Table of Contents : Journal of clinical and diagnostic research : 2025 - March - 19

A Case of Severe Methotrexate Toxicity: Clinical Insights and Management

Pradnya Diggikar, Bhavya Sri Yammanaru, Tushar Pancholi, Manosri Mandadi, R Janani Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Methotrexate (MTX), first synthesised in 1947, originated as a derivative of aminopterin, a medication initially used to treat acute leukaemia in children. It shares similar properties with aminopterin and has since demonstrated remarkable efficacy in managing a wide array of complex dermatological and rheumatological conditions. Despite its therapeutic benefits, MTX toxicity, though rare, can lead to severe and potentially fatal consequences. This case report describes a 62-year-old male who developed erythematous lesions over his scalp, face, upper limbs, and torso following an excessive intake of MTX (120 mg/week for one month). The patient exhibited symptoms consistent with severe MTX toxicity, including mucositis, pancytopenia, and neutropenic sepsis. Despite timely initiation of leucovorin rescue therapy, intravenous hydration, urine alkalinisation, and aggressive management of neutropenic sepsis the patient’s condition deteriorated. Respiratory support was provided, but he ultimately succumbed to multi-organ dysfunction, underscoring the challenges associated with managing High-Dose MTX (HDMTX) toxicity. This report highlights the mechanisms of MTX toxicity, including its impact on folate metabolism and cell division, resulting in widespread tissue damage and immunosuppression. It emphasises the critical need for early recognition of toxicity symptoms, such as mucositis and bone marrow suppression, to promptly initiate life-saving interventions. Furthermore, it underscores the importance of patient education on MTX dosing and monitoring to prevent such adverse outcomes, illustrating the necessity for vigilant clinical management in patients receiving MTX therapy.

Alloplastic Reconstruction in Post-ablation Oral Squamous Cell Carcinoma Surgery: A Case Report

Tikeshwari Kailas Gurav, Shreeya Pawar, Chetan Gupta, Nitin Bhola, Vikrant Jadhav Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Surgical management of Oral Squamous Cell Carcinoma (OSCC) leads to ablative defects. There are various reconstructive options for these defects, such as autogenous grafts from the patient, including local flaps, regional flaps and distant flaps. Harvesting these flaps to reconstruct the defects can cause a significant amount of morbidity. The use of alloplasts in the reconstruction of the head and neck can reduce this morbidity at the donor site and decrease the surgical time required for flap harvesting. The present case of a 45-year-old female patient presented a microinvasive squamous cell carcinoma in whom an alloplast was used to restore the ablative defect following excision. This case report demonstrates the innovative application of alloplastic materials in surgery, eliminating the need for harvesting autologous grafts and minimising pain, recovery time and complications for patients postsurgery. This method reduces operating time, enhances patient outcomes and is flexible enough to meet various clinical requirements. The present case study highlights the challenges of restoring shape and function while considering aesthetic concerns by examining a cutting-edge alloplastic reconstruction procedure used in a patient following OSCC ablation. The surgical technique, materials utilised and results obtained after surgery are described herein, illustrating how alloplastic techniques can successfully overcome the drawbacks of conventional reconstructive methods. The results suggest that, in the context of OSCC, alloplastic reconstruction can improve surgical outcomes and enhance the patient’s quality of life with proper planning and implementation. This instance emphasises the importance of customised treatment programs and the potential of advanced reconstructive methods to address the specific challenges posed by oral cavity abnormalities.

Ileal Neuroendocrine Tumour of Carcinoid Type 1: A Case Report

Saurabh Gawand, Rajesh Gattani, Arvind Chava, Suhit Naseri, Apoorva Pande Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Carcinoid tumours are uncommon neuroendocrine growths known for their slow growth, often remaining asymptomatic until they metastasise or cause carcinoid syndrome. Recent studies suggest that their incidence is increasing, challenging their previous perception as benign and highlighting their potential for malignancy. These tumours originate from different parts of the gastrointestinal tract during embryonic development. Foregut carcinoids typically originate in the lungs, bronchi, or stomach; midgut carcinoids arise in the small intestine, appendix, or upper large bowel; and hindgut carcinoids develop in the lower colon or rectum. Carcinoid syndrome, a rare complication, is most commonly associated with midgut carcinoid tumours. The diagnosis of carcinoid tumours frequently occurs unexpectedly during unrelated surgical procedures. The choice of treatment and the prognosis are influenced by where the tumour is located and the extent of metastasis identified at the time of diagnosis. The present case is a case of a 65-year-old female with a major complaint of abdominal pain that had been progressive in nature for 2.5 years. She had a positive history of leprosy and tuberculosis. The diagnosis was confirmed by Contrast Enhanced Computed Tomography (CECT) and she was managed by exploratory laparotomy with ileocolic anastomosis.

Anaesthetic Challenges in Pulmonary Alveolar Proteinosis: A Rare Case Report

Dasara Nongbet, Priyanka Dev, Vijay Noel Nongpiur, John Muchahary, Pranjal Kalita Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Pulmonary Alveolar Proteinosis (PAP) is a rare pulmonary disease characterised by the accumulation of surfactant within the alveoli, leading to impaired gas exchange. This case involves a 31-year-old male presenting with shortness of breath. Fine crackles were heard on auscultation, raising the suspicion of alveolar involvement. High-Resolution Computed Tomography (HRCT) of the chest revealed a “crazy paving” pattern in the bilateral lung parenchyma, a hallmark imaging finding in PAP. Histopathological analysis confirmed the diagnosis, showing alveoli filled with granular, eosinophilic, Periodic Acid Schiff (PAS)-positive material, indicative of surfactant accumulation. The patient was scheduled for Whole Lung Lavage (WLL), the standard therapeutic procedure for PAP, under General Anaesthesia (GA). A Double-lumen Endotracheal Tube (DLT) was employed to facilitate isolation of each lung, ensuring effective lavage of the affected lung while maintaining ventilation in the other. This case highlights the importance of a multidisciplinary approach, integrating clinical evaluation, advanced imaging, histopathology and specialised anaesthetic techniques in managing rare conditions like PAP. This comprehensive strategy aims to restore alveolar function and improve the patient’s respiratory status, underscoring the critical role of timely diagnosis and intervention in rare pulmonary disorders.

Hairy Cell Leukaemia with Leucocytosis: A Rare Case Report with Review of Literature

Ruchi Agarwal, Parul, Monika Gupta, Sunita Singh, Sunaina Hooda Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Hairy Cell Leukaemia (HCL) is an uncommon disease that accounts for 2% of all lymphoid leukaemias. It is characterised by the proliferation of lymphoid cells with abundant cytoplasm with circumferential fine hairy projections involving the peripheral blood, Bone Marrow (BM), and expanding splenic red pulp. A 50-year-old male presented to the medicine outpatient department with a history of weakness and breathlessness for three days hampering his daily chores. There was no history of any other chronic illness. The review of the peripheral blood smear demonstrated marked leucocytosis showing lymphocytosis. Some of these lymphocytes displayed hairy cytoplasmic projections. Red blood cells showed a dimorphic blood picture. BM aspiration was performed which was insufficient for opinion. BM cell block revealed mononuclear cells with perinuclear clearing giving a fried egg appearance. BM biopsy revealed a predominance of mononuclear cells with round nuclei suggestive of lymphoid cells. These cells showed an interstitial pattern of infiltration. Clear zones are seen around the nucleus (fried egg appearance). A diagnosis of lymphoproliferative disorder with the closest resemblance to HCL was made which was confirmed on Flow Cytometry (FCM) with these lymphoid cells showing positivity for CD45, CD20, CD25, and CD123. HCL with leukocytosis is relatively a rare presentation. Immunophenotyping plays a crucial role in making its diagnosis.

Tubercular Intramuscular Abscess Mimicking Lumbar Hernia: A Rare Case Report

Abhiram Chadive, Rajesh Gattani, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Tuberculosis (TB) is a worldwide health concern. Although pulmonary TB is common, extrapulmonary TB, such as infections of the musculoskeletal system, poses diagnostic challenges. The present report details a case of a tubercular intramuscular abscess in the lumbar region, which clinically resembled a lumbar hernia. The present report focuses on a 53-year-old male patient with a progressive, severe mass in the mid-lower back that had lasted for several months. The initial clinical assessment and radiography suggested a lipoma, sebaceous cyst, or lumbar hernia. An ultrasonographic examination revealed that the mass was heterogeneously hypoechoic with internal echoes that did not correlate with lipomas or sebaceous cysts. Further systemic cytological and histopathological analysis revealed tuberculous alterations, including caseation necrosis, epithelioid granulomas and Langhans giant cells. Surgical exploration revealed an abscess within the extrinsic muscular plane, which was drained successfully. Anti-tubercular Therapy (ATT) was initiated after surgery and resulted in marked improvement of the patient’s symptoms. At the one-year follow-up, the lesion had not recurred, nor were there any associated manifestations of systemic disease. The present case emphasises the importance of considering tubercular aetiology in unusual complaints of lumbar swellings, particularly in TB-endemic areas. The diagnostic process, based on imaging and histopathological examination, was instrumental in achieving the correct diagnosis and ruling out mimicking conditions, such as lumbar hernia or fat necrosis. Specifically, the early initiation of ATT, combined with surgical intervention, led to a positive outcome. Reporting such cases is essential to raise awareness and provide clinicians with knowledge about rare extrapulmonary TB.

Ayurvedic Management of Ovarian Cyst: A Case Report

Varun Gupta, Dnyanesh Joshi, Bhushan Mhaiskar, Utkarsha Khaire Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Ovarian cysts are fluid-filled sacs that develop either on or within a woman’s ovaries, which are part of the female reproductive system. They are frequently encountered and can form at any stage of life, but they are most often detected in women during their reproductive years. According to Ayurveda, ovarian cysts can be correlated to Kaphaja Granthi Roga. A 49-year-old female patient came to the Outpatient Department (OPD), with complaints of pain in the pelvic region, bloating, heaviness in the lower abdomen, and changes in menstrual patterns in the last six months. Her ultrasonography report suggested an ovarian cyst measuring 66.2×44.2 mm. The condition was addressed with a combination of various traditional ayurvedic medicines like Kanchnar guggulu 2 tab twice a day, Chandraprabha vati 2 tab twice a day, Bruhat panchmula kwath 20 mL twice a day, Ajmodadi churna 1 tsf at night, Varunadi kashyam 10 mL twice a day, all medicine were given for six months. The patient was satisfied with the outcomes. According to her Ultrasound (USG) reports, after six months of treatment there was no evidence of an ovarian cyst, and her symptoms also demonstrated improvement. The current case underscores the effectiveness of Ayurvedic treatment in achieving positive outcomes for managing ovarian cysts.

Signet Rings Beyond the Norm: A Report of Two Rare Cases

Mitila Thirupathy, Gramani Arumugam Vasugi, Leena Dennis Joseph, Abdul Majeed Arshad Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Pulmonary adenocarcinoma with Signet Ring Cell (SRC) morphology is a very rare and distinct subtype initially classified as signet ring adenocarcinoma in the 2004 World Health Organisation (WHO) classification of lung tumours. In the 2015 classification, however, it was removed as a distinct variant. SRC morphology is characterised by abundant intracellular mucin and a crescentic nucleus and is now considered a cytologic change that may occur in various histological patterns. Here, we present two cases reported over one month. The first case is of a 61-year-old female who presented with shortness of breath, loss of weight and loss of appetite for two months. Positron Emission Tomography-Computerised Tomography (PET/CT) scan showed a well-defined malignant-looking lesion in the right middle lobe with metastasis to the right pleura, lymph nodes, liver and adrenal gland. The core biopsy revealed the diagnosis of lung adenocarcinoma with SRC morphology, which was confirmed by Immunohistochemistry (IHC) which also demonstrated positivity for Anaplastic large cell Lymphoma Kinase (ALK) gene rearrangement. The second case was of a 62-year-old female who presented with breathlessness, cough with expectoration and loss of weight for the past six months. PET/CT done outside showed a Fluorodeoxyglucose (FDG) avid lesion measuring 2.3×1.6×1.0 cm, involving the left lower lobe, favouring lung carcinoma, with multiple enlarged lymph nodes. Core biopsy of the lesion revealed the diagnosis of lung adenocarcinoma with SRC morphology. Further, IHC work-up confirmed the diagnosis. Metastasis from other primary sites should be considered first since SRC carcinoma can commonly appear in various organs, including the stomach, colon, urinary bladder, prostate and breast. The presence of Thyroid Transcription Factor-1 (TTF-1) and Cytokeratin 7 (CK7) positivity supports a primary lung adenocarcinoma diagnosis. This variant is found alongside classic adenocarcinoma and frequently metastasises to lymph nodes harbouring ALK gene rearrangements. This case highlights the importance of recognising this distinct clinical entity within pulmonary adenocarcinoma due to its aggressive behaviour and the necessity for timely and accurate diagnosis for targeted treatment.

Stanford Type A Acute Aortic Dissection with Left Coronary Artery Involvement: Computed Tomography Angiography Findings

Nishant Narendra Kumar, Revathi Rajagopal, Deepthi Arunkumar, Senthil Kumar Aiyappan, Jayaselin Praveena Joseph Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X A 48-year-old female presented to the emergency department with complaints of acute onset chest pain radiating to the back and breathlessness for the past 24 hours. The patient reported no significant past medical history but had a family history of hypertension. On examination, her blood pressure was markedly elevated at 200/160 mmHg and she appeared distressed and diaphoretic. Auscultation revealed diminished breath sounds in the left lung base. An Electrocardiogram (ECG) revealed sinus tachycardia. Given the clinical suspicion of aortic dissection, urgent imaging studies were performed. A Computed Tomography Angiography (CTA) of the chest was conducted, revealing a Stanford Type A aortic dissection extending from the ascending aorta to the abdominal aorta. A thin, oblique intimal flap was noted, extending from the aortic root just above the right sinus of Valsalva through the entire course of the ascending aorta, arch of the aorta, descending thoracic aorta and abdominal aorta, up to the common iliac artery [Table/Fig-1a-d]. An extension of the flap transversely into the left sinus of Valsalva, involving the osteoproximal segment of the left main coronary artery, was observed (Table/Fig 2). Diffuse consolidations involving bilateral perihilar regions of both lung fields suggested pulmonary oedema [Table/Fig-3a]. Bilateral pleural effusions were also noted [Table/Fig-3b]. Despite the immediate initiation of antihypertensive therapy and arrangements for surgical consultation, the patient’s condition rapidly deteriorated. She developed profound hypotension and loss of consciousness within two hours of admission. Despite aggressive resuscitative measures, including fluid resuscitation and vasopressor support, the patient could not be stabilised. Cardiopulmonary resuscitation was initiated, but unfortunately, the patient succumbed to cardiac arrest.

Clinical Evaluation of Lesion Sterilisation and Tissue Repair Therapy using Bioceramic in Deciduous Molars with Chronic Periapical Periodontitis and Pulp Necrosis: A Randomised Controlled Trial

Jin Sun, Jiahui He, Wei Luo, Min Wu, Yun Liu Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Lesion Sterilisation and Tissue Repair Therapy (LSTR) has proven to be as effective as Root Canal Therapy (RCT) for treating deciduous molars with chronic periapical periodontitis and pulp necrosis. Given the routine use of a three-antibiotic mixture, it is important to investigate a more effective medication that offers antibacterial properties, good biocompatibility, and stable chemical characteristics. Aim: To evaluate the efficacy of LSTR with bioceramic (LSTR-bioceramic) in deciduous molars with chronic periapical periodontitis and pulp necrosis. Materials and Methods: A randomised controlled trial was conducted in the Stomatological Healthcare Centre, Shenzhen Maternity and Child Healthcare Hospital affiliated to Southern Medical University, Shenzhen, Guangdong, China, from January 2022 to December 2023. The study included 88 children aged 3-8 years, all diagnosed with chronic periapical periodontitis and pulp necrosis. These cases were treated according to the study protocol, with 44 subjects receiving RCT and the other half receiving LSTR therapy. The subjects were followed-up clinically and radiologically at six and 12 months. The results were rigorously analysed using a Z-test, with a significance level established at 0.05. Results: At six months, the clinical success rates of LSTR-bioceramic and RCT were 37 (84.09%) and 41 (93.18%), respectively; the radiological success of them were 39 (88.64%) and 37 (84.09%). And at 12 months, the clinical success rates of LSTR-bioceramic and RCT were 31 (73.81%) and 35 (81.4%), respectively; the radiological success of them were 25 (59.52%) and 27 (62.79%). No statistically significant differences were found between the radiological and clinical successes of two groups at six months and 12 months (p=0.093, 0.221, 0.456, and 0.271, respectively). Conclusion: LSTR-bioceramic can be used as an effective treatment for deciduous molars with chronic periapical periodontitis and pulp necrosis.

Analysis of Palatal Rugae Pattern in Angle’s Classification of Malocclusion using Dental Casts in Chengalpattu District, Southern India: A Cross-sectional Study

Kashish Kariya, KT Magesh, Ramya Mahalingam, M Sathya Kumar, R Aravindhan, A Sivachandran, R Swaathi Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Palatal rugae are uneven, asymmetrical ridges of the mucous membrane that stretch laterally from the anterior one-third of the mid-palatine raphe to the incisive papilla. Rugae are generally unique and stable, suggesting applications in forensics and orthodontics. During the early stages of intrauterine life, the formation of palatal rugae is completed, while dental malocclusion in the permanent teeth develops several years after birth. The objective of the present study was to identify the length, number and orientation of palatal rugae in various malocclusion groups. Aim: To investigate potential correlations between Angle’s classification of malocclusion and the palatal rugae pattern. Materials and Methods: A cross-sectional observational study was conducted in the Department of Oral and Maxillofacial Pathology at SRM Kattankulathur Dental College and Hospital, Chengalpattu, Tamil Nadu, India. Data was collected from the years 2021 to 2024 and data analysis was done from October 2023 to April 2024. Study was carried out on 105 archival pretreatment dental casts, ranging in age from 18-35 years. The samples were categorised into class I, class II and class III according to Angle’s system of malocclusion. Bilaterally, the three most prominent anterior primary rugae were counted, and their pattern, length and orientation were noted. STATA 17 software was used for data analysis. Results: The mean±Standard Deviation (SD) age of the study group was 26.5±23.64 years. According to mean±SD length of rugae significantly more (p-value <0.05) primary rugae were found in class I (1.39±1.34 mm) compared to class II (0.59±1.17 mm) and class III (0.5±0.97 mm). Both wavy and curved patterns showed statistical significance with the type of malocclusion (wavy: p-value=0.0001 and curved: p-value=0.0013) when compared to the straight pattern (p-value=0.1498). Regarding the mode of orientation, converging (0.39±0.6) and diverging (0.29±0.52) patterns were found to be statistically insignificant among the three classes of malocclusion. Conclusion: The study demonstrated slight variations in the palatal rugae pattern between Angle’s malocclusion classes. An additional finding that differed significantly among the malocclusion groups was the length of the rugae. However, the results did not reveal a specific pattern that is unique to any one type of malocclusion.

Reliability of Cephalometric Lines as Indicators for Dentoalveolar Stability in Forensic Identification: A Cross-sectional Study

Gandikota Kartheek, Manyam Ravikanth, Varma D Praveen Kumar, Pasupuleti Swetha, S Supraja, Birajdar Smita Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Cephalometric superimposition is an accepted method that has long been considered helpful for evaluating the growth and displacement of facial bones during orthodontic treatment. However, the use of these cephalometric records for individual identification has not been reported until recently. The present study emphasises the use of lateral cephalographs as a forensic tool for the identification of individuals. Aim: To assess the alterations in the measurements of specific cephalometric lines observed in tracings obtained before and after orthodontic intervention. Materials and Methods: A cross-sectional study was conducted in the Department of Oral Pathology, Vishnu Dental College, Bhimavaram, West Godavari District, Andhra Pradesh, India, from September 2024 to November 2024. Study involved 120 participants to assess the stability of cephalometric lines for forensic identification. Standardised lateral cephalometric radiographs, aligned with the Frankfort horizontal plane, were traced on acetate sheets by a single orthodontist to identify the chosen cephalometric lines: Pterygomaxillary fissure (Ptm)-nasion, basion-nasion, sella-nasion, Anterior Nasal Spine (ANS)-sella (anterior cranial base length), Frankfort Horizontal (FH), Posterior Nasal Spine (PNS)-nasion (posterior maxillary height), ANS-nasion (anterior maxillary height), ANS-PNS (maxillary length) and sella-articulare (posterior cranial base length). Pre and post-treatment cephalometric measurements were analysed using a paired t-test. Statistical analysis, performed using Statistical Package for the Social Sciences (SPSS) software version 26.0, deemed changes significant at p-value<0.05. To find significant differences, a paired t-test was used. Results: Among the 120 samples analysed, the gender distribution was equal, with 50% females and 50% males. The results showed no significant change in the measurements of ANS-sella, FH plane, PNS-nasion, ANS-nasion, ANS-PNS and Sella-articulare, with a p-value >0.05, indicating that skeletal and alveolar stability remained unchanged before and after orthodontic correction. Conclusion: The present study concludes that the ten reference lines taken can be used as reliable antemortem landmarks for personal identification. The present study is novel in the field of forensic dentistry and hence there is a need for further studies using a larger sample in order to establish a reliable forensic base.

Outcome of Mathieu Meatal-based Flip Flap Technique for Distal Hypospadias: A Retrospective Cohort Study from a Single Tertiary Care Centre, Bhubaneswar, India

Harish Chandra Tudu, Nikhil Pothugunta, Varsha Madhavnarayan Totadri, Subrat Kumar Mohanty, Pradeep Kumar Jena, Amaresh Mishra Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Several surgical procedures are used for the correction of distal hypospadias. Institutional protocols vary regarding the ideal procedure. The goal of modern hypospadias surgery is to achieve a functionally and cosmetically normal penis. Mathieu described a technique that utilises the perimeatal skin proximally to create a flap for the repair of distal hypospadias. It is a time-tested method with minimal complications. Aim: To highlight the incidence of complications and the surgical outcomes of distal hypospadias using Mathieu’s meatal-based flip flap technique. Materials and Methods: A retrospective cohort study was conducted in the Department of Paediatric Surgery at a tertiary care hospital at the Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India on 55 children aged 2-16 years from January 2021 to August 2024. The study population included children with distal penile hypospadias with or without mild skin-level chordee. Patients underwent surgery using the Mathieu meatal-based flip flap technique. The length of the skin flap was determined by the distance from the meatus to the glans tip, after which a ventral meatal-based skin flap was incised. The maximum flap length used was 2 cm. The proximal flap was dissected from the underlying urethra, flipped distally, and anastomosed to the distal urethral plate with running subcuticular sutures of 6-0 Polydiaxanone. The urethra was stented using an infant feeding tube for eight days, and the dressing with the catheter was removed on postoperative day 9. Postoperative complications were analysed using descriptive statistics of frequency and percentage. Results: The mean age at the time of urethroplasty was 6.6±3.2 years. Out of 55 patients, 1 (1.8%) developed meatal stenosis, 1 (1.88%) developed a urethrocutaneous fistula, 2 (3.6%) experienced meatal regression, and 3 (5.4%) had glans dehiscence. All patients (and their caregivers) were satisfied with the cosmetic and functional outcomes postoperatively during follow-up. Conclusion: In present study, Mathieu’s meatal-based flip flap urethroplasty resulted in successful outcomes with low complications. Thus, Mathieu’s meatal-based flip flap urethroplasty remains a time-tested and effective method for select cases of distal hypospadias.

Comparison between Extracorporeal Shock Wave Lithotripsy and Retrograde Intrarenal Surgery for Single Renal Calculus: A Prospective Interventional Study

Vilas Sabale, Ashish Gavade, Vikram Satav Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Urolithiasis is one of the most common pathological diseases, which is increasing day by day all over the world. It is important to understand the pathology, risk factors and various treatment modalities to tackle this prevalent disease. The management varies based on factors such as stone size, location and patient preference. Aim: To compare Extracorporeal Shock Wave Lithotripsy (ESWL) and Retrograde Intrarenal Surgery (RIRS) for a single renal calculus of size between 10 and 20 mm. Materials and Methods: A prospective interventional study was performed in the Department of Urology at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India, from October 2022 to October 2024. The population included individuals aged 18 to 60 years with a single renal calculus of 10 to 20 mm, who were eligible for either RIRS or ESWL. A total of 40 patients were studied and divided into two groups of 20. Various variables, such as duration of the procedure, complications, stone clearance, hospital stay, hospital visits and need for ancillary procedures, were compared. The Chi-square test was used to analyse categorical variables and statistical significance was considered when the p-value was <0.05. Results: The mean age of patients was 38.6±11.29 years for RIRS, while for ESWL, it was 40.3±9.49 years. Thirteen patients (32.5%) were from the 31-40 years age group. Present study had 25 patients (62.5%) with calculus sizes between 10-15 mm, while the rest were between 16-20 mm. Fourteen (35%) had middle calyx stones, 11 (27.5%) had lower calyceal stones, nine patients (22.5%) had renal pelvis calculi, and 6 (15%) had upper calyx stones. All RIRS procedures were completed within 120 minutes, while 9 (22.5%) undergoing ESWL took 150 to 180 minutes. Seventeen patients (85%) in the RIRS group achieved complete stone clearance, while stone clearance in the ESWL group was seen in 12 patients (60%). Both groups had similar complication rates of 25%. Haematuria was observed in three patients (15%) in the RIRS group and in four patients (20%) in the ESWL group. Pain was reported in two patients (10%) in the RIRS group and five patients (25%) in the ESWL group. Although sepsis occurred in one case (5%) of the RIRS group, none was reported in the ESWL group. Ten patients (50%) in the ESWL group did not required a hospital stay, compared to 16 patients (80%) in the RIRS group who required a stay of 3-4 days. All patients of RIRS needed only one visit for treatment, while four patients (40%) in the ESWL group required four visits, three patients (15%) required three visits, five patients (25%) required two visits and only four patients (20%) completed their treatment in one visit. Seventeen patients (85%) in the RIRS group did not required any ancillary procedures, while 12 patients (60%) in the ESWL group did not required any ancillary procedures. Conclusion: Both procedures have their own benefits. RIRS showed better stone clearance but is invasive in nature, whereas ESWL, being non invasive, required multiple hospital visits and could be performed on an outpatient basis. Therefore, the choice of procedure should be individualised for each patient, depending on both surgeon and patient preferences.

Relationship between Lower Limb Flexibility, Power, Agility and Speed in Football Players: A Cross-sectional Study

Tresha Parmar, Neha Mukkamala Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Football is a complex game characterised by unpredictable movement patterns. 17% of injuries in football have been attributed to tightness in the hamstring muscles and a lack of flexibility. In football, the ability to quickly change direction, produce a high rate of power output, and sprint at high velocity is essential for optimal performance. The effect of lower limb flexibility and its relationship to skills required in football, such as agility, power, and speed, have not been previously studied. Aim: To examine the relationship between lower limb flexibility, power, agility, and speed in football players. Materials and Methods: This cross-sectional study was carried out in the football field of Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India on 30 male football players who played at Sumandeep Vidyapeeth campus from January 2021 to August 2021. Football players aged between 18 to 25 years who had been involved in regular football training sessions atleast three times per week for the past year were included in the study. Participants with a history of musculoskeletal injuries to the back, shoulder, elbow, or lower limb within the past six months, or those with any history of cardiorespiratory or neurological problems that could affect test performance, were excluded. Apart from anthropometric measurements, participants were assessed for flexibility using the Active Knee Extension Test (AKET) and the V-sit and reach test, agility using the Arrowhead Agility Test (AAT), power using the Vertical Jump Test (VJT), and sprinting ability using the 40-yard dash test. Correlations among flexibility, agility, power, and speed were assessed using Pearson’s correlation coefficient. Statistical significance was set at p-value<0.05. Results: Total 30 participants were recruited, with a mean age of 20±1.5 years and a mean Body Mass Index (BMI) of 22±1.7 kg/m². The mean active knee extension angle for the right-side was 25±1.9°, and for the left-side, it was 24.6±8.5°. The mean value for the sit and reach test was 42±1.5 cm, the vertical jump was 44±7.9 cm, the AAT was 9.1±1.5 seconds, and the 40-yard dash test was 6.5±0.91 seconds. A significant positive correlation was found between AKET and AAT (r=0.482, p-value=0.007) and between the V-sit and reach test (VSRT) and VJT (r=0.491, p-value=0.006). However, no statistically significant correlations were found between AKET and VJT, AKET and the 40-yard dash, AAT and VJT, or VJT and the 40-yard dash. Conclusion: A positive correlation was found between hamstring flexibility with agility and negative correlation was found between hamstring flexibility with power. There was no statistically significant correlation found between flexibility and sprint.

Analysing the Effects of Longwave Diathermy on Quality of Life among Patients with Knee Osteoarthritis: A Pilot Study

Bhavna Anand, Pragya Kumar, Chitra Kataria Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Knee Osteoarthritis (OA) is a chronic degenerative condition that significantly impairs the Quality of Life (QoL) in individuals over the age of 50 years. Longwave Diathermy (LWD), known for its ability to improve circulation, reduce pain and enhance functional recovery, has emerged as a promising physiotherapeutic intervention. Aim: To evaluate and compare the effects of Pulsed Longwave Diathermy (PLWD) and Continuous Longwave Diathermy (CLWD) on QoL in individuals with knee OA, assessed across all domains of the World Health Organisation Quality of Life Brief version (WHOQoL-BREF): physical health, psychological health, social relationships and environmental health. Materials and Methods: A comparative pilot study was conducted in the Outpatient Department, Department of Physiotherapy, Amity Institute of Health Allied Sciences, Amity University, Noida, Uttar Pradesh, India, from January 2023 to May 2023. Study included 30 participants aged ≥45 years, diagnosed with grade 2-3 knee OA (Kellgren-Lawrence scale). Participants were randomly assigned to two groups: grade 1 received PLWD with conventional therapy and grade 2 received CLWD with conventional therapy for eight weeks, three times per week. The WHOQoL-BREF was employed as the primary outcome measure to evaluate QoL across four domains: psychological, social, physical and environmental well-being. Assessments using the WHOQoL-BREF were conducted at three key time points: baseline (prior to intervention), after four weeks of intervention and after eight weeks of intervention. Mann-Whitney U test was employed to compare baseline characteristics and differences between the two groups. Analysis of Variance (ANOVA) was used for significant interactions between time points and groups. Results: Both groups showed significant improvements in QoL across all WHOQoL-BREF domains. However, the CLWD group demonstrated greater improvements compared to the PLWD group. In the physical health domain, mean±Standard Deviation (SD) scores improved from 31.33±0.49 at baseline to 56.13±1.85 at eight weeks (F=2.575, p-value<0.05). For psychological health, mean±SD scores increased from 24±5.86 to 54±0 (F=2.575, p-value<0.05). Social relationships mean±SD scores rose from 39.33±10.77 to 68±0 (F=3.533, p-value<0.05). Lastly, the environmental health domain improved from 31.33±0.49 to 56.33±1.76 (F=17.92, p-value<0.05). Conclusion: The CLWD, when combined with conventional therapy, significantly enhances QoL in individuals with knee OA across all domains of the WHOQoL-BREF. These findings highlight its potential as an effective non invasive intervention for managing knee OA. Further large-scale studies are recommended to confirm these results and explore individualised treatment protocols.

Evaluation of the Antioxidant and Anti-Alzheimer’s Activity of Oleanolic Acid: An In-vitro Study

Viishaal Srikanth Srivatsa, Royapuram Parthasarathy Parameswari, Anitha Roy Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Alzheimer’s Disease (AD) is a neurodegenerative condition characterised by cognitive decline and memory loss, with oxidative stress and neuroinflammation playing key roles in its pathology. While traditional treatments primarily focus on managing symptoms and slowing disease progression, there is a growing recognition of the need for alternative treatment methods. Oleanolic Acid (OA), a natural triterpenoid, has shown neuroprotective and antioxidant properties. Aim: To assess the effects of OA in reducing oxidative stress and targeting major pathological features of AD, including amyloid-beta plaque accumulation and tau hyperphosphorylation. Materials and Methods: The present in-vitro study was conducted in the Centre for Global Health Research, Saveetha Medical College and Hospitals, Chennai, Tamil Nadu, India, from May 2024 to June 2024. AD models were used to assess OA’s impact on oxidative stress levels and amyloid-beta plaque formation. A series of in-vitro assays, such as the 2,2-Diphenyl-1-Picrylhydrazyl (DPPH) assay, the 2,2'-azino-bis (3-ethylbenzothiazoline-6-sulphonic acid) (ABTS) assay, and the Lipid Peroxidase (LPO) inhibition assay, were performed to evaluate the antioxidant properties of OA. The Acetylcholinesterase (AChE) inhibition assay, amyloid (Aβ 1-42) aggregation inhibition assay, and β-secretase inhibition assay were performed to assess the anti-alzheimer effects of OA. A two-way Analysis of Variance (ANOVA) test was used to assess the differences between means, and the Holm-Sidak test was used to compare the means with the standard group. Results: OA significantly reduced oxidative stress and demonstrated a strong antioxidant effect by scavenging free radicals and inhibiting the LPO enzyme, almost on par with ascorbic acid. At a concentration of 320 μM, OA exhibited an antioxidising effect comparable to that of ascorbic acid. It also decreased amyloid-beta plaque formation in AD models, inhibited AChE at the same level as donepezil at higher concentrations, and inhibited the β-secretase enzyme on par with donepezil at lower concentrations, thereby indicating its strong anti-alzheimer potential. Conclusion: In the present study, OA showed promising antioxidant and anti-alzheimer effects, suggesting its potential as a therapeutic agent for AD. By reducing oxidative stress and addressing key pathological features of the disease, OA may contribute to managing and slowing the progression of Alzheimer’s disease. Further studies are necessary to confirm its therapeutic potential in clinical settings.

Efficacy of Bilateral Transverse Abdominis Plane Block and Ilioinguinal Iliohypogastric Nerve Block for Post Lower Segment Caesarean Section Pain Relief: A Randomised Clinical Study

Jigisha Bharatbhai Mehta, Gayatri Vasagadekar, Sara Mary Thomas Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Insufficient pain management postcaesarean section causes maternal distress, which impacts mother-infant bonding and breastfeeding. Improving postoperative analgesia not only enhances patient satisfaction but also shortens hospital stay, reduces pulmonary complications, supports early mobilisation and decreases the risk of thromboembolism. Aim: To compare the efficacy of bilateral Transverse Abdominis Plane block (TAP) and Ilioinguinal Iliohypogastric block (II-IH) for postcaesarean section pain relief. Materials and Methods: A randomised clinical study was conducted at Dhiraj Hospital, Piparia, Vadodara, Gujarat, India, on 60 pregnant women, aged between 18 to 45 years, who were posted for elective Lower Segment Caesarean Section (LSCS). They were randomised into Group T (n=30) for TAP block or Group I (n=30) for II-IH block. Both groups received 20 mL of 0.25% bupivacaine on both sides. Patients were assessed for Visual Analogue Score (VAS), pulse rate, blood pressure and oxygen saturation at 1, 2, 4, 6, 8, 10, 12, and 24 hours postoperatively. The duration of analgesia, total analgesic consumption and complications were also noted. Rescue analgesia was administered if VAS was >3, in the form of 75 mg i.v. diclofenac. Data were analysed using the sample t-test and repeated measures Analysis of Variance (ANOVA) test. A p-value of <0.05 was considered significant. Results: Both groups were comparable in terms of demographic data (age, weight, height, Body Mass Index (BMI)) with a p-value of >0.05. The VAS score was not statistically significant for 24 hours postoperatively between the two groups with p>0.05 at each time point. The mean duration of analgesia was 606±35.24 minutes in Group T and 702±40.86 minutes in Group I, which was statistically significant (p-value=0.04). Total i.v. diclofenac consumption was 105±62.07 and 75±45.49 in Groups T and I, respectively, which was statistically significant (p-value=0.014). Pulse rate, blood pressure and oxygen saturation were comparable in both groups with no significant difference at any time point. No complications were encountered in either group. Conclusion: Both TAP block and II-IH block are safe and provide analgesia to parturients postoperatively. However, the II-IH block provides a longer duration of analgesia and reduces the postoperative intravenous analgesic requirement compared to the TAP block.

Prediction of Pulmonary Hypertension in Patients with Diffuse Parenchymal Lung Disease using Forced Vital Capacity/ Diffusion Capacity of Lung using Carbon Monoxide Ratio: A Cross-sectional Study

Anubhab Moulik, Jaydip Deb, Sourindra Nath Banerjee, Priyanka Ray, Pulak Kumar Jana, Sukanta Kodali, Saswata Ghosh Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Diffuse Parenchymal Lung Disease (DPLD) comprise a heterogeneous group of diseases that occur when an abnormal healing response is induced by injury to the lungs. The diagnosis of DPLD is based on clinical presentation and radiological features. The initial diagnostic work-up includes Pulmonary Function Tests (PFT), such as spirometry and diffusion tests. Aim: To evaluate the accuracy of the Forced Vital Capacity/Diffusion Capacity of Lung for Carbon Monoxide (FVC/DLCO) ratio in predicting the presence of pulmonary hypertension in patients with DPLD. Materials and Methods: A cross-sectional study was conducted from January 2023 to March 2024 in the Inpatient Department (IPD) and Outpatient Department (OPD) of Nilratan Sircar (NRS) Medical College and Hospital, Kolkata, West Bengal, India. A total of 50 patients underwent High-Resolution Computed Tomography (HRCT) thorax and spirometry with DLCO, along with some other ancillary investigations. The parameters evaluated primarily include a descriptive account of the spirometry values, which were Forced Expiratory Volume in 1 second (FEV1), FVC and DLCO, as well as the 6-Minute Walk Distance (6MWD) for physiological assessment and ECHO 2D for the evaluation of pulmonary hypertension. Simple logistic regression was performed between the FVC/DLCO ratio and the presence or absence of pulmonary hypertension based on ECHO 2D with Doppler as the binary outcome. The Receiver Operating Characteristic (ROC) curve was obtained and the FVC/DLCO cut-off ratio was adjusted to achieve the highest sensitivity for predicting pulmonary hypertension based on this dataset. Results: Out of 50 patients (30 females and 20 males), the most common HRCT thorax pattern was Usual Interstitial Pneumonia (UIP), observed in 19 patients (38%), followed by Non Specific Interstitial Pneumonia (NSIP) in 11 patients (22%). The single most common DPLD was Idiopathic Pulmonary Fibrosis (IPF), with 11 patients (22%), while the most common group was Connective Tissue Disease-related DPLD (CTD-DPLD), comprising 22 patients (44%). An FVC/DLCO ratio of 0.97 was found to have a sensitivity of 81%, specificity of 77%, a Positive Predictive Value (PPV) of 86%, a Negative Predictive Value (NPV) of 70% and a diagnostic accuracy of 80% in predicting pulmonary hypertension. Conclusion: The FVC/DLCO ratio of 0.97 represents a modality that could aid in the diagnosis of pulmonary hypertension.

Efficacy of Whole Body Vibration Training and Yoga along with Resistance Band Exercise for Urinary Incontinence: A Pilot Study

Thirulogachandar Gunasekar, V Ritheeka, D Monesh, V Saravanan, B Shivaranjani, Murali Ravi, K Saraswathi, K Muthulakshmi Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Urinary incontinence is the involuntary loss or leakage of urine. It occurs in both sexes but is more frequent in women. The most common subtypes are stress and urge incontinence. A patient exhibiting symptoms of both stress and urge incontinence is said to have mixed incontinence. Whole Body Vibration Training (WBVT) is a novel intervention reported as an effective training method for muscle enhancement and has recently been added as a modality for strengthening the pelvic floor muscles. Pelvic floor exercises performed using a resistance band have been proven to reduce urinary incontinence and improve Quality of Life (QoL). Yoga is a mind-body practice that is increasingly popular in the West, particularly among women, and involves the practice of physical postures. Aim: To assess the efficacy of whole body vibration training and yoga combined with resistance band exercises for urinary incontinence. Materials and Methods: This pilot study was conducted at Dr. MGR Research Institute, Department of Physiotherapy, Chennai. A total of 30 married multiparous women with any subtype of urinary incontinence, aged between 20 and 70 years, were randomly assigned to two groups. The duration of the study included 45-minute sessions three days a week for six weeks, starting in January 2022 and ending in March 2022. Group A (n=15) was assigned to WBVT with resistance band exercises, while Group B (n=15) was assigned to yoga with resistance band exercises. Pre- and post-test measures were taken using Pelvic Floor Muscle strength (PFMs), the Michigan Incontinence Symptom Index (M-ISI), and the Incontinence Quality of Life (I-QoL) questionnaire scores. Data were statistically analyzed using paired t-tests and independent t-tests. Results: In this study, the statistical post-test mean values of Group B (yoga with resistance band exercises) showed significant improvement in pelvic floor muscle strength (24.08±1.70) and M-ISI (12.06±2.52). The Incontinence Quality of Life (I-QoL) scores showed significant improvement in both the groups. Conclusion: This study concluded that yoga combined with resistance band exercises was effective in improving pelvic floor muscle strength and reducing the severity of urinary incontinence symptoms. The quality of life improved in both the groups in patients with urinary incontinence.

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Serum Selenium Status in Autoimmune Thyroid Disorders: A Case-control Study

Ceema Varghese, B Vijayalakshmi, Vergis Paul, JK Mukkadan, KC Thresiamma Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Selenium is a trace element essential for normal health, playing a crucial role in thyroid hormone synthesis and metabolism. In Autoimmune Thyroid Disorders (AITD), selenium deficiency can exacerbate inflammation, impair thyroid hormone production and escalate tissue damage. Assessing the selenium status as part of comprehensive management strategies for AITD is crucial. Aim: To evaluate the selenium levels and autoantibody levels in AITD and to establish the risk of AITD among patients with low selenium. Materials and Methods: This case-control study was conducted at the Department of Surgery, Medicine, Biochemistry and Physiology, MOSC Medical College, Kolenchery, Kerala, India from July 2022 to May 2023. A total of 134 participants were enrolled, including 67 cases with AITD and 67 matched controls. Serum selenium levels, thyroid function {Triiodothyronine (T3), Thyroxine (T4),Thyroid Stimulating Hormone (TSH)} and thyroid autoantibodies {anti-Thyroid Peroxide (TPO) and anti-Thyroglobulin (TGO)} were evaluated using blood samples collected in the morning (6-8 AM). Statistical analysis was performed with Pearson’s correlation coefficient to assess relationships and Chi-square tests evaluated the association between selenium status and AITD. Odds Ratios (OR) for AITD in relation to selenium levels were calculated. Results: Study population comprised of 38 hypothyroid and 29 hyperthyroid subjects, along with 67 euthyroid controls. Mean selenium levels among AITDs cases (0.088±0.07 μg/mL) were statistically significantly lower in comparison to controls (0.12±0.01 μg/mL). OR for association between serum selenium and AITD was 8.6 (95% CI 0.619-3.677; p<0.0001). Observed Relative Risk (RR) for low selenium to have AITD was 1.95. The Chi-square value of 8.59 with p=0.0034 indicated a statistically significant association between AITD and low selenium status. Conclusion: Selenium levels among hypothyroid and hyperthyroid subjects were significantly lower comparison to age- and sex-matched euthyroid controls. The calculated OR of 8.60 and an RR of 1.95 highlight selenium's potential role in thyroid health, particularly in regulating immune response and hormone metabolism.

Exploring Student Learning in Team-based Physiology Tutorials: A Quasi-experimental Study

Arun Kumar Mohan, P Srinivas, HS Shruthi, KO Thejaswini, Vivek Veeraiah Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Team-based Learning (TBL) has gained recognition as an effective pedagogical approach in medical education, particularly within tutorial settings. It fosters individual accountability, as students are required to prepare independently before engaging in group discussions, thereby reinforcing their understanding of the material. Additionally, TBL promotes the development of critical teamwork and communication skills among students, both of which are essential for medical practice. Aim: To explore the implementation of TBL in physiology tutorials for MBBS Phase I students, focusing on its impact on student learning outcomes and critical thinking abilities. Materials and Methods: A quasi-experimental study was conducted with 48 students from the Physiology Department. Participants were informed one week prior to the tutorial about the topics to be prepared for TBL. The individual Readiness Assurance Test (iRAT) was assessed using multiple-choice questions administered through Google Forms. Each group of six students completed a team Readiness Assurance Test (tRAT) and a team Application (tAPP) exercise. Descriptive statistics, such as the mean and standard deviation, were used to represent the scores of the study participants. Results: The performance of eight teams was assessed across the iRAT, tRAT and tAPP components. Team 3 achieved the highest average total score of 36.50±2.88 (77.65±6.13%) out of a possible 47, with a score of 14.50±0.83 out of 17 in the tRAT. In contrast, Team 4 scored the lowest average total of 29.17±3.49 (62.05±7.42%), which associated with their lower individual and team RAT scores, indicating varying levels of engagement and collaboration. Conclusion: The results suggest that TBL effectively enhances learning outcomes; however, variations in team cooperation and comprehension highlight the need for targeted interventions to support teams in achieving consistent academic success.

Impact of Nutritional Education Intervention on Mothers Knowledge, Practices and Nutritional Status of Children Under-Five in Rural Mangaluru, Karnataka: A Quasi-experimental Pilot Study

Savitha Naik, Abhay Nirgude, Priya Reshma Arahna Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Understanding the effectiveness of nutritional education interventions in rural settings is crucial for developing strategies to combat malnutrition and promote healthy growth in children. Enhancing mothers’ knowledge and practices can lead to better child health and development, and also contribute to more favourable long-term outcomes for both children and their communities. Aim: To implement a Nutrition Intervention Program (NIP) to enhance the nutritional status of children under-five by improving mothers’ knowledge and practices regarding child nutrition, thereby supporting the optimal growth and development of their children. Materials and Methods: A quasi-experimental study was conducted among parents of children under-five in the selected rural areas of Kukkuttu and Bhagambila, Mangaluru, Karnataka, India. The total sample size was 78 participants, with 39 in the intervention group and 39 in the control group. Data were collected using a structured knowledge questionnaire and an observational practice checklist. The parameters studied included height, weight, Mid-Upper Arm Circumference (MUAC), and the anthropometric indicators: weight for height, height for age, weight for age, and Body Mass Index (BMI) for age. These indicators are categorised based on growth and development standards established by the World Health Organisation (WHO). Epi Antro software was used to assess undernutrition, overnutrition and normal nutritional status among children under-five. Statistical analyses, including frequency, percentage, mean and standard deviation, multivariate ANOVA, two-factor repeated measures of ANOVA, Fisher’s exact test, Chi-square test, and post-hoc analysis, were used to analyse the data. Results: The mean age of the children under-five in the intervention group was 26.39±9.43 months and control group 22.74±10.65 months. The mean birth weight of the children in the intervention group was 2.75±0.28 kg and control group 2.64±0.27 kg. The mean birth order of the children in the intervention group was 2.02±1.15 and in the control group 3.10±1.75. There was a significant difference in parental knowledge scores within the groups (p-value=0.001, F=315.439) and between the groups (p-value=0.001, F=20.455). Parental practice scores also showed significant differences within the groups (p-value=0.001, F=333.897) and between the groups (p-value=0.001, F=196.446). There was a significant difference in stunting and underweight between the pretest and post-test (p-value <0.05) among children under-five. Conclusion: The study demonstrates that implementing a NIP effectively enhances mothers’ knowledge and practices related to child nutrition. Therefore, such interventions are valuable for promoting better health outcomes in children by educating and empowering mothers with the necessary knowledge and practices for optimal child nutrition.

Beneficial Role of Imeglimin as Add-on Drug with other Oral Hypoglycaemic Agents for Patients with Type 2 Diabetes: A Single centre Prospective Interventional Study

Naima Parveen, Sachin Chittawar Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: With Type 2 Diabetes Mellitus (T2DM) affecting over 74 million individuals in India alone, achieving glycaemic control remains a persistent challenge, especially in patients inadequately managed with Oral Hypoglycaemic Agents (OHAs). The present study explored the potential of imeglimin, a novel antidiabetic drug targeting mitochondrial function, to bridge this gap. By addressing insulin resistance and β-cell dysfunction, imeglimin emerges as a dual-action therapy tailored for patients who are hesitant to initiate insulin. Aim: To assess the short-term effectiveness and safety of imeglimin in T2DM patients who are inadequately controlled on two or three OHAs and who are hesitant to initiate insulin therapy. Materials and Methods: The present prospective, single-arm, single-centre interventional study was conducted in the Department of Endocrinology, Harmony Dr. Sachin’s 360 Degree Diabetes Care Centre, Bhopal, Madhya Pradesh, India, from January 2023 to June 2023. A total of 75 patients meeting the inclusion criteria were enrolled. Baseline and 12-week post-treatment data were systematically recorded, including demographic variables, anthropometric measurements {height, weight, and Body Mass Index (BMI)}, and glycaemic parameters {Fasting Plasma Glucose (FPG), Postprandial Glucose (PPG), and Glycated Haemoglobin (HbA1c)}. Statistical analysis was conducted using one-way ANOVA to evaluate treatment effects. Results: The study population comprised 75 participants with a mean±Standard Deviation (SD) age of 57±10 years and a duration of diabetes diagnosis ranging from six months to 25 years. Males represented a predominant 54.6% of the study cohort. Following 12 weeks of imeglimin treatment, HbA1c levels demonstrated a mean reduction of 1.1% (p-value=0.004) compared to baseline values. Furthermore, FPG levels decreased by a mean of 49.3 mg/dL (p-value=0.013), while PPG exhibited a mean reduction of 79.4 mg/dL (p-value=0.020). The most frequently reported treatment-emergent adverse events were gastrointestinal in nature. Conclusion: Imeglimin demonstrated short-term effectiveness in enhancing glycaemic control as an adjunct therapy to existing OHAs in T2DM patients who are hesitant to initiate insulin. The treatment was well tolerated, with gastrointestinal issues being the primary adverse effect. Further extensive studies with larger sample sizes are warranted to validate these findings and ascertain the long-term effects of imeglimin in T2DM management.

Hyponatremia among Sepsis Patients in the Critical Care Unit and its Association with the SOFA Score: A Cross-sectional Study

Ronak Prakashkumar Shah, Parth Rohitkumar Shah, Trupti Jansari, Amit Chauhan Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Hyponatremia is a frequent electrolyte imbalance observed in critically-ill patients. The Sequential Organ Failure Assessment (SOFA) score is a tool used in sepsis management to assess the severity of organ dysfunction and predict mortality in critically-ill patients. Thus, establishing an association between hyponatremia and the SOFA score aids in triaging patients at high risk of mortality and enhancing management strategies. Aim: To estimate the prevalence of hyponatremia in sepsis patients hospitalised in the critical care unit and analyse its association with SOFA scores. Materials and Methods: The prospective observational cross-sectional study was carried out at the Critical Care Unit of Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Piparia, Waghodia, Gujarat, India over a one-month duration in November 2024 on 88 sepsis patients aged over 18 years. Following informed consent, routine investigations such as Arterial Blood Gas (ABG), serum bilirubin, platelet count, creatinine, and sodium levels were performed. SOFA scores were calculated at the time of admission, and the severity of hyponatremia was assessed. Statistical tests for prevalence and associations within the data were applied, and the Chi-square test with a p-value of less than 0.05 was considered statistically significant. Results: The mean age of study patients with hyponatremia was 50.74 years, with a standard deviation of 16.49 years. The majority of study participants were male, comprising 62.32%, while females accounted for 37.68%. Hyponatremia was observed in 78.4% of sepsis patients, with 39.8% exhibiting mild hyponatremia, 25% moderate hyponatremia, and 13.6% severe hyponatremia. A SOFA score of 2 was most frequent in 19 patients (27.5%), and the mean SOFA score was 4.42, with a standard deviation of 2.34. The three most common aetiological diagnoses for hyponatremia were lower respiratory tract infection, followed by decompensated Chronic Liver Disease (CLD) and acute ischaemic stroke with aspiration pneumonia. The association between the SOFA score and the severity of hyponatremia was statistically significant, as indicated by the Chi-square test (p<0.05). Additionally, a statistically significant association was observed between the severity of hyponatremia and specific components of the SOFA score, namely platelet count and serum creatinine. Conclusion: Hyponatremia is highly prevalent in critically-ill sepsis patients. The association between hyponatremia and SOFA scores highlights the need for timely diagnosis and management of hyponatremia to reduce morbidity and mortality.

Airway Exchange Catheter-guided versus Conventional Techniques of Nasotracheal Intubation: A Prospective Interventional Study

Ameena Jabbar, KP Biji, KT Shafna, A Krishna Das, S Syam Kumar Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: The conventional Nasotracheal Intubation Technique (NTI), which involves the blind passage of an Endotracheal Tube (ETT) through the nose, is a potentially traumatic process. Airway Exchange Catheter (AEC) guidance for direct or Video Laryngoscopy (VLS) during NTI is likely to improve the first-attempt success rate, along with a reduced incidence of nasal trauma and bleeding. The primary objective is to assess the ease of ETT insertion into the oropharynx and trachea in terms of the number of attempts, navigability, and time taken for insertion. The secondary objectives are to assess the severity of bleeding, cuff rupture, and any other complications. Aim: To compare AEC-guided NTI with the conventional technique for successful NTI. Materials and Methods: This prospective interventional study was conducted in the main operation theatre complex of Government Medical College, Kozhikode, Kerala, India a tertiary care teaching hospital from January 2020 to August 2021 involving 70 patients who underwent oral and maxillofacial surgery. Patients were divided into two groups: group C (conventional NTI group) and group G (AEC-guided NTI group). The number of insertion attempts of the ETT into the oropharynx and trachea, navigability through the nasal passage, severity of bleeding, time taken for intubation, and incidence of cuff rupture were noted. Independent t-tests and Chi-square tests were used to compare variables. Results: The average age of patients in group G was 57.51±5.6 years, while in group C, it was 59.66±5.8 years. The results showed that ETT navigability was easier when using AEC, with a p-value of <0.01. There was a significant difference in the number of attempts for ETT insertion into the oropharynx and trachea (p<0.001). The total time taken for endotracheal intubation was significantly lower in group G compared to group C (p<0.01). The severity of bleeding was higher in group C, with 28.6% of intubations resulting in severe bleeding requiring suction, while the incidence was nil in group G. Conclusion: The first-attempt success rate was higher for the AEC-guided technique of NTI compared to conventional NTI. The incidence of complications was lower with AEC-guided techniques.

Efficacy of Ropivacaine alone Versus Ropivacaine with Dexmedetomidine in Ultrasound-guided Supraclavicular Brachial Plexus Block: A Randomised Controlled Study

Jampala Gowthami, Nadikuda SunilKumar, G Anand Isaac, T Kiran Kumar Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: The Supraclavicular Brachial (SCB) plexus block for upper limb surgeries has emerged as a rapid and reliable technique compared to general anaesthesia. With the advent of Ultrasound (US), the SCB plexus block has become an easy, accurate and popular procedure to perform. Dexmedetomidine, as an adjuvant to local anaesthetics, has improved the quality of the blocks. Aim: To compare the onset and duration of sensory and motor blockade of 0.5% ropivacaine versus 0.5% ropivacaine with 25 μg dexmedetomidine, as well as to assess the haemodynamic parameters in the SCB plexus block. Materials and Methods: This randomised controlled study was conducted at Osmania Medical College and General Hospital, Hyderabad, Telangana, India which included 60 adult patients {American Society of Anaesthesiologists (ASA) I and II} scheduled for elective upper limb surgery under SCB, according to the inclusion criteria. The patients were randomised into group R (n=30), which received 30 mL of ropivacaine with 1 mL of saline and group RD (n=30), which received 30 mL of ropivacaine with 25 μg of dexmedetomidine. The onset and duration of sensory and motor block, the duration of analgesia, haemodynamic parameters and any complications were recorded, tabulated in an Excel sheet and analysed using an unpaired t-test. Results: The demographic data among both groups were comparable, with a male predominance. The onset of sensory and motor block was faster in group RD compared to group R, respectively (4.78±1.68 mins vs. 7.87±1.98 mins, p-value <0.001) and (8.4±2.34 mins vs. 12.3±2.95 mins, p-value <0.001). The duration of sensory and motor block was longer in group RD compared to group R, respectively (807.5±165.51 mins vs. 485±81.31 mins, p-value <0.001) and (685±62.74 mins vs. 465±72.62 mins, p-value <0.001). Haemodynamic stability was well maintained without any complications in group RD. Conclusion: The addition of dexmedetomidine as an adjuvant to ropivacaine in ultrasound-guided SCB accelerates the onset of sensory and motor block, prolongs the duration of the block and analgesia, thereby improving the quality of the SCB.

Clinical Profile and Surgical Outcome of Paediatric Patients Diagnosed with Urethrocutaneous Fistula following Circumcision: A Retrospective Descriptive Study

AB Hamid Wani, Gurbir Singh, Davinderpal Singh, Nikhil Arya Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Circumcision is one of the oldest and most common surgical procedures performed in the world. While circumcision is generally considered a simple and short procedure, it can lead to undesirable complications, such as Urethrocutaneous Fistula (UCF). The repair of UCF is quite challenging for surgeons, with high chances of recurrence, often requiring multiple surgical procedures. Aim: To study the clinical profile of patients with UCF and the outcomes of various surgical repair techniques. Materials and Methods: This retrospective descriptive study was conducted in the Department of General Surgery at Government Medical College, Jammu, Jammu and Kashmir, India, from January 2016 to January 2023. A total of 30 male patients with UCF fistula following circumcision were included. The category of the circumcisionist, site and size of the fistulae, type of repair, and associated complications were recorded. Results were expressed in terms of frequency and percentage. Results: The age of the patients varied from nine months to eight years. Circumcision was most commonly performed by traditional circumcisionists, accounting for 22 (73.3%) subjects. Approximately 18 (60%) of the patients had a coronal fistula. The size of the defect varied from 2 to 9 mm. All patients had a single UCF. Simple closure was performed in 20 patients, while eight patients underwent Tubularised Incised Plate (TIP) repair, and two patients had Mathieu flip-flap urethroplasty. The most common complication was refistulisation, observed in four patients. Conclusion: Public awareness regarding circumcision by trained surgeons and additional training for healthcare providers is essential to prevent the formation of UCF.

Factors Determining Mortality in Stevens Johnson Syndrome and Toxic Epidermal Necrolysis: A 10 Year Retrospective Analysis from a Tertiary Care Centre in Southern India

Deepthy V Gopinath, Pradeep S Nair Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe cutaneous adverse drug reactions characterised by high fever, widespread blistering exanthema, and atypical target lesions accompanied by mucosal involvement. SJS/TEN ranks among the leading causes of mortality in dermatology. Adequate management of these conditions requires prompt recognition, identification of risk factors and timely intervention. Due to the rarity of these incidents, their mortality rates and the associated factors are less studied. Aim: To determine the factors contributing to mortality in SJS and TEN, as well as, the mortality rate in a tertiary care centre. Materials and Methods: The present single-centre retrospective observational study was conducted in the Department of Dermatology and Venereology, Government Medical College, Thiruvananthapuram, Kerala, India, from November 2022 to May 2023. Data were extracted from the case records of patients diagnosed with SJS/TEN over a period of 10 years, from January 2012 to December 2021. The variables studied included patients’ age, gender, suspected drug, interval between drug intake and onset of symptoms, time interval between the development of the rash and reporting to a healthcare facility, associated co-morbidities, involved Body Surface Area (BSA), duration of hospitalisation, laboratory investigations, and complications, including death. The data were analysed using the trial version of Statistical Package for Social Sciences (SPSS) software version 29.0. A Pearson’s two-sided Chi-square test was utilised to determine the statistical significance of the variables between the survival group and the mortality group. Results: A total of 146 cases of SJS/TEN were analysed, of which the mean±Standard Deviation (SD) age in the survived group was 42.07±16.704 years, while in the mortality group, it was 67.83±7.57 years (p-value=0.003). There were eight cases of mortality (5.48%). The most common drug in both the mortality group and the survival group was phenytoin. There was a statistically significant association between age (p-value=0.003), Hypertension (HT) (p-value=0.002), presentation with vesicles and bullae (p-value=0.002), and mortality. TEN was more likely to cause mortality than SJS (p-value=0.001), and urinary microscopy abnormalities were associated with mortality (p-value=0.04). Conclusion: A low mortality rate of 5.48% was observed in the present study. Older age, hypertension, presentation with vesicles and bullae, and urinary microscopy abnormalities contributed to mortality. Phenytoin was more likely to cause mortality than other drugs. Mortality was higher in TEN compared to SJS.

Assessment of Radiological Parameters of Lordosis in Chronic Low Back Pain: A Case-control Study

Sudhir Singh, Sankalp Singh, Vijay Pratap Singh Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Low Back Pain (LBP) is a global health problem with a multifactorial aetiology. Many clinicians believe that changes in lumbar lordosis contribute to LBP. The normal range of lordosis has not yet been agreed upon; hence, the practice of assessing the parameters of lordosis on sagittal radiographs becomes irrelevant, adding to treatment costs and exposing patients to radiation risk. Consequently, the practice of measuring lordosis needs to be re-evaluated. Aim: To determine the Lumbar Lordotic Angle (LLA) and Lumbosacral Angle (LSA) in individuals with and without LBP. Materials and Methods: This case-control study was conducted from November 2022 to March 2024 at Teerthankar Mahaveer Medical College, a tertiary care hospital, Moradabad, Uttar Pradesh, India. One hundred patients aged between 18 and 50 years with chronic non specific LBP were recruited as cases, matched for age, gender and Body Mass Index (BMI). Similarly, 100 healthy volunteers were taken as controls, also matched for these parameters. LSA and LLA were recorded on sagittal radiographs of all subjects, and the data were analysed statistically. Results: The cases and controls were similar with respect to age (p-value=0.407), gender (p-value=0.315), and mean BMI (p-value=0.239). The mean LSA was 34.17±5.86° (M: 35.19±6.86°; F: 33.55±5.07°) in the case group and 36.69±6.72° (M: 37.68±6.78°; F: 35.87±6.63°) in the control group (p-value=0.001). The mean LLA was 50.04±9.09° (M: 53.99±8.93°; F: 48.25±8.55°) in cases and 49.60±9.77° (M: 48.78±9.69°; F: 50.30±9.88°) in controls (p-value=0.737). LBP cases showed decreased LSA in individuals aged 31-40 years (p-value=0.013), in females (p-value=0.02), and in overweight individuals (p-value=0.002), alongside increased LLA in males (p-value=0.001); however, the difference in angles was only observed in the 20-40 years age range. LLA and LSA did not show any significant association or correlation with age, gender, BMI and VAS. Conclusion: The results indicate that LLA does not vary between those with and without LBP. The LSA was significantly lower in patients with LBP. Both LSA and LLA do not demonstrate a clear association and show an insignificant weak correlation with age, gender, BMI and VAS in both cases and controls.

Translation and Response Validation of Cerebral Palsy Quality of Life Questionnaire for the Child’s Primary Caregiver (Kannada Version): A Cross-sectional Study

KB Komal, Navami Mahaveer, Anvita Shiggavi, Prashanth Mukkannavar, Aditi Prayag Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Cerebral Palsy (CP) is a collection of long-term conditions that impact posture and movement, frequently accompanied by cognitive, sensory, behavioural and communication abnormalities. Children with CP experience a variety of effects on their Quality of Life (QOL), including social, emotional and physical aspects. The CP-specific questionnaire, known as the CP QOL-Child, has not yet been translated or validated in the Kannada language, limiting its applicability in regions where Kannada is the primary language. Aim: To translate and validate the CP QOL-Child Primary Caregiver questionnaire into Kannada. Materials and Methods: This was a cross-sectional cultural study conducted at Department of Paediatric Physiotherapy, KLE College of Physiotherapy, Hubballi, Karnataka, India, over the course of one month (September 14, 2024, to October 14, 2024). It included 50 children with CP (ages 4-12) and their primary caregivers. The Child Primary Caregivers were given a Kannada-translated questionnaire and the data were collected. The internal consistency was assessed using Cronbach’s alpha. The Gross Motor Function Classification System (GMFCS) levels and CP QOL were evaluated and compared. Cronbach’s alpha coefficient was used to evaluate the internal consistency of CP QOL scores; a value of >0.7 was considered indicative of internal consistency and response validity. Results: The mean age observed was 8.1±2.3 years, with 36 (72%) of the children being diagnosed with spastic quadriplegia. Cronbach’s alpha scores for the items in each quality-of-life area demonstrated very good reliability, ranging from 0.687 to 0.882. Overall, the QOL was found to be 41.8±4.2. QOL significantly decreased as GMFCS levels increased, particularly at levels IV (42.8±1.5) and V (36.8±1.4). Pain and the impact of disability showed no significant differences across the GMFCS levels. Conclusion: The present study concludes that the Kannada-translated CP QOL-Child Primary Caregiver questionnaire (for ages 4-12) is a reliable tool for assessing parent-reported CP QOL in Kannada-speaking primary caregivers.

Diagnostic Performance of Thyroid Imaging Reporting and Data system (TIRADS) and Acoustic Radiation Force Impulse (ARFI) imaging in Detection of Malignant Thyroid Nodules: A Cross-sectional Study

Sabarish Sekar, Subathra Adithan, Shubhamoy Gantait, Neelaiah Siddaraju, Gomathi Shankar Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Nodular lesions of the thyroid gland are frequent findings on Ultrasonography (USG). The Thyroid Imaging Reporting and Data System (TI-RADS) scores, based on USG, followed by Fine Needle Aspiration Biopsy (FNAB), are traditionally employed to study these nodules. Different TI-RADS systems are available for the risk stratification of Thyroid Nodules (TN). Thyroid Elastography (TE) is a novel method for diagnosing nodules in recent times. Aim: To determine the diagnostic accuracy of conventional USG TI-RADS scoring systems and TE using Acoustic Radiation Force Impulse (ARFI) in diagnosing malignant and benign TNs, taking FNAB as the gold standard. Materials and Methods: This was a cross-sectional study conducted at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India on a sample of 255 patients (with TNs >1 cm) who underwent thyroid USG (with colour Doppler) followed by TE using ARFI. Virtual Touch imaging (VTi) and VTq quantification (VTq) were performed during TE. TI-RADS scoring, as per the American College of Radiology (ACR) white paper and the Kwak system, along with Shear Wave Velocity (SWV), was recorded along with other qualitative parameters for all the nodules. All the nodules were subjected to either Fine Needle Aspiration Cytology (FNAC) or biopsy for final characterisation into benign or malignant. The Receiver Operating Characteristic (ROC) curve was plotted for the total score as per Kwak, the total number of points as per the ACR committee white paper, and mean SWV, with the best cut-off obtained for each. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and diagnostic accuracy were calculated as per these cut-offs. Results: Out of the 255 nodules, 204 were benign (80%) and 51 (20%) were malignant, as per FNAC or biopsy. The mean age of the patients was 42.77±13.7 years; 49 (19.2%) were male patients and 206 (80.8%) were female patients. According to ACR TI-RADS, 19 benign and 45 malignant nodules were categorised as TI-RADS 5, while the Kwak TI-RADS system identified 22 malignant nodules as TI-RADS 5. A total of 194 (95.1%) benign nodules had a VTi grade ≤2, while 45 (88.2%) malignant nodules had a VTi grade of 3 or above. There was a significant difference (p-value <0.05) in the VTi grade and SWV of the nodules between groups. Based on the ROC curves, the best cut-off to differentiate benign and malignant nodules was 3.4 m/sec for mean SWV (sensitivity 88.2%, specificity 92.2%, PPV 73.77%, NPV 96.91%). The diagnostic accuracy of SWV was 0.91 (0.85-0.95), ACR TI-RADS was 0.90 (0.78-0.90), and Kwak TI-RADS was 0.95 (0.91-0.97). Conclusion: ACR and Kwak TI-RADS scoring based on conventional thyroid USG, along with TE using ARFI, demonstrated good diagnostic accuracy in detecting malignant TNs. ARFI-based TE should be combined with conventional USG for better diagnostic performance and optimal management of nodules.

Combination of Whole Body MRI and MY-RADS: A Promising Standardised Approach for Treatment Response Evaluation in Multiple Myeloma Patients

Dipu Bhuyan, Hrishikesh Choudhury, Baloy Jyoti Talukdar, Subhosree Dey, Sushant Agarwal, Aditi Das, Rishabh Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Multiple Myeloma (MM) is a malignancy that impacts the bones, kidneys, and immune system. Whole-body Magnetic Resonance Imaging (MRI) is recognised as the most sensitive modality for bone marrow assessment, providing advantages such as enhanced speed, comprehensive coverage, and precise quantification compared to traditional MRI methods. This technique circumvent the necessity for intravenous contrast agents and minimises radiation exposure. The Myeloma Response Assessment and Diagnosis System (MY-RADS) represents a standardised framework designed to evaluate and document the therapeutic response of patients with multiple myeloma through imaging techniques, particularly utilising whole-body MRI. Aim: To evaluate the effectiveness of the MY-RADS scoring system using whole-body MRI for treatment response assessment of patients with Multiple Myeloma. Materials and Methods: A prospective observational study was conducted at Gauhati Medical College and Hospital from April 2021 to September 2022. A total of 50 patients diagnosed with multiple myeloma and undergoing treatment were subjected to whole-body MRI evaluations. All participants adhered to a standardised MRI protocol employing uniform sequence parameters utilising the 3T Siemens Magnetom Skyra technology both pre-and post-treatment, with a burden score allocated to reflect the extent and severity of the disease. Disease progression was subsequently evaluated following MY-RADS guidelines consisting of tumour burden score, Apparent Diffusion Coefficient (ADC), and fat fraction to improve reporting consistency and minimise exposure to ionizing radiation. Statistical analyses were conducted utilising IBM SPSS Statistics version 26.0. Pearson’s correlation test was applied to evaluate the correlation between various parameters assessed. A p-value of less than 0.05 was considered statistically significant. Results: A total of 18 (36%) patients were in the MY-RADS 5 score category indicating extensive disease followed by 13 (26%) patients in MY-RADS 4. The mean ADC seen on follow up was 0.71 +/- 0.08 x 10^-3 mm²/sec in MY- RADS score 5 while it was 1.47 +/- 0.22×10^-3 mm²/sec in MY-RADS score 1. There was a statistically significant correlation between MY-RADS score and clinical biomarkers. Conclusion: MY-RADS along with Whole-body MRI offers a non-invasive, radiation-free modality for assessment of response to treatment for Multiple Myeloma, enabling healthcare professionals to timely adjust treatment and improve patient outcomes.

Painting the Portrait of Fibro-osseous Lesions: An In-vitro Study on Staining Duel of Modified Gallego versus Hematoxylin and Eosin (H&E) Staining

Akash Shegaonkar, Shilpa Patel, Jigna Pathak, Niharika Swain, Rashmi Hosalkar, Rutuj Waghmare Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Oral cavity tumours involve a mix of soft and hard tissues, with varying levels of calcification posing diagnostic challenges. Detecting the presence or absence of calcification in connective tissue tumours, whether central or peripheral, benign or malignant, is particularly challenging. Routine stains like Haematoxylin and Eosin (H&E) fail to adequately reveal the specific features of these hard tissues. Alternative histochemical staining procedures, such as Modified Gallego’s Stain (MGS), offer better visualisation of the hard-tissue components in the decalcified sections. Aim: To evaluate and compare the staining efficacy of H&E and MGS to differentiate bone and cemental tissue in histopathologically diagnosed oral and maxillofacial pathologies. Materials and Methods: An in-vitro histochemical retrospective study was conducted at the Department of Oral and Maxillofacial Pathology at MGM Dental College, Navi Mumbai, Maharashtra, India, from October 2018 to January 2021. A total sample size of 60 was chosen using a convenient sampling technique, comprising decalcified tissue sections of normal teeth with periapical bone (n=10), normal bone (n=10) and normal teeth (n=10) as the control group. The study group included pathologies of bone and cemental tissues (cemento-ossifying fibroma, odontome, focal cemento-osseous dysplasia) (n=10), pathological bony tissue (juvenile ossifying fibroma, fibrous dysplasia, aneurysmal bone cyst, peripheral ossifying fibroma, juxtacortical osteosarcoma) (n=10) and pathological cemental tissue (odontome, cementoblastoma) (n=10). Serial sections from each sample were taken. One section was stained with H&E stain and another with MGS. Stained sections were viewed using routine light microscopy and evaluated under 40X, 100X and 400X magnification. Histochemical evaluation was performed for the intensity of stain and its tissue differentiation capability for osteoid, immature bone, mature bone, cementoid and cementum. All statistical analysis were performed using the Statistical Package for Social Sciences (SPSS v 26.0, IBM). The data obtained were presented using descriptive statistics. The Chi-square test was used and statistical significance was set at a p-value of less than or equal to 0.05. Results: The MGS had better efficacy than routine H&E stain in differentiating bone and cemental tissues of decalcified tissue sections from various oral and maxillofacial pathologies. A comparison of the H&E and MGS between various study and control groups showed statistically significant results (p<0.05) in differentiation and intensity. Conclusion: The MGS is a better histochemical stain than the routine H&E stain, with increased differentiation and clarity in identifying bone and cemental tissues; hence, it can be considered a reliable method to differentiate pathological tissues.

Association of Adenotonsillectomy with Vaso-occlusive Crisis Frequency in Sickle Cell Patients of Eastern Saudi Arabia: A Retrospective Study

Moath Alfaleh, Omar Alanzi, Ali Alaskari, Mohammed Alzamil, Hussain Al-Baharna Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: The Red Blood Cells (RBCs) in Sickle Cell Disease (SCD) are distorted into a crescent shape in conditions of low oxygen because of a mutant type of haemoglobin. Vaso-occlusive Crisis (VOC), a defining symptom of SCD, is acute painful assaults caused by vaso-occlusion in the bone marrow. SCD is substantially more prevalent in some regions of Saudi Arabia than in others, with the Eastern Province having the highest incidence rates, followed by the Southern and Western provinces. A 90% of SCD patients were hospitalised due to a painful crisis, often brought on by several reasons, including infection, dehydration, acidosis, hypoxia and many others. Many childhood infections are linked to tonsil and adenoid infections, often requiring tonsillectomy or adenoidectomy. Aim: To evaluate the relationship between adenotonsillectomy and VOC frequency in SCD patients who underwent adenotonsillectomy. Materials and Methods: A retrospective cohort study was conducted in the Otorhinolaryngology Department in Qatif Central Hospital, Qatif, Saudi Arabia, in June 2023. Data were collected retrospectively from January 2019 and January 2022. Patients diagnosed with SCD and who underwent Adenoidectomy and/or Tonsillectomy was included in the study. Clinical and demographic data, along with co-morbidities and laboratory results, were retrieved from electronic medical records. Intragroup comparison of presurgical and postsurgical intervention variables was done using a paired t-test. A p-value of 0.05 or less was considered statistically significant. Results: A total of 32 patients were included in the study. Among the participants, females accounted for 13 (40.6%) and males accounted for 19 (59.4%) of cases. The mean age at surgery of the participants was 10.16 years. The mean of preadenotonsillectomy admissions was less than that of postadenotonsillectomy admissions in all periods; however, this difference was not statistically significant, with p-values of 0.156 for one year, 0.376 for two years and 0.162 for three years. The mean preadenotonsillectomy VOC was higher than the postadenotonsillectomy VOC for the one-year, two year and three-year periods, with p-values of 0.400, 0.167 and 0.088, respectively. Regarding Blood Transfusions (BT), the mean preadenotonsillectomy value was higher than the postadenotonsillectomy mean; however, this difference was not statistically significant, with a p-value of 0.395 Conclusion: Over three years, Adenotonsillectomy did not affect the frequency of VOCs, BTs and hospitalisations, indicating that these procedures may not be suitable as preventive measures for the majority of patients. Future research with larger sample sizes, preferably randomised controlled trials, is required to confirm the findings and assess whether performing the procedure prophylactically in SCD patients with recurrent tonsillitis lowers the frequency of VOCs, potentially reducing the number of ED visits for pain management and control.

Association between Glycaemia and Neurodevelopmental Outcome at One Year of Age among Term Neonates At-risk for Hypoglycaemia: A Prospective Cohort Study

Naga Venkatesh Kuntamukkala, Yeshwini Nithiyananthan, Karthikeyan Kadirvel, Padmanaban Srinivasan, Palanisamy Soundararajan Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Hypoglycaemia during the newborn period is especially impactful because the brain is dynamically developing. The most common sequelae of hypoglycaemia are disturbances in neurologic development and intellectual function; although minor deficits, especially spasticity, ataxia and seizure disorders, can also occur. Aim: To assess the association between glycaemia and neurodevelopmental outcomes at one year of age among term neonates at-risk for hypoglycaemia. Materials and Methods: This prospective cohort study was conducted at the Department of Paediatrics, Mahatma Gandhi Medical College and Research Institute (a tertiary care hospital), Puducherry, India between November 2020 and July 2022. It involved a cohort of neonates at-risk for hypoglycaemia with a gestational age of ≥35 weeks who underwent intermittent monitoring of Blood Glucose (BG) for up to 72 hours of life. The estimated sample size was 146. Assessment at one year included Developmental Assessment Score for Indian Infants (DASII) scores and Amiel-Tison angles, with the assessor being masked to the neonatal glycaemic status. Results: Of the 146 neonates, 71 were euglycaemic and 74 were hypoglycaemic (57 asymptomatic and 17 symptomatic). The mean birth weights were 2853±0.61 grams for euglycaemic neonates, 2669±0.62 grams for asymptomatic hypoglycaemic neonates and 2965±0.671 grams for symptomatic hypoglycaemic neonates. Three of the 74 hypoglycaemic infants developed cerebral palsy. The mean Motor and Mental Developmental Quotients (MoDQ and MeDQ) were significantly lower at one year in any hypoglycaemic infants compared to euglycaemic infants (p<0.001). A BG level of <40 mg/dL demonstrated 98.9% sensitivity for MoDQ and 100% sensitivity for MeDQ, respectively. The Area Under the Curve (AUC) was 0.958 for MoDQ and 0.812 for MeDQ, respectively. Conclusion: Hypoglycaemia, regardless of whether it is symptomatic or asymptomatic, is associated with poor neurodevelopmental outcomes. All at-risk neonates should be monitored to prevent any episodes of hypoglycaemia.

Comparison of Placental Vitamin D Receptor Target Gene Expression in Idiopathic Foetal Growth Restriction Pregnancy and Gestational Age-matched Healthy Controls: A Case-control Study

Priya Sharma, Richa Aggarwal, BD Banerjee, Priyanka Gogoi, Richa Sharma Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Foetal Growth Restriction (FGR) is a common pregnancy complication that affects up to 10% of pregnancies and is associated with significant morbidity and mortality in the perinatal period and infancy. Despite extensive investigations, a definite etiology cannot be found in up to 70% of cases of FGR, which are termed idiopathic. One of the causative factors responsible for idiopathic FGR could be altered placental expression of Vitamin D Receptor (VDR) genes. Aim: To estimate placental VDR target gene expression in pregnancies affected by idiopathic FGR and to compare it with gestational age-matched healthy pregnant women. Materials and Methods: A case-control study was conducted in the Department of Obstetrics and Gynaecology, University College of Medical Sciences and GTB Hospital, New Delhi, India, from November 2019 to October 2021. All pregnant women ≥28 weeks gestation with FGR were evaluated to determine the etiology. Those with a negative work-up were defined as having idiopathic FGR (cases, n=30). Gestational age-matched healthy pregnant women were enrolled as controls (n=30). A maternal blood sample for Vitamin D levels was taken before delivery. After delivery, a small portion of the placenta was collected for Ribonucleic Acid (RNA) extraction to study the relative gene expression of VDR and the downstream target gene in the VDR pathway, Transforming Growth Factor Beta 3 (TGFβ3). Statistical tests used in the study included the Independent t-test and Analysis of Variance (ANOVA) for quantitative variables and the Chi-square test or Fisher’s exact test for qualitative variables. The Pearson’s correlation coefficient was used to correlate maternal Vitamin D level (ng/mL) with VDR messenger RNA (mRNA) expression fold change and TGFβ3 mRNA expression fold change. Univariate logistic regression was used to calculate the odds ratio. A p-value of <0.05 was considered significant. The software used for statistical analysis was Statistical Package for Social Sciences (SPSS) software version 21.0. Results: Both groups were comparable in demographic characteristics such as age, socio-economic status, parity and Body Mass Index (BMI). The mean value of maternal Vitamin D levels in idiopathic FGR was 15.73±7.65, compared to 20.01±5.27 in controls. The majority of the patients in our study had Vitamin D deficiency (<20 ng/mL), with 70% of cases and 60% of controls. The mean VDR mRNA ?ct value in cases was higher compared to controls (5.09±0.86 vs. 4.53±1.03, p-value=0.027), implying reduced VDR mRNA gene expression in cases. The mean TGFβ3 mRNA ?ct value was 8.11±1.81 in cases and 6.73±1.64 in controls (p-value=0.003), suggesting reduced TGFβ3 mRNA gene expression in cases. Maternal Vitamin D levels were not found to have any correlation with VDR mRNA and TGFβ3 mRNA expression (correlation coefficients 0.008 and 0.194, respectively). Conclusion: Women with idiopathic FGR had reduced placental VDR and TGFβ3 mRNA expression. However, no correlation was found with maternal Vitamin D levels, suggesting defects in the placental VDR pathway as an etiological factor in FGR.

Pharmaceutico-analytical Study of Dhananjayadi Vati and Assessment of its Antihistaminic Activity: A Research Protocol

Puja Maldhure, Anita Santoshrao Wanjari, Anjali S Katore, Kirti Naharwal Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: Histamine is the local hormone synthesised by mast cells in the tissue and basophils in the blood. Histamine and its Receptors (H1R-H4R) have a substantial impact on the onset of many allergic diseases. Allergic diseases, including asthma, pruritus, atopic dermatitis and allergic rhinitis, result from the complex interaction of inflammatory cells like basophils, mast cells, lymphocytes and dendritic cells responding to various environmental and allergic stimuli. Need of the study: An antihistamine is a medication that works against histamines to relieve allergy symptoms. These medications help to address conditions triggered by histamine in the body. However, some non steroidal antihistaminic drugs are proven to be quick-acting but are associated with potential side-effects, such as organ damage. In Ayurveda, several medicinal preparations have been mentioned to combat the allergic condition and the Dhananjayadi tablet (Vati) might also be significantly effective in allergic conditions. Aim: Pharmaceutico-analytical evaluation of Dhananjayadi Vati and assessment of its antihistaminic activity. Materials and Methods: An in-vitro study will be conducted in the Department of Dravyaguna at Mahatma Gandhi Ayurved College Hospital Research Centre, Salod (H) Wardha, Maharashtra, India from August 2024 to March 2025. All herbal drugs will be collected, verified and primarily authenticated by the Department of Dravyaguna and will be prepared as per the references. Organoleptic parameters (touch, appearance, taste, odour) and physicochemical parameters (hardness, pH value, uniformity of weight, loss of drying at 105°C, total ash, acid-insoluble ash, water-soluble extractive values, alcohol-soluble extractive values, disintegration time, friability and High-Performance Thin-Layer Chromatography (HPTLC) of the drug) will be evaluated. The antihistaminic action of Dhananjayadi tablet (Vati) will be evaluated in-vitro while assessing the proportion of contraction of goat tracheal tissue. A paired t-test will be conducted for pre- and postintervention evaluation and a p-value <0.001 will be considered statistically significant.

Contribution of JSS Academy of Higher Education and Research towards Global Research: Trends and Insights

Rohith Yampati, Chandrika Doddihal, Mallanagouda M Patil, BM Prasanna Kumar Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: JSS Academy of Higher Education and Research (JSSAHER) has a long-standing tradition of promoting interdisciplinary research and fostering global collaborations. The institution has made significant strides in health sciences, particularly in areas such as pharmacology, public health and clinical medicine. JSSAHER, a health sciences-oriented institution in India, has consistently emphasised research and global collaboration. This study evaluates its contribution to global research. Aim: This study used the Web of Science database to analyse the research output, growth and international collaboration of JSSAHER from 1996 to 2023 through scientometric analysis. Materials and Methods: This bibliometric study was conducted at JSSAHER, Mysuru, India, between January and June 2024, using data from the Web of Science database. A total of 4,680 publications were analysed based on specific inclusion and exclusion criteria. Parameters such as publication trends, citation metrics, international collaborations and keyword analysis were assessed using tools like Biblioshiny, VOSviewer, CiteSpace and MS Excel. Ethical clearance was not applicable, as this study involved secondary data analysis. Results: JSSAHER’s research output demonstrated an annual growth rate of 13.87%. In 2023, 649 papers were published, and 5,665 citations were recorded in 2022. Prominent keywords included “in-vitro,” “prevalence” and “oxidative stress.” Collaboration networks revealed partnerships with various countries. Conclusion: The analysis highlights JSSAHER’s growing influence in scientific research, marked by sustained publication output, impactful collaborations and diverse research themes. These insights guide the institution’s future research endeavours.

Unraveling the Mysteries of Exploding Head Syndrome: A Narrative Review

Smit Firke, Bhagyesh Sapkale, Gargi Mudey, Sachin R Gedam Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Exploding Head Syndrome (EHS) is a rare parasomnia characterised by the perception of loud, abrupt auditory hallucinations during sleep-wake transitions. Even though EHS is not associated with any physical pathology, it may cause substantial sleep disturbances and interruptions. To address these questions, the present narrative review synthesises the current knowledge and consensus on the nature of EHS, including its symptoms and possible causes, existing classification systems, and available interventions. Other frequent complaints include rhythmic noises in the ears, difficulty seeing and somatic sensations, such as electrical buzzing in the head. Stress or anxiety may potentially precede an episode, and dysfunction in the brainstem reticular formation and mild temporal lobe seizures have been suggested as possible neurological causes. EHS falls under the category of parasomnias within the International Classification of Sleep Disorders Third edition (ICSD-3) and is classified as an unspecified sleep-wake disorder under the Diagnostic and Statistical Manual of Mental Disorders Fifth edition (DSM-5). Current intervention strategies are still scarce; while topiramate has been shown to lessen the intensity of symptoms, no trials on this possibility have been conducted so far. Education and reassurance may be useful in alleviating these symptoms. More studies are required to increase knowledge about the underlying processes and to establish specific therapeutic strategies. The present review alerts readers to the growing evidence for EHS, which remains a condition that is not frequently identified, and urges investigators to conduct randomised controlled therapeutic trials.

Ustrakantaka (Echinops echinatus Roxburgh) from Folklore Field Practice to Therapeutics: A Narrative Review

Monika, Dattatray Sarvade, Rajkumar Gupta Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X “Ustrakantaka,” the botanical source of which is Echinops echinatus Roxb., is a wild branched xerophytic herb. It has a long history of use in traditional medicine, primarily valued for its stimulant properties in addressing sexual dysfunction and debility. The roots (mula), leaves (patra), flower (pushpa) and bark (twak) are frequently employed in folklore and Ayurveda. This plant exhibits multifaceted therapeutic potential, addressing urinary, liver and gynaecological disorders while also demonstrating antimicrobial, analgesic, antioxidant and anti-inflammatory properties. The plant’s pharmacological activities are rooted in its diverse phytochemical profile, featuring the flavonoid apigenin and apigenin-7-O-glucoside, the phenolic compound Echinacin and the alkaloid Echinopsine. The present literature review provides an in-depth examination of Echinops echinatus, synthesising contemporary research on its historical context, ethnomedical application, pharmacognosy, phytoconstituents, pharmacological action and biological activity of the plant.

Cutaneous Metastasis of Squamous Cell Carcinoma of the Tongue as Bilateral Neck Nodules: A Case Report

Sheeja Sainulabdeen, CK Anju, Suraj Madhavan Nair, TV Murali Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Squamous Cell Carcinoma (SCC) of the oral cavity is one of the most common malignancies in the head and neck region. Although lymphatic spread is the most common mode of metastasis, it can also metastasise via the haematogenous route to internal organs such as the lungs, liver and bones. While cutaneous metastasis has been reported in SCC of the oral cavity, metastasis presenting as subcutaneous nodules on both sides of the neck is extremely uncommon. Hereby, authors present a 66-year-old male with a history of smoking and diabetes, diagnosed with well-differentiated SCC of the tongue. He underwent wide local excision, selective neck dissection and adjuvant radiation therapy. He developed a recurrence in the level V cervical lymph nodes after one year, which was surgically excised. Histopathology confirmed metastasis in all the nodes, with two showing extranodal extension. A few weeks later, patient presented with painful, umbilicated skin nodules on both sides of the neck. A biopsy confirmed these as cutaneous metastasis from SCC. This case details a unique presentation of SCC of the tongue, which relapsed as painful subcutaneous nodules on both sides of the neck, highlighting the varied clinical presentation, diagnostic approach and pathological findings.

Impact of a Structured Educational Programme on the Knowledge of Antibiotic Usage and Resistance among Undergraduate Non Medical Students: A Research Protocol

Lalhmachhuani Hmar, Ruchira Ankar Journal of clinical and diagnostic research : 2025 - March - 19:0973-709X Introduction: One of the most widely used medications to treat infections in a variety of medical specialities is an antibiotic. While their names are well known and they are widely used, there is insufficient education in the community, especially in developing countries, regarding the appropriate administration of antibiotics, antibiotic resistance, and its effects. As the demand for antibiotics increases day by day, the need for awareness and education becomes increasingly crucial. Need of the study: Global health is seriously threatened by bacteria resistant to the drugs used to treat them. We call this resistance to antibiotics. This can lead to infections that are difficult or impossible to treat, as well as an increased risk of death and morbidity. Research on antibiotic resistance and public and healthcare provider awareness of these issues is essential to prevent Antimicrobial Resistance (AMR) and guarantee that antibiotics are used appropriately. Aim: To assess the efficacy of a structured educational intervention in raising undergraduate non medical students’ knowledge of antibiotics and their resistance. Materials and Methods: A quasi-experimental study will be conducted at the Indian state of Maharashtra’s Indraprastha New Arts Commerce and Science College, Wardha from August 2024 through December 2024. A quantitative method will be used to assess how well the structured teaching programme has affected students’ knowledge of antibiotics and their resistance. A total of 65 students will participate and a structured questionnaire will be used for data collection. The tools will consist of- Section I: Demographic data like age, gender, types of family, resident and socioeconomic status. Section II: Structured knowledge questionnaire on the knowledge of antibiotics and their resistance. Descriptive and inferential statistics will be used to classify and analyse the participant data to meet the study’s objectives. Frequency, mean, standard deviation, mean percentage, and structured questionnaires will be used to explain demographic variables. A paired t-test will be applied to ascertain the significance of the variation in the knowledge score between the pre and post-test. The Chi-square test will be applied to determine the association between the knowledge level and demographic variables.