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

Perioperative Challenges in Emergency Neurosurgery for a Paediatric Patient with Unrepaired Tetralogy of Fallot: A Case Report

Aishwarya Sanjay Borode, Dhawal Rameshpant Wadaskar, Kaustuv Das Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Paediatric patients with unrepaired Tetralogy of Fallot (TOF) presenting for emergency neurosurgery pose a unique perioperative challenge due to the delicate relationship between cyanotic heart disease physiology and elevated Intracranial Pressure (ICP). The anaesthetic management of an uncorrected six-year-old male with a lateral ventricular brain abscess, ventriculitis, hydrocephalus, and thrombocytopenia was presented. Preoperative evaluation revealed central cyanosis, a systolic murmur, and an aberrant coronary artery passing through the Right Ventricular Outflow Tract (RVOT), which posed a problem in anaesthetic management. Acute desaturation and hypotension during surgery after intracranial decompression were probably due to increased right-to-left shunting secondary to a decrease in Systemic Vascular Resistance (SVR). This was managed with phenylephrine boluses (10 mg) and 100% oxygen. A stable cerebral and cardiac status was achieved with an anaesthetic technique involving thiopentone, atracurium, and controlled sevoflurane administration. The patient recovered uneventfully postoperatively, without any new neurological deficit, and was haemodynamically stable on discharge. This case emphasises the importance of close perioperative care, anticipation of cyanotic spells, and individualised anaesthetic care in the management of complex neurosurgical emergencies in patients with cyanotic congenital heart disease. It reinforces that early therapy and understanding of cardiocerebral pathophysiology can optimise outcomes even in high risk children.

Flexor Digitorum Accessorius Longus in the Tarsal Tunnel: A Rare Anatomical Variant

Amit Purushottam Tirpude, A Anbarasan Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X During the routine dissection of an 80-year-old male cadaver, an unusual variant of the Flexor Digitorum Accessorius Longus (FDAL) muscle was identified in the left ankle. The FDAL, with two distinct heads- medial (tibial) and lateral (calcaneal)- was found occupying the tarsal tunnel and partially obscuring the deep flexor tendons and neurovascular structures. This variant crossed over the posterior tibial nerve, which had bifurcated into its medial and lateral plantar branches, contributing to a potential site for compression. The FDAL’s rare muscular form in the lower tarsal tunnel and its anatomical positioning suggest a predisposition to Tarsal Tunnel Syndrome (TTS), which may present with pain, paraesthesia, or movement restriction. Magentic Resonance Imaging (MRI) is essential for accurate diagnosis. This case supports evolutionary and embryological theories of muscle descent and highlights the clinical significance of FDAL in differential diagnosis and surgical planning for TTS. Awareness of such variations is crucial for anatomists, clinicians, and surgeons.

Primary Splenic Mesothelioma: A Rare Entity

Monika Kalyan, Nisha Marwah, Sneh Banwala, Smruti Soumya Panigrahi, Sanjay Marwah Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Malignant mesothelioma is a primary neoplasm that arises from the serous membranes lining the pleura, peritoneum, and pericardium. However, mesothelioma arising from the spleen is exceedingly rare and presents unique diagnostic and clinical challenges. A 59-year-old female came with a complaint of a lump in the abdomen and postprandial abdominal distension for one month. The Contrast-Enhanced Computed Tomography (CECT) abdomen showed a large cystic lesion with enhancing solid areas with specs of calcification. The probable diagnosis made radiologically was a splenic cyst or hydatid cyst. Cut-section of the splenectomy specimen had multiple papillary excrescences on the wall and a few areas of haemorrhage. The microscopic sections showed round to epitheloid tumour cells arranged diffusely, in the form of cords and sheets, ill-formed glands and papillary pattern. On Immunohistochemistry, these cells were Cytokeratin (CK), vimentin, Wilms’ tumour suppressor gene1 (WT1) and calretinin positive. However, markers like CK7, CK20, Caudal-type homeobox transcription factor 2 (CDX2), Thyroid Transcription Factor-1 (TTF1), Melan A, Human Melanoma Black 45 (HMB45), CD31, CD34, CD10, Paired Box Gene 8 (PAX8), CD99, Estrogen Receptor (ER) and Epithelial Membrane Antigen (EMA) were negative. Based on both histomorphological and immunohistochemical features, the final diagnosis rendered was epitheloid mesothelioma. Primary malignant mesothelioma of the spleen is a rare entity that should be considered in patients with solitary splenic lesions. Histopathological examination and immunohistochemistry are vital for diagnosis. Complete surgical excision and close follow-up are recommended due to the uncertain prognosis and lack of established treatment guidelines.

Extra Pulmonary Tuberculosis Presenting as Midline Sternal Swelling in Infancy: A Case Report

Ritika Singh, Kapil Bhalla, Naman Jain Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Sternal tuberculosis is an extremely rare form of Extrapulmonary Tuberculosis (EPTB) in infancy, often posing diagnostic challenges due to its nonspecific presentation. A 10-month-old infant presented with a 20-day history of a progressively enlarging, tender anterior chest wall swelling. The child was otherwise asymptomatic and haemodynamically stable. Examination revealed a firm, tender, 2×2 cm swelling over the manubriosternal junction without erythema or fluctuation. Laboratory findings showed lymphocytic leukocytosis and elevated Erythrocyte Sedimentation Rate (ESR); the Mantoux test was negative, and the chest X-ray was unremarkable. Ultrasonography demonstrated a hypoechoic lesion with internal echoes. Contrast-enhanced Computed Tomography (CT) revealed a well-defined, peripherally enhancing hypodense collection adjacent to the sternum, consistent with a cold abscess. Fine-Needle Aspiration Cytology (FNAC) revealed granulomatous inflammation with necrosis, and Ziehl-Neelsen staining confirmed acid-fast bacilli, establishing the diagnosis of sternal tuberculosis. The child completed a course of eight months of Anti-Tubercular Therapy (ATT), and on eight-month follow-up, the lesion completely resolved. Anterior mediastinal swellings encompass a diverse group of neoplastic and non-neoplastic lesions, presenting a diagnostic challenge due to their varied aetiologies and potential for serious complications. Early recognition of sternal tuberculosis in infants requires high clinical suspicion and comprehensive evaluation. Prompt initiation of therapy ensures favourable outcomes.

Currarino Syndrome: A Silent Challenger to the Hirschsprung Paradigm

Aniketh Purushothaman, Iqbal Ali, Varun Shetty Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Currarino Syndrome (CS) is a rare congenital anomaly defined by a triad of anorectal malformations, presacral mass, and sacral bony defects. Although it typically presents in early childhood, adolescent cases are increasingly recognised but often missed. Due to significant overlap in clinical features, CS may be mistaken for more prevalent conditions such as Hirschsprung’s Disease (HD). This diagnostic ambiguity often leads to prolonged evaluation, repeated testing, higher healthcare costs, and patient dissatisfaction. We present the case of an 18-year-old female with a 12-year history of severe, refractory constipation who was initially evaluated for HD. Cross-sectional imaging ultimately revealed sacral agenesis, a presacral mass, and a tethered cord, leading to a definitive diagnosis of CS. The patient subsequently underwent neurosurgical detethering and mass excision, resulting in substantial symptomatic relief. This case underscores the need to maintain a high index of suspicion for CS in adolescent patients with unexplained constipation, particularly when initial investigations are inconclusive. Early recognition is essential to ensure appropriate management and to avoid the burden of delayed diagnosis.

Anaesthetic Considerations in an Achondroplastic Child with Thermal Burns: A Case Report

Akondi Sai Hrudaya Harshitha, Anand Kuppusamy, Gayathri Balasubramanyam, Kumaran Dheepak Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Achondroplasia is the most common cause of disproportionate dwarfism and is associated with multiple systemic abnormalities that pose unique challenges to anaesthetic management. Characteristic features such as hypotonia, delayed motor development and obesity often complicate perioperative care. Craniofacial anomalies, including midface hypoplasia, macrocephaly and cranio-cervical junction compression, increase the likelihood of a difficult airway. Additionally, skeletal deformities such as thoracolumbar kyphosis, spinal canal stenosis and abnormal vertebral anatomy make neuraxial anaesthesia technically challenging. Fluid and electrolyte imbalances, hypovolemia and altered pharmacokinetics further complicate drug dosing and anaesthetic selection. Present case is of a 13-year-old child with achondroplasia who sustained extensive thermal burns following accidental kerosene exposure and subsequently required split-thickness skin grafting under general anaesthesia. This case highlights the importance of anticipating anaesthetic complications in patients with achondroplasia and burns and of adopting an individualised, multidisciplinary approach to ensure safe outcomes. Ultrasound guidance was used to facilitate intravenous access. The anticipated difficult airway was managed with video laryngoscopy to minimise cervical spine movement. Muscle relaxation was achieved with rocuronium and reversed with sugammadex. The intraoperative course was uneventful and the patient was discharged the following day.

An Uncommon Presentation of Renal Angiomyolipoma in a Patient with Segmental Neurofibromatosis: A Case Report

Namrita Jeyaraj, Gayathri Rajesh, Adikrishnan Swaminathan, Anuradha Priyadarshini Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Segmental Neurofibromatosis (SNF) occurs sporadically and is characterised by neurofibromas with or without café-au-lait macules confined to an area or segment of the body. It is a rare type of NF and is not usually associated with systemic manifestations. This case report discusses a 39-year-old female with segmentally distributed neurofibromas of the right side of the face in association with Renal Angiomyolipoma (RAML). Knowing this association may help clinicians to suspect, diagnose and treat the RAML at the earliest. Although RAMLs are frequently associated with Tuberous Sclerosis (TS), their occurrence in the case of SNF may be attributed to the shared mTOR signalling pathway targeted in both neurocutaneous syndromes.

Dual Outcomes: Live Pregnancy Amidst Partial Hydatidiform Mole

Shubhi Gaur, Pratap Singh Parihar, Roohi Gupta, Prasad Sanjay Desale, Gaurav Vedprakash Mishra Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Gestational Trophoblastic Disease (GTD) is a group of cancers that can metastasise to distant sites. Molar pregnancy, a rare and challenging condition, is characterised by Complete Hydatidiform Moles (CHM) occurring when one sperm fertilises an empty ovum, resulting in the absence of maternal chromosomes. Partial Hydatidiform Mole (PHM) is triploid and is often detected early in gestation. In one out of every 20,000 to 100,000 pregnancies, along with a CHM or PHM, a normal co-twin may emerge. Here, we present a similar case of a young primigravida presenting with a live foetus and a concomitant partial mole. In this case, a 22-year-old primigravida female presented with lower abdominal pain, nausea, and vomiting for the last two weeks. She was advised to undergo an antenatal scan at 24 weeks of gestation, which showed a dichorionic diamniotic pregnancy with a single live foetus and a molar placenta. Later, she was put on conservative management and followed up with subsequent delivery of a premature live baby and expulsion of a molar placenta. Twin pregnancies with a normal foetus and a CHM are rare but can lead to live deliveries with no appreciable rise in the probability of malignant transformation of CHM. It is critical to differentiate these pregnancies from other disorders such as Placental Mesenchymal Dysplasia (PMD) and PHM, which also involve a foetus and a cystic placenta. Suction dilation and curettage are the preferred treatments for women with a hydatidiform mole to maintain fertility.

Treatment of Peri-implantitis with Tongue-thrust by Cumulative Interceptive Supportive Therapy Protocol: A Case Report

Dipanshu Hansraj Pahuja, Simran Rajkumar Parwani, Prasad Vijayrao Dhadse, Rajkumar Parwani, Sanehi Devidas Punse Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Periimplantitis is an inflammatory condition with soft-tissue inflammation along with subsequent loss of supporting bone around an implant. The present case report portrays the complete diagnosis and treatment of a patient with a loose implant-supported prosthesis. A 23-year-old male patient reported with loosened prostheses with respect to teeth #11 and #21-23. On intra-oral and radiographic examination, the case revealed peri-implantitis with implants related to #21-23. The patient also had a tongue thrust habit, which exerted extra pressure on maxillary anterior implants, causing their loosening. First, nonsurgical treatment, i.e., debridement and disinfection of implants with titanium curettes, was rendered. Surgical treatment was done by CIST Protocol D with soft-tissue diode laser and Calcium phosphosilicate putty bone graft. A habit-breaking appliance, i.e., a tongue crib, was also provided to the patient. Three- and six-month clinical and radiographic follow-up views have portrayed successful re-osseointegration with concerned teeth, resulting in full return of function and fulfilling the patient’s aesthetic demands too.

Anal Nodular Melanoma Masquerading as Thrombosed Haemorrhoid: A Case Report

M Malarmannan, R Lakshmana, A Pravindhas, Debarath Das, N Soorya Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Anorectal Melanoma (AM) is an aggressive and rare malignancy with a poor prognosis. It is more commonly observed in women over the age of 50 years. Due to its rarity, AM is often undetected at the time of diagnosis or has already metastasised. This case describes a 67-year-old male who presented with a mass descending per annum for two years. This was associated with pain and blood in the stools for two weeks. History of constipation present. No known comorbidities and no past surgical history. The mass was lobular and soft in consistency. It was suspected to be thrombosed haemorrhoids, and he was taken up for surgery. The mass was excised in toto, and on histopathological examination, it was diagnosed to be invasive melanoma- Nodular melanoma of the anal canal with no evidence of lymph vascular emboli in the section. Immunohistochemistry (IHC) markers showed pan-Cytokeratin (CK)-negative, S-100-positive, HMB-45-positive and MELAN A-positive. No signs of recurrence were noted for six months, and the patient is currently on follow-up. Anal melanomas are often mistaken for a thrombosed pile mass, and improper surgery might result in recurrence. Careful planning and evaluation before proceeding with excision is advised.

Beyond the Beak: Anticipation of Airway Difficulty in Eagle’s Syndrome

Chhaya Suryawanshi, Rashmi Kelkar, Rajesh Kawale Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Eagle’s syndrome is a rare condition characterised by elongation of the styloid process or ossification of the stylohyoid ligament, which may result in facial or cervical pain, dysphagia, and restricted jaw movement. The normal length of the styloid process ranges from 20 to 30 mm; elongation can cause impingement on adjacent anatomical structures, leading to significant discomfort. Diagnosis is radiological, and symptomatic cases often require surgical intervention. A 38-year-old male presented with restricted mouth opening for six to seven months, along with sharp, intermittent pain triggered by eating and yawning. The pain radiated to the ear, neck, and back. He also reported two previous episodes of jaw locking that resolved spontaneously. Clinical examination revealed restricted and painful Temporomandibular Joint (TMJ) movements, deviation of the jaw to the right on opening, and bilateral hypertrophy of the masseter and temporalis muscles. Airway assessment showed Mallampati class II with slight limitation in neck extension. Imaging with Orthopantomogram (OPG) and Cone Beam Computed Tomography (CBCT) confirmed bilateral styloid process elongation, measuring 46.44 mm on the right and 48.13 mm on the left. The patient was scheduled for bilateral styloidectomy under general anesthesia. Multiple nasal intubation attempts were required due to poor laryngeal visibility, ultimately successful with the use of a bougie and a smaller Endotracheal Tube (ETT). Postoperative evaluation indicated that calcified stylohyoid ligaments may have contributed to the difficult airway management.

Uncommon Presentation of Isolated Triquetral Osteomyelitis: A Rare Case Report

Anooj Pravin Chheda, B Vijay Anand, RS Palanisami, C Rishab, Abraham Aleyas Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Osteomyelitis in the wrist is a rare musculoskeletal infection, accounting for about 1-6% of all wrist disorders. It generally relates to the carpal bones, metacarpals, or phalanges and frequently resembles other disorders such as acute synovitis. Timely diagnosis is difficult owing to ambiguous clinical and radiological indicators. Magnetic Resonance Imaging (MRI) is essential for early detection of bone involvement, although histology is the definitive diagnostic criterion. This case report describes the case of a 50-year-old male welder who experienced sudden pain, oedema, and limited mobility in the right wrist, absent any trauma history. The clinical assessment and MRI indicated osteomyelitis of the triquetral bone. Analysis in the laboratory revealed increased inflammatory markers. Surgical investigation disclosed necrotic dorsal interossei muscles and compromised synovium. Osteo decompression and debridement were carried out, and histopathological analysis verified acute-on-chronic osteomyelitis. The patient was administered culture-sensitive intravenous antibiotics, followed by oral antibiotics, resulting in excellent healing of the wound and full functional recovery around six weeks postoperatively. This case underscores the necessity of a heightened awareness of osteomyelitis in unusual presentations of wrist pain and emphasises the significance of prompt imaging, surgical intervention, and histological verification for timely diagnosis and effective therapy.

Ayurvedic Management of Shlishta Vartma (Allergic Conjunctivitis): A Case Report

Aparna Saxena, Praveena P Nair, Dheeraj Mandwal Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Shlishta Vartma, similar to allergic conjunctivitis, was described by Acharya Vagbhata as one of the Vartma Gata Rogas (lid disorders). It is characterised by Shlishta (stickiness of the eyelids), Kandu (itching), Shvayathu (oedema), and Raga (redness), and it mimics allergic conjunctivitis as described in modern medicine. Allergic conjunctivitis is a common condition with a prevalence of about 20%, caused by an inflammatory response to allergens such as pollen, dust, or pet dander, which triggers the release of histamines and other mediators. Modern treatment includes topical antihistamines, mast cell stabilisers, Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and immunomodulators. Present case is of a 20-year-old male with stickiness of the eyelids, itching, oedema and mild thickening of the lids for the past four months. He was not completely relieved by modern medicines. Therefore, the Ayurvedic protocol of Shlishta Vartma was tried, as the symptoms of both conditions were similar. It includes Lekhana karma (scraping) to purify the Rakta (blood), to supply fresh blood to the lids to enhance the healing process and maintain homeostasis. In a young age group, Jalauka (leech therapy) can be used to purify the blood at the site, along with immunomodulatory drugs such as Rajanyadi Choorna, which enhances Vyadhikshamatva (immunity).

Non-communicating Rudimentary Horn with Haematometra Manifesting as Adnexal Mass: A Case Report

Ashok Ranjan, Sundara Raja Perumal Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Female reproductive organs other than ovaries are formed from the mullerian ducts which develop into fallopian ducts, uterus, and the upper two third of vagina. Any defective formation and non-fusion of Müllerian ducts leads to multiple anomalies with varying combinations with variable presentations in these affected women. Anomalies like rudimentary horn without non-functional endometrium are asymptomatic and incidentally diagnosed while undergoing imaging studies like ultrasound and magnetic resonance imaging of pelvis. Anomalies of rudimentary horn with functional endometrium, patients may have dysmenorrhoea, abnormal bleeding at the time of menarche, ectopic pregnancy in the rudimentary horn, and endometriosis. The patient might experience a delayed onset of presentation, and some women may end up with life-threatening conditions such as ruptured ectopic pregnancy in the rudimentary horn. A 35-year-old female with a history of dysmenorrhoea for 15 years and recent aggravated pain, presented for imaging of the pelvis. Right adnexal lesion was suggested during the ultrasound imaging, and the Magnetic Resonance Imaging (MRI) pelvis suggested a rudimentary horn on the right-side with blood collection within the horn, causing haematometra. Laparoscopic removal of the rudimentary horn was done, and the presence of functional endometrium and myometrial tissue was confirmed in the histopathological examination. Early detection of these mullerian anomalies will help us prevent the morbidity and mortality associated with them.

Multimodality Imaging of a Rare Case of Cardiac Calcified Amorphous Tumour in an Asymptomatic Patient

Pulkit Kumar Santoshi, Jaybrata Ray, Annesha Majumdar, Prabhat Debbarma, Subrata Paul Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Calcified Amorphous Tumour (CAT) of the heart (cardiac CAT) is a rare non-neoplastic cardiac mass that mimics malignancy on imaging and can cause symptoms due to flow obstruction or embolisation of calcific fragments. However, most of the time, the tumour may remain asymptomatic and is incidentally detected on transthoracic echocardiograms and Computed Tomography (CT) thorax. Cardiac CT and/or cardiac Magnetic Resonance Imaging (MRI) are used as problem-solving tools to support the diagnosis made by echocardiography. We report a unique case of a cardiac CAT in a completely asymptomatic 52-year-old male patient who came for a routine annual health check-up. Under the panel of investigations, the patient underwent a CT chest. Although the lung fields were unremarkable, a calcified lesion was detected in the mediastinum, which, after applying the volume rendering technique, was localised in the Right Atrium (RA). Following this incidental finding, the patient underwent a battery of investigations, including an echocardiogram and a cardiac MRI, after which the calcified amorphous and benign nature of the tumour was finally identified. Although benign, such tumours can have catastrophic effects if they produce mass effects, resulting in abnormal sinus rhythm or deranged filling of heart chambers. Therefore, the detection, work-up, and follow-up of such tumours is mandatory, and if symptomatic, surgical resection is indicated.

Perioperative Anaesthetic Strategy for Neonatal Foetus-in-Foetu Excision: A Case Report

Akansha Singhal, Karuna Taksande, Amreesh Paul Francis Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Foetus-In-Foetu (FIF) is a congenital anomaly that involves the presence of a deformed parasitic twin within its host, most commonly presenting as a retroperitoneal mass at birth. Present case is of a 1.5-month-old female who was referred for elective excision of a gigantic abdominal mass diagnosed antenatally on an anomaly scan in the third trimester. Postnatal imaging showed an enormous retroperitoneal solid-cystic mass with displacement of the surrounding organs, Magnetic Resonance Imaging (MRI) showed consistent findings of a benign mature cystic teratoma. The clinical presentation was in the form of repeated vomiting with feeds, without systemic compromise. Induction of anaesthesia was done by balanced technique, utilising intravenous propofol, fentanyl and atracurium, followed by pressure-controlled ventilation and sevoflurane with oxygen-air for maintenance. Following induction, a single-shot caudal block using 0.2% ropivacaine (0.5 mL/kg) was given under strict asepsis with a 25G short-bevel styletted needle. It gave adequate analgesia for 6-8 hours without any complications. Surgical resection was by removal of the mass and right kidney with minimal blood loss and no transfusion or inotropic support. The postoperative course was uneventful and histopathological study revealed an immature teratoma with features of FIF type containing vertebral and limb elements. The current case emphasises the need for tailored anaesthetic approaches to neonatal FIF, with special reference to the usefulness of caudal analgesia in effective pain relief and opioid-sparing regimen. It also emphasises the imaging diagnostic significance, surgical removal as a gold standard for therapy and follow-up over a long period due to the risk of malignant transformation.

Ileo-Ileal Intussusception Caused by Inflammatory Fibroid Polyp in an Adult Female: A Case Report

S Vinith Balaji, M Reegan Jose, G Karthick, Najeem Fazil, M Surendhar Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Intussusception occurs when a segment of the intestine telescopes into an adjacent part, leading to obstruction and possible ischaemia. Although common in children, adult intussusception is rare and frequently associated with a pathological lead point. We report the case of a 62-year-old woman who presented with abdominal pain, vomiting, and constipation. Contrast-Enhanced Computed Tomography (CECT) revealed ileo-ileal intussusception with a suspected lesion measuring approximately 6 cm. Intraoperatively, a 3×3 cm serosal tumour was identified as the lead point. Resection and ileo-ileal anastomosis were performed, and histopathology confirmed the mass to be an Inflammatory Fibroid Polyp (IFP) with eosinophilic infiltration. This case highlights the importance of early diagnosis using imaging and the necessity of surgical intervention to avoid complications. Awareness of IFPs as rare causes of adult intussusception can guide timely and accurate clinical decision-making.

A Case Report on Post-haemodialysis Pyrexia Caused due to a Rare Species of Trichosporon

Aman Kumar Gupta, Sourya Acharya, Sunil Kumar, Dipika Shaw, Anjali Patond Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Hypertension is a global health threat, which, in coexistence with chronic kidney disease, increases the associated health risks. Most of the vulnerable patients receive prophylactic therapeutic intervention for fungal infections, though, in a few instances, there is a delay in symptomatic presentation. The patients with hypertension and chronic kidney disease receiving haemodialysis should be monitored strictly for the same. This is a case of a 41-year-old male infected with Trichosporon infection with a positive history of hypertension and chronic kidney disease, receiving haemodialysis treatment. The patient was timely confirmed to have the diagnosis and successfully managed with the systemic antifungal drug Itraconazole {100 mg (BD) for 14 days} and Fluoroquinolones {500 mg (OD) for seven days}. A follow-up at one month showed the patient with laboratory markers within normal limits.

Wooden Foreign Body in the Uterine Cavity in a Postmenopausal Woman: A Case Report

Jayveersinh A Makwana, Deepika Dewani, Sandhya Pajai Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Foreign bodies in the uterine cavity, though uncommon, can result in significant gynaecological morbidity. This case report discusses a rare finding of a wooden twig in the uterine cavity of a 55-year-old postmenopausal woman presenting with persistent foul-smelling vaginal discharge and lower abdominal pain. Diagnostic hysteroscopy revealed the intrauterine foreign body, which was successfully removed. This report highlights the importance of maintaining clinical vigilance for retained or introduced foreign bodies in postmenopausal women.

Ochronosis of the Lumbar Spine: A Case Report and Review of Literature

Abraham Aleyas, B Vijay Anand, Rishab Chandraprakash, Anooj Pravin Chheda, Ashwin Mathew Kadavil Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Alkaptonuria is an uncommon genetic condition inherited in an autosomal recessive pattern, characterised by a disruption in the metabolism of phenylalanine and tyrosine, leading to insufficient levels of the enzyme homogentisate and further causes a buildup of Homogentisic Acid (HA). This further leads to blackish discolouration of connective tissues where the acid accumulates. Initially, manifesting as alkaptonuria, it progressively develops into ochronotic arthropathy, which primarily affects the large joints and vertebral discs. Spinal involvement can lead to kyphosis, reduction in height, decreased lumbar flexibility, limited range of motion, and joint effusions. We present a case of a female in her late sixties with complaints of pain in her lower back radiating to her bilateral thighs. Past history revealed dark urine stains on her clothes; she underwent bilateral total hip arthroplasties. On further investigation, she was diagnosed with lumbar disc herniation secondary to ochronosis of the spine. The patient was taken up for L4-L5 decompression. Postoperatively, the patient had improvement of symptoms with no new complaints. We have also included a concise literature review of spinal ochronosis, emphasising the diagnostic hurdles and therapeutic methods associated with this rare condition.

Aesthetic Rehabilitation with Immediate Dental Implant of the Inflammatory Periapical Cyst Site: A Case Report with Three-year Follow-up

Venkat Ratna Nag, Manikandhan Ramanathan, Bhavna Vasudev Lokwani Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Rehabilitation with immediate implants has gained popularity for restoration in the aesthetic region, but immediate implant placement and function in infected periapical sites are still debatable. The conventional protocol of placing an implant and waiting for it to osseointegrate is time-consuming and compromises patients’ aesthetics and psychological comfort. The purpose of this case report is to illustrate the possibility of inserting an immediate implant into a fresh extraction socket in an infected site with the presence of a pre-existing cyst following meticulous protocol, such as antibiotic administration, thorough cleaning, and alveolar debridement. The report depicts the minimal removal of existing bone with a single drill implant protocol, and one abutment at one time concept, with a customised microgrooved abutment for a satisfactory functional and aesthetic outcome after three years.

Case of Waldenstrom Macroglobulinaemia Mimicking Multiple Myeloma: A Diagnostic Challenge

Harshitha Reddy, Tushar Sontakke, Lalit Raut, Neha Rahul, Jaswanth Varma Alluri Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X A rare form of lymphoplasmacytic lymphoma, Waldenstrom’s Macroglobulinaemia (WM) progresses slowly and requires treatment only when the patient exhibits symptoms. Organomegaly, cytopenia, hyperviscosity syndrome, and constitutional symptoms are the most common presentations of WM. The main affliction of the tumour is with the bone marrow, which is made up of plasma cells, tiny lymphocytes, and plasmacytoid lymphocytes. An Immunoglobulin M (IgM) gammopathy is also present in the circulating blood. Here, we describe a 77-year-old man who complained of epistaxis, hair loss, elevated serum creatinine, hypercalcaemia, and a reversal of the albumin-to-globulin ratio. Additionally, the patient showed M band positive, which led to the diagnosis of WM rather than multiple myeloma, as was first believed. Our case report highlights the importance of considering WM in the differential diagnosis of patients presenting with symptoms such as epistaxis, fatigue, weakness, and Raynaud's phenomenon, particularly in elevated serum IgM levels. Prompt recognition and diagnosis of WM are essential for appropriate management and prognosis. In summary, our case underscores the importance of vigilance in recognising the clinical manifestations of WM and the necessity of a comprehensive approach to diagnosis, treatment, and follow-up care. Further research is warranted to elucidate the underlying pathogenesis of WM and to develop more effective and targeted therapeutic strategies for this rare haematological malignancy.

Intrauterine Enema (Uttarbasti) with Yoga Therapy in the Successful Management of Unilateral Fallopian Tube Blockage: A Case Report

Vedangi Dinesh Wargantiwar, Punam Sawarkar, Radhika Pund Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Infertility is one of the most common problems encountered by gynaecologists in daily practice. It significantly affects an individual's social, familial, physical, and psychological well-being. This is a case study of a 30-year-old female diagnosed with a unilateral (left) cornual end block of the fallopian tube. In addition to specific internal Ayurvedic medications and Yogic practices, an intrauterine enema (Uttarbasti) with Apamargakshara Taila (5 mL) was administered for five days each month for five months. The internal medications included Pushpadhanwa Rasa and Laghumanjishthadi Kwatha, and the Yogic therapy of Kapalabhati. Assessment was done using Hysterosalpingography (HSG) before and after the treatment. The pre-treatment HSG confirmed the presence of a left fallopian tube blockage, while the follow-up HSG after five treatment cycles indicated that both fallopian tubes were patent. This case suggests that Uttarbasti, in combination with internal Ayurvedic medications and Yogic therapy, may be effective in managing fallopian tube blockages.

Spontaneous Colonic Perforation Due to Ventriculoperitoneal Shunt Migration in an Adult: A Case Report

Vinayak Pillai, Abhishek Patil, Sudarshan Chaugale Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X A Ventriculoperitoneal (VP) shunt is a Cerebrospinal Fluid (CSF) drainage system that typically consists of a tube with a valve to regulate pressure. It starts in the brain’s ventricular system and functions to reduce elevated intracranial pressure by diverting excess CSF to an external absorptive area, commonly the peritoneal cavity. We report a case of a 22-year-old male patient who underwent VP shunting for the management of post-traumatic communicating hydrocephalus, six months after which he noticed the distal shunt tip projecting out through the anal opening. Laboratory tests, including complete blood count, C-reactive protein level, blood culture, and CSF analysis, were within normal limits. Computed Tomography (CT) abdomen and pelvis revealed the distal part of the catheter within the lumen of the descending and sigmoid colon. We managed this case by removing the entire shunt system and achieving primary closure of the descending colonic perforation. Shunt migration may result in severe complications, including faecal contamination and the development of infections such as ascending meningitis or ventriculitis. This case report underscores one of the rarest yet most serious adverse outcomes associated with VP shunt placement. The VP shunt remains the mainstream treatment for CSF disordered mechanics, although they are well-known to be associated with many potential complications. In clinical practice, early identification of such complications can avoid life-threatening sequelae.

Malignant Transformation of the Plexiform Neurofibroma of the Back: A Case Report

Shailly Rajnish Tiwari, Samarth Shukla, Harsh Thesia, Sneha Sukumar, Suhit Naseri Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Neurofibromatosis (NF) is characterised by multiple skin lesions distributed across the body and follows an autosomal dominant inheritance pattern. There are two main subtypes: NF type 1 (NF1) and NF type 2 (NF2), each with distinct clinical features. NF1 typically presents with numerous cutaneous neurofibromas, café-au-lait spots, plexiform neurofibromas, Lisch nodules, freckling in the axillary or inguinal regions, and optic gliomas. In contrast, NF2 is marked by bilateral vestibular schwannomas and central nervous system tumours such as meningiomas and ependymomas. A 69-year-old male presented with a swelling on his back. He had a malignant tumour that had transformed from plexiform NF to neurofibrosarcoma. A wide-excision biopsy of the swelling was done and a Malignant Peripheral Nerve Sheath Tumour (MPNST) was given as a diagnosis on Histopathological Examination (HPE). He underwent surgery for excision of the swelling. The patient had undergone Contrast-Enhanced Computed Tomography (CECT) of the thorax, abdomen and pelvis, showing cystic bronchial changes in the lower lobe and minimal in the posterior segment of the right lower lobe. Also, there was evidence of a large heterogeneous enhancing lobulated soft tissue density lesion in the subcutaneous plane of the neck and upper back. NF can be prevented from progressing if the malignant change is identified early. Surgical excision is the primary therapy; nevertheless, there is a greater chance of local recurrence, particularly in those suffering from NF1. The patient had undergone wide local excision with vacuum-assisted closure, which was followed by skin grafting.

Solitary Osteochondroma of the Distal Radius in a 17-Year-Old Female: A Rare Case Report

Dhairya Vijay Veragiwala, Sandeep Shrivastava, Aditya Dalvi Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Osteochondroma is the most common benign bone tumour, but its occurrence at the distal radius is rare. These tumours usually arise from the metaphyseal region of long bones such as the femur, tibia, and humerus, making distal radial involvement particularly uncommon. Here, a case of a 17-year-old female with a progressively enlarging, painless swelling over her dominant wrist is presented. Radiographs revealed a sessile bony outgrowth continuous with the cortex and medulla of the distal radius, and Magnetic Resonance Imaging (MRI) confirmed a cartilage-capped lesion without soft tissue extension. The mass, measuring 4.5×4.5×3 cm, was excised completely via a volar approach with base curettage and bone cementing. Histopathology confirmed the diagnosis of osteochondroma. Postoperative recovery was uneventful, and at six-month follow-up, the patient had full wrist function and no recurrence. This case highlights the importance of thorough radiological evaluation for accurate diagnosis and surgical planning. Distal radial osteochondromas are uncommon in adolescents, and reporting such cases adds to the limited global and regional literature. Complete excision provides excellent functional and cosmetic outcomes, emphasising the need for awareness of this rare presentation in clinical practice.

Primary Cutaneous Adenoid Cystic Carcinoma: A Rare Entity

Shalaka Anand Deshpande, Samyaka Bhagat, Jayashri Chaudhari, Manisha Khare Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Primary Cutaneous Adenoid Cystic Carcinoma (PCACC) is an uncommon skin adnexal tumour that mostly affects people over 50 years and has no known gender preference. It has no apparent predilection and can appear in a variety of anatomical locations. Less than 200 instances have been reported in the literature so far. Here, we present a case report of cutaneous adenoid cystic carcinoma with unusual location. A 45-year-old male presented with synchronous painful flesh-coloured swellings on the chest and back in a local hospital. These were clinically misdiagnosed as sebaceous cysts. Wide local excision of both swellings was performed, and the samples were sent for histopathology examination. Histology of the swellings revealed an uncommon basaloid adnexal tumour, and the patient was diagnosed with PCACC. PCACC is an important histological diagnosis due to its aggressive tendency to metastasise and recur. Diagnosis of PCACC is primarily based on histopathological examinations, as there are no particular clinical distinguishing features. This case highlights the significance of histological assessment of the mass lesion for proper diagnosis and treatment, as well as thorough examination for PCACC diagnosis post-initial surgery. Here, we report a rare tumour, probably the only case in the literature showing synchronous/bifocal atypical presentation sites.

Sleep-related Breathing Disorder: A Rare Complication Following Coblation Adenotonsillectomy

Shakthesh Kadhirvelu, R Rejla, S Manjani, Jamunarani Srirangaramasamy Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Sleep-Disordered Breathing (SDB) encompasses a wide range of respiratory conditions, from primary snoring to Obstructive Sleep Apnoea (OSA). OSA is widely recognised as a potential cause of significant morbidity in children. We describe the case of a five-year-old girl who underwent coblation adenotonsillectomy to treat a Sleep-Related Breathing Disorder (SRBD). However, three months after surgery she experienced severe apnoeic episodes. Further investigation uncovered a polypoid-like growth in the upper posterior nasopharynx, which was effectively treated with a second surgery. This case highlights the importance of postoperative monitoring and thorough evaluation in patients who undergo adenotonsillectomy for SRBD. Despite initial surgery, the persistence or recurrence of severe symptoms, such as apnoeic episodes, may indicate underlying issues, such as polypoid lesions, that require further intervention. Successful management in this case was achieved through revision surgery, emphasising the need for vigilance and comprehensive follow-up in paediatric patient with SRBD.

Oxcarbazepine-induced Reversible Pancytopenia and Severe Hyponatremia in a Patient with Bipolar Affective Disorder: Two Case Reports

Sowmya Peyouse, S Gopinath, Priya Shivashankar Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Oxcarbazepine is a widely used mood stabiliser in Bipolar Affective Disorder (BPAD) due to its favourable tolerability compared with carbamazepine. However, it is associated with serious adverse effects, including hyponatraemia and pancytopenia, which require close monitoring. Hereby, the authors present two cases of middle-aged women with BPAD who developed severe hyponatraemia (Na+ <110 mmol/L) and pancytopenia within two to three weeks of oxcarbazepine initiation. Both patients exhibited generalised weakness, dizziness, and fatigue, prompting laboratory evaluations that confirmed marked electrolyte disturbances and haematologic abnormalities. Further investigations ruled out infectious and autoimmune causes. Oxcarbazepine was discontinued, and corrective interventions were initiated, leading to rapid clinical improvement. Sodium levels normalised within three to five days, and haematologic parameters recovered within a week. These cases reinforce the importance of early detection of oxcarbazepine-induced adverse effects, particularly in high-risk populations such as older adults and those with metabolic co-morbidities. Although oxcarbazepine remains an effective treatment for BPAD, clinicians must remain vigilant for life-threatening complications. Routine monitoring of serum sodium and blood counts should be an essential part of patient management. Early drug discontinuation in suspected toxicity can prevent serious morbidity and improve patient safety.

Role of Mental Imagery in the Post-operative Management of CABG: A Case Report

Sharmila Chaudhuri, Nidhi Oza, Shagun Agarwal Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Patients recuperating after Coronary Artery Bypass Grafting (CABG) frequently experience psychological distress, such as worry and anxiety, which can have a negative impact on long-term survival, quality of life, and rehabilitation results. Integrating mind-body techniques may offer extra advantages, even if traditional physiotherapy focusses on physical rehabilitation. This report showcases a unique case showing how mental imagery improved a 78-year-old man's physical performance, tension, anxiety, and discomfort after CABG surgery. Over the course of four weeks, the intervention included regular physiotherapy sessions along with guided visualisation techniques. Assessment conducted after the intervention showed a considerable increase in physical performance, a significant reduction in stress and anxiety, and a significant alleviation of pain. This case demonstrates how mental imagery can be used as a comprehensive approach to improve emotional health, encourage physical healing, and possibly lower psychologically related morbidity and mortality in post-CABG rehabilitation programmes.

An Uncommon Presentation of Single Bony Metastasis in Oropharyngeal Carcinoma: A Rare Case Report

Ankita Pandey, Pushkar Mishra, Laxman Pandey, Ankit Kumar Tebrawal Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Oropharyngeal Squamous Cell Carcinoma (OPSCC), a subtype of Head and Neck Squamous Cell Carcinoma (HNSCC), is known for its aggressive behaviour and tendency for local and distant metastasis. While lymphatic spread is the primary mode of metastasis, distant bone metastases, although rare, significantly impact patient prognosis and quality of life. This case report highlights an unusual occurrence of isolated clavicular bone metastasis in a 75-year-old male with OPSCC, presenting as a solitary lesion despite completing radiotherapy. The patient, with a history of tobacco use, initially underwent radical radiotherapy and concurrent chemotherapy for locally advanced OPSCC. Three months post-treatment, a follow-up Positron Emission Tomography (PET)/Computed Tomography (CT) scan revealed a metabolically active lesion in the right clavicle, indicative of bone metastasis. The rare nature of this metastasis site, combined with the absence of neurological or respiratory symptoms, underscores the need for vigilant monitoring and extended metastatic surveillance beyond typical sites. This report emphasises the importance of considering atypical metastatic patterns in OPSCC, particularly in non-Human Papilloma Virus (HPV)-associated cases, to facilitate early detection and timely intervention, ultimately improving patient outcomes and quality of life.

Inherited Factor V Deficiency: A Rare Cause of Gingival Bleeding in an Adolescent Girl

Vivek Selvaraj, Saurav P Singhvi, Naveena Dhandapani, Jennie Santhanam, Aswin Chakaravarthie Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Parahaemophilia, sometimes called Owren's disease, is a rare inherited disorder characterised by a lack of clotting factor V in the blood. It can present as uncommon bleeding ranging from mild unprovoked bleeding to a fatal bleed. Reasons for clotting factor deficiency may be due to congenital, acquired, or both. Identifying the deficient clotting factor(s) is crucial, as multiple clotting factors can be deficient in the same patient and the replacement of the deficient factors forms the core of treatment. This case is a 14-year-old female who had had a few instances of minor bleeding since childhood following trivial trauma; menorrhagia and iron deficiency anaemia at menarche. She was on symptomatic treatment until a prolonged bleeding episode. At present, she has a prolonged oozing from the recent tooth extraction site. Laboratory studies showed prolonged Prothrombin Time (PT) and activated Partial Thromboplastin Time (aPTT), and normal Thrombin Time (TT). Mixing studies corrected both PT and aPTT, suggesting a defect in the common pathway of the coagulation cascade and the absence of clotting factor inhibitors. Treatment with antifibrinolytics did not arrest the ongoing bleed. Fresh frozen plasma infusion served as the only modality of treatment. Coagulation factor(s) deficiency can present as chronic iron deficiency anaemia and prolonged bleeding. Identifying the cause is crucial for managing the patient effectively.

Extensive Intramedullary Spread of Oral Squamous Cell Carcinoma with Minimal Intraoral Manifestation: A Case Report

Kundan Shibjee Jha, Nitin Bhola, Sanjana Wadewale Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Globally, Oral Squamous Cell Carcinoma (OSCC) is a significant public health problem, especially in developing countries, where delayed diagnosis often leads to advanced-stage presentation and poor outcomes. OSCC typically presents with visible intraoral changes (e.g., ulceration, swelling, mucosal alterations), but uncommon cases with extensive intramedullary spread and minimal intraoral manifestations pose specific diagnostic challenges. Hereby, the authors present a case report of a 31-year-old female with a 10-year history of tobacco chewing who presented with severe mandibular pain radiating to the right ear and mild discomfort during clenching activities. Clinical examination revealed a firm swelling on the right lower jaw with an intraoral ulcerative lesion over the gingivobuccal region. Imaging demonstrated extensive intramedullary spread, erosion of the mandible crossing the midline, pathological fracture, and perineural invasion. Histopathology confirmed OSCC. Despite minimal intraoral features, radiological studies highlighted the aggressive nature of the tumour, with neurovascular involvement and metastatic spread to the lungs. The tumour was deemed unresectable due to extensive involvement of vital structures, and the patient was started on primary chemotherapy with curative intent. The present case illustrates the misleading presentation of OSCC with only minor intraoral manifestations, underscoring the importance of advanced imaging for timely diagnosis, accurate staging, and treatment planning. It further emphasises the need for a high index of suspicion in patients with known risk factors and the integration of radiological assessment in atypical cases to improve diagnostic accuracy.

Management of Dentoalveolar Fracture in an Eight-Year-Old Paediatric Patient: A Case Report

Vishal Sharma, Shalini Garg, Anil Gupta, Sakshi Jainer, Muskan Kalra Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Traumatic injuries, which commonly occur in school-going children, usually result from accidents, falls from heights, contact sports, violence and other outdoor sports activities. The most common type of injury considered a dental emergency is dentoalveolar fractures. Fracture of the alveolar process usually involves the facial or lingual plates or both; most of these fractures are accompanied by injuries to teeth; thus, they are referred to as dentoalveolar fractures. Dentoalveolar trauma usually requires intraoral periapical and occlusal images to obtain adequate anatomic detail. Most of the fractures of the alveolar process are open with trauma to the gingiva and the alveolar mucosa. Radiographic examinations of traumatised teeth may demonstrate the extent of injury to the bone (maxilla or mandible) and the tooth, which may involve the root, periodontal ligament, and alveolar process. A tooth that has been concussed, subluxated, or luxated may demonstrate varying degrees of widening of the periodontal ligament space. This case report describes an eight-year-old male patient who presented with a mobile left upper segment with avulsed primary teeth, which followed the management of an anterior maxillary dentoalveolar fracture and uneventful eruption of the maxillary lateral incisor. The novelty in managing the paediatric dentoalveolar fracture using Ivy eyelet wiring lies in combining the standard Ivy loop with functional refinements- notably the extended eyelet for horizontal support, the loop designed for rapid and safe use, and the clove-hitch for minimal dentition scenarios. Together, these modifications elevate an already trusted method, tailoring it effectively to the needs of an eight-year-old patient.

Comprehensive Orthodontic Management of Erupted Mesiodens in an Adult Patient: A Case Report

Aishwarya Rajesh Atey, Rizwan Gilani, Shefali Singh, Abhijeet Kadam Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Supernumerary teeth are relatively rare anomalies, with mesiodens being the most common type. They are often detected in childhood, but when left undiagnosed, can persist into adulthood and interfere with occlusion and aesthetics. Timely identification and management are therefore essential to prevent long-term complications. The presence of a mesiodens in adult patients, although rare, often leads to complications including midline deviation, localised spacing, and aesthetic concerns. This case report presents the comprehensive orthodontic management of a 25-year-old male with an erupted mesiodens positioned between the maxillary central incisors. The patient exhibited localised spacing in both arches with a skeletal and dentoalveolar Class I malocclusion. Following the extraction of the mesiodens under local anaesthesia, fixed appliance therapy with pre-adjusted MBT 0.022? brackets was initiated. Alignment and levelling were achieved with 0.016? NiTi wires progressing to 0.019×0.025? stainless steel wires. Space closure was accomplished using continuous light forces through elastomeric chains, with careful anchorage management to achieve midline correction and preserve molar and canine relationships. The total treatment duration was 12 months. Post-treatment assessment revealed successful space closure, corrected midline, and improved smile aesthetics. Bonded lingual retainers were placed to ensure long-term stability. This case highlights the importance of early identification and management of mesiodens to achieve optimal orthodontic and aesthetic outcomes. Detection of mesiodens in adulthood can still be regarded as early because it precedes the onset of secondary complications such as cyst formation, root resorption, or complex malocclusion. Additionally, orthodontic correction is more efficient and stable at this stage when compared to later decades of life. Controlled biomechanics and diligent retention protocols are crucial in achieving predictable and stable results in adult patients. The novelty of this case lies in managing space closure and midline correction following the extraction of an erupted mesiodens in an adult patient, which is rare compared to routine cases.

Unmasking the Uncommon: A Rare Case Report of Submucosal Lipomatosis of the Appendix Mimicking Acute Appendicitis

R Monica, Monika Singh, Drishti Pargai, Bhaskar Bisht, Smita Chandra Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Acute Appendicitis (AA) is a common medical emergency that presents with pain in the right iliac fossa and can mimic many other non neoplastic entities that clinically present as acute abdomen, such as intestinal obstruction, adhesions and perforation. Intestinal Submucosal Lipomatosis (SML) is a rare condition with a prevalence rate of 0.2%; however, it is even rarer in the appendix. Although SML can follow a varied course, it most commonly leads to AA or more serious complications like intestinal intussusception or massive intra-abdominal bleeding. Since AA can be a sequela of SML, it can obscure the true cause of inflammation on radiologic imaging due to wall thickening. Therefore, appendectomy, along with Histopathological Examination (HPE), is mandatory for diagnosing Appendiceal Submucosal Lipomatosis (ASL) and preventing complications associated with it. SML can be diffuse or focal and is microscopically characterised by the presence of increased mature adipocytes in the submucosal layer of the gastrointestinal tract, without a capsule—unlike lipoma—making this an important distinguishing feature between the two. Present case is of a 22-year-old male who presented to the surgical outpatient department with complaints of recurrent abdominal pain. Clinically, and even on radiology, it mimicked AA due to wall thickening but was later confirmed as SML of the appendix based on the final HPE report. This case highlights that an accurate preoperative diagnosis of SML, based on radiological findings of fat infiltration in the wall, can avoid laparoscopic appendectomy unless there is some associated complication; in some scenarios, it can also prevent potential complications.

Giant Splenic Cyst with Spectacular Gross Morphology: A Case Report

RG Mundada, CB Gargade, VD Dombale Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Splenic cysts are rare lesions with a documented prevalence of 0.07% to 2%. Primary splenic cysts have an epithelial lining. A 32-year-old female presented with a complaint of abdominal pain and a dragging sensation on the left side. On examination, a soft lump was palpable 20 cm below the left costal margin. A Computed Tomography (CT) scan of the abdomen revealed splenomegaly and a large, smooth-walled cyst. The diagnostic work-up for splenic cysts typically involves a combination of clinical assessment, imaging studies, and laboratory tests. The imaging modalities can provide information about the size, location, and nature of the cyst. Ultrasound can confirm the cystic nature of the lesion, while CT and Magnetic Resonance Imaging (MRI) offer more detailed visualisation of the cyst’s internal structure, septations, and wall characteristics. Radiological examination may not be sufficient to differentiate between various types of splenic cysts. In endemic regions, it is difficult to distinguish from non-parasitic cysts based on imaging alone and additional diagnostic measures are necessary. Cyst fluid examination, such as fluid amylase, titre of echinococcus and other biomarkers, may aid in differentiating between cysts in the pancreatic tail, parasitic cysts and malignancy. Image-guided biopsy or partial or complete splenectomy, and histopathological examination are necessary for definitive diagnosis. In this case, the cyst on histopathological examination showed features of a primary splenic mesothelial cyst. Primary splenic mesothelial cysts are extremely rare lesions with a documented prevalence of 0.07% to 2%. There is limited available literature, which merits the documentation of this case report. The various classifications of splenic cysts, clinico-radiological and morphological findings of mesothelial cysts are discussed in this case report.

Benign Centrotemporal Spikes in a Female Child with Rolandic Epilepsy: A Case Report

Abhiraj Parekar, Ketki Giradkar Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Benign Epilepsy with Centrotemporal Spikes (BECTS), also known as Rolandic epilepsy, is a common epilepsy syndrome that mainly affects children. It is more prevalent during the preschool and school years, with a higher incidence in males (M:F - 1.5:1). The present case report highlighted a case of a seven-year-old girl with typical Rolandic seizures with specific symptoms such as facial muscle contractions, drooling, and difficulty in speaking, which are common features of BECTS. The patient was immediately started on antiepileptic medication - Syp. Levetiracetam 5 mL BD and tab. clobazam 5 mg OD, due to the frequent nature of the seizures. A follow-up Electroencephalography (EEG) still showed centrotemporal spikes without clinical deterioration. Due to the benign progression, the antiepileptics were discontinued. In the present case report, the authors emphasised the importance of accurate diagnosis, reassurance for families and the need for follow-up in monitoring seizure frequency and severity, as BECTS typically resolves by adolescence and does not lead to long-term cognitive or neurological issues.

Case of Isolated Sacral Tuberculosis Diagnosed by Histopathological Examination in a Patient with End-stage Renal Disease: A Pathologist’s Perspective

Abhishek Tambile, Nandita Wadhwa, Charusheela Gore, Rupali Bavikar, Saurabh Patil Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Isolated sacral Tuberculosis (TB) is an exceptionally rare presentation of osteoarticular TB, often overshadowed by more common spinal involvements and frequently misdiagnosed due to its non specific clinical and radiological features. The authors present a case of a 43-year-old male with End-Stage Renal Disease (ESRD) on maintenance haemodialysis, who developed progressive low back pain and sacral tenderness without systemic symptoms. MRI of the lumbosacral spine revealed lytic lesions in the sacral vertebrae with surrounding soft-tissue oedema, raising concerns for malignancy or fungal osteomyelitis. Laboratory investigations revealed elevated Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) but were otherwise inconclusive. Due to the patient’s immunocompromised status and atypical imaging findings, a Computed Tomography (CT)-guided sacral bone biopsy was performed. Histopathological examination demonstrated multiple well-formed epithelioid granulomas with central caseation necrosis and Langhans-type multinucleated giant cells, consistent with tuberculous granulomatous inflammation. Ziehl-Neelsen staining revealed Acid-Fast Bacilli (AFB), confirming the diagnosis. Fungal stains and immunohistochemistry for malignancy were negative. The present case highlights the diagnostic dilemma posed by isolated sacral lesions in immunosuppressed patients and underscores the critical role of histopathology in establishing a definitive diagnosis. To the authors knowledge, this is among the few reported cases of isolated sacral TB in a haemodialysis-dependent patient, emphasising its novelty. Early pathological diagnosis enabled timely initiation of anti-tubercular therapy, leading to significant clinical improvement. The present report aims to raise awareness among clinicians and pathologists about considering TB in the differential diagnosis of sacral lesions, especially in high-risk groups advocates for early tissue diagnosis to avoid delayed or inappropriate treatment.

Hepatoid Adenocarcinoma of Lung Presenting as Soft-tissue Swelling: A Rare Case Report

Sunita Singh, Ankush, Monika Kalyan, Vaishali, Navneet Kaur Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Hepatoid Adenocarcinoma of the Lung (HAL) is a rare type of Non-Small Cell Lung Cancer (NSCLC), histologically similar to Hepatocellular Carcinoma (HCC). Hepatoid adenocarcinoma presenting as soft-tissue swelling is extremely rare. Less than 40 well-documented cases in the literature have been added to date. Diagnostic work-up included clinical history, Alpha-Fetoprotein (AFP) serum marker level, imaging, histological uniqueness, immunohistochemical expression, and molecular testing. Hepatoid adenocarcinoma of the lung has high malignancy and poor prognosis and needs a better treatment plan. Hence, we report a case of a 73-year-old male presenting with a history of swelling on the right arm for three months. On Magnetic Resonance Imaging (MRI), the soft-tissue swelling radiological features were suggestive of sarcoma. An excisional biopsy was done. Histomorphological and immunohistochemical expression revealing features of metastatic deposits from hepatoid adenocarcinoma of the lung. Patient expired during follow-up. Hepatoid adenocarcinoma of the lung is a special type of NSCLC. The surgical treatment of HAL in the limited stage can achieve long-term survival, but most of them are in the advanced stage when they are found, and the prognosis is poor, which requires multidisciplinary comprehensive treatment.

Methotrexate Toxicity Masquerading as Systemic Lupus Erythematosus Flare: A Case Report

Siddharth Shah, Sunil Kumar, Yash Anand Chordia, Hem Menpara Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X A 36-year-old woman with Rheumatoid Arthritis (RA) and class V lupus nephritis presented with fever, dysphagia and oral mucosal bleeding. She had been prescribed Methotrexate (MTX) 15 mg weekly but used it irregularly-almost daily-for four months. On examination, she had oral ulcers, reduced mouth opening, diffuse hair thinning, and erythematous papules. Laboratory findings revealed severe pancytopenia, elevated liver enzymes, and an increased MTX level. Complement levels were normal and anti-dsDNA negative, making a Systemic Lupus Erythematosus (SLE) flare unlikely. The diagnosis of MTX toxicity was confirmed. She was managed with immediate MTX withdrawal, folinic acid rescue (15 mg i.v. every six hours for three days), blood transfusions, and supportive care. Her counts normalised, and mucositis resolved within two weeks. This case emphasises the diagnostic challenge in differentiating drug toxicity from disease flare in autoimmune patients and underscores the need for strict adherence to MTX monitoring guidelines.

Comprehensive Management of Skeletal Class II Division 1 Malocclusion with Bilateral Crossbite using Haas Expander and Forsus^TM FRD: A Case Report

K Aathira Surendran, Lovely Bharti, Pallavi Daigavane, Ranjit Kamble, Aditya Pareek Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Skeletal Class II malocclusion is a jaw discrepancy where the mandible is retruded relative to the maxilla, leading to a convex profile, increased overjet, and potential deep bite. It may result from mandibular deficiency, maxillary excess, or both. This case report details the comprehensive management of a 19-year-old male patient with a Class II Division 1 malocclusion, characterised by an orthognathic maxilla, retrognathic mandible, increased overjet and overbite, and a convex facial profile. The treatment involved fixed orthodontic therapy using the McLaughlin-Bennett-Trevisi (MBT) 0.022” prescription for comprehensive tooth alignment and leveling. Maxillary expansion was achieved using a Haas expander, a tooth- and tissue-borne appliance designed to widen the upper arch. Class-II correction was carried out with the ForsusTM Fatigue Resistant Device (FRD), a Fixed Functional Appliance (FFA) that applies continuous force to advance the mandible and correct the sagittal jaw discrepancy. Following two years of active treatment, the patient achieved a well-aligned dentition, a Class I molar and canine relationship, and an improved facial profile. This case highlights the efficacy of FFAs in the non-extraction management of Class II malocclusion, demonstrating favourable dentoalveolar and soft-tissue changes.

Rare Presentation of Pelvi-ureteric Junction Obstruction: A Series of Three Cases

Sunil Mhaske, Ujjwal Bhardwaj, Vilas Sabale, Vikram Satav, Deepak Mane Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Pelvi-Ureteric Junction Obstruction (PUJO) is one of the most frequent causes of hydronephrosis in both children and adults. It may present with flank pain, vomiting, or progressive renal dysfunction, and if left untreated, may cause irreversible renal damage. Although laparoscopic and robotic techniques are gaining popularity, open pyeloplasty continues to be the gold standard, particularly in anatomically complex cases. A series of three cases of adult PUJO presented here, which were managed with open surgical reconstruction, each with distinct intraoperative findings and outcomes. A 30-year-old male presented with right flank pain and vomiting for two months. Computed Tomography (CT) urography revealed moderate hydronephrosis with a grossly dilated inferomedial calyx, while Diethylenetriaminepenta Acetic Acid (DTPA) scan showed reduced right renal function {24.2%, Glomerular Filtration Rate (GFR) 21.7 mL/min}. Intraoperatively, the dilated lower calyx was compressing a high-insertion ureter. Reduction calycoplasty with infundibular dilatation and Double J (DJ) stenting was performed. Follow-up DTPA showed a 10% increase in split function and +8 mL/min GFR improvement. A 20-year-old female with dull aching left flank pain for one year had a CT urography suggestive of severe hydronephrosis with cortical thinning. DTPA scan showed left kidney function at 18.3% (GFR 16.1 mL/min). Retrograde pyelography confirmed a grossly dilated pelvis. Anderson-Hynes dismembered pyeloplasty was performed, preserving a crossing systemic vein. Follow-up DTPA demonstrated a 10% rise in split function and +10.3 mL/min GFR gain. A 55-year-old female with intermittent right flank pain and vomiting for one year had Intravenous Pyelography (IVP) and Right Retrograde Pyelogram (RGP) suggestive of PUJO due to Pelvi-Ureteric Junction (PUJ) kink with poor drainage. She underwent standard dismembered pyeloplasty. Postoperative recovery was uneventful, and she remains asymptomatic with preserved renal function. In this case series, all three cases were rare and unique presentations of PUJO.

Images in Haematology: A Rare Visualisation of Histoplasma Capsulatum in Peripheral Blood Smear and Bone Marrow Aspirate

Khushi Soni, Kishor Hiwale, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X A 70-year-old Indian female with a history of Chronic Obstructive Pulmonary Disease (COPD), using an Asthalin inhaler (Salbutamol, 100 mcg/puff) (2 puffs as needed), presented with a low-grade fever, dry cough and mild hepatosplenomegaly. For fever, she was prescribed paracetamol 650 mg as needed, and for cough, benzydamine hydrochloride syrup 10 mL orally. Importantly, the patient had not received any corticosteroids. General examination revealed weight loss. On respiratory system examination, mild wheeze was noted bilaterally. Abdominal examination also demonstrated mild hepatosplenomegaly. Cardiovascular and central nervous system examinations were normal and revealed no significant abnormalities. Initial laboratory investigations showed haemoglobin 10 g/dL, total leukocyte count 7800/cu mm, platelet count 46000/cu mm, C-Reactive Protein (CRP) 36.4 mg/L, serum creatinine 1.1 mg/dL, total bilirubin 1.50 mg/dL (direct bilirubin 0.96 mg/dL), total protein 5.6 g/dL, and serum albumin 2.4 g/dL. Liver enzymes were also normal {Serum Glutamate Pyruvate Transaminase (SGPT 31 IU/L)}. The patient thus demonstrated isolated thrombocytopenia with mild anaemia and normal leukocyte count. Biochemistry showed hypoproteinaemia and hypoalbuminaemia, a slight rise in bilirubin, and increased C-Reactive Protein (CRP). Peripheral blood and buffy coat smears demonstrated intracellular and extracellular forms of Histoplasma capsulatum as shown in (Table/Fig 1). On the peripheral smear, small (2-5 μm) oval yeast forms with narrow-based budding and a surrounding clear halo were observed, which indicated a possible capsule-like structure. The presence of intracellular organisms within neutrophils was noted, which was thus consistent with disseminated infection, whereas the extracellular clusters among erythrocytes showed uniform budding yeasts with eccentric acorn-like nuclei. Bone marrow aspirate and special stains {Periodic Acid–Schiff (PAS), Gomori Methenamine Silver (GMS)} confirmed the presence of H. capsulatum as shown in (Table/Fig 2). The bone marrow aspirate showed small (2-5 μm) oval yeast forms with narrow-based budding, present as both intracellular and extracellular clusters, with a clear halo, which indicated the presence of a capsule. The PAS stain showed thick, magenta-stained capsules surrounding the yeasts, thus confirming the polysaccharide-rich cell wall. As a confirmation regarding the presence of fungal elements, GMS staining revealed fungal cell walls as black structures against a pale green background.

MRI Revelations in Dyke-Davidoff-Masson Syndrome: Understanding Hemiatrophy through Imaging

Tushar Kalekar, Niharika Prasad, Ankit Gupta, Garima Kaushik Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X A 22-year-old male presented with involuntary limb movements for two days, characterised by pronation-supination of the upper limbs. The patient had a history of perinatal hypoxic-ischaemic insult, as reported by his family. He had epilepsy for the past eight years and was on regular carbamazepine therapy, previously at a maintenance dose of 20 mg/kg/day, divided into two doses. Despite medication, he continued to experience breakthrough seizures approximately every 2-3 months.

Images of Placental Aging with Calcification in Pregnancy-induced Hypertension

Aashita Anil Zawar, Amardeep Tembhare Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X A 28-year-old primigravida with a history of Pregnancy-Induced Hypertension (PIH) diagnosed at 24 weeks of gestation, came to the emergency department at 37 weeks of gestation with the complaint of pain in the abdomen. She had no history of any other comorbidities. Her recent laboratory reports were within normal limits. Her last ultrasound scan, done at 32 weeks, revealed a single live intrauterine gestation with parameters of a 30-week foetus weighing approximately 1.7 kg with adequate liquor and grade 3 placental maturity with no Doppler velocimetry abnormalities. On examination, her Blood Pressure (BP) was 140/90 mmHg. Trial of normal labour was given with continuous intrapartum maternal and foetal well-being assessment. Due to foetal distress, the decision for a caesarean section was taken. A male child of 1.72 kg was delivered, cried immediately after birth, with an APGAR score of 8 at 1 min. Neonatal Intensive Care Unit (NICU) admission for further observation in view of low birth weight was advised.

Therapeutic Effect of Vastyamantak Ghrita Uttarbasti in Recurrent Urethral Stricture: A Case Report

Sanjay Kumar Srivastava, Amit Ashok Paliwal, Sanjay Chandrakant Babar, Mahesh Pandurang Jadhav, Priyanka Dushyant Patil Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Urethral stricture, commonly resulting from infections, trauma, or iatrogenic causes, continues to present therapeutic challenges despite advances in surgical interventions such as urethroplasty, visual internal urethrotomy and dilatation. In Ayurvedic literature, particularly in the Sushruta Samhita, this condition is described under the term Mutrasanga. Although urethroplasty remains the gold standard for treatment, the high recurrence rate associated with current surgical modalities highlights the need for adjunct or alternative therapeutic strategies. This case study explores the Ayurvedic management of recurrent urethral stricture through the administration of Vastyamantaka Ghrita via Uttarbasti (transurethral medicated oil instillation). A 44-year-old man with a history of recurrent strictures and unsuccessful outcomes from multiple dilatation procedures was treated with Uttarbasti every fourth day over an eight-week period, initiated post-dilatation. The intervention resulted in significant clinical improvement, including an increase in maximum urinary flow rate (Qmax) from 5.1 mL/s to 14 mL/s, a decrease in Post-Void Residual (PVR) urine volume from 230 mL to 55 mL, and normalisation of urinary frequency. Post-treatment imaging confirmed the absence of residual stricture. These findings suggest that Vastyamantaka Ghrita administered via Uttarbasti may represent a promising, non invasive therapeutic option for managing recurrent urethral stricture and potentially reducing its recurrence.

Photon versus Proton Therapy in the Management of Head and Neck Cancer: A Systematic Review

S Sowmya, R Sangavi, R Amritha Sripoo Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Head and Neck Cancers (HNC), particularly Head and Neck Squamous Cell Carcinoma (HNSCC), are major causes of cancer morbidity and mortality. Radiation therapy, commonly using photons, can damage surrounding healthy tissues. Proton Therapy (PT), with its ability to target tumours more precisely, may reduce toxicity and improve Quality Of Life (QOL). The present review compares the efficacy, toxicity, and QOL outcomes of proton versus photon therapies in HNSCC treatment. Aim: To evaluate and compare PT versus photon therapy in terms of therapeutic efficacy, adverse effects, and QOL in the management of HNC. Materials and Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electronic searches were performed across PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar, including studies published from February 2016 to January 2024. Eligible studies involved adult patients diagnosed with HNSCC and compared PT with photon therapy. A total of five studies were included, and their quality was assessed using the Newcastle-Ottawa Scale. A narrative synthesis of findings was performed, focusing on QOL and toxicity profiles. Results: The PT demonstrated a significant dosimetric advantage over photon therapy, particularly in reducing radiation exposure to critical structures such as salivary glands and the spinal cord. Patients receiving PT showed a 40-50% improvement in QOL, with fewer instances of xerostomia, dental problems, and head and neck pain. In comparison, photon therapy resulted in higher rates of acute and chronic toxicity, including greater feeding tube dependence and increased use of opioid medications. PT was also associated with a reduced incidence of weight loss and a decreased need for pain management compared to photon therapy. Conclusion: The PT offers a significant dosimetric advantage over photon therapy, improving QOL and reducing toxicity in patients with HNC. While PT has shown promising results, further research with longer follow-up is needed to confirm its long-term benefits and refine treatment protocols. PT is a viable alternative to photon therapy and is recommended for patients with HNSCC, especially those requiring precise radiation delivers to critical structures.

Diagnostic Yield of Different Bronchoscopic Procedures for Lung Cancer: A Retrospective Study

Urjitaben Parmar, Nisarg Patel, Dhruminkishan Prajapati, Ruchit Nawal Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Lung cancer represents the leading cause of cancer-related mortality globally, accounting for 1.76 million deaths annually worldwide. Flexible bronchoscopy remains the cornerstone diagnostic procedure for suspected pulmonary malignancy, offering multiple sampling techniques with varying diagnostic efficacy. Limited comparative data exists regarding optimal technique selection across different tumour presentations and morphological patterns in resource-constrained healthcare settings. Aim: To study comparison between different bronchoscopy techniques like Bronchial Brushings (BB), bronchial biopsy, and Bronchoalveolar Lavage (BAL) for diagnosis of lung cancer across different tumour locations and morphological patterns. Materials and Methods: The present hospital-based retrospective observational study was conducted at the Department of Pulmonary Medicine, BJ Medical College, Ahmedabad, Gujarat, India, data was collected from September 2018 to September 2020 and analysed during 2024-2025. A total of 50 patients aged ≥18 years with histopathologically confirmed lung malignancy who underwent diagnostic bronchoscopy were included. Given the retrospective nature utilising de-identified data, formal ethical clearance was exempted with verbal departmental approval obtained. Parameters which were evaluated include diagnostic yields of BBs, bronchial biopsy, and BAL across different tumour locations and morphological patterns, demographic characteristics, clinical presentations, smoking associations, radiological findings, and procedural complications. Statistical analysis was done using Microsoft Excel 2019 and R software version 4.0, utilising Chi-square tests for categorical variables, Fisher's-exact test when expected frequencies were <5, independent t-tests for continuous variables, and proportion tests for diagnostic yield comparisons, with significance defined as p <0.05. Results: Patient demographics were male predominance with 34 patients (68.0%) versus 16 females (32.0%), and elderly clustering with 34 patients (68.0%) between 66-80 years. Exposure to smoking affected 33 patients (66.0%), with strong association with squamous cell carcinoma (14/16 cases, 87.5%) whereas adenocarcininoma was equally distributed as in smokers (10 cases, 20.0%) versus non-smokers (10 cases, 20.0%). BBs yielded superior diagnostic yields of 16/25 procedures (64.0%, 95% CI: 42.5-82.0) in central tumours and 10/14 procedures (71.4%, 95% CI: 41.9-91.6) in peripheral lesions significantly better than bronchial biopsy (12/22 procedures, 54.5% central; 7/12 procedures, 58.3% peripheral) and Bronchial Washing (BW) (4/30 procedures, 13.3% central; 3/20 procedures, 15.0% peripheral). Brushings continued to outperform all patterns of morphology, with 66.7% yield in difficult mucosal irregularity cases. Adenocarcinoma was the most frequent (20 cases, 40.0%), followed by squamous cell carcinoma (16 cases, 32.0%). Total complications affected 16 patients (32.0%), primarily bleeding (12 cases, 24.0%) and pneumothorax (3 cases, 6.0%). Conclusion: These findings provide evidence-based support for prioritising BBs in lung cancer diagnostic protocols, particularly valuable for resource-limited healthcare settings seeking optimal conventional techniques.

Anatomical Variations of Renal Arteries: A Cross-sectional Cadaveric Study from Rajasthan, India

Nikhil Sharma, Hina Sharma, Vijay Kumar Dayma, Rasalika Miglani Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Kidneys are retroperitoneal organs normally supplied by the paired renal arteries. Variations in renal arterial anatomy are clinically significant for renal transplantation, angiographic interventions, and urological procedures. Aim: To evaluate the morphological patterns, incidence, and side-specific distribution of anatomical variations in renal arteries among the Rajasthan population. Materials and Methods: The present cross-sectional cadaveric study was conducted at Pacific Medical University, Udaipur, Rajasthan, India, from March 2024 to April 2025. The study was conducted on 50 human anatomical embalmed kidney specimens of unknown age and sex. To assess variations in renal arterial branching, the Sampaio FJ and Passos MA (1992) classification was used. Specimens free from pathological changes, trauma, surgery, or malformations were dissected to expose renal arteries and pre-hilar branches without the use of dyes or imaging; observations were recorded separately for each side. The proportions of the different variations were calculated as frequency and percentages by using the Epi Info software, Results: Out of 50 kidneys, a Single Renal Artery (SRA) was present in 11 cases (22.0%), whereas Multiple Renal Arteries (MRA) originating from the abdominal aorta was observed in 25 cases (50.0%). Double Hilar Arteries (DHA) was identified in 9 cases (18.0%), while no instances of triple hilar arteries were encountered. A combination of a hilar artery with a Superior Polar Artery (SPA) was recorded in 2 cases (4.0%), and a hilar artery with an Inferior Polar Artery (IPA) was noted in 3 cases (6.0%). Conclusion: Knowledge of the differences in renal artery anatomy is essential for surgical procedures related to renal transplantation, abdominal aorta aneurysm repairs, urological operations, and angiographic interventions.

Bridging the Gap between Clinicoepidemiological and Histopathological Variants of Psoriasis: A Cross-sectional Study

Pratiksha Kanubhai Rathwa, Hiral Shah, Sanjaykumar Somsingbhai Rathwa, Priyanka Rout Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Psoriasis is a chronic inflammatory immune-mediated skin disease associated with systemic manifestations that affects about 0.5% - 2.5% of the population, which varies according to regions. It is a conglomeration of multiple variants that have distinct morphological features. A histopathological study provides the diagnosis of psoriasis in classic form and its variants. Aim: The present study aimed to analyse the incidence of age, sex, disease duration, and distribution of various psoriasis variants while underscoring the clinical significance of histopathological assessment of epidermal and dermal features. Materials and Methods: The present cross-sectional study was conducted at Baroda Medical College, Vadodara, Gujarat, India, from January 2024 to December 2024. Hundred newly diagnosed patients of different variants of psoriasis visiting the Dermatology Outpatient Department (OPD) were included in the study, and a detailed clinical history with special reference to gender, duration, site of onset, seasonal exacerbation or remission, triggering factors, past treatment, family history and other systemic disease was taken. Complete head-to-toe cutaneous examination and systemic examination were carried out, and findings were noted. Biopsied specimens were processed in the histopathology section and stained with Hematoxylin and Eosin (H&E) stain, and 10 parameters like parakeratosis, elongated rete ridges, Munro’s microabscess, acanthosis, suprapapillary thinning, hypogranulosis, Kogoj abscess, capillary dilatation, dermal infiltrate, and spongiosis were used to assess and classify various types of psoriasis. Collected data were statistically analysed by the Chi-square test and a p-value of <0.05 was considered significant. Results: Total 100 patients were included among which male preponderance with 60 (60%) cases noted, with the maximum cases in the 31-40 year age group. The predominant histological type was Chronic Plaque Psoriasis (CPP) in 44 (44%) cases, followed by Palmoplantar Psoriasis (PPP) in 32 (32%). Amongst various cutaneous features of psoriasis, erythema was present in 79 (79%) followed by plaques 54 (54%). Auspitz sign and Woronoff ring were noted in 40 (40%) and 20 (20%) cases, respectively. Amongst the epidermal histopathological features of psoriasis, parakeratosis was found in 93 (93%) followed by hyperkeratosis 84 (84%). The dermal feature showed dermal infiltrate in 95 (95%) cases. These findings were statistically significant (p-value <0.0001). Conclusion: Present study emphasises the role of histopathological study in various clinical variants of psoriasis to see the two aspects simultaneously for effective diagnosis and treatment. The current study concluded that even though most changes occur in the epidermis, there are a few dermal changes which can help in arriving at a diagnosis.

Normal Saline versus Balanced Salt Solution in Diabetic Patients Undergoing Elective Surgery with Spinal Anaesthesia: A Randomised Control Study

Pritam Yadav, Sonam Meena, Preeti Gehlaut, Deepika Seelwal, Monica Chhikara Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Perioperative fluid management is of utmost importance in diabetic patients posted for surgery. Despite availability of a plethora of intravenous fluids, Normal Saline (NS) is still most commonly used in diabetic patients for perioprative fluid therapy. Aim: The present study was designed to compare NS with plasmalyte to study their effects on blood sugar, serum electrolytes, lactate levels and blood pH in diabetes mellitus patients undergoing elective surgery under subarachnoid block. Materials and Methods: The present double blinded randomised control study was carried out in the department of anaesthesiology and critical care at a Pt BDS PGIMS, Rohtak, Haryana, India, between November 2022 - April 2024. Seventy patients of age 30-85 years, with diabetes mellitus, American Society of Anaesthesiologists (ASA) class II scheduled for elective surgery under sub-arachnoid block were enrolled in a randomised controlled trial and randomly divided into two groups; Group A received NS and Group B received plasmalyte as intravenous fluid. Rest of the anaesthesia protocol was uniformly standardised in all the patients. Venous blood sample were drawn preoperatively, at one hour and six hours after the start of surgery for the measurement of blood sugar, serum sodium, potassium, chloride, serum lactate and pH. Recorded data was analysed with t-tests and Chi-square tests. Results: Mean age was 60.66±13.56 years in NS group and 64.80±12.52 years in plasmalyte group. Serum lactate levels were comparable in preoperative (mean value 1.34±6.57 mmol\L in NS group and 1.14±0.48 mmol/L in plasmalyte group; p-value 0.12) and postoperative period at six hours time point (mean value of lactate (mmol/L) in Group A (NS) was 1.33±0.61 mmol/L in NS group and 1.17±0.38 mmol/L in plasmalyte group; p-value 0.18), but lactate levels were significantly lower in plasmalyte group (1.05±0.32) than in NS group (1.29±0.56) in intraoperative period with p-value of 0.03. Serum electrolytes, blood pH and glucose levels were comparable at preoperative, intraoperative and postoperative in both groups. Conclusion: The present study results conclude that both plasmalyte and NS are comparable in maintaining blood sugar, serum electrolytes and blood pH perioperatively in patients with well optimised type II diabetes mellitus. However, plasmalyte is a promising alternative to 0.9% NS in terms of maintenance of lactate levels in diabetic patients.

Evaluation of Respiratory Mechanics and Endotracheal Tube Dynamics during Prone Positioning under General Anaesthesia: A Prospective Observational Study

Priyal Mittal, Sham Sunder Goyal Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Prone positioning is essential for various surgical procedures, including spinal surgeries, posterior cranial fossa procedures and urological interventions, as it provides optimal access to posterior anatomical structures. However, this positioning significantly alters respiratory mechanics and cardiovascular physiology, potentially affecting patient safety during general anaesthesia. Peak Airway Pressure (PAP) and Endotracheal Tube (ETT) cuff pressure are critical parameters that require careful monitoring during prone positioning to prevent complications such as barotrauma and tracheal injury. Aim: To evaluate simultaneous changes in PAP and ETT cuff pressure during prone positioning under general anaesthesia and to assess associated haemodynamic alterations. Materials and Methods: This prospective observational study was conducted at Department of Anaesthesiology and Critical Care, Adesh Institute of Medical Sciences and Research, Adesh University, Bathinda, Punjab, India. The study enrolled 105 consecutive American Society of Anaesthesiologists (ASA) I-II patients scheduled for elective procedures requiring prone positioning. Standardised protocols were used to document PAP, ETT cuff pressure and haemodynamic variables at multiple time points: baseline in the supine position, immediately after prone positioning and at 15-minute intervals throughout the procedure. Statistical analysis employed paired comparisons, with a significance threshold of p-value <0.05. Results: A total of 105 patients completed the study (mean age 45.36±10.26 years; 62.9% female; mean Body Mass Index (BMI) 21.41±2.56 kg/m^²). Transitioning from supine to prone position produced significant respiratory mechanical alterations. Baseline supine PAP (19.03±3.35 cm H2O) progressively increased to a maximum of 34.36±2.59 cm H2O during prone maintenance (p-value <0.001), representing an 80.6% elevation. Similarly, ETT cuff pressure increased from baseline (24.64±2.99 cm H2O) to 43.65±4.49 cm H2O at maximum prone measurement (p-value <0.001). Cardiovascular parameters demonstrated significant alterations during the initial 15 minutes post-positioning before stabilising during the maintenance phase. Conclusion: In patients under general anaesthesia, the prone position significantly increases PAP and ETT cuff pressure. This finding underscores the importance of regular monitoring and timely interventions to limit the risks associated with elevated pressures.

Comparison of Intubating Conditions for Nasotracheal Intubation with BPL^® Video Laryngoscope versus Standard Direct Macintosh Laryngoscope using Cuff Inflation Technique: A Randomised Clinical Study

Jigisha Bharatbhai Mehta, Dhananjay N Dhasade, Sara Mary Thomas, Pooja Arpan Shah Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Nasotracheal intubation is required in maxillofacial, oral and dental surgeries and it presents unique anatomical and technical challenges. The Macintosh laryngoscope is a gold standard for nasotracheal intubation but requires alignment of the oral, pharyngeal, and laryngeal axis. Conversely, video laryngoscopy helps in the visualisation of the real-time and enlarged video image of airway structures. Aim: To compare two laryngoscopy techniques- British Physical Laboratories^® (BPL) video laryngoscope and Macintosh laryngoscope - using the cuff inflation technique to optimise intubation conditions. Materials and Methods: This randomised clinical single-blinded study was carried out in the Department of Anaesthesiology at Dhiraj Hospital, Smt. B.K. Shah Medical Institute and Research Centre (SBKS) Medical Institute and Research Centre (Deemed to be University), Piparia, Waghodia, Vadodara, Gujarat, India, between September 2023 and May 2025, on 66 adult patients divided into two equal groups. Group V patients underwent BPL^® video laryngoscopy with cuff inflation, while group M patients underwent Macintosh laryngoscopy with the same technique. Patients were assessed for intubation time, Cormack–Lehane grading, number of attempts, initial 15 mL cuff inflation success, need of additional 5 mL inflation, need for Magill’s forceps or external laryngeal manipulation, haemodynamic parameters like Heart Rate (HR) and Mean Blood Pressure (MBP) and post-procedural complications. The Unpaired t-test was used for numerical variables, and the Chi-square test was used for categorical variables. A p-value <0.05 was considered statistically significant, and a p-value <0.001 was considered highly important. Results: Both groups were comparable in terms of demographic parameters like age, gender, weight, American Society of Anaesthesiologists (ASA) physical status classification and Mallampati Classification of the airway. Group V demonstrated significantly shorter intubation time (31.51±2.16 seconds vs. 45.97±3.15 seconds, p-value <0.001. Initial cuff inflation was more successful in group V (87.88% vs. 48.48%, p-value <0.001). Need for additional 5 mL inflation (12.12% vs 33.33%, p-value=0.04), need for Magill’s forcep (0% vs 18.18%, p-value=0.01) and external laryngeal manipulation (9.09% vs 36.36%, p-value=0.007) were significantly lower in group V. HR and MBP were significantly lower at laryngoscopy and intubation till 5 minutes post-intubation (p-value <0.05) in Group V. The incidence of sore throat (15.15% vs 54.55%, p-value <0.001) and post-procedure bleeding (12.12% vs. 45.45%, p-value=0.003) was significantly lower in group V. Conclusion: The BPL^® video laryngoscope with cuff inflation technique demonstrated superior intubating conditions compared to the standard Macintosh laryngoscope, providing shorter intubation times, higher success with initial 15 mL cuff inflation, better haemodynamic stability, and reduced complication rates during nasotracheal intubation.

Comparison of Analgesic Efficacy of Superficial Cervical Plexus Block versus Clavipectoral Fascia Block for Perioperative Pain Management in Clavicular Surgery: A Double-blinded Randomised Clinical Study

Aparna Bagle, KS Navya Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Analgesia during clavicle surgery is complicated due to intricate innervation and percutaneous anatomical placement. Regional anaesthesia methods, such as the Superficial Cervical Plexus Block (SCPB) and the Clavipectoral Fascia Block (CPFB), have proven beneficial, but direct comparative evidence of their analgesic potency is lacking. Aim: To compare the analgesic efficacy of SCPB and CPFB for patients undergoing clavicular surgery. Materials and Methods: A randomised double-blinded clinical study was conducted in the anaesthesiology department of Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India. The study took place from October 2024 to April 2025. A total of 40 American Society of Anesthesiologists (ASA) I-II patients, aged 18-65 years, who underwent clavicle surgery under General Anaesthesia (GA), were included. Under ultrasound supervision, each group of patients—Group A (SCPB) and Group B (CPFB)—received 15 millilitres of 0.25% bupivacaine. The outcome measures were postoperative Visual Analogue Scale (VAS) ratings, time to initial rescue analgesia, the number of analgesic doses in the first 24 hours, haemodynamic parameters and side-effects. Data were entered into an Excel sheet and analysed using Statistical Package for the Social Sciences (SPSS) version 21.0. Results were presented in tabular and graphical forms. An Independent t-test and Chi-square test were used to analyse continuous and categorical variables, respectively. Results: The mean age of patients was comparable between Group A (35.3±6.2 years) and Group B (35.2±6.2 years). The gender distribution and ASA grading were also comparable between the groups, with p-values of 0.74 and 0.75, respectively. There were no notable adverse effects in either group. The time to first rescue analgesia was similar between both groups (Group A: 9.4±5.5 hours vs Group B: 10.3±6.6 hours, p-value =0.664). The total number of rescue analgesic doses required in 24 hours was also similar between the groups, with most patients requiring one or two doses: one dose (Group A: 20% vs Group B: 25%), two doses (Group A: 45% vs Group B: 35%) and three doses (Group A: 35% vs Group B: 40%). Conclusion: This randomised clinical trial found that both SCPB and CPFB offer similar and effective pain control for clavicular surgery. Both blocks provide adequate perioperative analgesia, demonstrating similar pain control and safety profiles. The safety profile of both blocks was favourable, with only mild side-effects, such as nausea and no serious complications. Either block can be effectively used, with the choice guided by clinical judgment and patient needs.

A Scoping Review on Shudhabala Taila: Exploring its Healing Potential

Shalini Pathania, Shweta Parwe, Milind Nisargandha, Punam Sawarkar Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Shudhabala Taila, an Ayurvedic oil, is used for Vata-related disorders such as insomnia, paralysis and frozen shoulder. It contains Sida cordifolia, Sesamum indicum and cow’s milk, offering anti-inflammatory, neuroprotective and Rasayana effects. With increasing interest in integrative medicine, exploring its pharmacological basis and therapeutic potential is essential for broader clinical application. Aim: To review the therapeutic potential and clinical application of Shudhabala Taila in managing various disorders. Materials and Methods: This scoping review was conducted at the Department of Panchakarma, Mahatma Gandhi Ayurveda College Hospital and Research Centre, Datta Meghe Institute of Higher Education and Research (Deemed to be University) Salod (H), Wardha, Maharashtra, India, using comprehensive searches of the PubMed, Web of Science and Google Scholar databases. After carefully screening the studies, seven articles were selected. The extracted data were systematically organised and analysed to provide a comprehensive overview of the therapeutic potential of Shudhabala Taila. The present scoping review also emphasises the various routes of administration of Shudhabala Taila in treating different disorders. Results: These studies demonstrated a notable improvement in symptoms such as tremors, stiffness, pain, hypersensitivity and spasticity. According to the analysis, Shudhabala Taila is just as effective- if not more so- than alternative therapies or control groups. Conclusion: The review highlights that Shudhabala Taila is effective in providing symptom relief, improving quality of life and managing various health conditions. Incorporating Ayurvedic products like Shudhabala Taila into clinical practice can provide more holistic care. Nevertheless, further studies are required to understand its mechanism and to address the methodological shortcomings.

Comparing Single Spin versus Double Spin Techniques of Platelet Rich Plasma Preparation in Treating Male Androgenetic Alopecia: A Prospective Study

C Geo Danny, C Balakumaran, D Manoharan, N Ashok Kumar, A Sakthi Megalai, Dama Kondaiah Naidu Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Platelet Rich Plasma (PRP), a source of autologous growth factors, has been in use in many fields of medicine with different spin techniques but a standardised method is yet to be established. In this study, the authors have tried to compare the results of single spin vs double spin technique of PRP preparation on treating Androgenetic Alopecia (AGA). Aim: To compare the clinical outcome obtained with single spin versus double spin technique of PRP preparation in treating male AGA. Materials and Methods: The present prospective study was conducted in the department of Dermatology at Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India, with a total of 28 participants who were divided into two groups of 14 each and treated with PRP prepared either by single spin or double spin method and observed for a period of six months. This study was started in September 2022 and completed in April 2024. Males aged 18 years and above, with Grade III and Grade IV AGA as per the Hamilton-Norwood Scale were included in the study. They were regularly recalled and evaluated for hair count and also with the Merck Research Laboratories questionnaire. In addition, demographic details such as age, duration of onset of AGA were also collected. Chi-square test and One-way Anova test were used for categorical and continuous variables respectively. Results: While both methods of PRP preparations showed significant improvement in hair count post PRP administration, there was no statistical difference between the two groups (p-value=0.98). Patient satisfaction increased in both groups post treatment. Patients belonging to the age group of 20-24 years had a better response when compared to those belonging to the age group of 25-29 years. Patients with duration of AGA less than one year showed marked improvement in hair counts when compared with other groups. Conclusion: The present study concludes that both single spin and double spin techniques of PRP preparation are effective in AGA and as such, PRP is a good therapeutic option for the treatment of AGA irrespective of the method of preparation since both the methods showed significant improvement in hair growth. Single spin method is an easier, less time consuming and also a cheaper alternative to the commercial gel tubes and hence can be considered as a standard method.

Assessment of Suicidal Ideation and Depression among Patients with Chronic Pain: A Cross-sectional study from Uttar Pradesh, India

Himanshu Khatri, Prerana Gupta Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Individuals with chronic pain are at an increased risk of suicide. Chronic pain can lead to depression, hopelessness, provoke a desire for escape through death. However, the role of psychosocial factors that may influence their susceptibility to suicidal thoughts and behaviours has been largely overlooked. Aim: To assess the prevalence of suicidal ideation and depression among chronic pain patients and to examine the association of suicidal ideation with psychological factors in attending a tertiary care hospital in India. Materials and Methods: This descriptive cross-sectional study was conducted in the Psychiatry Outpatient Department (OPD) of Teerthanker Mahaveer Medical College and Research Centre, a tertiary care hospital in Moradabad, Uttar Pradesh, India, between November 2022 and May 2023. A total of 104 patients with chronic pain were included. Data were collected using a structured questionnaire. Suicidal ideation, depression, insomnia and pain severity were assessed using Beck’s Suicidal Ideation Scale (BSI), the Montgomery-Asberg Depression Rating Scale (MADRS), the Insomnia Severity Index (ISI), and the Visual Analogue Scale (VAS), respectively. Data were analysed using IBM-Statistical Package for Social Sciences (SPSS) version 22.0. Results: A total of 40 patients (38.5%) had the presence of suicidal ideation with an average pain score of 5.1±2.3. Mild to moderate depression was reported in 68 patients (65.4%), while 14 patients (13.5%) had severe depression. The majority 62 (59.6%) had moderate to severe insomnia. Suicidal ideation was more prevalent among those with severe pain (p-value=0.002). Depression was significantly associated with suicidal ideation. Conclusion: Suicidal ideation is common among patients with chronic pain, particularly in those with severe pain and depression. It highlights the urgent need for integrated care models in chronic pain management to identify and address suicidality early and effectively.

Histological and Histochemical Analysis of Foetal Suprarenal Gland Maturation from 13-40 Weeks of Gestation: An Observational Study

Jiby Livingta Herbert, Radhika J Krishnan, CD Anand, Sundarapandian Subramanian, Balakrishnan Ramamoorthy, Mohammed Junaid Hussain Dowlath Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: The Suprarenal Glands (SRG), a pair of endocrine glands located at the upper poles of the kidneys, originate from different developmental origins. The glands are divided into an outer cortex and an inner medulla. The cortex is further divided into the Zona Glomerulosa (ZG), Zona Fasciculata (ZF) and Zona Reticularis (ZR) while the medulla contains chromaffin cells—specialised neuroendocrine cells that synthesise and secrete catecholamines such as epinephrine and norepinephrine. These cells are also being studied for their regenerative applications in treating neurodegenerative diseases, including Parkinson’s disease. Aim: To identify the histological features of the foetal suprarenal cortex and medulla, track changes during development and measure the number of chromaffin cells at various developmental stages. Materials and Methods: This observational study was conducted from February 2024 to January 2025 in the Department of Anatomy, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India. Thirty-two foetuses of gestational ages 13–40 weeks were collected. The gestational age of the foetuses was estimated by Crown–Rump Length (CRL) and they were grouped into four groups (I–IV). The tissues from each sample were collected, processed and sectioned for histology and histochemical procedures. Images of the sections were captured with an inverted microscope attached to a CCD camera and these images were analysed using ImageJ software. The parameters measured included the thickness of the ZG, ZF, ZR and the medulla and the number of chromaffin cells. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25.0. Results: The cortex becomes progressively thinner with increasing gestational age. The medulla, on the other hand, shows an increase in thickness beginning around the late second trimester and reaches its maximum by the late third trimester. The right SRG showed a gradual increase in chromaffin cells up to the late second trimester, with around a 30–35% decrease in the early third trimester. The left gland showed a gradual increase in chromaffin cells from the early second trimester, reaching around a 50% increase by the late third trimester. Conclusion: The findings suggest functional and developmental asymmetries between the foetal SRGs, with the left gland undergoing more significant changes compared to the right. This asymmetry may have implications for understanding foetal stress responses and the maturation of neuroendocrine regulation.

Effect of Thoracic and Scapular Exercises on Pain and Craniovertebral Angle in Students with Forward Head Posture: A Quasi Experimental Study

Chandra Shekhar Kumar, Nancy, Neha Shukla, Adarsh Kumar Srivastav, Aamena Zaidi, Anamika Dixit Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Forward Head Posture (FHP) is a prevalent habitual postural malalignment that often develops at a young age and is frequently observed in individuals who spend extended periods sitting, reading, or working on computers. The decrease in the Craniovertebral Angle (CVA) is linked to a higher prevalence of FHP and an increased level of disability among individuals experiencing neck pain. Aim: To investigate the effect of scapular stability and thoracic exercises on pain and CVA in college students with FHP. Materials and Methods: This quasi experimental study was conducted at the Physiotherapy Outpatient Department (OPD), School of Health Sciences, Chhatrapati Shahu Ji Maharaj University, Kanpur, Uttar Pradesh, India, from August 2023 to March 2024. A total of 32 participants (aged 18-25 years) meeting the inclusion criteria {FHP, CVA <51° or less, and neck pain >3 on the Numeric Pain Rating Scale (NPRS)} were recruited. Participants underwent Scapular Stabilisation Exercises (SSE) and Thoracic Extension Exercises (TEE) four times weekly for six weeks. Demographic parameters such as age, gender, and baseline CVA were recorded. Pain and CVA were assessed pre- and post-intervention using the NPRS and modified universal goniometry, respectively. Statistical analysis was performed using paired t-tests, with a significance level set at p<0.05. Results: A statistically significant improvement was observed in NPRS scores (pre: 4.22±1.008; post: 3.34±0.902; p=0.001) and CVA (pre: 49.81±2.023°; post: 50.75±2.064°; p=0.002) after the intervention. Conclusion: The study concludes that SSE combined with TEE effectively alleviates pain and improves CVA among college students with FHP.

Perceptions of Mizo Professional Footballers on Injury Risk Factors, Preventive Measures and Management Strategies: A Cross-sectional Study

Lalpekhlua Chenkual, Jibran Ahmed Khan, Jannat Tasneem, Komal Trivedi, Aparna Sachan Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Injuries are common in professional football and can significantly affect player performance, team outcomes and career longevity. Mizoram, a state known for producing elite footballers, lacks region-specific research on injury perceptions and preventive strategies among its athletes. Aim: To assess the perceptions of Mizoram’s professional footballers regarding injury risk factors, injury history, preventive strategies and their effectiveness. Materials and Methods: This cross-sectional study was conducted in Mizoram, India, from January 2023 to March 2023. A structured questionnaire was administered to 43 male footballers aged 18-35 years from various leagues, including the Indian Super League (ISL), I-League and Mizoram Premier League (MPL). Data were analysed using IBM Statistical Package for the Social Sciences (SPSS) Statistics, version 25.0, applying descriptive statistics and Chi-square tests, with a p-value of <0.05 considered statistically significant. Results: A total of 38 players (88.4%) reported injuries, primarily affecting the knees (n=25, 65.8%) and ankles (n=20, 52.6%). Major perceived causes included player contact (n=25, 65.79%), overtraining (n=22, 57.89%) and poor playing surfaces (n=20, 52.63%). While 35 players (81.4%) were aware of injury-prevention strategies, warm-up exercises (n=30, 69.77%) and stretching routines (n=25, 58.14%) were most commonly practiced. Barriers to implementation included lack of time (n=20, 46.5%) and lack of guidance (n=15, 34.9%). Most participants rated the strategies as moderately effective (n=18, 41.86%). Conclusion: This study highlights the high prevalence of lower-limb injuries among Mizoram footballers and identifies key barriers to prevention strategies, underscoring the need to improve player education, infrastructure and the integration of structured prevention programs such as FIFA 11+ into daily practice.

Correlation between Stress, Self-esteem and Emotional Eating among MBBS Students in Central Gujarat, India: A Cross-sectional Study

Lakhan Kataria, Devashish Palkar, Dharti Shah, Apoorva Bang, Grishma Savaliya Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Medical students are exposed to many stressors and if stress is perceived negatively or becomes excessive can affect academic performance and health. Existing literature shows that people with higher stress and lower self-esteem often use unhealthy coping mechanisms like emotional eating. Aim: To find the prevalence of perceived stress, sources of stress and their correlation with self-esteem and emotional eating in third year MBBS students as a part of their Evidence Generating Community Health Intervention Project (EviGenCHIP). Materials and Methods: The present cross-sectional study was conducted among third year MBBS students of Smt BK Shah Medical Institute and Research Centre in Vadodara, Gujarat, India, from June 2023 to September 2023 after obtaining Institutional Ethical approval. All students (150) of third year MBBS who gave a written informed consent were included in the study. Data was collected through online Google forms which consisted of demographic details {age, gender, place of residence and Body Mass Index (BMI)}, Perceived Stress Scale (PSS), Sources of stress scale, Rosenberg Self-esteem Scale (RSES) and Emotional Eater Scale (EES). Descriptive and analytical statistical (Pearson’s correlation coefficient and unpaired t-test) methods using Statistical Package for Social Sciences (SPSS) trial version 25 software were used. Results: A total of 134 students out of the total 150 enrolled in the study completed the form, of which 18 (13.43%) students had low stress, 106 (79%) had moderate and 10 (7.5 %) had high perceived stress. Time pressure, fear of failure, loneliness, poor motivation and poor teaching support were the most common sources of high stress. Thirty students (22.3%) had low self-esteem of which 5 (16.67%) had low stress, 19 (63.33%) had moderate stress and 6 (20%) students had high stress levels. A 75 (56%) students were emotional eaters of which 12 (16%) had low stress, 55 (73.34%) had moderate stress and 8 (10.66%) students had high stress levels. There were 11 students who had both low self-esteem and higher tendencies for emotional eating of which nine students had moderate levels of perceived stress and two had high levels of perceived stress. Those who had higher self-esteem reported lower levels of perceived stress (r=-0.61, p=<0.00001) and those who experienced higher perceived stress were more likely to be emotional eaters (r=0.27, p=0.0015). Conclusion: It is important for medical institutions to provide support and resources to manage stress effectively. This includes stress management programs, mental health services, promoting a healthy work-life balance, fostering self-esteem and developing emotional intelligence.

Work-family and Family-work Conflict among Married Women in the IT Sector of India: A Cross-sectional Study

Chhavi Kiran Gupta, Nisha Singh, Manish Garg, Bhavya Khattri, Kaynat Nasser Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: The life of every working professional revolves around two significant poles: work and family, leaving the person with numerous responsibilities demanding both time and energy. The dual role expectations placed on working professionals, balancing work responsibilities and family obligations, often conflict and compete for time and attention. This obvious imbalance between work and family decreases employee productivity, performance at the workplace, job satisfaction and family satisfaction, including marital satisfaction; even providing child care seems like a herculean task. Aim: To compare Work-family Conflict (WFC) and Family-work Conflict (FWC) among married female Information Technology (IT) professionals in India, and to assess associated factors. Materials and Methods: A cross-sectional online survey was conducted in Delhi-NCR and nearby areas (Meerut, Muzaffarnagar and Modinagar), India, between December 2024 and February 2025 using a validated questionnaire including Breyer’s WFC Scale. Married female IT professionals aged 21–50 years, married for more than 3 years, living with family, currently married, and attending regular office work (at least 4 days per week) were included in the study. A total of 264 forms were considered for data analysis. Data were entered in Microsoft Excel, and analysis was done using One-way Analysis of Variance (One-way ANOVA) and Pearson’s correlation test. A p-value<0.05 is considered to be statistically significant. Results: Overall work experience was inversely correlated with both WFC (r-value=-0.415) and FWC (r-value=-0.405), while working hours were not. Dual role demands (WFC: r-value=0.358, FWC: r-value=0.302) and number of children (WFC: r-value=0.130, FWC: r-value=0.295) were significant contributors, whereas working hours showed no significant relation with either WFC nor FWC. Conclusion: The findings of the study highlight the need for policy interventions to support work-life balance among female IT employees, as it largely remains a neglected area of women’s health.

Comparison of the Outcomes between General Anaesthesia versus Combined Epidural and General Anaesthesia in Elective Lumbar Spine Surgery: A Randomised Control Study

Priyadharshini Venkatapathy, TK Vijaykumar, Basavaraj T Badadal, Santosh Kumar Alalamath Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: The choice of anaesthesia technique in elective lumbar spine surgery significantly influences perioperative outcomes. While General Anaesthesia (GA) remains the standard approach for lumbar spine surgery, Combined Epidural and General Anaesthesia (CEGA) has gained attention for its potential benefits. Aim: To compare intraoperative and postoperative outcomes of GA versus CEGA in patients undergoing elective lumbar spine surgery. Materials and Methods: This randomised controlled trial was conducted in the Department of Anaesthesiology at a tertiary care centre, BLDE (Deemed to be University) Shri BM Patil Medical College, Hospital and Research Centre in Vijayapura, Karnataka, India, on 64 patients of American Society of Anesthesiologists (ASA) grade I and II scheduled for elective lumbar spine surgery from December 2023 to November 2024. Participants were randomly assigned to receive either GA (Group A) alone or CEGA (Group B). The parameters observed included intraoperative vitals, isoflurane requirement, total blood loss during the surgery, and postoperative parameters such as vitals, pain assessed by Visual Analogue Scale (VAS), the rescue analgesic used, and intraoperative and postoperative complications. The Chi-square test was used for data comparison between the groups. Results: The mean ages were 40.34±11.05 years in Group A and 43.13±10.80 years in Group B. Preliminary results indicate that patients in the CEGA group experienced better intraoperative haemodynamic stability than those in the GA group. The inhalational anaesthetic requirement in CEGA (0.388±0.178) was significantly lower than in the GA group (0.782±0.278) (p<0.05). Intraoperative blood loss was higher in GA (387.5±101.6 mL) than in CEGA (138.75±37.22 mL) (p<0.05). In the postoperative period, the VAS score was higher in the GA group (4.43±0.58) than in the CEGA group (3.32±0.63) (p<0.05), and the time to first rescue analgesic requirement was significantly longer in the CEGA group (7.50±1.27 h) (p<0.05). Conclusion: The use of CEGA in elective lumbar spine surgery appears to offer significant advantages over GA alone in terms of intraoperative isoflurane use, blood loss, and postoperative pain management, suggesting that CEGA may be the preferable anaesthetic technique for lumbar spine surgery. Further research with a larger sample size is recommended to validate these results.

Performance of Rapid Antibiotic Susceptibility Testing from Semiautomated Blood Culture Bottles with Disk Diffusion using CLSI Guidelines: A Cross-sectional Study

Nayna S Najeem, HG Sreedhara Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: With currently available microbiological diagnostic tools, the Turnaround Time (TAT) of a positive Blood Culture (BC) report with conventional Antimicrobial Susceptibility Testing (AST) takes 5-9 days, delaying treatment. With Rapid Antimicrobial Susceptibility Test (RAST), a positive BC can be reported within 4-8 hours. Semiautomated ColorCult BC bottles have a chemical sensor at the bottom that continuously detects the increase in carbon dioxide produced by microbial growth. As of today, the RAST method has been validated only for automated systems, not for semiautomated culture systems. Aim: To evaluate the performance of RAST from semiautomated BC bottles with disk diffusion. Materials and Methods: This cross-sectional study was conducted at Hassan Institute of Medical Sciences, Hassan, Karnataka, India from February 2024 to August 2024 and included 144 positively flagged semiautomated BC bottles (Microxpress ColorCult vial, India) showing monomicrobial growth on Gram stain. These bottles were collected and processed for both RAST and standard AST. Results obtained in RAST at 4, 6 and 8 hours were correlated with the standard AST using Clinical and Laboratory Standards Institute (CLSI) M100 as the gold standard. Equivalence criteria, according to Food and Drug Administration (FDA), were: Categorical Agreement (CA) ≥90%, very major error (vmj) ≤1.5% and major error (maj) ≤3%. Results: Among 144 positively flagged semiautomated BC bottles, 53 (36.8%) showed monomicrobial growth. Escherichia coli (n=18, 34%), Klebsiella pneumoniae (n=16, 30.2%), Acinetobacter baumannii (n=9, 17%), Pseudomonas aeruginosa (n=5, 9.4%) and Staphylococcus aureus (n=5, 9.4%) were isolated. Among all antibiotic-organism combinations tested, CA for RAST at 4-, 6- and 8-hour readings were 80.5% (252/313), 87.4% (384/439) and 91.0% (491/540), respectively. Vmj rates were 5.2% (8/152), 2.95% (7/238) and 1.64% (5/306); maj rates were 6.08% (7/115), 4.8% (7/160) and 1.65% (3/193). Among all antibiotics tested, poor CA was noted for amikacin, tobramycin, piperacillin-tazobactam and ciprofloxacin at all reading times. Conclusion: RAST performed with semiautomated BC bottles at eight hours is equivalent to standard disk diffusion using CLSI guidelines, with a marginal VME rate.

Clinical Screening of Cytomegalovirus Infection beyond 21 Days in the Absence of its Routine Screening in Resource Limited Settings: A Cross-sectional Study

Sabbir Ansari, Sanat Kumar Ghosh, Rajendra Prasad Chatterjee, Koustav Chatterjee, Saptarshi Ghosh, Mousumi Nandy, Biswanath Basu, Nilanjan Chakraborty Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Testing for congenital Cytomegalovirus (cCMV) infection is not part of routine care in resource-limited settings. Consequently, the diagnosis is often missed because most infections are asymptomatic and when present, symptoms are non specific. Diagnosis is required to prevent long-term sequelae. Aim: To introduce a clinical screening strategy for detecting possible CMV infections, including both congenital and postnatal infections among symptomatic neonates/infants presenting after 21 days. Materials and Methods: In this cross-sectional study, 387 subjects with clinical signs or symptoms compatible with congenital or postnatal CMV infection from birth to 365 days of life were included from three metropolitan hospitals in Kolkata, West Bengal, India, from January 2018 to March 2020. CMV infection was determined by Polymerase Chain Reaction (PCR) analysis of the urine. The Constellation of Symptoms (COS) was employed as a clinical screening tool for subjects older than 21 days. The Chi-square test was used to compare categorical variables, while the Mann-Whitney U test assessed differences in numerical data. Results: Of the 387 subjects with compatible signs or symptoms, 126 (32.6%) tested positive for CMV. Among the CMV-infected group, 8 (6.3%) presented within 21 days, while 118 (93.7%) presented after 21 days. CMV-infected infants had slightly lower birth weight and younger age at presentation compared with CMV-negative infants, though the differences were not statistically significant. The presence of individual symptoms of CMV infection did not differ significantly between CMV-positive and CMV-negative groups (p-value>0.05). However, the COS was significantly associated with CMV positivity (p-value<0.001). The sensitivity and specificity of COS were in the ranges of 77%-81% and 40%-44%, respectively. The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were in the ranges of 38%-44% and 75%-82%, respectively. Conclusion: The COS-based strategy will be a valuable tool for screening symptomatic CMV infections in individuals up to one year of age in resource-limited settings where routine CMV screening is unavailable.

Survival Outcome of Patients with Vulvar Malignancy Treated at a Tertiary Care Cancer Centre: A Cohort Study

Ramani Gangadharan Ashitha, Adarsh Dharmarajan, Nila S Pradeep, Rachana Palakkal Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Vulvar malignancy is a rare gynaecological malignancy and understanding the determinants of vulvar cancer outcomes is essential for improving patient care and guiding future research in this field. The management of vulvar malignancy ranges from wide local excision to radical vulvectomy for early-stage and advanced disease managed by external beam radiotherapy with concurrent chemotherapy. Aim: To determine the Overall Survival (OS) and Disease-Free Survival (DFS) among patients with vulvar cancer. Materials and Methods: This was a retrospective cohort study of patients with vulvar malignancy who underwent treatment over a 10-year period (from January 2011 to December 2020) at a tertiary cancer centre in South India, Department of Gynaec Oncology, Malabar Cancer Centre (Postgraduate Institute of Oncology Sciences and Research), Thalassery, Kerala, India. Details such as age, Performance Status (PS), tumour histology, stage, intent of treatment, type of treatment and recurrence were collected from case records. The Kaplan-Meier test was used to estimate OS and DFS. Results: A total of 29 patients were analysed; the mean age was 67.03 years (ranging from 48 to 93 years). A total of 3 (10.34%) patients were premenopausal and 26 (89.66%) were postmenopausal. A total of 24 (82.8%) cases were squamous cell carcinoma and 3 (10.34%) were adenocarcinoma. A total of 12 (41.4%) patients received curative intent treatment, 13 (44.8%) received palliative intent treatment and 4 (13.79%) received best supportive care. The five-year OS was 28% for all stages, with a median OS of 23.16 months. The five-year OS for curative intent patients was 50%, while for palliative intent patients, it was 15.4%. Out of the nine cases that underwent surgery, 1 (11.1%) had local recurrence, 1 (11.1%) had regional nodal recurrence and one had a distant site recurrence. The estimated five-year DFS was 63.5%. Conclusion: The present study highlights that early-stage diagnosis and curative intent treatment significantly improve survival outcomes in vulvar cancer. Patients treated with curative intent had a five-year OS of 50% and a DFS of 63.5%, compared to a 15.4% OS in palliative cases. Advanced stage at presentation and older age were associated with poorer prognosis. These findings underscore the need for early detection and individualised, multimodal treatment strategies to optimise outcomes.

Role of National and International Aid Organisations in Disability Rehabilitation in Conflict Areas: A Scoping Review

Doly Bokalial, P Swarna Kumari Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Disability can result directly from displacement or conflict caused by war-related injuries or trauma, or indirectly from deterioration of medical services. Rehabilitation services alleviate or mitigate limitations that impede functioning, participation and involvement in daily life for People with Disabilities (PwDs). In low-resource settings, where access to healthcare remains a significant challenge, rehabilitation services play a vital role in enhancing Quality of Life (QoL) for PwDs. Various Non Governmental Organisations (NGOs) and international organisations have set up schemes and introduced initiatives to broaden rehabilitation support for PwDs. Aim: To analyse the contribution of national and international aid organisations in disability rehabilitation in conflict areas. Materials and Methods: This scoping review followed the PRISMA-ScR guidelines and Arksey and O’Malley’s framework. A comprehensive search was performed in three databases from 2010 to February 2025 using the keywords and Boolean operators: ((Disability rehabilitation) AND (Conflict areas) AND (Non Governmental Organisations OR International aid organisations)). Studies were screened for eligibility based on inclusion criteria focusing on rehabilitation programs in conflict zones. Results: Based on the criteria, a total of 16 studies were included. The studies underscored the importance of integrated, context-specific rehabilitation models that address both physical and psychosocial needs in PwDs in conflict-affected regions. While significant progress has been made in rehabilitation service provision, numerous challenges persist, including accessibility barriers, funding constraints and the need for standardised guidelines. Conclusion: The review emphasises the importance of integrated and context-specific rehabilitation models that address both physical and psychosocial needs in conflict-affected regions. Moreover, as numerous challenges persist, future research and policy efforts should focus on long-term sustainability, technological integration and inclusive rehabilitation frameworks to improve health outcomes and QoL for affected populations in conflict settings worldwide.

Lifestyle and Occupational Determinants of Semen Quality in Men Attending an Infertility Clinic: A Cross-sectional Study

Richa Gupta, Krunal Shah, Manu Singhal Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Male infertility contributes to nearly 50% of infertility cases worldwide. Emerging evidence suggests that modifiable occupational and lifestyle factors may adversely affect semen quality. Aim: To evaluate associations between semen parameters and various lifestyle factors among men presenting to an infertility clinic in India. Materials and Methods: This cross-sectional analytical study was conducted at the infertility clinic of the Department of Obstetrics and Gynaecology at SBKS Medical Institute and Research Centre, Vadodara, a tertiary care hospital in India, from January 2024 to April 2025. A total of 110 male partners of infertile couples were included. After obtaining informed consent, a detailed history was recorded, including occupation, exposure to heat or chemicals, cell phone usage and addictions (smoking, alcohol). Semen analyses were performed according to the World Health Organisation (WHO) 2021 criteria. Semen samples were categorised as normal or abnormal based on sperm count, motility and morphology. Statistical analyses included the Chi-square test and multivariable logistic regression to identify independent predictors of abnormal semen parameters. Results: The mean age of the participants was 33.4±5.7 years. A total of 38 (34.5%) were smokers, 44 (40.0%) reported regular alcohol consumption and 69 (62.7%) reported cell phone use >2 hours/day. A total of 26 (23.6%) had exposure to heat, while 15 (13.6%) had exposure to harmful chemicals and 54 (49.1%) had a sedentary occupation. Of the 110 participants, 67 (60.9%) had at least one abnormal semen parameter. Abnormal semen quality was significantly associated with smoking (OR 2.9, p=0.031), daily cell phone usage >2 hours (OR 3.7, p=0.001), occupational heat exposure (OR 4.6, p=0.003) and chemical exposure (OR 5.9, p<0.001). Alcohol use and sedentary occupation were not independently associated with abnormal semen quality. Conclusion: The present study highlights significant associations between semen abnormalities and modifiable factors such as smoking, prolonged cell phone use and occupational exposures. Addressing these risk factors through lifestyle counselling and workplace interventions may improve male reproductive health outcomes.

Expression of p53, VEGF and E-cadherin in Gastric Carcinoma and its Association with Pathological Prognostic Factors: A Cohort Study from a Tertiary Care Hospital in Eastern India

Chayasmita Mali, Pranati Misra, Urmila Senapati, Sabyasachi Parida Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Gastric Carcinoma (GC) has a poor prognosis with most of the cases being detected at an advanced stage. Several potential biomarkers like p53, Vascular Endothelial Growth Factor (VEGF) and E-cadherin, have been identified for early detection and guiding the management of GC. Aim: To analyse the expression of p53, VEGF and E-cadherin in GC and to find the association of these markers with various prognostic parameters. Materials and Methods: The present cohort study was conducted over a period of 26 months. Follow-up was done for a minimum period of six months in Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India. Gastrectomy specimens, with histopathological confirmation, were included in the study, p53, VEGF and E-cadherin expression was studied along with their association with pathological prognostic parameters like histological type as per Lauren classification, histological grade and pathological stage and clinical prognostic parameters like age and gender. Statistical analysis was carried out using Microsoft Spreadsheet Excel 2010 Mini Tab/Statistical Package for Social Sciences (SPSS) version 23. Chi-square test was used and a p-value of <=0.05 was taken as statistically significant. Patient survival was calculated by Kaplan-Meier survival plot analysis. Results: In the 40 cases studied, majority were males (75%), sixth decade being the most common age group affected (Mean=56.9±11.84years). Of the three biomarkers considered, E-cadherin showed a significant association with Lauren classification (p=0.002), histologic grade (p=0.026) and nodal stage (p=0.021) of the tumour. No significant association of p53 and VEGF expression was found with various prognostic markers in the study. The median survival time for the 19 cases followed up was 40.74 months. No significant results were obtained in cumulative survival rates. Conclusion: E-cadherin can be a valuable prognostic marker in GC. Studies on larger scale and longer duration are warranted for more information on prognosis, recurrence and survival.

Erector Spinae Plane Block versus Local Infiltration for Postoperative Pain Control in Percutaneous Nephrolithotomy: A Randomised Controlled Trial

Meela Ranjith Kumar, Naseema V Kanase, Vilas S Kapurkar, MB Leela Pratyusha, Vithal K Dhulkhed Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Percutaneous Nephrolithotomy (PCNL) is standard for large/complex renal stones, yet remains painful postoperatively. The Erector Spinae Plane Block (ESPB) may offer superior analgesia compared to conventional Local Anaesthetic Infiltration (LAI). Aim: To compare the efficacy of landmark-guided ESPB and LAI for postoperative analgesia following PCNL. Materials and Methods: This single-blind, randomised controlled trial was conducted at the Department of Anaesthesiology, Krishna Institute of Medical Sciences (KMISDU), Krishna Vishwa Vidyapeeth, Malkapur, Karad, Maharashtra, India, from March 2023 to August 2024. Sixty adults undergoing elective PCNL were randomly allocated (computer sequence, sealed envelopes) into two groups (n=30 each): Group A received landmark-guided ESPB with 20 mL 0.2% ropivacaine, and Group B received LAI with 20 mL 0.2% ropivacaine. The primary endpoints were time to first rescue analgesia, 24-hour tramadol consumption, and the number of rescue doses. Secondary endpoints were Postoperative Nausea and Vomiting (PONV), time to mobilisation, time to oral intake, patient satisfaction (0-10), and complications including local anaesthetic systemic toxicity. Analysis used Statistical Package for Social Sciences (SPSS) version 25.0; p-value <0.05 was significant. Results: All 60 patients were analysed (30 per group). Groups were comparable at baseline: age (42.3±9.6 vs 41.7±10.2 years), gender (male 60.0% vs 56.7%), weight (65.4±7.8 vs 64.7±8.1 kg), ASA I/II (66.7%/33.3% vs 73.3%/26.7%), and surgery duration (88.5±12.1 vs 89.3±13.4 min). ESPB significantly prolonged time to first rescue analgesia (8.10±1.41 vs 2.48±0.75 h; p-value <0.0001), reduced tramadol use (123.33±27.79 vs 205.00±39.86 mg; p-value <0.0001), and lowered rescue doses (1.67±0.66 vs 3.70±0.70; p-value <0.0001). Secondary outcomes favoured ESPB including lower PONV (10.0% vs 43.3%), earlier mobilisation (10.5±2.1 vs 18.7±3.3 h; p-value <0.01), faster oral intake (6.2±1.4 vs 12.3±2.5 h; p<0.01), and higher patient satisfaction (8.6±1.0 vs 6.3±1.4; p-value <0.001). No complications occurred in either group. Conclusion: Landmark-guided ESPB provided superior postoperative analgesia compared to LAI following PCNL, with delayed rescue need, lower opioid consumption, fewer rescue doses, faster recovery milestones, and greater satisfaction, without added complications. ESPB is a safe, opioid-sparing technique suitable for inclusion in multimodal analgesia protocols for PCNL.

Comparative Evaluation of the Healing Effect of Topical Jayanti (Tridax procumbens) Cream versus Topical Lignocaine and Nifedipine Cream in Parikartika (Acute Fissure in Ano): A Randomised Controlled Trial

Shubham Bobade, Sheetal Asutkar Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Fissure in ano is a common anorectal disorder, often characterised by the presence of an ulcer and increased anal sphincter spasm. The primary treatment goals focus on promoting wound healing and reducing sphincter spasm. Conservative management, including a fiber-rich diet and sitz baths, is effective in healing most cases. The disease typically presents with an ulcer in the anal canal as a key symptom. Aim: To evaluate the efficacy of topical Jayanti (T. procumbens) cream vs lignocaine and nifedipine cream in healing of Parikartika (acute fissure in ano). Materials and Methods: The present single-blind, double-arm, randomised controlled trial involved 70 patients with acute fissure in ano, and was conducted from April 2023 to November 2024. The patients were divided into two groups: Group A (Lignocaine 1.5% w/w and Nifedipine 0.3% w/w cream), and Group B (Jayanti (T. procumbens) cream), with 35 patients in each group. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) statistical software v 29.0. A p-value of less than 0.05 was considered statistically significant. The evaluation parameters, including wound healing, anal spasm, per rectal bleeding, pain, and itching, were assessed. Results: In group A (n=35), the mean score for wound healing improved from 2.40 on Day 0 to 0.46 on Day 30, while in group B (n=35), the score reduced from 2.37 to 0.31 over the same period, both showing statistical significance with p=0.0001. Spasm scores in group A (n=35) decreased from 0.86 on Day 0 to 0.14 by Day 30, and from 0.74 to 0.14 in group B (n=35), with p=0.0001. Per rectal bleeding in group A (n=35) dropped from 2.00 on Day 0 to 0.29 on Day 30, and from 1.57 to 0.23 in group B (n=35), with p=0.0001. For group A (n=35), improvement in itching after treatment showed a reduction from 23 to five patients, and for group B (n=35), from 25 to 7. The Chi-square (c2) values were 19.28 for group A (n=35) and 16.64 for group B (n=35). However, a p-value of 0.751 indicated no statistically significant difference between the two groups at the 95% confidence level after treatment. Conclusion: Lignocaine and Nifedipine cream (Group A) and Jayanti (T. procumbens) cream (Group B) on the symptoms of Parikartika (acute fissure in ano) were found to be equally efficacious, with both treatments showing statistically significant improvements across the overall assessment criteria.

Head Shape and Cephalic Index Variations across Communities in Sriganganagar District, Rajasthan, India: A Cross-sectional Study

Vijay Kumar Dayma, Parveen Kumar Sharma, Nikhil Sharma, Rasalika Miglani, Aakanksha Arora Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: The exploration of craniofacial relationships and their variations has historically played a significant role in differentiating racial groups within physical anthropology. The cephalic index is an important parameter for determining the race and sex of an individual of unknown identity. It has been utilised to categorise skulls into dolichocephalic (long-headed), mesocephalic (medium-headed) and brachycephalic (short-headed) types, which have historically contributed to racial classification frameworks. Human body dimensions are influenced by biological, geological, ecological, racial, sex and age factors. Aim: To determine the cephalic index and head shape in different communities of Sriganganagar, Rajasthan, India. Materials and Methods: This cross-sectional study was conducted at the Department of Anatomy, Dr S. S. Tantia Medical College and Research Centre, Sriganganagar, Rajasthan, India, from September 2023 to March 2025. The study involved 1000 participants from five communities, with 200 individuals from each of Sikh, Arora, Jat, Brahman and Rajput groups, all aged 18-40 years. The cephalic index was calculated as the ratio of the maximum width of the head to the maximum length, multiplied by 100. Head measurements were taken using Vernier and spreading calipers. Data were subjected to statistical analysis to find out mean±SD and an Independent-samples t-test was used to compare two independent groups. A p-value <0.05 was considered statistically significant. Results: The study analysed 1000 participants (n=500 males, n=500 females) across five communities in Sriganganagar. Males had a higher mean head length (19.46±1.7486 cm) and width (15.03±1.4321 cm) than females (18.20±1.2428 cm, 13.79±1.14832 cm), with a significantly higher cephalic index in males (77.23±5.9420) than in females (75.76±5.2432; p-value <0.01). The highest mean cephalic index was observed in Sikhs (81.75; n=200) and the lowest in Rajputs (71.98; n=200). Mesocephalic was the most common overall, while dolichocephalic dominated among Rajputs (79.5%; n=159) and brachycephalic among Sikhs (51%; n=102). Conclusion: The mesocephalic head shape was most prevalent overall, with notable inter-community variations—dolichocephaly among Rajputs and brachycephaly among Sikhs—highlighting ethnic diversity in cranial morphology within the region.

Genomic Insights into Vaccine Evasion: A Cross-sectional Study from a Tertiary Care Hospital of Northern India

Uksim Qadri, Bashir Ahmad Fomda, Shaista Nazir, Yawar Mir, Mehvish Saleem, Muneer Bhat Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Coronavirus Disease-2019 (COVID-19) vaccines are a crucial tool in controlling and ultimately ending the pandemic, complementing other preventive measures. India launched its vaccination campaign on January 16, 2021, initially using two vaccines that received emergency authorisation: Covaxin (BBV152) and Covishield (ChAdOx1 nCoV-19). The vaccination effort began with elderly individuals (60+ years) and frontline workers, eventually expanding to include various age groups. During this period, India faced a severe second wave of COVID-19, marked by a notable rise in postvaccination breakthrough infections throughout 2021, driven by more transmissible and potentially more immune-evasive variants. To date, no study is available that details the rate of these breakthrough infections and the variants responsible in our region. Aim: To determine the rate of breakthrough infections in our region and identify which Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) variants are responsible for these infections. Materials and Methods: This cross-sectional study was conducted in a tertiary care hospital in Northern India over one year, from January 2021 to December 2021. Nasopharyngeal swabs from suspected COVID-19 patients were collected and subjected to Ribonucleic acid (RNA) extraction, followed by Reverse Transcription-Polymerase Chain Reaction (RT-PCR) testing. The breakthrough infection rate was defined as infections occurring in individuals who were fully vaccinated with two standard doses of the AZD1222/Covishield vaccine. Genome sequencing was performed to identify the SARS-CoV-2 variants responsible for postvaccination breakthrough infections. Data analysis was conducted using Microsoft Excel Software 16. Results: Between January 2021 and December 2021, 513,197 nasopharyngeal swabs were analysed, with a total of 32,952 (6.42%) samples testing positive for SARS-CoV-2 by RT-PCR. Out of these, 2,043 (6.2%) samples were from cases in which individuals had been vaccinated with two doses of the vaccine. Genome sequencing of 11 such samples revealed that eight of the patients were infected with the Delta variant (Pango Lineage: B.1.617.2). One sample showed the Eta variant (Lineage B.1.575) with the E484K mutation. Unfortunately, two samples could not be processed due to inadequate quality. Conclusion: A breakthrough infection rate of 6.2% was recorded, with the Delta variant (Pango Lineage: B.1.617.2) of SARS-CoV-2 being commonly associated with these infections. This study underscores the need for continued and rigorous genomic surveillance of emerging SARS-CoV-2 variants to assess their potential to evade immune responses.

Evaluation of Traditional Exercises versus Continuous Passive Motion and Cryotherapy in Knee Osteoarthritis: An Interventional Study

K Kirupa, S Brightlin, Vignesh Srinivasan, G Santhiya, R Haripriya, B Abinesh, K Ganesh Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Osteoarthritis (OA) is a common degenerative joint disease and the second most frequent rheumatologic condition in India, affecting approximately 39% of the population, with a higher prevalence among women. The knee is a major site for OA, which impacts mobility and quality of life. Aim: The study aims to assess the efficacy of two treatment protocols for knee OA; Traditional exercises versus Continous Passive Motion (CPM) and cryotherapy. Materials and Methods: The study was an interventional study. The total duration of the study is one month from Feb 2023 to March 2023. The study included female participants aged 40 to 60 years, all diagnosed with primary OA of the knee. Total sample size was 30 (each Group 15). The present experimental study involved 30 female patients aged 40-60 years with primary knee OA. They were divided into two groups: group A received Continuous Passive Motion (CPM) combined with cryotherapy, and group B received conventional therapy. Each patient underwent a 20-30 minute treatment session once daily for four weeks. Pain and function were assessed using the Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scales. Statistical analysis was conducted using paired and independent t-tests with significance set at p≤0.05. Results: Both treatment groups showed significant improvements in mobility and pain reduction by the end of the study. However, group A, which received perturbation training, demonstrated a higher degree of pain reduction with a VAS score of 1.20±0.414 compared to group B’s score of 1.93±0.798. Statistical analysis indicated that this difference was significant, with group A experiencing greater pain relief than group B at a significance level of p≤0.05. Conclusion: The findings suggest that while both treatment protocols are effective for managing knee OA symptoms, CPM and cryotherapy offer a greater benefit in reducing pain compared to traditional exercises. This highlights the potential of perturbation training as a valuable addition to OA management strategies.

Prevalence of Quorum Sensing Regulator/Autoinducer Synthase (abaR/abaL) genes among the Multi-drug resistant strains of Acinetobacter baumannii: A Cross-sectional Study

Nithila Kadirvel, Kannika Parameshwari Kannan, AS Smiline Girija, J Vijayashree Priyadharsini Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Acinetobacter baumannii (A. baumannii) is a significant Multi Drug Resistant (MDR) opportunistic pathogen, documented as a priority pathogen due to its persistence in hospital environments and its ability to cause nosocomial infections. Aim: To investigate the prevalence of Quorum Sensing (QS) mediating abaR/abaL genetic determinants in MDR strains of A. baumannii isolated from wound infections. Materials and Methods: This cross-sectional study was conducted in the department of Microbiology, at Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Institute (SIMATS), Chennai, Tamil Nadu, India, from January to April 2024. A total of 20 clinical isolates of A. baumannii were obtained from patients with deep wound infections. The isolates were identified using the VITEK 2 system, and their antibiotic susceptibility profiles were evaluated. Biofilm formation was assessed using a microtiter plate assay, while abaR/abaL genes were detected via Polymerase Chain Reaction (PCR). Mutations were identified through Sanger sequencing. Fisher’s exact test was performed in Statistical Package for the Social Sciences (SPSS) with p<0.05 considered statistically significant. Results: A total of 20 isolates were identified as A. baumannii using the VITEK 2 system followed by their antibiotic susceptibility profiles. The findings revealed that antibiotic susceptibility testing indicated high resistance rates to common antibiotics, with complete susceptibility to tigecycline and colistin. Sixty percent of the isolates demonstrated strong biofilm-forming capabilities, and 100% of the isolates acquired the abaL gene, while 90% possessed the abaR gene. Sequence analysis showed significant genetic variability in both genes, with several mutations potentially linked to enhanced resistance and virulence. Conclusion: This study highlights the relationship between QS systems, biofilm formation, and antibiotic resistance, emphasising the importance of targeting the QS pathways as a novel therapeutic approach for controlling MDR A. baumannii infections. Further investigations into the molecular mechanisms underlying QS regulation are essential for developing effective antimicrobial strategies against this formidable pathogen.

Knowledge and Attitude towards Sports Injury Prevention and Management among Sports Playing College Students: A Cross-sectional Study

Jaykumar D Soni, Darshit Patel, Niketa Patel Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Sports is an emerging field among young people and has gained popularity worldwide. Consequently, the prevalence of sports-related injuries has increased day by day. To address this issue, all types of studies have been conducted. However, the knowledge and attitude of athletes are considered two key factors in preventing sports injuries. Aim: To determine the current status of knowledge and attitude regarding Sports Injury Prevention and Management (SIPM) among college students engaged in sports. Materials and Methods: This cross-sectional study was conducted under the affiliation of the College of Physiotherapy, Sumandeep Vidyapeeth, in the Vadodara district, Gujarat, India, from June 2022 to May 2023. A total of 141 male and female participants were included. Demographic details, including gender, number of total practice days per week and prior sports injury experience, were collected. Participants who had experience in playing various outdoor sports were included. The investigator conducted interviews with the participants and the information was noted. The t-test was used for statistical analysis. Results: The t-test was applied to the SIPM knowledge and attitude scales to analyse differences across demographic factors such as gender, total practice days per week and sports injury experience in the past year. The results showed no significant differences among subjects (t(141)=1.89, p-value>0.05). Pearson’s correlation analysis revealed that total knowledge scores and total attitude scores of SIPM among student athletes were positively correlated (r=0.3, p-value=0.003). Conclusion: The study concluded a positive correlation between knowledge and attitude, indicating that higher levels of knowledge are associated with a more positive attitude towards prevention and management of sports injuries.

Efficacy of Proprioceptive Neuromuscular Facilitation on Dynamic Balance in Children with Down Syndrome: A Pilot Study

Nusrat Jahan, Nitesh Malhotra Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Down syndrome is a non hereditary genetic condition characterised by an extra copy of chromosome 21. This is why it is also called trisomy 21. Normally developing children improve their balance with age and growth, but individuals with Down syndrome often do not achieve independent gait and proper balance even after years of therapy. There has been very limited research investigating the use of the Proprioceptive Neuromuscular Facilitation (PNF) technique for treating children with Down syndrome, and there is an essential need for research to establish the role of PNF in this population with neuromotor issues. The effect of PNF on Down syndrome is unclear in the literature. Aim: To determine the effect of the PNF technique on dynamic balance in Down syndrome. Materials and Methods: The present pilot pre- and post-interventional study was conducted at Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh, North India, from January 2024 to December 2024. Participants were allocated to an intervention group and a control group by convenience sampling. Balance was assessed before and after the intervention using (a) the Timed Up and Go (TUG) test and (b) the Timed Up and Down Stairs (TUDS) test, following anthropometric measurements for each child. Eight weeks of PNF intervention were delivered three days per week (on alternate days), for a total of 24 sessions. Each session lasted 40 minutes, including 10 minutes of warm-up and cool-down, with 30 minutes of pelvic PNF and lower-limb PNF techniques for each participant in the intervention group. The control group received home-based physiotherapy, including strengthening exercises for the lower limbs and pelvis, three days per week for eight weeks. The Mann-Whitney U test was used to compare baseline values and change scores (pre- to post-intervention) between groups. The Wilcoxon’s signed-rank test was applied to assess within-group differences between pre- and post-intervention values in both the experimental and control groups. Results: The TUDS time (p=0.17) was not statistically significant, while TUG time (p=0.02) demonstrated a significant difference. Furthermore, the experimental group exhibited a statistically significant improvement over the control group in both TUG (p=0.05) and TUDS (p=0.007), accompanied by a larger effect size. Conclusion: Proprioceptive Neuromuscular Facilitation (PNF) training enhances dynamic balance in children aged 4-10 years with Down syndrome. Improvements are evident in the performance of the TUG and TUDS tests.

Causes of Donor Blood Wastage in a Blood Centre from a Tertiary Care Hospital, Tirupati, India: A Cross-sectional Study

Lavanya Yadla, Sai Chandana Gali, Shahanuma Shaik, C Sujatha, Indrani Gattamneni Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: The transfusion of blood and blood components are an essential therapeutic intervention and at present India’s blood requirement is about 9 to 9.5 million units per year. But blood banks in India are able to collect only about 5 to 5.5 million units per year. The causes of donor blood wastage are classified into shelf life expiry, seroreactivity, Quantity Not Sufficient (QNS), broken bags, lipaemic, dispensed but not transfused. Based on previous studies the discarding rate is ranging from 4.3 to 26.6%. Aim: To evaluate the causes of donor blood wastage in a tertiary care hospital. Materials and Methods: The present cross-sectional study included all the blood units received in the blood bank of Sri Venkateswara Ramnarayan Ruia Government General Hospital (SVRRGGH) for a period of six months (July 2024 to December 2024). Causes of discarded blood were analysed based on shelf life expiry, serological positivity and QNS. The results were analysed in the form of rates and percentages. Results: The total number of 3,761 blood units were collected during the study period, of which 347 (10.1%) units of whole blood and its components were discarded during the study period. Shelf life expiry 254 (73%) followed by seroreactivity 60 (17%) units were the two most common causes of discarding the blood and blood components. Conclusion: Regular screening for Human Immunodeficiency Virus (HIV) and Hepatitis B surface antigen (HBsAg) by rapid tests before bleeding decreases the wastage by deferring the donor. To arrange near expiry blood units in front shelves of refrigerator, regular audit of blood issue and discard by hospital transfusion committee to be done to minimise the wastage.

Antibacterial Activity of Kabasura Kudineer on Periodontal Pathogens: An In-vitro Study

T Jessica Christella, Nizar Ahmed, Vamsi Lavu, S Lavanya, SK Balaji Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Antiseptic agents used in periodontics, such as bis-biguanide derivatives (Chlorhexidine - CHX) or essential oils, are primarily chemical substances. However, the recent rise of herbal derivatives, with their activity against putative periodontal pathogens, has sparked interest. This study delves into a polyherbal formulation, Kabasura Kudineer (KSK), which is a blend of medicinal herbs with known individual pharmacological benefits, to determine its antibacterial efficacy against periodontal pathogens in-vitro. Aim: To assess the Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) of KSK extract against pure strains of putative periodontal pathogens, namely Porphyromonas gingivalis (American Type Culture Collection - ATCC 33277), Fusobacterium nucleatum (ATCC 25586), and Aggregatibacter actinomycetemcomitans (ATCC 43718). Materials and Methods: An in-vitro study was performed in the Department of Periodontics, Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India, between December 2022 and February 2023. In the study, the aqueous extract of KSK was prepared by maceration and stored under controlled conditions at 4°C. The MIC and MBC were determined against commercially available strains of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Fusobacterium nucleatum using the broth dilution method and MIC assay method, respectively. The MIC and MBC activities of the KSK extracts were compared with CHX as a standard. Results: Kabasura kudineer has been proven to possess antibacterial activity against all three tested periodontal pathogens. The MIC value of KSK extract was similar to that of CHX, as assessed by the broth dilution method. The MIC of KSK extract for P. gingivalis was 0.4 μg/mL, while for A. actinomycetemcomitans and F. nucleatum, it was 0.2 μg/mL; the CHX values against all three periodontal pathogens were 0.2 μg/mL. The MBC of KSK extract for P. gingivalis was 0.8 μg/mL, and for A. actinomycetemcomitans and F. nucleatum, it was 0.2 μg/mL, with CHX values against all three periodontal pathogens also being 0.2 μg/mL. Conclusion: The aqueous extract of KSK demonstrated a noteworthy MIC and MBC, exhibiting effectiveness against the three periodontal pathogens evaluated in this study, thereby demonstrating its potential for use as an adjunct in periodontal therapy.

Adverse Effects of Paediatric Liquid Medications on Primary Teeth: A Systematic Review

Niketa N Deshmukh, Yogesh J Kale, Mahesh V Dadpe, Prasanna T Dahake, Shrikant B Kendre Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Paediatric liquid medications are widely administered due to their ease of use and high compliance. Emerging evidence, however, suggests these formulations may have unintended oral health consequences. Specifically, the primary dentition may experience erosion, discolouration, and altered surface properties. Studying the adverse effects of different paediatric liquid medications on primary teeth reflects a growing understanding of the complex interactions between medications and dental health and ongoing efforts to mitigate potential risks to children’s oral health. Aim: The present systematic review was conducted to summarise and assess the effects of various paediatric drugs on primary teeth by reviewing the available literature. Materials and Methods: The present systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines and was registered on PROSPERO (CRD42023413689). The PROSPERO record is available at https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023413689. An extensive search of electronic databases was conducted covering January 2000 to December 2023 to identify studies reporting adverse effects of paediatric drugs on primary teeth. Quality assessment of the included studies was performed using the Quality Assessment Tool For In Vitro Studies (QUIN) tool. Results: After meeting the eligibility criteria 24 in-vitro studies were included. Each study analysed the effects of medications on primary teeth. Enamel erosion, increased surface roughness, and discolouration were observed with most paediatric liquid medications. Conclusion: This systematic review, included 24 studies, demonstrated associations between paediatric liquid medications and deleterious effects on the primary dentition. These adverse effects are likely driven by the acidic components, colouring additives, and prolonged contact time of the formulations. Despite methodological variations among studies, the consistent findings across different medication classes reinforce these conclusions. By integrating this knowledge into clinical practice, healthcare professionals can contribute to the promotion of optimal oral health in paediatric patients.

Neutrophil to Lymphocyte Ratio, NTproBNP and Six-minute Walk Test as Predictors of Readmission and Mortality in Patients with Heart Failure: A Prospective Observational Study

KJ Rajaprasath, TA Vidya, D Reena Jose, R Sarath Kumar Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Heart Failure (HF) is a leading cause of morbidity and mortality worldwide, with a high-risk of hospital readmission. Identifying reliable prognostic markers is crucial for optimising clinical management. N-terminal pro-B-type natriuretic peptide (NTproBNP), Neutrophil-To-Lymphocyte Ratio (NLR), and the Six-Minute Walk Test (6MWT) have emerged as key predictors of HF outcomes. Aim: The present study evaluates the predictive value of NTproBNP, NLR, and the 6MWT in assessing mortality and readmission risks in HF patients. Materials and Methods: In the present prospective observational study, 170 HF patients were enrolled over 18 months. NTproBNP and NLR were measured at admission; 6MWT was conducted at discharge. Patients were followed for 90 days to assess mortality and readmission. Receiver Operating Characteristic (ROC) analysis determined cut-off values and predictive accuracy. Results: Mortality occurred in 14 patients (8.2%) and readmission in 19 patients (11.2%). NTproBNP levels were significantly higher in mortality (28,114.29±6799.08 pg/mL) and readmission groups (21,242.63±9553.81 pg/mL) with AUCs of 0.98 and 0.92, respectively (p<0.0001). NLR was elevated in mortality (6.70±2.53; AUC=0.64) and readmission groups (7.88±4.93; AUC=0.67). 6MWT distances were reduced in mortality (170.00±49.92 m; AUC=0.978) and readmission (214.74±73.66 m; AUC=0.915). Conclusion: NTproBNP and 6MWT are effective prognostic markers in HF, enhancing risk stratification. NTproBNP was the most predictive, 6MWT assessed functional status, and NLR reflected inflammation’s role.

Quality of Life Assessment after Percutaneous Transhepatic Biliary Drainage in Patients with Advanced Gall Bladder Carcinoma: A Prospective Interventional Study

Hareesh Nellikoppad, Smita Chauhan, Bhanu Pratap Singh, Adeeba Khan Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Gall Bladder Cancer (GBC) is associated with poor prognosis, particularly when presenting with jaundice. In these cases, jaundice often indicates advanced disease and precludes curative surgical options. Palliative management with biliary drainage may be the only available option to address symptom relief, restore liver function, and improve Quality Of Life (QOL). The impact of Percutaneous Transhepatic Biliary Drainage (PTBD) on QOL in such patients remains underexplored. Aim: To evaluate the effectiveness of PTBD in improving QOL in patients with advanced GBC and obstructive jaundice, using two validated QOL indices. Materials and Methods: A prospective interventional study in patients with unresectable GBC and jaundice undergoing PTBD was conducted on 70 patients at a tertiary care centre in northern India between 2019 and 2024. Just before and after PTBD, QOL was assessed using FACT-Hep and EORTC QLQ-BIL21/QLQ-C30 at three time points: preprocedure, one month postprocedure, and three months postprocedure. Data were analysed using descriptive statistics and repeated measures ANOVA. Results: Significant improvements were observed in overall QOL and key domains-physical, social, emotional, and functional well-being- between baseline and follow-ups (p<0.05). Jaundice-related symptoms, eating ability, and fatigue showed marked improvement, though pain and anxiety scores remained unchanged. Complications included periprocedural leaks in 22 patients (31.4%), catheter blockage or pull-out in 16 (22.9%), and cholangitis in 8 (11.4%). Conclusion: PTBD effectively improves QOL in patients with advanced GBC by alleviating jaundice-related symptoms and enhancing functional domains, despite procedural complications. Optimising post-procedural care and addressing complications are crucial for maximising palliative benefits in this patient population.

Perceptions of COVID-19 Positive Postnatal Women Who Delivered in an Isolation Facility: A Qualitative Study

Suman Paul, Swapna Mohan, Sajida Abdulla, Karunakaran Vidhukumar, KR Radha Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: During the pandemic, pregnant women were tested as part of admission protocols and, regardless of their symptoms, underwent the unique ordeal of giving birth in isolation. Isolating women from their families at the vulnerable perinatal period is likely to create mental health issues that may affect the mother-child dyad. Aim: To explore the lived experiences of mothers who delivered in isolation during the Coronavirus Disease 2019 (COVID-19) pandemic. Materials and Methods: This qualitative study was conducted in the Department of Obstetrics and Gynaecology at a designated COVID-19 Government Medical College, Ernakulam in the Indian state of Kerala from August 2021 to September 2021. A phenomenological approach was used to explore the perceptions and experiences of mothers who gave birth in isolation during the early days of the COVID-19 pandemic. The women were recruited through purposive sampling and contacted by phone due to pandemic restrictions. After obtaining consent, data were collected through telephonic, in-depth interviews using a semi-structured guide. Each interview lasted 40-60 minutes. Data saturation occurred after 12 participants. The audio recordings were transcribed, and the data were analysed using Colaizzi’s method of data analysis. Results: The participants were aged between 25 to 38 years; five were primigravidae. Most had no symptoms or only mild symptoms of COVID-19. From the analysis, two main themes and ten subthemes emerged. The main themes were negative feelings and positive feelings associated with giving birth in isolation. The negative subthemes included fear, sadness, worry, guilt, stigma, feelings of helplessness, and inconvenience. The positive subthemes included better medical care, supportive interpersonal interactions, and postpartum rest. Conclusion: The study concluded that the panic surrounding COVID-19, along with restrictive protocols, contributed to the negative experience. Peer support within the hospital environment emerged as an important positive factor, along with supportive care from hospital staff and encouragement from family. The findings can inform public health policies in future outbreaks to address the needs of women giving birth in isolation.

Efficacy of Ligation versus Bipolar Diathermy for Management of Intraoperative Haemostasis in Tonsillectomy: A Prospective Interventional Study

Tharun Rajeev, Mayur Ingale, Vinod Shinde, Tanmay Chaudhari Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Tonsillitis is a highly prevalent condition and represents a significant proportion of outpatient visits. Tonsillectomy, when indicated, is considered a high-risk procedure owing to the postoperative complications. Bipolar diathermy coagulation has gained popularity due to its potential advantages, including reduced intraoperative blood loss, fewer postoperative complications, shorter operative time, and improved postoperative recovery. Aim: To compare the efficacy of ligation and bipolar diathermy for haemostasis in tonsillectomy. Materials and Methods: The present prospective interventional study was conducted from October 2023 to March 2025, in the Department of Otorhinolaryngology at a tertiary care hospital, involving 40 patients undergoing elective tonsillectomy. Patients were randomly allocated into two equal groups (n=20 each) based on the method of haemostasis: Group A underwent tonsillectomy with haemostasis achieved using ligation with 3-0 vicryl sutures. In contrast, group B underwent haemostasis using bipolar diathermy coagulation. Both groups were evaluated for intraoperative time (measured in minutes using a stopwatch), intraoperative blood loss (calculated by measuring suction volume and gauze weight), postoperative pain (assessed using the Visual Analog Scale (VAS) on postoperative days 0, 3, and 5), and postoperative complications such as secondary haemorrhage, infection, and delayed healing. Intergroup comparisons were performed using the independent samples student’s t-test for continuous variables and the Chi-square test or Fisher’s-exact test for categorical variables. A p-value of <0.05 was considered statistically significant. Results: The mean age was 18.6±4.2 years in group A and 19.1±3.8 years in group B (p=0.612). Gender distribution was similar, with a male-to-female ratio of 12:8 in group A and 11:9 in group B (p=0.748). Patients in group B, demonstrated a significantly shorter mean haemostasis time (8.4±2.9 minutes) in comparison to group A (10.9±3.8 minutes), (p=0.02). The mean intraoperative blood loss was also significantly reduced in group B (23.8±6.1 mL) compared to group A (34.5±6.6 mL), p-value of <0.001. On postoperative day 0 (POD 0), the mean pain score in group B was 4.9±1.4, compared to 3.2±1.0 in group A (p<0.001). On POD 3, the mean scores were 2.7±0.8 in group B and 2.2±0.7 in group A (p=0.04), while on POD 5, group B reported a score of 1.8±0.6, which remained significantly higher than 1.3±0.4 in group A (p=0.003). Although postoperative pain scores decreased progressively in both groups, the differences persisted across the observation period, indicating a higher early postoperative pain burden associated with bipolar diathermy. Group A had complications in 5 cases (25%), comprising 2 cases (10%) of primary haemorrhage, 1 case (5%) of injury to the posterior pharyngeal wall, 1 case (5%) of soft palate injury, and 1 case (5%) of reactionary haemorrhage. In contrast, group B exhibited a lower complication rate in 3 cases (15%), which included 1 case (5%) of hypernasal speech, 1 case (5%) of injury to the anterior tonsillar pillar, and 1 case (5%) of transient velopharyngeal insufficiency. Conclusion: Haemostasis using bipolar diathermy appears to be more efficient and safer technique for tonsillectomy with reduced operative time and quicker recovery, making it a favourable alternative to traditional ligation.

Assessment of Prescription Quality in Cardiovascular Patients Using the Prescription Quality Index Tool: A Prospective Study

Geethu George Thannikot, Shrinivas R Raikar, Akram A Naikwadi Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: The Prescription Quality Index (PQI) is a tool consisting of 22 questions designed to assess the quality of prescriptions. A good prescription should be evidence-based, rational, complete, and precise, ultimately improving treatment outcomes. PQI includes 22 parameters and has been hailed as the perfect instrument for use across a broad range of drugs and clinical problems. Aim: The study aimed to evaluate the prescription quality of patients with cardiovascular disorders admitted to the Intensive Cardiac Care Unit (ICCU). Materials and Methods: The present prospective study was conducted in the ICCU of Shri B M Patil Medical college, Hospital and Research Centre, Vijayapura, Karnataka, India, from July 2023 to 2024. It included 151 patients admitted to the ICCU. The medications provided to cardiovascular patients were assessed using the PQI questionnaire. Each of the 22 questions has an answer for each of the medications specified in a single prescription. PQI answers range from 0-4 for very significant criteria, 0-2 for essential criteria, and 0-1 for less critical criteria. Spearman’s correlation coefficient was employed to assess the relationship between each variable and the total PQI score, establishing a threshold for statistical significance at a p-value of less than 0.05. Results: Out of 151 cases, it was found that 146 prescriptions (96.7%) did not include the least expensive drug available. There was only one documented case (0.7%) of drug-drug interactions. Furthermore, only 1 (0.7%) prescription was written using generic names. The legibility of prescriptions was deemed adequate in 66 (44%) cases. Prescriber and patient information were provided appropriately in 59 (39%) cases. Overall, the PQI scores suggested that all prescriptions demonstrated a high level of quality. Conclusion: This study demonstrates that high-quality prescriptions can be achieved through the diligent care doctors take while prescribing, in the intensive cardiac care setting of a tertiary care hospital. This quality is ensured by adhering to the key principles of good prescription writing, which have to be followed by all practitioners, to avoid unnecessary complications and burden.

Effect of Tadalafil on Prevention of Urethral Stricture after Direct Vision Internal Urethrotomy: A Prospective Cohort Study

Shyam Sundar Sarkar, Soumya Mondal, Debansu Sarkar Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Urethral stricture recurrence following Direct Vision Internal Urethrotomy (DVIU) remains a significant challenge. Phosphodiesterase type-5 inhibitors (PDE5-Is), such as tadalafil, have been proposed to reduce fibrosis and stricture recurrence by enhancing vascularity and inhibiting inflammation. Aim: To evaluate the efficacy of tadalafil in preventing stricture recurrence after DVIU. Materials and Methods: This prospective cohort study was conducted at the Department of Urology, IPGME&R, Kolkata, West Bengal, India, from March 2024 to February 2025. A total of 150 male patients with primary short anterior urethral strictures (<1 cm) were enrolled. Patients were divided into two groups: tadalafil group (n=81) and non tadalafil group (n=69). The exclusion criteria included recurrent or long strictures, congenital anomalies, cardiopulmonary compromise, and bleeding disorders. DVIU was performed under sedation and anaesthesia. Outcomes assessed were the need for further surgical intervention and peak urinary flow rate (Qmax) at three-month follow-up. Statistical analyses used was Chi-square test for categorical variables and Welch’s t-test for continuous variables; p-value <0.05 was considered statistically significant. Results: Baseline demographics were comparable. Further surgical intervention was significantly lower in the tadalafil group (18.5%) compared with the control group (33.3%; p-value=0.046). The mean Qmax was significantly higher in the tadalafil group (10.5±2.4 mL/s) than in the control group (9.1±2.8 mL/s; p-value=0.032). Kaplan-Meier analysis showed higher stricture-free survival in the tadalafil group (p-value=0.041). Conclusion: Tadalafil significantly reduces stricture recurrence and improves urinary flow after DVIU. Larger, long-term multicentre studies are needed to validate these findings and to integrate tadalafil into routine DVIU protocols.

Evaluation of the Prescription Pattern of Drugs Used in Treatment of Pelvic Inflammatory Disease at a Tertiary Care Hospital in Pune: A Cross-sectional Study

Abhijit V Tilak, Megha S Mamulwar, Zohra Neda Shaikh, Shantanu Chitale, Aadil Shah, Shraddha Bapat Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Pelvic Inflammatory Disease (PID) is an inflammation of female upper genital tract which includes inflammation of uterine endometrium, fallopian tubes, ovaries and peritoneum. PID, constitutes a major public health concern for women of reproductive age, potentially leading to significant sequelae impacting their fertility. PID is a frequent concern for younger women due to Sexually Transmitted Infections (STI) and often associated with sexually transmitted pathogens. Aim: To evaluate the prescription pattern of drugs used in PID. Materials and Methods: The present cross-sectional study was done in Outpatient and Inpatient Department facility (OPD and IPD) of Gynaecology and Obstetrics Department, of Dr. D Y Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India. Total 146 prescriptions were analysed in the study. Demographic factors, clinical symptoms, treatment facility and drug utilisation patterns among patients with PID were studied. The data was entered using Microsoft Excel. Statistical analysis of demographic characteristics and drug utilisation pattern was studied using frequencies and percentages. Results: The mean age of the study participants was 33.84 (7.10) years and 97.3% of patients were married. It was noted that the most common presenting complaint was per vaginal discharge and infertility was the least common symptom. It was observed that the metronidazole (79.4%) and doxycycline (78.1%) were commonly used for the treatment. The most commonly prescribed group of drugs is antibacterial drugs, followed by Non-steroidal Anti-inflammatory Drugs (NSAIDs) and antifungal agents. Conclusion: The present study focused on understanding the drug prescription and trends with respect to PID patients. Women with PID reporting to this tertiary health care facility were mostly young adults (31 to 40 years). Metronidazole, doxycycline and Cefixime were the most frequently prescribed antimicrobials. Based on the findings of the study, it was concluded that the antibacterial drugs prescribed are adhering the treatment guidelines by Centres for Disease Control and Prevention and Indian Council of Medical Research guidelines.

Association of Severity of Hyponatraemia with SOFA and APACHE II Scores in Critically Ill Diabetics: A Cross-sectional Study

Atharvan Sharma Mangalapalli, Vijayashree S Gokhale, Sangram S Mangudkar, Satbir Kaur Malik, Ponvijaya M Yadav, Sanket Genuji Shinde, Vineetha Naga Lakshmi Giduturi Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Hyponatraemia, the most common dysnatraemia in the critically ill, is an independent predictor of mortality, morbidity and poor clinical outcomes. It poses a significant challenge, as both severe hyponatraemia and its management can have lethal consequences. This holds true in diabetic patients as well, where mechanisms other than hyperglycemia contribute to low serum sodium levels, immune dysregulation, and where HbA1c itself is an independent predictor of all-cause mortality. Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores are well-established scoring systems that predict and stratify mortality in critically ill patients. The severity of hyponatraemia, defined by corrected sodium levels, may predict poor clinical outcomes in critically ill diabetic patients. Aim: To assess the association between the severity of hyponatraemia on admission and SOFA and APACHE II scores in critically ill diabetic patients within the first 24 hours of admission. Materials and Methods: This cross-sectional study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India from March 2023 to February 2025 with a sample size of 100 using purposive sampling. All critically ill patients admitted to the intensive care units with a history of diabetes mellitus (any type) were assessed for hyponatraemia (Na+ <135 mEq/L) on admission, corrected for hyperglycemia. A detailed history, physical examination and routine and study-specific investigations were performed. The SOFA and APACHE II scores were calculated from the worst values within the first 24 hours of admission. The data were assessed for normality and correlations were examined between the study parameters. Results: The mean age of participants was 44.09±11.3 years, with an approximately equal sex distribution; 50% were aged 45-60 years. The mean duration of diabetes was 6.5±5.3 years, predominantly between 1-5 years. Mild, moderate and severe hyponatraemia were observed in 47%, 36%, and 17% of cases, respectively, with mean SOFA and APACHE II scores of 4.77±3.68 and 12.5±8.8. Kruskal-Wallis analysis showed significant differences across hyponatraemia severity for both SOFA and APACHE II scores, with post hoc analyses indicating significant differences for APACHE II across all groups; SOFA scores were significantly higher in moderate and severe hyponatraemia compared with mild hyponatraemia. Corrected sodium levels significantly predicted both disease severity and organ dysfunction severity. Conclusion: There was a significant rise in the SOFA scores from mild to moderate hyponatraemia, but no significant difference between moderate and severe hyponatraemia patients. APACHE II scores significantly increased across all levels of worsening hyponatraemia severity, indicating the contribution of the extent of hyponatraemia to the overall disease severity but a weaker association with severity of organ dysfunction.

Clinicopathological Spectrum and Distribution Pattern of Neuroendocrine Neoplasms of the Gastroenteropancreatic System: A Cross-sectional Study of 152 Cases

Renu Sukumaran, Madhu Muralee, Choondal Devan Sivanandan, Aleyamma Mathew Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Gastroenteropancreatic Neuroendocrine Neopl-asms (GEP-NENs) are a heterogeneous group of tumours with varying biological, functional and clinical characteristics. GEP-NENs develop from the diffuse neuroendocrine system of the gastroenteropancreatic tract. Aim: To analyse the clinicopathological features and the distribution pattern of GEP-NENs. Materials and Methods: In this cross-sectional observational study, all cases of primary Gastrointestinal (GI) and pancreatobiliary tract NENs diagnosed in the Department of Pathology, Regional Cancer Centre, Trivandrum, Thiruvananthapuram, Kerala, India, from 1st January 2015 to 31st December 2020 were included. Pathological features, including tumour grade and stage, were analysed. The distribution pattern of NENs in different parts of the gastroenteropancreatic tract was noted and compared with tumour grade. Results: A total of 152 patients were included in the study. The age of patients ranged from 9 to 84 years. Gastrointestinal tract involvement was noted in 124 cases and pancreatic involvement in 28 cases. The most common site in the GI tract was the duodenum (25 cases), followed by the rectum (22 cases). There were 62 resection specimens and 90 endoscopic biopsies. The Well-Differentiated Neuroendocrine Tumour (WDNET) category accounted for 124 cases, of which the most common grade was G2 74 (48.7%). Grade 3 NET comprised 7.14% of GI tract (7 cases) and 26.9% of pancreatobiliary tract WDNETs. There were 28 cases of Neuroendocrine Carcinoma (NEC), of which 13 were Small Cell Neuroendocrine Carcinoma (SCNEC) and 15 were Large Cell NEC (LCNEC). The most common site of NEC involvement was the oesophagus. On Immunohistochemical (IHC) examination, synaptophysin positivity was noted in 96% of cases and chromogranin positivity in 76.11% of cases. A pathological Tumour (pT) stage was determined in 62 resection specimens and the most common stage was pT3 29 (46.77%). Among the 18 resection specimens of NET G1 tumours, three cases showed lymph node metastasis. Of the 32 cases of resected NET G2 tumours, seven showed lymph node metastasis and five showed liver metastasis. Conclusion: Morphology and the proliferation index play a crucial role in differentiating NET from NEC. WDNETs have metastatic potential, especially to lymph nodes and the liver. The differentiation of NET G3 from NEC is important for treatment decisions.

Correlation of Spiritual Health with Coping Orientation to Problems Experienced by Undergraduate Medical Students in a Private Medical College in Kanchipuram, Tamil Nadu: A Cross-sectional Study

Jaisankar Susmitha, Thiruvalluvan Thiruvotriyur Gopinath, Muthuchezhian Sakthivel, Velam Chokkalingam Punitha, Mallapu Keertana, Kanagasabapathy Shankar, Dharani Sujini Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Health was classically defined by the World Health Organisation (WHO) as physical, mental, and social well-being; however, a fourth dimension called spiritual health has gained recognition since the 1984 World Health Assembly. Studies have shown that medical students face multiple stressors, and coping is the mechanism through which individuals respond to stress. Despite this, less attention has been given to the role of spiritual health and its correlation with coping strategies. Aim: The present study aimed to determine the proportion of medical undergraduate students with spiritual health and Coping Orientation to Problems Experienced (COPE), and to assess the correlation between various domains of spiritual health and different coping strategies. Materials and Methods: The present cross-sectional study was conducted among 540 MBBS students at Meenakshi Medical College Hospital and Research Institute in Kanchipuram, Tamil Nadu, India, between November 2024 and January 2025. Participants were selected using a combination of proportional probability sampling and simple random sampling. Data were collected using the Spiritual Health Assessment Scale (SHAS) and the Brief COPE scale. Statistical analysis was performed using independent t-test, chi-square test, and Pearson correlation coefficient was employed to analyse the data. Results: Out of 540 participants, 300 (55.6%) had good spiritual health and 293 (54.3%) demonstrated good coping skills. Male students showed significantly higher mean spiritual health scores (p=0.018). A statistically significant association was found between the father's education and the spiritual health of students (p<0.001). A significant positive correlation (r=0.224, p<0.01) was observed between spiritual health and coping strategies. Conclusion: Over half of the undergraduate medical students demonstrated good spiritual health and coping abilities. The findings highlight a positive correlation between spiritual health and coping orientation. Academic institutions should promote interventions that enhance spiritual well-being, which may help students manage stress more effectively.

Clinical Profile and Outcomes of Obstetric Admissions to the High Dependency Unit in a Tertiary Care Hospital in Kolkata, India: A Prospective Observational Study

Debashree Saha, Indrani Das, Jaydeb Mandal, Nilanjana Chaudhury Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Despite substantial reductions in global and national maternal deaths, obstetric complications remain a crucial cause of maternal morbidity and mortality, especially in low- and middle-income countries. These women require early admission and appropriate management in the High Dependency Unit (HDU). Evaluating obstetric admissions to the HDU is a vital approach for monitoring critically ill women during pregnancy in a tertiary care facility. Aim: To investigate the indications for obstetric admissions to the HDU, the various interventions required in the HDU and the final maternal outcomes in terms of morbidity and mortality. Materials and Methods: This prospective observational study included all 485 obstetric patients admitted to the HDU over an 18-month period at a tertiary care hospital in Kolkata West Bengal, India. The study assessed outcomes related to the patients’ age, booking status, past obstetric history, pre-existing medical disorders, complications during the current pregnancy and interventions performed in the HDU. Outcomes were evaluated in terms of recovery, discharge from the HDU, need for transfer to the Critical Care Unit (CCU) and maternal deaths. Results: A total of 485 women experienced life-threatening conditions that necessitated admission to the HDU during the study period. Among these women, 285 (58.76%) belonged to the age group of 20–29 years, and 164 (33.81%) were booked patients admitted in an emergency. Among the complications, acute kidney injury following caesarean section and postpartum haemorrhage (PPH) were observed in 17.07% of cases each. The most common indication for HDU admission was eclampsia with uncontrolled seizures, which accounted for 81 (16.70%) of cases. Of the 485 admissions, 41 (8.45%) resulted in mortality. Conclusion: Among the 485 women admitted to the HDU, 85.36% recovered, 6.19% required a higher level of care, and 6.80% died. This study underscores the importance of access to the HDU for effectively managing and preventing morbidity and mortality in critically ill obstetric patients.

Dosimetric Comparison between TomoHelical and TomoDirect Radiotherapy in Locally Advanced Left-sided Breast Cancer Patients: A Retrospective Observational Study

Mandira Saha Mallik, Ajaz Nazeem, Ayan Basu, Sourav Padhee Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: India has the highest incidence of breast cancer, with treatment typically involving neoadjuvant chemotherapy, surgery, and radiotherapy. Newer techniques like Intensity-modulated Radiation Therapy (IMRT) and tomotherapy, including TomoDirect and TomoHelical, offer improvements over traditional 3Definitive Chemoradiotherapy (DCRT). Aim: To quantify the variabilities of TomoDirect (TD) and TomoHelical (TH) plans for chest wall and Supra-clavicular Fossa (SCF) irradiation in locally advanced left breast cancer treatment. Materials and Methods: The present retrospective observational dosimetric study was conducted from March 2019 to September 2019 at a private cancer centre in eastern India. TD and TH both plans were created in five left breast cancer patients using tomotherapy machine for chest wall and SCF region volumes. The prescription doses for both plans were 50 Gy in 25 fractions. The study measured dosimetric parameters such as Planning Target Volume (PTV) coverage, doses to Organ At Risk (OAR), and treatment times etc. Data analysis was performed using IBM Statistical Package for Social Sciences (SPSS) software, version 25.0. Result: Both plans were almost similar in terms of PTV coverage except for hot areas, which are more common in the TD plans {V107 2.075 cc (TD) vs. 0.4 cc (TH)}. For OARs, values of V5 for the ipsilateral lung and contralateral breast, mean dose (Dmean) were lower in TD, but other parameters were almost similar in both modes. Although TomoHelical improves homogeneity and regulates a high dose gradient better than the TD plan, it comes at the cost of a high integral dose to surrounding normal tissue. The average treatment time is less for TD as compared to TH (mean 325.5 sec vs. 403.35 sec, p-value=0.013). Conclusion: TomoHelical and TomoDirect plans have almost similar PTV coverage and conformity. TD achieves a lower ipsilateral lung low dose area and contralateral breast mean dose, whereas TH offers a more homogeneous plan. Hence, both plans are feasible modes of treatment. For intricate plans, like those incorporating chest wall plus SCF with or without axilla, TH will be a superior option; however, TD will be better for simpler plans, like those that need just chest wall irradiation.

Ferritin Levels in Acute Ischaemic Stroke: Insights and Association with Stroke Severity by National Institutes of Health Stroke Scale and Functional Outcomes on the Modified Rankin Scale

Ronak Prakashkumar Shah, Parth Rohitkumar Shah Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Acute Ischaemic Stroke (AIS) is a leading contributor to both mortality and long-term disability globally. Serum ferritin, an acute-phase reactant involved in iron metabolism, has been implicated in oxidative stress and neuronal damage in stroke patients. Exploring the relationship between serum ferritin levels, stroke severity, and functional outcomes can help improve risk assessment and optimise treatment strategies. Aim: The present study aimed to evaluate the association between serum ferritin levels and stroke severity as assessed by the National Institutes of Health Stroke Scale (NIHSS) and functional outcomes measured by the Modified Rankin Scale (mRS). Additionally, the study sought to identify clinical and demographic factors associated with serum ferritin levels in AIS patients. Materials and Methods: The present prospective cross-sectional study was conducted at the Critical Care Unit of Smt BK Shah Medical Institute and Research Hospital,Sumandeep VIdyapeeth Deemed to be University, Vadodara Gujarat, India, from January 2025 to February 2025. Ethical approval was obtained from the Institutional Ethics Committee. A total of 42 AIS patients meeting the inclusion criteria were enrolled. Serum ferritin levels were measured upon admission in all patients. Stroke severity was assessed using NIHSS at admission, and functional outcomes were evaluated using mRS on the seventh day. Statistical analyses, including Chi-square tests, were performed to determine associations, with a p-value <0.05 considered significant. Results: The study included 42 patients with AIS with mean age of 56.10±7.19 years, with 24 (57.1%) patients being male and 25 (59.5%) patients residing in rural areas. Elevated serum ferritin levels was observed in 29 (69.1%) patients which was significantly associated with severe stroke (p=0.002) and worse functional outcomes (p<0.001). Severe stroke (higher NIHSS) was more common in female patients, smokers, urban residents, and cardiac disease and Transient Ischaemic Attack (TIA). Similarly, severe disability (higher mRS) was linked to female sex, smoking, and dyslipidaemia. Abnormal ferritin levels were significantly associated with female sex (p=0.01), smoking (p=0.004), cardiac disease (p=0.02), and TIA (p=0.03). Conclusion: Serum ferritin levels were significantly associated with stroke severity and poor functional outcomes, indicating their potential role as a prognostic marker in AIS. Additionally, smoking, cardiac disease, and TIA history were linked to altered ferritin levels. These findings highlight the importance of ferritin as an inflammatory marker and its relevance in stroke management and risk stratification.

Efficacy of Natural Dye (Indigo blue), Lysochrome Dye (Sudan black) and Fluorescent Dye (Nile blue A) in Cheiloscopy as a Lip Print Enhancer in Forensic Odontology: A Cross-sectional Study

Bhavani Meesala, Smita Shrishail Birajdar, Ravikanth Manyam, P Swetha, Naga Supriya Alapati, S Supraja Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction:The study of lip prints is known as cheiloscopy. Lip prints are unique for each individual, which plays a key role in suspect identification. These imprints obtained on any surface may be in visible or latent form. Latent forms of lip prints are difficult to identify; hence various dyes are used to enhance the latent lip prints obtained from different surfaces. The present study has included the both porous and non porous surfaces. It is essential to determine how the surface of an object effects the enhancement efficiency of latent lip prints with different dyes. Aim: To compare the enhancement efficacy among of Indigo dye (Natural dye), Sudan black (Lysochrome dye) and Nile blue A (Fluorescent dye) on porous and non porous surfaces, assessing their applicability in cheiloscopy. Materials and Methods: The present cross-sectional study was carried out on 120 individuals. All the subjects were students from Vishnu Dental College, Bhimavaram, Andhra Pradesh, India. The Lip print collection completed within six months which was started in July 2022 and ended in January 2023. Individuals with age group of 18-25 years were considered. After obtaining informed consent, subjects were asked to make an imprint on the given surfaces like porous and non porous (white and red colour surfaces). They were enhanced immediately by applying Indigo blue, Sudan black and Fluorescent dye for evaluating the clarity of lip grooves. Chi-square test was used to compare the enhancement efficiency among three dyes. The p-value<0.05 was considered as statistically significant. Results: Fluorescent dye has better enhancement than the indigo dye and lysochrome dye with the significant p-value 0.001. When lysochrome dye and Fluorescent dye compared the results were not statistically significant (p-value=0.012). When compared between non porous and porous surfaces better enhancement was observed on porous surfaces predominantly by Fluorescent dye. Conclusion: The present study revealed the usefulness of latent lip print in individual identification in forensic dentistry. Fluorescent dye gives a better positive result than Indigo blue, but when compared with lysochrome dye there was no obvious significance during enhancement.

Antimicrobial and Phytochemical Evaluation of Nyctanthes arbor-tristis Linn. Leaf Extracts in Various Solvents against Pathogenic Microbial Strains: An In-vitro Study

Shrishti Raturi, Ankita, Ruksaar Praveen, Rohit Kamal, Deepak Som Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Antimicrobial Resistance (AMR) poses a growing global health challenge by reducing the effectiveness of conventional antibiotics against a wide range of pathogenic microorganisms. In this context, medicinal plants are increasingly being explored as alternative sources of bioactive compounds with antimicrobial potential. Nyctanthes arbor-tristis Linn., a traditionally used medicinal plant, holds promise due to its diverse phytochemical composition. Aim: To evaluate the in-vitro antimicrobial activity and phytochemical profile of N. arbor-tristis leaf extracts obtained using various solvents and to assess their efficacy against selected pathogenic microbial strains. Materials and Methods: This in-vitro study was conducted at the Shri Guru Ram Rai (SGRR) University campus, Dehradun, Uttarakhand, India, between June 2021 and September 2024. The study investigated the antimicrobial properties, chemical constituents and qualitative phytochemical composition of N. arbor-tristis extracts. Leaves were subjected to Soxhlet extraction using five solvents: water, methanol, acetone, chloroform and ethyl acetate. Antimicrobial activity was tested against Salmonella enterica serovar Newport {Microbial Type Culture Collection (MTCC) 3225}, Escherichia coli (MTCC 723), Staphylococcus aureus subsp. aureus (MTCC 740), and Candida albicans (MTCC 3017) using the well diffusion method. Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) were also determined at different concentrations. Phytochemical screening was performed to detect secondary metabolites. Following the antimicrobial susceptibility tests, the MIC was determined to identify the lowest concentration inhibiting microbial growth. Data were presented in tables and graphs, with p-values calculated using appropriate statistical tests. A p-value of <0.05 was considered statistically significant. Results: Methanolic extracts exhibited the highest antimicrobial activity across all tested pathogens, with the largest Zones Of Inhibition (ZOI) observed against Salmonella Newport (23.6±0.57 mm at 0.5 mg/100 μL and 24.6±0.57 mm at 1 mg/100 μL). Aqueous extracts showed the highest yield but were the least effective, particularly against Candida albicans, which showed no inhibition zone. Phytochemical analysis revealed the presence of alkaloids, flavonoids, tannins, glycosides, steroids, terpenoids and saponins, while anthraquinones and phlobatannins were absent. Methanol and acetone extracts demonstrated the richest phytochemical diversity. Conclusion: The study demonstrated that N. arbor-tristis methanolic leaf extract possesses significant antimicrobial activity, correlating with its rich phytochemical content. These findings support the potential of this plant as a natural source of antimicrobial agents, particularly in the context of rising antibiotic resistance.

Preparation and Characterisation of Flaxseed Microspheres and Assessment of its Anti-inflammatory and Antioxidant Properties: An In-vitro Study

Vazeeha Afrin Syed, Ananya Ravikumar, Arvina Rajasekar, Rajeshkumar Shanmugam Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Flaxseed (Linum usitatissimum), commonly known as flax or linseed, is a member of the Linaceae family and is high in calories, proteins, carbohydrates, fibres, fatty acids, vitamins and minerals. Flaxseed is a source of phytochemicals with possible health advantages. Given flaxseed’s rich phytochemical content with antioxidant and anti-inflammatory properties, it holds potential as a therapeutic agent for managing periodontitis. Aim: The present in-vitro study aimed to formulate flaxseed microspheres and to evaluate its anti-inflammatory and anti-oxidant potential. Materials and Methods: The present in-vitro research was done in Nanomedicine lab, Saveetha Dental College and Hospitals, Tamil Nadu, India, between May 2024 and July 2024. The flaxseed microspheres were prepared using the water-in-oil-in-water (w/o/w) double emulsion method. The obtained microspheres were subjected to topographic analysis via Scanning Electron Microscope (SEM). Also, anti-inflammatory and antioxidant properties were analysed using protein denaturation and 2,2-Diphenyl-1-Picrylhydrazyl (DPPH) assays, respectively. Intergroup comparison was done using an independent t-test and p-value <0.05 was considered statistically significant. Results: SEM images revealed spherical microspheres with a smooth, dense surface and slight aggregation. Protein denaturation and DPPH assays revealed that there was a significant increase in the percentage of inhibition with relation to the increase in the concentration of flaxseed microspheres. Conclusion: The fabricated flaxseed microspheres exhibited superior anti-inflammatory activity and antioxidant activity that gives promising view for future researches to further explore its therapeutic role in oral healthcare.

Evaluating the Efficacy of Tulsi and Aloe Vera in the Management of Oral Submucous Fibrosis and their Correlation with Salivary Levels of Iron and Lactate Dehydrogenase: A Prospective Study

A Usha Kiranmai, Ananya Tirumani, MPV Prabhat, G Sarat Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Oral Submucous Fibrosis (OSMF) is a chronic, potentially malignant condition marked by fibrous bands in the oral cavity. It causes burning sensation with spicy foods, blanching of the oral mucosa, and progressive stiffness, leading to restricted mouth opening. Natural remedies like Tulsi (Ocimum sanctum Linn), and aloe vera are known for their antioxidant, anti-inflammatory, and healing properties. However, clinical evidence evaluating their efficacy in OSMF management remains limited. Aim: This study Aimed to evaluate the effectiveness of natural antioxidants, “Tulsi” and “aloe vera”, in managing OSMF and their association with changes in salivary levels of iron and Lactate Dehydrogenase (LDH). Materials and Methods: The present prospective study was conducted from January 2020 to September 2021 at Drs Sudha & Nageswara Rao Siddhartha Institute of Dental Sciences, Andhra Pradesh, India. Sixty patients were divided into two groups: Group A received topical Tulsi paste, while Group B received aloe vera gel. Both groups included 28 males (93.3%) and 2 females (6.7%) with mean ages of 40.0 and 42.7 years, respectively. Salivary iron and LDH levels were measured before and after treatment. Clinical parameters such as mouth opening, burning sensation, and tongue protrusion were assessed bi-weekly over six weeks. Data was analysed using IBM Statistical Package for Social Sciences (SPSS) Version 20 software with descriptive statistics, Chi-square tests, t-tests, and Analysis of Variance (ANOVA). Statistical significance was set at p≤0.05. Results: Significant improvements in clinical parameters were observed in both groups (p<0.001). The Tulsi group showed more pronounced enhancements in mouth opening (p<0.001) and tongue protrusion compared to the aloe vera group. Salivary iron levels increased significantly in both groups (p<0.001), with no significant intergroup difference (p=0.39). However, the Tulsi group exhibited greater reductions in salivary LDH levels (p=0.001) compared to the aloe vera group (p=0.009). Conclusion: Topical application of Tulsi paste and aloe vera gel effectively reduced burning sensation while improving mouth opening and tongue protrusion. Tulsi demonstrated superior results compared to aloe vera in clinical outcomes and salivary LDH reduction, highlighting its potential for OSMF management.

Optimising Antibiotic use in the Neonatal Intensive Care Unit through Implementation of Antimicrobial Stewardship Program: A Double Cohort Study

Runjhun, Neha Agarwal, Amitesh Yadav, Yashwant Kumar Rao, Anika Rao Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Inappropriate use of antimicrobials in newborns can lead to serious consequences, including the emergence of multidrug-resistant organisms. Implementing antimicrobial stewardship strategies in neonatal units can reduce indiscriminate antibiotic use and its harmful effects. Aim: To study the effect of reducing antibiotic usage in newborns admitted to the Neonatal Intensive Care Unit (NICU) by creating a “No Antibiotic Zone” and implementing an Antimicrobial Stewardship Program (ASP). Materials and Methods: This double-cohort observational study was conducted in a Level III NICU at the Children’s Hospital, GSVM Medical College, Kanpur, Uttar Pradesh, India, from April 2021 to March 2023. During the preintervention period, most neonates were administered antibiotics irrespective of risk factors. During the stewardship period, neonates were assessed for red flags, risk factors and clinical indicators of sepsis. Neonates with minimal or no risk factors or clinical signs of sepsis (n=480) were placed in an aseptic “No Antibiotic Zone” within the NICU under close monitoring. Those who exhibited early signs of sepsis (n=178) were started on antibiotics and managed according to standard guidelines. Demographic and clinical characteristics, length of hospital stay and outcomes were compared between the preintervention (n=464) and postintervention (n=302) cohorts. Results: The baseline characteristics of the newborns, including gender, gestational age, birth weight and incidence of various diseases, were comparable between the two cohorts. The mean gestational age and birth weight were 36±2.06 weeks and 2400±500 g, respectively. The mean length of stay before the intervention was 10.1±2.8 days, which decreased to 6.5±2.4 days after the implementation of the ASP (p-value <0.001). Antimicrobial utilisation in the NICU declined by 42% without a corresponding increase in mortality, which was statistically significant (p-value <0.001). Conclusion: Given the growing threat of antimicrobial resistance, implementation of antimicrobial stewardship strategies—though challenging—can effectively minimise unnecessary antibiotic use in newborns.

Efficacy of Ceftazidime-avibactam against Multidrug-resistant Gram-negative Pathogens in ICU Patients: A Cross-sectional Study from a Subhimalayan Tertiary Care Hospital

Rajender Singh, Barnali Kakati, Garima Mittal Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Antimicrobial Resistance (AMR) is a pressing global health issue, posing challenges in clinical management, increasing morbidity and mortality rates, and burdening healthcare systems economically. The present study assesses the in-vitro efficacy of Ceftazidime-Avibactam (CZA) against Multidrug-Resistant (MDR) Gram-negative isolates from Intensive Care Unit (ICU) patients, comparing it to other beta-lactam/beta-lactamase inhibitors, with a focus on Carbapenem-Resistant Enterobacterales (CRE), Extended-Spectrum Beta-Lactamase (ESBL)- producing Enterobacterales, and MDR Pseudomonas aeruginosa. Aim: To determine the sensitivity pattern of CZA against various MDR Gram-negative isolates from ICU patient samples and compare its efficacy with other second-line drugs. Materials and Methods: The present cross-sectional observational study was conducted over a six-month period from January to June 2021 on 94 MDR bacterial isolates obtained from Intensive Care ICU patients at the Himalayan Institute of Medical Sciences (HIMS), Swami Rama Himalayan University (SRHU) Dehradun, Uttrakhand, India. All clinical samples received from ICU patients with clinically suspected sepsis were included in the study. These samples were routinely processed in the bacteriology laboratory following Standard Operating Procedures (SOPs). Bacterial identification and Antimicrobial Susceptibility Testing (AST) were performed using the VITEK-2 automated system from bacterial colonies isolated after overnight incubation. Demographic characteristics of the patients were systematically recorded and analysed. E-test strips for CZA were only applied to those bacterial isolates identified as MDR Enterobacteriaceae and Pseudomonas spp. Statistical analyses were conducted to determine antimicrobial susceptibility rates, with statistical significance set at p<0.05. Results: Among the 94 MDR Gram-negative isolates, Klebsiella pneumoniae and Escherichia coli were the most prevalent pathogens, comprising 34 (36.2%) and 32 (34.0%) of samples, respectively. CZA demonstrated a sensitivity rate of 35 (37.2%) across 94 samples, with limited efficacy against 46 CRE isolates i.e., 10(21.7%) and 15 MDR Pseudomonas aeruginosa i.e., 4 (26.6%), and no efficacy against Acinetobacter baumannii 0 (0%). Notably, CZA outperformed amoxicillin-clavulanic acid and piperacillin-tazobactam in-vitro activity against ESBL-producing Enterobacteriaceae but showed reduced efficacy against 61 carbapenem resistant isolates when compared to last-resort antibiotics like colistin 39 (63.9%). Conclusion: The findings indicate CZA’s moderate efficacy against ESBL-producing Gram-negative bacteria but limited effectiveness against CRE and MDR P. aeruginosa in ICU settings. These results suggest a need for careful evaluation of CZA use in ICU settings and highlight the importance of ongoing antimicrobial surveillance and the potential for combination therapy to address rising MDR infections.

Ability of Passive Leg Raising Test in Predicting Positive Fluid Response in Paediatric Patients with Shock: A Prospective Observational Study

Ritu Gupta, Mohd Kashif Ali, Yousuf Siddiqui Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Shock is an acute syndrome in which the circulatory system is unable to provide adequate oxygen and nutrients to meet the metabolic demands of vital organs. Fluid replacement is often necessary to optimise the cardiovascular function by maintaining adequate cardiac preload and output. It’s a reversible manoeuvre that simulates a rapid fluid bolus by shifting blood from the lower extremities and abdominal compartment into the central circulation. Aim: To evaluate the Passive Leg Raising (PLR) test as a simple bedside tool to assess volume responsiveness in children with shock aged less than eight years. Materials and Methods: The present prospective observational study was conducted in Paediatric Ward and Paediatric Intensive Care Unit of a tertiary level teaching hospital between November 2020 to October 2022. Total 42 children between one month to eight years of age diagnosed with shock were included in the study. Bedside echocardiography was done to calculate stroke volume combining Velocity Time Integral (VTI) at aortic root with the Cross-sectional Area (CSA) of the aortic root. VTI was measured at baseline, after PLR and after giving a fluid bolus of 10 mL/kg of crystalloid fluid. Change in VTI was compared between PLR and fluid bolus interventions. Cut-off for positive test was kept as ≥12% increase in VTI from baseline for both PLR and fluid bolus. Results: Mean age of study population was 55 months (SD- 50), out of which 27 (64.3%) were below four years of age. A total of 29 (69%) of patients were male. Overall sensitivity of passive leg raise test was 76.7%, specificity of 85.7% when cut-off value was taken as >12% for change in VTI post-PLR. Negative predictive value of PLR was 37.5% and positive predictive value of 97.1%. The Area Under the Receiver Operating Characteristic (AUROC) curve was 0.855 with significance of 0.021. Conclusion: The study found that the PLR test is a reasonably accurate tool for predicting fluid responsiveness in children younger than eight-year-old. When an increase in cardiac index of more than 12% is used as the indicator of a positive test, the PLR manoeuvre correctly identifies about 77% of fluid-responsive children and correctly identifies about 86% of children who are not fluid responsive.

Comparison of Palonosetron with Ondansetron in Prevention of Postspinal Shivering: A Randomised Controlled Trial

Sai Hrudaya Harshitha Akondi, Rajagopalan Venkatraman, Karthika Urkavalan Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Postspinal shivering is a frequent and distressing complication following spinal anaesthesia due to impaired thermoregulation that leads to redistribution of body heat, resulting in hypothermia, increased metabolic demand, and patient discomfort. Uncontrolled shivering can contribute to haemodynamic instability and increased oxygen consumption, which can be detrimental in vulnerable patients. Along with shivering, Postoperative Nausea and Vomiting (PONV) are common postoperative concerns that affect patient recovery and satisfaction. Therefore, effective prophylactic strategies targeting both shivering and PONV are crucial in improving perioperative outcomes. Aim: The present study aimed to compare the efficacy of prophylactic palonosetron versus ondansetron in preventing postspinal shivering and PONV among patients posted for lower limb orthopaedic surgeries under spinal anaesthesia. Materials and Methods: The present double-blinded, randomised controlled trial was conducted at SRM Medical College and Hospital Research Centre, Chennai, Tamil Nadu, India, involving 138 adult patients scheduled for elective lower limb orthopaedic surgeries. Patients were randomly allocated into three groups, each comprising 46 participants. Group P received 0.075 mg of intravenous palonosetron, Group O received 8 mg of intravenous ondansetron, and Group C received 5 mL of intravenous normal saline. All study drugs were administered 30 minutes before spinal anaesthesia. The study assessed haemodynamic parameters, the incidence and severity of shivering, and the incidence and severity of PONV at specified intraoperative and postoperative time intervals. Statistical analysis was performed using One-way Analysis of Variance (ANOVA) for continuous variables and the Chi-square test for categorical data. Results: Baseline demographics and haemodynamic data were comparable among the groups. Palonosetron was significantly more effective in reducing both the incidence and severity of shivering compared to ondansetron. At 15 minutes, Grade 2 shivering was recorded in 43.48% of Group C, 15.22% of group O, and 6.52% of group P (p<0.0001). A similar trend persisted at 45 minutes. By 60 minutes, shivering incidence declined across all groups without significant differences. Palonosetron also outperformed in reducing intraoperative nausea, particularly between 45-60 minutes, while vomiting rates were low and comparable. The overall incidence of PONV was significantly lower in the palonosetron group (p<0.0480). Conclusion: Prophylactic i.v. palonosetron is superior to ondansetron in preventing postspinal shivering and PONV, enhancing perioperative patient comfort and safety.

Effects of Remote Ischaemic Pre-conditioning in Patients undergoing Off-pump Coronary Artery Bypass Grafting Procedure: A Randomised Controlled Study

Sundararaj Rajkumar, Sankar Iswarya, Balasubramaniam Gayathri Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Remote Ischaemic Pre-conditioning (RIPC) is a simple, non invasive, cost-effective intervention using brief cycles of limb ischaemia/reperfusion that may reduce Peri-operative Myocardial Injury (PMI) in patients undergoing Coronary Artery Bypass Grafting (CABG) surgery. Aim: To study the effects of remote ischaemic pre-conditioning in cardiac patients undergoing off-pump CABG procedure. Materials and Methods: A double-blinded, randomised controlled study was conducted at the Department of Anaesthesiology, SRM Medical College Hospital and Research Centre, Tamil Nadu, India from November 2023 to July 2024. Among a total of 140 patients, 69 patients received RIPC (group A), and 71 patients were free of RIPC (group B). Total of 134 patients were included for final analysis. Preoperatively, the patient's routine laboratory investigations, including cardiac Troponin I (cTnI), were measured. cTnI is the primary endpoint used here to assess PMI. Post-procedure, the patient's cTnI level as well as the renal function tests were evaluated at 24, 48, and 72 hours (hrs). Secondary endpoints included short-term clinical outcomes. The Student’s t-test, and Pearson’s Chi-squared test were used, and p-values<0.05 were considered statistically significant. Results: The groups were comparable concerning demographic data and baseline haemodynamic parameters. Compared with the control group B at 24, 48, and 72 hrs, the cTnI was shown to be lower in the RIPC group throughout the trial (1.66±2.02, 2.52±1.92, 2.34±1.85, p-value: 0.001, 0.001, and 0.001, respectively). Acute renal injury was measured by comparing serum creatinine levels at 24, 48, and 72 hours, which were lower in the RIPC group A (1.07±0.44, 1.06±0.48, 1.08±0.48, p values: 0.001, 0.001, and 0.001, respectively). Conversely, the RIPC group remained a shorter stay in the Intensive Care Unit (ICU) (p-value <0.0001). Conclusion: Remote ischaemic pre-conditioning in off-pump CABG procedure has been shown to reduce the severity of peri-operative myocardial injury, as evidenced by lower cTnI levels at 24, 48, and 72 hrs post-intervention. RIPC also reduced the incidence of acute kidney injury, resulting in consistently lower serum creatinine levels. Additionally, patients in the RIPC group had a significantly shorter ICU, suggesting improved post-operative recovery.

Validation of Shear Wave Elastography as a Non Invasive Procedure to Detect and Grade Oesophageal Varices in Chronic Liver Disease: A Cross-sectional Study

Tom George, Rony Thomas, Arravelli Venkateshwar Rao Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Chronic Liver Disease (CLD) is characterised by progressive liver dysfunction. The most serious consequence of CLD is portal hypertension, which can lead to ascites, Gastroesophageal Varices (GEV) and hepatic encephalopathy. Of these, the development of GEV is a major complication. Given the high mortality associated with variceal bleeding, screening for GEV is recommended for all patients with diagnosed CLD. Shear Wave Elastography (SWE) is a novel imaging modality that can measure Liver Stiffness (LS) and Splenic Stiffness (SS) in real time. Most studies have assessed Transient Elastography (TE) and Acoustic Radiation Force Impulse (ARFI); however, only a few have evaluated SWE. Moreover, appropriate cut-off values to categorise the severity of varices are not available for liver. Aim: To evaluate SWE as a non invasive method to detect and grade Oesophageal Varices (EV) in CLD. Materials and Methods: A cross-sectional study was conducted in the Department of Gastroenterology at Believers Church Medical College Hospital, Thiruvalla, Kerala, India, from April 2023 to March 2024. All individuals aged 18 years or older, of any gender, with diagnosed CLD of any aetiology who consented to participate were eligible. The diagnosis of CLD was based on clinical, biochemical and radiological features. The study evaluated the role of SWE in conjunction with endoscopy in CLD and assessed variables such as age, Body Mass Index (BMI), aetiology and the grading of EV. The study estimated SWE’s ability to demonstrate associations between LS and SS with the presence and severity of EV. Sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated for validation of SWE. To assess SWE, Receiver Operating Characteristics (ROC) curves were plotted and optimal cut-off values were estimated using Youden’s index. Results: Of 96 patients evaluated, 76% were male, with a mean age of 45±13.42 years. Alcoholic cirrhosis emerged as the most prevalent aetiology, accounting for 54 (56.25%) cases. EV was detected in 59 patients (61.46%). The area under the ROC curve (AUC) values were 0.855 for Liver Stiffness, measurement (LSM) and 0.938 for Splenic Stiffness Measurement (SSM). LSM had a specificity of 97.03%, while SSM had a sensitivity of 91.5% and a specificity of 91.9%, indicating that SWE offers robust diagnostic capability for detecting and grading EV. Conclusion: The study underscores the clinical significance of SWE as a non invasive tool for assessing and grading EV in CLD.

Effect of Magnesium Sulphate on Anaesthetic Agent Requirements Under BIS-targeted Anaesthesia and Postoperative Analgesia: A Prospective Randomised Controlled Study

SP Kanchanaa, Aditi A Dhimar, Ananda Jyothi Velmayil Murugesan Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Administration of an appropriate dose of anaesthetic drug and simultaneously achieving adequate depth of anaesthesia with minimal side effects is a challenge. Magnesium Sulphate (MgSO₄) significantly reduces the requirements of anaesthetic agents. Aim: This study aimed to evaluate the impact of MgSO₄ on requirements of propofol, vecuronium, and sevoflurane under Bispectral Index (BIS) guidance, along with associated changes in haemodynamic parameters and postoperative analgesia. Materials and Methods: The present prospective randomised double-blinded controlled study was conducted at Medical College and SSG Hospital, Vadodara, Gujarat, India, from November 2019 to October 2020. It was carried out among 100 patients undergoing elective tympanomastoidectomy under GA. Group M received MgSO₄ 40 mg/kg, and Group N received normal saline. Both groups received fentanyl 2 μg/kg as premedication. Induction was carried out using propofol infusion at 30 mg/kg/hr and was stopped at a BIS index of 40-50. Following intubation with succinylcholine, maintenance of anaesthesia was achieved using O₂ + N₂O, sevoflurane and vecuronium, targeting a BIS index between 40 and 60. The primary parameters assessed included total propofol requirement for induction, intraoperative requirement of vecuronium and sevoflurane, haemodynamic variables {Heart Rate (HR), Mean Arterial Pressure (MAP)} and postoperative analgesic requirement. Haemodynamic variables were recorded at baseline (preinduction), during induction, immediately after intubation, every five minutes for the first 15 minutes, and then every 15 minutes until the end of surgery. Postoperative analgesia was assessed using Visual Analog Scale (VAS) scores at 0, 1, 2, 4, 6, and 12 hours, postoperatively. Statistical analysis was performed using the student’s t-test for normally distributed data and the Mann-Whitney U or Kolmogorov-Smirnov test for non-normally distributed data, with a p-value of <0.05 considered statistically significant. Results: The requirement of propofol was 101.6±21.21 mg in Group M while it was 141.6±14.14 mg in Group N (p<0.0001). Vecuronium requirement in Group M was 5.48±0.707 mg and in Group N it was 6.7±1.414 mg (p<0.0001). Sevoflurane consumption was 37.16±9.03 mg in Group M and 46.25±8.84 mg in Group N (p<0.001). The average duration of analgesia was 10.72±3.85 hours in Group M and 7±2.36 hours in Group N (p<0.0001). The number of rescue analgesia were less i.e., 1.44±0.54 in Group M than Group N which was 2.02±0.58 (p<0.0001). Conclusion: Magnesium Sulphate in GA significantly reduces the requirement of propofol, vecuronium and sevoflurane while maintaining BIS value of 40 to 60 with satisfactory postoperative analgesia.

Three-dimensional Evaluation of Dentoalveolar Parameters in Maxillary Unilaterally Impacted Buccal versus Palatal Canines: A Retrospective Cone Beam Computed Tomography Study

Diksha Tripathi, Geetika Tomer, Namrata Dogra, Tarun Kumar, Puneeta Vohra, Manisha Khanna Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: The accurate diagnosis and treatment planning of maxillary impacted canines are critical for achieving optimal aesthetic, functional, and periodontal outcomes. Buccal and palatal impactions often exhibit differing aetiologies, spatial characteristics and treatment challenges. Evaluating these differences may provide insights into tailored management strategies thus improving the treatment planning, minimising complications and optimising outcomes. By using Cone Beam Computed Tomography (CBCT) technology, the present study seeks to advance the understanding of the anatomical variations in buccal versus palatal maxillary impacted canines that may help in refining treatment approaches, improving surgical outcomes and reducing potential complications. Aim: The aim of this investigation was to evaluate and compare dentoalveolar parameters of subjects having unilateral buccal, palatal impacted and normally erupted maxillary canines with CBCT. Materials and Methods: The present retrospective observational study was conducted in the Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Dental Sciences, SGT University, Gurugram, Haryana, India, over a period of one year starting from November 2022 to November 2023. Seventy CBCT scan of patients with no congenital deformity, in the age group of 12-16 years of age, of both the genders, having unilateral buccal, unilateral palatal and normal erupted maxillary canines were screened from the existing database of the department, out of which 30 unilateral buccal, 30 unilateral palatal and 10 normal erupted maxillary canines were selected. Statistical comparisons were made using One-way Analysis of Variance (ANOVA) test while comparing unilateral impacted buccal, palatal, and normally erupted maxillary canines. The intergroup comparison was done using independent t-test, and p-value of 0.05. Results: Significant statistical differences (p <0.05) were found between buccal and palatal impacted and normal erupted maxillary canines with respect to the following parameters- buccopalatal alveolar ridge width (p-value 0.001), transverse arch width (p-value 0.001), anterior dentoalveolar height (p-value 0.001), tooth size-arch perimeter discrepancy (p-value 0.001), tooth angulation (p value 0.001), Crown and root Length (p-value 0.001). Significant differences were also found between palatal and buccal impacted maxillary canines when compared individually with relation to the following parameters: buccopalatal alveolar ridge width (p-value 0.001), transverse arch width (p-value 0.01), tooth size-arch perimeter (p-value 0.012), anterior dentoalveolar height (p-value 0.01), tooth angulation (p-value 0.001), crown and root length (p-value 0.001). Conclusion: In the present study, unilateral palatally impacted maxillary canines exhibited increased transverse arch width, tooth size-arch perimeter discrepancy, and root length compared to both buccally impacted and normally erupted canines. Conversely, cases with buccally impacted maxillary canines showed increased buccopalatal alveolar ridge width, anterior dentoalveolar height, and crown length compared to both palatally impacted and normally erupted canines.

In-silico Docking Analysis of Lupeol against the Enterococcal Surface Protein Receptor of Enterococcus faecalis: A Phytoendodontic Approach for Biofilm Disruption

Tanushree Saxena, Manish Ranjan, Aparna Mohan, Vivek Devidas Mahale Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Persistent root canal infections often involve Enterococcus faecalis, a biofilm-forming pathogen resistant to conventional irrigants like sodium hypochlorite and Chlorhexidine (CHX). The Enterococcal Surface Protein (Esp) is a key virulence factor facilitating adhesion and biofilm development. Natural compounds like lupeol, derived from Tinospora cordifolia, have shown antimicrobial properties, but their specific interactions with bacterial virulence proteins remain underexplored. Aim: To evaluate the binding affinity and molecular interaction of lupeol with the Esp receptor using in-silico docking, and compare it with CHX, a traditionally used endodontic irrigant. Materials and Methods: The present in-silico docking study was performed using the Esp crystal structure (PDB ID: 6ORI) in the Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals (SIMATS, Chennai, India). The protein and ligands were prepared and energy-minimised in AutoDockTools 1.5.6. Lupeol (PubChem CID: 259846) and CHX (PubChem CID: 9552079) were docked at the Esp active site with exhaustiveness set at 8. Binding affinities (kcal/mol) and key interactions were analysed. Results: Lupeol exhibited a strong binding affinity of -9.14 kcal/mol, interacting specifically with the Histidine (HIS) residue of the Esp receptor. In comparison, CHX demonstrated a higher binding affinity (-11.83 kcal/mol) with multiple interactions involving Tyrosine (TYR), Phenylalanine (PHE), Methionine (MET), Leucine (LEU), Arginine (ARG), and Glutamic Acid (GLU), residues. Despite a narrower interaction profile, lupeol’s targeted engagement and favourable binding energy suggest its potential as a natural Esp inhibitor. Conclusion: Lupeol demonstrated promising molecular interaction with the E. faecalis Esp receptor, indicating its potential as a natural, target-specific anti-biofilm agent. These findings support further experimental validation and highlight the relevance of phytoendodontics and in-silico methods in the discovery of safe and effective alternatives to synthetic irrigants.

Comparative Evaluation of Surface Roughness in CAD/CAM-milled, 3D-printed, and Conventional Polymethyl Methacrylate Denture Base Resin Materials: An In-vivo Study

Smruti Rekha Nayak, Sneha Shivkumar Mantri, Sumathi K Nitin, Pushkar Gupta, Abhilasha Bhasin Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: The surface roughness of denture-base resins significantly affects biofilm accumulation, aesthetics, and patient comfort. With advances in digital dentistry, CAD/CAM-milled and 3D-printed resins offer new fabrication options; however, their surface properties require further validation under clinical conditions. Aim: To compare and evaluate the surface roughness of CAD/CAM-milled, 3D-printed, and conventional heat-polymerised acrylic Denture Base Materials (DBMs) under in-vivo conditions. Materials and Methods: A comparative clinical in-vivo study was conducted in the Department of Prosthodontics, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India, from August 2023 to February 2025 on 270 disc specimens fabricated and equally distributed among three groups (n=90): Group A-CAD/CAM-milled; Group B-3D-printed; Group C-conventional heat-polymerised resin. Denture-base samples (6×2 mm) were embedded in the flanges of the dentures. After three and six-months of clinical use, the samples were retrieved and surface roughness was assessed using a contact profilometer; mean roughness values (Ra) were recorded and subjected to statistical analysis. Results: The CAD/CAM-milled resin consistently showed the lowest surface roughness at all time points, whereas 3D-printed resin exhibited the highest. Conventional PMMA resin showed an intermediate value. The interaction effect of material type and time was statistically significant (F=13271.91, p<0.05), confirming that CAD/CAM-milled resin maintained the smoothest surface, whereas 3D-printed resin demonstrated the greatest roughness progression over time. Differences among all three groups were statistically significant (p<0.001). Conclusion: The CAD/CAM-milled denture-base resins demonstrated superior surface smoothness compared with 3D-printed and conventional materials. The smoother surface of milled resins may promote better hygiene, reduce plaque accumulation, and enhance patient comfort, supporting their use in long-term prosthodontic care.

Exploring the Link Between Prolactin and Migraine: A Cross-sectional Study

Ananya Kundu, Barun Kumar Sen, Mousumi Mukhopadhyay Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Migraine headaches are a common type of headache that often requires frequent medical attention. In the absence of specific biomarkers, diagnosis of migraine is done by clinical criteria only. Multiple hormones, including prolactin, may have some role in the pathogenesis of migraine. Prolactin, as a laboratory test, can aid in the diagnosis of migraine. Aim: To compare serum prolactin levels in migraine patients and other primary headaches, and also to explore its association with migraine clinical profile. Materials and Methods: This cross-sectional study was conducted at the Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital (IPGME&R and SSKM) Hospital, Kolkata, West Bengal,India from February 2015 to June 2016. The present study included 164 adult patients: 82 subjects with migraine and 82 subjects with non migraine, other primary headaches (control). Serum prolactin was measured by Enzyme-Linked Immunosorbent Assay (ELISA), and hyperprolactinemia was defined as >25 ng/mL. An Unpaired two-sample Student’s t-test did statistical analysis. The level of significance was considered at p-value <0.05. Results: In the present study, the mean age among migraine patients was 30.01±7.69 yrs, and among other primary headache patients control was 39.94±7.81yrs. Among the total 164 patients, 101 (61.59%) patients were females and 63 (38.41%) patients were males; among the total migraine patients, 58/82 (70.73%) were females and 24/82 (29.27%) were males. Mean serum prolactin was significantly higher in migraine patients (25.46±13.28 ng/mL) than in other primary headaches controls (10.39±5.53 ng/mL) (p-value <0.0001). Hyperprolactinemia was observed in 39.02% of migraine patients versus 3.66% of other primary headache patients. Conclusion: Significantly higher serum prolactin level in migraine patients suggests a potential role in pathophysiology and possible use as a biomarker. Further research is needed on the therapeutic potential of prolactin inhibitory agents.

Prevalence and Pattern of Isolated Fungi from Bronchoalveolar Lavage in Patients with Lung Cancer: A Cross-sectional Study

Nandita Purohit, Manoj Meena, Shivprakash Sharma, Ashok Singh Charan Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Fungal infections have emerged as a significant healthcare challenge worldwide, particularly among terminally ill, debilitated, and immunocompromised populations. In patients with lung malignancy, fungal colonisation of the bronchial tree can predispose them to serious pulmonary infections and may adversely influence prognosis, especially in those undergoing chemotherapy. Understanding the prevalence and pattern of fungal colonisation in these patients is therefore clinically relevant, as it may directly affect outcomes and survival. Aim: To determine the prevalence and pattern of fungi isolated from Bronchoalveolar Lavage (BAL) samples in patients with lung cancer. Materials and Methods: This cross-sectional study included 101 patients with clinical and radiological suspicion of lung cancer who underwent Fiberoptic Bronchoscopy (FOB) with biopsy at Sawai Man Singh Medical College, Jaipur, Rajasthan, India. BAL samples were collected and processed for fungal culture. Demographic, clinical, and radiological findings, as well as histological types of lung cancer, were recorded. Data were analysed using appropriate statistical tests: the Chi-square or Fisher’s exact test for categorical variables, the independent samples t-test for normally distributed continuous variables, and the Mann-Whitney test for non normally distributed data. A p-value≤0.05 was considered statistically significant. Results: Fungal growth was detected in 34 of 101 patients (33.66%). The mean age in the fungal-positive group was 62.2±10.1 years. Candida albicans was isolated in nine cases (8.91%), Aspergillus niger in seven cases (6.9%), Candida tropicalis in six cases (5.9%), and other fungi in 12 cases (11.9%). Colonisation was more frequent in males (82.4%, n=28) and smokers (85.3%, n=29). Half of the patients with Chronic Obstructive Pulmonary Disease (COPD) demonstrated fungal infection compared to 35.8% of non COPD cases, although this difference was not statistically significant (p-value=0.16). Among species, Candida albicans was associated with higher dyspnoea scores (2.11±1.17). Lung mass (73.5%, n=25) was the most common radiological finding, followed by pleural effusion (41.2%, n=14). Squamous cell carcinoma (52.9%, n=18) was the predominant histological type among fungal-positive cases, followed by adenocarcinoma (20.6%, n=7). Conclusion: Fungal colonisation is relatively common in patients with lung cancer, particularly among males, smokers, and those with COPD. Its presence may adversely influence survival and response to chemotherapy, underscoring the need for early detection and targeted management.

Comparison of Fasting Insulin Levels and Insulin Resistance Indices in Preeclamptic and Normotensive Pregnant Women: A Cross-sectional Study

Vikas Dahariya, Keya Kalra, Vandana Saini Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Preeclampsia (PE), a pregnancy-specific disorder, is a leading cause of maternal and perinatal mortality. Women with PE exhibit significant hyperinsulinemia compared to normotensive women. Aim: To determine the levels of Fasting plasma Insulin (FI) and Insulin Resistance (IR) in women with PE and normotensive women. Materials and Methods: A cross-sectional study was conducted at Hindu Rao Hospital and North DMC Medical College, New Delhi, India from November 2020 to September 2021. Total 100 pregnant women (50 normotensive controls and 50 PE cases) were recruited. An oral glucose tolerance test with 75 grams of glucose was administered. Fasting plasma glucose (FPG), FI, and IR indices were calculated. Continuous variables of the case and control groups were compared using the t-test, and categorical variables were compared using the Chi-square test. A p-value of <0.05 was considered statistically significant. Results: The mean Fasting Plasma Glucose (FPG) level in the normotensive group was 81.52±2.95 mg/dL, while it was 83.4±3.77 mg/dL in the PE group (p-value 0.007). The mean FI level in the normotensive group was 5.06±2.14 μunits/mL, compared to 27.41±3.09 μunits/mL in the PE group (p-value 0.001). The increase in mean FI level was statistically significant when Blood Pressure (BP) was ≥160/110 mmHg, with liver enzymes ≥80 IU/L, or with a platelet count ≤100,000/mL. The Quantitative Insulin Sensitivity Check Index (QUICKI) and Fast Glucose-to-Insulin Ratio (FGIR) were lower in the case group (p-value <0.001). Log FI was significantly higher in cases (p-value <0.001). Conclusion: The FI levels were significantly increased in PE. FI and IR indices may serve as biomarkers of PE.

Analytical Study of Ajmoda (Carum roxburghianum Benth.) Distillate by Traditional and Clevenger Methods

Dnyanesh Joshi, Varun Gupta, Preeti Borkar Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Ajmoda (Carum roxburghianum Benth.), a valued Ayurvedic herb, is frequently used for its digestive and respiratory benefits. The present study was undertaken to bridge the gap between classical Ayurvedic knowledge and modern scientific validation by standardising and analysing Ajmoda Arka prepared by both traditional and Clevenger methods. Aim: To prepare and analyse the physicochemical and microbiological parameters in Ajmoda arka prepared by using traditional and Clevenger methods. Materials and Methods: The present experimental comparative analytical study was held in Rasashala of Mahatma Gandhi Ayurved College, Hospital and Research Centre Wardha, Maharashtra, India from October to November 2024. Ajmoda Arka was prepared by soaking Ajmoda seeds in water and distilling using both traditional and Clevenger apparatus. The resulting samples were analysed based on organoleptic, physicochemical, and microbiological parameters to ensure quality and efficacy. Results: Both samples (prepared by traditional and Clevenger methods) exhibited similar organoleptic properties: they were colourless, aromatic, and had a characteristic taste. Physicochemical analysis showed identical refractive indices (1.39) for both samples, with slight variations in specific gravity (0.981 for traditional and 0.958 for Clevenger) and pH (8.06 for traditional and 7.9 for Clevenger). Microbiological testing confirmed the absence of total viable count, Enterobacteriaceae, total fungus count, E.coli, Salmonella, Staphylococcus aureus, and Pseudomonas aeruginosa in both samples. Conclusion: Ajmoda Arka prepared by both traditional and Clevenger methods adhere to the quality standards expected of Ayurvedic formulations. This study not only validates traditional preparation methods but also provides a foundation for future standardisation and research in Ayurvedic pharmaceutics.

Impact of Aerobic and Body Weight Resistance Training Program in Post-bariatric Surgery Rehabilitation: A Double-blind Randomised Controlled Trial

Kinjal Trivedi, Madhavan Iyenagar, Bhavana Gadhavi, Prem Shah, Urvashi Kapadia Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Obesity is linked to a wide range of co-morbidities affecting multiple systems of the body, including the cardiovascular and metabolic systems and is therefore considered a major public health concern. Bariatric surgery has increasingly executed intervention for weight loss and for alleviating obesity-related co-morbidities. Additionally, mild aerobic and body weight resistance training are essential components of physical therapy for postoperative recovery and for optimising clinical outcomes in post-bariatric surgery patients. Aim: To assess the effectiveness of body weight resistance training and aerobic exercise regimen in post-bariatric surgery patients. Materials and Methods: A double-blind, Randomised Controlled Trial (RCT) was conducted at Bariatric Surgery Centre, Hope Obesity and Super Speciality Hospital, Ahmedabad, Gujarat, India, for a duration of one year (March 2022 to March 2023) to allow for recruitment, intervention and follow-up. A total of 132 post-bariatric surgery patients were enrolled for the study considering the dropout rate. However, 88 patients undergoing bariatric surgery were included and categorised into two groups (control and experimental) of 44 patients each. The control group received counseling on lifestyle modification, elimination of sedentary behaviour and enhancing physical activity and brisk walking. The experimental group, in addition to receiving the same counseling, participated in a structured body weight resistance and aerobic exercise protocol for three months. Outcome measures evaluated consisted of aerobic capacity and body composition. Statistical analysis involved the F-test and post-hoc Dunn’s test for comparison across different intervals, while the Mann-Whitney U test was performed for analysis of parameters between groups. A p-value ≤0.05 was considered statistically significant. Results: Both groups showed significant improvements in Body Mass Index (BMI), Body Fat Percentage (BFP), Waist Circumference (WC) and aerobic capacity (VO_2peak). BMI decreased from 38.13±7.64 kg/m₂ to 30.7±6.35 kg/m₂ in the control group and from 37.86±5.17 kg/m₂ to 29.91±4.13 kg/m₂ in the experimental group. BFP declined from 40.38±2.71% to 35.42±4.66% in the control group and from 40.43±2.75% to 34.29±4.76% in the experimental group. WC reduced from 48.61±4.16 cm to 41.43±3.62 cm in the control group and from 47.75±4.43 cm to 34.84±4.88 cm in the experimental group. VO_2peak increased from 10.39±2.78 mL/kg/min to 12.08±2.66 mL/kg/min in the control group and from 10.41±2.39 mL/kg/min to 13.11±2.38 mL/kg/min in the experimental group (p-value <0.05). Compared to the control group, the experimental group demonstrated significantly greater improvements in BFP, WC (p-value <0.001) and VO_2peak (p-value=0.011). BMI reductions were comparable between groups, with no statistically significant difference (p-value=0.396). The structured exercise intervention was well-tolerated, with high adherence rates and no reported adverse events. Conclusion: This study evaluated the effectiveness of a structured exercise regimen combining aerobic and body weight resistance training in post-bariatric surgery patients. The results demonstrated that while both the control and experimental groups achieved significant improvements in BMI, BFP, WC and VO_2peak, the experimental group showed significantly greater improvements in VO2peak, BFP and WC. BMI reduction was comparable in both groups. These findings suggest that incorporating structured exercise training in post-bariatric rehabilitation enhances key physiological outcomes beyond those achieved through lifestyle counseling alone, supporting the integration of exercise interventions into routine postoperative care for bariatric patients.

Assessing the Relationship between Healthy Eating and Oral Health Status among School Children Aged 7-12 Years in Chengalpattu, Tamil Nadu, India: A Cross-sectional Study

Nandhini Ramesh, Vishnu Prasad Subramanian, Indra Priyadharshini Karthikeyan, Mahesh Jagadeson, Karthikayan Ravi, Revanth Meenatchi Prabhakaraa Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Diet plays a major role in children’s nutritional status. Dietary intake and snacking habits, including consumption of low-nutrient-dense foods and high-sugar foods, contribute to the development of dental caries. The World Health Organisation (WHO) has reported that the prevalence of dental caries is higher among school children. Aim: To assess the Healthy Eating Index (HEI) and snacking patterns and their association with oral health status among children aged 7 to 12 years. Materials and Methods: An analytical cross-sectional study was conducted among 800 school children at the Karpaga Vinayaga Institute of Dental Sciences, Chengalpattu district, Tamil Nadu, India, over a six-month period (August 2023-January 2024). A four-part questionnaire collected data on demographic variables, HEI, snacking patterns and caries assessment. Oral hygiene status was measured using the Decayed, Missing and Filled Teeth (DMFT) index and the Oral Hygiene Index-Simplified (OHI-S), respectively, according to standard guidelines. Statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) version 20, with p<0.05 considered statistically significant. Results: Among the 800 children, 460 (57.5%) were male and 340 (42.5%) were female, with a mean age of 9.14±1.54 years. The majority were in the fair HEI category 539 (67.4%) and had an unhealthy snacking pattern 659 (82.4%). The poor-HEI group had higher mean DMFT and OHI-S scores (1.85±2.13 and 1.61±0.51, respectively) compared with the good and fair HEI groups. There was a statistically significant difference in OHI-S scores among the HEI groups (p<0.001). Participants with unhealthy snacking patterns had higher DMFT and OHI-S scores (1.51±1.97 and 1.47±0.53, respectively); however, there was no significant difference compared with the healthy-snacking group (p>0.05). HEI showed a negative relationship with DMFT scores (r=-0.34, p=0.333) as well as with OHI-S (r=-0.89, p<0.012), indicating that lower HEI is associated with higher DMFT and poorer oral hygiene. Age and parental occupation were both significantly associated with DMFT scores in the linear regression model. HEI was found to be a significant predictor of OHI-S scores. Conclusion: Children with poorer HEI scores had worse oral health and more dental caries. Children should be encouraged to eat healthily and to limit the intake of added sugars from sweetened beverages and meals to reduce the risk of dental illnesses.

Comparative Efficacy of Trisamagutika versus Kshargutika in the Management of Tundikeri (Chronic Tonsillitis) in Children: A Randomised Controlled Trial Protocol

Sonali Pandurang Dhumale, Renu Bharat Rathi, Bharat Rathi Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Tonsillitis is more common in children aged 5 to 15 years, and about 200,000 tonsillectomies are performed in India annually. Tonsillitis and Tundikeri can be correlated, as they share similar features. Trisamagutika and Kshargutika have not been assessed for long-term follow-up in the treatment of chronic tonsillitis. Need of the study: Repeated episodes of tonsillitis hamper growth and development and create an economic burden. They can also cause health hazards that lead to tonsillectomy. The immunological role of the tonsils in preventing infections is important to consider before resorting to tonsillectomy. Therefore, it is necessary to search for an alternative, cost-effective, feasible and potent therapy with fewer side-effects. Aim: To evaluate the comparative efficacy of Trisamagutika as the standard control medicine versus Kshargutika in children with chronic tonsillitis, based on objective and subjective parameters. Materials and Methods: A randomised, controlled, double-blind, superiority clinical trial with long-term follow-up to assess recurrence will be conducted at Mahatma Gandhi Ayurved College, Hospital and Research Centre, Wardha Maharashtra, India, from July 2024 to July 2025. Children with chronic tonsillitis meeting the inclusion criteria will be randomly divided into two groups (n=36 per group). Interventions will be administered orally twice daily for 15 days. Assessments will be performed at baseline, and on days 5, 10 and 15, including complete blood count and subjective criteria such as tonsil size by palpation, hyperemia, halitosis, fever and degree of dysphagia. Follow-up will be conducted monthly for up to one year. Data will be analysed using appropriate parametric and non parametric statistical tests. A 20% reduction in tonsil size and a p-value <0.05 will be considered statistically significant.

Efficacy of Panchabhautika Ghrita Nasya over Astamangala Ghrita Nasya for Cognitive Enhancement in Children with Cerebral Palsy: A Randomised Controlled Trial Protocol

Radhika Injamuri, Durga Prasad Dash, Suryanarayana Mudadla Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Cerebral Palsy (CP) is a neurodevelopmental disorder characterised by impaired movement, muscle tone, and cognition. Cognitive deficits in children with CP significantly impact their quality of life, necessitating effective interventions. Ayurveda offers Panchakarma therapies, including Nasya (nasal administration of medicated ghee or oils), which have traditionally been used for neurocognitive enhancement. Among these, Panchabhautika Ghrita and Astamangala Ghrita are formulations with potential neuroprotective and cognitive-enhancing properties. However, their comparative efficacy remains unexplored through rigorous clinical evaluation. Need of the study: This randomised clinical trial is essential to generate clinical evidence comparing the cognitive outcomes of Panchabhautika Ghrita Nasya versus Astamangala Ghrita Nasya in children with CP. The findings could guide Ayurvedic practitioners in personalised medicine approaches and support policy-level inclusion of validated therapies in paediatric neurorehabilitation. Aim: To compare the efficacy of Panchabhautika Ghrita Nasya and Astamangala Ghrita Nasya in enhancing cognitive functions in children with CP. Materials and Methods: A single-centre, open-label, randomised, parallel-group, controlled superiority clinical trial will be conducted in the Department of Kaumarabhritya, at Shree Jagadguru Gavisiddheshwara Ayurvedic Medical College and Hospital, Koppal, Karnataka, India. The total duration of the research project will be 30 months. This pilot study is designed as a Randomised Controlled Trial (RCT) with two parallel intervention arms. A total of 106 (53 in each group) children aged between 1 and 2 years diagnosed with CP and cognitive impairment will be recruited and randomised into two groups. Group A will receive Panchabhautika Ghrita Nasya, and Group B will receive Astamangala Ghrita Nasya, once daily on an empty stomach in the morning for 30 days. The interventions will be administered following standard Nasya procedures over the predefined treatment duration. Cognitive function will be assessed using the Mayes Motor Free Assessment Scale, while secondary outcomes such as quality of life and motor function will be evaluated using the Gross Motor Function Classification System (GMFCS). Data will be collected at baseline, midtreatment, post-treatment, and follow-up intervals to assess both immediate and sustained effects. Statistical analysis will include paired t-tests, ANOVA, and regression models to determine within-group and between-group differences. This study will provide scientific evidence on the comparative efficacy of Panchabhautika Ghrita Nasya and Astamangala Ghrita Nasya for cognitive enhancement in children with CP, potentially contributing to integrative management strategies for neurodevelopmental disorders.

Comparative Evaluation between Topical versus Sub-Tenon’s Anaesthesia in Manual Small Incision Cataract Surgery: A Research Protocol

Suyash Singh, Pravin Tidake Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Introduction: Intraocular lens implantation combined with cataract extraction is arguably the most successful surgical technique in the history of medicine. Cataracts are one of the major causes of preventable blindness worldwide. Cataract surgery is by far the most frequently performed procedure under local anaesthesia. Therefore, it is imperative to develop anaesthetic techniques that are safe, efficient, and financially viable, particularly in India. Need of the study: The study aims to provide significant insights into enhancing cataract surgical procedures in rural regions by comparing Sub-Tenon’s anaesthesia, which may offer improved akinesia and patient comfort, with topical anaesthesia, which is less invasive and easier to administer. Aim: To compare and evaluate patients’ outcomes after topical and Sub-Tenon’s anaesthesia in Manual Small Incision Cataract Surgery (MSICS). Materials and Methods: A two-arm parallel randomised controlled trial will be conducted at Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, Maharashtra, India, from June 2024 to June 2026, including 56 patients in total (allocated to topical anaesthesia or Sub-Tenon’s anaesthesia). Before the intervention, demographic data will be collected on a pro forma, and after the surgery the Visual Analogue Scale (VAS) score and postoperative outcomes will be recorded. Statistical analysis will be performed using the Mann-Whitney U test. A p-value<0.05 will be considered statistically significant.

Investigating the Physiological Impact of Manipura Chakra Activation on Prevention of Hepatic Steatosis: A Narrative Review

Monika Anand, Rakesh Giri, Udham Singh Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X The third of the seven chakras is the Manipura chakra, also known as the Coeliac plexus, located within the subtle body. It initiates and regulates various functions of the gastrointestinal system. Its proximity to the navel is often associated with personal power and self-esteem. The objective of the study is to clarify the influence of the Manipura chakra on Non-Alcoholic Fatty Liver Disease (NAFLD). Indigenous literature and recent research suggest that a balanced Manipura chakra may contribute to reducing inflammation and enhancing liver function. The present paper elaborates on the relationship between chakra alignment and physical health to reveal holistic methods that may complement conventional medical therapies for NAFLD. The research analyses consolidated literature from classical texts, contemporary science and published works (PubMed, Scopus, Web of Science and other esteemed journals) concerning the role of the Manipura chakra and its impact on gastrointestinal organs. The Manipura chakra is regarded as a center of fire, or Agni, which governs the functioning of the gastrointestinal system. Thus, it is considered essential for improving the condition of fatty liver disease. The gastrointestinal organs are closely connected to the coeliac plexus, which regulates their function. The physical and psychological characteristics of the Manipura chakra highlight its substantial importance. Disruptions in the energy flow of the Manipura chakra may lead to various disorders associated with the abdominal region, such as obesity, diabetes, pancreatitis and liver disease. Yoga and pranayama activate the Manipura chakra, thereby enhancing gastrointestinal function and alleviating the impacts of illness.

Synovial Fluid Variations in Temporomandibular Joint Disorders: Peek in Past and Current Understandings: A Narrative Review

Sachindra Dubey, Nitin Bhola, Akash Doshi Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Synovial Fluid (SF), a critical component of Temporomandibular Joint (TMJ) function, reflects physiological and pathological changes, offering valuable insights into conditions such as inflammation and osteoarthritis. This article explores recent studies and findings on changes in SF composition in TMJ disorders, highlighting its diagnostic and therapeutic significance. By reviewing literature on inflammatory mediators, cytokines, and molecular markers like Interleukin (IL)-1b, Tumour Necrosis Factor (TNF)-a, High Mobility Group Box 1 (HMGB1), and Netrin-1, the study underscores their roles in disease progression and potential as therapeutic targets. The dual effects of Hyaluronic Acid (HA), contingent on its molecular weight, and the efficacy of pharmacological interventions such as glucosamine-chondroitin and HA are discussed. The findings provide a comprehensive understanding of TMJ pathophysiology and emphasise the need for personalised treatment strategies to improve outcomes in TMJ disorders.

Role of Deep Learning in Neurodevelopmental Disorders: A Narrative Review

Nilah Ans Chacko, Nimmi Puthan Veedu, Abhinav Panayan, Sayali Satish Chodankar Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X The application of Deep Learning (DL) techniques in paediatric neuroimaging marks a significant milestone in the field. Using various DL methods, this study aims to provide a review of how these techniques can improve the diagnostic process for different neurodevelopmental conditions, including Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). The subsequent discussion addresses the prominent DL approaches applicable to paediatric neuroimaging and describes the key datasets that serve as the foundation of scientific research in this area. Additionally, the study highlights the limitations and shortcomings of these techniques, along with potential directions for future research and opportunities for further development. The adoption of these advanced methods has the potential to significantly improve patient outcomes, enhance diagnostic accuracy, and advance our understanding of early brain development.

Traditional Insights into Male Reproductive Health: A Narrative Review of Vajikarana Dravyas (Aphrodisiac Substances) in Raj Nighantu (The Royal Ayurvedic Lexicon)

Monika, Sneha Vidhate, Subash Sahu, Krati Gautam, Divya Jain Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Male reproductive disorders are varied and often inter-related, with prevalence ranging from common sexual dysfunction, infertility to rare congenital anomalies. Conventional therapies, which include hormonal treatment, surgical procedures, and assisted reproductive techniques, often face limitations in cost, accessibility and are associated with side-effects. To combat this, there is a need to identify new herbal sources that are natural, cost-effective, and free from adverse effects, which can be utilised both for prevention and treatment. One of the important Lexicons is Raj Nighantu, as it stands out for its practical relevance and regional adaptability. It offers more detailed entries and a wider range of substances, including many newer plant species. A thorough analysis of Raj Nighantu’s Vajikarana medications has been conducted for this purpose, utilising Ayurvedic classic texts, available printed sources and databases such as PubMed, Scopus, and Web of Science. Drugs that affect the male reproductive system have been investigated through experimental research and phytochemical screening. The Ayurvedic concept of Rasapanchaka was used to further confirm their pharmacodynamic activities. About 95 plants with the Vajikarana effect were found in this review; 34 of these have been shown to improve the functioning of the male reproductive system.

Radiation-free Imaging in Paediatric Dentistry: A Review

Mehuli Kar, Aruna Sharma, A Sanguida, Eswari Ramassamy Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Radiography is considered one of the most valuable diagnostic tools in dentistry, and new modalities are on the rise that offer greater precision and clarity. Traditional methods often fail to provide the required diagnostic information; hence, high-resolution, three-dimensional imaging modalities are necessary. Computed Tomography (CT) and Cone-Beam Computed Tomography (CBCT) produce precise images, but the radiation exposure involved is far greater than that of conventional radiographic modalities. Children are more susceptible to radiation effects than adults. Hence, clinicians should acquire knowledge of non ionising imaging modalities and their various applications, particularly in paediatric dentistry, so as to employ them in clinical practice. The present review encompasses details of various radiation-free imaging techniques, based on clinical evidence from original research and case reports.

An Unusual Acral Swelling: Histopathological Confirmation of Superficial Acral Fibromyxoma

Chaitanya Mahajan, Varun Shetty, Iqbal M Ali Journal of clinical and diagnostic research : 2025 - November - 19:0973-709X Superficial Acral Fibromyxoma (SAF) is an uncommon, benign mesenchymal neoplasm that predominantly involves the subungual and periungual soft tissues of the digits. Its indolent growth, painless nature, and non specific clinical features often lead to misdiagnosis, resulting in delayed treatment or inappropriate management. The present case described a 36-year-old male who presented with a decade-long history of a gradually enlarging, painless mass on the distal phalanx of the right ring finger, followed by a recent phase of accelerated growth over two months. Magnetic Resonance Imaging (MRI) demonstrated a well-circumscribed, T2-hyperintense lesion without underlying osseous involvement. Complete surgical excision was performed. Histopathological evaluation revealed a proliferation of bland spindle and stellate fibroblastic cells embedded in a fibromyxoid stroma, without evidence of cytologic atypia or mitotic activity. Immunohistochemical analysis showed diffuse positivity for CD34 and vimentin, with negative staining for S-100 and Epithelial Membrane Antigen (EMA), supporting the diagnosis of SAF. The postoperative course was uneventful, and there has been no evidence of recurrence to date. Given the potential for local recurrence, especially in incompletely excised lesions, accurate diagnosis through histopathology and Immunohistochemistry (IHC) is essential. Awareness of SAF's distinguishing features among clinicians, radiologists, and pathologists can aid in timely diagnosis, reduce the risk of misclassification, and facilitate appropriate surgical management, ultimately improving patient outcomes.