wave Dispersion in Individuals with and without Psoriasis: A Cross-sectional Study

Laya Jayarajan Nair, Sandhya Somasekharan Nair, Suresh Muthezathu Kesavadas, Anuja Elizabeth George Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Psoriasis is a prevalent, long-lasting inflammatory skin condition characterised by various clinical manifestations and arising from the interaction of genetic, environmental, and immunological factors. It has been found to be associated with several medical conditions, such as hypertension, diabetes, Cardiovascular (CV) diseases, and metabolic syndrome. Aim: To compare the Electrocardiographic P Wave Dispersion (PWD) in individuals with and without psoriasis and to correlate PWD with the Psoriasis Area Severity Index (PASI) score. Materials and Methods: This was a hospital-based cross-sectional study comparing the electrocardiographic PWD in 30 patients with psoriasis to that of 30 age- and gender-matched subjects without psoriasis who attended Government Medical College, Trivandrum, Kerala, India, during a period of one year (February 2021 to January 2022). A structured questionnaire was used to record history and examination findings. A 12-lead Electrocardiogram (ECG) was performed on study participants from both groups in a supine position following 15 minutes of rest. Categorical and quantitative variables were expressed as frequency (percentage) and mean±SD, respectively. The Karl Pearson test was used to find correlations. A p-value of ≤0.05 was considered statistically significant. Results: Ten (33.3%) patients belonged to the age group of 41-50 years. The duration of the disease ranged from six months to 21 years. Seventeen (56.7%) patients had a PASI score between 10-20, and 5 (16.7%) patients had a PASI score of less than 10. The maximum value of the P wave and PWD was higher in the case group and was statistically significant (p≤0.001 and p≤0.001, respectively). A statistically significant correlation was found between the severity of psoriasis and PWD (r=0.564, p≤0.001) and between the duration of psoriasis and PWD (r=0.372, p=0.04) in this study. Conclusion: PWD was found to be higher in psoriasis patients, with a significant correlation between PWD and both the severity and duration of the disease. Therefore, ECG should be considered as a screening test for Atrial Fibrillation (AF) in all psoriasis patients.

Evaluating RET-Hb vs Hb in Predicting Early Response in Oral Iron Therapy: A Prospective Interventional Study

Benita Mary Mathew, Rati Santhakumar, Susheela Jacob Innah, Vinod Jacob Cherian, Aboobaker Mohamed Rafi Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Children are more vulnerable to anaemia due to their rapid growth, which requires an expanding erythroid mass and a high tissue iron demand. Anaemia can negatively impact psychomotor and cognitive development and can lead to a decline in immunity. Reticulocytes are precursors to erythrocytes and make up about 1% (ranging from 0.5% to 2.5%) of circulating erythrocytes. The reticulocyte content serves as a measurement of haemoglobin within the reticulocyte and correlates directly with the functional availability of iron in the bone marrow. Consequently, it is considered one of the strongest predictors of Iron Deficiency (ID). The Reticulocyte Haemoglobin Content (RET-Hb) level is useful for diagnosing anaemia before it clinically manifests in a patient. Aim: To assess the effectiveness of RET-Hb content as a predictor for early response to oral iron therapy in comparison to haemoglobin levels. Materials and Methods: This prospective interventional study was conducted in the Department of Paediatrics at a tertiary care Hospital in Thrissur, Central Kerala, India, over a period of 18 months, from December 2019 to June 2021. A total of 44 samples were included in the study, and socio-demographic details were collected using a semistructured proforma from patients with haemoglobin levels below the mean reference value. Baseline haemogram parameters {Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), Mean Corpuscular Haemoglobin Concentration (MCHC), Red Cell Distribution Width (RDW), Haemtocrit (HCT)}, reticulocyte indices, and ferritin levels were measured before administering oral iron therapy (T0). These parameters were reassessed after seven days (T1) and 30 days (T2) following the initiation of therapy. The Chi-square test was used to assess the association between various factors, and Pearson’s correlation coefficient was utilised to find the correlation. Results: The mean age of the participants was 3.46±2.2 years, with 24 males and 20 females included in the study. The mean RET-Hb was 21.15±1.71 pg before the initiation of treatment, which significantly increased to 23.37±1.95 pg and 25.77±1.56 pg at days 7 and 30, respectively. The haemoglobin level increased from 8.37±1.25 g/L to 8.55±1.19 g/L and 9.72±0.98 g/L at T1 and T2, respectively, which was statistically significant. The Absolute Reticulocyte Count (RET#) also showed a significant early increase after initiating treatment. Conclusion: These findings indicate that RET-Hb and RET# are reliable early predictors of response to iron therapy, alongside haemoglobin levels, and can be used as effective alternatives.

Effect of Chlorhexidine and Benincasa Hispida Pretreatment on Microshear Bond Strength of Universal Adhesive System on Dentin: A Pilot Study

Girija S Sajjan, Manda Sri Swathi, P Arun Bhupathi, Madhu Varma Kanumuri, Rajulapati Kalyan Satish, Rama Krishna Alla, Tippireddy Srija, CH Uma Shalini Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Achieving strong bond strength of adhesive systems to deep dentin is challenging. Various methods to improve bond strength to deep dentin have been investigated. Chlorhexidine (CHX) enhances the longevity of the bond between adhesives and dentin by inhibiting the collagenolytic activity of Matrix Metalloproteinases (MMPs). Benincasa hispida is a natural plant-based functional food containing minerals and vitamins that help prevent osteoporosis and improve bone health. Aim: To evaluate the Microshear Bond Strength (MSBS) of a 10-methacryloyloxydecyl-dihydrogen Phosphate-based (10-MDP) universal adhesive system to coronal dentin with different dentin surface pretreatments, specifically CHX and Benincasa hispida. Materials and Methods: An in-vitro pilot study was conducted at the Department of Conservative Dentistry and Endodontics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India, from May 2023 to November 2023. Dentin discs (42) were prepared from human mandibular first molars. A standard etch-and-rinse protocol was performed on the discs. The specimens were assigned to different dentin pretreatments: Group-I (no pretreatment), Group-II (CHX) and Group-III (Benincasa hispida). CHX and Benincasa hispida were applied using micro applicator tips. A dentin bonding agent containing 10-MDP (DBA) was applied, photopolymerised and a composite restoration was fabricated. The MSBS to dentin was evaluated using a universal testing machine. The failure patterns were analysed using a stereomicroscope at 10x magnification. One-way Analysis of Variance (ANOVA) and Tukey’s Honestly Significant Difference (HSD) HSD tests were used for statistical analysis, with a significance level set at ?=0.05. Results: The mean MSBS values were 24.2732±5.41329 MPa for Group-III, 14.3848±4.23492 MPa for Group-II and 6.9724±3.15837 MPa for Group-I. Pretreatment of dentin with B. hispida resulted in significantly higher MSBS values compared to the other two groups (p<0.001*). Conclusion: Pretreatment with B. hispida significantly improved MSBS. Thus, B. hispida pretreatment may be beneficial in increasing dentin bond strength.

Cephalometric Evaluation of Soft-tissue Profile Changes in Class-II Division 1 Patients with Varied Growth Patterns Treated with all First Premolar Extractions: A Cross-sectional Study

Anamika Jakhar, Santosh Kumar, Namrata Dogra, Pandurangan Harikrishnan, Tarun Kumar Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Knowledge of the facial skeleton and its overlying soft-tissue is essential in determining facial harmony. Additionally, an individual’s growth pattern may influence post-treatment facial profiles and needs to be considered during treatment planning. Aim: To evaluate the soft-tissue profile changes in treated Class-II malocclusion patients with varied mandibular growth patterns and to compare these changes with patients having a skeletal Class-I relationship and a balanced facial profile. Materials and Methods: The present cross-sectional cephalometric study was conducted in the Department of Orthodontics, Faculty of Dental Sciences, SGT University, Gurugram, Haryana, India, from June 2021 to December 2022. The study included 210 lateral cephalograms of 120 patients. The cephalograms were divided into four groups based on the Frankfort horizontal Mandibular plane Angle (FMA): Group-1 (control, n=30): skeletal Class-I (FMA=22°-28°); Group-2 (n=30): skeletal Class-II with a horizontal growth pattern (FMA<22°); Group-3 (n=30): skeletal Class-II with an average growth pattern (FMA=22°-28°); and group-4 (n=30): skeletal Class-II with a vertical growth pattern (FMA>28°). All patients in the groups-2,3, and 4 were treated with all first premolar extractions using a 0.022? McLaughlin, Bennett and Trevisi (MBT) appliance. The student’s t-test and post-hoc test was used to analyse skeletal, dental and soft-tissue parameters using Statistical Package for the Social Sciences (SPSS) software (version 22.00 for Windows; SPSS Inc., Chicago, USA). Results: Of the total, 120 patients, 52 were males and 68 females with an age range of 18-28 years. On intergroup analysis, significant changes (p-value<0.05) in the Sella, Nasion and A point (SNA) and Sella, Nasion and B point (SNB) angles were observed in group-3. Clinically insignificant changes were found in the A point, Nasion and B point (ANB) angle across all experimental groups. However, a significant change (p-value<0.001) in the post-treatment ANB angle was observed in group-2, followed by group-3 and 4 when compared with group-1. The soft-tissue profile angle showed a significant change in Group-2 when compared with Group-1 (p-value=0.012). Conclusion: The post-treatment soft-tissue profiles of the experimental groups were comparable to the balanced profile of the control group patients.

Morphometric Assessment of Condyle and Glenoid Fossa using Cone Beam Computed Tomography in Gujarati Population: A Cross-sectional Study

Vaibhavi Mehta, Pritesh Ruparelia, Rashmi Venkatesh Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Several morphological alterations and remodelling occur in the mandibular condyle and glenoid fossa to adapt to trauma, malocclusion and other developmental disorders. Understanding these changes will aid healthcare providers in comprehending the pathophysiology of various Temporomandibular Joint (TMJ) problems. Aim: To evaluate the morphometric attributes of the condyle and glenoid fossa in the Gujarati population using Cone Beam Computed Tomography (CBCT). Materials and Methods: This cross-sectional radiographic morphometric investigation was conducted at the Department of Oral Medicine and Radiology at the College of Dental Sciences and Research Centre in Bopal, Gujarat, India using departmental archives from September 2019 to September 2022. A total of 40 CBCT scans (80 TMJs) were performed and analysed using the Papaya 3D and Genoray CBCT machines, along with Triana imaging software. Measurements were taken for condylar length, width, height, joint space (anterior, superior, posterior, medial, lateral) and the thickness of the Roof of the Glenoid Fossa (RGF) (sagittal, coronal) on the CBCT images. The aforementioned parameters were compared between genders, age groups and sides using a paired t-test and statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) software package (Chicago, IL, USA), version 21.0 for Microsoft (MS) Windows. Results: The mean age of the study participants was 34±9.6 years. The condylar width between males and females was the only condylar characteristic that differed significantly (p-value 0.001). Apart from the gender analysis, no statistically significant variations (p>0.05) were found in the thickness of the RGF when comparing age or side. However, in the gender-wise examination of joint space, males had significantly higher measurements of Superior Joint Space (SJS), Medial Joint Space (MJS) and Lateral Joint Space (LJS) than females. Conclusion: Gujarati males had a significantly larger condylar width compared to females. When considering gender-specific data, males also exhibited greater SJSs, MJSs and LJSs, as well as increased thickness of the RGF. The results of the present study may provide a relevant and comparable reference for the clinical assessment of individuals with healthy, functional, or pathological TMJs.

A Cross Sectional Study on Detection of Human Adenovirus from Clinical Samples of Conjunctivitis by Real Time PCR and Viral Cell Culture

Ashish Anshuman, MJ Praseetha, Ambica Rangaiah, G Nagaraju, M Swetha, Shantala Gowdara Basawarajappa Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Human Adenoviruses (HAdV) have been implicated in a variety of infections, including conjunctivitis, respiratory tract infections, genitourinary infections and gastroenteritis. Epidemic Keratoconjunctivitis (EKC) is a severe ocular surface infection strongly associated with HAdV, known to occur in widespread outbreaks. HAdV species B, D and E are associated with ocular manifestations ranging from simple follicular conjunctivitis (types 3, 4, 7) and pharyngoconjunctival fever (types 3, 7, 14) to the more severe EKC (types 8, 19, 37, 53, 54, 56 and 64). Viral cell cultures of conjunctival specimens help confirm adenovirus infection through the characteristic Cytopathic Effect (CPE) and Polymerase Chain Reaction (PCR) is the best standard method to diagnose viral conjunctivitis due to its sensitivity, accuracy and rapidity. Aim: To diagnose HAdV in clinically suspected cases of viral conjunctivitis using real-time PCR. To isolate HAdV in viral cell culture and confirm it by observing its characteristic CPE and performing adenoviral real-time PCR. Materials and Methods: A cross-sectional descriptive study was conducted from July 2023 to September 2023 at the state-level Virus Research and Diagnostic Laboratory (VRDL) at Bangalore Medical College and Research Institute (BMCRI), Bengaluru, Karnataka, India. A total of 45 conjunctival swab samples from patients with suspected viral conjunctivitis, who attended the Ophthalmology Outpatient Department (OPD) or were admitted to the wards, were included in the study. Conjunctival swab samples collected in Viral Transport Medium (VTM) were centrifuged at 3000 rpm for five minutes at 4°C. Real-time PCR was performed and samples positive for HAdV by real-time PCR were taken up for viral cell culture. Confirmatory PCR was conducted for samples showing CPEs in the cell line. The data collected were analysed using descriptive statistics. Results: The majority of patients in the present study were in the age group of 18-45 years, comprising 25 (56%) of the total patients. Out of 45 conjunctival samples tested, 8 samples were positive in adenovirus real-time PCR. All eight PCR-positive samples showed a CPE in viral cell culture on the A549 cell line. The study found PCR positivity in 8 samples (17.7%), while adenoviral recovery from cell culture was observed in 6 samples (13.3%). Conclusion: Real-time PCR has become the standard diagnostic procedure for detecting adenovirus conjunctivitis. Rapid and accurate diagnosis is key to interrupting the contagious spread of adenoviral conjunctivitis, along with timely treatment.

Smartphone Addiction and Non Suicidal Self-injury among Undergraduate Healthcare Professionals: A Cross-sectional Study from Southern India

Nisha Natarajan, Ajith Kumar, P Maithreyi, Mohamed Shaheep, Dhanraj Jalindar Bhore Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Non Suicidal Self-injury (NSSI) and mobile phone addiction have recently garnered considerable attention, especially among adolescents and young adults. There is significant neglect regarding the impact of each phenomenon on the daily functioning of individuals; however, few studies have explored their correlation, leaving a gap in understanding the relationship between these two phenomena. Aim: To determine the level of smartphone addiction and NSSI behaviours among undergraduate healthcare professionals and to examine the extent of smartphones’ influence on the emotional stability of young adults, potentially leading to self-injurious behaviour. Materials and Methods: A cross-sectional survey was conducted at ACS Medical College and Allied Health Sciences, Chennai, Tamil Nadu, India over five months, involving 448 undergraduate healthcare professionals. After applying exclusion criteria, 367 participants were included in the study. Socio-demographic details were collected using a semistructured proforma. The questionnaire included the Smartphone Addiction Scale-Short Version (SAS-SV) and the Inventory of Statements About Self-Injury (ISAS). The statistical tests used were the Chi-square test for categorical variables, Spearman correlation analysis (p-value <0.05), and frequencies/percentages for some quantitative variables. Results: The study primarily comprised first-year undergraduate students, with 206 (56.1%) female and 161 (43.9%) male participants. Social media (208, 56.7%) and making calls (195, 53.1%) were the most frequently cited reasons for smartphone usage. Among the participants, 114 (31.1%) exhibited addictive smartphone habits, with males outnumbering females. Furthermore, 50 (13.6%) reported intentional self-injury, with females constituting the majority. Common methods included hitting oneself (20, 40%), pulling one’s hair (18, 36%), and cutting (16, 32%). Significant correlations were observed between certain intrapersonal and interpersonal functions of NSSI behaviour and smartphone addiction among male individuals engaged in deliberate self-harm (p-value <0.05). Conclusion: In this study, 31.1% of the participants exhibited addictive smartphone habits, and 13.6% reported intentional self-injury. These findings underscore the critical need to investigate smartphone addiction to thoroughly understand NSSI behaviour, particularly among undergraduate students.

Split Nasopharyngeal Airway, a Tracking Tool for Fibreoptic Nasotracheal Intubation: A Randomised Controlled Study

Savita Saini, Manoj Kumari Katewa, Monica Chhikara, Susheela Taxak, Priyanka Aggarwal, Arvind Kumar, Sumit Kumar Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Managing a challenging airway in awake, sedated, or anaesthetised patients has made Fibreoptic Intubation (FOI) using a flexible Fibreoptic Bronchoscope (FOB) a mainstay in clinical practice. Aim: To evaluate and compare fibreoptic nasotracheal intubation with or without Split Nasopharyngeal Airway (SNPA) as a conduit, focusing on time taken, ease of insertion, and haemodynamic changes. Materials and Methods: This randomised controlled study was conducted at the Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India, on 80 patients who were randomly allocated into two groups: Group CL (the control group without SNPA) and Group NP (with SNPA). Both groups were induced with general anaesthesia, and nostrils were prepared for FOB. In Group CL, a well-lubricated FOB was inserted into the selected nostril without using SNPA, and endotracheal intubation was performed. In Group NP, an appropriately sized SNPA was lubricated and inserted into the selected nostril. The fiberscope was passed through the SNPA, the vocal cords were visualised, and the SNPA was removed before railroading the preloaded tube through the vocal cords to confirm correct placement. The time taken for bronchoscopy and intubation, ease of insertion, haemodynamic parameters, and bleeding were recorded in both groups. The data was coded, entered, and analysed using Statistical Package for the Social Sciences (SPSS) version 20.0. A significance level was set at a p-value ≤0.05. Results: Demographic data, including age and gender distribution, mean weight, height, Body Mass Index (BMI), and airway parameters such as Mallampati grading, neck circumference, inter-incisor distance, and ASA grading, were standardised. There was no significant difference between the CL and NP groups regarding these parameters. The time taken for FOB and intubation in Group CL was 2.59±0.96 minutes and 3.61±1.04 minutes, respectively, compared to 1.87±0.91 minutes and 2.51±0.86 minutes in Group NP (p-value=0.001). The time taken to visualise the glottis was also shorter in the NP group (6.70±13.97 minutes) compared to the CL group (24.02±13.06 minutes), which was significant. Fibreoptic bronchoscopy was considered easy in 16 patients (40%) in Group CL and 27 patients (67.5%) in Group NP (p-value=0.04). The increase in mean arterial blood pressure was significantly higher in Group CL than in Group NP just after the insertion of the FOB into the nasopharynx (p-value=0.05). Conclusion: Fibreoptic nasotracheal intubation through an SNPA is less time-consuming and results in easier intubation. It causes less trauma to the nasal passage and leads to fewer haemodynamic variations in terms of mean arterial pressure and heart rate. Hence, SNPA is a better method for facilitating FOI compared to intubation without it.

Serum Homocysteine and C-reactive Protein Levels in Diabetic Patients with Nerve Conduction Velocity Proven Neuropathy: A Cross-sectional Study

Mahabir Prasad Mishra, Vijayashree Gokhale, Satbir Kaur Malik, Ponvijaya M Yadav Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Diabetic Neuropathy (DN) is a well known difficult to treat microvascular complication of diabetes. Based on Nerve Conduction Velocity (NCV) studies, DN has been classified into various types. Many possible aetiologies have been proposed. C-Reactive Protein (CRP) plays a role in the development of diabetic microvascular complications, while Homocysteine (Hcys) can harm the endothelium by inducing excessive sulfation of connective tissue. Aim: To study the levels of Hcys and CRP in NCV-proven patients with DN and to associate these levels with the type of DN. Materials and Methods: This was a cross-sectional study conducted at a semi-urban medical college hospital in Western Maharashtra, India, between February 2022 and May 2024. The study included 70 patients over 18 years of age with NCV-proven DN in Type 2 Diabetes Mellitus (DM), in whom serum Hcys and CRP levels were evaluated. Data collected were analysed using Statistical Package for Social Sciences (SPSS) software version 26.0. Results: A total of 32 female participants (45.7%) and 38 male participants (54.3%). Among the study participants, 23 (32.9%) had a duration of diabetes of 5-10 years, and 47 (67.1%) had a mixed type of neuropathy. Elevated Hcys levels were observed in 18 (25.7%) participants, while 49 (70%) showed elevated CRP levels. CRP levels were raised in the mixed type of neuropathy, with 35 (71.4%) affected, while elevated Hcys levels were observed among the sensory neuropathies in 6 (33.3%) participants. Conclusion: No significant association was found between elevated Hcys and CRP levels and the type of neuropathy.

Bilateral Bacterial Endogenous Endophthalmitis following Haemodialysis in a Diabetic Patient: A Case Report

Varsha Manade, OK Radhakrishnan, Rutu Rao, Varsha Singh, Shailaja Anand Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Endogenous endophthalmitis, a severe infection originating from the bloodstream, can lead to blindness and is particularly dangerous for immunocompromised patients, including those with diabetes, cancer, or undergoing chemotherapy. This condition differs from exogenous endophthalmitis, which arises from external sources such as postoperative complications or trauma. Hereby, the authors present a case report of a rare instance of bilateral bacterial endogenous endophthalmitis in a 45-year-old male with multiple systemic co-morbidities. The patient experienced vision loss and photophobia; further investigation revealed septicaemia linked to an in-situ haemodialysis catheter. Prompt treatment with intravenous antibiotics is crucial, and vitrectomy may also be considered. The present case is unique because, despite the infection originating in the bloodstream, the patient developed ocular symptoms first. A retrospective analysis revealed the primary source of the infection, highlighting the importance of a thorough examination.

Comparison of Intravenous Lignocaine and Dexmedetomidine in Attenuating the Haemodynamic Response to Laryngoscopy and Intubation: A Randomised Double-blind Clinical Study

Deepika Seelwal, Nidhi Bangarwa, Ankit Tyagi, Manisha Manohar, Sanjay Johar, Preeti Gehlaut Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Endotracheal intubation often triggers a sympathetic response, leading to an increase in Heart Rate (HR) and blood pressure. Dexmedetomidine (DEX) and lignocaine have shown the potential to mitigate cardiovascular changes secondary to intubation. Aim: To compare the efficacy of 0.25 mcg/kg and 0.5 mcg/kg DEX with 1.5 mg/kg lignocaine in attenuating haemodynamic responses during the peri-intubation period. Materials and Methods: This randomised double-blind study included 90 patients classified as American Society of Anaesthesiologists (ASA) I and II, aged 16-65 years. Patients were divided into three groups: Group A received lignocaine (1.5 mg/kg); Group B received DEX (0.25 mcg/kg); and Group C received DEX (0.5 mcg/kg). Haemodynamic parameters were recorded at various intervals before and after laryngoscopy. Data were checked for normality before statistical analysis using the Shapiro-Wilk test. Normally distributed continuous variables were compared using Analysis of Variance (ANOVA), while categorical variables were analysed using the Chi-square test. For all statistical tests, a p-value of less than 0.05 was considered indicative of a significant difference. Results: All groups were found to be comparable in terms of age, weight, and gender distribution. The mean age in Group A was 36.10±12.60 years, in Group B was 36.10±13.47 years, and in Group C was 37.37±11.49 years. Inter-group comparisons between Group A and Group C showed statistically significant lower HR values in Group C (79.23±10.37 vs. 90.7±17.68) at T0 as well as T1 (90.07±14.65 vs. 99.93±17.02, p-value 0.019). The comparison between Groups A and C revealed significantly lower Systolic Blood Pressure (SBP) values in Group C at T0, T1, T3, and T5. Inter-group comparisons between Groups A and B showed that Diastolic Blood Pressure (DBP) values were significantly lower at T5 in Group B (69.33±10.09 vs. 62.33±9.11, p-value 0.006). Between Groups A and C, significant differences were noted at T0, T1, T3, and T5 in Mean Arterial Pressure (MAP). Conclusion: DEX at a dose of 0.5 mcg/kg appears to be a more effective option for managing haemodynamic responses compared to lignocaine. Nevertheless, the haemodynamic stability achieved with 0.25 mcg/kg of DEX is nearly equivalent to that observed with both 0.5 mcg/kg of DEX and 1.5 mg/kg of lignocaine.

Comparison of Surface Roughness of Class V Cavity Preparation using Diamond Abrasive Point and Ultrasonic Tip and Measurement of Shear Bond Strength after Restoration with Composite Resin: An In-vitro Study

Abhijit Ghosh, Priti D Desai, Ipsita Maity, Paromita Mazumdar Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Non Carious Cervical Lesions (NCCLs) represent a prevalent dental condition characterised by the erosion of tooth structure at the cementoenamel junction without the involvement of dental caries. These lesions pose significant challenges due to their aesthetic impact, potential for dentinal hypersensitivity, plaque accumulation, pulpal complications and compromised structural integrity of the teeth. Tooth preparation traditionally uses diamond abrasive points and tungsten carbide burs for micromechanical adhesion. Newer methods, like ultrasonic tips, offer a more conservative approach, but limited research has compared their effects on bond strength, particularly in cervical cavity restorations with nanohybrid composites. Aim: To compare the surface roughness of cervical cavity preparations utilising diamond abrasive points and ultrasonic tips, and to evaluate the shear bond strength of restorations with composite resin. Materials and Methods: The present in-vitro comparative study was conducted in the Department of Conservative Dentistry and Endodontics, Guru Nanak Institute of Dental Sciences and Research, Panihati, Kolkata, West Bengal, India, from October 2023 to December 2023. The study included 52 freshly extracted maxillary 1st premolar teeth extracted for orthodontic reasons. These teeth were divided into two groups: Group-I (n=26) underwent surface preparation using a diamond abrasive point (No. 835-012, Piranha, SS White, USA), while Group-II (n=26) was prepared using an ultrasonic tip (Woodpecker G 20, Guilin Woodpecker, China). Teeth were cleaned, disinfected and stored in 0.1% thymol solution before being prepared with diamond abrasive points or ultrasonic tips, following which the specimens were restored using nanohybrid composite material (Solare X, GC Corporation, Japan). Surface roughness was assessed using a digital profilometer before the restoration, and the shear bond strength of repaired specimens was measured with a Universal Testing Machine. Statistical analysis was performed using GraphPad Prism, with independent samples t-tests applied to compare results between groups, and a significance level set at 5%. Results: Group-I exhibited greater surface roughness (6.33±2.18 μm) compared to Group-II (4.91±1.57 μm). Group-I also showed higher shear bond strength (62±13 MPa) than Group-II (59.3±19.9 MPa), though this variation was not statistically significant (p-value=0.56). Conclusion: Within the present study’s limitations, diamond abrasive points created significantly greater surface roughness compared to ultrasonic tips. However, no statistically significant variations have been observed in shear bond strength among the two methods, suggesting that ultrasonic tips may be considered as an alternative to diamond abrasive points in clinical settings, avoiding their drawbacks while achieving adequate restoration retention.

Exploring Intraoral Photography: A Cross-sectional Analysis of Commercially Available versus Newly Designed and Patented Contraster using Self-designed Criteria

Srishti Jaiswal, Nimisha Chinmay Shah, Ajay Singh Rao, Rohan Jiteshkumar Doshi, Jash Mehta, Deebah Choudhary Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Intraoral photography is crucial in dentistry for documentation, communication and education. Contrasters play a pivotal role, influencing patient experience and image quality. Traditional metal contrasters have limitations regarding patient friendliness and procedural compatibility. Aim: To assess ease and comfort among patients and operators and to compare the contrasting ability of commercially available contrasters with newly designed contrasters in intraoral photography. Materials and Methods: A single-blinded, cross-sectional analytical study was conducted in the Department of Conservative and Endodontics and the Department of Orthodontics, KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from January 2024 to February 2024. After obtaining ethical approval, 50 patients with no pain, swelling, or discomfort in the maxillary anterior region, as well as, only those operators trained in intraoral Digital Single-lens Reflex (DSLR) photography, were enrolled. Following randomisation and standard camera settings, intraoral images were captured by 50 operators using both conventional metal and newly designed 3D-printed contrasters. Patients and operators evaluated ease, comfort, contrasting ability, and the presence of a palatal gap using self-designed criteria. The data were subjected to statistical analysis using International Business Machines (IBM) Statistical package for the Social Sciences (SPSS) software version 21.0. The Chi-square test of proportion was applied to evaluate differences in proportion, while the Mann-Whitney U test was used to compare the two contrasters. A confidence interval of 95% and p-value<0.05 were considered statistically significant. Results: The results revealed a statistically significant difference in discomfort and pain experienced by patients during the placement and removal of the contrasters between the conventional and newly designed groups (p-value<0.05). Similarly, operators reported significantly lower ease of placement and removal in the conventional group compared to the newly designed group (p-value<0.05). However, no statistically significant difference in contrasting ability was observed between the two groups (p-value>0.05). Conclusion: The newly designed contrasters demonstrated superior patient comfort and reduced pain compared to commercially available contrasters. Operators experienced easier placement with similar contrasting abilities.

Emerging Role of Photodynamic Therapy in Management of Periodontitis: A Systematic Review

Monali Shah, Sanyukta Chipre, Prasad Nadig, Suchit Dana Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Photodynamic Therapy (PDT) presents a non invasive avenue for treating various infections, including periodontal disease, offering an alternative to mechanical methods like scaling and root planing. Concerns about antibiotic resistance have fueled the exploration of PDT as an antimicrobial therapy. PDT combines low-power lasers with photosensitising drugs to eliminate microorganisms through the generation of cytotoxic reactive oxygen species upon light activation. Aim: To evaluate the scope of PDT and its role in periodontology. Materials and Methods: A comprehensive electronic search was conducted in major medical databases, including Google Scholar, PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Wiley. A total of 43 studies from 2007 to 2023 were selected, focusing on PDT for the treatment of periodontal disease. The review included Randomised Controlled Trials (RCTs), case-control studies, and cohort studies involving human subjects, using Photosensitisers (PSs) or Indocyanine Green (ICG) for subgingival irrigation in chronic periodontitis patients after scaling and root planing, with follow-ups extending over one month. The outcomes measured were Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), Plaque Index (PI), and Gingival Index (GI). Results: In present review, after thorough analysis, a total of 21 studies were selected from databases including Google Scholar, PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Wiley. The risk of bias assessment showed high-risk in 1 out of 128 studies (0.59%), low risk in 139 out of 168 studies (82.74%), and unclear risk in 28 out of 168 studies (16.67%). The results indicated significant clinical improvements when PDT was combined with conventional treatments. Conclusion: The PDT in periodontology showcases varied roles, from antimicrobial action to tissue healing and the promotion of periodontal health. Its efficacy as an adjunctive treatment, especially in challenging cases or against resistant microbes, is evident, accentuated by its non invasive nature and minimal adverse effects, making it an appealing option in periodontal care.

Role of Angiogenesis and Endothelial-mesenchymal Transition in Bone Marrow Fibrosis Associated with Haematopoietic Neoplasms: A Cross-sectional Immunohistochemical Analysis

Shweta Agarwal, Shruti Sharma, Monal Trisal, Zeeba S Jairajpuri, Sujala Kapur, Sumita Saluja, Purnima Paliwal Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: The bone marrow examination is an essential investigation in the diagnosis and management of many haematological disorders. The integration of all investigations, including peripheral blood analysis, bone marrow aspirate, and trephine biopsy findings, along with supplementary tests such as immunophenotyping, cytogenetic analysis, and molecular genetic studies, is crucial for arriving at a final diagnosis. Aim: To assess the presence of reticulin fibres in bone marrow biopsy sections in haematological malignancies, to evaluate the grade of BMF associated with haematological malignancies and to assess the role of angiogenesis using IHC markers in various haematological malignancies. Materials and Methods: A cross-sectional study was conducted in the Department of Pathology at the National Institute of Pathology, Safdarjung Hospital, New Delhi, India in 2009 for a duration of 18 months. Thirty-eight patients with a diagnosis of Acute Myeloid Leukaemia (AML), Acute Lymphoblastic Leukaemia (ALL), Chronic Myeloid Leukaemia (CML), and Chronic Lymphoproliferative Disorder (CLPD) were studied. Bone marrow biopsies were taken, fixed in 10% formalin, and decalcified in 10% Ethylene Diamine Tetraacetic Acid (EDTA). Routine paraffin embedding was performed, and serial sections of 4 μm were obtained on poly-L-lysine-coated slides for Immunohistochemistry (IHC) {Vimentin, Vascular Endothelial Growth Factor (VEGF), CD-34, Smooth Muscle Actin (SMA)}. The presence of reticulin fibres in the bone marrow biopsy sections was assessed using two special stains: Gomori’s Silver Impregnation and Masson’s Trichrome. Fibrosis was quantified according to the Baurmeister 0-4 grading system of Bone Marrow Fibrosis (BMF). Results: The results of the present study suggest that Endothelial to Mesenchymal Transition (EndMT) may play a role in the pathogenesis of BMF. Various grades of fibrosis were observed, with 15 cases (39.47%) in Grade 3, followed by 11 cases (28.95%) in Grade 2, 8 cases (21.05%) in Grade 1, and 4 cases (10.53%) in Grade 4. Conclusion: BMF was a significant finding even in the early stages of the majority of the lesions studied and was closely linked with angiogenesis. This study showed that angiogenesis plays an important role in the pathogenesis of haematological neoplasms and that VEGF is a prominent stimulus in the majority of these disorders. Additionally, this study suggests that EndMT has a possible role in the pathogenesis of BMF.

Analysing the Functional and Structural Impact of Single Nucleotide Polymorphisms in Matrix Metalloproteinase 3 Gene: An In-silico Approach

Rejitha Ramachandran, Saritha C Joseph, kc Sajeevan, Shajee S Nair Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Matrix Metalloproteinase 3 (MMP3) is a vital member of the MMP family, known for its wide range of substrate specificity and proteolytic activity against Extracellular Matrix (ECM) components. The role of functional polymorphisms in the MMP genes has been previously investigated in relation to cancer susceptibility, particularly breast cancer. Several Single-Nucleotide Polymorphisms (SNPs) in the MMP3 gene have been linked to a number of clinical illnesses, such as Coronary Artery Disease (CAD); however, the results were not entirely conclusive. Aim: To identify pathogenic missense SNPs in the human MMP3 gene and analyse their effects on structure and function. Materials and Methods: This was a record-based cross-sectional study performed using data retrieved from online resources. The analysis was conducted using a series of different bioinformatic tools, for which ethical clearance was obtained from the institution. The online tools used included Sorting Intolerant from Tolerant (SIFT), PolyPhen-2, PhD-SNP, PANTHER, PROVEAN, and SNPs and GO to predict harmful non synonymous SNPs (nsSNPs). Further analysis was performed using I-Mutant 2.0, MutPred2, Consurf, and HOPE software. These tools were able to filter out damaging SNPs and predict the impact of deleterious SNPs on the structure and function of the MMP3 protein. Results: This study predicted two potentially pathogenic SNPs (D175Y and Y116C) out of 443 missense SNPs from dbSNP, which is a database of SNPs available on the National Centre for Biotechnology Information website. Further analysis revealed that these SNPs were located in highly conserved regions and were predicted to decrease protein stability. Conclusion: In this study, two potentially pathogenic SNPs (D175Y and Y116C) were identified. Characterisation of these SNPs can help us gain a better understanding of the molecular basis of clinical conditions. The results of this study can be further validated by designing population-based studies and wet lab experiments. This will help in augmenting research and personalised medicine.

Change in Intraocular Pressure after Selective Laser Trabeculoplasty in North Indian Primary Open Angle Glaucoma Patients: A Prospective Analytical Study

Supriya M Buraniya, Piyush Kumar R Ramavat, Sarita Beri Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Glaucoma is the second leading cause of blindness in the world. The only known modifiable risk factor for the onset and progression of glaucoma is Intraocular Pressure (IOP). There are a limited number of studies documenting the IOP-lowering effect of Selective Laser Trabeculoplasty (SLT) in Primary Open Angle Glaucoma (POAG) patients, especially within the North Indian population. Understanding the effect of SLT on IOP reduction in this population is crucial for the proper management of glaucoma patients. Aim: To study the IOP-lowering effect of SLT in North Indian POAG patients (who had not achieved target IOP on two or more antiglaucoma drugs) after a period of six months. Materials and Methods: A hospital-based, single-arm, pre-post type of prospective analytical study was conducted at Lady Hardinge Medical College and associated hospitals in New Delhi, India, from January 2021 to June 2022. POAG patients aged 18 years or older, who had not achieved the target IOP while on two or more Antiglaucoma Medications (AGM), were given the option of treatment with SLT. A total of 33 eyes were considered for the study as per sample size calculations. Pre-SLT, IOP was recorded along with other baseline parameters. The SLT procedure was carried out according to the standard protocol. IOP was recorded during follow-ups at one week, one month, three months, and six months. The Friedman test was used to compare IOP values, with a significance level set at 0.05. Spearman correlation was employed to explore the correlation between baseline IOP and the change in IOP at six months. Results: A total of 33 eyes were included in the study. Of these, 28 (84.8%) eyes had advanced glaucoma, while 5 (15.2%) eyes had moderate glaucoma according to International Classification of Diseases, Tenth Revision (ICD-10) staging. Patients were on two or more commonly used AGMs, including prostaglandin analogues, beta blockers, alpha agonists, topical carbonic anhydrase inhibitors, and rho kinase inhibitors. The mean number of topical AGMs that patients were using was 3.03. The number and type of AGMs for each patient remained consistent pre and post-SLT throughout the study period. The mean IOP (baseline) was 16.39±2.73 mmHg, and after six months, the mean IOP was 13.86±1.99 mmHg. The mean IOP reduced by 2.53 mm Hg (15.44%). There was a strong negative correlation between baseline IOP and the change in IOP at six months, which was statistically significant (rho=-0.78, p-value<0.001). Conclusion: The present study indicates that SLT can be considered an adjunctive treatment for lowering IOP in North Indian POAG patients. A strong negative correlation was found between baseline IOP and IOP at six months post-SLT, suggesting that a higher reduction can be expected in patients with elevated baseline IOP.

Evaluation of Rate of Intrusion, Retraction and Amount of Periapical Root Resorption with Jayade’s Intrusion Arch versus Modified Three-piece Intrusion Arch using CBCT: A Research Protocol

Bulbul Manoj Baid, Ranjit Haridas Kamble, Vikrant Jadhav, Ruchika Pandey Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Deep bite, a common orthodontic malocclusion, necessitates timely intervention to prevent potential side-effects. If left untreated, a deep bite can lead to increased tooth wear, dental injuries, and Temporomandibular Joint (TMJ) disorders. Various treatment modalities, such as anterior teeth intrusion and posterior teeth extrusion, are employed to correct deep bite. However, selecting the optimal approach requires careful consideration of patient-specific factors and treatment objectives. While anterior teeth intrusion is effective for mild to moderate cases, posterior teeth extrusion may be preferred in severe deep bite scenarios. There are various treatment modalities for deep bite correction such as intrusion arches and mini screw implants. Jayade’s intrusion arch, detailed by A.V. Jayade in “Refined Begg for Modern Times” (2001), is an orthodontic appliance designed to correct vertical dental misalignments by intruding over-erupted anterior teeth. The modified three-piece intrusion arch is an advancement of the traditional intrusion arch technique. It incorporates three distinct segments: two lateral segments and a central segment. This design allows for greater precision and control over the intrusion forces applied to specific teeth or groups of teeth. Need of the Study: Simultaneous intrusion and retraction mechanics in orthodontic treatment are very challenging, and there is a paucity of data regarding the best modalities for achieving these with minimal root resorption. Aim: Comparative evaluation of the rate of intrusion, retraction and amount of periapical root resorption with Jayade’s intrusion arch and the modified three-piece intrusion arch using Cone Beam Computed Tomography (CBCT). Materials and Methods: The present prospective, two-arm parallel interventional study will be conducted in the Department of Orthodontics and Dentofacial Orthopaedics Outpatient Department, Sharad Pawar Dental College, Sawangi (Meghe), Wardha, Maharashtra, India, from September 2024 to February 2026. Study will involve the recruitment of 20 patients and all these patients will be divided into two groups for comparative analysis. The intervention will entail the use of the McLaughlin, Bennett and Trevisi (MBT) bracket system equipped with triple tubes on maxillary teeth, characterised by a slot dimension of 0.022 inches by 0.028 inches, as the standardised starting point for all cases. After initial alignment and leveling, and extractions as per the case, the intrusion arch will be applied. Jayade’s intrusion arch will be given in group A, while the modified three-piece intrusion arch will be given in group B. The assessment of intrusion rate, retraction rate and amount of root resorption will be conducted both prior to the initiation of intrusive and retractive forces, as well as, at intervals of two, four and six months following the application of the intrusion arches.

Recent Advances in Non Surgical Rehabilitation Approaches for Medial Collateral Ligament Injuries: A Narrative Review

Muneesh Chauhan, Rituraj Verma, Shahiduz Zafar, Shagun Agarwal, Abdur Raheem Khan Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X The Medial Collateral Ligament (MCL) is frequently injured, particularly in athletes involved in contact sports. Recent advancements in non surgical rehabilitation have shown promise in effectively treating MCL injuries, thereby avoiding the risks associated with surgical interventions. Cryotherapy remains the cornerstone of non surgical MCL rehabilitation, significantly reducing pain and inflammation. Ultrasound therapy has shown potential in promoting tissue healing and improving the range of motion. Low-level Laser Therapy (LLLT) and shockwave therapy have emerged as effective modalities for enhancing tissue repair and providing pain relief. Bracing plays a crucial role in providing stability and support, aiding the controlled rehabilitation process. Therapeutic exercises targeting the quadriceps and hamstrings are integral to restoring strength, flexibility and stability, thus facilitating the healing process. Despite these advancements, gaps remain in optimising the combinations and timing of these modalities. Future research should focus on comparing different rehabilitation protocols, evaluating long-term outcomes and exploring their cost-effectiveness. This review underscores the importance of non surgical rehabilitation in achieving favourable outcomes for MCL injuries, contributing to the growing body of evidence supporting these approaches.

Conceptual Study of Balgrahas (Microbes) in Kaumarbhritya: A Narrative Review

Riya Rajendra Rathor, Renu Bharat Rathi, Shruti Prakash Kapatkar Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Ayurveda is a time-tested science that systematically explains its concepts through eight branches. Grahas Chikitsa (Ayurvedic treatment of microbes) is one of these branches, and it is well-explained in the texts. “Graha” refers to a tiny, invisible living organism that may undergo several stages of development and can be pathogenic or antigenic to the body. Microorganisms can cause generalised pathogenic alterations in the body that affect multiple systems, similar to the concept of Grahas. This suggests a deeper understanding of microbes in relation to Grahas. This review paper aims to explore the age-old concept of Balgrahas (microbes) and its relevance in modern times. The review was conducted using published articles on paediatric disorders, electronic databases, textbooks on paediatrics, and traditional Ayurvedic writings related to Kauamarbhritya (Paediatrics). A distinguishing feature of this study is its compilation of information on Balgraha from classical texts, covering clinical characteristics, causal factors, and various internal and external treatments. It also discusses Ayurvedic treatment modalities such as Daiva Vyapashraya Chikitsa (Spiritual therapy) and Yukti Vyapashraya Chikitsa (Rational therapy). In this review, authors discussed several formulations for treating conditions associated with Balgraha (microbes) that have not been detailed in previous studies. Additionally, some Shodhan karma (Detoxification) procedures that are particularly recommended for both children and nursing mothers are also highlighted.

Exploring Biomarkers in Gestational Diabetes Mellitus: A Comprehensive Review

Dhivya Senthil Kumar, Sathya Selvarajan, KS Rajeswari Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Gestational Diabetes Mellitus (GDM) is a common complication during pregnancy, typically diagnosed in the second or third trimester. Factors such as advanced maternal age, obesity and a sedentary lifestyle contribute to its prevalence. The pathophysiology involves insulin resistance, β-cell dysfunction, gluconeogenesis, adipose tissue dysfunction, gut microbiota dysbiosis and oxidative stress. GDM is associated with maternal and neonatal complications, both short-term and long-term. Managing GDM requires interventions such as medication, dietary adjustments and regular physical activity. However, early detection in low-risk populations remains challenging. The Oral Glucose Tolerance Test (OGTT) is the gold standard for diagnosis but is limited by its inconvenience and reliance on multiple blood samples. The present review focuses on novel biomarkers for early and accurate GDM diagnosis. It discusses emerging biomarkers such as vitamin D, vitamin B9, vitamin B12, preptin, angiopoietin-like protein 8, adiponectin, chemerin, omentin-1, leptin, Interleukin-6 (IL-6), homocysteine, C-peptide, irisin, adropin, nesfatin-1, Afamin, fetuin A, amylin, galectin, osteocalcin, resistin, visfatin and Fatty Acid-binding Protein 4 (FABP4). The review explores the pathophysiology of these biomarkers in GDM and presents preliminary study findings.

A Narrative Review on Nutritional Strategies for Ultra-endurance Cyclists: Emphasising Requirements for Brevet de Randonneurs Events in India

Harpreet Kour, Shrihari L Kulkarni Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Ultra-endurance cycling, particularly in events such as the Brevet de Randonneurs Mondiaux (BRMs), demands exceptional physical exertion and sustained energy management. In India, BRMs events, which span distances of 200 to 1000 kilometres, pose unique challenges for cyclists, necessitating prolonged physical preparation and consistent performance under demanding conditions. Nutrition plays a critical role in optimising energy availability, enhancing recovery and sustaining performance throughout these events. Despite the wealth of information available through social media, there remains a significant gap in scientifically grounded nutritional guidance specifically tailored to ultra-endurance cyclists. The aim of the present narrative review is to highlight the critical nutritional requirements and strategies essential for ultra-endurance cyclists participating in BRMs events. The review emphasises the need for evidence-based dietary practices to support optimal performance and recovery while addressing the current gap in scientific understanding. It also provides practical, research-informed nutritional guidance for athletes involved in these ultra-endurance events. Pre-event preparation focuses on carbohydrate loading, hydration and balanced nutrition to maximise glycogen stores and ensure optimal hydration. During the event, continuous carbohydrate intake, electrolyte replenishment and hydration are critical for maintaining energy levels and preventing dehydration. Post-event recovery emphasises protein consumption for muscle repair, glycogen replenishment and rehydration. The findings underscore the importance of tailored nutritional strategies for ultra-endurance cyclists to achieve optimal performance and recovery. Despite the abundance of general information available, there is a clear need for more research-based, practical nutritional guidelines specifically for ultra-endurance cycling. Future research should address this gap to provide athletes with evidence-based recommendations that support their unique nutritional needs.

A Narrative Review on Confocal Laser Scanning Microscopy: Principle, Applications, Advancements and Challenges

Bhagyashri Patil-Takbhate, Srikanth Prasad Tripathy, Shakila Harshavardhan Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Confocal Laser Scanning Microscopy (CLSM) is an advanced imaging technique used in various fields. It offers several advantages over conventional microscopy due to its high resolution and ability to collect three-dimensional data using optical sectioning. While the resolution in confocal microscopy is comparatively lower than that of electron microscopy, it has effectively bridged the gap between these two imaging techniques. In the medical field, CLSM has a wide range of applications, including the diagnosis and treatment of corneal diseases, the study of biofilms and the diagnosis of various types of cancers, as well as the viral pathogenic cycle, including that of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). CLSM is also beneficial in food technology. The present review synthesises the current knowledge on CLSM, encompassing its applications, technological advancements and limitations. A comprehensive search of relevant databases identified studies and articles published by September 2023. The findings highlight CLSM’s versatility, with applications ranging from cell biology to materials science, while also addressing technical challenges and future prospects.

Exploring the Depths of Cryptic Aspergillosis: Species Variability, Clinical Spectrum, Diagnostic Quandaries and Therapeutic Options

Almas Fathima Upaisal, Anupma Jyoti Kindo Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Cryptic aspergillosis, characterised by infections caused by non classical Aspergillus species, presents unique challenges in clinical management due to species variability, diverse clinical manifestations, diagnostic complexities, and limited treatment options. This comprehensive review explores the emerging understanding of cryptic aspergillosis, highlighting the spectrum of clinical presentations across different species, diagnostic dilemmas in accurate species identification, and evolving treatment paradigms. Cryptic species, including A. lentulus, A. udagawae, A. calidoustus, and others, exhibit intrinsic resistance to commonly utilised antifungal agents, complicating therapeutic approaches. The diagnostic landscape is further complicated by phenotypic and genotypic similarities with classical Aspergillus species, necessitating advanced molecular techniques for precise identification. Treatment alternatives are limited, with azoles, echinocandins, and polyenes demonstrating variable efficacy against different cryptic species. Emerging antifungal agents, like fosmanogepix, ibrexafungerp, and rezafungin, hold promise in addressing resistance challenges. This review underscores the need for a multidisciplinary approach integrating clinical, microbiological, and molecular expertise to optimise the management of cryptic aspergillosis and improve patient outcomes.

Touch Imprint Cytology in Oral Cancer Diagnosis: A Narrative Review

Shradha Jaiswal, Sumiran Sinha, Bhupesh Bagulkar, Atul Bhat, Rupa Sharma Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Touch Imprint Cytology (TIC) is a simple, economical, and cost-effective method that can be used as a rapid tool for tissue diagnosis. It has been used for the intraoperative diagnosis of cancer, evaluation of surgical cut margins, evaluation of sentinel lymph nodes, diagnosis of head and neck lesions, and postmortem diagnosis. Intraoperative diagnosis includes both frozen section and TIC, which provide rapid pathological consultation. Brush biopsy can also be used for cytological diagnosis and acts as an adjunct to histopathological and TIC diagnosis. It has been found that TIC yields satisfactory and adequate material for diagnosis, allowing early counselling and preparation of the patient for further processes without having to wait for the results of histopathology. As technology continues to evolve, ongoing research aims to enhance the utility and accuracy of TIC in oral cancer diagnosis. Advancements in imaging techniques, such as confocal microscopy and molecular analysis of TIC samples, hold promise for improving diagnostic sensitivity and specificity.

Sterilisation of Dental Implant Surgical Instruments, Office Area and Implant Components: A Narrative Review

Deepesh Kumar Gupta, K Seethal, Jenifer Kerketta, Mahendra Kumar Anant, Sravani Vattigunta Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Implant surgical procedures require meticulous attention to sterilisation protocols to prevent infections and ensure successful outcomes. Various sterilisation methods, such as steam sterilisation, ethylene oxide sterilisation and hydrogen peroxide plasma sterilisation, are commonly used in healthcare facilities. Each method has its advantages and limitations and the selection of a sterilisation method depends on factors such as the type of implant material, instrument design and compatibility with the sterilisation process. Proper handling, packaging and storage of implant surgical components and instruments are essential to maintain their sterility until they are used. Healthcare facilities must follow standardised protocols and guidelines to ensure the effective sterilisation of implant surgical components and instruments, ultimately reducing the risk of infections and improving patient outcomes. Controversies exist regarding the reusability of healing abutments, with some advocating for single-use only to reduce the risk of contamination, while others argue for reusability under stringent sterilisation protocols. Further research is needed to establish clear guidelines on the reuse of healing abutments in implant surgery. The sterilisation of implant surgical components and instruments is a critical aspect of implant surgery that requires careful consideration of sterilisation methods and adherence to established protocols. Addressing the controversies surrounding the reusability of certain components, such as healing abutments, is essential to ensure patient safety and improve surgical outcomes.

A Narrative Review on Brain Gym Exercises: An Asset in Alleviating Insomnia and Augmenting Cognitive Functioning

Vaishnavi Mukund Thakre, Mitushi Deshmukh Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Insomnia is characterised primarily by difficulties with beginning or sustaining sleep, dissatisfaction with sleep duration and quality and significant discomfort and deficits in daytime activities. Females, elderly individuals and individuals experiencing socioeconomic hardships are prone to sleeplessness. Despite its widespread incidence and burden, the pathophysiology and aetiology of insomnia remain unclear. It also impacts cognition, mood, focus, healing and exhaustion. Psychological and medical conditions can cause insomnia. Non pharmacological treatments for this condition include Cognitive Behavioural Therapy for Insomnia (CBTI), acupressure, meditation and yoga. Brain gym exercise is an evolving therapeutic approach to alleviate insomnia. By engaging in brain gym exercises, individuals may experience improvements in their sleep patterns, leading to better overall sleep quality and duration and may experience enhancements in their ability to think, learn and perform cognitive tasks effectively. The review concludes that incorporating brain gym exercises offers notable benefits for both insomnia and cognitive functioning.

Therapeutic Potential of Centella asiatica Linn in Oral Submucous Fibrosis: A Short Communication

Pallavi Prakash Channe, Avinash Kharat Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Oral Submucous Fibrosis (OSMF) is a chronic progressive disease characterised by fibrosis of the oral mucosa, leading to restricted mouth opening and difficulties in speech and swallowing. Modern science has explored a variety of surgical and medicinal therapy approaches, but the outcomes are often unsatisfactory due to recurrence, side effects, and, at times, a worsening of the condition due to fibrosis. Adjuvant therapies, especially antifibrotic herbs, are urgently needed for better treatment outcomes in OSMF. Centella asiatica Linn, also known as Indian pennywort or Asiatic pennywort, has shown potential therapeutic benefits in the treatment of OSMF. This short communication summarises studies indicating that Centella asiatica Linn has the potential to act as an antifibrotic agent, as it downregulated most fibrotic markers in both in-vivo and in-vitro set-up.

Past, Present and Future Perspective of Artificial Intelligence in Healthcare and Nanotechnology: A Communication

Mansi Jain, Sakshi Vats, Chhavi Pahwa, Aksh Chahal, Kamran Ali Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Artificial Intelligence (AI) is an emerging technology that has the potential to impact all professions, including medicine and medical education. Over the last decade, there has been a multiple-fold increase in the use of AI tools in medical allied sciences and rehabilitation, as well as in nanotechnology research. This paper highlighted some of the AI-based outcomes in bioengineering, neuroscience, and related disciplines. In addition, current trends and future perspectives of AI-based applications will also be discussed. Consequently, fundamental concepts in AI, its contributions, and the promise of nanotechnology coupled with AI will be summarised.

A Case of Celiac Disease with Pericardial Effusion

Yogesh Kautikrao Kakde, Shilpa Abhay Gaidhane, Sourya Acharya, Sunil Kumar, Shubham Nimkar Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Celiac disease is a unique enteropathic immune disorder and is now considered a distinct disease entity with protein manifestation and worldwide distribution. The deposition of immune complexes in the small intestine could be a possible reason for the extraintestinal autoimmune manifestations of Celiac disease. Pericardial effusion, though rare in adults, is likely a result of these autoimmune disorders related to Celiac disease. In present study case report, the authors present the case of a 67-year-old female patient with generalised oedema, anasarca, and pitting oedema in the lower extremities. Due to multiple episodes of vomiting, upper gastrointestinal endoscopy was performed, which revealed atrophic duodenal mucosa, and duodenal biopsies were taken from the second part of the duodenum (D2 biopsies). The possibility of Celiac disease was considered, and anti-deamidated gliadin peptide, Immunoglobulin A (IgA), and Immunoglobulin G (IgG) antibodies were sent. Celiac disease was diagnosed based on elevated serum levels of anti-deamidated gliadin peptide, IgA, and IgG antibodies, as well as histologic findings in the small bowel (duodenal biopsies D2). During the thorough evaluation, pericardial effusion was incidentally detected. Celiac disease is an autoimmune disorder in which exposure to gluten triggers inflammation in genetically predisposed individuals. The illness is estimated to have a prevalence of 2%, and most affected people remain undiagnosed. Pericardial effusion is a possible manifestation of Celiac disease, but there is currently no evidence that the disease directly causes the effusion.

Enterobius vermicularis in Immunocompromised Patients: A Case Report

Sangitha Jayagandan, Oudhaya Kumaran, Nonika Rajkumari Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X One of the most prevalent nematode infections globally is Enterobius vermicularis, commonly known as pinworm. This infection is often seen among children living in poor socioeconomic conditions, in overcrowded households, and in immunocompromised patients with uncontrolled diabetes, hypertension, long-term steroid therapy, and other related issues. With treatment, the cure rate is between 90 to 95%. However, reinfection is frequent, particularly in cases where contacts are not treated concurrently. Hereby, the authors present a case report of two male patients (58 and 40 year-old) with uncontrolled diabetes mellitus who presented with pinworm infections in unconventional sites. Enterobius vermicularis can manifest in uncommon locations such as the caecum, the appendix, and other visceral organs of the abdomen, including the uterine endometrium. These atypical presentations can lead to more serious complications, such as granuloma and abscess formation, which may even result in infertility. Although pinworm infection is typically considered a childhood disease, immunosuppressed adults are also susceptible.

Efficacy of Novel PRP Loop versus Opus Loop for Anterior En-Masse Retraction in Angle’s Class I Dewey’s Type 2 Malocclusion: A Randomised Clinical Trial Protocol

Krushnali N Kolhatkar, Priyanka Niranjane, Pallavi Daigavane, Kushal Taori Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Optimal space closure is a pivotal aspect of orthodontic treatment, particularly challenging in patients with bimaxillary protrusions and Angle’s class II division 1 malocclusion. Two primary methods, friction, and frictionless mechanisms, are employed for anterior teeth retraction. However, concerns over prolonged treatment duration and increased anchorage demands have prompted exploration into non-frictional approaches. Biomechanical properties significantly influence the efficacy of retraction loops, with ideal loops exhibiting high Moment-to-Force (M/F) ratios and low Force-to-Deflection (F/D) ratios. The “PRP loop” was developed inspired by existing designs, showing promising biomechanical characteristics in a finite element study. However, its clinical efficacy remains unexplored. Need of the study: More research is required to assess the clinical efficacy of the recently created PRP loop in promoting retraction. This trial attempts to evaluate the effectiveness of the PRP loop compared to current techniques, focusing on attaining effective anterior en-masse retraction. Through an analysis of the benefits and limitations of both methods, the research aims to shed light on which loop provides the best space closure. Aim: This study aims to evaluate and compare the PRP loop with the Opus loop for anterior en-masse retraction in Angle’s class I Dewey’s Type 2 malocclusion. Materials and Methods: A prospective single-blinded randomised clinical trial will be conducted in the Department of Orthodontics and Dentofacial Orthopedics at Sharad Pawar Dental College and Hospital, Sawangi, Wardha, Maharastra from September 2024 to April 2026. Thirty patients between the age of 15-30 years having Angle’s Class I Dewey’s type 2 malocclusion requiring maxillary premolar extraction will be included and divided into two groups (PRP and Opus loop groups) with the exclusion of Angle’s Class II and III cases. Treatment procedures include initial alignment, maxillary premolar extractions, and retraction using respective loops. Evaluation criteria encompass retraction rate, efficacy, and anchorage loss measured through study models and radiographic assessments. Statistical analysis will employ Student’s paired and unpaired t-test and Chi-square test with GraphPad Prism 7.0 and SPSS 27.0 software and a significance level of p<0.05.

Evaluation of Bruhaniya Effects of Kushmanda Granules and Ashwagandha Granules in Karshya: A Randomised Controlled Trial Protocol

Pankaj Yadav, Vaishali Kuchewar, Tanika Yadav, Twinkle Joshi Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: Ayurveda asserts that a healthy diet can prevent many health issues. Food is essential as a source of nutrition and possesses significant medicinal value. Nutritional deficiencies, often referred to as undernutrition, arise from insufficient dietary intake. Karshya is a condition in which an individual's body becomes emaciated, characterised by a reduced quantity of rasa dhatu, leading to a state of Mamsahinata or Manskshaya. Need for the Study: Many individuals experience a lack of confidence and depression due to their emaciated condition. Various nutritional and bulk-promoting products available in the market are often very costly. Ashwagandha is commonly used by Ayurveda practitioners for its Bruhan effect. Although Kushmanda is mentioned as Bruhaniya in the Bhavaprakash Nighantu, there have been very few studies conducted on it. Since Kushmanda is more economical than Ashwagandha, research is needed to explore this cost-effective bulk-promoting medicine. Aim: To conduct a comparative evaluation of the Bruhaniya (bulk-promoting) effects of Kushmanda granules (Benincasa hispida) and Ashwagandha granules (Withania Somnifera Linn.) in cases of Karshya (Undernutrition). Materials and Methods: A single-blinded, randomised controlled trial will be conducted at the Department of Kayachikitsa, Mahatma Gandhi Ayurveda College Hospital and Research Centre (MGACHRC), Salad Hirapur (H), Maharashtra, India, from October 2023 to September 2024. A total of 60 subjects will be divided into two groups for the present study, with 30 subjects in each group. In Group A, Trikatu Churna will be administered in doses of 2 grams once a day with lukewarm water for the first seven days, followed by Ashwagandha granules in doses of 10 grams with milk twice a day for 90 days. In Group B, 2 grams of Trikatu Churna will be given once a day with lukewarm water for the first seven days, followed by Kushmanda granules in doses of 10 grams with milk twice a day for 90 days. Assessments will be made on the 0, 30th, 60th, and 90th days. The assessment will be based on improvements in body weight, Body Mass Index (BMI), and arm and waist circumference. Statistical analysis will be performed using Statistical Package for the Social Sciences (SPSS) version 22.0, and the statistical tests applied will include the Chi-square test, Wilcoxon’s rank sum test, and Wilcoxon’s signed rank test, with a significance level set at 0.05.

Comparative Evaluation of Rasa (Taste), Phytochemical Characterisation, HPTLC Fingerprinting and Antioxidant Activity of Taruni peya (Modified Rose Tea) Brewed using Five Methods: A Research Protocol

Shivani Durgadas Darje, Dattatray Sarvade Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Introduction: A “rose” is usually a flowering shrub of the genus Rosa that has thorny stems and fragrant blooms. Humans have been using roses and their preparations since ages for health benefits. Rose tea is an infusion prepared from rose buds and petals that is popular for its mild flavour and possible health benefits, including its antioxidant content. It can be drunk as a hot or cold infusion. Need of the Study: No research has been done to date on the effects of brewing procedures on Rasa, phytochemical characterisation, High-performance Thin-layer Chromatography (HPTLC) fingerprinting, and the antioxidant properties of modified rose tea. A new field for standardising the brewing process for beverages like modified rose tea will be made possible by the study of these factors. Aim: To evaluate of Rasa (taste), phytochemical characterisation, HPTLC fingerprinting, and antioxidant activity of Taruni peya {Modified Rose (Rosa centifolia Linn.) tea} prepared by five different brewing methods. Materials and Methods: An experimental study will be conducted in the Department of Dravyaguna Vigyan, Mahatma Gandhi Ayurved College and Hospital and Research Centre (MGACH and RC), Salod, Wardha, Maharashtra, India, from April 2024 to June 2025. Roses (Rosa centifolia Linn.) will be collected from the natural habitat of the plant. The plant material will be authenticated and identified from Foundation for Revitalisation of Local Health Traditions (FRLHT), Bengaluru, Botanical Survey of India (BSI), or the Botany Department or by an authorised person of the Dravyaguna (Pharmacology) Department. Rasa Nirdharana (Taste) of the samples will be analysed using parameters mentioned in Samhitas. Charaka, Sushruta, and other acharyas, have described the method of the perception and determination of taste by putting a substance on the tongue in which the Rasa perceived soon after the substance comes in contact with the tongue is called Rasa. Standard Pharmacognostical character and phytochemical characterisation will be performed on all samples using standard methods like macroscopy-microscopy and HPTLC fingerprinting will be studied as given in Ayurvedic Pharmacopoeia of India. Antioxidant properties will be studied by using 2, 2-diphenyl-1-picrylhydrazyl (DPPH), Ferric ion Reducing Antioxidant Potential (FRAP), and phosphomolybdenum assay. Analysis of Variance (ANOVA) test will be used for statistical analysis with a level of significance at p-value<0.05.

Resilience of Social Workers in India: Are They Surviving or Thriving?

Rajendra Devkar, Payal Waghmare Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Dear Editor, As dedicated social workers deeply invest in the wellbeing of individuals and communities in India, authors write to shed light on a critical issue faced in our profession: resilience, or the lack thereof. While resilience is widely acknowledged as a crucial attribute for navigating the challenges inherent in social work-particularly in a country as diverse and complex as India-it is evident that many social workers in our midst are struggling to uphold this principle in their daily lives. The demands placed on social workers in India are immense, ranging from addressing poverty, inequality, and discrimination to providing support for mental health issues, domestic violence, and child welfare. Yet, amidst these challenges, the concept of selfcare and resilience often takes a backseat, resulting in high levels of burnout, stress, and attrition within the profession (1). When it comes to anxiety, a study from Ireland reported that 30.6% of social workers scored in the mild range, 26.5% in the moderate range, and 10.7% in the severe category (2). Another Indian study on stress and anxiety levels in social work students reported that first-year students who had just been admitted experienced higher levels of stress and anxiety, with moderate levels in second-year students, whereas the highest levels were observed in third-year students (3). Most social workers work for Non Governmental Organisations (NGOs) at local, national, or global levels. Workplace policies usually tend to be vague and arbitrary. Low pay scales and frequent employer whims are two major issues regarding employment. Tasks and activities, as opposed to set, preset daily hours, dictate working hours. The job description is frequently vague, and social workers may be expected to carry out duties that fall entirely outside the scope of their training (4).

Efficacy of Nirgundi Lepa in the Management of Vatakantaka (Plantar Fasciitis): A Case Series

Yogesh Yadav, Sheetal Asutkar Journal of clinical and diagnostic research : 2024 - November - 18:0973-709X Plantar fasciitis, or Vatakantaka, is a common cause of heel pain characterised by inflammation and swelling in the plantar fascia, leading to discomfort. Standard treatments often yield poor results, which has motivated research into new therapies. The present case series includes 10 patients (five males and five females) with plantar fasciitis who were treated with a topical application of Nirgundi Lepa twice a day for four weeks. Pain levels were assessed using the Visual Analogue Scale (VAS), and foot function was evaluated with the Foot Function Index (FFI) at baseline, two weeks after treatment, and at the conclusion of the study. Nirgundi Lepa was applied to the feet of both limbs, resulting in a reduction in pain and an improvement in foot function. VAS scores decreased by an average of 65%, and the FFI-related symptom improvement rate increased to 55%. The therapeutic effects observed during the follow-up period were sustained, with minimal recurrence of symptoms. The present case series illustrates the utility of Nirgundi Lepa in patients with plantar fasciitis, positioning it as an effective non surgical modality for managing heel pain. Further research is needed to confirm these results and assess their value in clinical practice.