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

A Rare Case of Adenovirus-induced Transverse Myelitis: A Clinical Insight into Diagnosis and Treatment

Kishor M Khillare; Sheetal Nandha Kishore; Jagannath S Dhadwad; Anish Chitnis; Chandan Dash Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Adenovirus (Ad), a common virus, can cause a variety of symptoms such as respiratory issues, fever, and occasionally neurological problems. Transverse Myelitis (TM) is defined as a neurological disorder marked by inflammation of a section of the spinal cord which further damages the myelin sheath surrounding the nerve fibers. This can result in a variety of symptoms, including general weakness, sensory changes, pain and difficulties with bowel and bladder control. Ad causing TM is a topic of great significance in the field of medicine as it involves a rare yet serious condition. Hereby the case report of a 64-year-old female who presented to the Emergency Room with fever and bilateral lower limb weakness and was diagnosed with TM, with the Cerebrospinal Fluid (CSF) report Polymerase Chain Reaction (PCR) showing Ad. The patient was treated with plasmapheresis, antivirals, steroids and physiotherapy. The present case emphasises that timely diagnosis and identification of the underlying cause of TM are essential to prevent respiratory paralysis and other complications. It is also important to exclude other autoimmune conditions, as well as, bacterial and fungal infections, in every patient.

Multifocal Hepatocellular Carcinoma Extending into the Right Atrium: A Report of Two Cases

Bharadwaj Saraswathula; Shirish Vaidya; Pratap Singh Parihar; Ravishankar Patil; Devyansh Nimodia Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Hepatocellular Carcinoma (HCC) is one of the most aggressive malignant tumours, frequently inducing macrovascular invasion. Tumoural Thrombus (TT) production in mature HCC stages is prevalent and typically affects the hepatic or portal veins. Hereby, the authors present a case report of two cases, firstly, 68-year-old male who presented to the Emergency Department with bilateral pedal oedema and a lack of appetite; secondly, 62-year-old female who reported with weakness and giddiness for two months, abdominal distention for one month, black-coloured stools for one month, and a two-month history of weight loss. Abdominal Computed Tomography (CT) scans for both patients revealed multiple ill-defined solid lesions with necrotic foci in the liver in the former case, and multiple heterogeneously enhancing lesions with a few calcific foci and haemorrhages in the liver in the latter patient, consistent with HCC and tumoural thrombus extending from the hepatic vein into the Right Atrium (RA) via the Inferior Vena Cava (IVC). HCC with TT spreading into the RA is a serious and challenging condition with a poor prognosis. Early detection and aggressive treatment are critical, but they are typically insufficient to prevent rapid disease progression and high mortality.

Postoperative Superficial Thrombophlebitis of the Upper Limb: A Rare Complication following Total Laparoscopic Hysterectomy

Amey Chugh, Prashansa Gupta, Varshini Vadithala, Janvi Patel Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Superficial Thrombophlebitis (STP) is an uncommon vascular condition that involves inflammation and blood clotting (thrombosis) of a superficial vein. It often presents with redness, swelling and localised pain. Although it can cause significant discomfort, it is usually less severe than Deep Vein Thrombosis (DVT) and can sometimes lead to serious complications such as DVT or Pulmonary Embolism (PE). The three factors responsible for STP are venous stasis, injury to the endothelium, and hypercoagulability, collectively referred to as Virchow’s triad. The condition mainly affects the legs but can also occur in other parts of the body, such as the lower and upper limbs. Hereby, authors describe a case of a 51-year-old woman who developed STP in her left arm after a Total Laparoscopic Hysterectomy (TLH). Despite being uncommon, STP following gynaecological surgery necessitates early diagnosis and treatment to prevent its progression into life-threatening clotting disorders. This case demonstrates successful conservative management of uncomplicated STP and underscores the need for vigilance in postoperative care. Early diagnosis, risk stratification, and individualised treatment plans are essential for optimising patient outcomes and preventing serious complications.

Unravelling Chikungunya’s Neurological Toll: A Case Report with Insights from Magnetic Resonance Imaging of Brain

Ponvijaya M Yadav, Vijayashree Gokhale, Sangram S Mangudkar, Sindhuri Goud Nimmala, Vineetha Naga Lakshmi Giduturi Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Chikungunya, an emerging neurotropic virus, has the potential to induce various neurological abnormalities. When suspecting encephalitis, it is imperative to test for the Chikungunya virus, which requires an early diagnosis and course of treatment. This is a case report of a 54-year-old male who presented with fever, giddiness, ataxia and slurred speech. Magnetic Resonance Imaging (MRI) brain revealed typical hallmark features of chikungunya encephalitis, with an incidental right cerebellopontine angle tumour. A positive serum chikungunya antigen Polymerase Chain Reaction (PCR) validated the diagnosis. The patient was initially managed in the Intensive Care Unit (ICU), showing a dramatic response to the treatment, and then shifted to the medicine ward for further observation and management. This case underscores the importance of considering chikungunya in patients presenting with encephalitis differential diagnosis, especially in endemic regions like India. Comprehensive imaging and PCR testing were instrumental in diagnosis. Treatment included supportive care, intravenous antibiotics, antivirals and steroids, leading to significant improvement. By day 12, notable recovery was observed, and follow-up MRI brain showed no new abnormalities. This case adds to the evidence of severe neurological manifestations of Chikungunya virus, highlighting the need for early recognition and management to improve outcomes. The concurrent presentation of chikungunya encephalitis and a cerebello-pontine angle tumour emphasises the necessity for thorough neuroimaging and PCR testing in suspected cases. The patient’s dramatic recovery following timely intervention demonstrates the potential for positive outcomes with appropriate management.

Congenital Adrenal Hyperplasia Presenting as Life Threatening Hyponatremic Dehydration: A Tale of Missed Diagnosis

Dinkar Yadav, Poonam Dalal, Kapil Bhalla, Geeta Gathwala Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Congenital Adrenal Hyperplasia (CAH) is a group of autosomal recessive disorders that occur due to defects in steroid synthesis. It is characterised by a deficiency of adrenocortical hormones and an excess of steroid precursors. A deficiency of 21-hydroxylase is the most common type, constituting 90% of the cases. The authors hereby, report a case of a one-month-old baby who presented to the Paediatric Emergency Department with typical features of the salt-wasting form of CAH. The diagnosis was confirmed with elevated levels of 17-hydroxyprogesterone and a Cytochrome P450 Family 21 Subfamily A Member 2 (CYP21A2) gene mutation. The child was managed with hydrocortisone, fludrocortisone and salt supplementation, along with symptomatic and supportive care. The child is still under regular follow-up and is doing well.

Anaesthetic Management in a Patient with Pituitary Macroadenoma: A Case Report

Shyamolima Bhuyan, Deepjit Bhuyan Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Pituitary tumours are the second most common intracranial tumours. The anaesthetic management of pituitary tumours requires an in-depth understanding of the principles of neuroanaesthesia and pituitary disorders. Immaculate preanaesthetic evaluation, intraoperative management and postoperative care with interdisciplinary teamwork are essential for successful outcomes in surgeries for pituitary tumours. This case report discusses a 34-year-old female patient presenting for the management of a pituitary macroadenoma, illustrating the anaesthetic challenges faced in such cases. The presence of acromegaly, along with co-morbidities such as hypertension, necessitated a detailed anaesthetic management plan. The patient underwent thorough preanaesthetic evaluation and had a transnasal trans-sphenoidal tumour excision under general anaesthesia, following standard protocols for difficult airway management. The patient was intubated using a video laryngoscope and invasive blood pressure and central venous pressure monitoring were conducted. Following surgery, the patient was transferred to the neurosurgery intensive care unit and was subsequently discharged on the 10^th postoperative day.

Three Weeks of Extracorporeal Therapy and Telerehabilitation for Supraspinatus Calcific Tendinosis: A Case Report

Sachin Shetti, Sneha Katke, Prashant Naik, Manal Anthikat Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X This case report presents the treatment of a patient with shoulder calcification and reduced Range of Motion (ROM) using a combination of Extracorporeal Shockwave Therapy (ESWT) and telerehabilitation. The patient received three sessions of ESWT, once per week, followed by daily guided shoulder exercises delivered via telerehabilitation for three weeks. Pre- and post-treatment assessments included goniometry for ROM, the Shoulder Pain and Disability Index (SPADI) score for shoulder function and X-ray imaging. The results demonstrated significant improvements in pain, function and ROM suggesting the potential benefits of this combined approach in reducing patient burden and promoting sustainability in physiotherapy.

Potential Role of Ayurveda Interventions in the Management of Grade II Non Alcoholic Fatty Liver Disease: A Case Report

Babita Yadav, Vaishali Kuchewar, Bharti Gupta Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Non Alcoholic Fatty Liver Disease (NAFLD) represents a growing global health concern, particularly driven by rising obesity rates, with prevalence ranging from 11.2 to 37.2% in the general population. Ayurveda classifies NAFLD under Yakrit Roga (liver disease) and Medoroga (obesity), with traditional texts attributing its development to lifestyle factors that lead to imbalances in tridosha. Hereby, the authors present a unique case of 59-year-old male that highlights the therapeutic effects of Ayurveda interventions in managing grade II NAFLD, adding valuable insights to the scientific literature by demonstrating effective treatment in the absence of a standard care protocol. The patient presented with symptoms of indigestion and liver enlargement consistent with grade II NAFLD, confirmed through ultrasonography evaluation. Clinical findings included liver steatosis and mild hepatomegaly. The intervention involved Ayurveda-based therapies tailored to the patient’s condition, focusing on balancing Rakta-Kapha Dushti and dietary modifications based on classical Ayurveda guidelines. Following treatment, the patient experienced complete relief from symptoms of indigestion, and follow-up ultrasonography showed significant improvement, as there was no NAFLD. The present case report illustrates the potential of Chitrakadi Vati and Phaltrikadi Kashaya ghan vati as effective management strategies for NAFLD, particularly in the absence of established standard care. The takeaway lesson is that individualised Ayurveda treatment may offer a viable therapeutic approach for NAFLD, highlighting the importance of integrating traditional medicine into the broader clinical context of liver disorders.

Management of Chronic Kidney Disease through Ayurvedic Shodhana and Shamana Chikitsa: A Case Report

Mayank Rai, Sadhana Misar Wajpeyi Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Chronic Kidney Disease (CKD) has become a major public health issue affecting both younger and older individuals. The prevalence of CKD is on the rise, primarily driven by conditions such as hypertension and type 2 diabetes mellitus. CKD is characterised by progressive and irreversible damage to the kidneys, often presenting asymptomatically in its early stages. As the disease advances, patients may experience symptoms such as pedal oedema, decreased appetite, nausea, reduced urine output, frothy urine and fatigue. Laboratory tests typically show increased levels of creatinine and serum urea, indicating poor renal function. Traditional treatments, including dialysis and renal transplantation, remain mainstream approaches for managing CKD. However, these interventions are often financially prohibitive for many individuals in India, underscoring the urgent need for more affordable and accessible alternatives. In response to these challenges, Ayurvedic medicine offers promising alternative treatments. Hereby, the authors present a case of a 30-year-old male suffering from CKD; despite being recommended for dialysis, the patient opted for Ayurvedic treatment. Ayurvedic Shodhana chikitsa (purification and rejuvenating therapy) through Basti (therapeutic enema) combined with oral herbomineral formulations has demonstrated renoprotective effects and potential benefits in improving haematological parameters in CKD cases. The present case report highlights the importance of traditional Ayurvedic approaches as alternatives to prevent dialysis for CKD patients, particularly in low-income populations.

A Rare Paediatric Case Report of Neglected Traumatic Posterior Hip Dislocation

L Sabari Vaasan, K Santhosh Kumar, S Devi Prasad, Suraj J babar, J Kevin Dhas Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Traumatic posterior hip dislocation in paediatric age group is a rare but potentially debilitating condition, particularly when neglected. The delay in seeking medical care frequently leads to missed diagnosis, which can lead to an array of future complications. Hence, timely intervention is crucial in treating neglected traumatic hip dislocations in children to prevent complications like avascular necrosis of femoral head, sciatic nerve injury and early degenerative arthritis. Various treatment options exist, ranging from closed reduction and hip spica application to surgical interventions like open reductions and osteotomies. The primary goal of any treatment modality in hip dislocation is to achieve concentric reduction and preventing the possible associated complications. Additionally, there is limited research evaluating the outcomes of closed reduction in neglected traumatic posterior hip dislocations specifically in children. The present case report aims to address this gap by presenting a case of a six-year-old female child with a neglected posterior hip dislocation following a fall from tree six weeks prior, which was managed with continuous traction followed by closed reduction and hip spica cast application. The serial follow-up of the child showed satisfactory clinical outcome as evidenced by improved hip range of motion and normal gait. The successful outcome supports the effectiveness of this approach in managing neglected traumatic hip dislocations in children. This case also emphasises that there should be attempts of closed reduction in all neglected paediatric hip dislocations, followed by hip spica application, before undertaking any surgical interventions, even if they present after six weeks.

A Rare Case of Dilated Cardiomyopathy in Sjögren’s Syndrome

Pradnya Diggikar, Tushar Pancholi, Sreevidya Yekkaluru, Hansini Raju Reddy, Akhilesh Jagirdar Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Dilated Cardiomyopathy (DCM) is a rare but significant complication in patients with primary Sjögren’s Syndrome (pSS), a systemic autoimmune disease that primarily affects the exocrine glands. Cardiac involvement in pSS is uncommon, making the recognition of DCM in these patients crucial for timely intervention. This is a case of a 44-year-old female with well-controlled hypertension who developed progressively worsening shortness of breath, chest pain and bilateral pedal oedema. She also had a two-month history of dry eyes and dry mouth, indicative of sicca symptoms. Clinical examination revealed signs of fluid overload, a pansystolic murmur and sicca features. Electrocardiogram (ECG) and echocardiography demonstrated severe left ventricular dysfunction with an ejection fraction of 15%, consistent with DCM. Laboratory investigations revealed elevated N-terminal pro b-type natriuretic peptide (NT-proBNP) levels and positive anti-Ro52 and anti-La antibodies, pointing to an autoimmune aetiology. Cardiac Magnetic Resonance (CMR) Imaging confirmed non ischaemic DCM, ruling out ischaemic causes. The patient was diagnosed with DCM secondary to pSS. She was treated with diuretics, Angiotensin Converting Enzyme (ACE) inhibitors and immunosuppressive therapy, including methylprednisolone and a tapering course of prednisolone over six months. Significant clinical improvement was observed on follow-up. This case highlights the importance of recognising autoimmune aetiologies, such as pSS, in patients presenting with unexplained cardiomyopathy. Early diagnosis and interdisciplinary management are essential in preventing severe cardiac complications and improving patient outcomes in rare presentations of Sjögren-associated cardiomyopathy.

Adult Bladder Exstrophy Managed by Complete Primary Repair: A Case Report

Deepak Mane, Shivam Singh, Vikram P Satav, Vilas P Sabale Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Bladder Exstrophic diseases, referred to collectively as Bladder Exstrophy-Epispadiasis complex, are a spectrum of embryological anomalies with a rare prevalence of approximately 3.3 per 1,00,000 live births with a male gender predominance. An 18-year-old man presented to Urology Outpatient Department (OPD) with subumbilical abdominal wall defect, absent anterior bladder wall with epispadiasis and was diagnosed as a case of adult classic bladder exstrophy with Epispadiasis complex. There was no history of any fever, haematuria, dysuria or abdominal pain. His ultrasound abdomen and intravenous pyelography reported normal kidney function. He had a low Body Mass Index (BMI) (17.5 kg/m2) with serum creatinine of 0.6 mg/dL. The patient underwent a complete primary repair, including bladder template closure and bladder neck reconstruction using Young-Dees-Leadbetter technique. Epispadias was repaired with the Modified Cantwell-Ransley approach. Abdominal wall defect closure was done with the help of rectus abdominis muscle flap which was later grafted using Split Thickness Skin Graft (STSG). Postoperatively, a small vesicocutaneous fistula developed which healed spontaneously over two weeks period. On follow-up patient was on clean intermittent catheterisation with some incontinence episodes during night-time. Bladder exstrophy in adult patients is rare, as the condition is usually identified in the neonatal period and can be surgically corrected early on. Due to the complexity of the surgery, these cases require thorough multidisciplinary evaluation and careful planning for successful correction.

Basaloid Squamous Cell Carcinoma of the Oral Cavity: A Report of Two Cases with Review of Literature

Sudarvizhi Thiruvasagam, Shalinipriya Nesamani, Varsha Upadya, Soniya Adyanthaya, Maji Jose Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Basaloid Squamous Cell Carcinoma (BSCC) is a rare, aggressive variant of squamous cell carcinoma. It exhibits diverse histological features. The present case reports provide valuable insights by focusing on BSCCs of the tongue and gingiva, including a detailed review of 19 cases in the literature specific to gingival involvement, which is a less common location for BSCC. Case 1 involves a 76-year-old female with a history of BSCC who presented with a painful 4x4 cm recurrent lesion on her upper lip. Case 2 is a 62-year-old male smoker with a history of thyroid carcinoma who exhibited a rapidly growing, painful 2x2 cm lobulated mass on his tongue. In both cases, a thorough clinical evaluation and incisional biopsy were performed to establish a diagnosis. Histopathological examination confirmed BSCC and both lesions were surgically excised with wide margins, taking their age into consideration. Both patients have since remained recurrence-free under regular follow-up, emphasising the efficacy of timely intervention. The present study findings suggest that while radiation exposure may contribute to the development of BSCC of the tongue, it is not the only causative factor. Other factors, such as smoking or genetic predispositions, may also play a role. The aggressive nature of BSCC, particularly in the gingiva, highlights the need for a comprehensive diagnostic approach, including biopsy and histopathological evaluation. Furthermore, the present cases align with evidence suggesting that combining surgery with postoperative chemotherapy or radiation therapy may not significantly improve survival outcomes. Long-term follow-up remains important to monitor for any potential complications.

Gorham Disease of Mandible-Diagnostic Challenge: A Case report

Soumi Ghanta, Debanti Giri, Ritesh Aich, Anirban Das Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Gorham disease is a rare entity of unknown aetiology characterised by the progressive destruction of osseous matrix, which is later replaced by proliferation of non neoplastic vascular tissue followed by dense fibrous tissue without bone regeneration. It was first described by Jackson in 1838. This condition can occur at any age and may affect any bone, however, in the skull, the maxilla and mandible are affected. Generally, the mandible is involved unilaterally. When the jaws are affected, tooth mobility is the first problem, and because of this diagnosis is difficult as it mimics periodontal diseases. Hereby, the authors present a case report of Gorham disease in a 38-year-old female, affecting the mandible bilaterally. The patient underwent multiple extractions from the maxilla and mandible due to tooth mobility. Severe alveolar ridge resorption was also evident in present case. Initially, radiolucent foci are present mimicking osteoporosis, followed by cortical erosion without a sclerotic border with pointing of the remaining osseous tissue, leading to the “licked candy stick deformity”, which was noted in the present case. Pathological fractures is common in the later stages. In present case, pathological fractures were present bilaterally in the angle of the mandible. A aetiology of this disease remains unclear to researchers. Diagnosis and treatment of such cases pose a challenge for clinicians.

Diagnosis and Management of a Rare Case of Infective Spondylodiscitis Caused by Brucella Abortus

Pankaj Sharma, Amit Kale, Raj Pawar, Archit Gupta Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Brucella fever also called as Bangs disease or Malta fever is a relatively uncommon Zoonotic illness which is on the rise in many parts of India. The disease often presents in humans with constitutional symptoms such as fever, malaise, weight loss or generalised body weakness, but is not limited to this in all cases. The present case report involves a 47-year-old female who presented to the Orthopaedic Outpatient Department of a tertiary care centre with complaints of fever and low backache and was diagnosed as a case of Brucellar Spondylodiscitis after careful history taking revealing an exposure to cattle in her household. Brucellosis should also be considered as a differential diagnosis to Tuberculosis (TB) and thoroughly investigated through a detailed medical history and radiological imaging. Effective management can be achieved with a multidisciplinary team, including orthopaedic surgeons, infection specialists, radiologists and microbiologists, as was done in the present case to ensure a favourable outcome.

Villonodular Synovitis of the Index Finger: A Case Report

Anteshwar Birajdar, Talha Muneer Muneer Mohammed, Sahil Chowdhary, Raj Kamble Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Villonodular Synovitis (VNS) is a rare condition characterised by abnormal growth of synovial tissue and accumulation of haemosiderin within joints, tendon sheaths and bursae. While the exact aetiology remains unclear, chronic inflammation is a leading theory. Although VNS typically affects large joints, the present case report highlights the possibility of its occurrence in smaller joints like the index finger. Early diagnosis and surgical intervention are crucial for effective management of VNS. The present case report underscores the importance of considering VNS in the differential diagnosis of soft-tissue masses, even in atypical locations. The present case report describes a 24-year-old male presenting with a decade-long history of pain and swelling in his right index finger. Despite initial radiographic findings being normal, Magnetic Resonance Imaging (MRI) revealed a well-defined soft-tissue mass involving the proximal and middle phalanx, flexor tendons and annular pulley. The presence of haemosiderin deposition within the mass was evident on MRI. The patient underwent open synovectomy, during which a brownish nodular synovium was observed, further supporting the diagnosis of VNS. Histopathological Examination (HPE) of the removed synovial tissue confirmed the presence of haemosiderin granules and haemosiderin-laden macrophages, solidifying the diagnosis of VNS. Post-surgery, the patient initiated a regimen of passive flexion and extension exercises for 15 days. At the 12-month follow-up, there were no clinical or radiological signs of recurrence and the patient had regained full range of motion.

Juvenile Psammomatoid Ossifying Fibroma: A Rare Case Report

Anchal Varshney, Manish Bhargava, Pratijya Raj, Karuna Kumari Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Juvenile Ossifying Fibroma (JOF) is a rare, non cancerous overgrowth of bone in the face or jaw. There are two subtypes of JOF: Juvenile Psammomatoid Ossifying Fibroma (JPOF) and Trabecular Juvenile Ossifying Fibroma (JTOF). JPOF shows a modest male predominance (1.2:1), an age range of 3 to 49 years, with a mean age of 17.7 years. The majority of instances are associated with the orbital bones and paranasal sinuses. Proptosis is the most typical clinical sign of JPOF. Other features include nasal blockage, headaches, facial oedema, discomfort, recurrent sinusitis, and missing teeth. The lesion is identified under a microscope by a fibroblastic stroma that contains small ossicles resembling psammoma bodies. The preferred first-line treatment for JPOF is total resection due to the disease’s potential for rapid growth and recurrence. Hereby, the authors present a rare case of JPOF ossifying fibroma occurring in the left mandibular molar region of a 50-year-old female who complained of continuous expansion of the lower jaw. Although benign, the potential for recurrence necessitates follow-up and can impact treatment planning. Early diagnosis and intervention are crucial for a favourable outcome.

Ptosis without Ophthalmoplegia in Acute Motor Axonal Neuropathy Variant of Guillain-Barré Syndrome in Children: A Case Series

AM Shameem, MP Jayakrishnan, Harsha T Valoor, MD Fiji Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis in children. The clinical variants include Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP), Acute Motor Sensory Axonal Neuropathy (AMSAN), Acute Motor Axonal Neuropathy (AMAN) and Miller-Fisher syndrome. Cranial nerve involvement can occur in approximately 50% of patients with GBS, but it is rarely reported in the AMAN variant. Ptosis as a presenting symptom is extremely rare in the AMAN variant. Autonomic dysfunction is also rarely reported in the AMAN variant. In the present case series, authors hereby, report five children (3 males, 2 females, aged 4-11 years) diagnosed with the AMAN variant of GBS, who presented with early onset of ptosis and rapid progression of flaccid weakness. Autonomic dysfunction, in the form of tachycardia, hypertension and excessive diaphoresis, was a prominent feature in four of the cases. The average time to reach the nadir of weakness was 4.2 days and the average duration of hospital stay was 58 days. The average GBS disability score at discharge was four. Nerve conduction studies were suggestive of the AMAN variant of GBS in all five cases. All children were treated with Intravenous Immunoglobulin (IVIg) and all required mechanical ventilation, with an average duration of 35.8 days. All five cases presented in a short period of three months, from November 2022 to February 2023.

Clinical Image of Darwin’s Tubercle: A Rare Auricular Variant

Parindita Sarmah, Prasad Deshmukh, Sagar Gaurkar Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X A 13-year-old male presented to the Ear, Nose and Throat (ENT) Department complaining of a “bump” on the upper part of his left ear. The patient had noticed this prominence since childhood but reported no associated pain or discomfort. His primary concern was cosmetic, seeking reassurance and information about the condition. On physical examination, a cartilaginous prominence approximately 5 mm in diameter was noted on the posterosuperior aspect of the helix of the left pinna (Table/Fig 1). The overlying skin was unremarkable, and there was no tenderness, erythema, or discharge. The rest of the otoscopic examination was within normal limits.

Familial Adenomatous Polyposis: An Uncommon Autosomal Genetic Condition

Simran Khan, Shreya Giri, Suhit Naseri Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X A 40-year-old man presented to the Department of Emergency Medicine with severe pain in abdomen which was present for the past two days. He experienced three episodes of vomiting and two episodes of diarrhoea which was greenish in colour without any blood or mucus. A mass from the anal region was also noticed while defecating which was insidious in onset and gradually progressing in size since one month. Physical examination upon deep palpation revealed generalised abdominal pain but no signs of peritoneal involvement. He claimed to have lost weight during the last four months. Notably, his family history included several relatives who had intestinal polyps and colon cancer. Laboratory findings indicated 8.5 g/dL haemoglobin levels and a mean corpuscular volume of 70 fL, along with a positive faecal occult blood test. Normal serum levels of electrolytes, creatinine, glucose, haemoglobin, and pH were observed. A differential diagnosis of haemorrhoids and rectal ulcers was made.

Human Parechovirus Encephalitis in a Neonate: Neuroimaging Findings

Jaya Selin Praveena Joseph, Pabbisetty Sushma, Ashok Ranjan, Senthil Kumar Aiyappan Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X A seven-day-old female baby born of second-degree consanguineous marriage presented to the Casualty Department with a history of feeding difficulty, irritability, and seizures for one day. There were abnormal movements of the upper and lower limbs lasting less than five minutes, with 4-5 episodes in a day suggestive of bilateral multifocal chronic seizures. The baby was conscious on arrival and was admitted to the Neonatal Intensive Care Unit (NICU). The baby was delivered by lower segment caesarean section with a normal Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score of 8 and was discharged on day 3. There was no history of fever. On examination, the baby was dull and lethargic with normal vital parameters. The blood investigations were sent which included serum electrolytes, calcium, magnesium, glucose, ammonia, lactates, anion gap, pH, and ketone profile which were within normal limits. Because of the seizure and feeding difficulty, an inborn error of metabolism was suspected and the baby was subjected to Magnetic Resonance Imaging (MRI) of the brain. MRI of the brain showed no signal abnormalities in T2/Fluid Attenuated Inversion Recovery (FLAIR) images [Table/Fig-1a,b] with restricted diffusion in the subcortical, periventricular white matter of bilateral fronto-parieto-temporal lobes, external capsule, bilateral thalami, and corpus callosum [Table/Fig-2a-d]. Basal ganglia, brainstem, cerebellum, and occipital white matter were spared. Magnetic Resonance Spectroscopy (MRS) over basal ganglia was normal (Table/Fig 3). This imaging features with selective diffusion restriction involving subcortical, periventricular white matter of bilateral fronto-parieto-temporal lobes, external capsule, bilateral thalami, and corpus callosum were characteristic of Human Parechovirus (HPeV) encephalitis. On further workup for inborn errors of metabolism, Tandem Mass Spectrometry (TMS) 55 screening was normal. The baby was started on a loading dose of intravenous (IV) phenobarbitone, followed by an IV Levipil maintenance dose. On day 4 of admission, IV Levipil was changed to oral Levipil. On day 7 of admission, oral Levipil was stopped. The baby had no further seizures. Paediatric neurology opinion was obtained and an electroencephalogram (EEG) was taken on day 8 of admission, which turned out to be normal. Cerebrospinal Fluid (CSF) examination confirmed the finding of HPeV encephalitis. The baby improved symptomatically over the next few days with conservative management.

“Can Vaginal Microbiota Act as a Biomarker for the Risk of Gynaecological Precancer and Cancer?”

Bhagyashri Patil Takbhate, Swati Bhakare Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Dear Editor, The female reproductive system hosts unique microbial communities that are crucial for maintaining women’s vaginal health and safeguarding the vaginal environment from numerous genitourinary infections [1,2]. The Vaginal Microbiota (VMB) interacts continuously with both the host and its surroundings, forming a complex system. Recently, the correlation between microbiota and various health conditions has gained considerable attention. While the gastrointestinal microbiota has been the primary focus, research has increasingly explored other areas of the body, including the female genital tract. Dysbiosis in the female genital tract, marked by an imbalance in microbial communities, has been identified as a potential contributor to several gynaecological disorders, like endometriosis, inflammatory diseases of the pelvis, Polycystic Ovary Syndrome (PCOS) and gynaecological malignancies (1). Disruption of the VMB can trigger inflammation and weaken immune defences, potentially creating conditions conducive to cancer development.

Effects of Suryanamaskara and Sheetali Pranayama on College Students Aggression: A Prospective Interventional Study

Youganjaly Mehra, Malika Sharma, Kalpana Sharma Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Students today face a more fast-paced and demanding lifestyle due to heavy workloads and hectic schedules. By using the potential of Suryanamaskara, a dynamic sequence of yoga postures known for its energising and calming effects, along with Sheetali Pranayama, a cooling breathing technique that promotes relaxation and reduces stress, this study contributes to the growing body of research on non pharmacological interventions for emotional regulation in adults. The focus of this research is the effects of Suryanamaskara and Sheetali Pranayama on reducing aggression levels in college students. Aim: To investigate the effects of Suryanamaskara and Sheetali Pranayama in reducing aggression levels in college students. Materials and Methods: This prospective interventional study employed a stratified purposive random sampling design to evaluate the efficacy of Suryanamaskara and Sheetali Pranayama in reducing aggression levels among college students. Voluntary participants were initially screened using the Buss and Perry Aggression Questionnaire (AQ) and those who exhibited high aggression scores were selected for the intervention training programme. A total of 54 participants were randomly assigned to two experimental groups. Group 1 underwent a Suryanamaskara intervention, while Group 2 engaged in Sheetali Pranayama, both incorporating Sukshma Vyayama and a cooling down period within the framework. Intervention sessions lasted 45 minutes, five days a week, for 10 weeks. Aggression levels were assessed pre- and postintervention and paired sample t-tests and independent sample t-tests were used for statistical analysis. Results: The findings of this study demonstrate a significant reduction in aggression levels among college students following a 10 week yoga intervention programme, with the mean difference in aggression scores between pre- and postintervention being 14.40 for the Suryanamaskara group and 17.29 for the Sheetali Pranayama group, indicating a decrease in aggression levels. Both the Suryanamaskara and Sheetali Pranayama groups exhibited notable improvements in aggression scores as measured by the Buss and Perry AQ. However, a comparative analysis using independent sample t-tests and effect size showed that the pretest t-statistics were -1.59 (p-value=0.11) and for the post-test t-statistics were -1.16 (p-value=0.24), revealing no significant differences between the groups for either pretest or post-test scores (p-value>0.05). Conclusion: This experimental study demonstrated a significant reduction in aggression levels among college students following a 10-week intervention with either Suryanamaskara or Sheetali Pranayama programmes. A comparative analysis revealed equivalent changes in aggression levels between the two groups, indicating that both yogic interventions were equally effective in reducing aggression in college students.

Predisposing Factors of Delayed Onset of Muscle Soreness in Untrained Athletes: A Cross-sectional Study

Harini Sadasivuni, Nagarjuna Narayanasetti, Nityal Kumar Alagingi Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Delayed Onset Muscle Soreness (DOMS) is a common consequence of ultrastructural muscle damage. Following unusual eccentric exercises, individuals who are not professionally trained or are amateur athletes experience muscle tenderness that can range from mild discomfort to severe debilitating pain. Aim: To identify the factors that contribute to the development of DOMS in untrained athletes and to raise awareness about these factors. Materials and Methods: A cross-sectional observational study was conducted in the Department of Physiotherapy, GEMS College of Physiotherapy, Srikakulam, Andhra Pradesh, India on 50 untrained athletes aged 18-25 years, over a period of eight months from January to September 2022, with complete enrollment of untrained athletes. The history of pain, stiffness, decreased range of motion and DOMS was surveyed through a self-reported questionnaire, followed by quantitative statistical analysis using mean, standard deviation and percentages of the data. Results: The mean age of the participants was 21.04±2.7401 years. The current research examined various predisposing factors that influenced the occurrence of DOMS. Specifically, 35 (70%) athletes reported engaging in eccentric exercises; 24 (48%) athletes reported exposure to hot weather and outdoor environments; 32 (64%) athletes reported neglecting warm-up sessions; and 43 (86%) athletes reported skipping cool-down exercises. Conclusion: The study concluded that the group of muscles comprising the shoulders and biceps is particularly susceptible to experiencing pain, loss of strength, muscle tenderness and reduced range of motion as a result of DOMS. DOMS is commonly induced by engaging in high-intensity workouts, such as lifting heavy weights with eccentric contractions, without proper warm-up and cool-down routines, especially in hot outdoor environments.

Association of Marital Quality, Loneliness and Demographic Variables among Healthcare Professionals: A Cross-sectional Study from Gujarat, India

Kanishka Varyani, Ritu Sharma Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Marital quality, generally understood as a global evaluation of marriage based on certain criteria, is a significant determinant of psychological wellbeing and work efficacy among individuals, particularly among Healthcare Professionals (HCPs) facing high-stress environments and long working hours. Recently, the World Health Organisation (WHO) has recognised loneliness as a global threat with serious negative impacts on physical and mental health, affecting diverse populations, including HCPs. Aim: To investigate marital quality among HCPs and its association with loneliness, as well as demographic variables such as age, gender and duration of marriage. Materials and Methods: This cross-sectional research was conducted from September 2023 to January 2024, including 199 married HCPs practicing as doctors, nurses, or administrative staff in hospitals or clinics in Gujarat, India, based on their marital status and voluntary participation in the study. A semistructured questionnaire was used for demographic details, along with the Marital Quality Scale (MQS) and University of California Los Angeles (UCLA) Loneliness Scale (version 3) to collect data. Cross-tabulation, Chi-square (χ2) and Pearson correlation were used to analyse the data in Statistical Package for the Social Sciences (SPSS) software version 28.0. Results: Out of the 199 participants, 120 were males (60.30%) and 79 were females (39.70%). The average age of the participants was 42.8±9.12 years. An overwhelming majority of 152 HCPs (76.4%) reported severely impacted marital quality. A strong and significant correlation was observed between marital quality and loneliness (r=0.609, p-value<0.001). A non significant correlation was observed between age and marital quality (r=0.061, p-value=0.396) and loneliness (r=-0.048, p-value=0.505). Similar results were also observed between the duration of marriage and marital quality (r=0.033, p-value=0.644) and loneliness (r=-0.023, p-value=0.747). Conclusion: The findings suggest that interventions to enhance marital quality among HCPs should focus more on interpersonal and situational factors such as communication style, conflict resolution, support from the spouse, increasing empathy, sexual satisfaction and intimacy, rather than demographic variables.

Comparative Evaluation of Enamel Surface Abrasion Produced by Three Different Types of Toothbrush Bristle Designs: An In-vitro Study

Akanksha Mohan Karale, Pramod Waghmare, Vidya Dodwad, Pooja Pharne, Akshay Karale Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: The toothbrush is one of the most commonly used mechanical aids for plaque control, capable of removing plaque efficiently. However, improper toothbrushing habits can lead to tissue trauma, such as abrasion or gingival recession. The design of toothbrush bristles is one of the most common etiological factors for abrasion. Aim: To evaluate and compare the enamel surface abrasion produced by three different toothbrush bristle designs in conjunction with a standard dentifrice. Materials and Methods: In this in-vitro study conducted in the Department of Periodontics, Bharati Vidyapeeth Dental College and Hospital, Pune, Maharashtra, India, from June 2023 to January 2024, a total of 21 extracted human premolars were collected. After thorough cleaning, the teeth were stored in normal saline. The crown portions of the teeth were mounted on an acrylic resin base and profilometric analysis was performed to record the average enamel surface roughness (Ra) value. The teeth were randomly divided into three groups based on the toothbrush bristle design used for toothbrushing: Group A: Tapered bristle, Group B: End-rounded bristle, Group C: Flat-trim bristle. Toothbrushing was carried out using a customised toothbrushing device and a standard dentifrice twice daily for six weeks. After six weeks, profilometric analysis was conducted again. Descriptive statistics were expressed as means and standard deviations. The comparison of enamel surface abrasion among the three different toothbrush bristle designs was performed using the One-Way Analysis of Variance (ANOVA) test, followed by the post-hoc Bonferroni test for pair-wise comparison. In this test, a p-value less than or equal to 0.05 was considered statistically significant. All analyses were conducted using Statistical Package for the Social Sciences (SPSS) version 25.0. Results: The results showed significantly greater Ra values for Group C (flat-trim bristle: 0.13±0.06) compared to Group A (tapered bristle: 0.09±0.03) and Group B (end-rounded bristle: 0.04±0.02). Group B exhibited the lowest Ra value, indicating the least enamel surface roughness (p-value: 0.038*). Conclusion: Within the limitations of the study, stylus profilometer analysis demonstrated that the flat-trim toothbrush bristle design is more prone to causing enamel surface abrasion than the end-rounded and tapered bristle designs. The end-rounded toothbrush bristle design causes minimal enamel surface abrasion and is safer to use as an effective mechanical plaque control aid.

Perception of Paediatric Dentists on Use of i-Grip vs Flossed Endodontic Files during Pulpectomy Procedures in Children: A Quasi-experimental Study

Ishani Ratnaparkhi, J Jasmin Winnier, Shilpa Naik, Sonal Tandel, Deepshikha Mehrotra, Divya Shetty Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Mishaps such as the accidental ingestion of endodontic instruments and crowns may occur during dental treatment in children. Although such accidents are rare, they can be potentially harmful to patients. The use of a rubber dam is not always possible in paediatric dentistry; thus, the attachment of floss to endodontic files is commonly done during the pulpectomy procedure. However, there are some challenges associated with using Flossed Endodontic Files (FEFs). To overcome these difficulties, a system called i-Grip was introduced. Aim: To evaluate the perception and compare the ease, convenience and safety of i-Grip versus FEFs as perceived by Paediatric Dentists during pulpectomy procedures in children. Materials and Methods: A post-test quasi-experimental study was conducted in the Department of Paediatric and Preventive Dentistry, D.Y. Patil University, School of Dentistry, Navi Mumbai, Maharashtra, India, among 40 Paediatric Dentists over a period of three months. The Paediatric Dentists were asked to use the i-Grip for four weeks, after which they completed validated questionnaires. Statistical Package for the Social Sciences (SPSS) software version 23.0 was used for data analysis. The answers to the questions were statistically analysed using the Z-test of proportion. Results: The mean age of males were 35±0.743 years and females were 25.37±0.543 years. A total of 27 (67.5%) participants found placing the file in the i-Grip to be very easy. 22 (55%) found the i-Grip to be very convenient to use. 31 (77.5%) Paediatric Dentists found the i-Grip to be extremely safe, 6 (15%) considered it to be moderately safe and none found it to be extremely unsafe. There was a statistically significant difference between the ease, comfort and safety of i-Grip compared to FEF (p<0.05). Conclusion: Paediatric dentists reported that the i-Grip was easy to use, convenient and safe when compared to FEF. The i-Grip is an innovative safety tool that can be utilised in paediatric patients during pulpectomy procedures instead of FEF.

Maternal and Perinatal Outcomes in Women with Gestational Diabetes Mellitus Requiring Pharmacological Management: A Prospective Cohort Study

Prathima Prabhu, Anisha Gala Shah, Tarakeswari Surapaneni, Raman Bodulla Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Gestational Diabetes Mellitus (GDM), a common medical complication of pregnancy, is an independent risk factor for obstetric complications and adverse perinatal outcomes. Insulin has been the treatment modality for many years. Recent studies indicate that metformin, an oral hypoglycaemic agent, may be a safe and effective alternative. Aim: To evaluate and compare the effectiveness of metformin and insulin in managing glycaemic control, and assessing maternal and newborn outcomes among women diagnosed with GDM. Materials and Methods: The present prospective cohort study was conducted in the Department of Obstetrics, Fernandez Hospital, Hyderabad, Telangana, India, from December 2020 to November 2021. The study population included women attending antenatal check-ups after meeting the inclusion and exclusion criteria. Those who failed to respond to lifestyle modifications were started on either metformin or insulin as per the attending physician’s advice. A total of 369 pregnant women were included in the study. Parameters such as weight gain during pregnancy, need for additional pharmacologic treatment, maternal hypoglycaemia, onset of Hypertensive Disorders of Pregnancy (HDP), gestational age at delivery, mode of delivery and neonatal details such as birth weight, occurrence of Large for Gestational Age (LGA), Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score, birth injuries, neonatal hypoglycaemia, hyperbilirubinemia, respiratory distress, and neonates requiring Neonatal Intensive Care Unit (NICU) admissions were recorded. Data were subjected to statistical analysis. Analysis was performed using Statistical Package for the Social Sciences (SPSS) software version 22.0. A p-value of <0.05 was considered statistically significant. Results: Among the study population, 338 (91.6%) patients were on metformin, while 31 (8.40%) patients were on insulin. The metformin group exhibited good glycaemic control, whereas those on insulin had inadequate glycaemic control (p-value<0.001), a higher incidence of LGA babies (p-value=0.038) and more infants requiring phototherapy (p-value=0.022). Conclusion: The metformin group demonstrated effective control regarding both Fasting Blood Sugar (FBS) levels and postprandial blood glucose levels. Conversely, the group receiving insulin treatment exhibited a higher prevalence of neonates born LGA, a greater need for phototherapy, and inadequate maternal glycaemic control.

Correlation of Vertebral Column Length and Abdominal Circumference with Subarachnoid Block Characteristics of Hyperbaric Ropivacaine for Infraumbilical Surgeries: A Single-arm Interventional Study

Manju Bala, Pravesh Kumar, Monica Chhikara, Deepika Seelwal, Preeti Gehlaut Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Spinal anaesthesia is a neuraxial anaesthesia technique used for lower abdominal and lower limb surgeries. The spread of the intrathecally administered local anaesthetic drug during spinal anaesthesia may be affected by many factors. Aim: To evaluate the correlation between abdominal girth and vertebral column length with the intrathecal spread of hyperbaric ropivacaine. Materials and Methods: This prospective single-arm interventional study was conducted in the Department of Anaesthesia at Pt. BDS PGIMS Rohtak, Haryana, India from November 2022 to March 2024. A total of 100 patients of either sex, aged between 20 and 60 years, scheduled for infraumbilical surgeries under Subarachnoid Block (SAB), were included in this single-arm intervention study. Abdominal girth and vertebral column length of the enrolled patients were measured in sitting position. SAB was administered with 3 mL of 0.75% hyperbaric ropivacaine. Sensory and motor block assessments were conducted after the block. The highest sensory block level, time taken to achieve the highest sensory block level and Bromage score of 3, the time taken for two-segment regression and regression to Bromage score of 0 were recorded. Haemodynamic parameters and any complications were noted. Data was compiled and the correlation of vertebral column length and abdominal circumference with sensory and motor block characteristics was analysed at the end of the study. The Pearson’s correlation test was used to determine correlation and a p-value of <0.05 was considered statistically significant. Results: Out of the 100 patients included in the study, 81% were male and 19% were female. The mean age, weight and height of the patients were 36 years, 67 kg and 169 cm, respectively. The mean vertebral column length and abdominal circumference of the patients were 61 cm and 83 cm. Abdominal circumference was significantly correlated with the maximum sensory level (the Pearson’s correlation coefficient was 0.680 with a p-value <0.05). However, no significant correlation was found between vertebral column length and the maximum sensory level achieved (the Pearson’s correlation coefficient was 0.75 with a p-value of 0.06). The time to achieve maximum sensory and motor levels and the time to regress from the maximum block level were also not correlated with abdominal circumference and vertebral column length (p-value >0.05). Conclusion: Patients with larger abdominal circumference have more cephalad spread of intrathecal ropivacaine in non obstetric patients undergoing infraumbilical surgeries. However, the present study found no correlation between vertebral column length and any SAB characteristics.

The Effect of Hyaluronidase as an Adjuvant to Local Anaesthetics in Peripheral Nerve Stimulator-guided Supraclavicular Brachial Plexus Block: A Randomised Controlled Study

Tejash H Sharma, Jainy Shah, Amit Chauhan, Dushyant Chavda, Sara Mary Thomas Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: For upper limb procedures using the supraclavicular approach to brachial plexus block, various adjuncts to Local Anaesthetics (LA) have been employed to improve the quality and duration of anaesthesia and postoperative analgesia without leading to any adverse side-effects or prolonging the period of motor block. Hyaluronidase is an enzyme used with other drugs to accelerate their dispersion and distribution. It catalyses the hydrolysis of a component of the extracellular matrix, hyaluronan, thereby lowering its viscosity and improving tissue permeability. Aim: To evaluate the sensory and motor blockade resulting from the addition of hyaluronidase as an adjuvant to LA in Peripheral Nerve Stimulator (PNS)-guided Supraclavicular Brachial Plexus Block (SBPB). Materials and Methods: This prospective, comparative, double-blinded, randomised controlled study was conducted in a Department of Anaesthesiology S.B.K Shah Medical Institute and Research Centre, Vadodara, Gujarat, India at a tertiary care hospital on 72 patients undergoing elective upper limb surgeries under PNS-guided SBPB over 18 months from November 2022 to August 2024. Group B (n=36) received inj. bupivacaine (0.5%) 13 mL, inj. lignocaine with adrenaline (2%) (1:200,000) 13 mL, and inj. normal saline (0.9%) 4 mL, for a total of 30 mL, and Group H (n=36) received inj. bupivacaine (0.5%) 10 mL, inj. lignocaine with adrenaline (2%) (1:200,000) 10 mL, inj. hyaluronidase (900 IU) 6 mL, and inj. normal saline (0.9%) 4 mL, for a total of 30 mL. Sensory and motor blockade and rescue analgesia were recorded at 0, 1, 3, 5, 7, and 10 hours. Categorical variables were analysed using the Chi-square test. To analyse continuous variables, the student’s t-test was used. The p-value of less than 0.05 was deemed statistically significant. Results: The onset time of sensory and motor block was earlier with Group H (2.36±0.25 minutes and 4.2±0.29 minutes) than with Group B (4.54±0.25 minutes and 6.51±0.29 minutes), respectively (p<0.05). The sensory and motor block lasted longer in Group B (278.8±7 minutes and 266.8±6.78 minutes) than in Group H (263.2±7 minutes and 246.3±6.78 minutes) respectively, p<0.05. The duration of analgesia was longer with Group B (240.8±7.84 minutes) compared to Group H (220±7.84 minutes) p<0.05. No major adverse effects were observed. Conclusion: Addition of hyaluronidase to a lower volume of LA results in rapid onset of the block with minimal side-effects.

Clinical Profile of Children with Pleural Empyema in Community Acquired Pneumonia: A Cross-sectional Study

Nilofer Shaikh; Anjali Vasant Kale; Murali Krishna Goli; Saeed Siddiqui; Avinash L Sangle; Suvarna G Magar Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Empyema as a complication of Community Acquired Pneumonia (CAP) has been reported in a sizeable number of cases. Epidemiological studies on the clinical profile and outcome of CAP with empyema can help in better diagnosis and management of paediatric patients. Aim: To describe the clinical profile of empyema in paediatric patients with CAP attending the tertiary care hospital in Aurangabad, Maharashtra, India. Materials and Methods: The present cross-sectional study was conducted in the Department of Paediatrics at MGM Medical College and Hospital, Aurangabad, Maharashtra, India, from March 2022 to March 2023. Total 82 CAP diagnosed cases of age between two months and 18 years were included. Group A (cases) consisted of 41 cases of CAP with empyema and group B (controls) consisted of 41 cases of CAP without empyema. Data obtained was compiled and compared using unpaired t-test and Chi-square test. Results: The mean age in group A was 76.43±66.15 months and in group B was 45.29±59.19 months. Duration of fever was 8.9±2.84 days in group A and 4.7±0.97 days in group B. The nutritional status of study subjects was malnourished in 29 (70.73%) group A and 21 (51.22%) in group B. The study subjects among the group A were vaccinated for pneumococcal vaccine in 18 (43.9%), and in 29 (70.73%) of the group B. Neutrophil count and C-reactive Protein (CRP) levels were significantly higher, and lymphocyte count was significantly lower in CAP cases with empyema. All the study subjects recovered in the present study; however, the duration of hospitalisation was more in CAP cases with empyema. Conclusion: The number of subjects with malnutrition was more whereas vaccinated with pneumococcal vaccine were less in CAP cases with empyema. High leucocyte, neutrophil counts and raised serum CRP were observed in CAP cases with empyema. Decortication, Video-assisted thoracoscopic surgery and intercostal chest drain insertion were the treatment modalities used in CAP cases with empyema.

Comparison of Ultrasound Guided Hernia Block with Standard Subarachnoid Block: An Open Label Randomised Clinical Study

Dinesh Kumar Sahu, Dar M Faizana, Sonawane Alpa, Atul Sharma Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Inguinal hernia surgery is preferably performed under Subarachnoid Block (SAB) or General Anaesthesia (GA). However, some patients may have contraindications for both types of anaesthesia. An Ilioinguinal-Iliohypogastric Nerve (IIN-IHN) block can be administered for inguinal hernia surgery, but sometimes it provides unsatisfactory anaesthesia, and combining it with the genital branch of the genitofemoral nerve is suggested. The use of ultrasound is recommended to increase efficacy and reduce adverse effects of the block. Aim: To compare the intraoperative anaesthetic efficacy of ultrasound-guided ilioinguinal, iliohypogastric, and genitofemoral nerve blocks, collectively referred to as Hernia Block (HB), with SAB in patients undergoing elective unilateral uncomplicated open indirect inguinal hernia repair. Materials and Methods: An open-label randomised clinical study was designed to include 40 adults aged 18 to 80 years, classified as American Society of Anaesthesiologists (ASA) class I-III, undergoing elective open surgery for indirect inguinal hernia. Patients were randomised into two groups: Group A received SAB, while group B received ultrasound-guided HB only. A comparison was made between both groups in terms of intraoperative anaesthetic efficacy, success rate, duration of analgesia, haemodynamic changes, complications, time to ambulation, patient satisfaction, surgeon satisfaction, and adverse effects. Statistical analysis was performed using Analysis of Variance, Student’s t-test, and the Mann-Whitney test. Results: The median age (range) of group A was 56 (33-68) years, while that of group B was 50 (26-76) years. Mean arterial pressure showed a statistically significant reduction between 30 to 90 minutes in group A patients (p-value <0.05). The median time taken to perform the block was significantly shorter in group A, at 11 (5-22) minutes, compared to 41 (27-70) minutes in group B (p-value of 0.002). The median time to onset of surgical anaesthesia was significantly shorter in group A, at 5 (3-10) minutes, compared to 30 (15-75) minutes in group B (p-value=0.003). The duration of analgesia was significantly longer in group B, at 8 (2-11) hours, compared to 5 (3-7) hours in group A (p-value=0.002). The success rate in the ultrasound-guided HB group was 80%, while it was 100% in the SAB group (p-value=0.05). Adverse events related to the procedure were significantly higher in the SAB group (55% vs 10%, p-value=0.003). Both surgeon and patient satisfaction were significantly better in SAB group. The median ambulation time was significantly faster in the ultrasound group, at 5.5 hours, compared to 11.5 hours in the SAB group. Conclusion: The ultrasound-guided HB may be considered an effective alternative with an acceptable success rate to SAB for unilateral indirect inguinal hernia repair, particularly in terms of haemodynamic stability, postoperative analgesia, fewer complications, and early ambulation.

Agreement between Ki-67 Proliferative Index in Breast Cancer by Conventional Hotspot Method and International Ki-67 in Breast Cancer Working Group Global Scoring Method: A Cross-sectional Study

Nidhi Radhakrishnan, Padma Priya Kasukurti, Sulata M Kamath, Clement Wilfred Devadass, SR Mangala Gouri Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: The role of the Ki-67 Proliferative Index (PI) in the molecular classification and as a predictive and prognostic biomarker in breast cancer is definitive. To address the inconsistency in Ki-67 interpretation and scoring, the International Ki-67 in Breast Cancer Working Group (IKWG) introduced the visual scoring Android Application (APP) and proposed a standardised scoring method. Aim: To determine Ki-67 proliferative indices by both the Global Method (GW) with the Ki-67 visual scoring app recommended by IKWG and conventional institutional Hotspot Method (HM), and to analyse the agreement between the indices obtained by these two methods. Materials and Methods: A cross-sectional study involving 71 Ki-67 immunostained hormone receptor-positive trucut biopsies of breast cancers from January 2022 to January 2024 were retrospectively collected. Two observers independently scored the biopsies using HM and GW by an app in the Department of Pathology of a tertiary care centre. The GW scores of Ki-67 PI obtained were categorised into low, intermediate and high groups based on 2015 St. Gallen guidelines. A two-way random Intraclass Correlation Coefficient (ICC) was used to assess the absolute agreement between two scorers. Results: The overall intraclass correlation between interobserver values by HM was 0.819 (good), while it was 0.971 (excellent) by GW. The overall interobserver mean difference was five times greater (p-value=0.008, statistically significant) than the overall interobserver global weighted scores (p-value=0.901, not statistically significant). Conclusion: The study highlighted the significant interobserver variability in HM compared to GW scores by the app. The standardised app scoring method has the potential to broaden the prognostic role of Ki-67 as a companion diagnostic tool.

Impact of Half an Hour Inhalation of Lemongrass Oil on Audio Visual Reaction Time: A Quasi-experimental Study

Khushboo Shrimali, Manjinder Kaur, Suman Sharma, Saroj Chaudhary Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Lemongrass oil has become a significant focus in aromatherapy research due to its psychomodulatory effects, which are believed to act through the limbic system- a critical region for emotional control and memory. Research indicates that lemongrass oil can effectively lower anxiety, improve mood and enhance cognitive performance. However, the specific mechanisms by which lemongrass oil influences neuronal excitability and synaptic transmission remain unclear. Aim: To explore Auditory Reaction Time (ART) and Visual Reaction Time (VRT) to gain a better understanding of the neurophysiological effects of lemongrass oil and its potential therapeutic uses following 30 minutes of inhalation of lemongrass oil. Materials and Methods: This quasi-experimental study was conducted on 30 healthy volunteers after obtaining clearance from the ethics committee and informed consent from the participants. The audio visual reaction times were recorded twice for each subject, before and after the intervention- i.e., 30 minutes of inhalation of lemongrass oil using an aroma lamp. The data were analysed using Statistical Package for the Social Sciences (SPSS) version 20.0, and a paired t-test was applied. Results: The present study showed a significant decrease in both ART and VRT (p-value=0.001 and 0.02, respectively) after 30 minutes of inhalation of lemongrass oil. The pre-exposure values of ART (1.01±0.46 msec) decreased to 0.79±0.29 msec, while VRT (0.70±0.29 msec) decreased to 0.63±0.26 msec. Conclusion: The shortened ART and VRT indicate the stimulatory effect of inhaling lemongrass oil on central neurons, especially in the limbic system, through the activation of GABA (gamma-aminobutyric acid) receptors. Hence, this results in increased attention and alertness in the brain.

Serum Testosterone and Atherogenic Indices as an independent Risk Factor for Predicting the Severity of Coronary Artery Disease: A Cross-sectional Study from North Eastern Region of India

Niketa Ashem; Laikangbam Shaini; Thokchom Sachindeba Singh; Priya Laikhuram; Nikkita Laishram; Ongchu Phom; N Penjei Konyak; Sangeeta Chongtham Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Coronary Artery Disease (CAD) is one of the primary causes of mortality worldwide. Dyslipidaemia is associated with the development of Atherosclerotic Cardiovascular Disease (ASCVD). Atherogenic indices are emerging lipid parameters related to atherosclerosis and CAD. There is a limited amount of data regarding the relationship between CAD severity, serum testosterone, and lipid indices, especially in the northeastern region of India. Aim: To determine the relationship between serum testosterone and atherogenic indices as independent risk factors for the severity of CAD. Materials and Methods: This cross-sectional study was conducted in the Department of Biochemistry in collaboration with the Department of Cardiology at the Regional Institute of Medical Sciences, Imphal, Manipur, India, from January 2021 to October 2022, consisting of 70 male patients with CAD who underwent coronary angiography and 70 male patients without CAD. Serum total and free Testosterone (TT and fT), Total Cholesterol (TC), Triglycerides (TG), High-density Lipoprotein (HDL), and Low-density Lipoprotein (LDL) were assessed. Atherogenic indices, including the Atherogenic Index of Plasma (AIP), Atherogenic Index (AI), and Castelli Risk Indices I and II (CRI-I and II), as well as the Triglyceride Glucose Index (TyG), were calculated using conventional lipid parameters and glucose, respectively. Binary logistic regression analysis was performed to examine the association of the atherogenic indices and testosterone with the severity of CAD. Results: The mean age was found to be 63.4±11.8 years in cases and 60.8±9.1 years in controls. The median (interquartile range) of AI was 5.03 (4.2, 5.9) vs 3.04 (2.2, 3.6), p<0.001; AIP was 0.39 (0.36, 0.44) vs 0.14 (0.006, 0.24), p<0.001; CRI-I was 6.03 (5.22, 6.91) vs 4.04 (3.2, 4.61), p<0.001; CRI-II was 3.91 (3.3, 4.7) vs 2.31 (1.6, 2.78), p<0.001; and the TyG index was 4.84 (4.68, 4.96) vs 3.82 (3.7, 3.9), p<0.001. These values were significantly higher in the CAD group compared to the non CAD group. Total Testosterone (TT) was 2.05±1.1 ng/mL vs 4.93±0.65 ng/mL, p<0.001, and fT was (3.6±2.6 vs 15.7±4.7, p<0.001) were significantly lower in cases compared to controls. The Spearman’s correlation analysis showed that AI (r=0.446, p<0.001), AIP (r=0.518, p<0.001), CRI-I (r=0.446, p<0.001), CRI-II (r=0.406, p=0.001), TGL/HDL-C (r=0.502, p<0.001), and the TyG index (r=0.305, p<0.010) were positively correlated with the Gensini score. The binary logistic regression analysis indicated that AI (OR: 3.08, 95% CI: 1.70-5.57, p<0.001), AIP (OR: 2.54, 95% CI: 1.84-3.78, p<0.001), CRI-I (OR: 3.07, 95% CI: 1.65-5.57, p<0.001), CRI-II (OR: 3.17, 95% CI: 1.64-6.10, p<0.001), and TyG (OR: 1.7, 95% CI: 1.01-1.98, p=0.009) were independent risk predictors of the severity of CAD after adjustment for confounders. Additionally, TT (OR: 1.417, CI: 1.24-1.70) and fT (OR: 1.67, CI: 1.12-1.98) were also found to be independent risk predictors of the severity of CAD. Conclusion: The AI, AIP, CRI-I, CRI-II, TyG, TT, and fT were independent predictors of the severity of CAD and could serve as potential biomarkers for CAD risk assessment. To specifically explain the diagnostic use of these novel indices in the early diagnosis of ASCVDs and CAD incidence, long-term prospective cohort surveys must be designed.

Assessment of Nutritional Status and its Associated Factors among the Elderly Population: A Cross-sectional Study from Rural Area of Madurai, Tamil Nadu, India

A Ra Boornema, M Aarthy Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Elderly malnutrition is an iceberg phenomenon and remains undiagnosed most of the time. The elderly people are at risk of malnutrition due to physical, psychological, social, dietary and environmental risk factors. When malnutrition gets compounded with various co-morbidities, it turns into a vicious cycle. Aim: To focus on the assessment of nutritional status and its associated factors among the elderly population above 60 years of age in a rural area of Madurai district, Tamil Nadu, India. Materials and Methods: This was a community-based cross-sectional study done for a period of four months in the rural field practice area of Madurai Medical College, Madurai, Tamil Nadu, India. Following ethical clearance, study subjects were selected by using single stage area wise cluster sampling technique. Data was collected from 240 elderly individuals by face to face interview using semistructured questionnaire. Details regarding socio-demographic variables like age, gender, educational status, occupational status, economic dependency and place of residence were taken. Nestle’s Short Form Mini Nutritional Assessment (SF-MNA) screening tool was used to assess the nutritional status of the study participants. The association was assessed by Chi-square test. Significance level was considered at p-value of ≤0.05. Results: Prevalence of malnutrition was seen among 33 (13.75%) individuals. A 105 (43.75%) were at the risk of malnutrition and 102 (42.5%) had satisfactory nutritional status. The comparison between well nourished, at risk of malnutrition and malnourished groups showed significant differences with respect to age (p-value=0.016), economic dependency (p-value=0.002), place of residence (p-value=0.004), Body Mass Index (BMI) (p-value=0.024), calf circumference (p-value=0.016) and presence of co-morbid illness (p-value=0.015). Conclusion: The findings of the present study clearly indicate that malnutrition is a multifactorial condition associated with socio-demographic, somatic and functional status. A multidimensional approach is required to deal with these issues. Nutritional assessment and screening of elderly people should be done by opportunistic screening for early detection of malnutrition and to implement an appropriate nutritional intervention.

Effect of Ginger Oil Massage on Joint Pain among Elderly Inmates of Old Age Home: A Quasi-experimental Study

Menguphrenuo Mepfhuo, Prabha Lis Thomas Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Joint pain is widespread among elderly and is usually accompanied by stiffness that increases with daily activities. Ginger has been found to have similar properties to Non Steroidal Antii-inflammatory Drugs (NSAIDs) in reducing pain and inflammation associated with musculoskeletal conditions. Aim: To investigate the effect of ginger oil massage on joint pain in elderly inmates in old age homes. Materials and Methods: The study adopted a quasi-experimental one-group pretest post-test design and the study was conducted in the old age home Bengaluru, Karnataka, India, from October 2020 to April 2021. Purposive sampling technique was used to select 30 inmates of an old age home located in Bangalore and having joint pain with a score of >1 on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale. The demographic proforma and the WOMAC were used to collect the data. A skin test was performed, to check for any sensitivity reactions and massage using ginger essential oil diluted in coconut oil was administered on the knee joint on alternate days, for six sessions extending over a period of two weeks. The post-test was assessed after third and final (6^th) session of massage. Repeated Measures (RM) Analysis of Variance (ANOVA) was computed to determine the difference in pre and post-test WOMAC scores and a significance level of p<0.05 and a confidence interval of 95% was considered to indicate a statistically significant difference. Results: The mean age of the elderly was 69.500±7.505 years with a range 61-82 years. Repeated measure ANOVA demonstrated a significant difference in the second (13.10±5.38) and first post-test WOMAC scores (14.10±6.19) compared to the mean pretest WOMAC score (37.97±12.83) (F=121.14, p<0.001), indicating that ginger oil massage was effective in reducing joint pain among the elderly. Conclusion: Ginger oil massage resulted in the reduction of knee pain and joint stiffness among elderly and therefore, can be a used as an alternative therapy for the elderly with joint pain.

Role of Unenhanced Computed Tomography of the Chest in the Prediction of Anaemia: A Cross-sectional Study

Rajani Thakur, Tarani Chetana Naga Sai, Sankeerteerth Kendyala, Varigonda Mahidhar Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Anaemia is a common clinical condition. The detection of incidental findings on unenhanced Computed Tomography (CT) that predict the presence of anaemia may play a pivotal role in early diagnosis, treatment and prognosis. Aim: To assess the role of unenhanced CT thorax in predicting anaemia by determining the sensitivity and specificity of the Interventricular Septum Sign (IVS) and Aortic Rim Sign (ARS) in the prediction of anaemia. Materials and Methods: This was a cross-sectional study conducted on 300 patients who underwent High-resolution Computed Tomography (HRCT) of the thorax using a 128-slice CT scanner in the Department of Radiology, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India, Nizams Institute of Medical Sciences, Hyderabad, from July 2022 to September 2022. An estimation of haemoglobin levels was performed from a peripheral blood sample within 24 hours of the scan and the diagnosis of anaemia was made based on World Health Organisation (WHO) guidelines of haemoglobin values according to age and gender. On imaging, the following parameters were analysed: the variables considered for each patient included age and gender, the presence or absence of ARS, the presence or absence of an IVS and the Hounsfield Units (HU) values of seven selected Regions of Interest (ROI) on each examination. Three ROIs were placed in the Left Ventricular (LV) cavity, three on the IVS and a single ROI was placed in the aorta at the same level. Mean, percentage, frequency and standard deviation were calculated. The Chi-square test was applied for statistical analysis and a p-value of <0.05 was considered significant. Results: Out of the total sample size of 300, 188 were males and 112 were females with the mean age of 47.16±19.77 years. The mean haemoglobin percentage in the study was 11.62±2.25 gm%. Approximately 195 (65%) out of 300 patients were found to be anaemic based on blood reports. Among them, the majority were diagnosed with moderate anaemia 109 (36.3%), followed by mild anaemia 76 (25.3%) and severe anaemia 10 (3.3%), respectively. The sensitivity of the dense IVS was 100% for severe anaemia, 75.6% for moderate anaemia and 55.3% for mild anaemia. In comparison, the aortic rim sign showed a sensitivity of 100% for severe anaemia, 86.5% for moderate anaemia and 67.69% for mild anaemia, with a specificity of 88.57%. Conclusion: The presence of an IVS on an unenhanced CT predicts the likelihood of underlying anaemia and suggests the need for further evaluation and timely management.

A Rare Report of Carbapenem Resistant Vibrio fluvialis Isolated from a case of Walled off Necrosis: A Sequelae of Acute Necrotising Pancreatitis

P Ganesh Perumal; L Venkatakrishnan; B Appalaraju; R Rajakumar; R Someshwaran Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Vibrio fluvialis (V. fluvialis) is commonly found in coastal environments and is an emerging pathogen encountered in diarrhoeal outbreaks and sporadic extraintestinal cases. V. fluvialis infections usually manifest as watery bloody diarrhoea, nausea, vomiting, gastroenteritis and peritonitis. In this case report, an unusual presentation of Multidrug Resistant (MDR) V. fluvialis along with Klebsiella pneumoniae co-infection from a case of Walled Off Necrosis (WON)- A complication of Acute Necrotising Pancreatitis (ANP) is discussed. The patient presented with the acute abdomen and had peripancreatic collection for which Ultrasound (USG) guided 12F pigtail drain placed over the right lower quadrant of the abdomen and conservatively managed. Routine cultures were done and the growth on Sheep Blood Agar (SBA) plate and MacConkey (MAC) agar plates were subjected for automated phenotypic identification by Matrix Assisted Laser Desorption Ionisation Time of Flight-Mass Spectrometry (MALDITOF-MS) and Vitek-2 systems and was identified as V. fluvialis. Also, molecular tests like 16S rRNA Polymerase Chain Reaction (PCR) followed by Sanger’s sequencing was done and the identification was further confirmed. Phenotypic RESIST-5 TRURAPID O.K.N.V.I. commercial lateral flow immunochromatographic assay for detection of clinically relevant and common carbapenemase genes like NDM, OXA-48, VIM, IMP and KPC was done which revealed this V. fluvialis isolate as New Delhi Metallo betalactamase (NDM) type of Carbapenemase producer. Patient was managed with levofloxacin and doxycycline and patient condition improved and was discharged.

Development of a Preliminary Screening Tool for Predicting Polycystic Ovarian Syndrome using Machine Learning and Deep Learning Models with Non Invasive Qualitative Features: A Case-control Study

Hanumanth Narni, Vasudeva Rao Ananthasetty, SD Jilani Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Polycystic Ovarian Syndrome (PCOS) is a prevalent endocrine disorder affecting women of reproductive age, characterised by irregular menstrual cycles, hyperandrogenism and polycystic ovaries. Despite its high prevalence, the diagnosis of PCOS remains challenging due to the variability in symptom presentation. Traditional diagnostic methods involve clinical evaluation, biochemical assays and ultrasound imaging. Machine Learning (ML) and Deep Learning (DL) models offer promising avenues for predicting probable cases of PCOS using non invasive qualitative features. Aim: To develop and compare the performance of Random Forest (RF) and Feedforward Neural Network (FFNN) models in predicting PCOS using abundant non invasive qualitative features. Materials and Methods: A retrospective case-control study was conducted with 100 cases and 100 controls, selected based on ultrasound-confirmed PCOS diagnosis in the Obstetrics and Gynaecology, Gayatri Vidya Parishad Institute of Healthcare and Medical Technology (GVP IHC MT), Medical College departments from February 2024 to October 2024. Data were collected using a structured questionnaire capturing demographic and clinical variables. Feature selection was performed using the Chi-square filter method, with 10 features identified as significant. The data were split into training (80%) and testing (20%) sets and stratified 5-fold cross-validation was applied. Model performance was evaluated using accuracy, precision, recall, F1 score and Area Under Curve (AUC). Results: The RF model demonstrated high performance on the training set, with an average accuracy of 0.95, but exhibited variability on the testing set (accuracy of 0.80). The FFNN model showed consistent performance across both training (accuracy of 0.80) and testing datasets (accuracy of 0.82). The RF model identified irregular cycles and hirsutism as key predictors, while the FFNN model highlighted weight gain and abnormal Body Mass Index (BMI) as important features. The RF model required significantly less computational time compared to the FFNN model. Conclusion: The RF model is preferable for tasks requiring computational efficiency, while the FFNN model offers better generalisation. The complementary feature importance rankings suggest that integrating insights from both models could enhance the understanding of PCOS predictors. In epidemiological investigations, these models can be used as preliminary screening tools for identifying probable cases of PCOS using non invasive qualitative features, especially in areas where diagnostic facilities are not available.

Early Prediction of Non Invasive Ventilation Failure and Mortality in Chronic Obstructive Pulmonary Disease Patients using HACOR Score: A Cross-sectional Study

DV Pratapa Reddy, V Vijaya Kumari, K Kanaka Lakshmi, R Sunil Kumar, BMS Patrudu, S Praveena, A Vivek, P Siva Subramanian Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Non Invasive Ventilation (NIV) is an effective ventilatory measure in the exacerbation of Chronic Obstructive Pulmonary Disease (COPD). However, the response among some patients is not favourable, leading to a requirement for invasive ventilation. This not only increases hospital stays but is also reported to elevate mortality rates. Therefore, there is a need for a scoring system that predicts NIV failures. The Heart rate, Acidosis, Consciousness, Oxygenation and Respiratory rate (HACOR) score is a promising tool that has demonstrated excellent predictive power in detecting early NIV failure. Aim: To predict NIV failure based on the HACOR score at two hours after the initiation of NIV in patients admitted for acute exacerbation of COPD with type 2 respiratory failure. Materials and Methods: The present hospital-based cross-sectional study was conducted in the Department of Pulmonary Medicine, Government Hospital for Chest and Communicable Diseases, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India, from November 2023 to April 2024. A total of 70 patients admitted with acute exacerbation of COPD and type 2 respiratory failure were included. All five variables of the HACOR score were measured two hours after the initiation of NIV to predict early NIV failure. These variables include heart rate, arterial blood pH, Glasgow Coma Scale (GCS) score (consciousness), oxygenation and respiratory rate. After the initiation of NIV, the HACOR score was evaluated at various intervals. The diagnostic accuracy of the HACOR score in predicting NIV failure was recorded, which was the main outcome of the study. Receiver Operating Characteristic (ROC) curve and Youden index were applied. The dependent variables were analysed using the Youden index to obtain the best cut-off value of the HACOR score. Results: Out of 70 patients, 66 (94.3%) were males and 4 (5.7%) were females, with a mean±Standard Deviation (SD) age of 68.5±6.1 years. The study reported a 27.1% (19 patients) NIV failure rate based on the HACOR score measured after two hours of NIV. The total study population was divided into two groups based on the measured HACOR score cut-off value of 5. A total of 33 patients had a score ≥5, while 37 patients had a score <5. Among the group with a score ≥5, 17 (51.5%) patients experienced NIV failure. In the group with a score <5, 2 (5.4%) patients had NIV failure. The area under the ROC curve (AUROC) for the entire population was 0.899 for a score ≥5, with a sensitivity of 89.47% and a specificity of 86.27% in determining the outcome of NIV. Conclusion: The HACOR score is a simple bedside test that can effectively predict early NIV failure with good predictive power. A score ≥5 at two hours after the initiation of NIV therapy can be considered a cut-off value for predicting NIV failure.

Risk Factors in Chronic Kidney Disease in Newly Diagnosed Type 2 Diabetes Mellitus Patients Attending a Tertiary Care Hospital in South Tamil Nadu, India: A Cross-sectional Study

S Priya, S Revanth, Hemamalini Basker, K Essakiraja Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Chronic Kidney Disease (CKD) has become a major cause of global morbidity and mortality, especially in developing countries like India. When diagnosed at the end stage, the overall average cost incurred by the health system per haemodialysis session is INR 4,148, and the mean Out-of-Pocket Expenditure (OOPE) per patient is INR 2,838, which a poor can not afford. Indian CKD registry infers that Type 2 Diabetes Mellitus (T2DM) attributes for 31.2% of CKD cases. The high cost of haemodialysis and the expenditure spent out of pocket by impoverished patients warrants the need for the present study, which was aimed to assess CKD risk among newly diagnosed diabetics. Aim: To assess CKD risk among newly diagnosed diabetics using the Kidney Disease Improving Global Outcomes (KDIGO) 2021 guidelines, which utilise estimated Glomerular Filtration Rate (eGFR) and urine microalbuminuria as assessment tools. Materials and Methods: The present cross-sectional study was conducted in the Non Communicable Disease (NCD) Outpatient Department (OPD), Madurai Medical College (attached to the Government Rajaji Hospital), Madurai, Tamil Nadu, India, from July 1st 2022 to August 30th, 2022. Study was conducted among 200 newly diagnosed T2DM patients (diagnosed for less than 6 months), selected by consecutive sampling. After the initial administration of a questionnaire, blood and random spot urine samples were collected. CKD risk was assessed based on eGFR and urine microalbuminuria using the KDIGO 2021 guidelines, with eGFR calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software 21.0, employing the Chi-square test and Pearson’s correlation tests. Results: Of the total 200 study participants, 130 (65%) were females and 70 (35%) were males with a mean age of 47.74±10.35 years. Of the study participants, 106 (53%), belonged to the low-risk category, 74 (37%) to the moderate-risk category, and 20 (10%) to the high/very high-risk category for CKD. A statistically significant association was observed between alcohol intake and CKD (p-value=0.034). A significant negative correlation (p-value <0.001) was found between age and eGFR (Pearson’s coefficient=-0.400). In the present study, age and gender were not significant factors in CKD risk. While no link was found between carbonated drink consumption and CKD risk, alcohol intake did show a notable association. The study also noted a statistically significant negative correlation between age and eGFR. Conclusion: Identifying CKD risk in diabetic patients using KDIGO guidelines based on eGFR and microalbuminuria is crucial. Early detection is vital to slow progression, particularly from moderate to high-risk categories, thereby reducing personal and societal burdens. Regular monitoring with eGFR testing and follow-ups can improve outcomes and reduce the likelihood of advanced CKD. Collaborative efforts among primary care clinicians and specialists are essential for early CKD risk detection and management using these tools.

Experiences of Women who Faced Insecurity in Public Transport and its Impact on their Emotional Well-being: A Qualitative Study from Urban Area of Tamil Nadu, India

Sushmitha Govindaraj, VM Anantha Eashwar, P Sujitha, R Umadevi, Monica Albert Sekhar, Shirley Esther Priscilla, R Swathika Devi Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Harassment in public transport faced by women passengers has been pushed to the sidelines failing to acknowledge the impact it has on both physical and mental health. Most incidents do not reach the authorities or the media, who often turn a blind eye to the existing problems. As a result, women develop a sense of insecurity that prevents them from using the public transport system. Women from economically challenged backgrounds often have no choice but to use public transport, as it is the cheapest and sometimes the only available mode of transportation. Aim: To understand the experiences of women passengers commuting by public transport in Chennai city, Tamil Nadu, and the incidents that led to their insecurity about using the public transport system. Materials and Methods: This qualitative study was conducted in the Department of Community Medicine, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India between November 2023 and March 2024 among women over 18 years of age who had been using public transport for daily transit for atleast six months. Qualitative data were collected through in-depth interviews based on grounded theory among women who faced insecurity while traveling alone on public transport. Data saturation was reached after interviewing 20 participants. The transcribed data were analysed using Qualcoder software to identify relevant themes and subthemes. Results: In the current study, the majority of the women interviewed were between the ages of 18 and 50 years. Four major themes and 18 subthemes were identified through qualitative analysis. The four major themes were factors related to fear, social life, personal factors, and travel safety. Conclusion: The themes and subthemes highlight the gaps that have been overlooked by the authorities in the public transport system. It is crucial to understand that harassment occurring during transit, if not addressed immediately, will leave a lasting impression on women travelers, leading them to develop an irrational fear of crime that can have detrimental effects on their mental, physical, and social well-being. Further, research can be conducted using these themes, subthemes, and codes to develop a relevant research hypothesis that could be tested using quantitative study designs such as case-control and cohort studies.

Pattern and Clinical Reasons for Dental Extractions in Patients Visiting a Tertiary Health Care Centre in Southern District- Nuh of Haryana, India: A Retrospective Observational Study

Vijay Laxmy, Sakshi, Amita Sharma Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: The causes of tooth extraction exhibit significant geographical and cultural variations between regions within a country and across different countries. To date, no study has been conducted on the pattern of tooth loss in a comparatively socially and economically disadvantaged population in Nuh, Haryana, India. Aim: To analyse the pattern and clinical reasons for tooth extraction in relation to factors such as age and gender among patients visiting the Dental Department of a tertiary care centre in India. Materials and Methods: A retrospective observational study was carried out in the Department of Dentistry, Shaheed Hasan Khan Mewati (SHKM) Government Medical College Nalhar, Nuh, Haryana, India, from January 2017 to December 2019. Data were collected from the available records of patients across different age groups during the period from January 2017 to December 2019. Data on age, gender, reasons for extraction, jaw type and tooth number were recorded. The total number of extracted teeth was used for statistical analysis using Microsoft Excel software. Results: During the study period, 2643 patients underwent tooth extraction, with 1304 (49.33%) being males and 1339 (50.66%) females. A total of 3358 teeth were extracted, with 1382 in males and 1976 in females. The number of teeth extracted was higher in females (58.84%, n=1976) compared to males (41.15%, n=1382). The majority of extractions occurred in the 21-30 years age group, 750 (21.73%) followed by the 31-40 years age group, 663 (19.71%). The most common reason for extraction was dental caries and its sequelae, 2462 (73.34%). The most frequently extracted tooth was the first molar in the fourth quadrant (9.26%) followed by the first molar in the third quadrant (8.72%). Conclusion: Given the paramount importance of first permanent molars, it is concerning to see many young patients losing this tooth in the present study. Therefore, it is crucial to raise awareness among the general population about maintaining oral hygiene, regular dental check-ups and treatment. The role of pit and fissure sealants in caries prevention for first permanent molars cannot be overstated.

Role of Sepsis in Obstetric Score (SOS) to identify severe sepsis in pregnant women requiring ICU admission: A prospective observational study

Sangeeta Shah, L Rani Kumari, Firdous Fatima, Sri Manju Challakolusu, Nishitha Tummala, Bathula Mounika Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Obstetric sepsis is a significant contributor to maternal and perinatal morbidity and mortality, especially in low-income countries. Several scoring systems can help in identifying sepsis and its severity; however, their application in the obstetric population is not well-defined because of the altered physiology of pregnancy. The Sepsis in Obstetrics Score (SOS) is designed specifically for the obstetric population to identify the likelihood of the need for critical care admission for the obstetric population presenting with signs of sepsis. Aim: To determine whether the SOS can be used to identify the severity of sepsis. Materials and Methods: This was a prospective observational time-bound study conducted at Gandhi Hospital, Secunderabad, Hyderabad, Telangana, India over six months from February 2023 to July 2023 on 100 subjects that included pregnant women, postpartum women within six weeks, and postabortal women within two weeks of abortion with suspected obstetric sepsis presenting to Gandhi Hospital. SOS score was calculated for all study participants and grouped into scores of <6 and ≥6. Organ failure was assessed. SOS score was associated with culture positivity, organ involvement, need for critical care support, and the severity of sepsis. Data were analysed using Statistical Packages for Social Sciences (SPSS) software, and appropriate statistical tests were applied; the p-value for significance was set at 0.05. Results: The mean age of the study population was 25.48±5.13 years. Out of 100 women with obstetric sepsis, 50% had severe sepsis, graded by the presence of organ failure. When the cut-off score was considered as 6, SOS score had a sensitivity of 64% and specificity of 84%, a Positive Predictive Value (PPV) of 80.0%, a Negative Predictive Value (NPV) of 70.0%, and a diagnostic accuracy of 74.0% to detecting severe sepsis. Conclusion: The findings emphasised the utility of the SOS score as a valuable tool for assessing the severity of illness, predicting outcomes, and guiding clinical management.

Oral Endotracheal Intubation with Restricted Glottis View using C-MAC D Blade®: A Randomised Controlled Trial

Vaidarbhi Rasikbhai Patel, Nirali Nimeshkumar Panchal, Sanket Hirenbhai Mehta, Madhavi Sanjay Chaudhari, Bhumika Pradipkumar Pathak, Mayur Kiran Shinde Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: The perspective of airway management has undergone a considerable transformation since the advent of Video Laryngoscopes (VL). VL has rapidly been accepted as an intubation tool in a variety of clinical scenarios. This heralds a wide array of VL models with their own strengths and weaknesses. The C-MAC D blade® is one such VL with an angulated blade that provides an excellent glottis view, but negotiating the Endotracheal Tube (ETT) past the glottis opening and into the trachea might be difficult. No study till date was done on the C-MAC D blade® with different glottis views for intubation. Aim: To compare the Total Time of Intubation (TTI) with restricted glottis view and full glottis view with C-MAC D blade® as the primary aim, along with the first attempt intubation rate and complications during intubation. Materials and Methods: The present prospective single-centre randomised controlled trial was conducted in the Department of Anaesthesiology, Shree Krishna Hospital, PSMC, Karamsad, Gujarat, India, from September 2021 to August 2022. A total of 42 patients were randomly divided into two groups: group-F (n=21), which had a full glottis view, and group-R (n=21), which had a restricted glottis view. Randomised glottis views were achieved with the C-MAC D blade® VL during oral endotracheal intubation in both groups. Video recordings of the intubations were made, and TTI, first attempt success rate and complications during intubation were noted. Statistical analysis was done with an independent sample t-test to compare the two groups of continuous variables using STATA version 14.2. Results: The mean age in group-F was 45.86±10.83 years and in group-R was 47.76±9.14 years. The male-to-female ratio in group-F was 10:11 and in group-R was 9:12. Overall, the first-attempt successful intubation rate with the C-MAC D blade® in both groups was 90.48%. However, it was higher in group-R (95.24%) compared to group-F (85.71%). TTI was less in group-R compared to group-F (36.19±11.11 vs 45±15.89 seconds, p-value=0.0438). Group-R had lower incidence of postoperative sore throat (14.29% vs 57.14%, p-value=0.004) compared to group-F. Conclusion: Total time of intubation was less with a restricted glottis view compared to a full glottis view with C-MAC D blade® VL. Additionally, the restricted view had a higher first attempt intubation rate. Postoperative sore throat was significantly lower in the restricted view, with a lesser incidence of oropharyngeal trauma compared to the full glottis view.

Incidence and Outcome of Pressure Ulcers in Intensive Care Unit Patients: A Prospective Observational Study

Aneez Sadhik, Harishchandra Badekila Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Pressure sores are among the most challenging problems healthcare professionals face in patients with mobility limitations. These wounds can deteriorate the underlying condition and can sometimes be vitally threatening, making treatment challenging as well. Pressure sores can have a significant effect on the general health and quality of life of the patient. Aim: To determine the incidence, outcomes, common anatomical sites, and the most common clinical conditions leading to pressure ulcer formation in Intensive Care Unit (ICU) patients. Materials and Methods: A prospective observational study was conducted in the Medical and Surgical Intensive Care Units (ICU) of Yenepoya Medical College Hospital, Mangaluru, Karnataka, India from November 2021 to November 2022. Data were collected using a predesigned proforma and an observational assessment tool—the Pressure Ulcer Scale for Healing (PUSH), which is used to assess and monitor the healing of pressure ulcers. The variables studied included the incidence, aetiopathogenesis, and outcomes of pressure sores. Descriptive statistics were performed using mean and frequency distribution. Results: In present study, the incidence of pressure sores in the Medical Intensive Care Unit (MICU) and Surgical Intensive Care Unit (SICU) over one year was found to be 5.3% (48 out of 906 patients). The mean age of the patients was 55.42±16.58 years, with a male predominance of 32 (66.7%) cases compared to 16 (33.3%) cases females. Among the 48 patients who developed pressure sores, 20 patients (41.7%) were anaemic, as indicated by haemoglobin levels below 10 g/dL. The most common co-morbidity was diabetes mellitus, observed in 16 (33.3%) patients. Approximately 27 (56.3%) cases of the patients had one or more co-morbidities, while 21 (43.8%) cases had no co-morbidities. The most common anatomical site for pressure sores was the sacral region, affecting 41 (85.4%) patients, followed by the gluteal region, which affected 7 (14.6%) patients. Using the PUSH tool, it was found that 27 (56.3%) patients had epithelial tissue in their sores. A total of 16 (33.3%) patients had closed-type pressure sores, and 5 (10.4%) patients had granulation tissue. The mean wound area was 5.56±3.175 cm². The primary clinical conditions in patients who developed pressure sores included septic shock in 14 (29.17%) cases, Cerebrovascular Accident (CVA) in 12 (25%) cases, head injury in 8 (16.7%) cases, malignancy in 4 (8.33%) cases, pneumonia in 3 (6.25%) cases, and pancreatitis and Pott’s spine, each in 2 (4.17%) cases. Organophosphate (OP) poisoning, Tuberculosis (TB) meningitis, and Haemophilia were noted in 1 (2.08%) case each. Out of the 48 patients, 41 (85.4%) cases healed during their hospital stay, while 7 (14.6%) cases did not heal, with five of these patients dying due to sepsis and the other two due to CVA and end-stage malignancy. The mean duration for healing was 14.02±7.58 days, ranging from four to 32 days. Conclusion: Most patients who developed pressure sores were predominantly male, with common co-morbidities like diabetes, hypertension, and CVA. Sacral sores were the most frequent.

Comparison of Surgical Outcomes between Endovenous Laser Ablation and Conventional Surgery in Patients with Lower Limb Varicose Veins: A Prospective Interventional Study

Mannam Viswateja, Deepak R Chavan, Vijaya Patil, Vikram U Sindagikar Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Dilated, convoluted, subcutaneous veins measuring more than 3 mm in diameter when measured while upright and exhibiting reflux are called varicose veins. Varicose veins present a significant financial burden on the healthcare system, causing morbidity and lost work hours. Endovenous Laser Ablation (EVLA), a minimally invasive endovenous intervention that uses heat energy to induce aseptic inflammation of the vessel wall, obstructs and eliminates reflux. This technique has gained more attention recently because it eliminates the need for open surgical incisions. In contrast, standard surgery entails making an incision in the groin and excising the great saphenous vein anatomically to eliminate the abnormal reflux. Numerous studies have demonstrated the effectiveness of both thermal and non thermal endovenous methods in treating reflux in patients with axial venous reflux. However, there are limited comparative studies between various endovenous therapy modalities and traditional surgery concerning postoperative clinical outcomes. Aim: To evaluate the treatment outcomes of patients with Clinical (C), Aetiological (E), Anatomical (A), and Pathophysiological (P) - CEAP class C2-C6 who underwent either Endovenous Laser Ablation (EVLA) or conventional surgery for varicose veins. Materials and Methods: A prospective interventional study was conducted in the Department of General Surgery at Shri BM Patil Medical College Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura, Karnataka, India, that included all patients with CEAP classes C2-C6, from July 2022 to July 2024. A block randomisation method was used to allocate patients into two groups to ensure an equal distribution of demographic variables. Group A (n=39) underwent EVLA and Group B (n=35) underwent flush ligation of the saphenofemoral junction and stripping. Data were collected with a particular focus on the duration of surgery, duration of hospital stay, postoperative pain, and cosmetic acceptance, with a follow-up period of six months. Additionally, potential procedural complications and recurrence rates were assessed after the six-month follow-up. Statistical analyses were performed using Statistical Packages for Social Sciences (SPSS) version 25.0. The Wilcoxon rank sum test and Chi-square test/Fisher’s-exact test were used, with a p-value of <0.05 considered significant. Results: The mean age of patients was noted to be 42.02±9.73 years in cases and 44.51±8.23 years in controls. In the present study, Group A (n=39) underwent EVLA, of which 36 were males and 3 were females. Group B (n=35) underwent conventional surgery, comprising 31 males and 4 females. The mean operating time in Group A (cases) was 38 minutes, whereas in Group B (controls), it was 60 minutes. Operative time was shortened by 37%, thereby avoiding prolonged exposure to anaesthetic medication. The mean pain score in Group A (cases) was 1.94, compared to 4.48 in Group B (controls). Postoperative pain was significantly reduced by 53% in the EVLA group compared to the conventional surgery group. The mean duration of postoperative hospital stay was 2.51 days for cases and 5.88 days for controls. The hospital stay was shortened by 57%, highlighting the efficacy of EVLA in enhancing patient recovery. In Group A (cases), post-EVLA burns were observed in 1 (2.5%) patient, which healed spontaneously over two weeks. Skin discolouration was observed in 3 (7.6%) patients, which reduced spontaneously over 3-4 weeks. In Group B (controls), seroma was observed in 1 (2.8%) patient, for which suture removal and drainage were performed, followed by secondary suturing on day 4, leading to a prolonged hospital stay. Bruising was observed in 1 (2.8%) patient, which resolved over 3-4 weeks. Wound infection at the groin incision site was observed in 5 (14.2%) patients, for which daily dressings were conducted, and intravenous antibiotics were continued for five days. The case group experienced significantly lower complications postoperatively when compared with the control group, with a p-value of 0.008. Patients were interviewed at the end of the follow-up period regarding their subjective cosmetic outcomes. Total 14 (40%) patients in the conventional surgery group were unsatisfied with their scars, whereas only 1 (2.5%) patient in the EVLA group expressed dissatisfaction with the cosmetic outcome. However, no recurrences were observed in either group during the six-month follow-up. Conclusion: The EVLA is a better treatment modality for primary lower limb varicosities in terms of procedure duration, postoperative pain, hospital stay duration, and overall cosmetic acceptance by the patients.

Pain Neuroscience with exercise versus Biomedical Education with Exercise for treatment of Rotator Cuff-related Shoulder Pain: A Randomised Clinical Trial

Sidhant Silan, Bhawna Verma, Umesh Yadav, Kusum Yadav Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: A common clinical issue, rotator cuff pathology has a worldwide prevalence of 20.7%. It has been noted that exercise has traditionally been a primary treatment approach for shoulder disorders, but more recently, Pain Neuroscience Education (PNE) and Biomedical Education (BME) programs have shown promising effects in decreasing patients’ pain and disability. Aim: To compare the efficacy of pain neuroscience and BME programs with exercise in individuals with rotator cuff-related pain. Materials and Methods: A concurrent parallel randomised group clinical study was conducted at the College of Physiotherapy, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India from August 2022 to August 2023. 100 patients who were randomly assigned to two groups: 50 in the PNE plus exercise group and 50 in the BME plus exercise group. The study’s outcome measures included pain intensity (measured by the Numeric Pain Rating Scale, NPRS), shoulder disability (assessed using the Shoulder Pain and Disability Index, SPADI), kinesiophobia (measured by the Tampa Scale), and pain experience (assessed using the Pain Catastrophising Scale, PCS). Data were collected at baseline, two weeks, and four weeks for all variables. Between-group comparisons were performed using independent samples t-tests. Results: The mean age of participants in the PNE plus exercise group was 47.24±12.61 years, while in the BME plus exercise group, it was 45.46±11.87 years. In the PNE plus exercise group, there were 36 males and 14 females, whereas in the BME plus exercise group, there were 34 males and 16 females. A total of 30 females and 70 males participated in the study. At the 2nd and 4th weeks, there were statistically significant differences between the PNE and BME groups regarding kinesiophobia and pain-related beliefs (p≤0.05). However, there were no statistically significant differences between the two groups concerning pain intensity and shoulder disability (p>0.05). Conclusion: The study demonstrated that the PNE program, when coupled with exercise, was more effective in reducing kinesiophobia and altering perceptions about pain. This information, which emphasises the potential benefits of incorporating PNE into treatment regimens for patients with rotator cuff-related pain, is valuable for healthcare providers.

Magnesium Imbalance before and during Concomitant Chemoradiation in Cervical Cancer Patients: A Prospective Interventional Study

Monica Verma, Simmi Kharb, Abhishek Soni, Rutul Patel, Urvashi Saroha Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Cervical cancer is a major health concern, especially in developing countries. It is the second most common cancer among women in India, largely due to limited access to advanced screening and Human Papilloma Virus (HPV) vaccination. Despite significant advancements in cervical cancer prevention and treatment, the disease remains a major health burden, particularly in low-resource settings. Magnesium (Mg), an essential mineral involved in immune function, inflammation and Deoxyribonucleic Acid (DNA) repair, has been linked to various cancers, including colorectal and breast cancers, but its role in cervical carcinoma is underexplored. Aim: To investigate the association between magnesium levels and cervical carcinoma and to explore the association of hypomagnesemia with concomitant chemotherapy using cisplatin during chemoradiation. Materials and Methods: This was a hospital-based prospective interventional study, in which a total of 322 subjects were included in the study, of which 161 were healthy controls and 161 were diagnosed cases of cervical carcinoma. The magnesium levels were estimated before and after treatment using the Xylidyl blue complexing method on an autoanalyser. The data were compared between the two groups using appropriate statistical analysis with Statistical Package for the Social Sciences (SPSS) software version 20.0. Results: The mean magnesium levels were 2.08±0.24 mg/dL in controls and 1.56±1.02 mg/dL in cancer patients (p-value <0.001). Mean serum levels decreased in cancer patients postchemoradiation to 0.74±0.39 mg/dL. During concomitant chemoradiation with cisplatin, hypomagnesemia was observed as grade I in 62 (38.5%), grade II in 25 (15.5%), grade III in 12 (7.5%) and grade IV in 36 (22.4%). A significant correlation was found between hypomagnesemia and hyponatremia, hypokalemia and cumulative cisplatin dose toxicity. Conclusion: The study demonstrated a high prevalence of hypomagnesemia in cervical cancer patients, especially those undergoing cisplatin-based chemotherapy, with levels declining further during treatment. Routine magnesium monitoring and proactive management are essential to prevent complications and improve outcomes.

Comparative Evaluation of Marginal Gap and Flexural Strength of CAD/CAM Milled, 3D Printed and Conventional Chairside Interim 3-unit Fixed Dental Prosthesis: An In-vitro Study

Ayushi Botadra, Banashree Sankeshwari, Raghavendra Adaki, Dayanand Huddar, Channaveer Pattanshetti Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Interim prosthesis play an important role in maintaining integrity of abutment tooth till final prosthesis is fabricated. Thus, using different fabrication techniques which can affect the mechanical properties of material can be useful to determine longevity of prosthesis. Aim: To evaluate the marginal gap and Flexural Strength (FS) of Computer-aided Designing/Computer-aided Milling (CAD/CAM) milled, 3D printed and conventional chairside interim 3-unit Fixed Dental Prosthesis (FDP). Materials and Methods: The present in-vitro study conducted in the Department of Prosthodontics, Bharati Vidyapeeth Dental College and Hospital, Sangli, Maharashtra, India, for duration of one year and six months between May 2022 to November 2023, 45 dies were fabricated by 3D printing technique. A total of 45 3-unit fixed dental prosthesis were fabricated over these dies by various techniques i.e., CAD/CAM Milled, 3D Printed and Conventional i.e., 15 sample per group I and J. All samples were cemented on dies under 20 N force and were evaluated for marginal gap with stereomicroscope under 40X magnification and assessed in millimetre (mm). Mean of marginal gap at premolar and molar for each sample was evaluated. Thermocycling was carried out for 5,000 cycles in distilled water (5oC and 55oC) in a digitally controlled water-bath chamber. Universal testing machine was used to evaluate FS using “three-point bend test”. One-way ANOVA and Post-hoc Tukey’s Honest Significant Difference (HSD) test were used for statistical analysis. Results: On evaluation of marginal gap, a significant difference was noted between the three groups with p-value=0.0006 with 3D printed group showing the most marginal gap. On evaluation of FS, a significant difference was noted between the three groups with p-value=0.0001. On pair-wise comparison, highly statistically significant difference was seen between all groups where CAD/CAM Milled showed greater FS followed by conventional and 3D printed. Conclusion: The CAD/CAM Milled showed better marginal adaptation and greater FS followed by conventional and 3D printed group.

Risk Factors,Diagnosis and Outcome of Proven and Probable Invasive Trichosporonosis in a Tertiary Care Hospital: A Cross-sectional Analytical Study

Sharanya Pillai, Thayanidhi Premamalini, P Sathyamurthy, Anupama Jyoti Kindo Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Trichosporon species are basidiomycetous yeast like fungus that is ubiquitous in the environment. They form part of the normal flora in humans. In recent years, they have been causing invasive infections, especially in the immunocompromised hosts. Disseminated cases including trichosporonemia can rapidly progress, leading to increased morbidity and mortality. Aim: To diagnose and identify risk factors and outcomes of proven and probable invasive Trichosporon species infections. Materials and Methods: This cross-sectional analytical study was done at Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India, over a period of one year (March 2023 till February 2024). All the clinical samples sent for routine diagnostics to the laboratory during the study period and archived samples were included (Total isolates, n=60). European Organisation for Research and Treatment of Cancer/Invasive Fungal Infection Cooperative Group (EORTC/IFICG) and the National Institute of Allergy and Infectious Disease/Mycoses Study Group (NIAID/MSG) definitions were used to categorise samples as proven invasive and probable invasive trichosporonosis. Phenotypic characterisation was done by colony morphology on Sabouraud Dextrose Agar (SDA), Gram stain, Dalmau technique and urea hydrolysis. Genotypic characterisation was done by Trichosporon genus specific and Trichosporon asahii specific Polymerase Chain Reaction (PCR). The reference strains used as quality control were Trichosporon asahii Microbial Type Culture Collection (MTCC) 6179, Trichosporon jirovecii MTCC 9036 and Candida albicans American Type Culture Collection (ATCC) 90028. All statistical analysis was performed using Microsoft Excel (2016) and descriptive statistics were presented as numbers and percentages. Results: All the 60 (100%) isolates were characterised as Trichosporon asahii. Amongst them 4 (6.7%) were categorised as proven invasive trichosporonosis and 56 (93.3%) were probable invasive trichosporonosis. Some important risk factors for invasive disease were Intensive Care Unit (ICU) admission, antibiotic usage, diabetes and hypertension. All 4 (6.3%) proven cases were isolated from blood and 2 (50%) amongst them succumbed to the disease. Amongst the probable cases, 16 (28.6%) succumbed to the disease. Conclusion: Invasive infections caused by Trichosporon species have high mortality especially amongst immunocompromised hosts. Hence, identification at an early stage by appropriate diagnostic methods and initiating appropriate antifungal agents can result in better outcome of the patient.

Congenital Heart Defects in Paediatric Patients with Congenital Urogenital Abnormalities: A Cross-sectional Study

Sonal Khatavkar, Nayana Raveendran, Dhananjay Dilip Vaze Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Congenital Heart Defects (CHD) are the most significant co-morbidity in children with congenital anomalies of the kidney and urinary tract, according to past research. The fundamental cause is a combination of certain genetic factors and environmental influences on foetal development. Aim: To investigate the incidence of CHD in congenital urogenital abnormalities in paediatric patients. Materials and Methods: A cross-sectional study was conducted at Dr. D.Y. Patil Medical College, Pune, Maharashtra, India, from June 2023 to December 2023 on 110 patients with congenital urogenital abnormalities undergoing elective surgical procedures to find the incidence of CHDs. All routine investigations, clinical history and examination, ultrasonography, and echocardiography were done. The association of the variables that were quantitative and not normally distributed in nature was analysed using the Mann-Whitney’s Test, and variables that were quantitative and normally distributed in nature were analysed using an independent t-test. The association of variables which were qualitative in nature was analysed using the Fischer’s-exact test. Results: The maternal demographic characteristics that were included were maternal age, gestational age, parity, and consanguinity of marriage. The mean maternal age was 25.65±2.79 years. The mean gestational age was 38.55±1.27 weeks. Consanguinity of marriage was observed in four out of 110 cases. Out of 110 cases, the mean primigravida was 37.27%, gravida 2 was 46.36%, gravida 3 was 13.4%, and gravida 4 was 2.73%. The demographic characteristics of children with urogenital anomalies showed a female-to-male ratio of 50:60. Clinically, a murmur was observed in 15% of cases, and other anomalies were detected in two cases. Out of the total 110 patients with urogenital abnormalities, 15 patients had CHD. Among the 15 cases, four cases were Atrial Septal Defects (ASD), six cases were Patent Ductus Arteriosus (PDA), and five cases were Ventricular Septal Defects (VSD). The total incidence of CHDs was 13.6%. Conclusion: Therefore, authors infered that the incidence of CHD was 13.6% in paediatric patients with congenital urogenital abnormalities. Children with congenital urogenital abnormalities need to be investigated with routine echocardiography. Thus, early diagnosis and therapeutic intervention of CHDs shall not only improve the surgical outcome of congenital urogenital anomalies but also improve the long-term outcome of this high-risk patient population.

Comparison of Shear Bond Strength for One-step Self-etch versus Universal Adhesives on Contaminated and Decontaminated Dentin Surfaces: An In-vitro Study

Asritha Kondapaneni; Anila Bandlapally Sreenivasa Guptha; Sayesh Vemuri; Roopadevi Garlapati; Mayana Aameena Banu; Niharika Halder Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Ensuring strong adhesion of composite resin to dentin requires isolation, as moisture contamination from gingival fluid, blood, or saliva can weaken the bond. This can lead to microleakage, restoration loss, recurrent caries, postoperative sensitivity and discolouration. Long-lasting restorations are crucial in adhesive dentistry, but contamination often results in adhesion failure. To restore bond strength, various decontamination procedures are recommended. Aim: To evaluate and compare the effects of different contaminants and ethanol decontamination on the shear bond strength of one-step self-etch versus universal adhesives to dentin. Materials and Methods: This in-vitro study, conducted in the Department of Conservative Dentistry and Endodontics at Sibar Institute of Dental Sciences in Guntur, Andhra Pradesh, India, from July 2023 to October 2023, utilised the buccal surfaces of 70 human molars. The molars were divided into two groups (n=35): Group 1 - One-step self-etch adhesive and Group 2 - Universal adhesive. Each group was further subdivided into five sub-groups (n=7): Control (Subgroup A), Saliva contamination (Subgroup B) Blood contamination (Subgroup C) Saliva contamination followed by ethanol decontamination (Subgroup D) and Blood contamination followed by ethanol decontamination (Subgroup E) followed by ethanol decontamination. A plastic tube loaded with composite resin was placed over the dentin surface and light-cured. Shear bond strength at the dentin-composite interface was evaluated using a Universal Testing Machine (UTM). One-way Analysis of Variance (ANOVA) for intergroup comparison followed by Tukey’s post-hoc test for multiple comparisons was performed. Differences were considered significant at p-value ≤0.05 between groups. Results: The average shear bond strength (MPa) for subgroups in both adhesive groups showed a statistically significant difference (p-value ≤0.05). Subgroup A had the highest bond strength (25.786 MPa and 46.943 MPa) and subgroup C had the lowest (8.986 MPa and 9.871 MPa). In both groups, the mean shear bond strength followed this order: Subgroup A > D > E > B > C. Comparison between Group 1 and Group 2 using an independent t-test showed no statistically significant difference in any subgroup (p-value >0.05). Conclusion: The present in-vitro study found that blood and saliva contamination reduced shear bond strength to dentin, with blood having a greater impact. Decontamination with ethanol improved bond strength in both adhesive groups.

Comparison of Conventional Palliative Radiotherapy Fractionation Schedule with Quad Shot Regimen in Locally Advanced Head and Neck Cancer Patients: A Randomised Clinical Trial

Srishti Puraiya, Jitendra Kumar, Arun Kumar Yadav, Afroz Kahkashan Zaidi, Rajendra Kumar, Geeta Singh Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Head and Neck Cancer (HNC) accounts for 14.3% of all cancers in India and 4.8% of all cancers worldwide. In India, the most common sites are the lip and oral cavity (>80%), which are more prevalent in men than in women. Histologically, most cases are Squamous Cell Carcinomas (SCC). The majority of patients present with locally advanced stages, where surgery and definitive chemoradiation therapy are not possible and palliative Radiotherapy (RT) is considered a treatment option for better symptomatic relief and improved Quality of Life (QoL). The Quad Shot (QS) palliative regimen has shortened treatment time, reduced toxicity and increased compliance. Aim: To compare the QS regimen administered over two consecutive days versus the Conventional Palliative Regimen in the treatment of locally advanced HNC, in terms of treatment response, acute toxicities and QoL. Materials and Methods: In this prospective randomised clinical trial conducted from May 2023 to July 2024 in the Department of Radiation Oncology at King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India, patients with biopsy-proven locally advanced carcinoma of the head and neck were recruited, with a sample size of 50 in each of the study Group B and control Group A arms. Patients in the control arm received 30 Gray (Gy) in 10 fractions, 5 fractions per week over two weeks (Conventional palliative arm). In the study arm, patients received 14 Gy in 4 fractions delivered in two daily sessions, six to eight hours apart, for two consecutive days over three cycles (QS arm). The Response Evaluation Criteria in Solid Tumours (RECIST) Criteria 1.1 was used to assess the tumour response objectively three months post-RT. Health-related QoL was assessed using questionnaires developed by the European Organisation for Research and Treatment of Cancer (EORTC), specifically the EORTC Quality of Life Questionnaire (QLQ). Continuous data were compared using the t-test for nominal data and the Mann-Whitney U test was used otherwise. Results: The mean age was 39.66±12.05 years in Group A and 42.76±11.65 years in Group B. The QS and conventional palliative arms each had 47 and 49 patients recruited, respectively. The QS arm exhibited fewer instances of skin toxicity, with 25 (53.2%) experiencing Grade I and 7 (14.9%) experiencing Grade II toxicity, compared to the conventional palliative arm, where 30 (61.2%) had Grade I and 12 (24.5%) had Grade II toxicity. Mucositis in the QS arm included 22 (46.9%) cases, with 14 (29.7%) classified as Grade I and Grade II, whereas the conventional arm had 12 (24.5%) Grade I cases, 29 (59.5%) Grade II cases and 3 (6.1%) Grade III cases. The treatment response, in terms of partial and stable disease combined, was observed in 61.2% of the conventional arm compared to 78.7% in the QS arm. QoL was reported to be better in the QS regimen post-treatment. Conclusion: Given the total number of patients recruited, the QS arm, with its shorter treatment time, demonstrated better benefits in terms of reduced toxicities and improved treatment response, as well as enhanced QoL compared to the conventional palliative arm.

Ayurvedic Management of Mukhadushika (Acne Vulgaris): A Case Report

Sakshi Yashwant Khapre, Anita Santoshrao Wanjari, Kirti Naharwal Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Acne vulgaris, also known as Mukhadushika; described under Kshudraroga (minor diseases) in Ayurveda is a common skin condition that can have serious psychological and physical effects, especially among adolescents. The present study set out to evaluate the efficacy of Ayurvedic medicines for treating Mukhadushika (Acne vulgaris). A 24-year-old female patient presented with Acne (facial), papules with burning sensation and pain on both cheeks. Her symptoms significantly improved after receiving medicine for both internal and external application. The treatment approach, including the use of Herbo-mineral drugs like Ras manikya, Gandhaka rasayana, Kamdudha Ras, Khadiraristha and Varnya gana lepa. The papules resolved and the discharge, pain and burning sensation disappeared.

A One-year Cross-sectional Study on Analysis of Financial Losses in Serology Section of Microbiology Laboratory: A Quality Improvement Project

Chaitali Suresh Dabhi, Amita Lalitkumar Dabhi, Chirag Manojkumar Modi Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Clinical diagnostic laboratories hold a significant place in healthcare as they play an important role in diagnosis, treatment and prevention of disease and draw a substantial hospital budget as well as generate considerable revenue. Profit earned by a diagnostic laboratory is the difference between the income generated from and expenditure incurred by the laboratory in performing laboratory tests. These expenses can be further divided into: i) direct cost-amount related directly to test performance, supplies and labour; and ii) indirect costs apply to items necessary to run laboratory, are not test specific. It has been observed that apart from expenditures mentioned above, there are several financial losses that are not evident in terms of their presence and magnitude are not taken into account by the cost-accounting system Aim: To identify hidden losses, analyse its magnitude in terms of financial loss and identify the reasons for the same in serology section of Microbiology laboratory. Materials and Methods: This quality improvement, cross-sectional study was conducted at serology section of Microbiology laboratory, Shree Krishna Hospital, Karamsad, Gujarat, India from 1st April 2021 to 31st March 2022 which included all tests/control repeated, tests which are outsourced due to unavailability of test kits or consumables required to run the test, test kits/devices that crosses the expiry date and are discarded unused were included in the study. All calculations were done in Indian National Rupees (INR) with predefined formulas in Microsoft excel sheet involving simple summation and deduction to find out financial loss in particular category. As it was time bound study all the tests fulfilling inclusion criteria were included. Result: Maximum loss was observed in serology section was due to: (i) repeat testing, 55508.9 INR; and (ii) outsourcing of tests due to unavailability of test kits or consumables, 10485 INR. No loss observed due to kit/test device crossed expiry date and are discarded unused. Conclusion: This study will enable the laboratory to plan and implement corrective and preventive actions that are targeted towards reduction of such financial losses and generate more profit at laboratory level.

A Preliminary Study on Effectiveness of Varying Dose of Paretic Upper Limb Training with Visual Deprivation in Poststroke Patients: A Randomised Clinical Trial

R Sampath Pulimoot, CKV Bhuvaneswari, G Harshavardhan, Kabilan Annadurai Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Poststroke Upper Limb (UL) rehabilitation with visual deprivation has shown potential in enhancing motor recovery through neural plasticity. However, the optimal dosage remains unclear. Aim: To evaluate the effectiveness of varying doses of paretic UL training with visual deprivation in stroke patients. Materials and Methods: This single-centre, parallel-group, single-blinded, randomised clinical trial involved 36 stroke patients who were randomly distributed into three groups varying in treatment frequency: Group A (n=12) received two sessions per week, Group B (n=12) received three sessions per week, and Group C (n=12) received five sessions per week for four weeks. Each session lasted 40 minutes of visual deprivation training for the paretic UL. A trained physiotherapist, who was blinded to group allocation, conducted pre- and postevaluations. The Wolf Motor Function Test was the principal outcome measure. This study utilised Analysis of Variance (ANOVA) for between group comparisons and independent sample t-tests for within group pre-post comparisons, with a significance level of 5%. Results: Out of the 36 study participants, three dropouts were recorded by the completion of the study: one from Group A and two from Group B. The average age of participants was 54.75±8.06 years, and the duration of stroke was 10.08±4.35 months, with 69.4% experiencing left-sided involvement. All groups showed significant improvement. Group C exhibited the highest improvement in the Wolf Motor Function Test score, with an F value of 42.86 (p-value=0.001). Post-hoc analysis revealed a significant difference in motor score improvement in Group C, (p-value=0.001). Additionally, Group C demonstrated greater improvements in the Wolf Motor Functional Ability Score (WMFAS), with a mean improvement of 15.00±0.82 (F=158.00, p-value=0.001). Conclusion: Visual deprivation training with higher intensity (five sessions per week) was effective in improving UL motor function in poststroke patients, proving superior to lower intensity (two or three sessions per week). These results highlight the importance of frequent training. Future research with larger and more diverse stroke patient populations, as well as long-term follow-up studies, is needed to validate these findings.

Impact of Diabetes on Clinical Characteristics and Angiographic findings in Young Adults with ST-Elevation Myocardial Infarction: A Cross-sectional Study

Abhishek Golla; Mohammed Hidayathulla; Sowmya Deepthi Chavala; Rajashekar R Gurrala; Hussain Bangi Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: The prevalence of diabetes among young patients with ST-Elevation Myocardial Infarction (STEMI) is increasing, but its impact on this population remains understudied. Limited data on diabetes in young patients with STEMI exist. The presence of diabetes among young patients experiencing STEMI deserves special consideration, as it manifests with unique clinical patterns and can significantly impact their active lifestyle. Aim: To determine the effect of diabetes and associated clinical characteristics in young patients with STEMI. Materials and Methods: A cross-sectional study was conducted at a tertiary care centre in India between April 2018 and December 2019. Fifty-one STEMI patients aged below 40 years were enrolled and categorised into diabetic (n=23) and non diabetic (n=28) groups based on glycated haemoglobin (HbA1c) levels. Clinical characteristics, laboratory parameters and angiographic findings were compared between the groups. This study analysed continuous variables using Student’s t-test and Analysis of Variance (ANOVA) (expressed as mean±SD), and categorical variables using Chi-square or Fisher’s exact tests (shown as n, %). A p-value of <0.05 was considered significant. Results: The mean age was 35.6±3.4 years, with 80.4% male predominance. Diabetic patients showed higher prevalence of dyslipidaemia (p-value=0.009), hypertension (p-value=0.043), and metabolic syndrome (p-value=0.002). They also exhibited significantly higher levels of total cholesterol, triglycerides and Low-Density Lipoprotein Cholesterol (LDL-C). Anterior Wall Myocardial Infarction (AWMI) was predominant in both groups (p-value=0.442). Single-Vessel Disease (SVD) was most common, but Triple-Vessel Disease (TVD) was observed exclusively in diabetic patients (p-value=0.198). The Left Anterior Descending (LAD) artery was the most involved vessel in both groups. Conclusion: Compared to non diabetic patients, young STEMI patients with diabetes demonstrated a more adverse cardiovascular risk profile and lipid abnormalities.

Analysis of Preanalytical Errors in Clinical Biochemistry Laboratory of a Tertiary Care Hospital: A Retrospective Study

Dhanalakshmi Balasundararaj, M Senthil Prabhu, S Thilagarajan, Kathiravan Rajendran Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Pre-analytical phase of laboratory testing is the most susceptible phase, as errors in this phase leads to more than 50% of erroneous results and often breaches the trust of the stakeholders on the quality of the laboratory results. Many pre-analytical errors occur during the pre-analytical phase, encompassing sample collection, labelling and transportation- factors often beyond the laboratory’s direct control. Aim: To determine the type and frequency of pre-analytical errors leading to sample rejection in clinical biochemistry laboratory. Materials and Methods: Being a retrospective descriptive study, convenient sampling was used to analyse sample rejection due to pre-analytical errors in clinical biochemistry laboratory of a tertiary care teaching hospital- PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India for a period of six months from May 2023 to October 2023. All the cases/blood samples from Outpatient Department (OPD) and Inpatient Department (IPD), received and rejected during this period were included under study. The data collection and analysis was done over a period of five months using the sample rejection and resample description from Laboratory Information System (LIS). Using Statistical Package for the Social Sciences (SPSS) version 28.0, data were summarised using descriptive statistics such as numbers and percentages. Results: During the six months period out of the total of 667454 samples, 1505 (0.23%) samples were rejected due to pre-analytical errors. The majority of the samples which were rejected were from IPD than OPD. Among the pre-analytical errors, haemolysis accounted for 806 (53.6%), clotted samples 256 (17%), delta check 217 (14.4%), insufficient sample 129 (8.6%), contamination 74 (4.9%), identification error 14 (0.9%), sample without request form 3 (0.2%) while missing samples, billing error, inappropriate tube, delay in transport and wrong test selection accounted for <3 (0.1%). Conclusion: Haemolysis and clotted samples were the most common pre-analytical causes for sample rejection in the laboratory. The samples from IPD were rejected more often than OPD due to incorrect phlebotomy techniques. This accentuates the need for proper hands-on phlebotomy training sessions for novice nurses following their recruitment, as their competency will be instrumental in bringing down the errors in pre-analytical phase.

Epidemiology of Rotavirus Diarrhoea in Children and Adults Presenting with Acute Gastroenteritis at a Tertiary Care Hospital in Northern India: A Cross-sectional Study

Aarsi Aarsi, Loveena Oberoi, Shailpreet Kaur Sidhu, Manmeet Kaur Sodhi, Tavishi Oberoi Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Rotavirus is an important cause of severe diarrhoea in children under five years of age, accounting for approximately 78,000 deaths annually in this age group. The magnitude of acute gastroenteritis caused by rotavirus is often underestimated due to the lack of investigations into these cases. Although rotavirus disease is less common in adults, it can occur, possibly because of contact with children who have rotavirus gastroenteritis. Aim: To assess the current trend of the disease in both children as well as adults presenting with acute diarrhoea. Materials and Methods: This cross-sectional study was conducted over a period of one year (January 2023 to January 2024). A total of 185 stool samples were collected from children under five years of age and adults over 18 years presenting with acute diarrhoea at the outpatient and inpatient departments of Guru Nanak Dev Hospital (GNDH), Amritsar, Punjab, India. Commercially available Enzyme Linked Immunosorbent Assay (ELISA) kits were used to detect the VP6 antigen of Group A rotavirus in the stool samples of the patients. The data collected were analysed using Statistical Package for the Social Sciences (SPSS), and relevant conclusions were drawn. Results: Out of the 185 samples collected, 32 samples (17.3%) tested positive for rotavirus antigen. Vaccinated children experienced milder disease compared to unvaccinated ones. Non breastfed infants showed a higher detection rate of rotavirus, with 20 children (80%) testing positive compared to their breastfed counterparts. The rural-urban distribution indicated a greater burden in rural areas, with 16 children (64%) affected. Conclusion: This study identifies the risk factors, clinical profile, current burden and seasonal variation of rotavirus diarrhoea. It will be helpful in evaluating the impact of the rotavirus vaccine on the severity of the disease.

Correlation between Vitamin D and Urine Microalbumin among Patients with Diabetic Nephropathy: A Cross-sectional Study

Saka Prasanna, Patil B Preethi Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Diabetic nephropathy is characterised by microalbuminuria (30-300 mg/day). Vitamin D is thought to affect pathophysiology of diabetes mellitus through vitamin D receptor activation or by regulating calcium homeostasis, thus contributing to development of diabetes mellitus and its complications in deficiency status. Aim: To study the relationship between vitamin D levels and urine microalbumin among individuals with type 2 diabetes mellitus, both with and without diabetic nephropathy. Materials and Methods: This was an analytical cross-sectional study conducted in Department of Biochemistry and Nephrology, JJM Medical College, Davangere, Central Karnataka, India, between January 2019 and January 2020, involving 150 subjects: 50 with Type 2 Diabetes Mellitus (T2DM) without nephropathy, 50 with T2DM with nephropathy, and 50 healthy individuals. Glycaemic control of subjects was estimated using Glycosylated Haemoglobin (HbA1c), and renal damage was screened with serum creatinine, vitamin D, and urine microalbumin levels. The comparison of HbA1c, serum creatinine, microalbumin in urine, and vitamin D was analysed by Kruskal-Wallis test, while the association between vitamin D and HbA1c, and its correlation with microalbumin, was analysed by Spearman’s correlation. Results: The median age of controls and type 2 diabetics without nephropathy was 48 years, compared to 56 years among subjects with nephropathy, and the difference was statistically significant. A male preponderance was observed in all groups: 33 (66%) among type 2 diabetics without nephropathy, 34 (68%) among nephropathy subjects, and 36 (72%) among controls. The median concentrations of HbA1c, creatinine, and microalbumin were higher in diabetic nephropathy (8, 2.4, 140) compared to subjects without nephropathy (7, 1.16, 17) and controls (5.9, 1, 14). The median concentration of serum vitamin D was lower in diabetic nephropathy (12) compared to subjects without nephropathy (18) and controls (31). Furthermore, vitamin D and HbA1c were reciprocally related among diabetic nephropathy subjects (r=-0.61, p<0.001). In contrast, HbA1c and microalbumin were positively correlated (r=0.73, p<0.001). Conclusion: There is a substantial correlation between glycemic control, in the form of HbA1c and renal damage, in the form of microalbumin, and vitamin D levels. This justifies the inclusion of vitamin D as a potential new screening tool for diabetic nephropathy along with microalbumin.

Aesthetic and Functional Outcomes of Primary Hypospadias Repair: A Single-centre Prospective Interventional Study

Tibar Banerjee, Anirban Basu, Sudipta Bera, Souvik Adhikari Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: The results of hypospadias repair are often marred by a high rate of complications. The contemporary hypospadias repair aims to reduce the complications with the utilisation of plastic and urogenital surgical principles. However, the aesthetic and functional outcomes are often less emphasised. Aim: To evaluate the functional and aesthetic outcomes related to the clinical grades of hypospadias and different surgical methods used for hypospadias repair. Materials and Methods: In this single-centre prospective interventional study, a total of 50 patients were operated on for hypospadias and studied between March 2020 and October 2021 at the Department of Burn and Plastic Surgery, IPGMER and SSKM, Kolkata, West Bengal, India. The severity of hypospadias was assessed with the Glans-Meatus-Shaft (GMS) score. The postoperative aesthetic and functional outcomes were evaluated with the Penile Perception Score (PPS) and Hypospadias Objective Scoring Evaluation (HOSE), respectively. The tabulated data were analysed with Statistical Package for the Social Sciences (SPSS) software (Version 29.0.2.0 Armonk, NY: IBM Corp). The subgroups within the population were compared with the Student’s t-test and a p-value <0.05 was considered statistically significant. Results: The mean age of the study population was 9.92±8.61 years, ranging from one year to 34 years. The mean GMS score was 6.8±2.33. The mean PPS and HOSE scores were 7.62 (SD 1.5) and 11.6 (SD 1.96), respectively. A 72% of patients had a satisfactory outcome of PPS score (6-9), which is mostly obtained in distal hypospadias cases (25/50). There were significant differences in PPS score (p=0.008*) and HOSE score (p=0.012*) between cases with no chordee and those with severe chordee, but not among other groups based on the severity of chordee. There were significant differences in the PPS score (p=0.002*) and HOSE Score (p=0.035*) were observed between granular and perineal hypospadias. There was significant difference in the PPS score between the procedures for proximal and distal hypospadias group, but not between the procedures within each group. Conclusion: The chance of obtaining a better aesthetic outcome depends on the lesser severity of the chordee and a distal location of the meatus. The location of meatus, rather than the type of surgery, remains the most important factor influencing both the aesthetic and functional outcome. Use of an intermediate layer with the Dartos flap and Tunica Vaginalis (TV) flap may improve the functional outcome of the surgery. However, this finding needs further larger sample analysis and randomised controlled analysis to draw a strong conclusion.

Comment on, ‘Assessment of Anthropometric Variables in Type 2 Diabetes Mellitus among 4,473 Subjects in 10 Wards of Urban Belagavi District, North Karnataka, India: A Community-based Cross-sectional Study’

Mahesh Karandikar, Madhura Deshmukh Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Dear Editor, We recently read the article titled “Assessment of Anthropometric Variables in Type 2 Diabetes Mellitus among 4,473 Subjects in 10 Wards of Urban Belagavi District, North Karnataka, India: A Community-based Cross-sectional Study,” published in your esteemed journal (1). We commend the authors for conducting a well-planned and executed community-based study. Involving a large sample size, the present study highlights the need of an anthropometry-based screening program in the management of Type 2 Diabetes Mellitus (T2DM).

Genomic Identification of Genital Ureaplasma urealyticum and Ureaplasma parvum Infection by Duplex Polymerase Chain Reaction in Symptomatic Women Attending a Tertiary Care Hospital: A Cross-sectional Study

P Lavanya, N Vivek Mandal, G Vinoj, R Ramya, Samal Rupal, M Balasubramanian, AN Uma, J Pradeep Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Ureaplasma urealyticum (U. urealyticum) and Ureaplasma parvum (U. parvum) are the two causative agents for Sexually Transmittable Diseases (STDs), they are often accompanied by Pelvic Inflammatory Disease (PID), vaginitis, endometriosis, etc. Aim: To detect the prevalent genotypes/biovars of Ureaplasma species by using Duplex Polymerase Chain Reaction (PCR) in symptomatic women attending the Obstetrics and Gynaecology clinic of a tertiary care hospital. Materials and Methods: This was a cross-sectional study, comprised of 200 symptomatic women aged from 18 to 45 years. This study was carried out in the Department of Microbiology, School of Allied Health Sciences, Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute, and Mahatma Gandhi Medical Advanced Research Institute, Sri Balaji Vidyapeeth, Puducherry, India for the period of January 2021 to January 2024. Duplex PCR was performed for the presence of U. urealyticum and U. parvum in endocervical samples. Amplified PCR products were analysed and the positive PCR products were sent for sequencing and the sequenced results were compared with GenBank and phylogenetic analysis was constructed. Data was analysed using Chi-square tests to test level of significance between the two groups (p-value≤0.05). Results: The overall results found that 48 (24%) of symptomatic women were positive for Ureaplasma species. In Duplex PCR, 24 (12.0%) were positive for both urease and upv genes; followed by 15 (7.5%) for urease and 9 (4.5%) for upv genes only. The phylogenetic tree concluded that the genetic sequences of Ureaplasma species are closely related to various isolates within a species. Conclusion: The study concludes that U. parvum is the most common pathogen in symptomatic women with predominant age of 26-35-year-old. The duplex PCR, increase the sensitivity and specificity by the application of two different genes in a single amplification reaction. Since the research will focus on different gene targets of Ureaplasma species by the application of multiplex in future study.

Factors Associated with Burst Abdomen in Patients of Midline Laparotomy, Assessed using Risk Scoring System: A Retrospective Observational Study

Mohanesh Sadh, Peeyush Kumar, Lalit Kumar Bansal, Pooja Ramesh, Atul Jain Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Burst abdomen can result in evisceration (protrusion of abdominal viscera), requiring immediate treatment. If, left untreated, it can cause perioperative mortality. Some studies have been conducted in the past to develop risk scoring systems to identify patients who have a significant risk of developing a burst abdomen. The Rotterdam score considers all three risk factors (i.e., preoperative, intraoperative, and postoperative) and is a standard scoring system for predicting the risk of burst abdomen in the Western population. The Krishna Institute of Medical Sciences (KIMS) 14 score compares only preoperative and intraoperative factors. Aim: To evaluate the demographic and clinical profile of patients developing burst abdomen following laparotomy for peritonitis and to assess their Rotterdam and KIMS 14 risk scores. Materials and Methods: This retrospective observational study was conducted in the Department of Surgery at GTB Hospital, New Delhi, India, from January 2024 to March 2024. The case sheet records of patients operated on in the last three years (January 2021 to December 2023) were evaluated. A total of 100 patients were enrolled as per inclusion and exclusion criteria. A total of 50 patients were classified as cases (who developed burst abdomen) and 50 patients as controls (who did not have burst abdomen). The outcome measures included demographic and clinical data of patients, associated co-morbidities, preoperative status, and intraoperative findings (organ affected, type of contamination, postoperative complications). The Rotterdam score and KIMS 14 score were calculated. For qualitative variables, the Chi-square test or Fisher’s-exact test was used. Statistical significance was set at p<0.05. Results: Most subjects in the dehiscence group were males (40), and the rate was higher in the older age group (17 patients). The maximum number of dehiscences occurred postoperatively on day 6, with a mean of 6.66±2.66 days. The duration of surgery exceeding two hours was higher (80%) in the dehiscence group. The total leucocyte count (11074.00±6238.35 /mm3) and liver enzymes {Serum Glutamic Oxaloacetic Transaminase (SGOT) 68.72±58.90 U/L and Serum Glutamic Pyruvic Transaminase (SGPT) 68.22±75.62 U/L} were elevated in the dehiscence group. The incidence of Surgical Site Infection (SSI) in the postoperative period was higher (98%) in the dehiscence group. The mean Rotterdam and KIMS 14 scores were higher in patients who developed wound dehiscence (Rotterdam score of 5.05 and KIMS 14 score of 11.76) compared to patients who did not develop dehiscence (Rotterdam score of 3.73 and KIMS 14 score of 8.92). The p-values were 0.001 and 0.002 for the Rotterdam and KIMS 14 scores, respectively. Conclusion: Rotterdam and KIMS 14 scores were found to be statistically significant in patients developing burst abdomen. The mean score in both scoring systems was higher in patients who developed burst abdomen.

Efficacy of Intrathecal 0.5% Hyperbaric Ropivacaine for Day Care Gynaecological Procedures: An Interventional Study from a Tertiary Care Centre, Telangana, India

Sravya Thoyyeti, Hymavatathi Jakki, Neelima Junjunuru Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Although various beneficial effects of intrathecal local anaesthetics have been proven, their use is limited by dose-dependent adverse effects. Ropivacaine, a local anaesthetic, has been demonstrated to provide safe and reliable spinal anaesthesia of the required duration, with a relatively shorter duration of motor block that encourages earlier mobilisation in patients. Aim: To examine the efficacy of a hyperbaric solution of ropivacaine for spinal anaesthesia in minor gynaecological surgeries in a day care setting. Materials and Methods: This was an interventional study involving 60 subjects undergoing day care gynaecological surgery. The subjects were between 18 and 65 years old. Basic vital signs were recorded. All patients were preloaded with 15 mL/kg of Ringer’s lactate 15 minutes before surgery. Lumbar puncture was performed at the L3-L4 space. Patients received 3 mL of 0.5% hyperbaric ropivacaine (2 mL of 0.75% ropivacaine combined with 1 mL of 5% dextrose). Variations in vital signs were recorded during all phases of surgery. The onset and total duration of sensory and motor blockade, variations in vital signs at preoperative and postoperative phases, side-effects, time for ambulation and time for rescue analgesics were assessed. The values were expressed as means, frequencies and percentages. IBM Statistical Package for the Social Sciences (SPSS) Statistics version 29.0 was used to analyse all the data. Results: The onset of sensory blockade to reach T10 occurred in 214.90 seconds, while the onset of motor blockade occurred in 205.13 seconds. The sensory blockade persisted for 366.17 minutes, whereas the motor blockade continued for 153.57 minutes. Significant changes were observed from the preoperative period to 60 minutes in the mean values of Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Mean Arterial Pressure (MAP) (p-value<0.05), while there was no change in Heart Rate (HR) and Oxygen Saturation (SpO2). Conclusion: Day care surgery can be performed effectively with spinal anaesthesia using intrathecal ropivacaine. The more reliable and effective anaesthesia provided by intrathecal ropivacaine improves the expediency for anaesthetists.

Efficacy of Resorbable versus Non Eugenol Packs in Enhancing Early Wound Healing following Gingival Excisional Procedures: A Randomised Controlled Study

Lakshmi Ramachandran, Anupama Tadepalli, Priyanka Cholan, Santo Grace Umesh, Harinath Parthasarathy, Chinmaya Agarwal Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Conventionally, the raw wound after gingival excision is protected with non eugenol periodontal pack, in order to alleviate pain and preserve healing tissue which includes some potential disadvantages such as patient intolerance, pack loosening, speech difficulties and plaque accumulation. Aim: To clinically evaluate wound healing following the use of a resorbable periodontal dressing following gingival excisional procedures and to compare the outcomes with the conventional COE-PAKTM periodontal dressing. Materials and Methods: A randomised controlled trial was conducted in the Department of Periodontology, SRM Dental College, Chennai, Tamil Nadu, India from June 2022 to March 2023. Patients requiring gingival excision for gingival pigmentation, gummy smile correction and crown lengthening were included in this study, 36 patients in control group were treated with Laser assisted surgery followed by conventional COE-PAKTM and 36 patients in test group were treated with Laser assisted surgery protected with resorbable pack (RESO-PAC®). Wound healing scores (Landry’s scale) and patient comfort assessment {Visual Analogue Score (VAS)} was recorded at 7, 14 days following therapy. Data were analysed with IBM Statistical Packages for Social Sciences (SPSS) software 17.0 version using Independent t-test with level of significance 5%. Results: A total of 72 patients (38 males and 34 females) with a mean age range of 32.6 years were randomised into two study groups. Following the intervention, two participants in the test group and one subject in the control group could not report for the seven day follow-up and hence, the data of 69 participants, control (n=35) and test (n= 34) was used for final analysis. Both test and control groups showed satisfactory healing. Results in the test group were significantly better with respect to both wound healing and VAS assessment. Statistically significant difference was noted in the Wound Healing Index (WHI), VAS and Pain Intensity (PI) scores at the 7th and 14th day follow-ups (p<0.001). VAS and PI scores at 7th and 14th day (p<0.001). No of analgesics consumed during the first week were also significantly higher in the control group as compared to the test group (p<0.001**). Conclusion: RESO-PAC®, resorbable pack aided in wound healing following gingival excision and improved patient comfort during the initial healing phase. To add on the patients in the test group reported better compliance to the resorbable dressing and reported no adverse effects. Resorbable dressings could possibly facilitate secondary wound healing following surgical excision of gingiva.

Efficacy of Pasteurised Donor Human Milk on the Growth of Preterm Neonates: A Research Protocol of a Randomised Control Trial

Akansha Sisodia, RJ Meshram, Sagar Karotkar Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Growth restriction is a common complication affecting a significant proportion of Very Low Birth Weight (VLBW) infants, with estimates suggesting that up to 97% of these vulnerable newborns are impacted. While Maternal Own Milk (MOM) is the gold standard for nutrition, pasteurised Donor Human Milk (DHM) offers a safe and nutritious alternative when MOM is not available. This research investigation aims to examine and compare the effects of MOM and DHM on growth parameters and outcomes in preterm infants. Need of the Study: Preterm infants are disproportionately vulnerable to neurodevelopmental delays and other complications, underscoring the importance of identifying effective interventions to support their growth and development. While MOM is widely recognised as the optimal source of nutrition, the potential benefits of DHM warrant further investigation. Given the limited research directly comparing MOM and DHM, this study aims to address this knowledge gap and explore the impact of these nutritional sources on the developmental outcomes of preterm neonates. Aim: To compare the efficacy of pasteurised DHM on anthropometric indices (Weight/Head circumference/Length) of preterm neonates until the age of discharge. Materials and Methods: This randomised controlled trial will be conducted in the Neonatal Intensive Care Unit (NICU) and Ward of Jawaharlal Nehru Medical College and AVBRH Hospital, Sawangi, Wardha, Maharashtra, India, from January 2024 to January 2026. All preterm infants born before 37 weeks of gestation and receiving enteral nutrition during the study duration will be enrolled. Participants will be randomly assigned to one of three groups based on the type of milk consumed: MOM, DHM, or a combination of both. Anthropometric measurements {Weight (once every day in the morning from 6 AM to 8 AM), head circumference and length (both once weekly on every Sunday in the morning from 6 AM to 8 AM)} will be recorded regularly until discharge. Recording anthropometric measurements regularly (daily/weekly) at consistent times (6 AM-8 AM) enables timely detection of growth issues, prompt intervention and informed discharge planning. This approach ensures accuracy, consistency and comprehensive tracking of patient growth and development until discharge. Data analysis will be performed using Statistical Package for the Social Sciences (SPSS) version 21.0 software. Analysis of Covariance (ANCOVA) will be employed to compare anthropometric indices among groups. Weight Gain Velocity (WGV) will be calculated by dividing the weight on the 10th day by the weight on the 1st day, multiplying by 1,000 and expressing the result in grams per kilogram per day (g/kg/day). Logistic regression analysis will be used to compare the incidence of Feeding Intolerance (FI) among groups.

Utility of Serum Lipids and CEA Levels as Novel Markers in Comparison to Various Histopathological Parameters and TNM Staging in Colorectal Carcinoma: A Research Protocol

Abhishek Ghose Biswas, Pravin Gadkari Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Colorectal Cancer (CRC) is the third most widespread type of cancer around the globe. Elevated Carcinoembryonic Antigen (CEA) levels, a blood protein, are often observed in CRC patients. Need of the Study: Among gastrointestinal cancers, CRC is the most frequent cause of death. This research aims to investigate the potential link between serum lipid profiles, the levels of CEA, and the risk of developing CRC. Early detection and staging of CRC are crucial for effective management and improved outcomes. Aim: To evaluate the efficacy of serum lipids and CEA levels as novel markers compared to different Tumour Node Metastasis (TNM) staging and histopathological parameters in CRC. Materials and Methods: A cross-sectional study will be conducted in the Department of Pathology at Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi, Wardha, Maharashtra, India from October 2024 to April 2026. Peripheral blood samples will be collected from CRC patients to determine serum lipid profiles and CEA levels. Resected colon specimens will be processed and graded using TNM staging with appropriate staining. Karl Pearson’s test (data distributed normally) or Spearman’s test (data distributed non normally) will be used to conduct a correlation between continuous variables. A p-value of less than 0.05 will be considered statistically significant.

Prognostic Significance and Therapeutic Implications of CD34, an Angiogenic Marker, in Oral Squamous Cell Carcinoma: A Narrative Review

Niva Mahapatra, S Nithya, Divya Uppala, Soundarya Srinivasan, Daffney Mano Doss Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Head and neck cancer is the 7^th most common malignancy worldwide. Few decades earlier, there has been an enormous rise in genetic events as the source in the development of Oral Squamous Cell Carcinoma (OSCC) and metastasis to various organs. The seeding of neoplastic cells occurs via blood vessels (haematogenous spread), lymphatics (lymphogenous spread), or invasion into body cavities (transcoelomic spread). Neoangiogenesis results in haematogenous spread from the site of the primary tumour. Various angiogenic markers have been recognised, like Vascular Endothelial Growth Factor (VEGF), Angiopoietin-1 (Ang-1), Ang-2, Cluster of Differentiation (CD34), in head and neck neoplasms. The specificity and sensitivity of CD34 helps in vascular endothelial cell staining. CD34 is a type I transmembrane molecule of 110 kDa that is heavily glycosylated and expressed on haematopoietic progenitor cells selectively. The quantification of new blood vessels using CD34 antibody by Microvessel Density (MVD) can be used as a diagnostic and therapeutic indicator in many solid malignancies, like OSCC. Increased expression of positive CD34 antibody induces neoangiogenesis in neoplasms, upsurges the stemness of cancer and boosts its potential to metastasise. In this context, the present review focuses on use of CD34 antibody as a potential angiogenic marker that can be used to determine the the aggressiveness and potential outcome of the tumour based on the literature overview.

The Path towards a Unified Health System in India: From Fragmentation to Integration: A Narrative Review

Shubham Bobade, Sheetal Asutkar Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X India’s healthcare system is a complex structure divided into public and private sectors. The public sector, funded and managed by the government, aims to offer accessible and affordable healthcare to the citizens. It includes a network of primary health centres, district hospitals, and specialised medical institutions like the All India Institute of Medical Sciences (AIIMS). In contrast, the private sector, comprising of the small clinics and large hospitals offering a wide range of services often at a higher cost. This dual structure reflects the challenges of ensuring equitable access to quality healthcare across the country, highlighting the need for integrated strategies to bridge the gap between these sectors. This review discusses a patient-centric model, rather than a pathy-centric one, which can offer a more effective healthcare solution. Patient-centric models offer various health services at a single point of contact, allowing patients to benefit from the strengths of different systems of medicine in one place. Achieving this model requires a multilevel approach, with systems of medicine functioning alongside each other as complementary services. Key areas for integration include clinical practice, medical education, and research, all aimed at fostering a patient-centric approach. The benefits of such an integrated system include holistic health approaches, improved accessibility, and enhanced research opportunities. However, significant hurdles must be addressed, including cultural biases, regulatory fragmentation, and the need for evidence-based practices. Strategies for overcoming these challenges include the development of supportive national health policies, educational reforms, and community engagement initiatives. This review article explores the concept of “One Nation, One Health System”, which proposes the integration of traditional and modern health practices into a unified framework to enhance healthcare delivery.

Exploring the Dynamic Concept of Mechanobiology in Regenerative Rehabilitation: A Narrative Review

Purva Gulrandhe, Sourya Acharya, Pratik Phansopkar, Waqar Naqvi Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Physical therapists, equipped with unique diagnostic and treatment capabilities, play a pivotal role in advancing regenerative medicine. The present review explores the integration of mechanotherapy and mechanical techniques in physiotherapy, shedding light on the burgeoning field of mechanobiology and its implications for rehabilitative therapies. A comprehensive literature search was conducted using various databases, including Google Scholar, PubMed, Scopus, Web of Science, and CINAHL. Initially, a total of 217 articles, including research papers, reviews, and systematic reviews, were identified. After thorough evaluation, 26 articles were deemed relevant to the present study. The authors analysed these selected articles to explore the utilisation of mechanotherapy, mechanotransduction, and the integration of mechanobiological principles into physiotherapy practice. Physiotherapists employ mechanotherapy and mechanical techniques, such as manual mobilisation and exercise interventions, to treat diseases and injuries and restore function. Mechanobiology studies the essential functions that these physical variables perform through mechanotransduction, while Mechanotherapies emphasise natural mechano-adaptation to promote healing. They are active mechano-interventions that transform possible damaging mechanical effects into therapeutic benefits. Therefore, interventions should be planned accordingly. The growing field of mechanobiology and regenerative medicine is opening new avenues for rehabilitative therapies. Applying mechanobiology principles to various body systems linked to physical therapy interventions provides scope for future research.

A Scoping Review on the Clinical Decision Support Systems in COVID-19 and the Exigent Need to Develop and Accelerate its Implementation in Long COVID-19

Krishna Mohan Surapaneni, Manmohan Singhal, Ashish Joshi Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has caused global disruption, putting health experts and healthcare systems at risk. However, the ultimate goal of medical systems to offer precise medical care in a holistic manner for the benefit of patients cannot be compromised. With the massive advancements in digital technology, it is now possible for healthcare systems and medical practitioners to handle and utilise enormous amounts of patient data to provide appropriate medical assistance with minimal error. Integrated with Electronic Health Records (EHR), Clinical Decision Support Systems (CDSS) are digital programs that analyse patient data and assist medical professionals in making decisions and recommendations, thereby enhancing patient care. CDSS have played a critical role in maximising care during the pandemic by helping clinicians offer evidence-based medical care using patient data, paving the way for a more accurate and personalised healthcare delivery. However, their extended usability to manage post-COVID-19 conditions remains unexplored. Aim: This scoping review seeks to outline the use of these CDSS in the management of COVID-19 and their potential usability in risk assessment, severity prediction, and treatment goals for patients experiencing long COVID-19 symptoms. Materials and Methods: A thorough literature search was conducted on Google Scholar and PubMed using key search terms to identify relevant articles that support the objective of this study. A total of 3,010 records were available, of which 13 articles were chosen for inclusion in this review after extensive screening in accordance with the eligibility standards set up. The supporting data were meticulously extracted and charted to provide a clear outline of the utility of CDSS. This scoping review also features a conceptual framework for the extended usability of CDSS in long COVID-19 management. Results: After the methodological search and selection process, data from 13 articles were analysed. Most of the included studies were conducted in the United States. The majority of the CDSS were designed to assess the severity of COVID-19. These CDSS predominantly analysed blood investigations, COVID-19 symptoms, and radiological findings of patients to make appropriate clinical decisions for managing the disease. There was a lack of scientific literature supporting the use of CDSS in long COVID-19 management. Conclusion: With healthcare systems dealing with massive amounts of patient data, especially during the pandemic and postpandemic crisis, appropriate methods to manage and handle this information are critical to delivering patient-centered medical care. CDSS have been widely utilised in this regard to enhance the health outcomes of patients by guiding health professionals to make the right treatment choices in the most evidence-based manner using patients’ health data. Thus, given the future of healthcare systems with Artificial Intelligence (AI), a greater emphasis on expanding the usability of these CDSS beyond the scope of COVID-19 is essential.

Aberrant Origin of Splenic Artery Detected by Computed Tomography Abdominal Angiogram: A Case Report

Mohan Shobana Aparna, Sundara Raja Perumal Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X The splenic artery is one of the terminal arteries arising from the coeliac axis, supplying the spleen, pancreas and stomach. It courses along the superior border of the pancreas and travels into the splenorenal ligament and into the hilum of the spleen, accompanied by the splenic vein. The splenic vein joins with the superior mesenteric vein to form the portal vein. This is the most common anatomical pattern. Anatomical variations of the coeliac axis and splenic artery have been documented in the literature, but variations in the origin of the splenic artery are unusual and rare occurrences. This variation is important in the case of abdominal surgeries, like liver transplantation and pancreatic surgery. A 45-year-old male patient with cirrhosis of the liver underwent a Computed Tomography (CT) abdominal angiogram and Contrast-Enhanced Computed Tomography (CECT) abdomen as part of the assessment for liver conditions, portal hypertension, portosystemic collaterals and to rule out any hepatic neoplastic complications, like Hepatocellular carcinoma. In this patient, the splenic artery, instead of arising from the coeliac axis, was observed to originate from the superior mesenteric artery. Knowing this variation before surgery could prevent potentially life-threatening complications like as intraoperative or postoperative intra-abdominal bleeding.

A Narrative Review on Clinical and Experimental Evidence of Shatavari Ghrut

Ashvini Deshmukh (Paradkar), Anita Wanjari Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Ayurvedic dosage forms possess unique characteristics in both formulation and therapeutic applications. Sneha Kalpana encompasses a range of medicated oils and ghee-based products, which are effectively used to treat a diverse array of ailments across various age demographics. On the other hand, the liposomal drug delivery system represents a modern advancement in traditional medicine. Shatavari Ghrut (SG) is a notable formulation that falls under the category of Ghrut Kalpana in Ayurveda. There are numerous references to SG in Ayurvedic classics for various diseases. It is fascinating to observe the wide range of applications and the growing interest in the efficacy of SG through clinical and preclinical studies. Narrative reviews play a crucial role in summarising existing evidence and identifying gaps in knowledge for further exploration. Here’s an outline of the potential therapeutic uses and the importance of narrative reviews in evaluating SG. Relevant sources include Ayurvedic texts and scientific databases such as Pubmed, Scopus, Ayush Research Portal, ResearchGate, Digital Helpline for Ayurveda Research Articles (DHARA), Cochrane, Shodhganga, and Google Scholar, using keywords like Asparagus racemosus Wild, clinical studies on Shatavari Ghrut, lipid preparations of Shatavari, preclinical studies on Shatavari Ghrut, and Shatavari as a key.

Comparative Evaluation of Salivary Flow Rate in Oral Submucous Fibrosis Patients before and after Transcutaneous Electric Nerve Stimulation: A Research Protocol

Tanaya Teredesai, Suwarna Dangore Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: A persistent, precancerous, and frequently debilitating condition-Oral Submucous Fibrosis (OSMF) is characterised by a slowly progressing fibrosis of the oropharynx and oral cavity. A reduction in salivary flow is one of the common symptoms experienced by sufferers. Using electric current to stimulate nerves, Transcutaneous Electric Nerve Stimulation (TENS) can be an effective method for improving salivation. TENS serves as a simple, affordable, and non invasive approach that can decrease the discomfort associated with long-lasting hyposalivation. Need of the Study: Although the effectiveness of TENS on salivary flow rate has been studied in various conditions, there is a lack of evidence or studies describing the effect of TENS on salivary flow rate in patients with OSMF. This has led to the intention of the present study. Aim: To evaluate and compare the salivary flow rate in OSMF patients before and after TENS. Materials and Methods: This prospective research investigation will be conducted in the Department of Radiology and Oral Medicine, Sharad Pawar Dental College and Hospital, Sawangi, wardha, Maharashtra, India, from February 2024 to January 2025. Patients aged between 18 and 45 years suffering from OSMF will be included in the study, evaluated based on the Inventory of Xerostomia (XI) questionnaire to confirm reduced salivation. Each patient will receive TENS treatment at 40 Hz for 15 minutes. The Modified Schirmer Test (MST) will be used to evaluate the salivary flow rate before and after TENS therapy. All findings will be recorded in a tabular format and subjected to appropriate statistical tests to evaluate the statistical significance regarding the improvement in salivary flow rate.

Comparative Efficacy of Carbamazepine Therapy With and Without Transcutaneous Electrical Nerve Stimulation Therapy in Trigeminal Neuralgia Patients: A Randomised Controlled Trial Protocol

Rutumbara Gajanan Dhone, Vidya Krunshnarao Lohe Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Introduction: Trigeminal Neuralgia (TN) is one of the most painful diseases. Typically, medication therapy starts at an initial titrated dose of 100 mg every other day of Carbamazepine (CBZ) 200-1200 mg/day. There is less evidence to support second-line treatments such as clonazepam, valproic acid, baclofen, gabapentin, lamotrigine, and baclofen. Transcutaneous Electrical Nerve Stimulation (TENS) is a widespread technique used for managing neuropathic pain. TENS therapy, which involves the transmission of an electric current across the intact skin surface to activate deeper nerves in an attempt to relieve pain, is a recent and promising alternative for the treatment of both acute and chronic pain. Need of the Study: Few research has been done on TENS therapy for pain management in TN. These studies have poor study designs, no control groups, and unclear information regarding the type of concurrent pharmacological therapy. TENS in combination with CBZ may reduce the dose of CBZ therapy, therefore, there is a need to conduct the study on “Comparative efficacy of CBZ therapy with and without TENS therapy for the management of TN”. Aim: To evaluate and compare the efficacy of CBZ therapy with and without TENS therapy for the management of TN. Materials and Methods: A Randomised Controlled Trial (RCT) will be conducted in the Outpatient Department (OPD) of Oral Medicine and Radiology at Sharad Pawar Dental College and Hospital, Wardha, Maharashatra, India between July 2024 and May 2026. Once diagnosed and enrolled, 38 individuals between the ages of 20 years and 80 years will receive a primary diagnosis of TN will be included and they will receive further treatment, based on International Headache Soceity (IHS) diagnostic criteria (IHS, 2018). Then these patients will randomly be allocated to one of the following groups, 19 subjects in each group, respectively: Group 1 (CBZ therapy): The baseline parameters of patients will be evaluated who will be treated with CBZ Initially at 100 mg TDS per day (300 mg), the patient will receive an additional titrated dose 100 mg of CBZ every 48 hours until they reach the maximum tolerated dose or total relief and Group 2 (CBZ with TENS therapy): CBZ initially, at 100 mg TDS per day (300 mg), the patient will receive an additional titrated dose 100 mg of CBZ every 48 hours until they reach the maximum tolerated dose or total relief. The pulse duration of TENS therapy will be 125 μS. The TENS will be applied during the first twenty minutes at a low frequency (2 to 10 Hz) and the last twenty minutes at a high frequency (50 to 100 Hz), with no break in between, for a total of 40 minutes per session. The outcome of Group 2 will be more efficacious in reduction of Visual Analogue Scale (VAS) score as compare to Group 1. The statistical analysis will be performed using Chi-square test at 5% level of significance (p<=0.05).

Frugal Innovation of Natural Teeth

Jeyaseelan Ramasamy, Preethi Murali Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X

Congenital Anterior Urethral Obstruction: A Case Series

Sreelakshmi Madhusoodanan, Aravind C Soman, GM Asok Kumar, Hridya Menon Journal of clinical and diagnostic research : 2024 - December - 18:0973-709X Congenital Anterior Urethral Diverticulum (CAUD) and Anterior Urethral Valve (AUV) are rare but well-described causes of urinary obstruction in male children. The clinical presentation can range from isolated poor urinary stream with normal bladder and upper tracts to severe obstructive uropathy with renal failure. In the present case series, six children with anterior urethral obstruction managed between June 2014 and June 2024 were retrospectively identified. Age at presentation, clinical features, investigations, management and long-term follow-up were studied. The age at presentation ranged from newborn to seven years. Severe disease, as evidenced by progressive renal failure, was present in 1 of the 6 children (16.6%). One child had undergone foetal intervention by valve ablation but had progressive renal failure on follow-up. Three children (50%) underwent diverticulum excision with urethroplasty, of which one child developed a postoperative urethrocutaneous fistula. One child with AUV had a dorsal urethral fold causing obstruction, unlike the ventral pathology observed in the other children. CAUD and AUV are rare yet important causes of obstructive uropathy. Careful assessment is crucial for making the correct diagnosis. Temporary diversion may be essential when cystoscopy or primary repair is not feasible or in cases of urosepsis.