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

Prenatal Ultrasonic Diagnosis of Persistent Right Umbilical Vein with Single Umbilical Artery in Twin Pregnancy: A Case Report

Shubhi Gaur, Pratap Singh Parihar, Vaishali Dhawan, Devyansh Nimodia, Prasad Sanjay Desale Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Persistent Right Umbilical Vein (PRUV) is a developmental abnormality of the vascular system that occurs during embryonic development when the right umbilical vein remains open while the left umbilical vein becomes atretic. PRUV presents in two forms: the extrahepatic variety, which is less prevalent but more often associated with complications, and the intrahepatic type, which is the most common (90-95%). A Single Umbilical Artery (SUA) occurs when there is only one umbilical artery in the cord, and it is associated with an increased risk of various abnormalities, including cardiovascular defects. Hereby, the authors present a case report of a 32-year-old primigravida, approximately 20.3 weeks into her pregnancy, underwent an anomaly scan that revealed a two-vessel umbilical cord, showing an SUA and a PRUV in one of the foetuses, while both foetuses demonstrated normal intrauterine growth. PRUV in foetuses is linked to preterm births, oligohydramnios, and intrauterine growth restriction. It can also lead to gastrointestinal malformations, various cardiac anomalies, skeletal malformations, urinary tract anomalies, and SUA defects. Therefore, prenatal diagnosis of PRUV is essential.

Visceral and Vascular Imaging Findings of Hypovolemic Shock in Contrast-enhanced Computed Tomography: A Case Report

Vaishali Bodhraj Dhawan, Rakshanda Pravin Agrawal, Gahana Kataria Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Shock, a medical emergency condition secondary to an underlying cause, requires urgent diagnosis for timely management. Imaging can play an important role in this process. Certain identifiable features on Contrast-enhanced Computed Tomography (CECT) may alert radiologists to the presence of Hypovolemic Shock (HS). A spectrum of visceral and vascular CT signs has been documented to represent the underlying shock condition. Authors, hereby present a case of 78-year-old male patient, depicting visceral and vascular imaging findings of HS, as observed on a CECT of the abdomen and pelvis. The visceral findings included hypoenhancement of the liver and spleen, heterogenous hyperenhancement of the kidneys and adrenal glands and abnormal dilation of small bowel loops. The vascular findings were characterised by the flattening of the Inferior Vena Cava (IVC). The present case report was aimed to help radiologists increase their awareness of the CT signs of HS and assist physicians in taking early measures for adequate management.

Management of Neglected Floating Knee with Rotational Deformity and Limb Shortening Using the Ortho-SUV Frame: A Case Report

Vishal S Patil, Mohammed Talha Muneer, Archit Gupta, Raj Kamble Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Floating Knee Injury (FKI) are associated with significant complications, including deformity and limb shortening. The Ortho-Solomin-Utekhin-Vilensky (SUV) (OSF) system, integrated with computer software for precision correction, offers an effective solution for treating complex cases, particularly those with rotational deformities. Hereby the authors present the case of a 38-year-old male who sustained a floating knee injury following a high-velocity Road Traffic Accident (RTA). Initial management included stabilisation with an external fixator following Damage Control Orthopaedic (DCO) principles. However, the patient was lost to follow-up and presented three months later with a neglected flexion deformity and significant external rotation of the knee. Clinical and radiological findings showed malunion, knee deformity and a limb length discrepancy of 2 cm. The external fixator was removed and deformity correction and limb lengthening were planned using the OSF frame, a hexapod system designed for complex deformity corrections. Intraoperative findings revealed full-thickness quadriceps muscle loss. The OSF system was used to correct rotational deformities and induce limb lengthening through corticotomy and distraction osteogenesis over a three-month period. Radiological assessments confirmed new bone formation, although residual proximal tibia displacement required screw fixation. After six weeks of non weight bearing, the patient achieved full weight-bearing with normal range of motion. The present case highlights the utility of the OSF system in achieving deformity correction and limb lengthening, demonstrating satisfactory functional outcomes in a neglected floating knee injury. The case underscores the importance of timely follow-up and the role of advanced external fixation techniques in managing complicated orthopaedic injuries.

Ayurvedic Management of Huntington’s Chorea (Tandava Roga): A Case of Rare Genetic Condition

Mrunal Sunil Bole, Sourabh Deshmukh, Trupti Thakre Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Huntington’s chorea is a rare genetic neurodegenerative disorder. It is an inherited disease that manifests as motor, cognitive, and psychiatric abnormalities. The disease is caused by a genetic mutation involving Cytosine-Adenine-Guanine (CAG) repeat expansion on chromosome 4. According to Ayurveda, Huntington’s chorea can be correlated with Tandava Roga, as mentioned in the Sharangdhara Samhita. A 50-year-old male patient presented to the Outpatient Department of Kayachikitsa, diagnosed with Huntington’s chorea based on positive family history, molecular genetic analysis, and chief complaints of abnormal involuntary movements. The Ayurvedic treatment approach was classically based on Shodhana and Shamana. The principles used included Balya (strengthening), Vatahara, Rasayana, and nerve-stimulating actions. The patient underwent Shodhana with medicated enema (basti) for strotoshodhana (detoxification of body channels), along with other procedures such as Shashti Shali Pind Swedan, Nasya, Shirodhara, and Shirotalam for three sittings. The same treatment was followed, with the patient returning for Panchakarma procedures every two months (three sittings). Along with Shodhana, some Shamana medications were advised during the course of treatment for six months, accompanied by Pathya sevan. Assessment was done using the Abnormal Involuntary Movement Scale (AIMS), which showed marked improvement, with the score reducing from 33 to 11 over six months of treatment. The Ayurvedic approach can help improve the condition of patients with Huntington’s chorea. Similar treatments can be utilised in such patients to study their efficacy in varied individual cases.

A Rare Case of Paediatric Traumatic Intraperitoneal Urinary Bladder Rupture

LS Prabhanjan, Mangesh Hivre, Dilip Gupta, Aarhata Pramod Singh Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Blunt trauma to the abdomen is widely encountered in the Emergency Department (ED) among both children and adults. Trauma is a major contributor to morbidity and mortality, even in the paediatric population. However, post-traumatic rupture of the urinary bladder in children is a rare occurrence. Hereby, the authors present a case report of a seven-year-old male, who was a victim of a bike versus truck collision, was brought to the Emergency Department in a state of haemodynamic shock. Two out of the three passengers on the motorcycle succumbed to their injuries on the spot. The survivor was rushed to the ED by ambulance. Upon initial examination, the patient was in a state of haemodynamic shock, with abdominal tenderness, lower abdominal guarding, and left inguinal subcutaneous emphysema. Fluid resuscitation was initiated at 10 mL/kg of crystalloids through intravenous access. Insertion of a Foley catheter revealed frank haematuria without urine output, and a Contrast-enhanced Computed Tomography (CECT) scan of the abdomen and pelvis showed gross haemoperitoneum. The patient was taken for emergency exploratory laparotomy, as the suspicion of bladder rupture was high. The procedure revealed a 3×4 cm rent in the dome of the urinary bladder. The bladder was repaired with Polydioxanone Suture 2-0 sutures in two layers. An abdominal drain was placed in the pelvic cavity, and the abdomen was closed in layers. The patient was discharged after seven days with an indwelling Foley catheter. The Foley catheter was kept in place for 14 days, after which it was removed following a successful trial voiding. On subsequent follow-up, the patient had no urinary complaints and recovered well. The present case report is significant as it addresses the bladder rupture of a young child who was a victim of a road accident. It is evident that double-layer repair of the bladder rupture with absorbable sutures yields significant outcomes even in children.

Inferior Vena Cava Filter and Catheter-based Thrombolysis for Treatment of Massive Deep Vein Thrombosis: A Case Report

Sangram S Mangudkar, Sanket Genuji Shinde, Varun Bhaskar Lingneni, Satbir Kaur Malik, Sai Sirisha Nallani Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Deep Vein Thrombosis (DVT), a subtype of Venous Thromboembolism (VT) is more likely to occur in areas such as the lower leg, thigh or pelvis when vessel wall damage, blood flow stasis and hypercoagulability are present. Untreated DVT in the lower extremities can enlarge and result in further complications such as Post Thrombotic Syndrome (PTS) and an elevated risk of pulmonary thromboembolism. Prothrombotic anomalies may arise as a result of a variety of circumstances including the degree and type of infection, inflammation, bed rest, the use of mechanical ventilators and venous catheterisation. The rise in DVT cases in recent years along with thrombus complications in various patient populations calls for customised DVT care and intervention. This research was carried out on a young man without any notable medical history and no history of addictions who arrived complaining of severe swelling that had developed over the course of a day, affecting his left lower limb. A bilateral lower limb doppler ultrasound suggested thrombosis in the popliteal vein, great saphenous vein, deep femoral vein and common femoral vein in the left lower limb. Low molecular weight heparin injection was used to treat the patient. However, as the patient had not shown any significant signs of clinical improvement, an Inferior Vena Cava (IVC) filter was inserted to prevent pulmonary thromboembolism, and catheter-based thrombolysis was performed to break down clots and restore blood flow, thereby reducing the risk of long-term complications like PTS. Following recovery, the patient was discharged on oral anticoagulants and is currently on regular follow-up.

Non Tuberculous Mycobacterium Infection with Cavernolith: A Rare Case Report

Anjana Ledwani, Babaji Ghewade, Vivek Alone, Ashwin Karnan Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Cavernolithiasis is defined as a calcified focus found inside a lung cavity. The patient can remain asymptomatic or exhibit non specific symptoms such as haemoptysis and recurrent chest infections. Its diagnosis poses a challenge to clinicians worldwide, making it a topic of interest. A collection of more than 190 various mycobacteria that cause infections in different body organs, especially the lungs, is collectively referred to as Non Tuberculous Mycobacteria (NTM). Hereby, authors report a rare case of cavernolithiasis in a 35-year-old-female patient with an NTM infection who was previously diagnosed and treated for Pulmonary Tuberculosis (PTB). This patient’s sputum was positive for Acid-fast Bacilli (AFB), and sputum culture showed growth of NTM species. High-resolution Computed Tomography (CT) of the thorax revealed bilateral cavitary lesions with the presence of calcified material inside the cavities. She did not require any surgical intervention and was managed conservatively. NTM infection poses a diagnostic challenge, making treatment milestones very difficult due to the complex treatment regimen involving multiple drugs administered for a prolonged period. Therefore, appropriate measures such as cessation of substance abuse, pulmonary hygiene, a nutritional diet, adherence to treatment, and regular follow-up must be taken to improve the quality of life.

An Unusual Phenomenon of Tourniquet-induced Hypertension in a Young Adult Male Undergoing Lower Limb Surgery under Subarachnoid Block: A Case Report

Mridul Madhav Panditrao, Sarita Swami, Rohan Thombare Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X The employment of tourniquet to achieve bloodless surgical field is an essential step, especially in upper/lower extremity orthopaedic surgical procedures. However, tourniquet itself can lead to many possible problems, posing challenges to the anaesthesiologists. One such is exaggerated hypertensive response sometime after inflation of tourniquet, aptly termed as Tourniquet-induced Hypertension (TIH/T-HTN). It may not be evident in some patients, but if and once established, it becomes practically impossible to minimise/reverse it. This can be a nightmarish experience for the anaesthesiologist concerned. The authors hereby present one such case where, a young, healthy 25-year-old male posted for arthroscopy of right knee, who was administered subarachnoid block with dexmedetomidine as an adjuvant to bupivacaine. Within 35 to 40 minutes of inflating the torniquet, he developed severe hypertensive response, with blood pressures ranging from a Systolic Blood Pressure (SBP) of 190 to 210 mmHg and a Diastolic Blood Pressure (DBP) of 118 to 125 mmHg. It remained unresponsive to any form of treatment, including, the sedation with Inj. Midazolam or incremental doses of Inj. Labetalol. The hypertension persisted throughout the duration of surgery, while patient remained comfortably asleep. However, at the end of the surgical procedure, as soon as the tourniquet was deflated, the Blood Pressures (BPs), both SBP and DBP dropped to baseline values. Also, includes an in-depth review of the available literary evidence about this phenomenon and provided specific deductions and recommendations/remedial measures.

Pericardial Effusion as a First Symptom of Thymoma: A Case Report

Suprit Malali, Sourya Acharya, Samarth Shukla, Sunil Kumar, Priti Mishra Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Thymomas, which account for 25% of all mediastinal tumours, primarily originate from the anterior mediastinum and tend to grow slowly, often being incidentally discovered during radiographic investigations. The clinical spectrum of thymoma ranges from asymptomatic incidental findings to the development of paraneoplastic syndromes and symptoms caused by local or metastatic involvement. Myasthenia Gravis symptoms may also be present, and in some cases, manifestations can arise due to pressure on adjacent structures. However, pericardial effusion as an initial and early presenting feature of thymoma remains extremely rare. In advanced and disseminated cases, pericardial and pleural effusions may occur. Therefore, it is crucial to consider the possibility of a concealed cardiac silhouette mimicking pericardial effusion in asymptomatic patients, ensuring a comprehensive evaluation. The current report represents a case study of a 56-year-old female patient with a history of subacute and progressive dyspnoea. Despite no significant positive clinical findings upon general and systemic examination, the diagnostic work-up revealed a modest pericardial effusion attributed to an unexpected thymoma. The present case highlights the unusual clinical manifestation, emphasises the diagnostic challenges involved, and underscores the importance of considering thymoma in the differential diagnosis of pericardial effusions.

Management of Grahani Roga (Acute Pancreatitis) by Ayurvedic Modalities: A Case Report

Sonali Balu Sahane, Renu Bharat Rathi, Pavan Navkarkar, Shrish Jaishwal Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Acute pancreatitis is one of the most critical health conditions in the paediatric age group. A one-to-one correlation of pancreatitis is not found in Ayurveda classics; however, it can be considered under Grahani Roga. Hereby, the authors present a case report of a five-year-old male patient complaining of recurring pain in the epigastric and left hypochondriac regions, referred to the back, along with nausea and severe projectile vomiting. The patient was diagnosed just five days ago with Grahani Roga (acute pancreatitis) using ultrasonography and laboratory findings, and he approached the Kaumarbhritya (Paediatric) Outpatient Department (OPD) for management. Considering the severity of the disease and the condition of the patient, Ayurvedic Shamana and Shodhana Chikitsa were initiated. Grahani Roga (acute pancreatitis) is classified as a Pittaj Vikara. Virechana is the best treatment modality for Pittaj Vikara; hence, in this patient, Mridu Virechana (mild purgation) using Avipattikar Churna was administered. Due to the extreme pain in the patient, which is associated with Vata Dosha vitiation, Matra Basti with Til Taila was started. Alongside this, Shamana Aushadhi was initiated, which included Sankh Vati, Aamlaki Churna, and Yashtimadhu Churna as Rasayana drugs. After eight days of treatment, improvement was observed in symptoms such as abdominal pain and nausea. Shamana and Shodhana Chikitsa were continued for 21 days, resulting in significant improvement in overall symptoms. No recurrence had been observed until the sixth month of follow-up.

Rifampicin-induced Stevens-Johnson Syndrome: A Rare Case Report

Bhaveshkumar Manilal Patel, Mugdha Manaji Kadam, Arti Dhawal Shah, Chirag Chakravarti, Virenkumar Jayendrakumar Patel Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Tuberculosis (TB) continues to be a major global health issue, necessitating effective treatment regimens primarily involving antitubercular drugs. First-line antitubercular drugs are commonly used in combination with other medications to treat TB. These drugs are essential for the treatment of TB, a contagious bacterial infection caused by Mycobacterium tuberculosis. However, antitubercular drugs can lead to various skin reactions, which may range from mild to severe. Stevens-Johnson Syndrome (SJS) is a rare and severe reaction characterised by extensive skin peeling and mucosal involvement. It can occur with any antitubercular drug but is more commonly associated with isoniazid and rifampicin. Rifampicin, an essential medication in the treatment of TB, is known for its efficacy but also for its potential to cause severe adverse reactions. The spectrum of skin reactions can vary widely, from benign rashes to Severe Cutaneous Adverse Reactions (SCARs), like SJS. Early recognition and appropriate management are crucial to mitigate complications. Understanding these adverse effects is essential not only for immediate patient care but also for fostering long-term adherence to TB treatment, as fear of side effects can lead patients to abandon their regimens prematurely. Hereby, the authors present a rare case of a 55-year-old male who developed life-threatening skin reactions, including SJS, following the initiation of rifampicin therapy. Rapid recognition and intervention were critical, leading to the immediate discontinuation of rifampicin and the initiation of supportive care and corticosteroids. The patient was closely monitored, and his condition improved significantly over the following weeks, with gradual resolution of skin lesions and restoration of mucosal integrity.

One-Lung Ventilation with Double-Lumen Tube in Decortication of Lung Abscess: A Case Report

Shafaque Maqusood, Vivek Chakole, Amol Bele, Sambit Dash, Saylee Shedge Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X A microbial lung infection that causes the pulmonary parenchyma to necrotise is called a lung abscess. Lung decortication can be a straightforward process, but it may also present significant challenges. To allow the underlying lung parenchyma to expand, the thick fibrinous layer must be removed from the pleural surface. Patients with long-standing empyema, pleural thickening, haemothorax, and pleural tumours are candidates for decortication. Such patients require One-Lung Ventilation (OLV), as the lung being operated on must be isolated. Complications, such as the tube becoming malpositioned or the inability to achieve unilateral isolation, are not uncommon when using a Double-Lumen Tube (DLT) due to the intrinsic challenges involved. A DLT can be utilised to accomplish OLV, which is necessary for adequate lung isolation and exposure during surgery. The present article discusses the valuable experience of managing the use of DLT in a 42-year-old male who had a lung abscess and was scheduled for lung decortication due to respiratory distress. Proper preoperative assessment and appropriate anaesthesia planning are essential for handling such cases without complications and achieving better surgical outcomes.

Guillain-Barré Syndrome Triggered by Tetanus Vaccination during Pregnancy: A Rare Case Report

Jagannath Dhadwad, Prince Yadav, Kunal Modi, Bana Reddy, Chandan Kumar Dash Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Guillain-Barré Syndrome (GBS) following tetanus immunisation during pregnancy is an extremely rare occurrence. GBS is an autoimmune disorder in which the immune system targets peripheral nerves, causing muscle weakness and in extreme cases, paralysis. GBS after vaccination, especially after the tetanus, diphtheria and pertussis (Tdap) vaccine, is extremely rare. Here, a case of 21-year-old woman (G2A1, gravida 2, abortion 1) with acute onset of bilateral symmetrical ascending paralysis with areflexia in both upper and lower limbs, with a prior history of Tetanus vaccination 15 days back is described. The patient was examined thoroughly and all other causes were ruled out. Management of this patient was challenging, as it required treating the GBS along with ensuring the wellbeing of the foetus. The aetiological diagnosis also posed a challenge, as there was no clear history of any incriminating cause. Intravenous Immunoglobulins (IVIG) and physiotherapy were given which led to an improvement in the patient's condition. Although the routine practices followed in pregnancy, like vaccination, is vital, this case highlights the potential complications of the same. Reporting such cases is essential to enhance understanding of vaccine safety and guide future recommendations. The clinical implications enforce the need for early diagnosis and prompt management to ensure favourable outcomes for both the mother and foetus.

A Case of Variceal Bleeding with Cricopharyngeal Web: A Challenge to Variceal Band Ligation

Dandi Kranthi, Debabrata Banerjee, Amol S Dahale, Abhijeet Karad, Yogesh Bade Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Acute Variceal Bleeding (AVB) is a life-threatening complication of portal hypertension that necessitates prompt and effective intervention. Endoscopic Variceal Ligation (EVL) is the primary treatment modality; however, anatomical variations, such as oesophageal webs, can impede the procedure. The present report describes a 40-year-old female patient presenting with haematemesis and melena. Endoscopy confirmed active variceal bleeding, but the advancement of an endoscope equipped with a band ligator was obstructed by a cricopharyngeal web, rendering EVL unfeasible. Haemostasis was initially achieved using sclerotherapy with sodium tetradecyl sulfate. Subsequent endoscopic dilation of the web with a Controlled Radial Expansion (CRE) balloon facilitated successful band ligation. The present case underscores the importance of early recognition of anatomical anomalies and highlights the need for adaptable strategies in the management of AVB, particularly in emergent settings where time is critical. The clinical implications are significant, as the case highlights a previously unreported barrier to EVL in the form of a cricopharyngeal web. It emphasises the necessity for endoscopists to consider anatomical variations when standard procedures fail. The present report contributes to the literature by documenting an unusual clinical scenario that required modification of the standard therapeutic approach to achieve haemostasis in a life-threatening situation.

Scrub Typhus Induced Thrombotic Thrombocytopenia: A Rare Case Report

Maharshi Patel, Sourya Acharya, Samarth Shukla, Shubham Nimkar, Sunil Kumar Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Scrub typhus is a zoonotic disease caused by Orientia tsutsugamushi. The bacterial infection is spread via Trombiculidae mites. A 50-year-old male patient was admitted with a complaint of fever, cough, breathlessness, and irrelevant talk for five days. The patient was chronic alcoholic and hypertensive for one year. After investigation patient was positive for scrub typhus. The patient had hepatitis, renal failure, thrombocytopenia, and right lower lobe pneumonia. The cause of thrombocytopenia in scrub typhus individuals could be the development of Thrombotic Thrombocytopenic Purpura (TTP), Disseminated Intravascular Coagulation (DIC), and thrombotic microangiopathy. In scrub typhus patients, TTP and Multiple Organ Dysfunction Syndrome (MODS) can be avoided with early diagnosis and effective treatment. Further research is warranted in such conditions to understand the molecular mechanism as well as to prevent mortality.

New Horizons in Gingival Depigmentation: A Case Report Comparing Blue®m Oxygel and Coe-Pak™ Periodontal Dressing

Sakshi Vishal Kotecha, Priyanka Jaiswal, Shweta Bhagat Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Gingival hyperpigmentation can be defined as a darker gingival colour beyond what is normally expected. The colour of the gingiva is vital for facial beauty and contributes in a great manner to the appearance of an aesthetic and confident smile. A dark colour of gingiva can have a negative psychological impact, particularly when combined with a higher lip line or a smile with visible gingiva. The gold standard for managing gingival pigmentation is by scalpel surgical technique, despite its disadvantage of resulting in an open wound that requires special care and dressing. Hereby, the authors present a case report of 21-year-old-male patient with concern about dark colour of gums and used scalpel surgical technique for gingival depigmentation and aimed to assess and evaluate the efficacy of reactive oxygen available in gel form (Blue®m gel™) and long-accepted Coe-Pak™ dressing on healing of the gingiva, pain perception, and re-epithelisation following surgical depigmentation. On follow-up, it was inferred that gingival healing, pain tolerance, and re-epithelisation was better with Blue®m gel™.

A Rare Case Presentation of Synovial Haemangioma of the Knee

Arun Karthik Ravichandran, Rajavel, Gowtham Senguttavan, Sharath Rajkumar, Saravanan Vasudevan Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Synovial haemangioma is a benign vascular neoplasm that commonly affects the knee joint. It is often underdiagnosed as a cause of chronic knee pain, leading to delays in the management of this rare tumour. Magnetic Resonance Imaging (MRI) and arterial Doppler serve as vital diagnostic modalities that aid in the diagnosis of synovial haemangioma. Here, the authors present a case of a 15-year-old male who had experienced swelling and pain in his left knee joint for the past 13 years without receiving any prior treatment. The patient's parents reported no history of trauma. Following further investigations, an MRI of the left knee showed evidence of T1 hypointense and T2 moderate Short Tau Inversion Recovery (STIR) hyperintense soft-tissue lesions involving the anterior and posterior recess of the synovium of the knee joint with finger-like projections, which is considered one of the definitive findings of synovial haemangioma. The patient underwent Ultrasound (USG)-guided sclerotherapy using sodium tetradecyl sulfate, after which he experienced rapid relief of his symptoms. Sodium tetradecyl sulfate acts by damaging the endothelium of the feeder vessel, resulting in a thrombus, which later leads to fibrous tissue formation around the feeder vessel. Thus, blood flow is redirected to the healthy veins, resulting in the shrinkage of the haemangioma. The present case report highlights the importance of ultrasound-guided sclerotherapy as a valuable treatment modality in the management of synovial haemangioma.

Collapsing Pattern Class-IV Lupus Nephritis Presenting as Posterior Reversible Encephalopathy Syndrome and Cardiac Tamponade: A Rare COVID-19 Sequelae

K Harshitha Reddy, Pranjal Kashiv, Sunil Kumar, Sourya Acharya, Kapil Navin Sejpal Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X One of the most detrimental and severe presentations of Systemic Lupus Erythematosus (SLE) is Lupus Nephritis (LN), which is a type of glomerulonephritis. Type-IV Lupus Nephritis, or diffuse Lupus Nephritis, is a severe illness characterised by diffuse proliferative lesions. In this setting, the prognosis worsens if cellular crescent is present. It is divided into two types: diffuse segmental and the other being diffuse global. Wire-loop lesions could also be observed. There have been reports of Collapsing Glomerulopathy (CG) in SLE patients with Focal Segmental Glomerulosclerosis (FSGS). The collapsing variety of FSGS (cFSGS) is defined histopathologically by segmental or global glomerular capillary condensation and obliteration, the appearance of hyperplastic and hypertrophic podocytes, and substantial tubulointerstitial damage. Numerous aetiologies have been proposed, including viral infections such as Human Immunodeficiency Virus (HIV), Cytomegalovirus (CMV), Epstein-Barr virus, and Parvovirus B19, as well as medications and acute ischaemia. Patients infected with Coronavirus Disease-2019 (COVID-19) have an increased risk of acute renal injury as there is a systemic inflammatory cascade due to an acute infection, causing impairment of basic cellular activities in podocytes. Hereby, the authors present a case report of a 17-year-old female who experienced cardiac tamponade and seizures due to Posterior Reversible Encephalopathy Syndrome (PRES). Further investigation and kidney biopsy revealed she had lupus nephritis Stage-IV Diffuse Proliferative Glomerulonephritis (DPGN) but with the collapsing variety, which is a rare finding. Additionally, the patient tested positive for COVID-19, which may have contributed to the development of the collapsing type of DPGN.

Reconstruction of a Large Groin Defect using Pedicled Chimeric Tensor Fascia Lata and Vastus Lateralis Muscle Flaps Following Malignant Melanoma Excision: A Case Report

Archita N Rai, Swati Deshpande, Firoz Borle, Raju Shinde, Aditya Kale Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X The reconstruction of large oncologic defects, especially in the groin region, poses significant surgical challenges due to the exposure of vital structures such as the femoral vessels. A 68-year-old male, previously treated for melanoma of the left foot, presented with a recurrent swelling in the left inguinal region. Fine Needle Aspiration Cytology (FNAC) confirmed malignant melanoma. Imaging studies revealed a lobulated, infiltrative lesion in the left proximal thigh, abutting the femoral triangle but without muscle invasion. The patient underwent radical excision of the lesion along with inguinal lymph node dissection, resulting in a 20×10 cm defect with exposed femoral vessels that required complex reconstruction. A pedicled chimeric left Tensor Fascia Lata (TFL) perforator flap and a vastus lateralis muscle flap were harvested. The TFL flap was raised based on a single dominant perforator, while the vastus lateralis muscle flap was based on the descending branch of the Lateral Circumflex Femoral Artery (LCFA). Both flaps were successfully tunneled under the rectus femoris muscle and inset into the defect. The donor site was partially closed, and the remaining area was planned for delayed secondary skin grafting. The pedicled chimeric TFL and vastus lateralis flaps effectively covered an extensive groin defect with exposed femoral vessels. This approach offers a robust reconstructive option for complex oncologic defects, ensuring functional and aesthetic outcomes. Further studies and case series are warranted to explore the versatility and limitations of this technique.

Breast Diffuse Large B-cell Lymphoma, Activated B-cell like Subtype: A Case Report

Sneha Samir Babaria, Jinalben Shaileshbhai Patel Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Primary Breast Lymphoma (PBL) is an uncommon form of Non Hodgkin Lymphoma (NHL) that arises within the breast tissue, representing less than 1-2% of all cases of NHL and under 0.5% of all breast cancers. Most PBL cases are of the B-cell type, accounting for up to 50% of all PBL. Diffuse Large B-cell Lymphoma (DLBCL) of the breast is a rare subtype of NHL, with a common age of presentation in females being 50-60 years. It typically presents as a painless breast mass without pathognomonic radiologic findings. Authors hereby, report a case of a 43-year-old female who complained only of heaviness in the right breast, followed by a discretely palpable lump upon examination. High-grade NHL was diagnosed via core needle biopsy and turned out to be DLBCL, Activated B-cell (ABC)-like subtype, as determined by Immunohistochemistry (IHC). This study emphasises that histopathological analysis of core needle biopsy with IHC is paramount for establishing the diagnosis and distinguishing it from other benign and malignant breast conditions. By sharing this case, authors aimed to contribute to the growing knowledge of this rare entity, which has steadily increased over the past four decades, to ensure timely and accurate diagnosis for the implementation of appropriate therapy.

Dental Trauma following Animal Attack: A Case Report

Meetkumar Dedania, Nimisha Shah, Sankalp Mahajan, Riddhi Thakkar Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Animal attacks are a common cause of human injuries worldwide, with human-leopard encounters frequently reported in India. Animal attack injuries are increasingly common in trauma centres due to human encroachment into wildlife habitats, leading to more human-animal interactions. These attacks, especially to the face, can cause significant functional, cosmetic, and structural damage. A 40-year-old woman was attacked by a leopard, resulting in tooth mobility, pain, and orofacial lacerations. Initial treatment and primary wound closure were performed in Ratlam, Madhya Pradesh, India. On further examination, necrosis with blackish discolouration of the left ala of the nose was observed, along with scarring on the lips. Tooth 22 exhibited luxation without alveolar bone involvement, leading to proclination. A multidisciplinary treatment approach was adopted, beginning with manual manipulation and repositioning of tooth 22, followed by stabilisation and endodontic treatment. For extraoral management, plastic surgery was performed, involving a paramedian forehead flap and alar cartilage remodelling using left auricular cartilage. The patient underwent follow-ups at one, three, six months and one year. In conclusion, managing dental trauma from animal attacks requires a multidisciplinary approach and ongoing follow-up. By fostering collaboration among healthcare professionals and ensuring vigilant care, we can significantly improve patient outcomes and recovery.

Atypical Origin of Lateral Pectoral Nerve: A Case Report

Bidyarani Devi Loitongbam, Anjulata Rai, Jyoti Arora, Harshika Khatri Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X In the present case, two Lateral Pectoral Nerves (LPN) were in the right axilla. The upper branch, superior LPN arose from the proximal part of the axilla deep to the clavicle from the anterior division of the upper trunk. This branch descends medially and enters the deep surface of the pectoralis major muscle. A larger LPN is seen originating from the distal part of the right lateral root of the median nerve at the lower part of the axilla, medial to the third part of the right axillary artery. This inferior LPN is 2 cm long, descends medially, and joins with the Medial Pectoral Nerve (MPN) forming ansa pectoralis. The branches from the ansa pierce the pectoralis minor muscle and enter the pectoralis major muscle. It supplies both the pectoral muscles. LPN fibers passing from the Lateral Cord (LC) through the lateral root of median have not been reported yet. The LPN is the main nerve of pectoralis major muscle. A thorough understanding of Pectoral Nerve (PN) anatomy is a must for surgeons practicing mastectomies, breast augmentation surgery, axillary dissection, harvesting pectoralis major muscle island flap, and dealing with trauma and fracture of the shoulder.

Segmental Spinal Anaesthesia for Laparoscopic Cholecystectomy in Situs Inversus Patient: A Case Report

Richa Chandra, Gaurav Misra, Navneeta Bisht, Gopal Dutta, Sumit Khandelwal Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Situs inversus is a rare congenital anomaly and presents with transposition of abdominal and thoracic viscera to the opposite side, including the heart and gallbladder. Laparoscopic Cholecystectomy (LC) is the gold standard for chronic cholelithiasis and has been reported in patients with situs inversus under General Anaesthesia (GA). Segmental Spinal anaesthesia (SS) has been gaining popularity as a safe alternative to GA in high-risk patients and for LC as well. Present case is of a 48-year-old male with situs inversus, dextrocardia without any other cardiopulmonary anomaly, and short stature who was electively operated on under the SS for chronic cholelithiasis electively. The patient was aware of his congenital condition and preferred awake anaesthesia. After a multidisciplinary discussion involving surgery, cardiology and the anaesthesia team the patient was operated on with LC successfully under SS with isobaric levobupivacaine and fentanyl through T8-9 space. The intraoperative and postoperative periods were uneventful. Present case conclude that SS can provide considerable safety in well-investigated patients who pose a risk for GA due to various factors, such as altered anatomy, birth abnormalities associated with cardiac and pulmonary risk and difficult airways. This case report can be used as a reference for the preferred use of SS instead of GA in such cases.

Primary Hyperparathyroidism-Phosphaturic Mesenchymal Tumour: An Unusual Association and a Probable Syndrome

Gwendolyn Fernandes, Avanika, Gloria Khumanthem Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Phosphaturic Mesenchymal Tumour (PMT) is a rare and underdiagnosed tumour that causes Tumour-Induced Osteomalacia (TIO). These tumours produce Fibroblast Growth Factor-23 (FGF23), which inhibits renal tubular phosphate reabsorption, leading to hyperphosphaturia and oncogenic osteomalacia. The association of primary Hyperparathyroidism (pHPT) with PMT is extremely rare, with only two cases reported in the literature to date. A 51-year-old male presented in a bedridden state with multiple episodes of fractures throughout his skeleton over six years. Investigations revealed mild hypocalcaemia, marked hypophosphatemia, elevated serum Alkaline Phosphatase (ALP), low 25-Hydroxy Vitamin D, and persistently raised Parathormone (PTH) levels. A 68-Ga-DOTANOC 3D PET (Positron Emission Tomography) scan revealed a 4.1×3.2×2.5 cm DOTA avid mass in the right thigh. FGF23 levels were found to be 1466 pg/mL. A diagnosis of hypophosphatemic osteomalacia with pHPT was made, and the mass was subsequently excised. The thigh mass measured 3.5×2.5 cm and had a tan-brown cut surface. Microscopy revealed a benign spindle cell tumour with a vasoformative pattern and areas of grungy calcification. Immunohistochemistry demonstrated strong positivity for Vimentin, while CD34, CD68, CK, and Desmin were negative. A diagnosis of PMT, Mixed Connective Tissue type, was established. Normal phosphate, calcium, and FGF23 levels were restored after surgery, and the patient was able to walk again. This unusual case of a patient with pHPT and PMT, and the possible existence of a “pHPT-PMT syndrome, “was reported in the Times of India on November 20, 2022, as “Rare phosphorus-guzzling tumour left Dongri man bedridden for three years.” The exact aetiology for the association of PMT and pHPT is not known, and the hypothesis of aberrant gene expression has been implicated.

Methicillin-resistant Staphylococcus Aureus Bacteraemia in a Young Boy following Mumps Infection: A Case Report

Jayakanthan Saravanan, AP Krithika, M Geetha Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Mumps infection is regarded as one of the main vaccine-preventable diseases in the world. Although mumps is considered one of the most innocuous infections, it can also cause serious complications such as meningoencephalitis, pancreatitis, myocarditis, and long-term issues like deafness and multiple cranial nerve palsies. Due to its predominantly benign nature, it has long been a neglected infection. The Government of India includes the administration of the Measles and Rubella (MR) vaccine only (without the mumps vaccine) at 9 and 15 months of age for all children in the National Immunisation Schedule. In the present case, a nine-year-old boy was brought in with complaints of fever and bilateral swelling in the parotid region for three days, accompanied by pain during chewing. Clinically, patient was diagnosed with a mumps infection. The parotid swelling gradually decreased over the course of one week. However, the boy continued to experience persistent high-grade fever even after the parotitis improved. Complications of mumps, such as orchitis, pancreatitis, and meningoencephalitis, were ruled out. Laboratory investigations revealed the growth of Methicillin-resistant Staphylococcus Aureus (MRSA) in the blood, which was sensitive to the antibiotics doxycycline, ciprofloxacin and clindamycin. The boy was started on doxycycline, and the fever abated within 24 hours, leading to constitutional improvement. This unusual presentation of MRSA bacteraemia following a mumps infection underscores the importance of considering all possible differential diagnosis when a child does not follow the expected clinical course and continues to exhibit symptoms without improvement.

Nevus Sebaceous of Jadassohn Mimicking a Pilonidal Sinus of Forehead: A Rare Case Presentation

Parindita Sarmah, Prasad Deshmukh, Sagar Gaurkar Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Nevus Sebaceous of Jadassohan (NSJ) is a hamartoma that presents as a cutaneous lesion, which can be considered an overgrowth of sebaceous glands, hair follicles, and other epidermal structures. Although it is usually a benign condition, the lesion is capable of producing secondary neoplasms, both benign and infrequently, malignant. This case report discusses a 21-year-old male patient who presented with a lesion on the forehead, manifesting as a pilonidal sinus due to the presence of a tuft of hair at the end of the sinus tract following childhood trauma. The presence of a sinus tract with hair growth in the glabellar region is a rare and diagnostically challenging presentation of NSJ. This case highlights the complexities of managing such chronic wounds and the potential complications arising from trauma.

Anaesthetic Management of a Neonate with Ebstein’s Anomaly Undergoing a Meningomyelocele Surgery: A Case Report

Prakriti, Monika Yadav, Vaishali Gupta, Komal Yadav, Shikha Garg Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Ebstein’s Anomaly (EA) is a congenital heart defect characterised by the downward displacement of the posterior and septal leaflets of the tricuspid valve toward the right ventricular apex. Hereby the authors discuss a 16-day-old female neonate with EA who underwent surgery for a ruptured meningocele. The baby, born at full term, had an Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score of 7 at one minute and 9 at five minutes. Upon further observation, she showed multiple episodes of breath-holding and cyanosis. On examination, an enlarged head and swelling on the lumbar spine led to an ultrasound that confirmed hydrocephalus and meningocele. An Electrocardiogram (ECG) showed supraventricular tachycardia, and a chest X-ray revealed cardiomegaly. The diagnosis of EA was confirmed by two-dimensional (2D) echocardiography. General anaesthesia with inhalational induction was planned. Perioperative considerations for this patient included right-to-left shunting with the possibility of paradoxical emboli, prolonged onset time for intravenous drugs due to pooling and recirculation of blood in the right atrium, increased Pulmonary Vascular Resistance (PVR), perioperative pulmonary hypertension, right and left ventricular dysfunction, and arrhythmias. Key cardiovascular goals for this patient included maintaining normal sinus rhythm, ensuring adequate preload while avoiding significant changes in Systemic Vascular Resistance (SVR) or PVR, avoiding medications and factors that depress myocardial function, and promptly identifying haemodynamic instability or inadequate tissue perfusion with appropriate corrections. The surgery for excision and repair of the meningocele was uneventful, and the neonate was sent to the Neonatal Intensive Care Unit (NICU) for further monitoring.

Mucinous Cystic Neoplasm of the Liver Mimicking as Hydatid Cyst: A Case Report

Ranjita Panigrahi, Ajit Kumar Singh, Arlene Bhuyan, Amaresh Mishra, Subrat Kumar Sahu Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Mucinous Cystic Neoplasms (MCNs) of the liver are rare cystic tumours, accounting for less than 5% of all liver cysts. They usually arise in the liver parenchyma and less frequently in the extrahepatic bile duct. Women in their 5th and 6th decades are predominantly affected. Various liver cystic lesions, such as hydatid cysts, simple cysts and endometriotic cysts, can mimic this rare entity radiologically. The present case involved a 38-year-old female who was admitted with chief complaints of skin rash, swelling in the face and feet, pain in all limbs, and abdominal distension for six months. She experienced significant weight loss and was unable to perform daily activities. Ultrasonography (USG) of the abdomen showed a well-defined multiloculated cyst in segment IV of the liver, which was further confirmed by a Contrast-enhanced Computed Tomography (CECT) scan. The patient underwent laparoscopic surgery based on the radiological diagnosis of a hydatid cyst. Histopathological (HP) study of the cyst wall revealed a diagnosis of MCN, which was further confirmed by Immunohistochemistry (IHC). The postoperative period remained uneventful. Complete surgical excision is the treatment of choice over conservative management and partial excision, as it has low recurrence rates and a good survival rate. Due to its rare presentation and the varied number of radiological differential diagnosis, it often leads to delayed or misdiagnosis. Authors hereby report the present case along with a brief review of the literature to increase radiological and clinical awareness, which is essential to keep MCN as a differential diagnosis during the initial evaluation of any cystic lesion of the liver.

A Case of Renal Pelvi-venous Fistula Diagnosed by Nephrostogram: A Rare Complication of Percutaneous Nephrostomy

Vishal Nandkishor Bakare, Ritesh Kumar Sahu, Rohan Rahul Thakur, Aniketh Davangere Hiremath Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Percutaneous Nephrostomy (PCN) is a minimally invasive procedure used in patients with hydronephrosis. Major haemorrhagic complications requiring transfusions occur in 1-4% of PCNs, while major vascular injuries (requiring embolisation or nephrectomy) occur in 0.1-1% of cases. The sources of bleeding are usually from pseudoaneurysms or Arteriovenous (AV) fistulas when the nephrostomy tract passes near the renal hilum. A calyceal-venous or renal pelvi-venous fistula is a rare but significant complication that can arise following PCN, ureteric obstruction, and renal transplantation. Invasive treatment options for managing these fistulae include transvenous embolisation, external drainage to relieve outflow obstruction, and open surgical management, which may involve closure of the fistula, partial nephrectomy, or complete nephrectomy. Hereby, the authors present a case of 74-year-old male patient with carcinoma of the urinary bladder, who had a history of bilateral PCN due to vesico-ureteric junction involvement. He presented post-procedure with continuous haematuria from the left PCN catheter. There was a significant drop in haemoglobin; however, the patient remained vitally stable. A nephrostogram performed by injecting contrast via the PCN catheter revealed a renal pelvis-renal vein (pelvi-venous) fistula. He was managed by placing a pigtail catheter with its tip in the mid-ureter to provide external drainage and a tamponade effect at the fistula site. The haematuria gradually resolved within two days, with clear urine output. Therefore, the authors aimed to draw attention to the rare finding of a renal pelvi-venous fistula on nephrostogram following PCN and its management through the repositioning of the nephrostomy tube.

Near-mortality Scenarios in Obstetrics: Case Studies of Severe Complications and their Management

Jayshree P Kulkarni, Swapnali Sansare, Sneha Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Near-mortality instances among women facing severe obstetric complications, often referred to as “maternal near-miss” cases, involve situations where women experience life-threatening complications during pregnancy, childbirth, or postpartum but survive due to timely and effective medical interventions. These cases are critical for understanding healthcare gaps, risk factors, and improving maternal health outcomes. The present case series examines five near-miss instances among women experiencing severe obstetric complications. Case 1 details a 28-week primigravida with Dichorionic-Diamniotic twins (DCDA) and severe preeclampsia, leading to an emergency caesarean section. She presented with Haemolysis, Elevated Liver enzymes, Low Platelets syndrome (HELLP), and Disseminated Intravascular Coagulation (DIC). Case 2 involves a 37-year-old Gravida 3 Para 2 Living 0 Abortion1 (G3P2L0A1) woman with 28.5-week In-vitro Fertilisation (IVF)-conceived DCDA twins and a history of a previous Lower Segment Caesarean Section (LSCS), requiring an emergency subtotal obstetric hysterectomy due to Postpartum Haemorrhage (PPH). Case 3 describes a 35-year-old primigravida at 39.4 weeks with a retained placenta, managed through step-wise interventions, which eventually resulted in the spontaneous expulsion of the placenta. Case 4 presents a 32-year-old multigravida at 40.3 weeks with uterine rupture and abruptio placentae, necessitating an obstetric hysterectomy. Lastly, Case 5 involves a 27-year-old female with a scar ectopic pregnancy, treated successfully with methotrexate. These cases underscore the critical need for timely medical interventions and improved maternal healthcare systems to manage life-threatening obstetric emergencies effectively.

Reversible Manifestations of Hypothyroidism causing Diagnostic Dilemma: A Case Series

Kaushik Hazra, Somnath Maitra, Sunetra Roy, Isha Ghosh Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Hypothyroidism causes a wide spectrum of clinical manifestations, with various signs and symptoms. Some symptoms are common and aid in diagnosis, while the uncommon manifestations may be the sole feature causing diagnostic delays, leading to increased morbidity and mortality. Hereby the authors present a combination of three cases (50-year-old female, 22-year-old female, 56-year-old female): ascites, congenital hypothyroidism and myxoedema coma, respectively. Ascites in hypothyroidism responds to treatment and can help avoid unnecessary investigations; however, since this presentation is rare, clinicians should remain alert for low Serum Ascites Albumin Gradient (SAAG) with high protein ascites. myxoedema coma was diagnosed after excluding cerebrovascular accident, sepsis and dyselectrolytemia, with low body temperature serving as a diagnostic clue. Congenital hypothyroidism should be identified and treated promptly to prevent complications in newborns, as thyroid hormone is crucial for growth and development. Deficiency may lead to severe complications in newborns, so it is essential to rule out other causes. The importance of the present case series lies in the fact that hypothyroidism may present with variable manifestations. It is crucial to identify this hormone deficiency, as replacement with widely available thyroid hormone supplementation can promptly reverse some of the clinical manifestations, thereby aiding in accurate diagnosis and timely management with appropriate therapy.

Rare Neurological Manifestations of Scrub Typhus: Case Series from a Tertiary Care Centre in Kerala, India

NR Salini, T Sreena Sreekumar, Sudharmma Ramakrishnan, S Srikantan, Jacob Antony Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Scrub Typhus has emerged as an important cause of acute febrile illness in various parts of India over the last decade. Scrub Typhus is caused by Orientia tsutsugamushi, a rickettsia transmitted through the bites of infected chigger larvae. The neurological manifestations of Scrub Typhus can be highly variable. The most common neurological manifestation is meningoencephalitis. In addition to two cases of meningoencephalitis, hereby, the authors report three different rare neurological manifestations of Scrub Typhus that presented in the second week of illness. These included isolated sixth cranial nerve palsy, opsoclonus myoclonus, and transient Parkinsonism. All the patients responded to treatment with doxycycline, and authors had to use steroids for one patient with opsoclonus myoclonus. A characteristic eschar was seen in only one patient out of the five cases. Therefore, a high index of suspicion for Scrub Typhus is needed in patients presenting with acute febrile illness and Central Nervous System (CNS) manifestations in endemic areas.

Computed Tomographical Characterisation of Dyke-Davidoff-Masson Syndrome: A Case Series

Krishna Madhukarrao Maske, Kalyani Santosh Jethlia, Anil Gopal Tapdiya, Ameet Chandrakant Panchmahalkar, T Rajalakshmi Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Dyke-Davidoff-Masson Syndrome (DDMS) is a rare neurological disorder that primarily manifests through various neurological symptoms, with a significant focus on contralateral hemiparesis and convulsive disorders that often show resistance to standard treatments. It is mainly characterised by hemicerebral atrophy, bony calvarial thickening and hyperpneumatisation of the ipsilateral paranasal sinuses on imaging. Computed Tomography (CT) is a crucial diagnostic tool in settings with limited resources, offering an effective means to identify and diagnose this syndrome. In the present paper, the authors present case reports of three patients (2 females, 1 male) with seizure disorders and hemiparesis who were admitted to the Medicine Department and had CT brain imaging performed within six months. The objective to highlight the diagnostic process and discuss the clinical presentation of this syndrome in a limited-resource setting, emphasising the role of CT in aiding diagnosis and further medical management.

Unveiling the Cytological Enigma of Malignant Spindle Cell Neoplasm of Peripheral Nerve Sheath: A Clinicopathological Image

Shreya Giri Goswami, Poornima Pandey, Jayashree Bhawani Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Peripheral Nerve Sheath (PNS) tumours are rare neoplasms arising from deeper soft tissues, peripheral nerves, perineural cells, or Schwann cells with ectomesenchymal origins (1). The incidence rate is between 4-13%, with the upper extremity being the most commonly involved site (45%) (2). The role of Fine Needle Aspiration Cytology (FNAC), based on the cytomorphology of these neoplasms of the PNS, is challenging and often confusing, underscoring the complex diagnostic nature of the lesions. Therefore, FNAC details were highlighted by presenting a clinicopathological image and providing insight into the intricate cytomorphology involved. A 55-year-old woman presented to the surgery outpatient department with complaints of swelling near the elbow joint of her left forearm, accompanied by dull, aching pain for one year (Table/Fig 1). The swelling was initially small, but over 10 months, it gradually increased to its current size. There was no history of locoregional trauma or falls. Upon locoregional examination, a 5×4 cm nodular swelling was observed, which was firm, fixed and tender, with surface ulceration of the skin present on the extensor aspect of the forearm, distal to the left elbow joint. There was no local temperature rise or involvement of the ulnohumeral joint. The general examination did not reveal any swelling at other sites. She did not provide any history of prior surgeries. The levels of electrolytes were within normal limits, and the serum urea and creatinine levels indicated normal kidney function. The patient underwent ultrasonography (USG) of the left forearm, which showed a well-defined, heterogeneously hyperechoic lesion in the subcutaneous plane. There was no evidence of bony involvement and a radiodiagnosis of a soft-tissue tumour was given. Resonance Imaging (MRI) revealed a well-defined ovoid mass in the subcutaneous plane. The lesion was heterogeneously hyperintense with areas of central necrosis (Table/Fig 2). The differential diagnosis included fibrosarcoma, dermatofibrosarcoma protuberans, poorly differentiated carcinoma, malignant fibrous histiocytoma nerve sheath tumour, along with the need for FNAC correlation. FNAC was carried out under USG guidance. The smears were of high cellularity, revealing multiple fragments of spindle nuclear cells (Table/Fig 3). A few fragments showed peripheral nuclear palisading and attempted whorling. In some areas, the cell borders exhibited feathery margins (Table/Fig 4). These elongated spindle nuclei showed moderate pleomorphism and were hyperchromatic. A few cells demonstrated bipolar blunting of nuclei and prominent nucleomegaly with uneven chromatin (Table/Fig 5). The cytoplasm of these cells appeared to merge with intracellular hyalines. There were also a few spindle bare nuclei with atypia and infrequent mitosis in the background. The diagnosis of malignant spindle cell neoplasm of peripheral nerve sheath tumour (MPNST) was offered. Following the cytodiagnosis, the patient underwent surgical resection of the tumour (Table/Fig 6). The histopathology revealed pleomorphic spindle cells arranged in a fascicular arrangement. These cells exhibited scant wavy cytoplasm with marked anisonucleosis and a high N/C ratio. The hyperchromatic nuclei contained loose open chromatin, with nucleoli present in some. Mitotic figures were also observed. The histopathological features were suggestive of a malignant mesenchymal tumour (Table/Fig 7). Immunohistochemical analysis confirmed the diagnosis of MPNST, showing diffuse positive immunoexpression for S-100 (Table/Fig 8) and SOX-10. The patient was followed-up by the Institute’s tumour board committee and was initiated on postoperative radiotherapy and chemotherapeutic drugs such as doxorubicin and ifosfamide as part of the adjunctive treatment plan.

Retrieval of a Cold Welded and Damaged Gingival Former: A Clinical Tip

Unmesh Wani, Rajashree Jadhav, Paresh Gandhi, Bhushan Pol Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X A 62-year-old male patient was referred to the Department of Prosthodontics at Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Pune, Maharashtra, India, for the retrieval of a gingival former in the lower anterior region. An implant from COWELL^® Implant Solution was placed in the regions of 33 and 43 at a private clinic approximately 11 months ago. The second stage surgery was performed seven months ago. Two gingival formers with a collar height of 2 mm were placed in the regions of 33 and 43. For the commencement of the prosthetic phase, the gingival formers needed to be removed.

Imaging Findings of Ovarian Adenofibroma in Multiparous Woman

Sangavi Jeyaraj, Jaya Selin Praveena Joseph, Ashok Ranjan, Senthil Kumar Aiyappan Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X

Evolving Paradigms in Gynaecological Practices: From Clinical Judgment to Technological Precision

Amey Chugh, Madhura Deshmukh Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Dear Editor, Over the past few decades, the landscape of gynaecological practice has changed significantly, reflecting advances in medical technology, societal views, and patient demographics (1). Historically, gynaecology largely relied on subjective evaluations and clinical judgment. With limited means of investigations, diagnoses and treatments were frequently made only on the basis of personal experience and physical examinations. In contrast, advances in technology are driving gynaecological practice today.

Innovative Use of Tina Bed as a Cost-effective and Comfortable Dressing for Burn Wounds on the Torso: A Clinical Exploration

Vishal Kaundal, Ankur Dhirajlal Modi Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Dear Editor, I would like to share an experience using Tina bed as an alternative dressing for burn wounds in a burn centre at a tertiary care facility. Typically used in hospitals to prevent bedsoiling from urine, Tina beds (under pads) have shown impressive fluid absorption and are often utilised in situations involving urinary incontinence, paediatric care and obstetric clinics (Table/Fig 1) (1). Each Tina bed measures 60×90 cm and is cost-effective. The Tina bed comprises three distinct layers: the inner layer, a non woven cotton layer, promotes comfort; the intermediate layer, composed of an absorbent layer and gel, provides maximum absorbency while effectively managing moisture and odour; and the outermost layer, a polyethylene backing with sealed edges, ensures waterproof protection (2). The exploration of Tina bed’s application for burn wound management involved two male patients, both aged six. One had a second-degree superficial scald burn (Table/Fig 2)a,b and the other had a second-degree mixed electric burn (Table/Fig 3)a,b. Application of Tina bed: Both patients underwent sterile dressing procedures in the burn unit. This process involved preparing a new, sterile Tina bed pack, measuring and cutting it to fit the shoulder area for optimal conformity (Table/Fig 4). The burn wounds were then cleansed with running water, followed by the application of a generous layer of 1% silver sulfadiazine. The Tina bed was subsequently placed over the torso, ensuring overlapping ends to cover the entire burn area and was secured with micropore tape (Table/Fig 5)a,b. Feedback from parents indicated that both patients experienced increased comfort and reduced irritability following the dressing changes. Notably, the patient with superficial and partial-thickness burns healed spontaneously within a mean duration of 12 days, aided by the use of the Tina bed and silver sulfadiazine. The second patient, suffering from full-thickness burns, ultimately required a split-thickness skin graft. Tina bed dressings offer several advantages for burn wound management. Firstly, they are simple to apply, saving time for both plastic surgeons and nursing staff. Secondly, by reducing the need for traditional dressing materials, Tina beds promote resource efficiency. Thirdly, their non adherent nature ensures painless removal, minimising patient discomfort. Fourthly, Tina beds effectively retain moisture, preventing wound dryness and mitigating the risk of deeper tissue damage (2). Furthermore, they are cost-effective, reducing expenses on dressing materials and their absorbent layers and waterproof backing effectively prevent soiling (3). In conclusion, the findings suggest that Tina bed presents a cost-effective and efficient alternative to conventional composite synthetic dressings for burn wounds in healthcare settings. Its ease of application, coupled with the benefits of moisture retention and patient comfort, supports its use. We recommend additional controlled clinical, histological and bacteriological studies to fully evaluate its efficacy in burn management.

Correspondence: Can Menstrual Cycle Length Predict Cardiovascular Risk in Healthy Indian Females?

Avnesh Kumar Singh, Shikha Singh Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Dear Editor, We read with great interest the article entitled “Can Menstrual Cycle Length Predict Cardiovascular Risk in Healthy Indian Females? A cross-sectional Study” by Shilpi Vashishta et al., published in your esteemed journal (Journal of Clinical and Diagnostic Research) 2024;18(6):CC22-CC25. We would like to share a few of our thoughts regarding this study, mainly about the sampling and statistical techniques used. Although it was worthwhile research, the sampling technique was not properly chosen. It is impossible to conduct quality research without adequate sampling. There are two main varieties: probability sampling and non probability sampling. Convenient non random sampling was incorrectly referred to as simple random sampling in the article. The sampling technique should be stratified instead of relying on convenient sampling. Stratified sampling is used to separate the population into smaller groups that may differ significantly from one another. Ensuring that each subgroup is fairly represented in the sample allows for moreprecise conclusions (1).

Genetic Polymorphisms in RNF138, ABCA1 and ESRRG-GPATCH2 Genes and their Role in Insulin Resistance Risk among Normal BMI Individuals in Indian Population: A Case-control Study

Sabitha Thummala, Sarah Fathima, Nithya Kruthi, Junaid Ahmed Khan Ghori, Katherine Saikia, Vivek Belde, Balamurali Andiyakkal Rajendran, Rahul Ranganathan Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: India, characterised as the “diabetes capital” of the world, faces a rapidly increasing diabetes crisis, with over 65 million cases diagnosed. Despite the growing prevalence, the genetic underpinnings of Insulin Resistance (IR) among Indians with a normal Body Mass Index (BMI) remains understudied. Aim: To fill the knowledge gap by investigating the association of specific gene variants (RNF138, ABCA1, and Oestrogen-Related Receptor γ (ESRRG)-GPATCH2) with IR risk in this demographic. Materials and Methods: This study was a case-control study conducted in Bengaluru, Karnataka, India on a total of 191 participants (90 men and 101 women). The study, including data collection and analysis, was completed over a period of six months. Participants were categorised into cases (Homeostasis Model Assessment Insulin Resistance (HOMA2-IR) >2) and controls (HOMA2-IR <2) based on HOMA2-IR values. Genotyping for rs4799327 (RNF138), rs2275543 (ABCA1), and rs1497828 (ESRRG-GPATCH2) was performed using the Illumina Infinium Global Screening Array (GSA). Statistical analyses, including Odds Ratios (ORs), 95% Confidence Intervals (CIs), and inheritance model analysis, were conducted to assess the association between genotypes and IR. Results: Significant associations were found between IR and genetic variants rs4799327 (OR=2.74, 95% CI: 1.28-5.88, p-value=0.006) in RNF138, rs1497828 (OR=2.90, 95% CI: 1.51-5.57, p-value=0.0011) in ESRRG-GPATCH2 (dominant inheritance model), and rs2275543 (OR=3.50, 95% CI: 1.17-10.42, p-value=0.011) in ABCA1 (additive model). The study highlights a notable susceptibility to IR linked to these genetic markers among individuals with a normal BMI in the Indian population. Conclusion: This study underscores the importance of genetic factors in the risk of developing IR among Indians with a normal BMI, suggesting a complex interplay of genetics beyond traditional risk factors. These findings necessitate further research into the functional significance of these associations and their potential implications for targeted interventions and preventive strategies in high-risk populations.

Exploring the Link between Generalised Ligament Laxity and Flexible Flatfoot in Paediatric and Adolescent Populations: A Case-control Study

Ashish Yadav, Shalu Arimbooth, Avinash Muraleedharan, Shweta Chaubey Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Flatfoot, or pes planus, is a postural deformity resulting from the inadequate development of the Medial Longitudinal Arch (MLA) of the foot. Generalised ligament laxity is the most important aetiological factor among various predisposing factors. Previous research has explored these conditions independently rather than investigating their potential association. This study focuses on understanding how generalised ligament laxity contributes to flexible flatfoot, which could provide valuable insights that have not been thoroughly explored in paediatric and adolescent populations. Aim: To determine the association between flexible flatfoot and generalised ligament laxity in paediatric and adolescent populations. Materials and Methods: This case-control study was conducted on 180 patients attending the Physical Medicine and Rehabilitation (PMR) Outpatient Department (OPD), aged 5 to 19 years, from September 2019 to March 2021. Footprints were taken from the subjects and a flatfoot assessment was performed using Staheli’s plantar arch index. The Jack test was conducted in all flatfoot subjects to exclude rigid flatfoot. All patients with flexible flatfoot were enrolled as cases, while those without flatfoot were enrolled in the control group. Both groups were further evaluated using the Beighton Score for the presence of generalised ligament laxity and results were recorded. Demographic factors were expressed as frequencies, and quantitative data were presented as median with 25^th and 75^th percentiles (IQR=interquartile range). Differences in qualitative variables between the groups were analysed using the Chi-square test. Results: Out of the 180 subjects, 126 (70%) were male, and the majority, 108 (60%), were aged 11 to 19 years, with a mean ± SD age of 11.46±3.1 years. The proportion of ligament laxity was higher in cases 30 (41.67%) than in controls 20 (18.52%), and this association was statistically significant (p-value=0.016). Patients with flatfoot had a 3.14 times higher chance of having ligament laxity than those lacking flatfoot, which was statistically significant. Conclusion: Children and adolescents with increased generalised ligament laxity are more predisposed to the development of flexible flatfoot compared to those without ligament laxity.

Artificial Intelligence in Nursing Education: A Cross-sectional UTAUT Analysis Study

Latifah H Alenazi Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Artificial Intelligence (AI) is a transformative force in nursing education, applicable in academic and clinical settings. It equips nursing students with skills to evaluate and apply AI in future patient care, preparing the nursing workforce for a healthcare landscape increasingly supported by AI. However, lack of studies focus on nursing students as AI users and the behavioural intention to accept and utilise AI. Aim: This study investigated the factors influencing nursing students’ acceptance and use of AI based on the Unified Theory of Acceptance and Use of Technology (UTAUT). Materials and Methods: A cross-sectional study was conducted at one of the oldest and most prominent universities, collecting data from April to May 2022. The survey included 213 nursing students and aimed to evaluate the influence of the four UTAUT constructs- Performance Expectancy (PE), Effort Expectancy (EE), Social Influence (SI), and Facilitating Conditions (FC)- on behavioural intention and usage behaviour. Additionally, the study explored the moderating effects of age and gender on the UTAUT model. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 29.0 for descriptive statistics and SmartPLS version 4 for Partial Least Squares (PLS) structural equation modeling. Results: The findings indicated that PE positively influenced the behavioural intention of nursing students to adopt and use AI in nursing education. Regarding moderation effects, age moderated the relationship between PE and behavioural intention, whereas gender did not exhibit any moderation effect. Conclusion: This study provides a foundation for its integration to enhance learning outcomes and prepare students for technology-driven healthcare. It highlights the importance of evidence-based strategies tailored to meet diverse educational needs, ensuring effective adoption and utilisation.

Morphometric and Growth Pattern Analysis of Corpus Callosum in Paediatric Population on Magnetic Resonance Imaging: A Retrospective Observational Study

Sweta Swaika, Harshit Koshta, Apurva Shukla Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: There is development and myelination of axons within the Corpus Callosum (CC) in children and early adulthood, causing modifications in its various dimensions. Previous studies have reported age-wise and/or sex-related variations in morphological measurements of CC in different population groups. Aim: To evaluate the age and sex-related disparity in morphometric parameters of CC and derive growth curve of CC in children in the central Indian population. Materials and Methods: A retrospective observational study was done in Radiology Department, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India, from January 2020 to June 2023. Study was conducted in 141 children with ≤15 years of age. CC was manually evaluated on mid-sagittal T2-weighted images for following measurements: Anteroposterior Length (APL), Total Length (TL), maximum Genu Thickness (GT), mid-Body Thickness (BT), maximum Splenium Thickness (ST), Maximum body Thickness (MT) and Height (HT). The Anteroposterior length of Brain (APB) was measured, and ratio between APL and APB was calculated (APL/APB). All the subjects were divided according to five age groups: group 1 (≤1 year), group 2 (>1-≤3 years), group 3 (>3-≤5 years), group 4 (>5-≤10 years) and group 5 (>10-≤15 years). Data analysis was performed using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) software version 29.0, using student’s t-test, Chi-square test, Spearman’s correlation and linear regression. Results: The mean±Standard Deviation (SD) age was 6.5±4.9 years. The study included 83 (58.9%) males and 58 (41.1%) females. The study revealed periods of major increase between birth to three years and between 5-10 years. The CC growth in children and adolescents had a non linear course with periods of peak and plateau phases in between. Linear regression showed a significant correlation between APB and age (independent parameter) and the CC dimensions (dependent parameter). There was no considerable difference in these dimensions between the sexes. Conclusion: In the current study, there were age-wise variations in CC dimensions in paediatric population (≤15 years) without any sex-related differences. The present study values helps to understand the variations in CC with age-wise brain development.

Analysis of Fine Needle Non Aspiration Cytology for the Diagnosis of Cervical Lymph Node Tuberculosis: A Cross-sectional Study

S Rajesh Kumar Jain, Samta, RK Divya, V Abhirami Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Conventionally, excision biopsy is performed for the diagnosis of Lymph Node Tuberculosis (LNTB). Comparatively, Fine Needle Non Aspiration Cytology (FNNAC) is a simple, reliable, inexpensive, painless, less invasive, outpatient procedure for the diagnosis of peripheral LNTB and is recommended as the first diagnostic technique for this condition. Fine Needle Non Aspiration Cytology (FNNAC), i.e., fine needle sampling without aspiration, is relatively painless, less traumatic and more patient-friendly compared to FNAC. Although FNNAC is easy to perform, it is not routinely practiced. Aim: To evaluate the results of FNNAC in cervical lymphadenopathy and determine the various cytomorphological presentations in cervical LNTB. Materials and Methods: This institutional-based, cross-sectional study was conducted at the Department of Respiratory Medicine, Princess Krishnajammanni TB and Chest Diseases Hospital (PKTB and CDH), Mysore Medical College and Research Institute (MMC and RI) in Mysuru, from January 2019 to September 2022 on presumptive cervical LNTB patients who underwent FNNAC followed by an excision biopsy of the same Lymph Node (LN). The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy of FNNAC for diagnosing LNTB were estimated. Results: A total of 415 subjects were studied. The sensitivity, specificity, PPV and NPV rates of FNNAC for Tuberculosis (TB) were 97.92%, 100%, 100% and 99.3%, respectively, with an accuracy of 99.4%. A total of 36 samples (8.7%) were considered Non Diagnostic (ND). Among these 36 ND samples, 31 were of benign origin (4 were TB), while the remaining five ND samples were of malignant origin. Conclusion: The present study reveals that TB is currently the most common cause of cervical lymphadenopathy, with other common causes being malignant metastasis and reactive lymphadenitis. FNNAC is highly accurate in the diagnosis of LNTB. Therefore, FNNAC is a simple, safe, economical, reliable and accurate method for diagnosing cervical LNTB.

Comparison of Functioning, Quality of Life, and Cognition between Lithium and Sodium Valproate Combination Therapy and Sodium Valproate Monotherapy in Euthymic Bipolar Patients: A Cross-sectional Study

M Ashwini, R Jhamuna, V Jaikumar Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: The combination of lithium and valproate is the most recommended treatment for relapse prevention in Bipolar Affective Disorder (BPAD) after the failure of monotherapy. If it is proven that functioning, quality of life and cognitive functioning in bipolar patients on a sodium valproate and lithium combination are better than those on valproate monotherapy, this could further encourage the use of combination therapy. Aim: To compare the functioning, quality of life and cognitive functioning of euthymic bipolar patients on lithium and sodium valproate combination therapy with those on sodium valproate monotherapy. Materials and Methods: The present hospital-based cross-sectional study was conducted in the Outpatient Department, Institute of Mental Health, Madras Medical College, Chennai, Tamil Nadu, India, from March 2017 to July 2017. A total of 80 patients were included in the study. Forty euthymic bipolar disorder patients on a lithium and sodium valproate combination for at least a year were chosen as group 1. Forty euthymic bipolar patients on sodium valproate monotherapy for at least a year were chosen as group 2. Socio-demographic details and clinical characteristics of both groups were collected. The Global Assessment of Functioning (GAF) scale and the World Health Organisation Quality of Life Brief (WHOQoL-BREF) version scale were applied to both groups. Cognitive assessment using the Frontal Assessment Battery (FAB), Trail Making Test-A (TMT-A) and Trail Making Test-B (TMT-B) was conducted. Statistical analysis was performed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) software version 20.0. An independent t-test was used to compare quality of life and cognitive variables, as well as, the number of episodes post-treatment between the two groups. A Chi-square test was used to compare functioning between the two groups. Results: The mean±Standard Deviation (SD) age of onset in group 1 was 26.73±5.77 years and in group 2 was 27.03±6.49 years. There were 22 (55%) males and 18 (45) females in group 1 and, 20 (50) males and 20 (50) females in group 2. There were no statistical differences in socio-demographic characteristics between both groups (p-value>0.05). Functioning and quality of life were significantly better in the combination therapy group (p-value ≤0.01). Cognitive variables like FAB score, and time taken to complete TMT-A and TMT-B in seconds showed no significant differences (p-value>0.05). By independent t-test, the reduction in episodes of bipolar illness after treatment was found to be greater in group 1 (p-value=0.006). Conclusion: The functioning, quality of life and effectiveness of treatment for those euthymic bipolar patients on lithium and sodium valproate combination therapy were found to be better than those on valproate monotherapy alone. There was no significant change in cognitive functioning between the two groups.

Middle Cerebral Artery Pulsatility Index for Prediction of Successful Induction of Labour in Postdated Pregnancy: A Prospective Observational Study

Yashi Nagar, Rekha Bharti, Kajal Baleja, Amita Malik, Divya Pandey, Jyotsna Suri Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Postdated pregnancy is the most frequent indication for Induction of Labour (IOL). The foetal Middle Cerebral Artery Pulsatility Index (MCA PI) is assessed to predict foetal wellbeing in cases of late foetal growth restriction. It has also been studied as a predictor of IOL and is reported to be more sensitive than the conventional Bishop score. Aim: To evaluate the MCA PI as a predictor of successful labour induction in postdated pregnancy. Materials and Methods: This prospective observational study was conducted in obstetrics wards of Safdarjung Hospital over a period of 15 months, including 296 nulliparous women with singleton postdated pregnancy admitted for IOL. After obtaining a detailed history and conducting a physical examination, per vaginal examination for Bishop’s score and transabdominal ultrasound for foetal MCA Doppler was done. Women were followed for progression to active labour, and mode of delivery was noted. Primary outcome measure was successful IOL, defined as women entering active phase of labour, which is defined as cervical dilation of >5 cm. Other outcome measures studied included the induction to active phase interval, induction to delivery interval and mode of delivery. Receiver Operating Characteristics (ROC) curve was used to find out Area Under Curve (AUC) for MCA PI and Bishop score for predicting successful IOL. De Long et al., test was used to compare AUC. Univariate and multivariate logistic regression was used to assess the predictors of successful labour induction. A p-value of <0.05 was considered statistically significant. Results: Out of 296 women enrolled in the study, 285 women (96.3%) had successful IOL. Around 281 (98.9%) women with successful IOL had a vaginal delivery. At a cut-off of <1.67, MCA PI had a sensitivity of 100%, a specificity of 99.3%, a Positive Predictive Value (PPV) of 84.6%, a Negative Predictive Value (NPV) of 100%, and diagnostic accuracy of 99.3%, for prediction of successful IOL. MCA PI had almost perfect reliability for predicting the outcome of labour induction, Kappa=0.91 and Youden index score of 99.3. Conclusion: MCA PI is a good predictor of successful labour induction in nulliparous women with postdated pregnancy.

Pharmacoeconomics and Utilisation of Antidiabetic Medications among Type 2 Diabetes Mellitus Patients: A Longitudinal Study

Bikash Chandra Das, P Ansuman Abhisek, Deepak Choudhury, Suvendu Kumar Panda, Jayanti Prava Behera, Supriya Pradhan, Trupti Rekha Swain, Sasmita Mallick Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Patients with Type 2 Diabetes Mellitus (T2DM) typically require long-term treatment with antidiabetic medications, resulting in a significant financial burden on both the individual and the global economy. Aim: To assess the patterns of drug utilisation and the economic aspects of antidiabetic medications in individuals with diabetes mellitus. Materials and Methods: The current study was a hospital-based longitudinal study conducted between October 2017 and September 2019. A total of 132 diagnosed cases of T2DM, aged 18 years and older, who had been on antidiabetic medications in the past three months, were included in the study. Pregnant women and patients in diabetic coma were excluded from the study. A predesigned, pretested, semistructured questionnaire was used to collect data from the patients or their legally accepted relatives. The subjects were followed-up at three and six months to determine any changes in the type and doses of medication. Laboratory parameters such as Fasting Blood Sugar (FBS) and Postprandial Blood Sugar (PPBS) were measured at baseline and at six months, along with a history of any complications of diabetes. The data were analysed using Statistical Package for the Social Sciences (SPSS) version 27.0. Results: A total of 132 patients were included, of which most patients were male (65.9%), aged 60 years or above (50.8%), illiterate (79.5%), and resided in rural areas (94.7%). The Average Cost-Effectiveness Ratio (ACER) for reducing a unit of FBS was higher compared to PPBS across all forms of the drug. The ACER at three months showed a constant increase, from 24.56 for metformin only to 2709.26 for insulin with Oral Hypoglycaemic Agents (OHA) for FBS, and from 7.83 for metformin only to 907.47 for insulin with OHA for PPBS. Metformin was the most commonly prescribed medication, both as a standalone therapy and in combination therapy. Conclusion: Present investigation showed that rational prescribing effectively reduced blood sugar readings. Metformin and Glimepiride were the predominant pharmaceuticals utilised for the treatment of diabetes. The cost-effectiveness study indicates that the financial burden of diabetes is substantial, particularly when considering the socio-economic status of individuals.

Analysis of Role of Haematological Parameters in Diagnosis of Gram-positive and Gram-negative Urinary Tract Infection: A Case-control Study

Sudha Srinivasan, Ayeesha Sithika Thajudeen, Kundhavai Chandrasekaran, Vijayashree Raghavan, D Roshini Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Urinary Tract Infections (UTIs) are a prevalent global health issue, primarily caused by bacterial infections. Early diagnosis and intervention are critical to preventing complications like pyelonephritis and mitigating the risk of recurrent infections that can lead to permanent scarring. Aim: To investigate the haematological parameters in patients with confirmed UTIs, comparing them with non UTI counterparts and discerning variations in haematological parameters between UTIs caused by gram-positive and gram-negative bacterial organisms. Materials and Methods: This prospective case-control study was conducted at Chettinad Hospital and Research Institute (tertiary care centre), Chengalpattu, Tamil Nadu, India between January 2023 and July 2023, included 105 culture-positive UTI cases and 105 age- and gender-matched culture-negative controls. Cases included patients over 12 years of age with confirmed UTIs, while exclusions for both groups included pregnancy, individuals under 12 and those with haematological disorders. Controls were also excluded if they had diabetes or chronic kidney disease. Urine cultures on blood and MacConkey agar identified pathogens such as E. coli, Pseudomonas, Klebsiella, Enterobacter, Proteus and Citrobacter. Gram-positive isolates included Enterococci species, Staphylococcus aureus and Staphylococcus saprophyticus. Haematological parameters such as Haemoglobin (Hb), White Blood Cell Count (WBC), platelet count, Mean Platelet Volume (MPV), Red Cell Distribution Width (RDW), Platelet Distribution Width (PDW) and Plateletcrit (PCT) were analysed using an automated haematology analyser. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software version 22.0 with significance set at p-value <0.05. Results: The UTI patients exhibited lower Hb and higher WBC, platelet count, MPV, RDW, PDW and PCT compared to controls. Gram-positive UTI infections showed higher WBC count, platelet counts, RDW, PDW and PCT, but lower MPV compared to gram-negative UTI infections. E. coli and Enterococcus were the predominant gram-negative and gram-positive pathogens, respectively, reflecting distinct haematological profiles. These results highlight distinct immune and haematological profiles in UTI patients, depending on the infecting organism. Conclusion: The UTI patients exhibited lower Hb and higher WBC, platelet count, MPV, RDW, PDW and PCT compared to controls. Gram-positive UTI infections showed higher WBC count, platelet counts, RDW, PDW and PCT, but lower MPV compared to gram-negative UTI infections. E. coli and Enterococcus were the predominant gram-negative and gram-positive pathogens, respectively, reflecting distinct haematological profiles. These results highlight distinct immune and haematological profiles in UTI patients, depending on the infecting organism.

Mutational Analysis of KCNQ1 Gene in Type 2 Diabetes Mellitus: A Case-control Study

Ankush Ganjewar, Ishwar B Bagoji, Sharan Badiger, Rudragouda B Bulagouda, Gurushnatappa Kadakol Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: KCNQ1 (Potassium voltage-gated channel subfamily Q member 1) gene encodes for pore-forming subunit of a voltage-gated K+ channel that is essential for the depolarisation phase of the action potential in cardiac muscle. KCNQ1 is also associated with impaired insulin secretion in Type 2 Diabetes Mellitus (T2DM), suggesting that this impairment might underlie the diabetes susceptibility conferred by rs151290, which is associated with 30-min C-peptide levels during an Oral Glucose Tolerance Test (OGTT) and first-phase insulin secretion. Variants rs2237892, rs2237895 and rs2237897 have been associated with OGTT-derived insulin secretion indexes. The risk associated with KCNQ1 may increase the expression of KCNQ1 in pancreatic β cells, promoting the development of T2DM. Aim: To know the association of KCNQ1 gene common variant rs2237895 risk factor for T2DM. Materials and Methods: The present case-control study was conducted at the Department of General Medicine and Genetics Laboratory of the Anatomy Department at BLDE (Deemed to be University) Shri BM Patil Medical College Hospital and Research Centre in Vijayapura, Karnataka, India. The duration of present study was from March 2023 to December 2023. A total of 30 peripheral blood samples were collected from the T2DM and 30 samples of healthy controls, and then subjected to genetic analysis. Amplification of DNA products were analysed using Sanger-based DNA sequencing. Results: Sequencing analysis revealed g.6956 C>T and c.C1956T mutations in seven patients. Out of these, three were in homozygous condition and four were in heterozygous condition. All these mutations were observed in 3’ untranslated region and exhibited a benign phenotype. Conclusion: KCNQ1 gene is not associated with Type 2 DM. To establish a definitive association between the KCNQ1 gene and T2DM, further screening in larger population is necessary.

Automated Breast Cancer Detection in Mammograms using Transfer Learning-based Deep Learning Models

Preeti Katiyar, Krishna Singh Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: When considering cancer mortality rates in general, Breast Cancer (BC) is a major contributor among females. Patients’ chances of survival increase when BC is detected early and treated with the appropriate treatment at the right time. There is strong evidence that mammography, when used as a screening tool, can detect BC at an early stage. Mammography is a diagnostic tool that uses low-dose X-rays to visualise the breast and evaluate its anatomy. For screening purposes, it is currently the preferred method. The present study employs deep learning models trained using Transfer Learning (TL) techniques. Aim: To automate the process of BC diagnosis in mammograms. The main goal of this approach is to simplify the process of early detection and diagnosis of BC for healthcare practitioners. Materials and Methods: The dataset obtained from the Mammographic Image Analysis Society (MIAS) was categorised into three distinct categories: benign, malignant and normal. The initial MIAS dataset underwent several preprocessing techniques, including noise reduction, breast image contrast enhancement, non breast region deletion and malignant lesion identification, before analysis. An intricately designed fully connected classifier complements pretrained Convolutional Neural Network (CNN) architectures like ResNet50 and VGG16 in the proposed model. Results: The VGG16 model performed admirably, achieving an Area Under the Curve (AUC) of 0.950 and an accuracy rate of 96.00%. In addition, it displayed an outstanding F-score of 97%, along with high sensitivity, specificity and accuracy. These outcomes are significantly better compared to the other methods. Conclusion: The model’s enhanced capabilities for early-stage cancer detection could improve patient outcomes and reduce mortality rates. Furthermore, new tools can ease the workload for radiologists, leading to more standardised and efficient diagnostic procedures.

Baska Mask versus I-gel in Spontaneously Breathing Anaesthetised Patients: A Randomised Clinical Study

Bhagyavardhan Botta, Yogarajan Ramalingam, Grishma Robba, Tanya Elizabeth, Kala Balasubramanian, Selvamani Subramanian, Senthil Kumar Vannivedu Santhnam, Kavyasri Morampudi Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Supraglottic Airway Devices (SGAD) are effective substitutes for general anaesthesia with endotracheal intubation. Compared to endotracheal intubation, these SGADs provide haemodynamic stability and lesser airway morbidity. Now-a-days, second and third generation SGADs, differing in their design, have been used in clinical practice due to their better clinical performance. The Baska mask, which belongs to the third generation of SGADs, has features that assist in the aspiration of gastric content and provide higher oropharyngeal leak pressure. Its unique design claims suitability for use in spontaneously breathing anaesthetised patients. Hence, the present study was conducted to compare the performance of the Baska mask and the I-gel. Aim: To compare the Baska mask and I-gel in terms of ease of insertion, haemodynamic stability, oropharyngeal sealing pressure at five minutes and 30 minutes post-placement, and post-extubation complications. Materials and Methods: A prospective randomised single-blinded study was conducted in the Department of Anaesthesiology, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India from October 2019 to October 2020 on 60 American Soceity of Anaesthesiology (ASA) physical status I and II patients, aged between 18-65 years, who were scheduled for minor surgical procedures while spontaneously breathing under general anaesthesia. These patients were randomly assigned to either the Baska group (Group B) or the I-gel group (Group I) using computer-generated random numbers. Both groups were compared with respect to airway pressure, sealing pressure, ease of insertion of the device, number of attempts to insert, haemodynamic changes during and after insertion, and any complications. The outcomes were analysed using statistical software Statistical Package for Social Sciences (SPSS) version 23.0 and repeated measures Analysis of Variance (ANOVA) was applied to find the relationship between the two groups. Results: It was observed that the I-gel mask was easier to insert compared to the Baska mask (p=0.03). The first-attempt success rate for the Baska mask was lower compared to the I-gel group (p=0.03). However, the Baska mask provided higher airway sealing pressure (p=0.04) and a good seal in spontaneously breathing anaesthetised patients. Conclusion: Based on the results of present study, it can be concluded that the Baska mask provided better sealing pressure, which was beneficial in spontaneously breathing anaesthetised patients. However, the I-gel mask was superior to the Baska mask in terms of ease of insertion, shorter insertion time, and negligible postoperative complications.

Effects of Intrathecal Bupivacaine with Adjuvants Midazolam versus Magnesium Sulphate in Tibia Fibula Surgeries: A Randomised Clinical Study

Tejash H Sharma, Jagrati Jain, Aanal Shah, Dushyant Chavda, Dinesh K Chauhan Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Intrathecal adjuvants like magnesium sulphate, midazolam and opioids are increasingly used with local anaesthetic for spinal anaesthesia to intensify subarachnoid block and improve haemodynamic stability. Midazolam, a benzodiazepine, is mainly used for anxiolysis, amnesia and sedation. It also exhibits a muscle relaxant effect via its action on the glycine receptors in the spinal cord. Magnesium sulphate is a pharmacological agent used in a variety of clinical conditions. It potentiates opioid nociception and prolongs the duration of anaesthesia. The analgesic properties of magnesium sulphate are primarily related to regulating calcium influx into cells and antagonism of N-methyl D-aspartate (NMDA) receptors. Aim: To observe the efficacy of intrathecal 2.5 mg midazolam and 50 mg magnesium sulphate as adjuvants to 0.5% hyperbaric bupivacaine in tibia-fibula surgeries and haemodynamic stability in both groups. Materials and Methods: The present double-blind, prospective randomised clinical study was conducted in the Department of Anaesthesiology, Dhiraj Hospital, Sumandeep Vidyapeeth, Piparia, Vadodara, Gujarat, India, from February 2021 to December 2022. Study included 64 patients of either gender, classified as American Society of Anaesthesiologists (ASA) grade I/II, undergoing tibia-fibula surgeries. Patients were divided into two groups: Group BM (Midazolam) received 0.5% hyperbaric bupivacaine 3.2 mL+2.5 mg midazolam (0.5 mL), totaling 3.7 mL and group BMS (Magnesium sulphate) received 0.5% hyperbaric bupivacaine 3.2 mL+50 mg magnesium sulphate (0.5 mL), totaling 3.7 mL. The primary objective was to observe Heart Rate (HR), Blood Pressure (BP), Oxygen Saturation (SpO₂) and Respiratory Rate (RR). Secondary objectives were to observe the time to onset of sensory and motor blockade, duration of sensory and motor blockade, time of two-segment regression, duration of analgesia, sedative effect (intra and postoperative), and any side effects or complications. Statistical analysis was performed using International Business Machines (IBM) Statisical Package for the Social Sciences (SPSS) statistics for Windows software. Results: The mean Standard Deviation (SD) age in group BM was 37.63±11.50 years and in group BMS was 40.81±11.93 years. The onset and duration of sensory and motor blockade were better in group BM than in group BMS (p-value <0.05). In terms of complications, bradycardia was noted in a few cases in group BM after giving spinal anaesthesia. In group BM at two minutes, the mean HR was 76.12±10.71 beats per minute, which was significantly lower than in group BMS 87.56±7.76 beats per minute (p-value <0.05). Hypotension was noted after spinal anaesthesia in group BM. At two minutes, Systolic Blood Pressure (SBP) was 94.81±19.69 mmHg in group BM and 123.0±8.34 mmHg in group BMS (p-value <0.05); at 10 minutes, SBP was 106.0±14.91 mmHg in group BM and 117.3±12.20 mmHg in group BMS (p-value <0.05). Conclusion: Intrathecal magnesium sulphate (50 mg) provided better haemodynamic stability compared to intrathecal midazolam (2.5 mg) in patients undergoing tibia-fibula surgeries.

Association between Corrected QT Interval, QT Dispersion and Clinico-biochemical Severity of Diabetic Ketoacidosis in Children Aged 1-12 Years: A Prospective Cohort Study

Hamritha Ashokkumar, A Suriya, Poovazhagi, Rangesh Balakrishnan, Shreenivas Rachakonda Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Diabetic Ketoacidosis (DKA) is a serious complication in children with type 1 diabetes, characterised by hyperglycaemia, metabolic acidosis and ketosis. It often leads to cardiac arrhythmias due to electrolyte imbalances and prolonged corrected QT interval (QTc). Aim: To investigate the frequency of QTc prolongation and QT dispersion (QTd) in paediatric DKA patients and their relationship with serum electrolytes and pH. Materials and Methods: A prospective cohort study was conducted over a one-year period (August 2022 to August 2023) in the paediatric Intensive Care Unit (ICU) of the Institute of Child Health and Hospital for Children, Egmore, Chennai, Tamil Nadu, India. The study included 150 children aged 1 to 12 years diagnosed with DKA. Electrocardiograms (ECGs) were recorded both at presentation and after recovery from DKA, with QTc and QTd evaluated using a 12-lead ECG. The Mann-Whitney U test was employed to compare medians and Interquartile Ranges (IQR) between two groups, while Spearman’s correlation coefficient was used to assess relationships between variables, with results illustrated through a scatter plot. A p-value <0.05 was considered statistically significant. Results: Significant correlations were found between prolonged QTc intervals and severe acidosis, with affected patients exhibiting lower bicarbonate levels and higher anion gaps and blood ketone levels. After treatment, both QTc intervals and QTd significantly decreased, indicating improved cardiac repolarisation. Strong positive correlations were noted between QTc intervals and both the anion gap and blood ketone levels. Conclusion: The study highlights the QTc prolongation and QTd in children with DKA, which are closely linked to metabolic derangements. Routine ECG monitoring is essential for the early detection of QT prolongation, aiding in the prevention of life-threatening arrhythmias and improving patient outcomes.

Dexmedetomidine versus Dexamethasone as an Adjuvant to Ropivacaine in Transversus Abdominis Plane Block in Infraumbilical Surgeries for Postoperative Analgesia: A Randomised Clinical Study

Anupama Kumari, Aarjvi Patel, Payal Berawala, Sara Mary Thomas Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Postoperative pain due to abdominal wall incision in infraumbilical surgeries can negatively impact surgical outcomes and increase the risk of complications. Effective postoperative analgesia facilitates rehabilitation and recovery. The Transversus Abdominis Plane (TAP) block is a regional analgesic technique that blocks the nerves supplying the anterolateral abdominal wall (T7-L1). Adjuvants like dexamethasone and dexmedetomidine added to local anaesthetics can prolong the duration of the block. Aim: To compare the duration of analgesia (the time of first rescue analgesia) and the quality of pain relief, as assessed by the Visual Analogue Scale (VAS), between dexmedetomidine and dexamethasone as adjuvants to ropivacaine in the TAP block for infraumbilical surgeries. The secondary objective was to compare postoperative haemodynamic changes and side effects. Materials and Methods: In this randomised double-blinded prospective clinical study, conducted in the Department of Anaesthesia, Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre (SBKS MIRC), Piparia, Vadodara, Gujarat, India from March 2023 to September 2024. 80 patients of American Society of Anaesthesiologists (ASA) I and II, aged 18-60 years, undergoing elective infraumbilical surgeries (open abdominal hysterectomy and open bilateral inguinal hernia repair) under spinal anaesthesia were randomly allocated into two groups of 40 patients each. Group-R1 received 0.2% ropivacaine 3 mg/kg plus dexamethasone 0.1 mg/kg, while Group-R2 received 0.2% ropivacaine 3 mg/kg plus dexmedetomidine 1 μg/kg in a bilateral TAP block. The total volume was made up to 50 mL with normal saline. Postoperative pain was assessed using VAS scores. The time to first rescue analgesia demand and haemodynamic parameters were recorded. Results: The mean age of the study participants was 40.15±7.46 years (Group-R1) and 39.5±5.59 years (Group-R2). Demographic data, type of surgery, and duration of surgery were comparable between the two groups. VAS scores were significantly lower in Group-R2 compared to Group-R1 at all time points up to six hours postoperatively (p<0.0001). The mean duration of analgesia was significantly longer in Group-R2 (308.18±12.3 minutes) compared to Group-R1 (239.78±14.23 minutes) (p<0.0001). Haemodynamic parameters were comparable between the groups, with no significant side effects observed. Conclusion: Dexmedetomidine 1 μg/kg as an adjuvant to 0.2% ropivacaine in the TAP block provided a longer duration of analgesia and better quality of pain relief compared to dexamethasone 0.1 mg/kg for postoperative analgesia in infraumbilical surgeries.

Pattern of Refractive Error among Patients attending a Tertiary Care Hospital in Southern Assam, India: A Cross-sectional Study

Nilanjan Kaushik Thakur, Ruma Das Debsikdar, Srawani Sarkar, Surabhi Prasad, S Lakshmi, Devajit Deka Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Uncorrected Refractive Errors (URE) are a primary cause of vision impairment worldwide and a leading contributor to blindness. These errors impact daily productivity, limit job opportunities and can significantly diminish quality of life, increasing both morbidity and financial burdens. Consequently, understanding the prevalence and types of UREs is essential for primary care physicians, ophthalmologists and policymakers. Aim: To assess the pattern and magnitude of UREs among patients at a tertiary care hospital in South Assam, India. Materials and Methods: A cross-sectional study was conducted at Silchar Medical College and Hospital, Silchar, Assam, India from May 2023 to April 2024, which included patients aged five years and older visiting the ophthalmology department. Patients with visual acuity worse than 6/6, which improved with pinhole testing, were further evaluated. Each participant underwent a comprehensive ophthalmic examination, including refraction testing. Data on uncorrected and corrected visual acuity, age, and sex were gathered. Spherical equivalents were used for refractive error analysis. The difference between categorical variables was estimated using the Chi-square test. Results: Of the 11,932 participants screened, 6,112 were males (51.22%) and 5,820 were females (48.78%), aged 5-89 years. UREs were identified in 1,434 individuals (12%), with a median age of 41 years. In the URE group, 718 (50.1%) were females and 716 (49.9%) were males. The mean age of males was 39.51±18.16 years, and that of females was 38.44±19.12 years. The mean refractive error was -0.58±3.11 DS. Emmetropia was present in 469 (32.7%), myopia in 427 (29.8%), high myopia in 38 (2.7%), and hypermetropia in 500 (34.9%). A total of 264 (18.4%) patients had astigmatism greater than 0.5. Anisometropia greater than 1.0 was present in 67 (4.7%). The proportion of different refractive errors was similar in males and females. Conclusion: This study offers key insights into the magnitude and types of UREs in South Assam, India. The proportion of UREs was found to be 12%, with hypermetropia being the most common refractive error, followed by myopia. These findings underscore the need for targeted intervention programmes to improve access to corrective lenses and address vision impairment among these communities.

Characterisation of EfbA from the Endodontic Pathogen Enterococcus faecalis and Prediction of Immunodominant EfbA Epitope Peptides: An In-vitro and In-silico Study

Dev Arora, AS Smiline Girija, J Vijayashree Priyadharsini Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Enterococcus faecalis (E. faecalis) belongs to Group D Streptococci and causes recalcitrant infections such as urinary tract infections, wound infections, intra-abdominal and pelvic infections, bacteraemia, and endocarditis. The emergence of multiple drug resistance, including to the last-resort drug vancomycin, is a major concern with E. faecalis infections. Therefore, it is necessary to implement alternative strategies to combat E. faecalis infections in dental settings. An immuno-informatics approach is one such strategy that can predict and assess the immunodominant B-cell and T-cell epitopes. Thus, there is a need to identify novel vaccine candidates as immunodominant epitope peptides from the Enterococcal Fibronectin Binding Protein-A (EfbA) protein for E. faecalis. Aim: To predict the immunodominant B-cell and T-cell epitopes from the EfbA protein of E. faecalis. Materials and Methods: An in-vitro and in-silico pilot study was conducted in the Department of Microbiology at Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India. Total of 20 carious scrapings were collected from patients with root caries and were phenotypically characterised for E. faecalis and the EfbA genetic determinant by Polymerase Chain Reaction (PCR) amplification. The EfbA protein was retrieved from the National Center for Biotechnology Information (NCBI) database, after which prediction of antigenicity and allergenicity was performed via the VaXiJen and Algpred servers, respectively. The prediction of T-cell epitopes was carried out with the help of the EpiDOCK server, and B-cell predictions were made using the Kolaskar and Tongaonkar tool. Docking of the epitopes with reference to Human Leukocyte Antigens (HLA) alleles was assessed using the ClusPro server, and the results were evaluated for the T-cell dominant epitopes. Results: Among the 20 samples, E. faecalis was characterised in 5 (25%) patients, with three strains exhibiting Multidrug Resistant (MDR) traits. Among the three MDR strains, two strains showed the presence of the EfbA gene by PCR. In-silico analysis of the EfbA protein yielded a total of 17 epitopes, and based on the assessments, a final selection of two epitopes (IRAKGKNHK and LLLSAHPSY) was made, showing promising docking scores with HLA alleles and TLR2. Conclusion: Among the two epitopes, LLLSAHPSY was identified as the most significant immune-dominant epitope predicted, which needs to be further evaluated for vaccine synthesis and experimentation.

A Comparative Study to Determine the Efficacy of Atosiban versus Nifedipine in Management of Preterm Labour

Vidya Gaikwad, Jay Patel, Suhas Gaikwad Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Preterm Labour (PTL) remains a significant challenge in obstetrics, contributing to neonatal morbidity and mortality. The management of PTL involves the use of tocolytic agents to delay delivery, thereby allowing for further foetal development. Aim: To compare the tocolytic efficacy of Nifedipine and Atosiban in the management of PTL. Materials and Methods: This prospective interventional study was conducted at Dr. DY Patil Medical College, Hospital, and Research Centre, Pune, Maharashtra, India from October 2022 to August 2024. Ninety pregnant women between 24 to 34 weeks of gestation, diagnosed with PTL, were assigned to receive either Atosiban (n=45) or Nifedipine (n=45) according to the inclusion criteria. The primary outcomes measured were the duration of pregnancy prolongation, neonatal outcomes and Neonatal Intensive Care Unit (NICU) admissions. Chi-square tests or t-tests were used to compare these categorical variables. Results: Nifedipine was associated with a slightly higher percentage (36 cases, or 80%) achieving pregnancy prolongation for more than seven days compared to Atosiban (34 cases, or 75.56%). Nifedipine also demonstrated better neonatal outcomes and reduced NICU admissions (Nifedipine: 14 cases, or 31.11% vs. Atosiban: 20 cases, or 44.44%). However, Nifedipine was linked to a higher incidence of maternal side-effects , such as headache, hypotension and tachycardia, whereas Atosiban was better tolerated, with fewer reported side-effects . Atosiban was more frequently used in cases with earlier gestational ages, reflecting its utility in more acute clinical scenarios. Conclusion: Both Atosiban and Nifedipine were effective in managing PTL, with each drug offering distinct advantages depending on the clinical scenario. Nifedipine was more effective in prolonging pregnancy and improving neonatal outcomes, while Atosiban was associated with fewer maternal side-effects and is preferred in acute cases.

Comparison of Intraoperative and Postoperative Outcomes of Sleeve and Dorsal Slit Technique of Circumcision: A Prospective Interventional Study

N Snigdha, R Lakshmana, Das Debarath, Natarjan Soorya, A Pravindhas, M Malar Mannan Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Circumcision is the excision of the foreskin of the penis. Adult circumcision, although less prevalent, produces more discomfort and carries a fair share of complications if not performed meticulously. The dorsal slit technique and sleeve technique are the most followed techniques, the dorsal slit being the conventional method. Aim: To compare the intraoperative and postoperative outcomes of the dorsal slit technique and sleeve technique of circumcision. Materials and Methods: A prospective interventional study was conducted at SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India from October 2022 to April 2024. Sixty patients diagnosed with phimosis, balanoposthitis, paraphimosis and patients who requested circumcision for religious reasons were randomly assigned to undergo either the sleeve technique (Group A) or the dorsal slit technique (Group B). Postoperatively, patients were followed-up on the 3rd, 7th, and 14th day. Data included variables such as intraoperative blood loss, postoperative complications, wound healing time, operative time, postoperative pain and surgeon’s comfort. Categorical variables were presented in the form of percentages. The association between categorical variables was tested using Chi-square tests and p-value < 0.05 was considered statistically significant. Results: A total of 27 patients had blood loss of more than 50 mL. A total 19 (63.3%) of the 27 patients belonged to Group B, while 8 (26.7%) patients were a part of Group A. Operative time was extended in sleeve technique as opposed to dorsal slit technique (58.84 min vs. 54.77 min, p-value=0.020). Complications were noted more in dorsal slit technique than in sleeve (33.3% vs. 10%, p-value=0.028). Moderate pain was more common after dorsal slit technique than after the sleeve technique (40% vs. 16.7%, p-value=0.045). Delayed wound healing was noted more in the patients subjected to dorsal slit technique (76.7% vs. 36.7%, p-value=0.002). The surgeon’s comfort was found to be more in dorsal slit technique than with sleeve technique (10% vs. 56.7%, p-value=0.001). Conclusion: The sleeve technique of circumcision showed lesser intraoperative bleeding, faster healing, lesser postoperative pain and complications as compared to the conventional dorsal slit technique.

Compulsive Buying Disorder among Medicine, Dentistry, and Nursing Undergraduate Students from Chengalpattu District, Tamil Nadu, India: A Cross-sectional Study

A Hari Narayanan, Vedapriya Dande Rajasekar, Raja Danasekaran, BN Surya, P Manoj, S Madhush Kumar, Rehana Syed, R Harishma Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Compulsive Buying Disorder (CBD), also known as buying shopping disorder or Oniomania, is a growing concern that affects mental health, relationships, and financial stability. It is characterised by excessive and uncontrollable buying behaviour. With the rise of consumerism and the proliferation of online shopping, compulsive buying has increased, particularly among adolescents and young adults. Aim: To estimate the prevalence of CBD and identify associated risk factors among undergraduate medical, dental, and nursing students. Materials and Methods: A cross-sectional study was conducted in the Chengalpattu district of Tamil Nadu, India from November 2023 to March 2024 among undergraduate students from six colleges. A total of 380 students from medical, dental, and nursing disciplines participated in the study. A pretested semistructured questionnaire was used to collect information on socio-demographic details and various risk factors associated with CBD. The validated Richmond Compulsive Buying Scale (RCBS) was employed to determine the prevalence of CBD. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 22.0. Results: Among the participants, 232 (61.1%) were female, and 148 (38.9%) were male, with the majority, 272 (71.6%), being under 21 years of age. Educationally, 201 (55.3%) were medical students, while 85 (22.4%) were from nursing and dental disciplines. CBD was observed in 113 (29.7%) of the participants. Significant associations with CBD included female gender, medical education, family history of shopaholics, online shopping, shopping-induced euphoria, anxiety or distress when unable to shop, and lying to family or friends about shopping expenses (p-value <0.05). Conclusion: The study revealed that 29.7% of undergraduate students exhibited Compulsive Buying Behaviour (CBB). These findings underscore the importance of targeted interventions and awareness campaigns that address identified risk factors, such as gender, academic discipline, family history, and emotional triggers related to shopping. Such efforts could enhance mental health, financial stability, and interpersonal relationships among students.

Does the Temperature of the Distension Medium Affect Pain Perception in Patients undergoing Ambulatory Hysteroscopy?

Sai Kalmegh, Meenal Patvekar Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Ambulatory Hysteroscopy (AH) has become a valuable tool for modern gynaecologists. However, its success largely depends on the patient’s perception of pain. Advances such as the vaginoscopic technique and the use of smaller instruments have significantly reduced discomfort. Additionally, the use of warm saline as the distension medium is thought to further alleviate pain. Aim: To compare the degree of pain perceived by patients undergoing office hysteroscopy using normal saline as a distension medium at room temperature with that using normal saline warmed to 37.5°C. Materials and Methods: A prospective interventional study was conducted at the Department of Obstetrics and Gynaecology, Dr. D. Y. Patil Medical College Hospital and Research Centre, Pimpri, Pune, Maharashtra, India from August 2022 to August 2024. AH was performed on 60 patients using the vaginoscopic technique. Patients were randomly classified into two groups of 30 each. Group A used room temperature normal saline as a distension medium, while Group B used normal saline warmed to 37.5°C. After 15 minutes of the procedure, patients from both groups were asked to rate their level of discomfort throughout the procedure on a 10-cm Visual Analogue Scale (VAS), and the pain scores were compared. The Chi-square test was utilised to determine the association between two independent categorical variables. Results: The age of the women ranged from 34 to 53 years, with a mean age of 41.77±6.28 years. Among the 60 patients, 40 (66.67%) were premenopausal, and 20 (33.33%) were menopausal. The most common indication was Abnormal Uterine Bleeding (AUB) in 17 (28.3%) patients. Mild pain (0-3) was reported by 15 women in Group A and 24 women in Group B (p-value=0.041). Moderate pain was experienced by 10 women in Group A and 6 in Group B. Severe pain was reported by 5 patients in Group A and none in Group B. Conclusion: The use of warm saline in AH is a simple, easy and cost-effective method for reducing pain and optimising clinical outcomes.

Indications, Surgical Technique and Outcomes of Laparoscopic Splenectomy: A Retrospective Descriptive Study from Srinagar, India

Mushtaq Chalkoo, Mudasir Habib, Ashiq Hussain Raina, Firdous Hamid, Sajad Nazir Malla, Imtiyaz Ahmad Malik Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Laparoscopic splenectomy has become the preferred approach because it offers several advantages over traditional open surgery, including smaller incisions, decreased postoperative pain, reduced blood loss and shorter hospital stays. For mild to moderately enlarged spleens, it has become the procedure of choice. Although it can be more challenging for massively enlarged spleens, with proper planning and surgical expertise, the procedure can be performed safely. Aim: To assess the indications and outcomes of laparoscopic splenectomy across a range of spleen sizes, from normal to massively enlarged spleens, in a tertiary care hospital. Materials and Methods: A retrospective descriptive study was conducted in the Department of Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India, from May 2018 to May 2023. A total of 41 patients were included in the study. Patients aged 18 to 65 years who had undergone elective laparoscopic splenectomies, with no cutoff for spleen size, were included. The endpoints of the study were to measure perioperative parameters such as operative time, blood loss, postoperative complications, hospital stay and analysis of indications. Continuous variables were expressed as mean±SD and categorical variables were summarised as frequencies and percentages. Results: The study group consisted of 20 (48.80%) males and 21 (51.20%) females. The mean age was 43.42±11.28 years. The most common indication for splenectomy was Immune Thrombocytopenic Purpura (ITP) (n=15), followed by hereditary spherocytosis (n=7). The mean spleen size of 26 patients was 12±1.62 cm; in seven patients, it was 17±0.76 cm; and in eight patients, it was 23.5±2.29 cm. The largest spleen operated on measured 28 cm in size. One patient required conversion to open surgery due to bleeding. Conclusion: Laparoscopic splenectomy is a safe method associated with a low risk of perioperative complications. Proper planning and a reproducible operative technique are critical for success in laparoscopic splenectomy, even for massive spleens.

Simultaneous Debridement and Titanium Mesh Reconstruction in Patients with Compound Depressed Skull Fracture: A Retrospective Descriptive Study

Srikant Das, Acharya Suryakant Pattajoshi, Mahesh Kumar Kusta, Dibakar Sarkar Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Around 6% of head injuries are compound skull fractures. Not all compound fractures require surgical intervention; however, some fractures pose surgical challenges due to their location and the extension of fracture segments to adjacent dural venous sinuses. Surgical management includes thorough debridement of fractured segments, along with devitalised and contaminated soft tissues, followed by cranioplasty either in the same sitting or as a staged procedure. Aim: To analyse the results of single-stage titanium mesh reconstruction in the management of compound and comminuted skull fractures. Materials and Methods: This was a retrospective descriptive study in the Neurosurgery Department at Veer Surendra Medical Sciences and Research (VIMSAR), Burla, Sambalpur, Odisha, India, from January 2018 to June 2023 and consisting of case records of 98 patients with head injuries associated with compound skull fractures who were admitted. All patients underwent debridement followed by an immediate titanium mesh cranioplasty procedure. The standard debridement technique was followed in all cases. Patients were followed for three months after their discharge from the hospital. Clinicoradiological follow-up was conducted, and outcomes in terms of surgical site infection, titanium mesh exposure, and rejection of the prosthesis were evaluated. Data collected from patients were checked, entered, and analysed using Microsoft Excel, and results were described in percentages. Results: The mean age of the subjects was 28.48±13.79 years. The predominant mechanism of injury was Road Traffic Accident (RTA), affecting 59 (60.2%) patients. The frequency of skull fractures was significantly higher in men 91 (92.8%) patients compared to women 7 (7.2%) patients. The mean Glasgow Coma Scale (GCS) score was 13.35 at admission, while it was 14.90 at discharge. The fracture was located most commonly in the frontal region in 64 patients (65.3%), followed by the parietal region in 23 (23.5%) patients, and mixed fronto/temporo/parietal bone fractures in 11 (11.2%) patients. Approximately 41 (41.9%) patients had paranasal sinus involvement, and 69 (70.4%) patients had associated dural injury. A very low incidence of complications was observed in patients during their hospital stay and three-month follow-up. Only one patient developed a surgical site infection. One patient experienced sinus formation with intermittent discharge and subsequently required removal of the mesh, while two patients had a transient postoperative Cerebrospinal Fluid (CSF) leak. There were no incidences of immediate postoperative seizures. Conclusion: Simultaneous debridement and mesh reconstruction do not pose an increased risk of infection, contrary to previous beliefs.

Assessment of Learning Styles of First-year Medical Students’ using VARK 8.02 Model Questionnaire: A Cross-sectional Study

Senthil Ganesh P Kannappan, Ravichandran Doraisamy, Vijayakumar Jagadesan Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Students are constantly in search of additional and innovative ways to stimulate their attention in learning various subjects. Assessing medical students’ learning styles can help both teachers and students make informed decisions about teaching strategies. Adopting a suitable teaching style can improve teaching effectiveness. Fleming’s VARK Questionnaire version 8.02, which consists of V- Visual, A- Aural, R- Read/Write, and K- Kinaesthetic learning styles, was used in present study. Aim: To evaluate the learning styles of first-year MBBS students in a private medical college in Tamil Nadu India, identify the prevalence of unimodal and multimodal learners, and examine the correlation of learning styles between genders. Materials and Methods: A descriptive cross-sectional questionnaire survey was conducted among first-year MBBS students at Sri Venkateswaraa Medical College in Tamil Nadu, India from January 2024 to March 2024. A total of 125 students out of 150 provided their informed consent to participate in the research. Subsequently, a copy of the VARK questionnaire version 8.02, which contains 16 multiple-choice questions, was issued to the first-year MBBS students. To compare the learning styles of male and female students, Chi-square tests and paired sample t-tests were performed. Results: A total of 125 students participated in the present study. Participants’ age ranged from 18 to 22 years, with 37% being male and 63% female. Among the students, 38.4% were found to be unimodal, 46.4% were bimodal, 13.6% were trimodal, and 1.6% were quadrimodal learners. The individual scores in the unimodal category were V-3, A-14, R/W-5, and K-26, with kinaesthetic learning being the most preferred mode, followed by aural mode. There was no significant gender difference in the preferred learning style (p-value=0.35). The p-values for the association between learning styles and gender, determined through the Chi-square test in the unimodal category, were as follows: visual (p-value=0.93), aural (p-value=0.48), read/write (p-value=0.22), and kinaesthetic (p-value=0.18). Conclusion: Individual learning styles be identified at the entry level. Teachers can plan their lessons based on students’ learning preferences to improve the effectiveness and efficiency of their teaching and learning methods. To accommodate different learning styles, educators should combine various teaching methods.

Histomorphological Study of Rodenticide Poisoning: An Autopsy-based Cross-sectional Study from a Tertiary Care Centre, Krishnagiri, Tamil Nadu, India

P Narmadha Priya, Jayalakshmy Pechimuthu, V Palaniappan, Teleflo Boopathy, Jeevanandham Anbazhagan, Jeevitha Muniraj Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: In the rise of the modern era, which intensifies mental health issues, some individuals consider suicide using methods such as poison ingestion. Rodenticides, commonly used for pest control, including brodifacoum, bromadiolone and bromethalin, are often involved in these cases. In a retrospective study conducted by the National Poison Information Centre, it was found that death due to rodenticide poisoning accounted for about 17.06% when compared to other pesticides, indicating a rise in the global burden of rodenticide poisoning. Prompt medical intervention and hospitalisation are vital in cases of rodenticide poisoning. Hence, histomorphological examination of affected organs is essential to determine the damage to vital organs, thereby guiding clinicians in future perspectives to facilitate patient recovery. Aim: To study the histomorphological findings of various organs affected by rodenticide poisoning and to assess which organ is most commonly involved. Materials and Methods: This cross-sectional study investigated the effects of rodenticide poisoning through medicolegal autopsy specimens at Government Medical College and Hospital, Krishnagiri, Tamil Nadu, India from June 2023 to June 2024 over a duration of 12 months. The study utilised retrospective data from autopsies, focusing on cases where death resulted from rodenticide poisoning. Autopsy specimens, including the heart, lungs, kidneys, liver, spleen and brain, were preserved in formalin and subjected to gross and microscopic examination by a pathologist. Histopathological sections were stained with Haematoxylin and Eosin (H&E). The study employed a convenience sampling technique with a sample size of 30, determined using Solvin’s formula. Data from crime history, clinical history and autopsy findings were recorded and analysed using Statistical Package for the Social Sciences (SPSS) version 25.0, and compiled to draw conclusions regarding the impact of rodenticide poisoning on organ damage. Results: During the one-year period of the study, 450 medicolegal autopsies were processed, of which 180 (40%) cases were due to poison consumption. Of these, 32 cases (17.78%) were from rodenticide intake. Male predominance was observed in this study, comprising 20 males (62.50%) and 12 females (37.50%), with a ratio of 5:3. Histopathology revealed congestion in most of the organs, with the liver showing steatosis and necrosis, kidneys exhibiting acute tubular necrosis, and lungs displaying haemorrhage and oedema. The heart showed features of atherosclerotic changes in seven cases, whereas the brain showed congestion in 11 cases and cerebral haemorrhage in one case out of the 32 cases, respectively. Conclusion: This study found a higher prevalence of poisoning among males and increased susceptibility in teenagers and elderly individuals. The study emphasises the histomorphological findings of various organs in rodenticide poisoning and concludes that the liver, kidneys and lungs appear to be the most affected organs. It also highlights the importance of yoga in preventing suicides.

Outcomes of Percutaneous Ultrasound-guided Splenic Procedures: A Retrospective Observational Study from a Tertiary Care Centre in Southern India

Ruth Anna Stephen, Vinu Moses, George M Varghese, KB Santhosh Babu, Suchita Chase, Shyamkumar N Keshava Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Data on image-guided percutaneous procedures of the spleen are limited, particularly for infectious lesions. Aim: To evaluate the complication rate of percutaneous ultrasound-guided splenic procedures. Materials and Methods: A retrospective observational study was conducted in a tertiary care centre in Southern India. Data from all consecutive patients who underwent ultrasound-guided splenic procedures from January 2008 to October 2023 were analysed. Information was extracted from digital radiology reports, images, inpatient records, outpatient records and blood investigation reports. Complications were categorised according to standardised guidelines. Descriptive statistics for categorical data were reported. Pearson Chi-square test were used to assess associations between categorical variables. Statistical Package for the Social Sciences (SPSS) software version 21.0 was used. Results: A total of 312 patients were included, with mean age of 42.2±15.8 years. Of these, 212 (68%) were males and 100 (32%) were females. There were 259 diagnostic procedures: 125 (40.1%) Fine Needle Aspiration Cytology (FNACs), 18 (5.8%) biopsies and 116 (37.2%) aspirations. Fifty-three procedures were therapeutic: 52 (16.7%) drainages, and 1 (0.3%) percutaneous injection of sclerosant. The overall complication rate was 22 in 312 patients (7.1%, with 95% CI of 4.7% to 10.4%). As per the Society of Interventional Radiology (SIR) Clinical Practice Guidelines classification, six patients (27.3%) had Category-A complications with small perisplenic haematomas, three patients (13.6%) had Category-B complications, 10 patients (45.5%) had Category-C complications and two patients (9.1%) had Category-D complications. One patient (4.5%) died during the postoperative period (Category-F complication). No patients had SIR Category-E complications. Conclusion: Percutaneous ultrasound-guided procedures were safe and efficacious in this patient cohort, which predominantly consisted of individuals with infectious diseases and exhibited a low mortality rate.

Seroprevalence of Immunoglobulin G Levels (IgG) against Varicella in Healthy Indian Adults: A Cross-sectional Study

Huidrom Manimohon Singh, Vikas Suri, Kapil Goyal Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: The key role of vaccines is to prevent infections caused by viruses and bacteria. Many adults remain unaware and unvaccinated. Varicella-Zoster Virus (VZV) is a pathogenic human herpes virus that causes varicella (chickenpox) infections in both children and adults. Only a fraction of the population in India receives the varicella vaccination through private practitioners, as it is not part of the national immunisation programme. Aim: To determine the levels of protective antibodies against varicella among different age groups of healthy adults. Materials and Methods: A cross-sectional study was conducted from July 2019 to September 2020 in the Department of Internal Medicine and the Blood Donation Centre of the Department of Transfusion Medicine at PGIMER, Chandigarh, Punjab, India. The study involved healthy adults aged 18 years and above attending blood donation camps or those accompanying patients in the Internal Medicine Outpatient Department (OPD). They were divided into four groups: Group A: Adults aged 18-30 years, Group B: Adults aged 31-45 years, Group C: Adults aged 46-60 years, Group D: Adults aged >60 years. Variables like age, sex, socioeconomic status, history of VZV vaccination, history of natural varicella infection in the past and VZV IgG levels tested with a commercially available Enzyme-linked Immunosorbent Assay (ELISA) kit were analysed. The dependent variables were classified as Varicella IgG positive (>12 U/mL), equivocal (8-12 U/mL) and negative (<8 U/mL). Data collected were analysed using Statistical Package for the Social Sciences (SPSS) version 21.0. The Chi-square test (c) and Fisher’s-exact test were used for proportions, while the Spearman’s correlation test was used to assess the correlation between age and Immunoglobulin (IgG) levels. A p-value of <0.05 was considered significant. Results: Out of 300 participants, 244 (81.3%) were male and the mean±SD age was 44.26±15.50 years. A total of 88.7% had protective levels of varicella IgG >12 U/mL. Lower socioeconomic status and younger age groups were associated with negative or equivocal (<12 U/mL) IgG levels. A positive correlation between age (in years) and VZV IgG (in U/mL) was found in the present study. Conclusion: Overall, protective immunity among adults against varicella was found to be 88.7%. Serosurveillance surveys in the community and healthcare facilities should be implemented for vaccine-preventable diseases so that vaccination can be offered to the susceptible population, thereby preventing outbreaks.

Efficacy of Intramuscular versus Intravenous Dexmedetomidine on Attenuation of Haemodynamic Responses to Laryngoscopy and Endotracheal Intubation: A Randomised Clinical Trial

Anupama Kumari, Paras Anand, Jigisha Mehta, Sara Mary Thomas Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Laryngoscopy and endotracheal intubation during anaesthesia administration provokes physiological stress responses like tachycardia, hypertension and can also lead to potential adverse events such as bronchospasm, myocardial ischaemia, arrythmias, cerebrovascular accidents etc. Dexmedetomidine, an alpha-2 adrenergic agonist has been extensively used perioperatively for stabilising intraoperative haemodynamics. Intravenous dexmedetomidine can cause major adverse effects such as bradycardia, hypotension, cardiac arrhythmias and biphasic response when used as premedication for attenuation of the laryngoscopy and intubation response which mandates exploration of other routes of administration of dexmedetomidine. Aim: To evaluate the efficacy of intramuscular dexmedetomidine and intravenous dexmedetomidine to attenuate the stress response of laryngoscopy and endotracheal intubation in patients undergoing general anaesthesia via these routes. Materials and Methods: This prospective, randomised clinical trial was single-blinded study conducted in the Department of Anaesthesia, Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre (SBKS MIRC) in Piparia, Vadodara, Gujarat, India over a period of six months from January 2024 to June 2024 on 64 adult patients of American Soceity of Anaesthesiology (ASA) physical status I and II, aged between 18-60 years, posted for surgery under general anaesthesia. The patients were divided in two groups: Group D_IM (intramuscular Dexmedetomidine) received Inj. Dexmedetomidine 1 μg/kg intramuscularly 45 minutes prior to induction. Group D_IV (intravenous Dexmedetomidine) received Inj. Dexmedetomidine 1 μg/kg intravenously as infusion in 100 mL Normal Saline (NS) over 10 minutes 45 minutes prior to induction. Haemodynamic changes during laryngoscopy and intubation, postoperative complications and sedation score were recorded. Results: Demographic data and baseline haemodynamics were comparable between the two groups. Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) were raised from laryngoscopy and intubation in both groups. This increase was significant in Group D_IV compared to Group D_IM (p=0.0424, p=0.0235, p=0.0004, 0.0021, respectively). The rise in all haemodynamic parameters from laryngoscopy and intubation returned to baseline values at around three minutes in D_IM group, while in D_IV group they returned at around seven minutes, and remained comparable throughout. No patient experienced significant complications or sedation in postoperative period. Conclusion: Dexmedetomidine administered via intramuscular route was more effective than intravenous route at same dosage in attenuating haemodynamic stress response to laryngoscopy and intubation.

Identification of Breastfeeding Problems using LATCH Score and the Impact of Lactation Counselling: A Quasi-experimental Study

Sandhya Devi Lingala, Nerella Jwala Vasavi, Amara Jyothi Addanki, Lakshmi Prasanna Chintha, Nagireddy Anusha Reddy Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Breastfeeding has important positive long-term health consequences for infants and their mothers. Assessing breastfeeding in the early postnatal period, prior to discharge, is crucial for successful breastfeeding. LATCH (Latch, Audible swallowing, Type of nipple, Comfort and Hold) score can be used to categorise mothers with poor breastfeeding scores and counsel them to prevent early breastfeeding cessation. Aim: To identify breastfeeding problems using the LATCH score and to assess the impact of lactation counselling among postnatal mothers. Materials and Methods: This quasi-experimental study was conducted in the Department of Paediatrics, ACSR Government Medical College and Hospital, Nellore, Andhra Pradesh, India, from June 2023 to December 2023. The study included 400 healthy term and singleton babies. LATCH scores were assessed at 6-12 hours after delivery. Mothers with breastfeeding problems were identified, corrected and counselled. The LATCH scores were reassessed again after 24-48 hours. Data were statistically analysed using Chi-square test. The p-value <0.05 was considered to be statistically significant. Results: The average age of the participants was 24.5 years, and most of them were illiterate. Out of 400 mothers, 344 (86%) mother-infant dyads had a LATCH score of <8 at 6-12 hours after delivery; this reduced significantly to 66 (16.5%). at 24-48 hours after breastfeeding support and training (p-value <0.001). Analysis of the association between demographic characteristics and LATCH scores showed that infants of certain subgroups, such as primi, caesarean, young, and less educated mothers, continued to experience lower LATCH scores. Conclusion: The incidence of breastfeeding problems was high during the initial days after childbirth and was particularly prevalent among certain subgroups, such as caesarean mothers, primi-parous mothers, younger mothers and less educated mothers. However, systematic assessment using the LATCH score and timely supportive interventions can significantly improve breastfeeding outcomes.

Polymorphism of Dehydrocholesterol Reductase (DHCR7) Gene and its Effects on Metabolic Components of Polycystic Ovary Syndrome in Women: A Cross-sectional Study from Tertiary Care Hospital of Eastern India

Susmita Banerjee, Shuvankar Mukherjee, Anindya Dasgupta, Palash Kusum Ghosh Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Polycystic Ovary Syndrome (PCOS) is a disorder characterised by various metabolic derangements with multiple origins, one of which may be linked to vitamin D metabolism. Vitamin D deficiency in individuals with PCOS not only leads to reduced bone mineralisation but also exacerbates the various symptoms associated with the condition. The role of gene variants involved in vitamin D metabolism in PCOS suggests an association with metabolic and endocrine parameters in the general population. Aim: To investigate the association of the DHCR7 gene with metabolic and endocrine parameters, including 25 Hydroxy Vitamin D {25(OH)D} levels, in women with PCOS. Materials and Methods: This was a cross-sectional study conducted in the Department of Biochemistry, Calcutta National Medical College, Kolkata, West Bengal, India, from January 2018 to February 2020. A total of 128 women with PCOS and age-matched healthy controls were enrolled. All participants were aged between 16 and 45 years. Anthropometric, metabolic, and endocrine tests were performed on both the control (n=50) and PCOS groups (case group, n=78). Polymerase Chain Reaction (PCR) with suitable primers, followed by restriction digestion using Taq1 enzyme, was used to identify Dehydrocholesterol Reductase (DHCR7) gene polymorphism in women with PCOS in Eastern India. Observations were documented regarding the associations with PCOS susceptibility. The data evaluation was conducted using Statiscal Package sfor Social Sciences (SPSS) version 20.0. A p-value<0.05 was considered statistically significant. Results: The mean age was 26.73±7.4 years for PCOS subjects and 27.68±9.2 years for healthy controls. The genotypic frequency between the two groups did not differ significantly (p-value=0.165). However, there were significant differences in Fasting Blood Sugar (FBS) with a p-value of 0.029 and Waist-hip Ratio (WHR) with a p-value of 0.05 among the individual genotypes. The lipid profile and endocrine parameters did not differ significantly between the individual genotypes. Conclusion: No statistically significant association was found between DHCR7 polymorphism and 25-hydroxy vitamin D (25-OHD) levels, as well as other metabolic parameters. However, it was observed that the susceptibility of individual genotypes in women with PCOS to alterations in certain parameters was directly related to the aggravation of symptoms and the risk of Metabolic Syndrome (MetS).

Early Markers of Liver Fibrosis in Children with Beta-thalassaemia Major: A Cross-sectional Study

Himani Aggarwal, Monica Verma, Shuchi Bhalla, Dinkar Yadav, Kapil Bhalla, Abhishek Soni Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Hepatic fibrosis secondary to iron overload in beta-thalassaemia is a known complicating factor. Liver biopsy is considered the gold standard; however, it is burdened with a multitude of risks, highlighting the need for ongoing studies to evaluate the risk of fibrosis using less invasive methods. Aim: To evaluate the diagnostic utility of non invasive liver parameters such as the Aspartate Aminotransferase to Platelet Ratio Index (APRI) and the Fibrosis-4 Index (FIB-4) in detecting liver fibrosis, as well as the potential of YKL-40 (tyrosine (Y), lysine (K), leucine (L)) as an early marker of liver dysfunction by correlating it with Transient Elastography (TE) in children with beta-thalassaemia major receiving regular transfusions. Materials and Methods: This descriptive, cross-sectional study was conducted in the Department of Paediatrics, along with the Department of Hepatology and Gastroenterology, at Pt. B.D. Sharma Postgraduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana, India, between January 2020 and February 2022. The study consisted of 75 paediatric patients with beta-thalassaemia major. Early markers for liver fibrosis were evaluated using serum YKL-40 levels, APRI, and FIB-4 scores, which were then compared to fibrosis scores obtained from TE. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software version 20.0. Results: The mean age of the patients was 10.71±2.54 {mean±Standard Deviation (SD)} years, with a median age of 11 years and an age range of 6 to 16 years. In terms of diagnostic performance, YKL-40 (pg/mL) emerged as the best parameter regarding both Area Under the Receiver Operating Characteristics (ROC) Curve (AUROC) and sensitivity, demonstrating its strong ability to detect liver fibrosis. At a cut-off of APRI ≥0.356, APRI performed best in terms of specificity (98%). The AUROC for APRI was 0.937 (95% CI: 0.84-1), indicating very strong predictive capability and statistical significance (p<0.001). YKL-40 (pg/mL) emerged as the most effective parameter for negative predictive value, with an AUROC of 0.971 (95% CI: 0.924-1) in predicting fibrosis. Overall, both YKL-40 and APRI showed the highest diagnostic accuracy, highlighting their complementary roles in assessing liver dysfunction. Conclusion: Regular transfusions in beta-thalassaemia major often lead to iron overload and liver fibrosis. Non invasive tools like APRI, FIB-4, and the biomarker YKL-40 show promise as alternatives to biopsy and elastography, enabling earlier detection and intervention.

Effect of Nebulisation with Dexmedetomidine versus Magnesium Sulphate on Haemodynamic Response to Laryngoscopy and Intubation and Incidence of Postoperative Sore Throat: A Randomised Clinical Trial

Fateh Pal Singh Gill, Chhaya Suryawanshi Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Laryngoscopy and endotracheal intubation are essential procedures in general anaesthesia but can induce sympathetic hyperactivity, leading to transient increase in blood pressure and Heart Rate (HR). This can be particularly risky for patients with co-morbidities. Various agents, including dexmedetomidine and magnesium sulphate, have been studied for their potential to mitigate these responses. Aim: To compare the effects of preoperative nebulisation with dexmedetomidine versus magnesium sulphate on haemodynamic responses during laryngoscopy and intubation and to determine the incidence of Postoperative Sore Throat (POST) in both groups. Materials and Methods: This randomised clinical, double-blind trial was conducted at Dr. D.Y. Patil Medical College, Pune, Maharashtra, India over the period of two years. It involved 80 patients undergoing surgery under general anaesthesia, divided into two equal groups. Group A received nebulisation with dexmedetomidine (1 μg/kg) and Group B received magnesium sulphate (240 mg) diluted in 0.9% normal saline to make a 3 mL solution. Institutional ethical approval and Clinical Trials Registry India (CTRI) registration were obtained. Haemodynamic parameters including HR, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) and POST were monitored. Statistical Package for the Social Sciences (SPSS) version 20.0 was used for statistical analysis. Data were analysed using unpaired t-tests for quantitative data and Pearson’s Chi-square test for qualitative data, with significance set at p-value<0.05. Results: Before nebulisation, group A had significantly higher HR and SBP than group B (p-value=0.003 and 0.009, respectively). Postnebulisation, there were no significant differences in HR or SBP between groups. However, group A had lower DBP and MAP during and after intubation and skin incision (p-value <0.001, 0.001, and <0.001 respectively for DBP and 0.030, 0.031 and 0.002 for MAP). Group A had a lower, though not statistically significant (p-value=0.36) incidence of POST compared to group B. Conclusion: Nebulisation with dexmedetomidine and magnesium sulphate both provided effective management of haemodynamic responses during intubation. Both agents decreased the incidence of POST.

Exploring Motor Recovery Differences in Paretic Upper and Lower Extremity after Stroke: A Cross-sectional Study

Rathinasabapathy Sampath Pulimoot, CKV Bhuvaneswari, Annadurai Kabilan Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Stroke globally cause permanent disability, often impairing upper and lower limb function. Poststroke rehabilitation focuses on enhancing functional outcomes, but limb recovery differs and has various contributing factors. Understanding these differences and their clinical and demographic relationships helps develop comprehensive or individualised rehabilitation plans for better outcomes. Aim: To compare the motor recovery of paretic upper and lower extremities in poststroke patients and analyse their relationship with demographic and clinical factors. Materials and Methods: This cross-sectional study was conducted at the Department of Physiotherapy, Government Medical College and Hospital, Annamalai Nagar, Chidambaram, Tamil Nadu, India. A total of 41 stroke participants were recruited through purposive sampling. The Fugl-Meyer Assessment (FMA) scale was used to evaluate both Upper Limb (FMA-UL) and Lower Limb (FMA-LL) motor recovery. Statistical tools such as t-tests and Chi-square tests were used for data analysis. Results: The mean age of the participants was 52.15±13.51 years, with a mean stroke duration of 21.17±16.96 months. Most participants were males (63.41%) with right-sided involvement (75.6%), and the most common subtype was ischaemic stroke (78%). The mean FMA-LL score was 23.88±5.13 (70.2%), which was significantly higher than the FMA-UL mean score of 28.07±11.13 (42.5%), indicating better motor recovery in the lower extremity. Most patients had moderate to severe strokes, with 14.6% experiencing very severe impairment. Gender differences were statistically significant for lower-limb recovery (p-value =0.024), with males showing a mean score of 24.73±5.59, indicating greater recovery. Differences in stroke type were also statistically significant for lower-limb recovery (p-value <0.001), with ischaemic stroke patients having a mean score of 25.50±3.90, demonstrating greater improvements. No significant relationship was observed between age and duration of stroke with recovery patterns. Conclusion: Lower extremity demonstrated better motor recovery than upper extremity in poststroke patients. Ischaemic and male stroke subjects showed better lower extremity recovery than haemorrhagic and female stroke survivors respectively. The results indicate the implications for customised therapeutic plans in poststroke rehabilitation.

Effect of Aromatherapy using Lavender Oil on Audio and Visual Reaction Time: A Quasi-experimental Study

Saroj Chaudhary, Manjinder Kaur, Suman Sharma, Naren Kurmi, Khushboo Shrimali, Soniya Pipliwal, Muskan Singh Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Recently, the aromatheraphy has been a topic of interest in field of research and is reported to exert psychomodulatory effects through the limbic system. Lavender oil is widely researched for its effects on nervous system and shows calming effects. Aim: To evaluate Auditory Reaction Time (ART) and Visual Reaction Time (VRT) after 30 minutes of inhalational of lavender oil. Materials and Methods: This quasi-experimental study was conducted on 30 healthy volunteers after obtaining the clearance from ethics committee and informed consent from the participant. The audiovisual time was recorded twice for each subject, before and after the intervention i.e., 30 minutes of inhalation of lavender oil using aroma lamp. The data was analysed using Statistical Package for the Social Sciences (SPSS) version 20.0. Results: The present study showed significant prolongation of both ART and VRT (p-value=0.04 and 0.01, respectively) after 30 minutes inhalation of lavender oil from pre-exposure value of ART increased from 0.76±0.25 msec to 0.91±0.31 msec and VRT increased from 0.62±0.20 msec to 0.74±0.18 msec was observed. Conclusion: The prolongation of ART and VRT indicates the inhibitory effect of the inhalational lavender oil on the central neuron especially in the limbic system, through the activation of GABA (gamma-aminobutyric acid) receptors. Hence, it results in calming effect on the brain, inducing relaxation and sedation.

Temporal Changes in Bacterial Profile of Burn Wound Infections in a Tertiary Care Hospital and Risk Factors for Invasion: A Prospective Cohort Study

Aarti A Gandhi, Priyanka S Prasad, Gita Nataraj, Vinita Puri Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Burn wound infections remain a significant cause of morbidity and mortality in patients admitted to burn units. Burn wounds serve as a susceptible site for opportunistic colonisation by endogenous and exogenous organisms due to local and systemic immunosuppression. The bacterial infection profile changes over time in hospitalised patients which increases the risk of systemic invasion. Aim: To determine the temporal changes in the bacterial profile of burn wound infections and identify the risk factors associated with invasive infections. Materials and Methods: A prospective cohort study of patients with burn injuries was conducted over 15 months in the burns unit of a tertiary care hospital in Mumbai, Maharashtra, India. Since, it was a time bound prospective cohort study, samples from all patients admitted with burn wounds between June, 2018 and September, 2019 were considered as study participants (n=131). Wound swabs were obtained from patients upon admission and subsequently at regular intervals. Bacterial isolates were identified and their antibiotic susceptibility patterns were determined. Data were analysed to identify temporal changes in the bacterial profile to determine the risk factors associated with invasive infections. Results: A total, of 131 patients with burn injuries were included. A total of 503 swabs were collected, of which 373 (74.2%) showed bacterial growth; five (1.34%) were contaminants and were excluded from analysis. Gram-negative bacteria were the predominant isolates in the first week, whereas gram-positive organisms predominated from the second week onwards. The most common organism isolated was Pseudomonas aeruginosa (n= 100, 27.17%) followed by Staphylococcus aureus (n=84, 22.83%), Acinetobacter baumannii (n=74, 20.11%), and Klebsiella pneumoniae (n=65, 17.66%). A total of 74 blood culture specimens were collected from 47 patients suspected of having invasive infections based on clinical signs and symptoms of systemic infection clinically. Of these, 37 patients (78.7%) were culture positive. Mortality was noted in 28 patients (28/31, 90.32%) in the group with invasive infections. Upon calculating the Odds Ratio (OR), risk factors found to be associated with invasive infections included a higher degree and depth of burns and a longer hospital stay. Conclusion: The shift from gram-negative to gram-positive bacteria and the increasing resistance over time highlight the importance of ongoing surveillance and appropriate antimicrobial stewardship measures in the management of burn wound infections.

Prevalence of Hepatitis C Virus Infection in Cancer Patients: A Cross-sectional Study from Regional Cancer Care Centre, Gujarat, India

Hirenkumar Ashokbhai Patel, Foram Maulin Patel Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Hepatitis C infection is a liver disease caused by the Hepatitis C Virus (HCV). It is one of the major risk factors for acute to chronic liver diseases, such as altered liver functions, chronic hepatitis, cirrhosis, hepatocellular carcinoma and liver failure. Additionally, the HCV poses significant risks to cancer patients undergoing treatment. Understanding the prevalence of HCV infection in cancer patients is crucial. Aim: To determine the prevalence of HCV infection in patients attending a cancer care hospital which may help in the early detection of HCV infection and prevent complications. Materials and Methods: This cross-sectional study was carried out with patients attending the Gujarat Cancer and Research Institute (GCRI), a tertiary care cancer hospital in Gujarat, India, between August 2018 and December 2019 in the Department of Microbiology. A total of 45,886 serum samples were collected and screened for HCV using the Enzyme-Linked Immunosorbent Assay (ELISA). All demographic and clinical information was documented for analysis. Statistical Package for the Social Sciences (SPSS) software was used for data analysis. Results: The study revealed a prevalence of HCV infection of 190 (0.41%) among the cohort. Adult patients residing in rural areas exhibited higher rates of HCV positivity. Solid tumours, particularly those of the digestive system, accounted for 112 (58.9%) of the HCV-positive cases. The surgical oncology units reported the highest proportion of HCV-positive patients, with 115 (60.5%) cases. Risk factors such as blood transfusion and radiotherapy were associated with HCV transmission. Notably, 101 (53.2%) of the positive patients had no identifiable risk factors. Conclusion: Routine screening for blood-borne viruses in cancer patients, especially before immunosuppressive treatments, is crucial. Comprehensive prevention strategies, including the promotion of injection safety, blood safety through screening, and infection control measures, are essential in healthcare settings. These findings underscore the significance of national guidelines and surveillance activities to combat HCV infection effectively.

Critical Appraisal of Materials and Methods in Observational Studies Published in Pathology Journals: A Cross-sectional Study

Supriya Siddavatam, BN Kumarguru Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Critical appraisal is the craftmanship of scrutinising and assessing the accuracy and credibility of data in published research work. It is of paramount importance to distinguish between scientifically helpful and well-written articles from imprecise and fallacious articles. Critical appraisal of methodology is a crucial prerequisite for medical students, young clinicians and accomplished physicians. However, the critical appraisal of methodology in the studies published in pathology journals has not been thoroughly explored. Aim: To compare and critically evaluate the materials and methods related to aspects of observational studies published in indexed National (Indian) and International (foreign) pathology journals concerning different evaluation parameters. Materials and Methods: A cross-sectional study was conducted in the Department of Pathology at PES University Institute of Medical Sciences (PESU IMSR) in Bengaluru, Karnataka, India and PES Institute of Medical Sciences (PESIMSR) in Kuppam, Andhra Pradesh, India, from September 2023 to October 2023. A total of 50 articles were randomly selected for evaluation using computer-generated random numbers. Out of 50 articles, 25 were selected from National journals and the other 25 were from International journals. The articles were meticulously evaluated concerning materials and methods-related aspects. A total of 15 parameters were evaluated. The first 13 parameters were evaluated for major and minor errors, while the last two parameters were categorised as concordant or discordant. If the parameter was not mentioned, it was considered a major error. If the parameter was mentioned but the information was found to be inadequate, it was considered a minor error. The resulting data were entered into an Microsoft Excel sheet (2021 version) and analysed statistically by using Stata Software (17.0 version). The Chi-square test was employed to analyse the data and the p-value of <0.05 was considered as statistically significant. Results: Out of 15 parameters, study participants, study variables, sample size and methodology procedure details were mentioned in all 50 articles (100%). Study bias was the most underreported parameter, being mentioned in only 7 articles (14%). Major errors were found to be relatively more frequent in the National journals [76 errors (58.46%)] in comparison with the International journals [54 errors (41.54%)]. These values were found to be statistically significant (p=0.030). Minor errors were also relatively more frequent in the National journals [44 errors (51.76%)] in comparison with the International journals [41 errors (48.24%)]. However, these values were not statistically significant (p=0.443). Conclusion: Without a doubt, both National and International pathology journals significantly contribute to the knowledge databases. However, the present study suggested the need for improvement in the quality of publications in both National and International journals concerning the materials and methods-related aspects.

Level of Physical Activity and its Correlation with Mental Health in Community-dwelling Older Individuals: A Cross-sectional Study

Vipra Paragkumar Dalal, Subhash Khatri Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: The global population is ageing rapidly. Physical activity is one of the important factors that can positively impact physical function, mental health and quality of life. Hence, the promotion of healthy living and active ageing is essential for achieving an active and healthy life during this phase. Aim: To evaluate the level of physical activity and its correlation with mental health in community-dwelling older individuals. 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. Data was collected from various community-dwelling older individuals in East Ahmedabad, Gujarat, India. The nature and purpose of the study were explained and written informed consent was obtained from a total of 111 participants. The level of physical activity was measured using the Rapid Assessment of Physical Activity (RAPA) (in both English and Gujarati versions). Wellbeing status was measured using the World Health Organisation-5 (WHO-5) wellbeing index (also in English and Gujarati versions). Spearman’s correlation coefficient was used to determine the correlation between the level of physical activity and wellbeing status in community-dwelling older individuals. The level of significance was set at a p-value of <0.05. Results: The ages of participants ranged from 60 to 80 years, with a mean age of 70.11±3.98 years. Out of 111 participants, 65 were male (58.56%) and 46 were female (41.44%). The mean RAPA score for the study participants was 2.42±1.14, and the mean WHO-5 wellbeing index score of participants was 13.99±3.39. A positive correlation was found between the level of physical activity and wellbeing status (r-value=0.922, p-value=0.001), which was statistically significant. Conclusion: The present study showed a significant very strong positive correlation between the level of physical activity and the mental health of community-dwelling older individuals. Clinicians may advise older individuals to engage in physical activity to improve their mental health outcomes.

Navigating Patient Satisfaction: A Qualitative Insight into Healthcare Delivery during the COVID-19 Pandemic

Shazina Saeed, Manmohan Singhal, Mohd Shannawaz, Mandeep Kumar Arora Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has significantly impacted healthcare delivery systems worldwide, necessitating a re-evaluation of patient satisfaction metrics and experiences within this altered landscape. These changes, while ensuring continuity of care, posed unique challenges, including accessibility, technological adaptation and the maintenance of the quality of patient interactions. In addition, healthcare facilities faced immense strain due to resource allocation, workforce shortages and heightened safety protocols. This unprecedented shift underscores the need to explore how these systemic adaptations have influenced patient satisfaction and shaped their overall healthcare experience in a postpandemic context. Aim: To explore the qualitative aspects of patient satisfaction in healthcare delivery during the COVID-19 pandemic, identifying key factors that influenced patient experiences and perceptions. Materials and Methods: A qualitative research design was employed, utilising an in-depth interviews with patients who accessed healthcare services during the pandemic. The study was conducted in New Delhi, India, among COVID-19 survivors during the period of July 2023 to June 2024. Ethical clearance was obtained from the Institutional Ethics Committee of Amity University (AUUP/IEC/2023/4). Thematic analysis was conducted to identify common themes and insights regarding patient satisfaction. Statistical analysis was performed using the R platform for data visualisation and thematic analysis. Results: The findings revealed several critical themes influencing patient satisfaction, including the accessibility of healthcare services, the quality of communication from healthcare providers, adjustments to telehealth services and the emotional support patients received during their care. Patients expressed both challenges and positive experiences, highlighting the importance of empathy and understanding in healthcare interactions. Conclusion: The study underscores the need for healthcare systems to adapt to evolving patient needs and expectations, particularly in crisis situations like the COVID-19 pandemic. Participants expressed a range of emotions, from frustration to gratitude, highlighting the complexities of navigating healthcare during an unprecedented time. Enhancing communication, increasing accessibility and fostering emotional support are essential strategies to improve patient satisfaction in future healthcare delivery.

Propofol Priming for Enhancing Induction Safety in Hypertensive Patients: A Prospective Double-blind Randomised Controlled Trial

Tarun Yadav, Mayuri Golhar, Chhavi Saini Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Propofol is popular for inducing general anaesthesia, but it has drawbacks such as hypotension and bradycardia in a dose-dependent manner, especially in hypertensive patients. Reducing the total dose of Propofol using the priming principle has proven to be effective; however, it has not been studied in high-risk hypertensive patients. Therefore, the current study was planned. Aim: To evaluate the effects of priming on Propofol induction in controlled hypertensive patients, with objectives to assess haemodynamic parameters, total dose, and side-effects. Materials and Methods: This prospective, comparative, double-blind randomised controlled trail was performed at the Department of Anaesthesiology, Pt. Bhagwat Dayal Sharma (B.D.) Postgraduate Institute of Medical Sciences (PGIMS) Rohtak, Haryana, India, from April 2023 to April 2024. A total of 60 patients scheduled for elective surgery under general anaesthesia with controlled hypertension were randomly assigned to either Group 1 (study group, n=30), where Propofol priming was used, or Group 2 (control group, n=30). Demographics, total Propofol dose, haemodynamic parameters {Heart Rate (HR), Systolic Blood Pressure (SBP), Mean Arterial Pressure (MAP)}, and adverse events were evaluated using International Bussiness Machine (IBM) Statistical Package of Social Sciences (SPSS) version 25.0. The Kolmogorov-Smirnov test was used for normalisation, and the Mann’s-Whitney U test, Independent t-test, and Chi-square test were used for data analysis. Results: In Group 1 (study), the mean age was 49.36±9.42 years, while in Group 2 (control), it was 49.36±9.19 years (p=0.91). A lesser dose of Propofol was needed in the study group (Group 1) (90.07±19.73 mg) compared to the control group (Group 2) (120.00±21.81 mg) (p=0.001). Haemodynamic alterations were more pronounced in the controls compared to the study group. After induction, a significant fall in MAP was observed in the controls compared to the study group (67.63±5.86 mmHg vs. 90.63±4.33 mmHg) (p=0.001). Adverse effects, such as pain at the injection site, were reported in one patient (n=1) in Group 2. Conclusion: The priming principle significantly reduces the total Propofol dose and leads to more stable haemodynamics during general anaesthesia induction in controlled hypertensive patients. Priming with Propofol is advised for patients with hypertension when inducing general anaesthesia.

Diagnostic and Surgical Challenges in Recurrent Dermatofibrosarcoma Protuberans: A Case Report

Yogesh Manek, Swati Deshpande, Darshana Tote, Suhas Jajoo, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Dermatofibrosarcoma Protuberans (DFSP) is a low-grade cutaneous soft-tissue sarcoma that originates in the dermis and infiltrates deeper structures. It comprises less than one percent of all soft-tissue sarcomas and is histologically defined by their slow growth, localised invasiveness and a tendency to recur when not adequately excised. However, unlike other cancers, distant metastasis is relatively uncommon; the invasive nature of DFSP infiltration causes diagnostic and therapeutic challenges. DFSP can involve any area of the body; however, it predominantly favours the trunk and extremities. The mainstay of management is wide local excision, which should achieve negative margins, as inadequate margins have a propensity to recur. Recurrent cases require specific surgical management to balance oncological security with the management of their consequences. The presented case involves a 72-year-old man with recurrent DFSP, manifesting as a long-standing swelling of the left great toe that progressively increased over 10 years. Initially, conservative treatment was attempted, but the condition became symptomatic, leading to excision and a diagnosis of Chronic Granulomatous Changes (CGC) and liquefactive necrosis. Although the swelling was initially excised, it recurred after eight months and was treated by amputation due to its aggressive nature and the impossibility of definitive resection. Radical surgical re-intervention for wound dehiscence, which later reopened, was supplemented by Split-thickness Skin Grafting (SSG). In the management of recurrent soft-tissue tumours, early diagnosis and individualised treatment planning should be emphasised to maximise patient outcomes and minimise recurrence.

Surgical Outcomes of Concurrent Intraperitoneal Onlay Meshplasty and Laparoscopic Cholecystectomy: A Retrospective Observational Study

Prachi Praveen Agrawal, Abhijit S Joshi Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Laparoscopic Cholecystectomy (LC) and Intraperitoneal Onlay Meshplasty (IPOM) have established themselves as standard and popular surgeries for gallstone disease and ventral hernia, respectively. However, their concurrent performance for co-existing gallstone disease and ventral hernia has never been studied. Aim: To determine the outcomes of the concurrent performance of LC and IPOM in patients with co-existing gallstone disease and ventral hernia. Materials and Methods: This retrospective observational study was conducted at the Department of General and Laparoscopic Surgery, Dr. L H Hiranandani Hospital, Mumbai, India from August 2005 to July 2024. Over 19 years, 15 patients with coexisting gallstone disease and ventral hernia (primary/recurrent) were operated upon in a single sitting. The following outcomes were studied: duration of surgery, intra and postoperative complications including mesh infection, duration of hospital stay, recurrence of hernia, time taken to resume normal activity, and cost of treatment. Proportions, percentages, and means were calculated. Results: The mean age of the patients was 55±12.36 years (range 35-77 years). The average duration of surgery was 62 minutes (range 48-70 minutes). There was no conversion to open surgery. The mean postoperative stay was 2.5 days. Total 3 (20%) patients developed seromas, which were identified on day 10. All three seromas were small in size, managed conservatively, and resolved by six weeks. No patient experienced any significant intra- or postoperative haemorrhage. There was no superficial or deep surgical site infection, and there was not a single case of mesh infection. There was no recurrence of the hernia. Patients resumed normal activity in an average of seven days. The total cost of concurrent treatment for both conditions was reduced by 28% compared to the sum of costs, if both operations had been done separately in two separate hospital stays at present Institution. Conclusion: Concurrent LC and IPOM is a safe, practical, and cost-effective procedure in carefully selected patients.

Evaluation of Modified Frailty Index-5 as a Predictor of 60-day Perioperative Morbidity and Mortality in Geriatric Patients Presenting for Orthopaedic Surgery: A Prospective Cohort Study

Aparna Ashay Nerurkar, Amreen Fatima Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Frailty indices predicting perioperative adverse outcomes have been used predominantly in retrospective studies for prediction of surgical adverse outcomes. Aim: To evaluate the modified 5-item Frailty Index (mFI-5) as a predictor of anaesthetic and surgical complications up to 60 days in geriatric patients presenting for orthopaedic surgery. Materials and Methods: The prospective cohort study was conducted at Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India, from December 2019 to December 2020. Details of participants and caregivers, mFI-5 scores and surgical details of 62 patients aged >65 years undergoing orthopaedic surgeries were studied. The mFI-5 score was calculated based on the presence of five co-morbidities: Congestive Heart Failure (CHF), Diabetes Mellitus (DM), Chronic Obstructive Pulmonary Disease (COPD) or pneumonia, functional health status and hypertension, as defined in NSQIP database. Complications of perioperative bleeding and inotropic support, along with others mentioned in the National Surgical Quality Improvement Program (NSQIP) database, were noted up to 60 days, with milestones of 48 hours, seven days and 30 days. The data were analysed for association between mFI-5 and complications by applying t-test, Chi-square test and multivariate analysis using the Statistical Package for the Social Sciences (SPSS) 20.0 version. Results: Mean age was 71.44±6.70 years, with 26 patients having an mFI-5 >3 (mean 2.33±0.96). Forty-five patients had at least one complication (mean 2.39±2.59). Mortality was observed in three out of 26 patients with an mFI-5 >3 (11.54%), while one in 36 patients (2.78%) died with mFI-5<3. No association with mortality was observed with either unit increase in mFI-5 scores or mFI-5>3. Complications included use of blood and blood products, inotropes and postoperative ventilation in the first 48 hours (mean 0.73±0.75), respiratory complications and blood and blood product transfusions in the 48 hours to seven days period (mean 0.65±1.13), Surgical Site Infections (SSIs) and reoperations between 8-30 days (mean 0.74±1.41) and renal insufficiency and death in the 30-60 days period (mean 0.27±0.61). Age (p-value=0.315), gender (p-value=0.635), scheduling (p-value=0.530), site (p-value=0.077) and nature of surgery (p-value=0.172) were not statistically significant, while mFI scores ≥3 (p-value <0.001), American Society of Anaesthesiologists (ASA) grades (p-value=0.016), surgical duration (p-value=0.012), CHF (p-value=0.003) and DM (p-value=0.002) were statistically significant. Conclusion: Patients aged >65 years with mFI-5 scores ≥3, having CHF, DM, ASA grades >2, undergoing orthopaedic surgeries of duration up to three hours, had statistically significant chance of developing postoperative complications, other than death, up to 60 days. A randomised controlled trial with mFI-5 cut-off of ≥3 and longer follow-up periods would yield better results.

Mental Health Literacy among Accredited Social Health Activists in a Community Development Block, West Bengal, India: A Mixed-method Study

Ankita Moulik, Santanu Ghosh, Amrita Samanta Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Mental health disorders significantly impact global health, yet they remain a low priority in many Low-and-Middle-Income Countries (LMICs), including India. The role of Accredited Social Health Activists (ASHAs) is crucial in bridging the gaps in Mental Health Literacy (MHL) care. Aim: To assess the MHL of ASHAs and to determine any association between MHL scores and the socio-economic and socio-demographic determinants of the study participants. Materials and Methods: This mixed-method study was conducted in the Barrackpore II block of the North 24 Parganas district, West Bengal, India between July and September 2023. A cross-sectional descriptive approach was used for the quantitative segment, while two Focused Group Discussions (FGDs) were conducted for the qualitative component. The sample size was 67, selected by simple random sampling. Socio-economic and socio-demographic data were collected using a standardised validated questionnaire, and MHL data were gathered using the revised Mental Health Literacy Scale (MHLS) questionnaire. FGDs were conducted using a pretested, predesigned FGD guide. Data were analysed using Jamovi (v2.4.8). An Independent samples t-test was performed, with p-value <0.05 considered significant. Results: The mean age of participants was 37±13.5 years, with 70.1% being Hindus and 47.8% being unreserved. The MHL score ranged from 50 to 115. The Independent samples t-test revealed a statistically significant difference in means between the two age groups (less than 38 years vs. 38 years or older). There was also a statistically significant difference in MHL scores between the two caste categories (p-value=0.006) and among different years of work experience (p-value <0.001). FGDs revealed low mental health awareness among ASHAs and villagers. Conclusion: The MHL status of ASHAs was low, mainly due to a lack of training. Further research and training for healthcare workers are needed to improve MHL.

Efficacy and Safety of High-dose versus Standard-dose Prazosin in Paediatric Scorpion Envenomation: A Single-blinded Randomised Controlled Study

Apoorva Gayatri Abbadi, Hidaytullah R Bijapure, Chandrika R Doddihal, Bhavana B Lakhkar, Y Rohith, VJ Prakash, Kumar BM Prasanna, Mallanagouda Patil Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Scorpion sting is a serious health problem in the world, especially in developing countries like India. It is often associated with serious clinical manifestations. As children have a small body surface area, they are prone to more serious cardiac, respiratory and neurological complications. Prazosin, an alpha-blocker, is the drug of choice for the treatment of scorpion envenomation. With the increasing incidence of paediatric scorpion envenomation in rural India, there is a need to optimise prazosin dosing protocols to improve outcomes and reduce hospital stays. Aim: To evaluate and compare the efficacy and safety of standard-dose versus high-dose prazosin protocols in managing paediatric scorpion envenomation in a tertiary care hospital in North Karnataka, India. Materials and Methods: A single-blinded randomised controlled study was conducted in Paediatric Intensive Care Unit (PICU) at BLDE DU Shri BM Patil Medical College Hospital and Research Centre, Vijayapur, Karnataka, India, from January 2017 to December 2022. Children below 18 years of age admitted to the hospital with history of scorpion sting with severity grades II and III were enrolled. Children were randomised into three groups: Group A: 30 μg/kg every three hours; Group B: 60 μg/kg initially, followed by 30 μg/kg every three hours; and Group C: 90 μg/kg initially, followed by 30 μg/kg every three hours. They were monitored for sweating, cold or warm extremities, the appearance and disappearance of pain, vital parameters and priapism (in male children) hourly until stabilised, then every third hourly for 24 hours and then sixth hourly til discharged from the PICU. After the patient was haemodynamically stable for 24 hours shifted to a high-dependency unit. The time interval between sting and treatment, various vital parameters, duration of the PICU stay and hospital stay were noted. Categorical variables were compared using the Chi-square test and continuous variables were analysed using the Student’s t-test. Results: A total of 86 children were recruited. The standard protocol (Group A) had 26, Group B had 29 and Group C had 31 children. Forty-eight (56%) of the children were over five years old (12, 21 and 15 were in Groups A, B and C, respectively). The male-to-female ratio of 1.8:1, 2.6:1 and 1.8:1 in Groups A, B and C, respectively. The sting-to-symptom interval, priapism, duration of hypertension and duration of hospital stay were higher in Group B compared to Group A. The duration of hypertension, cardiac involvement and priapism were higher in Group C, whereas a shorter sting-to-symptom interval and symptom-to-prazosin initiation were noted in Group C compared to Group A. Conclusion: High-dose prazosin is a safe and effective treatment for scorpion envenomation in children, offering a potential advantage over the standard dosing protocol.

Patient’s Perspectives on the Preference for the Gender of Medical Professionals in Perioperative Care and Attitudes Toward Anaesthesiologists: A Cross-sectional Study

Usha Devi, Minnu Panditrao, Shilpa Bansal Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Historically, women’s roles in society were primarily as caretakers and healers. As women’s roles in healing became more complex and lucrative, they faced social opposition to taking on instrumental healing tasks. Currently, women make up about 50% of the medical workforce; however, they still face discrimination in healthcare due to their gender, both from patients and professional colleagues. Aim: To evaluate patients’ perspectives on the preference for the gender of surgeons and anaesthesiologists for elective surgeries, as well as their awareness of anaesthesia and their attitudes toward anaesthesiologists. Materials and Methods: An institution-based, cross-sectional study was conducted in the operating theatre complex of a postgraduate institute in a rural area of Northern India. After obtaining approval from the Institutional Ethics Committee (IEC) and patient consent, the study was conducted on 400 patients aged 18 to 85 years who were admitted for elective surgeries in different specialties. A structured questionnaire was prepared and divided into three sections: patients’ demographic profile, surgical history and preference for the gender of surgeons and patients’ awareness and knowledge about anesthesia and the role of anaesthesiologists. The questionnaire was administered to patients who attended the preanaesthesia clinic for preanaesthesia assessment. Patients were asked questions from the proforma in their vernacular language and appropriate answers were marked on the questionnaire sheet. All collected data was recorded in a Microsoft Excel sheet and analysed using Microsoft Excel software. Results: Data was collected and analysed from a total of 400 patients, of whom 207 (51.7%) were males and 193 (48.3%) were females. A total of 174 (43.5%) patients preferred a male surgeon, 99 (24.8%) preferred a female surgeon and 127 (31.7%) had no preference. A total of 197 (49.3%) patients who preferred a same-gender surgeon stated that they felt more comfortable with a doctor of the same gender. Interestingly, although a significant number of patients acknowledged the importance of anesthesia 392 (98%), they had poor awareness regarding anaesthesiologists as specialist medical professionals. Conclusion: The findings of the current study conclude that gender bias exists in the medical profession, as female surgeons are not acknowledged in the same way as their male professional colleagues. Additionally, the level of knowledge about anesthesia and anaesthesiologists among surgical patients is quite low, despite their recognition of the importance of anesthesia during surgery.

Concordance of Bronchoalveolar Lavage Fluid Cytology with Respect to Histological Diagnosis of Cancer: A Cross-sectional Study

Richa Singh, Krachi Agarwal, Preeti Agarwal, Madhu Kumar, Malti Kumari Maurya, Riddhi Jaiswal, Ajay Kumar Singh, Anand Srivastava Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Bronchoalveolar Lavage (BAL) is a minimally invasive procedure that allows for the sampling of distal airways and the alveolar environment to diagnose infectious and non infectious respiratory tract diseases. It is a safe and reliable method considered for diagnosis. Aim: To evaluate the concordance of BAL cytology with the histopathology report of biopsied cases concerning cancer diagnosis. Materials and Methods: The study was a cross-sectional observational study conducted in the Department of Respiratory Medicine at King George’s Medical University, Lucknow, Uttar Pradesh, India, which is a tertiary care teaching hospital in northern India. Reported BAL cytology cases for one year, from September 2022 to September 2023, were retrieved from records and consecutive histology was followed for cytohistological correlation. The sensitivity, specificity, Negative Predictive Value (NPV) and Positive Predictive Value (PPV) of BAL cytology were calculated with reference to the identification of malignancy. Histological diagnosis was considered the gold standard and the specificity, sensitivity, positive predictive value and NPV of BAL were calculated. Results: The BAL was performed in 261 cases with a mean age of 56.79 years. The adequacy of BAL cytology was 88.12% (230/261). Of the 261 cases, eight were positive for epithelial malignancies, three were suspicious for malignancies, 219 were reported as negative for malignant cells and 31 cases were deemed inadequate. A biopsy was performed in 56 out of 261 cases (21.45%) and 32 of these cases were found to have epithelial malignancy. A total of 13 cases were reported negative for malignancy, of which 12 were in concordance with BAL results. Three cases were reported as suspicious for malignancy and three were diagnosed as non epithelial malignancies on biopsy, which were deemed inadequate on cytology. Based on the interpretation of the data, the specificity of BAL cytology with respect to histology was 100%, with a PPV of 100%; however, the sensitivity was 14.28% and the NPV was 28.57. Conclusion: The present study results clearly show that BAL cytology is a specific test for malignant diagnosis in lung lesions, in addition to its role in inflammatory conditions. However, due to its low sensitivity, it may not serve as a good screening method. BAL fluid cytology primarily samples the lower respiratory tract, which may not always be affected by malignancy. The low sensitivity may also be attributed to procedural and interpretation limitations. It can serve as a complement to bronchial brushings and histology for the diagnosis of lung cancers.

Facial Anthropometry and Self-expressed Behaviours: A Systematic Review

Ankit Srivastava, Vilas Chimurkar, Nisha Mani Pandey, Anand Bihari Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Facial anthropometry is a systematic technique based on a series of measurements and proportions of the face. It is useful for identifying a person’s self-expressed behaviours (physiognomic evaluation). Previous research on humans and non human primates has revealed an association between the facial Width-to-Height Ratio (fWHR) and various traits, including achievement drive, aggression, unethical behaviour and dominance. Additionally, facial symmetry has been significantly associated with the Big Five personality factors, which encompass traits such as averageness, truthfulness, judgment and youthfulness. Aim: To assess the association of facial measurements with self-expressed behaviours and to determine how strongly these behaviours correlate with facial measurements. Materials and Methods: A PubMed database search was performed using the following keywords: Behaviour* OR Threat* OR Aggress* OR trait* OR Socia* AND Personality Mesh term and fWHR OR Facial* AND Anthropometry Mesh term. The eligibility criteria for including studies were: selection of primary data, English language and facial anthropometric measurements (fWHR, bizygomatic width, forehead length, forehead width, forehead slant, facial index and upper facial index) related to self-expressed or actual behaviour in humans and monkeys. After applying the eligibility criteria, 340 articles published between 2004 and 2022 were identified, of which 17 articles/studies were found relevant for the results analysis. The identified titles and abstracts were screened independently by two authors and studies that mentioned facial anthropometry in relation to self-expressed behaviour or personality in humans and monkeys were included. Results: This review describes the statistical results and conclusions of 17 studies regarding different behaviours and their relation to facial anthropometry. A meta-analysis of four studies involving a total of 236 subjects was conducted, with weighted assignments to each study ranging from 8.4 to 25.8%. The correlation coefficients from individual studies ranged between 0.38 and 0.53, except for one study, which showed a negative correlation of -0.40. The overall coefficient across all studies was r=0.37, 95% Confidence Interval (CI) (0.27, 0.47), p <0.01, indicating a moderate positive correlation. Conclusion: The data from various populations in present review support the hypothesis that facial structures are important biological markers for assessing behaviours or personality traits. The findings of present review provide new insights for future research in the fields of behavioural medicine and computational face recognition.

Gender-based Morphometric Analysis of the Human Orbital Aperture Profile using 3D Reconstruction Computed Tomography: A Cross-sectional Retrospective Study

Muhammad Omer Afzal Bhatti, Mujeeb Ur Rehman Parrey, Muhammad Ikram Ali, Allah Rakhyo Shoro, Abdulkrem Ahmed Alenazi, Rayan Alhumaidi Alruwaili Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Sex estimation is a crucial aspect of forensic medicine and requires primary consideration when examining skeletal remains. Among the various anatomical features, the orbital region holds significant importance due to its distinct morphological variations. These variations provide valuable insights for sex determination, making orbital anatomy an indispensable tool in forensic investigations and analysis. Aim: To measure and compare orbital apertures between males and females using 3D Computed Tomography (CT) in a sample from the Saudi population. Materials and Methods: A cross-sectional retrospective study was conducted from January to June 2024 in the Radiology Department of Tower Hospital, Arar, Kingdom of Saudi Arabia, following the acquisition of ethical approval from the Local Bioethics Committee at Northern Border University. A total of 100 CT scans were randomly selected from the available dataset. The study encompassed CT scans of subjects from both genders, aged 18 years and above. However, CT scans of patients who had sustained head trauma or orbital injuries were excluded from the study. The data retrieved were analysed using Statistical Package for the Social Sciences (SPSS) version 23.0. All continuous data were tested for normality and expressed as Mean±Standard deviation (SD). The significant differences in orbital measurements between males and females were assessed using the Independent t-test. A p-value of <0.05 was considered statistically significant. Results: A total of 100 participants were included in the study, with the majority being females (52%). The mean age of male and female subjects was 40.5±13.19 years and 39.13±13.10 years, respectively. A statistically significant difference was found in right orbital width (p-value=0.011), left orbital area (p-value=0.04), and Interzygomatic Distance (IZD), with these measurements being higher in males compared to females (p-value=0.009). Conclusion: The study revealed that males have greater orbital width, orbital area and IZD compared to females. These gender-specific variations in orbital and facial dimensions may play a crucial role in gender determination within forensic medicine.

Association of Light’s Criteria with Pleural Fluid Procalcitonin Levels and Ultrasound Thorax with its Impact on the Management of Pleural Effusion: A Cross-sectional Study

BK Likhitha, Keertivardhan D Kulkarni, Madhav Mahawar Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Pleural effusion, the abnormal accumulation of fluid in the pleural space, affects around 1.5 million people every year. Light’s criteria is routinely employed to distinguish between transudative and exudative effusions based on the test results obtained after thoracentesis. However, this procedure cannot be preferred in certain conditions due to its invasiveness. Thoracic Ultrasound (TUS) is a crucial bedside non invasive tool for identifying and differentiating pleural effusion types and helps guide treatment decisions. Light’s criteria can misdiagnose transudates as exudates, necessitating specific biomarkers like Procalcitonin (PCT). Aim: To determine ultrasound thorax findings among patients with pleural effusion and to assess the impact of these findings on management. To associate Light’s criteria with ultrasound findings and pleural fluid PCT levels. Materials and Methods: A cross-sectional study involving 89 patients diagnosed with pleural effusion was conducted at the Department of Respiratory Medicine, Shri BM Patil Medical College, Vijayapura, Karnataka, India from 2022 to 2024. Ultrasound of the thorax was performed on each patient, Light’s criteria were calculated and pleural fluid PCT levels was measured via Enzyme-linked Immunusorbent Assay (ELISA). Categorical variables between the two groups (exudative group and transudative group) were compared using the Chi-square/Mann-Whitney U test, with p<0.05 considered statistically significant. Results: The mean age of the study participants was 50.8±18.1 years. The study found that complex septate findings were the most common Ultrasonography (USG) feature, with thin septations being the most frequent, followed by anechoic findings. The majority of the cases, 49 out of 89, were unilateral, more often on the right-side. Management varied from simple effusions treated with aspiration to complex cases that required interventions like intercostal drainage tube insertion or decortication. A cut-off of 0.345 ng/mL of pleural fluid PCT level effectively distinguished transudative from exudative effusions. There was a statistically significant association (p<0.05) between ultrasound findings as well as pleural fluid PCT levels with Light’s criteria. Conclusion: In conclusion, USG findings such as complex septate and thickened pleura are highly supportive of exudative effusions in the present study, while the anechoic appearance is indicative of transudative effusions. TUS is crucial in characterising pleural effusion and guiding treatment. PCT measurement in pleural fluid further aids in distinguishing between transudative and exudative effusions and also in identifying infectious effusions from other types, optimising patient management.

Evaluation of Common and Atypical Clinical Presentations of Tinea Faciei: A Cross-sectional Study from Barabanki, Uttar Pradesh, India

Suganita, Deepika Agarwal, Sonal Sachan, Vandana Yadav, Harshit Jaiswal, Divya Prajapati Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Tinea faciei is a dermatophytic infection affecting the glabrous skin of the face. While it is less common than dermatophyte infections of other anatomical sites, tinea faciei has become more prevalent in recent years, being reported in Dermatology Outpatient Departments. Aim: To enrich our understanding of tinea faciei with the intention of improving diagnostic accuracy and treatment outcomes. Materials and Methods: The present cross-sectional study was conducted in the Department of Dermatology, Venereology and Leprosy, Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India, from October 2022 to October 2023. Total 75 patients with the clinical diagnosis of tinea faciei were recruited and subjected to Potassium Hydroxide (KOH) preparation for direct microscopic examination. Epidemiological data, as well as, information on exposure to systemic and oral steroids, and previous treatment was collected. Different morphologies of tinea faciei, involved site on the face, severity of itching, and additional affected body areas were also noted. Coding, data entry, clearing and compiling were done in Microsoft Excel sheets, and statistical software including Statistical Package for the Social Sciences (SPSS) software version 29.0 was used for statistical analysis. Results: The present study comprised 45 (60%) males and 30 (40%) females, with a mean age of 30.7 years. A total of 27 (36%) patients had pets at their homes, and 35 (46.6%) patients were involved in handling domestic animals. A family history was positive in 21 (28%) patients. The most common site in the face was the cheeks, affecting 45 (60%) patients, followed by areas around the eyes and nose in 26 (34.6%) patients each, the forehead in 23 (30.6%), and around the mouth and on the external ear in 22 (29.3%) patients each. The initial index lesion involving the face was found in 34 (45.3%) patients, while other sites were involved in 41 (54.6%) patients. The most common morphology included ill-defined margin, absence of scaling, the central clearing, pustular lesions, incomplete circle, psoriasiform and erosions. Steroid abuse was found in 73 (97.3%) patients, where most patients giving a history of only topical steroid usage. Conclusion: The present study offers important insights into various aspects of tinea faciei, including its occurrence, epidemiology, risk factors, and the role of steroid abuse. The authors have described various common and atypical clinical morphologies and distributions of tinea faciei and recognising these atypical signs can help clinicians diagnose the condition early and initiate timely treatment. Moreover, the present study highlights that many patients use steroids in the form of topical, oral and injection to get quick relief, which can complicate the diagnosis.

Epidemiology of Lumbar Puncture and the Validity of Meningeal Signs in Predicting Meningitis in Children: A Cross-sectional Study

Mehjabin, Shiji Joseph, Arun Ravi, Kalyani Pillai Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Predictive models have been developed to estimate the likelihood of bacterial meningitis in patients with clinical features suggestive of Central Nervous System (CNS) involvement. Early diagnosis and prompt treatment of bacterial meningitis in children are crucial due to the severity and rapid progression of the disease. However, making a definitive diagnosis in the early stages can be challenging, as clinical symptoms are often non specific and may overlap with other conditions. Lumbar Puncture (LP) is a crucial diagnostic and therapeutic procedure in paediatric medicine to diagnose various neurological diseases, particularly meningitis, by analysing Cerebrospinal Fluid (CSF). Aim: To analyse the epidemiological trends of LP performed in children and to evaluate the accuracy of meningeal signs in predicting the presence of meningitis in paediatric patients. Materials and Methods: This was a cross-sectional study conducted in the Department of Paediatrics at Amala Institute of Medical Sciences, Thrissur, Kerala, South India, from August 2018 to July 2019. The records of paediatric patients (aged 1 month to 12 years) who underwent LP during the one year from August 2018 to July 2019 at the centre were collected. A checklist was prepared for all the patients, where demographic data, clinical presentations, findings of CSF, and blood analysis were recorded. The data obtained were analysed using Statistical Package for Social Sciences (SPSS) version 23.0. Results: Out of 3,125 paediatric admissions during the study period, LP was performed in 125 (4%). The most common indication for LP was fever with seizure in 53 (42.4%), followed by fever and vomiting in 44 (35.2%). There was a statistically significant association between both CSF protein and CSF sugar and a diagnosis of meningitis. Among children presenting with fever and seizure in the age group of one month to two years, 19 (52.8%) had meningitis. The incidence of pyogenic meningitis was 26 (20.8%). Organisms were isolated in 2 (1.6%) of cases. Among the meningeal signs, the Johny Vincent sign and neck stiffness showed better sensitivity, while Kernig’s sign was the most specific. Conclusion: The present study concludes that, in paediatrics, LP remains an essential procedure for differentiating patients with meningitis from those without meningitis when they present with the same symptoms, especially in children less than two years of age. In older children, clinical variables such as meningeal signs and seizures at admission had lower sensitivity and Positive Predictive Value (PPV), which again highlights the need for performing an LP.

Effects of Video-based Gesture Gaming on Hand Functions in Autistic Population: A Quasi-experimental Study

J Sangeetha Priya, Kalidasan Varathan Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Autism is a complex neurodevelopmental disorder with broad spectrum of intricacies and challenges, affecting 1 in 100 individuals, as estimated by World Health Organisation (WHO). Symptoms mainly are related to behavioural abnormalities, motor control deficits and social communication issues. Video gaming technology are emerging as valid tool in the intervention protocols for autism, by showing significant improvements in motor strength and executive functions. Aim: To evaluate the impact of gesture gaming on dexterity, grip strength and working memory in individuals with autism. Materials and Methods: A quasi-experimental study was carried out at Krupanidhi College of Physiotherapy Outpatient Department (OPD) in Bengaluru, Karnataka, India. The duration of the study was one year, from June 2022 to June 2023. Subjects were selected primarily based on the Childhood Autism Rating Scale. Thirty autistic subjects were selected using convenient sampling and four different games were given for three alternate days for 12 weeks, lasting 40 minutes per session. Hand grip strength, visuo-spatial working memory and dexterity were measured by a dynamometer, Corsi-Block Tapping Test and the Jebsen-Taylor Hand Function (JTHF) test. Subjects from 11 to 16 years were considered. Statistical analysis was done using a paired t-test, with a significance level set at p-value<0.05. Results: After 12 weeks of intervention and 16 weeks of follow-up, significant difference (p-value<0.05) was noticed in all three variables. Hand grip strength for the right hand was measured at post-test (21.48±8.08) and follow-up (21.40±8.11), while for the left hand, it was post-test (13.26±3.75) and follow-up (13.15±3.76). Visuospatial Working Memory (VSWM) showed a backward span post-test (4.86±0.77) and follow-up (4.46±0.73) and forward span post-test (5.36±0.71) and follow-up (5.20±0.76). Dexterity for the non dominant hand was post-test (148.4±5.11) and follow-up (148.8±5.07), while for the dominant hand, it was post-test (138.8±7.86) and follow-up (139.0±7.86). Conclusion: Gaming technology has shown beneficial effects in improving hand grip strength, dexterity and working memory.

Exploring the Decision-making Process of Medical Students’ on Choosing Radiology as a Specialty in Northern Saudi Arabia: A Cross-sectional Study

Pakeeza Shafiq Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Radiology is an important medical field that provides non invasive insights into the human body. However, the decision-making process regarding speciality choice among medical students is influenced by various personal, educational and societal factors. Aim: To identify the key factors that significantly shape the decision-making process of medical students. Materials and Methods: This cross-sectional study was conducted at the College of Medicine, Northern Border University, Arar, Kingdom of Saudi Arabia, from June to August 2024, involving 149 medical students, both males and females, in their clinical years (4^th, 5^th and 6^th year). Data was collected using a predesigned proforma, along with demographic information. All data were entered into the Statistical Package for the Social Sciences (SPSS) Software version 22.0 for analysis. The normality of the data was checked using the Shapiro-Wilk test. Qualitative variables were presented as frequencies and percentages, while quantitative variables were presented as means with standard deviations. A p-value of ≤0.05 was considered statistically significant. Result: The gender distribution was 56 males (37.58%) and 93 females (62.42%), with only 16 participants (10.74%) having chosen radiology as their specialty, despite significant exposure to the specialty (76 participants, or 51.01%). Various factors, such as work-life balance, income, family expectations and patient contact, played a significant role in specialty choice. The Chi-square test found no significant association between gender and choice of specialty. Conclusion: Radiology’s critical role in patient diagnosis and management is well recognised, but factors such as academic performance, patient contact, family expectations and income significantly influence career choices among medical students. To attract more students to radiology, targeted educational initiatives and early exposure are essential.

Prevalence of Diabetic Retinopathy in Patients with Cerebrovascular Accident: A Cross-sectional Study

(Col.) OK Radhakrishnan, Rutu K Rao, Varsha Manade, Swaranjali Gore, Shreya Gandhi, Khushboo Goyal, Tushar Agrawal Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Diabetes Mellitus (DM) causes high blood sugar, leading to complications such as cerebrovascular events, chronic kidney disease, cardiovascular issues and retinopathy. Diabetic Retinopathy (DR) is a key microvascular complication and may indicate other diabetic issues. Studies suggest a link between DR and Cerebrovascular Accidents (CVAs) (strokes), particularly in low and middle-income countries where stroke rates are increasing. Aim: To assess the prevalence of DR among individuals who have experienced CVAs and to explore the relationship between DR and CVAs within the Indian population. Materials and Methods: The present cross-sectional study was conducted in the Department of Ophthalmology, Dr. D. Y. Patil Medical College and Research Centre (tertiary care hospital), Pimpri, Pune, Western Maharashtra, India, from November 2022 to June 2024. The study included 100 patients (200 eyes) aged 40-70 years with CVAs and diabetes. Details regarding age, gender and, detailed ocular and systemic information were recorded. Diagnosis of DM and CVA is done according to standard methods. Intraocular pressure was measured using the Goldmann Applanation Tonometer (GAT) and Optical Coherence Tomography (OCT). DR was classified based on severity into mild, moderate and severe groups. Data were analysed using Statistical Package for Social Sciences (SPSS) software version 26.0. Statistical significance was set at 5%. Results: In the present study, patients with DR had a mean±Standard Deviation (SD) age of 57.13±7.63 years. Among the CVA patients, 79% had DR. A total of 44 (44%) patients had moderate Non Proliferative Diabetic Retinopathy (NPDR), 20 (20%) had mild NPDR and 15 (15%) had severe NPDR. The average age of DR patients was 57.13±7.63 years, compared to 51.48±6.36 years for non DR patients. Haemorrhagic strokes were more common, occurring in 59 (59%) patients. Patients with both DR and CVAs were older and had higher blood sugar and HbA1c levels than those without DR. No association was found between DR and the type of stroke (p-value 0.761). Conclusion: Diabetic retinopathy was present in 79% of stroke patients, with moderate NPDR being the most common type. DR patients were older and had higher blood sugar and HbA1c levels. Haemorrhagic stroke was more prevalent in this group. However, no significant association was found between the types of stroke and DR.

Clinical Outcomes in Diabetic Females Presenting with STEMI: A Cohort Study

Anjana Ajith Beena, Priya Shanmukhan, Veena Felix, Alummoottil George Koshy, Kunjukrishnapilla Sivaprasad Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Although the incidence of Acute Coronary Syndrome (ACS) is lower in women, outcomes are worse, particularly in diabetic females. Despite advances in revascularisation and treatment, mortality rates among diabetic females remain higher, with poorer postpercutaneous coronary intervention outcomes. Studies have rarely addressed the differences in the course of myocardial infarction in diabetic females and this underrepresentation has influenced the formulation of guidelines. Aim: To evaluate the in-hospital composite outcomes of death, non fatal myocardial infarction, emergency revascularisation, heart failure and cerebrovascular accident in diabetic women presenting with ST Elevation Myocardial Infarction (STEMI), as well as the individual in-hospital outcomes and outcomes at one and three months follow-up. Materials and Methods: This was a prospective single-centre cohort study conducted between November 2017 and October 2018 on 204 patients with STEMI and followed-up for three months. Data were collected from patients using a semistructured questionnaire-based interview, clinical examination, laboratory investigations, echocardiography and angiography. In-hospital outcomes—death, non fatal MI, emergency revascularisation, heart failure and cerebrovascular accident—were studied. Telephonic follow-up was conducted at one and three months. The comparison of variables was carried out using the Independent Student’s t-test or Chi-square test, and regression analysis was performed to identify predictors of mortality. Results: The mean age was 64±11 years; 60.3% were hypertensive and 26% had dyslipidaemia. A total of 12.3% were newly diagnosed diabetics. The mean prehospital delay was 201.9±156.8 minutes. Primary angioplasty was performed in 77%, while thrombolysis was done in 16.7%. The composite outcome was observed in 26.3% of the patients, with heart failure occurring in 19%, cardiogenic shock in 27.9% and death in 16.2%. Cerebrovascular accidents were noted in 0.5% and renal dysfunction was present in 13.2%. At one and three months, heart failure occurred in 7.6% and 5.8%, respectively. Among those with in-hospital mortality, a higher proportion had Anterior Wall Myocardial Infarction (AWMI) (p=0.043), were in Killip class>II (p-value <0.0001), and had qRBBB (Right Bundle Branch Block) (p-value <0.0001). They presented later, with higher blood sugar (p-value <0.0001) and creatinine values (p-value=0.009) and had a lower Ejection Fraction (EF) (p-value=0.003). Killip class (OR=16.0), presence of Ventricular Septal Rupture (VSR) (OR=23.4), no-reflow phenomenon (OR=23.4) and development of renal dysfunction (OR=9.0) were identified as predictors of mortality. Conclusion: Despite a high rate of revascularisation and fewer procedure-related complications, outcomes remain grim, with a higher incidence of heart failure, cardiogenic shock, renal dysfunction and mortality. A worse clinical profile, left ventricular dysfunction and renal dysfunction were significant predictors of mortality.

Evaluation of Root Canal Diameters and Radicular Wall Thickness of the Human Primary Molars by using Multidetector Computed Tomography: A Cross-sectional Study

Piyali Datta, Shabnam Zahir, Kaushik Dutta, Pratik Kumar Lahiri, Sudipta Kar, Biswaroop Chandra, Trishik Basak, Shreya Tripathi Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Paediatric endodontics is critical for preserving the primary tooth until its physiologic exfoliation and ensuring the child’s quality of life. Endodontic treatment of human primary molars with varying internal geometry of the root canal necessitates extensive knowledge and skills. Aim: To evaluate the diameters of the root canals and the radicular wall thickness of human primary molars using Multidetector Computed Tomography (MDCT). Materials and Methods: This cross-sectional study study was performed in the Department of Paediatric and Preventive Dentistry in collaboration with the Department of Oral and Maxillofacial Surgery, Department of Antaomy of Guru Nanak Institute, Kolkata, West Bengal,India on selected 64 human primary maxillary and mandibular molars through inclusion and exclusion criteria and grouped them (Group 1, maxillary 1st molars; Group 2, maxillary 2nd molars; Group 3, mandibular 1st molars; and Group 4, mandibular 2nd molars). After proper sterilisation, the teeth were mounted on a wax platform, and the mounted teeth block was scanned by a computed tomography scanner. Analysis of these Computed Tomography (CT) scan images was done through Denta Scan (GE Healthcare, USA) software. In each of the corresponding cross-sections, the diameters of the root and the root canals were measured at their greatest diameter. The radicular wall thickness of the roots was derived by subtracting the measured diameter of the root canals from that of the roots in their respective cross-sections. Descriptive statistical analysis (Student’s t-test) was performed. A p-value less than equal to 0.05 was considered statistically significant. Results: The maximum mean diameter of the canal was found in the mesiobuccal root canal of both primary mandibular first molars (1.16±0.22 mm at cervical third) and second molars (1.12±0.16 mm at cervical third); and the minimum diameter was found in the distolingual root canal of both primary mandibular first molars (0.87±0.12 mm at cervical third) and second molars (0.89±0.16 mm at cervical third). The mean radicular wall thickness of the roots gradually increased from the apical third to the cervical third of both primary molars. Conclusion: The maximum root canal diameter and radicular wall thickness were found in the cervical third of the palatal root of maxillary second molars. The study evaluates the mean maximum and minimum diameters of each canal of human primary molars and radicular wall thickness in different cross-sections, which enables paediatric dental practitioners to establish effective paediatric endodontic treatment.

Comparative Evaluation of Tear Film and Corneal Surface in Chronic Smokers and Non Smokers: A Cross-sectional Study

Ruchi Dabas, Meena Kumari, Manisha Rathi, Monika Dahiya, Rajni Yadav, Sumit Sachdeva Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Tobacco smoking is the primary avoidable cause of mortality, resulting in the deaths of seven million people worldwide annually. Tobacco smoke is a well-documented ocular irritant that exacerbates Dry Eye Disease (DED) and its associated symptoms. Aim: To compare tear film and corneal surface parameters in chronic smokers and non smokers. Materials and Methods: This cross-sectional study was conducted among chronic smokers and non smokers presenting at a tertiary eye care centre in Northern India. A total of 80 subjects were included in the study and divided into two groups of 40 subjects each, comprising group A (chronic smokers) and group B (non smokers). All participants underwent a series of measurements: Schirmer I test, Tear Breakup Time (TBUT), Central Corneal Thickness (CCT) and endothelial cell count using specular microscopy. Results: The mean age of smokers was 50.15±6.89 years, whereas the mean age of non smokers was 49.25±6.39 years, with a significant male preponderance. The dry eye parameters, such as the Schirmer I test and TBUT, were significantly lower in smokers compared to non smokers, with a statistically significant difference (p-value <0.001). Similarly, CCT and endothelial cell count were significantly lower in smokers than in non smokers, with a statistically significant difference (p-value <0.001). Conclusion: The study highlights the detrimental effects of smoking on ocular surface health. Smoking predisposes users to DED due to lower tear production and an unstable tear film.

Role of Cardiac Magnetic Resonance Imaging in Detecting Myocardial Viability in Patients with Chronic Ischaemic Heart Disease: A Prospective Observational Study

Subhosree Dey, Parul Dutta, Bornali Dutta, Baloy Jyoti Talukdar, Sushant Agarwal, Dhiraj Baruah Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Myocardial viability refers to a phenomenon in which dysfunctional myocardium, due to acute or chronic ischaemia, retains the potential to recover its systolic function after revascularisation. The assessment of myocardial viability using Contrast-enhanced Magnetic Resonance Imaging (CE-MRI) has become a quintessential imaging method for the guidance of treatment in patients with Myocardial Infarction (MI). Aim: To assess cardiac morphology, function, perfusion and myocardial viability in patients with chronic ischaemic heart disease, and to stratify patients into conservative and operative management based on the myocardial viability. Materials and Methods: The present hospital-based prospective observational study was conducted in the Department of Radiodiagnosis, Gauhati Medical College and Hospital, Guwahati, Assam, India, from April 2021 to October 2022. A total of 50 patients with a prior history of MI and abnormal findings on electrocardiography and echocardiography were subjected to cardiac MRI (3 Tesla). Functional parameters like wall motion and Left Ventricular Ejection Fraction (LVEF) were evaluated along with perfusion scan. On Late Gadolinium Enhancement (LGE) scan, patients were classified into two categories: ≤50% LGE (viable) and >50% LGE (non viable). The quantitative values like age and LVEF were summarised as mean and Standard Deviation (SD) based on the distribution of data. A Pearson’s correlation test was done to check the correlation between various parameters. A p-value (using Chi-square test) of less than 0.05 was considered statistically significant. Results: The mean age was 52±14 years. A total of 27 (54%) patients were males and 23 (46%) patients were females. Out of 50 patients, 17 showed an LGE score ≤50%, while 33 showed an LGE score >50%. The segments showing >50% LGE showed more severe wall motion abnormalities than those with ≤50% LGE (p-value <0.005). There was positive correlation between perfusion defect and LGE (Pearson’s correlation 0.951). Out of 17 patients in LGE ≤50% group, 15 (88.2%) patients had clinical improvement, whereas out of 33 patients in the LGE >50% group, only 2 (6.10%) patients had clinical improvement following coronary revascularisation. Conclusion: Delayed Enhanced-Cardiac Magnetic Resonance (DE-CMR) imaging assesses severity of the infarcted myocardium and helps in predicting recovery following intervention.

Evaluation of Metabolic Characteristics of Brain Tumours Utilising 31-Phosphorus MR Spectroscopy in 3T MRI: A Cross-sectional Study

Nivetha Kannan, Babu Peter Sathyanathan Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: The characterisation of brain tumours is predominantly based on Magnetic Resonance Imaging (MRI) for structural details and invasive histopathology for certainty. MR spectroscopy, a non invasive technique has provided access to the novel field of metabolomics in-vivo. Proton (H+) MR spectroscopy has gained unanimous acceptance as a neuroimaging technique. In addition, 31-Phosphorus MR spectroscopy provides insight into the energetics of normal and abnormal tissues. Aim: To metabolically characterise brain tumours and compare them with normal brain parenchyma using 31-Phosphorus spectroscopy by obtaining applicable parameters for evaluation, diagnosis and grading of brain tumours. Materials and Methods: This cross-sectional study was conducted at the Barnard Institute of Radiology, Madras Medical College, Chennai, Tamil Nadu, India, from December 2019 to December 2021. The study included 32 patients diagnosed with brain tumours based on conventional MR imaging, followed by histopathology, and 10 normal healthy volunteers who underwent 31-Phosphorus MR spectroscopy using a customised birdcage 31-P dual-tuned head coil on a Siemens 3-Tesla MRI scanner (Rapid Biomedical, Wurzburg, Germany). The phosphorus metabolites and ratios analysed included Phosphodiesters {Glycerophosphoethanolamine (GPE) and Glycerophosphocholine (GPC)}, Gamma Adenosine Triphosphate (γ-ATP), Phosphocreatine (PCr), and Inorganic Phosphate (Pi). The metabolite ratios assessed were GPC/GPE, GPC/Pi, GPC/PCr, GPC/γ-ATP, GPE/Pi, GPE/PCr, GPE/γ-ATP, PCr/Pi, PCr/γ-ATP, and Pi/γ-ATP. Additionally, pH was derived. The values were recorded within the tumour, in the peritumoural oedema, and in the normal-appearing contralateral brain parenchyma. These values were compared with each other and also with the brain parenchymal values of the controls. One-way Analysis of Variance (ANOVA) was used to compare the metabolite ratios observed in various sites. Results: The subjects included 13 females and 19 males, with a mean age of 41.7 years and 43.4 years respectively. A mild alkalinisation trend was observed within the brain tumours (pH 7.1±0.12) compared to the control group (7.05±0.02). Significantly increased GPE/γ-ATP and PCr/γ-ATP values, as well as significantly decreased PCr/Pi values, were observed within the tumour in comparison to the control group (p-value <0.05). Gliomas and metastases showed relatively higher pH compared to the controls (7.05±0.02). High-grade gliomas exhibited alkaline pH compared to low-grade gliomas, with a p-value of 0.000439. Significant differences were noted between gliomas and metastases compared to the control group. Conclusion: A 31-Phosphorus MR spectroscopy has provided new insights into cellular metabolism in the pathological brain and has enhanced the understanding of the ongoing pathomechanisms in various brain tumours.

Posterior Quadratus Lumborum Block versus Transversus Abdominis Plane Block with Bupivacaine and Dexmedetomidine for Postoperative Analgesia following Caesarean Delivery: A Randomised Clinical Study

V Rajesh Kumar Kodali, Kiran Muthu Rajah, Varun Karuppaiah Thiagarajan Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Pain management after caesarean delivery is vital for the early recovery of the mother. In the absence of long-acting opioids, fascial plane blocks such as the Quadratus Lumborum Block (QLB) and Transversus Abdominis Plane (TAP) block significantly prolong the duration of analgesia and increase maternal comfort. Aim: To compare the number of rescue analgesic boluses required in the 24-hour postoperative period between the QLB and TAP block groups. Materials and Methods: This study was a prospective, single-blind, randomised clinical trail conducted in the Department of Anaesthesiology at a teritary care teaching Hospital, Chennai, Tamil Nadu from March 2021 to March 2022 on 94 patients (47 in each group) scheduled for elective Lower Segment Caesarean Section (LSCS) and were randomised into two groups: Group T and Group Q. Patients in Group T received a TAP block, while patients in Group Q received a QLB. The primary outcome assessed was the number of rescue analgesic boluses used in 24 hours. Secondary outcomes assessed included the time to initial onset of pain, time to the first request for analgesia, total amount of rescue analgesic consumption for 24 hours, and postoperative pain scores. The Chi-square test and Fisher-Freeman-Halton Exact test were utilised to compare the categorical variables. Results: Mean rescue bolus doses were significantly lower in Group Q (1.0±0.6 doses) compared to Group T (2.5±0.6 doses) (p<0.01). Total rescue analgesic consumption in Group Q (51 mg) was significantly lower than in Group T (127 mg) (p<0.01). The time to the initial onset of pain and time to the first rescue analgesia were significantly longer in Group Q (17.9 hours and 18.2 hours, respectively) than in Group T (11.9 hours and 12.2 hours, respectively) (p<0.01). Lower pain scores were noted from 12 hours to 24 hours in Group Q compared to Group T. Conclusion: The QLB with dexmedetomidine reduces the number of rescue boluses in 24 hours and decreases rescue analgesic consumption. The QLB also prolongs the initial onset of pain and the time to the first rescue analgesic, with lower pain scores from 12 to 24 hours compared to the TAP block group.

Immediate Effect of Kinetic Chain Activation and Mulligan’s Bent Leg Raise Technique in Patients with Asymptomatic Hamstring Tightness: A Randomised Clinical Trial

Santosh Channabasapa Metgud, Santosh D Patil, Omkar Anand Gaonkar Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Hamstring shortness is an important mechanical marker for hamstring strain injuries, often related to a muscle imbalance between the quadriceps and hamstrings. Muscle tightness is considered a limiting factor for optimal performance, including individuals’ daily activities. Aim: To compare the immediate effects of the Kinetic Chain Activation Technique (KCAT) and Mulligan’s Bent Leg Raise (BLR) on hamstring tightness using the active knee extension test, diagnostic ultrasonography and the Sit and Reach Test (SRT) test. Materials and Methods: A randomised clinical trial was conducted in the Orthopaedic Manual Therapy Department of KAHER Institute of Physiotherapy, Belagavi, Karnataka, India, from December 2022 to June 2023. In this trial, subjects with asymptomatic hamstring tightness were enrolled and randomised into two interventional groups: KCAT (n=15) and BLR (n=15). Kinetic chain activation was applied to Interventional group A, while Mulligan’s BLR was applied to Interventional group B. Measurements were taken of the hamstring muscle’s length using the SRT test, the active knee extension test and diagnostic ultrasound to determine the immediate effects. To compare the length and thickness of the hamstring, AKT and SRT test within groups, the paired t-test was used. For between-group analysis, the independent t-test was applied. Results: The mean age of the subjects was 23.8±0.47 years. There were 10 males and five females in group A and eight males and seven females in group B. Significant differences were identified in the thickness of the hamstring muscles in both groups when analysed within groups (p-value=0.001). However, there was no significant difference in the between-group analysis (p>0.001). Conclusion: The study concluded that both Mulligan’s BLR and KCAT were equally effective and could be used as adjuncts in improving hamstring flexibility.

Comparison of the Insertion Conditions and Haemodynamic Changes during I-Gel Insertion using Propofol, Ketamine-Propofol (Ketofol) and Thiopentone Intravenous Induction Agents: An Interventional Study

Pooja Arpapan Shah, Aashi Nilesh Surti, Anupapama Kumari, Dinesh K Chauhan, Sara Mary Thomas Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: The I-gel was designed to mitigate adverse reactions by providing the advantages of a secure airway without the complications associated with visualisation and tracheal intubation, specifically reducing the risk of barotrauma and vocal cord damage. Insertion requires a good induction agent and adequate depth of anaesthesia to achieve proper jaw relaxation and to prevent effects such as coughing, gagging, laryngospasm and any movements. Induction agents like propofol, ketamine and thiopentone have facilitated Laryngeal Mask Airway (LMA) insertion with ease. Aim: To compare insertion conditions and haemodynamic changes during I-gel insertion using propofol, ketamine-propofol (ketofol) and thiopentone as intravenous induction agents. Materials and Methods: An interventional study was conducted at a tertiary care hospital, Anaesthesiology Department of Dhiraj General Hospital in Piparia, Vadodara, Gujarat, India from August 1, 2023, to July 31, 2024. within one year after receiving ethical clearance from the institutional ethical committee. A total of 36 patients with American Society of Anaesthesiologists (ASA) physical status I and II, aged 18-60 years, were randomly divided into three groups. The induction agents administered before I-gel insertion for general anaesthesia in groups 1, 2 and 3 were propofol (2 mg/kg), ketofol (1 mg/kg ketamine and 1 mg/kg propofol) and thiopentone (4 mg/kg), respectively. Intubating conditions such as jaw mobility, number of attempts, ease of insertion, duration of insertion and haemodynamic response during I-gel insertion were recorded. The Kruskal-Wallis test and Chi-square test were used for quantitative and qualitative parameters, respectively. A p-value of ≤0.05 was considered statistically significant. Results: The mean age of Group-1, Group-2 and Group-3 was 34.67±5.97 years, 33.25±8.70 years and 36±8.48 years, respectively. Complete jaw relaxation and mouth opening were better in the ketofol group than in the propofol group (p-value: 0.003) and were significantly lower in the thiopentone group. Induction time was faster in the ketofol group than in the other groups. Patients in the ketofol and propofol groups exhibited better intubating conditions and preserved haemodynamics following I-gel insertion compared to those in the thiopentone group. Conclusion: Compared to propofol and thiopentone, ketofol demonstrated a faster onset of action and ensured better insertion conditions and greater haemodynamic stability, making it a preferred choice for I-gel insertion.

Circulating Galectin-3 Levels Associated with Insulin Resistance in Gestational Diabetes Mellitus: A Cross-sectional Study

Lakshmi Vijukumar, P Renuka, VM Vinodhini, Karthiga J Prabhu, Ashish Kumar, Aryan Kumar Singh Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Gestational Diabetes Mellitus (GDM) is a prevalent pregnancy complication with significant health implications for both the mother and offspring. Galectin-3, a protein expressed in various cells, contributes to cellular and systemic insulin resistance and is secreted into extracellular fluid. However, the link between Galectin-3 and insulin resistance in the development of GDM has not been firmly established. Aim: To estimate the circulating Galectin-3 levels in diagnosed GDM patients and compare them with those of healthy pregnant women. Materials and Methods: This cross-sectional study was conducted in the Obstetrics and Gynaecology Outpatient Department (OPD) at SRM Medical College Hospital and Research Centre, SRM Institue of Science and Technology, Kattankulathur, Chengalpattu, Tamil Nadu, India, from July 2023 to December 2023, including 40 pregnant women aged ≥18 years in each group. The parameters measured between both groups included the diabetic profile, lipid profile and Galectin-3 levels. The case group consisted of individuals diagnosed with GDM whose Oral Glucose Challenge Test (OGCT) value was ≥140 mg/dL, whereas the control group comprised pregnant women with OGCT values below 140 mg/dL {selected using Diabetes in Pregnancy Study Group of India (DIPSI) criteria}. Independent t-tests, Mann-Whitney U tests and Pearson Correlation were performed using Statistical Package for the Social Sciences (SPSS) (27.0). Results: The mean age of the patients was 27.78±3.84 years in the GDM group and 26.88±3.89 years in the normal pregnancy group. The mean Galectin-3 levels were higher in GDM patients compared to normal pregnant women (4.84±0.75 ng/mL vs. 3.34±0.78 ng/mL; p<0.001). Additionally, GDM patients exhibited significant increases in Fasting Plasma Glucose (FPG), fasting insulin, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), Triglycerides (TyG) index and Glycated Haemoglobin (HbA1c) compared to normal pregnant women. Conclusion: The present study confirmed the presence of insulin resistance and elevated Galectin-3 levels in pregnancies affected by GDM but did not find a correlation between them.

Functional Outcome of Arthroscopic Management of Anterior Cruciate Ligament Injury using Four-strand Hamstring Tendon Graft: A Prospective Cohort Study

R Kavin Kumar, M Mohan, C Rishab, L Sabari Vaasan Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Anterior Cruciate Ligament (ACL) injuries are common, particularly among athletes and can significantly affect an individual’s functional abilities and sports career. ACL reconstruction using a four-strand hamstring tendon graft has become the gold standard for restoring knee stability and function. Aim: To assess the functional outcomes resulting from arthroscopic ACL reconstruction using a four-strand hamstring tendon graft. Materials and Methods: This prospective cohort study was conducted at SRM Medical College and Hospital, Chennai, Tamil Nadu, India, including 33 patients with Grade II and Grade III ACL tears with or without associated meniscal injuries, who underwent ACL reconstruction using a four-strand hamstring tendon graft. The study population included patients aged 20-55 years, with follow-up assessments conducted at three and six months postoperatively. Knee function was measured using the Tegner Lysholm Knee Score, and pain levels were assessed using the Visual Analogue Scale (VAS). Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 16.0, employing Analysis of Variance (ANOVA) to evaluate clinical outcomes. Results: The majority of patients, i.e., 18 (54.55%), were between 21 and 30 years of age. Most of the participants were male, 29 (87.88%). The involvement of the right knee was slightly higher, with 17 (51.52%) compared to the left knee, which had 16 (48.48%). Isolated ACL tears were diagnosed in 21 (63.64%) of the patients. The Tegner Lysholm Knee Score improved significantly from a preoperative mean of 35.97 to 71.97 at three months and 88.85 at six months (p-value<0.0001). Pain, as measured by VAS, showed a significant reduction from the second postoperative day to the six-month follow-up (p-value<0.0001). Conclusion: ACL reconstruction using a four-strand hamstring tendon graft resulted in significant improvements in knee function and a reduction in pain within six months of surgery.

Microtrabeculectomy versus Conventional Trabeculectomy in Primary Open Angle Glaucoma: A Prospective Interventional Study

Rekha Ramesh Mudhol, Ameena Shirin Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Glaucoma is a group of multifactorial, irreversible, progressive optic neuropathies characterised by the loss of retinal ganglion cells. Trabeculectomy has been widely accepted as the gold-standard intervention for glaucoma for more than 30 years. A newer technique, microtrabeculectomy, was introduced to overcome the ocular complications encountered with Conventional Trabeculectomy (CT). Aim: To compare the efficacy of microtrabeculectomy with CT in treating Primary Open-angle Glaucoma (POAG). Materials and Methods: A prospective interventional study was conducted in the Department of Ophthalmology at Shri BM Patil Medical College Hospital and Research Centre (tertiary care centre), BLDE (DU), Vijayapura, North Karnataka, India, from June 2023 to August 2024. The study included 16 cases diagnosed with POAG, divided into two groups of eight patients each: Group-I- Microtrabeculectomy and Group-II- CT. Preoperative baseline characteristics were documented for all cases. They were followed-up for a three-month period to check for Intraocular Pressure (IOP) and any complications. Results: The mean preoperative and three-month postoperative IOP in Group-I was 30.75±6.04 and 13.87±2.80 mmHg, respectively, whereas in Group-II, it was 30.0±7.27 and 14.12±2.80 mmHg, respectively. The difference was statistically significant between the two groups (p<0.001). However, the differences in postoperative IOP values at the follow-ups and the differences in preoperative IOP values between both groups were not statistically significant (p>0.05). Intraoperative and postoperative complications were observed more frequently in Group-II compared to Group-I. Conclusion: Microtrabeculectomy is a safe procedure with efficacy comparable to CT for reducing IOP, while producing good filtering blebs with fewer complications.

Assessment of Knowledge, Attitudes and Needs of Accredited Social Health Activist (ASHA) in Community based Cancer Awareness and Screening Programme: A Mixed Method Study from a Rural Area in Central Kerala, Southern India

L Meenu, N Divyamol, K Anupriya, TK Abdu Saleem Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Cancer is the leading cause of death worldwide. Primary prevention through health education and secondary prevention through early detection and treatment can alter cancer burden and outcomes. The current study focuses on the possibility of establishing Accredited Social Health Activist (ASHAs) as facilitators in cancer awareness generation and screening. Aim: To assess the knowledge and attitudes of ASHAs in awareness generation and encouraging screening for cancers, and to explore their needs as facilitators in cancer control. Materials and Methods: A mixed-method study was conducted in Kuzhalmannam Panchayath in Palakkad district of Kerala, India, among 30 ASHAs, for two-months from 15th August 2022 to 14th October 2022 in two phases. In phase 1, data regarding knowledge about common cancers, risk factors, danger signs, and screening methods, along with attitudes toward functioning as facilitators, were collected (cross-sectional). Phase 2 comprised Focus Group Discussions (FGDs) for exploring needs. Data were analysed using Statistical Packages for Social Sciences (SPSS) version 20.0 (phase 1). Thematic analysis followed in phase 2. Quantitative and qualitative variables were summarised as means and percentages. Results: The mean age of the ASHAs surveyed was 44.73±5 years. All ASHAs were aware that cancer did not transmit through contact, and 27 (90%) participants knew about the existence of risk factors. Knowledge about family history and the human papillomavirus as risk factors for cancers of the breast and cervix was inadequate. Breast lumps 6 (20%) and blood loss 5 (16.67%) were the common danger signs known. Though 26 (87.67%) participants knew that screening could detect cancers early, knowledge about PAPs smear 6 (20%) and breast self-examination 5 (16.6%) was inadequate. All ASHAs had positive attitudes to raise awareness and encourage screening. For 10 (33.33%) participants, incomplete knowledge created anxiety. Their needs as facilitators emerged under two global themes: functional and aspirational. The quantitative data showed a gap in specific knowledge areas, which was also echoed in FGDs, where ASHAs requested more training and supervision. Conclusion: The ASHAs had a positive attitude to serve as advocates for cancer control. Knowledge gaps created anxiety. Interventions including training, supervision, and better payment are required to address their needs.

Comparative Assessment of 0.5% Levobupivacaine and 0.5% Ropivacaine for Anaesthetic Potency in Mandibular Third Molar Extractions: A Randomised Controlled Trial

Prachi Surolia, Rajanikanth Kambala, Nitin Bhola, Anchal Agarwal Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Patients often experience postoperative pain for more than 24 hours after the extraction of impacted mandibular third molars. This has led to the consideration of using long-acting anaesthetic drugs to alleviate patients’ discomfort. However, there is no conclusive evidence comparing the anaesthetic efficacy of long-acting anaesthetic drugs such as Levobupivacaine and Ropivacaine in impacted mandibular third molar surgery. To address this gap, a study was conducted to compare these two drugs in the context of oral and maxillofacial surgery for third molar extraction. Aim: To evaluate and compare the anaesthetic effectiveness of 0.5% Levobupivacaine and 0.5% Ropivacaine in impacted mandibular third molar surgery. Materials and Methods: A prospective, randomised, triple-blind trial was conducted in the Department of Oral and Maxiilofacial Surgery at Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India from November 2023 to May 2024 on 60 healthy patients, aged 18-40 years, who required extraction of an impacted mandibular third molar, were included in the study. The patients were divided into two groups; Group A and B were anaesthetised locally using 0.5% Levobupivacaine, and 0.5% Ropivacaine, respectively. The study assessed and compared latency, depth of anaesthesia, and time to rescue analgesia. Statistical analysis was performed using descriptive and inferential statistics, including the Student’s unpaired t-test for intergroup comparison and Fisher’s-exact test to assess the non random association between two categorical variables. A p-value of <0.05 was considered significant for interpreting the results. Results: The mean age of subjects in the study sample was 27.26±6.13 years in Group B and 27.23±5.24 years in Group A. The study found that Levobupivacaine demonstrated a faster onset of anaesthesia (104.06 seconds) compared to Ropivacaine (192.33 seconds), with a significant difference (p=0.0001). Both Levobupivacaine and Ropivacaine showed similar efficacy in achieving the depth of anaesthesia during surgery, with no statistically significant difference observed (p=1.00). The Levobupivacaine group exhibited a longer time to rescue analgesia (656.50 minutes) compared to the Ropivacaine group (501.83 minutes), with a statistically significant difference (p=0.0001). Conclusion: A 0.5% Levobupivacaine provides a quicker onset of anaesthesia and a longer duration of pain relief compared to 0.5% Ropivacaine, with a comparable depth of anaesthesia in both groups. Clinicians could consider using 0.5% Levobupivacaine to provide early onset of anaesthesia, prolonged pain relief, and greater postoperative comfort for the patients.

Evaluation of Comparative Efficacy of Ashwagandha (Withania somnifera) vs Brahmi (Bacopa monnieri Linn) on Stress Level and Quality of Sleep in the Subjects Experiencing Mental Stress: A Clinical Trial Protocol

Mohnish Vijay Gokhale, Vaishali Kuchewar, Pankaj Yadav, Bhishmani Tarare Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Adequate sleep is essential for the preservation of both physical and mental health. Sleep deprivation or interruption can cause a variety of physical, metabolic and cognitive problems, resulting in stress, anxiety, obesity and other neurocognitive dysfunctions. Sleep deprivation causes loss of sleep-dependent processes in the hippocampus and pyriform cortex, which are responsible for memory and perception. Need of the Study: Everyone in today’s world has stress and insufficient sleep as a result of their work load, hectic lifestyle, adoption of sedentary habits and other factors. Ayurveda has described many herbs under ‘medhya rasayan’. Ashwagandha is commonly used than Brahmi. Brahmi is relatively easy to cultivate and inexpensive, hence this study is planned. Aim: To study the comparative efficacy of Ashwagandha (Withania somnifera) vs Brahmi (Bacopa monnieri Linn) on stress level and quality of sleep in the subjects experiencing stress. Materials and Methods: It is a double-blind standard control clinical trial and the study will be undertaken at Department of Kayachikitsa, Mahatma Gandhi Ayurved Hospital and Research Centre (MGACHRC) at Salod (H), Wardha, Maharashtra, India starting from January 2024 to June 2025. This study will include 60 patients (30 in each group) experiencing mental stress. Group-A (Experimental Group) and Group-B (Control Group) will be given Brahmi ghana (extract of Bacopa monnieri Linn) and Ashwagandha ghana (extract of Withania somnifera), respectively with Luke warm water at bed time for 60 days. The patients will be assessed on every 15th day through Perceived Stress Scale (PSS) and Pittsburgh Sleep Quality Index (PSQI) scales.

Efficacy of the Healing Effect of Topical Jayanti (Tridax procumbens) Cream versus Topical Lignocaine with Nifedipine Cream in Parikartika (Acute Fissure-in Ano): A protocol for Randomised Controlled Trial

Shubham Bobade, Sheetal Asutkar Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: Fissure-in-ano are a notably prevalent anorectal condition, primarily associated with ulcers and raised anal sphincter spasm. The management options largely focus on promoting wound healing and reducing anal spasm. Medical treatment, which includes a fibre-rich diet and sitz baths, results in the healing of nearly half of the fissure-in-ano. The ulcer of the anal canal is the presenting complaint in this condition. Topical Ayurvedic medicine can be utilised to heal such ulcers. Need of the Study: A review of the literature suggests that T. procumbens exhibits potent wound healing, antioxidant, antimicrobial, anti-inflammatory, procoagulant and immunomodulatory properties. Given that an acute fissure-in-ano presents as an ulcer in the anal canal, this study proposes the use of T. procumbens for its management. Aim: To evaluate the efficacy of Jayanti (T. procumbens) cream versus topical Lignocaine and Nifedipine cream in the treatment Materials and Methods: A single-blind, double-arm comparative randomised control trial will be conducted at the Department of Shalyatantra, Mahatma Gandhi Ayurveda College Hospital and Research Centre (MGACHRC), Salod Hirapur (H), Maharashtra, India, from April 2023 to November 2024, with 70 subjects enrolled. In the control group, topical Lignocaine and Nifedipine cream will be applied, while in the interventional group, topical Jayanti (T. procumbens) cream will be applied to the acute fissure-in-ano. The evaluation parameters, including wound healing, anal spasm, per rectal bleeding, pain and itching, will be assessed.

Characterisation of Chemical Constitutes and Spermatogenic Activity of Ushir (Vetiveria Zizanioides Linn) versus Ikshu (Saccharum Officinarum Linn) in Male Wistar Rats: A Research Protocol

Akshay Sudhir Pargaonkar, Jaymala Jadhav, Bhagyashree Ratan Jibkate, Minakshi Urkude Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Introduction: In men, infertility may results from impaired sperm quality, quantity and abnormalities. In Ayurveda, there are various herbal medicines that are stated to possess effective aphrodisiac (Vajikarana) properties and purification of the semen (shukrashodhana) activities that are relevant to both aphrodisiac and spermatogenic effects. One such herb that possesses the purification of semen (shukrashodhangana) and is often used is Ushir (Vetiveria zizanioides) and Ikshu (Sugarcane) (Saccharum officinarum). Standardisation of Ayurvedic medicines at the pharmaceutical and analytical levels is important for proceeding with preclinical or clinical studies. The outcomes of animal research have helped consider the drug’s benefits and drawbacks. Need of the study: There is a need to evaluate this fact. Ikshu swaras (juice of S. officinarum) (Juice of Sugarcane) has a shelf life of one hour, while Ushir churna (powder of V. zizanioidis) is easily available and has a shelf life of two years. If both drugs have similar actions, then Ikshu (sugarcane) can be replaced by Ushir. The phytochemical characterisation of Indian species of these two drugs also needs to be discovered, as it may provide detailed information regarding chemical constituents and may explore additional utility. Aim: To evaluate the characterisation of chemical constituents and the spermatogenic activity of Ushir (Vetiveria zizanioides) versus Ikshu (Saccharum officinarum) (sugarcane) in male Wistar rats. Materials and Methods: An experimental study will be conducted at the preclinical animal research facility of Datta Meghe Higher Education and Research (DIMHER), Wardha, Maharashtra, India (DU) from January 2022 to January 2025. The preparation of the drugs will be standardised as per Ayurvedic Pharmacopoeia of India (API) in the analytical laboratory of Dattatray Rasashala of MGACH&RC Salod, Wardha, Maharashtra, India. Five groups will be formed, each consisting of six male Wistar rats. The groups will include a normal control group, a disease control group, a standard control group and two test groups. Parameters that will be assessed include sperm morphology, sperm motility, pH, agglutination, sperm count, serum testosterone levels and histopathology. The experimental study will be conducted as per Organisation for Economic Cooperation and Development (OECD) guidelines. For statistical analysis, the mean and standard deviation of the treated groups will be calculated using an unpaired t-test and one-way Analysis of Variance (ANOVA) analysis, with a significance level set at p<0.05.

Patient-centered Outcomes in Modern Endodontic Microsurgery: A Narrative Review

Haytham Jaha Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Endodontic Microsurgery (EMS), a minimally invasive approach to root canal treatment, has seen a notable increase in popularity due to its potential for enhanced outcomes. The present review seeks to evaluate the current state of Patient-Centered Outcomes (PCOs) in contemporary EMS, focusing on comparative analyses of surgical techniques, adjunctive therapies and the influence of technological advancements. The literature was examined to assess the effectiveness of various microsurgical techniques, including lasers, ultrasonic instrumentation and specialised irrigation solutions. Furthermore, the role of adjunctive therapies, such as regenerative techniques and antimicrobial agents, in improving treatment outcomes has been discussed. The impact of technological advancements, such as digital radiography and 3D imaging, on the precision and efficiency of microsurgical procedures is also explored. By providing a comprehensive overview of the existing evidence, the present review will assist clinicians in making informed decisions regarding the selection of microsurgical techniques and adjunctive therapies to optimise patient outcomes.

Neurobiological Changes Associated with Excess Weight: A Narrative Review

B Sharmila, Sovan Bagchi, Mohd Imran, Tamalika Chakraborty, K Pushpalatha Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Brain and neuronal changes related to excessive weight and obesity is critical due to address, given the rising global prevalence of obesity and its significant impact on neurological health. Obesity is associated with significant neuronal changes that can have profound effects on brain structure and function. These neuronal changes highlight the complex interplay between obesity and brain function, emphasising the importance of addressing both physical and neurological aspects of obesity in treatment and prevention strategies. Early reviews have often overlooked the intricate relationship between obesity and brain function, focusing more on peripheral effects, such as cardiovascular and metabolic complications, while neglecting the specific effects on brain structure and function. The present review explores the research question of how does excess weight contribute to specific structural and functional changes in brain regions involved in cognitive control, reward processing and memory and what are the implications of these changes for clinical outcomes and obesity management. It focuses on the clinical implications of neural changes in the context of obesity management. The analysis provides a comprehensive understanding of the underlying mechanisms driving these brain modifications and their potential impacts on clinical outcomes.

Navigating the Risk Landscape in ST-Elevation Myocardial Infarction Patients Post-percutaneous Coronary Intervention: A Narrative Review

Utkarsh Gaur, Charuta Gadkari, Aditya Pundkar Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X The ST-Elevation Myocardial Infarction (STEMI) remains one of the major contributors to death and disability worldwide. The primary Percutaneous Coronary Intervention (pPCI) has gained wide adoption as the preferred reperfusion strategy over time. The present narrative discussion highlights a wide range of factors that can confer mortality in patients with STEMI treated with PCI, focusing strongly on demographic variables and clinical presentation issues that present inherent challenges to treatment strategies. Age stands out as a predictor of poor outcomes, with the worst prognoses found in those older than 80 years. In this population, diabetes mellitus, hypertension, and reduced cardiac function all dramatically increase the risk of poor outcomes. The presence of cardiogenic shock is another prime determinant of mortality and often multiplies these risks when combined with multivessel Coronary Artery Disease (CAD) and delayed initiation of treatment. Other notable risks post-PCI include repeated myocardial infarction, arrhythmias, and in-stent thrombosis, each of which further complicates clinical management. All these factors together create a complex, high-risk profile of patients who will need individualised and directed management strategies for optimum reduction in mortality. Delays in door-to-balloon times continue to be a major challenge to achieving better outcomes in regions with limited resources. Additionally, a significant long-term challenge is the management of multivessel disease and personalised therapy for high-risk patients, particularly during the acute phase. While PCI has resulted in a substantial reduction in mortality among patients with STEMI, gaps in outcomes still exist, predominantly among older patients and those with a greater complexity of co-morbidities. Treatment protocols must be continuously refined to address these gaps. The paper underscores the need for continuous innovation and research at both pre-hospital and post-PCI management levels to reduce mortality rates and improve the long-term outcomes of high-risk STEMI patients.

Unravelling the Enigma of Highly Superior Autobiographical Memory: Signs, Symptoms and Treatment Perspectives: A Narrative Review

Rohit Wani, Bhagyesh Sapkale, Supriya Meshram, Sachin R Gedam Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Highly Superior Autobiographical Memory (HSAM) is an extremely rare phenomenon characterised by an exceptional ability to recall personal life events vividly. The present review article explores the unique characteristics of HSAM that distinguish it from other memory phenomena, such as mnemonics. Currently listed on the global diagnosis list up to 2024, with only 62 documented cases, HSAM presents a fascinating cognitive and neurological complexity, including increased functional connectivity within some brain regions, particularly the left temporoparietal junction. Typically, individuals with HSAM exhibit very vivid recollections of both significant and mundane events, which they cannot control or intentionally suppress. The article also reviews some possible psychological and biological substrates of HSAM; among these, semantic processing and atypical neurodevelopment are of particular importance. The overlap between HSAM and conditions such as autism is also discussed, as they might share features such as compulsive fixations on dates and an inability to “get over” bad memories. While the mechanism by which certain treatments become effective for HSAM is poorly understood, the use of interventions such as deep brain stimulation or cognitive-behavioural therapy may be warranted. This review calls for more research, hoping to stimulate interest in therapeutic interventions designed for patients with HSAM, ultimately leading to a greater understanding of this intriguing cognitive phenomenon.

Mutational Analysis of BRAF^V600E by Polymerase Chain Reaction in Breast Cancer: A Narrative Review

Simran Khan, Arvind Bhake Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X A major cause of cancer-related death for women globally is breast cancer, calling for molecular insights to better prognosis and treatment. One of the genetic changes that contributes to the constitutive activation of the MAPK/ERK (mitogen-activated protein kinase/extracellular signal-regulated kinase) pathway and promoting carcinogenesis is the BRAF^V600E mutation, which has been extensively studied in melanoma. BRAF^V600E has been associated with aggressive forms of breast cancer, including Triple-Negative Breast Cancer (TNBC), and worse clinical outcomes, despite its rarity. The Polymerase Chain Reaction (PCR)-based methods for analysing BRAF^V600E mutations in breast cancer, specifically Invasive Ductal Carcinoma (IDC), are the main topic of this narrative review. The sensitivity and precision of different PCR techniques, such as droplet digital PCR (ddPCR), qPCR and traditional PCR, in identifying this mutation vary. The review emphasises BRAF^V600E potential as a therapeutic target and prognostic marker, particularly considering the poorer efficacy of BRAF inhibitors in treating breast cancer than melanoma. The available data, which mostly comes from non Indian populations, highlights the need for additional thorough studies in a variety of populations, including Indian women, to fully comprehend the clinical significance of the mutation.

Respiratory Muscle Strength Training for Athletes: A Narrative Review

Thiagarajan Subramanian, Manu Goyal Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Respiratory Muscle Training (RMT) has become an alternative approach to boost athletic performance by improving respiratory function and delaying inspiratory muscle fatigue. The objective of the present study is to synthesise recent works on the benefits of RMT regarding muscle strength, respiratory system function and exercise performance in athletes and healthy individuals. The reviewed studies suggest that RMT can significantly increase pulmonary function parameters; however, the impact of RMT on these parameters remains inconsistent across studies. Regarding exercise performance, RMT has been shown to improve endurance, as evidenced by increased time to exhaustion, VO₂ max, Repeated Sprint Ability (RSA) and postural control in some studies. This author aimed to analyse the different studies on respiratory training with the aforementioned outcomes. A thorough search of studies were conducted using various databases. The review included studies published in English, which were peer-reviewed and focused on RMT interventions in sports players. The following keywords were used as search strategies: RMT, Inspiratory Muscle Training (IMT), pulmonary function, Maximum Inspiratory Pressure (MIP), Maximum Expiratory Pressure (MEP), exercise performance, VO₂ max and endurance training. All 10 studies were extracted based on their research design, including randomised controlled trials, pre-post experimental studies, randomised sham-controlled trials and randomised group factorial designs and were synthesised and analysed qualitatively. The activation of the metaboreflex mechanism and improved blood flow distribution to working muscles during exercise are proposed as potential underlying mechanisms for these performance benefits. However, the additive effects of RMT when combined with regular strength and endurance training remain debatable. The present analysis identified a suitable metric that could substantiate the evidence supporting the enhancement of athletic performance through RMT.

Serum microRNAs as Diagnostic Markers in Polycystic Ovary Syndrome: A Narrative Review

K Lavanya, N Palaniappan, VM Vinodhini, Santhi Silambanan Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Polycystic Ovarian Syndrome (PCOS) is thought to be common worldwide among middle-aged women. Increased androgen production, recurrent anovulatory cycles and ovaries with multiple cysts are symptoms of this multiorgan endocrine condition. MicroRNAs (miRs) and several candidate genes, including CYP11A, CYP21 and CYP17, have been linked to PCOS. Single-stranded non coding RNAs known as microRNAs have been shown to alter several cell cycle processes, including metabolism, apoptosis, differentiation and proliferation. By targeting hormone receptors and their release, microRNAs influence the production of steroid hormones and play a significant role in the formation and regulation of follicular growth in the ovaries. Physiological development, including physical growth and embryonic development of the ovaries, alter the levels of microRNA expression. It has been discovered that the altered pattern of microRNAs under pathological circumstances is specific to certain disorders. Therefore, a variety of medications that are either agonists or antagonists of microRNAs may be useful in initiating tailored treatments. The profiles of microRNAs differ depending on the tissue from which they originate. Due to ribozyme activity, microRNAs are persistent and resistant to hydrolysis. Since serum microRNAs are present in various bodily fluids, they are novel markers for diseases like PCOS. The microRNA profile constantly changes depending on the pathogenic stage of the disease. There are correlations between the levels of established biomarkers and the up- and down-regulation of certain microRNAs. Furthermore, it has been found that microRNAs are more specific and sensitive than conventional biomarkers. This article was created to address the altered microRNA profiles in systemic circulation and in different ovarian tissues.

Epigenetic Mechanisms in Type-2 Diabetes Mellitus: A Narrative Review

Deenadhayalan Ashok, Monisha Prasad, Mohammad Fareed, Anis Ahmad Chaudhary Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X The incidence of Type-2 Diabetes Mellitus (T2DM) has increased significantly in the last several decades, which is an important challenge for health professionals and researchers. The systems that mediate the interaction between environmental factors and the genes, such as epigenetics, may have a specific bearing on the aetiology of T2DM. With an emphasise on the part that epigenetics plays in the pathophysiology of T2DM, the present study attempts to give a thorough overview of the mechanisms behind disease initiation, possible biomarkers, and the consequences for T2DM. The findings suggest that β-cell malfunction, insulin resistance, and other metabolic abnormalities connected to T2DM are related to epigenetic alterations, which include histone modifications, Deoxyribonucleic Acid (DNA) methylation, and non coding Ribonucleic Acids (RNAs). Environmental factors that impact the development and course of the disease, including nutrition, exercise and pollution exposure, also have an impact on these epigenetic modifications. Knowing the complex interactions among genetics, epigenetics and environment is essential to pinpointing the precise aetiology of T2DM and creating customised treatment regimens. Epigenetic biomarkers could be helpful for risk assessment, early diagnosis, and tailored therapy for people with T2DM who are at risk or who have already been diagnosed. Future research must concentrate on unravelling the mechanistic understanding of the epigenetic pathways of T2DM in order to enhance therapeutic treatment and delve deeper into the pathophysiology of the condition.

Irritable Bowel Syndrome: Gut Microbiota Dysbiosis and Psychological Co-morbidities

Bijita Bhowmick, Sharmistha Banerjee, Sanchaita Gayen, Supriya Samanta, Nilotpal Banerjee Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Irritable Bowel Syndrome (IBS) is a prevalent Gastrointestinal (GI) disorder, affecting approximately 10-15% of the global population, with significant implications for public health. It is characterised by chronic abdominal discomfort, altered bowel habits and a spectrum of symptoms that often co-exist with psychological conditions such as anxiety and depression. Emerging evidence highlights a critical imbalance in gut microbiota among individuals with IBS, underscoring the intricate gut-brain-microbiome axis. This dysbiosis not only exacerbates GI symptoms but also contributes to mental health challenges, creating a vicious cycle that impacts overall wellbeing. The broader consequences of IBS extend beyond individual health, leading to considerable impairment in daily functioning, reduced workplace efficiency and diminished Quality of Life (QoL). The socio-economic burden is reflected in increased rates of absenteeism, presenteeism and healthcare costs. Current therapeutic interventions, including probiotics, prebiotics, Faecal Microbiota Transplantation (FMT) and targeted medications, hold promise but require further research to establish their long-term efficacy and safety. This review aims to provide a comprehensive analysis of IBS, focusing on its microbial aetiology, the interplay with psychological co-morbidities, and its profound effects on work-related activities and societal productivity. By consolidating existing evidence, it seeks to emphasise the urgent need for innovative and effective therapeutic strategies. Addressing IBS as a multifaceted public health challenge requires interdisciplinary efforts to develop tailored interventions that alleviate its wide-ranging impacts on individuals and communities.

A Narrative Review on Microbial Response to Antibiotic Stress: Mechanisms of Resistance and Adaptation

Nazia Khan Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Microbial populations are constantly exposed to antibiotic pressures, which drive the evolution of diverse resistance mechanisms. This paper explores the complex responses of microbes to antibiotic stress, focusing on genetic and phenotypic adaptations. Key resistance mechanisms include Horizontal Gene Transfer (HGT), mutations leading to target site modification and the activation of efflux pumps. Additionally, the paper examines how microbial communities adapt to prolonged exposure through biofilm formation and altered metabolic pathways. Understanding these processes is crucial for developing strategies to combat antibiotic resistance and designing next-generation antimicrobial therapies.

Loss of PTEN Immunoexpression in Endometrial Carcinoma: A Narrative Review

Garima Chandrakar, Arvind Bhake Journal of clinical and diagnostic research : 2025 - January - 19:0973-709X Endometrial carcinoma is one of the important health issues addressed globally. Therefore, understanding the molecular pathogenesis of endometrial carcinoma for the purpose of prognostic and predictive markers remains in the centre of research. It has been reported in recently published literature that loss of Phosphatase and Tensin Homolog (PTEN) expression, a tumour suppressor gene, is one of the key events in the pathogenesis of endometrial carcinoma. This review aims to study the data for loss of PTEN expression in literature. Based on the inclusion and exclusion criteria, eight studies were finally included in the review. Comparative statistics of various studies showed that loss of PTEN expression is a key molecular event in endometrial carcinoma. The detection of lost PTEN expression could help in knowing the progressive nature of Atypical Endometrial Hyperplasia (AEH) and in distinguishing AEH from endometrial carcinoma. This will facilitate the choice of targeted therapy.