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

IgA Nephropathy in a HIV Positive Patient: A Rare Case Scenario

Anuja Makan, Shreeharsh Godbole Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Human Immunodeficiency Virus (HIV) affects almost every organ in the body. There may be direct cytopathic effects, or the affected individual may be infected by opportunistic organisms. HIV has been known to cause various renal syndromes and histopathological conditions. The kidneys are among the most commonly affected organs in individuals with HIV. Renal dysfunction is the most frequent complication of HIV, both before and after the introduction of Antiretroviral Therapy (ART), and it is the leading cause of mortality in AIDS. Kidney disease can present as HIV-associated nephropathy (HIVAN), immune complex disease in HIV, or Thrombotic Microangiopathy (TMA). HIV-associated focal glomerulosclerosis is the most common biopsy finding; however, other conditions, such as IgA nephropathy, may also be observed in certain cases. This report discusses a 21-year-old male HIV patient who developed renal failure and subsequently required haemodialysis. To determine the cause of the renal failure, a decision was made to perform a renal biopsy. The renal biopsy results were suggestive of IgA nephropathy. The patient was treated with corticosteroids and did not require dialysis thereafter. This case represents a rare scenario in which a patient with HIV presented with renal failure due to IgA nephropathy. Thus, despite its rarity, IgA nephropathy should be considered as a differential diagnosis in HIV patients experiencing renal failure.

Degloving Injury of the Groin in a Young Factory Worker: A Case Report

Ashna Nagpal, Firoz Borle, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Genital degloving injuries are rare and mainly occur due to industrial machine accidents affecting workers at their places of employment. Most cases of genital degloving result in the loss of function—both urination and sexual capability—as well as the appearance of the genital organs. Immediate treatment is essential for minimising infection and necrosis, and it is also important for addressing potential psychological distress and preserving fertility. This case report presents an Indian factory worker, aged 24 years, who sustained severe penile and scrotal degloving injuries from a textile roller machine accident. Upon arrival, the patient exhibited no significant blood pressure disturbances but required urgent surgical intervention due to the exposure of his testicles and the complete separation of his penile skin from his body. The initial treatments included fluid resuscitation, broad-spectrum antibiotics, tetanus prophylaxis, analgesics, and surgical debridement. Reconstruction was carried out after serial debridement procedures resulted in a granulating wound surface. This allowed the surgeons to utilise a left gracilis muscle flap to cover the exposed testes. Vacuum-Assisted Closure (VAC) therapy promoted both wound healing and effective graft integration at the surgical site. The patient experienced a smooth postoperative recovery, as the skin flap survived without any complications, effectively preventing infection. Semen analysis conducted after the surgical intervention confirmed that spermatogenesis remained normal, indicating successful testicular recovery. This case highlights the necessity of strengthening workplace safety requirements to prevent accidents. It also demonstrates that gracilis flap surgery combined with VAC therapy yields positive outcomes in both health and aesthetic recovery. The preservation of fertility should be prioritised for all young adult males who sustain genital trauma.

Oculofaciocardiodental Syndrome: A Rare Disorder with Canine Radiculomegaly

Aishwarya Rathod, Priyanka Jaiswal, Pankaj Banode, Gajendra Manakshe, Deepika Masurkar Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X The ocular, face, dental, and cardiac systems are all impacted by the uncommon condition known as Oculofaciocardiodental (OFCD) syndrome. OFCD is only present in females due to its X-linked genetic inheritance and male embryonic lethality. The most common ailment in these patients is canine radiculomegaly. This particular feature highlights the role of dentists in detecting this syndrome. Accompanied with a report on a female patient with unique facial traits, we provide a comprehensive description of OFCD. In this case we have discussed with the typical features of OFCD. A 20-year-old female patient with OFCD syndrome presented with unique characteristics affecting ocular, cardiac, facial, and dental systems. Patient had congenital cataract, elongated roots of canine and incisors, elongated face with convex profile, cardiac abnormalities like atrial septal defect and ventricular septal defect. On the basis of clinical and radiographic findings and necessary medical diagnostic procedures, patient was diagnosed with OFCD syndrome. But due to lack of keen observation, the syndrome was undiagnosed and treatment was delayed. It is critical for every clinician to find out reasons and answers of abnormal finding in patient.

Endovascular Rescue Strategies For Non-opening of Flow Diverter: A Case Report

Sambhaji Pawal, Aniketh Hiremath, Ritesh Sahu, Rohan Thakur Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Flow diversion and correction of haemodynamic disturbances are the mainstays of treatment for any intracranial aneurysm. Flow Diverters (FD) are widely accepted as effective treatments for fusiform, wide-necked, large, and giant intracranial aneurysms. Thromboembolic events and intra- and postoperative aneurysmal ruptures are the most frequently encountered complications. Rarely, mechanical, anatomical, and technical challenges can result in deployment failure and incomplete opening of an FD. When these devices fail, they can jeopardise the treatment, necessitating immediate rescue strategies to avoid complications. This is a case of a 40-year-old female presenting with chronic headache that acutely worsened over the preceding two days. Computed Tomography (CT) revealed a large aneurysm in the left supraclinoid internal carotid artery (ICA) with a subarachnoid bleed. FD stent placement and partial coil embolisation of the aneurysm was planned. During deployment, the proximal end of the FD failed to open despite employing standard rescue manoeuvres, including ‘waggling’ and intra-catheter unsheathing. Balloon angioplasty using a monorail coronary balloon successfully restored stent patency and wall apposition. The patient had an uneventful recovery and complete aneurysm occlusion at four months’ follow-up angiography. This case highlights the importance of recognising deployment complications and underscores the need for preparedness with advanced endovascular techniques, such as balloon angioplasty, when standard rescue manoeuvres fail.

Hypoglycaemia-induced Parkinsonism in a Patient with Diabetes Mellitus and Tuberculous Encephalitis: A Complex Case Report

Venkatramani Padma, Pusapati Lakshmi Chaitanya Varma, Sathyapriya, Mathisha Ebby Perin, Ishai Vannan, Sarath Nalla Perumal Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Hypoglycaemia-induced Parkinsonism is a rare but significant complication of metabolic brain dysfunction, characterised by movement disorders following severe hypoglycaemia. We present a 65-year-old male with a 12-year history of type 2 diabetes mellitus, Autoimmune Haemolytic Anaemia (AIHA), and recent tuberculous encephalitis who was found unresponsive due to severe hypoglycaemia. Despite intravenous glucose administration, he developed new-onset Parkinsonism, manifesting as tremors, rigidity, and bradykinesia. Neurological imaging revealed hippocampal involvement on Magnetic Resonance Imaging (MRI), while a Dopamine Transporter (DaT) scan demonstrated reduced striatal uptake, confirming a dopaminergic deficit. The patient was managed with basal-bolus insulin therapy, corticosteroids for AIHA, and anti-tubercular treatment, while Parkinsonian symptoms improved with levodopa/carbidopa, trihexyphenidyl, and amantadine. Hypoglycaemia-induced neuronal injury results from metabolic failure, oxidative stress, excitotoxicity, and neuroinflammation, leading to selective neuronal necrosis, particularly affecting the basal ganglia, hippocampus, and substantia nigra. While some cases demonstrate reversible outcomes due to vasogenic oedema, others progress to irreversible neurodegeneration, emphasising the need for stringent glycaemic management and early recognition of neurological sequelae in diabetic patients.

Hypoxaemia without Respiratory Distress in a Patient with Oral Cancer: A Case Report

Mansi Dey, Akash Gupta, Bibhu Prasad Mishra, Malini Kulshrestha, Arjun Agarwal Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Methaemoglobinaemia is a rare disorder caused by oxidisation of divalent ferrous-iron (Fe²⁺) of Haemoglobin (Hb) to ferric-iron (Fe³⁺) of Methaemoglobin (MetHb), and it has a life-threatening potential. Here, we present a case of oral cancer with methaemoglobinaemia. A 40-year-old male patient reported to us with a swelling on the left-side of the face since six months. He was diagnosed with resectable oral cancer and hence planned for surgery. He had a very peculiar finding with low SpO₂ without any respiratory distress. After obtaining pre-anaesthetic-clearance, he was operated under general anaesthesia. Brown ring test was positive, which was suggestive of methaemoglobinaemia. Serum methyloglobin was found to be present in a concentration of 9.7% when the blood sample was sent for testing. Patient was administered 5 mL of Methylene Blue (MB) intravenously in 100 mL Normal Saline (NS) at 3-4 drops per minute within 1/2-1 hour daily. Improvement in SpO₂ on the pulse-oximeter was observed, from about 20% to about 66% in five days after administration of MB. Thus, it was concluded that methaemoglobinaemia is not always a life threatening condition, and knowledge about previous history of exposure to the substance that might lead to methaemoglobinaemia is important, so that such substances can be avoided in the future to prevent further worsening of the condition.

Anaesthetic Considerations in Myasthenia Gravis: Strategies to Mitigate Cholinergic Crisis during Thymectomy

Chhaya Mahesh Suryawanshi, Jekha Mary Babu Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Myasthenia Gravis (MG) is an autoimmune neuromuscular disorder characterised by muscle weakness due to antibodies directed against acetylcholine receptors at the neuromuscular junction. Patients with MG presents with significant anaesthetic challenges, including prolonged neuromuscular blockade, higher risk for perioperative myasthenic or cholinergic crises and risk of postoperative respiratory failure, chances of delayed extubation, potential need for postoperative ventilator support and risks associated due to close proximity to mediastinal structures. Thymectomy is the key treatment for MG and these challenges are to be anticipated during procedures like Video-Assisted Thoracoscopic Thymectomy (VATS). We present the anaesthetic management of a 24-year-old female with MG and co-existing hypothyroidism, who underwent laparoscopic VATS. Anaesthesia was induced using a non-depolarising muscle relaxant under neuromuscular monitoring, along with thoracic epidural analgesia and left-sided Double Lumen Tube (DLT) to facilitate one lung ventilation. Despite thorough preoperative optimisation, the patient exhibited intraoperative signs suggestive of cholinergic crisis, most likely due to excessive anticholinesterase therapy. The crisis was promptly recognised and effectively managed by providing appropriate supportive care and discontinuing anticholinesterase therapy. Postoperatively, the patient was extubated successfully without the need for ventilator support. This case emphasises the critical role of comprehensive preoperative assessment, vigilant intraoperative monitoring, and the ability to accurately distinguish between myasthenic and cholinergic crises. It also illustrates the anaesthetic challenges associated in managing MG, particularly in patients with coexisting endocrine disorders such as hypothyroidism. Timely recognition and a tailored anaesthetic approach are essential for optimising outcomes in such complex cases.

Cryptococcal Meningitis: Challenges Faced in the Management of a Patient with Cryptococcoma

Priyaadarshini Urjan Mohan, Anupma Jyoti Kindo, SMH Waseem Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Cryptococcus is a genus of opportunistic fungal pathogens that have garnered significant attention in the medical community due to their ability to cause life-threatening infections, particularly in immunocompromised individuals. Cryptococcosis is a fungal infection that can present as an acute, subacute, or chronic infection. Cryptococcus neoformans are basidiomycetous encapsulated yeasts classified into five serotypes based on their capsule. The primary mode of infection is through the inhalation of basidiospores or small, poorly encapsulated yeasts. Cryptococcus neoformans is ubiquitous in the environment, often recovered from eucalyptus trees and bird droppings. This infection typically presents as meningoencephalitis in Human Immunodeficiency Virus (HIV) patients, while in immunocompetent individuals, the infection can be subclinical, manifesting as small granulomatous disease in the lungs without dissemination. The principal symptoms include meningitis, fever and intracranial hypertension. Additionally, altered mental status, seizures, visual changes and focal neurological deficits may arise. Diagnosis relies on the identification of encapsulated yeasts in the cerebrospinal fluid using India ink staining, which has a sensitivity of 50% in immunocompetent individuals. Biopsies of the lungs, skin, bone marrow, brain and other organs may also be conducted, offering higher sensitivity than the former method. The preferred treatment involves a combination of amphotericin B and 5-flucytosine during the induction phase to reduce the fungal load, followed by oral fluconazole in the maintenance phase. In contrast, cerebral cryptococcomas necessitate a longer treatment duration with additional antifungals. The low clinical suspicion of Cryptococcosis often leads to a delayed diagnosis of the infection. Early diagnosis and treatment are crucial for patient survival. Here, a case of Cryptococcaemia in an immunocompetent patient is reported.

A Rare Case of Dermatofibrosarcoma Protuberans of the Left Arm

Khushbu Vaidya, Raju Shinde, Sangita Jogdand, Venketesh Rawale, Tushar Nagtode Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Dermatofibrosarcoma protuberans is a rare form of soft-tissue tumour mostly arising from the dermis layer of the skin, precisely from fibroblastic cells. These are slow growing tumours, usually infiltrating surrounding tissues and are locally invasive. These tumours can infiltrate the subcutaneous tissue, and also the underlying fascia, muscle or deeper structures. These tumours can be neglected due to its initial non-specific and painless clinical presentation. Haemorrhagic and cystic presentations are commonly noticed in large tumours of >5 cm size. It can be classified as low- to intermediate-grade tumours. These are associated with chromosomal translocation, which produces fused COL1A1-PDGFB protein in majority of the cases. Also, dermatofibrosarcoma protuberans has been reported to have higher local recurrences but a favourable prognosis. A regular follow-up is crucial, attributed to its local recurrence risk. These tumours are managed by local incision and adjunct radiation or immunotherapy, if required. This case of 35-year-old male, presented with ulcerative growth over his left arm. The patient was managed by wide local excision and Latissimus Dorsi (LD) flap graft.

The Spotted Iris: Unveiling a Case of Bilateral Iris Mammillations in a Type 1 Diabetic Adolescent

Swaranjali Gore, Nagyang Dani, (Col.) OK Radhakrishnan, Harshita Kashyap, Naina Chaturvedi Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Bilateral iris mammillations are an exceedingly rare ocular anomaly characterised by small, papilliform nodules that cover part or the entire surface of the iris. Although often associated with systemic conditions such as Neurofibromatosis (NF), oculodermal melanocytosis, or phakomatosis pigmentovascularis, isolated bilateral cases are infrequently reported. This report describes a case of a 14-year-old male who presented for a routine dilated fundus examination at a tertiary care centre. The patient, a known case of Type 1 Diabetes Mellitus (DM) for 11 years, was maintained on subcutaneous human Actrapid insulin. He reported no ocular complaints. Examination revealed a best-corrected visual acuity of 6/6 in both eyes with intact colour vision. Slit lamp examination identified multiple, diffuse, small, round, nodular elevations over the surface of both irides without evidence of iris neovascularisation. Gonioscopy revealed open angles without trabecular hyperpigmentation. Posterior segment evaluation, including Optical Coherence Tomography (OCT) and B-scan ultrasonography, was unremarkable. Ultrasound biomicroscopy confirmed the absence of ciliary body involvement. Systemic examination showed no evidence of NF, oculodermal melanocytosis, or phakomatosis pigmentovascularis. Genetic testing for NF type 1 returned negative. The presence of isolated bilateral iris mammillations without systemic association is exceedingly rare. This case adds valuable data to the limited literature on such presentations and highlights the importance of thorough ocular and systemic evaluation to differentiate these nodules from other ocular anomalies. Continued surveillance and long-term follow-up are crucial, given the potential but rare association with secondary glaucoma and ocular malignancy.

Tuberculous Surgical Site Infection Following Lateral Pancreaticojejunostomy: A Case Report

Somya Goel, Raju Shinde, Khushbu Vaidya, Ashish Jivani Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Chronic pancreatitis is commonly managed by lateral pancreaticojejunostomy. Common early complications post-procedure include abscess formation, upper gastrointestinal bleeding, drain tract infection, pancreatic fistula, transient fluid collection, and haematoma, whereas late complications can manifest as recurrent pancreatitis, pain, cancer, re-intervention, and small bowel obstruction. Surgical Site Infection (SSI) is a common postoperative complication. We report a case of a 41-year-old male who presented with epigastric pain. He had a medical history of tuberculosis and was diagnosed with pancreatitis, subsequently managed by lateral pancreaticojejunostomy. However, a purulent discharge was observed at a two-week follow-up from the surgical site, which was later found to be Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) positive, indicative of a relapse of latent mycobacterial infection. The patient was timely intervened upon and initiated on a medical regimen for the same. Latent presentation of tuberculosis was noted in this case.

Anaesthetic Management of a 4-Day-Old Neonate with Congenital Diaphragmatic Hernia: A Case Report

Sonal S Khatavkar, Shweta Singh, Grace Mammen Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Congenital Diaphragmatic Hernia (CDH) is a life-threatening condition characterised by the herniation of abdominal organs into the thoracic cavity through a diaphragmatic defect, leading to pulmonary hypoplasia and Persistent Pulmonary Hypertension (PPHN). This case report highlights the perioperative anaesthetic management of a 4-day-old, 2.5 kg neonate with left-sided CDH and severe pulmonary hypertension undergoing surgical repair. The neonate was intubated immediately after birth due to respiratory distress and was managed with Synchronised Intermittent Mandatory Ventilation (SIMV). Cardiopulmonary support was provided using infusions of milrinone, sildenafil, and dobutamine. After stabilisation, surgical repair was performed on day four of life. Anaesthesia was induced with sevoflurane and oxygen under spontaneous respiration to minimise barotrauma, transitioning to controlled anaesthesia with atracurium following bowel exteriorisation. A caudal epidural catheter was placed for intraoperative and postoperative analgesia using 0.1% ropivacaine. Following surgery, the neonate remained on SIMV with gradual weaning from respiratory support, achieving successful extubation by postoperative day three. Regular monitoring and a multidisciplinary approach ensured stabilisation and optimal recovery. This case underscores the importance of comprehensive perioperative strategies in managing neonates with CDH. Key measures include careful preoperative stabilisation, use of spontaneous ventilation during anaesthesia induction to reduce lung trauma, and effective analgesia using caudal epidural techniques. Combining these interventions with cardiopulmonary support can significantly improve outcomes in this high-risk population.

Ayurvedic Management of Katishool (Lumbar Spondylosis): A Case Report

Mohnish Vijay Gokhale, Vaishali Kuchewar, Ashvini Pardhekar, Pankaj Yadav Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Katishoola, or low back pain, is a prevalent condition because of the aggravation of Vata Dosha, causing neurological and musculoskeletal disorders. In Ayurveda, it is experienced as an expression of disturbed Vata in the lower back. In Western medicine, this condition is associated with lumbar spondylosis, a degenerative spine disease commonly associated with pain, stiffness, and neurological findings. Both systems are concerned with the management of pain and improvement in mobility. However, Ayurveda offers a holistic and individualised regimen that controls the symptoms and tries to balance the underlying doshas. This case study presents the management of a 56-year-old male patient with acute pain in the lumbar region, with anal and perianal numbness. The patient had these symptoms for 20 days, with aggravation of discomfort and decreased movement. After diagnosis, the management was based on the principle of Vata Prakopa (degenerative process due to increased Vata dosha). The therapies applied were Snehan (oil massage), Swedan (sudation), Kati Basti (localised application of oil for the lumbar region), Matra Basti (medicated enema), and oral administration of Kamdudha Vati and Trayodashanga Guggulu. Surprisingly, after a week of regular management, the patient showed marked relief from pain and increased mobility. The neurological symptoms also showed marked improvement, making this case a strong indication of the efficacy of Ayurveda in managing lumbar spondylosis and other related spinal diseases.

Navigating Anaesthetic Complexities in Perimesencephalic Epidermoid Cyst with Obstructive Hydrocephalus: A Case Report

Sharayu Paunikar, Vivek Chakole, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Perimesencephalic epidermoid cysts are rare intracranial lesions that present with atypical neurological symptoms caused by obstructive hydrocephalus. This case report details the complex neuro-anaesthetic management of a 53-year-old male {Body Mass Index (BMI) 26.6} who presented with altered sensorium, vomiting, tinnitus, and headache for one week. Neurological assessment showed a Glasgow Coma Scale (GCS) of E3V4M5, with the involvement of cranial nerves VIII–X and disorientation. An MRI of the brain (plain) revealed a perimesencephalic epidermoid cyst measuring 4.2×1.6×2.1 cm, accompanied by obstructive hydrocephalus. The anaesthetic plan involved a staged approach: External Ventricular Drainage (EVD) followed by definitive tumour excision in the left lateral sitting position. The patient, classified as ASA Grade III, had stable cardiovascular status but exhibited a potentially difficult airway (Mallampati class III). Intraoperative management included invasive monitoring through radial artery and central venous catheterisation, controlling Intracranial Pressure (ICP) using mannitol, a scalp block for analgesia, and the avoidance of nitrous oxide. Precautions were taken to prevent Venous Air Embolism (VAE), which included the use of a precordial Doppler and adequate head elevation of the patient. Anaesthesia was maintained with a fentanyl-sevoflurane-air-oxygen regimen. Extubation was complicated by transient laryngospasm, requiring reintubation. Postoperative care was notable for the presence of transient pneumocephalus, which resolved with supportive care. The patient was successfully extubated on postoperative day 3, showed complete neurological recovery, and was discharged on day 7. This unique case highlights the challenges faced in managing posterior fossa tumours such as perimesencephalic epidermoid cysts, which require multidisciplinary anaesthetic approaches and vigilant postoperative care to ensure adequate neurological outcomes.

Trichofolliculoma in Paediatric Age Group Boy: A Rare Case Report Highlighting Dermoscopic and Histopathological Findings

Yeragonda Susmitha, TS Rajashekar, K Suresh Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Trichofolliculoma (TF) is a rare, benign skin appendage tumour derived from hair follicle structures, most frequently observed in adults and primarily affecting the head and neck regions. Its occurrence in the paediatric population, particularly on the scalp, is exceptionally uncommon and often overlooked, as it can clinically resemble more prevalent lesions such as dermoid cysts, epidermoid cysts, and pilar cysts. This case report presents a unique situation involving a nine-year-old boy with a solitary, asymptomatic, skin-coloured nodule on the scalp that had slowly increased in size since early childhood. Clinical evaluation revealed a central pore with a tuft of protruding hair, along with mild surrounding erythema and fine scaling. Dermoscopy showed a central white plug of hair, yellowish-white lobular areas, and visible dilated blood vessels, collectively pointing toward a follicular tumour. Complete surgical excision was performed, and histological analysis confirmed the diagnosis of TF, revealing a dilated central follicle giving rise to multiple smaller secondary follicles and keratin-filled cystic areas. This case underscores the importance of considering TF as a potential diagnosis in children presenting with longstanding scalp nodules, even when asymptomatic. Early dermoscopic assessment, followed by confirmatory histopathology, plays a vital role in accurate diagnosis and curative treatment, helping to prevent misdiagnosis and avoid unnecessary interventions. The rarity of this presentation highlights the need for clinical awareness and reinforces the diagnostic value of correlating clinical, dermoscopic, and histological findings in paediatric dermatology.

Type 3 Multiple Autoimmune Syndrome and Vision Loss: A Case Report

Manne Lakshmi Narasimha Sandeep, Karra Keerthi Reddy, Taruguvandla Sandhya Rani Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Autoimmune diseases often co-exist due to shared genetic and immunological mechanisms. The term Multiple Autoimmune Syndrome (MAS) is used when three or more such diseases are present in a single patient. Early recognition of MAS is critical, as overlapping autoimmune pathologies can lead to complex, life-threatening presentations. This case describes a 25-year-old female who presented with acute, painless bilateral vision loss following a seven-day history of holocranial headache. She had recently been diagnosed with vitiligo. Examination revealed left homonymous hemianopia, and neuroimaging confirmed Cerebral Venous Thrombosis (CVT) involving the right occipito-parietal region. Laboratory investigation revealed hypothyroidism with elevated antithyroid peroxidase antibodies, consistent with Hashimoto’s thyroiditis. A pro-thrombotic work-up was positive for anti-phospholipid and beta-2 glycoprotein IgM antibodies, confirmed on repeat testing after 12 weeks, establishing the diagnosis of Anti-Phospholipid Syndrome (APS). These three autoimmune diseases fulfilled the diagnostic criteria for Type 3 MAS. Although APS is not traditionally considered a component of Type 3 MAS, its co-existence with Hashimoto’s thyroiditis and vitiligo in this patient warranted its inclusion. She was managed with enoxaparin followed by oral warfarin to maintain a target INR of 2.5-3.0, along with levothyroxine and atorvastatin. Her vision improved from 2/60 to 6/9 during follow-up, with no recurrence of thrombotic events. The case underscores the importance of suspecting MAS in young patients with multiple autoimmune manifestations and highlights CVT as a rare, life-threatening presentation of APS. Early diagnosis and prompt management can prevent irreversible complications. Clinicians are required to maintain a heightened level of suspicion and perform thorough autoimmune screening upon the identification of any autoimmune condition.

Vulval Verrucous Carcinoma: A Case Report of Rare Subtype

Apoorva Pande, Samarth Shukla, Milind Pande, Suhit Naseri, Saurabh Gawand Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Verrucous Carcinoma (VC) of the vulva is a rare subtype of Squamous Cell Carcinoma (SCC) that typically manifests as a slowly growing, wart-like lesion with a generally favourable prognosis. It is considered a rare occurrence due to its very low incidence in valvular cancers, with an incidence of approximately <1%. There are different underlying associated aetiologies for VC, and risk factors such as smoking, hormonal deficiency, and diabetes might also play a role. VC predominantly affects elderly, postmenopausal women, with most cases >60 years of age. On the contrary, this is a rare case of a 37-year-old female who came to the gynaecology outpatient department with a complaint of a rapidly growing mass in the vulvar region and urinary retention for the past six months. She was managed by surgical approach aiming to ensure complete excision of the tumour while preserving surrounding healthy tissue, reflecting a good treatment strategy for this rare and indolent form of vulvar cancer in a relatively young female.

Managing an Uncommon Complication of Pectoralis Major Myocutaneous Flap Surgery: Chest Wall Sinus with Rib Osteomyelitis

Jayesh Khadse, Devendra Yadav, Chaitanya Mahajan Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Chest wall sinus with underlying rib osteomyelitis is a rare complication following Pectoralis Major Myocutaneous (PMMC) flap reconstruction in head and neck cancer surgeries. Effective identification and surgical management are essential to prevent recurrence. A 58-year-old male presented with a history of squamous cell carcinoma of the left lower alveolus, initially managed with composite resection and PMMC flap reconstruction. One month postoperatively, the patient presented with a discharging sinus over the anterior chest wall. High-Resolution Computed Tomography (HRCT) revealed rib osteomyelitis. Surgical excision of the sinus tract was performed using methylene blue dye to delineate its extent, followed by rhomboid flap reconstruction. The patient had an uneventful recovery, with healthy flap healing and no recurrence by postoperative day 10. After PMMC flap reconstruction, the anterior chest wall sinus with rib osteomyelitis is an uncommon but significant postoperative complication. Prompt identification, total sinus excision, and rhomboid flap reconstruction guarantee efficient treatment and the best possible outcome.

Burkitt’s Lymphoma in a Post-renal Transplant Recipient: A Rare and Aggressive Malignancy

Divya Dagaji Jadhav, Abhijeet Sugriv Ghodke, Sushil Kachewar, Kranthi Dandi Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Burkitt lymphoma is a highly aggressive form of non-Hodgkin B-cell lymphoma known for its rapid proliferation. It commonly involves areas such as the jaw, abdominal region, or Central Nervous System (CNS). This type of lymphoma is often associated with infections like Epstein-Barr Virus (EBV) and Human Immunodeficiency Virus (HIV). Additionally, it frequently features chromosomal translocations that affect the MYC oncogene. The case involves a 34-year-old man with diabetes who has been undergoing immunosuppressive treatment for 10 years following a kidney transplant. He presented with complaints of lower abdominal swelling, nausea, vomiting, and backache for the past 15 days, along with signs suggestive of intestinal obstruction for the last five days. Comprehensive history-taking, clinical examination, and diagnostic investigations indicated an intestinal obstruction caused by a mobile intra-abdominal mass located in the suprapubic region. An ultrasound-guided Tru-Cut biopsy of the intra-abdominal mass identified it as Non-Hodgkin Lymphoma (NHL), most likely Burkitt Lymphoma (BL), which was subsequently confirmed through Immunohistochemistry (IHC). The patient was managed with Rituximab (a monoclonal antibody), and his immunosuppressive therapy was continued. However, he showed a poor response to treatment after four weeks, prompting a revision of the regimen to the Cyclophosphamide, Vincristine, Doxorubicin, and High-Dose Methotrexate/Etoposide, Ifosfamide, and Cytarabine (CODOX-M/IVAC) chemotherapy protocol. The aim of this paper presentation is to highlight the rarity of the disease and the management of a patient on immunosuppressant therapy following an organ transplant.

Gliosarcoma: A Very Rare Biphasic Histopathological Engima Associated with Very Poor Prognostic Parameters

Pal Ruchismita, CD Anand, J Sowmiya, TP Jayaselvan, Manasa Raj Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Gliosarcoma (GS) is rare type of brain tumour characterised by a combination of glial and mesenchymal elements. It is a sporadic and aggressive malignancy, categorised as a variant of Glioblastoma with an Isocitrate Dehyrogenase (IDH) wild-type phenotype. These tumours generally present as well-defined masses and are most frequently observed in adults between the ages of 40 and 60 years, with a slight predominance in males. Common clinical features include focal neurological impairments such as hemiparesis and aphasia, often accompanied by tumour-associated oedema that contributes to elevated intracranial pressure. Due to the rarity of the condition, existing knowledge is primarily based on limited published reports. This report discusses a 57-year-old male who presented to the Emergency Department after experiencing a six-day progression of weakness affecting both the left upper and lower limbs, ultimately leading to significant mobility issues and difficulty walking. However, there was no history of loss of consciousness or vomiting. Upon hospital arrival, on clinical assessment, the patient was found to be drowsy but responsive, with both pupils irregularly dilated. A detailed examination revealed impaired balance and coordination, gait disturbance, numbness and tingling on the left-side of the body, as well as weakness in the left limbs and tongue, contributing to slurred speech and a stuporous state. Following the initial clinical evaluation,Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans were recommended. A CT scan revealed a hetero-dense, intra-axial solid-cystic lesion with relatively well-defined margins located in the right frontal lobe, measuring 4.6×5.0×5.5 cm (craniocaudal×transverse×anteroposterior). The mass was associated with surrounding vasogenicoedema, causing a mass effect on nearby sulci and resulting in compression of the frontal and temporal horns, as well as the body of the right lateral ventricle. MRI findings corroborated the CT results, additionally highlighting a dominant necrotic component within the lesion. These imaging features strongly suggested a brain tumour, with differential diagnoses including high-grade astrocytoma and GS. Surgical management was promptly initiated, and a complete tumour resection was performed via a right Fronto-Temporo-Parietal (FTP) craniotomy. Subsequent histopathological and immunohistochemical analysis confirmed the diagnosis of GS. The patient’s family member consent was taken verbally before reporting this case in this current literature. Hence, we are reporting this rare entity to add to the literature and to be considered in the differential diagnosis of high grade malignant glial tumours as GS holds worse prognosis compared to Glioblastoma due to its rapid metastasis.

Serotonin Syndrome Triggered by Ondansetron in Organophosphorus Poisoning Presenting as a Dual Clinical Challenge: A Case Report

Karra Keerthi Reddy, Manne Lakshmi Narasimha Sandeep, Nalabothula Ravi Teja Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Organophosphorus compound poisoning continues to be a significant clinical concern in developing countries, presenting with diverse neurological and systemic complications. While cholinergic crisis and intermediate syndrome are well-recognised sequelae, serotonin syndrome remains a rare and underreported complication in such cases. We describe the case of a 48-year-old man who intentionally ingested a large amount of a chlorpyrifos-based pesticide (Killer 505) in an act of self-harm. Upon admission, he was drowsy but arousable, with a Glasgow Coma Scale (GCS) score of 14/15, and was initially managed with atropine and pralidoxime infusions. By the fourth day, he developed signs of intermediate syndrome and required mechanical ventilation. On day 7, he was started on ondansetron 8 mg intravenously every eight hours for persistent nausea. Within 24 hours, he developed fever, agitation, spontaneous clonus, and hyperreflexia. Clinical assessment, supported by Hunter’s Criteria, led to a diagnosis of serotonin syndrome. His brain Magnetic Resonance Imaging (MRI) showed old infarcts but no new findings to explain the sudden change in his neurological status. After stopping ondansetron, his condition improved rapidly, confirming the diagnosis. He was later decannulated and discharged with a full recovery. This case illustrates that ondansetron, a 5-HT3 antagonist, can trigger serotonin syndrome in high-risk individuals, especially those already affected by neurotoxicity from organophosphorus compound poisoning. Early detection and withdrawal of the triggering drug are critical. Clinicians must remain vigilant for unusual symptoms and drug-induced effects in complex toxicology cases.

Neuroendocrine Tumour in a 37-Year-Old Female: A Diagnostic Challenge

Manoj Dongare, Parin Nilesh Patel, Dakshyani Satish Nirhale, Kishore Jeughle, Siddharth Veerla Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Pancreatic Neuroendocrine Tumours (PNETs) are a rare group of neoplasms arising from hormone-producing cells in the pancreas. Unlike the more common pancreatic adenocarcinomas, PNETs often grow more slowly and may produce hormones, leading to distinct clinical symptoms. We present a rare and diagnostically challenging case of a PNET in a 37-year-old female who presented with a three-month history of epigastric pain. Initial imaging studies revealed a mass in the liver, mimicking Hepatocellular Carcinoma (HCC), while subsequent investigations, including Positron Emission Tomography-Computed Tomography (PET-CT) and ultrasound-guided Fine-Needle Aspiration Cytology (FNAC), suggested a PNET. A Whipple procedure was performed, and histopathological examination confirmed the diagnosis. This case highlights the importance of a multidisciplinary approach in managing rare and challenging malignancies, emphasising the need for clinical vigilance, advanced imaging, and histopathological evaluation to confirm the diagnosis. The successful management of this case underscores the critical role of timely surgical intervention and personalised treatment strategies in achieving favourable outcomes.

Reversible Wenckebach Phenomenon in a Young Patient with Dengue Fever: A Case Report

Subash Mohan Thulasi, Yohidha Balamurugan, Sornavalli Valliappan, Visvesvaran Salitteeswaran, PK Ananthakumar Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Dengue fever, caused by the Dengue Virus (DENV) of the Flaviviridae family, is widespread in tropical and subtropical regions, with India experiencing a high burden of disease. Although many cases remain asymptomatic or mild, severe complications, including cardiac manifestations, can occur. This article reports uncommon presentation of dengue-associated transient conduction disturbances without overt myocardial injury. A previously healthy 22-year-old male presented with intermittent fever, chills, generalised myalgia, gastrointestinal symptoms and dehydration for five days. Initial evaluation at a local clinic revealed thrombocytopenia and a normal Electrocardiogram (ECG). On hospital admission, the patient exhibited dehydration, bleeding manifestations (oral mucosal and gingival haemorrhages), and an irregular pulse. Laboratory tests indicated thrombocytopenia, transaminitis, and pre-renal acute kidney injury, while dengue NS1 antigen and IgM antibodies were positive. A 12-lead ECG performed on admission revealed a second-degree Mobitz Type I (Wenckebach) atrioventricular block, which was confirmed by 24-hour Holter monitoring. Cardiac enzymes were within normal limits, and echocardiography showed preserved left ventricular function without evidence of myocarditis. Management included intravenous hydration and platelet transfusions. Serial ECG monitoring demonstrated resolution of the Atrio-ventricular (AV) block by day 4 of hospitalisation, and the patient’s renal and hepatic functions normalised, leading to discharge on day 7. This case underscores the need for diligent cardiac monitoring in dengue fever, as transient conduction disturbances may occur even without significant myocardial involvement. Transient low-degree AV block in dengue fever, although seemingly benign, may herald severe cardiac complications. Prompt recognition and supportive management are pivotal in mitigating potential cardiac complications.

Uncommon Presentation of Retroauricular Lipoma: A Case Report

Saurabh Gawand, Rajesh Gattani, Apoorva Pande, Abhiram Sai Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Lipomas are rare benign tumours composed of adipose tissue cells. They are the most common type of soft tissue tumours, but the presence of a lipoma in the retroauricular region is a rare clinical presentation. Lipomas are commonly found subcutaneously in the upper trunk, shoulders, neck, and back, and can occur in any part of the body with adipose tissue. They are noted for their presence as a soft, doughy mass, typically around 5 centimeters in size. These masses are usually painless and slow-growing, often diagnosed through radiological assessments. Management is recommended in most cases for aesthetic reasons, using both surgical and non-surgical methods. This is a case of a 55-year-old male presenting with a retroauricular, non-mobile, painless swelling for the past three years. He was successfully managed by surgical excision of the mass, which was confirmed as a lipoma by histopathological evaluation. Three months of follow-up showed no signs of recurrence. This case report highlights diagnostic challenges in retroauricular masses and considers a differential diagnosis of lipoma in consideration even in unusual locations.

Talocalcaneal Coalition with Os Sustentaculum-Hovering the Anomalous Bridge: A Case Report

Garima Varshney, Preetham Patavardhan, Rahul Dev Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Tarsal coalition is a congenital abnormality that leads to a coalition between tarsal bones. This coalition can be bony, cartilaginous, or fibrous, with the talocalcaneal and calcaneonavicular joints commonly involved. The onset of symptoms is typically in the second decade of life and include pain, stiffness, reduced range of motion, and flatfoot deformity. Computed Tomography (CT) imaging depicts coalitions exclusively, with bony coalitions being straightforward to identify, whereas non-osseous coalitions manifest as secondary bony changes. Magnetic Resonance Imaging (MRI) shows signal changes parallel to the parent bone in cases of osseous coalition. In contrast, non-osseous coalitions exhibit variable intermediate to low signal changes, with bone marrow oedema displaying a high signal on fluid-sensitive sequences. The coalition can be located intraarticularly or extraarticularly. We present a case of an 18-year-old female who presented with right ankle pain. A CT scan of the right ankle showed an articulation between the talus and calcaneus along the medial aspect of the joint with an interspersed accessory ossicle. The extraarticular non-osseous Talocalcaneal Coalition (TCC) was diagnosed, along with the os sustentaculum located along the medial facet. In this case, we demonstrate TCC with an interspersed os sustentaculum forming an extraarticular TCC, which was detected incidentally during the evaluation of a young patient presenting with ankle pain and a visible bony deformity.

Parkinsonism and Seizures in Fahr’s Disease: A Report of Two Cases

Bolisetty Shanmukha Sai, Tankasala Gangaram, Taruguvandla Sandhya Rani, Jennie Santhanam, SN Meenakshi Sundari Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Fahr’s disease, also known as primary familial calcifications, is a rare neurodegenerative disorder characterised by abnormal calcium deposits in the brain caused by genetic mutations. Fahr’s syndrome, or secondary brain calcification, results from infections, metabolic, and endocrine abnormalities leading to calcium deposits in the brain. Although Fahr’s disease and Fahr’s syndrome are recognised as separate entities, they are often used interchangeably in the literature. The prevalence of Fahr’s disease is <1 per 100,000, with no significant gender differences, and it often goes undiagnosed since one-third of the patients are asymptomatic. Patients may present with headaches, movement disorders, seizures, cognitive defects, and psychiatric manifestations, which are usually mistaken for other neurological conditions. The pathophysiology is still unclear but is postulated to be due to abnormal calcium and phosphate metabolism and transport in the brain. Fahr’s disease can be diagnosed based solely on neuroimaging, even without an identifiable etiology. While genetic testing is supportive, it is not mandatory, as many patients lack mutations despite a positive family history. Both conditions show characteristic symmetrical calcifications in the basal ganglia, as well as areas like the thalamus, cerebellum, and subcortical white matter on neuroimaging. Management primarily focuses on symptomatic treatment to control movement disorders, preserve cognition, and alleviate neuropsychiatric manifestations through a multidisciplinary approach. Through this case report, the authors highlight two cases with brain calcifications and their management. The first patient had parkinsonian features, while the second patient experienced a generalized tonic-clonic seizure and were diagnosed with Fahr’s disease due to an unidentifiable etiology and Fahr’s syndrome due to hypoparathyroidism, respectively.

Cervicofacial Subcutaneous Emphysema Post Tonsillectomy: A Case Report

Anand Kuppusamy, Thankam Abraham Reshma, Manoj Bhaskar Vishak, A Pushparani Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Tonsillectomy is a routine procedure, commonly performed in children. However, it carries higher risks in older patients due to fibrosis. Post-tonsillectomy, primary or secondary haemorrhage remains the most significant complication. One of the rare but serious complications is cervicofacial Subcutaneous Emphysema (SCE), where air enters the subcutaneous tissue through a defect or weakness in the dissected tissues during or after the surgical procedure. Triggering factors of SCE associated with tonsillectomy include trauma to the tonsillar bed during dissection, excessive pressure from mechanical ventilation or manual bag-mask ventilation, and even excessive coughing or straining in the postoperative period. Though rare, cervicofacial SCE can rapidly progress to life-threatening complications like tension pneumomediastinum, airway obstruction, or even cardiac arrest. In this case report, we present a rare case of SCE following adenotonsillectomy in a six-year-old girl, highlighting the clinical presentation, diagnostic work-up, and management strategies used to successfully treat the patient. The procedure was uneventful; however, post-extubation, the child developed periorbital oedema, neck swelling, and crepitus. Despite this, she remained stable with a normal respiratory rate and oxygen saturation. A neck X-ray was taken to confirm the presence of subcutaneous air. The child was closely monitored, and conservative management was initiated, including supplemental oxygen, corticosteroids, and antibiotics. The child’s condition improved without respiratory compromise, and the emphysema resolved gradually. This report emphasises the importance of recognising this complication early, maintaining vigilance throughout the perioperative period, and implementing appropriate measures to mitigate the risks of this life-threatening condition.

A Case Series of Alport Syndrome with Posterior Lenticonus

Sumit Navneet Toshniwal, OK Radhakrishnan, Nikhil Toshniwal, Priyanka Aher, Deepaswi Bhavsar Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Alport syndrome is a genetic disorder primarily affecting the kidneys, eyes, and ears, characterised by a classical triad of haematuria, anterior lenticonus, and sensorineural deafness. This case series examines the ocular manifestations, particularly posterior lenticonus, in three patients with Alport syndrome evaluated at a tertiary care centre. By integrating current findings from recent studies, this series highlights the significance of ophthalmic assessment in diagnosing and managing Alport syndrome.

Varied Presentations of Carcinoma Penis in India: A Case Series

Abhirudra Mulay, Onkar Singh Sangha, Vilas Sabale, Vikram Satav Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Penile cancer is an uncommon but significant malignancy affecting men, with a disproportionate burden in developing countries. India has one of the highest incidences of penile cancer in the world, with rates as high as 3.32 per 100,000 men. Socio-economic factors, limited awareness and social stigma contribute to delayed presentation and diagnosis, often resulting in advanced-stage disease at the time of treatment. This case series presents five patients diagnosed and treated for penile carcinoma at the Urology Department in the hospital over the past 12 months, from February 2023 to February 2024. The demographics, presenting symptoms, diagnostic findings, treatment plans, surgical outcomes, postoperative outcomes and follow-up were recorded. A delay in diagnosis of penile cancer was noted in all patients, owing to social stigma, neglect and social embarrassment, along with a lack of education. This series emphasises the critical need for public health education and initiatives focused on early detection and management of penile cancer. Breaking the silence around penile cancer by addressing social stigma and making healthcare more accessible can encourage men to seek help earlier- often allowing for simpler treatments and better outcomes. There is a clear need for ongoing research and larger community-based studies to develop consistent care guidelines and practical prevention strategies, especially for those most at risk.

A Rare Clinical Presentation of Left Vulval Verrucous Cancer (Figo Stage 3): Image in Medicine

Jyoti Dwivedi, Deepali Ghungrud, Swapna Morey, Arti Raut, Samruddhi Gujar Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X A 40-year-old perimenopausal female P1L1 with exophytic growth over the vulval region was admitted to the hospital with a history of discharge from the vagina. The patient was apparently healthy six months ago. After which, she started experiencing exophytic growth progressive in nature, with foul-smelling discharge. She complained of decreased appetite and weight loss. Also, she had complained of urinary retention for the last six months.

Giant Pleomorphic Adenoma of the Parotid Gland: Images in Medicine

Priyanka Sontakke, Gaurav Khemka, Sakshi Khemka, Mithil Deotare, Neha Pankhey Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Pleomorphic Adenoma (PA) is the most common benign salivary gland tumour, predominantly affecting the parotid gland. It arises from both epithelial and myoepithelial components, forming a mixed histological pattern. Clinically, PA presents as a slow-growing, painless mass that can attain a significant size if left untreated. Malignant transformation, although rare, remains a concern, especially in long-standing tumours (1).

Clinical Image of Shingles

Pratiksha Mahure, Bharat Rathi, Bhagyashree Jib Kate, Shubham Khanke Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Shingles, clinically referred to as Herpes Zoster, is a viral dermatological condition that arises from the Varicella Zoster Virus (VZV). Following a prior varicella infection, this virus persists in an inactive state within the sensory ganglia associated with the cranial nerve or the dorsal root ganglia (1).

Direct Gallbladder Extraction versus Endobag Extraction during Laparoscopic Cholecystectomy: A Prospective Observational Study

Swathy Elangovan, K Vivekananda Subramania Nathan, R Sivamarieswaran, M Reegan Jose Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: The most effective treatment for gallstone disease symptoms is Laparoscopic Cholecystectomy (LC). Gallbladder retrieval is a crucial step, with direct extraction and endobag-assisted extraction being commonly used techniques. Direct extraction may lead to increased bile spillage and port-site infections, whereas the endobag provides protection against contamination but may increase operative time. Aim: To compare the outcomes of direct gallbladder extraction versus endobag-assisted extraction in LC, focusing on bile spillage, port-site infections, operative time, postoperative pain and hospital stay duration. Materials and Methods: This prospective observational study was conducted in the Department of General Surgery, SRM Medical College Hospital and Research Institute, Kattankulathur, Chengalpattu, Tamil Nadu, India, from December 2024 to March 2025. A total of 60 patients undergoing elective LC were randomised into two groups: Group A (direct extraction) and Group B (endobag extraction). Primary outcomes included intraoperative complications (gallbladder perforation and bile spillage) and postoperative complications (port-site infections and pain levels). Secondary outcomes assessed operative time and hospital stay duration. Continuous variables were expressed as means with standard deviations, and categorical variables as frequency counts and percentages. An independent t-test was used for comparing continuous variables and the Chi-square test for categorical data. A p-value <0.05 was considered statistically significant. Results: The mean age of subjects in Group A was 38.1±13.9 years {males: 16 (53.3%), females: 14 (46.7%)}, and in Group B, it was 44.3±12.5 years {males: 13 (43.3%), females: 17 (56.7%)}. The endobag group (Group B) had significantly lower rates of bile spillage (6.7% vs. 23.3%, p-value=0.036) and port-site infections (3.3% vs. 16.7%, p-value=0.019) compared to direct extraction (Group A). Group B also demonstrated significantly shorter operative times (32.2±3.7 minutes vs. 39.1±5.4 minutes, p-value <0.001) and hospital stay durations (1.5±0.5 days vs. 2.2±0.8 days, p-value <0.001). Postoperative pain scores on the 1st day (5.4±1.3) and 3rd day (2.2±0.8) were significantly lower in Group B (p-value <0.001). Conclusion: Endobag-assisted gallbladder extraction significantly reduces bile spillage, port-site infections, and postoperative pain while decreasing the duration of hospital stay. It is a safer alternative to direct extraction, particularly in high-risk patients.

Effect of Body Height on Aerobic Capacity of Young Adults: A Cross-sectional Study

S Kanchan, Kalpesh Satani Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Maximal oxygen consumption (VO₂ max) is a vital component of overall fitness and a direct predictor of the risk of cardiovascular and metabolic diseases. Body height, as a part of body composition, can affect the body’s overall physiology. However, limited literature has documented the relationship between body height and maximal oxygen consumption. Aim: To determine the effect of body height on the aerobic capacity of young adults using the multistage 20 m shuttle run test. Materials and Methods: A cross-sectional study was conducted at the Department of Cardio-Respiratory Physiotherapy, College of Physiotherapy, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India, from July 2020 to May 2021. A total of 106 participants were included in the study and categorised into short, medium and tall-height groups. They performed the Multistage 20 m Shuttle Run test, which involved a pre-recorded audio signal. Participants were motivated to pace themselves with the audio signals until their exhaustion level. ₂ max was calculated using the equation that incorporates maximal aerobic speed. Chi-square tests and independent sample t-tests were performed to find the associations between different categorical variables. One-way Analysis of Variance (ANOVA) and post-hoc analyses were applied to determine intergroup significance among the three groups. The level of significance (p-value) was set at <0.05. Results: There was no significant difference in maximal oxygen consumption among the three groups (p-value=0.930). However, a statistically significant difference was found in ₂ max between males and females (p-value=0.003). Conclusion: The present study concludes that height does not affect maximal oxygen consumption in healthy young adults. Other factors, such as body composition, genetics, level of training and anatomical, physiological and biomechanical differences, contribute significantly to the levels of maximal oxygen consumption in adults. The commercials and unresearched data claiming that body height is an essential aspect of a healthy life can be rejected and/or questioned based on this study.

Speciation of Clinically Significant Coagulase Negative Staphylococci Isolates from Clinical Samples and their Susceptibility Pattern: A Cross-sectional Study from Western Uttar Pradesh, India

Priya, Ismat Rehana, Anita Pandey, Rajesh Kumar Shah, Jitendra Kumar Chaudhary Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Coagulase-negative Staphylococci (CoNS) have emerged as predominant organisms associated with a variety of infections, particularly Bloodstream Infections (BSIs). As CoNS isolates become increasingly resistant to antimicrobials, this presents a potentially concerning emerging characteristic. There is a need to identify the species and resistance profile of CoNS. These organisms are increasingly recognised as nosocomial pathogens and are associated with multiple antimicrobial resistance mechanisms, particularly methicillin resistance. Rapid and reliable identification at the species level is essential to predict the potential pathogenicity or antibiotic susceptibility of each clinical isolate. Aim: To isolate and assess the speciation of CoNS from various clinical specimens and to determine the antibiotic susceptibility profile, with special reference to linezolid and vancomycin. Materials and Methods: This was a hospital-based cross-sectional study carried out in the Department of Microbiology at Subharti Medical College, a tertiary care teaching hospital in Western Uttar Pradesh (UP), India. The duration of the study was one year, from January 2019 to December 2019. A total of 1,061 clinically significant isolates of CoNS were presumptively identified by standard bacteriological techniques, which were further confirmed at the species level by an automated Vitek-2 Compact system. Antimicrobial Susceptibility Testing (AST) was conducted using the Kirby-Bauer disc diffusion method, and the Minimum Inhibitory Concentration (MIC) for vancomycin was assessed using the automated Vitek-2 Compact system. The data were analysed using the Statistical Package for the Social Sciences (SPSS) version 20.0. Statistical analysis included the Chi-square test. Results: A total of 1,061 CoNS were isolated. CoNS were predominantly isolated from Inpatient Department (IPD) samples, with 993/1,061 (93.60%) coming from these sources, and the majority from blood (928/1,061; 87.46%), followed by pus (69/1,061; 6.50%) and urine (31/1,061; 2.92%). There was male predominance, with 606/1,061 (57%), and isolation rates were higher among the extremes of age. Staphylococcus epidermidis (472/1,061; 44.48%) was the predominant species isolated, followed by Staphylococcus haemolyticus (360/1,061; 33.93%). The majority of the isolates were resistant to penicillin (995/1,061; 93.77%), followed by erythromycin (896/1,061; 84.45%) and cotrimoxazole (798/1,061; 75.2%). The prevalence of methicillin resistance among CoNS was 964/1,061 (90.9%). The emergence of resistance to linezolid in 27/1,061 (2.54%) was concerning; however, all isolates were sensitive to vancomycin. Conclusion: Multidrug-resistant CoNS are an emerging therapeutic problem in hospital settings because their prevalence not only limits treatment options but also acts as a reservoir for drug-resistant genes. Speciation and susceptibility testing of these isolates are essential for better clinical outcomes.

Effectiveness of ultrasound-guided Continuous Unilateral Erector Spinae Plane Block for Postoperative Analgesia in Modified Radical Mastectomy: A Randomised Clinical Study

Sooraj Chambath, Binu Sajid, S Syamkumar, KR Radha Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Modified Radical Mastectomy (MRM) can cause postoperative pain, which is often difficult to relieve due to the complex innervation of the breast. This may lead to chronic pain syndrome if not managed adequately. Continuous Erector Spinae Plane (ESP) block could be useful as it provides analgesia over a wide range of dermatomes and avoids opioid-related adverse events. Aim: To evaluate the effectiveness of unilateral continuous ESP block in providing postoperative analgesia in MRM. Materials and Methods: A prospective randomised clinical study was conducted involving 56 females scheduled for MRM in Government Medical College, Kozhikode, Kerala, India. They were divided into two groups. Group E (n=28) received an ultrasound-guided ESP block using inj. Ropivacaine 0.5% 20 mL and an indwelling catheter was inserted in the plane. Group I (n=28) received local infiltration around the incision with 20 mL of 0.2% Ropivacaine. Postoperatively, patients in Group E received an infusion of Inj. Ropivacaine 0.2% at 5 mL/hr for 24 hours through the catheter. Postoperative pain was assessed using the Numerical Rating Scale (NRS). The time to the first rescue analgesic and the cumulative dose of rescue analgesic over 24 hours were recorded. The incidence of nausea or vomiting and haemodynamic parameters were also recorded. The Student’s t-test was used to determine the significance of parameters on a continuous scale, while the Fisher’s exact test/Chi-square test was employed for categorical variables. Results: The mean NRS pain scores were significantly lower in Group E (p-value <0.001) at all time intervals. Group I required rescue analgesia earlier than Group E (p-value <0.001). The mean cumulative dose of rescue analgesics in 24 hours was significantly lower in Group E (p-value <0.001). The incidence of postoperative nausea or vomiting at six hours and 12 hours was significantly lower in Group E. Conclusion: Unilateral continuous ESP block is an effective technique for providing postoperative analgesia for patients undergoing MRM. It offers a longer duration of analgesia, a lesser requirement for postoperative rescue analgesics and a reduced incidence of nausea and vomiting.

Serum Uric Acid and Arterial pH in ICU Patients with Sepsis and their Correlation with SOFA Score: A Prospective Observational Study

Govind Shiddapur, Sonali Agarwal Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Sepsis remains a critical medical emergency characterised by a dysregulated host response to infection, leading to life-threatening organ dysfunction. Early and accurate prediction of clinical outcomes in septic patients is essential for timely intervention. Common prognostic tools, such as the Sequential Organ Failure Assessment (SOFA) score, are widely used, but additional biochemical markers, such as Serum Uric Acid (SUA) and arterial blood pH, may enhance risk stratification. Aim: To evaluate the role of SUA and arterial pH as prognostic markers in patients with sepsis admitted to the Intensive Care Unit (ICU) and to assess their correlation with SOFA scores. Materials and Methods: A prospective observational study was conducted over a 12-month period in the Department of General Medicine at Dr. D. Y. Patil Medical College, Hospital, and Research Centre, Pimpri, Pune, Maharashtra, India. A total of 150 adult ICU patients diagnosed with sepsis were enrolled. SUA and arterial pH levels were measured on days 0, 1, 2, and 7, alongside serial SOFA scoring. Data were statistically analysed to determine trends and correlations between biomarkers and organ dysfunction severity. Results: SUA levels and SOFA scores showed a statistically significant rising trend from day 0 to day 7 (p-value <0.001), while arterial pH progressively decreased, reflecting increasing metabolic acidosis. A strong positive correlation was observed between uric acid and SOFA scores (r-value=0.74) at day 7, whereas arterial pH showed an inverse correlation (r-value=-0.72). Both biomarkers demonstrated predictive utility for clinical deterioration in septic ICU patients. Conclusion: SUA and arterial pH are valid and readily available biomarkers that are significantly correlated with the SOFA score. Their incorporation into SOFA scoring could enhance early prognostication and facilitate more accurate ICU management.

Effects of Exercise Training on Ventricular Remodelling in Patients with Myocardial Infarction: A Systematic Review with Meta-analysis

Tejas R Chokshi, Sohil Takodara, Dinkey Mankad Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Ventricular remodelling refers to the process of alteration in ventricular size, shape, and function. It occurs physiologically as a result of exercise or pathologically following cardiac injury and/or abnormal haemodynamic loading conditions. However, the effects of exercise on ventricular remodelling need further investigation. Aim: The aim of the present systematic review was to provide a comprehensive analysis of Exercise Training (ET) interventions for ventricular remodelling in patients with Myocardial Infarction (MI). Materials and Methods: The present systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines (PRISMA guidelines). Two independent reviewers completed the title, abstract, and full-text screening for inclusion in the study. Discrepancies were resolved through discussion or by a third reviewer. A literature search was conducted on PubMed, EMBASE, Scopus, PEDRO, Google Scholar, and ResearchGate by two independent investigators using the following keywords: “aerobic exercise,” “strength training,” “ventricular remodelling,” “Left Ventricular (LV) remodelling,” “Randomised Controlled Trials (RCT),” and “MI.” A total of 10 randomised controlled trials were included in the study. All analyses were conducted using RevMan version 5.4.1, following the Cochrane handbook for systematic reviews. For both primary and secondary outcomes, pooled means and Standard Deviations (SD) were extracted along with a 95% Confidence Interval (CI). Results: A total of 10 RCTs were included in the present study combining the data from 550 patients and the mean age of participants was 38 years, ranging from 18 to 65 years. Of the 10 studies, six employed aerobic exercise as an ET intervention, while the remaining four studies included a combination of aerobic and resistance training as an ET intervention. The mean rehabilitation duration was between 3 and 8 months. The majority of studies in this review demonstrated that ET has favourable outcomes in LV end diastolic volume and LV mass. Conclusion: Based on the analysis of the studies included in this review, we can conclude that LV remodelling following MI is enhanced by ET. An early start of ET and a longer duration of up to six months offer more benefits in the recovery of myocardial and LV functions.

Comparison of Antimicrobial Activity between Ceftriaxone-Sulbactam-Disodium EDTA and Ceftazidime-Avibactam against Carbapenemase Producing Enterobacterales Isolates from a Tertiary Care Hospital: An In-vitro Study

R Vijay Suriya, KV Leela, Gopinathan Anusha Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: The spread of Multidrug-Resistant (MDR) organisms worldwide poses a significant public health challenge, particularly in the South Asian region, including India. Infections caused by Metallo-β-Lactamase (MBL) producing Enterobacterales are a notable concern. The rising incidence of MBL-producing isolates underscores the urgent need for innovative therapeutic strategies and effective antimicrobial combinations to address these threats. Combination treatments such as Ceftriaxone Sulbactam-disodium Ethylenediamine Tetraacetate (EDTA) (CSE) and Ceftazidime-Avibactam (CZA) have emerged as promising alternatives to conventional antibiotics. Aim: To compare the in-vitro efficacy of two antibiotic combinations, namely CSE and CZA, against Carbapenemase-producing Enterobacterales isolates. Materials and Methods: An in-vitro study was conducted over a period of six months from June 2024 to November 2024 at the Department of Microbiology, SRM Medical College Hospital, Chengalpattu, Tamil Nadu, India. A total of 141 Enterobacterales isolates that were resistant to either Imipenem or Meropenem, obtained from various clinical samples, were included. Phenotypic differentiation was performed using the EDTA-modified Carbapenem Inactivation Method (eCIM) method in conjunction with the modified Carbapenem Inactivation Method (mCIM) method. Further in-vitro susceptibility testing was conducted using the Kirby-Bauer disk diffusion method to compare the two antibiotic combinations, namely CSE and CZA. Demographic parameters including age, gender, sample type, ward and organism-wise distribution were assessed throughout the course of this study. Data analysis was performed using percentage susceptibility and frequency distribution. The p-value was determined using Fisher’s exact test, with a p-value<0.05 regarded as statistically significant. Results: Among 141 Carbapenem-Resistant Enterobacterales (CRE) isolates, 39 (27.66%) were phenotypically identified as Carbapenemase producers using the mCIM-eCIM method. Antimicrobial susceptibility testing of these isolates, performed using the Kirby-Bauer disk diffusion method, revealed that all 39 (100%) Carbapenemase-producing isolates were susceptible to CSE. In contrast, only 9 (23%) serine carbapenemase-producing isolates were susceptible to CZA, while 30 (77%) MBL-producing isolates demonstrated resistance. Conclusion: In this study, CSE emerged as a potent antibacterial agent against MBL-producing isolates. Therefore, it is strongly recommended to include CSE in the routine susceptibility panel and consider its use as a carbapenem and colistin-sparing drug against carbapenemase producers, especially MBL-producing Enterobacterales isolates.

Morphologic and Morphometric Analysis of Crista Galli for Gender Determination using Cone Beam Computed Tomography: A Cross-sectional Study

Vaishnavi Sawant, Amita Aditya, Radhika Nair, Neha Kulkarni, Alisha Fargade, Samata Parakh Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Gender determination is a key process in forensic investigations. The Crista Galli (CG) is a significant anatomical structure of the skull and a crucial endoscopic landmark in pituitary surgeries and the frontal sinus approach. A few studies have reported a certain degree of sexual dimorphism in the morphology of the CG. Considering the scarcity of studies in which the CG and adjacent structures were analysed using Cone Beam Computed Tomography (CBCT), especially in the Indian population, a need was felt to conduct this study. Aim: To analyse the morphologic and morphometric characteristics of the CG and its application for gender determination using CBCT. Materials and Methods: The present cross-sectional study was conducted in the Department of Oral Medicine and Radiology at Dr. D. Y. Patil College and Hospital, Pimpri, Pune, Maharashtra, India, over a period of six months from April 2024 to October 2024. A total of 228 CBCT scans, 114 for each gender, were retrospectively analysed by two independent observers using Image Comparison Analysis Tool (i-CAT) software version 1.9.3.14. The height, width, length, and shape of the CG, as well as the presence of pneumatisation, were assessed. Kero’s classification was used for morphological categorisation. Descriptive and inferential statistics, unpaired t-tests, and Chi-square tests were performed for statistical analysis. The Cronbach alpha test was used to measure inter-examiner reliability. Results: Out of the 228 participant scans, the mean±SD of the length of the CG in males was 11.17±2.14 mm, whilst in females it was 11.45±2.19 mm. The mean±SD of the width of the CG in males was 4.72±1.66 mm, whereas in females it was found to be 5.08±1.35 mm. The mean±SD of the height of the CG in males was 13.08±2.88 mm and in females it was 13.32±2.52 mm. A statistically significant difference (p-value=0.049) in the width of the CG was observed between the two genders. A significant association was found between Kero’s classification and gender, but not between pneumatisation and gender. The Cronbach alpha score of 0.911 was indicative of good inter-examiner reliability. Conclusion: This study suggests that the CG could serve as a potential indicator for gender determination. Additionally, since the CG shows morphological variation, its meticulous examination before any interventional procedure in the anatomical region is essential.

Association between Dyslipidaemia and Sensorineural Hearing Loss: A Cross-sectional Study

Megha Doiphode, Gundappa D Mahajan, Vinod V Shinde, Mayur Ingale Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Sensorineural Hearing Loss (SNHL) is a common condition with various causes, including issues related to blood flow and metabolism. Recent studies have suggested a possible association between abnormal blood lipid levels and SNHL. Aim: To assess the association between sensorineural hearing loss and fasting lipid profiles. Materials and Methods: This cross-sectional study was conducted at Dr. D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India, from April 1, 2023, to October 30, 2024. It included 38 patients with SNHL and 38 age- and sex-matched patients without hearing loss. Fasting lipid levels, including Total Cholesterol (TC), Low-Density Lipoprotein (LDL), Very Low-Density Lipoprotein (VLDL), High-Density Lipoprotein (HDL), and Triglycerides (TG), were measured in both groups. Pure Tone Audiometry (PTA) was employed to assess the degree of hearing loss. Data were analysed using Chi-square and t-tests, with p-values <0.05 considered statistically significant. Results: The mean age of participants was comparable between groups, with the SNHL group having a mean age of 52.6±11.4 years and the control group having a mean age of 51.9±10.8 years. The cases had significantly higher mean TC (215.4±32.7 mg/dL), LDL (138.2±24.5 mg/dL), and TG (175.6±40.2 mg/dL) compared to controls. HDL levels were significantly lower in cases (36.8±6.9 mg/dL) compared to controls (44.1±5.8 mg/dL). Additionally, 73.7% (n=28) of cases had HDL <40 mg/dL compared to 21% (n=8) in controls. Dyslipidaemia was significantly associated with increased hearing thresholds across all tested frequencies. Conclusion: Dyslipidaemia was significantly associated with SNHL, suggesting the importance of monitoring lipid profiles in at-risk individuals. Early intervention may help prevent or mitigate hearing loss.

Association of LDL Cholesterol and hs-CRP with Subtypes of Heart Failure in Type 2 Diabetes Mellitus Patients: A Cross-sectional Study

Vineetha Naga Lakshmi Giduturi, Vijayashree Gokhale, Sangram S Mangudkar, Satbir Kaur Malik, Ponvijaya M Yadav, Sanket Genuji Shinde Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Heart Failure (HF) in patients with Type 2 Diabetes Mellitus (T2DM) is classified based on Ejection Fraction (EF) into HF with reduced EF (HFrEF) and HF with preserved EF (HFpEF). Low-Density Lipoprotein Cholesterol (LDL-C), a marker of dyslipidaemia, and high-sensitivity C-Reactive Protein (hs-CRP), an inflammatory biomarker, are recognised for their roles in contributing to cardiovascular diseases and HF progression in T2DM patients. Aim: To explore the clinical and aetiological characteristics of HF in T2DM patients and to analyse the association between LDL-C and hs-CRP levels with different HF subtypes. Materials and Methods: The present cross-sectional study was conducted from October 2023 to March 2025 at a tertiary care hospital in Western Maharashtra, India. The study included 100 patients over 18 years of age with Type 2 Diabetes and HF, in whom LDL-C and hs-CRP levels were elevated. LDL-C was calculated using the Friedewald formula, and hs-CRP was measured using the nephelometry method. The Statistical Package for Social Sciences (SPSS) statistics package version 20 was used for statistical analysis. The χ2 test, t-test, and non-parametric tests were employed, with statistical significance acknowledged at the p-value <0.05 level. Results: The study included 100 T2DM patients with HF. hs-CRP levels were elevated in both the HFrEF and HFpEF groups; however, no significant difference was found between them (p-value=0.698). LDL-C showed no statistically significant association with HF type (p-value=0.931). HbA1c was higher in the HFrEF group (9.84±1.6) compared to the HFpEF group (8.73±1.4), with statistical significance (p-value=0.001). Conclusion: LDL-C and hs-CRP levels showed no significant association with HF subtypes, although trends suggested an inverse correlation with EF that was not statistically significant. A significant inverse relationship between HbA1c and EF highlighted the impact of poor glycaemic control on cardiac function. These findings support the need for comprehensive metabolic and inflammatory profiling in diabetic HF patients.

Association of Selected Non Communicable Diseases with Sleep Behaviour among the Rural Geriatric Population in the Northern Districts of Tamil Nadu, India: A Cross-sectional Study

R Suba Shree, R Kalaivanan, Roshni Mary Peter, M Logaraj Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Non Communicable Diseases (NCDs) and sleep disturbances are significant health concerns, especially among the elderly. Understanding the association between behavioural factors, NCDs and sleep quality in rural geriatric populations is crucial for developing effective interventions. Aim: To estimate the prevalence of selected NCDs and to assess the relationship between these NCDs and sleep behaviour among the rural geriatric population in the northern districts of Tamil Nadu, India. Materials and Methods: A cross-sectional study was conducted from July 2018 to May 2020 among 7,200 elderly individuals (≥ 60 years), selected using multistage stratified random sampling from the Chengalpattu, Kancheepuram and Thiruvannamalai districts. Data on socio-demographic variables, behavioural factors (e.g., smoking, tobacco chewing, alcohol use), sleep patterns and NCDs (e.g., hypertension, diabetes, depression) were collected using validated tools. Statistical analyses, including Chi-square tests and logistic regression, were performed to identify associations. Results: The prevalence of poor sleep was found to be 4,580 (64%), with a higher proportion among females {Odds Ratio (OR)=1.25, p-value <0.001} and unmarried individuals (OR=1.36, p-value <0.001). A total of 2,728 (37.9%) study participants had hypertension, 1,284 (17.8%) had diabetes and 4,043 (56.2%) had depression. Depression was significantly associated with poor sleep (OR=1.52, p-value <0.001), while 1,758 (38.4%) participants with poor sleep reported hypertension and 17.8% reported diabetes. No significant associations were found between these NCDs and sleep quality. Conclusion: The present study emphasises that the rural elderly population has an elevated risk of inadequate sleep. Poor sleep was significantly predicted by depression, highlighting the necessity for integrated mental health interventions for the elderly. Targeted behavioural and psychological therapies to address sleep issues may enhance the overall well-being and quality of life of this vulnerable population.

Comparative Evaluation of Smart Dentin Replacement and its Combination with Fiber in Reinforcing Endodontically Treated Teeth: An In-vitro Study

Richa Ratanrao Chaure, Sarita Vikram Singh, Jyoti Shankar Mandlik, Aishwarya Neeraj Handa, Shivani Vinayakrao Chavan, Mineet Satish Kaul Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Root canal treatment is essential for addressing pulp damage caused by decay or trauma. However, it significantly weakens the tooth structure, especially in posterior teeth, which endure strong chewing forces. The resulting susceptibility to fracture necessitates careful selection of restorative materials that can both protect and reinforce the remaining tooth structure. The present study explores novel restorative approaches using Smart Dentin Replacement (SDR) alone and in combination with Polyethylene Fiber (PEF) to potentially enhance the fracture resistance of endodontically treated mandibular molars, addressing the ongoing challenge of post-endodontic restoration. Aim: To compare SDR and combination of SDR and fiber in reinforcing endodontically treated lower molars. Materials and Methods: The present in-vitro study was conducted at the Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Pune, Maharashtra, India, from June 2023 to February 2024. It included a total of 27 extracted human mandibular posterior teeth, which were collected and embedded in acrylic blocks in groups of three, with nine teeth in each group (n=9). Teeth in the experimental groups (Groups 2 and 3) underwent access cavity preparation. Group 1 consisted of intact teeth. In Group 2, the access cavities were reinforced using SDR material. Group 3 involved reinforcing the inner circumference of the access cavities with a combination of PEF and SDR. The fracture resistance of all the teeth was then evaluated using a universal testing machine. One-way Analysis of Variance (ANOVA) and post-hoc Tukey’s test for intragroup comparison were used to calculate the statistical results of the present in-vitro study (p-value<0.05). Results: The control group showed the highest fracture resistance (2178.20 N), followed by SDR+PEF (1872.57 N) and SDR (1740.40 N). The differences between all groups were statistically significant (p-value<0.001). Conclusion: The combination of PEF and SDR material demonstrated superior fracture resistance in endodontically treated teeth compared to SDR alone. This reinforcement technique could potentially provide better clinical outcomes by enhancing the structural integrity of treated teeth, thereby reducing the risk of fracture and improving long-term success rates.

Psychometric Hepatic Encephalopathy Score in the Diagnosis of Minimal Hepatic Encephalopathy in Cirrhosis of Liver: A Cross-sectional Study

Mounika Maragari, Ninad Mulimani, Mallanna S Mulimani, Shravankumar Potkar Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Minimal Hepatic Encephalopathy (MHE) is a subclinical condition in patients with liver cirrhosis, often preceding Overt Hepatic Encephalopathy (OHE). MHE impairs driving ability and Quality of Life (QoL) but requires specialised neuropsychological tests such as the Psychometric Hepatic Encephalopathy Score (PHES) for diagnosis, as routine exams are insufficient. Aim: To establish normal values for the PHES and assess its diagnostic efficacy for MHE in patients with liver cirrhosis. Materials and Methods: A cross-sectional study was conducted at BLDE (DU) Medical College, Vijayapura, Karnataka, India, from May 2023 to December 2024, with a sample of 166 participants (cases and controls). Patients with OHE were excluded. The PHES was administered and biochemical tests including Alanine Transaminase (ALT), Aspartate Transaminase (AST), International Normalised Ratio (INR) and albumin, among others, were performed. Imaging {Ultrasound (USG) abdomen/pelvis} was also conducted. MHE was diagnosed if the PHES score was < -4 based on healthy nomograms. Statistical analysis was performed using the t-test, Mann-Whitney U test and Chi-square test, with a p-value <0.05 considered statistically significant. Results: Of the 166 participants, 83 had cirrhosis and 83 unmatched participants without cirrhosis were included for comparison. Cases were predominantly male (92.77% vs. 67.47%, p-value <0.001). Higher proportion of controls had primary education while secondary and higher secondary education levels were slightly more prevalent among cases (p-value=0.330). Cases showed significant impairment in all PHES subtests (p-value <0.001) and a lower mean PHES score (-4.40 vs. 2.28, p-value <0.001). A total of 37.35% of cases had MHE, while none in the control group had MHE (p-value <0.001). No correlation between ammonia levels and MHE status was observed. Conclusion: PHES is a reliable, non invasive tool for the early detection of MHE in cirrhosis patients, aiding timely intervention. While it should complement clinical evaluation, its cost-effectiveness and accessibility enhance patient management and outcomes.

Functional Reach Test between Dominant and Non Dominant Leg: A Cross-sectional Study

Danah Mohammed Alyahya Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Elderly individuals with balance disorders are vulnerable to falls. To prevent such events, it is imperative to evaluate and recognise the underlying causes of balance-associated issues. The functional reach test measures limits of stability and balance and does not require any special apparatus. The body weight bearing is greater on the dominant side. However, there is no scientific literature on the side preference (right or left) for performing a functional reach test. Aim: To determine the difference in functional reach test scores between the non dominant and the dominant leg. Materials and Methods: A cross-sectional study was conducted at the Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al-majmaah, Saudi Arabia, from May 2023 to September 2023. A total of 64 healthy individuals were included. Basic demographics such as age, height, weight, Body Mass Index (BMI), and foot dominance data, were gathered. The dominant foot was established by asking participants which leg they use while kicking a ball. For the outcome measure of the difference in functional reach test scores between the non dominant and dominant leg, participants were subjected to a functional reach test, which assesses an individual’s postural stability. Independent samples t-test and Analysis of Covariance (ANCOVA) were applied for statistical evaluation. A p-value <0.05 was regarded as statistically significant. Results: A total of 64 healthy subjects participated. The mean functional reach test scores for the right side were 13.22±2.64, while the left side was 12.81±2.68. A trend was noted for a higher functional reach test score for the right side in the dominant compared to that of the non dominant side (p-value=0.076). There was also no significant difference in the adjusted mean functional reach test scores of the right side (p-value=0.134) and left side (p-value=0.266) between the two groups after controlling for gender and BMI categories. Conclusion: The findings did not demonstrate statistically significant differences in functional reach test scores between the non dominant and dominant legs. These results imply that physical therapists could utilise functional reach test scores from both legs as a reference when evaluating unilateral balance function.

Correlation between Vitamin D Levels and Recurrent Lower Respiratory Tract Infection in Children: A Cross-sectional Study

Bhushan Bhaskarrao Korde, Rajesh Naranbhai Pankhaniya, Hetal Pramod Budh Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Vitamin D is a vital nutrient with immunomodulatory effects that may impact susceptibility to infections. Lower Respiratory Tract Infections (LRTI) are among the leading causes of morbidity and mortality in children. However, there is limited research exploring the relationship between vitamin D levels and LRTI in children in India. Aim: To find a correlation between vitamin D levels and recurrent LRTI in children aged 6 months to 5 years. Materials and Methods: A cross-sectional study was conducted in the Pediatric ward of Bokaro General Hospital in Jharkhand, India, between June 2019 and May 2020. A total of 222 children aged 6 months to 5 years diagnosed with recurrent LRTI were enrolled as cases (n=111), while other children in the same age group who were admitted with different diagnoses and required blood sampling were enrolled as controls (n=111) after obtaining parental consent. The blood levels of 25-hydroxy vitamin D [25(OH)D] were estimated and compared for both groups. Qualitative data were analysed using the chi-square test, while the Pearson’s correlation coefficient was used to compute the correlation between quantitative variables. Results: Among a total of 222 children, the majority 53 (47.7%), exhibited Vitamin D Deficiency (VDD), while most controls, 44 (39.6%) had normal vitamin D levels (p-value=0.03). The mean vitamin D level in the case group was significantly lower (p-value=0.022) compared to the control group. The VDD was found in 36 (39.13%) of the 92 cases with 2-3 episodes of LRTI, whereas it was observed in 17 (89.47%) of the 19 cases with 4-5 LRTI episodes (p-value=0.001). A significant inverse correlation was noted between the number of LRTI episodes and vitamin D levels (r-value=0.53, p-value<0.01). Conclusion: The present study reinforces the role of VDD and insufficiency in the occurrence of recurrent LRTI in children. Therefore, all children diagnosed with recurrent LRTI should be checked for their vitamin D status and should receive repletion therapy in addition to antibiotic treatment if found to be vitamin D deficient.

Prevalence of Microalbuminuria in Essential Hypertension and its Association with Coronary Artery Disease: A Cross-sectional Study

JS Dhadwad, Kunal Modi Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Hypertension is a leading aetiology of cardiovascular and renal diseases. Microalbuminuria, an indicator of endothelial dysfunction, has been linked with hypertensive nephropathy as well as cardiovascular disease. Tests to detect microalbuminuria, like the spot urine albumin-creatinine ratio, are easily accessible and not expensive. Aim: To determine the prevalence of microalbuminuria in essential hypertension and its association with Coronary Artery Disease (CAD) based on Electrocardiogram (ECG) and Echocardiographic (2D-ECHO) findings. Materials and Methods: The present cross-sectional survey of 150 patients with hypertension was was performed in the Department of General Medicine at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune,India during an 18-month period from October 2023 to March 2025 and assessment of blood pressure, Body Mass Index (BMI), and biochemical parameters was done. Microalbuminuria was assessed and its association with cardiovascular abnormalities was checked by ECG and 2D-ECHO findings. Statistical association (done using Chi-square tests or Fisher’s-exact test for categorical data; Logistic regression analysis for establishing microalbuminuria as a predictor of cardiovascular disease) was checked to ascertain whether microalbuminuria has any prognostic value in stratifying cardiovascular risk. Results: The incidence of microalbuminuria in patients with hypertension was 67 (44.6%) and there was a significant relationship between microalbuminuria and systolic (p=0.041) and diastolic blood pressure (p=0.019). Left Ventricular Hypertrophy (LVH) was seen in 32 (21.3%) of the patients. It is a marker of long standing, uncontrolled hypertension and was significantly associated with microalbuminuria (p=0.014). Logistic regression analysis detected microalbuminuria (OR=3.759, p=0.006) as independent predictor of cardiovascular abnormalities. Conclusion: Hypertension is a major healthcare burden with increasing prevalence. It can lead to several complications. Microalbuminuria was found to be present in about 44% of the study population. This study shows a positive association between microalbuminuria and cardiovascular disease {Odds Ratio (OR) of 3.759}.

Bridging Knowledge Gaps: The Influence of Structured Education on Parental Knowledge and Attitude towards the Right to Education in Community

Neha Anil Katakwar, Darshana Wankhede, Bibin Kurian, Archana Maurya Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: One of the most significant and widely acknowledged rights in international human rights law is the Right to Education (RTE). The field of society is significantly impacted by education. Since it is safe to infer that an individual is incomplete without schooling. Education is what makes a person civilised, polished, cultured and knowledgeable. Education plays a major role in creating an optimal environment and encouraging openness and effective governance within an entity. Aim: To evaluate parental knowledge and attitude regarding the RTE Act and its implications for their children within a defined community. Materials and Methods: This quasi-experimental study was conducted in the Sawangi Meghe Wardha community area of Maharashtra, India, from November 2023 to May 2024. A convenience, non probability sampling technique was used to recruit a sample size of 55 parents. After ensuring each participant that their information would remain anonymous, the researcher contacted them, explained the purpose of the research and solicited their concerns. A knowledge questionnaire and attitude scale was given to assess the knowledge and responses of rural parents. The findings of the study were analysed using t-test and one-way Analysis of Variance (ANOVA). Results: The majority of parents were middle-aged, with 80% falling within the 31-35 years age range. Most parents were male, making up 69.1% of the total, while 30.9% were female. A comparative analysis of parents’ knowledge and attitudes regarding the RTE across different neighbourhoods revealed significant improvements following the planned teaching initiative. The knowledge scores showed a marked increase, with a t-value of 18.38, indicating the programme’s effectiveness in enhancing RTE awareness. Furthermore, parental attitudes toward the RTE Act also improved significantly, as evidenced by a t-value of 9.11 (p-value <0.05), confirming that the initiative successfully fostered a more positive outlook on children’s RTE in the targeted communities. Conclusion: The parental attitudes and knowledge regarding RTE Act were considerably enhanced by the Planned Teaching Initiative. Increasing community involvement in guaranteeing access to high-quality education and improving advocacy for children’s educational rights might result from raising parental understanding of the RTE Act.

Pharmacoepidemiological Evaluation of Glaucoma among Patients Attending Ophthalmology Outpatient Department: A Hospital-based Cross-sectional Study

Rashmi Ranjan Bhadra, Jayanti Prava Behera, Aurobindo Samantray, Padmaja Priyadarshini Kar, Y Roja Ramani Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Glaucoma is the leading cause of irreversible blindness in India, accounting for 5.5% of total blindness. In South Odisha, there are limited studies evaluating the pharmacoepidemiology of glaucoma. Understanding the sociodemographic characteristics of glaucoma patients, along with their medication usage and prescribing trends, is essential for optimising disease management at tertiary care centers. Aim: To evaluate the sociodemographic characteristics of glaucoma patients and the drug utilisation pattern of anti-glaucoma medications in the study population. Materials and Methods: The present hospital-based observational cross-sectional study was performed from September to October 2023. Based on previous literature and the prevalence of glaucoma, the sample size was estimated to be 70. A standardised case record form was used for data collection, which included the patients’ demographic details and the drugs prescribed. Data were analysed using MS Excel and IBM Statistical Package for Social Sciences (SPSS) Version 25 software. Fisher’s Exact test was employed to establish an association between age groups (<50 years and ≥50 years) and gender association with combination therapy and monotherapy. The Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) systems as per World Health Organisation (WHO) and WHO core prescribing indicators were used as study tools for pharmacoepidemiological evaluation. Results: A total of 70 patients participated in the present study in which female preponderance was observed. The most common age group was 50-70 years. Patients were mostly affected by open angle glaucoma 48 (68.57%) compared to angle closure glaucoma 22 (31.43%). A total of 114 drugs were prescribed for the treatment of glaucoma, with an average of 1.63 drugs per prescription. Combination therapy was prescribed for 41 (58.57%) of patients, with the most commonly used combination being brimonidine and timolol 30 (73.17%), followed by dorzolamide and timolol 11 (26.83%). Monotherapy was used for 29 (41.43%) of patients, where dorzolamide 16 (55.18%) was the drug most frequently prescribed, followed by timolol 8 (27.58%) and Latanoprost 5 (17.24%). No statistically significant association was found between gender distribution and the two age groups (<50 years and ≥50 years) with combination therapy or monotherapy. Conclusion: This study provided a detailed analysis of the sociodemographic characteristics of glaucoma patients and evaluated the utilisation pattern of anti-glaucoma drugs. By focusing on rational drug use, this research aimed to improve the understanding of prescribing trends and identify areas for optimising treatment practices in glaucoma management.

Heart Rate Variability in Young Adults with Bronchial Asthma with and without Previous COVID-19 Infection: A Cross-sectional Study

Gunaseelan Deivendran, Thamarai Selvi Kanagaraj, Bhavisha Sreenivasan Leelabai, Nalini Jayanthi, Saravanan Ayyavoo Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Heart Rate Variability (HRV) is a validated, non invasive measure of Autonomic Nervous System (ANS) function. Both bronchial asthma and post Coronavirus Disease-2019 (COVID-19) syndrome are independently associated with autonomic dysregulation. However, the combined impact of asthma and prior COVID-19 infection on HRV in young adults remains underexplored. Aim: To compare HRV parameters between young adult bronchial asthma patients with and without a history of COVID-19, and assess the extent of autonomic dysfunction attributable to COVID-19. Materials and Methods: This cross-sectional study included 100 bronchial asthma patients aged 20-40 years, equally divided into two groups based on COVID-19 history. Standardised HRV recordings were obtained in the supine position following a 15-minute rest period. HRV was assessed using time domain indices- Standard Deviation of NN intervals (SDNN) and Root Mean Square of Successive Differences (RMSSD)- and frequency domain indices- Low Frequency (LF), High Frequency (HF), and LF to HF ratio (LF/HF ratio)- using Kubios HRV software. Haemodynamic parameters including Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Pulse Rate (PR) were also compared. Statistical analysis was performed using One-way Analysis of Variance (ANOVA) and independent t-tests, with a p-value of less than 0.05 considered statistically significant. Results: Asthma patients with prior COVID-19 infection demonstrated significantly higher DBP (84.48±7.38 vs. 79.12±6.22 mmHg; p<0.001) and PR (88.38±10.48 vs. 79.88±9.74 bpm; p<0.001). HRV analysis revealed significantly lower SDNN (30.18±5.18 vs. 33.54±6.27 ms; p=0.002), RMSSD (23.80±4.72 vs. 28.00±5.54 ms; p<0.001), and HF power (92.54±11.67 vs. 115.48±17.53 ms2; p<0.001) in the post COVID group, along with elevated LF power (232.76±24.62 vs. 193.32±20.28 ms2; p<0.001) and LF/HF ratio (2.52±0.32 vs. 1.67±0.23; p<0.001), suggesting heightened sympathetic activity and reduced vagal modulation. Conclusion: Asthma patients with prior COVID-19 infection exhibit significant autonomic dysfunction marked by reduced parasympathetic modulation and heightened sympathetic dominance. These findings highlight the importance of cardiovascular autonomic assessment in asthma patients recovering from COVID-19, particularly for early identification of dysautonomia and cardiovascular risk stratification.

Effect of Ticagrelor on Glycaemic Parameters and Inflammatory Mediators in High Fat Diet and Streptozotocin Induced Diabetic Rats: An Experimental Study

Sachin Patel, Nayana K Hashilkar, Vidya Mahalmani Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Type 2 Diabetes Mellitus (T2DM) is a growing global health concern, often associated with chronic inflammation and cardiovascular complications such as Acute Coronary Syndrome (ACS). Emerging evidence suggests that antiplatelet agents may exert beneficial effects beyond their cardiovascular indications, including the modulation of glycaemic control and inflammatory responses. Ticagrelor, a P2Y12 receptor antagonist primarily used for managing ACS, has been proposed to influence metabolic and inflammatory pathways. Aim: To evaluate the effect of ticagrelor on glycaemic parameters in a High Fat Diet (HFD) and Streptozotocin (STZ)-induced diabetes mellitus in male Wistar rats. Materials and Methods: The present experimental study was conducted in the Department of Pharmacology at Jawaharlal Nehru Medical College, Belagavi, Karnataka, India, from March 2021 to February 2022. A total of 36 rats were utilised in the study. Among these, six were designated as the normal control group. The remaining 30 rats were subjected to diabetes induction through a combination of HFD administration for two weeks and a single intraperitoneal injection of STZ at a dose of 35 mg/kg. Following the induction of diabetes, one group served as the diabetic control with no treatment, while other groups received oral treatment either with metformin, ticagrelor (16.2 mg/kg), or ticagrelor (35 mg/kg) for six weeks. Body weights and Fasting Blood Glucose (FBG) levels were measured at baseline, 14 days of HFD, three weeks following treatment, and at the end of the study. Glycated Haemoglobin A1c (HbA1c) was measured at baseline and at the end of the study. Inflammatory markers Interleukin (IL)-1β, Tumour Necrosis Factor (TNF)-α, and IL-6 were assessed at the end of the study. Data were presented as Mean±Standard Error of the Mean (SEM). A p-value ≤0.05 was considered statistically significant. One-way Analysis of Variance (ANOVA) followed by Bonferroni’s post hoc test was used for the analysis of study variables, and paired data were analysed using the paired t-test. Results: All three treatments significantly reduced FBG (p<0.0001) and HbA1c (p<0.0001) compared to the untreated rats. Additionally, compared to the ticagrelor (16.2 mg/kg) group, the ticagrelor (35 mg/kg) group significantly decreased these values (p<0.0001). The inflammatory markers (IL-1β, IL-6, TNF-α) were significantly reduced (p<0.0001) in all treatment groups compared to untreated rats. Conclusion: The treatment of diabetic rats with oral ticagrelor improved the HFD and STZ-induced elevations in Fasting Blood Sugar (FBS), glycosylated hemoglobin (HbA1c), and inflammatory mediators. Furthermore, ticagrelor (35 mg/kg) was found to be more efficacious across all trial variables compared to Ticagrelor (16.2 mg/kg).

Impact of Gaming Addiction on Sleep Quality among Medical Students: A Cross-sectional Study from Chengalpattu District, Tamil Nadu, India

BG Shakthi Chakravarthy, Aamina Hussain, Roshni Mary Peter, VV Anantharaman Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Games are one of the most common forms of recreation, whether played in solitude or with others. Obsessive video game playing can affect a person’s everyday activities, alter their behaviour, and have numerous negative repercussions on their physical and mental health. Addiction to video games has become a public health concern, particularly among youth and college students. It impacts daily functioning, disrupts sleep, and poses physical and psychological risks. According to the National Sleep Foundation, students should get between seven and nine hours of sleep each night; yet, college students often struggle to meet their basic needs, including adequate sleep. Aim: To estimate the prevalence of gaming addiction and its association with sleep quality among medical college students in Chengalpattu, Tamil Nadu, India. Materials and Methods: The present cross-sectional study was conducted among 484 medical students in the Chengalpattu district from May to July 2024. A two-stage random sampling method was used for sample selection. A semi-structured questionnaire consisting of sociodemographic details, the Gaming Addiction Scale (GAS), and the Pittsburgh Sleep Quality Index (PSQI) to assess gaming addiction and sleep quality, respectively, were employed to collect data. Data were analysed using SPSS version 26. Results: The mean age of participants was 21.65±3.17 years. The majority of them came from nuclear families 352 (72.7%), and 268 (55.4%) were hostellers. The mean score for sleep quality was 6.08±2.69. Approximately 49.6% of students reported poor sleep quality. Chi-square tests indicated a statistically significant association (p=0.001) between gaming addiction and sleep quality, with 140 (87.5%) of addicted gamers showing poor sleep. A significant association was also found between age, residence, and addiction status with sleep quality (p<0.05). A regression model showed that addiction, age, and type of family were strong predictors of poor sleep, indicating that older individuals and males had poorer sleep quality. Conclusion: Gaming addiction was observed in 33.1% of participants, while 49.6% reported poor sleep quality. Among those with gaming addiction, 87.5% experienced poor sleep. The likelihood of poor sleep quality was found to be three times higher in addicted gamers compared to non-addicted individuals.

Evaluation of Training Programme on Vision Screening and Primary Eyecare for the Frontline Healthcare Workers in Kathua District, India: A Mixed-method Study Design

Priyanka Sodani, Yangchendolma, Monikajasrotia, Parveensingh, Anureet Kour Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Frontline healthcare workers are the first link between the community and health facilities. By acquiring proper training and providing them with basic logistics, frontline health workers can identify patients with vision impairment and refer them to primary eye care centres. Aim: To assess the training outcomes of frontline healthcare workers in primary eye care and vision screening. Materials and Methods: A prospective cohort study (mixed-method) was conducted in the Kathua district from February 2022 to February 2024, involving 96 frontline healthcare workers from five blocks of the district. A one-day training session was conducted for each block using charts, diagrams, role-plays and small group discussions. The training of frontline healthcare workers was evaluated on four aspects of the Kirkpatrick model. Data analysis was performed using Open Epi version 3.01. Quantitative data analysis was conducted using paired t-test and Chi-square test, with a p-value <0.05 considered significant. For qualitative data analysis, all audio responses were transcribed, and themes were generated for each component. Results: Out of 96 frontline healthcare workers, 56 were included in the study. The mean age of the frontline healthcare workers was 36.14 years, ranging from 20 years to 58 years. Pre- and post-training scores were 7.08±2.29 and 10.75±2.58, respectively, with p-value <0.01 (paired t-test). Focus Group Discussions (FGD) revealed that healthcare workers were now confident in performing vision screenings and could guide people regarding eye diseases. They also mentioned issues related to transportation and incentives. There was no significant difference in Outpatient Department (OPD) patient turnout three months before and after training when considering the five blocks of Kathua district. Conclusion: Training of frontline healthcare workers has notably increased their knowledge about primary eye care and their skills in vision screening. This observation reinforces the potential of frequent training for healthcare workers to ensure sustained outreach, follow-up and compliance with treatment regimens, which are often challenging in remote and underserved areas. The study also highlights the experiences, practical problems and challenges faced by healthcare workers, as well as their knowledge application in the community, which needs to be addressed by healthcare policymakers.

Pathological Response Assessment following Long Course Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer: A Single Institutional Cohort Study

Maria Baby, Jomon Raphael, B Rajkrishna, Mathew Varghese, Febin Antony Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Neoadjuvant chemoradiation and Total Mesorectal Excision (TME) have shown pathological complete response (pCR) rates of 15-27%. The pCR is a significant predictor of survival. The Mandard Tumour Regression Grading (TRG) system is used to report pathological response. Aim: To evaluate the pathological response in patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiation and to investigate Disease-Free Survival (DFS). Materials and Methods: This single-centre cohort ambispective study was conducted from January 2019 to July 2023 at the Amala Institute of Medical Sciences, Thrissur, Kerala, India. It included patients aged 18-75 years with T3, T4, any NM0, and any T, N1, N2M0 rectal cancer, with an Eastern Cooperative Oncology Group (ECOG) performance status of 1-2. Patients who did not undergo surgery or chemotherapy at our centre, those who refused surgery, and those planned for Total Neoadjuvant Therapy (TNT) or short-course radiation therapy were excluded. Thirty-nine patients meeting the criteria were included in the study. All patients underwent neoadjuvant chemoradiation using Intensity Modulated Radiation Therapy (IMRT) to a dose of 50.4 Gy in 28 fractions over five and a half weeks, combined with concurrent chemotherapy using Capecitabine 825 mg/m² twice daily. All operable patients subsequently underwent TME, followed by adjuvant chemotherapy. Pathological response was assessed using Mandard TRG. Results: Thirty-nine patients were enrolled. The most common tumour location was found to be between 6-10 cm from the anal verge (22, 56.41%). The most frequent radiological T stage was T3, constituting 26 patients (66.67%), and 16 patients (41.03%) presented with N2 disease. TRG 1 was observed in seven patients (17.95%), TRG 2 in six patients (15.38%), TRG 3 in 21 patients (53.85%), TRG 4 in four patients (10.26%), and TRG 5 in one patient (2.56%). The median follow-up time was 24 months (range: 3-60 months). The two-year DFS was 86%. Conclusion: Neoadjuvant chemoradiation in locally advanced rectal cancer demonstrated meaningful pathological tumour regression and encouraging DFS outcomes.

Diagnostic Accuracy of Artificial Intelligence-assisted Chest X-ray Interpretation Tools for Screening of Tuberculosis: A Systematic Review and Meta-analysis

Raju Sarkar, Medha Wadhwa, Dhaval Parmar, Apurvakumar Pandya, Devang Raval, Somen Saha, Harsh Shah, Kavitha Rajsekar Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Tuberculosis (TB) continues to be a major worldwide health concern, which is the leading cause of death in nations like India. Despite various efforts to combat TB, effective screening and timely diagnosis remain challenging. The use of Artificial Intelligence (AI) in computer-aided interpretation of Chest X-Rays (CXRs) has demonstrated potential in improving TB detection. Aim: To evaluate the diagnostic accuracy of AI-assisted CXR interpretation tools for TB screening. Materials and Methods: Authors employed Systematic Review and Meta-analysis (SR/MA) using the Preferred Reporting Items for SR/MA of Diagnostic Test Accuracy (PRISMA-DTA) guideline. A comprehensive literature search was conducted for studies published between January 2019 and December 2023, focusing on AI-assisted software’s diagnostic accuracy in interpreting CXRs. Electronic databases such as Google Scholar, ScienceDirect, PubMed, and Institute of Electrical and Electronics Engineers Xplore (IEEE) were used. The raw diagnostic accuracy data, sensitivity, specificity, and Area Under the Curve (AUC) of the studies that met the inclusion criteria were examined and meta analysed to estimate pooled diagnostic accuracy measures. Results: There were 1,825 records found in the database search. Ensuing screening and duplication removal, 170 full-text publications were assessed; 14 of them satisfied the requirements for inclusion in the SR/MA. The findings of SR highlight the important role of AI assisted diagnostic tools in faster and larger screening of patients. The meta-analysis revealed the overall sensitivity of AI assisted tools to be 92% (62.9-98.7%) while specificity was 98.2% (68.4-99.9%). Conclusion: Although the large confidence interval questions the generalisability of the findings and consistency of the results, the present review signifies the important horizon that can be explored further for strengthening the TB elimination efforts.

Immunophenotypic Aberrancies in Acute Lymphoblastic Leukaemia: A Cross-sectional Study from a Tertiary Care Centre in Rajasthan, India

Shikha Goyal, Manoj Sharma, Neha Sethi, Shweta Bansal, Maneesh K Vijay, Ram Mohan Jaiswal, Abha Mathur, Aditya Mundra Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Leukaemic cells display characteristic patterns of surface antigenic expression. Aberrant phenotypes are defined as patterns of antigen expression on neoplastic cells that deviate from the process of normal haematopoietic maturation. Flow cytometric immunophenotyping in acute leukaemia is an important tool for the detection of these aberrancies. Aim: The present study aimed to access immunophenotypic aberrancies in B and T Acute Lymphoblastic Leukaemia (ALL). Materials and Methods: This prospective cross-sectional study included 137 newly diagnosed ALL (B and T lineage) patients from June 2023 to November 2024 at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India. Haematological parameters, including mean haemoglobin levels, Total Leukocyte Count (TLC), platelet count, and blast percentage were analysed using a cell counter and peripheral blood and bone marrow examination. Flow cytometric analysis was performed using the Beckman Coulter DxFLEX 13-colour flow cytometer. Cytogenetic studies were carried out using conventional G-banding karyotyping. Statistical analysis was conducted using the Statistical Package for Social Sciences (SPSS) statistics software windows version 22.0 released 2013. Statistical tests like Pearson’s Chi-square test and Mann-Whitney Test were applied. Results: Out of 137 cases of ALL; B-ALL comprised 114 (83.2%) cases and T-ALL 23 (16.7%) cases. For B-ALL, the mean age was 23.9±20.05 years whereas T-ALL subjects had a mean age of 25.3±20.88 years. The proportional frequency of aberrant antigen expression in B ALL and T-ALL was 53 (46.50%) and 7 (30.4%), respectively. The most common aberrant antigen in B-ALL was CD33 and in T-ALL was CD13. No significant association between haematological parameters and cytogenetic abnormalities in cases with conventional and aberrant phenotype. Conclusion: B-ALL showed greater antigen heterogeneity than T-ALL. Aberrant markers may aid in residual disease monitoring, indicate genetic events, predict prognosis, and serve as therapeutic targets.

Association of Single Nucleotide Polymorphisms with Type 2 Diabetes Mellitus within the Punjabi Population: A Case-control Study

Jaswant Kaur, Sahiba Kukreja, Mandeep Kaur, Jaskiran Kaur Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Type 2 Diabetes Mellitus (T2DM) is influenced by both genetic and environmental factors. The TCF7L2 gene, especially the rs12255372 polymorphism, is linked to a higher risk of T2DM in various groups. However, its effect on the genetically and environmentally unique Punjabi population is not well-studied. Aim: To determine the impact of the TCF7L2 (rs12255372) polymorphism on T2DM in the Punjabi Population, India. Materials and Methods: A case-control study was conducted at Sri Guru Ram Das Institute of Medical Sciences and Research, Sri Amritsar, Punjab, India, from April 2022 to July 2024. The study included 200 participants, divided into two groups: Group I consisted of 100 T2DM patients (cases), while Group II comprised 100 healthy individuals (controls). A range of anthropometric, biochemical, and genetic parameters were assessed, including the genotyping of the rsrs12255372(G/T) SNP using real-time Polymerase Chain Reaction (PCR). Measurements were taken for Fasting Plasma Glucose (FPG), Glycated Haemoglobin (HbA1c), and lipid profiles. Odds Ratios (OR) were calculated and statistical analyses were performed using student’s t-test, with a significance level set at p<0.05. Results: In the present study, cases had significantly higher mean age (47.05±8.76 vs. 37.70±7.19 years, p<0.001) and had higher Body Mass Index (BMI) (27.7±5.8 vs. 21.8±1.6, p<0.001) than controls. Most participants in both groups were aged 41-50. Females were more prevalent in the case group (77 vs 62%). Cases also exhibited higher fasting blood glucose (248.8±82.36 vs 93.56±11.72) and HbA1c (9.7±2.1 vs 5.44±0.37%). The TCF7L2 rs12255372 “T” allele was more prevalent in cases. The GT genotype was more frequent in cases (38%) than controls (24%, OR=1.86, 95% CI 1.01-3.45), as was the TT genotype (4 vs 1%). Triglycerides (TG) were significantly higher in cases (176.0±38.8 vs. 153.76±36.61 mg/dL, p<0.001), with a significant association between high TGs and the rs12255372 GT/TT genotypes in cases (p=0.001). Conclusion: The current study identified a significant correlation between the TCF7L2 gene (rs12255372 (G/T) polymorphism) and an increased risk of T2DM in the Punjabi population of India.

Analysis of Off-label Use of Intravenous Immunoglobulin in a Tertiary Health Care Facility: A Record-based Cross-sectional Study

Mitali Ganapati, Snigdha Rani Panigrahy, Abinash Panda, Jayanti Prava Behera Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: The off-label clinical use of Intravenous Immunoglobulin (IVIG) has increased despite the existence of its approved indications by drug regulatory agencies. IVIG is an expensive drug and its availability is also limited; hence, judicious use of IVIG is highly recommended. Aim: To evaluate the utilisation pattern and cost burden of IVIG in the In-Patient Departments (IPD) of a tertiary healthcare facility. Materials and Methods: This record-based cross-section observational study was carried out in the IPD of MKCG Medical College, Department of Pharmacology, MKCG, MCH, Berhampur, Odisha, India, from September 2022 to September 2023, where a total of 108 patients who were prescribed and received IVIG for any clinical condition were included. Clinical data, like clinico-demographic profile, diagnosis, dosage and duration of IVIG, were collected in a predesigned structured Case Record Form (CRF). The utilisation pattern was compared with the drug regulatory agencies’ United States Food and Drug Administration (USFDA) approved IVIG conditions to determine the proportion of such use. Data were collected, compiled and analysed using MICROSOFT (MS) Excel and Statistical Package for Social Sciences (SPSS) version 25.0. Data were expressed as frequency, percentages, median and interquartile range. Results: The median age of patients who received IVIG was 12 years and Interquartile Range (IQR) was 29 (Q1=3, Q3=32). Majority of the cases receiving IVIG, i.e., 59 (54.6%), were from paediatrics IPD. The proportion of male patients was higher at 57 (52.7%). Guillain-Barré Syndrome (GBS) was the most common off-label indication, accounting for 55 (50.9%), followed by Multisystem Inflammatory Syndrome (MIS-C) in 12 (11.1%) children. In 73 (67.59%) of cases, IVIG was administered for off-label indication, 8 (6.48%) of cases for FDA-approved indication and remaining for others. The highest expenditure was done on diseases with off-label indications, which accounted for 88.63% of total expenditure for IVIG. Conclusion: In the present study, the use of IVIG for off-label indications was higher than for approved indications. National or local drug protocols are needed to prescribe more rational IVIG utilisation and assist physicians to use IVIG for approved or high evidence-based indications.

Ultrasonographic Nomograms of Foetal Fourth Ventricle Biometry and its Correlation with Transcerebellar Diameter and Gestational Age among Normal Foetuses: A Cross-sectional Study

N Padmalatha, Paarthipan, Parthasarathy, Francis Nanda Prakash Monteiro Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: The foetal fourth ventricle marks an important landmark for evaluating the development of the posterior fossa. Prenatal diagnosis of midbrain and hindbrain abnormalities is based on aberrant cerebellum and retrocerebellar space size and shape, with the most prevalent sign being an ‘open fourth ventricle’. Aim: To present the normal range of measurements of the foetal fourth ventricle and correlate the fourth ventricle biometry with Transcerebellar Diameter (TCD) and Gestational Age (GA) in normal foetuses. Materials and Methods: This cross-sectional study included 260 pregnant women with low-risk pregnancies between 19 and 35 weeks of gestation, with the known Last Menstrual Period (LMP) confirmed by first trimester ultrasonography. The foetal heads were scanned in the axial plane. The TCD and fourth ventricle anteroposterior and transverse diameters were obtained ultrasonographically from the pregnant women who were recruited to the Department of Radiology, Rajarajeswari Medical College and Hospital, Bengaluru, India, between January 2021 and December 2023. The routine foetal biometric parameters, such as Biparietal Diameter (BPD), Head Circumference (HC), Abdominal Circumference (AC), and Estimated Foetal Birth Weight (EFBW), were also recorded. Pearson correlation coefficients were calculated to examine the strength of the linear relationship between each of the fourth ventricle parameters, GA, and TCD. Regression analysis was performed to determine the equation of the linear fitted function with each of the independent variables (GA, TCD). All statistical analyses were performed using Statistical Package for Social Sciences (SPSS) software, Version 22.0 (IBM, Armonk, New York). Results: The mean and Standard Deviation (SD) of the fourth ventricle anteroposterior and transverse diameters are 2.122 mm (SD=0.309) and 5.648 mm (SD=1.975), respectively. The Pearson correlation coefficients of the fourth ventricle anteroposterior diameter for GA and TCD were r=0.917 and r=0.931, respectively. The coefficients of the fourth ventricle transverse diameter for GA and TCD were r=0.869 and r=0.884, respectively (p<0.001). The regression equations were plotted between GA and fourth ventricle anteroposterior diameter (r=0.917; p<0.001; y=0.406+(0.0716×GA (weeks) and transverse diameter (r=0.869; p<0.001; y=-4.753+(0.434×GA in weeks. A linear regression line was also plotted between TCD and fourth ventricle anteroposterior diameter (r=0.931; p<0.001; y=0.783+(0.0511×TCD (mm) and transverse diameter (r=0.884; p<0.001; y=-2.483+(0.310×TCD in mm. Conclusion: The study established normal foetal fourth ventricle measurements and found strong correlations between GA and TCD. These results support their use as reliable markers of normal foetal brain development.

Preoperative Serum Albumin, Serum Prealbumin, Serum Transferrin and Body Mass Index as Predictors of Postoperative Morbidity and Mortality in Laparotomy Cases: A Prospective Observational Study

Garlapati Sai Teja, S Biradar Dayanand, B Patil Mallikarjun, U Sindagikar Vikram, B Suntan Anand, Hanchinal Avinash Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Malnutrition significantly impacts postoperative outcomes in patients undergoing emergency laparotomy. Despite advances in surgical care, the role of preoperative nutritional parameters in predicting surgical outcomes remains crucial. Aim: To study the efficacy of preoperative serum albumin, serum prealbumin, serum transferrin and Body Mass Index (BMI) as predictors of postoperative morbidity and mortality in laparotomy cases. Materials and Methods: A prospective observational study was conducted at BM Patil College Hospital and Research Center, Vijayapura, Karnataka, India, from April 2023 to March 2024, which included 83 patients undergoing emergency laparotomy were included. Preoperative serum albumin, prealbumin, transferrin levels and BMI were measured. Primary outcomes included postoperative complications, mortality and length of hospital stay. Chi-square test, Student’s t-test, and Receiver Operating Characteristic curve (ROC) analysis were used for statistical evaluation (p<0.05). Results: The study population predominantly comprised middle-aged adults, with 34 (41%) aged 41-60 years, and showed a male predominance i.e., 58 (69.9%). Low albumin levels (<2.5 g/dL) were significantly associated with wound infection rates (77.8%, p<0.001). Transferrin levels <160 mcg/dL were associated with increased mortality (18.9%, p=0.04). Higher BMI was associated with increased mortality (p=0.007). ROC curve analysis showed BMI as the strongest predictor of mortality (AUC=0.735). Wound infection occurred in 48.2% of cases, with overall mortality rate of 9.6%. Conclusion: Preoperative serum albumin, prealbumin, transferrin, and BMI are significant predictors of postoperative outcomes in laparotomy patients, with low protein levels linked to complications and BMI showing the strongest association with mortality. Routine nutritional assessment is essential for improving surgical outcomes.

Comparison of Levobupivacaine 0.5% versus Ropivacaine 0.75% with Dexmedetomidine as an Adjuvant in Ultrasound-guided Supraclavicular Brachial Plexus Block: A Randomised Clinical Study

Dinesh Kumar Sahu, K M Akshay, Alpa S Sonawane, Atul Sharma, Reena Parampill Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Peripheral nerve blocks not only provide surgical anaesthesia but also minimise the stress response, in addition to providing postoperative analgesia. The addition of adjuvants augments the anaesthetic action of the drug and reduces the dose required, thus improving the safety margin. However, no single drug can be considered the optimum local anaesthetic or adjuvant at this time. In the quest to find a better local anaesthetic and adjuvant combination, dexmedetomidine has recently emerged as a promising adjuvant to local anaesthetics during regional anaesthesia procedures. Aim: To study the efficacy of levobupivacaine and ropivacaine with dexmedetomidine as an adjuvant using ultrasound in the Supraclavicular Brachial Plexus Block (SCPB). Materials and Methods: A randomised, double-blinded clinical study was conducted in the Department of Anaesthesiology, Jagjivan Ram Railway Hospital, Mumbai Central, Maharashtra, India from November 2019 to April 2021 on 60 adults aged 21-65 years with American Soceity of Anaesthesiology (ASA) class I and II, scheduled for upper limb surgery. Patients were randomised into two groups, each containing 30 patients. Group A received 20 mL of levobupivacaine 0.5% with 50 mcg of dexmedetomidine, while Group B received 20 mL of ropivacaine 0.75% with 50 mcg of dexmedetomidine. A comparison was made regarding the efficacy in terms of the onset of sensory and motor blockade, duration of sensory and motor blockade, haemodynamics, any adverse effects, and postoperative analgesia. Categorical covariates were compared using the Chi-square test, and continuous covariates were compared using the unpaired t-test. Results: The groups were comparable concerning demographic data and baseline haemodynamic parameters. There was no statistically significant difference when comparing the mean Heart Rate (HR), mean blood pressures, and mean oxygen saturations at different time intervals between the groups. The mean time±Standard Deviation (SD) for the onset of sensory block and motor block in the levobupivacaine group was 19.13±1.87 min and 29.53±2.86 min, respectively; this was statistically faster at 11.26±1.92 min and 7.53±1.35 min in the ropivacaine group (p-value <0.05). The mean duration of sensory and motor block in the levobupivacaine group was 459.83±26.40 min and 539.33±23.77 min, respectively, while it was longer at 878.66±17.46 min and 786.16±17.50 min in the ropivacaine group (p-value <0.05). Conclusion: The use of dexmedetomidine with ropivacaine for SCPB results in a quicker onset and longer anaesthetic effect compared to levobupivacaine. Dexmedetomidine should be utilised as an adjuvant to reduce anaesthesia induction time in SCPB.

Comparison of Placental and Birth Weight Ratios in Term Neonates, Neonates with Low Apgar Score, and Stillbirths in Asian Indian Population: A Retrospective Observational Study

Nuzhat Aziz, AV Thankamani, Sailaja Devi Kallur Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Unanticipated stillbirth or a low Apgar score baby at term gestation is an adverse outcome that is difficult to communicate to parents. Such conditions can be partly attributed to placental factors, indicated by low placental weight and a mismatch in the Birth Weight to Placental Weight (BW/PW) ratio. India has the largest burden of stillbirths; however, there is a lack of data from India on BW/PW ratios for stillbirths. Aim: To determine if there are significant differences in PW between normal live births, live births with low Apgar scores and stillbirths at term using local population centiles. Materials and Methods: A retrospective observational study was conducted using data retrieved from electronic medical records from January 2019 to December 2022 at the obstetrics department of Fernandez Hospital, a private tertiary referral perinatal institute with an Asian Indian population. All singleton term births were included after excluding multifoetal births, medical disorders and placental pathologies. The population was divided into three groups: newborns with normal Apgar scores, those with low Apgar scores and stillborn infants. STATA v14.0 (College Station, TX, USA) was used for statistical analysis to assess differences between the groups, with newborns with normal Apgar scores as the reference group. Results: There were 35,576 births during the study period, with 18,143 singleton term pregnancies, including 17,986 term normal Apgar births, 110 low Apgar births (0.36%), and 47 stillbirths (1.37 per 1,000). The mean BW, PW (p-value<0.001), and the proportion with PW <10^th centile (p-value<0.001) differed significantly between the three groups. The BW/PW ratio was >90^th centile in 10 stillbirths (21.74%), reflecting a mismatch in foetal and placental weight. Conclusion: Lower PW and higher BW/PW ratio centiles in term stillbirths validate their use as measures of placental function in evaluating all term adverse outcomes.

Comparison of Dimensional Stability of Casts Obtained from Elastomeric Impression Materials with Different Impression Techniques at Different Time Intervals of Cast Pouring after Subjecting them to Disinfection Protocols: An In-vitro Study

Marthala Sruthi Reddy, VVSN Raju Jampana, Sumeet Sharma, Mangipudi Krishna Sravan Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: The success of fixed prosthodontic treatment depends on many steps among which impression making is critical step. During impression making, the impression material is exposed to infected blood and saliva which is the potential source for cross contamination especially to clinicians and laboratory workers. When an impression is subjected to disinfection there may be change in dimensional accuracy which results in faulty prosthesis. Aim: To evaluate the dimensional stability of two elastomeric impression materials namely Vinyl Poly Siloxane (VPS) and Vinyl Poly Ether Siloxane (VPES) after subjecting them to chemical disinfection and making models through multiple pours at varying time intervals. Materials and Methods: The present in-vitro study was conducted in KIMS Dental College and St. Joseph Dental College, Andhra Pradesh, India, over a period of 5 months from August 2023 to December 2023. A total of 480 samples were prepared by pouring the casts with VPS and VPES materials using one stage and two stage impression techniques and then the impressions were subjected to korsolex and surfasept disinfectants. After disinfection the casts were poured at time interval of one hour, 24 hours, one and two weeks. Stereomicroscope was used to measure the diameter and height of die and digital calipers were employed to measure the inter distance between the dies. Four-way factorial Analysis of Variance (ANOVA) and pair wise comparisons were done using Least Significant Difference (LSD) Bonferroni test to analyse the data. The level of significance was set at p<0.05. Results: Significant differences were noticed (p=0.001) between VPS (7.99±0.05), and VPES (7.95±0.11) where the mean die height was significantly lower in VPS and VPES. Method of disinfection yielded an F ratio of 8.019 (p=0.001), indicating a significant difference between three disinfection protocols. The mean die diameter was significantly lower after Korsolex disinfection. Conclusion: Disinfection of VPES with korsolex, showed decrease in mean die height when the impressions are made with two step impression technique at two week time interval. When VPS was disinfected with surfasept, the mean values of die diameter are decreased for casts poured at one week time interval.

Medication Adherence and its Association with Treatment Satisfaction and Diabetes Related Psychological Distress among Type 2 Diabetes Mellitus Patients: A Cross-sectional Study from Rural Thiruvallur District, India

PL Thameen Raja Mohamed, AH Irfaunul Azees, Vinodhini Balamurugan, S Shravan Kumar, Ruma Dutta Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Effective management of Type 2 Diabetes Mellitus (T2DM) requires sustained medication adherence. However non adherence coupled with low treatment satisfaction and psychological distress, can adversely impact glycaemic control. Aim: To assess the level of medication adherence among patients with T2DM, and also to determine its relationship between treatment satisfaction, diabetes-related psychological stress. Materials and Methods: A community based cross-sectional study was conducted at ACS Medical College and Hospital, Thiruvallur, Tamil Nadu, India, from January to April 2024 among 350 adult T2DM patients selected through systematic random sampling. Data collection involved a semi-structured questionnaire, Morisky Medication Adherence Scale-4 (MMAS-4), Diabetes Treatment Satisfaction Questionnaire (DTSQ), and Diabetes Distress Scale-17 (DDS-17). Statistical analysis was performed using Chi-square tests and multiple logistic regression in Statistical Package for Social Sciences (SPSS) version 25 with significance value at p<0.05. Results: The mean age of participants was 46.3±10.4 years. Majority of the participants were female 186 (53.1%). Most of the participants were married 340 (97.1%) and 220 (62.9%) were employed, and over 189 (54%) belonged to the upper-middle class as per the Modified BG Prasad Scale. Among the participants, 135 (38.6%) exhibited high adherence, 137 (39.1%) moderate adherence, and 78 (22.3%) low adherence. Moderate treatment satisfaction was observed in 278 (79.4%), and 126 (36%) reported clinically significant psychological distress. Bivariate analysis reported that medication adherence showed significant associations with age, educational status, occupation, Socioeconomic Status (SES), mode of drug intake, number of doses per day, family support, glycaemic control drug regimen (p-value <0.05). Medication adherence also showed significant associations with treatment satisfaction scale (p-value=0.0001) and DDS (p-value=0.022). Multiple logistic regression analysis showed significance for age (p-value=0.002), educational status (p-value=0.010) and mode of drug intake (p-value=0.008). Conclusion: Medication adherence among rural T2DM patients was moderate and influenced by treatment satisfaction and psychological distress. Strengthening education, enhancing psychological support and implementing community based interventions are critical in improving adherence and clinical outcomes.

Efficacy of Diclofenac and Ketoprofen Transdermal Patches for Postoperative Analgesia and their Effect on Renal Functions in Patients Undergoing Percutaneous Nephrolithotomy: A Randomised Clinical Study

Sandip Baheti, Vaibhavi Singh Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Postoperative pain management following Percutaneous Nephrolithotomy (PCNL) is critical for patient comfort and recovery. Ketoprofen transdermal patches, a recent addition to Non Steroidal Anti-Inflammatory Drug (NSAID) analgesia, may offer better tolerability and analgesic efficacy compared to diclofenac patches. Aim: To compare the efficacy of diclofenac versus ketoprofen patches for postoperative analgesia and their effects on serum creatinine in patients undergoing PCNL. Materials and Methods: This double-blind, randomised clinical study included 52 patients (aged 18–60 years, American Society of Anaesthesiologists (ASA) I–II) undergoing elective PCNL at a tertiary care centre. Patients were randomly assigned to Group K (n=26, 30 mg ketoprofen patch) or Group D (n=26, 100 mg diclofenac patch). Patches were applied 30 minutes before the end of surgery. Pain was assessed using the Visual Analog Scale (VAS) at 0, 4, 8, 12, 16, 24 and 48 hours. Rescue analgesia (tramadol 50 mg) was administered for VAS ≥ 5. Serum creatinine was measured preoperatively and at 24 hours postoperatively. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 21.0, with p-value <0.05 considered significant. Results: Baseline demographics, including age, gender and ASA grading, were comparable between the groups. Group K had significantly lower VAS scores at eight hours (3.1±1.1 vs. 4.19±0.56; p-value <0.001), 24 hours (2.65±0.68 vs. 3.35±0.48; p-value <0.001) and 48 hours (2.4±0.5 vs. 3±0.74; p-value=0.002). More patients in Group D required rescue analgesia at four hours (p-value=0.009). Group D showed a statistically significant rise in serum creatinine postoperatively (p-value=0.02), while Group K did not (p-value=0.057). The incidence of headaches was higher in Group D (19.2%), with fewer overall side-effects reported in Group K (p-value=0.05). Conclusion: Ketoprofen patches provided superior analgesia and fewer adverse effects compared to diclofenac in post-PCNL patients. Both drugs demonstrated comparable renal safety over 24 hours. Ketoprofen may be a better alternative for transdermal analgesia in this setting.

Beam Data Validation during Transition from Flattened to Unflattened Beams in IMRT and VMAT Delivery: An Experimental Study

Pradeep Goswami, Punam Kumari, Brijesh Goswami, Rakesh Kumar Jain, Suresh Yadav, S Choudhary, Asiya Hilal, Kishore Singh Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: The commissioning process for Intensity-Modulated Radiotherapy (IMRT) and RapidArc is very rigorous and tedious. It involves manifold beam data measurement, Quality Assurance (QA) and acceptance testing of different parts of Linear Accelerator (Linac). Aim: To find out how the commissioning parameter of TG-119 will change when it is shifted from a flattened beam (6X) to Flattening Filter Free (6X_FFF) for RapidArc and IMRT plans. Materials and Methods: In this experimental study conducted at the Department of Radiation Oncology, Subharti Medical College, Meerut, Uttar Pradesh, India, between December 2021 to November 2022 the authors evaluated the effect of dose rate, gantry speed, leaf speed and intentional error by Picket Fence (PF) tests using Electronic Portal Imaging Device (EPID) and GafchromicTM EBT3 films during commissioning of TrueBeam Linac (Varian Medical System, Palo Alto, CA). For comparison, RA and IMRT plans are made for all tests as per American Association of Physicists in Medicine Task Group-119 (AAPM TG-119). Confidence Limit (CL) was set to have 95 percent of the measured data within tolerance limit. Results: For IMRT (static and arc mode) recommendations and methodology were evaluated effectively to check commissioning parameter precision. Average absolute deviation (DiffAbs) for variable Dose Rate and Gantry Speed (DR_GS) has been within 1.5 % for both 6X and 6X_FFF energies. Their (DiffAbs) for variable Leaf Speed and Dose Rate (LS_DR) was also within 1.5%. Result for field-by-field measurements for IMRT and RapidArc for 6X and 6X_FFF energies shows that overall mean for 6X energy is 99.83 and 99.88, respectively, for IMRT and RapidArc cases, with CL values of 0.50 and 0.32. The 6X_FFF energy result is 99.81 and 99.87 for IMRT and RapidArc cases, with CL values of 0.55 and 0.34.In comparison to RapidArc, IMRT plans have more Monitor Units (MUs). RapidArc plans require less time to deliver the same or better results than IMRT plans. Conclusion: Accurate delivery of RapidArc and IMRT plans for different beam modalities (6X and 6X_FFF), accepted CL values can be utilised as a baseline to evaluate the quality of QA procedure, accuracy and wholeness of Treatment Planning System (TPS).

Comparison of Cemented Bipolar Hemiarthroplasty versus Proximal Femoral Nail Antirotation in Patients with Unstable Intertrochanteric Femur Fractures: A Prospective Interventional Study

Aditya Kumar Singh, Akshat Mittal, Manvendra Singh Rawat, Sanjay Dalakoti, Anil Kumar Joshi, Pavneesh Kumar Lohan, Chandra Shekhar, Indrajit Das Bhoumik Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Unstable intertrochanteric femur fractures in the elderly present treatment challenges due to high complication and mortality rates. While Intramedullary Fixation (IMF) with Proximal Femoral Nail Antirotation (PFNA) is the standard for stable fractures, its effectiveness in unstable fractures is limited. Cemented Bipolar Hemiarthroplasty (BH) has emerged as an alternative, potentially reducing implant-related complications. Aim: To compare clinical and functional outcomes of cemented BH versus PFNA in elderly patients with unstable intertrochanteric femur fractures. Materials and Methods: A prospective interventional study was conducted at Department of Orthopaedics, Government Doon Medical College and Associated Hospital, Dehradun, Uttarakhand, India, from July 2023 to December 2024. A total of 100 patients aged ≥65 years with AO type A2 unstable intertrochanteric fractures were allocated to hemiarthroplasty (Group I, n=50) or PFNA (Group II, n=50). Outcomes assessed included Harris Hip Score (HHS), pain using the Visual Analogue Scale (VAS), operative time, blood loss, time to weight-bearing, hospital stay and complications. Data were analysed using appropriate statistical tests, with significance set at p-value<0.05. Results: Group I participants had a slightly higher average age (78.2 years) compared to Group II (76.7 years). The groups were comparable demographically. Group I had longer operative times (96.2±12.5 min vs. 65.3±12.5 min, p=0.001) and greater blood loss (280.2±50.0 mL vs. 150.3±45.0 mL, p=0.001). Hospital stay was similar for both groups. HHS was higher in Group I at one and three months (p=0.001) but comparable at six months and one year. VAS scores indicated less pain in Group I at one month. Complications were low and similar; one reoperation occurred in Group II. Conclusion: Cemented BH yields functional outcomes comparable to PFNA but involves longer surgery and more blood loss. It may facilitate earlier mobilisation and reduce implant complications. The treatment choice should be individualised.

Role of Resilience Factors Affecting Work Performance among Allied Health Professionals: A Systematic Review

H Lalrohlui, Jyoti Sharma, Mohammad Sidiq, Aksh Chahal Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: It is becoming more and more important for health services worldwide that allied health professionals make sure they give patients the most appropriate and timely care. However, the demands of time pressure, workload, emotional worries, and interacting with numerous professional groups and clients frequently cause allied health practitioners stress that is detrimental to their physical and mental wellbeing. To cope with daily high-performance resilience, play an important role where resilience is defined as a capacity to bounce back from or change with ease. Aim: The study aimed to to identify the resilience elements that have an impact on work performance of allied health professionals. Materials and Methods: In the present Systematic review electronic databases like Scopus, PubMed, Google Scholar, Cochrane and Pedro were searched with keyword “allied health professionals”, “resilience factors”, “resilience” and “performance’’ using boolean operators “AND” and “OR” in between (“Resilience” OR “Resilience factors” OR “Psychological resilience” OR “Occupational resilience” OR “Coping strategies”) AND (“Allied Health Professionals” OR “Health workers” OR “Rehabilitation professionals” OR “Physiotherapists” OR “Occupational therapists” OR “Speech-language pathologists” OR “Radiographers” OR “Medical technologists”) AND (“Work performance” OR “Job performance” OR “Occupational performance” OR “Work productivity” OR “Job satisfaction” OR “Professional efficacy” OR “Burnout” OR “Stress management”).A total of 291 articles were found in the year between January 2013 to December 2023. A number of 63 articles fell under eligibility criteria out of which 14 were included in this review. Results: The resilience factors affecting work performance of allied health professionals were found from the literature. Primary resilience factors like coping, communication, mindfulness, and self-efficacy directly enhance work performance by improving stress management, focus, and confidence. Secondary factors such as positive emotions, self-management, and grit support sustained productivity and perseverance. Tertiary factors including life experience, maturity, optimism, social support, and healthy habits indirectly strengthen resilience, promoting well-being and long-term effectiveness. Together, these factors build a foundation for consistent, high-level work performance in challenging environments. Conclusion: The study concluded key factors that impact the performance of allied health professionals were effective ways of coping, good communication skills, practicing mindfulness and feeling confident in one’s abilities.

Assessment of Nail Growth by Election Ink Mark in Normal and Co-morbid Individuals: A Prospective Observational Study

Siddharth Shah, Shubham Darda, Jitendra Lakhani, Vishalkumar Rameshbhai Kathrotiya, Shivamkumar Patel, Maulikkumar Karpatiya, Satyam Kumar, Som Jitendra Lakhani Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: During an election, an individual who casts a ballot is identified by the indelible electoral ink on their left index fingernail. Since nails are thought of as a window to internal organs, the disappearance of this ink mark from the nail and skin can be seen as a surrogate sign of the growth of nail and skin tissue in both healthy and diseased individuals. Aim: To investigate nail growth by observing indelible election nail ink marks in normal nails and in patients with systemic illnesses that affect the nails. Materials and Methods: This prospective observational study was conducted during India’s 18th Lok Sabha General Election, which took place from 19 April 2024 to 1 June 2024. Approval was obtained prior to the study. Participants were split into two groups: those with healthy nails and those with systemic disorders that impact the nails. Consent was obtained from the participants, who were asked to take serial digital photographs of the left index fingernail on four occasions (on voting day, once after the ink mark had left the skin and remained on the nail, once after approximately one month ±2 days and once at the end when the election ink mark had vanished). Results: Out of 312 participants (168 males and 144 females), 198 were healthy and 114 had co-morbidities. The mean time for the disappearance of the ink mark for participants with co-morbidities affecting the nails was 57.8±14.6 days, which was less than the mean time for disappearance for healthy participants (60.9±13.1 days). The findings, however, lacked statistical significance (p-value=0.06124). The disappearance of skin marks in both normal and co-morbid individuals was approximately a week. It was observed that patients with clubbing exhibited a faster rate of disappearance than those with other co-morbidities, with an average of 52.8±12.2 days. Conclusion: The development of nails slows down with age, although it can accelerate under systemic conditions. The findings, however, lacked statistical significance.

Prevalence of Human Leukocyte Antigen Incompatibility between Recipients of Live Relative Donor and Deceased Donor in Renal Transplantation in a Tertiary Care Centre in Southern India: A Cross-sectional Study

Therese Mary Dhason, Sornaranjani Manickam, Ananthakrishnan Parthasarathy, Kalpanaraj Dorairaj, Thyagarajan Ravinder, Suganthi Manikesi, Madhumathy Augustine, Devi Chithsabesan Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: The treatment options available for End-Stage Renal Disease (ESRD) are dialysis or kidney transplantation. Renal transplantation increases the lifespan of the patient and affords a better quality of life when compared to dialysis. The demand for organs is very high compared to the availability of donors. The donors in kidney transplantation can either be a relative (live donor) or a deceased donor. The outcomes of renal transplantation depend on the Human Leukocyte Antigen (HLA) match between the donor and the recipient. Aim: To determine the prevalence of HLA mismatch between recipients of live relative donor kidneys and deceased donor kidneys in renal transplantation. Materials and Methods: The study was a cross-sectional observational study conducted from May 2023 to May 2024 at Government Kilpauk Medical College, Chennai, Tamil Nadu, India after obtaining approval from the Institutional Ethics Committee. Since renal transplantation has been occurring only from May 2023 onwards and the number of samples received for testing was limited, all the samples received for crossmatch testing were included in this study to find the prevalence of HLA incompatibility. HLA crossmatching was performed using the microlymphocytotoxicity test. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 21.0. A Chi-square test was applied to determine the significance of the study results. Results: In this study, 49 live relative donors and 49 recipients were included, along with 12 deceased donors and 42 recipients awaiting renal transplantation. Female donors predominated among live donors, with 34 (69.39%) compared to 15 (30.61%) male donors in the live donor crossmatch. In the deceased donor crossmatch, male donors were predominant, with 7 (58.33%) compared to 5 (41.67%) female donors. The compatibility between live donors and recipients was 48 (97.96%), whereas for deceased donors and recipients it was 35 (83.33%). A comparison of the positive crossmatch between the recipients of live donors and deceased donors showed statistical significance (p-value=0.01438 at 0.05). A Chi-square test was conducted to assess the statistical significance of the Complement Dependent Cytotoxicity (CDC) test crossmatch and Flow Cytometry crossmatch, which was not significant (p-value=0.289013 at 0.05). Conclusion: Live relative donor transplantation has a better match than deceased donor transplantation. The CDC test plays a major role in HLA crossmatching in resource-constrained healthcare facilities.

Fistula Tract Laser Closure (FiLac) versus Standard Fistulectomy in the Treatment of Simple Perianal Fistula: A Prospective Interventional Study

Shreethi Sasidharan Pillai, D Balaji, Harshwanth Chandhar, G Tilak Ramu, K Shanmugapriya Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Perianal fistulas pose significant challenges due to their impact on patient Quality of Life (QoL) and their recurrent nature. Traditional treatments, such as standard fistulectomy, are effective but may lead to complications such as prolonged healing and postoperative pain. Fistula Tract Laser Closure (FiLaC) is a promising alternative that offers minimally invasive benefits. Aim: To compare short-term (postoperative pain, bleeding, mean hospital stay) and intermediate-term (wound healing) outcomes between FiLaC and standard fistulectomy in the treatment of simple perianal fistulas. Materials and Methods: A prospective interventional study was conducted at SRM Medical College Hospital and Research Centre, Chengalpettu, Tamil Nadu, India, in the Department of General Surgery over a period of 18 months, involving 108 patients randomised into FiLaC (group A) and standard fistulectomy (group B). Data on demographics, chief complaints, co-morbidities, short-term (postoperative pain, bleeding, mean hospital stay), and intermediate-term (wound healing) outcomes, as well as postoperative recovery, were collected and compared. Continuous variables were presented as descriptive statistics (mean and standard deviation), and a t-test was applied to determine associations. Categorical variables were expressed as frequency distributions and percentages. The association between categorical variables was tested using Chi-square tests, with a p-value of <0.05 considered statistically significant. Results: A total of 108 patients were involved in the present study. In group A (fistula laser closure), most participants (50%) were aged 20-40 years, while in group B (standard fistulectomy), the majority (46.3%) were aged 41-60 years. In group A (fistula laser closure), 40 (74.1%) were males and 14 (25.9%) were females. In group B (standard fistulectomy), 34 (63%) were males and 20 (37%) were females. group A exhibited shorter average operating times (27.59 vs. 34.8 minutes, p<0.001), reduced mean hospital stays (5 vs. 7 days, p<0.001), and faster wound healing. Postoperatively, FiLaC patients reported lower pain scores (p<0.001) and experienced less blood loss (p<0.001) compared to those who underwent standard fistulectomy. Moreover, FiLaC demonstrated a lower recurrence rate (9.3 vs. 25.6%, p=0.023), highlighting its efficacy in preventing fistula recurrence. Conclusion: FiLaC demonstrates advantages over standard fistulectomy in terms of efficiency, recovery time, and complication rates for treating simple perianal fistulas. Further research involving larger cohorts is warranted to validate these findings.

Clinical Profile of Cataract Patients with Asteroid Hyalosis in a Tertiary Care Centre: A Retrospective Observational Study

Raveena Jeyabalan, T Sangeetha, T Kavya Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Asteroid Hyalosis (AH) is an asymptomatic degenerative ocular condition of the vitreous associated with old age. Since vision is rarely affected, the focus is on clinical challenges in impaired optical biometry from light scatter and obscured fundus reflex caused by dense asteroid bodies during cataract surgery and subsequent visual outcomes. Aim: To study the associated factors, visual outcomes and complications in cataract patients with AH. Materials and Methods: This retrospective observational study included 45 patients with AH who underwent cataract surgery at the Ophthalmology Department of RL Jalappa Hospital and Research Centre in Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India. Medical records from January 2023 to June 2024 were reviewed for demographic details, associated factors, axial length, visual outcomes and postoperative complications. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 22.0, with the paired t-test applied to assess mean differences in visual acuity before and after surgery. A p-value of <0.05 was considered statistically significant. Results: The majority of patients were aged between 65 and 74 years (40.0%) and were predominantly normotensive (77.8%), non diabetic (71.1%), non smokers (93.3%), and reported no alcohol use. Visual acuity significantly improved postoperatively from a preoperative mean of 1.15±0.64 to 0.11±0.13 at one month follow-up (p-value <0.001). Common complications observed included striae keratopathy (28.9%) and intraocular lens (IOL) pigment dusting (11.1%). A significant inverse correlation was found between axial length and postoperative refraction (r-value=-0.373, p-value=0.012). Conclusion: In this older cohort, cataract surgery significantly improved visual acuity at one month. Mild complications included striae keratopathy and IOL pigment dusting. An inverse correlation between axial length and postoperative refraction observed which reinforces the importance of accurate biometry and potentially adjusted IOL power selection in these patients.

Association of Physical Activity with Sleep and Health-related Quality of Life in Patients with Polycystic Ovarian Syndrome: A Cross-sectional Study

Jincy Samuel, GC Swastika, Ashara Maharjan, Shreya Raju Nidavani Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Polycystic Ovarian Syndrome (PCOS), a condition prevalent among women in their childbearing age has been seen to impact sleep, Health-related Quality of Life (HrQoL) and Level of Physical Activity (LPA). However, not enough studies shown that how being physically active affects sleep and HrQoL in PCOS. Finding an association of physical activity with sleep and HrQoL in PCOS may be beneficial in including physical activity to improve sleep and HrQoL in PCOS. Aim: To explore an association of the LPA with sleep and to further explore an association between LPA and HrQoL in PCOS. Materials and Methods: This cross-sectional study was carried out at Department of Physiotherapy, Krupanidhi College of Physiotherapy, Bengaluru, Karnataka, India, from March 2023 to March 2024 on 270 women with PCOS in accordance to the Rotterdam criteria and aged between 18-24 years. The recruited subjects were evaluated for LPA, sleep quality and HrQoL using self-reported scales that were the International Physical Activity Questionnaire (IPAQ) scale, Pittsburg’s sleep quality scale and the Short Form Health Survey questionnaire (SF-36) scale respectively followed by statistically analysing the data using descriptive analysis, Kruskal Wallis test and Chi-square test. A p-value of less than 0.05 was considered as statistically significant. Results: The mean age of the subjects was 21.82±1.65 years. Level of being physically active was associated with all the domains of SF-36 (p<0.01) other than role limitation due to emotion (p=0.177) and domain of emotional well-being (p=0.142) where the association was non significant. Sleep quality was also associated with the LPA (p≤0.001). Conclusion: The LPA does have an association with sleep quality as well as with the physical domains of HrQoL. Thus, the level of being physically active is a determining aspect in the quality of sleep and HrQoL in PCOS. Including education and awareness on the importance of having the right LPA thereby may have an impact on sleep and HrQoL in PCOS.

Correlation between Performance-based and Self-reported Outcome Measures in Individuals with Frozen Shoulder: A Cross-sectional Study

Bhumika Kokadiya, Vipra Dalal Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Frozen shoulder is characterised by the development of dense adhesions, capsular thickness, and capsular restrictions. Due to restrictions in shoulder movement, individual with frozen shoulder face difficulties in activities of daily living. Shoulder Pain and Disability Index (SPADI) is 13-item self-reported measure containing subscale of pain and disability, with total score of 130. Performance-based measure include three functional related tests of shoulder: hand to neck, hand to scapula, and hand to opposite scapula. In self-reported measures, factors like environmental, physical, social, and psychological aspects can lead to perceptual differences, while in performance-based measures, scoring is based on therapist point of view regarding patient functional impairment. So need for present study to examine any correlation between these two different outcome measures, determining whether both measures are required or if one can be used instead of other for individuals with frozen shoulder. Aim: To find correlation between performance-based and self-reported outcome measures in individuals with frozen shoulder. Materials and Methods: A cross-sectional study was conducted from November 2023 to January 2024 at the Apollo Institute of Physiotherapy in Ahmedabad, Gujarat, India. The study was conducted in different physiotherapy clinics of Ahmedabad. Total 69 participants aged of more than 40 years, comprising both male and female gender, with pain predominantly in one shoulder and limitations of passive movements at Glenohumeral joint compared to unaffected side, individual with or without diabetes mellitus who could read and write in Gujarati were also included. After taking written informed consent, basic demographic data, including name, age, and gender, were collected. Then self-reported outcome measure scores were recorded using SPADI Gujarati (G) version. Performance-based measure scores were recorded using three function-related tests. Spearman’s rank correlation was used to determine the correlation between SPADI-G and the functional-related tests of shoulder. The level of significance was set at p≤0.05. Results: A total of 69 participants were included, with 42 males and 27 females. Result shows that hand to neck test (r-value=0.35, p-value=0.003) and hand to opposite scapula test (r-value=0.29, p-value=0.014) exhibited a weak positive significant correlation with SPADI. Whereas hand to scapula shows weak positive correlation (r-value=0.18, p-value=0.136) but was not significant. Conclusion: The present study showed a weak positive correlation between performance-based and self-reported outcome measures in individuals with frozen shoulder. This study concludes that assessment for individuals with frozen shoulder must incorporate both performance-based and self-reported measures.

Combined Effects of Static Stretching and Ergonomic Modifications on Forward Head Posture among Desk Job Employees: A Quasi-experimental Study

Smita Kumari, Shubham Kumari, Sanghamitra Jena, Mohammad Sidiq Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: The musculoskeletal condition known as Forward Head Posture (FHP) is common among desk workers and is frequently affected by extended screen time and inadequate ergonomic set-ups. This changed posture might result from muscle imbalance, decreased productivity, and neck pain. For posture correction and pain reduction, static stretching as well as ergonomic adjustments are proven techniques. Aim: To evaluate the combined effects of static stretching and ergonomic modifications on FHP among desk job employees. Materials and Methods: The present quasi-experimental multi-center study was carried out in the of Delhi NCR area, India among desk job workers. Thirty people between the age group of 20 to 50 years participated in the three weeks trial. group A (static stretching +ergonomic modifications) and group B (ergonomic modifications+ general physical activities) were randomly assigned to participants after they were examined by the inclusion criteria. Each participant did static stretching four times a week in three sets of ten repetitions each. Assessments were conducted utilising conventional musculoskeletal and postural criteria both before and after the intervention. Data analysis was done with Statistical Package for Social Sciences (SPSS) version 27.0 using a paired t-test. The level of significance was set at 0.05. Results: Thirty volunteers with an average age of 31.87±1.65 years were included in the study. Both groups experienced significant improvements in Craniovertebral (CV) angle, with group B increasing from 45.77±1.73 to 47.46±1.72 (p<0.001) and group A increasing from 44.74±2.29 to 48.07±2.06 (p<0.001). In the same manner, Numeric Pain Rating Scale (NPRS) scores dropped dramatically in group B from 7.40±0.73 to 3.87±0.64 (p<0.001) and in group A, respectively, from 6.87±1.24 to 2.73±0.88 (p<0.001). The post-intervention results showed that group A CV angle and scores for pain improved more than group B. Conclusion: Static stretching combined with ergonomic modifications has greater benefits than ergonomic modifications with general activities; however, both stretching and ergonomic modifications, as well as ergonomic modifications with general activities, have significant effects on FHP among desk job employees.

Impact of Alarm Frequency on Dialysis Adequacy using Online Clearance Monitor System in Haemodialysis Machine: A Cross-sectional Study

S Swadeeshwaran, P Hemanth, Aksa Shibu Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Haemodialysis (HD) adequacy is critical for patient outcomes. Alarms frequently interrupt treatments, making it important to understand the relationship between alarm frequency and dialysis adequacy (Kt/V). Aim: To evaluate the impact of HD machine alarm frequency on dialysis adequacy using the Online Clearance Monitor (OCM). Materials and Methods: This cross-sectional study was conducted at the Dialysis Unit of Yenepoya Medical College Hospital, Mangaluru, Karnataka, India, from September 2023 to May 2024, involving 43 HD patients. OCM was used to determine HD adequacy. Data such as postdialysis weight, haemoglobin, Kt/V goal achievement and alarm occurrences during the four-hour session on Fresenius 4008S machines were collected. Regression analysis was employed to examine the association between adequacy and alarm frequency. Results: The study population comprised 12 females and 31 males, with a mean age of 51.44±15.822 years. The mean frequency of alarm muting was 2.02±2.858 times per treatment, with an average achieved Kt/V of 1.251±0.088. Conductivity alarms were the most frequent (mean±SD=4.55±3.83), followed by upper and lower vein alarms. Multiple linear regression analysis revealed a statistically significant positive association between alarm muting frequency and Kt/V values {β=0.010, 95% CI (0.0011, 0.0195), p-value=0.0282}. Conclusion: The study found that increased alarm muting frequency was associated with improved dialysis adequacy, as measured by Kt/V. This suggests that selective alarm muting based on clinical judgment may not negatively impact treatment effectiveness. However, further research is needed to establish optimal protocols for alarm management that balance treatment efficiency with patient safety.

Comparison of Ultrasound-guided Costoclavicular Block versus Axillary Block for Below Elbow Surgery: A Randomised Clinical Study

BN Chaithrashree, Surbhi Gupta, Thomas T Vellapally Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Ultrasound-guided brachial plexus blocks are widely used to provide anaesthesia for upper limb surgery. Costoclavicular Block (CCB) is a newer infraclavicular approach to brachial plexus block where local anaesthetic is deposited between the midpoint of the clavicle and the first rib. Aim: To compare the efficacy of ultrasound-guided CCB to Axillary Block (AXB) for below elbow surgery. Materials and Methods: This randomised clinical study included 70 patients belonging to ASA I and II category, aged between 18 and 59 years undergoing below elbow surgery. Patients were randomly allocated to either CCB group or AXB group under ultrasound guidance using 20 mL of local anaesthetic mixture (10 mL of 0.5% bupivacaine and 10 mL of 2% lidocaine with adrenaline). Sensorimotor block onset time, block performance time, total anaesthesia-related time, success rate and complications were recorded. Independent t-test was used to determine significance between two quantitative variables and Fischer’s-exact test was used as test of significance for qualitative data. Results: Both groups were comparable in terms of demographic data (age, sex, body mass index and American Society of Anaesthesiologists (ASA) grading) with a p-value of >0.05. The mean (SD) sensorimotor onset time was similar between the CCB and AXB groups (14.71±1.18 vs 14.85±2.33 minutes), respectively; p-value=0.764. Mean block performance time was shorter in CCB than AXB group (5.83±0.82 vs 8.74±0.85 minutes) respectively; p-value <0.001. CCB group had a shorter total anaesthesia-related time compared to AXB group (20.69±0.87 vs 23.79±2.19 minutes) respectively. Success rate was similar between costoclavicular and axillary approaches. No complications were noted in either group. Conclusion: Though the onset time and success rate were similar between the two groups, CCB resulted in a shorter performance time and total anaesthesia-related time. Thus, CCB is a safe and reliable alternative to AXB for below elbow surgery.

Cosmetic Outcome and Level of Patient Satisfaction after Oncoplastic Breast Surgery in Breast Cancer Survivors: A Cross-sectional Study from Tertiary Care Centre in Kerala, India

Ansar Pullampara Pookunju, Rohit Krishna Ajith Kumar, Shabana J Thaha, Nithin Varghese Abraham, Kingini Krishnan Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Oncoplastic Breast Surgery (OBS) has revolutionised breast cancer treatment by combining oncological surgery with plastic surgery techniques, thereby allowing for both cancer control and aesthetic preservation. Evaluating the cosmetic outcomes and levels of patient satisfaction post-OBS is critical for understanding its impact in the Indian context, where cultural, socio-economic and healthcare factors play important roles in shaping patients’ postoperative experiences. Patient satisfaction is influenced by factors such as overall outcomes and specific breast features, including size, shape and symmetry. Aim: To assess the cosmetic outcomes and levels of patient satisfaction after OBS in breast cancer survivors, using the Kyungpook National University Hospital (KNUH) Breast Q rates. The study also compares responses among patient groups who underwent different techniques of OBS and examines the association of these outcomes with various qualitative variables, such as age, co-morbidities, stage of disease and adjuvant treatments, among others. Materials and Methods: This cross-sectional study included 40 breast cancer patients who underwent Breast Conservation Surgery (BCS) with volume displacement and replacement techniques in the Department of Surgical Oncology at Sree Gokulam medical college and Research Foundation, Trivandrum, Kerala, India. Each patient was given the modified KNUH Breast-Q questionnaire during follow-up visits to the department. Based on their responses, cosmetic outcomes and satisfaction levels were measured using the Breast-Q score. The Chi-square test and Fisher’s exact test were utilised to determine the association between categorical variables. Results: In this study, of 40 patients following OBS, 100% of patients reported a positive response of either excellent or good/fair satisfaction. Considering the association of patient responses to various surgical techniques, 100% of patients who underwent reduction mammoplasty, including superomedial and inferomedial pedicle reduction mammoplasty, gave an excellent response. Among the most commonly performed techniques, the round block (n=13) received an excellent response from 61.5% of patients, while 38.5% reported fair/good satisfaction. The p-value was found to be 0.044, indicating a statistically significant association. No significant association was found between satisfaction levels and age or stage of disease (p-value>0.05). Conclusion: The cosmetic outcomes and patient satisfaction, based on breast Q scores, indicated either excellent or good/fair responses in 100% of the study patients who underwent OBS. OBS can be a viable option in breast cancer surgery, achieving patient satisfaction in the Indian population while maintaining oncological safety.

Cutaneous Adverse Effects of Cancer Chemotherapy Drugs: A Cross-sectional Study from Tertiary Care Centre in Chennai, Tamil Nadu, India

Suchithra, Aravindan, Aiswarya Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: The incidence of cancers is increasing over the past few decades. With the surge of cancer cases, the usage of cancer chemotherapy drugs has increased. These drugs cause a myriad of cutaneous adverse effects leading to decreased quality of life. Aim: To study the frequency of cutaneous adverse effects of cancer chemotherapy drugs. Materials and Methods: This cross-sectional study was conducted in the Department of Dermatology Government Royapettah Hospital, Chennai, Tamil Nadu, India, from October 2024-November 2024. In present study, all the patients under cancer chemotherapy drugs for various malignancies with cutaneous adverse effects were included. All the cutaneous adverse effects were noted with proper documentation. The results were statistically analysed and tabulated in terms of frequency and percentage. Results: A total of 70 patients were included in the study. Among the 70 patients, 32 (45.7%) were male and 38 (54.2%) were female. Among the patients, 6 (8.6%) were less than 40 years of age, 29 (41.4%) were between 40-49 years, 15 (21.4%) were between 50-59 years, 9 (12.9%) were between 60-69 years, 6 (8.6%) were between 70-79 years and 5 (7.1%) were between 80-89 years. Carcinoma (Ca) breast was the most common malignancy observed in 23 (32.8%) in our study followed by Ca lung in 11 (15.7%) and Chronic Myeloid Leukaemia (CML) in 6 (8.5%). Anagen effluvium was the most common adverse effect observed in 53 (75.7%) followed by xerosis in 48 (68.6%), acneiform eruptions in 17 (24.3%), hyperpigmentation involving the skin, mucosa and nail in 14 (20%) and sweet syndrome in 8 (11.4%). Conclusion: The knowledge of adverse effects of chemotherapy drugs can help in early recognition and treatment. This helps in increasing the patient’s compliance and thereby increasing the quality of life.

Variations in Nasal Index among Punjabi Population: A Cross-sectional Study

Rishu, Anupama Mahajan, Punita Sharma Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Anthropometry serves as a scientific framework for collecting and analysing morphometric data, enabling the study of human diversity across geographical and ethnic boundaries. The nasal index is a multifaceted anatomical entity. Nasal anthropometry is a study concerned with the precise measurement and analysis of nasal size, shape, and proportions. The human nose exhibits considerable variation in size and shape, which is attributed to the combined effects of age, sex, environmental influences, ethnic background, and regional characteristics. Knowledge of nasal measurements is indispensable for rhinoplasty, facial surgery, and forensic analysis, enabling professionals to make informed decisions and achieve optimal outcomes. Aim: To provide the variations in nasal index among Punjabi males and females in the age group of 18-25 years. Materials and Methods: The present cross-sectional study was conducted on 1,420 participants (710 males and 710 females) from Punjab, aged between 18 and 25 years. Nasal length and nasal width were measured with the help of a digital sliding vernier caliper in the natural head position, and the nasal index was calculated using the validated formula: Nasal Index = (Nasal Width/Nasal Length) × 100. Results: The mean value of the nasal index was 67.32±6.21 for males and 65.40±6.07 for females. A significant difference was found in nasal length, nasal width, and nasal index between males and females, with a p-value<0.05. Conclusion: A significantly higher nasal index was observed in males than in females of the Punjabi population. From this study, it was concluded that the dominant nose type in both males and females was leptorrhine.

Vitamin D Deficiency and its Propensity for Severe Dengue Fever: A Prospective Observational Study in a Tertiary Care Centre, Odisha, India

Swapna Sarit Sahoo, Bhabesh Chandra Khatua, Thakura Soren, Swapnesh Mishra Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: In addition to being necessary for maintaining the body’s calcium and phosphorus levels and regulating bone metabolism, vitamin D (vit D) is regarded as a potent immunomodulator that influences both innate and adaptive immune responses and is crucial for pathogen defence systems. There is growing interest in vitamin D’s potential role in Dengue Virus (DENV) infection. Aim: To ascertain whether vitamin D deficiency is related to severe dengue disease in individuals diagnosed with Dengue Fever (DF) or its sequelae. Materials and Methods: The current study was a single-centre, cross-sectional study, including 172 patients diagnosed with dengue after obtaining written informed consent. The diagnosis was confirmed by a Non Structural Protein 1 (NS1) test or a dengue specific IgM or IgG antibodies test using Enzyme Linked Immunosorbent Assay (ELISA). A structured questionnaire was used to collect information from the patients, including demographic factors, vital signs, laboratory parameters, and radiology findings. Vitamin D levels were measured in all patients using spectrometry and were divided into two groups: deficient (≤20 ng/mL) and sufficient (>20 ng/mL). Data collected were analysed using Statistical Package for Social Sciences (SPSS) version 27. Results: The mean age of the study participants was 37 years, and most of the patients were male 102 (59.3%). With respect to dengue infection, 49 (28.5%) had DF, 84 (48.8%) had Dengue Haemorrhagic Fever (DHF), and the remaining 39 (22.7%) had Dengue Shock Syndrome (DSS). According to vitamin D status, 118 (68.6%) had insufficient vitamin D levels, while the remaining 54 (31.6%) had sufficient vitamin D. The proportion of females in the vitamin D deficient group was significantly higher (82.9%) compared to the vitamin D sufficient group (17.1%) (p-value=0.001). The severe forms of dengue infection, such as DHF and DSS, were found to be significantly higher in the vitamin D deficient group compared to the sufficient group, with a p-value of 0.041. Conclusion: The study found a significant association between vitamin D levels and the severity of DF. The use of vitamin D as a therapeutic measure for all forms of DF is supported by the study findings.

Effect of Low Level Laser Therapy with Neuromuscular Training Program on Pain, Function and Muscle Strength in Participants with Knee Osteoarthritis: A Randomised Controlled Trial

D Thaheera, K Kotteeswaran, K Nishitha Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: The predominantly encountered progressive musculoskeletal condition that may negatively impact joints is Osteoarthritis (OA), which often affects the joints of the lower extremities since they support more than half of the body weight. By 2020, OA was predicted to increase by almost 40% in prevalence, ranking as the fourth most prevalent cause of disability globally. Aim: To compare the effect of Low Level Laser Therapy (LLLT) with a neuromuscular training programme and an aerobic exercise programme on pain, function, and muscle strength in participants with knee OA. Materials and Methods: A randomised, double-blind study was carried out at Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India, from 26 October 2024 to 20 January 2025, involving 36 participants aged 50-65 years, diagnosed with unilateral OA of the knee (Kellgren-Lawrence grade II/III) based on American College of Rheumatology criteria. Participants were randomly assigned to the neuromuscular training programme group (age: 60.27±3.05 years, Body Mass Index (BMI): 24.285±0.50) or the aerobic exercise programme group (age: 61.055±2.7 years, BMI: 23.88±0.52) using a simple random sampling technique (lottery method). Outcome measures included the pressure algometer, Timed Up and Go (TUG) test, and 30-second sit-to-stand test. Pre and post-tests were conducted before and after eight weeks of intervention. Statistical analysis was performed using independent t-tests, both paired and unpaired, with a significance level of p<0.0001. Results: The post-test mean±SD values using the pressure algometer for the LLLT with the neuromuscular training group were 8.433±0.594, while for the LLLT with the aerobic exercise programme group, they were 6.661±0.566. The post-test mean±SD values using the 30 seconds sit to stand test for the LLLT with the neuromuscular training group were 18.67±1.24, but for the LLLT with the aerobic exercise programme group, they were 12.83±1.38. The post-test mean±SD values using the TUG test for the LLLT with the neuromuscular training group were 10.44±1.76, while for the LLLT with the aerobic exercise program group were 16.28±1.84. Conclusion: This study concludes that the neuromuscular training programme showed a promising effect in reducing pain and improving function and muscle strength when compared with the aerobic exercise regimen.

Association of Serum Interleukin-6 and Erythrocyte Sedimentation Rate with Glycemic Control and Body Mass Index in Type 2 Diabetes Mellitus: A Comparative Cross-sectional Study

Rosmi Johnachan, Diana Mariam, Sibiya Odayappurath Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder marked by insulin resistance and persistent hyperglycaemia. Increasing evidence indicates that low-grade systemic inflammation contributes to its development and progression. Interleukin-6 (IL-6), a proinflammatory cytokine, serves as a potential marker of metabolic and vascular complications. Similarly, elevated Erythrocyte Sedimentation Rate (ESR) reflects ongoing inflammation and correlates with poor glycaemic control. Aim: To assess and compare serum IL-6 and ESR levels in patients with T2DM and healthy controls, and to evaluate their correlation with glycaemic indices and Body Mass Index (BMI). Materials and Methods: This comparative cross-sectional study included 66 participants: 33 diagnosed T2DM patients (on treatment for 2-5 years) and 33 age and sex-matched healthy controls. Fasting Blood Sugar (FBS), Glycated Hemoglobin (HbA1c), ESR, BMI, and serum IL-6 were measured. IL-6 levels were estimated using sandwich Enzyme Linked Immunosorbent Essay (ELISA). Statistical analysis was performed using the Mann-Whitney U test and Spearman’s correlation, with p<0.05 considered significant. Results: T2DM patients showed significantly higher mean FBS (132.7 mg/dL), HbA1c (7.56%), ESR (25.76 mm/hr), IL-6 (103.0 pg/mL), and BMI (25.70 kg/m2) compared to controls (p<0.001 for all). A weak but statistically significant positive correlation was found between IL-6 and BMI (ρ=0.38, p=0.03). HbA1c also showed a positive trend with ESR. Although IL-6 levels were higher in patients with longer diabetes duration, the difference was not statistically significant. Conclusion: To conclude, IL-6 and ESR levels were significantly elevated in T2DM, indicating a strong inflammatory component in the disease. IL-6 showed a positive correlation with BMI, supporting its role in obesity-related inflammation. These findings highlight the potential utility of IL-6 as a biomarker for monitoring inflammation and disease progression in T2DM.

Outcome Following Chest Tube Removal with Respect to Phase of Respiration in Chest Trauma Patients: A Randomised Controlled Trial

Ritesh Kumar, Sandeep Chauhan, Mahavir Singh, Mohammed Faiz, Deepak, Gaurav Sharma, Manish Kumar Yadav, Sanjay Marwah Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Chest tube placement remains amongst the most performed emergency procedure in trauma patients to drain blood or air from the pleural space. After evacuation of pleural contents, removal of chest tube is equally important since its careless removal can cause serious complications like Recurrent Pneumothorax (RP) and even lung collapse. There is no consensus in the available literature about the phase of respiration favourable for the removal of chest tube. Aim: To compare the outcome in terms of complications like RP following chest tube removal with respect to phase of respiration in chest trauma patients and risk factors responsible for development of these complications. Materials and Methods: The present study was a randomised controlled trial conducted at the Department of Surgery, Pt. BD Sharma Post Graduate Institute of Medical Sciences, Rohtak, India, between 1st August 2020 and 31st July 2022. Total one hundred and forty-six patients presenting in emergency with thoracic trauma requiring intercostal intubation were initially enrolled in the study; out of which 20 patients were excluded based on exclusion criteria. The remaining patients were randomised into case group (group EI) in which chest tube was removed at end of inspiration and control group (group EE) in which chest tube was removed at end of expiration with 63 patients in each group. Complications after chest tube removal were noted and possible risk factors for development of these complications were analysed. Results: A total of 146 patients participated in the study of which the majority of the patients were male (n=54 in EE group and 58 in EI group) in both the groups and the distribution of gender in both the groups was comparable. Mean age for the patients in EE group was 38.71±15.23 years and EI group was 41.35±14.91 years and was statistically comparable. 10 (15.87%) patients in EE group and 9 (14.29%) patients in EI group developed complications and the difference was statistically not significant (p=0.803). Factors like duration between trauma and placement of chest tube, Thoracic Trauma Severity Score (TTSS), duration of intercostal drainage in situ, mechanism of injury and presence of air leak were noted however none of these factors showed statistical significance for development of complications in both the groups. Conclusion: It is safe to remove chest tube at the end of inspiratory as well as expiratory phase of respiration without any additional risk of complications irrespective of mechanism of injury, duration of chest tube in situ, presence of air leak, duration between trauma and chest tube insertion and TTSS. However, immediate and complete sealing of the entry site after removal of chest tube helps in minimising the risk of complications.

Assessment of Knowledge and Practice of Toothbrush Contamination and Disinfection among Dental Students in Chengalpet District, Tamil, Nadu, India: A Cross-sectional Study

AB Anu, Karthikeyan Indrapriyadharshini, Subraman Vishnuprasad, Ravi Karthikayan, Jagadeson Mahesh, MP Revanth Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Toothbrushes and dental floss are imperative for removing dental biofilm and preventing dental caries and periodontal diseases. Toothbrushes become contaminated after repeated usage. Contaminated toothbrushes may be a significant contributor to systemic and oral diseases. It is the responsibility of dentists to inform their patients about preventive oral health behaviours, to promote improved oral hygiene in society. Aim: To evaluate dental students’ knowledge and practice about toothbrush contamination and disinfection in Chengalpet district, Tamil Nadu, India. Materials and Methods: The present cross-sectional study was conducted among 232 dental students from January 2023 to June 2023 at a private dental college, Chengalpet, Tamil Nadu, India. A structured questionnaire consisting of two domains, with 16 questions was prepared, validated, and distributed to the third years, final years, and interns to assess the knowledge (8 questions) and practice (8 questions) about toothbrush contamination and disinfection. The descriptive analysis of demographic variables was done and knowledge score and attitude score were performed using the Kruskal-Wallis H test. The p-value<0.05 was considered statistically significant. Results: The participants of the present cross sectional study had a mean age of 23.49±1.56 years, with 36 (15.5%) males and 196 (84.4%) being female. The study values revealed that there was no statistically significant difference regarding the knowledge about toothbrush contamination between interns, final years and third years (p=0.806) and the further values obtained from the study revealed there was no statistically significant difference regarding the practice followed for toothbrush disinfection between all three groups (p=0.613). Conclusion: According to the study results there was no statistically significant difference in the knowledge and practice of toothbrush contamination and disinfection among the interns, final years, and third years. Since their education and expertise may allow them to enforce it on their patients, dental students ought to be required to learn more about this, thereby encouraging better oral hygiene.

Assessing the Holistic Impact of Accreditation Standards on Healthcare Professionals at a Tertiary Care Setting in India: A Cross-sectional Study

R Diwakar, Meera Premanand, K Bincy, Kaveri Palanisamy, M Manoharan Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Healthcare accreditation systems, such as the National Accreditation Board for Hospitals and Healthcare Providers (NABH), aim to improve the quality and safety of patient care by implementing structured frameworks. However, limited research exists to measure NABH’s impact on healthcare professionals. Aim: To assess healthcare professionals’ perceptions of NABH’s influence on service quality and adaptability in a tertiary care setting, examine the role of designation and years of experience, and identify implementation challenges. Materials and Methods: A cross-sectional study was conducted at SRM Medical College Hospital and Research Centre and SRM Global Hospitals in the Chengalpattu district of Tamil Nadu, India, from June 2024 to October 2024. A total of 321 healthcare professionals were selected using simple random sampling. Data were collected via a semi-structured questionnaire focusing on service quality and adaptability. Chi-square and multivariate logistic regression were used for statistical analysis. A p-value of less than 0.05 was considered statistically significant. Results: Favourable perceptions were observed regarding patient safety among 226 (70.4%) participants and infrastructure among 184 (57.3%) participants. In contrast, perceptions were less favourable for adaptability metrics, including updating procedures among 145 (45.2%) participants and role confidence among 152 (47.4%) participants. Multivariate regression analysis indicated that nurses (p-value=0.009), pharmacists (p-value <0.001), and those with less than five years of experience (p-value=0.001) were significantly associated with variations in perceptions of service quality, while health administrators (p-value=0.046, p-value=0.034) were significant for service quality and adaptability post-accreditation. Challenges such as time constraints and excessive workload hindered implementation. Conclusion: NABH positively impacted adaptability but revealed gaps in service quality. Targeted interventions addressing workload and training may enhance the integration of accreditation standards.

An Upper Motor Neuron Lesion Causing an Isolated Unilateral Lingual Paresis: A Case Report

Gangaram Tankasala, Shanmukha Sai Bolisetty, Chakradhar Siddem, Lakshmi Narsimha Sandeep Manne, Arunakumari Kotteti Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X A Cerebrovascular Accident (CVA) is a primary cause of mortality and morbidity globally, presenting with a diverse range of appearances contingent upon the location of the infarct. Isolated hypoglossal nerve supranuclear palsy is an uncommon clinical manifestation of ischaemic stroke, typically associated with pre-existing vascular risk factors. The neurological finding of isolated unilateral lingual paresis is rarely observed. While Lower Motor Neuron (LMN) lesions involving the hypoglossal nerve (cranial nerve XII) are extensively described, Upper Motor Neuron (UMN) aetiologies are less commonly noted. This case report discusses solitary unilateral lingual paresis resulting from an UMN infarction, emphasising the clinical manifestation, diagnostic difficulties, and underlying pathophysiology. A 62-year-old individual with type 2 diabetes exhibited dysarthria without accompanying neurological deficits. The Magnetic Resonance Imaging (MRI) revealed an acute non-haemorrhagic infarction in the left corona radiata. The patient demonstrated steady improvement while undergoing dual antiplatelet therapy, high-dose statins, and speech therapy. This case highlights a rare UMN cause of isolated hypoglossal nerve palsy.

A Cross-sectional Study to Assess the Association between the Cognitive Function with Severity of Dependence and Motivation to Quit in Patients with Substance Use Disorder

Shivani Dua, Ramchandra Das, Sudipta Kumar Das Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Long-term substance abuse can impact an individual’s cognition and higher mental abilities, which can, in turn, affect their judgment-making capacity and lead to a higher chance of relapse. This is because the individual’s motivation to quit is linked to their cognitive functioning. Aim: To assess the association between cognitive function, the severity of dependence, and the motivation to quit in patients with Substance Use Disorder (SUD). Materials and Methods: This was a cross-sectional observational study conducted in a tertiary care hospital in Eastern India between October 2018 and September 2020. The study includes total 83 patients diagnosed with substance dependence according to the International Classification of Diseases-10 guidelines by the treating psychiatrist, and admitted to the inpatient unit of the Department of Psychiatry Socio-demographic details such as age, gender, background, marital status, primary substance, and duration of use were obtained using a semi-structured questionnaire. Cognitive functions were assessed using the Montreal Cognitive Assessment Scale (MoCA) and the Frontal Assessment Battery (FAB). The severity of dependence was assessed using the Leeds Dependence Questionnaire. Motivation to quit substances was assessed using the Stages of Change Readiness and Treatment Eagerness Scale. Statistical Package for the Social Sciences(SPSS) v23 was used for data analysis. Results: All subjects included in the study were male. Approximately 56 (67.5%) were admitted for alcohol dependence, followed by opioid dependence. The majority of the study sample had moderate severity of dependence, with 52 (62.7%) participants showing good motivation. A total of 53 (63.9%) participants had global cognitive deficits, and frontal lobe dysfunction was seen in 41 (49.4%) of the study sample. Both cognitive functioning and frontal lobe functioning were significantly associated with motivation to quit. The severity of dependence on the substance was not significantly associated with either cognitive function or frontal lobe functioning. Conclusion: Out of the total sample, almost two-thirds had cognitive deficits, and half had frontal lobe dysfunction. The correlation between poor motivation and cognitive impairment, as well as frontal lobe dysfunction, was found to be statistically significant, indicating that poor motivation to quit substances in patients may be affected by cognitive process dysfunction or frontal lobe damage.

Comparison of Maternal Ophthalmic Artery Doppler Parameters in Gestational Hypertensive and Normotensive Pregnant Women: A Cross-sectional Study

Prashansa Gupta, Himadri Bal, Col Yoginder Singh, Tushar Pancholi, Priyanka Aher, Janvi Patel, Varshini Vadithala Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Hypertensive disorders of pregnancy, including gestational hypertension and preeclampsia, significantly contribute to maternal and perinatal morbidity. Identifying early vascular changes through non invasive methods is crucial for improving risk stratification and clinical outcomes. Aim: To compare the ophthalmic artery Doppler parameters in gestational hypertensive and normotensive pregnant women. Materials and Methods: A cross-sectional study was conducted in the of Department of Obstetrics and Gynaecology at Dr. D.Y. Patil Medical College, Hospital, and Medical Research Centre, Pimpri, Pune, Maharashtra, India, from September 2023 to March 2025. A total of 450 primigravida and second-gravida women between 30 and 37 weeks of gestation, with confirmed gestational age based on first or early second-trimester ultrasonography, were included in both the gestational hypertension (n=80) and normotensive groups (n=370). Doppler ultrasound assessed key ophthalmic artery parameters, including the first and second Peak Systolic Velocities (PSV), the Peak Ratio (PR), and the Pulsatility Index (PI). Statistical analysis was performed to compare Doppler indices between the groups using appropriate statistical tests. Results: The mean maternal age was 29.4±5.7 years. The first and second PSVs were significantly elevated in hypertensive pregnancies (p<0.001). The PR was also significantly higher in hypertensive pregnancies (p<0.001), suggesting altered arterial compliance. While one PI parameter (PI-C) was significantly elevated (p<0.001), other PI values did not show significant differences. Conclusion: Ophthalmic artery Doppler parameters, mainly first and second PSVs and PR, serve as promising non invasive markers for hypertensive disorders in pregnancy.

Ameliorating Effect of 7,3'-Dihydroxyflavone in Paclitaxel Induced Neurotoxicity: An In-silico and In-vitro Study

G Krithiga, Kavitha Ramasamy, S Ramya Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Paclitaxel is an antineoplastic agent belonging to taxane group. It stabilises microtubule structure and one of its major dose limiting side-effects is neurotoxicity. Flavones are promising compound to alleviate paclitaxel induced neurotoxicity as it has anti-nociceptive, anti-inflammatory effect, antioxidant and neuroprotective effect. Aim: To evaluate the neuroprotective property of 7,3´-dihydroxyflavone (7,3´-DHF) against Paclitaxel induced neurotoxicity in SH-SY5Y neuroblastoma cell line through a combined in-silico and in-vitro approach with a focus on its ability to modulate ion channels. Materials and Methods: The present in-vitro study employing human neuroblastoma cell line SH-SY5Y was conducted at Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, from April to July 2024. Molecular docking was performed against Cav3.2, Nav1.7 and Kv7.2 protein targets using auto dock tools 1.5.7, followed by Molecular Dynamics (MD) analysis using PyMOL version 2.0. Flow cytometry was done to assess antioxidant effect of 7,3´-DHF by free radical scavenging activity. Reverse Transcription Polymerase Chain Reaction (RT-PCR) was done to study gene expression of CACNA1H gene associated with paclitaxel induced peripheral neuropathy. Results: Molecular docking scores of 7,3´-DHF with target was -6.66 kcal/mol for Nav1.7, -6.56 kcal/mol for Cav3.2 and -6.66 kcal/mol for Kv7.2. In MD, Root Mean Square Deviation (RMSD) stabilised around 5 Å for both Cav 3.2 and Kv 7.2 after 50 ns. Molecular Mechanics/Generalised Born Surface Area (MM/GBSA) binding free energy (?G Bind) values were -62.2 kcal/mol for Cav 3.2 and -66.1 kcal/mol for Kv 7.2. Flow cytometry showed reduced Reactive Oxygen Species (ROS) generation in cells treated with 7,3´-dihydroxyflavone in dose dependent manner. Gene expression showed that 7,3´-dihydroxyflavone down regulates the CACNA1H gene that encodes Cav 3.2 which is associated with paclitaxel induced peripheral neuropathy. Conclusion: This study adds evidence to the significant neuroprotective potential of 7,3´-dihydroxyflavone against paclitaxel-induced neurotoxicity, demonstrated through in-silico and in-vitro approaches and identifies it as one of the promising therapeutic candidates for mitigating neurotoxicity in paclitaxel-treatment. However further confirmation through in vivo study is needed.

Association between Systemic Hypertension and Ocular Perfusion Pressure in an Adult Population of North Karnataka, India: A Cross-sectional Study

Rekha R Mudhol, Lingamaneni Sneha Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Glaucoma, a major cause of irreversible blindness, is influenced by Intraocular Pressure (IOP) and ocular blood flow. Systemic hypertension may affect the risk of developing glaucoma by influencing Ocular Perfusion Pressure (OPP), although this relationship remains complex and not fully understood. Nocturnal hypotension, especially in individuals on antihypertensive treatment, may further compromise optic nerve perfusion. There is limited data on this association, warranting a focused investigation. Aim: To evaluate the impact of blood pressure on OPP in the adult population of North Karnataka. Materials and Methods: A cross-sectional study was conducted at the Department of Ophthalmology, BLDE (DU) SBPMC, Vijayapura, Karnataka, India, involving 168 participants (84 hypertensives and 84 normotensives) from May 2023 to December 2024. Comprehensive eye examinations, including the measurement of IOP and fundus evaluation, were performed. Blood pressure was recorded at 7 am, 1 pm, 6 pm and 12 am. OPP values—Mean Ocular Perfusion Pressure (MOPP), Systolic Perfusion Pressure (SPP), and Diastolic Perfusion Pressure (DPP)—were calculated. Statistical analysis included Chi-square, Mann-Whitney U, Spearman’s rho, and Kruskal-Wallis tests (p-value <0.05). Results: Hypertensive participants exhibited significantly (p-value <0.05) higher IOP and OPP at all time intervals. Peak values were observed at 1 pm and 6 pm. OPP correlated positively (r value=+0.7 to +0.91, p-value=0.001) with systolic, diastolic, and mean arterial pressure at each time point in hypertensives. Antihypertensive medications significantly influenced OPP (p-value=0.01). Conclusion: Individuals with hypertension demonstrated elevated OPP and IOP, suggesting an increased risk of glaucoma. Regular screening and integrated management of blood pressure and ocular parameters are crucial for the prevention of glaucoma.

Impact of Makarasana on Cardiovascular Parameters: A Prospective Interventional Study

Meenu Dahiya, Deepti Dwivedi, Nimarpreet Kaur, Pushpa Lamba, Sunil Chamola Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Makarasana, a yogic posture also known as the crocodile pose on elbows, is a gentle backbend practised in yoga for its potential physiological benefits, including enhanced breathing, digestive function and purported effects on spiritual and emotional wellbeing. Aim: To study the changes in Heart Rate (HR), blood pressure, and Heart Rate Variability (HRV) during Makarasana in healthy young adults. Materials and Methods: A prospective interventional study was conducted involving 80 healthy students aged 18-25 years in the Department of Physiology, Faculty of Medicine and Health Sciences, SGT University at Budhera, Gurugram, Haryana, India over 12 months from April 2023 to March 2024. This study aimed to investigate the effects of Makarasana on cardiovascular parameters. Baseline measurements of Pulse Rate (PR) and Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) were recorded in the Shavasana posture (lying flat on the back), followed by Makarasana practised for 15 minutes daily over three consecutive days. Changes in cardiovascular parameters were assessed using Physio Pac HRV analytic equipment and a digital Omron sphygmomanometer. Continuous data were expressed as mean±SD, while discrete data were expressed as numbers and percentages. The t-test was applied, considering p-value <0.05 significant at the 95% confidence interval. Results: Participants’ ages ranged from 18 to 25 years, with a mean±SD of 20.15±1.9 years; 25 were males (31%), and 55 were females (69%). Makarasana done for 15 minutes revealed statistically significant decrease in SBP, DBP and MAP on day 1, day 2 (non significant decrease in MAP) and day 3 (non significant decrease in DBP) and a decrease in SBP (from 108.82±6.71 to 105.8±6.7 mmHg, p-value <0.01) during Makarasana. DBP and Mean Arterial Pressure (MAP) showed non significant differences. Analysis of HRV parameters—Low Frequency (LF), High Frequency (HF), and LF/HF ratio—showed no significant changes between the two poses. Conclusion: The cardiovascular parameters are significantly influenced by Makarasana. The postural holding of Makarasana particularly enhances the PR.

Burden of Abdominal Obesity and Hypertension among Fishermen: A Cross-sectional Study from Chennai, Tamil Nadu, India

L Nancy, R Suba Shree, R Kalaivanan, M Logaraj, K Narmatha Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Fishermen are more likely than the general population to develop hypertension due to their altered sleeping patterns as well as their high salt intake. There is a substantial correlation between obesity and the development of hypertension, in conjunction with other disorders. The primary risk factor for hypertension is Body Mass Index (BMI), which increases with BMI. Aim: To estimate the prevalence of hypertension and abdominal obesity among the fishermen population, to determine the association between hypertension and abdominal obesity and to identify the factors associated with hypertension. Materials and Methods: A cross-sectional study was conducted among fishermen in the Chennai district with a sample size of 310. They were selected using a multistage random sampling technique and a detailed interview was conducted with the participants using a pretested, validated, modified STEPwise questionnaire. Statistical analysis included frequency, percentages, Chi-square tests, univariate regression done for categorical variables and multivariate logistic regression for significant variables (p-value <0.05) to control for confounders. Results: Out of the 310 respondents, the majority, 188 (60.6%) were aged 45 years or older, with 167 (53.9%) living in nuclear families. Additionally, 223 (71.9%) reported having an unhealthy diet. The prevalence of hypertension and abdominal obesity was 48.7% (151) and 64.5% (200), respectively. The majority felt that lowering salt intake was not important at all, accounting for 41.3%. Age and education level were significantly associated with hypertension. Conclusion: The prevalence of abdominal obesity and hypertension was 64.5% and 48.7%, respectively, which was higher among fishermen. As this burden among fishermen is on an increasing trend compared to the general population, they require a multifaceted approach that addresses the unique lifestyle, environmental and occupational challenges they face.

Risk Factors and Protective Role of Vitamin C in Coronary Artery Disease: Insights from a Case-control Study

Tilak Kumar Kadipaku, BS Gopala Krishna, Ahammad Basha Shaik Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Coronary Artery Disease (CAD) is a major global health burden, with oxidative stress playing a critical role in its pathogenesis. Vitamin C, a potent antioxidant, may offer protective effects against CAD; however, evidence from rural Indian populations remains limited. Aim: To investigate the association between plasma vitamin C levels and CAD, and to assess cardiovascular risk factors contributing to CAD among patients attending a tertiary care hospital in rural Southern India. Materials and Methods: A hospital-based prospective case-control study was conducted at the Department of Cardiology, Narayana Medical College, Nellore, Andhra Pradesh, India, between July 2023 and December 2024. The study included 200 participants aged ≥30 years, diagnosed with CAD via Coronary Angiography (CAG). Age- and sex-matched healthy controls were also recruited. Plasma vitamin C levels were measured using ultra-High-Performance Liquid Chromatography (u-HPLC). Statistical analysis was performed using IBM Statistical Package for the Social Sciences (SPSS) version 27.0 and R Studio Version 2024.12.0. Chi-square tests, paired t-tests, Odds Ratios (OR) with 95% Confidence Intervals (CIs), and logistic regression analyses were employed. Results: Of the 200 participants, 100 had CAD (cases) and the remaining 100 were non CAD (controls). The overall mean age of participants was 56.94±11.70 years, with ages ranging from 30 to 83 years. The mean serum vitamin C level was significantly lower among cases (65.53±8.75 μmol/L) than in healthy controls (71.63±7.67 μmol/L; p-value<0.001). Hypertension (OR=1.84; 95% CI: 1.05–3.23; p-value=0.033) and diabetes (OR=2.01; 95% CI: 1.14–3.55; p-value=0.015) were significantly associated with CAD, while dyslipidaemia was not (OR=1.99; 95% CI: 0.95–4.22; p-value=0.066). A significant negative correlation was observed between plasma vitamin C levels and CAD severity (r-value=–0.348; p-value<0.01). In multivariate analysis, increasing age and lower vitamin C levels were found to be significant independent predictors of CAD. Conclusion: Lower plasma vitamin C levels were significantly associated with CAD, supporting its potential protective role. Hypertension and diabetes emerged as major risk factors. These findings highlight the need for preventive strategies focusing on dietary antioxidants and the control of modifiable risk factors to reduce the burden of CAD.

Assessment of Filifactor alocis and Porphyromonas gingivalis Levels in Subgingival Plaque of Patients with Type 2 Diabetes Mellitus with and without Periodontitis: A Case-Control Study

Rajalakshmi Ashok Kumar, Ram Sabarish, Reshma Achu Joseph, Balaji Subbusamy Kanakasabapathy, Mohanapriya Chinambedu Dandapani Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Periodontitis, a chronic inflammatory condition, is influenced by microbial dysbiosis and the host’s immune response. Type 2 Diabetes Mellitus (T2DM) represents a significant public health challenge in India and exacerbates periodontal inflammation due to hyperglycaemia, compromised immune regulation, and increased oxidative stress. Key pathogens such as Porphyromonas gingivalis and Filifactor alocis, an emerging anaerobe, are known to play a central role in disease progression, especially in diabetic individuals, where their coexistence appears more pronounced. Despite this, there is a significant gap in comparative data on the presence of these bacteria in the subgingival microbiome of diabetic patients with and without periodontitis. Aim: This study investigates the levels of Filifactor alocis (F. alocis) and Porphyromonas gingivalis (P. gingivalis) in subgingival plaque samples from patients with T2DM with and without periodontitis. Materials and Methods: This case-control study was conducted at the Departments of Periodontics and General Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India from September to December 2022. Ethical clearance was obtained (IEC No: CSP/22/JUL/114/429). The study included 24 T2DM patients aged 30-60 years, with 12 having periodontitis and 12 without, based on the American Academy of Periodontology (AAP) 1999 criteria. Clinical parameters (Plaque Index, Bleeding on Probing (BOP), Periodontal Probing Depth (PPD), Clinical Attachment Loss (CAL), Periodontal Inflamed Surface Area (PISA), Periodontal Epithelial Surface Area (PESA), fasting/Postprandial Blood Sugar (PPBS), and subgingival levels of P. gingivalis and F. alocis (via species-specific qPCR) were evaluated. Data were analysed using SPSS v23 with the Mann-Whitney U test and Spearman correlation; significance was set at p-value ≤0.05. Results: Periodontitis patients exhibited significantly higher mean values for BOP, plaque index, PPD, CAL, PISA, and PESA (p-value <0.05). Lower Ct values (indicative of higher bacterial loads) of both P. gingivalis and F. alocis were observed in the periodontitis group, although differences were not statistically significant. A significant positive correlation was found between P. gingivalis levels and Fasting Blood Sugar (FBS) (r=0.617, p-value=0.032). No significant correlations were found between F. alocis levels and clinical or glycaemic parameters. Conclusion: These findings underscore the synergistic role of these pathogens in periodontal inflammation and their potential impact on glycaemic control, highlighting the importance of integrated oral and systemic care.

Antibacterial Efficacy and Antioxidant Potential of Hafnium-coated Titanium Implants: An In-vitro Assessment

Vishaka Kothari, Vaishnavi Rajaraman, Padma Ariga, Saravanan Sekaran, Dhanraj M Ganapathy Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Implant related infections and oxidative stress remain major concerns in dental and orthopaedic implantology, often leading to complications and implant failure. Titanium, though biocompatible and widely used, lacks inherent antibacterial and antioxidant capabilities. To overcome these limitations, surface coatings on biomedical implants have gained significant attention for their ability to enhance antibacterial and antioxidant properties, addressing challenges such as infection and oxidative stress. Aim: This study evaluated the antibacterial efficacy and antioxidant potential of hafnium-coated titanium implants through in-vitro experiments. Materials and Methods: The present in-vitro study was conducted at the Saveetha Dental College and Hospitals, Chennai, India, over a duration of three months (March to May 2024) in an in-vitro experimental set-up. Hafnium oxide nanoparticle-coated titanium micro screws (Group A; n=6) were compared with uncoated titanium screws (Group B; n=6) using Zone of Inhibition (ZOI) and bacterial viability tests against S. mutans, E. faecalis, and C. albicans. Antioxidant activity was assessed using the 2,2-Diphenyl-1-Picrylhydrazyl (DPPH) radical scavenging assay. Statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) Statistics for Windows, version 23.0 (IBM Corp., Armonk, N.Y., USA). Independent sample t-tests were used to compare the mean values of ZOI, Colony Forming Units (CFU) counts, and DPPH scavenging percentages between the two groups. Results: Hafnium-coated titanium implants exhibited significant antibacterial activity, with ZOI values of 13.0±0.5 mm, 24.0±0.6 mm, and 21.0±0.4 mm for S. mutans, E. faecalis, and C. albicans, respectively, outperforming uncoated titanium (11.0±0.4 mm, 22.0±0.5 mm, and 16.0±0.6 mm, respectively). Bacterial viability tests further confirmed the efficacy of hafnium coatings, showing reduced CFU counts (S. mutans: 3.0±0.2×104 CFU/mL; E. faecalis: 2.5±0.3×104 CFU/mL; C. albicans: 4.0±0.2×104 CFU/mL) compared to uncoated controls. While the DPPH assay revealed moderate antioxidant activity for hafnium-coated surfaces, it was lower than uncoated titanium. Conclusion: These findings suggest that hafnium-coated titanium implants possess enhanced antibacterial properties, likely due to the inhibitory effects of hafnium ions on bacterial growth and biofilm formation. The moderate antioxidant activity indicates potential for reducing oxidative stress, improving implant biocompatibility. This study highlights the promise of hafnium coatings in developing infection-resistant and durable dental and orthopaedic implants. Further research is warranted to optimise coating performance and validate clinical applications.

Comparison of First Attempt Success Rates between LMA Protector™ and i-gel™ in Elective Surgical Procedures: A Randomised Controlled Study

Geetha Ramalakshmi, A Sujina Hermin, K Karthik, R Balaji Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Supraglottic Airway Devices (SADs) are vital alternatives to endotracheal intubation in anesthesia and critical care. Second generation SADs like the i-gel™ and Laryngeal Mask Airway (LMA) Protector™ offer improved airway management- i-gel™ uses a soft thermoplastic for quick insertion without cuff inflation, while LMA Protector™ features silicone construction with dual gastric drainage channels to reduce aspiration risk. Comparing their leak pressures, first attempt success rate, and postoperative complications is essential to determine their safety and effectiveness. Aim: To compare the effectiveness of the LMA Protector™ and i-gel™ regarding first attempt success rate, insertion time, airway sealing, and postoperative complications in patients undergoing elective surgery. Materials and Methods: The present double-blinded, randomised controlled trial was conducted at SRM Medical College Hospital and Research Centre, a tertiary care facility in Chennai, India. involving 110 elective surgery patients aged 18-60 years with American Society of Anaesthesiologist (ASA) physical status 1 or 2. Participants were randomised into two groups using LMA Protector™ or i-gel™ devices. Patients with Mallampati class I or II were included, excluding those with Body Mass Index (BMI) >30 kg/m2 or histories of Gastroesophageal Reflux Disease (GERD) or Chronic Obstructive Pulmonary Disease (COPD). The primary outcome was first attempt insertion success, with secondary outcomes including insertion time, oropharyngeal leak pressure, and postoperative complications. Data were analysed using Statistical Package for Social Sciences (SPSS) 21.0, intergroup analysis was done using Student’s t-test or Mann-Whitney U test and Chi-square test. Results: The two groups demonstrated similar baseline characteristics, with no statistically significant differences in age, sex distribution, height, weight, or BMI. Group B (i-gel™) had a significantly higher first attempt success rate (100 vs. 71%, p<0.0001) and shorter insertion time (16.35±3.47 vs. 51.69±8.47 sec, p<0.0001) than group A (LMA Protector™). However, LMA Protector™ showed a higher mean oropharyngeal leak pressure (32.11±3.37 vs. 26.53±1.93 cmH₂O, p<0.0001). Postoperative sore throat was more frequent in group A (65.5 vs. 50.9%) but without statistical significance (p=0.122). Conclusion: The i-gel™ showed enhanced efficacy compared to the LMA Protector™ in several key areas. It achieved higher first attempt success rates, insertion time, and minimal postoperative complications. The findings of this study reinforce the clinical preference for utilising the i-gel™ in patients undergoing elective surgeries.

Predicting Acetabular Component Size in Bipolar Hip Hemiarthroplasty Using Digital Radiographs: A Prospective Study on Accuracy

Umesh Samria, Naveen Sathiyaseelan, Akib Nisar Sheikh, Pankaj Jain, Pradeep Khinchi Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Elderly individuals frequently suffer from hip fractures, particularly femoral neck intracapsular fractures, which can cause serious morbidity. Bipolar hip hemiarthroplasty is a preferred treatment for displaced fractures, but accurate preoperative templating is essential to predict acetabular component size and to improve surgical outcomes. Aim: To assess the accuracy of preoperative digital radiographs in predicting acetabular component size for bipolar hip hemiarthroplasty, thereby improving surgical planning and implant selection. Materials and Methods: A hospital-based prospective study was conducted at SMS Hospital, Jaipur, Rajasthan, India, involving 50 patients undergoing bipolar hip hemiarthroplasty from November 2017 to December 2019. The primary inclusion criteria included age over 20, a diagnosis of hip arthrosis or femoral neck fracture, skeletal maturity, no significant concomitant disorders, and informed consent to participate. The demographic parameters included age, gender, Body Mass Index (BMI), diagnosis (hip arthrosis or femoral neck fracture according to Garden's classification), side of hip involvement, and ethnicity/race (if applicable) for anatomical variations. Preoperative digital radiographs were analysed using templating software to predict the acetabular component size. Intraoperatively, the actual implant size was determined and compared with the predicted size. Accuracy, deviations, and influencing factors were assessed using statistical analysis. A paired t-test was used to compare the predicted acetabular component sizes with the actual intraoperative sizes and to evaluate the reliability of digital radiographs for preoperative sizing. A p-value of < 0.05 was considered statistically significant for all tests. Results: The predicted acetabular size ranged between 40 and 53 mm, with an accuracy of 14 (28%) for the exact size and 42 (84%) within one size including the most accurate ones. Accuracy was slightly higher in female patients at 24 (90%) compared to males at 18 (78.3%). The inconsistencies were attributed to the limited availability of prosthesis sizes and the quality of radiography. Conclusion: Digital templating improves preoperative planning for bipolar hip hemiarthroplasty, but it is less accurate than for Total Hip Arthroplasty (THA). To improve the templating outcomes in clinical practice, it is advised to implement better radiography techniques, calibration protocols, and surgeon training.

Clinicomicrobiological Profile, Antibiotic Resistance Trends and Radiological Association in Paediatric Urinary Tract Infections: A Prospective Observational Study

Krunal Dipakbhai Rana, Pankaj Abrol, Parveen Kumar Antil, Vaishali Pratik Jariwala Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Urinary Tract Infection (UTI) is a common bacterial infection in children, with a varied clinical presentation that often leads to diagnostic challenges. Delayed diagnosis and inappropriate treatment in India can result in complications such as renal scarring and hypertension. The rising antimicrobial resistance in Haryana, India, among uropathogens necessitates continuous monitoring of the clinicomicrobiological profile and antibiotic susceptibility patterns. Aim: To analyse the clinical presentation, microbiological profile, and antibiotic susceptibility patterns in paediatric UTI cases, emphasising the role of imaging in diagnosis. Materials and Methods: The present prospective observational study was conducted at the Department of Paediatrics, SGT Medical College, Haryana, India, over 12 months. A total of 120 children (aged 1 month to 18 years) with laboratory confirmed UTI were included. Clinical history, urine analysis, urine culture with sensitivity testing, and imaging studies were performed. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) software. Results: Out of 120 children, 69 were male and 51 were female. UTI was more common in males under five years, whereas females had a higher prevalence after five years (p=0.012). Escherichia coli were the most common uropathogen (40.7%), followed by Klebsiella and Staphylococcus aureus. High resistance to third generation cephalosporins was noted, while amikacin and gentamycin showed high sensitivity. Radiological abnormalities were present in 91.6% of cases, with cystitis and hydronephrosis as the most common findings. Conclusion: This study found that fever was the most common clinical presentation of paediatric UTIs. E.coli was the predominant pathogen isolated, with high resistance to ampicillin and ceftriaxone, while showing good sensitivity to amikacin and nitrofurantoin. Early imaging, particularly ultrasound, proved valuable in detecting structural abnormalities in a significant number of cases. These findings underscore the importance of tailored empirical therapy based on local resistance patterns and support the routine use of imaging in evaluating paediatric UTIs.

Comparative Evaluation of Apical Fit of Various Corresponding Gutta-percha Cones in Prepared S-shaped Canals of Simulated Mandibular Premolars: An In-vitro Study

Parul Bansal, Garima Singh, Mohit Kumar, Nikita Sharma, Smrity Sinha, Darshana Baruah Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: The goal of root canal obturation is to completely seal the root canal system in three dimensions, in order to stop the recurrence of bacterial infections. Root canal curvatures may be apical, gradual, sickle-shaped, severe-moderate-straight curve, bayonet/S-shaped curve and dilacerated curve. Curved root canals exhibit great difficulty in cleaning, shaping and obturation of the root canal system. Normally, corresponding Gutta-percha (GP) as per the file systems are used but what is seen is that GP’s don’t fit properly sometimes. So, this study was done to evaluate the apical fit of four corresponding size GP points by keeping the same/ standard endodontic file system in prepared simulated canals. Aim: To evaluate the apical fit of various corresponding GP cones in prepared S-shaped canals of simulated mandibular premolars. Materials and Methods: The present In-vitro study was conducted at Shree Bankey Bihari Dental College, Ghaziabad, Uttar Pradesh, India for a period of one month starting from August to September 2023. After the approval of the Ethical Research Committee at Shree Bihari Dental College. A total of 40 simulated mandibular premolar models, having S-shaped canal morphology were taken. E3 Azure Files (Endostar, Poland) were used to prepare root canals. The rotational speed was set to 300 rpm and 2.5 Nm of torque. Each model’s orifice was widened with an orifice opener (30/08), and then a Glide file until the Working Length (WL) was determined. The sequence used for canal enlargement was 20/04, followed by 20/06 rotary file, in a Clockwise (CW) and Counterclockwise (CCW) motion. Every tooth was prepared from the crown down, with an apical size of 20 mm with 0.06 taper. To remove debris, saline irrigation was applied to the models in combination with an ultrasonic activator. Each time a file was changed, irrigation was performed. Paper points were used to dry the canals (Dentsply). The models were then divided into four groups based on the different GP points; Group 1 (n=10) Diadent, Group 2 (n=10) Hygenic, Group 3 (n=10) Dentsply, Group 4 (n=10) META. The apical fit of GP cones in all the models was assessed using Cone Beam Computed Tomography (CBCT). The obtained results were tabulated (One-way ANOVA and Post-hoc Tukey tests, p-value ≤0.0001, (highly significant) and subjected to statistical analysis using Statistical Package for Social Sciences (SPSS) Software. Results: The apical fit of GP cones in all the models was assessed by distance vbetween the end of GP and the prepared canal (in mm) using CBCT. Highest mean value was present among group 3 Dentsply 0.58±18 and least mean value was among group-2 hygenic (0.03±0.04). Among the groups used, Group 2 hygenic GP points showed less discrepancy in apical fit followed by META, Diadent and then Dentsply where the p-value was ≤0.0001, indicating the result to be highly significant. Conclusion: Based on the findings of this study, it can be concluded that Hygenic GP provided the best fit among the materials tested, followed by META, Diadent, and Dentsply. Further research with broader parameters may be necessary to validate these findings across different conditions.

Comparison of Serum Adiponectin in Patients with Psoriasis and Healthy Controls: A Cross-sectional Study

Diana Mariam, Sibiya Odayapurath, Rosmi Johnachan Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Psoriasis, a chronic inflammatory skin condition, is increasingly recognised as a systemic illness due to its associations with obesity, dyslipidaemia, insulin resistance, Metabolic Syndrome (MetS), and cardiovascular disorders. Adipocytes produce the insulin-sensitising and anti-inflammatory hormone adiponectin, which is linked to metabolic homeostasis and may serve as a biomarker for metabolic disorders associated with psoriasis. Aim: To evaluate serum adiponectin levels in psoriasis patients compared to healthy controls and analyse its relationship with metabolic parameters. Materials and Methods: The present comparative cross-sectional study was conducted at Government Medical College, Kozhikode, Kerala, India from June 2018 to June 2019. The study included 40 psoriasis patients (age 18-65 years) and 40 age and sex matched healthy controls. The lipid profile, serum adiponectin levels, anthropometric characteristics, and Fasting Blood Sugar (FBS) were measured. Psoriasis patients were further assessed for MetS using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Spearman's correlation analysis was used to examine relationships between adiponectin levels and metabolic markers. Group comparisons were performed using the Chi-square and Mann-Whitney U tests, with significance set at p-value <0.05. Results: The mean age of psoriasis patients was 46.0±12.0 years, compared to 40.9±9.8 years in controls. Women comprised 62.5% of cases and 80.0% of controls. Serum adiponectin levels were significantly lower in psoriasis patients (15.81±5.76 ng/mL) than in controls (23.10±8.06 ng/mL; p-value <0.001). Psoriasis patients also had significantly higher Waist Circumference (WC) (98.20±8.33 vs. 92.00±12.66 cm; p-value=0.03) and FBS (107.90±27.61 vs. 89.10±5.90 mg/dL; p-value <0.01). Adiponectin showed weak negative correlations with FBS and BMI (rho=–0.22; p-value=0.18). MetS was present in 75% of cases. Conclusion: Reduced adiponectin levels in psoriasis patients, particularly those with MetS, highlight its potential as a biomarker for metabolic dysfunction. Targeting adiponectin pathways may help mitigate psoriasis-associated metabolic complications.

Effectiveness of Telenursing Intervention Program Focusing on Social Communication Skills and Behavioural Challenges in Parents of Children with Autism: A Research Protocol

Neelam Narula, Pawan Kumar Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Telenursing is the use of technological resources and communication systems such as computers and mobile phones to encourage the development of nursing from a remote setting. It has recently been employed to enhance access to healthcare. Through telenursing, nursing and healthcare, in general, can be accelerated. Telenursing can assist parents of children with autism by creating a bridge between the treatment and support systems. Need of the study: Children with autism often exhibit challenging behaviour and poor social communication skills, which can lead to anxiety for their parents. Despite many advances in improving the quality of life for children with autism, many parents still struggle with unresolved issues. Aim: To assess the effectiveness of the Telenursing Intervention Programme (TNIP) for parents of children with autism, in terms of their knowledge, attitude and self-efficacy regarding social communication skills and challenging behaviour. Materials and Methods: A quasi-experimental pre- and postintervention study will be conducted at the autism Intervention Clinic of DEIC- Early Intervention Centre of the Department of Paediatrics, Safdarjung Hospital, Delhi, India, from March 2024 onwards until May 2025 (tentative). The target population will be parents of children with autism, with a sample size of 156 parents. A purposive sampling technique will be used. Socio-demographic variables, including age, relationship with the child, mother’s education, father’s education, type of family, child’s gender, age of the child at the time of autism diagnosis and whether parents have attended any sessions on autism before, will be recorded through a questionnaire. The TNIP will consist of a 60-minute video conference session divided into two sessions of 30 minutes each, conducted over two days. The session will include a 20-minute didactic lecture on social communication skills and challenging behaviour in children with autism, followed by a 10-minute discussion. The TNIP session will be held online via an online video platform. After the TNIP, parents will be reassessed for their knowledge, attitude and self-efficacy through a Google Form. Data will be collected using a structured knowledge questionnaire, an attitude questionnaire and the General Self-Efficacy (GSE) tool in both pretest and post-test formats.

Effect of Two Weeks Scapular Stabilisation Exercises, Upper and Lower Limb Plyometrics as a Part of Warm up on Cricket Medium Paced Bowlers: A Research Protocol

Basavaraj S Motimath, Sanjiv Kumar Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: Shoulder injuries are common in cricket. Such injuries can result from an ineffective training routine, traumatic injury, and micro-trauma-induced muscle strains. Scapular stabilising exercises should be prescribed during the early part of a shoulder rehabilitation programme to increase the strength of the upper limb musculature and prevent re-injury. Need of the study: Upper and lower limb plyometrics involve explosive, high-intensity exercises that can improve power, speed, and agility, which are crucial for bowlers to deliver fast and accurate deliveries. Therefore, studying the effect of a two-week training programme consisting of scapular stabilisation exercises and upper and lower limb plyometrics as part of a warm-up routine on medium-paced bowlers can provide valuable insights into enhancing their performance and reducing the risk of injury. The effectiveness of various training programmes on medium-paced bowlers’ performance is an area of ongoing research, and there is a need to investigate the potential benefits of incorporating scapular stabilisation exercises and upper and lower limb plyometrics into their warm-up routine. Aim: To evaluate the effect of two weeks of scapular stabilisation exercises with upper limb plyometrics versus scapular stabilisation exercises with upper and lower limb plyometrics as part of a warm-up on bowling speed in medium-paced cricket bowlers. Materials and Methods: This research protocol is planned to conduct a randomised clinical trial in Belagavi, Hubli, and Dharwad in Karnataka, India, and will employ a randomised, parallel-armed clinical experimental design. The duration of the study will be approximately four years, from January 2023 to February 2027. A total of 66 male cricketers from various KSCA-registered cricket clubs in Belagavi, Hubli, and Dharwad, with medium-paced bowling speed, aged between 18 and 35 years, will be randomly allocated to either a scapular stabilisation and upper limb plyometric group (N=33) or a scapular stabilisation upper limb and lower body plyometric group (N=33) for a period of two weeks (6 times per week). Bowling speed will be used to determine the speed of the ball, the one-minute pull-up test will be used to determine the strength of the upper limb, the vertical jump test will be used to determine the power of the lower limb, a goniometer will be used to determine shoulder range of motion and Glenohumeral Internal Rotation Deficit (GIRD), and target-based bowling accuracy will be used to determine bowling accuracy for one over. Inferential as well as statistical methods will be used to analyse the gathered data. A test for normal distribution will be conducted to determine whether non-parametric tests (Wilcoxon signed rank test, Mann-Whitney U test) will be performed. A probability value of <0.05 will be considered statistically significant.

Utility of CA15-3 as a Tumour Proliferation Marker in Breast Carcinoma Patients: A Cross-sectional Study Protocol

Apoorva Pande, Samarth Shukla, Milind Pande, Suhit Naseri, Saurabh Gawand Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Introduction: The Carcinoma Antigen (CA) 15-3 is a protein antigen from the mucin family that contains carbohydrates. It has shown potential as a tumour marker in breast cancer for detection, diagnosis, prognosis, therapy monitoring and assessing disease progression. Elevated CA 15-3 levels may correlate with tumour burden, making it a useful tool in preoperative evaluation. Need of the study: There is a need for reliable, non invasive biomarkers that can support the clinical evaluation of tumour growth in breast cancer. Assessing CA 15-3 levels before surgery may help in predicting tumour behaviour and enhancing the accuracy of preoperative staging. Aim: To evaluate the usefulness of CA 15-3 as a marker of tumour growth in patients with preoperative breast cancer. Materials and Methods: This prospective observational study will be conducted over a span of two years (2023-2025) within the haematology and histopathology segment of the Department of Pathology, in collaboration with the General Surgery and Biochemistry Departments at Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha, Maharashtra, India. This study will include 50 female patients diagnosed with breast carcinoma based on biopsy. Each case will be staged according to the Tumour, Node, Metastasis (TNM) classification system. CA 15-3 levels will be measured before surgery using the Enzyme-Linked Immunosorbent Assay (ELISA) technique. Over two years, CA 15-3 levels will be analysed in biopsy-confirmed breast carcinoma cases, with the expectation of finding higher levels in malignant and progressive tumours. The present study aims to validate CA 15-3 as a prognostic biomarker, supporting early detection, tailored treatment and improved patient outcomes. The study will assess the correlation between CA 15-3 levels, histopathological markers and TNM staging in breast carcinoma. It aims to establish CA 15-3 as a cost-effective diagnostic tool and refine treatment protocols. By integrating CA 15-3 with existing markers, the study seeks to improve early detection and personalise treatment strategies for better patient outcomes.

The Holistic Impact of Omkar Chanting: A Narrative Review of it’s Physiological, Psychological and Acoustic Effects

Jayashree Pattanayak, Judu Ilavarasu Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Mantra chanting, being a timeless practice in Vedic literature, has fascinated scholars and practitioners alike in diverse traditions. It is one of the simplest yet most effective part of traditional yoga practices for millennia, particularly Omkar or Om chanting. Chanting of mantra brings clarity of thought, inner peace, and spiritual growth. The benefits of chanting can be understood both scientifically and spiritually, with the impact on multiple levels- mental, emotional, and even physical levels of the individual. Mantra chanting, particularly repetitive vocalisations, has been found to promote relaxation, reduce stress hormone levels, including meditative brainwave patterns. The review article discusses the multifaceted background of the Omkar mantra by tracing its significance. This article delves into the Vedic literature bridging its relevance in contemporary research. Through historical text analysis and recent scientific studies, the study aims to understand the potential benefits of the vocal practice of the Omkar mantra. The novelty of this review lies in how acoustic analysis of Omkar chanting affects psychological and physiological parameters evaluating the effectiveness of treatment approaches. The paper also discusses case studies and clinical findings that emphasise the potential benefits of regular Omkar chanting in mood improvement, rehabilitation of anxiety and depression, cognitive functioning, and its physiological impact on respiratory dynamics, heart rate variability, and neural activity. This article also proposes the future scopes for integrating acoustic analysis of Om chanting with different clinical applications research.

A Comprehensive Review of the Implementation and Impact of Nikshay Poshan Yojana in India’s National Tuberculosis Elimination Programme

Sethuraman Sivaraman, Saurabh Kumar Banerjee Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X This comprehensive review examines the implementation and impact of Nikshay Poshan Yojana (NPY), a Direct Benefit Transfer (DBT) scheme for Tuberculosis (TB) patients in India. The review synthesises findings from multiple studies conducted across various states between 2018 and 2024. Key aspects analysed include coverage and enrolment rates, disbursement processes, awareness and utilisation patterns, implementation challenges, and the scheme’s impact on treatment outcomes and nutritional status. The review reveals significant variability in NPY implementation across different regions, with coverage rates ranging from 28.7 to 76.1%. Common challenges identified include delays in benefit disbursement, inadequate benefit amounts, and barriers to access for vulnerable populations. Despite these challenges, several studies report positive associations between NPY receipt and improved treatment outcomes. The review concludes with evidence-based recommendations for enhancing the effectiveness of NPY in supporting TB patients’ nutritional needs and treatment adherence.

Revamping Paediatric Dentistry with Multisensory Snoezelen^® Dental Environment: A Narrative Review

Ram Chidhambaram Annamalai, Vignesh Guptha Raju, M Sunil Kumar, P Agisha Raaje, S Narendra Prassath, S Sudhakar Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Dental fear or anxiety is the main cause of aversion to dental treatments in paediatric dental practice. The Snoezelen^® room, or multisensory environment, is a novel non-pharmacological approach to sensitising children to dental settings. It facilitates engagement of all the senses, especially for children with intellectual or developmental disabilities, helping them to familiarise themselves with dental environments through visual, auditory, tactile, and olfactory stimuli. Snoezelen^® multisensory therapy is an ideally equipped space that combines all human senses through captivating music, vibrations, aromas, tactile sensations, and well-lit surroundings. Research suggests that Snoezelen^® can alleviate anxiety and fear in children, enhance their mood, promote relaxation, and improve their cooperation with dentists. However, there is no “one-size-fits-all” approach; therefore, it needs to be customised according to individual patient preferences. This review discusses the concept, implementation, and benefits of the Snoezelen^® room in paediatric dentistry.

The Evolving Role of Anaesthesiologist in Chronic Pain Management: A Narrative Review on Innovations and Future Perspectives

Vinit Sunil Dhanure, Nikhil Bhalerao, Amreesh Paul Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Chronic pain is a widespread and complex medical condition that profoundly diminishes the quality of life, emotional status and functional ability. As knowledge about pain pathophysiology becomes more profound, the anaesthesiologist’s role has been extended beyond the perioperative period to become responsible for chronic pain management. This narrative review discusses the changing roles of anaesthesiologists in diagnosing, treating and managing chronic pain patients, offering an in-depth review of recent pharmacological approaches, interventional methods and advanced neuromodulation techniques applied in the practice setting. It highlights the relevance of multimodal and multidisciplinary pain management paradigms that incorporate physical, psychological and behavioural therapies. Together with tried-and-tested approaches, new advances like regenerative medicine, precision pain management and health technologies involving digital interventions—e.g., mobile applications and wearable monitoring—are presented. Increasing integration of Artificial Intelligence (AI) and machine learning with personalised pain care represents a new frontier, promising greater diagnostic accuracy, treatment planning and predictive outcomes. Despite these advances, persistent difficulties continue to exist, such as subjective pain measurement, opioid addiction, unequal access to treatment and systemic barriers to healthcare. The originality of this review lies in its holistic approach, crossing traditional methods with innovative technologies and patient-oriented models of care. It highlights the pivotal role of anaesthesiologists in changing the pain management paradigm for chronic conditions from mere symptom control to functional recovery and improved quality of life, while also mapping out future pathways in terms of innovation, education and policy reforms that can enable anaesthesiologists to spearhead this revolution in pain medicine.

AI-Powered Dental Forensics in Transforming Age Estimation Techniques: A Narrative Review

Parul Khare, Kalyani Bhargava, M Siddharth, Deepak Bhargava, Anoushka Chauhan Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Artificial Intelligence (AI) has opened new avenues for researchers all over the world with its rapid results, accuracy and efficiency. This paper specifically aims to identify the role of AI in forensic odontology by assisting odontologists in age estimation. It discusses the evolution from conventional methods to fast and efficient AI models, including Convolutional Neural Networks (CNN), Deep Learning (DL) and Machine Learning (ML) and compares the efficiency of each to conclude which AI model yields the best results for researchers. The paper also highlights the role of the CNN network in dental age estimation using Orthopantomogram (OPG), Cone Beam Computed Tomography (CBCT) and Magnetic Resonance Imaging (MRI) datasets. It aims to help researchers incorporate global advancements into their studies, with a focus on applications for the Indian population. OPG is widely used in routine dental examinations due to its efficiency and accessibility; however, it has limitations, such as image distortion and the lack of 3D visualisation. AI models, particularly CNNs, have improved the accuracy of age estimation from OPG images. Magnetic Resonance Imaging (MRI), though less commonly utilised, is beneficial for non invasive and precise age estimation in younger individuals because it provides clear images of pulp cavities. Cone Beam Computed Tomography (CBCT) offers superior 3D imaging, allowing for more accurate assessments of pulp-to-tooth ratios and root development, although it involves higher radiation exposure. This review highlights how combining AI with different imaging techniques can enhance accuracy, reduce human error and address population-specific variations in forensic age estimation.

Expanding Treatment Horizons with Chemical Agents and Drug Adjuvants in Odontogenic Keratocyst: A Comprehensive Review

Nidhi Vijaykumar Bodiwala, Nitin D Bhola, Chetan S Gupta Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Odontogenic Keratocyst (OKC), characterised by its unique histopathological features and propensity for recurrence, presents a clinical challenge in oral and maxillofacial surgery. The present review provides a comprehensive overview of OKC, delving into its aetiology, clinical presentation, and the intricacies of conventional treatment approaches. The significance of addressing OKC lies not only in its distinctive histological nature but also in its potential association with Nevoid Basal Cell Carcinoma Syndrome (NBCCS). The purpose of present review is to synthesise current knowledge on OKC, offering insights into its pathogenesis and emphasising the importance of a holistic understanding for informed clinical decision-making. Conventional treatment modalities, such as surgical excision, decompression techniques, marsupialisation, and enucleation, are explored in detail, highlighting their merits and associated challenges. The high Recurrence Rates (RR), particularly following conservative approaches, underscore the necessity for adjunctive therapies. Additionally, the review navigates recent advances in the treatment landscape, including molecular targeted therapies and immunotherapy, opening avenues for more targeted and effective interventions. The scope of this review extends beyond conventional treatments, addressing the nuances of OKC from molecular and genetic perspectives to the challenges posed by its anatomical location. By providing a comprehensive resource for clinicians, researchers, and dental healthcare professionals, the present review aimed to contribute to the evolving understanding of OKC, guiding future research endeavours and enhancing the clinical management of this intriguing odontogenic lesion.

The Pencil That Hid Too Well: A Missed Gluteal Foreign Body

Trupti Tonape, Sai Charan Reddy Nagarla Journal of clinical and diagnostic research : 2025 - August - 19:0973-709X Dear Editor, Retained Foreign Bodies (FBs) in soft tissues often present diagnostic dilemmas, especially when they are radiolucent and the clinical history is unclear or underestimated. We report a rare and instructive case of a missed gluteal FB in a paediatric patient.