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

Methicillin-resistant Staphylococcus aureus Intraepiphyseal Osteomyelitis of Distal Femur: A Rare Case Report

Pankaj Sharma, Rishyendra Varma, Amit Kale, Ketan Kulkarni, Ashwinkumar Vasant Khandge Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Epiphyseal osteomyelitis caused by Methicillin-resistant Staphylococcus aureus (MRSA) is a rare bone infection, usually occurring secondary to metaphyseal bone involvement due to a separate system of epiphyseal arteries that penetrate the epiphysis near the capsular insertion close to the growth plate. We report a unique case of a two-year-old girl who presented with a history of fever for one week, followed by pain and swelling in the left knee. She had a flexion deformity of 20 degrees. Laboratory findings showed elevated inflammatory markers, while blood cultures showed no growth. Magnetic Resonance Imaging (MRI) revealed epiphyseal osteomyelitis of the distal femur. Bone marrow biopsy confirmed MRSA infection. The patient underwent debridement of the epiphyseal lesion, taking care not to injure the growth plate, and STIMULAN® local antibiotic-impregnated dissolvable synthetic calcium sulphate beads were placed in and around the bone and knee joint. Postoperative purulent material and tissue cultures showed no growth. All inflammatory markers trended downward, and there were no further fever spikes. The patient recovered well without complications. High clinical suspicion is necessary for early diagnosis, and follow-up is important to detect any limb length discrepancy or deformities at an early stage.

Atypical Presentation of Nephrotic Syndrome and Cerebral Venous Sinus Thrombosis in Minimal Change Disease: A Case Report

Jayanth Kumar, Sourya Acharya, Sushrut Gupta, Khadija Hamdulay, Manikanta Nelakuditi Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Minimal Change Disease (MCD) is a major cause of nephrotic syndrome in children and a minority in adults. MCD and primary Focal Segmental Glomerulosclerosis (FSGS) are both examples of pathogenic mechanisms that predominantly affect the podocytes. MCD has also been linked to thrombotic consequences. The term Cerebral Sino-Venous Thrombosis (CSVT) refers to a group of conditions that involve thrombosis of the cerebral venous system. The patient presented with a severe headache for seven days, accompanied by vomiting and he was diagnosed with Cerebral Sino-Venous Thrombosis (CSVT) with underlying MCD. There was no associated medical or surgical history. Laboratory examination showed serum hypoalbuminaemia, low protein levels, and an altered urine-protein creatine ratio. A follow-up magnetic resonance imaging showed chronic occlusion of the right transverse and sigmoid sinus with multiple flow voids adjacent to the right transverse and sigmoid sinus. The patient was managed with low molecular weight intravenous corticosteroids, which led to symptomatic relief, followed by a switch to oral steroids. This index case highlights that while MCD is typically a kidney disease, it can lead to severe and potentially overlooked thrombotic events in adults. The case underscores the link between nephrotic syndrome and a hypercoagulable state, which, although not definitively proven as a direct cause of thrombosis, is associated with profound clotting factor abnormalities.

A Case Report of Traumatic Neuroma in the Buccal Mucosa: Role of Histopathology in Unravelling Clinical and Diagnostic Hurdle

Neha Shah, Shreya Batabyal, Mehebuba Sultana, Sangeeta Sinha, Mousumi Pal Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Traumatic neuroma, also known as amputation neuroma, is a benign, non-neoplastic proliferation of nerve tissue that occurs in response to long-standing nerve injury or trauma. While this condition is mostly associated with peripheral nerves, it can also manifest in the oral cavity, particularly following surgical procedures, accidental injury, or chronic irritation. Although traumatic neuromas are relatively rare in the paediatric population, their occurrence in the oral cavity warrants attention due to potential diagnostic challenges and the impact on the patient’s quality of life. Traumatic neuromas can be easily overlooked or misdiagnosed, as there is no consensus on their clinical presentation due to their rarity. This article presents a case report of a 14-year-old female patient complaining of excruciating pain in the left side of her face. The case highlights the unusual and obscure clinical presentation of traumatic neuroma, posing a diagnostic dilemma and the importance of histopathology for definitive diagnosis and proper treatment and management.

Co-existence of Multifocal Ductal Carcinoma in Situ with Microinvasion and Benign Phyllodes Tumour in the Same Breast: A Rare Case Report

Khushi Soni, Kishor Hiwale, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X The presented case is a rare instance of multifocal Ductal Carcinoma In Situ (DCIS) with microinvasion in the presence of a benign phyllodes tumour in a 60-year-old postmenopausal woman. The patient reported that she had painless right breast lumps for four months and no previous trauma, hormonal treatment or family history of breast/ovarian carcinoma. A physical examination showed four discrete, mobile and non-tender masses without any skin changes or lymphadenopathy. Biochemical and haematological investigations were unremarkable. Mammography and targeted ultrasound imaging showed several heterogeneous nodules, one of which was lobulated fibroepithelial with the rest being segmental calcifications, which led to suspicion of multifocal DCIS with microinvasion. Wide local excision of all nodules was done. Histopathology also confirmed DCIS with microinvasion in three nodules and one benign phyllodes tumour, without having epithelial malignancy. This case underlines diagnostic challenge in coexisting DCIS and phyllodes tumours, emphasising the importance of proper imaging, surgical excision and histopathology for diagnosis and management of such rare cases.

Intranasal Lobular Capillary Haemangioma of the Anterior Inferior Turbinate: A Case Report

PM Raghuraman, Karthika Rajendran, CRK Balaji, S Anand Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Intranasal Lobular Capillary Haemangioma (LCH), also known as pyogenic granuloma, is a rare benign vascular lesion of the nasal cavity, typically presenting with recurrent epistaxis and nasal obstruction, predominantly in females. It arises from the nasal septum or turbinates and is characterised by rapid growth with a tendency to bleed easily. Although benign, its presentation often mimics more aggressive conditions, making an accurate diagnosis essential. This is a case report of a 23-year-old female who presented with intermittent left-sided epistaxis for two months and progressive nasal blockage for six weeks. Nasal endoscopy revealed a reddish-yellow, polypoidal mass arising from the anterior inferior turbinate, which bled upon contact. Computed Tomography (CT) revealed a well-defined, hypodense, non-enhancing lesion without bony erosion or sinus involvement. The patient underwent complete endoscopic excision with bipolar cauterisation of the pedicle under general anaesthesia. Intraoperative bleeding was minimal, and the recovery was uneventful. Histopathological examination confirmed LCH, revealing lobular proliferation of capillary-sized vessels lined with plump endothelial cells without atypia or malignancy. The patient remained symptom-free during the six-month follow-up period. This case highlights the importance of considering LCH in young females presenting with recurrent unilateral epistaxis and nasal obstruction. Early diagnosis, imaging, histopathological confirmation, and complete endoscopic excision with pedicle cauterisation are crucial for effective management and prevention of recurrence.

Lingual Lipoma: An Atypical Case Presentation of a Common Tumour in an Uncommon Site

Balaram Mandadi, Ashwin Rangan Anandasubramanian, Tharun Ganapathy Chitrambalam, Ram Prakash Ramanathan, SG Jano Roy Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Lipomas are common benign mesenchymal tumours composed of mature adipose tissue, but they are rare in the oral cavity, particularly on the tongue. This report describes the case of a 53-year-old female who presented with a slowly enlarging, painless swelling on the right lateral border of the tongue for four years, causing difficulty in speech and eating. Clinical and radiological evaluations, including Magnetic Resonance Imaging (MRI), revealed a well-defined, fat-containing lesion without invasion. Fine Needle Aspiration Cytology (FNAC) suggested a lipoma, and complete surgical excision was performed under general anaesthesia. Histopathological examination confirmed a simple lipoma with no signs of malignancy. The postoperative course was uneventful, and the patient remained symptom-free with no recurrence at the one-year follow-up. Although they are rare, lingual lipomas should be included in the differential diagnosis of asymptomatic oral swellings, and their surgical removal provides excellent outcomes.

Dentigerous Cyst Associated with Impacted Supernumerary Tooth in Anterior Palatal Region: A Case Report

Sivagami Muthukrishnan, Priyadarshini Kedarnath, Vijayalakshmi Dhanaraj, Asha Jeyakumar, Jeya Varshini Ravi Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X The dentigerous cyst is the most common developmental odontogenic cyst, originating from the accumulation of fluid between the reduced enamel epithelium and the crown of an unerupted or impacted tooth. It is most frequently associated with the mandibular third molars and maxillary canines, followed by the maxillary third molars. Occurrence in the anterior maxillary region is exceptionally rare; however, when present in this location, it is typically associated with a supernumerary tooth. Supernumerary teeth are additional teeth that develop beyond the normal dentition and can be found in any region of the maxilla or mandible. The most common type is the mesiodens, typically located in the anterior maxilla, followed by the distomolar, situated distal to the third molars. Although most supernumerary teeth erupt normally into the oral cavity, a subset remains impacted. Of these, only a small proportion are associated with clinical complications such as crowding, delayed eruption of adjacent teeth, or the development of an odontogenic cyst or tumour. This article presents a rare case of a dentigerous cyst associated with an impacted supernumerary tooth in the anterior maxilla of a 40-year-old male, who presented with pain and mild swelling in the anterior palatal region. The case highlights the diagnostic process, radiographic evaluation, and surgical management of this uncommon presentation.

Transverse Mesocolon Volvulus: A Case Report

Ruchika Prabhu, Saumya Ranjan Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Volvulus is described as the axial twisting or rotation of a part of the colon around its mesentery. It constitutes approximately 5% of all cases of bowel obstruction, making it an extremely rare pathology. We report a case of transverse colon volvulus in a 38-year-old female who presented with a sudden onset of right upper abdominal pain, distension, constipation, and emesis. An erect X-ray of the abdomen revealed two air-fluid levels in the right lumbar region. Preliminary ultrasonography showed the presence of a mesenteric twist in the right hypochondriac region and a dilated fluid-filled ascending colon and caecum. Contrast-enhanced Computed Tomography (CT) imaging demonstrated the presence of a twisted transverse mesocolon with a vascular pedicle in its centre, consisting of branches of the superior mesenteric artery and dilated, tortuous collaterals arising from inferior mesenteric vessels. These findings were later confirmed with histopathological correlation.

Undetected Hepatocellular Carcinoma Initially Manifesting as Pathologic Fracture of Femur: A Case Report

Sarojini Raman, Prajna Das, Urmila Senapati, Bhabani Shankar Mahapatra Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Hepatocellular Carcinoma (HCC) is the most common primary liver malignancy and its global incidence and mortality have shown an upward trend recently. According to GLOBOCAN 2020, it is the 4^th most frequent cause of death worldwide. Despite advances in diagnostic and therapeutic modalities, many patients present at an advanced stage with a dismal prognosis. HCC often metastasises to the lungs, lymph nodes and abdominal organs. Bone metastasis is reported in only 5–7% of primary HCCs. The long bones, such as the femur, are rare sites for distant metastasis compared with the axial skeleton. HCC typically presents as a large space-occupying lytic lesion with systemic symptoms. Extrahepatic isolated bone metastasis without clinical signs or symptoms of liver injury as the sole initial manifestation in HCC is very uncommon. Present case is of primary HCC in a non cirrhotic liver metastasising to the femur in a patient with no known co-morbidities. This case highlights the fact that metastatic HCC should be included in the differential diagnosis in cases presenting with lytic bone lesions of unknown primary in older males, even in the absence of liver cirrhosis. Early radiological intervention and aggressive management policies should be adopted to extend survival.

A Case Report on Gas Gangrene with a Fatal Outcome

Priyadharshini Srinivasan, Vishak Manoj Bhaskar, Nanditha Padikkasu, Pushparani Anand Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Gas gangrene, a life-threatening illness caused by Clostridium perfringens, progresses rapidly, resulting in systemic toxicity, multiorgan failure and ultimately death. This case report describes a 19-year-old male patient presenting with dyspnoea, limb oedema, and severe pain following an intramuscular injection. Examination revealed significant oedema, palpable crepitus, absent peripheral pulses, metabolic acidosis and septic shock. The patient underwent emergency surgical debridement under general anaesthesia with inotropic support. Despite aggressive resuscitation, he died seven hours after arrival. Posthumous tissue cultures confirmed Clostridium perfringens infection. This case underscores the critical importance of prompt diagnosis, aggressive intervention and the challenges of perioperative management in gas gangrene.

Malignant Transformation in Tailgut Cyst Presenting as Retrorectal Adenosquamous Carcinoma: A Case Report

Dipkana Das, Raya Banerjee, Durgaprasad Nanda, Namrata Maity Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Tailgut cysts are rare congenital retrorectal lesions that can rarely undergo malignant transformation. Occurring predominantly in middle-aged females, these lesions are mostly asymptomatic, with rare symptoms arising mostly in association with malignant transformation. The mainstay of therapy is surgical excision with adequate clear margins. Postoperative radiotherapy is indicated in cases with involved or close margins postoperatively, high histologic grade of malignancy, presence of perineural or lymphovascular invasion or high proliferative index of tumour, in order to prevent local site recurrence. In this study, we present a case of adenosquamous carcinoma arising from a retrorectal tailgut cyst. The patient was treated with surgical excision followed by adjuvant chemoradiotherapy. Patient is currently doing well and is on routine follow-up as per institutional protocol.

Psoas Abscess as an Atypical Presentation of Acute Necrotising Pancreatitis in a Diabetic Patient: A Case Report

Gowtham Ganesan, Velvizi Raveendran, S Jayakanthan Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Psoas abscess can be challenging to diagnose due to non specific symptoms. It is commonly noted to have tuberculous or pyogenic aetiologies. Acute necrotising pancreatitis can be defined as pancreatitis with necrosis. This can cause the formation of a psoas pseudocyst, which may be misdiagnosed as a psoas abscess. The likelihood of misdiagnosis is higher in diabetic patients due to the associated increased risk of infection. This is a case report of a 37-year-old male presenting with fever, swelling and left lumbar region pain, with a history of long-standing diabetes and alcohol consumption. The patient was diagnosed with a pancreatic pseudocyst with left psoas abscess by Computed Tomography (CT) imaging. The abscess was treated with percutaneous drainage, culture and drug-sensitivity analysis, followed by intravenous antibiotics tailored to the results. This case highlights the need to consider necrotising pancreatitis as a potential differential diagnosis in cases of psoas abscess, particularly in cases with retroperitoneal involvement.

Malakoplakia of Bone Presenting as Bilateral Septic Arthritis: A Case Report

S Supriya, B Krishnamoorthi Adiga Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Malakoplakia is an uncommon chronic inflammatory disorder that usually involves an abnormal immunological response to underlying infection. Though it is reported in almost every organ system, involvement of bone is extremely rare, where it usually presents as a solitary lytic lesion. We report a case of bilateral knee swelling in a 58-year-old woman yielding pus on aspirate due to Proteus and Citrobacter infection with osteolytic lesions of adjacent bones. As the disease was refractory to antibiotics, a biopsy was taken, which revealed malakoplakia. The aim of this article is to present a unique first case of malakoplakia involving joints. The patient was diabetic and had recently recovered from nephrotic syndrome. Detailed discussion of the case along with characteristic histopathological features, challenge in diagnosis and management with review of the literature of bony malakoplakia is presented.

Delayed Diagnosis of Atypical Neuroleptic Malignant Syndrome Precipitated by Olanzapine: A Case Report

Jiang Cao, Na-Hua Yuan, Yan Zhang Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Neuroleptic Malignant Syndrome (NMS) is a life-threatening and idiosyncratic adverse reaction to common antipsychotic medication. The diagnosis of NMS remains controversial and unclear, as most criteria used in practice fail to correspond to empirical diagnoses. Here, we present a case of NMS diagnosis and management. A 48-year-old man with bipolar disorder was frequently admitted to a psychiatric ward with recurrent episodes. He had been stable for six months since his last hospitalisation and was being treated with oxcarbazepine and olanzapine. Oxcarbazepine was discontinued, and olanzapine (20 mg/d) was continued because of hyponatraemia and hypochloraemia. Clinical manifestations after olanzapine intake comprised confusion, agitation, fever, urinary retention, and increased Creatine Kinase (CK). A urinary tract infection was considered because of absent muscle rigidity in the first five days. Furthermore, the patient had an increased body temperature, frequent urination, urgency, and pain. Upon muscle rigidity and pulmonary infection development, the patient was medically treated. Following quetiapine monotherapy (administered at 25 mg and gradually increased to 600 mg in two oral doses) at week 3 post-NMS recovery, the mental state of the patient improved. He maintained a rational conversation with no evidence of autonomic instability or disorientation. He was discharged from the psychiatric ward 3.5 months after admission. NMS is a rare neurological disorder with a potential atypical presentation and requires emergency medical treatment rather than psychiatric care. Clinicians must carefully distinguish between medical and mental illnesses, prioritising multiple illnesses promptly in case of identification difficulties.

Elevated NT-proBNP in a Patient with Grade 1 Renal Cell Carcinoma undergoing Axitinib Therapy: A Case Report

Abhijit Pratap, Pradnya Phalak, Anjali Garg, Deepali Jain Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X The N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) elevation in oncology patients underscores the importance of considering paraneoplastic syndromes, specific drug toxicities, and tumour-related vascular complications alongside primary cardiac. A 58-year-old male with Grade 1 clear cell Renal Cell Carcinoma (RCC) on Axitinib therapy presented with a three-week history of progressive fatigue, significant weight loss (5 kg), and anaemia. Despite normal renal function and preserved cardiac ejection fraction (60%), his NT-proBNP level was persistently elevated above 35,000 pg/mL. Comprehensive cardiac workup, including troponin, Electrocardiogram (ECG), and echocardiography, revealed no evidence of heart failure. Diagnosis was confirmed via Positron Emission Tomography (PET)-Computed Tomography (CT), which identified a right renal mass with an Inferior Vena Cava (IVC) thrombus and bilateral lung lesions, and biopsy with immunohistochemistry. This case highlights an extreme elevation of NT-proBNP in low-grade RCC, potentially mediated by paraneoplastic activity, Axitinib-related cardiotoxicity, anaemia, or tumour thrombus effects, suggesting its role as a biomarker beyond cardiac dysfunction. Monitoring NT-proBNP in such patients may offer insights into tumour behaviour and treatment-related stress.

Accidental finding of Strongyloides stercoralis Hyperinfection in an Immunocompetent Patient: A Case Report

Shahin Vishani, Dhruba Hari Chandi, Dipika Shaw, Supriya Meshram, Gargi Mudey Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Soil-transmitted helminths commonly present as asymptomatic gastrointestinal discomfort, abdominal pain, diarrhoea, anaemia, and decreased work productivity. They are rarely fatal. Strongyloides stercoralis is a soil-transmitted intestinal nematode that can remain asymptomatic for a very long time. Hyperinfection and disseminated infection, commonly associated with immunocompromised patients, can have a grievous outcome. In this case, the patient was admitted to the hospital with an electric burn wound and was treated with partial amputation of the right hand, along with other wounds. During hospitalisation, it was found that he was anaemic with a haemoglobin of 8.3 g/dL, for which he was evaluated. Stool examination revealed multiple larvae of S. stercoralis, suggestive of hyperinfection. The patient was treated to prevent further complications and was discharged later. This implies the importance of having a high index of suspicion, while evaluating patients in tropical and subtropical climates for parasitic infections.

Multimodal Imaging in the Diagnosis of Juvenile Retinoschisis: A Case Report

Gufran Ali Kamdar, Shikha Rai, Sumit Navneet Toshniwal, (Col) OK Radhkrishnan Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Retinoschisis is a retinal disorder characterised by splitting within the neurosensory retina, which leads to structural disorganisation and varying degrees of visual loss. Among hereditary forms, X-Linked Juvenile Retinoschisis (XLRS) is the most common subtype. It arises due to mutations in the RS1 gene encoding retinoschisin, a protein vital for cellular adhesion and synaptic integrity within the retina. Because of its X-linked recessive inheritance, XLRS predominantly affects males and typically manifests in the first decade of life. In this case report, a 20-year-old male, born to a consanguineous marriage, presented with gradual, painless, bilateral diminution of vision for one year. There was no history of trauma, systemic illness, surgery, or family history. Best-corrected visual acuity was 6/24p in the right eye and 6/18p in the left eye, with normal anterior segment and trichromatic colour vision. Fundus revealed spoke-wheel foveal schisis, suggestive of XLRS. Optical Coherence Tomography (OCT) confirmed intraretinal splitting, and Electroretinography (ERG) demonstrated a negative waveform with reduced b-wave, characteristic of XLRS. The prevalence of XLRS varies globally but is often higher in populations with frequent consanguineous marriages, which increase the likelihood of transmitting recessive mutations. Early diagnosis with careful clinical and imaging evaluation is important for monitoring progression and identifying complications. Management remains largely supportive, including low-vision rehabilitation and treatment of associated complications. Although no curative therapy is currently available, gene therapy targeting RS1 mutations is under active investigation and holds promise as a future treatment option for preserving vision.

Management of Plummer-vinson Syndrome: A Report of Two Cases

S Aravind Warrier, Arnesh Garg, M Vaishnavi, Preethi Ramesh, CV Divyambika Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Plummer-Vinson Syndrome (PVS), also referred to as Paterson-Kelly syndrome, is a complication of Iron Deficiency Anaemia (IDA) that is associated with the formation of oesophageal webs and dysphagia. The oesophageal webs are thin, membranous structures that partially obstruct the upper oesophagus, hindering the passage of food. PVS occurs more frequently in middle-aged women and is linked to an increased risk of squamous cell carcinoma of the pharynx and oesophagus. Due to the high risk of malignant transformation, PVS has been grouped under the category of Oral Potentially Malignant Disorders (OPMD). Identification of the disease, early intervention, and long-term follow-up are essential to prevent complications associated with PVS. A thorough history and clinical examination to evaluate possible etiologic causes, haematological evaluation of the blood count and erythrocyte morphology, along with evaluation of the oesophagus using barium swallow or endoscopy, are needed to diagnose the severity of the case and plan appropriate treatment. Treatment with iron supplementation can lead to the improvement of symptoms and regression of oesophageal webs, emphasising the importance of timely intervention and long-term surveillance. This case report aims to highlight the various oral and systemic manifestations, investigations, treatment, and follow-up of PVS in two female patients. The highlight of the cases is timely medical intervention leading to the disappearance of webs, eliminating the need for mechanical dilatation. Thus, early diagnosis and prompt management of such cases can improve the overall quality of life of such patients.

Nasal Septal Schwannoma: A Rare Tumour at an Atypical Site

Vaibhavi Patil, Prasad Deshmukh, Sagar Gaurkar Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Schwannomas are benign tumours originating from Schwann cells of peripheral nerves. Although common in the head and neck region, their occurrence in the nasal cavity is rare, and involvement of the nasal septum is exceptionally uncommon. Due to their non-specific symptoms and rarity, nasal schwannomas often pose a diagnostic challenge. In this report, we present a case of a schwannoma arising from the right side of the nasal septum in a 50-year-old male, who presented with a slowly enlarging nasal mass and progressive nasal obstruction. The mass was excised surgically, and histopathological evaluation confirmed the diagnosis. This case highlights the diagnostic challenges and therapeutic considerations in managing nasal septal schwannomas, a seldom-seen entity.

Anaesthetic Considerations for Neurosurgery in a Patient with Large Atrial Septal Defect and Left Parietal Cystic Glioma: A Case Report

Kavya Kalluri, Teena Tanaji Desai, Narendra Patil Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Atrial Septal Defect (ASD) can pose unique anaesthetic challenges for patients undergoing non-cardiac surgeries, such as craniotomy. The presence of a shunt can affect haemodynamic stability, oxygenation, and anaesthetic management. The current case report detailing the anaesthetic considerations and management strategies employed for a patient with ASD undergoing craniotomy highlights the importance of careful perioperative planning and monitoring to ensure optimal outcomes. A rare case of a 60-year-old female patient with a large ASD and severe Pulmonary Arterial Hypertension (PAH) who underwent left frontotemporoparietal craniotomy and excision of a left-sided parietal cystic glioma. The patient's medical history included palpitations, exertional dyspnoea, slurring of speech, and right-sided upper and lower limb weakness. Echocardiography (ECHO) revealed a large ostium secundum ASD (3.7 cm) with left-to-right shunt, moderate tricuspid regurgitation, severe PAH, and a left ventricular ejection fraction of 50%. The patient was carefully managed perioperatively by a multidisciplinary team approach. Anaesthetic techniques and medications were selected to minimise haemodynamic instability and Pulmonary Vascular Resistance (PVR). Intraoperative monitoring included monitoring of cardiac function, oxygenation, and ventilation. The patient underwent successful surgery without major complications. This case report highlights the anaesthetic complexities of managing patients with large ASDs and severe PAH undergoing non-cardiac surgery. Careful perioperative planning, multidisciplinary collaboration, and close monitoring are essential to ensure optimal outcomes. Our experience demonstrates that with careful management, patients with complex cardiac and neurological conditions can undergo successful surgery. This case report provides valuable insights into the perioperative management of patients with large ASDs and severe PAH, highlighting the importance of a multidisciplinary approach and careful anaesthetic planning.

Parkinsonism as a Rare Manifestation of Hashimoto Encephalopathy Associated with Autoimmune Polyendocrine Syndrome: A Case Report

Diksha Samsukha, Rohidas T Borse, Meenal Chandanwale Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Hashimoto’s encephalopathy is a rare manifestation of a common autoimmune disease, characterised classically by its association with autoimmune thyroid disease and responsiveness to steroids. Usual clinical manifestations include a relapsing-remitting course of seizures, stroke-like episodes, cognitive decline, neuropsychiatric symptoms and myoclonus. Diagnosis requires raised Thyroid Peroxidase (TPO) antibody titre and exclusion of other encephalopathies, including neuronal surface and paraneoplastic antibodies. Here, we delve into a case of Hashimoto’s encephalopathy for: 1) its rare linkage to an Autoimmune Polyendocrine Syndrome (APS); and 2) an uncommon manifestation in the form of Parkinsonism. We report a case of a 45-year-old male with previously diagnosed hypothyroidism, vitiligo and likely adrenal tuberculosis. The current presentation included a fluctuating sensorium with gradually declining mobility and all classical features of Parkinsonism. Investigations revealed hyponatraemia owing to decreased morning serum cortisol levels, normal thyroid profile, and a normal Cerebrospinal Fluid (CSF) analysis. The Electroencephalogram (EEG) showed generalised slowing. The autoimmune and paraneoplastic encephalitis panel was negative. A raised anti-TPO antibody level clinched the diagnosis of Hashimoto encephalopathy associated with APS (Autoimmune thyroid disease, vitiligo and autoimmune adrenalitis). He showed remarkable improvement with steroids, thyroxine and levodopa-carbidopa. On follow-up, the patient showed marked improvement in bradykinesia, tremors and rigidity. This rare case underscores the importance of suspicion of rare manifestations in relatively common and potentially reversible disorders.

Rare Presentation of Early Gastric Carcinoma with Bone and Bone Marrow Metastases: A Case Report

Ashwin J Dhas, Rao Oshmi Rajesh, Nirmala Devi Chandrasekaran, PV Abinaya, Janardana Subramonia Kumar Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Gastric carcinoma has emerged as a global health problem in recent decades. Bone and bone-marrow metastases are common findings in the diagnostic work-up for malignancies; however, they are rarely seen in early gastric carcinoma. This case report describes a 60-year-old male patient who presented with severe back pain for three weeks. The patient underwent blood tests and radiologic imaging, including abdominal ultrasonography and Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) of the brain and spine, upper Gastrointestinal (GI) endoscopy, gastric biopsy, and bone marrow biopsy. The MRI of the lumbar spine revealed patchy heterogeneous T2 hyperintense signals in multiple vertebrae along with a focal defect at the L2 vertebra. A differential diagnosis of multiple myeloma and bone metastases was initially contemplated. The Histopathological Examination (HPE) of the stomach biopsy indicated poorly differentiated adenocarcinoma exhibiting localised signet-ring cell characteristics. Bone marrow biopsy revealed a similar histopathological picture, confirming metastasis to the bone marrow. A diagnosis of gastric adenocarcinoma with bone and bone-marrow metastases was made. Chemotherapy was deferred due to the patient’s poor performance status and, in part, because of worsening cytopenia and Disseminated Intravascular Coagulation (DIC). During the patient’s hospital stay, managing the patient’s pain, cytopenia, and ongoing DIC became difficult, and the patient succumbed on day 21 of hospitalisation. This case presents an unusual instance of early gastric carcinoma with extensive bone and bone-marrow metastases without visceral or peritoneal involvement.

Rasmussen Encephalitis Closely Mimicking Infantile Spasms: A Case Report

Touheer Pasha, Shilpi Agrawal, MG Ravanagomagan Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X A six-month-old male infant was brought to the paediatric neurology department with the chief complaint, described by his parents, of repeated jerky movements of the left hand for the past three weeks. These episodes occurred multiple times daily, each lasting 15 to 30 seconds, without any associated fever, loss of consciousness, or postictal drowsiness. The child had been developmentally normal before the onset of seizures and had achieved appropriate milestones for age. The parents noted that the seizure frequency had gradually increased to six to eight episodes per day, prompting them to seek further medical care. He was born at term via normal vaginal delivery, with an uneventful antenatal and perinatal history. The mother had no known comorbidities during pregnancy. There was no family history of epilepsy or autoimmune disease. Initially evaluated at a local facility, the child was suspected of having infantile spasms and was started on empirical antiepileptic therapy. However, despite two weeks of treatment, the seizures persisted. At the time of presentation to our centre, he was alert, active, feeding well, and not in respiratory distress. No seizure activity was witnessed during examination. His vital signs were within normal limits, with a temperature of 36.8°C, heart rate of 128/min, respiratory rate of 36/min, oxygen saturation of 98% on room air, and blood pressure of 82/58 mmHg. Birth and antenatal history were unremarkable, with no perinatal complications.

Inflammation-induced Giant Retroperitoneal Lymphangioma in an Adult: An Unusual Case Report

Saurabh Boralkar, Samir Gupta, N Santhosh Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Cystic lymphangiomas belong to the group of tumours arising from the lymphatic system. In adults, they are less commonly seen, with the abdomen being the least common site. Here, the present case study included a 32-year-old female who had a history of tube drainage of an abdominal cystic mass six years ago at the same hospital. Following that procedure, she developed tachycardia clinically, along with fever and rigors. The patient now presented with abdominal pain and distension for five months. She was evaluated with an ultrasound and a Computed Tomography (CT) scan of the abdomen and pelvis, which revealed a similar retroperitoneal cystic lesion. The patient underwent complete excision of the cystic lesion, and her postoperative course was uneventful. We are reporting this case of a lymphangioma that became iatrogenically infected and resulted in a giant lymphangioma within six years. According to the literature, only three cases of retroperitoneal lymphangioma in adults with a size greater than 20 cm have been reported. Compared to these, this cystic lymphangioma represents the fourth largest reported case.

Regional Hyperhidrosis as an Unusual Presentation of Juvenile Amyotrophic Lateral Sclerosis: A Case Report

S Indulekha, Raj Kumar Yadav, Hrishikesh Das, Paras Yadav Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Juvenile Amyotrophic Lateral Sclerosis (JALS) is a progressive neurodegenerative disorder affecting motor neurons in the brain and spinal cord, which occurs before the age of 25 years. A 21-year-old man without a family history of neurological diseases started having increased sweating in his right hand and slippage of a pen 5 and a half years back. Within two years of the symptoms first appearing, progressive weakness in the right hand and forearm muscles, leading to difficulty in writing, grasping and lifting heavy objects, was noticed. This weakness gradually progressed to the left upper limb also. There was no history of dysphagia or dysarthria. Physical examination revealed spasticity and exaggerated deep tendon reflexes in all four limbs, along with wasting and fasciculations, with normal cranial nerves, sensory and cerebellar examinations. Blood investigations were normal. Needle Electromyography (EMG) denervation changes were noted in the upper and lower limbs and thoracic paravertebral muscles. He was diagnosed with JALS according to the modified El-Escorial criteria and age of the patient. After counselling, Riluzole was started along with non-pharmacological management. The purpose of this case is to highlight an unusual initial autonomic presentation of JALS. Here, the patient initially had increased sweating, i.e., hyperhidrosis, as the only complaint. The reason might be the increased autonomous neural firing rate.

Delayed Suture Granuloma Imitating Tumour Recurrence following Hemithyroidectomy: A Case Report

Diksha Bhimrao Sangale, Nareddy Akarsh Reddy, Manu Suresh Babu, Rashmi Prashant Rajashekar Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Suture granulomas are rare benign inflammatory reactions to retained non absorbable suture materials that may clinically and radiologically mimic neoplastic recurrence. Present case is of a 48-year-old female who developed multiple anterior neck swellings 18 months after undergoing hemithyroidectomy for a biopsy-proven follicular adenoma. Imaging and cytology raised suspicion of recurrence. However, histopathological examination of excised tissue confirmed the diagnosis of a suture granuloma. This case highlights the diagnostic challenge posed by this entity and underscores the importance of considering benign postoperative complications in the differential diagnosis of new neck masses in previously operated patients.

A Case of Bilateral Antrochoanal Polyp: Breaking the Unilateral Norm

Haritha Kakumanu, Vijaya Kumar Lukka, Satya Prabhakara Rao Yedluri, Sai Mahesh Pethakamsetty Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Antrochoanal Polyps (ACPs) are benign lesions arising from the maxillary sinus mucosa, typically unilateral, with bilateral presentation being exceedingly rare. We present the case of a 53-year-old female with progressive bilateral nasal obstruction for three years and recent onset of right-sided facial pain. Endoscopic examination revealed large polypoidal masses originating from both middle meati, with the right-sided lesion extending into the choana. Imaging confirmed bilateral maxillary sinus opacification. The patient underwent successful endoscopic sinus surgery with bilateral uncinectomy and middle meatal antrostomy. Histopathology confirmed inflammatory polyps with side-specific differences- right-sided specimen showing eosinophilic infiltration and cholesterol clefts, and left-sided specimen exhibiting pigment-laden macrophages. Postoperative recovery was uneventful, with complete symptomatic relief. However, at the 12-month follow-up, bilateral recurrent ACPs were noted. This case adds to the limited reports of bilateral ACPs and highlights the importance of high clinical suspicion and tailored surgical management in such presentations.

Management of Partial Hanging Accompanied with Acute Onset Decreased Left Ventricular Systolic Function: A Case Report

Aishwarya Ramanathan, Meenal Muthiah, Ragavendra Chanthanamuthu, Keerthiga Mohan Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Hanging can lead to cardiovascular complications like negative pressure pulmonary oedema, ventricular tachycardia and fibrillation, hypotension, shock, myocardial infarction, heart blocks, carotid dissection and even cardiac arrest. Stress cardiomyopathy after attempted hanging is an unusual and rarely encountered complication, particularly in young patients. It is usually a transient and reversible condition. Routinely, patients have no antecedent cardiac history or symptoms. It is precipitated by extreme physical and emotional stress. The presenting symptoms can mimic those of myocardial infarction, leading to a misdiagnosis of cardiac pathology. Extreme vigilance and awareness are paramount for the diagnosis and management. The blood investigations and electrocardiogram can be normal in the initial stages, but with careful monitoring, this complication can be successfully treated. In the current case, the patient was a young female with no significant cardiac history who presented with an alleged history of attempted hanging. Echocardiography revealed severe left ventricular dysfunction with an ejection fraction of 30%. She was intubated and managed for cardiac failure. Coronary angiography was done to rule out any organic lesions, which came out negative. She was discharged after seven days in stable condition with improvement in cardiac function to near normal with an ejection fraction of 55%. We report this as a case of stress-induced cardiomyopathy precipitated by acute stress of hanging to ensure that clinicians have a high index of suspicion while dealing with a patient with hanging.

Endoscopic Excision of Glomus Tympanicum: A Case Report

Vinod Shinde, Mohak Kumar, Mayur Ingale Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Navigating the delicate anatomy of the middle ear demands precision, especially when confronting rare vascular tumours such as glomus tympanicum. This report highlights the successful endoscopic excision of a glomus tympanicum tumour in a 44-year-old female presenting with persistent tinnitus, hearing loss, and aural fullness. Diagnostic imaging confirmed a Grade 2 glomus tympanicum tumour localised to the middle ear. The patient underwent a successful endoscopic transcanal excision, achieving complete tumour removal without compromising adjacent structures. Postoperative recovery was uneventful, with complete resolution of symptoms. This case underscores the efficacy, safety, and favourable outcomes of minimally invasive endoscopic techniques for treating localised glomus tympanicum tumours.

Comprehensive Multimodal Imaging in Tuberous Sclerosis Complex: A Case Report

Sanmeet Gumber, Shivali Kashikar, Pratap Singh Hanuman Parihar, Pallavi Kar, Arindam Gupta Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Tuberous Sclerosis Complex (TSC) is an autosomal dominant disorder caused by mutations in the TSC1 (hamartin) or TSC2 (tuberin) genes, affecting multiple organ systems. A 23-year-old female presented with cosmetic concerns due to malodorous facial plaques and oral papules. Clinical examination revealed characteristic skin manifestations such as facial angiofibromas and hypomelanotic macules. Magnetic Resonance Imaging (MRI) of the brain showed subependymal and subcortical tubers with radial bands, while abdominal ultrasound and Computed Tomography (CT) scans demonstrated bilateral renal angiomyolipomas and pulmonary cystic lesions, suggesting Lymphangioleiomyomatosis (LAM). TSC impacts both children and adults, with significant variability in clinical features, even within families. Early recognition of imaging findings such as radial migration lines and renal angiomyolipomas can significantly improve outcomes. Multimodal imaging is crucial in assessing disease severity and planning appropriate management.

Perioperative Management of Hypernatraemia: An Anaesthetic Perspective

Sandeep Veer, Pragya Pramanik Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Preoperative hypernatraemia remains a rare yet formidable challenge in anaesthetic practice, especially in emergency surgical situations where time constraints often limit full preoperative optimisation. Severe hypernatraemia is associated with increased perioperative morbidity and the risk of significant neurological complications if corrected too rapidly. Present case is a unique case of a 68-year-old male with type 2 diabetes mellitus who presented for emergency hepatic jejunostomy due to suspected bowel obstruction. The patient had a one-month history of recurrent vomiting, jaundice, and generalised weakness. Preoperative investigations revealed marked hypernatraemia, with a serum sodium level of 158 mEq/L, raising serious concerns about intraoperative and postoperative management. Given the urgency of the procedure, gradual preoperative correction of sodium was initiated with hypotonic saline while proceeding to surgery. Anaesthetic management involved rapid sequence induction with close airway protection, maintenance with sevoflurane and remifentanil, and intraoperative haemodynamic monitoring. The patient experienced transient intraoperative hypotension, requiring norepinephrine support. A major focus of care was the controlled correction of hypernatraemia, which was achieved over 72 hours postoperatively, avoiding rapid osmotic shifts. The patient was extubated on postoperative day 2, transferred to the surgical ward on day 4, and discharged home on day 10 without neurological sequelae. This case underscores the importance of vigilant perioperative care, multidisciplinary coordination, and a tailored anaesthetic approach in managing patients with severe hypernatraemia. It also adds to the limited body of literature addressing anaesthetic considerations in such high-risk, time-sensitive cases, where both fluid and electrolyte management play a pivotal role in patient outcomes.

Dengue Fever Associated Secondary Haemophagocytic Lymphohistiocytosis in an Adolescent with Beta Thalassaemia Trait: A Case Report

Prema Lakshmi, Touheer Pasha Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Dengue-associated Haemophagocytic Lymphohistiocytosis (HLH) is a rare but life-threatening hyperinflammatory complication. It arises when an exaggerated immune response is triggered by viral infection, leading to multi-organ involvement and high morbidity. Early identification and judicious management are critical for favourable outcomes. A 14-year-old boy presented with the dengue-associated secondary HLH, confirmed by fulfilling five of the eight HLH 2004 diagnostic criteria, including fever, splenomegaly, cytopenia, hyperferritinaemia, and hypofibrinogenaemia. The patient also carried beta thalassaemia trait, contributing to his anaemia, though it was incidental to the acute presentation. Management with broad-spectrum antibiotics (cephalosporin, followed by piperacillin-tazobactam) and supportive care led to prompt resolution, without immunosuppressive or HLH-specific therapy. Clinical improvement occurred within 48 hours, and sustained resolution was confirmed at one-week follow-up. This case supports the notion that, in selected dengue-associated HLH patients, especially those showing early clinical improvement, aggressive immunosuppressive therapy may be deferred. It emphasises the need for early suspicion, exclusion of differential diagnoses, and careful monitoring. The incidental beta thalassaemia trait, while unrelated to HLH pathogenesis, underscores the importance of genetic counselling. An extended follow-up validated complete recovery without complications. In dengue-associated HLH, prompt supportive and antibiotic therapy may suffice in certain cases, avoiding unnecessary immunosuppression. Clinicians should consider case-by-case management, guided by response trajectory and diagnostic completeness.

Redefining Smiles by Malo Bridge: A Case Report on Digitally Fabricated Fixed Prosthetic Solution for Anterior Mandible

Ritul Jain, Sweta Kale Pisulkar, Surekha Godbole, Shruti Deshmukh Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X The rehabilitation of edentulous spaces with implant-supported fixed prostheses has evolved significantly, with digital workflows enhancing precision and predictability. This case report details the prosthetic rehabilitation of a 50-year-old male patient presenting with missing teeth in the anterior mandibular region. The patient reported difficulty with mastication and aesthetic concerns due to a long-standing edentulous space. Clinical and radiographic evaluation revealed moderate to severe alveolar ridge resorption and a high crown height space, posing a challenge for conventional prosthetic options. To address the functional and aesthetic demands of the case, a digitally planned implant-supported Malo bridge was selected as the optimal restorative solution. The prosthetic workflow incorporated customised abutments, a screw-retained substructure, and cement-retained individual crowns, all designed using Computer-Aided Design (CAD)-Computer-Aided Manufacturing (CAM) technology and fabricated via Direct Metal Laser Sintering (DMLS) Three-Dimensional (3D) printing. This case highlights the advantages of integrating advanced digital techniques for the fabrication of complex implant-supported prostheses, offering a predictable and durable solution for high crown height space restorations.

Oral and Clinical Manifestations of DiGeorge Syndrome with Primary Hypoparathyroidism: A Case Report

Nayantara Menon, BB Shahala, MP Uthkal, Shahana P Sulaiman, Amjad Ali Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X DiGeorge syndrome is an autosomal dominant inherited disorder caused by a deletion of chromosome 22q11.2. It is a multisystem condition, classically presenting with a triad of congenital heart defects, hypoplasia of the parathyroid glands and thymus, and congenital immunodeficiency. The present article reports a 24-year-old female with a DiGeorge syndrome with primary hypoparathyroidism, with emphasis on craniofacial and extraoral features, which included a hypoplastic mandible, flattened forehead, bulbous nose, and flattened nasal bridge. Radiographic findings revealed a thickened calvarium, frontal calcifications, and sutural diastasis. Early diagnosis and intervention, including genetic testing, can significantly improve patient outcomes.

Central Mucoepidermoid Carcinoma of Maxilla: A Case Report with Immunohistochemical Analysis

Maanyam Hema Lakshmi Supraja, P Swetha, Ravikanth Manyam, Jyothirmai Koneru, U Shivaji Raju Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Mucoepidermoid Carcinoma (MEC), which accounts for 3-4% of all cancers of the maxillofacial region, is the most common type of salivary carcinoma. It most commonly occurs in the major salivary glands. The palate, retromolar region, buccal mucosa, tongue, and lips are common sites for tumors arising in minor salivary glands. Central MEC (CMEC) is an infrequent neoplasm of the jaw bones, accounting for 2-4% of MECs and showing varied biological behaviour. The aetiology of this tumour is uncertain, but several concepts have been proposed based on neoplastic transformation of the odontogenic cyst epithelium or ectopic salivary tissue. Most of these lesions occur in the third to fifth decades with a female predilection and are common in the mandible but rare in the maxilla. Radiographically and clinically, CMEC is often misinterpreted as an odontogenic lesion. To confirm the diagnosis, identifying the origin with the aid of immunohistochemistry is crucial. Hereby, the authors present a rare instance of low-grade CMEC in the maxilla of a 51-year-old male patient, which posed a diagnostic challenge and is accompanied by a review of the literature.

Reviving Knee Function with Panchakarma Therapy: Case Report of a Meniscal Tear

Kavita B Sutagatti, Pradeep L Gramapurohit Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X The knee is the largest weight-bearing compound synovial joint, important for activities like sitting, walking, and running. Knee injuries significantly impact the quality of life regardless of age, gender, or occupation. This case report evaluates the effect of panchakarma therapies on the medial meniscal tear of the left knee. A 41-year-old female experienced left knee trauma, resulting in acute pain, swelling and tenderness after a sudden twist of the left leg while walking. Magnetic Resonance Imaging (MRI) revealed a grade III medial meniscus tear of the left knee. The patient had on-and-off episodes of knee pain and instability while walking, even after repeated sessions of physiotherapy treatment and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). After three years, patient opted for panchakarma for complete recovery of the condition. She was treated with panchakarma therapies for the period of four months, which included Godhuma Upanaha, Sthanika Parisheka with Ashwagandha Balalakshadi Taila and Murivenna Taila, Janu Basti with Murchita Tila taila and Nirgundi Taila, Erandmoola Niruha Basti, and Anuvasana Basti with Guggulu Tikthaka Ghrita in a Yoga Basti schedule and oral ayurvedic medication. After the panchakarma therapies, left knee pain reduced from Visual Analogue Scale (VAS) 5 to 0 along with improved range of movements, knee flexion from 60 degrees to 110 degrees and the MRI report showed normal medial meniscus. This case report highlights the efficacy of Panchakarma therapies by addressing doshic imbalances, reducing inflammation, and supporting tissue repair, thus providing comprehensive relief and complete recovery for a grade III meniscus tear.

From Misdiagnosis to Precision: Genetic Testing Reveals MODY in Adolescents Initially Treated as Type 1 Diabetes

Kumar Ajith, Varalakshmi Sureka, J Jayannan, Purushothaman Indu Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Maturity-Onset Diabetes of the Young (MODY) is a heterogeneous form of clinical monogenic diabetes caused by genetic abnormalities resulting in an autosomal dominant mode of inheritance. MODY accounts for approximately 4.8-10.9% of diabetes cases worldwide; its clinical characteristics often resemble those of Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM), causing underdiagnosis. In this study, we have presented three cases, initially diagnosed with T1DM but later identified as Monogenic Diabetes (MODY) caused by mutations in the HNF1A and HNF4A genes. All patients, despite insulin therapy, suffered from recurrent Diabetic Ketoacidosis (DKA) and poor glycaemic control, prompting further investigation. Genetic analysis revealed two instances of HNF1A (MODY3) mutations and one case of HNF4A (MODY1) mutation. These findings were pivotal in reclassifying the patients' conditions from T1DM to MODY. Understanding the genetic mutations, the patients were switched to a minimal sulfonylurea regimen, resulting in significant improvement in blood glucose control and a reduction in DKA episodes. The studies emphasise the significance of genetic testing in accurately diagnosing MODY and tailoring a personalised treatment with oral sulfonylureas.

Tolosa-hunt Syndrome following COVID-19 Pandemic: A Case Series Describing the Clinical Presentations and Response to Steroids

Nimmy Jimmichan, Surya Dinesh Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Tolosa-Hunt Syndrome is a rare condition characterised by unilateral periorbital headache with ophthalmoplegia caused by inflammation of the superior orbital fissure or cavernous sinus. There has been an increase in cases of Tolosa-Hunt Syndrome following the Coranavirus Disease-19 (COVID-19) pandemic. This case series describes the clinical details of three such patients and their response to steroid therapy. The first patient was a 61-year-old woman with a history of post COVID infection who had received two doses of the COVID vaccine. She presented with second, third, fifth, and sixth cranial nerve palsies of the left eye. She received steroid therapy, following which there was recovery of extraocular movements and improvement in vision. The second patient was a 43-year-old male who had received two doses of the COVID vaccine. He presented with multiple cranial nerve palsies affecting the second, partial third, and fifth cranial nerves of the left eye. He reported symptomatic relief and improvement in ptosis after steroid therapy. The third patient was a 40-year-old male who had received two doses of the COVID vaccine. He presented with painful external ophthalmoplegia involving the second, third, fourth, and sixth cranial nerves of the right eye. Following steroid therapy, he experienced symptomatic relief and recovery of extraocular movements.

Isolated Oculo-auricular Manifestations in Goldenhar Syndrome: A Case Series of Three Paediatric Patients

Vishakha Vatkar, Pradipta Potdar, Shreya Gandhi, Rutuja Patil, Lokisha Chandwani Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Goldenhar Syndrome (GS), also known as the Oculo-Auriculo-Vertebral Spectrum (OAVS), is a rare congenital disorder characterised by variable craniofacial and ocular anomalies due to aberrant development of the first and second branchial arches. This case series describes three paediatric patients who exhibited diverse phenotypic features of the syndrome, highlighting its clinical heterogeneity and the importance of individualised management. All three patients presented with epibulbar dermoids since birth, an ocular hallmark of GS. The first patient, a 12-year-old female, had a limbal dermoid, medial canthal swelling suggestive of nasolacrimal duct obstruction, a symblepharon, and microtia with preauricular tags. She was advised dacryocystorhinostomy and excision of the dermoid but was lost to follow-up. The second patient, a 15-year-old had a reddish limbal mass extending to the lateral canthus and preauricular tags, and a cosmetic symblepharon release was advised. The third patient, a 15-year-old had a non-progressive limbal dermoid with no significant adnexal involvement and was managed conservatively. None of the patients had associated spinal, cardiac, or neurological anomalies on systemic evaluation. This case series reinforces the phenotypic variability of GS and underscores the importance of early ophthalmic diagnosis, systemic screening, and a multidisciplinary approach to optimise functional and cosmetic outcomes in affected children.

Emerging and Unusual Gram-positive Coccal Infections: A Case Series

Suwarna Uday Phute, Shekhar Panditrao Shiradhonkar, Seema Umesh Kulkarni, Sushil Sharad Deshpande, Anita Balakrishnan Nair Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Gram-Positive Cocci (GPC), like coagulase-negative staphylococci and a few beta-haemolytic streptococci, are usually found as a part of the normal flora of the human body. Opportunistic infections, caused by these cocci, are increasingly being reported. Worldwide, there are a few reports of infections caused by these commensal GPC in immunocompetent patients, too. Kocuria kristinae is a coagulase-negative coccus. K. kristinae has been isolated in paired blood culture of a 54-year-old patient on haemodialysis, who presented with fever. His Echocardiography (ECHO) revealed endocarditis with vegetations on the mitral and pulmonary valves. Staphylococcus warneri is also a coagulase-negative Staphylococcus. S. warneri was reported as a pathogen in paired blood culture of a three-year-old kid with fever who was being investigated for pyrexia of unknown origin. Gemella sanguinis and Globicatella sanguinis are beta-haemolytic streptococci. G. sanguinis was isolated from a 46-year-old man with recurrent sebaceous cyst on the left lumbar region and G. sanguinis from the sputum of a 54-year-old lady with fever and cough with expectoration. All four isolates are commensals of the human body. In this case series, they have been reported as pathogens due to standard techniques of sample collection and processing, growth of no other pathogen in the culture and clinical evidence.

Genitourinary Tuberculosis with Co-existing Transitional Cell Carcinoma of the Urinary Bladder: Imaging findings and Diagnostic Challenges

Varsha Reddy, Yatham Rama Rao, Senthil Kumar Aiyappan Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X A 56-year-old male presented with gross haematuria, increased frequency of micturition, dysuria for two months and passage of clots in urine for one week. There was no history of fever, nausea, vomiting, or weight loss. The patient had been evaluated at an outside hospital for haematuria six months earlier, during which Genitourinary Tuberculosis (GUTB) was suspected. Consequently, empirical Anti-Tuberculosis Therapy (ATT) was initiated and continued for six months. The patient had a 30-year history of smoking. He did not have a known history of hypertension. No other relevant medical or surgical history could be elicited. Urine analysis revealed reddish-brown discolouration with a turbid appearance. Microscopic examination demonstrated numerous red blood cells and occasional urothelial epithelial cells, with no significant presence of white blood cells, casts, or crystals.

Imaging findings in Klippel-Feil Syndrome with Unilateral Renal Agenesis and Ectopic Pelvic Kidney

Jatin Nehra, Madhu Sowmitha Pachipala, Senthil Kumar Aiyappan, Sabari S Ramesh, Kirthi Sathyakumar Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X A 22-year-old male presented with a five-day history of insidious-onset neck pain, rated 5/10 on the numeric rating scale, aggravated by neck turning and relieved by rest. The pain was localised to the neck, non radiating, with no history of trauma, bowel or bladder incontinence, weakness, numbness, neurogenic claudication, or morning stiffness. The patient’s past medical history was unremarkable, with no known co-morbidities. On examination, there was no gross deformity, scar, or sinus over the cervical spine. Palpation revealed no warmth, no local rise in temperature, or tenderness. Range of motion of the neck in side-to-side movement was painful. Neurological examination showed full power (5/5) in all cervical myotomes (C2-C7) and normal sensation. Provisional diagnosis was neck muscle spasm. Differential diagnoses included cervical spondylosis, congenital vertebral anomaly, inflammatory and neoplastic aetiology.

Exploring the Scope of the Jigsaw Classroom: An Innovative Teaching-learning Method for Ayurveda Undergraduates

Seema Thakare, Sumant Pande Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Dear Editor, Various innovative teaching-learning methods have been incorporated into medical education to enhance skills such as communication, critical thinking, and attitude development among students. However, the challenge lies in selecting and implementing strategies that are both feasible and impactful for learners. Didactic lectures are often teacher-centred and monotonous, which ultimately reduces students’ interest in the classroom.

Clinical Outcome of Extended Total Extraperitoneal Rives-stoppa versus Intraperitoneal Onlay Mesh Repair in Ventral Hernia: A Prospective Interventional Study

RS Sharan Dhev, Balaji Durairaj, Harshwanth Chandhar, Mohana Priya, Nitya Jandhyala Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Umbilical hernias are a common anterior abdominal wall defect, often necessitating surgical intervention to prevent complications such as incarceration and recurrence. Among minimally invasive approaches, the extended Total Extraperitoneal Rives-Stoppa (eTEP-RS) and Intraperitoneal Onlay Mesh (IPOM) techniques are widely used. Aim: To compare the clinical outcomes of two laparoscopic techniques, the eTEP-RS and IPOM techniques, in patients undergoing umbilical hernia repair. Materials and Methods: A prospective interventional study was conducted over 16 months (March 2023 to July 2024) in the Department of General Surgery, SRM Medical College Hospital and Research Centre, Tamil Nadu, India, involving 60 patients diagnosed with primary umbilical hernia. Participants were equally divided into two groups: eTEP-RS group (n=30) and IPOM group (n=30). Parameters assessed included operative time, postoperative pain by Visual Analogue Scale (VAS ) score, Surgical Site Infection (SSI), hospital stay and recurrence rates. Continuous variables such as operative time, VAS scores, and duration of hospital stay were first assessed for normality. Non normally distributed data were expressed as median with interquartile range and compared using the Mann-Whitney U test. Categorical variables, including SSI and recurrence, were presented as frequencies and percentages, and compared using the Chi-square test or Fisher’s-exact test where appropriate. A p-value of less than 0.05 was considered statistically significant. Results: Patients in the eTEP-RS group had significantly lower postoperative pain scores at 6 hours, 24 hours, and one week postoperatively (p-value <0.001). The eTEP-RS group also showed a shorter mean hospital stay (4.6±3.17 days) compared to the IPOM group (5.9±2.19 days) (p-value=0.02). The operative time was significantly longer in the eTEP-RS group (p-value <0.001). SSIs were absent in the eTEP-RS group but occurred in one patient in the IPOM group. No recurrences were reported in either group during the follow-up period. Conclusion: The eTEP-RS technique offers significant benefits in terms of reduced postoperative pain and shorter hospital stay, with comparable safety and recurrence rates. It represents a promising alternative to IPOM, particularly in resource-optimised laparoscopic settings.

Clinicopathological Features of Malignant Melanoma with Emphasis on S-100, HMB-45, and BRAF Expression: A Cross-sectional Study

Sayantan De, Mamata Guha Mallick Sinha Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Malignant melanoma is one of the most lethal forms of skin cancer. While it predominantly originates from the skin, it can also develop in extracutaneous sites, including ocular, mucosal, and leptomeningeal regions. S-100 and HMB-45 immunohistochemical markers are widely used for melanoma detection. Additionally, the V600E missense mutation, which changes valine to glutamic acid, is a common BRAF alteration in melanoma and serves as a target for therapeutic interventions. Aim: To evaluate the clinico-epidemiological and histopathological features of malignant melanoma, with emphasis on the immunohistochemical expression of S-100, HMB-45, and BRAF. Materials and Methods: The present prospective cross-sectional study was conducted in the Department of Pathology, IPGME&R, Kolkata, West Bengal, India, from January 2020 to June 2023. A total of 26 specimens diagnosed as malignant melanoma were analysed. Only excision specimens were included in this study. Histopathological parameters, including type, pigmentation, Breslow thickness, lymph node status were recorded. Subsequent immunohistochemical testing of paraffin-embedded blocks was performed using S-100, HMB45, and BRAF markers. Collected detailed epidemiological and histopathological and immunohistochemical data were entered into Microsoft excel sheet. From that tabulated descriptive measures obtained including percentages and frequencies. Statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) Statistics software (version 25). A Chi-square test of independence was used to assess the association between melanoma type, pigmentation, subtype, lymph node involvement and BRAF expression levels. A p-value of less than 0.05 was considered statistically significant. Results: Among the 26 cases, nineteen were of cutaneous origin, six were mucosal, and one was congenital. All cutaneous melanomas were located on the lower extremities. Superficial Spreading Melanoma (SSM) was the most common type (13/19 cases), followed by Nodular Melanoma (NM) (5/19 cases). Lymph node involvement was observed in six cases, all from the cutaneous group, with inguinal lymph nodes being the primary site. All cases showed diffuse S-100 and HMB-45 positivity. BRAF positivity was detected in 26.92% of cases (7/26 cases). Conclusion: A thorough assessment of histopathological parameters, supplemented by immunohistochemical analysis of markers such as S-100 and HMB-45, is essential for precise diagnosis, prognostication, and the formulation of effective therapeutic strategies. Although BRAF immunoexpression was identified in approximately one-fourth of the cases, its detection holds significant therapeutic relevance by facilitating the implementation of targeted molecular therapies, thereby potentially improving overall patient survival.

Association of Fasting Blood Sugar to High-density Lipoprotein Ratio with Short Term Outcome in Patients of Acute Coronary Syndrome: A Cohort Study

Donisri Morampudi, Sethuraj Selvaraj, Vignessh Raveekumaran, KS Chenthil Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Acute Coronary Syndrome (ACS), which includes Unstable Angina (UA) and Myocardial Infarction (MI) both ST-elevated and non-ST-elevated (STEMI and NSTEMI), is a critical condition with high morbidity and mortality, emphasising the need for early identification of prognostic markers. Although biomarkers like Fasting Blood Sugar (FBS) and High-Density Lipoprotein cholesterol (HDL-c) have been individually linked to Cardiovascular (CV) health, the combined FBS/HDL-c ratio’s (F:H) potential as a prognostic marker for short-term outcomes in ACS patients is not well understood. Aim: To investigate the association of F:H ratio Major Adverse Cardiovascular Events (MACE) and CV mortality within 30 days of discharge in ACS patients. Materials and Methods: The present hospital-based analytical cohort study was conducted from June 2023 to May 2025 at the tertiary care teaching hospital, in Pondicherry, India. The study included 95 patients, of age >18 years and both genders, newly diagnosed with ACS. On admission, FBS and HDL-c levels were measured, and outcomes were evaluated 30-day post-discharge. Analysis was done in Statistical Package for Social Sciences (SPSS) software (ver_24.0) and inferential statistics was done based on the normality of the variables and p-value <0.05 was considered statistically significant. Results: Among 95 ACS patients, majority were males (70.5%), with the mean age of 59.89±13.31 years. About 64.2% had diabetes and the ACS types included NSTEMI (36.8%), UA (30.5%), and STEMI (32.6%). Mean FBS and HDL-c was 141.67±57.80 mg/dL and 38.69±12.96 mg/dL, and the F:H was 4.075±2.42. Within 30-day post-discharge, 24.2% experienced MACE, and 10.5% suffered CV death, with F:H significantly associated with MACE (p<0.001) and CV death (p 0.030). The diagnostic level was found to be at ≥3.26 by Receiver Operating Characteristics (ROC) curve and the sensitivity and negative predictive value was 73.91% and 83.78%, respectively. At ≥3.26 found to be statistically significant with MACE (p 0.019). Conclusion: Elevated F:H strongly associate with adverse outcomes in ACS, suggesting their usefulness as a prognostic marker for targeted therapies, requiring further studies with larger populations.

Role of First Trimester Screening Test Results (Beta-hCG, PAPP-A, Nuchal Translucency) in Predicting Fetal Growth Restriction: A Retrospective Study

Aziz Kindan, Can Ozan Ulusoy, Sinem Ece Kindan, Ahmet Kurt, Salim Erkaya Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Foetal Growth Restriction (FGR) is defined as the rate of foetal weight that is smaller compared to the week of gestation below 10 percentile. The increased prenatal mortality and morbidity associated with FGR make its detection all the more important. It can lead to serious perinatal complications, including prematurity, cerebral palsy, intrauterine foetal death, and neonatal mortality. Given the burden of FGR and the lack of reliable early screening tools, further studies are warranted to evaluate the predictive value of these widely used biomarkers. Aim: The present study aimed to investigate the effectiveness of first trimester screening test results {Pregnancy-Associated Plasma Protein A (PAPP-A) and free β Human Chorionic Gonadotropin (free β-hCG), and foetal Nuchal Translucency thickness (NT)} in predicting patients with FGR. Materials and Methods: The present retrospective study was carried out to assess 659 pregnant women diagnosed with FGR and an equal number of women with normal foetal development, all of whom delivered at the Health Sciences University Ankara Etlik Zübeyde Hanim Gynaecology Training and Research Hospital between February 2016 and June 2020. The investigation focused on comparing first trimester serum levels of PAPP-A, free β-hCG, and NT measurements to explore their potential link with FGR. Statistical analysis involved the use of an independent samples t-test or Mann-Whitney U test for continuous variables, based on their distribution, and the Chi-square test for categorical data. To determine the predictive value of PAPP-A, free β-hCG, and NT, Receiver Operating Characteristic (ROC) curve analysis was utilised. A p-value of less than 0.05 was considered indicative of statistical significance. Results: The median age of pregnant women in the FGR group was 26 (18-43) years, and in the control group was 26 (18-42) years (p=0.206). Demographic data of both groups were similar. The mean free βhCG value was 46.53±36.28 ng/mL in the FGR group and 41.24±34.26 ng/mL in the control group (p=0.006). The mean PAPP-A value was 2.89±2.47 mIU/mL in the FGR group and 3.38±2.57 in the control group (p<0.001). In the FGR group, the mean value of Nuchal Translusens was 1.16±0.38 mm, the mean value of NT (MoM) was 0.75±0.24, and in the control group, the mean value of nuchal translusens was 1.23±0.36 mm, NT (MoM) mean value was 0.78±0.21 (p<0.001). Low PAPP-A (AUC=0.576, p<0,001) and NT values (AUC=0.570, p<0,001) and high free βhCG (AUC 0,576, p<0,001) levels were found to be associated with FGR. Conclusion: The present study shows that FGR is associated with low PAPP-A, high free β-hCG, and low NT values in the first trimester. However, none of these parameters alone demonstrated sufficient predictive value for the early detection of FGR. These findings suggest that while early screening markers may reflect placental dysfunction, they should not be solely relied upon for FGR prediction in clinical practice.

Epidemiological Investigation of an Outbreak of Acute Diarrhoeal Disease in a Coastal Area in Central Kerala, India: A Cross-sectional Study

Carol Pinheiro, Priyanka Shibu, TS Sudhiraj, VG Anupama Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: A disease outbreak is the occurrence of cases of disease in excess of what would normally be expected in a defined community, geographical area or season. Early detection and reporting of such events is crucial in limiting the spread of the disease and minimising its negative social and economic impact. Aim: To explore the clinico-epidemiological features of the diarrhoeal disease outbreak in a municipal area in a coastal region of Central Kerala and to identify the factors associated with the diarrhoeal disease outbreak. Materials and Methods: This was an epidemiological investigation conducted as a cross-sectional analytical study done in December 2022 in the coastal wards, namely ward no. 41, 42 and 43 of Alappuzha Municipality, Alappuzha, Kerala, India from where an increased number of ADD cases were reported in November 2022-December 2022. An investigator administered questionnaire was used to collect information from 191 residents. Water samples were taken from four points in the community to check the coliform count, and stool and rectal swabs for microbiological examination. Continuous variables were summarised as Mean±Standard Deviation (SD), and categorical variables as proportions. Associations were tested with the Chi-square test, and a p-value of less than 0.05 was considered statistically significant. Results: The prevalence of ADD among children in the under-five age group in the coastal wards was 0.020 (2.1%) 95% Confidence Interval (CI): 1.2- 3.4 and in the age group above five years in the coastal wards was 0.0041 (0.42%), 95% CI: 0.31- 0.55 The median age of the 66 cases with ADD was 9 years, majority of the cases were below or equal to the age of 20 years. There was an almost equal distribution of gender. The majority of the cases had watery diarrhoea, followed by fever. About one-half of the cases used a public pipe water supply for drinking and washing utensils.There is significant statistical association between the practice of drinking unboiled water (p-value=0.036) and lack of hand hygiene practices (p-value=0.011) with the diarrhoeal cases. Conclusion: The outbreaks of diarrhoeal diseases provide information to understand the factors associated with food and waterborne diseases and to identify ongoing and emerging threats. The practice of consuming unboiled water, lack of hand hygiene practices, water used for washing utensils and consuming food from places other than home were the significant transmission factors resulting in the current outbreak.

Distinct Radiological and Clinical Characteristics of Intestinal Perforation caused by Jujube Pits and Fishbones: A Retrospective Observational Study

Yi-zhi Zhao, Xue-xia Sheng, Long Xu, Yu-cheng Qian, Zhi-gang Min Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Jujube pits and fishbones are common ingested foreign bodies leading to intestinal perforation. Their clinical presentation is often atypical, with patients frequently lacking a history of ingestion and less than 50% showing pneumoperitoneum on plain films. Accurate diagnosis is challenging, emphasising the critical role of radiologists and Computed Tomography (CT) imaging. Aim: To compare the clinical and imaging characteristics of intestinal perforations caused by jujube pits and fishbones. Materials and Methods: The present retrospective analysis was conducted on patients with surgically or endoscopically confirmed perforations caused by jujube pits (n=17) and fishbones (n=15) in the Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, China, between January 2016 to September 2024. All patients underwent conventional or contrast-enhanced CT scans using dual-source 64-slice scanners. Imaging parameters included Multiplanar Reconstructions (MPRs), Maximum Intensity Projection (MIP), and Volume Rendering (VR). Clinical and imaging features, including foreign body type, location, intestinal wall thickening, and pneumoperitoneum, were analysed. Numerical data and categorical variables were compared using student’s t-test and Chi-square test, respectively. Results: Patients in the jujube pit group were older than those in the fishbone group (77.3±17.0 vs. 66.9±14.7 years). A marked female predominance was observed in the jujube pit group (male: female ratio 3:14), contrasting with the relatively balanced gender distribution in the fishbone group (7:8). However, neither age nor gender distribution showed statistically significant differences between the groups. The jujube pit group exhibited significantly higher White Blood Cell (WBC) counts (13.8±4.3×109/L vs. 10.5±3.9×109/L, p=0.033) and more frequent bowel oedema (15/17 vs. 6/15, p=0.008) and fatty infiltration (16/17 vs. 9/15, p=0.027) compared to the fishbone group. The ileum was the most common perforation site (66%). Surgical management was required in 29 cases (72% primary repair, 28% resection), with three fishbone cases treated endoscopically. The jujube pit group had significantly longer hospital stays (p<0.05). Conclusion: Jujube pits cause more severe inflammatory responses and tissue damage than fishbones, often necessitating surgical intervention. Recognising these differences can guide appropriate treatment strategies for intestinal perforations caused by these foreign bodies.

Evaluation of Colour Stability of Conventional versus 3D-printed Crown and Bridge Resins after Surface Treatment and Artificial Tooth Brushing: An In-vitro Study

J Jesima, R Kamala Kannan, Y Sameera, P Kabilan, A Balamurugan, J Raghunathan Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Three-Dimensional (3D)-printing is becoming increasingly popular, especially for Interim Fixed Dental Prostheses (IFDPs). However, there is limited evidence regarding the colour stability of 3D-printed IFDPs and the combined effects of advanced surface treatment along with good oral hygiene practices. Aim: To evaluate the effect of surface treatment and artificial tooth brushing on the colour stability of conventional and 3D-printed crown and bridge resin after immersion in a colouring medium. Materials and Methods: An in-vitro study was conducted in the Prosthodontics and Crown and Bridge Department at Karpaga Vinayaga Institute of Dental Sciences, Chennai, Tamil Nadu, India, between December 2023 and May 2024. A total of 30 specimens were divided into three groups: Group 1 - Polymethyl Methacrylate (PMMA), Group 2 - 3D-printed polished, and Group 3 - 3D-printed glazed, with 10 specimens in each group. All specimens were immersed in coffee and subjected to artificial tooth brushing for 12 days, equivalent to three months of oral exposure to coffee and tooth brushing. Colour stability was assessed using Vita EasyShade spectrophotometer at baseline (T0), on the 4^th day (T1), the 8^th day (T2), and the 12th day (T3) for all groups. The data were analysed using Statistical Package for the Social Sciences (SPSS) software version 20.0. Repeated measures Analysis of Variance (ANOVA) was used for intragroup comparisons, and an independent Student’s t-test was employed for intergroup comparisons to interpret the results. A p-value of <0.05 was considered significant. Results: The mean and Standard Deviation (SD) of colour change (?E - Delta E) for the three groups were 6.6, 4.8, and 11.2 at T1, showing decreased colour change at T3. A statistically significant difference was found between groups (p<0.001). The highest colour change was observed for Group 2 (mean=4.5), followed by Group 3 (mean=2.8). Conclusion: The results conclude that the glazed 3D-printed group showed better colour stability than the polished 3D-printed group and was comparable to the conventional group. A 3D-printed sample can be glazed to reduce the adhesion of stains to its surface.

Precision of Working Length Determination of Two Different Apex Locators in Teeth with Periapical Lesion: An In-vivo Study

Anithakumari Rangappa, Jayalakshmi Somasundaram, Ashel Olivia Dsouza, MS Adarsha, Shivekshith Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Accurate working length determination is critical for the success of root canal treatment. While Electronic Apex Locators (EALs) have improved accuracy compared to radiographs, their performance can be affected by presence of periapical lesion. Aim: To evaluate and compare the precision of a fifth generation Integrated apex locator (CanalPro CL2i) with a third generation apex locator (Root ZX Mini) in determining the working length in single-rooted teeth with and without periapical lesion. Materials and Methods: In the present in-vivo study, 30 single-rooted teeth indicated for root canal treatment, were assigned into two groups. Teeth with absence of periapical lesion (Group 1) consisted of 15 teeth and the periapical lesion group (Group 2) included 15 teeth with presence of radiographic periapical lesion of size 5 mm, approximately. In each canal, CanalPro CL2i and Root ZX mini were used to determine working length. Under local anaesthesia and rubber dam isolation, an access cavity was prepared for each tooth. Electronic working length measurements were determined with a #15k file in the presence of 2.5% Sodium hypochlorite (NaOCl) irrigant. The mean value of working length of both EALs was recorded and evaluated by the independent sample t-test. A p-value of <0.05 was considered significant. Results: A total of 30 patients were included with mean age of 41.2 years. Out of 30, 18 were female and 12 male patients. Intragroup analyses of mean working length measurements did not show significant differences within both the groups, Group 1 (p=0.987) and Group 2 (p=0.663), when using either Canal Pro CL2i or Root ZX mini. Conclusion: Presence of periapical lesion had no influence on the precision of both EALs. Both RootZx Mini and Integrated apex locator Canal Pro Cl2i were comparable in precision in determining working length in cases with and without periapical lesion.

Evaluation of Dulaglutide in Acute and Subacute Inflammation Models of Male Wistar Rats: An Experimental Study

Aarti Gulabrao Bhosale, Nayana Kamalnayan Hashilkar, Sunita Y Patil Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Dulaglutide, a Glucagon-Like Peptide-Receptor Agonist (GLP-1 RA) commonly used for the treatment of Type 2 Diabetes Mellitus (T2DM), is known for its glycaemic and cardiovascular benefits. However, its anti-inflammatory effects remain uncertain. Aim: The present study aimed to assess dulaglutide’s anti-inflammatory potential in acute and subacute inflammatory models using male rats of Wistar strain. Materials and Methods: The present experimental study included healthy adult male Wistar rats that received treatment with either dulaglutide or aspirin (as a benchmark) and subjected to carrageenan-induced paw oedema (acute) or foreign body-induced granuloma (subacute). Paw oedema volume, granuloma weight, inflammatory cytokine levels in the serum (IL-1β, CRP, TNF-α), and histopathological changes were evaluated. Results: A total of 36 healthy adult male Wistar rats were used in this study. the acute model, dulaglutide did not significantly reduce paw oedema compared to the control, while aspirin significantly reduced oedema at 2, 4, and 5 hr (p<0.05). In the subacute model, dulaglutide failed to reduce granuloma weight or significantly alter serum inflammatory markers. Histopathological examination revealed abundant granulation tissue, fibroblasts, and collagen in the dulaglutide-treated group, similar to that in the control. In contrast, aspirin-treated rats showed reduced granulation tissue, fibroblasts, and collagen. Conclusion: Dulaglutide showed no significant independent anti-inflammatory effects in both acute and subacute animal models of inflammation. Thus, GLP-1 receptor agonists like dulaglutide may exert beneficial effects on inflammation associated with metabolic diseases; however, their direct anti-inflammatory actions appear to be limited. Further research is required to explore dulaglutide’s role in inflammation and its broader therapeutic implications in inflammatory diseases.

Occupational Health Problems and Co-morbidities among Food Handlers in Kozhikode District, Kerala, India: A Cross-sectional Study

Sruthikrishna Punathukandi, Jayakrishnan Tayyil, Saniya K Salim, Anupama Arumadi, Risa Mathu Vayalil Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Over the past five years, India’s food service market has grown at 10.3%, with many people consuming food from outside. Food handlers can passively transmit infections to consumers, and occupational health problems contribute to this transmission. Therefore, it is essential to identify the morbidity and occupational health problems among food handlers. Aim: To assess the prevalence of morbidity and occupational health problems among food handlers in the Kozhikode district, kerala. Materials and Methods: The present cross-sectional study was conducted among food handlers in Kozhikode district, Kerala, India, during January to December 2024. A multistage sampling was done and data were collected from 1132 participants by expert team through direct interviews using a pretested semi structured questionnaire. Questionnaire consisted of demographic parameters like age, gender, education and native place, occupational parameters, general examination and laboratory tests. Descriptive and inferential statics were analysed using Statistical Package for Social Sciences (SPSS)Ver.25. Chi-square test was used to find the association between qualitative variable and p-value <0.05 was considered as statistically significant. Results: The study participants were predominantly male 998 (88.2%), with mean age of 39.92±13.39 years. In acute morbidity, 22 (1.9%) had a fever. Other morbidities such as diarrhoea, vomiting and boils were less than 1%. Out of the total tested 35 (7.51%) were positive for S.Typhi O,10 (0.88%) were positive for S.Typhi H and 4 (0.35%) were positive for S.Paratyphi AH but only few had acute morbidities. During examination, one-fourth of the participants were found to be hypertensive according to Joint National Committee-8 criteria. The prevalence of occupational health problems was 125 (11.04%), with paronychia being most common 59 (5.21%). Cooking was significantly associated with cut injuries (OR=3.64, p<0.001). No participants were dewormed in the last six months. Conclusion: The prevalence of morbidities and occupational health problems among food handlers was low, but the public health implications are significant. Occupational health issues, particularly paronychia and contact dermatitis were common among participants involved in washing and cut injuries were prevalent among participants engaged in cooking. To prevent food-borne disease transmission, regular health screening, awareness classes, and the promotion of hand washing and safe food handling practices should be implemented. Additionally, exempting ill workers from duty can enhance public health.

Role of Blood Ketone Levels in the Diagnosis and Management of Patients with Diabetes Ketoacidosis: A Cross-sectional Study

Gnanasa Kalapala, Vignessh Raveekumaran Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Diabetic Ketoacidosis (DKA), a potentially fatal complication of diabetes, is characterised by accumulation of ketone bodies, metabolic acidosis, and hyperglycaemia. Blood ketone levels serve as key indicators for the diagnosis and management of DKA. The clinical significance of blood ketone cut-off values remains underexplored, necessitating further research to improve patient outcomes. Aim: To determine the role of blood ketone levels in the diagnosis and management of patients with DKA. Materials and Methods: The present cross-sectional, hospital-based study was conducted over two years among patients presenting with signs and symptoms of DKA or elevated blood glucose (>250 mg/dL, or ≤250 mg/dL in suspected euglycaemic DKA) were included. Blood ketone levels were measured at baseline, at the time to half reduction (t1/2), and at resolution, and their diagnostic characteristics were evaluated. Data were analysed using Statistical Package for Social Sciences (SPSS) (v_24.0) software, diagnostic performance of blood ketone measurements was assessed by Receiver Operating Characteristic (ROC) curve analysis. Results: Among 45 patients, 23 (51.1%) were female. Age distribution was 35.6% (31-50 years) and 31.1% (51-70 years). Urine ketone testing was positive in 53.3% and negative in 46.7%. Mean blood ketone levels were 2.231±1.91 mmol/L at presentation, decreasing to 0.982±1.06 mmol/L after two hours, and 0.253±0.23 mmol/L at resolution. Sensitivity of blood ketone measurement was 100%, specificity 42.9%, Positive Predictive Value (PPV) 66.7%, and Negative Predictive Value (NPV) 100%. Conclusion: Serum ketone measurement is more reliable than urine dipstick testing for DKA diagnosis. The ketometer is less accurate than conventional clinical assessments and should be used as an adjunctive diagnostic tool in emergencies rather than as a standalone modality.

Influence of Two Forms of Chlorhexidine on the Accuracy of Working Length Determination using Different Generation Apex Locators: An Experimental Study

Rajaram Sundaravaradhan, R Anitha Kumari, Jayalakshmi Somasundaram, Chethana S Murthy, L Vijayalakshmi, R Vikram, Apeksha Rao, Harini J Raj Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Variations are observed in working-length measurements of root canals in the presence of different irrigants due to differences in electrical conductivity. Chlorhexidine is commonly used as an irrigant in endodontics, primarily in concentrations of 0.2%, 1% and 2%. These solutions are favoured for their broad-spectrum antimicrobial properties, with higher concentrations being particularly effective against a wide range of bacteria, including resistant strains like Enterococcus faecalis. Additionally, chlorhexidine gel formulations have been introduced, which offer enhanced lubricating properties and improved retention within the root canal system compared with traditional liquid solutions. Aim: To determine the influence of 2% chlorhexidine gel, 2% chlorhexidine solution and 2.5% sodium hypochlorite on the accuracy of the 4th-generation Root ZX Mini (J Morita Corp, Tokyo, Japan) and the 6th-generation Canal Pro™ (Coltene/Whaledent, Switzerland) Electronic Apex Locators (EALs). Materials and Methods: This experimental study was conducted at the Department of Conservative Dentistry and Endodontics, Vokkaligara Sangha (VS) Dental College, Bengaluru, Karnataka, India over six months (January 2021-June 2021). A total of 48 single-rooted premolar teeth were selected. After obtaining ethical clearance, the teeth were randomly divided into three groups based on the irrigant used: Group 1 (G1)—2% chlorhexidine gel; Group 2 (G3)—2% chlorhexidine solution; Group 3 (G3)—2.5% sodium hypochlorite solution. A sample size of 16 teeth per group was used. Under local anaesthesia with rubber dam isolation, access cavities were prepared. Working length measurements were performed using the 4th- and 6th-generation EALs. The coronal access was sealed and the tooth was extracted atraumatically. Actual Working Length (AWL) was determined using Cone- Beam Computed Tomography (CBCT). Inferential statistics were performed using Fisher’s-exact test. Statistical analysis was conducted with Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Accuracy of the Root ZX Mini and Canal Pro™ EALs in the presence of chlorhexidine gel was 81.25% and 93.0%, respectively; in the presence of chlorhexidine solution, the accuracy was 81.25% and 87.5%, respectively; and in the presence of sodium hypochlorite solution, the accuracy was 68.75% and 81.25%, respectively. Conclusion: The EALs Root ZX Mini and Canal Pro™ showed the highest accuracy in working-length measurements with chlorhexidine gel, followed by chlorhexidine solution and then sodium hypochlorite solution.

Efficacy of Chelating Agents on Calcium Hydroxide Removal from the Root Canals and their Influence on the Penetration of a Bioceramic Sealer: An In-vitro Evaluation

Devika Chinnam, Ravi Chandra Ravi, Jyothi Mandava, Ravikumar Konagala, Sruthi Kapu, CH Varaha Venkata Narasimha Raju Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Eliminating Calcium Hydroxide {Ca(OH)2} remnants from root canal walls presents a significant challenge. Nevertheless, its complete removal enhances the deeper penetration of a sealer, which improves the three-dimensional (3D) seal against the canal walls. Aim: To analyse the intracanal Ca(OH)₂ removal efficacy of different chelators and evaluate their influence on the depth of penetration of a bioceramic sealer. Materials and Methods: The present in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India, from October 2024 to April 2025. In this study, 120 extracted mandibular premolars were selected. After biomechanical preparation, Ca(OH)₂ was placed in all root canals, except those assigned to the control group, and the teeth were incubated for 7 days. Intracanal medicament removal was carried out using various chelating agents: 17% Ethylenediaminetetraacetic acid (EDTA), 9% etidronic acid, 7% maleic acid, or 0.7% fumaric acid (n=24 each), irrigation in combination with ultrasonic activation. A total of 60 teeth were sectioned longitudinally to calculate the number of open dentinal tubules and assess canal cleanliness with Scanning Electron Microscopy (SEM). In the remaining 60 teeth, following Ca(OH)2 removal, the canals were obturated with gutta-percha using CeraSeal. Sealer penetration depth was evaluated utilising Confocal Laser Scanning Microscopy (CLSM). The data obtained were subjected to statistical analysis using one-way Analysis of Variance (ANOVA) followed by Tukey’s post hoc test, with a significance threshold of p-value <0.05. Results: The use of 7% maleic and 0.7% fumaric acids resulted in significantly cleaner canals and enhanced sealer penetration compared to 17% EDTA and 9% etidronic acid (p-value <0.05). The coronal third of the canal demonstrated the greatest efficiency in both medicament removal and sealer penetration, whereas the apical third showed the lowest effectiveness (p-value=0.0001). Conclusion: Compared to 17% EDTA and 9% etidronic acid, increased dentinal tubule patency and superior penetration of sealer were observed with 7% maleic and 0.7% fumaric acids.

Assessment of Salivary CD26/DPP-IV Levels and their Association with a Ketogenic Gluten-free Diet in Autism Spectrum Disorder: A Cross-sectional Study

Kavya Soundararajan, Sham S Bhat, Devika Jayarajan, A Fahizah, Riaz Abdulla Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterised by challenges in social interaction, communication, and the presence of repetitive behaviours. Gastrointestinal (GI) problems are frequently observed in patients with ASD, and dietary interventions, such as the Ketogenic Gluten-Free (KGF) diet, have been employed to manage these symptoms. Dipeptidyl-peptidase IV/CD26 (CD26/DPP IV), an enzyme expressed in the small intestine, plays an important role in protein digestion. Low levels of CD26/DPP IV have previously been reported to have implications in ASD. Aim: To evaluate salivary CD26/DPP IV levels in children with ASD and compare them with healthy controls, considering KGF diet adherence. Materials and Methods: The present cross-sectional study was conducted on children with ASD at the Arivu Early Intervention Centre for Special Children, Mangalore, Karnataka, India over one year (April 2021 to March 2022). The study group included children aged 3-14 years diagnosed with autism, selected using the Childhood Autism Rating Scale (CARS) criteria. The control group consisted of age- and sex-matched healthy children. Unstimulated saliva samples were collected from 42 participants (21 children with ASD and 21 healthy controls). CD26/DPP IV expression levels were estimated using Enzyme-Linked Immunosorbent Assay (ELISA). Information on GI symptoms and KGF diet adherence was obtained through a questionnaire completed by caregivers. Statistical analysis was performed using the Mann-Whitney U test to compare and correlate salivary CD26/DPP IV levels between groups. A p-value <0.05 was considered statistically significant. Results: A total of 21 children with ASD and 21 age-matched neurotypical controls were included. The mean salivary CD26/DPP IV level was significantly lower in children with ASD (0.61±0.16 ng/L) compared to controls (0.88±0.25 ng/L; p<0.001). Within the ASD group, children adhering to a KGF diet showed slightly higher CD26 levels (0.56±0.17 ng/L) than those not on the diet (0.47±0.16 ng/L), and this difference was statistically significant (p=0.0113). Conclusion: Salivary CD26/DPP IV levels were lower in children with ASD compared to healthy controls. Although children with ASD on a KGF diet showed slightly higher CD26/DPP IV levels, this difference was not statistically significant. Further studies are needed to establish the sensitivity and specificity of CD26/DPP IV and its potential role in early intervention for ASD.

Comparison of the Linear and Angular Mandibular Measurements in Asthmatic and Non-asthmatic Children: A Cross-sectional Study

Shradha Akolkar, Shweta Chaudhary, Preetam P Shah, Laxmi Lakade, Shweta Jajoo, Gandhali Joshi Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Chronic asthma, often associated with increased airway resistance and thoracic gas-trapping, can significantly impact respiratory biomechanics. This may result in adaptive shortening of cervical respiratory muscles, subsequently influencing head and cervical spine alignment resulting in structural changes in craniofacial development. Aim: To assess and compare the linear and angular mandibular measurements in asthmatic and non-asthmatic children using Orthopantomographic (OPG) imaging. Materials and Methods: The present cross-sectional study performed with a sample of 50 patients grouped into Group-A (Asthmatic children) and Group-B (Non-Asthmatic children). Standardised OPG imaging was performed for all participants. The radiographs from both groups were carefully traced and evaluated. The obtained data was subjected to statistical analysis by an expert statistician using Statistical Package for Social Sciences (SPSS) software v26.0. Independent t-test was used to analyse the linear and angular measurements between right and left-side in each group and also compare the linear and angular measurements between asthmatic breathing subjects and normal subjects. The Chi-square test was employed to assess differences in the cant of the occlusal plane and the Ag-Go-M relationship between the asthmatic and non-asthmatic groups. The p-value <0.05 was considered to be statistically significant. Results: Statistical analysis revealed that asthmatic individuals exhibited no significant bilateral differences in most linear and angular measurements, except for a notably greater mandibular corpus height on the right-side (p=0.05). Similarly, normal-breathing subjects showed no significant asymmetries (p>0.05), apart from the Co-Go-Me angle. When comparing the two groups, asthmatic subjects demonstrated significantly increased condylar length (p=0.001) and mandibular corpus height (p=0.006). Conversely, they presented significantly reduced coronoid process length (p=0.002), the angle between the condyle and coronoid process (p=0.016), and the Co-Go-Me angle (p=0.023), relative to normal-breathing counterparts. Conclusion: The present study demonstrated that asthmatic children exhibit distinct mandibular alterations, including increased condylar length and corpus height, along with reduced coronoid process length and angular measurements, when compared with non-asthmatic counterparts. These findings suggest that chronic asthma, through its impact on breathing patterns and head posture, may influence mandibular development during critical growth phases

Changing Epidemiology of Influenza in Post COVID-19 Era: A Retrospective Observational Study

Milind Ramchandra Ubale, Vaibhavi Pushkar Matkari, Ayushi Pandey, Tarini V Deshmukh, Tushar R Bagle Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Coronavirus Disease (COVID-19) is a highly transmissible viral infection and has challenged the world’s healthcare systems. COVID-19 co-infections with other respiratory pathogens may complicate the diagnosis, treatment and prognosis. Despite Severe Acute Respiratory Syndrome- Coronavirus-2 (SARS-CoV-2) high transmissibility and dominance, influenza circulation persisted throughout the COVID-19 pandemic. Due to their evolving nature and capability to evade the immune system, the available vaccines for these viruses protect from severe disease but not infection. There are varying strains of influenza and SARS-CoV-2 viruses and also their transmission is dynamic over time, thus emphasising the need to continue and expand surveillance across countries for improved decision-making. Aim: The present study was conducted with a aim to study Severe Acute Respiratory Infections (SARI) and Influenza-like Illness (ILI) with reference to COVID-19 and influenza. Materials and Methods: The present retrospective observational study was carried out at the tertiary health care centre at Department of Microbiology of Rajiv Gandhi Medical College and Hospital, Kalwa, Thane, Maharashtra, India, from August 2022 to September 2024. The study population includes all patients presenting with ILI and SARI whose samples have been tested for COVID-19 and influenza at the RT-PCR Laboratory during the above-mentioned period. Since it was a retrospective study, the sampling method was consecutive sampling. A total of 1170 patients presenting with ILI and SARI were studied in the given period. Patients of all age groups, presenting at Outpatient Department and hospitalised patients were included in the study. Retrospective analysis of Influenza and SARS-CoV-2 positive cases was carried out. Different clinical and epidemiological parameters were noted. As the data is quantitative in nature, the proportions and percentages were computed accordingly. To study the association of meteorological seasons with that of surge of the Influenza cases, Chi-square test was performed and p-value was noted. Results: A total of 1170 patients were tested in the given period. Among these 893 presented with SARI and 277 presented with ILI. SARS-CoV-2 infection was found in 61 (6.83 %) of SARI and 35 (12.64%) of ILI patients, respectively. The total Influenza positive cases were 62 (6.94%) in SARI and 61 (22.02%) in ILI patients. SARS-CoV-2 variant was predominant in the year 2022 and Omicron and recombinant XBB variant were predominant in 2023. Significant surge in Influenza cases was seen in monsoon season in 2023. COVID-19 and Influenza co-infection was seen in 2 (0.17%) of 1170 cases. In ILI, 5 (20%) patients having co-morbidities while in SARI 15 (10.34%) patients having co-morbidities were positive for either SARS-CoV-2 or Influenza. Mortality was seen in 2 (3.23%) SARI influenza patients. Conclusion: Due to the varying circulating strains, seasonal variations of SARS-CoV-2 and influenza viruses, continuous surveillance is essential for management and prevention of SARI and ILI cases.

Clinical Outcomes of Single Lateral versus Dual Plating in Isolated Comminuted Intra-articular Distal Femur Fractures among Adults: A Retrospective Study

Tanmay Datta, Manik Roy, Pritam Rahaman Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Distal femur fractures are relatively rare compared to hip fractures. Distal femur fractures, particularly Arbeitsgemeinschaft für Osteosynthesefragen (AO) 33-C2 and C3 types with multiple fragments, pose significant treatment challenges. Complex comminution and articular extension markedly increase the difficulty of achieving stable fixation. Aim: To compare the effectiveness of Single Lateral Plating (SLP) and Dual Plating (DP) techniques in treating comminuted distal femur fractures, with a focus on clinical improvement and complication rates. Materials and Methods: The present hospital-based retrospective study was conducted on 50 cases of comminuted intra-articular distal femur fractures managed surgically at a tertiary care medical institute in eastern India between January 2020 and December 2022. Patients were divided into two groups: Group A (n=25) received SLP, while Group B (n=25) underwent DP. Key outcomes were evaluated at the level of functional recovery and union time, with additional data collected on the intraoperative blood loss, surgical time and frequency of complications. Clinical outcomes were assessed based on functional recovery, as measured by the Knee Society Scores (KSS). Statistical analyses were conducted using unpaired t-tests and Chi-square tests. A p-value of <0.05 was considered statistically significant. Results: Fifty adults were analysed (SLP, n=25; 16 men/9 women; 53.2±9.8 years) and (DP, n=25; 15 men/10 women; 50.0±10.9 years). The DP cohort showed higher KSSs at every follow-up- one month: 64.5±5.0 vs 54.0±6.0 (p<0.001); three months: 75.4±5.6 vs 62.5±6.8 (p<0.001); six months: 82.1±6.1 vs 66.3±6.2 (p=0.003); 12 months: 87.3±4.9 vs 69.0±5.7 (p=0.021); 15 months: 89.0±4.5 vs 70.2±5.1 (p=0.047). Radiographic union occurred earlier with DP (p<0.0001). No significant between-group differences were observed in intraoperative blood loss (p=0.21) or operative time (p=0.12), while implant failure and non-union were less frequent with DP; surgical-site infection occurred in one patient per group. Conclusion: The DP group showed superior functional outcomes, faster healing, and fewer complications, with no significant increase in blood loss or operative duration.

Perception, Attitude and Practice of Doctors towards Complementary and Alternative Medicine in a Tertiary Care Teaching Hospital: A Cross-sectional Questionnaire-based Study

Smitha Rai, Padma Gopinath Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: The use of Complementary and Alternative Medicine (CAM) is increasing worldwide, including in India. People who are not satisfied with conventional medicine often turn to CAM. The World Health Organisation (WHO) also encourages the integration of CAM into modern medicine, which is possible only with the right perception and attitude of modern practitioners toward CAM. Aim: To assess the perception, attitude, and practice of modern practitioners toward CAM. Materials and Methods: A cross-sectional, non interventional, questionnaire-based study was conducted at Sapthagiri Institute of Medical Sciences and Research Centre (SIMS & RC), Chikkabanawara, Bengaluru, Karnataka, India, from August 2024 to December 2024. A total of 107 consultants, including senior residents, assistant professors, associate professors, and professors working at SIMS and RC and willing to participate, were enrolled in the study. The final sample size considered for analysis was 98. Participants were provided with an offline questionnaire related to the perception, attitude, and practice of CAM. Their responses were recorded using a five-point Likert scale ranging from “strongly agree” to “strongly disagree” and analysed using descriptive statistics. Statistical analyses were conducted using IBM Statistical Package for the Social Sciences (SPSS) Statistics version 26.0. Results: A total of 107 questionnaires were analysed. The demographic parameters included name, gender, designation, and department of the consultants. Males (71, 66.4%) outnumbered females (36, 33.6%), and most participants were professors (50, 46.7%). The majority belonged to the departments of Surgery (20, 18.7%), Orthopaedics (19, 17.8%), Medicine (13, 12.1%), and Anaesthesiology (13, 12.1%). A total of 82 out of 107 (76.6%) practitioners believed that CAM is not reliable in acute conditions. Only 26 (24.3%) doctors believed that CAM is quite safe. Sixty-seven (62.6%) believed that the therapeutic response in CAM is slow to develop, and 76 (71%) agreed that a change in the patient’s lifestyle is necessary to obtain maximum benefit from CAM. Fifty-five (51.4%) doctors believed that CAM mainly focuses on disease prevention rather than cure. The majority (93, 87%) agreed that more scientific studies are required to substantiate the use of CAM. Almost half of the participants (52, 48.6%) reported using or considering the use of CAM in their clinical practice, with Yoga being the most commonly practiced branch (51, 47.7%). Additionally, 45 (42%) expressed willingness to undergo training in CAM. Conclusion: Modern practitioners’ perception and attitude toward CAM are generally positive. Nearly half (52, 48.6%) are open to incorporating CAM into their clinical practice. The most commonly used branch was Yoga (51, 47.7%), followed by Ayurveda (19, 17.8%). Many participants (45, 42.1%) also expressed willingness to undergo future training in CAM.

Prevalence of Dental Implant Positioning Errors among the Saudi Arabian Population: A Retrospective Observational Study

Mohammed Ziauddeen Mustafa, Ghaida Mohammad Alhamad, Ahmed Homoud Alsabt, Asim Mesfer Almutairi, Mohammed Kateb Althobiti, Yahya Deeban, Tahani Mohammed Binaljadm, Angel Mary Joseph Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Despite being an established procedure with a success rate exceeding 90%, dental implant therapy can be associated with certain complications, such as peri-implantitis and mechanical failures. Among the factors contributing to implant failure, implant placement-related factors may play a crucial role; however, their prevalence has been less frequently reported in the scientific literature. Aim: To assess the prevalence of errors in dental implant placement using Orthopantomogram (OPG) records of patients. Materials and Methods: A retrospective observational study was conducted in the Dental Clinics at Al Zulfi, College of Dentistry, Majmaah University, Al-Majmaah, Riyadh Province, Saudi Arabia from August 2013 to June 2023. Approximately 500 records of patients who had received atleast one dental implant were reviewed. Data regarding gender, type of implant, and implant position (anterior vs posterior; maxilla vs mandible) were collected. Implant placement errors, such as violation of the minimum distance between two implants (<3 mm) or between a tooth and an implant (<1.5 mm), as well as thread exposure, were assessed on OPGs by three independent investigators. Other factors associated with implant positioning errors were also evaluated. The Chi-square test was used to determine significant differences between implant positioning errors and implant location. Results: The study included 147 participants with a total of 500 dental implants, of whom 116 (78%) were male and 31 (22%) were female. A total of 348 implants (69.6%) exhibited placement errors. Implants placed in the maxillary arch showed a significantly higher prevalence of violation of the minimum distance between the implant and the tooth compared to those placed in the mandibular arch (p<0.05). Conversely, implants placed in the mandibular arch had a higher incidence of thread exposure compared to those in the maxillary arch (p<0.05). Conclusion: Successful dental implant therapy depends on multiple factors, including patient selection, meticulous treatment planning, precise surgical technique, prosthetic design, and long-term maintenance.

Analgesic Efficacy of Perineural versus Intravenous Dexamethasone and Paracetamol in Supraclavicular Block for Forearm Surgeries: A Randomised Control Trial

Chhaya Suryawanshi, Rashmi Kelkar Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Supraclavicular brachial plexus block is commonly employed for forearm surgeries, but its duration of analgesia with local anaesthetics alone is limited. Enhancing adjuvants in regional anaesthesia can lead to better analgesia, decreased opioid consumption, and improved recovery and patient satisfaction. Aim: To compare the onset and duration of sensory and motor blockade, time to rescue analgesia, and overall pain-relief effectiveness of perineural versus intravenous dexamethasone administered with paracetamol following supraclavicular block in forearm surgeries. Materials and Methods: The present double-blind randomised control trial was conducted at Dr DY Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, where 60 patients scheduled for forearm surgeries under supraclavicular block were randomly divided into two groups. In Group A, patients received 20 mL of 0.5% bupivacaine, 10 mL of 2% lignocaine with adrenaline, and 8 mg of dexamethasone. Group B received the same local anaesthetic with the addition of 2 mL of 0.9% normal saline, followed by intravenous administration of 8 mg dexamethasone and 1 gm paracetamol after the block. Parameters evaluated were sensory and motor block onset and duration. Postoperative pain relief duration and time to first rescue analgesia were assessed using the Visual Analogue Scale (VAS), and any adverse effects were documented. Data were analysed with student’s t-test and Chi-square test; p<0.05 was significant, p<0.001 highly significant. Results: The two groups were comparable with respect to demographic characteristics. The mean age was 43.07±11.6 years in Group A and 42.33±10.42 years in Group B (p=0.79). Both groups had a similar gender distribution, with no statistically significant difference. Group A had a faster onset of sensory block (4.93±0.82 min) compared to Group B (7.87±0.97 min) and a longer sensory block duration (511.4±31.4 min vs. 432.3±19.5 min). Motor block onset was also quicker in Group A (9.93±0.82 min) than in Group B (13.2±1.04 min), with a longer duration (401.4±30.3 min vs. 366.4±26.7 min). Group A experienced more extended analgesia (527.9±30.9 min vs. 447.4±19 min). Haemodynamic variables were stable in both groups, with no significant complications. Conclusion: Perineural dexamethasone significantly prolonged the duration of sensory and motor blockade and delayed the requirement for rescue analgesia compared to intravenous dexamethasone with paracetamol. Both routes were safe and well-tolerated, making perineural dexamethasone a more effective adjuvant for enhancing postoperative analgesia in supraclavicular block for forearm surgeries.

Short-term Effects of Non Surgical Periodontal Therapy on Oral Fluid Calprotectin Levels in Stages III or IV Periodontitis: A Longitudinal Observational Study

Annie Kitty George, Sankari Malaiappan, Vivek Narayan, Selvaraj Jayaraman, Nidhita Suresh Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Periodontal diseases cause destruction of the tooth supporting structures and contribute to low-grade systemic inflammation. Calprotectin is a major cytosolic protein of immune cells; it is highly expressed in sites of inflammation and has been explored as a biomarker in many inflammatory conditions including periodontitis. Cross-sectional studies have reported elevated calprotectin levels in oral fluids of periodontitis patients, but evidence regarding the impact of periodontal therapy on Gingival Crevicular Fluid (GCF) and salivary levels of calprotectin is inconclusive. Present study was conducted to assess whether calprotectin levels in oral fluids would be altered by Non Surgical Periodontal Therapy (NSPT). Aim: To observe the short-term impact of NSPT on the GCF and salivary levels of calprotectin. Materials and Methods: The present longitudinal observational study was carried out in the Department of Periodontology Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India, over a period of four months from January to April 2023. A total of 11 patients clinically diagnosed with stages III or IV periodontitis and who met inclusion and exclusion criteria were enrolled in the study. Gingival Index (GI), mean Probing Pocket Depth (PPD), mean Clinical Attachment Loss (CAL), percentage of sites with PPD ≥5 mm and sites with CAL ≥5 mm were recorded. GCF and salivary samples were collected to measure calprotectin levels by Enzyme Linked Immunosorbent Assay (ELISA). Professionally administered oral hygiene instructions, mechanical supragingival plaque removal (PMPR) and sub gingival instrumentation were performed for these patients. They were recalled for their first follow-up visit after a period of six weeks. Re-evaluation of periodontal parameters was done and GCF and salivary samples were collected to estimate calprotectin levels. Mean and standard deviation was used to summarise the variables. The comparison between baseline and follow-up periodontal parameters were done using non parametric Wilcoxon signed rank tests. Oral fluid calprotectin levels were compared using paired t-test. The p-values less than 0.05 were considered statistically significant. Results: A total of 11 participants were recruited for the study. Only 10 participants returned for the first follow-up visit at six weeks. Statistically significant differences were seen in pre and post-treatment values for GI, mean PPD, mean CAL, percentage of sites with PPD ≥5 mm and sites with CAL ≥5 mm. Salivary calprotectin was 1160.17±596.18 at baseline and was lowered to 1100.46±604.75 pg/μL at follow-up. (p=0.74) GCF calprotectin was 1605.11± 79.29 before NSPT and decreased to 1556.24±37.56 pg/ μL post therapy (0.092). Conclusion: This study observed a significant improvement in all clinical periodontal parameters at six weeks after NSPT. Calprotectin levels in both saliva and GCF decreased but the differences were not statistically significant. Calprotectin levels in oral fluids of stages III or IV periodontitis patients was not significantly altered at six weeks after NSPT.

Assessment of Surface Roughness and Wettability of Hafnium Oxide Coated Titanium Discs: An In-vitro Analysis

Meghan Ranjan Singh, Vaishnavi Rajaraman, Padma Ariga, Saravanan Sekaran Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Surface modifications of titanium implants play a crucial role in enhancing their performance, particularly in terms of surface roughness and wettability, which directly influence osseointegration and biological responses. Hafnium Oxide (HfO₂) coatings are emerging as potential surface modifiers due to their unique physicochemical properties. Aim: The aim of the present study was to evaluate and compare the surface roughness and wettability of uncoated titanium discs and hafnium oxide coated titanium discs using Atomic Force Microscopy (AFM) and contact angle goniometry. Materials and Methods: The present in-vitro study was conducted in the Department of Prosthodontics, Saveetha Dental College and Hospitals, Chennai, India, between March 2024 and June 2024. Twenty titanium discs were divided into two groups: uncoated Ti (Group A) and hafnium oxide coated Ti (Group B). Surface roughness parameters (Ra, Rq, Rm) were evaluated using AFM and wettability was assessed by static contact angle goniometry. Data were analysed with the Shapiro-Wilk test for normality and independent samples t-tests for intergroup comparison. Results: AFM analysis revealed that the hafnium oxide coated titanium discs (group B) exhibited significantly higher surface roughness (Ra: 62.19 nm; Rq: 78.123 nm) compared to the uncoated titanium discs (group A) (Ra: 37.762 nm; Rq: 49.261 nm) (p<0.05). Contact angle measurements indicated that group B had substantially higher contact angles (average: 86.56°) compared to group A (average: 41.42°) (p=0.018), suggesting reduced surface wettability following HfO₂ coating. Conclusion: Hafnium oxide coating on titanium discs significantly increases surface roughness while decreasing surface wettability. These surface modifications could potentially influence the biological behaviour of titanium-based implants.

Biochemical Correlation of FGF23 with other Biomarkers in Patients with End-stage Renal Disease on Haemodialysis: A Cross-sectional Study

Barat Yusubov, Mirkhalig Javadov, Khanbaba Huseynov, Muradali Bakhshiyev Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: In patients with End-Stage Renal Disease (ESRD) undergoing Haemodialysis (HD), Fibroblast Growth Factor 23 (FGF23), intact Parathyroid Hormone (iPTH), and homocysteine (Hcy) are frequently elevated and have each been associated with disordered mineral metabolism and increased cardiovascular risk. In addition to FGF23, both iPTH and Hcy play important roles in Chronic Kidney Disease (CKD)-related Mineral Bone Disorder (MBD) and Cardiovascular Disease (CVD) risk. Aim: To evaluate the correlation of FGF23 with iPTH, Hcy, and routine biochemical parameters in patients with ESRD. Understanding these correlations may help identify new prognostic markers and inform treatment strategies in HD patients. Materials and Methods: This cross-sectional study was conducted in the Department of Nephrology at Yeni Klinika Hospital, Baku, Azerbaijan between February 2024 and November 2024. ESRD patients who had been on dialysis for atleast three months were recruited. Data were collected from 103 patients who consented to participate. Patients were divided into two groups: the main group (n=75) with elevated FGF23 and Hcy levels, and the control group (n=28) with normal FGF23 and Hcy levels. Baseline laboratory parameters included Haemogram (Hg), C-reactive Protein (CRP), Glucose (Gluc), Creatinine (Crea), estimated Glomerular Filtration Rate (eGFR), Potassium (K), Sodium (Na), Calcium (Ca), Phosphorus (P), Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), iPTH, Hcy, and FGF23. Descriptive statistics and frequency analysis were used to summarise demographic and clinical characteristics. The Chi-square (χ2) test was used to compare categorical variables between groups, and the Mann-Whitney U test was applied to compare clinical parameters. Statistical significance was set at p<0.05. Analyses were performed using IBM Statistical Package for the Social Sciences (SPSS) Statistics version 25.0. Results: The sample included 65 (63.1%) males and 38 (36.9%) females, with a mean age of 64±13.64 years, mean height of 170±6.9 cm, and mean weight of 79±13.04 kg. In the main group, FGF23 levels showed positive correlations with phosphorus (r=0.72, p=0.01), creatinine (r=0.78, p=0.01), iPTH (r=0.61, p=0.01), and Hcy (r=0.74, p=0.01). FGF23 was negatively correlated with eGFR (r=-0.64, p=0.01). No statistically significant correlation was observed with calcium levels (r=-0.12, p=0.29). Conclusion: Changes in FGF23, iPTH, and Hcy levels, particularly when assessed alongside other biochemical parameters, may serve as early prognostic markers in HD patients. Monitoring these parameters could help guide prognosis and support timely treatment management in patients with ESRD.

Rapid Characterisation of Carbapenem-resistant Klebsiella pneumoniae using the OKNVI RESIST-5 Multiplex Lateral Flow Assay and Evaluation of the Synergistic Activity between Aztreonam and Ceftazidime-avibactam: A Cross-sectional Study

Madhumati Jagadish Patil, Meera Rajeev, Anjali Patil Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Carbapenemase-Producing Klebsiella pneumoniae (CP-KP) is a major public health concern, since such isolates are inherently resistant to most available antibiotics. A newer therapeutic option, namely Ceftazidime-Avibactam (CAZ-AVI), is effective against Extended-Spectrum Beta-Lactamase (ESBL) producers and carbapenemase-producing organisms. However, CAZ-AVI is not active against strains bearing class B Metallo-Beta-Lactamases (MBLs) such as NDM, VIM, and IMP. The monobactam antibiotic Aztreonam (ATM) is stable against all MBLs (NDM, VIM, IMP) and hence serves as a good therapeutic choice for MBL-producing Enterobacterales. There are no established standards (CLS I/EUCAST) for evaluating synergy of CAZ-AVI and ATM. The RESIST-5 OKNVI (O-Oxacillinase (OXA)-48, K-Klebsiella pneumoniae Carbapenemase (KPC), N-New Delhi Metallobetalactamase (NDM, V-Verona Integron-encoded Metallobetalactamase (VIM), I-Imipenemase (IMP) assay enables rapid and accurate detection of five major carbapenemases, supporting timely and appropriate antimicrobial treatment. Aim: To detect carbapenemases using the RESIST-5 (OKNVI) test and to determine the in vitro activity of CAZ-AVI alone or in combination with ATM against carbapenemase-producing Klebsiella pneumoniae isolates. Materials and Methods: A cross-sectional study was conducted over four months (February 2024-May 2024) in the Department of Microbiology, KLE’s Prabhakar Kore Hospital, Belagavi, Karnataka, India. A total of 123 nonduplicate Klebsiella pneumoniae isolates from various clinical specimens, identified using standard biochemical methods during the study period, were included. The most common clinical samples were wound swabs, urine, and blood. Antibiotic susceptibility was tested by the disc diffusion method, with an ertapenem disc (10 μg) used to screen for carbapenem resistance. Carbapenem-resistant Klebsiella pneumoniae were subjected to the Modified Carbapenemase Inactivation Method (mCIM) to confirm carbapenemase production. Klebsiella pneumoniae isolates were further tested using the OKNVI RESIST-5 test for rapid detection of carbapenemases and were also evaluated for synergy between CAZ-AVI and ATM using modified disc diffusion and E-test methods. Statistical significance was assessed using the Chi-square test, with a p-value <0.05 considered significant. Results: Ceftazidime-avibactam (CAZ-AVI) and aztreonam (ATM) synergy testing showed that synergy between CAZ-AVI and ATM was observed in 24 out of 30 Klebsiella spp. isolates (80%) using both the E-test and ATM disc diffusion methods. Fifteen isolates (50%) were resistant to CAZ-AVI and 18 (60%) to ATM, while 6 (20%) isolates were resistant to CAZ-AVI plus ATM by disc diffusion and E-test methods. Among 33 CP-KP isolates, 94% showed one or more carbapenemases, with 42% coproducing NDM and OXA-48. NDM and OXA-48 were detected in 26% and 32%, respectively, while 6% were negative for all five carbapenemases. Conclusion: CAZ-AVI in combination with ATM is effective against carbapenemase-producing Klebsiella pneumoniae. This study suggests that further commercialisation of ATM-AVI as a pharmaceutical preparation could be an attractive option to treat infections caused by MBL producers.

Efficacy of 6% Hydroxy Ethyl Starch Pre Administration to Alleviate Pain following Propofol Injection: A Randomised Control Study

Jigisha Bharatbhai Mehta, S Sreya Sri, Sara Mary Thomas Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Propofol is widely used intravenous induction agent owing to its rapid onset and short duration of action; however, Pain On Propofol Injection (POPI) remains a common adverse effect, with reported incidence between 28–90%. Despite the evaluation of multiple preventive strategies, including lignocaine, opioids, and formulation modifications, none have achieved complete effectiveness in eliminating POPI. Colloids, particularly Hydroxyethyl Starch (HES), may reduce pain through their effects on endothelial permeability and inhibition of contact activation. Aim: To evaluate the efficacy of pre-administration of 50 mL of 6% HES 130/0.4 compared with 0.9% Normal Saline (NS) in alleviating POPI. Materials and Methods: This double-blinded randomised control study was conducted at Dhiraj General Hospital, Sumandeep Vidyapeeth, Waghodia, Vadodara, Gujarat, India, from March 2025 to July 2025. A total of 84 patients of either gender belonging to the American Society of Anaesthesiology (ASA) physical status grade I or II were randomised into two groups. Group HES received 50 mL 6 % HES, and group NS received 50 mL 0.9% normal saline via 20-G intravenous cannula over 3-5 min before propofol. Pain during propofol injection was assessed every 10 seconds before loss of verbal contact. Data were analysed with the Unpaired t-test. A p-value <0.05 was considered significant, and a p-value <0.001 was considered highly significant. Results: Both groups were comparable with respect to demographic variables, including age, weight, gender distribution and ASA physical status. The dose of propofol required for induction was also comparable between the HES and NS groups (136.10±21.25 vs. 131.67±16.22 mg; p-value=0.28). The incidence of pain on propofol injection was significantly lower in the HES group, with 78.57% of patients reporting no pain compared to 28.57% in the NS group (p-value <0.001). Pain grade 1 (14.29% vs. 38.09%; p-value=0.01), grade 2 (4.76% vs. 19.05%; p-value=0.04), and grade 3 (2.38% vs. 14.29%; p-value=0.04) were significantly more frequent in the NS group. Haemodynamic parameters showed no significant difference between groups. Conclusion: Administration of 50 mL 6% HES before propofol injection results in significantly less incidence of pain compared to 0.9% NS. Thus, authors conclude that it is effective to alleviate POPI.

Clinical Outcomes in Acute Stroke: A Cohort Comparison of Dysnatraemia and Normonatraemia

Sureshkumar Vellingiri, Bhargav Kiran Gaddam, K Suganya Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Stroke is the leading cause of mortality throughout the world, with significant economic and social implications.Electrolyte disturbances especially dysnatraemia is common in acute stroke patients and may affect clinical outcomes though its prognostic impact remains unclear. Aim: To compare clinical outcomes between acute stroke patients with dysnatraemia and those with normonatraemia. Materials and Methods: In the present prospective cohort study, 130 neuroimaging-confirmed acute stroke patients admitted to a tertiary care hospital in India were enrolled. Serum sodium was measured at admission and during hospitalisation and was categorised into dysnatraemia (both hyponatremia or hypernatremia) as group I and normonatraemia as group II. Primary outcomes were Intensive Care Unit (ICU), and hospital stay lengths, National Institutes of Health Stroke Scale (NIHSS) scores at admission and discharge, and in-hospital mortality. Secondary outcomes included the need for interventions such as intubation, Central Line Placement (CLP) and tracheostomy. Statistical Package for Social Sciences (SPSS) (ver_20) was used for analysis and appropriate tests of significance i.e., Chi-square test or Fisher exact test, Student t-test, Mann-Whitney test and multivariate logistic regression was used to test the significance. Values of p<0.05 was statistically significance. Results: The mean age of group I was 61.2±15.1 years versus 57.6±13.2 years in group II, with approximately 71% of males in both groups. Of 130 patients, 70 (53.8%) had dysnatraemia and 60 (46.2%) had normonatraemia. Group I experienced longer ICU stays (Median 2.5 days versus 2 days, p=0.002) and higher NIHSS scores at discharge (mean 6.35±6.33 vs. 4.36±5.46, p=0.043) than group I. They also had increased rates of CLP (21.4% vs. 6.7%, p=0.018) and requires intubation (31.4% vs. 10%, p=0.003) compared to group II. Conclusion: Dysnatraemia in acute stroke patients is linked to prolonged ICU stays, more interventions, and poorer neurological outcomes at discharge. Early identification and management of dysnatraemia may improve outcomes in acute stroke patients.

Effectiveness of Mulligan’s Spinal Mobilisation with Leg Movement Technique and Specific Exercise Therapy in Improving Clinical Outcome in Individuals with Lumbar Radiculopathy: A Randomised Controlled Study

Pratap Ravi, Subbiah Kanthanathan, Antony Leo Aseer Peter Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Low Back Pain (LBP) is a common musculoskeletal problem affecting the general population and involvement of Sciatic nerve is the common cause for leg Pain dominance. Mulligan’s Spinal Mobilisation With Leg Movement (SMWLM) technique is recommended as management. Limited data is available regarding the combined effect of SMWLM and specific exercises. Aim: The aim of the study was to find the effectiveness of Mulligan’s SMWLM technique with self GATE mobilisation and sustained lumbar rotation exercise on the clinical outcome compared to conventional care in individuals with Lumbar Radiculopathy (LR). Materials and Methods: The present randomised controlled study was conducted in a tertiary care hospital during March to August 2024, around 69 participants were included after receiving the informed consent and are divided into three groups. The leg pain intensity using Visual Analogue Scale (VAS), Numerical Pain Rating Scale (NPRS), disability using Oswestry Disability Index (ODI), Abdominal core muscle strength, passive Straight Leg Raise (SLR) range self-perceived improvement were measured before and after treatment. group 1 received Neural Mobilisation (NM), lumbar spine range of motion exercises. group 2 received SMWLM, NM and lumbar spine range of motion exercises. group 3 SMWLM, NM, self GATE mobilisation and sustained lumbar rotation exercise. All participants received electrotherapy for pain modulation. The treatment was given to all three groups for one week, and the Global Rating of Change (GROC) scale was evaluated after 1st treatment and end of therapy. The outcomes were analysed using paired t-test, and ANOVA with a significance set at <0.05. Results: The mean age of the participants in group 1,group 2,group 3 were 44.21,47.78,46.52 respectively. The findings reveal that group 3 had greater improvement in leg pain (p<0.001), back pain (p<0.001), disability (p<0.001), core muscle strength (p<0.001), SLR range (p<0.0042) and GROC (p<0.0001) post-treatment. Conclusion: Mulligan’s SMWLM self GATE mobilisation and lumbar rotational exercises improved the clinical outcomes when compared to SMWLM alone and general exercises in individuals with LR. Mulligan’s SMWLM can be combined with technique specific exercise for maximum clinical improvement.

Role of Candida in the Pathogenesis of Oral Squamous Cell Carcinoma: A Systematic Review

Suganya Panneer Selvam, Deepak Pandiar Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Oral Squamous Cell Carcinoma (OSCC) is the sixteenth most prevalent cancer globally, with a significant proportion of cases originating in India. The progression from healthy oral mucosa to OSCC often involves Oral Potentially Malignant Disorders (OPMDs). However, recent classification updates have excluded chronic candidiasis from the list of OPMDs. Despite this, Candida species are frequently associated with cases of severe dysplasia and OSCC, suggesting a potential role in the pathogenesis of OSCC. By exploring specific pathways through which Candida may promote carcinogenesis, this review highlights the importance of recognising chronic candidiasis as an OPMD for early diagnosis and improved patient outcomes. Aim: The present systematic review aimed to consolidate evidence on the potential association between chronic Candida infections and the pathogenesis of OSCC. Materials and Methods: The present systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Original studies involving tumour tissues or archival blocks from patients with oral cancer and those addressing OSCC pathogenesis were included; case reports, case series, and studies using only saliva samples or oral swabs were excluded. A comprehensive search across PubMed, Scopus, and Web of Science was performed up to December 10, 2023. Study quality was assessed using the Newcastle-Ottawa Scale, with modifications to fit the review’s objectives. Data extraction included information on Candida species and diagnostic approaches, with results synthesised narratively due to variability among studies. Results: The search strategy yielded 624 articles from multiple databases (PubMed: 263; Scopus: 204; Web of Science: 157). After applying the inclusion and exclusion criteria, only 13 studies were selected for the review. Candida prevalence in Oral Leukoplakia (OL) ranged from 6.8 to 100%, with three studies reporting malignant transformation rates of 2.5%, 6.5%, and 28.7%. C. albicans was the most frequently detected species, followed by C. dubliniensis, C. glabrata, C. guilliermondii, and C. krusei. Some studies identified additional fungal species, though they were considered potential contaminants. Histological analysis revealed Candida hyphae penetrating deep into OSCC tissues, suggesting a role in tumour progression. Conclusion: The review highlights the importance of recognising chronic candidiasis as an OPMD due to its potential role in the pathogenesis of OSCC. Early identification and management of chronic Candida infections could serve as a preventive strategy in high-risk populations. The findings advocate for the inclusion of chronic candidiasis in future classifications of OPMDs to enhance early diagnosis and improve patient outcomes.

Early Detection of Fluconazole Resistance Targeting Y132F Mutation in ERG11 Gene among Candida tropicalis Clinical Isolates using Polymerase Chain Reaction: A Cross-sectional Study

Kanagasabapathi Karthika, Thayanidhi Premamalini, Rajyoganandh Vijayaraman, Sukumar Bavadharani, Vijayakishore Thanneru, Anupma Jyoti Kindo Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Candida tropicalis is the most prevalent yeast associated with high mortality rates in candidaemia patients. The extensive use of fluconazole for prophylaxis has led to the emergence of resistance. The Y132F mutation occurs in the active site of the enzyme, making the organism resistant to fluconazole, and may serve as a significant marker. Aim: To detect the presence of the Y132F mutation in the ERG11 gene for early identification of fluconazole-resistant C. tropicalis isolates. Materials and Methods: This cross-sectional study was carried out in the Department of Microbiology at Sri Ramachandra Institute of Higher Education and Research, Chennai Tamil Nadu, India, over a period of 19 months from May 2018 to December 2019. Blood samples received in the Microbiology laboratory that grew Candida during the study period were included. A total of 92 Candida isolates from candidaemia patients were studied. Among these, isolates identified as C. tropicalis by phenotypic and genotypic methods were subjected to Antifungal Susceptibility Testing (AFST) by the broth microdilution method, according to the Clinical and Laboratory Standards Institute (CLSI) guidelines (M27-A3). Subsequently, Polymerase Chain Reaction (PCR) assays were performed on fluconazole-resistant C. tropicalis isolates, targeting the Y132F mutation in the ERG11 gene using in-house primers. Additionally, sequencing of the C. tropicalis ERG11 gene was performed to confirm the presence or absence of the Y132F mutation in both resistant and susceptible isolates. Results: Among the 92 candidaemia patients, 37 (40.2%) cases were caused by C. tropicalis, of which 10 (27%) were resistant to fluconazole. The PCR assay accurately detected all 10 fluconazole-resistant C. tropicalis isolates and also produced bands for control strains with the Y132F mutation. DNA sequencing further confirmed that the Y132F mutation was present in fluconazole-resistant isolates, with results consistent with the PCR assay. Conclusion: This PCR-based detection of the Y132F mutation highlights the importance of molecular diagnostics in identifying fluconazole resistance in C. tropicalis. Such early detection enables healthcare providers to initiate appropriate treatment, reducing the risk of treatment failure and improving patient outcomes. Moreover, this assay could be a valuable screening tool to detect potentially resistant strains and monitor their spread.

Radiological Assessment of Supratubal Recess and Sinus Tympani Dimensions: A Retrospective Descriptive Study

Avinesh Varadane, Umamageswari Amirthalingam, Elamparidhi Padmanaban, Palle Manjunatha Reddy Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: The hidden recesses of the temporal bone, particularly the Supratubal Recess (STR) and the Sinus Tympani (ST), play a crucial role in the presence and recurrence of cholesteatoma. Due to their complex anatomy and limited surgical visibility, these areas pose significant challenges in otologic surgery, often leading to residual disease. High-Resolution Computed Tomography (HRCT) provides a non invasive method for preoperative assessment, enabling better surgical planning and improved patient outcomes. Aim: To determine the mean length, height, and width of the STR and to classify the ST and STR. Materials and Methods: This retrospective descriptive study analysed 110 HRCT temporal bone scans from patients referred between June 2019 and June 2020 at Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India. Patients with a history of ear surgery, trauma, or those in the paediatric age group were excluded. Scans were performed on a PHILIPS MX-16 (16-slice) CT scanner with a slice thickness of 0.67 mm and multiplanar reconstruction. STR grading and ST classification were assessed based on studies conducted by El-Anwar MW et al., and Marchioni D et al. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 24.0, with continuous variables expressed as mean±standard deviation, and categorical variables as frequencies and proportions. Results: HRCT analysis of 110 patients revealed a mean STR length (STR-L) of 4.78 mm (SD: 2.45-6.94 mm), width of 2.67 mm (SD: 1.09-4.71 mm), and height of 3.39 mm (SD: 2.07-5.69 mm). STRs were classified into three grades, with Grade 2 (n=141; 64.09%) being the most common, followed by Grade 3 (n=77; 35%). The STs were categorised into three types, with Type B (n=171) being the most prevalent. Conclusion: Grade 3 STR is associated with a higher risk of residual cholesteatoma; therefore, preoperative evaluation of the STR is essential to aid surgeons in its prevention. The likelihood of residual disease due to partial removal, as well as the risks of ossicular discontinuity and hearing loss, can be effectively assessed before surgery.

Effect of Ursodeoxycholic Acid on Unconjugated Hyperbilirubinemia in the Term Neonates Treated with Phototherapy: A Prospective Interventional Study

Chinthapuvu Vivek, Shrishail M Gidaganti, Raghavendra H Gobbur, Mallangouda M Patil Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Neonatal hyperbilirubinemia affects 60–80% of term neonates in the first week of life. Phototherapy (PT) is the standard treatment; however, prolonged PT has limitations. Ursodeoxycholic Acid (UDCA) is a potential adjuvant therapy to enhance bilirubin clearance. Aim: To evaluate UDCA as a safe and useful adjuvant to PT in term neonates with Unconjugated Hyperbilirubinemia (UCHB) by comparing bilirubin reduction, PT duration, and length of hospital stay. Materials and Methods: A prospective interventional study was conducted at the Level 3 Neonatal Intensive Care Unit (NICU) of Shri BM Patil Medical College, Hospital and Research Institute, Vijayapura, Karnataka, India, from January 2024 to January 2025. Total 100 term neonates were allocated into two groups: Group 1 (n=50) received oral UDCA (10–15 mg/kg/day) with PT, and Group 2 (n=50) received standard PT alone. Total Serum Bilirubin (TSB) levels were measured at admission, 24 hours, and 48 hours. PT duration, NICU stay, and adverse effects were assessed. The independent samples t-test or the Mann–Whitney U test was used to compare continuous variables, and the Chi-square test or Fisher’s-exact’s test was used to assess categorical variables. A p-value <0.05 was considered significant. Results: Baseline characteristics such as gestational age (38.4±1.2 vs 38.2±1.3 weeks), birth weight (2.79±0.43 vs 2.76±0.40 kg), and gender distribution were comparable between groups. The decline in TSB at 48 hours was 9.3±1.75 mg/dL in the UDCA+PT group versus 9.8±1.90 mg/dL in the PT-only group (p=0.175). The mean PT duration was 47.84±2.50 hours in the UDCA group and 48.22±5.50 hours in the control group (p=0.66). UDCA was well tolerated, with only mild vomiting observed in three neonates. Conclusion: The UDCA may modestly enhance bilirubin clearance, but differences in bilirubin reduction, PT duration, and NICU stay were not statistically significant. Larger randomised controlled trials are needed.

Effects of Anaesthetic Techniques on Cancer Recurrence and Survival: A Systematic Review and Meta-analysis

Hemlata, Aparna Shukla, Reetu Verma Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Many anaesthetic agents and techniques are used in surgical oncology, yet their effects on cancer cells remain inconclusive. Some studies suggest that propofol-based Total Intravenous Anaesthesia (TIVA) and regional anaesthetic techniques may protect against cancer progression, while volatile anaesthetics and high-dose opioids could increase recurrence. Other research indicates that anaesthetics may have no effect. Aim: To evaluate the impact of General Anaesthesia (GA) supplemented with Regional Analgesia (RA) on Overall Survival (OS) in adult cancer surgery patients, as well as the effects of TIVA versus Inhalational Anaesthesia (INHA) on OS. Materials and Methods: The present systematic review and meta-analysis was conducted at King George’s Medical University, Lucknow, Uttar Pradesh, India, PUBMED/MEDLINE, EMBASE/Emtree, Google Scholar, and ResearchGate were searched. Original retrospective studies from 2005 to 2020 on adult cancer surgeries were included. Eligible studies involved primary cancer surgeries under general anaesthesia (TIVA or volatile) alone or with regional anaesthesia. Only studies published in English and providing numeric Hazard Ratios (HR) were considered. The selected studies were divided into two groups: 10 studies comparing GA with or without RA, and 13 studies comparing TIVA versus INHA. Forest plots were generated to analyse pooled data, and Begg’s funnel plots were used to assess publication bias. The Risk Ratio (RR) was used to measure dichotomous outcomes with 95% confidence intervals (CI). Heterogeneity was assessed using the τ² statistic, and a fixed-effects model was applied. The risk of bias in included studies was assessed using the Newcastle-Ottawa Scale (NOS). The GRADE system was applied to ascertain the level of evidence. Results: A total of 23 retrospective studies involving 67,550 patients were included. In the GA+RA versus GA comparison (10 studies, 46,425 patients), GA+RA was associated with improved overall survival (RR=0.91, 95% CI: 0.89-0.92) but showed no significant difference in recurrence-free survival (RR=1.01, 95% CI: 1.00-1.02). In the TIVA versus INHA comparison (13 studies, 21,125 patients), TIVA was associated with modestly better overall survival (RR=1.11, 95% CI: 1.09-1.13) and recurrence-free survival (RR=1.06, 95% CI: 1.04-1.08). Heterogeneity was low to moderate, and the quality of evidence was graded as low to moderate due to the retrospective design. All 23 studies were evaluated using NOS, with scores ranging from 6 to 9. Most studies scored 7 or higher, indicating moderate to high quality. Evidence certainty was rated as low to moderate for both OS and RFS outcomes across comparisons due to the retrospective nature of the studies. Conclusion: This study provides evidence that anaesthetic technique may impact long-term outcomes in patients undergoing cancer surgery. General anaesthesia combined with regional analgesia (GA+RA) was associated with improved OS, although no significant difference was observed in recurrence-free survival (RFS). Additionally, TIVA showed a survival benefit over INHA, with improvements in both OS and RFS. Despite these findings, the overall certainty of evidence is limited by the retrospective design of the included studies.

Impact of Nursing Resignations on Annual Recruitment Strategies in Sudair Region Hospitals, Saudi Arabia: A Cross-sectional Study

Noor Fallaj T Almutaieri, Yousif Mohamed Abdallah, Habib Fallaj AlMutairy, Abdelaziz Fallaj Almutairi, Muslet Khalid S Alotabibi, Zaki Alhumaidi F Almtairi, Hamed Ibrahim F Alutaieri, Zayed Abdullah J Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Many healthcare organisations are grappling with a critical issue of having critically low nurse staff levels. This leads to high workload stress, job dissatisfaction, and frustration among nurses and triggers a disruptive cycle of high turnover. This turnover, in turn, disrupts the workforce, creating an urgent need for action. The negative impact on patient care is significant, compromising the quality of service and the well-being of patients. Nurses' resignations have become a global issue that has been researched over the last decade. Aim: The present study aimed to evaluate the impact of nursing resignations on annual recruitment plans in hospitals in the Sudair region, Saudi Arabia. Materials and Methods: The present cross-sectional study was conducted in Sudair area hospitals from November 2023 to January 2024. A total of 403 nurses completed a questionnaire about their experiences. Statistical analysis was done using the Chi-square test and ANOVA, and a p-value less than 0.05 was considered statistically significant. Results: A total of 403 nurses participated of which 135 (33.5%) of participants were aged 36-45 years, 118 (29.3%) aged 26-35 years, 82(20.3%) aged 20-25 years, and 68(16.9%) aged 46 years and above, most participants were Saudi nationals 388 (96.3%). The majority had a bachelor's degree, 123 (30.5%) had a diploma, and 54 (13.4%) were postgraduates. Nearly 97 (24.1%) had 10-15 years of experience. Participants' responses to motivation, effective leadership, and human resources strategies to reduce turnover ranged from 3.14 to 3.43, 2.93 to 3.3, and 3.1 to 3.28. Conclusion: The present study highlights the need to understand workforce dynamics to create effective recruitment strategies for hospitals in the Sudair region, promoting staffing solutions and healthcare growth. Understanding workforce dynamics is vital for effective recruitment strategies in Sudair hospitals, helping address staffing challenges and promote growth.

Morphometric Analysis of Dry Typical Thoracic Vertebrae: A Cross sectional Study from Telangana, India

BH Shiny Vinila, Masooma Begum, K Ephraim Vikram Rao, E Rajshekhar Reddy Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Morphometric measurements of dry typical thoracic vertebrae play an important role clinically in managing scoliosis, performing laminectomies, guiding pedicle screw fixation, and in designing spinal implants or prostheses for traumatic injuries. A precise understanding of typical thoracic vertebral dimensions is essential when planning thoracic spine surgery. Most of the screw and implant sizes are derived from Caucasian data, and hence may not be appropriate for all populations. Therefore, developing region specific morphometric data for typical thoracic vertebrae is crucial. Aim: To establish the normative morphometry of typical thoracic vertebrae in the population of Telangana region to guide spinal instrumentation. Materials and Methods: The present cross sectional study involved 80 adult dry typical thoracic vertebrae collected from the Department of Anatomy, Mahavir Institute of Medical Sciences, Vikarabad, Telangana, India. The study was conducted from October 2024 to February 2025. Various parameters including dimensions of the vertebral body, diameter of the vertebral foramen, pedicle dimensions and angles, laminae dimensions and length of spinous process were measured using vernier callipers. The statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 21. Range, Mean and standard deviations were calculated for all the parameters and Student’s t-test was performed to compare the right and the left-sides. Results: The mean transverse and anteroposterior diameters of the bodies were 31.49±3.35 mm and 22.05±3.53 mm, respectively. The vertebral foramen transverse and anteroposterior diameters were 15.61±1.34 mm and 13.75±1.26 mm, respectively. The transverse angle of the pedicle was 14.55±3.72° on the right side and 14.95±3.95° on the left-side. The sagittal angle of the pedicle was on the right-side 10.54±2.74° and 10.36±2.90° on the left-side. The mean laminar height and the thickness on the right-side were 21.03±2.42 mm and 06.18±1.06 mm, respectively and on the left-side were 20.96±2.09 mm and 06.35±1.03 mm, respectively. There was no statistically significant difference observed between the right & left-sides of the pedicle and laminar dimensions and also chord length as the p-value was more than 0.05. Hence, bilateral symmetry was observed. Conclusion: There were few variations observed in Telangana regional data collected in the current study namely transverse diameter of vertebral bodies, pedicle chord lengths, and sagittal and transverse angles were greater than in previous studies. These parameters are crucial for spinal surgeries and also the current study provides baseline data for the Telangana population that could help in improving instruments accuracy, reducing the risk of misplaced pedicle screws and neural injury.

Evaluating DMARDs Adherence in Patients with Psoriasis, Psoriatic Arthritis and Rheumatoid Arthritis: A Quasi-experimental Study

Nidhi Sanjeev Kudari, Aishwarya Pravin Patil, Satish S Karoli, Manjula Gudhoor, Darshini Prashant Shetti, Tabishahmed Shamsher, Bhavana Doshi, MS Ganachari Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Psoriasis (Ps), Psoriatic Arthritis (PsA), and Rheumatoid Arthritis (RA) are chronic autoimmune conditions requiring long-term pharmacological management. Medication adherence is crucial for effective disease control and improved patient outcomes. Drug-Related Problems (DRPs) and non-adherence significantly impact treatment efficacy. Disease-Modifying Antirheumatic Drugs (DMARDs) improve long-term outcomes and slow disease progression in Ps, PsA, and RA. Understanding adherence patterns helps healthcare providers address barriers to effective therapy. Aim: This study aimed to assess medication adherence and identifies factors influencing adherence in patients suffering from Ps, PsA, and RA. Materials and Methods: The present quasi-experimental study was conducted in KLE’s Dr. Prabhakar Kore Hospital and MRC, Belagavi, Karnataka, India. The study was conducted for a period of seven months from September 2023 to April 2024) on 124 patients diagnosed with Ps, PsA, and RA. Medication adherence was measured using the Medication Adherence Rating Scale (MARS) across baseline, first follow-up (second week), and second follow-up (fourth week). Factors affecting adherence, such as demographic variables, forgetfulness, carelessness, Adverse Drug Reactions (ADRs), and polypharmacy, were analysed. Clinical pharmacists provided targeted interventions, including patient education and counselling via Patient Information Leaflet (PIL). Data were analysed using Statistical Package for Social Sciences (SPSS) v23 with Friedman and McNemar tests to assess adherence changes, using a 5% significance level (α=0.05). Results: Of the 124 patients, 57.26% were females, and the most affected age group was 41-60 years. Methotrexate was the most commonly prescribed DMARD. Adherence improved from 54.03% at the baseline to 75.00% at second follow-up (p<0.001**). Forgetfulness (32.25%) and carelessness (50.80%) were major barriers to adherence. Pharmacist-led interventions significantly enhanced adherence rates over time. Conclusion: Clinical pharmacists play a crucial role in improving medication adherence through patient education and counselling. Enhancing adherence to conventional DMARDs leads to better disease management and reduced complications. Ongoing interventions, including regular follow-ups and personalised support, are essential for sustaining adherence in chronic autoimmune diseases. Improving adherence to DMARDs is vital for effective management of chronic autoimmune diseases. Clinical pharmacists play a key role through education, counselling, and ongoing patient support.

International Classification of Functioning as a Framework for Understanding Activity Limitation and Participation Restriction in Elderly Adults with Knee Osteoarthritis in Rural and Urban Community: A Cross-sectional Observational Study

Megha Desai, Prashant Naik, Gayathri Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Knee OA is the most common joint degeneration disorder which can lead to inactivity with ageing, secondary to pain and reduced function thus ultimately impairing the Quality of Life (QoL). International Classification of Functioning Disability and Health is a universal language that can be used across all professions for an easy communication. Aim: To assess the activity limitations and participation restriction in elderly adults with knee Osteoarthritis (OA) using ICF functional profile Materials and Methods: The present cross-sectional observational study was conducted in affiliation to KLE Institute of Physiotherapy at the rural and urban community of Belagavi, Karnataka, India, April 2020 to March 2021. A total of 386 adults from both rural and urban community above the age of 60 years with knee pain were included for the study. A door to door survey for activity limitations and participation restrictions was done using ICF and the data was later statistically analysed using Statistical Package for Social Sciences (SPSS) 20. Results: A 52.85% (n=193) of the urban population used western toilets and showed greater amount of difficulty in activities of daily living. The study included 69.95% (n=386) of the population who were females and 71.24% were under the age group of 60-70 years. The comparison of rural and urban communities showed that both communities faced the similar limitations and restrictions in functional activities whereas the type of toilet used had a major impact over the urban population where 37.31% (n=193) of the individuals in urban community showed the need of external support during toileting activities. Conclusion: The ICF functional profile was helpful in understanding the framework for activity limitation and participation restriction in elderly adults with knee OA. It can also be used as a clinical tool to evaluate activities of daily living and also provides a detailed frame work of understanding the interaction of personal environmental and medical factors.

Evaluation of Platelet Count, Anti-microbial Efficacy, and Fibrin Network Pattern for Advanced Platelet Rich Fibrin versus Titanium Platelet Rich Fibrin Prepared from Blood Samples of Young Adults: An Ex-vivo Study

Bhavya Chadarajupalli, Anil Kumar Kancharla, Anwesh Reddy Nandigam, Sheema Tasneem, Swatantrata Dey, Sowjanya Kantipaka Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Platelet concentrates have gained popularity in periodontal regenerative therapy owing to their autologous nature. Platelet Rich Fibrin (PRF) can be classified into various types based on the centrifugation protocol. Among these, Advanced PRF (A-PRF) and Titanium-prepared PRF (T-PRF) have gained recognition because of their regenerative potential. Aim: To evaluate platelet count, antimicrobial efficacy, and fibrin network pattern for A-PRF and T-PRF in young adults. Materials and Methods: This ex-vivo study was conducted at the department of Periodontology and Oral Implantology, Sree Sai Dental College and Research Institute, Andhra Pradesh, India, over a period of six months from January to June 2024 and it included a 15 systemically healthy subjects. From each subject, 10 mL of blood was collected, of which 5 mL was centrifuged to obtain A-PRF (1400 RPM, 15 minutes) and 5 mL for T-PRF (3000 RPM, 10 minutes in titanium tubes). The obtained PRF membranes were analysed for platelet count, antimicrobial activity, and changes in the fibrin network. Data were analysed using Statistical Package for the Social Sciences (SPSS) 20 with an independent t-test. Results: A total of 15 patients (7 females and 8 males) were included in this study, with a mean age of 23.8±2.54 years. The T-PRF had greater antimicrobial efficacy than A-PRF, with statistical significance (p<0.001), whereas the platelet count and fibrin network pattern did not show any statistical significance (p>0.05). Conclusion: According to finding of the present study result it was observed that T-PRF exhibited superior antimicrobial efficacy when compared to A-PRF.

Diagnostic Utility of the Absent Cremasteric Reflex and Prehn’s Sign in Testicular Torsion: A Multicentre Retrospective Observational Study Comparing Clinical Examination with USG and Colour Doppler Imaging

G Raghavendra Prasad, Abdullah Umayr Khan Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Testicular torsion is a urological emergency requiring timely diagnosis and surgical intervention to prevent ischaemia and testicular loss. Clinical signs such as the absent cremasteric reflex and Prehn’s sign are traditionally used, but their accuracy compared to Ultrasonography (USG) and colour doppler imaging needs validation. Aim: To validate the diagnostic utility of the absent cremasteric reflex and Prehn’s sign in identifying testicular torsion and compare them with USG and colour doppler imaging. Materials and Methods: The present multicentre retrospective observational study was conducted at Princess Esra Hospital and Deccan College of Medical Sciences, Hyderabad, India. The study reviewed records of 332 male patients presenting with acute scrotum over a five-year period (January 2015 to December 2019). The study was planned, executed, and data analysed between January 2020 and March 2021. Patients were divided into pre USG era (n=229) and USG era (n=103) based on the availability of imaging at the time of presentation. However, only 93 cases with complete clinical and imaging documentation met the inclusion criteria and were used for detailed statistical analysis. Clinical signs (absent cremasteric reflex and Prehn’s sign) and imaging findings (USG and colour doppler) were compared against surgical exploration outcomes. Diagnostic performance was evaluated using sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and accuracy. Statistical comparison between clinical signs and imaging modalities was performed using the McNemar test with significance set at p<0.05. Results: The absent cremasteric reflex showed sensitivity of 82.43% and accuracy of 74.19%, comparable to USG and colour Doppler, which demonstrated sensitivity of 81.08% and accuracy of 81.72%, as confirmed by the study results. Prehn’s sign had lower reliability, with sensitivity of 63.51% and accuracy of 59.14%, consistent with the original data. Conclusion: The absent cremasteric reflex is a reliable clinical sign for diagnosing testicular torsion, with sensitivity comparable to USG and Doppler. Prehn’s sign is less reliable. In ambiguous cases, immediate surgical exploration remains crucial.

Antimicrobial Efficacy of Methanolic Extracts of Tinospora cordifolia and Cinnamomum zeylanicum against Enterococcus faecalis Biofilm Production: An In-vitro Study

Tanushree Saxena, Manish Ranjan, Aparna Mohan, Chinnasamy Ragavendran, Mohmed Isaqali Karobari, Vivek Devidas Mahale Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: The robust nature of Enterococcus faecalis (E. faecalis) biofilms poses substantial challenges during endodontic therapy. Conventional irrigants, such as Sodium Hypochlorite (NaOCl) and Chlorhexidine (CHX), are effective but are cytotoxic and have deleterious effects on fracture resistance. Natural alternatives like Tinospora cordifolia (TC) and Cinnamomum zeylanicum (CZ) offer promising antimicrobial properties against biofilms. Aim: To evaluate the antimicrobial efficacy of TC and CZ against 21-day-old E. faecalis biofilms, compared to conventional irrigants. Materials and Methods: This an in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Chennai, India, between February 2024 and May 2024. Methanolic extracts of TC and CZ were prepared, and Minimum Inhibitory Concentrations (MICs) were determined using an agar diffusion test. Thirty-one single-rooted teeth were vertically sectioned (N=62) and incubated in an E. faecalis suspension for 21 days to establish biofilms, confirmed via Scanning Electron Microscopy (SEM). Samples were categorised into five groups (n=12): TC, CZ, NaOCl, CHX, and saline (control) and each group was treated with 2 mL of the respective solution for 10 minutes. Microbial load was assessed quantitatively via Colony-forming Unit (CFU) counts/mL and qualitatively. CFU data were expressed as mean±SD. One-way Analysis of Variance (ANOVA) with Tukey’s post-hoc test was used for intergroup comparison. Results: The findings revealed a statistically significant variation among the tested irrigants. MIC was 7 mg/L for TC extract and 7.5 mg/L for CZ extract. CFU counts/mL (mean±SD) were lowest for 5.25% NaOCl (0) and 2% CHX (0), followed by TC (15.430±4.320×107), CZ (20.564±2.234×107), and saline (34.45±5.653×107). Conclusion: Both methanolic extracts of TC and CZ show considerable antimicrobial efficacies against E. faecalis biofilm as compared to the negative control, suggesting their potential as alternative or adjunctive endodontic irrigants.

Impact of Food Insecurity on Oral Health Related Quality of Life among Brick Kiln Workers of Rayagada District, Odisha, India: A Cross-sectional Study

Payal Dash, Anandamoy Bagchi, Ipseeta Menon, Gunjan Kumar Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Food insecurity is a pressing public health issue that adversely affects both general and oral health, particularly among marginalised groups. Brick kiln workers, who are part of the informal labour sector, often lack access to adequate healthcare and nutrition. However, limited data exist on how food insecurity influences their Oral Health-Related Quality of Life (OHRQoL). Aim: To assess the impact of food insecurity on OHRQoL among brick kiln workers in Derigaon Gram Panchayat, Rayagada District, Odisha, India. Materials and Methods: A community-based cross-sectional study was conducted among 1,240 adult brick kiln workers selected through multi-stage stratified random sampling. A structured, pretested, and Odia-translated questionnaire was utilised, incorporating the Food Insecurity Experience Scale (FIES), Oral Health Impact Profile-14 (OHIP), and sociodemographic details. Descriptive statistics, Analysis of Variance (ANOVA), and Pearson’s correlation were applied for data analysis, with a significance threshold of p<0.05. Results: A high prevalence of food insecurity was observed in the study population. ANOVA revealed significant differences across FIES categories in OHIP domains such as psychosocial discomfort, physical disability, and psychological disability (p<0.05). Pearson’s correlation showed weak but significant associations between food insecurity and functional limitation (r=0.057, p=0.045), physical pain (r=0.075, p=0.008), and psychological disability (r=-0.084, p=0.003). The overall OHIP score did not significantly correlate with FIES. Conclusion: Food insecurity significantly influenced several aspects of OHRQoL among brick kiln workers. Integrated strategies targeting both nutrition and oral health are essential for improving outcomes in these vulnerable labour populations.

Ocular Manifestations in Children with Developmental Delay: A Cross-sectional Study

Renu Magdum, Arpit Gupta, Priyanka Aher, Gufran Ali Kamdar, Preethi Abraham Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Children with Developmental Delay (DD) are at increased risk for ocular abnormalities, which may further hinder their overall growth and neurodevelopment. Understanding the spectrum of these manifestations is essential for early intervention. Aim: To investigate the prevalence and types of ocular manifestations in children with DD milestones, and to study antenatal, natal and postnatal factors present in these children with ocular manifestations. Materials and Methods: The present cross-sectional study was conducted at a tertiary care centre in Western Maharashtra from September 2023 to March 2025. A total of 201 children aged six months to 15 years with a clinical diagnosis of DD were included. Each child underwent a comprehensive ophthalmic examination, including visual acuity assessment, cycloplegic refraction, squint evaluation and anterior and posterior segment examination. Relevant antenatal, natal, and postnatal histories were also recorded. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 27. Descriptive statistics were used to summarise the data. A 95% confidence level was maintained, and a p-value<0.05 was considered statistically significant Results: The mean age of the participants was 5.73±4.07 years, with 120 (59.7%) males and 81 (40.3%) females. Ocular abnormalities were present in 166 (82.6%) children with DD, while 35 (17.4%) had normal ocular findings. Refractive errors were the most common, found in 119 (59.2%) children, including hypermetropia {55 (27.4%)}, astigmatism in {42 (20.9%)}, and myopia in {22 (10.9%)}.Other common ocular conditions included strabismus {59 (29.4%)}, Cortical Visual Impairment (CVI) {13 (6.5%)}, cataract {12 (6%)} Only round off done, The values are matching with the values given in table 5 and 6, amblyopia {7 (3.5%)}, keratoconus {8 (4%)}, and optic atrophy {7 (3.5%)}. Ocular abnormalities were slightly more frequent in children with Isolated Developmental Delay (IDD) {37 (18.4%)} than those with Global Developmental Delay (GDD) {129 (64.1%)}, though this difference was not statistically significant (p=0.942). No significant associations were observed between ocular abnormalities other than refractive errors and age group, sex, or consanguinity. However, preterm birth showed a statistically significant association with ocular abnormalities (p=0.016). Conclusion: Children with DD, especially those with global delay, are at high-risk for ocular abnormalities. Early diagnosis and intervention for conditions such as refractive errors, strabismus, and CVI are essential to improve visual outcomes and support overall development. Routine vision screening and multidisciplinary collaboration are vital for ensuring timely care and preventing long-term visual impairment.

Effect of Pelvic Proprioceptive Neuromuscular Facilitation on Balance, Postural Sway and Quality of Life in Chronic Stroke Patients: A Case Series

Divyanshi, Priya Mahto, Chhavi Kumar Sharma, Sachin Gupta, Shahiduz Zafar, Shagun Agarwal Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Among long-term stroke survivors who are also chronic stroke patients, balance impairments are common, leading to increased postural sway and reduced Quality of Life (QOL). Pelvic Proprioceptive Neuromuscular Facilitation (PNF) is a targeted treatment approach focused on the pelvic region to improve coordination, mobility, and stability, thereby enhancing daily functioning and well-being. Aim: To determine the effect of pelvic PNF on balance, postural sway, and QOL in chronic stroke patients. Materials and Methods: The present case series included five patients (4 males and 1 female) aged 40-65 years with chronic stroke. Baseline data for balance, postural sway, and QOL were collected pre and post intervention. Balance was assessed with the Berg Balance Scale (BBS); postural sway was measured with a sway meter; QOL was evaluated with the Stroke-Specific Quality of Life (SS-QoL) scale. The effectiveness of pelvic PNF was determined by comparing pre and post intervention data. Results: A paired t-test showed significant differences between pre and post intervention scores (p<0.05). The BBS score increased from a preintervention mean of 30.8 to a post intervention mean of 38.2, indicating improved balance. Postural sway decreased in all directions: anterior sway from 6.9 cm preintervention to 5.3 cm post intervention, and posterior sway from 8.6 cm to 7.2 cm. Similarly, right lateral sway improved from 8.1 cm to 6.9 cm, and left lateral sway decreased from 7.1 cm to 5.9 cm, reflecting better stability. The SS-QoL score rose from 92.4 preintervention to 109.2 post intervention, indicating improved quality of life. Conclusion: Pelvic PNF improves balance, reduces postural sway, and enhances quality of life in chronic stroke patients.

App-based Assessment of Hearing Impairment among Undergraduate Medical Students in Chengalpattu District, Southern India: A Cross-sectional Study

PM Nishanth Kumaran Shri, Vedapriya Dande Rajasekar, BN Surya, Pragadeesh Palaniappan, PM Aishwarya, Vijayalakshmi Sridharan, Geethanjali Murthy, TA Durga Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Hearing loss is a significant global health issue, affecting over 430 million people worldwide, including 6.3% of the Indian population. Risk factors include excessive use of audio devices, high volume levels, and prolonged noise exposure. Early identification through accessible and cost-effective screening methods is essential, and mobile applications offer a promising approach for hearing assessment. Aim: To determine the prevalence of hearing loss among medical students and identify associated risk factors using the World Health Organisation (WHO)’s hearWHO app. Materials and Methods: A cross-sectional study was conducted between May 2024 and October 2024 among 250 undergraduate students from two medical colleges in the Chengalpattu district, Tamil Nadu, India. A pretested semi-structured questionnaire was used to collect sociodemographic details and information on various risk factors associated with hearing impairment among students aged above 18 years. The hearWHO app was used to assess hearing loss through a digits-in-noise test, categorising scores as >75, 50-75, and <50. Participants with scores <50 were classified as having hearing loss. Data analysis was performed using SPSS version 22. Statistical analysis included Chi-square tests, bivariate analysis, and multivariate logistic regression, with a significance threshold of p<0.05. Results: The prevalence of hearing loss among participants was 69 (27.6%). Significant associated factors were age >22 years (AOR=2.372, p=0.007), female gender (AOR=4.011, p<0.001), prolonged audio device usage >4 hours/day (AOR=4.216, p<0.001), listening at volumes >50% (AOR=2.866, p=0.006), and media usage during sleep (AOR=3.055, p=0.022). Symptoms such as ear discomfort or fullness and a history of ear infection were also associated with hearing loss. Conclusion: This study highlights a high prevalence of hearing loss among medical students, emphasising the need for early screening, education, and interventions. Addressing modifiable risk factors such as device usage habits and listening volume is crucial in mitigating hearing loss and promoting auditory health among young adults.

Morphological and Morphometric Characterisation of Lateral Ankle Ligament Complex in Human Cadavers: A Descriptive Cross-sectional Study

Reba Babu Alex, Smitha Sasidharan Nair, Sreekumar Rajasekharan Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: The lateral ankle ligaments are the most common to get involved in ankle sprains and problems related to ankle instability, and a precise knowledge of the morphological features of these ligaments would be highly beneficial for diagnosis and treatment. Aim: To describe the attachments, and mean dimensions of the lateral ankle ligament complex. Materials and Methods: A descriptive cross-sectional study was conducted in the Department of Anatomy, Government Medical College, Thiruvananthapuram, Kerala, India, from March 2022 to 2023. A total of 56 embalmed cadavers donated for teaching purposes were dissected to evaluate the lateral ankle ligaments. The three lateral ankle ligaments, namely Anterior Talofibular (ATFL), Calcaneofibular (CFL), and Posterior Talofibular (PTFL) were identified. Their positions with respect to external bony landmarks were defined. The morphology of the ligaments, their site of attachments, length, and width were documented. The stretching of the ligaments and their orientation with the long-axis of the fibula with dorsiflexion and plantarflexion of the foot was noted. The morphological observations were presented in percentages. Assuming the numeric measurements of the morphometric analysis to be normally distributed, the data were summarised in mean and standard deviation. Results: The ATFL was found to consist of two bands in 32 (57.14%) ankles and a single band in 24 (42.86%) ankles. The CFL was cord like in 38 (67.9%) ankles and was single banded in 18 (32.1%) ankles. The lateral talocalcaneal ligament was observed to reinforce CFL in four ankles. The mean length of ATFL, CFL and PTFL were 19.24±2.31 mm, 28.16±3.56 mm, 25.03±3.53 mm, respectively and the mean width were 8.21±1.52 mm, 5.25±1.10 mm, 7.56±1.25 mm, respectively. Conclusion: The detailed anatomical knowledge would be vital in diagnosis and arthroscopic reconstruction of the injured ankle ligaments In the era of minimally invasive surgeries, the study findings would be promising for clinical practice and research.

Pattern of Cardiac Autonomic Modulation Assessed by Heart Rate Variability in Normal Pregnancy: A Longitudinal Cohort Study

Deepali Khatri, Priya Rajeev Mardikar, Ketaki Junnare, Leena Sanjay Phadke Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Normal pregnancy is associated with adaptive maternal haemodynamics, viz., increase in blood volume, Heart Rate (HR), cardiac output, and fall in blood pressure. Alterations in hormones and plausible autonomic modulation may regulate these haemodynamic changes and failure of such alterations could have clinical consequences like pregnancy-induced hypertension and preeclampsia. Heart Rate Variability (HRV), a non-invasive measure of cardiac autonomic activity may provide insights in pattern of cardiac autonomic modulation during pregnancy, and tracking it may be useful clinically. Aim: To evaluate the pattern of cardiac autonomic modulation assessed by HRV during the course of healthy pregnancy. Materials and Methods: The present longitudinal cohort study was conducted from August 2019 to April 2021 in SKNMC & GH, Pune, Maharashtra, India. A total of 31 pregnant females who underwent repeated HRV assessment between 11^th-13^th, 18^th to 20^th, and 24^th to 26^th weeks of gestation and tracked for pregnancy outcome till delivery, were included. High sampled Electrocardiogram (ECG) (1Kz) for 15 minutes was recorded in supine left lateral position and HRV indices from last five minutes were measured. Multiple group comparisons and between-group comparisons were done using non parametric tests and p<0.05 was considered significant. Results: The mean age of 31 pregnant females was 24.1±3.4 years. Significant increase in average HR (p=0.002)was observed from first to third trimester significant decrease in overall HRV (p=0.01), total power (ms²) (p=0.008), High Frequency (HF) (ms²) (p=0.03) and Low Frequency (LH) (ms²) (p=0.001) was also observed. A trend in HFnu decrement was observed. Conclusion: As pregnancy advances, (till 26 weeks) a pattern of parasympathetic withdrawal (decreased overall variability and HF (ms²) along with increase in average HR and reduced baroreflex sensitivity (decrease in LF power) was observed with healthy pregnancy.

Efficacy of Chlorhexidine Alcohol versus Povidone Iodine Alcohol in Reducing Peripheral Venous Catheter Colonisation in Paediatric Patients: A Randomised Controlled Trial

Ajinkya Wazurkar, Sham Lohiya, Supriya Meshram, Keta Vagha, Jayant Vagha, Ashish Nimje, Shailesh Wandile, Abhiraj Parekar Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Peripheral Venous Catheters (PVCs) are routinely used in paediatric patients but are associated with catheter-related infections. Adequate skin antisepsis prior to catheter insertion is critical in preventing these infections. Aim: To compare the efficacy of 2% chlorhexidine in alcohol (CHA) with 10% povidone-iodine in alcohol (PI) in reducing catheter-tip colonisation in paediatric patients. Materials and Methods: A double-blind randomised controlled trial was conducted at the Paediatric Ward of Acharya Vinoba Bhave Rural Hospital, Maharashtra, India, from May 2024 to December 2024. A total of 102 paediatric patients aged 1 month to 16 years, admitted to the paediatric ward with an indication for intravenous catheterisation, were randomly assigned to two groups: Group A received 2% CHA and Group B received 10% PI in alcohol before PVC insertion. Upon catheter removal, the distal tips were cultured for microbial colonisation. Parameters assessed included gender, age group, mean age, incidence of catheter-tip colonisation, and type of organism isolated. Statistical tests applied included Chi-square test, Independent t-test, and Fisher’s exact test. Results: Demographic data showed comparable gender distribution (M:F=31:20 in Group A, 30:21 in Group B) and mean age (6.6±3.05 years vs 7.14±3.42 years) between the two groups. Catheter-tip colonisation occurred in 1 (1.96%) patient in Group A and 6 (11.76%) in Group B (p-value=0.112). Staphylococcus was the predominant organism in both groups, while Klebsiella and Gram-positive Cocci (GPC) were additionally isolated in the PI group. Conclusion: Catheter-tip colonisation was higher in the PI-alcohol group (6/51) compared with the CHA group (1/51); however, this difference did not reach statistical significance (p-value=0.112). A larger study is warranted to provide more definitive evidence.

Students’ Perception on Problem-based and Limerick-based Learning Methods: A Mixed-method Study

Asitava Deb Roy, KA Narayan, Mala Mukherjee, Shivasakthy Manivasakan, Aarushi Khajuria, Veena Jyoti, Himel Mondal Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Medical education continuously explores innovative teaching methods to enhance student engagement, critical thinking, and knowledge retention. Problem-based Learning (PBL) and Limerick-based Learning (LBL) are two distinctive approaches aimed at fostering these skills. PBL emphasises real-world problem solving and critical thinking, while LBL uses creative mnemonic techniques to improve memory retention. Aim: To assess medical students’ perceptions of both PBL and LBL approaches after undergoing sessions of both methods. Materials and Methods: The present mixed-method study was conducted at Mata Gujri Memorial Medical College, Kishanganj, Bihar, India, from June 2024 to September 2024. The study included 66 medical students who participated in three PBL and three LBL sessions. The students provided feedback on various aspects of the sessions using a Likert-scale questionnaire and in open-ended feedback. Since the data were non parametric, the Mann–Whitney U test was applied to compare the two samples. Alongside, a thematic analysis of student feedback was performed to identify common themes and insights. Results: There were 66 medical students: 39 males and 27 females, with a mean age of 21.75±1.49 years. PBL was found to be more effective in improving critical thinking skills and applying theoretical knowledge to practical scenarios (p<0.0001). Students found LBL to be more enjoyable and creative, fostering better memory retention of medical concepts (p<0.0001). Both methods were perceived as equally beneficial in enhancing collaboration (p=0.09), but LBL received higher satisfaction in terms of time and resource adequacy (p<0.0001). Qualitative feedback highlighted PBL’s strength in critical thinking, while LBL was appreciated for simplifying difficult concepts and making learning more enjoyable. Conclusion: Both PBL and LBL provide valuable learning experiences. A blended approach that combines the strengths of both methods may optimise medical education by fostering deep, critical thinking and efficient recall of essential medical concepts. Further research is needed to explore how these methods can be integrated effectively into medical curricula.

Comparative Outcomes of Thoracic Endovascular Aortic Repair versus Open Surgical Repair for Descending Thoracic Aortic Aneurysms: A Retrospective Cohort Analysis

Nishant Bhargava, Zakir Hussain, Jayesh Dholakiya, Prarabdh Saxena Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Descending Thoracic Aortic Aneurysms (DTAAs) pose significant management challenges, with Thoracic Endovascular Aortic Repair (TEVAR) increasingly replacing Open Surgical Repair (OSR) due to its minimally invasive nature. However, debates persist regarding long-term outcomes, durability, and optimal patient selection between these approaches. Aim: The present study aimed to compare perioperative and long-term outcomes of TEVAR versus OSR for DTAAs over a 10-year period focusing on mortality, complications, reinterventions and survival. Materials and Methods: The present retrospective cohort analysis was conducted on 133 consecutive patients (TEVAR: n=91; OSR: n=42) treated at a tertiary aortic center in Central India (2015-2025). Data collection included preoperative demographics, procedural details, and outcomes (30-day mortality, complications, reinterventions, and survival). Statistical analyses employed Kaplan-Meier survival analysis, Cox regression, and propensity score matching to adjust for confounders. Results: TEVAR demonstrated superior perioperative outcomes, with significantly lower rates of respiratory failure (p<0.01) and Acute Kidney Injury (AKI) (p=0.02), along with a trend toward reduced 30-day mortality (3.3% vs 9.5%, p=0.18). At 5-year follow-up, TEVAR showed better overall survival (80.1% vs 58.3%, p=0.042) but required more reinterventions (34.7% vs 0%, p<0.01). Multivariable analysis identified age {Hazard Ratio (HR) 1.05/year} and renal insufficiency (HR 2.12) as independent mortality predictors, while treatment modality showed no significant association (p=0.39). Conclusion: TEVAR provides superior early safety and intermediate-term survival, making it ideal for high-risk patients, while OSR offers greater durability for younger patients. Treatment selection should be individualised based on patient risk profile and anatomic suitability.

Comparison of Intravenous Ibuprofen and Paracetamol for Postoperative Pain Relief in Functional Endoscopic Sinus Surgeries: A Randomised Controlled Study

Geetha Ramalakshmi, Karthik Kanthan, Sujina Hermin, Ramamurthy Balaji Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Functional Endoscopic Sinus Surgery (FESS) is widely performed for chronic rhinosinusitis and sinonasal disorders. Despite being minimally invasive, it can cause moderate to severe postoperative pain, necessitating effective analgesia with minimal opioid use. Aim: To compare the efficacy of intravenous (i.v.) ibuprofen and i.v. paracetamol for postoperative pain management in patients undergoing FESS. Materials and Methods: This double-blind, randomise, controlled study was conducted at SRM Medical College Hospital and Research Centre in Chennai, Tamil Nadu, India done from 15th November 2024 and 2nd February 2025. It included 100 adult patients undergoing elective FESS under general anaesthesia. Patients were divided into two groups (n=50 each) to receive either i.v. ibuprofen (400 mg) (group I) or i.v. paracetamol (1 g) (group P), 30 minutes before the end of surgery. Postoperative pain intensity was assessed using the Visual Analogue Scale (VAS) score at 0, 4, 8, 12, 16, 20, and 24 hours. Secondary outcomes included total rescue opioid (i.v. tramadol) consumption, rescue analgesia requirement. Results were considered significant if ‘p’ was less than 0.05 (two-tailed). The analysis was done using IBM Statistical Package for Social Sciences (SPSS) version 21.0. Results: The baseline characteristics of groups I and P were comparable, with no significant differences observed across age (p-value=0.956), gender distribution (p-value=0.229), and weight (p-value=0.651). The ibuprofen group had significantly lower Non Steroidal Anti-Inflammatory Drugs (NSAIDs) requirements at 4, 8, 16, and 20 hours postoperatively (p-value <0.0001). Only 8% of patients in the ibuprofen group required rescue analgesia compared with 36% in the paracetamol group (p-value=0.001). Conclusion: The i.v. ibuprofen provides superior early postoperative analgesia compared to i.v. paracetamol in FESS patients, with reduced need for rescue opioids and better patient satisfaction, makes it a valuable choice in opioid-sparing pain management protocols.

Pattern of Abdominal Organ Injuries in Road Traffic Accidents: An Autopsy Based Cross-sectional Study from Central Kerala, India

Joseph Ajin, Baby Neeraja, Rajan Boney, Neeratty Asokan Balaram, Babu Boban Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: The abdominal wall usually avoids severe damage by transferring stress to the abdominal organs. Analysing the pattern of abdominal injuries in Road Traffic Accidents (RTAs) may help clinicians in providing more targeted treatment to trauma victims at the earliest. Aim: The present study aimed to analyse the pattern of abdominal organ injuries in RTAs based on medicolegal autopsies. Materials and Methods: The present cross-sectional study included data from medicolegal autopsies of RTA victims conducted between December 2019 and September 2021 at a Government Medical College hospital in Thrissur, Central Kerala, South India. All cases in which death occurred as a result of RTA-related injuries were included. Postmortem examinations were performed, and injuries were recorded. Data were statistically analysed using the chi-square test and Cramer’s V effect size value Statistical Package for Social Sciences (SPSS), version 16.0, Illinois, CA, USA). Results: A total of 70 cases were included. Males accounted for 57 (81.42%) (p=0.022). The majority of victims 55 (78.57%) were brought dead to the hospital, most of whom were between 40-59 years of age. Among single-organ injuries, the liver was most commonly involved 38 (54.28%), followed by the mesentery 23 (32.85%). The most common type of injury was liver laceration (35/67, 52.22%), followed by mesenteric contusion (20/31, 64.51%) and splenic laceration (17/67, 25.37%). Multiple-organ injuries were also observed, most commonly involving two organs. Conclusion: Liver and mesenteric injuries were the most frequently observed, highlighting the severity and complexity of abdominal trauma. These findings emphasise the need for early diagnosis, efficient trauma care systems, and preventive strategies to reduce mortality associated with such injuries.

Comparison of Two-handed Mask Ventilation using C-E versus V-E Techniques for Induction of General Anaesthesia: A Randomised Clinical Trial

Richa Tailor, Jigisha Mehta, Sara Mary Thomas Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Mask ventilation is a fundamental skill in airway management, requiring optimal hand positioning for effective ventilation. Two-handed techniques are preferred for challenging mask ventilation scenarios. Aim: To compare the effectiveness of the C-E versus the V-E techniques of two-handed mask ventilation during the induction of general anaesthesia. Materials and Methods: This randomised clinical trial was conducted in the Department of Anaesthesiology at Dhiraj General Hospital, Vadodara, Gujarat, India from August 2024 to July 2025. Seventy adult patients (American Society of Anaesthesiologists (ASA) I-III, aged 18-60 years) undergoing elective surgery were randomly allocated into two groups: Group A (C-E technique, n=35) and Group B (V-E technique, n=35). The primary outcome measured was expired Tidal Volume (TVe). Secondary outcomes included peak airway pressure (Pmax), ease of ventilation score, haemodynamic parameters, and ventilation failure rates. Data were analysed using unpaired t-tests for continuous variables and the Chi-square test for categorical variables. A p-value of <0.05 was considered statistically significant. Results: The groups were comparable in demographics (mean age: Group A-42.3±8.7 years vs. Group B-41.8±9.2 years, p-value=0.832; weight: 84.2±12.1 kg vs. 85.1±11.8 kg, p=0.751; BMI: 26.8±2.4 kg/m² vs. 27.2±2.6 kg/m², p-value=0.513). The mean TVe was significantly higher in the V-E group (677.9±76.8 mL) compared to the C-E group (450.7±71.2 mL; p-value<0.001). Peak airway pressures were similar between groups (C-E: 21.5±1.8 cmH₂O vs. V-E: 20.3±1.6 cmH₂O; p-value=0.074). The ease of ventilation score was significantly better with the V-E technique (4.2±0.6 vs. 2.7±0.8; p-value<0.001). Ventilation failure occurred in five patients (14.3%) with the C-E technique and none with the V-E technique. Conclusion: The V-E technique provides superior ventilation with higher tidal volumes, better ease of ventilation, and lower failure rates compared to the C-E technique during mask ventilation. The V-E technique achieved 50% higher tidal volumes without requiring increased airway pressures, demonstrating superior ventilation efficiency. This technique should be preferentially used for two-handed mask ventilation in clinical practice.

Adhatoda vasica and Tetracycline Coated Type I Collagen Membrane for Periodontal Regeneration: An In-vitro Study

Bawatharani Maharavi, Jaideep Mahendra, Balaji Ganesh, Aisvarya Naagendran Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Periodontitis is a chronic inflammatory disease that leads to the destruction of periodontal tissues and alveolar bone loss. The lost periodontium has been restored using regenerative materials such as collagen membrane. Enhancing these membranes with antibiotics or bioactive agents can improve their antimicrobial and physiochemical properties. Aim: This in-vitro study aimed to analyse the antibacterial and physiochemical properties of herbal agent Adhatoda vasica and tetracycline coated type I collagen membrane. Materials and Methods: The present in-vitro study was conducted at Central Research Laboratory Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India. The study was carried out over a period of four months, from December 2024 to March 2025. Type I collagen membranes devoid of pre-existing antimicrobial agents and exhibiting no structural defects were included for analysis. A total 40 membrane samples were used and divided equally into four groups (n=10 per group) to ensure uniform distribution for analysis. Adhatoda vasica extract was prepared using ethanol and coated onto Type I collagen membranes via dip coating, alone and in combination with tetracycline. The study comprised four groups: Group 1: Type I collagen membrane, (CM), Group 2: Adhatoda vasica (Av) coated CM (Av+CM), Group 3: Tetracycline coated CM, (T+CM) and Group 4: Av and T coated CM (Av+T+CM). Antibacterial efficacy was assessed through culture tests, while physicochemical properties such as membrane integrity was checked using Fourier-Transform Infrared Spectroscopy (FTIR), hydrophilicity via Ossila goniometer, surface roughness via Atomic Force Microscopy (AFM), drug release was measured via a plate reader and degradation rate was determined by electronic weighing balance machine. Data were analysed using Statistical Package for Social Sciences (SPSS) version 25.0. One-way Analysis of Variance (ANOVA) was used for intergroup comparisons. A p-value <0.05 was considered statistically significant. Results: Group 4 (Av+T+CM) showed the highest antibacterial activity with zone of inhibition significantly greater than other groups (p<0.001). Surface roughness was significantly increased in Group 2 (Av+CM) and Group 4 (p<0.01) indicating enhanced topography. Hydrophilicity varied significantly with Group 2 showing the lowest contact angle (p<0.01). FTIR analysis showed no significant spectral shifts confirming structural integrity. Group 4 exhibited burst release during the initial three hours followed by sustained release upto 48 hours and exhibited slow rate of degradation. Conclusion: The present in-vitro study suggested that Adhatoda vasica and tetracycline when used synergically as a coating on Type I collagen membrane, provides excellent antibacterial and physiochemical properties and hence can be used as a therapeutic material for preventing infections and promoting periodontal regeneration after periodontal surgery.

Insights from Histogram and Flag Analysis in Pseudothrombocytopenia Cases: A Single-centre Cross-sectional Study

Rajeswari Thivya Dhanabalan, Aarthi Kannan Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Pseudothrombocytopenia (PTCP), also known as Spurious Thrombocytopenia (TCP), is a common problem encountered in many laboratories. When stable patients are evaluated for thrombocytopenia, the first step is to exclude PTCP. Most haematology analysers are equipped with software-generated flagging algorithms that identify abnormal platelet distributions, indicating the presence of giant platelets or platelet clumping, which is reflected in the histogram. Aim: To analyse the White Blood Cell (WBC) and platelet histograms in cases showing falsely low platelet counts. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology, Chettinad Hospital and Research institute, Tamil Nadu, over a period of six months from January 2021 to June 2021. Haemogram samples were analysed using the Beckman Coulter LH 750 analyser within two hours of sample collection. Samples showing platelet counts of less than one lakh (1,00,000/μL) on the analyser were further evaluated using Leishman-stained peripheral smears to confirm platelet counts. All cases that showed low platelet counts on the analyser but adequate platelet counts on the peripheral smear were included in the study. Demographic details such as age and sex were recorded. Platelet and WBC histograms, along with platelet parameters such as Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW), were analysed. The results were tabulated using Microsoft Excel, and mean and median values were calculated. Results: In this study, PTCP cases constituted 0.32% of the total cases (18,654) and 1.96% of thrombocytopenic cases (3,060). Among the 60 identified PTCP cases, 44 were males (73%) and 16 were females (27%), giving a male-to-female ratio of 2.75:1. The study population ranged from 19 to 73 years of age, with a mean age of 45±15.11 years. MPV was within normal limits in 40 cases, increased in 15 cases, and decreased in five cases. PDW was increased in 43 cases and normal in 17 cases. Platelet histograms showed changes such as the presence of Multiple Peaks (MP flag) in 41 cases (68.3%). In WBC histograms, platelet clumping was identified by an abnormal curve in front of the lower discriminator in 53 cases (88.3%). Conclusion: Microscopic blood smear examination in cases of PTCP along with analysis of histogram can prove to be valuable tool to provide the details of the etiology and pathogenesis of PTCP.

Assessment of Central Corneal Thickness and Corneal Curvature in Patients with Pseudoexfoliation: A Cross-sectional Study

Rekha Mudhol, Nitheesha Vaddeboina Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Pseudoexfoliation Syndrome (PEX) is the most frequently reported cause of secondary open-angle glaucoma, accounting for approximately 25-30% of global cases. PXG is typically more aggressive than Primary Open-Angle Glaucoma (POAG), as evidenced by higher Intraocular Pressures (IOP), greater pressure fluctuations, and faster progression of visual field loss. Central Corneal Thickness (CCT) is a key parameter in ocular assessment for PEX patients. However, current literature offers conflicting findings regarding CCT in PEX patients. Aim: The present study compared CCT and corneal curvature between individuals with and without PXF to evaluate the IOP readings in PXF patients, thereby aiding in the early detection and management of glaucoma. Materials and Methods: The present hospital-based, cross-sectional, study included 53 patients with unilateral or bilateral PXF (study group) and 53 age-matched control patients without corneal pathology. CCT was measured using Anterior Segment-Optical Coherence Tomography (AS-OCT), and corneal curvature was measured using an auto refractometer. Independent sample t-tests and paired sample t-tests were used for statistical comparisons between groups. Results: The mean CCT was 506.15±36 μm in the study group and 501.4±34.74 μm in the control group (p=0.626). The mean corneal curvature (K1) in the right eye (OD) was 44.2±2.0 D in the study group and 45.11±2.03 D in the controls (p=0.024). K2 in OD was 46.1±1.3 D in the study group and 46.9±1.2 D in controls (p=0.005). In the left eye (OS), the mean K1 was 44.06±1.7 D in the study group and 45.04±1.5 D in controls (p=0.002), while the mean K2 was 46.5±1.2 D in the study group and 47.2±1.3 D in controls (p=0.009). There was no statistically significant difference in CCT between PXF and control eyes (p=0.626). However, keratometry values (K1 and K2) were significantly lower in PXF eyes compared to controls in both OD and OS. Conclusion: There was no significant difference in mean CCT between the PXF and control groups, nor between PXF eyes and fellow eyes in unilateral PXF cases. However, the mean corneal curvature was significantly lower in individuals with PXF than those without, suggesting possible implications for accurate IOP measurement and early glaucoma management.

Intranasal Vacha Taila Nasya as Add-on Therapy for Postdural Puncture Headache: A Pilot Randomised Controlled Trial

Amit Ashok Paliwal, Sanjay Babar, Rutuja Bhosale, Shital Rasane, Vasudha Asutkar Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Postdural Puncture Headache (PDPH) is a common complication of spinal anaesthesia, typically managed with conservative measures or invasive epidural blood patch. Vacha (Acorus calamus) Taila Nasya, described in Ayurveda for head disorders, offers potential as a safe, non invasive adjunct therapy. Aim: To evaluate the efficacy and safety of Vacha Taila Nasya as an add-on therapy in routine postoperative care for PDPH. Materials and Methods: This single-centre, pilot, randomised controlled trial was conducted at the Inpatient Departments of Shalyatantra and Stree Prasuti, Dr. D. Y. Patil College of Ayurved and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune, Maharashtra, India over a period of 1 year and 6 months. A total of 40 patients diagnosed with PDPH following spinal anaesthesia were enrolled. Participants were randomised into two groups: Group A (control: routine postoperative care including hydration, bed rest, analgesics, and caffeine as required) and Group B (intervention: routine postoperative care plus Vacha Taila Nasya, 2 drops per nostril, twice daily for 3 days). The study was conducted in an open-label design; however, outcome assessment was performed by a blinded investigator. The primary outcome was change in Visual Analogue Scale (VAS) pain score. Secondary outcomes included resolution of associated symptoms (neck stiffness, tinnitus, hypoacusis, photophobia, nausea) and incidence of adverse events. Data analysis was carried out using the Mann–Whitney U test with Statistical Package for the Social Sciences (SPSS) software, version 26.0 (IBM Corp., Armonk, NY, USA). Results: Patients in the Vacha Taila Nasya group (Group B) demonstrated significantly greater pain reduction compared to the control group (mean VAS score reduction was 5.6±1.2 in Group B compared to 3.1±1.4 in Group A (p-value=0.004). Associated symptoms such as nausea, neck stiffness, and photophobia also improved significantly (p-value <0.05 for all). No major adverse events were observed; only 2 patients (10%) reported mild nasal irritation, which resolved spontaneously without intervention. Conclusion: Vacha Taila Nasya was safe, feasible, and demonstrated promising efficacy as an adjunct therapy in the management of PDPH. As part of an integrative approach, it may reduce symptom burden, minimise reliance on conventional analgesics, and enhance patient comfort in the postoperative setting. Early adoption in selected cases could provide a simple, non invasive supportive therapy alongside routine care.

Prevalence and Patterns of Musculoskeletal Injuries among Female Karate Athletes: A Cross-sectional Study

Suma Patil, Pushparaj Kulal, Brinda Dcosta Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Karate is a high-intensity combat sport that subjects athletes to repeated biomechanical stress, often resulting in Musculoskeletal Injuries (MSIs), particularly among female athletes. Despite the increasing participation of females in this sport, there remains a paucity of gender-specific injury data. Aim: To determine the prevalence and patterns of MSIs among female karate athletes in the Hubli-Dharwad region. Materials and Methods: This cross-sectional observational study was conducted from January 2025 to April 2025, involving 70 female karate practitioners aged 18-35 years across six registered karate academies in the Hubli-Dharwad region, Karnataka, India. Participants had a minimum of two years of consistent training. The Nordic Musculoskeletal Questionnaire (sport-adapted) was used to document symptoms over the past 12 months. Injury prevalence across anatomical regions was calculated, and correlations between injury sites were assessed using Spearman’s coefficient. A p-value of <0.001 was considered statistically significant. Results: The overall prevalence of MSIs was observed in 51 participants (72.9%). The most commonly affected areas were the lower back (24 participants, 34.3%), knees (21 participants, 30.0%), shoulders (20 participants, 28.6%), and wrists/hands (18 participants, 25.7%). Statistically significant correlations were observed between several adjacent or functionally linked areas, including the shoulders and upper back (r-value=0.467; p-value <0.001) and knees and ankles/feet (r-value=0.540; p-value <0.001), suggesting biomechanical interdependence. The Sport-adapted Nordic Musculoskeletal Questionnaire (SNMQ) demonstrated acceptable internal consistency, with a Cronbach’s α of 0.761. Conclusion: Female karate athletes exhibit a high burden of MSIs, predominantly affecting the lower back and lower extremities, followed by the shoulder and upper back. These findings emphasise the need for gender-specific preventive strategies and biomechanically informed training modifications to safeguard athlete health and performance.

Prevalence of Post COVID-19 Pulmonary Arterial Hypertension and its Clinical Association with CT Severity Score among COVID-19 Pneumonia Survivors in a Tertiary Care Hospital of Western Odisha, India

Panda Sibaram, Panda Mayadhar, S Nanda, Sharma Sunil Kumar Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus targets the Angiotensin Converting Enzyme 2 (ACE2) receptor, which is abundantly present in two vital organs of the body, namely the lungs and the heart, making the pathogen devastating. Because these organs are closely linked in their pathophysiology, disease in one organ can affect the other. It has been observed that patients recovering from Coronavirus Disease 2019 (COVID-19) pneumonia can later develop fatal cardiac complications such as Pulmonary Arterial Hypertension (PAH) as a result of multiple and complex pathophysiological phenomena. PAH leads to right ventricular failure and death due to increased pulmonary vascular resistance. However, early diagnosis with appropriate medical management can increase survival and quality of life. The chest Computed Tomography (CT) severity score on High Resolution Computed Tomography (HRCT) of the lungs is a standard index for estimating the severity of pneumonia in hospitalised COVID-19 patients. Aim: To estimate the prevalence of post COVID-19 PAH and to assess the association between chest CT severity score and post COVID-19 PAH among survivors of COVID-19 pneumonia. Materials and Methods: A cross-sectional study was conducted in the Department of Cardiology, VIMSAR, Burla, Odisha, India, from October 2020 to October 2023, enrolling 854 patients with cardiac complaints in the post COVID-19 period. Severity of COVID-19 pneumonia was graded as mild, moderate, or severe according to the semiquantitative chest CT severity score method, based on the CT reports from the COVID-19 period. The enrolled patients were thoroughly examined; those with abnormal cardiac signs and Electrocardiography (ECG) or chest X-ray suggestive of underlying PAH underwent echocardiography. Diagnosis of PAH was performed according to the 2022 European Society of Cardiology (ESC) Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension. Nonparametric statistical methods, such as the Chi-square test, were used to analyse qualitative data, whereas quantitative variables were expressed as means with standard deviations, and an unpaired t-test was used to compare means between two groups. Results: The prevalence of PAH in the post COVID-19 period among pneumonia survivors was 12.1%. A total of 104 patients were diagnosed with PAH: 35 (33.7%) had severe pneumonia, 26 (25.0%) had mild pneumonia, and 43 (41.3%) had moderate pneumonia. The chest CT severity score was significantly associated with the development of post COVID-19 PAH. Conclusion: Higher chest CT severity scores during acute COVID-19 pneumonia are associated with a greater risk of developing PAH in the post COVID-19 period. Proper screening of these patients can enable earlier detection of post COVID-19 PAH.

Efficacy of Oral Ketamine and Midazolam Combination versus Oral Midazolam alone as Premedicants in Paediatric Surgical Patients: An Interventional Study

Shweta R Devaranavadagi, Basavaraj B Devaranavadagi, RB Ravishankar, Gurushantappa S Kadakol Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: In paediatric patients midazolam and ketamine are commonly used as premedicants, intended to reduce emotional trauma and ensure smooth induction. Hence, we undertook a study to evaluate if addition of oral ketamine 3 mg/kg to oral midazolam 0.5 mg/kg resulted in better premedication than oral midazolam 0.5 mg/kg alone. Aim: To evaluate whether the addition of oral ketamine 3 mg/kg to oral midazolam 0.5 mg/kg results in more effective premedication compared to oral midazolam 0.5 mg/kg alone in paediatric surgical patients. Materials and Methods: The present interventional study was conducted on 100 children who were assigned equally to the two groups (n=50 each) aged eight months to six years belonging to ASA grade I and II undergoing elective surgeries. Group KM received oral ketamine 3 mg/kg with midazolam 0.5 mg/kg and group M received oral midazolam 0.5 mg/kg 30 minutes prior to proposed surgery. Sedation score, anxiolysis score, parental separation and mask tolerance was assessed in all patients 30 minutes after the drug administration. The data was analysed by using statistical Statistical Package for Social Sciences (SPSS) software. The p-values <0.05 were considered statistically significant, and 95% confidence intervals are reported where applicable. Results: A total of 100 children were randomly divided equally into two groups. The mean age was 3.42±1.48 years in group KM and 3.81±1.69 years in group M, while the mean weight was 12.24±3.59 kg and 13.64±3.77 kg, respectively. Gender and ASA status were comparable between the groups. Satisfactory sedation was achieved in 72% of children in group KM compared to 54% in group M. Anxiolysis was significantly better in group KM (80% score IV) than in group M (24% score IV). Parental separation was smoother in group KM (96% calm separation) compared to 78% in group M. Mask tolerance was also superior in the KM group. All differences were statistically significant (p<0.05). Conclusion: Oral ketamine 3 mg/kg with midazolam 0.5 mg/kg produces significantly better sedation, anxiolysis, parental separation and mask acceptance without significant side effects when compared to oral midazolam 0.5 mg/kg alone. The quality of sedation, anxiolysis and separation parameters are significantly better in midazolam and ketamine combination group.

Efficacy of Gambhari Phala Granules versus Haridra Khanda in the Management of Sheetapitta (Urticaria): A Randomised Controlled Clinical Trial

Tanika Yadav, Vaishali Kuchewar Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Large wheals or erythematous, pruritic rashes on the skin are characteristic of urticaria. It is characterised by raised, itchy lesions that may last longer than six weeks in chronic cases and resemble a nettle sting. About 20% of people experience it at some point in their lives. Conventional medicine mainly addresses symptoms and often requires long-term medications, which may cause undesirable side-effects. The hallmark of Sheetapitta (urticaria) is itchy red rashes that may appear nearly everywhere on the body. In Ayurveda, repeated Shodhana (detoxification) and Shaman Chikitsa (internal medication) are recommended for Sheetapitta. Various Acharyas have described different herbal and herbo-mineral treatments for Sheetapitta. Yogratanakara mentions Gambhari phala (Gmelina arborea fruit) with milk. Aim: To determine whether Gambhari phala (Gmelina arborea fruit) granules and Haridra Khanda (Curcuma longa granules) are effective in reducing wheal appearance, intensity and the duration of itching in Sheetapitta. Materials and Methods: This randomised controlled trial was conducted for 30 days at Mahatma Gandhi Ayurved College, Hospital and Research Centre, Wardha, Maharashtra, India. Two equal groups of 60 patients were enrolled. In Group H, Haridra Khanda (Curcuma longa granules) was administered as an adjuvant, while Gambhari Phala (Gmelina arborea fruit) granules were administered to Group G, at a dose of 3 g twice daily for 30 days. The effectiveness of the intervention was evaluated using baseline subjective and objective measures and the data were compared. Results: There was no statistically significant difference between the groups (p-value=0.67), with the mean age of Group G (Gambhari Phala granules) 38.53±13.18 years and Group H (Haridra Khanda) 39.43±12.51 years. Comparable distributions were found for gender, diet, Koshtha and Prakruti (p-value> 0.05 for all). Absolute Eosinophil Count (AEC) values decreased significantly in Group G from 217.20±74.63 to 184.48±50.25 (p-value=0.012); however, Group H did not show a significant change (p-value=0.32). By Day 15 (p-value=0.0056) and day 30 (p-value=0.0001), Group G showed significant improvement from baseline Urticaria Activity Score (UAS) scores, which were similar between groups (p=0.26). According to the 5D Pruritus Scale, 100% of patients in Group G reported less than 6 hours of itching per day by Day 30, compared with 57.1% in Group H. Group G showed a substantial reduction in itching duration across all time points (p-value <0.01). On day 30, 86.2% of patients reported no irritation, compared with 57.1% in Group H (p-value=0.026), indicating a considerable improvement in itching in Group G. During the 30-day treatment period, neither group experienced adverse events. Conclusion: Gambhari Phala granules in patients with Sheetapitta significantly improved clinical outcomes, including reductions in pruritus intensity and wheal severity, without notable adverse effects. Gambhari Phala appears to be a safe and effective Ayurvedic alternative and was more effective than Haridra Khanda in terms of UAS and 5D Pruritus Scale scores. Regarding urticaria symptoms, Haridra Khanda was less effective than Gambhari Phala.

Intraoral Nitroglycerine Spray versus Intraoral Lignocaine Spray to Suppress the Haemodynamic Response to Endotracheal Intubation in Patients undergoing Elective Surgeries under General Anaesthesia: A Randomised Clinical Trial

Karthickvel Murugavel, Kala Balasubramanian, Bhagyavardhan Botta, Jaya Hasita Goda Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: General Anaesthesia (GA) is the keystone in the management of complicated and specialised surgeries, enabling the safe and effective performance of procedures that would otherwise be intolerable or unsuccessful for patients. Airway manipulation during GA, especially laryngoscopy and endotracheal intubation, leads to acute haemodynamic changes that may pose risks in susceptible individuals. Aim: To compare the effect of intraoral Nitroglycerine (NTG) spray versus the intraoral lignocaine spray before laryngoscopy and endotracheal intubation. Materials and Methods: A single-centre, double-blinded, randomised clinical trial was conducted in the Department of Anaesthesia, Sree Balaji Medical College/BIHER, Chennai, Tamil Nadu, India over 18 months from January 2021 to June 2023. Total of 60, American Society of Anaesthesiologists (ASA) grade I and II patients undergoing elective surgery under GA were randomised into two groups: group A received an intraoral spray of nitroglycerin 400 mcg, and group B received an intraoral spray of 10% lignocaine 20 mg. Haemodynamic parameters were recorded at multiple time points during induction, intubation and at various time intervals post-intubation. Data were analysed using Statistical Package for Social Sciences (SPSS) software version 23.0 via independent two-tailed t-test and One-way Analysis of Variance (ANOVA) for parametric data and via Chi-square test for non parametric data. A p-value < 0.05 was considered statistically significant. Results: Among total of 60 participants, 33 (55%) belonged to the age group 20-29 years, and 37 (61.67%) were males. The data showed significant attenuation of Blood Pressure (BP) and Heart Rate (HR) changes during laryngoscopy, intubation and post-intubation in both groups (Mean HR: 85.42 vs 77.22 bpm) {Mean Systolic Blood Pressure (SBP): 124.1 vs 128.53 mmHg} {(Mean Diastolic Blood Pressure (DBP): 78.16 vs 81.27 mmHg} and {Mean Arterial Pressure (MAP): 93.47 vs 97.04 mmHg}, with comparative analysis suggesting that NTG exhibited superior control over blood pressure and the results were statistically significant (p-value <0.05). Conclusion: Both intraoral lignocaine and nitroglycerin sprays effectively attenuate intubation-induced haemodynamic responses, with nitroglycerin providing superior blood pressure control during laryngoscopy and intubation. Nitroglycerin spray may be preferred for patients requiring enhanced haemodynamic stability, especially those with hypertension or coronary artery disease, pending further large-scale studies.

Impact of Prolonged Tourniquet Time on Wound Healing in Orthopaedic Surgeries: A Retrospective Cohort Study

V Venkataram, Karthik Prakash, Gayatri R Nair Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Tourniquet application is routinely used in orthopaedic surgeries to reduce intraoperative blood loss and enhance surgical field visualisation. However, prolonged use of it may adversely affect tissue perfusion and delay wound healing. Aim: To evaluate the association between tourniquet duration and wound healing in patients undergoing orthopaedic surgeries. Materials and Methods: The present retrospective cohort study was conducted at Mahatma Gandhi Medical College and Research Institute, Pondicherry, India, over a period of six months involving 40 patients who underwent orthopaedic procedures involving tourniquet use. Participants were categorised into two groups based on tourniquet time: less than 120 minutes (n=23) and 120 minutes or more (n=17). Delayed wound healing was defined as wound dehiscence requiring clinical intervention, delayed suture removal beyond postoperative day 12, or the presence of a surgical site infection confirmed clinically or microbiologically. Delayed wound healing incidences were compared between groups using Fisher’s-exact test. Results: A total of 40 patients were included in the study, of whom 7 were females and 33 were males. Delayed wound healing occurred in 4 out of 17 patients (23.5%) with tourniquet time ≥120 minutes, while none of the patients in the <120-minute group experienced delayed healing. The difference was statistically significant (p=0.026). Conclusion: Prolonged tourniquet application of 120 minutes or more is significantly associated with delayed wound healing in orthopaedic surgeries. Careful consideration of tourniquet duration is warranted to minimise postoperative complications and support optimal healing.

Comparison of Efficacy and Durability of Three Desensitising Agents in Non Carious Non Restorable Lesions: A Randomised Clinical Study

Sankalp Mahajan, Nimisha Shah, Meetkumar Dedania, Anuja Bhavsar, Vishnu Pratap Singh Rathore Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Dentin hypersensitivity arises from stimulus transmission across exposed dentin, leading to pain through a hydrodynamic mechanism. The primary goal in treating this condition is to provide immediate and lasting pain relief while restoring the impermeability of dentinal tubules. However, an ideal desensitising agent has yet to be identified. Aim: To compare the efficacy of Admira Protect, Gluma Desensitizer, and Seal&Protect as an antihypersensitive agent in non carious, non restorable lesions and the durability of the bond for one, three and six months. Materials and Methods: This randomised clinical study was carried out in the Department of Conservative Dentistry and Endodontics at K.M. Shah Dental College and Hospital, Vadodara, Gujarat, India, from January 2016 to July 2017, with 90 teeth from 27 patients randomly assigned to one of three groups, each containing at least 30 teeth with a Visual Analogue Scale (VAS) score of 4 or higher. Admira Protect-group A (n=30); Seal&Protect-group B (n=30), and Gluma Desensitiser-group C (n=30). Dentin hypersensitivity was evaluated using tactile, thermal (cold), and evaporative stimuli at four time points: baseline, immediately after treatment, and at one, three, and six months post-treatment. Sensitivity levels were recorded using a VAS. The experimental agents were applied by a co-investigator per the manufacturer’s instructions, while the principal investigator assessed sensitivity at all time points. Data were analysed using One-way Analysis of Variance (ANOVA) and post-hoc Tukey tests. Results: All three treatment groups demonstrated significant differences (p-value <0.05) at baseline, immediately after treatment, and during the 3 months and 6 months follow-ups. A statistically significant difference was observed between Admira Protect (A) and Gluma Desensitiser (C). However, no significant differences were found between Admira Protect (A) and Seal&Protect (B), or between Seal&Protect (B) and Gluma Desensitiser (C). Overall, all three agents proved effective for approximately six months. Conclusion: Admira Protect demonstrated a statistically significantly greater reduction in dentin hypersensitivity compared to Gluma Desensitiser, particularly at immediate, 1-month, and 3-month assessments.

Correlation of an Emerging Inflammatory Marker Neutrophil Lymphocyte Ratio with Obesity Markers among Medical Students: A Cross-sectional Study

Divyashree, Anand Kachigere Siddeshwara Siddegowda Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Obesity contributes to chronic low-grade systemic inflammation and increases the risk of non-communicable diseases such as cardiovascular disease, diabetes, and hypertension. The Neutrophil-to-Lymphocyte Ratio (NLR) is a simple and accessible marker that reflects the balance between innate and adaptive immunity, thereby serving as an indicator of early systemic inflammation. Although elevated NLR has been associated with metabolic and cardiovascular disorders, limited evidence is available on its significance in healthy young adults, particularly among medical students. This highlights the need to explore its relationship with obesity markers in this population. Aim: To assess the relationship between obesity markers and NLR among first-year medical students. Materials and Methods: The present cross-sectional study was conducted at a rural medical college in southern India and included 202 first-year undergraduate medical students who provided written informed consent. Demographic details and medical history were recorded. Anthropometric measurements, including height, weight, and waist circumference, were taken using standardised methods. Body Mass Index (BMI) was calculated and classified according to World Health Organisation (WHO) Asian criteria. Venous blood samples were collected for complete blood count, and NLR was calculated by dividing the absolute neutrophil count by the lymphocyte count. Associations were analysed using Pearson correlation in GraphPad Prism version 10.60. Results: Mean NLR values increased across BMI categories: 1.98 in normal weight, 2.2 in overweight, and 2.5 in obese participants (p<0.0001). BMI showed a strong positive correlation with NLR (r=0.604, p<0.0001), while waist circumference also demonstrated a significant correlation (r=0.542, p<0.0001). Total leukocyte count did not differ significantly between BMI groups. Conclusion: NLR increases with rising BMI and waist circumference, indicating subclinical inflammatory changes in healthy young adults. Monitoring NLR may serve as a practical and early marker of systemic inflammation, helping to guide timely preventive interventions for at-risk young individuals. Screening for NLR in obese individuals can aid in the early identification of inflammatory risk.

Comparison of Wilson’s Score and Intubation Prediction Score for Prediction of Difficult Endotracheal Intubation: A Prospective Observational Analytical Study

Jigisha Bharatbhai Mehta, Apoorva Tarafdar, Sara Mary Thomas, Arpan Patel Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Prediction of a difficult airway is of utmost importance, as an unanticipated difficult airway can lead to severe adverse events. Clinically, prediction is done using independent bedside tests; however, these often lack accuracy. Moreover, most airway assessment scores are cumbersome and subject to interobserver variability because of subjective parameters. Wilson’s Score and the Intubation Prediction Score (IPS) are commonly used scoring systems for preoperative airway evaluation. Aim: To determine the diagnostic accuracy of the Wilson Score and IPS in predicting difficult airways. Materials and Methods: This prospective, observational, analytical, single-blind study was conducted among 120 patients aged 18 to 70 years who underwent surgeries requiring endotracheal intubation. All patients underwent airway assessment using both the Wilson Score and IPS. General anaesthesia with endotracheal intubation was performed by an anaesthesiologist who was unaware of the patients’ scores. The ease of laryngoscopy and intubation was assessed using the Intubation Difficulty Scale (IDS), where an IDS score greater than 5 indicated a difficult airway. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and overall accuracy of both scoring systems were calculated. McNemar’s test was used to compare diagnostic performance, with p-value <0.05 considered statistically significant. Results: A total of 120 patients were assessed, of whom 58 (48.33%) were male and 62 (51.67%) were female. The mean age and weight of the patients were 40.47±12.14 years and 70.53±13.76 kg, respectively. Sixty-six (55%) patients belonged to American Society of Anaesthesiologists (ASA) Grade I, and 54 (45%) to ASA Grade II. The actual incidence of difficult airway was 11.67%. Wilson’s Score showed a sensitivity of 21.43%, specificity of 93.40%, PPV of 30.00%, NPV of 90.00%, and accuracy of 85.00%. IPS demonstrated significantly better sensitivity (71.43%; p-value=0.014), PPV (83.33%; p-value=0.023), and overall accuracy (95.00%; p-value=0.012). Both systems showed high specificity (IPS: 98.11%; Wilson’s: 93.40%; p-value=0.172), while NPV was higher for IPS (96.30% vs. 90.00%; p-value=0.057). Conclusion: The IPS outperforms Wilson’s Score in predicting difficult endotracheal intubation, particularly in terms of sensitivity, PPV, and overall accuracy. Incorporating IPS into routine preoperative assessment may enhance patient safety. Therefore, it can be preferred as a simple and accurate bedside tool for predicting difficult airways in patients undergoing endotracheal intubation under general anaesthesia.

Correlation between Cognition, Functional Ability and Quality of Life in Older Adults having Subjective Cognitive Decline: A Cross-sectional Study

Madhuchhanda Mohanty, Jasobanta Sethi, Prakash Kumar, Meenakshi Batra Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Subjective Cognitive Decline (SCD) represents self-perceived cognitive impairment that may precede objective signs of cognitive decline. Exploring the association between cognition, functional ability, and Quality of Life (QoL) among older adults having SCD, will help in identification of at-risk population and tailor interventions. Aim: To investigate the association between cognition, functional ability and QoL among older adults having SCD across different Socioeconomic Status (SES) and gender. Materials and Methods: The present a cross-sectional study included data collected from the Outpatient Department (OPD) of a Rehabilitation Institution in Delhi, India between July 2023 to October 2023. Data from 130 older adults with SCD was taken by random sampling for cognition, functional ability, QoL and SES. Cognition was assessed using Montreal Cognitive Assessment (MOCA) and Addenbrooke's Cognitive Examination III (ACE-III). Functional ability was measured by Lawton Instrumental Activities of Daily Living (L-IADL) Scale, QoL {Health Related Quality of Life (HRQoL)} by SF-36 Health Survey and Kuppuswamy socioeconomic scale was used to measure SES. Descriptive statistics, Pearson product-moment correlations, and chi-square tests were used to explore the association between the variables. Results: SES was not significantly correlated with IADL (r=-0.098, p=0.267), SF-36 scores (r=0.131, p=0.138), or ACE-III scores (r=0.145, p=0.099). In males, a statistically significant moderate positive correlation was found between MOCA and ACE-III scores (r=0.521, p<0.001), indicating consistency in cognitive assessment tools and no significant correlations were found between SES and MOCA (r=0.137, p=0.221), IADL (r=-0.076, p=0.502), or SF-36 scores (r=0.072, p=0.520). Among females, a statistically significant moderate-to-strong correlation was also observed between MOCA and ACE-III scores (r=0.546, p<0.001). Additionally, a weak but positive, nearly significant correlation was observed between SES and MOCA scores (r=0.255, p=0.078), indicating a possible trend. The correlation between SES and SF-36 was also weak and non-significant (r=0.212, p=0.143). Conclusion: A statistically significant moderate positive correlation was observed between MOCA scores and ACE-III scores. This indicates that participants who scored higher on the MOCA also tended to have higher ACE-III scores. The correlation between SES and MOCA score was weak and not statistically significant. Other variables did not show strong or statistically significant relationships.

Om (Aum) Chanting as a Physiological Approach for Managing Type D Personality: A Narrative Review of Cognitive, Autonomic, Psychological, and Biochemical Outcomes in Adults

Paulson Jose, Punita Pushpanathan, Sendil D Kumaran, Joseph Kurian Mukkadan, Muninathan Natarajan Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Type D personality includes negative emotions and social withdrawal with constant stress activation and different biological regulation. This leads to autonomic dysfunction, hormonal imbalance, and immune activation thus increasing the vulnerability to cardiovascular and mental health problems. Aim: To examine the psychobiological features of Type D personality and assess the role of “OM” chanting in improving vagal tone, reducing stress reactivity in individuals. Materials and Methods: A comprehensive search strategy was conducted in PubMed, Scopus, Web of Science, and Google Scholar (1990–2025) using keywords related to Type D personality. vagal tone, and OM chanting. A total of 1,287 records were identified, 1,019 were screened after the removal of duplicates, 80 full-text reports were sought for retrieval and assessed for eligibility, with 30 studies finally included in the review. Studies were narratively synthesised, focussing on Type D’s psychobiological impact and OM chanting’s effects on autonomic and psychological parameters. Results: Type D personality showed exact signs of stress system overactivity, with higher cortisol levels, lower heart rate variability, and increased inflammatory markers. These patterns show the chronic stress, poor autonomic control, and higher risk for cardiovascular problems. OM chanting had measurable calming effects which increases parasympathetic activity, improves heart rate variability, and lowers blood pressure. Type D individuals showed better memory and coordination after regular practice, and group chanting helped lower cortisol and strengthen social bonding. Overall, OM supports both mental and physical relaxation. Conclusion: “OM” chanting is a non-invasive, accessible intervention that can reduce the physiological and psychological burden of Type D personality, complementing care, easing stress, and lowering cardiovascular risk in preventive and therapeutic settings.

An In-vitro Evaluation of Fracture Resistance of Pulpotomised Permanent Teeth Restored with Different Aesthetic Restorative Materials

Anila Bandlapally Sreenivasa Guptha, Jahnavi Kolluri, Sayesh Vemuri, Nagesh Bolla, Roopadevi Garlapati, Chukka Ram Sunil, Mayana Aameena Banu, SK Afreen Kamal Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: One of the fundamental goals of modern dentistry, centered around the ideology of minimally invasive dentistry, is to maintain tooth pulp viability. The dental pulp has the capacity for repair, depending on the intensity of damage and the level of pulp inflammation. All attempts are made to preserve the vitality of the radicular pulp. Pulpotomy has been reinvestigated as a definitive therapeutic option for mature permanent teeth with extensive carious lesions. Furthermore, Class II Mesio-Occluso-Distal (MOD) cavity preparation undergoing pulpotomy reduces the teeth’s fracture resistance. Aim: To evaluate and compare the fracture resistance of pulpotomised premolars treated with calcium silicate materials, such as Mineral Trioxide Aggregate (MTA) or Biodentine (BD), in Class II MOD cavities restored using Cention-N and nanohybrid composite. Materials and Methods: An in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India, from November 2023 to December 2023. A total of 55 extracted maxillary premolars were collected, embedded in acrylic resin molds, and divided into five groups of 11 teeth each. Group 1: Intact teeth, Group 2: Standardised Class II MOD cavities were prepared, coronal pulpotomy was performed, and teeth were restored with MTA. After the complete setting of MTA, a Glass Ionomer Cement (GIC) base was placed, followed by restoration with a nanohybrid composite, Group 3: Similar procedure as Group 2, but with MTA as the capping material and restored with Cention-N, Group 4: Similar procedure as Group 2, but with BD as the capping material and restored with a nanohybrid composite, Group 5: Similar procedure as Group 2, but with BD as the capping material and restored with Cention-N. Specimens were subjected to a fracture resistance test using a Universal Testing Machine (UTM). The load at which restorations fractured was recorded in Newtons (N), and the obtained data were statistically analysed using One-way Analysis of Variance (ANOVA) and post-hoc tests. Data were considered significant if p≤0.05. Results: Intact teeth (1273.64 N) had the highest mean fracture resistance compared to other groups. Group 5 (973.64 N) showed the highest mean fracture resistance, followed by Group 3 (895.45 N), Group 4 (700 N), and Group 2 (633.64 N). The differences in fracture resistance were statistically significant (p<0.05). Conclusion: The present in-vitro study found that intact teeth had the highest fracture resistance. Among the experimental groups, pulpotomised premolars restored with BD and Cention-N showed significantly greater fracture resistance. In contrast, restorations using MTA and nanohybrid composites exhibited lower resistance. BD and Cention-N outperformed the MTA-Cention-N, BD-Nanohybrid, and MTA-Nanohybrid combinations. Therefore, BD and Cention-N can be considered preferred materials for restoring pulpotomised maxillary premolars with Class II MOD cavities.

Ultrasound and Fluoroscopy-assisted Central Venous Catheterisation: A Retrospective Evaluation of Device Survival and Complications in a Tertiary Care Setting

Vishal Nandkishor Bakare, Ritesh Kumar Sahu Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Central Venous Access Devices (CVADs) are indispensable in tertiary care for administering chemotherapy, parenteral nutrition, and haemodialysis. Image-guided insertion, particularly under Ultrasonography (USG) and fluoroscopy, has significantly reduced complications compared to landmark-based techniques. However, data on outcomes and complications in diverse patient populations remain limited. Aim: To evaluate the technical success, device survival, and complications associated with image-guided CVAD insertions, focusing on patient demographics, catheter types, and risk factors. Materials and Methods: A retrospective analysis was conducted on 100 patients who underwent CVAD placement in the Department of Interventional Radiology of a tertiary care setting, Pune, India, from January 2015 to June 2016. Data were collected using a structured case record form, including demographics, catheter types (tunneled, non-tunneled, Peripherally Inserted Central Catheters (PICC), ports), access sites (internal jugular, femoral, basilic veins), and complications (early: <24 hours; intermediate: 24 hours-30 days; late: >30 days). Technical success was defined as successful catheter placement with tip confirmation at the cavoatrial junction and functional patency. Statistical analysis included descriptive statistics (mean, SD, percentages) and device survival analysis (from insertion to removal or patient death). Results: The study comprised 60 males and 40 females (mean age: 37.13±16.61 years). Tunneled catheters (Permacath) were most common (41%), followed by PICCs (36%). The right internal jugular vein was the preferred access site (61%). Technical success was achieved in 100% of cases. Device survival averaged 146.32±98.9 days (median: 135.5 days). Complications included infection (4%), catheter occlusion (2%), and tip migration (1%). Seven patients died during follow-up, none from catheter-related causes. Conclusion: Image-guided Central Venous Catheter (CVC) insertion demonstrated excellent technical success rates. The right internal jugular vein was the safest access site, while infectious complications remained the most common adverse outcome despite relatively low occurrence rates. These findings support current practice standards while identifying areas for continued quality improvement.

Effect of Sensor Monitored Upright Sitting on Core Muscle Thickness, Contractibility and Spinal Posture among Asymptomatic University Students: A Study Protocol for RCT

Varsha Huddar, Sanjiv Kumar, Ashwin Patil Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Prolonged sitting in classrooms predisposes students to poor posture, muscle imbalance, and low back pain. Tonic activation of the core muscles that stabilise the spine increases when seated upright, and this may have positive effects on pulmonary function and overall wellbeing. Need of the study: Although there is extensive literature on upright sitting activating the core, little is known about upright sitting as an intervention for core strengthening compared with conventional exercises in asymptomatic students with core weakness. Hence, this study aims to determine and compare the effect of four weeks of upright sitting as an intervention. Aim: To compare the effects of four weeks of sensor-monitored upright sitting, conventional exercises, and a combination of upright sitting and conventional exercises on core strength, as measured by the plank test, surface Electromyography (EMG), and ultrasonography, in asymptomatic university students with core weakness. Materials and Methods: This is a randomised three-arm, assessor-blinded controlled trial that will be conducted in the physiotherapy department of a tertiary-care hospital in North Karnataka, India. A total of 120 university students with core weakness, aged 18 to 25 years, will be randomly assigned to one of three groups: upright sitting group; conventional exercises group; or combined upright sitting and conventional exercises group. Ethical clearance for the study was obtained from the KAHER Ethics Committee (KAHER/EC/24-25/417). The outcome include plank hold test to evaluate the core endurance, surface EMG to assess muscle contractability and ultrasonography to assess muscle thickness, Forced Vital Capacity (FVC), and Forced Expiratory Volume in one second (FEV1) ratio by portable spirometer and posture by Artificial Intelligence Posture Evaluation and Correction System (APCES) application, will be assessed at pre, post 4th week. Follow-up assessment of core endurance by plank hold test will be done at the end of 8th week. Data will be analysed using Statistical Package for the Social Sciences (SPSS) version 28.0. Descriptive statistics will include frequency, percentage, mean, and standard deviation. Chi-square test will be used for association. Repeated-measures Analysis of Variance (ANOVA) (or mixed-design ANOVA) will be used to assess differences over time, followed by appropriate post hoc procedures. For normally distributed data, independent t-tests (between groups) and paired t-tests (within groups) will be used; for non normally distributed data, Mann-Whitney U tests (between groups) and Wilcoxon signed-rank tests (within groups) will be used. A significance level of 0.05 will be used.

Effect of Transdermal Magnesium and Moderate Intensity Theraband Training on Pressure Pain Threshold, Disability and Quality of Life among Adults with Sciatic Pain: A Research Protocol

Sakshi Vats, Mohammad Sidiq Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Sciatic pain, commonly known as sciatica, is a prevalent condition characterised by radiating pain along the sciatic nerve pathway, significantly affecting an individual's quality of life due to discomfort, numbness, and muscle weakness. Need of the study: Cost-effective, non-invasive methods of treating sciatic pain are increasingly necessary. Investigating the synergistic effects of TM and MIT training may provide an innovative approach to promoting integrative pain management techniques by enhancing quality of life, reducing disability, and improving pressure pain threshold in affected individuals. Aim: To study the effect of Transdermal Magnesium (TM) and moderate-intensity Theraband (MIT) training on quality of life among adults with sciatic pain. Materials and Methods: A two-group, randomised, pretest-post-test clinical trial will be conducted in recognised hospitals in Delhi, India using simple random sampling from February 2025 to February 2026. Two groups will be formed, each consisting of 56 participants. Group A will be the experimental group and will receive a TM spray and MIT training using Theraband exercises. Group B, the control group, will receive sham TM spray and MIT training with Theraband exercises. Both groups will undergo the intervention three days per week for eight weeks. The paired t-test will be employed to assess within-group changes, while the unpaired t-test will be used for intergroup comparisons, with a significance level of p<0.05. This integrated approach addresses both biochemical and functional aspects, offering comprehensive rehabilitation benefits.

Comparing the Effect of Preoxygenation using High-flow Nasal Oxygen and the Tight Facemask Technique during Rapid Sequence Induction in Abdominal Surgeries: A Research Protocol

Dara Lakshmi Harshitha, Vivek Chakole Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Preoxygenation is a critical step during Rapid Sequence Induction (RSI) to prevent hypoxemia during the apnoeic phase, particularly in patients undergoing abdominal surgeries who are at higher risk due to full stomachs, elevated intra-abdominal pressure, and compromised respiratory mechanics. Need of the study: Tight-fitting facemasks have traditionally been used for oxygen delivery in high-risk patients, but they can cause discomfort and may lead to inadequate oxygenation. High-flow Nasal Oxygen (HFNO) has emerged as an effective alternative, offering warmed, humidified oxygen and continuous apnoeic oxygenation, which enhances patient comfort. Despite these benefits, there is limited research on the efficacy of HFNO in abdominal surgeries. Investigating its impact on oxygenation, recovery times, and overall patient satisfaction during these procedures is essential for improving clinical outcomes. Aim: To compare the effectiveness of preoxygenation using HFNO versus a tight facemask during RSI in patients undergoing abdominal surgeries. Materials and Methods: This randomised interventional study will be conducted at Jawaharlal Nehru Medical College (JNMC), Sawangi, Wardha, Maharashtra, India, from February 2025 to July 2026. The study will include 76 adult patients (38 per group) undergoing abdominal surgeries under general anaesthesia. After obtaining informed consent and ethical approval, eligible patients will be randomised into two groups: the HFNO group or the tight-fitting facemask group. Standard monitoring and premedication will be administered. The primary outcome will be oxygen saturation during preoxygenation and one minute after intubation. Secondary outcomes include End-tidal CO₂ (EtCO₂), haemodynamic responses, and complications. Data will be analysed using an Independent t-test to find the significant difference between the two groups. A p-value <0.05 will be considered statistically significant.

Comparative Evaluation of Sesame Oil Massage, Epsom Salt Hot Water Application, and their Combination for Managing Knee Joint Pain in Homemakers: A Research Protocol

Jaya Khandar, Abhay Mudey, Deeplata Mendhe, Achita Sawarkar Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Knee pain is a common musculoskeletal disorder, particularly observed among homemakers who engage in prolonged standing and repetitive activities. The burden of knee pain significantly affects mobility, Quality of Life (QOL), and daily functioning. Osteoarthritis (OA) remains the leading cause of knee pain, and non-pharmacological interventions are increasingly being recognised as safe and effective alternatives to conventional treatments. Need of the study: Homemakers, due to their daily household activities, have a higher tendency to develop knee pain, which often goes unaddressed because of financial constraints and limited access to healthcare. Prolonged use of pharmacological management for knee pain is associated with adverse effects, thereby necessitating alternative, cost-effective, and community-based interventions. Sesame oil is known for its anti-inflammatory and antioxidant properties, while Epsom salt, rich in magnesium sulphate, promotes muscle relaxation and circulation. Despite these potential benefits, limited research has compared their effectiveness when used individually and in combination. This study aims to fill this gap and provide evidence-based recommendations for the management of knee pain in homemakers. Aim: To compare and evaluate the effectiveness of Epsom salt hot water application, sesame oil massage, and their combination for knee pain management among homemakers. Materials and Methods: A three-arm parallel Randomised Controlled Trial (RCT) will be conducted from May 2024 to May 2026 in selected rural areas of the Wardha district, India. A total of 126 homemakers aged 40-60 years with mild to moderate knee pain will be randomly assigned to three groups of 42 participants each. Group A will receive sesame oil massage, Group B will receive hot water fomentation with Epsom salt, and Group C will receive a combination of both interventions. Outcome measures will include pain severity and functional status, assessed at baseline (Day 0) and after three weeks of intervention. Pain severity will be evaluated using the Visual Analogue Scale (VAS), and functional status will be assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). For intergroup and intragroup comparisons, one-way ANOVA and paired t-tests, respectively, will be applied. Additionally, for pairwise comparisons, post-hoc Tukey’s test will be used. Associations between demographic variables and intervention outcomes will be analysed using Pearson’s Chi-square test. Statistical significance will be set at p<0.05.

Assessment of Add-on Effect of Satvavajaya Chikitsa (Counselling), Bhramari Pranayama versus Brahmi Ghrita in Vishada (Depression): A Three-arm Randomised Control Trial Protocol

Vikas Chaurasiya, Dnyanesh Joshi, Sushil Kumar Dubey Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Depression (Vishada) has emerged as a significant mental health concern worldwide, affecting over 300 million individuals globally, with a particular rise in young people in India. Traditional Ayurvedic approaches offer alternative and holistic treatments, emphasising the balance of mind (Mana) and body (Sharira). Vishada, as described in classical texts like Charaka Samhita and Sushruta Samhita, represents a state of persistent sadness, loss of self-confidence, and mental incapacity, often leading to disturbances in daily functioning. Traditional Ayurvedic treatments such as Satvavajaya Chikitsa (Counselling), Bhramari Pranayama, and Brahmi Ghrita have been suggested for managing Vishada. The current study aims to evaluate the efficacy of these interventions in comparison. Need of the study: Over 300 million people globally suffer from depression, projected to be the leading cause of disability by 2030. In India, 31-57% of youth are affected, yet 75% in low and middle-income countries lack access to treatment. Conventional antidepressants often have side effects, highlighting the need for affordable, holistic alternatives. This study evaluates the effectiveness of three Ayurvedic therapies - Satvavajaya Chikitsa (counselling), Bhramari Pranayama (breathing exercise), and Brahmi Ghrita (herbal formulation)-in managing depression. Aim: To assess the add-on effect of Satvavajaya Chikitsa (Counselling), Bhramari Pranayama versus Brahmi Ghrita in Vishada (Depression). Materials and Methods: The present study will adopt a randomised controlled trial design. The study will start from June 2025 and be conducted over 21 days for all groups, with measurements recorded on the 0^th, 7^th, 14^th, and 21^st days. Patients will be enrolled for treatment at the Mahatma Gandhi Ayurved College, Hospital, and Research Centre in Wardha Maharashtra, India, covering both Outpatient Department (OPD) and Inpatient Department (IPD) services under the Kayachikitsa Department. The sample consists of 123 patients diagnosed with depression, aged 16-40 years, both male and female, with a Beck Depression Inventory (BDI) score between 21-30 and a Hamilton Depression Rating Scale (HDRS) score between 17-23. Participants are randomly assigned to three groups: Satvavajaya Chikitsa (Counselling) and Brahmi Ghrita, Bhramari Pranayama, Brahmi Ghrita, and Brahmi Ghrita alone. Each group undergoes a 24 day treatment period. The primary outcome was the reduction in depression symptoms measured by the BDI and HDRS scales. Secondary outcomes include improved psychological well-being, reduced anxiety and stress, and overall patient satisfaction.

Evaluation of Ozonated Water and Ozonated Olive Oil as an Adjunct to Non Surgical Periodontal Therapy in Chronic Periodontitis: A Research Protocol

Sakshi Vishal Kotecha, Priyanka Jaiswal, Shweta Bhagat Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: Periodontitis is characterised by inflammation of the supporting tissues of the teeth, leading to progressive destruction of the periodontal ligament and alveolar bone, which results in the formation of periodontal pockets and gingival recession. The primary goal of periodontal therapy is to eliminate these pathological features. While Scaling and Root Planing (SRP) is a widely accepted treatment, it has limitations, such as difficulty accessing deeper pockets and root concavities. Need of the study: Ozone therapy, known for its antimicrobial and anti-inflammatory properties, has gained attention as a potential adjunctive treatment in the management of Chronic Periodontitis (CP). Despite growing interest in these treatments, limited research has directly compared the effectiveness of ozonated water and ozonated olive oil in combination with SRP for treating CP. The present study seeks to fill the gap in the literature by assessing and comparing the clinical outcomes when ozonated water or ozonated olive oil is applied as an adjunct to SRP. Aim: This study aims to assess the efficacy of ozonated water and ozonated olive oil as adjuncts to non surgical periodontal therapy, specifically SRP, in treating CP. Materials and Methods: A double-blind, randomised controlled clinical trial will be conducted in the Outpatient Department of Periodontics at Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India. from June 2025 to June 2026. A total of 30 participants will be divided into two groups: Group 1 will receive SRP followed by ozonated water application, while Group 2 will receive SRP followed by ozonated olive oil application. The participants will be assigned to each group by coin-flip randomisation. Pocket probing depth, plaque index, papillary bleeding index, and Clinical Attachment Level (CAL) will be assessed at each follow-up interval. Unpaired and paired t-tests will be used to evaluate data from baseline, 1-month, and 3-months for each group. A p-value of less than 0.05 will be deemed significant.

A Comparative Analysis of Vidarikand Vati (Pueraria tuberosa DC) and Ashwagandha Vati (Withania somnifera Linn.) for Karshya (Underweight): A Randomised Controlled Trial Research Protocol

Nikita Maroti Rathod, Vaishali Kuchewar, Ashvini Pardhekar Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Introduction: The term “karshya” refers to a person who is thin, weak, or malnourished. It originates from the root word “Tanukarane dhatu,” which translates to “Alpa, Suskshma” (small, subtle). According to Dalhanacharya, Karshya is characterised by a deficiency in Upachaya (growth), Bala (stamina), and Rupa (appearance). In Ayurveda, Ahara (food) is considered the most crucial of the three pillars of health, known as Tryopasthambha. Ayurvedic medicine emphasises the concept of Agni, the digestive fire, which transforms food into nourishment. Malnutrition occurs due to Mandagni, or weak digestive fire, leading to malabsorption and poor digestion. Karshya (underweight) is classified into aetiology, prodrome, signs and symptoms, complications, and chronic diseases, and is considered a poor predictor of overall health outcomes. Need of the Study: There are numerous research articles on weight gain. However, many nutritional and bulk-promoting products in the market are expensive and are known to have significant side-effects. Charaka Samhita mentions Vidarikanda as balya (strengthening) and bruhaniya (growth-promoting). It is a cost-effective and readily available bruhaniya herb for weight gain. Despite this, only a few individuals are aware of herbal medications to gain weight. Hence, this study is planned. Aim: To evaluate the comparative efficacy of Ashwagandha vati (Withania somnifera) versus Vidarikand vati (Pueraria tuberosa DC) in the management of Karshya (underweight). Materials and Methods: A double-blind, controlled trial will be conducted at the Mahatma Gandhi Ayurved College Hospital and Research Centre Salod (h) Wardha, Maharashtra, India from April 2025 to February 2026. Sixty patients (30 in each group) who are underweight will be included in this study. Group A (the control group) and Group B (the experimental group) will be treated with Ashwagandha vati (Withania somnifera Linn) and Vidarikand vati (Pueraria tuberosa DC), respectively, for 90 days. Patients will be assessed based on Body Mass Index (BMI), body weight, and body circumference (arm and waist) on Day 0, Day 30, Day 60, and Day 90. Statistical analyses will be performed using paired and unpaired t-tests. A p-value < 0.05 will be considered statistically significant.

Managing Neuraxial Anaesthesia in Patients undergoing Anticoagulation Therapy: A Narrative Review

Prachi Siddharth Kamble, Neeta Verma, Amreesh Paul Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Neuraxial anaesthesia in patients taking antithrombotic medications, including anticoagulants and antiplatelet agents, poses considerable challenges due to the increased risk of bleeding complications such as spinal or epidural haematomas. The use of both conventional anticoagulants like warfarin and newer drugs like Direct Oral Anticoagulants (DOACs) has made the decision-making process for anaesthesiologists more complex because these drugs affect the coagulation system differently. This review covers the mechanisms of action of antiplatelet and anticoagulant medications, and their impact on bleeding risk and complications during neuraxial anaesthesia. Preoperative considerations of relevance, e.g., drug cessation timing and coagulation monitoring, also receive mention as key to avoiding patient harm. Bleeding risks are minimised with appropriate drug regimen adjustment, selective anaesthetic practice, and case-by-case assessment of patients, all of which are discussed here. The review examines the influence of antithrombotic therapy on anaesthetic practice. It emphasises the necessity of meticulous planning to weigh the advantages of neuraxial anaesthesia against the risk of poor outcomes. In spite of the availability of some guidelines, there are a lot of controversies in the management of patients on dual or multiple antithrombotic therapy, particularly in light of the recent trend of the usage of novel anticoagulants. The review brings into focus the need for further studies to formulate evidence-based guidelines to perform neuraxial anaesthesia safely in such patients. Ultimately, better comprehension of the coagulation management, testing, and safety profile of such therapies will come to bear as improved outcomes and more precise clinical practice guidelines in this high-risk population.

Management of Paediatric Traumatic Brain Injury: A Comprehensive Review of Current Evidence and Emerging Strategies

Nayakawadi Akhil, Amar Taksande, Revat J Meshram Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Paediatric Traumatic Brain Injury (TBI) is a significant health concern, contributing to morbidity and mortality. Epidemiology shows variations influenced by demographics, age and injury severity. Status Epilepticus (SE) is a common complication of seizure activity, negatively affecting clinical outcomes. Secondary TBI increases neuronal damage, underscoring the necessity of effectively managing Intracranial Pressure (ICP) and Cerebral Perfusion Pressure (CPP). Assessing strategies such as direct ICP measurement and brain tissue oxygen monitoring is pivotal for informing interventions. Pharmacological agents, including osmotic therapies and antiepileptic medications, are crucial for managing TBI symptoms and preventing complications. Temperature monitoring is essential for reducing metabolic demand. Individuals surviving severe TBI (sTBI) face functional disabilities, cognitive impairments and mental health issues, impacting their quality of life. Despite diagnostic advancements, the pathophysiology and optimal management of paediatric TBI remain controversial. Nevertheless, global perspectives exist to enhance knowledge and optimise clinical management guidelines to improve outcomes. The present study aimed to provide a comprehensive review of the epidemiology, pathophysiology and management strategies for paediatric TBI, emphasising current approaches and emerging modalities.

Potential of Yoga Therapy in Modulating Neurotransmitters for Treatment and Prevention of Autism Spectrum Disorder: A Narrative Review

Soccalingam Artchoudane Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterised by impairments in communication, social interaction, and behaviour. Increasing evidence suggests that maternal psychological stress during pregnancy can lead to neuroinflammation and disruption of neurotransmitter systems. This review aims to critically evaluate the potential role of yoga therapy in regulating neurotransmitter systems to mitigate ASD symptoms in children and reduce maternal psychological stress during pregnancy. A comprehensive literature review was conducted using PubMed and Google Scholar. The keywords used for the search included “Yoga,” “pregnancy,” “maternal psychological stress,” “ASD,” and “foetal neurodevelopment” in various permutations and combinations with “neurotransmitters.” The focus was on neurotransmitters, including serotonin, dopamine, and Gamma-Aminobutyric Acid (GABA), emphasising their roles in mood regulation, behaviour, and cognitive functions. The review found that yoga therapy modulates neurotransmitter systems by reducing stress and enhancing emotional regulation and cognitive function in the treatment of ASD. It also helps prevent the adverse effects of maternal psychological stress on foetal neurodevelopment during pregnancy.

Role of Terahertz Radiation in the Detection and Treatment of Cancer: A Narrative Review

Sayali Satish Chodankar, Nimmi Puthan Veedu, Omkar Uttam Gaonkar Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Terahertz (THz) waves occupy a distinctive position in the electromagnetic spectrum, between the long-wavelength far-infrared and the high-frequency microwave ranges. THz imaging and spectroscopy have proven useful in identifying tumour margins, assessing biochemical changes, and distinguishing between cancerous and normal tissues in breast, skin, and brain cancers. Experimental studies suggest that THz radiation may also affect cellular structures, offering potential as a treatment method through selective heating and alterations in Deoxyribo Nucleic Acid (DNA) and Ribonucleic Acid (RNA) structures. Advancements in source technology, detector sensitivity, and the application of Artificial Intelligence (AI) are driving progress in this field, while hybrid imaging strategies may further enhance diagnostic accuracy. This review highlights the potential of THz technology as a novel technique for the early diagnosis and treatment of cancer. However, additional research is required to enable its application in medical imaging so that it can compete with conventional techniques such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI), and further develop its potential in cancer therapy.

Role of Physiotherapy in the Outcome of High-risk Neonates in the NICU: A Narrative Review

Namrata Sanjeetkumar Sant, Shweta Ghodake, Pallavi Palaskar, Swati Gupta, Vikrant Salphale Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X In India, the role of physiotherapy in the Neonatal Intensive Care Unit (NICU) is crucial for effective outcomes. Early intervention measures have a positive impact on premature babies. One of the main causes of neonatal death is premature birth. It is believed that prolonged immobilisation or inactivity is the cause of growth retardation and demineralisation of the bones in newborns. This, in fact, prompted us to analyse the beneficial impact of early physiotherapy intervention on premature infants with Low Birth Weight (LBW), decreased irritability, increased parent-infant bonding, sucking, improved respiratory and developmental outcomes, improved motor skills, and enhancement in neurodevelopment and medical conditions in terms of optimal improvement. Early physiotherapy intervention is a useful and successful tactic for encouraging optimal growth and enhancing outcomes in high-risk newborns in the NICU. More investigation is required to enhance the provision of physiotherapy treatments to optimise Physiotherapy services for high risk neonates to analyse the impact of an early physiotherapy intervention, specifically in those who are less than 28-week-old, moderately preterm neonates (32-37 weeks), and very premature neonates (28-32 weeks), and to gain a deeper understanding of the precise mechanisms of action. The study examines the growing physiotherapy services provided to high-risk newborns admitted to the NICU.

Advancements in Orthodontic Bonding to Non Conventional Surfaces: A Comprehensive Review

Akhalya Chockalingam, Davis Devasahayam, Ravi Kannan, Sushil Chakravarthi, Shreya Kishore Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Orthodontic bonding traditionally relies on composite resin to adhere brackets to enamel surfaces. However, the emergence of non conventional surfaces, such as ceramic, zirconia and composite materials, presents new challenges due to the increasing demand for aesthetically pleasing orthodontic options and the widespread use of these materials in dental restorations. This review explores recent advancements in orthodontic bonding for non conventional surfaces, evaluating innovative techniques and materials while analysing their effectiveness, reliability and longevity through a critical analysis of bonding protocols. Relevant information was gathered using databases and search engines including PubMed, Scopus and Google Scholar. The present article reviews the materials and techniques used for bonding orthodontic brackets to restorative material surfaces termed non conventional surfaces in contrast to conventional bonding to tooth enamel.

A Narrative Review on Comprehensive Approaches to Chronic Pain Management: Integrating Medical, Psychological, Lifestyle, and Emerging Therapies

Tejswini Gaidhane, Vishal Lanjewar, Vivek Chakole, Nitesh Badwaik, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2025 - December - 19:0973-709X Chronic pain, defined as pain lasting longer than three months, profoundly affects physical, emotional, and social wellbeing and cannot be understood through a single disciplinary lens. This narrative review synthesises traditional and emerging strategies for chronic pain management, emphasising a multimodal, patient-centred approach. Pharmacologic therapies—including Non Steroidal Anti-Inflammatory Drugs (NSAIDs), opioids, antidepressants, and anticonvulsants—remain central and may be used alone or in combination with interventional methods such as nerve blocks or spinal cord stimulation, depending on pain phenotype and risk–benefit considerations. Psychological strategies, notably Cognitive-Behavioural Therapy (CBT), mindfulness, and guided imagery, are integrated to modulate pain perception and enhance coping. Concurrent lifestyle modifications—regular physical activity, anti-inflammatory nutrition, weight management, and adequate hydration—are highlighted for improving function and quality of life. The review also discusses barriers to implementation, the varying quality of evidence across conditions, and the need for individualised, patient-centred care. Gaps in long-term outcomes and safety are acknowledged, with future directions pointing toward precision medicine and digital health tools to optimise multimodal pain management.