Table of Contents : Journal of clinical and diagnostic research : 2026 - March - 20

Bilateral Thalamic Glioma in a 10-year-old Child: An Unusual Case Report

Ritika Singh, Naman Jain, Kapil Bhalla Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Bilateral thalamic gliomas are extremely rare tumours of the central nervous system. Although they are usually benign in nature, their outcome is poor because of the involvement of thalamic nuclei and inadequate surgical excision, making their excision extremely difficult. A 10-year-old girl presented with right-sided abnormal body movements for 2 months, fever for 10 days, followed by right-sided weakness, left facial palsy, and blurred vision in the left eye. Neurological examination showed right hemiparesis and left seventh nerve palsy. Magnetic Resonance Imaging (MRI) revealed bilateral thalamic lesions with a left-sided mass extending to the midbrain, and MR spectroscopy findings were suggestive of a bilateral low-grade glioma. She was started on antibiotics, and a stereotactic brain biopsy was planned. The present index case highlights the rarity of thalamic tumours in the paediatric population; wherein early diagnosis helps in prognosticating the family/caregivers of the child. However, the decision for further management is up to the parents, considering that the poor prognosis of the disease process and the associated morbidity and mortality is crucial. Management primarily includes tumor excision along with chemotherapy and radiotherapy, which entails a poor prognosis.

Direct Left Inguinal Hernia in A 75-Year-Old Female: A Case Report

Harini Krishnan, Rajesh Gattani, Saurabh Gawand, Abhiram Sai, Pranjal Prem Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Inguinal hernia is rare in females compared with males. The hernia can be classified into two types: Direct and indirect. The typical clinical presentation of an inguinal hernia in elderly females includes groin pain or discomfort during physical activity, swelling in the groin area, and discolouration of the skin over the hernia. This is a case of a direct left inguinal hernia in a 75-year-old female. The patient observed a swelling in her left groin area, which was associated with pain that was progressive in nature. The patient was successfully managed with Lichtenstein tension-free meshplasty. Timely diagnosis and management are recommended in females with inguinal hernia to prevent associated adverse outcomes.

Appendiceal Mucocele Managed with Right Hemicolectomy in a Middle-aged Male: A Case Report

RS Sharan Dhev, R Kavin Shanmugavel, Mohana Priya, Balaji Durairaj, G Tilak Ramu Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Appendiceal mucocele is a rare but clinically significant entity, defined as mucinous distension of the appendix due to various aetiologies, ranging from benign to malignant. It accounts for fewer than 0.3% of all appendectomies and is often detected incidentally or during the workup of non specific abdominal complaints. A 61-year-old male presented to the surgical clinic with a two-year history of intermittent, dull aching pain in the right lower abdomen. Over the preceding three months, the pain had become more frequent, prompting him to seek medical attention. Radiological evaluation revealed a grossly dilated appendix with internal mucin and mural calcification. Given the suspicion of a low-grade mucinous neoplasm, the patient underwent an open right hemicolectomy. Postoperative histopathology confirmed a Low-grade Appendiceal Mucinous Neoplasm (LAMN) with negative margins and no peritoneal involvement. The patient recovered well and remains on regular follow-up. The present case emphasises the role of early imaging and timely surgical management in preventing disease progression and complications such as pseudomyxoma peritonei.

Fatal Glyphosate Poisoning Presenting with Myocarditis and Multiorgan Failure: A Case Report

Parav Tantia, Sourya Acharya, Sonali Garg Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Glyphosate-based Herbicides (GBHs) are widely used agricultural chemicals linked to increasing reports of intoxications. Disruption of oxidative phosphorylation, along with cardiotoxic effects related to polyoxymethylene amines, is considered to play a role in the toxic actions of Glyphosate (GLY). The present case reports reveal a fatal case of GLY poisoning in a 34-year-old male who ingested approximately 100 mL of Roundup herbicide containing 41% GLY. Despite aggressive medical and supportive management, the patient's condition rapidly deteriorated, leading to multi-organ failure and death. Laboratory investigation revealed severe leukocytosis, electrolyte derangements, hepatic dysfunction, as well as cardiac injury, with elevated troponin I and CK-MB levels, and 2D echocardiography presented global Left Ventricular (LV) hypokinesia with an Ejection Fraction (EF) of 25%. This case highlights the potential lethality of GLY poisoning and the importance of prompt recognition and treatment, as in this case patient reported approximately 25 hours after ingestion. The findings suggest that GLY toxicity can cause severe systemic inflammation, myocardial injury, and multi-organ failure, leading to a poor prognosis. This case report aims to increase awareness about the severity of GLY poisoning and the emphasis the early intervention and aggressive management.

Polycythemia-linked Cerebral Venous Thrombosis with Right Fronto-Temporo-Parietal Infarct: A Case Report

K Gokul Kannan, Vignessh Raveekumaran Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Cerebral Venous Thrombosis (CVT) is a rare form of stroke, often linked to prothrombotic states, inducing Philadelphia-negative Myeloproliferative Neoplasms (MPN) such as Polycythemia Vera (PV) and Essential Thrombocythemia (ET), which predispose via hyperviscosity and Janus Kinase-2 (JAK2)-mediated platelet activation. We report a unique case of CVT in a 65-year-old hypertensive woman, an atypical demographic compared to the usual population, with chronic headaches developed four days of left lower limb weakness. Neuroimaging revealed a superior sagittal and right transverse sinus thrombosis with a non-haemorrhagic fronto-temporo-parietal infarct. Laboratory evaluation demonstrated leukocytosis (14×103/μL), thrombocytosis (739×103/μL), alongside JAK2-V617F positivity. This constellation of findings places her phenotype between ET and PV. Reflex JAK2 testing enabled early provisional diagnosis of MPN-associated CVT despite the absence of marrow biopsy. Prompt anticoagulation with Low-Molecular-Weight Heparin (LMWH) was transitioned to apixaban 5 mg twice daily, and achieved marked neurological improvement by discharge. This case highlights the rarity of CVT in an older hypertensive patient with JAK2-positive MPN but no erythrocytosis, and underscores the importance of reflex mutation screening and timely anticoagulation in achieving favourable outcomes.

Probable Congenital Tuberculosis in a 1.5-Month-Old Infant: A Rare Case Presentation

Alok Khanna, Deepika Yadav, Jai Bhagwan, Dinkar Yadav, Anjali Verma Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Congenital Tuberculosis (TB) is a rare but serious condition transmitted from an infected mother in utero or during delivery. Early diagnosis is often challenging due to nonspecific symptoms in neonates. Delayed treatment can lead to high morbidity and mortality. The authors hereby report a rare case of congenital TB in a 1.5-month-old female child who presented with complaints of persistent fever since birth and loose stools for the past four days. She had hepatosplenomegaly, pulmonary involvement with hilar lymphadenopathy and central nervous system involvement. A strong maternal history of pulmonary TB and early postnatal maternal demise raised clinical suspicion. The child responded well to anti-tubercular therapy and corticosteroids. This case emphasises the need for high suspicion of congenital TB in neonates born to mothers with active TB and highlights the importance of early initiation of treatment to improve outcomes.

Ventriculoperitoneal Shunting and Endoscopic Adhesiolysis of Multiloculated Obstructive Hydrocephalus in an Extreme Preterm: A Case Report

Pavitra Alva, Swapnil Pattanshetti, Abhishek Patil, Mahesh Kamate Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Multiloculated obstructive hydrocephalus is a complication of infection in early life, especially in preterms. In cases of obstructive hydrocephalus with loculated fluid pockets, procedures like Ventriculo-Peritoneal (VP) shunting can target 1-2 loculi, subsequently leading to occlusion of Cerebrospinal Fluid (CSF) even after shunting, resulting in obstruction of the shunt. Incomplete treatment leads to a progressive increase in head circumference and subsequent developmental delay. Obstructive hydrocephalus in infancy poses a significant neurosurgical challenge, particularly in cases with multiloculated compartments or congenital anomalies such as aqueductal stenosis. An extreme preterm infant born at 27 weeks presented with progressive head enlargement and was diagnosed with obstructive hydrocephalus at three months of age. The child underwent right VP shunt placement, followed by a contralateral shunt after 14 months due to further obstruction. Despite this, she presented again with signs of raised intracranial pressure, and imaging revealed multiloculated hydrocephalus with midline shift. Endoscopic adhesiolysis and septostomy with fenestration were subsequently performed, resulting in clinical improvement. This case emphasises the importance of neuroendoscopy as a minimally invasive and effective alternative in selected cases of shunt malfunction, avoiding repeated shunt revisions and associated complications. This case report presents a challenging scenario of recurrent obstructive hydrocephalus in an ex-preterm infant, initially managed with VP shunt placement but ultimately requiring endoscopic adhesiolysis and septostomy due to multiple intraventricular septations and compartmentalised hydrocephalus.

Management of Accidental Dural Puncture using Continuous Spinal Catheter in High-risk Geriatric Patient: A Case Report

C Gokula Varshini, P Nandhini Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Accidental Dural Puncture (ADP) during epidural placement occurs in 0.5-2% of cases. This can lead to significant complications. Converting such incidents into a Continuous Spinal Catheter (CSC) technique offers a practical approach and is an effective alternative for high-risk surgical patients. This approach not only salvages the neuraxial access but also provides titratable neuraxial blockade and postoperative analgesia. We report the case of a 75-year-old hypertensive female with a history of Pulmonary Thromboembolism (PTE) after prior hip surgery, who has presented for implant removal and uncemented hemiarthroplasty. During epidural placement, an ADP occurred at the L2-L3 level, so the catheter was deliberately secured in the subarachnoid space and used as a CSC. A titrated spinal anaesthesia was administered and supplemented intraoperatively. General Anaesthesia (GA) was also used due to anticipated discomfort. The patient remained haemodynamically stable throughout the 3.5-hour surgery. The catheter was retained for one day postoperatively, with no neurological complications or Post-Dural Puncture Headache (PDPH). CSC is a safe and effective alternative following ADP, providing stable haemodynamics and a reliable anaesthesia, and good postoperative analgesia, especially in high-risk patients. Administration of incremental doses of Local Anaesthesia (LA) through this technique reduces the risk of profound hypotension and allows real-time adjustments based on the patient’s haemodynamic responses.

Anaesthetic Management of a Cerebellopontine Angle Tumour in a Primigravida Undergoing Craniotomy: A Case Report

N Mohammed Arshad, M Shaheen Khan, CK Swetha Ramani, Hari Pooja Mutukundu Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Cerebellopontine Angle (CPA) tumours are uncommon intracranial neoplasms that can present significant anaesthetic challenges, particularly in pregnant patients. The physiological, hormonal, and anatomical changes of pregnancy can mask neurological symptoms, delay diagnosis, and complicate both surgical and anaesthetic management. The authors report a rare case of a 22-year-old primigravida at 14 weeks of gestation who presented with progressive blurring of vision and left-sided tinnitus. Magnetic Resonance Imaging (MRI) revealed a large left CPA lesion compressing the fourth ventricle. She had a history of Ventriculoperitoneal (VP) shunt placement for hydrocephalus two weeks prior. The patient was subsequently planned for an elective left retromastoid suboccipital craniotomy. The procedure was performed under Total Intravenous Anaesthesia (TIVA) using propofol and dexmedetomidine, with continuous neurophysiological monitoring to preserve cranial nerve function. Muscle relaxants were avoided following intubation to facilitate Electromyographic (EMG) monitoring. Haemodynamic stability and foetal heart rate were maintained throughout the eight-hour procedure. The patient was electively ventilated overnight, extubated on the first Postoperative Day (POD) without neurological deficits, and postoperative imaging confirmed complete tumour excision. She later delivered a healthy male infant at 36 weeks via elective caesarean section. The present case highlights the successful perioperative management of a large CPA tumour during early pregnancy, where the timing of surgery, meticulous use of TIVA without muscle relaxants, and continuous foetal and cranial nerve monitoring ensured favourable maternal and foetal outcomes.

Oral Manifestations of Household Disinfectant Exposure: Two Case Reports and Review of Literature

Jeyaseelan Ramasamy, RJ Vijayashree, Preethi Murali, Logeswari Jayamani Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X The main chemical component of household disinfectants is Hydrochloric acid (HCl). Exposure to this harmful chemical can result in mild to severe tissue injuries and is termed as allergic dermatitis. When the oral mucosa undergoes such state, termed allergic or contact stomatitis, which may manifest as chemical burn. Due to unrestricted availability of these substances, accidental exposure of oral cavity to commonly used disinfectants may produce mild to severe injuries and even be life-threatening. Two cases are presented here to insist on the allergic reaction caused by the accidental and misconceptional exposure of oral mucosa to household disinfectants, along with their clinical presentation and management. The first case involves accidental exposure of oral mucosa to a drain cleaner in a 30-year-old female patient. The second case is about a 26-year-old male patient who has placed the disinfectant over the decayed tooth. Oral allergic lesions results in allergic stomatitis, an allergic condition associated with significant morbidity. The severity of these lesions may be directly related to the type and quantity of the materials and the duration of exposure. Timely diagnosis, appropriate management, along with elimination of causative allergen quickly may be helpful in complete resolution of the manifestations.

Effect of Aerobic and Resistance Training on Body Composition, Strength, and Quality of Life in a Postmenopausal Woman with Type 2 Diabetes: A Case Report

Sonali Guliya, Subhasish Chatterjee Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Type 2 Diabetes Mellitus (T2DM) is a significant metabolic disease that commonly occurs in postmenopausal women and interacts with oestrogen deficiency, which accelerates visceral obesity, muscle loss, and decreases insulin sensitivity. The co-existence of low muscle mass and excessive fat, referred to as sarcopenic obesity, is increasingly prevalent among postmenopausal women with T2DM. This condition is a risk factor for metabolic dysfunction, muscle weakness, reduced muscle mass, and poor quality of life. Structured exercise interventions are required to reverse sarcopenia, enhance glucose disposal, improve cardiorespiratory fitness, and increase insulin sensitivity. Resistance training and aerobic exercise have been shown to positively influence muscle mass, muscle strength, and metabolic control. The authors report the case of a 54-year-old postmenopausal woman with T2DM who was referred for body composition analysis using the InBody 270 analyser due to complaints of body weakness, excessive adiposity, and decreased functionality. Baseline assessment revealed low skeletal muscle mass, reduced muscle strength, poor quality of life, and high fat percentage. The patient underwent a six-week combined resistance and aerobic training program (three sessions per week, including warm-up and cool-down). After six weeks, outcomes showed improvement in body composition, skeletal muscle mass, fat percentage, muscle strength, and quality of life. The present case demonstrates the clinical importance of personalised combined resistance and aerobic training as a non-pharmacological intervention capable of improving muscle strength, body composition, and Quality of Life (QoL) in postmenopausal women with T2DM. It highlights the under-reported significance of evidence-based physiotherapy interventions in this population.

Hepatopathy with Common Hepatic Duct Stenosis Diagnosed with Endoscopic Retrograde Cholangiopancreatography in a Sickle Cell Anaemic Female Child: A Case Report

Aditya Jain, Sarika Gaikwad, Keta Vagh, Ashish Verma, Krupa Bhanushali Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Hepatic complications are common in sickle cell disease, particularly among patients with the Sickle Cell Anemia (SS genotype). Liver injuries may result from viral hepatitis, iron overload due to transfusions, or vascular issues caused by sickled red blood cells. Clinical manifestations include sequestration crises, ischaemic hepatocyte injury, pigment gallstones, and biliary obstruction. In rare cases, these complications can progress to coagulopathy, jaundice, encephalopathy, or acute liver failure requiring transplantation. Acute sickle cell intra or extrahepatic cholestasis, though rare, is often fatal and presents with severe jaundice, Right Upper Quadrant (RUQ) pain, elevated liver enzymes, and coagulopathy. In the present case report, an 11-year-old girl with known sickle cell anemia (SS genotype) presented with yellowish discoloration extending to her palms and soles, abdominal pain, and palpable liver and spleen, accompanied by hepatic insult indicated by increasing levels of liver enzymes and bilirubin. She was diagnosed with Common Hepatic Duct (CHD) stricture using advanced radiological intervention, specifically Magnetic Resonance Cholangiopancreatography (MRCP). This condition was managed through Endoscopic Retrograde Cholangiopancreatography (ERCP). Following this procedure, she was discharged with a diagnosis of acute sickle cell hepatopathy, exhibiting a spectrum of hepatobiliary involvement. After approximately 30 days, a decreasing trend in her bilirubin levels was noted. Patients with sickle cell disease are more susceptible to hepatic complications, which can lead to significant morbidity and even mortality. Clinical manifestations can range from asymptomatic conditions to acute hepatic crises and chronic liver disease. Advanced investigations can be helpful for early intervention, which, in turn, can lead to better disease management and prevention of adverse outcomes.

Tuberculous Oophoritis Presenting as Adnexal Abscess with Abdominal Wall Sinus: A Case Report

Sundara Raja Perumal, Kirthi Sathyakumar, Madhu Sowmitha Pachipala, S Yuvashree Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Ovarian tuberculosis is an uncommon entity of tuberculosis, which is mostly undetected and under-reported. Female genital tuberculosis is caused mostly by Mycobacterium tuberculosis, and some cases are caused by Mycobacterium bovis and atypical mycobacteria. This patient presented with a history of serous discharge at the surgical scar with a skin gap of 1.5 cm at the suprapubic region. Imaging studies revealed pus pus-filled, enlarged left ovary and forming a sinus tract and communicating with the skin at the suprapubic region. Another intercommunicating midline adnexal lesion was also noted. Intraoperative findings confirmed these findings and left salpingo-oophorectomy and excision of the sinus tract were done. Histopathological examination revealed granulomatous inflammation. The patient was put on anti-tuberculosis treatment, and the patient is on follow-up. Female genital tuberculosis is relatively uncommon among post-primary pulmonary tuberculosis and presents with subtle and uncertain clinical symptoms and if left untreated, leads to significant complications like infertility. Clinical suspicion and early treatment may potentially cure this disease and avoid uncorrectable complications.

Incidentally Detected Castleman Disease of the Thorax and its Surgical Management: A Case Report

Sudhansoo Khanna, Rana Sandip Singh, Poonam Bhaker Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Castleman Disease (CD) is a rare lymphoproliferative disorder, the aetiology and pathogenesis of which remain unclear. It most commonly presents as a localised form, known as Unicentric CD (UCD), and less frequently as a generalised form, termed Multicentric CD (MCD). The thorax is the most common site of UCD; however, due to its rarity, UCD is seldom included in the differential diagnosis of an intrathoracic mass. Preoperative identification of CD is challenging. On imaging, CD typically appears as a well-defined, homogeneous mass. A characteristic feature of UCD on Contrast-Enhanced CT (CECT) is intense enhancement during the arterial phase, which decreases in the portal venous phase. This intense enhancement is attributed to the hypervascular nature of UCD. Therefore, multiphase CECT may be considered the investigation of choice when UCD is suspected. The lesion is highly vascular and often exhibits dense adhesions with adjacent organs, making surgical resection challenging. Authors report a case of a posterior mediastinal mass located in the left paraspinal region, which was incidentally detected in a 53-year-old female. The mass was successfully resected via a left postero-lateral thoracotomy and was postoperatively diagnosed on Histopathological Examination (HPE) as Castleman Disease, Hyaline Vascular Variant (HVV). The postoperative course was uneventful. Preoperative suspicion of CD would aid surgeons in planning the procedure appropriately and help avoid unexpected findings during surgery.

Recurrent High-grade Spindle Cell Sarcoma of the Thigh Mimicking Dermatofibrosarcoma Protuberans and Malignant Melanoma: A Case Report

Khushi Soni, Kishor Hiwale, Arvind Bhake, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X High-grade Spindle Cell Sarcomas (SCS) are rare, aggressive soft-tissue tumours that can be extremely challenging to diagnose, particularly when recurrent or when they morphologically overlap with other spindle-cell neoplasms. This case involves a 76-year-old Indian female who presented with a recurrent right posterolateral thigh swelling six months after surgical excision of a poorly differentiated liposarcoma. The swelling was firm, non tender, and subcutaneous, with no associated systemic symptoms. Primary Fine-Needle Aspiration Cytology (FNAC) revealed polygonal and spindle-shaped cells with hyperchromatic nuclei, mild pleomorphism, and prominent nucleoli, leading to an impression suggestive of malignant melanoma. Ultrasonography (USG) showed a heterogeneous hypoechoic lesion, while Magnetic Resonance Imaging (MRI) demonstrated a 3.5×2.6×1.6 cm subcutaneous mass with mild septal thickening, scarring, and postcontrast enhancement—findings suggestive of recurrent liposarcoma. Intraoperative frozen-section analysis shifted the differential diagnosis to Dermatofibrosarcoma Protuberans (DFSP) versus liposarcoma due to the spindle-cell morphology. Gross examination of the total specimen (measuring 6.5×5×4 cm) revealed a 2.8×1.8×1.5 cm protuberant, greyish-white, firm, lobulated nodular mass arising from the skin. Histopathological evaluation showed a storiform and fascicular pattern of spindle-cell proliferation infiltrating the dermis and subcutis, with pleomorphism and frequent mitoses, confirming a diagnosis of high-grade SCS. This case highlights the limitations of FNAC and frozen-section analysis in the evaluation of recurrent soft-tissue tumours and underscores the importance of integrating histopathology, imaging findings, and prior clinical history for accurate diagnosis.

Alobar Holoprosencephaly with Ectrodactyly, Oesophageal Atresia and Other Rare Anomalies: A Case Report

CP Archana, Akshay Sankar, Pronami Borah, Giriraj Kusre Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Synophthalmia with severe holoprosencephaly is a rare congenital anomaly, with a prevalence of approximately 1 in 100,000 total births and a female preponderance. It is characterised by a single midline orbit with two fused eyeballs, with or without a proboscis, along with absence of the nose and philtrum. The authors report a case of a 38-week-old male stillborn foetus, delivered vaginally to a 24-year-old healthy, non diabetic, second-gravida mother. On gross examination, the foetus exhibited low-set ears, a single midline orbit with two fused eyes, a proboscis above the orbit, absence of the nose and philtrum, microstomia, micrognathia, peripheral cyanosis and bilateral lobster foot. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) revealed a single orbit with ill-defined sinuses and alobar holoprosencephaly, characterised by absence of the corpus callosum, septum pellucidum, interhemispheric fissure and uncleaved thalami. Internal examination revealed a type I single umbilical artery, type A oesophageal atresia and valvular pulmonary stenosis. The presence of more than three associated anomalies in the present case underscores the rarity of this association.

Tailored Anaesthesia in Paediatric Beckwith-Wiedemann Syndrome: A Case Report

Garima Anant, GR Sreenath, Urmi Malik, Paras Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Beckwith-Wiedemann Syndrome (BWS) is a complex overgrowth disorder characterised primarily by macroglossia, omphalocele, and gigantism, along with a range of anatomical and metabolic abnormalities such as neonatal hypoglycaemia, embryonal tumours, visceromegaly, naevus flammeus, and anal dimple. Airway management in paediatric patients poses a significant challenge for anaesthesiologists. Anaesthetic management in patients with BWS is demanding because macroglossia may cause difficult mask ventilation, intubation, and extubation. These patients often require repeated anaesthetic exposure for the correction of macroglossia and associated abnormalities, and their perioperative management can be taxing for anaesthesiologists. Therefore, the anaesthetic management of children with BWS is particularly challenging due to the combination of age-related physiological limitations and disease-specific abnormalities. Here, the authors present the case of a five-month-old female infant diagnosed with BWS, with macroglossia, naevus flammeus, and an anal dimple, who underwent surgical reduction of macroglossia. The patient also demonstrated additional systemic findings including non-obstructing hydrocephalus, syringohydromyelia, hepatosplenomegaly, and enlarged kidneys on imaging, further increasing the complexity of anaesthetic care. Given the likelihood of a difficult airway, comprehensive preoperative evaluation, meticulous preparation, and well-structured backup strategies for airway management, endotracheal intubation, and intraoperative haemodynamic management are critical to navigating the anaesthetic complexities in patients with BWS. In addition, vigilant postoperative monitoring is essential due to the risk of airway obstruction and hypoglycaemia. The present case underscores the importance of multidisciplinary coordination and individualised anaesthetic planning to ensure safe perioperative outcomes.

Management of Urachal Sinus in an Adult: A Case Report

Madhuri Tribhuvan, Mahesh Jadhav Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Urachal anomalies, though rare, represent a spectrum of congenital conditions resulting from the incomplete obliteration of the urachus. These anomalies are typically identified in paediatric populations, with their occurrence in adults being uncommon and often posing diagnostic challenges. The authors present a case of a 31-year-old male who presented with intermittent abdominal pain, fever, and umbilical discharge. Imaging studies revealed an infected urachal sinus. The patient was treated with broad-spectrum antibiotics followed by surgical excision of the sinus tract. He recovered uneventfully and remained asymptomatic at follow-up. It is important to consider urachal anomalies in the differential diagnosis of umbilical discharge and abdominal pain in adults. Early diagnosis and appropriate surgical intervention are essential to prevent complications and ensure optimal patient outcomes.

Pigmented Epidermoid Cyst: A Report of Two Cases

Meryl Saji Kottarathil, Leena Dennis Joseph, Mohanapriya, Madhu Ramasundaram, Archana Balasubramanian Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Epidermoid cysts are benign cystic lesions of the hair follicular infundibulum. Commonly found in hair-bearing regions of the body, these lesions frequently occur among young adults. Epidermoid cysts can occasionally be pigmented because of the presence of melanin. This pigmentation is observed in both intact cysts and cysts that have ruptured, showing adjacent foreign body giant cell reaction and macrophage infiltration. Published literature documents that pigmentation in epidermoid cysts is more common among individuals with deeply pigmented skin. The nature of the pigment can be confirmed through special stains or immunohistochemical analysis, which highlights melanocyte proliferation in the basal layer. Presented below are two cases of pigmented epidermoid cysts diagnosed by the authors at their institution. The first patient was a 32-year-old male who presented with complaints of swelling on the extensor aspect of his left forearm. The second patient was a 14-year-old girl with complaints of swelling on her scalp. Both patients underwent wide local excision of the lesions, and histological examination revealed epidermoid cysts containing sheets of pigment-laden macrophages and multinucleated giant cells adjacent to a focus of cyst discontinuity. The nature of the pigment was confirmed to be melanin by a melanin bleach reaction, which showed complete removal of the pigment. These two cases are documented due to their unique histology and the potentially common oversight of pigmented epidermoid cysts.

Management of a Gluteal Abscess through Kshara Taila Gauze Packing: A Case Report

Kamal Sahu, Pooja Shrivastav Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Intramuscular injections can sometimes lead to serious complications, such as abscess formation, particularly in the gluteal region. A 27-year-old female presented with a gluteal abscess at the injection site, exhibiting pain, swelling, and pus discharge. Standard treatments, such as Incision and Drainage (I&D), often cause significant pain and carry a risk of recurrence. In the present case, a novel Ayurvedic approach was employed, involving irrigation of the abscess with Kshara Jala (an alkaline solution) and packing with Kshara Taila, a medicated sesame oil infused with alkaline herbal extracts. Over a 28-day treatment period, the patient demonstrated complete symptom resolution: pain decreased by day 8, pus discharge ceased by day 9, granulation tissue formed by day 7, and full healing was achieved by day 28. No recurrence was noted on follow-up, suggesting that Kshara Taila may be an effective alternative for managing postoperative abscesses with less pain and discomfort.

Pentafurcation of Coeliac Trunk with Accessory Hepatic Arteries and Replaced Middle Colic Artery: A Cadaveric Case Report

Jayasree Srinivasan, Dinesh Kumar, Dharmaraj Tamgire Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X The present report documents a rare case of Coeliac Trunk (CT) pentafurcation identified during routine cadaveric dissection in a male cadaver of approximately 60 years of age, with the CT giving rise to five distinct branches: the Left Gastric Artery (LGA), Common Hepatic Artery (CHA), Splenic Artery (SA), and both the Right and Left Inferior Phrenic Arteries (RIPA and LIPA). Additional notable arterial variations included the presence of accessory left and right hepatic arteries, as well as a replaced Middle Colic Artery (rMCA) originating from the SA, deviating from classical vascular anatomy. Such complex configurations carry significant clinical implications for hepatobiliary, pancreatic, and gastrointestinal surgery, where unexpected vascular routes can affect organ perfusion and complicate surgical intervention. Recognition of accessory hepatic and cystic arteries is particularly vital in procedures involving the porta hepatis and gallbladder, while aberrant mesenteric branching necessitates careful planning during colonic and pancreatic resections. Preoperative detection of these anomalies using advanced imaging modalities is crucial to mitigating intraoperative risks, preventing ischaemic complications, and optimising outcomes in transplantation and oncologic surgery. The present case underscores the necessity for heightened anatomical awareness and individualised operative strategies in the presence of rare vascular variants, thereby serving as a valuable reference for clinicians and anatomists striving for excellence in patient safety and surgical precision.

Unveiling Superior Vena Cava Syndrome in a Case of Recurrent Pulmonary Tuberculosis: A Case Report

Tamizharasan Masilamani, Subramanian Suriyan, Nagarjun, Muthu, Shaz Assain Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Superior Vena Cava Syndrome (SVCS) is a rare but potentially life-threatening complication of lung cancer. It is most frequently caused by mechanical obstruction of the Superior Vena Cava (SVC) due to extraluminal compression by intrathoracic malignancies. Intraluminal obstruction of the SVC can occur due to thrombus formation, often associated with indwelling central venous catheters or pacemaker leads. The authors present a case report of an unusual presentation of SVCS in a 66-year-old male follow-up patient with recurrent pulmonary tuberculosis who was on anti-tuberculosis therapy and was later diagnosed with co-existent adenocarcinoma of the lung. The present case underscores the importance of considering malignancy as a potential cause of SVCS in patients with complex medical histories, including prior tuberculosis, and highlights the need to explore different aetiopathogenesis in venous thrombus formation, particularly its occurrence as a paraneoplastic phenomenon.

Pelvic Fibromatosis Following Total Abdominal Hysterectomy with Bilateral Salpingo-oophorectomy: A Case Report

Sagar Sarvaiya, Pratik Shaparia, Vaishakhi Shah Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Desmoid tumours, also known as aggressive fibromatosis, are rare, benign, non-inflammatory, fibroblastic tumours. They are characterised by locally aggressive behaviour and a high potential for recurrence, but they do not metastasise. Here, the authors report the case of a 51-year-old female who presented with a lump in the lower abdomen for one month. The patient had a history of exploratory laparotomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy for ovarian cystadenocarcinoma 15 years earlier. Following Ultrasonography (USG) and Contrast-Enhanced Computed Tomography (CECT) of the abdomen and pelvis, an exploratory laparotomy was performed, and a mass that was free from adjacent structures was excised. Histopathological examination revealed benign desmoid-type fibromatosis with osseous and chondroid metaplasia. The patient was discharged uneventfully. The current incidentally detected desmoid-type fibromatosis with osseous and chondroid metaplasia highlights the importance of vigilant follow-up and consideration of diverse pathologies, even in low-risk clinical scenarios.

Anaemic Retinopathy as a Rare Sequela of Gastrointestinal Haemorrhage: A Case Report

N Gayathri, R Malarvizhi, S Fahima Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Anaemia is defined by a low count of healthy red blood cells, low haemoglobin levels, or both. Anaemic retinopathy is most likely to present in cases of severe anaemia. Although uncommon, anaemic retinopathy may initially be asymptomatic and can progress into a sight-threatening condition. Hereby, the authors present a case report of a 40-year-old male presented to the Outpatient Department with complaints of sudden, painless loss of central field of vision in the Right Eye (RE) for the past three months. He had six episodes of haematemesis and two episodes of melena three months ago. He was a known chronic alcoholic for four years. His Best Corrected Visual Acuity (BCVA) in the RE was 6/36 with Pinhole Not Improving (PH NI); in the Left Eye (LE), the BCVA was 6/6, N6. The anterior segment showed tarsal conjunctival pallor, and fundus examination of both eyes revealed white-centred haemorrhages (Roth spots) with a pre-retinal macular haemorrhage in the RE. Complete Blood Count (CBC) showed haemoglobin of 7.6 g/dL, White Blood Cell (WBC) count of 3,500 cells/cu.mm, and a peripheral blood smear suggestive of microcytic hypochromic anaemia. Endoscopy showed Grade 2 oesophageal varices with severe portal hypertension. The patient was treated with parenteral iron therapy, nutritional supplements, and underwent endoscopic band ligation for oesophageal varices. After one month of follow-up, the patient’s BCVA improved to 6/6 in both eyes, with haemoglobin of 10 g/dL. Fundus examination showed resolution of sub-inner Limiting Membrane (ILM) macular haemorrhage in the RE, along with resolution of Roth spots in both eyes. The present case is unique because retinopathy secondary to acute gastrointestinal bleeding from oesophageal varices has rarely been reported. The combination of haematological and portal hypertensive factors appears to be the underlying mechanism, and prompt management with iron supplementation and endoscopic variceal ligation led to resolution of retinal pathology. This highlights a novel association between systemic management of portal hypertension and ocular outcome.

A Case of Calcific Metamorphosis in Trauma-affected Maxillary Anteriors: A Guided Approach for Success

Pushpal Ingle, Srinidhi Surya Raghavendra Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Pulp Canal Obliteration (PCO) is a frequent sequela of dental trauma that is defined by the radiographic presentation of augmented dentin deposition, which results in partial or total reduction of the pulp chamber and canal system. While usually asymptomatic, PCO may complicate subsequent endodontic treatment, especially when traditional techniques are used to navigate the calcified canals. Conventional approaches are dependent on the expertise of the clinician and are often associated with risks like perforation and unnecessary removal of tooth structure. Static Guided Endodontics (GE) is a new approach to treating such difficult cases. This method combines Cone-Beam Computed Tomography (CBCT) imaging with Computer-Aided Design (CAD) and 3D printing to create a custom-made guide that guides the access preparation with greater accuracy. By offering a pre-determined path to the canal, static GE reduces the risk of iatrogenic mistakes and enhances overall treatment results. This case report describes the treatment of a 19-year-old male with a history of dental trauma who presented with pain, swelling and discolouration of 11 and tenderness with respect to 21. Clinical and radiographic findings showed calcified canals and apical changes, leading to a diagnosis of pulp necrosis with PCO. GE treatment was planned. The report outlines the diagnostic procedure, planning, and implementation of the treatment.

Preauricular Epidermoid Cyst and it’s Surgical Management: A Rare Case Report

Shaheera Tarnoom, MK Rajasekar Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Preauricular epidermoid (keratinous) cysts are uncommon benign lesions that clinically resemble inflammatory or infectious conditions, such as abscesses, salivary gland pathology, or congenital sinuses, often resulting in misdiagnosis and delayed treatment. Early recognition is critical to prevent complications and unnecessary interventions. Hereby, the authors present a rare case of a 23-year-old male who developed a progressively enlarging swelling in the preauricular region, which acutely became painful, erythematous, and tender, with a central punctum discharging keratinous material. Although the clinical features initially suggested an abscess, the superficial location, absence of a sinus tract, and characteristic cyst contents raised suspicion of an infected epidermoid cyst. The patient was treated with antibiotics to control infection, followed by complete surgical excision under local anaesthesia. Intraoperative findings revealed a cystic mass containing laminated keratin debris, and histopathological examination confirmed the diagnosis of an epidermoid cyst lined by stratified squamous epithelium. The postoperative course was uneventful, with no recurrence at 12-month follow-up. Reporting present case is important due to the rarity of preauricular localisation and its clinical mimicry of other pathologies, particularly parotid abscesses and branchial cleft anomalies, which can lead to inappropriate management. The present case highlights the significance of considering epidermoid cysts in the differential diagnosis of preauricular swellings and reinforces that infection control followed by complete excision of the intact cyst capsule is crucial for optimal outcomes. Awareness of this entity may guide clinicians toward timely diagnosis, prevent recurrence, and avoid unnecessary imaging or invasive procedures.

Omental Lymphatic Cyst Torsion Mimicking Urinary Retention: Case Report

Swapnil Annasaheb Pattanshetti, G Sai Gayathri, Priyanka Gadvi, Tanmaya Metgud, Vidya M Mahalmani Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Omental lymphatic cysts are rare, benign intra-abdominal lesions in children that often pose diagnostic challenges due to nonspecific clinical features. We present a four-year-old male who manifested with lower abdominal pain, dysuria, and acute urinary retention, initially suspected to be due to a urinary tract infection. Radiological evaluation revealed a large suprapubic cystic lesion displacing the bladder. Exploratory laparotomy identified a torsed omental lymphatic cyst. Complete surgical excision led to full recovery. This case highlights the diagnostic dilemmas and surgical challenges associated with omental cysts in children, especially when presenting with atypical genitourinary symptoms.

Inadequate Neuromuscular Blockade Due to Donepezil During General Anaesthesia for Cataract Surgery: A Case Report

Shashikant Shankarrao Swami, Rahim Rahiman, Deepika Rani Basappakokati Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Donepezil, an acetylcholinesterase inhibitor used to treat dementia and Alzheimer's disease, can interfere with non-depolarising neuromuscular blockers by increasing synaptic acetylcholine, potentially leading to inadequate neuromuscular blockade. A 57-year-old male with Down syndrome, dementia, and chronic donepezil therapy underwent elective cataract surgery under general anaesthesia. Despite standard dosing of rocuronium, neuromuscular blockade was delayed and incomplete, requiring repeated boluses. Quantitative Train of Four (TOF) monitoring revealed resistance to non-depolarising muscle relaxants, likely due to donepezil-induced acetylcholinesterase inhibition. Rapid recovery occurred despite Chronic Kidney Disease (CKD) Stage 3, and reversal with sugammadex was successful. This case highlights the importance of neuromuscular monitoring and tailored anaesthetic planning in patients on cholinesterase inhibitors.

Ayurvedic Modalities in the Management of a Suspected Hailey-Hailey Disease: A Case Report

Mahesh Sharma, Sourabh Deshmukh, Rohit Waskar, Trupti Thakre Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Hailey-Hailey Disease (HHD), or familial benign chronic pemphigus, is a rare autosomal dominant genetic disorder caused by mutations in the ATP2C1 gene, leading to impaired calcium homeostasis in the Golgi apparatus. A 28-year-old male presented with recurrent painful blisters, erosions, and crusting in the axillary region, accompanied by intense pruritus and burning sensation, persisting for two years. Diagnosis was clinically established based on characteristic lesions in intertriginous areas and a positive family history. This case explores an integrative treatment approach combining Ayurvedic and modern dermatological approaches and highlights the potential of evidence-based integrative management in HHD.

Mandibular Osteosarcoma: A Case Report on Physiotherapeutic Rehabilitation

Shivani Nathe, Subrat Samal, Neha Chitlange Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Osteosarcomas are aggressive malignant bone tumours that rarely affect the jaw in comparison to long bones. When these tumours impact the mandible, they present distinct challenges, necessitating not only complex surgical procedures but also causing significant functional and psychological impairment. Surgical management, such as mandibular reconstruction, frequently results in reduced jaw mobility, decreased mastication, changed speech, persistent discomfort, and mental anguish, all of which have a substantial influence on daily life and social interaction. Physiotherapeutic rehabilitation is essential for regaining function, avoiding subsequent problems, and fostering psychological adaptation. This case report describes a systematic physical therapy regimen designed specifically for a patient who had mandibular reconstruction after osteosarcoma resection. The rehabilitation strategy included targeted jaw mobility exercises, muscle strengthening, soft-tissue treatments, and speech-focused therapy, as well as counselling to address psychosocial issues. Improved mandibular function, less discomfort, improved masticatory efficiency, better speech articulation, and increased psychological resilience were noted. The findings emphasise the need for an integrated physiotherapy strategy in maximising recovery and guaranteeing long-term functional and emotional well-being in patients with jaw osteosarcoma.

Epidermoid Cyst of the Buccal Mucosa: A Case Report and Review of Literature

Aayushi Pakhale, Samiha Jameel Ahmed Khan, Alka Hande, Swati Patil, Archana Sonone Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Epidermoid Cysts (ECs) are rare, benign cystic lesions that result from surface epithelium entrapment or, more frequently, from abnormal infundibular epithelium repair following a flare-up of follicular inflammation. They occur anywhere on the body, but are more commonly found on the neck, scalp and torso. In the head and neck region, ECs constitute 7% out of which only 1.6% are reported in the oral cavity. The most common sites for oral ECs include the floor of the mouth, lips, palate, tongue and jaws. Here, we present a case of EC of the buccal mucosa in a 21-year-old male. The patient reported with a swelling on the right buccal mucosa. After clinical examination, it was diagnosed as a cystic lesion. The lesion was excised under general anaesthesia. Histopathological examination showed the presence of keratinised stratified squamous epithelium and a cystic lumen filled with keratin. There was no evidence of dermal appendages. Hence, a final diagnosis of EC of the buccal mucosa was made. The ECs are common in the skin (scalp, back, trunk) but rare in the oral cavity. The novelty of the case lies in the extremely rare intraoral occurrence of an EC in the buccal mucosa, a site seldom reported in the literature. Thereby, highlighting the importance of considering this entity in the differential diagnosis of buccal swelling like mucocoele, lipoma, fibroma and minor salivary gland adenoma.

Chondroid Lipoma Arising over the Plantar Aspect of Right Foot: A Case Report

Ramya Banage, Vishnu Prakasam, Anish Chandran, Sushma Pabbisetty, Muthu Sudalaimuthu Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Chondroid lipoma is a rare benign soft-tissue tumour characterised by the presence of both mature adipose and chondroid-like extracellular matrix components. We present the case of a 34-year-old male who reported a slow-growing, painless swelling on the plantar aspect of the right foot evolving over two years, with a history of preceding trauma. The swelling was associated with sharp, pricking pain exacerbated by walking and relieved on rest in the last eight months. The patient had no similar lesions elsewhere and was newly diagnosed with diabetes without other comorbidities. Clinical evaluation and imaging are crucial for diagnosis, given the rarity and non-specific presentation of this tumour, especially at the uncommon plantar foot location, which can mimic other soft tissue masses. Magnetic Resonance Imaging (MRI) plays a significant role in delineating the tumour's extent and composition, aiding in surgical planning. Histopathological examination confirms the diagnosis by revealing a biphasic pattern of mature adipocytes mixed with chondroid areas devoid of malignant features. Complete surgical excision is the treatment of choice, with an excellent prognosis and a low likelihood of recurrence. This case underscores the importance of considering chondroid lipoma in the differential diagnosis of slow-growing, painful swellings in the foot, especially post-trauma, to avoid misdiagnosis and ensure appropriate management. Awareness of this rare entity enables clinicians to differentiate it from more aggressive neoplasms and tailor treatment accordingly, leading to better patient outcomes.

Lumbar Spine Pseudogout Mimicking Disc Prolapse and Radiculopathy: A Rare Case Report

Aishwarya Manish Bhaskare, Maithili Mandar Kulkarni, Shital Gosavi, Jaai Naiknavare, Siddhi Gaurish Sinai Khandeparkar Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Calcium Pyrophosphate Dihydrate (CPPD) deposition disease, also known as pseudogout, is a crystal-induced arthropathy that primarily affects larger, weight-bearing joints such as the knees, hips, and shoulders. CPPD can present with a wide spectrum of clinical manifestations, ranging from asymptomatic chondrocalcinosis to acute inflammatory arthritis. CPPD in the spine is rare and can lead to calcification of the ligamentum flavum, potentially causing spinal cord compression, myelopathy, and significant neurological impairment. The absence of chondrocalcinosis on imaging does not rule out the diagnosis of spinal CPPD. On microscopy, CPPD is characterised by rhomboid-shaped, positively birefringent crystals, in contrast to the needle-shaped, negatively birefringent crystals observed in gout. The present case report of a 78-year-old female highlights a rare and isolated clinical presentation of CPPD causing lumbar spine myelopathy, which was discovered incidentally on histopathology after spinal decompression and discectomy surgery. Although imaging modalities may raise suspicion for CPPD by revealing chondrocalcinosis, they often lack the specificity to differentiate it from other degenerative or inflammatory conditions. Histopathological analysis and polarised microscopic examination remain the cornerstones in diagnosing CPPD, even in atypical clinical presentations or ambiguous imaging findings. This underscores the importance of including pseudogout in the differential diagnosis of lumbar myelopathy, particularly in elderly patients, to provide early, targeted treatment and prevent severe irreversible neurological deficits.

Filiform Polyposis (A Rare Form of Pseudopolyps) with Co-existing Cytomegalovirus Infection in a Case of Ulcerative Colitis

Akruti Mishra, Ranjana Giri, Pranati Misra, Arunima Aishwariya Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Filiform Polyposis (FP) is a rare form of pseudopolyps, occurring most commonly in the large intestine. It usually occurs as a rare complication of inflammatory bowel disease (Crohn’s disease or, more commonly, ulcerative colitis). But it can also occur in other chronic inflammatory or infectious diseases affecting the large bowel. Most common locations are the rectum and sigmoid colon for FP, but they can involve any length of the large intestine. They can occur as finger-like projections, sometimes with interconnections and can affect the entire colonic mucosa in a diffuse manner. Colonoscopy is the usual and most common modality for diagnosis. They are known to occur as a reparative process to chronic inflammatory conditions affecting the bowel. Inflammatory Bowel Disease (IBD) patients harbouring Cytomegalovirus (CMV) infection can also predispose the colonic mucosa to develop FP. Management usually depends on the symptoms. Surgical management is restricted in cases of complications like intestinal obstruction or bleeding and pain. Here, we report a case of a 55-year-old male with pre-existing ulcerative colitis with co-existing CMV infection, now presenting with severe intestinal obstruction. Colonoscopy revealed many polypoidal projections involving the rectum and sigmoid colon, following which he underwent subtotal colectomy. The colon specimen histopathologically revealed to have multiple interconnecting polypoidal projections lined by normal colonic mucosa with areas of chronic inflammatory changes, which was confirmed to be FP in a known case of ulcerative colitis. Though FP has no malignant potential, it can lead to intestinal obstruction and other complications, making routine follow-up necessary for patients with IBD.

Late Presentation of Tetralogy of Fallot with Major Aortopulmonary Collateral Arteries in the Postpartum Period: A Case Report

Priyanka Kalpesh Negandhi, Shilpa Gaidhane, Karan Singh, Raj Soni, Akshay Padwal Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Tetralogy of Fallot (TOF) with Pulmonary Atresia (PA) and Major Aortopulmonary Collateral Arteries (MAPCAs) represents the most severe expression of TOF. In this condition, instead of pulmonary stenosis, there is complete pulmonary valve atresia. Consequently, blood flow to the lungs occurs through collateral vessels that arise from the systemic circulation. The survival rate for patients with TOF and MAPCAs without surgery is low: approximately 50% at one year and 8% at 12 years. TOF accounts for about 3.5% of all congenital heart diseases, occurring in one in 3,600 live births, or 0.28 per 1,000 live births. Both genders are equally affected. Most patients present with symptoms in early childhood, which include fatigue, cyanosis, and shortness of breath, necessitating prompt medical intervention. The present case report is of a 25-year-old female who remained asymptomatic until the postpartum period of a third pregnancy.

Torsion in an Ectopic Testis: A Case Report

B Jagdish, Rajat Piplani, Poonam Sherwani, Sarita Syal, Soumya Kashiv Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Torsion of an ectopic testis represents a rare but clinically significant condition, often complicated by its atypical anatomical location and the resulting diagnostic uncertainty. Because the testis lies outside the normal scrotal position, classical signs of testicular torsion may be absent or misleading, contributing to delay in recognition and definitive management. We describe the case of an adolescent male who presented to the emergency department with a four-day history of progressively worsening right inguinal pain and swelling, accompanied by a known history of an empty right hemiscrotum since birth. This case underscores the importance of considering torsion of an ectopic or undescended testis in the differential diagnosis of acute inguinal or lower abdominal pain, especially in pediatric and adolescent patients with an empty hemiscrotum. Failure to recognise this possibility can result in irreversible testicular damage and subsequent loss. Moreover, the report highlights the critical value of Doppler ultrasonography as a non-invasive, rapid, and accessible diagnostic tool that can provide essential information regarding testicular perfusion and guide urgent surgical decision-making. Enhanced awareness of this uncommon presentation may contribute to earlier detection, timely management, and improved clinical outcomes in similar cases.

Myeloid Sarcoma: A Series of Five Cases from a Tertiary Care Centre in Tamil Nadu, India

D Saranya, S Preetha, P Vijayabaskar, S Gomathi, P Vinodhini Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Myeloid Sarcoma (MS) constitutes a rare extramedullary manifestation characterised by the clonal proliferation of myeloid precursor cells. It may present in association with Acute Myeloid Leukaemia (AML), Myelodysplastic Syndromes (MDS), or Myeloproliferative Neoplasms (MPN), or as an isolated entity. Its variable morphology and frequent absence of a prior haematological history present a significant diagnostic challenge. This report delineates five cases of MS diagnosed at our tertiary care centre between July 2023 and June 2025. All patients were male, with a median age of 36 years. Affected anatomical sites included soft tissue (n=2), bone (n=1), lymph node (n=1), and testis (n=1). Two patients had an underlying diagnosis of Chronic Myeloid Leukaemia (CML). Histopathological evaluation consistently revealed blastic morphology, often closely mimicking lymphoma or small round cell tumours. Immunohistochemistry (IHC) proved indispensable for definitive diagnosis, with all cases demonstrating positivity for CD34 and Myeloperoxidase (MPO). Notably, one case also exhibited CD99 and FLI-1 expression, thereby creating diagnostic overlap with Ewing sarcoma. This case series highlights the diverse presentations and inherent diagnostic pitfalls of MS, emphasising the importance of considering MS in the differential diagnosis of extramedullary masses and employing judicious IHC, particularly MPO and CD34, to ensure accurate diagnosis.

Acute Onset Pneumonia with Scrub Typhus in the Peripartum Period: A Case Report

Akella Manasa Alekhya, Neema S Acharya, Megha Karnik, Sachin Rathod, Sourya Acharya Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Scrub typhus is a major contributor to acute fevers throughout endemic areas of Asia. This condition is triggered by Orientia tsutsugamushi, transmitted by the bite of infected chigger larvae (Leptotrombidium mites). In the present case report 26-year-old primigravida presented to the Outpatient Department with acute intermittent fever and dyspnoea. Following a thorough clinical evaluation and differential exclusion, the patient was diagnosed with scrub typhus pneumonia-an atypical manifestation of scrub typhus, which is commonly associated with eschar formation and maculopapular rashes. The patient demonstrated significant improvement with multidisciplinary intervention, rapid diagnostic measures, and prompt therapeutic management. In the literature, scrub typhus presenting as acute pneumonia in the peripartum period is extremely uncommon, making this case unique for its presentation during labour and absence of classical features. This case underscores the importance of considering scrub typhus as a differential in endemic regions, even in the absence of characteristic clinical markers, and highlights the need for early serological testing and timely therapy.

Unveiling the Uncommon: A Rare Encounter of Solid Pseudopapillary Neoplasm of Testis

Nashna Nassar, Subin R Mullamala, Neetha Unnikrishnan, V Letha Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Solid Pseudopapillary Neoplasm (SPN) of the pancreas is a rare and intriguing entity within the spectrum of pancreatic neoplasms, accounting for approximately 1-2% of all pancreatic tumours. Extra-pancreatic SPN is even rarer. It has been reported in locations such as the mesocolon, ovary, retroperitoneum, paratesticular region, and others. A case of extra-pancreatic SPN of the testis was reported in the Department of Pathology, Government Medical College, Kottayam, in 2024. A 48-year-old male presented with a right hemiscrotal swelling of one-year duration, with normal serum tumour markers and laboratory investigations. Radiological evaluation (MRI and Doppler ultrasound) suggested a neoplastic aetiology, and the patient underwent high inguinal orchidectomy. Histopathological examination revealed morphological features consistent with SPN, supported by immunohistochemical findings.

Enhancing Perio-aesthetics using Lip Repositioning Technique: A Case Series

Nishi Tanwar, Aparna Kaushik, Chander Parkash, Geetanjali Sharma, Anjali Yadav Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Individuals’ perceptions of self-confidence, trustworthiness, attractiveness, intelligence, and friendliness are negatively influenced by Excessive Gingival Display (EGD). Perio-aesthetics focuses on the factors that contribute to a beautiful smile by improving the balance between the pink (gingival) and white (teeth) components of the dentition. Lip repositioning is a surgical technique used to correct excessive gingival display. The present case series includes three young female patients with excessive gingival display (5-6 mm) to assess the outcomes of the lip repositioning technique. Lip Repositioning Surgery (LRS) was performed after Phase I therapy. Aesthetic crown lengthening and gingival depigmentation were also performed wherever required to correct short clinical crown lengths and gingival pigmentation. Patients were recalled at 6 months. Gingival Display (GD) was assessed presurgically, postsurgically, and at six months. There was a significant improvement in GD at maximum smile at six months, with high patient satisfaction regarding smile enhancement.

Duodenojejunal Flexure Perforation Following Blunt Abdominal Trauma: A Series of Three Surgically Confirmed Cases

Namdev Seth, Mayank Srivastav, Saumya Verma, HariKesh Yadav Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Duodenojejunal (DJ) flexure perforation due to blunt abdominal trauma is a relatively uncommon condition, but it carries significant morbidity and mortality. Such cases are challenging to diagnose due to their subtle presentation and retroperitoneal location. This case series presents three surgically confirmed cases of DJ flexure perforation, each demonstrating distinct radiological findings on Contrast-Enhanced Computed Tomography (CECT). Key imaging features included free intraperitoneal air, bowel wall thickening, mesenteric fat stranding, and intramural haematoma. The cases underscore the importance of maintaining a high index of suspicion in trauma patients with vague abdominal symptoms. Early identification of these radiological signs led to timely surgical interventions, resulting in favourable outcomes. Through detailed imaging and clinical correlation, this series provides valuable insights for radiologists and emergency clinicians, emphasising the critical role of CECT in diagnosing traumatic bowel perforations at anatomically complex regions like the DJ flexure. Improved awareness and interdisciplinary coordination can significantly enhance early detection and reduce complications from delayed treatment.

Diabetic Amyotrophy (DA) with Diabetic Neuropathic Cachexia (DNC): An Underrated Combination

Sourya Acharya, Samarth Shukla Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Amongst the myriad neuropathic variants of diabetes mellitus, Diabetic Amyotrophy (DA) and neuropathic cachexias are rare complications. DA was first defined in the year 1980 and goes by the name ‘Bruns-Garland syndrome and diabetic lumbosacral radiculoplexopathy’. Diabetic Neuropathic Cachexia (DNC) is a rare form of peripheral neuropathy. It is characterised by weight loss, sleep disorders, severe muscle wasting involving the femoral regions bilaterally associated with burning pain and allodynia.

Chronic Knee Pain in a Young Adult: Unmasking a Synovial Haemangioma after a Decade

Srilakshminagasaikrishnapraneeth Addagarla, Subhalakshmi Kumaran, Madhu Sowmitha Pachipala, Kirthi Sathyakumar Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X A 21-year-old male presented with complaints of pain in the left knee for the past 10 years. The pain was insidious in onset, persistent, non-radiating, and had worsened over the last two months, particularly during weight-bearing and knee movements, with no identifiable relieving factors. There were no similar symptoms in the contralateral knee. The patient was not diabetic or hypertensive and had no history of smoking, alcohol use, or any significant past medical history. General examination was unremarkable.

Perforating Folliculitis: A Transepidermal Elimination Disorder

Balakumaran, Sukanya Mathupal, G Gowripriya, Madhumita Rajmohan Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X A 62-year-old male presented with complaints of dark, raised, pruritic lesions over bilateral upper and lower limbs for two months. The lesions initially started on the legs and were associated with pruritus and gradually progressed to involve the entire upper and lower limbs. The patient gave a 10-year history of uncontrolled diabetes, treated with oral hypoglycaemics and a 5-year history of chronic kidney disease. On examination, the patient exhibited multiple hyperpigmented papules and nodules over the bilateral upper and lower limbs (Table/Fig 1).

Clinical Presentation and OPG Features of Ameloblastoma

Rutumbara Dhone, Vidya Lohe, Mrunal Meshram Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X A 52-year-old male presented to the Department of Oral Medicine and Radiology with a chief complaint of swelling in the mandibular incisors and the right and left canine regions of the jaw, which had persisted for 2-3 months. The patient first noticed swelling in the same area 8-10 years ago, which tended to increase in size over time. Seven to eight years earlier, the right mandibular premolar and molar were extracted.

Clinical Image of the Rare Co-existence of Amyand’s and Littre’s Hernia

Tushar Nagtode, Shubham Bobade Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X A 70-year-old male presented to the Department of General Surgery with a chief complaint of a reducible swelling in the right inguinal region, which had been progressively increasing over the past 10 years. Occasionally, the patient experienced discomfort in the same region. He had no history of trauma, systemic illness, or prior surgeries, but reported a history of strenuous physical activity for nearly 30 years. There was no history of abdominal pain, vomiting, or constipation. On examination, a soft, reducible swelling with a positive cough impulse was noted in the right inguinal region. Based on the clinical findings, a diagnosis of right reducible inguinal hernia was made.

Correspondence: A Letter to Editor Regarding Evaluation of the Prescription Pattern of Drugs used in the Treatment of Pelvic Inflammatory Disease at a Tertiary Care Hospital in Pune: A Cross-sectional Study

Nitin Chintaman Gawari, Sujata Prakash Shingare Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Dear Editor, The authors of this letter recently reviewed the article titled “Evaluation of the Prescription Pattern of Drugs Used in Treatment of Pelvic Inflammatory Disease at a Tertiary Care Hospital in Pune: A Cross-sectional Study,” published on November 1, 2025, in the Journal of Clinical and Diagnostic Research (JCDR) (1).

Revolutionising Human Identification in Forensic Odontology Using the Selfie Forensic ID App

Krishnanand P Satelur, Vidya Mallipattana Annegowda Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Dear Editor, Human identification using a mobile application was first proposed in 2018 as a tool to capture and archive selfie images of smiles and anterior teeth through social media platforms such as Instagram, Tumblr and Twitter, for use as potential antemortem dental data in human identification. The application includes features such as grids for standardised photography, passport photo creation, mirror functions and emergency alerts with geolocation, aimed at facilitating the search for missing or unidentified persons.

Correspondence: 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

Kundan Mehta, Somireddy Navothna, Madhu Sudan Barthwal Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X

Effectiveness of Diaphragmatic Breathing Exercises on Cardiopulmonary Endurance and Perceived Exertion in Patients with Pulmonary Cancer: A Quasi-experimental Study

Jagurothula Bhaskara Rao, Kshitija Bansal Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Lung cancer contributes to the worsening of a patient’s respiratory condition by causing cardiopulmonary fatigue and increasing the effort to perform tasks. Supportive care includes exercises for the diaphragm like Diaphragmatic Breathing Exercises (DBE) to alleviate some of these symptoms. Aim: The present study investigates the efficacy of DBE in improving cardiopulmonary endurance measured by maximal oxygen uptake (VO₂ max) and reducing Perceived Exertion (PE) by using Borg Scale in patients with stage II and III lung cancer. Materials and Methods: This quasi-experimental study was conducted as a pre-post quasi-experimental design in collaboration with City Cancer Hospital, Vijayawada; Mahatma Gandhi Hospital, Visakhapatnam, Andhra Pradesh, India and other regional cancer centres for a period of one year from June 2023-May 2024, with a sample of 35 patients with lung cancer (stage II: n=16; stage III: n=19) from cancer hospitals in Vijayawada and Visakhapatnam. The patients underwent guided DBE training four times a day for five days a week. The study measured VO₂ max for cardiopulmonary endurance and the modified Borg Rating of Perceived Exertion (RPE) for exertion. The descriptive statistics were summarised for the demographic variables and the pre- and post-intervention changes within and between groups were assessed using Student’s t-test with statistical significance set at p-value <0.05. Results: The maximum number of patients belonged to the 45-49 years age group (54.3%) among the recruited patients, with 51.4% being males. A significant improvement was observed in VO₂ max for both stages. Stage II participants had VO₂ max of 31.69 mL/kg/min, which improved to 35.47 mL/kg/min (p-value <0.001). Stage III participants had VO₂ max of 31.67 mL/kg/min, which improved to 35.33 mL/kg/min (p-value <0.001). Furthermore, RPE showed significant changes as well; stage II participants from 3.63 to 2.50 and stage III participants from 4.26 to 2.37, both with p-value=0.001. Conclusion: In patients with stage II and III lung cancer, DBE markedly improved cardiopulmonary function and reduced PE. It is a worthwhile investment and a physiologically beneficial intervention across various stages of the disease.

Evaluation of Efficacy and Usability of mHealth Applications in Management of Neck Pain: A Scoping Review

Juhi Kiran Bharnuke, Twinkle Yogesh Dabholkar Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Neck pain is a prevalent condition that contributes significantly to disability worldwide. Traditional management often involves pharmacological treatments and physical therapy; however, adherence to home exercise programs remains a major challenge. The rise of mobile Health (mHealth) applications offers a novel solution, with the potential to enhance adherence and support self-management of neck pain. Aim: To evaluate and synthesise existing literature on the efficacy, usability, and potential benefits of mHealth applications for pain management, functional recovery, and overall health status in individuals with neck pain. Materials and Methods: The present comprehensive literature search for this scoping review was conducted across PubMed, Embase, ProQuest, and Google Scholar, covering studies published from 2004 to 2024. Inclusion criteria comprised randomised controlled trials, pre-post study designs, and cohort studies assessing mobile applications delivering exercises for neck pain. Parameters analysed in the review included neck pain, neck function, health status, and app usability. Results: Eleven studies met the inclusion criteria, with eight reporting significant reductions in pain through the use of mHealth applications. Exercises delivered via the apps ranged from neck mobility routines to postural re-education programs. Improvements were observed in pain intensity (measured by Numeric Pain Rating Scale (NPRS) and Visual Analog Scale (VAS), neck function (measured by Neck Disability Index (NDI) and Patient Specific Functional Scale (PSFS), and overall health status (measured by MUSCULOSKELETAL HEALTH QUESTIONNAIRE (MSK-HQ) and Short Form(SF) -36). High patient satisfaction and adherence were reported in multiple studies, supporting the usability and effectiveness of these interventions. Conclusion: mHealth applications show significant potential in enhancing neck pain management by improving adherence to therapeutic exercise programs. Their integration into clinical practice may offer a more personalised and accessible approach to rehabilitation, ultimately improving patient outcomes and quality of life.

Impact of Social Media Addiction on Academic Procrastination among College Students: A Cross-sectional Study from Chengalpattu, Tamil Nadu, India

S Devadharshini, R Kalaivanan, M Logaraj, VV Anantharaman, BG Shakthi Chakravarthy Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: The widespread use of social media has significantly impacted the daily routines of college students. While it facilitates communication and access to information, excessive use may lead to negative outcomes such as social media addiction, reduced sleep quality, impaired academic performance, and increased levels of anxiety and depression. This, in turn, is associated with academic procrastination, delaying academic tasks and responsibilities. Both conditions can affect students’ academic performance and overall well-being. Aim: To determine the prevalence and the relationship between social media addiction and academic procrastination among college students in Chengalpattu, Tamil Nadu, India. Materials and Methods: This cross-sectional analytical study was conducted at SRM Institute of Science and Technology (SRMIST), Chengalpattu, Tamil Nadu, India, from January 2025 to March 2025 among 235 college students selected via multistage random sampling from three colleges within a multidisciplinary university. Data were collected using two validated tools: the Bergen Social Media Addiction Scale (BSMAS) and the Multidimensional Academic Procrastination Scale (MAPS-15). Data were analysed using Statistical Package for Social Sciences (SPSS) version 27.0, employing descriptive statistics, Chi-square tests, and binary logistic regression. Exploratory Factor Analysis (EFA) was performed to examine the construct validity of the scales in the study population. Results: The prevalence of social media addiction was 139 (59.1%), and academic procrastination was observed in 120 (51.1%) of students. A statistically significant relationship was identified between social media addiction and academic procrastination, with social media addicted students being 4.7 times more likely to procrastinate (OR=4.792, 95%CI: 2.716-8.457). Conclusion: The findings highlight a high burden of both social media addiction and academic procrastination among students, with a strong predictive link between the two. Targeted interventions addressing digital habits and time management may help reduce academic delays and improve student well-being.

Prevalence and Patterns of Anxiety Disorders among Rural School Students in Jammu and Kashmir, India: Insights from SCARED Questionnaire

Mohd Irshad, Yasmeena Akhter, Zainab, Rabiya Kousar, Syed Shahid Siraj Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Anxiety disorders typically begin in late childhood and manifest in most individuals by the end of adolescence. Their prevalence may be higher than reported due to internalisation of symptoms and reluctance to seek medical care, emphasising the importance of the present study. Aim: To determine the prevalence and patterns of anxiety disorders in school settings using the Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire. Materials and Methods: The present descriptive cross-sectional study was conducted at Life School in the Char-I-Sharif area of Budgam district, Kashmir division of Jammu and Kashmir, India, over a period of one month in August 2024. Data were collected by administering the SCARED questionnaire to 60 students from classes 8th to 10th, selected using stratified random sampling. Only students who were willing to participate and had no previous history of psychiatric treatment were included. All parameters of the SCARED questionnaire were assessed. Statistical analysis was performed using the Chi-square test and Fisher’s exact test. Results: A total of 60 students with uniform distribution across classes and genders were evaluated using the SCARED questionnaire. Among them, 40 students (66.66%) were older than 15 years, and the most common family type was nuclear. The prevalence of panic disorder with significant somatic symptoms, Generalised Anxiety Disorder (GAD), social anxiety disorder, separation anxiety disorder, and school avoidance was 48 (80%), 31 (51.7%), 21 (35%), 39 (65%), and 31 (51.7%) respectively. The proportion of students affected by more than one disorder varied across age groups and anxiety subtypes. A statistically significant association was found between certain anxiety subtypes and older age as well as female gender. Conclusion: The present study reports a much higher prevalence of anxiety disorders with a female preponderance in this region, highlighting the need for further studies to determine whether this finding is attributable to small sample size, ethnicity, sociocultural factors, or genetic influences.

Intraperitoneal Ropivacaine versus Levobupivacaine for Postoperative Analgesia in Laparoscopic Surgeries: A Randomised Controlled Trial

Sandip Baheti, Vaibhavi Singh Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Management of postoperative pain in laparoscopic surgeries remains challenging, often necessitating multimodal analgesic strategies to enhance patient comfort and recovery. Intraperitoneal Local Anaesthetic (IPLA) administration offers a promising approach for pain control while minimising systemic opioid use and associated side-effects. Ropivacaine and levobupivacaine are commonly used long-acting amide local anaesthetics with favourable safety profiles. Aim: The present aimed to compare the efficacy of intraperitoneal ropivacaine versus levobupivacaine for postoperative analgesia in patients undergoing elective laparoscopic surgeries. Materials and Methods: In the present double blinded, randomised controlled study, 48 patients {American Society of Anaesthesiologists (ASA) I-II, aged 18-65 years} undergoing elective laparoscopic surgeries were randomly allocated into two groups. Group R (n=24) received 20 mL 0.25% ropivacaine and group L (n=24) received 20 mL 0.25% levobupivacaine intraperitoneally before trocar removal. Postoperative pain was assessed using Visual Analog Scale (VAS) scores over 12 hours. Haemodynamic parameters, rescue analgesic requirements, and side-effects were monitored. Data were analysed using Statistical Package for Social Sciences (SPSS) version 26, with independent t-tests for normally distributed numerical variables and Chi-square tests for categorical variables, with statistical significance set at p<0.05. Results: Both groups were comparable in demographic characteristics with mean (SD) age being 35.42±10.4 and 35.04±10.8 years in group L and group R, respectively. VAS scores were similar until five hours, after which group L showed significantly lower scores upto 10 hours. Rescue analgesia requirements peaked at five hours (group L: 20.8% vs group R: 16.7%, p<0.001) with no requirements after six hours in either group. Haemodynamic parameters remained stable except for significantly lower Systolic Blood Pressure (SBP) in group L at specific time points. The side-effects were minimal. Most patients in group L (87.5%) and group R (79.2%) had no side-effects. Nausea was the same in both groups (12.5%), but vomiting (8.3%) happened only in group R. Conclusion: Both ropivacaine and levobupivacaine provide effective postoperative analgesia when administered intraperitoneally in laparoscopic surgeries. Levobupivacaine demonstrated superior pain control after five hours, making it a potentially preferable option.

A Prospective Cohort Study Comparing Retinopathy of Prematurity between Small for Gestational Age and Appropriate for Gestational Age Babies at a Tertiary Care Centre in Western Maharashtra, India

Rohit P Tiwari, Ankita T Chavan, Ashish Doshi, Manjusha Kanetkar, Prachi Agashe, Rakesh Barot Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Retinopathy of Prematurity (ROP) is a leading cause of preventable blindness in premature infants. Differences in incidence and severity between Small for Gestational Age (SGA) and Appropriate for Gestational Age (AGA) infants have been variably reported. Aim: To compare the incidence, risk factors, and clinical characteristics of ROP between SGA and AGA neonates admitted to a tertiary care hospital in Western Maharashtra. Materials and Methods: A prospective cohort study was conducted at the Department of Ophthalmology at Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital, Kalwa, Thane, Maharashtra, India, from May 2022 to May 2023. A total of 150 neonates ≤ 34 weeks GA and/or ≤ 2000 g birth weight were enrolled and classified as SGA (n=103) or AGA (n=47) using the Fenton growth chart. ROP screening was performed with the Forus Trinetra Neo fundus camera. Sample size was calculated using Cochran’s formula, and data were analysed using Statistical Package for Social Sciences (SPSS), version 26.0, with the Chi-square test, considering p-value <0.05 as statistically significant. Results: ROP was identified in 32 infants (21.33%), comprising 23 SGA (22.33%) and 9 AGA (19.14%) neonates (p-value=0.82). Prematurity, oxygen exposure, and low birth weight were the predominant neonatal contributors, while maternal hypertension and anaemia were more frequently noted among SGA pregnancies. Among infants diagnosed with ROP, 34.37% required treatment primarily intravitreal bevacizumab, whereas 65.63% demonstrated spontaneous regression. There were no statistically significant differences in ROP incidence or associated maternal and neonatal risk profiles between SGA and AGA infants, suggesting that SGA status did not independently influence ROP development in this population. Conclusion: Early screening of preterm SGA neonates is crucial to prevent ROP-related blindness, and addressing modifiable risk factors can reduce ROP-associated morbidity and improve neonatal visual outcomes. There was no statistically significant difference between the groups for ROP incidence.

Evaluation of the Anatomical Limit for Mandibular Arch Distalisation in Skeletal Class III Patients with Different Growth Patterns: A Systematic Review

Abhishree Keshan, Asmita Kharche, Sonali Deshmukh, Chaitra Mastud, Rajaganesh Gautam Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Temporary Anchorage Devices (TADs) enable distalisation of the mandibular dentition in patients with mild to moderate Class III jaw bases. The extent of distalisation is influenced by the Mandibular Posterior Anatomical Limit (MPAL), which varies with growth patterns. Aim: To evaluate and compare the MPAL across different growth patterns in skeletal Class III patients. Materials and Methods: The present systematic review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD42024616501). A comprehensive search of PubMed, Web of Science, Embase, Scopus, Cochrane Library, Google Scholar, and OpenGrey was conducted from inception up to December 2024. Following the PICOS framework: (P) adult patients with skeletal Class III malocclusion and varying vertical growth patterns; (I) no intervention, grouping by growth pattern; (C) comparisons between normodivergent, hypodivergent, and hyperdivergent patterns; (O) MPAL measured on Cone Beam Computed Tomography (CBCT); (S) observational cross-sectional studies. Extracted data was used to study measurements of MPAL in different growth patterns included reference planes, reference point and reference levels; additional parameters were third molar status, sex distribution, and racial background. Risk of bias was assessed using the Critical Appraisal Checklist of the Joanna Briggs Institute (JBI). Results: Out of 5117 studies 11 studies on class III malocclusion with varying growth patterns, used the mandibular occlusal plane as the reference. Nine studies used the Posterior Occlusal Plane (POL) as the reference line and the most lingual point of the second molar’s distal root as the reference point; five measured at the subfurcation level and six at the sub-CEJ level. Conclusion: In class III malocclusion, the MPAL distance decreases from the furcation to the apex, making apical distance critical during distalisation. The racial group of the subjects, third molar status, vertical pattern and skeletal sagittal pattern all had an impact on MPAL. Of the three development patterns, patients with hyperdivergent growth patterns have the smallest MPAL and the highest risk of cortical contact in molar distalisation, whereas those with hypodivergent growth patterns have the lowest risk.

Correlation of Serum Fetuin A with hs-CRP Levels and Lipid Profile in Assessment of Cardiovascular Risk in Hypothyroid Pregnant Females: A Cross-sectional Study

Meenakshi Puri, Roli Saxena, Richa Goel, Himanshu Madaan, Priyanka Dahiya, Sujith Vadlamudi, Anup Singh, Rajesh Kumar Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Pregnancy is associated with multiple metabolic and hormonal alterations. In India, hypothyroidism is substantially prevalent endocrinal disorder seen in pregnant women. Fetuin A is a carrier plasma glycoprotein synthesised by the liver and its reduced levels result in increased risk of peripheral arterial disease, Coronary Artery Disease (CAD) in patients with type 2 diabetes mellitus and in dialysis patients. Reduced fetuin A levels have been seen in hypothyroid females. However higher levels of proinflammatory marker high sensitivity C-Reactive Protein (hs-CRP) have been associated with hypothyroidism and also with cardiovascular disease risk. Aim: To analyse and correlate serum Thyroid Stimulating Hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4) and Anti-Thyroid Peroxidase antibodies (Anti TPO antibody), lipid profile, hs-CRP and fetuin A level in pregnant females. Materials and Methods: This cross-sectional study was conducted in Kalpana Chawla Government Medical College, Karnal, Haryana, India, from September 2022 to December 2023. The study included 160 pregnant females without any chronic disease who were investigated for TSH, fT3, fT4 and Anti TPO antibody, Lipid profile, fetuin A and hs-CRP. Statistical analysis was done using t-test, Mann-Whitney U test and Pearson correlation coefficient with p-value <0.05 as significant and p-value <0.001 as highly significant. Results: The median gestational age was 22 weeks (with IQR 11.50-32.0) in cases and 16 weeks (IQR 11.50-27.0) in controls. Fetuin A levels were lower in case group with median value of 4.98 ng/mL (IQR 2.28-10.35) versus control group with median value 5.44 ng/mL (IQR 2.75-12.24). hs-CRP levels were also higher in pregnant hypothyroid females (case group) with median value 2.89 mg/dL ( IQR 1.74-6.10) as compared to controls (median 2.32 IQR 1.74-6.46). Conclusion: There was no significant correlation of fetuin A with hs-CRP, but triglycerides, Very Low Density Lipoprotein (VLDL) and Atherogenic Index of Plasma (AIP) showed a statistically significant negative correlation with fetuin A.

Effect of Magnetic Field on Dentin Remineralisation using Magnetic Nanoparticle Incorporated Nanohydroxyapatite and Calcium Phosphate Ion Clusters: An In-vitro Study

Ram Chowdary Basam, Nagesh Bolla, Sayesh Vemuri, Roopadevi Garlapati, BS Anila, Sridevi Enuganti Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Dentin caries leads to significant tooth structure loss, especially comma where restorative access is limited. While conventional treatments replace decay mechanically, they often neglect dentin’s biological potential for remineralisation. Agents like nanohydroxyapatite, fluoride, Casein Phosphopeptide - Amorphous Calcium Phosphate (CPP-ACP), and bioactive glass can promote surface-level mineral repair but typically fall short in regenerating deeper intrafibrillar structures vital for functional dentin remineralisation. Aim: To investigate the effect of a magnetic field on dentin remineralisation using Nanohydroxyapatite (NHAP), Magnetic Nanoparticle-Enhanced Nanohydroxyapatite (MNHAP), and its combination with Calcium Phosphate Ion Clusters (CPIC). Materials and Methods: This in-vitro study was conducted at the Department of Conservative Dentistry and Endodontics at Sibar Institute of Dental Sciences in Guntur, Andhra Pradesh, India, from September 2022 to November 2022. Ninety-six dentin blocks were prepared from 48 extracted mandibular molars using a slow-speed water-cooled diamond saw. Samples were divided into four groups: Group A – Control, Group B – NHAP, Group C – MNHAP, and Group D – CPIC + MNHAP. Powder X-ray Diffraction (XRD) analysis was performed for Group D to assess particle structure and phase. Knoop microhardness, High-resolution Transmission Electron Microscopy (HRTEM), and Scanning Electron Microscopy-Energy-Dispersive X-ray Spectroscopy (SEM-EDAX) were used to evaluate dentin hardness, particle morphology, and surface elemental composition, respectively. Overall and within-group comparisons were performed using Analysis of Variance (ANOVA) and repeated-measures ANOVA, respectively, with a significance level set at p-value <0.05. Results: Microhardness varied significantly among the groups, with group D displaying the highest values (61.2067±12.15492) (p-value <0.001*). XRD confirmed the transformation of CPIC into amorphous calcium phosphate, which later converted to nanohydroxyapatite in group D. TEM revealed uniformly distributed, crystalline rod-shaped nanoparticles in MNHAP and CPIC+MNHAP samples, whereas NHAP showed needle-shaped crystals. EDAX analysis indicated the highest Ca/P ratio in group D and confirmed the presence of Fe ions in groups C and D. Conclusion: MNHAP alone and in combination with CPIC, under a magnetic field, enhanced dentin remineralisation, indicating potential applicability of magnetically assisted nanoparticle-based dentin repair.

Comparison of Intubation Conditions of Cisatracurium with and without a Priming Dose in Patients under General Anaesthesia: A Randomised Controlled Trial

Kattula Leela Krishna, Sanjot Ninave, Meenal Rajput Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Endotracheal intubation is a crucial procedure during general anaesthesia that maintain a patent airway and facilitate mechanical ventilation. Cisatracurium, a benzylisoquinolinium non depolarising neuromuscular blocker, offers advantages such as a predictable duration of action and organ-independent metabolism; however, it has a relatively delayed onset. Priming with a subparalysing dose may expedite the onset and improve intubating conditions. Aim: To compare the intubating conditions of cisatracurium with and without a priming dose in patients undergoing general anaesthesia. Materials and Methods: This randomised controlled trial was conducted from July 2023 to July 2025 at Department of Anaesthesia, Jawaharlal Nehru Medical College (JNMC) and Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, Maharashtra, India. After obtaining informed consent, 60 American Society of Anaesthesiologists (ASA) physical status I-II patients undergoing elective surgeries were enrolled. Patients were randomised and single-blinded into two groups: Group C (cisatracurium intubating dose of 0.15 mg/kg) and Group CP (a priming dose of one-fifth of 0.15 mg/kg followed by the remaining dose for intubation). The onset of neuromuscular blockade, intubating conditions, haemodynamic parameters, and adverse events were recorded. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 27.0, applying Independent samples t-tests and Chi-square tests, with p-value <0.05 considered statistically significant. Results: The demographic characteristics of the study population were comparable between Group CP (cisatracurium with priming) and Group C (cisatracurium without priming). There was no significant difference in age distribution between the two groups. Group CP demonstrated a significantly faster onset of neuromuscular blockade (116.8±13.58 seconds) compared to Group C (180.63±13.47 seconds; p-value <0.01). The duration of action was significantly shorter in Group CP (29.87±5.01 minutes) than in Group C (35.60±4.44 minutes; p-value <0.01). Ease of laryngoscopy and favourable vocal cord positioning were significantly better in Group CP (p-value=0.003 and p-value=0.0049, respectively). Haemodynamic stability and the incidence of adverse events were comparable between the groups. Conclusion: Priming with cisatracurium effectively enhances intubating conditions and shortens the onset time without compromising haemodynamic stability. It represents a safe and reliable modification in anaesthesia practice for achieving smooth and rapid intubation.

Management of Distal Radius Fractures Using Volar Locked Compression Plates: Functional and Radiological Outcomes with a Ten-year Follow-up

Sarang Shete, Shekhar Srivastav, Hemlata Khanapure Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Distal Radius Fractures (DRFs) are among the most common fractures of the upper extremity, with varying degrees of instability that significantly influence treatment outcomes. The management of unstable DRFs has evolved with the introduction of volar Locked Compression Plates (LCPs), allowing stable fixation and early rehabilitation. Aim: To evaluate the functional and radiological outcomes of unstable DRFs managed with open reduction and internal fixation using LCPs. Materials and Methods: This prospective study included 25 adult patients with unstable DRFs presenting within 14 days of injury. All patients underwent open reduction and internal fixation using volar LCPs. Fractures were classified preoperatively according to the Fernandez classification. Radiological assessment was performed at 3, 6, and 12 months to evaluate fracture union and restoration of anatomical parameters. Wrist range of motion was measured using goniometry. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire at six weeks, three months, six months, one year, and annually up to 10 years. Statistical analysis was performed using paired t-tests, with a p-value <0.05 considered statistically significant. Results: All surgical wounds healed primarily without major complications. Twenty-three fractures achieved union within three months, while two cases showed delayed union by six months. Transient median nerve symptoms were observed in two patients and resolved with conservative management. Radiological parameters demonstrated significant improvement postoperatively and were maintained throughout follow-up. Functional outcomes showed progressive improvement, with a mean DASH score of 6.85 at one year and 1.28 at ten years, which was statistically significant (p<0.001). Conclusion: Volar LCP fixation for unstable DRFs provides stable fixation, facilitates early mobilisation, and results in excellent long-term functional and radiological outcomes with minimal complications.

International Conference on Bridging Conventional and Alternative Health Care Practices: Innovative Futuristic Approach

Divya Sanghi Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X International Conference on Bridging Conventional and Alternative Healthcare Practices: An Innovative Futuristic Approach, hosted by Manav Rachna International Institute of Research and Studies (MRIIRS), Faridabad, Haryana, on the 27^th and 28^th of February 2025.

Current Utilisation and Challenges of Point-of-Care Ultrasound in Emergency Department Settings of Saudi Arabia: A Mixed Method Study

Muhammad Omer Afzal Bhatti, Majed Gorayan Alrowaili, Mujeeb Ur Rehman Parrey, Abdul Majeed Alruwaili Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Point-of-care Ultrasound (POCUS) has transformed emergency medicine by providing immediate, non invasive diagnostic imaging directly at the patient’s bedside. In Saudi Arabia, the adoption of POCUS has been gradual, with emergency physicians and trainees facing unique challenges in its implementation. Aim: To assess the current practices of POCUS utilisation in Saudi Arabia, identify the key challenges encountered by emergency physicians and trainees, and suggest effective strategies to address these obstacles. Materials and Methods: A mixed-methods approach was conducted from May to July 2025 among emergency physicians and trainees across multiple government and private hospitals in Saudi Arabia. A total of 387 participants were included. Data were collected using a self-developed questionnaire designed to capture participant demographics, POCUS training, usage patterns, and perceived barriers. The questionnaire was distributed through professional networks and hospital administrations. Staff members and other healthcare professionals were excluded from participation. Chi-square tests followed by multivariable regression analysis were used to perform the statistical analysis, and a p-value<0.05 was considered statistically significant. Thematic analysis was performed for qualitative data to identify recurring themes and patterns. Results: Regarding POCUS training and competence, 356 participants (91.99%) reported having received formal POCUS training. Among them, 115 (32.30%) indicated participation in various POCUS workshops. Of those trained, 314 (81.14%) expressed satisfaction with their training in terms of clinical application. In terms of utilisation patterns, 176 participants (45.48%) stated that they use POCUS at least once a month. The majority, 307 (79.33%), reported using POCUS most frequently for evaluating abdominal pain, followed by cases of respiratory distress. Out of the total 387 participants, lack of training and the absence of standardised protocols were considered the main barriers to POCUS utilisation by 271 (70.03%) and 249 (64.34%) participants, respectively. To improve POCUS utilisation in Saudi Arabia, 386 participants (99.74%) believed that mentorship from experienced POCUS users would be beneficial, 381 (98.45%) highlighted the importance of structured training programs, and 370 (95.61%) believed that the implementation of standardised protocols and guidelines would enhance POCUS utilisation in clinical practice. Conclusion: High training rates, strong clinician confidence, and recognised patient benefits indicate encouraging progress in the integration of POCUS into clinical practice, particularly within Saudi Arabia’s emergency care system.

Distribution and Radiographic Assessment of Post-retained Restorations: A Retrospective Study from Saudi Arabia

Meer Zakirulla, Faisal Ali Bin Abbooud AlQhtani, Zuhair Motlak Alkahtani, Hussam S Alahmari, Bandar Yahya Alshehri, Malaz M Mustafa, Lujain S Alshareif, DN Jayashankar Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Restoring endodontically treated teeth with significant coronal loss often requires intraradicular posts to provide retention for core build-up and definitive prostheses. The long-term success of these restorations depends on adherence to radiographic criteria such as optimal post-length, post-width, and adequate apical gutta-percha. Limited evidence exists regarding the prevalence and radiographic characteristics of post-retained restorations in the study population. Aim: To assess the distribution and radiographic quality of post-retained restorations in a selected patient cohort. Materials and Methods: This retrospective study analysed patient records and radiographs obtained between April 2019 and October 2024 This retrospective study was conducted at the Department of Paediatric Dentistry and Orthodontics Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia. The retrospective study analysed patient records and radiographs obtained between April 2019 and October 2024. A total of 625 radiographs were screened and 71 teeth with post-retained restorations from 61 adult patients, who met the inclusion criteria. Orthopantomogram (OPG), periapical, and bitewing radiographs were evaluated for tooth type, arch, post-type, post-length, post-width , and the remaining gutta-percha. Radiographic analysis was performed by a single examiner and descriptive statistics were calculated using Statistical Package for Social Sciences (SPSS) (p-value<0.05). Results: Most post-retained restorations occurred in males (60.6%) and individuals aged 36-45 years (34.4%). The premolars (39.4%) were the most frequently restored teeth, followed by the molars (33.9%). Glass Fiber Posts (GFP) constituted the majority (80.3%). However, most restorations showed deviations from the ideal guidelines, with 67.6% having a 1:3 post-length and 70.4% demonstrating a 1:3 post-width. Over half of the teeth retained more than 5 mm of apical gutta-percha, whereas 15.5% exhibited overfilled or unacceptable apical conditions. Conclusion: Post-retained restorations were most common in middle-aged adults, particularly in the premolars and mandibular molars. Despite the predominant use of fiber posts, substantial deviations from the recommended radiographic standards were observed. These findings highlight the need for improved clinical training and strict adherence to evidence-based prosthodontic protocols.

Development, Psychometric Validation and User Centred Evaluation of a Patient Information Leaflet for Bipolar Disorder: A Quasi-experimental Study

A Ashvil, Diya Kiran, Juno Jerold Joel, Shrinivasa Undaru Bhat, Prakash Patil, Uday Venkat Mateti, Deepak C Gopinath Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Bipolar Disorder (BD) is a complex psychiatric mood disorder. Despite its complexity, nearly half of the patients experience medication non adherence due to poor insight into the illness. Therefore, improving patient knowledge using a Patient Information Leaflet (PIL) regarding the disease and its treatment is crucial. Aim: To develop and validate a PIL and to assess knowledge levels among patients with BD. Materials and Methods: A prospective quasi-experimental study was conducted from June 2025 to November 2025 at Justice KS Hegde Charitable Hospital (JKSHCH), Dakshina Kannada, India. A total of 42 patients with BD aged 18 years or older were included. Demographic details, including age, gender, education, and domiciliary status were collected for analysis. The PIL was developed using information from relevant literature and translated into regional languages. Content validity was assessed using the Content Validity Index (CVI). Readability was evaluated using the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) formulas. The design quality was assessed using the Baker-Able Leaflet Design (BALD) criteria. The reliability of the Patient Knowledge Questionnaire (PKQ) was determined using the Intraclass Correlation Coefficient (ICC). A paired t-test was performed using Statistical Package for the Social Sciences (SPSS) version 29.0 to compare knowledge levels before and after reading the PIL. A p-value<0.05 was considered as statistically significant. Results: The PIL achieved CVI scores of 0.93 for relevance and 0.91 for clarity, indicating excellent content validity. Readability scores of 83.3 (FRE) and 2.8 (FKGL) suggest that the leaflet can be easily understood by individuals with education beyond grade three. BALD scores were 28 in English and 26 each in Kannada and Malayalam, indicating good leaflet design. ICC values ranged from 0.6 to 1 across questionnaire versions, demonstrating high reliability. The post-test results results showed a significant improvement in patient knowledge after reading the PIL. Conclusion: The systematically developed and validated PIL effectively improves patients’ understanding of BD and its treatment, which may enhance medication adherence and quality of life.

Dermoscopic Skin Pattern Differences between Male and Female Young Adults: A Cross-sectional Study

Anitta Shojan, Tereesa Shojan, M Lakshmi Priya, Priya Prathap Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Dermoscopy is a rapidly evolving non invasive diagnostic tool that utilises an easy-to-use hand-held dermatoscope attached to mobile phones. It captures clear and magnified images of the skin’s surface and subsurface structures. Aim: To determine the dermoscopic differences in the male and female skin. Materials and Methods: A cross-sectional study was conducted at the Government Medical College, Thrissur, Kerala, India from October 2021 to November 2021 after getting ethics committee approval. A total of 82 first-year MBBS students, aged 18-25 years who had no prior skin conditions and were willing to participate in the study were included. Questionnaire was given to obtain personal details. Dermoscopic photographs of the lateral aspect of the forearm was taken- Skin surface changes, vascular patterns and pigmentation patterns were the main parameters considered. The data was coded and entered into Microsoft Excel, expressed as frequencies and percentages. A Chi-square test (χ2) was used to determine whether the observations differed between males and females. Results: There were 82 study subjects, comprising 37 males and 45 females, aged 18-25 years. None of the subjects regularly used sunscreen or moisturiser. The duration of sun exposure was never more than two hours per day. The Chi-square test showed a significant difference in pigmentation and hair pattern on the lateral side of the forearm among males and females. Small brown globules showed a p-value=0.027, eccrine skin hypopigmentation-p-value=0.002, follicle skin hypopigmentation-p-value=0.011 and hair changes- p-value=0.002. Conclusion: Understanding the differences between male and female skin helps identify physiological and hormonal influences on skin, guides personalised dermatological assessment, and improves diagnostic accuracy and treatment strategies.

Clinicopathological Analysis of Plasmablastic Lymphoma Cases: A Cross-sectional Study from a Tertiary Care Cancer Centre in Kerala, India

CM Simi, Rekha A Nair, AV Jayasudha, Priya Mary Jacob, Sreejith G Nair, KM Jagathnath Krishna Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Plasmablastic Lymphoma (PBL) is an aggressive lymphoid neoplasm composed of large atypical B cells with plasmablastic or immunoblastic morphology and a terminal B-cell differentiation phenotype predominantly presenting at extranodal sites. PBL is rare comprising 1% of large B-cell lymphomas. Most PBLs occur in the context of immune deficiency/dysregulation. Aim: To analyse the morphology, immunophenotype, clinical details and diagnostic challenges in cases diagnosed as PBL. Materials and Methods: The present study was a cross-sectional cohort study analysing cases of PBL diagnosed during 2011 to 2021 in the Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India. Morphology and Immunohistochemistry (IHC) (CD45, CD3, CD5, CD20, CD79a, Pax5, CD38, CD138, MUM1, EMA, Kappa, Lambda, CD56, CD30, Alk-1, Ki-67) of tumour cells were reviewed. Epstein-Barr Virus (EBV) by Rapid in Situ Hybridisation (RISH) was also documented. Clinical details including patients age, sex, clinical presentation were elaborated using descriptive statistics. Treatment details and overall survival also noted. Results: During the study period there were a total of 36 cases. The median age at presentation was 57 years (range: 10 to 85 years). Six cases (16.7%) had associated HIV, 26 cases (72.2%)had extranodal disease. Tumour cells in all cases were positive for CD138 and MUM1, and negative for CD20, PAX5, and T-cell markers with a high Ki-67 proliferation index (80-95%). Leukocyte Common Antigen (LCA) were negative in 22 cases (61.11%) or weakly positive in 14 cases (38.9%), CD 79a was faintly positive in one case (2.8%) and weak Pax5 positivity was seen in two cases (5.6%). EBV was positive in 21 cases (58.3%) Median overall survival was 17.5% for 3-year in the present study. Conclusion: PBL is a rare aggressive lymphoma having association with HIV, predominant extranodal location, and characteristic IHC pattern. Lymphoproliferative neoplasms with plasmablastic morphology share many morphologic and immunophenotypic similarities and diagnosis requires integration of clinical morphological and IHC findings.

Assessment of Cardiac Biomarkers in Pregnant Women with and without Hypertensive Disorders: A Cross-sectional Study

Pawan Kumar Kare, Tripti Saxena, Haresingh Makwane, Pallavi Singh, Shubhishee Joshi Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Hypertensive Disorders of Pregnancy (HDP) remain a leading cause of maternal and foetal morbidity worldwide. Given the rising burden of cardiovascular morbidity in India, there is a critical need to evaluate specific cardiac biomarkers to identify subclinical cardiac strain in regional clinical settings. Aim: To compare the serum level of cardiac biomarkers in pregnant women with and without hypertensive disorders attending Antenatal Clinic at a Tertiary Care Hospital of Central India. Materials and Methods: The present cross-sectional study was conducted between May 2023 to May 2024 at Hamidia Hospital a Tertiary Care Hospital associated with Gandhi Medical College, Bhopal, Madhya Pradesh, Central India. Total 312 study participants were enrolled and divided into normotensive (n=239), Gestational Hypertension (GH) (n=33) and Preeclampsia (PE) (n=40). The cardiac biomarkers such as Creatine Phosphokinase-MB (CPK-MB), Lactate Dehydrogenase (LDH), Serum Glutamic Oxaloacetic Transaminase (SGOT), High-sensitivity C-Reactive Protein (hsCRP), glucose and creatinine were measured by fully automated biochemistry analyser and Troponin-I and NT-proBNP by Enzyme Linked Immunosorbent Assay (ELISA) method. One-way Analysis of variance (ANOVA) and Chi-square test was used for comparison of data among groups. the p<0.05 was considered as significant level. Results: No significant difference was found in age and Body Mass Index (BMI) among the groups. A significant, step-wise increase was found in the levels of multiple cardiac biomarkers as the severity escalated from GH to PE (p<0.001 for all). Specifically, the median levels of NT-proBNP, a marker of ventricular wall stress, showed a dramatic surge from 29 pg/mL (Normotensive) to 40 pg/mL in GH group and a striking 155 pg/mL in the PE group. Similarly, Troponin I (myocardial injury) and CPK-MB, SGOT, and LDH (tissue damage) were all significantly elevated in the HDP groups. Conclusion: HDP are associated with a progressive rise in cardiac and tissue injury biomarkers, with the highest levels observed in PE. The marked increase in NT-proBNP highlights significant cardiac stress and supports the potential role of these biomarkers in risk assessment and clinical monitoring. These findings advocate for the integration of specific biomarkers into routine screening to enable early risk stratification and improve maternal-foetal outcomes in HDP.

Prevalence of Pulmonary Hypertension as Post-tuberculosis Lung Sequelae: A Hospital-based Cross-sectional Study

Sagar Vishwas Gaikwad, Sonal Suresh Arsude, Rakhi Ashok Gosavi, Sanjay Narayan Gaikwad Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Pulmonary Tuberculosis (PTB) remains a major global health burden, particularly in developing countries. Even after microbiological cure, a significant proportion of patients develop post-tuberculosis (post-PTB) lung sequelae, which may predispose them to Pulmonary Hypertension (PH), a condition associated with increased morbidity and mortality. Aim: To determine the prevalence and severity of pulmonary hypertension in patients with post-tuberculosis lung sequelae. Materials and Methods: This hospital-based cross-sectional study was conducted at BJ Government Medical College (GMC) and Sassoon Hospital, Pune, Maharashtra, India, from October 2022 to March 2023. A total of 70 patients with post-tuberculosis lung sequelae were included. Clinical profile, chest radiographic findings, Electrocardiographic (ECG) changes, and echocardiographic parameters, including Right Ventricular Systolic Pressure (RVSP), Tricuspid Regurgitation Velocity (TRV), were assessed. Data were analysed using descriptive statistics. Results: There were 55 males and 15 females. The majority of patients were middle-aged males with a high proportion of smokers. PH was detected in 29 (41.43%) patients. Mild, moderate, and severe PH were observed in 4 (5.71%), 17 (24.29%), and 8 (11.43%) patients, respectively. The mean RVSP was 39.86±17.74 mmHg and the mean TRV was 2.75±0.58 m/s in patients with extensive radiological lung involvement. Conclusion: The present study highlights a high prevalence (41.43%) of PH among post-PTB patients. Echocardiographic screening revealed elevated RVSP in patients with PH, and TRV was elevated in a significant proportion of cases. Thus, PTB patients require long-term follow-up to diagnose and treat functional impairment after cure.

Correlation of 25-hydroxy Vitamin D Deficiency with Advanced Glycation End Products and Their Receptors in Type 2 Diabetic Patients with Coronary Artery Disease: A Cross-sectional Study

Shaheena Yassir, Prabha Adhikari, Nivedita L Rao Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Vitamin D Deficiency (VDD) has emerged as a possible risk factor for Insulin resistance and Type 2 Diabetes Mellitus (T2DM), which in turn is an established risk factor for Coronary Artery Disease (CAD). Advanced glycation End Products (AGEs) measurements may be considered promising biomarkers of late diabetic complications. Aim: To assess the correlation of 25-OH vitamin D levels with advanced glycation end products and its receptors in T2DM patients with CAD. Materials and Methods: The present cross-sectional study included 130 T2DM patients with CAD, aged between 35-65 years, admitted in Yenepoya Medical College Hospital, Mangalore, Karnataka, India, during the time period of July 2019 to August 2022. Total 25-OH vitamin D, fasting insulin (Chemiluminescence Immunoassay method), and fasting plasma glucose (Glucose oxidase-peroxidase method) and Glycated Haemoglobin (HbA1c) were estimated. Insulin resistance was calculated using the HOMA-IR method. AGE and soluble receptors for AGE were estimated using an ELISA kit. The correlation of 25-OH vitamin D with with advanced glycation end products and its receptors was done by Spearmann correlation. The comparison of parameters among the groups based on 25-OH vitamin D was done by Analysis of Variance (ANOVA) and p-value <0.05 was considered to be statistically significant. Results: The mean age of the study population was 54.06 ± 7.31 years with a gender distribution of 71.5% (93/130) males and 28.5% (37/130) females. The mean value of 25-OH vitamin D among the study population was 22.92±8.67. Among 130 study participants, 103 (80%) of study participants had insufficient or deficient vitamin D. A significant negative correlation was seen with HbA1c (r=-0.287; p<0.001). The HbA1C value was significantly higher in vitamin D deficient group compared to insufficient and sufficient group with a p value of <0.001. Conclusion: There was a significant negative correlation between the 25-OH vitamin D level and HbA1c. The HbA1c was significantly higher in Vitamin D deficient group compared to insufficient and sufficient group (p value <0.001). This indicates that vitamin D may play an indirect role in the pathophysiology of CAD, which emphasizes the significance of adequate vitamin D in a diabetic population.

Synthesis and Assessment of the Antimicrobial Efficacy of a Novel Graphene Oxide-Copper Oxide Nanocomposite Against Oral Pathogens: An In-vitro Study

Soundaria Srinivasan, R Ramesh Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: The growing threat of Antimicrobial Resistance (AMR) has necessitated the development of alternative therapeutic agents. Oral pathogens, such as Enterococcus faecalis, Candida albicans, and Streptococcus mutans, contribute to various dental infections, often exhibiting resistance to conventional antibiotics. Nanotechnology, particularly the use of graphene oxide (GO) and copper oxide (CuO), offers a promising approach for overcoming these limitations. Aim: To synthesise a novel GO-CuO nanocomposite using a green synthesis method and evaluate its antimicrobial efficacy against common oral pathogens using in-vitro assays. Materials and Methods: The present in-vitro experimental study was conducted at the White Lab and Department of Paediatric Dentistry, Saveetha Dental College, Chennai, Tamil Nadu, India, from August to November 2024. It evaluated the antimicrobial efficacy of a GO-CuO nanocomposite synthesised via a modified Hummers’ method for GO and green synthesis using Glycyrrhiza glabra root extract for CuO. The nanocomposite was prepared by combining the suspensions and probe-sonicating to ensure uniform dispersion. Antimicrobial activity against Candida albicans, Enterococcus faecalis, and Streptococcus mutans was assessed using agar well diffusion and time-kill assays. Statistical analysis employed Analysis of Variance (ANOVA) and Tukey’s post-hoc test with significance at p<0.05. Results: The GO-CuO nanocomposite demonstrated a concentration-dependent antimicrobial effect. At 100 μg/mL, significant inhibition zones were observed, with E. faecalis showing the highest sensitivity (15.86±0.77 mm), followed by C.albicans (10.74±0.32 mm). S. mutans showed minimal sensitivity. Time-kill kinetics revealed a marked reduction in CFU/mL for E. faecalis and C.albicans at higher concentrations. These results were statistically significant (p<0.001) Conclusion: The green-synthesised GO-CuO nanocomposite exhibits potent antimicrobial activity against key oral pathogens, especially E. faecalis and C.albicans. Its dual-action mechanism- physical membrane disruption by GO and ROS generation by CuO- makes it a promising candidate for integration into dental materials. Further studies are needed to assess cytotoxicity, mechanical properties, and clinical performance.

Effect of Dialysis on Iron Profile and Haematological Parameters in Patients with Chronic Kidney Disease: A Retrospective Observational Study

Mriganka Kushal Boruah, R Sai Deepika, A Hemalatha Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Iron is an essential mineral to trigger erythropoiesis in response to Erythropoietin (EPO) from kidneys. In Chronic Kidney Disease (CKD), dialysis is a treatment option when the kidneys fail to filter out the toxins from blood which may cause absolute or relative iron deficiency causing anaemia. Aim: To elucidate significance of iron profile in dialysis cases for management of anaemia post-dialysis in male and female patients with CKD. Materials and Methods: The present retrospective observational study was conducted from September 2023 to November 2023 at Sri Devaraj Urs Medical College and Hospital, Kolar, Karnataka, India. A total of 84 subjects including male and female patients undergoing dialysis with or without diabetes mellitus, CKD cases and Haemodialysis cases were included in the study. Latest and recent values of iron profile and Complete Blood Count (CBC) parameters of patients were collected from biochemistry and haematology sections for the study, the statistical analysis was performed with Statistical Package for Social Sciences (SPSS) version 25 (IBM). Results: The Transferrin Saturation (TSAT) was comparable between males (median 22.74%, IQR: 15.34-31%) and females (median 24.3%, IQR: 15.7-30.4%) (p=0.47). Non-diabetic patients showed higher TSAT (median 22.74%, IQR: 15-32%) compared to diabetics (median 24.3%, IQR: 15.7-30.4%). The Unsaturated Iron Binding Capacity (UIBC) was 160.1±60.2 μg/dL in males and 164.6±38.61 μg/dL in females (p=0.73), being higher in non-diabetics (165±515.43 μg/dL) than diabetics (156.4±58.3 μg/dL) (p=0.5), demonstrating the inverse relationship with serum iron as per iron physiology. Conclusion: Iron profile assessment including calculated parameters (TSAT and UIBC) is essential for precision management of anaemia in dialysis patients. There was no significant gender-based difference but there was notable variation between diabetic and non-diabetic CKD cases.

Management Strategies for Hypertension in Patients with Diabetes and Other Co-morbidities: Insights from the HYDIA Cross-sectional Survey

Anirban Majumder, Manish Gutch, Mathew John, Raman Boddula, Shehla Shaikh, Shefali Karkhanis, Vishal Kastwar, Snehal Bansode Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: The simultaneous rise of hypertension and diabetes in Indian patients necessitates effective management strategies to prevent severe complications. The study addresses the limited understanding of hypertension management in diabetic patients within the Indian clinical context, highlighting gaps in region-specific data on expert perceptions and preferred strategies. Aim: To assess Indian physicians’ perceptions and practices regarding the impact of hypertension in patients with diabetes and the most appropriate strategies for managing it. Materials and Methods: The present study was a cross-sectional, questionnaire based electronic survey. A total of 1618 physicians throughout India were invited to participate in an online survey and virtual meetings. The study questionnaire had two sections. Section 1 consisted of four questions focusing on the detrimental effects of hypertension on diabetes. Section 2 included seven questions regarding appropriate management approaches for hypertension. The data collected was analysed using Microsoft Excel 2019 and presented as frequency. Results: Majority of the physicians (39.9%) were from Western region. The majority of participants in this survey had 10-20 years of experience (n=504, 41.2%) and practiced in their clinic (n=541, 44.3%). The expert panel reported that cardiac events (48.22%) were the most common consequence of hypertension in diabetic patients. They recommended telmisartan (85.9%), amlodipine (64.7%), and metoprolol (76.0%) as preferred treatments for managing diabetes with hypertension and cardiovascular Co-morbidities. For patients with diabetes, hypertension, and Chronic Kidney Disease (CKD), telmisartan (84.0%), amlodipine (63.4%), and hydrochlorothiazide (63.1%) were favoured. Additionally, 51.3% of diabetologists did not recommend the use of dual RAAS inhibitors (ACE inhibitors+ARB). In a patient with diabetes, hypertension and a history of stroke, if Blood Pressure (BP) remains uncontrolled on an optimal ARB dose, Calcium Channel Blockers (CCBs) should be added as a second-line therapy. Conclusion: Appropriate management strategies, such as enhancing medication adherence, patient education, and selecting effective treatments, can prevent the detrimental effects of hypertension in patients with diabetes and Co-morbidities. Indian diabetologists typically prefer ARBs as the first-line therapy and CCBs, beta-blockers, or diuretics as second-line options. The most commonly chosen medications include telmisartan, amlodipine, metoprolol, and hydrochlorothiazide. As a second-line treatment, CCBs are particularly preferred for patients who have both diabetes and CKD.

Pre and Post Chemoradiotherapy Assessment of Quality of Life in Individuals Diagnosed with Cervical Cancer in Tripura, India: A Cross-sectional Study

Sarada Sutradhar, Satish Kumar Gupta, Partha Sarathi Sutradhar Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Cervical cancer is among the most common malignancies affecting women in India. Assessment of Quality of Life (QoL) has become a vital part of patient care, extending beyond traditional survival outcomes. Despite the high disease burden in Tripura, India limited evidence exists on QoL changes before and after treatment. Aim: To compare the QoL of women with cervical cancer before and after treatment, identify variables influencing QoL, and evaluate the impact of treatment modalities. Materials and Methods: The present cross-sectional study was conducted at the Atal Bihari Vajpayee Regional Cancer Centre, Agartala, Tripura, India, from March 2022 to December 2024. A total of 384 patients were enrolled and reassessed six months after therapy using validated European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CX24 questionnaires. The data were analysed using Statistical Package for Social Sciences (SPSS) version 24. Paired sample t-tests and Chi-square tests were employed to compare pre and post-treatment EORTC QLQ-C30 and QLQ-CX24 scores, with a significance threshold set at p<0.05. Baseline characteristics were summarised using descriptive statistics. Results: The mean age at diagnosis was 50.38±11.66 years. Overall health status improved significantly after treatment (64.67±2.68 vs. 45.32±4.59; p<0.001). Post-treatment, significant gains were observed in physical, cognitive, and emotional functioning. Conversely, symptom experience worsened (23.42±3.36 vs 3.36 vs 10.44±4.23; p=0.037), and both sexual satisfaction and functioning declined. Patients who received combined chemoradiotherapy showed greater improvements in QoL and overall health scores compared with those receiving radiotherapy alone. Conclusion: Cervical cancer survivors in Tripura experienced significant improvement in overall health scores following therapy, particularly in functional domains. However, persistent challenges, including sexual dysfunction and treatment-related toxicities, underscore the need for integrated survivorship care focusing on counselling, rehabilitation, and supportive interventions.

Foetal Modified Myocardial Performance Index as a Predictor of Pregnancy Outcome in Gestational Diabetic Mothers: A Prospective Observational Study

Rajat Khurana, Sunil Kumar Bajaj, Parikha Rampal, Reeta Kanaujia, Ritu Nair Misra Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Foetuses of mothers with Gestational Diabetes Mellitus (GDM) are at increased risk for cardiac complications even with metabolic control. Conventional Doppler methods often fail to detect early cardiac dysfunction in these cases. The Modified Myocardial Performance Index (Mod-MPI) offers a sensitive and non-invasive tool for early detection of foetal cardiac impairment in GDM pregnancies. Aim: To assess foetal cardiac function using Mod-MPI by doppler in gestational diabetic mothers in early third trimester (28-32 weeks) and to evaluate its utility in prediction of perinatal outcome. Materials and Methods: The present prospective observational study was conducted at VMMC and Safdarjung Hospital, New Delhi, India, from November 2017 to November 2018. A total of 30 singleton pregnant females in the third trimester (28-32 weeks) with a known history of GDM and 30 singleton pregnant females in the third trimester with no history of GDM were included. Patients with multiple pregnancy intrauterine growth retardation, Pre GDM, congenital anomalies, history of cardiac disease or hypertension were excluded from the study. Using doppler ultrasonography, the Mod-MPI was calculated in the foetal left ventricle. Multiple statistical tests and Receiver Operating Characteristic (ROC) analysis was used to determine the optimal Mod-MPI cut-off for predicting adverse foetal outcomes. A p-value <0.05 was considered statistically significant. Results: The pregnant females with GDM had significantly higher mean MPI (0.67±0.14) compared to those females without GDM (0.47±0.08). The mean age in the cases was 26.77±3.45, and in the controls, it was 26.87±3.7 years. Abnormal outcomes were recorded in 9 of 30 foetuses of gestational diabetic mothers, and these foetuses had significantly higher MPI measurements (0.85±0.06), compared to the 21 GDM foetuses who had normal Mod-MPI (0.6±0.09) values without any adverse outcome. The MPI served as an excellent predictor of adverse outcomes in GDM foetuses with a total area under the ROC curve being 0.98. Three abnormal outcomes were recorded in the control group, including Apgar <7, stillbirth, and Intensive Care Unit (ICU) admission. Conclusion: Mod-MPI has the potential to predict adverse pregnancy outcome and improve foetal surveillance in gestational diabetes.

Epidemiology and Emerging Antimicrobial Susceptibility Profiles of Multidrug-resistant Aerobic Pathogens Causing Burn Wound Infections: A Cross-sectional Study from a Tertiary Care Teaching Hospital

S Preeti Maste, SM Shivaswamy, V Sunil Subedar Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Infection of burn wounds causes delayed wound healing, which can further lead to sequelae like prolonged hospital stay, excessive use of antibiotics, higher treatment costs, increased morbidity, and increased risk of mortality. Timely evaluation of the microbiome profile and antibiotic susceptibility patterns can help prevent these complications. Aim: To determine the epidemiology and emerging antimicrobial susceptibility profiles of Multidrug-resistant (MDR) aerobic pathogens causing burn wound infections at a tertiary care teaching hospital. Materials and Methods: A descriptive cross-sectional study was conducted in the Burn Ward of KLES Dr. Prabhakar Kore Hospital and Medical Research Centre (MRC), Belagavi, Karnataka, India, from January 2024 to August 2024. A total of 187 wound swabs were collected during this period from all burn wound patients admitted to the ward. Only descriptive analysis was performed using frequency and percentage. No inferential statistics were applied. Age and gender distribution were recorded but not used for statistical correlation. Pathogen identification and antimicrobial susceptibility testing were performed using the Beckman Coulter MicroScan WalkAway automated system according to Clinical and Laboratory Standards Institute (CLSI) 2023 guidelines. Data were analysed using descriptive statistics and expressed as n (%). Results: Of the 187 samples, 120 (64.2%) were culture-positive, yielding 176 isolates. Pseudomonas aeruginosa was the most common pathogen, accounting for 77 (43.7%) isolates, followed by Staphylococcus aureus with 27 (15.3%) isolates. Mixed infections were observed in 42 (35%) of the culture-positive samples. Extended-spectrum Beta-lactamase (ESBL) production was detected in 11 (61.1%) of 18 Escherichia coli isolates and 7 (43.7%) of 16 Klebsiella pneumoniae isolates. MDR was observed in 21 (27.3%) Pseudomonas aeruginosa isolates and 3 (27.2%) Acinetobacter spp. isolates. Conclusion: The present study identified Pseudomonas aeruginosa and Staphylococcus aureus as the predominant pathogens causing burn wound infections, with a high prevalence of resistance to commonly used antibiotics such as cephalosporins and carbapenems. These findings highlight the urgent need for regular local surveillance and tailored antimicrobial stewardship interventions to optimise empirical therapy and curb the spread of MDR organisms in burn units.

Impact of Sanyinjiao Point Complementary Therapy for the Primary Dysmenorrhoea: A Quasi-experimental Study

Lavanya Nandan, Jagdish Gohil Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Dysmenorrhoea, characterised by chronic menstrual pain often accompanied by symptoms such as fatigue, nausea and reduced functional ability, remains a prevalent issue among young women, particularly nursing students. This condition significantly contributes to absenteeism and diminished academic performance due to its physical and psychological impacts. Previous studies have explored various complementary therapies, with acupressure emerging as a promising non pharmacological intervention. Aim: To evaluate the effectiveness of acupressure applied at the Sanyinjiao (SP6) point in alleviating symptoms of primary dysmenorrhoea among nursing students. Materials and Methods: The study employed a quasi-experimental, non equivalent pretest-post-test control group design. It was conducted from May 2022 to August 2022 at the Nightingale Institute of Nursing in Noida and the Sharada School of Nursing Sciences and Research in Greater Noida, Uttar Pradesh, India. Participants were nursing students with primary dysmenorrhoea, selected through purposive sampling. A total of 60 students were divided into two groups: experimental and control (30 each). Dysmenorrhoea severity was assessed using the standardised Working activity, Location, Intensity, Days, Dysmenorrhea (WaLIDD) scale. A pretest pain assessment was performed for both groups. The experimental group received 30 minutes of acupressure at the Sanyinjiao (SP6) point, based on theoretical acupressure principles suggesting energy circuit modulation within 24 minutes. The control group received sham acupressure consisting of light touch at SP6 without applying pressure. The total duration, including pretest and intervention, was approximately 40–60 minutes per participant. Demographic variables such as age, course, type of family, religion, age at menarche, menstrual cycle pattern, pain onset and pain location were recorded. Data analysis was conducted using Statistical Package of Social Sciences (SPSS) version 28.0. Results: Findings revealed a significant reduction in pain intensity, days of pain and improvement in working ability in the experimental group post-intervention. Pain intensity decreased from 2.17±0.747 to 1.57±0.504), t(29)=4.289, p<0.001. Days of pain and working ability also showed statistically significant improvements. Analysis of Covariance (ANCOVA) results revealed a significant effect of the intervention on post-test pain scores after controlling for baseline demographic differences, F(1, 50)=18.356, p<0.001, partial η^²=0.269. Conclusion: The results conclude that SP6 acupressure is effective in reducing dysmenorrhoea symptoms, offering a low-cost, accessible alternative for menstrual pain management. These findings advocate for the inclusion of acupressure in menstrual health education and nursing self-care strategies.

Computer Vision Syndrome in Digital Era: A Cross-sectional Study on its Prevalence, Risk Factors and Protective Behaviours among Young Adults

Hetaj Sheth, Jash Bavishi, Hasmukh Ahir, Kshama Popat, Jaini Shah, Vishwa Hadvani Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: The increasing use of digital screens among young adults has led to a surge in cases of Computer Vision Syndrome (CVS), a condition characterised by eye and vision problems related to prolonged screen exposure. Aim: To determine the prevalence of CVS and assess associated risk factors and protective measures for preventing CVS among young adults. Materials and Methods: A cross-sectional clinical study was conducted among 166 individuals aged 21-30 years with significant daily screen time at Smt. B. K. Shah Medical College, Dhiraj Hospital, Vadodara, Gujarat, India, from October 2022 to December 2023. Participants underwent a comprehensive ophthalmic evaluation, including assessment of CVS-related symptomatology, Schirmer’s I and II tests, Tear Break-Up Time (TBUT), and visual acuity testing. Data regarding screen use, symptoms, and break habits were collected and analysed using Fisher’s exact test and the Chi-square test. A p-value of <0.05 was considered statistically significant. Results: A total of 166 participants aged between 21 and 30 years were enrolled in the study. The mean age of the participants was 25±3 years, with a male-to-female ratio of approximately 1:0.64. Common symptoms of CVS included dryness, burning sensation, and blurred vision. The prevalence of CVS was observed in 121 participants (72.89%). Associated risk factors included prolonged screen time (>4-6 hours) and inadequate break intervals. Approximately 65.66% of participants took breaks of more than one minute per hour. Protective measures included taking sufficient breaks of ≥20 seconds every 20 minutes (i.e., ≥1 minute per hour). Conclusion: CVS is highly prevalent among young adults with extensive screen exposure, with dry eye and blurred vision being the most common complaints. Preventive strategies such as frequent breaks, ergonomic adjustments, and regular ophthalmic evaluations are essential.

Anatomical Correlation Between the External Diameters of the Internal Jugular Vein and the Common Carotid Artery: A Cross-sectional Study

K Shobha, R Shubha Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: The Internal Jugular Vein (IJV) and the Common Carotid Artery (CCA) are vital vascular structures in the neck, frequently encountered during diagnostic and interventional procedures. While their physiological interdependence is well established, evidence on the morphometric correlation between their external diameter is limited. Most earlier studies are imaging-based, and there remains limited cadaveric evidence correlating their external vessel diameters. Aim: To assess the correlation between the external diameters of IJV and CCA. Materials and Methods: This cross-sectional cadaveric study was conducted in the Department of Anatomy, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India, from June 2011 to Jan 2013, on 50 embalmed adult cadavers (100 sides). Measurements were taken at the level of the arch of the cricoid cartilage using a sliding vernier calliper. Data were analysed to compare right- and left-sided differences, categorise vessel sizes, and assess associations between the external diameters of the IJV and CCA. Parameters evaluated included the external diameters of the right and left IJV and CCA, side differences, vessel size categories, and inter-vessel correlations. All readings were made by a single observer to avoid inter-observer variability, and statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 20.0 with paired t-test, Chi-square test, and Pearson’s correlation coefficient (p-value <0.05 considered significant). Results: Significant differences were observed between the mean diameters of the IJV and CCA on both right and left sides. The mean external diameter of the right IJV was 12.94±2.85 mm and that of the right CCA was 8.92±1.45 mm (p-value <0.001); on the left, the IJV measured 11.33±2.60 mm and the CCA 8.51±1.37 mm (p-value <0.001). Categorisation revealed that 40% of large CCAs were associated with large IJVs, while 35% of small CCAs corresponded with small IJVs. Overall, statistical analysis demonstrated a modest yet statistically significant positive correlation between the external diameters of the IJV and CCA (r-value=0.278, p-value=0.005). Paired t-test, Chi-square test, and Pearson’s correlation were applied, with p-value <0.05 considered statistically significant. Conclusion: This study demonstrates a weak positive correlation between the external diameters of the IJV and CCA, providing anatomical support for previous imaging-based observations. Recognising this morphometric relationship enhances anatomical understanding and may offer a supportive context for vascular imaging, central venous access, and surgical planning; however, the findings should be interpreted with caution.

Role of Transarterial Preoperative Embolisation in the Management of Juvenile Nasopharyngeal Angiofibroma: A Prospective Interventional Study

Sushant Agarwal, Rishabh, Deep Ujjal Das, Hrishikesh Choudhury, Dipu Bhuyan Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Juvenile Nasopharyngeal Angiofibroma (JNA) is a benign yet highly vascular tumour that primarily affects adolescent males. Surgical resection is the standard treatment; however, it is often associated with significant intraoperative blood loss and increased morbidity. Preoperative Transarterial Embolisation (TAE) has emerged as an adjunctive procedure to minimise vascularity, thereby reducing surgical complications. Aim: To evaluate the impact of preoperative embolisation of JNA on the surgical outcome including intraoperative blood loss, intraoperative time and Intensive Care Unit (ICU) admissions in North Eastern India. Materials and Methods: The hospital-based prospective interventional study was conducted in the Department of Radiology at Gauhati Medical College and Hospital (GMCH), Guwahati, Assam, India, from November 2023 to October 2024 on 50 patients diagnosed with JNA and referred for preoperative embolisation from the Departments of Ear, Nose and Throat (ENT) and Paediatrics. Patients underwent Contrast Enhanced Computed Tomography (CECT) evaluation by the Philips Brilliance iCT 256 slice CT machine for staging (Radowski). Embolisation was done under the Siemens Artis Zee Biplane Digital Subtraction Angiography (DSA) machine by using Polyvinyl Alcohol (PVA) particles. Preoperative embolisation used PVA particles in all cases and parameters such as stage of tumour, grade of devascularisation, mean intraoperative blood loss, intraoperative time, postoperative complications and Intensive Care Unit (ICU) admission were obtained. These data were entered into Statistical Pacakge for Social Sciences (SPSS) software version 26.0 and Chi-square and Analysis of Variance (ANOVA) tests were applied. Results: The study included 50 patients (all males) aged 8 to 17 years with mean age of 14.18 years. In the present study, 6 patients (12.0%) were classified as stage IA JNA, while 18 patients (36.0%) had stage IB. All cases were embolised using PVA particles. The mean intraoperative blood loss was 246.16±110.18 mL. The mean operative time was 122.10±41.52 minutes. Mostly grade II devascularisation was achieved in the majority (58%) of patients. There was a significant association between grade of devascularisation and intraoperative blood loss, time and ICU admissions (p-value<0.05). No significant Post-embolisation complications were encountered. Conclusion: Preoperative embolisation of nasopharyngeal angiofibroma is a safe and effective technique to reduce intraoperative blood loss and reduce postoperative complications. Minor complications may be encountered, but major complications are rare if done using the correct technique.

Unveiling the Weapons of Superbug Pseudomonas: A Cross-sectional Observational Study on Virulence Factors and Antimicrobial Resistance of a Lurking Pathogen

Smita Vijayraj Mohod, Ravindra K Khadse, Sonal Prakash Chavan, Sharmila S Raut Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Pseudomonas is an opportunistic pathogen that thrives in a wide range of environments and poses a severe threat. Known for acquiring additional resistance mechanisms, it has become a formidable challenge in healthcare. Understanding its weapons and defenses is key to unveiling its strategies and identifying vulnerabilities to disarm this dangerous pathogen. Aim: To characterise clinical isolates of Pseudomonas species in terms of speciation, expression of key virulence factors, and antimicrobial resistance profiles. Materials and Methods: This cross-sectional observational study was conducted at Indira Gandhi Government Medical College and Mayo Hospital, Nagpur Maharashtra, India, from January 2020 to December 2020. A total of 500 Pseudomonas isolates were tested for speciation, virulence factors, and antibiotic susceptibility using standard laboratory tests. The biofilm detection methods were analysed using Chi-square test and Antibiotic Susceptibility Testing (AST) was done using Z test. A p-value of <0.05 was considered statistically significant. Results: Out of 500 Pseudomonas isolates, a maximum of 282 (56.4%) were from pus, while fewer than 12 (2.4%) were from other specimens. A total of 416 (83.2%) samples were pigment producers. Among these, 392 (84.12%) P. aeruginosa were identified as pigment producers. P. putida and P. fluorescens were also pigment producers, while P. stutzeri did not produce any pigment. The Tissue Culture Plate (TCP) method was more quantitative, with 244 (52.36%) being a reliable method for detecting biofilm. Out of 500 Pseudomonas isolates, 332 (66.4%) were resistant to Ceftazidime; 200 (40%) were identified as Extended-Spectrum Beta-Lactamase (ESBL) producers; 104 (20.8%) were resistant to imipenem; and 58 (11.6%) were classified as MBL. Out of 218 (43.6%) AmpC producers, 94 (18.8%) were inducible, while the remaining 124 (24.8%) were non inducible. Co-expression of beta-lactamases showing AmpC and ESBL was found in 58 (11.6%) isolates of Pseudomonas. Conclusion: Pseudomonas, armed with a wide array of virulence factors and resistance mechanisms, can evade host defenses and resist antimicrobial treatments, presenting significant challenges in healthcare settings. Efforts to curb this superbug include implementing infection prevention practices and using novel antibiotics and inhibitors targeting biofilm formation, which are vital to staying ahead of this adaptable adversary.

Assessment of Serum Interleukin-10 as a Marker of Severity in Dengue Virus Infection: A Cross-sectional Study

S Nithya Gomatheswari, R Poornakala, T Jeyamurugan, C Sabitha Devi Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Interleukin-10 (IL-10) plays an important role in dengue pathogenesis, reflecting an immunosuppressive function that causes Interferon (IFN) resistance, followed by impaired immune clearance and a persistent infectious effect for acute viral infection. Aim: To evaluate and compare IL-10 levels as a potential indicator of disease severity in dengue infection. Materials and Methods: The present cross-sectional study was conducted in the Department of Microbiology, Government Thoothukudi Medical College, Tamil Nadu, India, from March to September 2023. A total of 315 clinically suspected dengue patients in the age group of 1 to 80 years were subjected to IgM Enzyme Linked Immuno Sorbent Assay (ELISA). All samples that tested positive were considered confirmed dengue cases and were included in the study. Out of which 43 samples were positive for dengue (Group 1, n=28) and (Group 2, n=15). Group 1 included Dengue Fever (DF) with or without warning signs, Group 2 included severe dengue and Group 3 included 30 healthy volunteers. IL-10 was measured using the Diaclone ELISA kit. Patient’s demographic profiles and laboratory parameters were collected. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) v19.0 with Pearsons Chi-square test and One-way Analysis of Variance (ANOVA). A p-value <0.05 was considered significant. Results: Out of 315 samples, 43 were confirmed by Dengue IgM ELISA. Out of the total 43 positive samples, 24 (55.8%) were paediatric patients and 19 (44.2%) were adult patients. Twenty (46.5%) were males and Twenty Three (53.5%) were females, respectively. Out of 43 samples, 28 (65.1%) in Group 1 and 15 (34.9%) were in Group 2. There was a significant association (p<0.05) between the IL-10 and the dengue severity. The mean IL-10 in severe dengue cases (222±80.7 pg/mL, median=130) was significantly (p<0.0001) raised as compared to non-severe dengue (IL-10: 51.4±21.37, median=35) and healthy controls (4.05±0.45, median=3.5). Conclusion: Early prediction of the severity of the disease will help in better management, ultimately benefiting the patients. The present study suggests that IL-10 may serve as an indicator for identifying patients with severe dengue and those with or without warning signs, highlighting the urgent need for a marker that reflects endothelial damage.

Association of KRAS Mutation with Clinicopathological Variables in Colorectal Carcinomas: An Observational Cross-sectional Study

Mohanapriya Baskaran, Padmavathi Rajagopalan, Suma Sukumaran Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Colorectal carcinoma is one of the most common malignancies worldwide. The development of carcinoma occurs as a multistep process involving a wide variety of genetic alterations, among which Kirsten Rat Sarcoma (KRAS) mutations play a pivotal role in increasing proliferation and decreasing apoptosis of tumour cells. Aim: To determine the incidence of KRAS mutations in colorectal carcinomas and establish associations with age, histopathological findings such as tumour site, size, angiolymphatic invasion, lymph node status, and staging of carcinoma. Materials and Methods: A cross-sectional analytical observational study was conducted in the Pathology Department of Rajiv Gandhi Government General hospital, Chennai in Tamil Nadu, South India, on colorectal carcinoma biopsy samples. Over a study period of two years, from January 2022 to December 2024, 30 tissue samples of colorectal carcinoma were collected. Formalin-fixed paraffin-embedded blocks of these samples were subjected to molecular KRAS mutational analysis at codons 12 and 13 of exon 2 through Polymerase Chain Reaction (PCR), followed by Sanger sequencing. The incidence of KRAS mutations and their concurrent association with histopathological variables such as age, tumour site, size, angiolymphatic invasion, lymph node status, and staging of carcinoma were studied. Statistical evaluations were performed using International Business Machine (IBM)-Statistical Packages for Social Sciences (SPSS) version 20.0. Pearson’s Chi-squared test was utilised to analyse the association between variables. Results: The mean age of presentation in the study was 55.2±13.95 years. Out of 250 colorectal adenocarcinoma biopsy samples examined, 30 adequate samples were extracted. Of these, 27 were conventional adenocarcinomas and 3 were mucinous carcinomas with moderate differentiation. The sample included 17 males and 13 females. KRAS mutations were seen in 5 (16.7%) samples of patients older than 50 years. There was no statistically significant association between the incidence of KRAS mutations and age (p=0.686), gender (p=0.410), histopathological findings such as tumour site (p=0.807), size (p=0.828), angiolymphatic invasion (p=0.787), lymph node status (p=0.640), and staging of carcinoma (p=0.730); nevertheless, their importance should not be undermined. Conclusion: The KRAS mutations, commonly observed in codons 12 and 13 of exon 2, are involved in the multistep tumourigenesis of colorectal carcinoma. These mutations contribute to tumour aggressiveness, favoring metastasis and reducing apoptosis, thereby being associated with poor survival outcomes for patients. KRAS mutations are predictive of resistance to anti-EGFR targeted therapies, highlighting the necessity of analysing them in all cases of colorectal carcinoma to develop effective screening strategies and management plans.

Evaluation of Non Conformances in the Total Testing Process of a NABL-accredited Clinical Biochemistry Laboratory: An Observational Study

Dharmikkumar Savjibhai Patel, Harshkumar Darji, Khushbu R Panchal, Komal J Rathod Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Maintaining quality within clinical laboratories is fundamental to patient safety and reliable diagnosis. Every stage of the Total Testing Process (TTP) from sample collection to result reporting, is prone to errors that can affect both clinical decisions and operational efficiency. Systematic identification and analysis of Non Conformances (NCs) form an integral part of accreditation and continual quality improvement. Aim: To analyse the nature, frequency, and underlying causes of NCs in a National Accreditation Board for Testing and Calibration Laboratories (NABL)-accredited, clinical biochemistry laboratory attached to a medical college Materials and Methods: An observational study was conducted in the Clinical Biochemistry Laboratory of a tertiary care teaching hospital located in rural Gujarat, India, over a 12-month period, from March 2023 to February 2024. All recorded NCs were reviewed and categorised according to seven domains, including type, recurrence, severity, root cause, and impact. Root Cause Analysis (RCA) was undertaken using the “5 Whys” and Fishbone (Ishikawa) diagram approaches. Data were analysed descriptively and expressed as frequencies and percentages. Results: A total of 439 NCs were documented. Pre-analytical errors were most frequent (53.30%), followed by analytical (43.51%) and post-analytical (3.19%) errors. Human error (62.18%) and technical factors (36.90%) were the main root causes. Most NCs were isolated (76.77%) and minor (70.16%), chiefly affecting resource utilisation (59.91%) and turnaround time (29.16%). Conclusion: Pre-analytical weaknesses and human-related factors remain the key contributors to laboratory NCs. Regular monitoring, structured RCA, and continuous staff training are essential to sustain accuracy, efficiency, and quality within clinical biochemistry laboratories.

Altered Mineral Metabolism, Serum Uric Acid to Creatinine Ratio and Atherogenic Index of Plasma as Cardiovascular Risk Predictors in Chronic Kidney Disease: A Cross-sectional Study

Deepthi Mahendrakar, Mangala N Sirsikar Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Chronic Kidney Disease (CKD) is a significant public health issue associated with increased cardiovascular morbidity. Mineral metabolism imbalance and dyslipidaemia exacerbate Vascular Calcification (VC) and cardiac dysfunction. Serum Uric Acid to Creatinine Ratio (UACR) and Atherogenic Index of Plasma (AIP) have been explored as biomarkers for cardiovascular risk in CKD; however, limited data is available in this regard. Aim: The study aimed to evaluate the utility of UACR and AIP as cardiovascular risk factor and also to study the correlation of CKD stages with UACR, AIP, lipid profiles, and mineral metabolism in CKD patients. Materials and Methods: A cross-sectional study was conducted from December 2013 to June 2016 at Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India. The study included 50 CKD patients and 50 healthy controls. CKD diagnosis was confirmed using Kidney Disease: Improving Global Outcomes (KIDGO) criteria. Participants included adults aged 18-70 years with confirmed CKD stages 3-5 who provided informed consent. Data on demographics, serum uric acid, creatinine, lipid profiles, calcium, and phosphate levels were collected. UACR and AIP were calculated. Statistical analyses—including Independent t-tests, Chi-square tests, and Pearson correlation analyses—were performed, with a statistical significance of p-value <0.05. Results: The mean age of CKD patients was 47.74±11.01 years, with a male predominance (62%). From Stage 3 to Stage 5 CKD, lipid profiles deteriorated significantly with TC/HDL-C ratio increasing from 3.45 to 4.05 (p-value <0.001) and TG/HDL-C from 2.55 to 5.55 (r-value=0.70, p-value <0.001). AIP increased from 0.04 to 0.26 (p-value <0.001), while UACR showed negative correlation (r-value=-0.30, p-value=0.05) with lipid parameters. Calcium-phosphorus product showed a strong correlation with CKD progression (r-value=0.62, p-value <0.001). Renal function declined with elevated blood urea (119.88 to 190.45 mg/dL, p-value <0.001) and creatinine levels (7.04 to 10.76 mg/dL, p-value <0.001). Conclusion: UACR and AIP are effective predictors of cardiovascular risk in CKD patients, correlating with dyslipidaemia and declining renal function. These findings support their use in risk stratification and management in CKD care.

Serum Retinol-binding Protein 3 as a Potential Biomarker for Diabetic Retinopathy Severity: A Cross-sectional Study

Kinjal P Patel, Chirag K Pandya, Bhargav J Patel, Sandip S Sendhav, Prasad Khodke Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Diabetic Retinopathy (DR) is one of the leading causes of visual impairment worldwide. Its progression is influenced by complex metabolic, inflammatory and neurodegenerative mechanisms. Retinol-binding Protein 3 (RBP3), a retina-specific glycoprotein essential for the visual cycle, has recently gained attention due to its potential neuroprotective and anti-inflammatory roles. Reduced RBP3 levels may contribute to retinal dysfunction, making it a possible biomarker for DR risk stratification. Aim: To assess serum RBP3 levels among Type 2 Diabetes Mellitus (T2DM) patients and determine its association with the severity of DR, glycaemic control and systemic inflammation. Materials and Methods: A hospital-based cross-sectional study was conducted at Nootan Medical College and Research Centre, Visnagar, Gujarat, India, from January 2023 to February 2024, in collaboration with the Departments of Biochemistry, Ophthalmology, and Medicine. A total of 100 T2DM patients (aged 45-65 years) were enrolled. Detailed retinal examinations were performed to classify DR severity. Serum RBP3 levels were measured using Enzyme-Linked Immunosorbent Assay (ELISA). Glycated Haemoglobin (HbA1c) and high-sensitivity C-Reactive Protein (hs-CRP) were evaluated as indicators of glycaemic status and systemic inflammation. Statistical analysis was performed using MedCalc software, with p-value <0.05 considered significant. Results: The study included 100 patients with T2DM presenting with vision problems, with a mean age of 55.04±4.47 years (range: 45-65 years); 55% were female, and 45% were male. DR was present in 87% of participants, with mild non proliferative DR being the most common stage. Serum RBP3 levels showed a strong inverse correlation with DR severity (p-value <0.0001). Significant negative correlations were observed between RBP3 and HbA1c (r=–0.9136, p-value <0.0001) and between RBP3 and hs-CRP (r=–0.9654, p-value <0.0001). Conclusion: Serum RBP3 levels show a significant inverse association with the severity of DR, hyperglycaemia, and inflammation. These findings indicate that lower serum RBP3 levels are associated with more advanced retinopathy, poorer glycaemic control, and heightened systemic inflammation. RBP3 may serve as a promising biomarker for early detection and risk assessment in DR. Larger, longitudinal studies with predictive analysis are required to establish its diagnostic and therapeutic relevance.

Early Detection of Carbapenemases Producing Gram Negative Isolates by NG-Test CARBA 5: A Cross-sectional Study

Umesh Santlal Hassani, Kalpana Parag Date, Neena Vinay Nagdeo, Vishwajit Madhaorao Paikrao Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Rapid and accurate detection of carbapenemase producing Gram negative bacteria is prerequisite for effective clinical management and infection control strategies. The limited susceptibility of carbapenemase producing bacteria to antibiotics leads to serious global health issues. Currently various molecular and phenotypic test are available for early screening and identification of carbapenamase producing organisms. Aim: The aim of the present study was to detect various types of carbapeneamase produced by multidrug resistant Gram negative bacterial isolates obtained from clinical samples during the study period and to compare the effectiveness of NG-Test CARBA 5 assay with TaqMan based Real-Time Polymerase chain reaction (RT-PCR) for the early detection of carbapenmase producing Gram negative isolates. Materials and Methods: The present cross-sectional study was conducted at NKP Salve Institute of Medical Sciences & Research Centre and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India a Tertiary Care Hospital involving non-duplicate Gram negative carbapenem resistant isolates. NG-Test CARBA 5 was employed to detect carbapenemase production in different bacterial isolates. The study was conducted in duration of six months from August 2023 to February 2024. All the ertapenem resistant Gram negative bacterial isolates obtained from clinical samples during the study period were included in the study. Types of carbapeneamase produced by multidrug resistant Gram negative bacterial isolates obtained from clinical samples by of NG-Test CARBA 5, by immunochromatographic assay during the study period were documented. For 30 randomly selected isolates and a negative reference strain, the results obtained from NG-Test CARBA 5 were confirmed by TaqMan based multiplex RT-qPCR, for detection of carbapeneamase genes, NDM, KPC, IMP, VIM, OXA. The test was performed as per the kit protocol. PCR results were considered as the gold standard for detection of genes. Sensitivity, specificity, Positive Predictive Value (PPV) and Negitive Predictive Value (NPV) for NG-Test CARBA 5 was calculated using Microsoft Excel 2016. Results: Out of 277 Gram negative isolates, 75 (27.07%) isolates which were resistant to carbapenam were evaluated for presence of carbapeneamase genes by NG-Test CARBA assay. The results revealed that 54 (72%) isolates were positive for one or more carbapenemase genes, whereas 21 (28%) isolates were confirmed to be negative. The negative control (E. coli ATCC 25922) showed appropriate results. To validate and evaluate the feasibility of the NG-Test CARBA 5 assay, RT-qPCR test was performed for 30 (20 isolates NG-Test CARBA 5 Positive and 10 isolates NG-Test CARBA 5 negative) randomly selected isolates, and a negative reference strain; all the isolates tested by RT-qPCR, showed presence of one or more genes and the reference negative strain was confirmed as a negative. Conclusion: As per the present study findings, it is 64.5% sensitive and 100% specific, The PPV and NPV of NG-Test CARBA 5 is 100% and 8.4%. NG-Test CARBA 5 showed promise in detecting carbapenemase producing isolates although it needs further evaluation with large number of samples under Indian environmental conditions.

Effect of Antipsychotic Medications on ECG Parameters in Psychiatric Patients: A Cross-sectional Study

Srikanta Panigrahy, Jayanti Prava Behera, Suvendu Kumar Panda, Chandra Sekhar Tripathy, Pratyush Mishra Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Antipsychotic drugs are associated with Electrocardiogram (ECG) changes at therapeutic doses, although these changes are generally benign. Several psychotropic drugs have been linked to sudden death due to their prolongation of the corrected QT (QTc) interval, which can lead to polymorphic ventricular arrhythmia. Aim: To study the ECG changes induced by antipsychotic medications and potential Drug-Drug Interactions (DDIs) contributing to these changes in psychiatric patients. Materials and Methods: A cross-sectional study was conducted by the Department of Pharmacology in the Outpatient Department (OPD) of Psychiatry at Maharaja Krishna Chandra Gajapati (MKCG) Medical College and Hospital, Berhampur, Odisha, India, from December 2022 to November 2023. ECGs were obtained using a 12-lead portable ECG device (Spandan) in each case. Potential DDIs that may cause QTc prolongation were assessed using the Lexicomp® tool. Results: A total of 205 psychiatric patients were included in the present study, of which 142 (69%) were males and 31% (n=63) were females, with a mean age of 42.4±14.64 years. A total of 82 patients (40%) exhibited some ECG abnormalities. Among these abnormalities, 40% displayed abnormal ST/T changes, followed by 36% with QTc prolongation, and 16% with abnormal heart rates. Among the antipsychotics, haloperidol (p=0.037) showed a significant association with QTc changes. Female sex (p=0.027) was identified as a significant risk factor associated with QTc changes. The drug combinations with the highest potential for causing QTc changes were Olanzapine+Escitalopram (25%), followed by Haloperidol+Olanzapine (16%) The association of drugs with ECG changes and risk factor associations were analysed using the Chi-square test and odds ratio. Conclusion: The use of psychotropic drugs may be associated with ECG changes at usual doses. Therefore, psychiatric patients should be evaluated for ECG abnormalities prior to the initiation of antipsychotic medications to avoid potential cardiovascular complications. Regular medication reviews are also necessary to identify and prevent potential drug-drug interactions.

Effect of Short Duration versus Long Duration Muscle Energy Technique in Hamstring Tightness: A Randomised Clinical Trial

Vijayalaxmi Patil, Anand Heggannavar Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Hamstring tightness, which is common in both active and sedentary people, is caused by factors such as prolonged sitting, overuse, and poor posture, resulting in reduced flexibility and range of motion in normal daily activities. Muscle Energy Technique (MET) is acknowledged as an effective intervention to address this issue, but the impact of the duration on its effect remains underexplored. Aim: To compare the effect of short duration and long duration MET on hamstring flexibility in healthy young adults. Materials and Methods: A randomised clinical trial was conducted at KLES Prabhakar Kore Hospital, Belagavi, Karnataka, India, from November 2024 to April 2025. A total of 72 volunteers aged 18-25 years were screened, of which 64 participants met the inclusion criteria and were randomly allocated into two groups (n=32 each). Group 1 received short duration MET (5 repetitions) with Hot Moist Pack (HMP), while group 2 received long duration MET (10 repetitions) with HMP. Outcome measures included Active Knee Extension (AKE), Straight Leg Raise (SLR), and the Sit and Reach test, which were assessed both pre- and post-intervention. Data were analysed using the Wilcoxon signed-rank and Mann-Whitney U tests (p-value <0.05). Results: Each group demonstrated a statistically significant gain in every outcome measure (p-value =0.001). Between group comparison indicated significant post intervention differences favouring group 2 with effect sizes across AKE (2.49), sit to reach (l.95) and SLR (2.63), indicating a large treatment effect, highlighting the superior efficacy of long duration MET in improving hamstring flexibility. Conclusion: Both short and long duration MET protocols were effective in improving hamstring flexibility, however, the long duration protocol demonstrated superior outcomes. Incorporating prolonged MET into physiotherapy practice may enhance flexibility interventions for young adults with hamstring tightness.

Exploring the Therapeutic Synergy of Quercetin Gel and Mechanical Debridement in Peri-implantitis Management: A Prospective Clinical Evaluation

Mohamed Thaha, Arvina Rajasekar Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Peri-implantitis is a chronic inflammatory disorder characterized by continuous bone loss around dental implants, endangering their stability and long-term function. While mechanical debridement remains the cornerstone of therapy, emerging evidence supports the enhancement of outcomes through adjunctive agents, including antibiotics, antiseptics, and antioxidants. Aim: To evaluate the adjunctive efficacy of quercetin gel when applied locally alongside non-surgical mechanical debridement in peri-implantitis management. Materials and Methods: The present prospective clinical study was conducted at the Department of Periodontology, Saveetha Dental College and Hospitals, Chennai,Tamil Nadu, India between August and December 2024. Fifty patients diagnosed with peri-implantitis were included and randomly divided into two groups (n=25 each). group 1 (Control) received mechanical debridement alone, while group 2 (Test) received mechanical debridement with subgingival application of 1.2% quercetin hydrogel. Demographic data such as age, and gender were recorded. Clinical parameters including Plaque Index (PI), Gingival Index (GI), Periimplant Probing Depth (PPD), and Clinical Attachment Level (CAL) were assessed at baseline and after three months. Statistical analysis included paired and independent t-tests, with significance set at p<0.05. Results: At baseline, no significant differences were observed between the two groups in terms of age, gender, or clinical parameters (p>0.05). After three months, both groups showed statistically significant improvements in all clinical indices (p<0.05). However, group 2 demonstrated significantly greater reductions in PI (2.57±0.06 to 0.39±0.18), GI (2.55±0.16 to 0.66±0.19), PPD (5.84±0.19 mm to 3.01±0.02 mm), and CAL (6.47±0.11 mm to 3.13±0.12 mm) compared to group 1 (p<0.05 for all intergroup comparisons). Conclusion: Incorporating quercetin gel into standard mechanical debridement protocols yielded enhanced periimplant health outcomes. These findings suggest that quercetin gel may serve as a valuable adjunct in the non-surgical management of Peri-implantitis.

Immunophenotypic Evaluation of Mismatch Repair Proteins in Various Solid Tumours: A Cross-sectional Study from a Tertiary Care Cancer Centre in Rajasthan, India

Neha Sethi, Maneesh K Vijay, Shikha Goyal, Kusha Sharma, Praveena Vyas, Shweta Bansal, Usha Raina Kiran, Abha Mathur Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Mismatch Repair (MMR) proteins are essential in correcting DeoxyRibo Nucleic Acid (DNA) replication errors, including point mutations, to maintain genetic stability. Among atleast seven MMR proteins in humans, four- MLH1 (MutL homolog 1), MSH2 (MutS homolog 2), MSH6 (MutS homolog 6), and PMS2 (Postmeiotic segregation increased 2) are most significant in cancer biology, particularly in Colorectal Carcinoma (CRC), gastric, endometrial, and ovarian cancers. Deficiencies in these genes can lead to Microsatellite Instability (MSI), which promotes tumourigenesis. Aim: The present study done to assess the expression of MMR proteins and their association with clinicopathological features in solid tumours like colon, liver, stomach, gall bladder and others. Materials and Methods: The present retrospective and comparative study was conducted at a North Indian Cancer Centre at Jaipur, Rajasthan, India for three years, 55 cases of various solid tumours were examined for the expression of MMR proteins using immunohistochemistry. The cases were categorised into two groups: proficient (normal expression of MMR proteins, low MSI probability) and deficient (loss of MMR proteins, high MSI probability). The immunophenotypic expression was analysed in relation to clinical and pathological parameters by tabulating the data in Microsoft Excel sheet and statistical analysis was done by using the Statistical Package for Social Sciences (SPSS) statistics software windows version 22.0 released 2013. Results: Results showed that 8 (14.5%) out of 55 patients had a loss of MMR protein expression. Of these cases, 5 (62.5%) displayed a combined loss of MLH1 and PMS2, while 3 (37.5%) showed a combined loss of MSH2 and MSH6. All cases with MMR deficiency were located proximal to the splenic flexure and exhibited mucinous differentiation along with high levels of Tumour-infiltrating Lymphocytes (TILs). The mean age in the proficient group (59.4 years) was higher compared to the deficient group (54.5 years), with males {5 (62.5%) in MMRd and 25 (53.2%) MMRp} being more commonly affected than females {3 (37.5%) in MMRd and 22 (46.5%) in MMRp} in both groups. Adenocarcinoma was the predominant histological type in both groups {5 (62.5%) in MMRd and 30 (63.8%) in MMRp}. Conclusion: The study highlights the importance of MMR protein testing, particularly for CRC patients aged around 50 years with low-grade tumours. However, given the limited sample size, larger studies are needed to further explore the relationship between MMR protein deficiencies and clinicopathological features in various cancers.

Retention of Maxillary Denture Bases Fabricated Using Three Different Border Moulding and Final Impression Materials: A Comparative Experimental Study

Sreya Kundu, Jayanta Bhattacharyya, Soumitra Ghosh, Preeti Goel, Shubhabrata Roy, Sourav Maji, Saumyadeep Ghosh Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Denture dislodgement is prevented by retention and stability which in turn depends on the optimum extension of a denture base. Development of border seal is of utmost importance to maintain the contact between the denture and the adjacent vestibular tissue, achieved by border moulding. Establishing a correlation between the final impression and border moulding materials and the improvement of denture base retention will help to ameliorate post insertion patient satisfaction. The rationale of this study was to identify the best materials for border moulding and final impression to improve denture retention, stability, and fit. Aim: To compare maxillary complete denture retention with three different types of materials used for border moulding and final impression. Materials and Methods: The present comparative experimental study was conducted in the Department of Prosthodontics and Crown and Bridge, GNIDSR, Kolkata, West Bengal, India, involving 10 completely edentulous patients of either from November 2017 till July 2019, making use of three different border moulding and impression techniques to fabricate maxillary denture bases, whose retention was measured using a digital force gauge. Subjects were analysed for retention in three different groups: Group A (Green stick + Zinc Oxide Eugenol (ZOE), Group B (Addition silicone putty + light body), Group C (Polyether). Statistical analysis for the study was done using version 24.0 of Statistical Package for Social Sciences (SPSS) and 5th version of GraphPad Prism Statistical analysis was done using Analysis of Variance (ANOVA) and student’s t-test and significance was set at p<0.05. Results: Ten edentulous patients (mean age range of 50-70 years, 60% females and 40% males) were analysed for retention. Demographic parameters considered were age, gender and oral health status of the patient. ANOVA and student t-test was used for statistical analysis (p<0.05 was considered significant). Group A and B showed similar retention and both showed significant higher retention than Group C. Mean retention values were highest in Group A (4599.4000), followed by Group B (3605.5000) and Group C (2526.9000), respectively. Conclusion: Green stick border moulding proved to be more retentive followed by addition silicone putty with polyether exhibiting the least retention. Sectional moulding is more retentive than single step emphasising the importance of incremental adaptation. The findings confirm that border moulding technique and material selection is highly impactful on patient satisfaction and denture retention.

Evaluation of Serum Gamma-Glutamyl Transferase and Ferritin in Chronic Kidney Disease: A Cross-sectional Study

Okram Reshmi, Laikangbam Shaini, Ngangom Arunkumar Singh, Takhellambam Brojen Singh, Maharabam Purnima Devi, Sangeeta Chongtham, Soibam Pritam Singh, E Emaya Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Chronic Kidney Disease (CKD) is a leading cause of morbidity and mortality worldwide. Oxidative stress and chronic inflammation are important factors in the development of CKD. Gamma-Glutamyl Transferase (GGT) and ferritin are emerging biomarkers of oxidative stress and inflammation, respectively. However, their synergistic role in CKD remains understudied, and there is limited regional evidence on their association with kidney function in CKD. Aim: To estimate and compare serum levels of GGT and ferritin in individuals with and without CKD, and to assess their correlation with serum creatinine as a marker of renal function. Materials and Methods: This was a hospital-based, cross-sectional study conducted at the Department of Biochemistry in collaboration with the Nephrology Department at the Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India, from March 2023 to March 2025. A total of 200 participants were included- 100 diagnosed CKD patients and 100 age- and sex- matched healthy controls. Serum GGT, ferritin, urea, creatinine, and electrolytes were analysed using the Beckman Coulter DxC 700 AU autoanalyser. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 27.0. Student’s t-test and Pearson’s correlation were applied, and a p-value <0.05 was considered statistically significant. Results: The average age was 55.47±15.07 years. Serum GGT (61.29±43.12 IU/L) and ferritin (391.35±205.05 ng/ml) levels were significantly higher in CKD patients compared to controls (23.48±9.28 IU/L and 78.11±39.46 ng/ml, respectively; p-value <0.001). GGT showed a moderate positive correlation with serum creatinine (r-value=0.364), while ferritin exhibited a strong positive correlation (r-value=0.585). A significant positive correlation was also observed between GGT and ferritin (r-value=0.527, p-value <0.001). Conclusion: GGT and ferritin levels were significantly elevated in CKD and correlated positively with serum creatinine. These findings reflect the potential role of these markers in assessing oxidative stress, inflammation, and disease progression in CKD. They may serve as add-on markers for early CKD detection and monitoring. Further longitudinal studies are needed to establish the causality and therapeutic implications of these biomarkers in CKD.

Diagnostic Value of Neutrophilic-lymphocytic Ratio, Platelet-lymphocyte Ratio, Platelet Indices in Preeclampsia: A Case-control Study

SP Smitha Vadana, Swathi Samalla, Dinesh Kasturi, Chandana Anantha, Aishwarya Jawalkar, Uzma Parveen Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Preeclampsia (PE) is a pregnancy-specific disorder affecting 3-14% of pregnant women characterised by endothelial dysfunction, and activation of the coagulation system. Neutrophil to Lymphocyte Ratio (NLR), Platelet to Lymphocyte Ratio (PLR), Mean Platelet Volume (MPV) and Plateletcrit (PCT) have all been recognised as Systemic Inflammatory Response (SIR) markers. Alteration of these parameters can have significant effect on prognosis. Aim: To compare the NLR, PLR, and platelet indices between women with preeclampsia and normotensive pregnant women at Tertiary Care Centre. Materials and Methods: The present case-control study was conducted from June 2022 to May 2023 at Government medical college Nizamabad, Telangana, India. The study compared 44 pregnant women aged 18-40 years with preeclampsia diagnosed at term with 44 normotensive women matched for gestational age. A 3 mL of venous blood samples were drawn and Complete Blood Count (CBC) was analysed using Sysmex XN 1000, 5-part analyser. The parameters recorded were haemoglobin, platelet count, MPV, PCT, and Platelet Distribution Width (PDW). Results were analysed using Statistical Package for Social Sciences (SPSS) software version 23. Independent sample t-test was used to compare continuous variables between cases and controls. Diagnostic accuracy was calculated from ROC curve analysis. Results: A significant difference was found in NLR, MPV and PDW values between PE group and normotensive group (p<0.05). NLR, MPV, PDW showed an increase in mean difference of 6.76±3.76, 10.63±1.13,14.19±2.75 in PE group, respectively. However, PLR (p=0.628) doesn’t show any statistical significance. Conclusion: From the above findings of the study it is emphasised that NLR, MPV, PDW are significantly higher in PE than normotensive pregnancies and serve as cost-effective, accessible inflammatory marker in predicting preeclampsia.

Comparative Efficacy of Nebulised Magnesium Sulphate and Lignocaine in Attenuating the Haemodynamic Response to Laryngoscopy and Intubation: A Randomised Controlled Study

Nidhi Bangarwa, Suresh Kumar Singhal, Mohit Halder, Vandana Arora Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: The haemodynamic alterations occurring during laryngoscopy and intubation presents a significant challenge for Anaesthesiologists. It causes a transient but marked rise in Heart Rate (HR) and blood pressure which is highly undesirable. Aim: To analyse the comparative role of nebulised magnesium sulphate and nebulised lignocaine in managing the pressor response triggered by laryngoscopy and endotracheal intubation under anaesthesia. Materials and Methods: The present randomised controlled was carried out in the Department of Anaesthesia and critical care at PGIMS, Rohtak,India from September 2023 to August 2024 .The study included 80 patients scheduled for elective surgery requiring general anaesthesia. Group M (n=40) received nebulisation with 5 mL of a solution containing 1 mL of 50% (500 mg) magnesium sulphate diluted in 4 mL of saline. Group L (n=40) was nebulised with 5 mL of a 2% lignocaine hydrochloride solution. Baseline haemodynamic parameters (V₀) were recorded, and subsequent parameters were measured after nebulisation (V₁), prior to laryngoscopy (V₂), and at intervals following endotracheal intubation: one minute (V₃), three minutes (V₄), and 5 minutes (V₅). Data was expressed as frequency(n) or mean with standard deviation and appropriate statistical tests were applied for intragroup and intergroup comparison. Results were considered significant if the p-value was less than 0.05. Results: The demographic and clinical profiles of patients (age, sex, Body Mass Index (BMI), American Society of Anaesthesiologists (ASA) and Mallampatti Grading (MPG) were statistically similar across both groups. Baseline measurements for haemodynamic parameters were comparable between the groups. Group M had higher SBP values just before laryngoscopy (p=0.004) while Group L demonstrated significantly higher mean Systolic Blood Pressure (SBP) values than Group M at multiple time points: 1^st minute (p=0.003), 3^rd minute (p=0.001), and 5^th minute (p=0.001) after laryngoscopy and endotracheal intubation. Similarly, Group L exhibited higher mean Diastolic Blood Pressure (DBP) values at comparable time intervals (p=0.03, p=0.001, p=0.001 and p=0.003). A more pronounced rise in mean MAP was observed in Group L compared to Group M at 1^st min (p=0.001) and 3^rd min post-intubation (p=0.001). Group L also had higher HR values than Group M after nebulisation (p=0.03), before laryngoscopy (p=0.04), and at 1^st minute (p=0.006) and 3^rd minute (p=0.001) postintubation. Conclusion: The present study revealed that Group L exhibited significantly greater haemodynamic responses to laryngoscopy and endotracheal intubation than Group M at multiple time points in patient receiving general anaesthesia when compared with nebulised lignocaine. So The authors concluded that nebulised magnesium sulphate provided more persistent and effective attenuation for the pressor response.

Effects of Telerehabilitation versus Physical Rehabilitation on Kyphotic Index in Adolescent Girls: A Randomised Controlled Study

Pallavi Wakode, Shiny Raizada, Janhvi Dongre Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: One of the major concerns during adolescence is the development of postural deviations and musculoskeletal disorders, particularly affecting the cervical, thoracic, and lumbar spine. Thoracic kyphosis is characterised by an excessive anterior curvature of the thoracic spine. The Kyphotic Index (KI) is a quantitative indicator representing the ratio of thoracic width to thoracic length. Aim: To compare the effectiveness of telerehabilitation and physical (in-person) rehabilitation on KI in adolescent girls. Materials and Methods: The present Randomised Controlled Trial (RCT) was conducted among adolescent girls studying in peri-urban schools located in Dhayri and Khadakwasla, Pune, Maharashtra, India. Schoolgirls between 12 and 16 years of age who were beginning puberty were selected. Girls with protracted shoulders and a forward head posture were included. Girls with documented musculoskeletal, neurological, or cardiopulmonary diseases, as well as those with functional or structural scoliosis or visual impairment, were excluded from the study. The KI was used as a quantitative metric to assess the degree of thoracic spinal curvature. A total of 114 schoolgirls were selected and divided into three groups: telerehabilitation, physical rehabilitation, and control. The intervention was conducted over eight weeks with three sessions per week, and KI was measured pre- and postintervention. Strengthening exercises for the rotator cuff, scapular stabilisers, and cervical muscles, along with stretching for the pectoral and neck muscles, were administered in the intervention groups. The telerehabilitation group received sessions via an online video platform, whereas physical rehabilitation was delivered in person at school. Post-hoc comparisons using the Bonferroni adjustment were conducted to examine differences in postintervention KI (Post_Kyp) between treatment groups. Results: Physical rehabilitation produced the greatest improvement (adjusted mean=9.59) compared to telerehabilitation (10.26) and control (10.65). These results indicate that both physical rehabilitation and telerehabilitation significantly reduced postintervention KI compared to the control group, with physical rehabilitation showing a greater reduction than telerehabilitation (p-value <0.001). Conclusion: The telerehabilitation group significantly reduced KI in adolescent girls; however, physical rehabilitation showed a greater reduction than telerehabilitation.

Assessment of Malignant Potentiality of Oral Submucous Fibrosis Through Histomorphometry and E-cadherin Expression: A Cross-sectional Study

Sangeeta Sinha, Mousumi Pal, Rudra Prasad Chatterjee, Neha Shah, Swagata Gayen, Arunit Chatterjee, Mehebuba Sultana, Jyotir Moy Chatterjee Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Oral Submucous Fibrosis (OSF) is an oral precancerous condition with highest potential for malignant transformation. When OSF advances to oral cancer, epithelial cells undergo several dysplastic changes that alter the epithelial properties and architecture. Analysis of these features can provide useful diagnostic information to assess malignant potentiality of the disease process to avoid progression to oral cancer. Aim: The aim of the study was to assess the progression of non dysplastic and dysplastic OSF to malignancy using histomorphometry and E-cadherin expression in different layers of epithelium. Materials and Methods: The present cross-sectional study was conducted in the Department of Oral and Maxillofacial Pathology, Guru Nanak Institute of Dental Sciences and Research (GNIDSR), Panihati, Kolkata, and School of Medical Science and Technology (SMST), IIT, Kharagpur, West Bengal, India during the period of December 2019 to August 2021. It included 50 subjects divided into two groups, with 43 individuals suffering from OSF and seven individuals without disease process. Biopsy was conducted to establish diagnosis of OSF and stained sections were classified into nondysplastic and dysplastic category. Some sections were also prepared on lysine coated slides for immunohistochemical analysis. Finally, both sections were taken to SMST, IIT, Kharagpur, India, for staining with E-cadherin antibody and for procurement of photomicrographs using inverted microscope to undergo histomorphometrical analysis in basal-parabasal layers of epithelium and for assessing/comparing expression of adhesion molecule (E-cadherin) in basal-parabasal and spinous layers of non dysplastic and dysplastic OSF tissue using Image J software. Results: The mean cell area was found to be gradually increased from Normal Oral Mucosa (NOM) (35.60±3.26) to OSF with dysplastic (wd (39.12±4.99) followed by OSF without dysplastic (wtd) (64.11±9.90). The mean value of major axis was highest in OSFwtd (14.53±3.20) in comparison to OSFwd (11.23±1.98) and NOM (8.14±0.99), whereas the mean of minor axis was found to be decreased in OSFwd (4.24±0.89) and increased in case of OSFwtd (6.62±1.11) when compared with NOM (6.60±0.83). aspect ratio was highest in OSFwd (2.82±0.86), which showed gradual decrease in OSFwtd (2.37±0.71) and NOM (1.24±0.08). The gray scale value of membranous expression of E-cadherin in basal-parabasal layers was found to be highest in OSFwd (124.6±14.8) whereas it showed decrease in cytoplasmic expression in OSFwd (89.85±20.08) indicating loss of E-cadherin expression in cell membrane and simultaneous accumulation in cell cytoplasm (as gray scale value is inversely proportional to E-cadherin expression).The spinous cell layer also showed increased membranous gray scale value in OSFwd (143.17±15.5) and decreased cytoplasmic gray scale value in OSFwd (93.03±6.98). Conclusion: The study concluded that semiquantitative light microscopic histomorphometrical parameters like cellular size (area, major axis, minor axis) and shape (aspect ratio) depicting various statistically significant alterations, along with membranous loss of E-cadherin with concomitant cytoplasmic accumulation, both in basal-parabasal and spinous layers of the surface epithelium can be regarded as a significant indicator in predicting the disease progression of OSF to malignancy.

Seroprevalence of Transfusion Transmitted Infections among Healthy Voluntary Blood Donors: A Cross-sectional Study from Northern Kashmir Valley, India

Baba Iqbal Khaliq, Roudha Binti Farooq, Junaid Ahmad, Masroor Mustafa, Shakil Rehman, Nazima Nazir Bhat Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Blood transfusion is an effective treatment that saves millions of lives globally; however, Transfusion Transmissible Infections (TTIs) pose a potentially life-threatening risk. It is estimated that each unit of blood transfusion carries nearly a 1% risk of complications, including TTIs. Developed countries have significantly reduced the risk of TTIs through effective blood donor selection and advanced testing methodologies. In contrast, TTIs remain a considerable challenge to safe blood transfusion in developing countries, including India. Aim: To determine the seroprevalence of TTIs among apparently healthy voluntary blood donors at Government Medical College, Baramulla, Jammu and Kashmir, India. Materials and Methods: A cross-sectional study was conducted to determine the seroprevalence of TTIs among donors who donated blood at the Blood Centre, Department of Pathology, Government Medical College, Baramulla, Jammu and Kashmir, India between April 2021 and March 2025. Donated blood units were screened for five TTIs: Human Immunodeficiency Virus (HIV), Hepatitis B virus (HBV), Hepatitis C virus (HCV), syphilis, and malaria. Each blood unit was tested by ELISA for HIV, HBV, and HCV, while syphilis and malaria were screened using rapid antigen diagnostic tests. All reactive blood units were discarded as per the standard operating procedures of the blood centre. Results were expressed in numbers and percentages. Results: Out of 14,154 voluntary blood donors, 13,973 (98.72%) were male and 181 (1.28%) were female. A total of 95 donors (0.67%) tested seropositive for TTIs. Notably, all TTI-positive cases were observed among male donors. The prevalence rate was highest for HCV at 60 (0.42%), followed by HBV at 22 (0.16%), syphilis at 11 (0.08%), HIV at 2 (0.01%), and malaria at 0 (0%). The highest percentage of TTI cases was noted in the 21-30 years age group with 54 (56.84%) cases, followed by the 31-40 years age group with 32 (33.68%) cases. Conclusion: The increasing trend of HCV seropositivity among apparently healthy voluntary blood donors is a major concern. To combat TTIs, public awareness regarding the benefits of voluntary blood donation, adoption of modern screening techniques such as Nucleic Acid Testing (NAT) and Chemiluminescence Assays (CLIA), along with thorough donor evaluation, rigorous post-donation counselling, and follow-up alerts are strongly recommended.

Analysing the Emerging Role of Community Pharmacists in Improving Healthcare Economics: A Qualitative Study to Explore Perspectives and Practices Regarding Pharmacoeconomics and Patient-centred Services

SH Lavanya, L Kalpana, CB Anagha, Medha A Joshi Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Community pharmacies are among the most accessible points of care for patients seeking healthcare advice and services. With escalating out-of-pocket healthcare expenditure and a burgeoning Over-The-Counter (OTC) drug market in India, there is a substantial opportunity for community pharmacists to evolve from product-oriented service providers to patient-centred care providers. This transition has the potential to reduce healthcare costs and improve patient outcomes. Aim: To explore community pharmacists’ perspectives and practices regarding Patient-Centred Services (PCS) and to motivate them to apply pharmacoeconomic principles in patient care. Materials and Methods: An exploratory study design with a qualitative approach, employing both purposive and convenience sampling, was used to explore the perspectives of community pharmacists from urban areas in the vicinity of BGS Global Institute of Medical Sciences, Bangalore, from November 2022 to January 2023. Face-to-face interviews using a semi-structured interview guide were conducted with 25 pharmacists who held a minimum qualification of a Diploma in Pharmacy and who consented to participate. The entire study was planned and executed in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) studies guidelines. Audio recordings were transcribed verbatim, and the transcripts were thematically analysed using a content analysis approach. Descriptive statistics were used to represent the emerging themes and subthemes that were coded and categorically grouped. Upon completion of the study, a self-prepared and pre-validated awareness manual was distributed to the participants. Results: A total of 25 qualified community pharmacists (19 males and 6 females), aged between 22 and 60 years, with professional experience ranging from four months to 35 years, were interviewed. Six major themes-prescription handling; patient-centred services beyond drug dispensing; barriers to offering PCS; practices related to OTC dispensing; understanding of pharmacoeconomic principles; and perceived roles in improving the Indian healthcare system-along with eleven subthemes, were identified. Eighty percent of participants expressed a positive outlook towards offering patient-centred services and reducing overall healthcare costs. However, time constraints and a lack of recognition and support from consumers and doctors were major concerns reported by more than 76% of respondents. Conclusion: The present study highlights community pharmacists’ readiness and acceptance of expanded professional roles and establishes that they are indispensable yet underutilised healthcare professionals. With appropriate support and recognition, community pharmacists can significantly contribute to improving the Indian healthcare system.

Alterations in Inflammatory Markers in Women with and Without Gestational Diabetes Mellitus: A Case-control Study

Uma Rani Saravanan, K Sowmya, Santhi Silambanan Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Gestational Diabetes Mellitus (GDM) is diagnosed when pregnant women develop hyperglycaemia. GDM during pregnancy causes many complications in the mother and the foetus. Until now, GDM is diagnosed by an Oral Glucose Tolerance Test (OGTT) that becomes positive in the second trimester of pregnancy. Widespread inflammation is present in GDM. Inflammatory markers could help diagnose GDM. Aim: To evaluate the levels of inflammatory markers in women with GDM. Materials and Methods: The present case-control study was conducted at the Department of Biochemistry, SRIHER, Chennai, Tamil Nadu, India. The data were collected from medical records from January 2022 to December 2023. Data on plasma glucose and Complete Blood Count (CBC) were collected. Inflammatory indices such as Neutrophil Lymphocyte Ratio (NLR), Monocyte Lymphocyte Ratio (MLR), Platelet Lymphocyte Ratio (PLR), Systemic Immune inflammation Index (SII), Systemic Inflammation Response Index (SIRI) were calculated. Pregnant women between the ages of 20 and 40 years without diabetes (n=119) and pregnant women with GDM (n=118) were included. Pregnant women with pre-existing diabetes mellitus, gestational hypertension, and inflammatory disorders were excluded. The obtained data were subjected to the normality of distribution. Student’s t-test and Chi-square test were used. The Pearson correlation coefficient was used to compare the variables. The p-value ≤0.05 was considered statistically significant. Results: The mean age of women in non-diabetic group was 32.5±7.51 years and in diabetic group was 30.9±8.9 years (p=0.13). Among the White Blood Cells (WBC), only monocyte count (%) showed a statistically significant difference (p=0.03) between the groups. All the derived variables showed statistically significant differences between the groups NLR (p=0.007), MLR (p=0.007), PLR (p=0.03), SII (p=0.03), and SIRI (p=0.02). Fasting plasma glucose, 1-hr OGTT, and 2-hr OGTT were positively correlated with RBC, PLR, and SII, which were statistically significant. Conclusion: All the derived variables, such as NLR, MLR, PLR, SII, and SIRI, showed higher values in GDM individuals than non-diabetic pregnant women. Plasma glucose was correlated with the systemic immune inflammation index and platelet-to-lymphocyte ratio. Thus, inflammatory markers (NLR, MLR, PLR, SII, and SIRI) could serve as potential diagnostic markers of GDM.

Comparative Evaluation of Broth Microdilution, Disc Elution and Rapid Colistin NP Test for Detecting Colistin-resistant Enterobacterales: A Cross-sectional Study

Oikya Mukhopadhyay, Anusha Gopinathan, Shweta Naik, SS Jaya Lakshmi, Datachanamoorthy Maheshwary, KV Leela Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: As Antimicrobial Resistance (AMR) continues to pose a global health crisis, rapid and accurate antimicrobial susceptibility testing is crucial. In Intensive Care Unit (ICU) patients with sepsis, the 48-hour delay associated with conventional culture-based reports can be critical. The present study aimed to compare the rapid Colistin NP test with conventional culture techniques as a key strategy to combat antibiotic resistance caused by Multidrug Resistant (MDR) organisms. Aim: To perform a comparative evaluation of three different methods for detecting colistin resistance: Broth Microdilution (BMD), Disc Elution (DE), and rapid colistin NP tests. in Enterobacterales And to determine the Minimum Inhibitory Concentration (MIC) of colistin using the BMD test, to determine the MIC of colistin. Materials and Methods: The present cross-sectional study was conducted over twelve months (January 2023 to December 2023) at SRM Medical College Hospital and Research Centre, Chengalpattu, Tamil Nadu, India. The primary inclusion criteria that was set for the study was that blood specimens from ICU patients testing positive for Gram Negative Bacilli (GNB) were included in the study. The sample size was determined to be 178. Blood samples positive only for GNB belonging to Enterobacterales were taken into consideration. BMD and DE tests were performed to determine the MIC of colistin. Additionally, the rapid colistin NP Test was conducted to assess antibiotic susceptibility.The assessment was conducted directly from BacT/ALERT bottles as well as from bacterial isolates. The blood samples were collected from patients above 18 years of age. Statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) software. The Chi-square test was used to assess the correlation between BMD (the gold standard method) and other methods such as DE and the rapid colistin NP Test (from both isolates and BacT/ALERT bottles). A p-value of <0.05 was considered statistically significant. Results: Over the study period, 178 GNB isolates were identified. Of these, 151/178 (84.8%) were found to be colistin-sensitive by BMD and DE tests. Using the rapid colistin NP Test, 153/178 (85.9%) isolates from bacterial cultures and 154/178 (86.5%) from BacT/ALERT bottles were identified as colistin-sensitive and resistant, respectively. The sensitivity and specificity of the rapid colistin NP Test were 92.5% and 100% for bacterial isolates, and 88.9% and 100% for BacT/ALERT bottles, respectively. Conclusion: The present study demonstrates that the rapid colistin NP test is an effective and reliable method for the early detection of colistin resistance in GNB within the enterobacterales group. The test showed high sensitivity and specificity, offering rapid results that can significantly aid clinical decision-making. Its implementation can facilitate timely initiation of appropriate antimicrobial therapy, helping to curb the spread of resistant strains and improve patient outcomes. These findings support the routine use of the rapid colistin NP Test in clinical microbiology laboratories for the prompt identification of colistin-resistant pathogens.

Exploring the Causes and Factors Contributing to Pre-hospital Delays in Acute Myocardial Infarction Patients: A Hospital-based Cross-sectional Study from a Resource-limited Setting

Raed Mohamed, Bashir A Yousef, Kannan O Ahmed, Ahmed A Suliman Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Early treatment of Acute Myocardial Infarction (AMI) is crucial for reducing mortality. However, not all patients arrive early enough to receive optimal therapy, especially in developing countries. Several factors contribute to increased pre-hospital delays. Aim: To explore the frequency and causes of delayed presentations among patients with AMI in Sudan. Materials and Methods: This hospital-based cross-sectional study included 224 patients admitted to Al-Shaab Teaching Hospital and the Sudan Heart Centre, Khartoum State, Sudan between September 2022 and November 2022. A validated questionnaire was used to collect data, and patients were categorised into two groups: those who arrived after 12 hours (delayed) and those who arrived within 12 hours (non delayed). Statistical analysis was performed using the Chi-square test to assess associations between pre-hospital delay and patient characteristics, with a p-value of <0.05 considered statistically significant. Results: More than half of the patients, 119 (53.1%), experienced a delay in arriving at the hospital. The most common cause of delay was seeking care at a non reperfusion centre, affecting 76 (64%) of delayed patients. The study found significant associations between delayed presentation and factors such as education level (p=0.03), smoking status (p=0.004), and residency location (p=0.04). However, no significant associations were observed with age, gender, mode of transportation, chronic co-morbidities, previous myocardial infarction, or family history of AMI. Conclusion: The study concluded that more than half of the patients experienced delays, primarily due to visiting non reperfusion centres. Delays were also linked to lower education levels, non smoking status, and living outside the capital, Khartoum. Public education campaigns about the importance of early hospital presentation for AMI could help reduce delays and improve outcomes.

Diagnostic Accuracy of EUS versus MRCP for Extrahepatic Biliary Tract Disorders: A Prospective Observational Study

Divij Agarwal, Varun S Shetty, Iqbal Ali Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Accurate diagnosis of Extrahepatic Biliary Tract Disorders (EHBTDs) is essential for guiding appropriate management. Magnetic Resonance Cholangiopancreatography (MRCP) is a widely used non-invasive modality but may miss small calculi or early lesions. Endoscopic Ultrasound (EUS), with its superior spatial resolution and ability for tissue sampling, may provide enhanced diagnostic yield. Aim: To compare MRCP and EUS in EHBTDs, with special focus on obscure Common Bile Duct (CBD) dilatation. Materials and Methods: The present prospective observational study was carried in the Department of General Surgery at Dr DY Patil Medical College, Hospital and Research Centre, Pimpri, Pune, Maharashtra, India, from January 2024 to March 2025. It included 100 adults with suspected EHBTDs who underwent MRCP followed by EUS within one week. Final diagnoses were confirmed using Endoscopic Retrograde Cholangiopancreatography (ERCP), operative findings, histopathology, and structured follow-up. Diagnostic performance was assessed by sensitivity, specificity, predictive values, and area under the ROC curve (AUC). Subgroup analysis was performed for obscure CBD dilatation (n=9). Results: The EUS consistently outperformed MRCP across diagnostic categories. For choledocholithiasis, EUS achieved sensitivity and specificity of 97.2% and 95.4% (AUC 0.96), compared with 91.8% and 90.1% for MRCP (AUC 0.91). In benign biliary strictures, EUS reached 98.3% sensitivity and 96.2% specificity, surpassing MRCP (91.7% and 89.6%). For neoplastic lesions, EUS showed sensitivity of 96.8% and specificity of 95.0%, slightly higher than MRCP (95.0% each). The most striking difference was observed in obscure CBD dilatation: MRCP failed to reveal any aetiology, whereas EUS correctly identified the underlying pathology in six of nine patients. The remaining three cases required ERCP for definitive confirmation. Conclusion: These results reinforce the higher diagnostic accuracy of EUS in EHBTDs and emphasise its role when MRCP is inconclusive. In obscure CBD dilatation, EUS not only clarified the diagnosis in most patients but also reduced unnecessary reliance on diagnostic ERCP

Comparative Evaluation of Two Doses of Intrathecal Dexmedetomidine (3 μg vs 5 μg) as an Adjuvant to Hyperbaric Ropivacaine in Caesarean Section: A Randomised Double-blind Controlled Trial

Himani Taiwade, Dipakkumar Ruparel, Krunal Borkar, Shweta Sedani Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Spinal anaesthesia is commonly used for caesarean sections because of its rapid onset, reliable sensory and motor blockade, and excellent analgesia. Ropivacaine is preferred for its improved safety profile and reduced motor block. Aim: To assess the impact of adding dexmedetomidine (3 μg vs 5 μg) to intrathecal hyperbaric ropivacaine in patients undergoing elective caesarean section. Materials and Methods: This randomised, double-blind, controlled study was conducted at the Department of Anaesthesiology, Government Medical College, Gondia, Maharashtra, India, from July 2023 to January 2025. A total of 90 parturients were enrolled and received spinal anaesthesia with 12.5 mg of intrathecal ropivacaine. Participants were randomly assigned to one of three groups: ropivacaine alone (R group), ropivacaine with 3 μg dexmedetomidine (RD3 group), and ropivacaine with 5 μg dexmedetomidine (RD5 group). The study evaluated intraoperative sensory and motor block characteristics, haemodynamics, postoperative analgesia, and adverse events. Statistical analysis was performed using the Chi-square test and one-way Analysis of Variance (ANOVA). Results: The demographic characteristics of patients in all three groups were comparable regarding age, Body Mass Index (BMI), height, and gestational age (p-value >0.05). Addition of dexmedetomidine to intrathecal ropivacaine significantly enhanced anaesthetic efficacy. Both RD3 and RD5 groups showed faster onset of sensory block to T10, T4, and peak levels compared to the R group (p-value <0.05). Sensory regression times and duration of motor block were significantly longer in the RD3 and RD5 groups, with RD5 showing the longest motor recovery time (207.9±22.38 vs 121.82±2.56 mins in R group; p-value <0.001). Motor block onset was faster in the dexmedetomidine groups (p-value <0.001). Intraoperative conditions, including visceral traction tolerance and muscle relaxation, were superior in the RD3 and RD5 groups. Postoperative VAS scores at 12 hours were lower in RD3 and RD5 than in the R group. All three groups experienced a decline in systolic blood pressure after spinal anaesthesia; however, the RD5 group exhibited the greatest fall. Conclusion: Intrathecal dexmedetomidine, when used as an adjuvant to ropivacaine, enhanced intraoperative somatovisceral sensory block quality and improved postoperative analgesia, particularly at a dose of 3 μg. Although the 3 μg dose produced fewer side-effects compared to 5 μg, it was associated with significant prolongation of motor block duration—though less than that observed with 5 μg—making it a suitable and balanced dose for clinical use.

Association of Coping Strategies and Quality of Life with Lifetime Traumatic Events among University Students: A Cross-sectional Study

Harshitha, Jayesh Chandran, Pamidigantam Raghava Priya Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Research on psychological trauma has primarily focused on evaluating the psychological effects of specific incidents. Individuals who have experienced a traumatic event are at a higher risk of exposure to multiple traumatic events in the future. Coping models typically distinguish between three main categories: task-oriented, emotion-oriented, and avoidance-oriented coping. Physical, psychological, social, and environmental factors all affect Quality of Life (QoL), and trauma frequently leads to distress and reduced wellbeing. Aim: To evaluate the association between coping strategies and QoL in relation to lifetime traumatic events among university students. Materials and Methods: The present cross-sectional study was conducted at NITTE (Deemed to be University), NITTE Institute of Physiotherapy, Mangalore, Karnataka, India. The study was conducted at the university wellness centre between March 2024 and March 2025. The study enrolled college students aged 18 years and above. The Brief Trauma Questionnaire (BTQ) was used to differentiate between students who screened positive and negative for lifetime traumatic events. This was followed by assessing coping strategies using the Coping Inventory for Stressful Situations and QoL using the World Health Organisation (WHO) Quality of Life Brief version (WHOQoL-BREF). A total of 189 participants were screened, of whom 94 were included and 95 were excluded. Data were analysed using Statistical Packages for the Social Sciences (SPSS) v29.0.10, with descriptive statistics, t-tests, one-way Analysis of Variance (ANOVA), likelihood ratio tests, and the Karl Pearson’s correlation coefficient. A p-value <0.05 was considered statistically significant. Results: The mean age of thje study participants was 20.39±1.44 years {mean±Standard Deviation (SD)}. psychological, environmental, and overall QoL domains (mean and cumulative scores) were all strongly associated (p<0.004) with task-oriented coping. Additionally, emotion-oriented coping strategies were found to be negatively associated with both environmental and overall QoL domains, with the association reaching statistical significance (p<0.04). However, none of the QoL domains were associated with avoidance-oriented coping strategies. Conclusion: The evidence from present study underscores the positive influence of task-oriented coping on QoL across several domains. In contrast, emotion-oriented and avoidance-oriented coping strategies are generally less beneficial and may contribute to poorer outcomes in specific areas, such as environmental quality and overall QoL.

Clinical Profile of Paediatric Head Injury Patients at a Tertiary Care Teaching Hospital of Gujarat, Western India: Prospective Observational Study

Nikita J Prajapati, Rahul Tandon, Akshat K Vadaliya, Bhavdeep M Mungala, Ankita Agrawal, Krutika Rahul Tandon Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Paediatric Traumatic Brain Injury (TBI) is a leading cause of morbidity and mortality in children. The accompanying Cervical Spine Injuries (CSI) are not well studied in the Indian subcontinent, particularly with respect to adherence to stabilisation protocols during inter-hospital referrals. Aim: To evaluate the clinical profile, neuroimaging characteristics, and outcomes of paediatric TBI cases at a tertiary care hospital in Gujarat, Western India. Materials and Methods: The present one-year, prospective, observational study included 95 paediatric patients (1 month to 18 years) with head injuries who presented to a tertiary care teaching hospital in Gujarat, Western India, between October 2023 and September 2024. Data were collected on demographics, mechanisms of injury, symptoms, neuroimaging, transport, cervical spine immobilisation, hospital course, and outcomes. Descriptive and inferential analyses were used to describe the profile and examine associations between key parameters. Results: Among 95 patients, 74 (77.9%) were males. Nearly half (47, 49.5%) were below eight years of age. Falls (39, 41.1%) and Road Traffic Accidents (RTA) (38, 40%) were the most common causes of injury. Only 2 (2.1%) children received cervical spine immobilisation during transport. Of the total, 31 (32.6%) were moderate-to-severe cases, and neuroimaging was indicated or performed in 30 (31.9%). Out of these 30, Subdural haematoma (13, 43.3%) and cerebral contusions (10, 33.3%) were the most frequent radiological findings. Most patients (60, 63.2%) were discharged within 48 hours. Full recovery occurred in 77 (81.1%), while 17 (17.9) had disabilities and 1 (1.1%) died. Lack of cervical spine stabilisation and the need for intubation were significantly associated with poorer outcomes (p<0.05). Conclusion: Most patients were male, and mild-to-moderate head injuries were common. A substantial number of severe cases were also noted, with subdural hematoma and contusions strongly linked to poor neurological outcomes. Only two patients received cervical spine stabilisation during transport, highlighting a major gap in prehospital trauma care.

The Relationship between Quality of Life, Self-efficacy, and Psychological Wellness among Women on Maintenance Haemodialysis: A Cross-sectional Study

Sheeba George, M Nalini, KK Sarosh Kumar, Fatima D’Silva, M Pradeep Shenoy Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Chronic Kidney Disease (CKD) is associated with physical, psychological, social, and functional problems. While Maintenance Haemodialysis (MHD) is therapeutically beneficial, patients continue to face multiple challenges. Together, the disease and its treatment contribute to a significant decline in quality of life. Self-efficacy and psychological wellness are two key factors influencing the quality of life of patients undergoing long-term treatment. Understanding these relationships is particularly important among female patients in culturally sensitive settings. Aim: The present study aimed to assess the quality of life, self-efficacy, and psychological wellness among women undergoing Haemodialysis (HD), and to determine the correlation between these variables. Materials and Methods: A cross-sectional study was conducted among 100 female participants undergoing MHD at two selected dialysis units in Northern Kerala, India: the Government Medical College, Kannur, and the CH dialysis centre, a nearby charitable facility from 24 March 2024 to 15 May 2024, enrolled using the consecutive sampling technique. The Kidney Disease Quality of Life-36 (KDQOL-36) was used to assess quality of life, the Strategies Used by People to Promote Health (SUPPH) scale to measure self-efficacy, and Ryff’s Psychological Well-Being (PWB) scale to evaluate psychological wellness. Data were analysed using descriptive statistics and Spearman’s rank correlation coefficient. Results: Among the quality-of-life subdomains, the burden of kidney disease had the lowest median score {18.75 (12.50-25.00)}, followed by the Physical Component Summary (PCS) {30.57 (24.91-35.29)}. Relatively higher median scores were obtained for self-efficacy {84.00 (77.00-93.75)} and psychological wellness {74.00 (70.00-78.75)}. A positive correlation was found between self-efficacy and quality of life (ρ=0.358, p<0.001), while self-efficacy showed a weak correlation with psychological wellness (ρ=0.226, p=0.024). No significant correlation was observed between quality of life and psychological wellness (ρ=0.009, p=0.932). Conclusion: The above findings indicate that when patients feel more confident and capable, their quality of life tends to improve. However, self-efficacy may not be a standalone predictor of quality of life, which is likely influenced by a complex interplay of multiple factors. Tailored interventions that enhance confidence in managing the disease, while also addressing physical and psychological challenges, could positively influence quality of life.

Relationship between Impulsivity, Personality Traits and Social Media use among Medical Students: A Cross-sectional Study

Akshay Naik, Sindhuja Balu, Suprakash Chaudhury, Madhura Ajitkumar Gandhi Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Excessive social media use is increasingly prevalent among medical students, potentially leading to addiction and affecting well-being. Psychological constructs such as impulsivity and personality traits may predispose this vulnerable group to social media addiction. Aim: To investigate the relationship between impulsivity, personality traits, and social media addiction among medical students. Materials and Methods: A cross-sectional study was conducted at the Department of Psychiatry, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, from October 2023 to September 2024, among medical students studying at the Medical College affiliated with a Tertiary Healthcare Hospital in Pune, India. After Institutional ethics approval, 305 undergraduate medical students were recruited by convenience sampling. Participants completed sociodemographic questionnaires and validated psychometric instruments, including the Barratt Impulsivity Scale (BIS-11), the Big Five Inventory (BFI), and the Social Media Addiction Scale (SMAS). Data were analysed using Mann-Whitney U and Chi-square tests with a significance threshold of p-value <0.05. Results: Social media addiction was prevalent in 81.6% of students. Individuals with addiction reported significantly more daily screen time (p-value=0.001) and a higher frequency of checking updates (p-value <0.001). Neuroticism was substantially higher, while agreeableness and openness to experience were significantly lower among addicted students (p-value <0.001, p-value=0.001, and p-value=0.030, respectively). While overall impulsivity scores were not significantly different between the groups, addicted participants exhibited higher attentional, motor, and non planning impulsivity (p-value <0.001, p-value=0.001, and p-value=0.044, respectively). The SMAS total score showed a positive correlation with the number of platforms used, daily screen time, frequency of checking updates, neuroticism, and BIS-11 scores. Regression analysis revealed increased daily screen time, increased frequency of checking updates, neuroticism, and BIS-11 scores as significant positive predictors and openness and agreeableness as significant negative predictors of social media addiction. Conclusion: Social media addiction affects a significant proportion of medical students and is characterised by elevated neuroticism, reduced agreeableness and openness to experience, and increased impulsivity in all sub-domains. These findings suggest the need for early identification of those at risk and the development of focused interventions to address addiction and, therefore, promote the mental health of medical students in academic settings.

Volumetric Analysis of Post Space Impressions Made using Digital Scan and Cone Beam Computed Tomography Imaging: An In-vitro Study

N Vanamala, N Thejashree, BS Keshava Prasad, K Harrini, Apoorva Karanam Prakash, K Supreetha S Naik Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Digital impressions are dental scans captured using Three-dimensional (3-D) scanning technology. Scanning deeper areas can affect the accuracy and completeness of the digital impression, potentially leading to inaccuracies in the final restoration. Scanning post spaces at greater depths and narrower diameters can pose significant challenges for digital scanning. Aim: To compare the volume of post space impressions made using the digital impression technique (Primescan/Dentsply Sirona) with the volume obtained from Cone Beam Computed Tomography (CBCT) imaging. Materials and Methods: The present in-vitro study was conducted between January and April 2025 in the Department of Conservative Dentistry and Endodontics at DAPM RV Dental College, Bengaluru, Karnataka, India. A total of 15 extracted single-canal, single-rooted permanent teeth were collected for this in-vitro study. All the teeth were cut coronally to maintain an equal length of 22 mm. Endodontic treatment was performed on all the teeth, followed by post space preparation, leaving behind 5 mm of gutta-percha. Group A: A CBCT reference scan was performed for all the samples; the volume of the post space was measured using on-demand software for each tooth, which served as a control. Group B: The same samples were subjected to a digital impression (Primescan/Dentsply Sirona), and the volume of the post space was recorded using Exocad software. Group B values were compared with the corresponding group A reference values. Results: The intraoral scanned images (group B) recorded a slightly smaller volume than that obtained from CBCT. Although the mean difference between the two methods was 0.7384 mm³, it was shown to be statistically significant (p<0.001). Conclusion: Based on the analysis of the study results, it can be concluded that the mean difference in volume between CBCT and Primescan was 0.738 mm³, with the Primescan recording 97.82% of the volume. The Primescan demonstrates clinically acceptable accuracy in scanning the post space.

An Umbrella Review of the Accuracy in Dental Implant Placement Techniques Comparing Static Computer-aided Implant Placement versus Partially Guided Implant Placement and Freehand Implant Placement

Pranjal Bhagawat Patil, Amrita Pandita Bhatia, Yukta Gadhe, Shilpi Tiwari, Khushbu Patel Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: The accuracy of dental implant placement is critical for the long-term success of implant-supported restorations. Different techniques have been developed to improve precision, including freehand placement, partially guided approaches, and fully static Computer-aided Implant Placement (sCAIP). Despite advancements in technology, there is still no consensus on the best method for achieving consistently accurate implant positioning. Aim: To systematically evaluate existing systematic reviews that compare the accuracy of sCAIP (fully guided) with partially guided and freehand techniques. Materials and Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, which were registered with PROSPERO (Registration number: CRD42024604187). A thorough electronic search was conducted using databases such as PubMed, Cochrane Central, EBSCOhost, and Google Scholar for studies published between January 2013 and October 2024. Inclusion criteria included systematic reviews that reported deviation values for implant placement accuracy among the three techniques. Results: Out of 55 articles identified, five systematic reviews met the inclusion criteria using the Assessment of Multiple Systematic Reviews (AMSTAR 2) checklist to eliminate the risk of bias. The reported deviation measurements were: Static computer-aided (fully guided): Mean angular deviation ranged from 2.1° to 3.8°; mean coronal deviation ranged from 0.9 mm to 1.2 mm; and apical deviation ranged from 1.2 mm to 1.6 mm. Partially Guided: Angular deviation ranged from 4.2° to 6.5°; coronal deviation from 1.3 mm to 2.1 mm; apical deviation from 1.9 mm to 2.8 mm. Freehand: Angular deviation ranged from 5.7° to 8.4°; coronal deviation from 2.0 mm to 3.2 mm; apical deviation from 2.8 mm to 4.5 mm. Due to differences in study designs, measurement techniques, implant systems, and reporting metrics, a quantitative meta-analysis was not possible. The findings clearly demonstrate a progressive increase in deviation from the planned implant position as the level of guidance decreases. Fully guided sCAIP consistently showed the lowest angular, coronal, and apical deviations, confirming its superiority in translating virtual planning into clinically accurate implant positions. The narrow range of deviations in this group also suggests greater predictability and reproducibility. Partially guided approaches exhibited moderate accuracy, falling between fully guided and freehand methods. The higher deviations in this group are likely attributed to limited guidance during specific drilling steps, which increases the potential for cumulative error as manual control becomes more prominent. Freehand implant placement demonstrated the greatest deviations across all measured parameters, reflecting the inherent operator-dependent variability associated with unguided techniques. These larger deviations may have clinical implications, particularly in anatomically sensitive regions or in cases requiring prosthetically driven placement. Conclusion: The sCAIP (fully guided) showed better accuracy in all measured parameters-angular, coronal, and apical deviations-compared to partially guided and freehand methods. This improved accuracy may lead to a reduced risk of damage to anatomical structures, better prosthetic outcomes, and higher long-term success rates.

Effectiveness of Vipassana Meditation and Yoga in Enhancing Forgiveness and Reducing Anger among Individuals with Coronary Heart Disease: A Prospective Interventional Study

Shraddha Sharma, Ritu Sharma Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: The detrimental effects of anger on psychological and physical health have been highlighted by traditional and contemporary perspectives. Conversely, forgiveness is increasingly recognised as a protective factor that contributes to emotional regulation and good health. In recent years, mind-body practices, such as yoga and Vipassana meditation, have gained empirical support for their therapeutic potential, particularly in managing stress-related conditions. Aim: To examine the effectiveness of Vipassana meditation and yoga in enhancing forgiveness and reducing anger among individuals diagnosed with Coronary Heart Disease (CHD). Materials and Methods: The prospective interventional study design was used in the present research. The purposive sampling technique was used to collect data from Agra, Gwalior and Firozabad cities of India. Subjects were contacted through personal and social connections as this study required six-months commitment. Nearly 230 subjects were contacted and 74 gave consent to participate. In the final stage, a total of 60 patients with CHD, aged 40-60 years, participated in the study. Based on their willingness to engage in regular practice, participants were assigned to one of three groups: Group I, Vipassana meditation (n=20); Group II, yoga (n=20); and Group III, control (n=20). The experimental groups engaged in their respective interventions for six months, while the control group received no such intervention. The anger scale (2017) and the forgiveness scale (2021) were used to collect data from participants. Results: The findings indicated significant improvement in forgiveness (p=0.01) and reductions in anger (p=0.01) among participants in both intervention groups. Specifically, Vipassana meditation demonstrated significant efficacy in reducing revenge-related tendencies (p=0.01) and enhancing both self (p=0.01) and other-forgiveness (p=0.01). Yoga was found to have a broader impact, significantly improving the emotional, cognitive, and trait dimensions of forgiveness. No significant changes were observed in the control group. Conclusion: The study concluded that regular engagement in yoga or Vipassana meditation is significantly helpful in promoting forgiveness and in reducing anger in patients with CHD. These practices show potential as accessible, non-pharmacological approaches for enhancing emotional well-being and may also contribute to cardiovascular health.

Concordance with Evidence-based Acute Coronary Syndrome Care Metrics and Predictors of Cardiovascular Outcomes: Data from an Indian Tertiary-care Setting

Preet Chapatwala, Vaibhav R Suryawanshi, Vaibhav B Patil, Sanket Dharma, Akshata Shirodkar, Shivakumar Iyer, Atmaram Pawar Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Acute Coronary Syndrome (ACS) remains a leading cause of morbidity and mortality worldwide, with India experiencing a disproportionately high burden of premature Cardiovascular Disease (CVD). International guidelines provide evidence-based care metrics to optimise outcomes, yet adherence to these recommendations in real-world Indian practice is often inconsistent. Aim: To assess the extent of concordance with evidence based ACS care metrics in Indian clinical practice, and to evaluate its association with clinical outcomes while identifying key predictors of cardiovascular events. Materials and Methods: The present prospective observational study was conducted over 1.5 years at a university hospital based in western India. Concordance with evidence based ACS care, defined by a total of 16 “American Heart Association (AHA)” quality metrics, was evaluated in relation to clinical outcomes. The primary outcomes assessed were all cause mortality, Discharge Against Medical Advice (DAMA), recurrent Myocardial Infarction (MI), Major Adverse Cardiac And Cerebrovascular Events (MACEs), and cardiac rehospitalisation. Secondary outcomes included length of hospital stay and other medical complications. Multivariate regression analyses were employed to examine the association between concordance with evidence based ACS care and clinical outcomes, as well as to identify predictors of mortality and MACEs. Results: Among 190 ACS admissions, ST elevation MI (STEMI) was diagnosed in 121 (63.7%) patients, non ST elevation MI (NSTEMI) in 35 (18.4%) patients, and Unstable Angina (UA) in 34 (17.9%) patients. The median age was 59.5 years {Inter-quartile Range (IQR), 48-67}. Eligible patients received intravenous thrombolysis (80/98, 81.6%) and primary Percutaneous Coronary Intervention (PCI) (51/62, 82.3%), with concordance to recommended Door To Needle (DTN) and Door To Ballooning (DTB) times observed in 39/80 (48.7%) and 23/51 (45.1%) patients, respectively. Overall concordance (all or none metrics) varied across ACS subtypes, highest in STEMI patients {64/121 (52.8%)}. Adherence to thrombolysis, primary PCI, and all or none metrics was significantly associated with reduced mortality and MACEs (p<0.001). In STEMI, predictors of mortality and MACEs included age >60 years, dyslipidaemia, uncontrolled diabetes, History, Electrocardiogram (ECG), Age, Risk factors, and Troponin (HEART) score 7-10, delayed hospitalisation (>6 hours), DTN >30 minutes, and DTB >90 minutes. Conclusion: Beyond other identified predictors, adherence to evidence based ACS care metrics was strongly associated with improved outcomes, underscoring the critical role of timely primary PCI and intravenous thrombolysis in acute management.

Occlusal Bite Force Changes in Skeletal Class-II Patients during Functional and Fixed Mechanotherapy: A Prospective Study

Deepika Dahiya, Pandurangan Harikrishnan, Santosh Kumar Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Orthodontic treatment in skeletal Class II malocclusion initially leads to transient disturbances in bite force, occlusal contacts and fluctuations in Body Mass Index (BMI) due to functional adaptation and altered eating patterns. As the treatment progresses, occlusal stability and masticatory efficiency are progressively restored, leading to normalisation of masticatory efficiency and BMI. Aim: To assess maximum occlusal bite force changes and its effects on BMI in skeletal Class II patients following functional and fixed mechanotherapy using TekscanFlexiforce sensors with extreme low frequency system (T-scan). Materials and Methods: The present prospective study was conducted in the Department of Orthodontics, Faculty of Dental Sciences, SGT University, Gurugram, Haryana, India, from March 2021 to September 2022. A total sample of 45 patients (age 10-15 years) having Cervical Vertebrae Maturation Index (CVMI) 2, 3, and 4 were divided into three equal groups. Group I and group II consisted of skeletal Class II individuals who were treated using myofunctional therapy and fixed orthodontic mechanotherapy, respectively. Group III with Class I skeletal Malocclusion was used as control group. Occlusal contacts bite force and BMI were evaluated at the beginning of treatment (T0), first week (T1), first month (T2), third month (T3), sixth month (T4) and at the end of therapy or eight months (T5). Statistical methods like the unpaired t-test was used to analyse the quantitative variables. Statistical significance is considered for p-values<0.05. Results: The maximum bite forces started decreasing as the treatment progressed in group I (271.20 N at T0 to 82.9 N at T4) and group II (348.27 N at T0 to 262.13 N at T2) which was more significant in group I, There was a reduction in the BMI in both group I and II but it showed a gradual recovery towards the end of the treatment. The maximum bite force for control group III was 287.73 N. Conclusion: There was significant reduction of maximum bite force in the functional appliance therapy group as compared to fixed mechanotherapy. In the initial stages of the treatment, there was a reduction in the BMI and occlusal contacts in both the groups which gradual recovered towards the end of the treatment.

Assessing the Predictive Value of D-dimer in Acute Pancreatitis: A Systematic Review and Meta-analysis

Muhannad S Alhamrani, Ahmed Alsaiari Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Acute Pancreatitis (AP) often leads to multi-organ dysfunction with high morbidity and mortality necessitating early identification for optimal management. Traditional severity scores have limitations, prompting exploration of biomarkers like D-dimer. Aim: To evaluate D-dimer’s accuracy as a severity marker in AP when compared to theother biomarkers. Materials and Methods: The present comprehensive search was conducted on multiple databases. The authors included randomised clinical trials, cohort, cross-sectional, and case-control studies with adults diagnosed with AP and D-dimer measurements. Non-human studies, case reports, and non-English articles were excluded. Risk of bias was assessed using the Newcastle-Ottawa Scale. Data were analysed with R software focusing on diagnostic accuracy. Results: Nineteen studies met the inclusion criteria. Most were retrospective with predominantly male participants. The pooled sensitivity for D-dimer in identifying Severe AP (SAP) was 0.85 (95% CI: 0.78-0.91), and specificity was 0.58 (95% CI: 0.31-0.85). The AUC for diagnostic accuracy was 0.75 (95% CI: 0.66-0.83). For severity assessment, sensitivity was 0.77 (95% CI: 0.71-0.83), specificity was 0.75 (95% CI: 0.67-0.83), and AUC was 0.78 (95% CI: 0.73-0.83). D-dimer had 0.86 sensitivity for organ failure detection (AUC 0.72, 95% CI: 0.63-0.81). Conclusion: D-dimer shows moderate-to-high accuracy in identifying SAP and predicting organ failure. It is a promising, cost-effective, and easily accessible biomarker for early severity assessment. Further research is needed to confirm its clinical role and integration into severity models.

Determinants of Postoperative Mortality in Neonates with Congenital Diaphragmatic Hernia: A Prospective Observational Study from a Tertiary Care Centre, Southern India

AM Shameem, KS Deepa, V Arun Preeth, S Gireesh, K Mohandas Nair Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Congenital Diaphragmatic Hernia (CDH) is a life-threatening developmental anomaly characterised by a defect in the diaphragm that allows abdominal viscera to herniate into the thoracic cavity, leading to pulmonary hypoplasia and pulmonary hypertension. Despite advances in prenatal diagnosis, neonatal intensive care, and surgical techniques, the management of CDH continues to pose considerable clinical challenges, particularly in resource-constrained settings. Aim: To determine the outcomes and identify the risk factors associated with mortality in neonates undergoing surgical repair for CDH. Materials and Methods: The present hospital-based prospective observational study was conducted in the Departments of Paediatrics, Neonatology, and Paediatric Surgery at Government Medical College, Kozhikode, Kerala, India, from 1st January 2021 to 31st December 2022. All neonates diagnosed with CDH who underwent surgical repair were included in the study. The standard institutional protocol was followed, which included preoperative stabilisation, risk stratification for surgical candidacy, early decision-making regarding operative intervention, and continuation of postoperative ventilation. Results: During the study period, out of 5,850 Neonatal Intensive Care Unit (NICU) admissions, 72 neonates were diagnosed with CDH. Of these, 44 (61.1%) underwent surgical correction. The mean gestational age was 38±1.63 weeks, and the mean birth weight was 2,850±508 g. Post-repair survival to discharge was 79.5% (35 neonates), while 9 of the 44 operated neonates (20.5%) died in the postoperative period. The presence of Pulmonary Hypertension of the Newborn (PPHN), intraoperative hypothermia, postoperative air leak, and associated congenital anomalies were significantly associated with increased postoperative mortality in the present study cohort. Conclusion: Preoperative clinical stability, intraoperative hypothermia, and the presence of PPHN were found to be significantly associated with postoperative mortality in neonates undergoing surgery for CDH.

Platelet Rich Plasma Therapy for Knee Joint Pain in Diagnosed Cases of Rheumatoid Arthritis: A Prospective Observational Study

Srabani Sarker, Saumen Kumar De, Debdipta Das, Dipasri Bhattacharya Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Rheumatoid Arthritis (RA) is a chronic disease characterised by severe inflammation, leading to degradation of articular cartilage and bony erosions. Women are affected two to three times more frequently than men. Platelet-Rich Plasma (PRP), a regenerative medicine therapy, has prompted interest in its potential use in patients with RA. Aim: To assess the effectiveness of PRP in modulating chronic RA in terms of pain relief, work capacity and overall satisfaction. Materials and Methods: This prospective observational study was conducted at Pain Clinic of R.G.Kar Medical College and Hospital, Kolkata, West Bengal, India, in collaboration with the blood bank. The effectiveness of PRP therapy in relieving knee joint pain was studied among 30 diagnosed cases of RA. Pain relief was analysed using the Visual Analogue Scale (VAS), and functional improvement was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline (0-week), 12th week, and 24th week. Blood samples were collected, and a centrifugation protocol was followed for PRP preparation. A total of 12 mL (6 mL per knee) of PRP was administered intra-articularly into the suprapatellar recess of both knee joints. Data on age, gender, VAS, and KOOS scores were recorded in an Excel sheet. Statistical analysis was performed, and a p-value <0.05 was considered significant. Results: The mean age of participants was 43.70±8.96 years {mean±Standard Deviation (SD)}, with 26 (86.7%) females and 4 (13.3%) males (N=30). Age distribution was as follows: 31-40 years: 46.7%, 41-50 years: 30%, and 51-60 years: 23.3%. Paired sample descriptive statistics for VAS and KOOS scores at 0, 12, and 24 weeks showed statistically significant improvement (p<0.05). Conclusion: The PRP significantly improved pain scores on the VAS and enhanced pain, symptoms, daily activities, sports function, and quality of life as measured by KOOS over 24 weeks. PRP administration was associated with high patient satisfaction and no reported adverse effects or complications.

Comparison between Intrathecal Dexmedetomidine versus Nalbuphine as Adjuvants to Hyperbaric Bupivacaine in Lower Limb Orthopaedic Surgeries: A Randomised Clinical Trial

Richa Tailor, Kartik Sangam, Nilesh Shah, Pooja Shah, Sara Mary Thomas Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Spinal anaesthesia with local anaesthetics alone provides a limited duration of action for lower limb orthopaedic surgeries. Adjuvants can enhance anaesthetic efficacy while minimising side-effects. Both dexmedetomidine and nalbuphine have been used as intrathecal adjuvants. Aim: To compare the efficacy and safety profiles of intrathecal dexmedetomidine versus nalbuphine as adjuvants to hyperbaric bupivacaine 0.5% in spinal anaesthesia for lower limb orthopaedic surgeries. Materials and Methods: This randomised clinical trial was conducted at the Department of Anaesthesiology, Dhiraj Hospital, Vadodara, Gujarat, India, from January 2023 to June 2024. Sixty patients (American Society of Anaesthesiologists Physical Status (ASA PS) I-II, aged 20-60 years) undergoing elective lower limb orthopaedic surgeries were randomly allocated using a computer-generated sequence into two groups (n=30 each). Group D received hyperbaric bupivacaine 0.5% (3.3 mL=16.5 mg) with dexmedetomidine 10 μg, and Group N received hyperbaric bupivacaine 0.5% (3.3 mL=16.5 mg) with nalbuphine 1 mg intrathecally. Primary outcomes included the onset and duration of sensory and motor blockade. Secondary outcomes included haemodynamic parameters, sedation levels, duration of analgesia, and side-effects. Statistical analysis was performed using unpaired Student’s t-tests and Chi-square tests, with p-value <0.05 considered statistically significant. Results: The demographic profiles of patients in both groups were comparable, with no statistically significant differences observed. Dexmedetomidine provided a significantly faster onset of sensory blockade at L1 (2.06±0.32 vs 2.98±0.63 mins, p-value <0.0001) and motor blockade (2.58±0.32 vs 3.86±0.84 mins, p-value <0.0001). The duration of sensory blockade (490.9±32.81 vs 337.73±29.85 mins, p-value <0.0001) and motor blockade (456.6±35.19 vs 354.4±33.22 mins, p-value <0.0001) was significantly longer in Group D. Two-segment regression time was prolonged in Group D (159.47±14.38 vs 138.97±9.97 mins, p-value <0.0001). Systolic blood pressure was significantly lower intraoperatively in Group D. Time to first rescue analgesia was 420.8±39.14 mins in Group D versus 370.67±34.65 mins in Group N (p-value=0.001). Hypotension occurred in 23.33% of Group D patients versus 10.00% of Group N patients, while shivering was more common in Group N (16.67% vs 3.33%). Conclusion: Both dexmedetomidine and nalbuphine are effective adjuvants to hyperbaric bupivacaine. Dexmedetomidine provides a longer duration of blockade with potential anti-shivering effects, whereas nalbuphine offers earlier motor recovery with more stable haemodynamics. Adjuvant selection should be individualised based on surgical requirements and patient characteristics.

Identifying Unmet Needs of Community-dwelling Older Adults: A User-centred Design Approach of a Mobile Health Application

Gunjan Wadhwa, Prakash Kumar Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: ‘Population ageing’ and ‘ageing in place’ are major challenges worldwide. To manage population ageing, it is crucial to fulfil the needs of elderly care. Digital health technologies have emerged to support the needs of Older Adults (OA). Mobile health (mHealth) apps are cost-effective digital tools to achieve health objectives. The unmet needs of community-dwelling OAs need to be identified and incorporated into the development of mHealth apps. Aim: To identify the unmet needs of community-dwelling OAs by adopting the User-centred Design (UCD) approach. Materials and Methods: The present qualitative study was conducted in 3 stages. In stage 1, the interview questions were framed for OAs, informal caregivers, and Healthcare Professionals (HCP). Two qualitative review rounds of these interview questions were conducted by 15 experts/HCPs. In stage 2, the interview questionnaires were translated into Hindi, and then both English and Hindi questionnaires were pilot tested on five OAs and 5 informal caregivers. In stage 3, semi-structured interviews were conducted with 20 OAs and 10 informal caregivers. The interview responses were audio recorded or written. The recorded interview responses were transcribed verbatim. Thematic analysis of interview responses was conducted. Results: Thematic analysis of interview responses resulted in 4 themes and 17 codes that indicated the unmet needs of OAs. The 4 themes included self-care, life essentials, work, leisure and social activity. These findings were incorporated into the design of the mobile app in consultation with a software engineer. Conclusion: The present study established the utility of user involvement to identify the unmet needs among community-dwelling older individuals. Hence, the study guides researchers to include stakeholders in all stages of the creation of mHealth apps, particularly during the initial content development stage. The findings of this study provide input for designing an mHealth app to promote functional independence.

Low-grade Appendiceal Mucinous Neoplasm: A Clinicopathological Study of 38 Cases

Renu Sukumaran, Elsa Joy, Thara Somanathan, Iswarya S Nair, Roshni Sivasevan, Aleyamma Mathew Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Low-grade appendiceal mucinous neoplasm (LAMN) is a rare, yet clinically significant entity. LAMN lack the potential for haematogenous metastasis. It can disseminate in the peritoneum, depositing extracellular mucin and epithelium along peritoneal surfaces, causing Pseudomyxoma Peritonei (PMP). It is important to differentiate LAMN from mucocoele, serrated lesions, adenomas and mucinous adenocarcinoma. Thorough histopathological evaluation is important in the differentiating these entities. Aim: To analyze the clinicopathological features of LAMN. Materials and Methods: This is a cross sectional study, included all cases reported as LAMN in 8 years (from 1 January 2016 to 31 December 2023) from Regional Cancer Centre, Thiruvananthapuram, Kerala, India. Clinical findings, radiological features, gross findings and detailed histopathological features were analysed.Descriptive statistical analysis was performed to summarise the clinicopathological characteristics. Results: Total number of cases in the present study were 38.The mean age at diagnosis was 48 years,with a slight female predominance (M:F=1:1.3). Abdominal pain was the most common presenting symptom 24 (63.16%). The average tumour size of appendiceal mass lesions was 4.5 cm.Histopathologicalfindings demonstrated variable epithelial architecture-epithelialdenudation 32 (84.21%), villiform proliferation 22 (57.89%), flat epithelium 16 (42.11%) - with low gradenuclearatypia. On thebasis of the American Joint Committee on Staging eighth edition cancer staging manual, 24 (63.15%) of cases were categorised as pTis, 2 (5.26%) as pT3, and 12 (31.57%) as pT4.Pseudomyxoma Peritonei (PMP) was observed in 8 (21.05%) patients. Concurrent ovarianinvolvement was identified in 3 (7.89%) patients. These findings underscore the propensityof LAMN for peritoneal dissemination. Conclusion: Given its potential for progression to PMP and metastasis, meticulous histopathological evaluation is essential for accuratediagnosis and risk stratification. This study highlights the necessity of a multidisciplinaryapproach in diagnosing and managing LAMN, incorporating surgical, radiological, andpathological expertise.

Biliary and Pancreatic Ductal Anatomical Variations in a South Indian Population: An MRCP Based Analysis and its Clinical Applications

Ealai Athmarao Parthasarathy, Jeffrey Skaria Joseph, MP Shiva Shankar, KS Ramprasath, Sathyanarayanan Venkatesan, Einstien Arulraj Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: The biliary and pancreatic ductal systems exhibit considerable anatomical variability, which holds significant surgical and clinical relevance. Accurate preoperative delineation of these variations helps prevent inadvertent injuries during hepatobiliary or pancreatic procedures. Magnetic Resonance Cholangiopancreatography (MRCP) serves as a safe, non-invasive modality for evaluating ductal anatomy with high diagnostic accuracy. Aim: To determine the prevalence of anatomical variations in the biliary tree, cystic duct, and pancreatic duct in a South Indian population using MRCP. Materials and Methods: A cross-sectional study was conducted at a Chettinad Hospital and Research Institute, Kelambakkam, Chennai, Tamil Nadu, India from January 2023 to July 2025. A total of 345 MRCP studies were reviewed retrospectively, of which 45 were excluded due to poor image quality. The remaining 300 studies were analysed independently by two senior radiologists, with discrepancies resolved by consensus. Variations of the right and Left Hepatic Ducts (LHD) were classified according to Lyu SY et al., while cystic duct and pancreatic duct morphology were evaluated based on their course and insertion patterns. Data were analysed using Statistical Package for Social Sciences (SPSS) version 23. Results: Among 300 patients (mean age 44.3 years), the most common Right Hepatic Duct (RHD) variant was Type A1 (48%), followed by A2 (30%). LHD anatomy was predominantly Type B1 (82%). Right lateral insertion of the cystic duct was the most frequent variant (62%), while low insertion was noted in 15% of cases. The mean CBD diameter was 6.5±3.2 mm, and the mean Main Pancreatic Duct (MPD) diameter was 2.1±1.2 mm. The descending type of pancreatic duct was observed in 78% of patients, and pancreatic divisum was identified in two cases. No statistically significant association was found between ductal variations and gender (p-value >0.05, using chi-square test). Conclusion: MRCP effectively characterises hepatobiliary and pancreatic ductal variations, many of which bear important surgical and endoscopic implications. Understanding these variants is essential for safe operative planning, particularly in donor hepatectomy, laparoscopic cholecystectomy, and Endoscopic Retrograde Cholangiopancreatography (ERCP). Further multicentric studies across India are recommended to improve demographic representation.

Determination of Sex using Foramen Magnum Measurements: A Cross-sectional Study from Karur, Tamil Nadu, India

S Selvajeni, P Mohan Kumar, R Sangeetha Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Sex determination is a fundamental goal in both forensic analysis and archaeological studies. The foramen magnum, the largest opening in the base of the skull, carries vital structures from the brain to the spinal cord. Because of its resistant nature, this portion of the skull is not only anatomically noteworthy but also useful for forensic investigations. Aim: To determine the sex of the individuals using measurements of the foramen magnum. Materials and Methods: A cross-sectional study was conducted in the Department of Forensic Medicine at Government Medical College and Hospital, Karur, Tamil Nadu, India, from September 2022 to February 2023. A total of 100 skulls were taken from individuals aged above 20 years. The transverse and Anteroposterior Diameters (APD) of the foramen magnum were measured using a digital vernier calliper. The area of foramen magnum was calculated using the Radinsky formula (R) and Teixeira formula (T). All variables were analysed using Levene’s test. The Binary Logistic Regression (BLR) model is run for all the foramen magnum variables. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 20.0 statistical software. Results: Males exhibited higher foramen magnum measurements than females, which were statistically significant (p<0.05). The mean APD for male skulls was found to be 38.10±2.90 mm, while that of the female skull was 36.08±3.46 mm. The mean Transverse Diameter (TD) for males was 29.89±3.17 mm, whereas for females it was 26.14±3.24 mm. The mean area (R) for male was 897.53±138.23 mm2 and for females it was 745.16±146.64 mm2. The mean area (T) for males was 911.43±136.10 mm2, while for females it was 769.45±141.67 mm2. The analysis of APD indicated a p-value of 0.013; the Foramen Magnum Index (FMI) showed a p-value of 0.005 and other parameters, including TD and areas (R and T), demonstrated p-value <0.001. The overall sex determination rate was 73% when the BLR model was applied to all the parameters, with the highest accuracy at 78% for TD. Conclusion: Foramen magnum is regarded as an efficient tool for sex determination and it can be combined with other methods for higher accuracy.

Comparison of Wells and Revised Geneva Scores in Patients with Computed Tomography Pulmonary Angiography-confirmed Pulmonary Thromboembolism: A Cross-sectional Study

CS Samartha, G Hemamalini Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Pulmonary Thromboembolism (PTE) is the third most common acute cardiovascular condition globally, following myocardial infarction and stroke. Clinical Decision Tools (CDTs) such as the Wells score and the revised Geneva score assist in risk stratification for suspected PTE. While widely validated in Western populations, data from India are scarce. Aim: To compare the Wells and revised Geneva CDTs in patients with Computed Tomography Pulmonary Angiography (CTPA) confirmed PTE. Materials and Methods: This single-centre, cross-sectional study was conducted in the Department of General Medicine, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India, from April 2023 to April 2024. A total of 100 patients aged >18 years with CTPA-confirmed PTE were included. Detailed clinical history, co-morbidities, recent surgery or immobilisation, and systemic examination findings were recorded. Both Wells and revised Geneva scores were applied. Statistical analysis was performed using Epi Info version 7, and a p-value <0.05 was considered significant. Results: Of the 100 patients, 72% were aged >50 years; 56% were males. Breathlessness was the most common presenting symptom and immobilisation >three days was the most prevalent risk factor. Deep Vein Thrombosis (DVT) was observed in 56% of patients. Based on Wells score: 16% were low-risk, 34% intermediate, and 50% high-risk. According to the revised Geneva score: 0% was low-risk, 34% intermediate, and 56% high-risk. Considering “intermediate or high probability” as positive, the Wells score had a sensitivity of 84%, while the revised Geneva score showed a higher sensitivity of 100%. All patients had D-dimer levels >500 ng/mL. Conclusion: Both Wells and revised Geneva scores demonstrated a significant association with PTE, validating their applicability in the Indian setting. The revised Geneva score had higher sensitivity than Wells score, but cannot be considered superior in diagnostic accuracy, as the study design included only confirmed PTE cases. D-dimer remains a highly sensitive screening tool in the diagnosis of PTE.

Perceived Role of Vitamin D in Individuals with Depression: A Qualitative Analysis

Anaswara Dev, Roshni Mary Peter, Alex Joseph Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Depression is a complex mental health condition with multifactorial origins, including psychological, social, and biological factors. Recent evidence suggests that Vitamin D3, a micronutrient traditionally associated with bone and calcium regulation, may also influence neurological functions and mood regulation. However, the role of Vitamin D in mental health remains underexplored, particularly in relation to depression severity. Aim: To explore perceptions and beliefs, among individuals with varying levels of depression and serum Vitamin D3. Materials and Methods: The present qualitative study was conducted in Unique health Private hospital in Ernakulam, Kerala, India, between April and May 2025. A purposive sample of eleven adults (n=11), both males and females aged 20-45 years, was selected based on documented depression scores (moderate to severe) and serum Vitamin D3 levels. Data were collected through in-depth semi-structured interviews conducted in private settings using a pretested interview guide. The researcher, trained in qualitative methods with a background in psychology and public health, maintained reflexivity throughout the process. The study evaluated participants’ depression severity and Vitamin D3 status to explore perceptions and experiences related to mental health and nutrition. Data were analysed manually using Braun and Clarke’s six-phase thematic analysis framework, with Microsoft Excel 2021 used for organising codes and sociodemographic details. Results: Five major themes were identified: (1) Lack of awareness about the link between Vitamin D3 and mental health; (2) Patterns of deficiency among individuals with severe depression; and (3) Clinical neglect of Vitamin D3 screening in routine psychiatric assessments; (4) Emotional and social impacts of limited knowledge; and (5) Hopes for holistic and multidisciplinary care. Sub-themes revealed misconceptions about depression, inadequate nutritional education, and limited adoption of integrative care practices. Conclusion: The present study highlights limited awareness among study subjects about the role of Vitamin D3 in mental health and a lack of Vitamin D screening in clinical practice. Findings advocate for a holistic, interdisciplinary approach to depression management, bridging biological and psychosocial models. Broader public health initiatives are needed to increase awareness, reduce stigma, and improve clinical practices surrounding the role of micronutrients in mental health.

Comparison of Oral Moxonidine versus Clonidine in Adults Undergoing General Anaesthesia: A Double-blinded Randomised Controlled Study

Shree Bakshi, Anirudha Dewri, Paramanand Maheshwari, HM Ravikiran, D Gita Devi, Prateek Shukla Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Anxiolysis helps in reducing perioperative adverse events. Clonidine is an established anxiolytic premedication but Moxonidine with a similar mechanism, has not been explored for the same. Moxonidine is an imidazoline receptor agonist which plays a significant role in modulating anxiety and stress response. Aim: To evaluate the anxiolytic action of 0.2 mg oral Moxonidine versus 0.1 mg oral Clonidine given as premedication to adults undergoing general anaesthesia for elective surgeries. Materials and Methods: A randomised double-blinded controlled study was conducted at the Department of Anaesthesiology, N F Railway Central Hospital, Guwahati, Assam, India from January 2024 to December 2024 on a sample size of 44 patients aged 30 to 55 years, further divided into 2 groups-Group M (n=22) who received 0.2 mg Moxonidine and Group C (n=22) who received 0.1 mg Clonidine. In the preoperative period, the anxiety score calculated using Amsterdam Preoperative Anxiety and Information Scale (APAIS), Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), Respiration Rate (RR), Oxygen Saturation (SpO2) measured before and 90 minutes after administration of the drug. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 22.0 and a p-value <0.05 was considered significant. Results: Demographic profiles were comparable among both the groups with insignificant p-value. The mean anxiety score was 23.82±4.32 in the Clonidine group and 22.09±5.71 in the Moxonidine group (p-value=0.264). Post-intervention, the anxiety scores significantly reduced within both groups (p-value <0.001), with no significant difference between the groups (p-value=0.838). The mean change in HR from baseline to intubation, five minutes, 10 minutes, 15 minutes were -0.45, 2.91, 4.77, 7.68 in Moxonidine group and -1.73, 3.23, 8.77, 7.68 in the Clonidine group, respectively. The mean change in MAP from baseline to intubation, five minutes, 10 minutes, 15 minutes were -6.27, 5.5, 13.64, 12.09 in Moxonidine group and -1.36, 5.05, 10.19, 11.95 in Clonidine group, respectively. The mean respiratory rate and SPO2 before intervention was 12.27±0.70 breaths per minute (bpm) and 99.64±0.73% in the Clonidine group, respectively and 13.18±2.02 bpm, 99.68±0.65% in the Moxonidine group, respectively. Post-intervention the mean respiratory rate and SPO2 was 12.27±0.70 bpm and 99.64±0.73% in Clonidine group, respectively and 12.27±0.70 bpm, 99.73±0.63% in Moxonidine group, respectively. Thus, the changes in HR, MAP, RR and SPO2 at various intervals were not significantly different between the Clonidine and Moxonidine groups (p>0.05 for all). Conclusion: Oral Moxonidine provides similar anxiolysis as compared to oral Clonidine. The intubation blunting response is also similar. Further studies are required for establishment of equivalent doses.

Comparative Evaluation of Titanium Platelet Rich Fibrin Infused with Triphala indica and Mangosteen Gels for Osteogenic Cell Viability and Gene Expression on Osteosarcoma Cells (MG-63): An Ex-vivo Study

Shiva Shankar Gummaluri, Kaarthikeyan Gurumoorthy, Trinath Kishore Damera, Raghunandakumar Subramanian, Parkavi Arumugam Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Titanium-platelet Rich Fibrin (T-PRF) is a second-generation Platelet Concentrate (PC) that had a thicker fibrin meshwork, better cellular entrapment and greater with-hold of growth factors. Incorporation of herbal extracts in the form of gels into T-PRF is a novel protocol. To the authors knowledge no study was performed incorporating Triphala indica (Ti) gel and Mangosteen Rind (MS) extract into T-PRF and checked for its effect on cell lines so that it can be claimed as Sustained Drug Delivery Systems (SDDS). Aim: To evaluate the osteogenic cell viability and differentiation of MG-63 cells upon interaction with elutes of T-PRF alone or T-PRF incorporated Triphala indica (Ti) or MS. Materials and Methods: The present ex-vivo study was performed at Department of Periodontics, Saveetha Dental College and Hospital, Saveetha Institute of Technical and Medical Sciences (SIMATS), Chennai, Tamil Nadu, India between February 2025 to April 2025. A 30 years age group healthy volunteer who was willing to take part in the study, without any history of periodontal disease and non-smoker was included. Blood was centrifuged and T-PRF clots were prepared, lyophilised and stored. Further, elutes of Ti and MS were taken and mixed with elute of T-PRF. MTT assay was performed at 1, 3 and 7 days on the cultured MG-63 osteoblastic cell lines. Gene expression was checked for Alkaline Phosphatase (ALP), Bone Morphogenic Protein 2 (BMP 2) and Osteopontin (OSP) at 7^th day and Alzarin Red Staining (ARS) for late mineralisation on 21^st day. Data was gathered and subjected to statistical analysis. One-way Analysis of Variance (ANOVA) with Post hoc HSD Tukey’s multiple comparisons were performed to assess the time changes (1, 3 and 7 days) for MTT assay and qPCR analysis. A p-value <0.05 was considered statistically significant. Results: T-PRF alone showed significantly better outcomes than T-PRF+Ti and T-PRF+MS at 1st and 3rd day whereas at 7^th day there was no statistically significant difference; whereas T-PRF+Ti showed better significant expression of genes (ALP, BMP 2 and OSP) followed by T-PRF+MS and last T-PRF alone. Alizarin Red (AR) staining showed greater staining in order of T-PRF+MS> T-PRF+Ti > T-PRF alone. Conclusion: T-PRF incorporated with Ti or MS didn’t alter the property of T-PRF and also helped in greater release of ALP, BMP 2 and OSP which showed the positivity of osteoblastic differentiation in in-vitro model making T-PRF a SDDS.

Knowledge, Attitudes, and Practices of Obstetricians in Managing Postpartum Surgical Site Infections in India: A Cross-sectional Survey

Brian Benjamin, Krunal Dalal, Ramiya Ravindranath, Puja Nijhara Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Caesarean section and surgical procedures during vaginal delivery are significant contributors to Surgical Site Infections (SSIs). SSIs are associated with extended hospitalisation and increased financial and clinical burden. Antibiotic prophylaxis, chlorhexidine skin preparation, clipper-based hair removal, and vaginal cleansing with povidone-iodine are recommended preventive measures. Topical agents, mupirocin and antiseptics are increasingly used, but adoption remains inconsistent in countries like India due to limited training, resources and varying protocols. Aim: To assess the Knowledge, Attitudes and Practices (KAP) of obstetricians in India for the prevention and management of post-partum SSIs. Materials and Methods: A descriptive cross-sectional survey was conducted at GlaxoSmithKline (GSK), Mumbai, India, which included 200 obstetricians across metro, tier 1 and tier 2 cities in India between May 2024 and August 2024. Participants were obstetricians practising in India with at least 5 years of experience, spending 70% or more of their time in patient care, handling a minimum of 20 deliveries per month, having treated at least 3 SSI cases in the month prior to the survey, and residing in one of 12 selected cities. Data on the knowledge, attitudes and beliefs and practices followed by the obstetricians for the prevention and management of post-partum SSIs were collected using a 7-item questionnaire through face-to-face computer-assisted personal interviews. Statistical analyses were primarily explorative and descriptive and were performed using R software (version 4.3.1 or higher). Results: Among the 200 participants, 105 (52.5%) practiced in large hospitals, 58 (29%) in multispecialty hospitals, and 37 (18.5%) in standalone maternity clinics. The average clinical experience was 17 years. In the knowledge assessment, 144 (72%) of participants scored between 50-90%, while 56 (28%) scored below 50%; none scored above 90%. The most common knowledge gaps were related to the appropriate duration of topical antibiotic use, bacterial coverage, and indications for antiseptics versus antibiotics. Conclusion: The present study reveals that while obstetricians generally follow consistent practices for managing post-partum SSIs, significant gaps remain, especially in the use of topical antiseptics and antibiotics, highlighting the need for standardised guidelines and targeted training to ensure evidence-based care and better maternal outcomes.

Comparison of Crown Root Morphology in Maxillary and Mandibular Anterior Teeth of Different Sagittal Skeletal Patterns in Bengali Population: A Retrospective CBCT Study

Rupam Kumari, Sidhartha Das, Prasenjit Banerjee, Anusree Paul, Mita Mandal, Manish Jha, Samarendra Ray, Arunavo Nandy Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Individual diversity is the cornerstone of human biology and this is also reflected in the crown and root morphology of teeth. The maxillary and mandibular anterior teeth can be differentiated based on their crown-root morphology, collum angle, Labial Surface Angle (LSA) and torque angle. In clinical orthodontic practice, the collum angle is often assumed to be zero, as seen in standardised cephalometric incisor tracing templates. This assumption overlooks the variations in collum angles observed in different malocclusions, leading to difficulties in achieving proper root angulation after treatment. Aim: To evaluate and correlate the collum angle, LSA and torque angle in maxillary and mandibular anterior teeth across different skeletal patterns in the Bengali population. Materials and Methods: This retrospective study was conducted at the Department of Orthodontics and Dentofacial Orthopaedics, Guru Nanak Institute of Dental Sciences and Research, Kolkata, West Bengal, India, from March 2022 to January 2024. It involved 90 Cone-Beam Computed Tomography (CBCT) scans of young adult patients aged 18–24 years, with no history of orthodontic treatment, cleft lip and palate, or oral habits. Participants were divided into three groups based on the angle between Point A, Point B and Nasion (ANB angle): skeletal Class-I (2°< ANB< 4°), Class-II (ANB>4°) and Class-III (ANB<2°), with 30 subjects in each group. The collum angle, LSA and torque angle were measured for different malocclusions and compared using Pearson's correlation analysis and one-way Analysis of Variance (ANOVA) (p<0.05). Results: A positive correlation (p<0.05) was found between the collum angle and LSA in all types of malocclusions. The smallest collum angle was observed in the lower left central incisor. The maxillary lateral incisor showed a larger crown-root angulation than the central incisor. The maxillary canine and mandibular central incisor exhibited the smallest collum angles in the maxillary and mandibular arches, respectively. An increase from 3.5 mm to 5 mm in the calculation of LSA resulted in a difference of 3.7° for maxillary incisors and 3.5° for mandibular incisors. In skeletal Class-I malocclusion, the maxillary lateral incisor showed the largest torque angle, while the mandibular lateral incisor had the smallest. In Class-II malocclusion, the maxillary central incisor had the largest torque angle, whereas the maxillary canine had the smallest. In Class-III malocclusion, the maxillary lateral incisor exhibited the highest torque angle, while the mandibular canine showed the smallest. Conclusion: A statistically significant difference was observed in the crown-root morphology of maxillary and mandibular anterior teeth. Understanding the variations and correlations among the collum angle, torque angle and LSA across different sagittal skeletal malocclusions can help refine orthodontic treatment planning and improve post-treatment outcomes.

Variation of Electrocardiographic Indices in Normal Pregnancy: A Systematic Review and Meta-analysis

Pallaseena Seetharaman Seshadrinathan, Aruna Bholenath Patil Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Heart disease is a significant cause of maternal mortality. An Electrocardiogram (ECG) is the most common diagnostic modality available for its detection. ECG indices display a variety of changes during normal pregnancy. Aim: To analyse changes in electrocardiographic indices during pregnancy compared to controls and at different trimesters in normal pregnant patients. Materials and Methods: Data on relevant published articles in English were retrieved from PubMed using predefined search terms, including MeSH, manual searches, and references from 1932 to 2025. Normal pregnant patients without clinical heart or systemic disease were included in the study. Nineteen ECG indices were compared between pregnant and non pregnant groups. The p-value<0.05 was considered significant. Pooled estimate of the effect sizes was calculated using Hedges’ g with a random-effects model to assess the variability in comparison groups. Heterogeneity was evaluated using Cochran’s Q, τ2, and I2 statistics, with I2 >50% indicating substantial heterogeneity. The Newcastle–Ottawa Scale (NOS) and an adapted version (NOS-xs) were used to assess the risk of bias of the included studies Results: After initial screening, 25 studies were included in a pregnant group (4645 patients) and a control group of non pregnant women (1191 patients) The statistical analysis was performed for values of the control compared to the 1st, 2nd, and 3rd trimesters, as well as the control versus the average value of all three trimesters for each of the ECG indices. Only the ECG indices of heart rate and Mean Corrected QT (QTc) interval showed increased statistical significance at p-value=0.0332 and p-value=0.0050, respectively, in the comparison of the control group versus the average value of all three trimesters of pregnancy. The remaining ECG indices did not show any statistically significant differences in any comparison. The magnitude of variation was found to be small by the pooled estimate of effect size. Overall, the risk of bias of the included studies was found to be low to moderate in most of the included studies. Conclusion: A statistically significant small magnitude increase was noted only for heart rate and mean QTc in the pregnant group compared to the non pregnant control. The meta-analysis could not demonstrate statistically significant changes in any of the ECG indices between the trimesters of pregnancy.

Suicidal Ideation, Coping Styles and Cortisol Levels in Patients with Illness Anxiety Disorder: A Cross-sectional Study

R Guna, Shabeeba Z Kailash, Kailash Sureshkumar, Aravindh Manogaran, Nivedita Saravanan Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Illness Anxiety Disorder (IAD) is characterised by a persistent preoccupation with having a serious illness despite adequate medical reassurance. This preoccupation is driven by cognitive distortions and maladaptive coping mechanisms that amplify distress. Emerging evidence links IAD to heightened suicide risk; however, data on suicidal ideation and coping profiles-particularly from Indian clinical settings-remain scarce. Aim: The present study aimed to determine levels of suicidal ideation, coping mechanisms, and serum cortisol levels among patients with IAD, in comparison with the general population. Materials and Methods: The present single-centre, hospital-based cross-sectional study was conducted in the psychiatry Outpatient Department of a tertiary hospital in Southern India from July 2024 to June 2025 (N=66; IAD=33; controls=33). Suicidal ideation was assessed using the Beck Scale for Suicide Ideation (BSS), coping strategies were evaluated with the Brief Coping Orientation to Problems Experienced (COPE) subscales, illness-anxiety severity was measured using the Short Health Anxiety Inventory (SHAI), and morning serum cortisol levels were estimated using Chemiluminescent Microparticle Immunoassay (CMIA). Data analysis was performed in IBM Statistical Package for the Social Sciences (SPSS) Statistics version 27.0 using t-tests or Mann–Whitney U tests for continuous variables, Chi-square or Fisher’s exact tests for categorical variables, and Pearson or Spearman correlations; a two-sided α=0.05 was considered statistically significant. Results: The IAD and control groups were comparable in terms of sociodemographic characteristics (age 39.0±7.2 vs 38.2±10.9 years). Suicidal ideation was higher in the IAD group (BSS 0.4±1.0 vs 0.0±0.0; p=0.034). Total coping scores were similar (52.4±4.8 vs 53.7±7.9; p=0.412); however, participants with IAD used less positive reframing (p<0.001), humor (p=0.001), and acceptance (p<0.001), and relied more on denial (p=0.024), venting (p=0.004), and instrumental support (p=0.027). SHAI scores did not correlate with suicidal ideation but were inversely associated with total coping (r=-0.354; p=0.043) and avoidant coping (r=-0.542; p=0.001). Within the IAD group, maladaptive coping was associated with higher BMI (29.8±3.3 vs 25.8±3.4; p=0.023) and joint-family residence (p=0.002). Conclusion: Patients with IAD exhibited higher suicidal ideation and greater reliance on maladaptive coping strategies compared to the general population. The above findings underscore the importance of integrating psychological interventions focused on adaptive coping in the management of illness anxiety.

Efficacy of Paracetamol Plus Lignocaine versus Lignocaine Alone for Pain on Propofol Injection: A Randomised Controlled Trial

Jyotsna Rhea Dass, Kunda Dimble, Naseema Kanase, Meela Ranjith Kumar Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Propofol triggers endothelial irritation and nociceptor activation, producing early injection pain. Lignocaine blunts this response but does not abolish it completely. A brief systemic analgesic may help close this residual gap. This randomised evaluation tested whether intravenous paracetamol added to lignocaine further reduces the frequency and intensity of pain during induction. Aim: To assess the efficacy of paracetamol plus lignocaine versus lignocaine alone for propofol injection pain. Materials and Methods: This double-blinded, randomised, parallel-group trial was conducted at a tertiary care centre in the Department of Anaesthesiology, Krishna Institute of Medical Sciences (Deemed to be University), Karad, Maharashtra, India, from May 2023 to August 2024 (16 months) {n=98; American Society of Anaesthesiologists (ASA) I-II adults, 20–60 years; Body Mass Index (BMI) 19-30 kg/m²}. Group 1 received intravenous paracetamol 15 mg/kg infused over 10 minutes before theatre, plus lignocaine 2% (2 mL, diluted to 5 mL) with 2-minute venous occlusion. Group 2 received the identical lignocaine protocol without paracetamol (1:1, n=49 each). After tourniquet release, 25% of the propofol induction dose (2.5 mg/kg total) was injected over five seconds through the same cannula and pain was scored immediately on a 0-3 Verbal Rating Scale (VRS). Primary comparisons used risk ratio with 95% confidence intervals and Chi-square (χ²); ordinal severity was analysed using a trend/non parametric test. Two-sided α=0.05; intention-to-treat analysis was applied. Results: Baseline characteristics were similar between groups: age 38.2±10.1 vs 37.6±9.8 years; sex 28/21 vs 26/23 (M/F); BMI 24.9±2.8 vs 25.1±2.7 kg/m²; ASA I/II 30/19 vs 32/17 (Group 1 vs Group 2). Pain occurred in 12/49 patients receiving paracetamol+lignocaine versus 28/49 receiving lignocaine alone {Relative Risk (RR) 0.43, 95% Confidence Interval (CI) 0.25-0.74; Absolute Risk Reduction (ARR) 32.7%; Number Needed to Treat (NNT=4); p=0.001). Severity distribution: none 37 vs 21; mild 10 vs 14; moderate 2 vs 10; severe 0 vs 4 (p=0.0013). No patient in either group developed injection-site complications (erythema, phlebitis, or swelling). Both regimens were well-tolerated. Conclusion: Intravenous paracetamol, when added to standard lignocaine pretreatment, substantially decreases both the likelihood and intensity of propofol injection pain without causing new local adverse effects. This approach is simple, inexpensive and immediately transferable to routine practice.

Comparison of Hyperbaric Levobupivacaine and Hyperbaric Bupivacaine for Spinal Anaesthesia in Infraumbilical Procedures: A Double-blind Randomised Clinical Trial

Prathamesh Jagale, Ramesh Sugandh, Dipakkumar Hiralal Ruparel, Gitika Pardhi Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Spinal anaesthesia remains a preferred technique for infraumbilical surgeries due to its simplicity, rapid onset, and stable perioperative profile. Levobupivacaine, the levo-enantiomer of bupivacaine, offers comparable anaesthetic efficacy with improved cardiovascular safety. Aim: To compare the hyperbaric levobupivacaine and hyperbaric racemic bupivacaine in patients undergoing elective infraumbilical surgeries. Materials and Methods: The present randomised, double-blind, clinical study conducted at a Tertiary Care Teaching Hospital Government Medical College, Gondia, Maharashtra, India. Hyperbaric levobupivacaine and hyperbaric racemic bupivacaine were compared in patients undergoing elective infraumbilical surgeries 62 American Society of Anaesthesiologists (ASA) I-II patients aged 18-60 years were randomly allocated into two groups (n=31 each) to receive 3 mL of 0.5% hyperbaric levobupivacaine (Group L) or 3 mL of 0.5% hyperbaric bupivacaine (Group B) intrathecally. Sensory and motor block characteristics, duration of anaesthesia, effective analgesia, ambulation time, and adverse events were analysed using the Independent t-test or Mann-Whitney U test for continuous variables and the Chi-square test for categorical variable, with p<0.05 considered significant. Results: Demographic and surgical characteristics, including age, gender, weight, height, ASA grade, type, and duration of surgery, were comparable between Group B and Group L (p>0.05). The onset of sensory and motor block was significantly faster with bupivacaine (5.41±1.05 min and 3.09±0.83 min, respectively) than with levobupivacaine (6.29±1.27 min and 3.74±0.85 min; p<0.01). The durations of anaesthesia, motor block, and analgesia were significantly longer in Group B (165.3±13.8, 249.4±6.3, and 276.5±7.3 min, respectively) compared with Group L (140.96±11.6, 188.7±7.4, and 211.3±10.1 min; p<0.001). Time to ambulation was earlier with levobupivacaine (251.6±9.9 min vs. 347.1±13.3 min; p<0.001). Hypotension occurred more frequently with bupivacaine (45.1% vs. 9.6%; p=0.002). The quality of anaesthesia was excellent in all patients. Conclusion: Hyperbaric levobupivacaine (0.5%, 3 mL) provides anaesthesia of comparable quality to racemic bupivacaine with the added advantages of faster motor recovery and greater haemodynamic stability. These features make levobupivacaine a favourable choice for ambulatory or short-duration infraumbilical surgeries.

Evaluation of Neonatal Outcome (Major Congenital Malformation) in First Trimester Pregnant Women with SARS-CoV-2 Infection: A Prospective Cohort Study

Madhumita De, Rajarshi Ray, Swasti Banerjee, Abhijit Rakshit Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Coronavirus Disease 2019 (COVID-19) infection has been difficult to control despite advancements in medical science. Many short and long-term complications following COVID-19 infection are still being observed. The hypoxaemia episodes occurring in the first trimester of pregnant women and their potential role in causing congenital malformations in newborns remain unclear. Limited information is available regarding the effects of Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19) during the first trimester of pregnancy and its association with the risk of developing Major Congenital Malformations (MCMs). Aim: To compare the development of congenital malformations in pregnant women who tested SARS-CoV-2 positive and those who tested negative during the first trimester of pregnancy. Materials and Methods: A prospective cohort study was conducted in a small town in the Hooghly district of West Bengal between January 2021 and December 2021. Two nursing homes were selected for sample collection, with approximately 100 patients per centre. The study included 100 pregnant women in their first trimester who tested SARS-CoV-2 positive and another 100 pregnant women in their first trimester who tested negative. An unpaired t-test was performed to analyse the association between the development of MCMs in both groups. Results: The mean maternal age was comparable between the COVID-19-exposed group (24.6 years) and the non-exposed group (25.2 years). The proportions of primigravida and multigravida women were also similar in both groups (62% vs. 64% primigravida, respectively). The odds ratio for MCMs in the COVID-19-exposed group was 0.49, indicating a lower likelihood compared to the non-exposed group. The average Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability/response), Activity (muscle tone), and Respiration (breathing effort) (APGAR) scores at 1 and 5 minutes were slightly higher in the exposed group (7.01 and 7.45) than in the non-exposed group (6.8 and 7.28), though the differences were not statistically significant (p=0.28 and p=0.50, respectively). Conclusion: The present study concludes that there is no evidence of increased risk of MCMs associated with first-trimester maternal SARS-CoV-2 infection. Overall, the findings do not support any major teratogenic effects resulting from maternal COVID-19 infection in early pregnancy.

Impact of Integrated Exercise Protocol on Musculoskeletal Symptoms, Neck Disability and Quality of Life among Computer Professionals: A Quasi-experimental Study

Anupam Garg, Jasmine Anandabai, Shikha Singh Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Prolonged computer use is a known risk factor for Cervical Spondylosis (CS) and associated musculoskeletal complaints. Occupational neck disorders can negatively impact function, productivity, and overall well-being. Multimodal interventions that integrate exercise and ergonomic strategies offer promising therapeutic benefits. Aim: To evaluate the effectiveness of a 10-week Integrated Exercise Protocol (IEP) on neck disability, musculoskeletal symptoms, and Quality of Life (QoL) among computer professionals experiencing CS-related symptoms. Materials and Methods: This quasi-experimental study was carried out at the Outpatient Department of Jyotirao Phule Subharti College of Physiotherapy from August 2024 to March 2025. A total of 120 computer professionals aged 25-50 years presenting with clinical signs of CS or neck and upper back musculoskeletal complaints were included in this study. The Integrated Exercise Group (IEG) underwent a 10-week supervised program including cervical mobility, strengthening exercises, postural correction, and ergonomic training. The Control Group (CG) received only standard ergonomic advice. Primary outcomes were measured using the Neck Disability Index (NDI) and the World Health Organisation Quality of Life Brief version (WHOQOL-BREF). The Nordic Musculoskeletal Questionnaire (NMQ) served as a secondary measure. Pre- and post-intervention scores were analysed using Paired t-tests (within-group comparisons) and an Independent t-test (between-group comparisons). A two-tailed p-value <0.05 was considered statistically significant. Results: At baseline, no significant differences were noted between groups. After 10 weeks, the IEG showed considerable improvement in NDI scores (p-value <0.001) and WHOQOL-BREF domains (p-value <0.001) compared to the CG. A substantial reduction in reported neck and upper back musculoskeletal symptoms was also observed in the IEG via NMQ (p-value <0.001). Conclusion: An IEP combined with ergonomic training significantly reduced neck-related disability, alleviated musculoskeletal symptoms, and improved quality of life in computer professionals. Structured physiotherapeutic interventions should be prioritised in occupational health strategies for sedentary workers with CS-related complaints.

Susceptibility Profile of Beta-lactam/Beta-lactamase Inhibitor Combinations against Multidrug Resistant Gram-negative and Positive Bacteria at a Tertiary Care Centre in Northern India: A Retrospective Study

Radhika Chaudhary, Radha Chauhan, Chitra Bhartiya, Chinmoy Sahu, Akshay Arya, Sangram Singh Patel, Mitali Agrahari Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Currently, Antimicrobial Resistance (AMR) is a major global public health concern. Infections caused by resistant microorganisms are more difficult to treat in humans and animals, leading to longer illnesses, higher mortality rates, and increased medical expenses. Aim: To determine the susceptibility profile of five beta-lactam/beta-lactamase inhibitor combinations for gram-negative and gram-positive bacteria. Materials and Methods: This was a retrospective study conducted in the Department of Microbiology at SGPGIMS, Lucknow, Uttar Pradesh, India, from January 2022 to January 2023. The analysis evaluated the susceptibility of Ceftazidime-Avibactam (CZA), Tazobactam-Piperacillin (TZP), Ticarcillin-Clavulanic Acid (TCC), Ampicillin-Sulbactam (SAM), and Cefoperazone-Sulbactam (SCF). These combinations were used for gram-negative and gram-positive bacteria isolated from various specimens. A total of 1,648 samples were tested for these combinations. The isolates were identified using conventional methods and Matrix-Assisted Laser Desorption/Ionisation Time-of-Flight (MALDI-TOF). Antibiotic Susceptibility Testing (AST) was performed by the Kirby-Bauer disc diffusion method on Mueller-Hinton agar (MHA). Results: Out of the 1,648 samples (756 urine, 382 pus, 322 blood, and 188 sputum), the beta-lactam/beta-lactamase inhibitor combinations were tested. The most susceptible combination found in this study was CZA (76%), followed by TZP (60.7%), TCC (50%), SAM (38.2%), and SCF (31%). Conclusion: CZA demonstrated better susceptibility compared to other beta-lactam/beta-lactamase inhibitor combinations. Recently discovered beta-lactam/beta-lactamase inhibitor combinations can be utilised as carbapenem-sparing agents for treating ESBL-producing Enterobacteriaceae (ESBL-PE), Pseudomonas aeruginosa, and Acinetobacter baumannii.

Assessment of Different Personality Traits Amongst Dental Interns and First-year Undergraduate Students: A Cross-sectional Study

Ajay Khanna, Mousumi Goswami, Shruti Balasubramanian, Aditya Saxena, Bakhtawar Shakil Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Personality traits are stable patterns of cognition, emotion, motivation and behaviour that individuals display across various situations. Performance in medical and dental education requires a range of personality traits; therefore, understanding human behaviour and individual differences necessitates an understanding of these traits. Research on the personalities of medical students and those in training programmes for other health professions has revealed certain traits that are linked to academic and clinical success throughout the educational process. Aim: To assess the different personality traits amongst dental interns and first-year undergraduate students. Materials and Methods: A cross-sectional study was conducted at the Department of Paediatric and Preventive Dentistry, I.T.S. Dental College, Hospital and Research Centre, Greater Noida, Uttar Pradesh, India, from March 2024 to June 2024. The study included 206 participants, comprising 98 interns and 108 first-year students. A Big Five Personality Test (BFPT) questionnaire consisting of 44 questions was distributed via Google Forms through mail and WhatsApp to the participants. The questionnaire focused on five personality traits: extroversion, agreeableness, conscientiousness, emotional stability and openness to experience. The normality of the data was tested by the Shapiro-Wilk test and was found to be normally distributed. The significance of the differences in means of parameters between the two groups was tested using an independent t-test, with a significance level set at p<0.05. Results: A total of 206 participants were included in the present study. The agreeableness and conscientiousness traits were significantly higher in interns (p<0.001; t-value: 19.235 and 13.103, respectively), while the openness to experience trait (p<0.001; t-value: -16.918) was expressed more by first-year dental students. The traits of extroversion and emotional stability showed similar scores in both interns and first-year dental students. Conclusion: Conscientiousness and agreeableness were found to be higher amongst interns, whereas first-year students exhibited the openness to experience trait more significantly. The authors suggest further exploration of the impact of different personality types on academic performance, clinical skills and patient management.

Pharmaceutico-analytical Study of Lakshadi Guggulu and Pravalyukta Lakshadi Guggulu and their Comparative In-vivo Evaluation of Anti-osteoporotic Activity: A Research Protocol of Experimental Study

Meenakshi Mayur Manerikar, Mujahid Khan, Varsha Tegeli Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Osteoporosis is a progressive bone disease characterised by a decrease in bone mass and density. It is a major public health problem and a significant risk factor for fractures, especially among elderly women. Additionally, long-term Glucocorticoid (GC) therapy is associated with a significant reduction in bone density and is one of the most common causes of secondary osteoporosis. Need of the study: Conventional medical management of osteoporosis typically involves calcium supplementation, Hormone Replacement Therapy (HRT), and the use of drugs such as bisphosphonates, which reduce osteoclast activity and, atleast in the short term, increase bone density. However, these interventions slow overall bone turnover. The present study aims to investigate the effectiveness of the Ayurvedic medicine Lakshadi Guggulu and its modified form, Pravalyukta Lakshadi Guggulu, in managing osteoporosis. According to Ayurvedic classics, Lakshadi Guggulu is a highly effective calcium formulation for correcting bone metabolic disorders, facilitating fracture repair, treating joint dislocations, and providing analgesic and anti-inflammatory effects. Aim: To conduct a pharmaceutico-analytical study of Lakshadi Guggulu and Pravalyukta Lakshadi Guggulu, and to evaluate their comparative anti-osteoporotic activity in vivo. Materials and Methods: The present experimental study will be conducted from June 2025 to November 2025 in the animal house at Datta Meghe College of Pharmacy (DMCP), Datta Meghe Institute of Higher Education and Research (DMIHER) Deemed University (DU) Wardha, Maharashtra, India. Raw materials will be collected from the local market and verified and authenticated by the Taxonomist/Dravyaguna Department. The medicines will be prepared, standardised, and analysed at Mahatma Gandhi Ayurved College Hospital and Research Centre (MGACH and RC) as per the Ayurvedic Pharmacopoeia of India (API). Analytical studies will be conducted for both Lakshadi Guggulu and Pravalyukta Lakshadi Guggulu. The animal study will adhere to Organisation for Economic Co-operation and Development (OECD) guidelines 423 and include a total of 78 female Wistar rats: 24 rats will be used for the acute toxicity study, and the remaining 54 rats will be divided into nine groups for the efficacy study. General clinical observations, biochemical and haematological parameters, and histopathological examinations will be conducted. Data will be statistically analysed using the Student’s t-test and Analysis of Variance (ANOVA) as appropriate. A p-value <0.05 will be considered statistically significant.

Comparative Efficacy of Amalaki Vati and Manjishtadi Serum versus Tablet Limcee and Retinol Serum for Facial Rejuvenation: A Randomised Controlled Trial Research Protocol

Aishwarya Kadam, Sourabh Deshmukh, Ashvini Pardhekar, Trupti Thakre Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: The ageing process begins at birth and becomes apparent as the years go by. Wrinkles and hyperpigmentation or photoaging {due to exposure to Ultraviolet (UV) radiation} are signs of ageing facial skin. Nowadays, facial ageing is a big issue, with attention being paid especially to premature ageing, facial laxity, and roughness. Therefore, the safest alternative to achieve a healthier and more radiant face is to apply herbal cosmetics. Need of the study: Modern cosmetic formulations are costly as well as may cause various side effects. There are some Ayurvedic rasayanas and cosmetic formulations with potential effects on ageing, which have not yet been studied on face rejuvenation. Out of which Amalaki has antioxidant properties mentioned in the Charaka Samhita. Manjishtadi taila is mainly indicated in Vali palita (wrinkles), Twak vaivarnya, depicted in Chakradatta samhita. So, using Manjishtadi serum as a modified form can give better results in face rejuvenation. Also, no study has been done on Amalaki vati and Manjishtadi serum in terms of face rejuvenation. Hence, the present study will mitigate the empirical knowledge gap. Aim: To evaluate the comparative efficacy of Amalaki vati and Manjishtadi serum versus tablet limcee and retinol serum in terms of face rejuvenation. Materials and Methods: The present randomised open labelled standard control superiority clinical trial will be held at Kayachikitsa Outpatient Department (OPD), Inpatient Department (IPD) of MGACH and RC Salod (H) Wardha, Maharashtra, India and Speciality Camps from March 2025 to February 2026. Two groups will be taken, with 31 patients in each. In group A (control group), participants will be given one tablet of Limcee (500 mg) once daily, along with the nightly application of retinol serum. In group B (trial group), participants will be given one tablet of Amalaki Vati (500 mg) once daily, combined with the nightly application of Manjishtadi serum. Assessment parameters i.e., wrinkle severity scale and hyperpigmentation severity scale, will be compared before and after treatment in each group by performing paired and unpaired t-tests. A p-value of <0.05 will be considered significant.

Efficacy of 0.1% Topical Nepafenac in Maintaining Transoperative Mydriasis and Preventing Postoperative Macular Oedema in Phacoemulsification Cataract Surgery: A Research Protocol

Srashti Jain, Pravin Tidake Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Following standard cataract surgery, postoperative Cystoid Macular Oedema (CMO) may result in visual impairment. Currently, phacoemulsification is considered the best surgical technique for cataract extraction due to the superior visual outcomes achieved after Intraocular Lens (IOL) implantation. Despite advancements in surgical techniques and improvements in IOL materials over the past decade, there remains a risk of unintentional ocular injury during surgery. Need of the study: Miosis during cataract surgery can hinder surgical access and visualisation, increasing the likelihood of complications. It is caused by the release of Prostaglandins (PGs) triggered by surgical trauma, which stimulates contraction of the iris sphincter muscle. Nepafenac, a Non Steroidal Anti-Inflammatory Drug (NSAID), inhibits Cyclooxygenase (COX), thereby reducing PG synthesis and preventing miosis when administered prophylactically before surgery. Maintaining adequate mydriasis ensures better surgical access and reduces intraoperative risks. Additionally, nepafenac’s anti-inflammatory properties help reduce the incidence of macular oedema—a postoperative complication arising from inflammation and disruption of the blood-retinal barrier. Aim: To evaluate the effectiveness of prophylactic topical nepafenac 0.1% in maintaining intraoperative mydriasis and preventing postoperative macular oedema in patients undergoing topical phacoemulsification cataract surgery. Materials and Methods: A prospective, randomised, single-masked comparative study will be conducted from June 2024 to June 2026 in the Ophthalmology Outpatient Department at Acharya Vinobha Bhave Rural Hospital (AVBRH), Sawangi, Meghe, Maharashtra, India. A total of 38 patients undergoing phacoemulsification cataract surgery will be equally divided into two groups (n=19 each). All patients will receive two doses of tropicamide 0.8% and phenylephrine 5% at 15-minute intervals. The experimental group will additionally receive nepafenac 0.1%—four doses administered hourly before surgery and three times daily for six weeks postoperatively. The control group will receive only prednisolone and moxifloxacin eye drops in a 15-day tapering regimen. Postoperative assessments will include Best-Corrected Visual Acuity (BCVA), Intraocular Pressure (IOP), fundoscopy, slit lamp evaluation of cells and flare and macular Optical Coherence Tomography (OCT) at two and six weeks. Statistical analysis will include descriptive tests, Chi-square test and Fisher’s-exact test to determine associations among clinical and demographic variables.

Evaluating the Influence of Near-Peer Teaching on Biochemistry Learning Outcomes: A Case-control Study Research Protocol

Sanghamitra Chakraborty, Mithilesh Dhamande, Vaibhav Anjankar Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Near-Peer Teaching (NPT) is a rapidly expanding area of research in medical education. Literature reviews show that peer-assisted learning is embedded in the curriculum of various medical schools. Several studies indicate that NPT is an effective teaching tool in problem-based learning. Moreover, the close proximity in age and recent shared experiences of peer tutors in medical school examinations provides an added benefit, allowing learners to appreciate the tutors’ knowledge and facilitating teaching at an appropriate level. Additionally, learners can interact more comfortably with peer tutors. Need of the study: In the context of the new competency-based curriculum, which includes provisions for early clinical exposure and electives, alternative teaching methods are increasingly required. NPT serves as a viable supplement to traditional faculty-led teaching. Furthermore, it enhances the teaching skills of near-peer tutors while enriching their own learning. Therefore, there is a need to study formal and structured NPT to validate its effectiveness, particularly in preclinical disciplines like biochemistry, and to explore its impact on student self-efficacy. Aim: The present case-control study aims to analyse the impact, effectiveness, and acceptability of NPT in biochemistry practical training sessions as an alternative teaching method to conventional faculty teaching. Materials and Methods: The proposed case-control study will be conducted over one year (October 2024 to November 2025) in the Department of Biochemistry at Nil Ratan Sircar Medical College and Hospital, Kolkata, India. Phase I MBBS students of Batch 2024-2025 will be selected as study participants on a voluntary basis. Near-Peer Tutors (NPTs) will be trained regarding the specific learning objectives, desired competencies, and teaching-learning methodologies for the sessions. Students will be divided into two equal groups: one group taught by Near-Peer Tutor and the other by traditional faculty. Both groups will cover the same topic. The effectiveness of NPT versus conventional teaching will be evaluated by comparing students’ scores. Students’ perceptions of NPT will be recorded using a pre-validated questionnaire (Kirkpatrick Level 1).

Comparative Quality Control and In-vitro Antioxidant Evaluation of Shramahara-Mahakashaya and its Modified Anti-fatigue Drink: A Research Protocol

Amrapali Ganesh Ingle, Bharat Jagdishji Rathi Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Nutraceuticals, derived from medicinal plants, marine organisms, vegetables, and fruits, are gaining popularity due to their health benefits, including antioxidant properties that combat oxidative stress. In India, the Food Safety and Standards Act of 2006 regulates this industry, promoting nutraceuticals over conventional medicine due to their fewer side effects. Ayurvedic formulations, such as the ten dravyas of Shramahara Mahakashaya (SMK), are known for relieving fatigue by providing essential nutrients. Fatigue, often linked to depressive disorders, responds slowly to traditional treatments, highlighting the need for new therapeutic approaches. Electrolytes are vital for cellular functions, and imbalances can lead to serious health issues. Need of the study: There is an ongoing need to explore ways to expand the range of available therapeutic alternatives. Consumer demand for foods containing physiologically active compounds, particularly antioxidants that help the body combat oxidative stress, has increased due to rising health awareness. Improved therapeutic outcomes can be obtained by combining several medicinal components in a single formulation. Shramahara Drink (SD), also known as the “Antifatigue Drink,” can be recommended to patients of all ages, from young children to the elderly, as an alternative to other unappealing supplements on the market because of its fruity flavour. Aim: To modify the dosage of SMK into a drinkable form (SD) to alleviate fatigue and to conduct comparative quality control assessments along with in-vitro evaluations of Antioxidant Activity (AA). Materials and Methods: This in-vitro study will be conducted at the Central Research Laboratory of JNMC, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Wardha, Maharashtra, India, from July 2025 to November 2025. The drugs required for the preparation of the Shramahara (Antifatigue) Drink will be procured from Dattatraya Ayurved Rasashala, Wardha, and the drink will be prepared in the Department of Rasa Shastra and Bhaishajya Kalpana, Mahatma Gandhi Ayurved College Hospital Research Centre, Salod (H), Wardha. Organoleptic and physicochemical parameters will be examined, and AA of the Shramahara Drink will be assessed using in-vitro methods. One-way Analysis of Variance (ANOVA) will be employed for statistical analysis, and a p-value of <0.05 will be considered statistically significant.

Psychometric Testing and Validation of Comprehensive Assessment Scale for Chronic Low Back Pain in Northern Indian Population: A Research Protocol

Aditi Popli, Manu Goyal Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Low Back Pain (LBP) ranks as one of the most prevalent musculoskeletal conditions worldwide. The average lifetime prevalence of LBP in Northern India is reported to be 57%, with women (65%) exhibiting a significantly higher prevalence than men (47%). Need of the study: The existing literature evaluating the combined effects of functional disability and psychological status in patients with chronic LBP in Northern India is quite limited. In countries like India, clinicians and researchers often rely on assessment scales developed in Western nations. However, no indigenous scales exist that simultaneously measure both functional limitations and psychological aspects in chronic LBP patients. When these internationally developed scales are used in Northern Indian clinical settings, they may fail to accurately capture patient progress during assessments and reassessments, as they are designed with different cultural and geographical considerations in mind. Aim: The study aims to validate and test the psychometric properties of a Comprehensive Assessment Scale for patients with chronic LBP in Northern India. Materials and Methods: The present cross-sectional study will be conducted at MM Super-Specialty Hospital, Mullana, Ambala, Haryana, India. The duration of the study will be from February 2025 to February 2026, and it will comprise three phases: 1) development phase, 2) validation phase, and 3) testing of psychometric properties. For the formation of domains and the framing of a pre-final draft for scale development, 7-8 patients with chronic LBP who have been experiencing symptoms for the past year will be interviewed over three rounds. This will be followed by literature searches and opinions from an expert panel. The draft will be validated in terms of content validity via the Delphi survey method. Construct validity will be examined through confirmatory factor analysis, and concurrent validity will be analysed by correlating the Comprehensive Assessment Scale (CAS) with other validated questionnaires such as the Oswestry Disability Index (ODI) and the Roland-Morris Disability Questionnaire (RMDQ-24). Data will be collected from patients to test the final draft of the CAS for its psychometric properties. Statistical analysis will be performed using IBM Statistical Package for the Social Sciences (SPSS) software (version 26). The data collected will be analysed for absolute and relative reliability, as well as other psychometric properties such as sensitivity, specificity, small worthwhile change, minimal detectable change, standard error of mean, and coefficient of variation.

Comparative Evaluation of the Functional and Aesthetic Outcomes of Orbital Floor Reconstruction Using Poly Lactic Co-glycolic Acid and Titanium Mesh: A Randomised Controlled Trial Research Protocol

Yash Sanjay Deshpande, Nitin Bhola, Anchal Agarwal Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Orbital floor fractures are common facial injuries that often result in functional and aesthetic impairment. Open Reduction and Internal Fixation (ORIF) using various materials, like Poly Lactic-Co-glycolic Acid (PLGA) mesh and titanium mesh, have been employed to repair these fractures. Need of the study: Recent advancements in hybrid bone mesh, including bioactive materials or elements to promote fracture healing, show significant promise. One such innovation involves using biodegradable PLGA material to create a bone screw mesh, which has demonstrated benefits for fracture healing and has gained interest recently. These developments aim to enhance treatment plans for patients by offering superior aesthetic and functional properties. However, evidence comparing their functional and aesthetic outcomes is limited. Aim: The present randomised controlled trial aims to compare and evaluate the functional and aesthetic outcomes of ORIF using PLGA mesh and titanium mesh in patients with orbital floor fractures. Materials and Methods: A randomised single-blinded controlled trial will be conducted at Siddharth Gupta Memorial Cancer Hospital (AVBRH), Datta Meghe Institute of Higher Education and Research, Sawangi, Wardha, Maharashtra, India, from September 2024 to December 2025. A total of 12 patients presenting with orbital floor fractures will be included and two parallel groups, A and B, will be allocated by randomisation and they undergo ORIF using either or titanium mesh (Group A- Control group) or PLGA mesh (Group B-Experimental group). Functional outcomes, including diplopia, enophthalmos, ocular motility, and infraorbital nerve function, will be assessed using standardised clinical measures. Aesthetic outcomes will be evaluated based on facial symmetry, globe position, and patient satisfaction using validated scoring systems. Follow-up assessments will be conducted at regular intervals of 10-15 days. An unpaired t-test will be applied for intergroup comparison, and a p-value of less than 0.05 will be considered statistically significant.

Utility of Programmed Cell Death Ligand One (PDL1) Expression for Assessing Tumour Behaviour in Comparison to Histopathological Grading and TNM Staging in Oral Squamous Cell Carcinoma Patients: A Research Protocol for a Cross-sectional Study

Shailly Rajnish Tiwari, Samarth Shukla, Harsh Manoj Kumar Thesia Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Conventional prognostic indicators such as histopathological grade and TNM staging often fail to fully capture the heterogeneity in tumour behaviour. Recent advances in molecular pathology have highlighted the role of immune checkpoint markers, particularly Programmed Cell Death Protein 1 (PD-1)/Programmed Cell Death Ligand-1 (PD-L1), in tumour progression and immune evasion. Evaluating PD-L1 expression in Oral Squamous Cell Carcinoma (OSCC) may therefore provide important insights into prognosis and therapeutic strategies. Need of the study: Although PD-L1 has been recognised as a predictive biomarker in several malignancies, its diagnostic and prognostic utility in OSCC, especially within the Indian population, is inadequately studied. Given the high incidence of OSCC in India and the limited effectiveness of conventional prognostic tools, assessing PD-L1 expression in relation to histological grading and TNM staging is essential. Such findings may refine risk stratification, improve patient outcomes, and aid in integrating immunotherapy into treatment protocols. Aim: To evaluate the role of PD-L1 expression as an immunohistochemical marker in assessing tumour behaviour in OSCC and compare its utility with histopathological grading and TNM staging. Materials and Methods: The present two-year observational cross-sectional study will be conducted from April 2024 to April 2026 in the Department of Pathology, Jawaharlal Nehru Medical College, Sawangi (Meghe), in collaboration with Oral Surgery, Sharad Pawar Dental College and Hospital, Sawangi, Wardha, Maharashtra. Ninety-five histopathologically confirmed OSCC cases will be included. Formalin-fixed paraffin-embedded sections will undergo Haematoxylin and Eosin (H&E) staining for histological grading (CAP guidelines) and staging (AJCC 8th edition). PD-L1 immunohistochemistry will be performed using clone 22C3 (Dako), and expression scored by Combined Positive Score (CPS), with CPS <1 negative and CPS ≥1 positive. Tonsillar carcinoma will serve as the positive control and omission of secondary antibody as the negative control. Associations between PD-L1 expression, grade, and TNM stage will be tested by Chi-square, with p<0.05 considered significant.

Comparative Efficacy of Medopachak Yoga by Three Different Routes (Basti, Udvartan, Oral Route) in the Management of Obesity (Sthoulya): A Research Protocol

Shubham Sudhakar Kalode, Punam Sawarkar, Shweta Parwe, Gaurav Sawarkar Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Obesity, or Sthoulya, is a metabolic disorder characterised by excessive fat accumulation that adversely affects overall health. It is defined as a Body Mass Index (BMI) greater than 30 kg/m². The global prevalence varies, with rates reported as 67% in the Americas and 31% in Southeast Asia and Africa. It is estimated that 16% of adults over 18 years of age will be obese by 2027. In Ayurveda, obesity is viewed as a nutritional illness (Santarpanjanotha Vyadhi) linked to vitiated Kapha and Medha due to Medovaha Srotas Dushti. Acharya Charaka states that Udvartan, which includes both dry and unctuous procedures, may contribute to the excessive accumulation of Meda Dhatu (fat tissue). Need of the study: Obesity significantly contributes to numerous co-morbid conditions, including type 2 diabetes, hypertension, dyslipidaemia, osteoarthritis, and various cancers such as colon and breast cancer. Although conventional pharmaceutical and surgical treatments may offer short-term benefits, they are often associated with side effects, high costs, and poor long-term adherence. Ayurveda provides a safe, holistic, and personalised approach to managing Sthoulya by addressing both physical and psychological components. The primary therapeutic methods oral medication (systemic modulation), Udvartan (external stimulation), and Basti (colon cleansing)—have individually demonstrated effectiveness. However, comprehensive comparative studies evaluating their long-term efficacy are lacking. The present study aims to bridge this gap in integrative obesity management and provide scientific evidence for standardised Ayurvedic treatments, potentially influencing public health and clinical practice. Aim: To evaluate the comparative efficacy of a Medopachak formulation (Yoga) administered through three different routes—Basti (enema), Udvartan (local application), and oral Medopachak Ghana tablets (Vati) in the management of obesity (Sthoulya). Materials and Methods: A randomised controlled trial will be conducted from May 2025 to May 2026 at Mahatma Gandhi Ayurved College, Hospital and Research Centre, Datta Meghe Institute of Higher Education and Research, Salod (H), Wardha, Maharashtra, India A total of 78 patients will be enrolled and treated with the Medopachak formulation via three different routes. Group A: Medopachak formulation (Yoga) administered as Basti (enema) through the anal route for eight days. Group B: Medopachak formulation (Yoga) applied through Udvartan (local application) for eight days. Group C: Medopachak Ghana tablet (Vati), 250 mg two tablets with lukewarm water twice a day for 24 days. Objective parameters Body Mass Index (BMI), body weight, anthropometric measures, serum lipid profile, and skinfold thickness—will be assessed on days 16 and 24. Statistical analysis will include Analysis of Variance (ANOVA) paired t-test, or Wilcoxon Signed-rank test. A p-value <0.05 will be considered statistically significant.

Bioceramic Materials for Root-end Modification in Necrosed Immature Permanent Teeth: A Narrative Review

Prabha Shristha, Vijay Kumar Shakya, Rakesh Kumar Yadav, Promila Verma Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X The endodontic management of immature permanent teeth with open apices that subsequently become necrotic presents a significant clinical and research challenge. Such cases are problematic due to the difficulty in achieving effective disinfection, proper apical closure, and long-term sealing of the root canal system. Over the years, various treatment approaches have been introduced to address this issue and promote apical closure and repair. These include apexification with calcium hydroxide, the use of Mineral Trioxide Aggregate (MTA), and, more recently, the application of advanced bioceramic materials, which have shown promising outcomes in root-end modification. These modern bioceramics include MTA, Biodentine®, which is used in successful root-end procedures due to the benefits of biocompatibility, sealing ability, and bioactivity. Issues include the long setting times, sensitivity towards handling, and high costs. This paper also reviews the more traditional apexification techniques and newer approaches like pulp revascularisation and regeneration against modern bioceramic materials. While these materials have had encouraging results, more clinical trials are needed to evaluate their long-term effectiveness.

Perineural Invasion in Oral Squamous Cell Carcinoma: A Review

Samreen Fatma, Priya Nimish Deo, Tauseef Fazal Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Perineural Invasion (PNI) in cancer is a continuous, multistep process. PNI, generally understood as the invasion of cancer cells into or around nerves, is recognised as a high-risk pathological feature. The extent of tumour progression into nearby and distant lymph nodes, as well as the degree of invasiveness of the primary tumour, largely determines the prognosis of Head and Neck Squamous Cell Carcinoma (HNSCC). Among high-risk factors, PNI is strongly associated with the greatest risk of locoregional and distant metastasis. With rapid advancements in precision medicine and molecular biology, it has become evident that PNI does not result from a single causative factor. Instead, it is increasingly recognised as a significant pathological characteristic of several cancers, including those of the stomach, biliary tract, prostate, colon, rectum, pancreas, and head and neck. PNI is considered a hallmark of tumour invasion and metastasis and is associated with poor patient prognosis. Although the pathological description and clinical implications of PNI are well established, research into its molecular mechanisms is still evolving. Recent studies suggest that tumour migration and invasion into nerves may result from complex molecular interactions within the tumour-nerve microenvironment, involving various signalling molecules that promote both tumour cell invasion and neuronal growth. Historically, it was believed that PNI occurred because the anatomical region provided a path of low resistance. However, given its strong association with poor prognosis, advancing our understanding of PNI may help clarify mechanisms of tumour metastasis and recurrence, aid in improving staging systems, and lead to the development of novel therapeutic strategies and potentially new paradigms in patient management.

Disconnected Pancreatic Duct Syndrome: A Narrative Review of Pathophysiology, Classification, Emerging Diagnosis and Treatment Approaches

Prithvansh Malhotra, Raju Shinde, Khushbu Vaidya, Jaideep Reddy, Bhagyesh Sapkale Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Disconnected Pancreatic Duct Syndrome (DPDS) is a complicated outcome of pancreatic injury which is characterised by persistent secretory leakage from an isolated upstream pancreatic segment. Clinically, DPDS is associated with recurrent or non resolving Peripancreatic Fluid Collections (PFC), external pancreatic fistulae, chronic abdominal pain and metabolic derangements, which in most cases result in exocrine and endocrine dysfunction. Different radiological, endoscopic and anatomical-based classification systems have been designed to guide clinical decision-making. Diagnosis also has been progressing to a large extent due to the increasing utility of secretin-enhanced Magnetic Resonance Cholangiopancreatography (MRCP), Endoscopic Retrograde Cholangiopancreatography (ERCP), 3D-MRCP, peroral pancreatoscopy and Endoscopic Ultrasound (EUS)-assisted interventions, which enhance the detection of complete ductal disconnections. Management is based on the anatomy of the duct, endoscopic transmural drainage is preferable in cases of partial disruptions, and complete ductal disconnection often requires surgery, such as distal pancreatectomy or pancreaticojejunostomy. The current advances, which include Lumen-Apposing Metal Stents (LAMS), EUS-guided Pancreatic Duct Interventions (EUS-PDI), hybrid endoscopic-percutaneous techniques, and bioengineered anastomotic methods, are changing therapeutic practices to minimally invasive organ-preserving solutions. Early identification and multidisciplinary treatment should also be utilised to decrease morbidity and avoid recurrence of DPDS. Further research on the functional imaging and ductal reconstructive technologies holds promise to advance the long-term outcomes in DPDS. The article critically reviews clinical manifestation of the DPDS, its evolution of classification, diagnostic advancements, and modern management strategies in order to maximise patient outcome.

Transformative Non-surgical Strategies for Adult Class III Malocclusion: A Narrative Review

Ashida Sherin Olappilan, Vincy Antony, Muhamed Shaloob, Sinjimol Thomas, Fahsina Hamza Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Adult skeletal Class III malocclusion presents a complex orthodontic challenge, often necessitating orthognathic surgery for definitive correction. However, in carefully selected adult patients with mild to moderate skeletal discrepancies, non-surgical treatment strategies offer promising alternatives. This narrative review highlights current advancements in non-surgical management, including Bone-Anchored Maxillary Protraction (BAMP), Micro-Implant Assisted Rapid Palatal Expansion (MARPE), and hybrid tooth-bone-anchored appliances. These modalities enable maxillary advancement and transverse expansion while minimising undesirable dentoalveolar effects. Camouflage treatment, utilising extraction or non-extraction protocols, offers functional and aesthetic correction through controlled dental compensation. Techniques such as the Multiloop Edgewise Archwire (MEAW) and Mandibular Molar Distalisation (MMD), facilitated by Temporary Anchorage Devices (TADs), miniplates, aligners, or the Carriere Motion Three-Dimensional (3D) appliance, expand the spectrum of treatment options. While these strategies do not modify underlying skeletal bases, they offer improved occlusal function and facial aesthetics, particularly in well-selected cases. Emerging technologies such as digitally guided planning, 3D-printed expansion devices like the Dutch Maxillary Expansion Device (D-MED), and skeletal anchorage innovations continue to evolve the landscape of non-surgical Class III correction. Optimal outcomes hinge on accurate diagnosis, individualised planning, and patient compliance. Non-surgical management represents a dynamic, patient-centred alternative to surgery in selected adult Class III cases.

Use of Prostaglandin E1 in Neonates with Severe Persistent Pulmonary Hypertension (PPHN): A Narrative Review

Ravi Kiran Kumar Reddy, Sagar Karotkar, Mahaveer Lakhra, Aditi Rawat, Nayakawadi Akhil Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Persistent Pulmonary Hypertension of the Newborn (PPHN) is a significant health issue characterised by the inadequate circulatory transitions at birth, subsequent to considerable hypoxaemia and increased Pulmonary Vascular Resistance (PVR). Inhaled Nitric Oxide (iNO) is the preliminary treatment approach; however, it fails to achieve favourable outcomes in approximately 30-40% of neonates. Consequently, therapeutic alternatives, particularly Prostaglandin E1 (PGE1), are capturing attention for their considerable vasodilatory features and capability to maintain Ductus Arteriosus (DA) patency. Additionally, PGE1 decreases right ventricular afterload and augments systemic oxygen delivery, thus functioning as a valuable option for managing PPHN in this vulnerable population. This review article aims to comprehensively determine the intricate role of PGE1 in the context of PPHN, focusing on its pathophysiology, clinical utility and novel treatment methods. The study also examines current research concentrating on optimising PGE1 protocols, including dosage clinical guidelines and evaluating potential long-term complications, with the objective of enhancing paediatric care through both established practices and innovative strategies.

Causes of Tobacco Use and its Effects on Human Health: A Comprehensive Review

Mansi Dey, Deepti Awasthi, Sakshi Wali Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Tobacco use is a major cause of morbidity and mortality worldwide. It affects not only children and adolescents but also adults and the elderly. The detrimental effects on human health include psychiatric disorders, a tendency to use other illicit drugs, infertility and more. It also harms foetuses and infants when used by pregnant and lactating mothers. Complications of pregnancy caused by maternal smoking include placenta previa, placental abruption, premature rupture of membranes, ectopic pregnancy, miscarriage and an increased risk of abnormal bleeding during pregnancy and delivery. Babies born to women who smoke throughout pregnancy are more likely to be small for gestational age and there are chances of stillbirth, neonatal respiratory and gastrointestinal diseases, transfer to the Neonatal Intensive Care Unit (NICU) and admissions for more than seven days. Intrauterine death, Sudden Infant Death Syndrome (SIDS) and neonatal infections can also occur. Nicotine secreted into breast milk has adverse effects on the newborn. In the elderly, tobacco use is more likely to cause cognitive impairment, dementia and other sensory disabilities, as well as loss of function, mobility and independence. It also causes age-related diseases such as osteoporosis and breast cancer in elderly women. Major causes of death in the elderly due to tobacco use include cardiac, cerebrovascular and respiratory diseases. It increases the risk of myocardial infarction, Chronic Obstructive Pulmonary Disease (COPD) and lung cancer in the elderly and is associated with poorer wound healing. Hence, the integration of tobacco cessation programs into routine health services is very important.

Next Generation Footwear for Diabetic Neuropathy: A Narrative Review on Biomechanical Innovations and Smart Technologies for Ulcer Prevention

Chhavi Arora Sehgal, Ruchi Basista, Sanghamitra Jena, Majumi M Noohu, Nitesh Malhotra Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Diabetic Neuropathy (DN) significantly alters foot biomechanics, leading to abnormal pressure distribution, impaired gait patterns, and a heightened risk of foot ulcers, which often precede lower-limb amputations. Traditional diabetic footwear focuses on static pressure relief but lacks real-time adaptability to biomechanical changes. Recent advancements in smart sensor technology, Artificial Intelligence (AI), and 3D printing offer a dynamic approach to ulcer prevention and mobility enhancement. This narrative review explores emerging innovations in diabetic footwear that integrate biomechanical adaptations and smart technologies to optimise pressure redistribution, improve gait stability, and reduce ulcer risk in individuals with DN. A comprehensive literature review was conducted using PubMed, SCOPUS, Web of Science, and PEDro databases. Studies focusing on pressure-sensing insoles, AI-assisted gait analysis, thermal ulcer detection, and 3D-printed orthotics were analysed. The impact of these technology on plantar pressure offloading, gait mechanics, and ulcer prevention was evaluated. Recent findings indicate that smart footwear incorporating pressure sensors can reduce peak plantar pressures by up to 35%, thereby significantly lowering the risk of ulcer formation. AI-driven wearable technologies enables early detection of abnormal gait patterns, allowing real-time interventions to help prevent diabetic foot complications. Additionally, 3D-printed footwear offers personalised pressure redistribution, surpassing traditional diabetic shoes in providing customised foot support. Integrating biomechanical principles with sensor technology shows considerable potential for improving mobility and foot health in diabetic patients. Future research should focus on large-scale clinical trials, cost-effectiveness, and practical implementation to ensure widespread accessibility in diabetic foot care.

District-wise Geospatial Distribution of Fluoride in Groundwater of Uttar Pradesh, India: A Narrative Review based on Secondary Data Synthesis

Khushboo Arif, Vinay Kumar Gupta, Nishita Kankane, Seema Malhotra, Aayushi Aggarwal Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Globally, fluoride contamination in groundwater is a major environmental and public health concern. Current district-level fluoride mapping is inadequate in Uttar Pradesh, India, as data available from the early 2000s no longer accurately reflects present-day groundwater fluoride contamination. The present study synthesised secondary data to analyse the distribution of fluoride levels, particularly where concentrations exceed the permissible limit of 1.5 mg/L, and to understand environmental influences on fluoride distribution. A comprehensive search was conducted using MEDLINE (PubMed), Google Scholar, Embase, reports from governmental and institutional agencies, and public health databases related to fluoride contamination, its health implications, and district-level fluoride mapping studies published between 2000 and 2024. The findings of present review emphasise substantial variation in fluoride contamination across different districts of Uttar Pradesh, with some regions showing very high concentrations. Reported fluoride levels ranged from marginal exceedances to extreme hotspots exceeding 20–30 mg/L, highlighting the need for a multidisciplinary approach integrating environmental management, public health strategies, and sustainable water resource planning.

Efficacy of Kati Basti, Kati Dhara and Patrapinda Sweda in Treating Gridhrasi (Sciatica): A Narrative Review

Neha, Shweta Parve, Punam Sawarkar, Milind Nisargandha Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Gridhrasi (Sciatica) is a condition characterised by radiating pain, stiffness and restricted movement, significantly affecting quality of life. Although current management is largely symptomatic, recurrence is common because the underlying pathological processes remain unaddressed. Ayurvedic therapies such as Kati Basti, Kati Dhara and Patrapinda Sweda offer holistic management by correcting Vata and Kapha dosha imbalances. In this narrative review, the efficacy of these therapies in managing Gridhrasi—specifically in terms of pain reduction, improved mobility and restoration of function—is compared. Based on the literature, authors reviewed clinical trials, case series and comparative studies. The primary outcome parameters included pain relief measured using the Visual Analogue Scale (VAS), functional disability assessed by the Oswestry Disability Index (ODI) and range of movement assessed by the Straight Leg Raise Test (SLRT). The review found that Kati Basti was the most effective in relieving local pain and stiffness, primarily due to its role in correcting Vata imbalances. Kati Dhara was particularly effective in relieving stiffness and limited movement associated predominantly with Kapha dosha. Patrapinda Sweda, through its combined oleation and sudation effects, offered benefits for both Vata and Kapha imbalances, providing comprehensive relief. All therapies demonstrated significant improvements in pain, mobility and quality of life, with no notable side-effects. In conclusion, Kati Basti, Kati Dhara and Patrapinda Sweda are effective, safe and cost-efficient treatment modalities for Gridhrasi, when administered according to doshic imbalance-based individualised treatment plans. Large-scale studies are necessary to validate these findings.

Effectiveness of Scapular Stabilisation Exercises in the Management of Forward Head Posture: A Narrative Review

Maithri Sudhin, Saumya Srivastava Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Forward Head Posture (FHP) is a condition in which the head is positioned more anteriorly, resulting in an exaggerated anterior convexity of the cervical spine. It is associated with flexion of the lower cervical spine (C4-C7) and hyperextension of the upper cervical spine (C1-C3). FHP is linked to a range of consequences, including altered scapular mechanics, postural impairments, muscular imbalances, compromised respiratory function, impaired balance, and reduced cervical proprioception. Scapular Stabilisation Exercises (SSE), as a targeted therapeutic approach, can effectively address FHP by reducing pain and impairment, restoring normal muscle function, and improving cervical range of motion. The current narrative review aimed to assess the efficacy of SSE in the management of FHP and to augment the existing body of evidence supporting its clinical application. Based on the findings, the present review highlights SSE as a clinically effective intervention for individuals presenting with FHP.

Contemporary Approach and Current Treatment Modalities for Management of Heart Failure Across Asia: A Literature Review

Mahesh Bhupal Chendake, Vaishali Rajsinh Mohite, Abhijeet Bhausaheb Shelke Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X With millions being affected, Heart Failure (HF) has become a growing health concern in Asia, especially in South Asia, where it affects a younger population presenting with multiple co-morbidities. Despite global advancements in HF treatments, existing guidelines remain largely based on American and European populations; however, there is a need for tailored strategies in Asia. The present literature-based review provides an overview of the existing HF management guidelines and highlights guidelines specific to Asian countries. It further summarises findings from recent publications that describe current treatment patterns for HF, including pharmacological and non pharmacological strategies as well as the use of medical devices. While older medications continue to remain the standard of care, newer therapies show promising potential to enhance treatment effectiveness and recovery in patients with HF. Developing region-specific HF guidelines is essential, considering Asia’s unique genetic, socioeconomic and healthcare-related factors.

Delivering Patient-centered Care by Promoting Integrative Nursing

Saurabh Rambiharilal Shrivastava, Prateek Sudhakar Bobhate, Harshal Gajanan Mendhe Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Patient-centered care is an approach to healthcare delivery, where the patient’s requirements, likes and cultural values occupy the Centre stage for all decisions related to their management. The purpose of the Present article is to ascertain the role of integrative nursing in the delivery patient-centered care, identify the barriers involved in practising integrative nursing, and propose potential recommendations to overcome these identified barriers. Integrative nursing is a comprehensive, evidence-driven approach that envisages the necessity to treat the whole person instead of targeting their symptoms or the disease they are suffering from. The adoption of integrative nursing plays a vital role in delivering the patient-centered care, which is the need of the hour. This can be attributed to the fact that it advocates a holistic, personalised approach, and this immensely contributes to patient satisfaction, because patients are being heard, respected, and valued for their views. Common barriers to successful implementation of integrative nursing include insufficient training of healthcare professionals, time-intensive nature of these practices, the lack of policies to implement integrative nursing, reluctance among healthcare professionals to adopt integrative approaches. In conclusion, integrative nursing can create an environment for the delivery of comprehensive, compassionate, and culturally sensitive patient-centered care, eventually contributing to better patient satisfaction and treatment outcomes.

Angiomyxolipoma of Right Cheek: A Rare Case Report

Rupali Bavikar, Apeksha Sharma, Charusheela Gore, Bhaskar Bhardwaj Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X A lipoma is a benign tumour of adipose tissue and is the most common soft-tissue tumour in adults. It is typically a well-encapsulated, slow-growing, painless mass composed of mature fat cells. Lipomas can develop anywhere in the body, but they are most frequently found in the arms, shoulders, back, neck, and thighs. Angiomyxolipoma (AML) is a very rare variant of lipoma that consists of an admixture of adipose and myxoid elements with numerous vascular structures. Hereby, the authors present a case of a 56-year-old male who presented with a solitary swelling in the right cheek that had been present for the last two years. The Fine Needle Aspiration Cytology (FNAC) findings showed a few bland spindle cells along with some areas of dilated benign cells with elongated nuclei. Histopathological examination revealed a well-encapsulated tumour composed of mature adipose and myxoid tissues, along with blood vessels, confirming the diagnosis of AML of the right cheek. AML is a rare, benign soft-tissue tumour composed of adipose, myxoid, and vascular components. It is considered a variant of lipoma and is typically slow-growing, painless, and well-circumscribed. As of recent literature, fewer than 20 cases of AML have been reported in the English medical literature. Due to their rarity and histological overlap with other myxoid and vascular-rich tumours, such as myxoid liposarcoma or angiomyxoma, accurate diagnosis is crucial. Immunohistochemical staining and careful histopathological evaluation are essential to distinguish AML from other entities.

An Atypical Peripheral Ossifying Fibroma of the Mandible in a Male Patient: A Clinico-pathologic and Surgical Case Report

Manjeu Jayakumar, Potluri Venkata Durga Rao, Rupali Das, Abhilash Neelakanti Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Peripheral Ossifying Fibroma (POF) is an uncommon reactive, inflammatory gingival lesion believed to originate from the periodontal ligament in response to chronic irritation such as plaque, calculus, trauma, or defective restorations. It belongs to the spectrum of reactive gingival overgrowths, including pyogenic granuloma and Peripheral Giant Cell Granuloma (PGCG). Pathologically, POF displays a fibrocellular connective tissue matrix with characteristic areas of mineralisation. These may appear as immature woven bone, cementum-like deposits, or dystrophic calcifications. The presence of these mineralised foci is a key histopathological hallmark and reflects the osteogenic potential of periodontal ligament fibroblasts, which are capable of differentiating into cementoblasts or osteoblast-like cells under persistent inflammatory stimulation. POF typically occurs in young females and most frequently involves the maxillary anterior region. This case report describes an atypical presentation of POF in a 54-year-old male who reported a slowly enlarging, asymptomatic gingival mass in the mandibular canine–premolar area. Clinical examination revealed a firm, sessile, well-circumscribed nodular overgrowth in the attached gingiva of the mandibular left canine-premolar region, with normal surface appearance and no bleeding. Adjacent teeth showed pathologic migration, and periodontal support appeared compromised clinically. As part of the diagnostic work-up, an intraoral periapical radiograph was obtained, which demonstrated bone loss, widening of the periodontal ligament space, and migration of adjacent teeth, but no radiopaque material. Complete surgical excision was performed, and the specimen was submitted for histopathological evaluation. The gingival origin, clinical behaviour, radiographic and histopathological evaluation supported the diagnosis of POF. The patient was followed up regularly for three years and demonstrated no recurrence. This case underscores the importance of detailed clinical, radiographic and histopathologic evaluation when assessing atypical gingival enlargements occurring outside their usual demographic and anatomical patterns.

Pharmacological and Therapeutic uses of Abhadighanvati in Avabahuka (Frozen Shoulder): A Narrative Review

Sudha Rani Verma, Vinod N Ade, Aruna Ojha, Mukesh Kumar Bisen, Divya Patel Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Avabahuka, known as frozen shoulder, is a condition described in Ayurvedic texts under Vatavyadhi, which includes neurological and musculoskeletal disorders. It primarily affects the shoulder joint, leading to muscle wasting, stiffness, and restricted movement, particularly in abduction and external rotation. Standard treatments like analgesics and corticosteroid injections often provide only temporary relief and can result in side effects with prolonged use. Abhadighanvati is a traditional Ayurvedic formulation utilised for managing Avabahuka. It contains herbs such as rasna, shunthi, guduchi, ashwagandha, and shatavari, which possess anti-inflammatory, analgesic, and neuroprotective properties. These ingredients help relieve pain, reduce stiffness, and improve mobility by addressing the underlying pathophysiology of the condition. This review highlights the pharmacological benefits of Abhadighanvati and its effectiveness as an adjunct or standalone therapy for Avabahuka, affirming its relevance in both classical and modern medicinal practices.

External Application of Varuna (Crataeva nurvala Buch-ham) Patra Kalka with Ghrita after the Gomaya Gharshana versus Varuna Patra Siddha Ghrita versus Manjistha Ghrita in the Management of Striae Gravidarum: A Research Protocol for a Three Arm Study

Pallavi Dewangan, Jaimala Jadhav Journal of clinical and diagnostic research : 2026 - March - 20:0973-709X Introduction: Ayurveda emphasises both preventive and curative aspects of disease, with an extensive repertoire of treatments, including those with cosmetic applications. Striae gravidarum, a prevalent dermatological condition, affects 75-90% of pregnant women globally. In Ayurveda, striae gravidarum is referred to as “Kikkisa,” and is attributed to the stretching and tearing of the skin during pregnancy. Need of the study: Many cosmetic products and procedures claim to improve the appearance of striae; however, most merely alter superficial appearance rather than addressing the underlying physical characteristics of the condition. In some cases, they may even lead to undesirable side effects. Therefore, there is a pressing need to explore safe and reliable treatments grounded in Ayurveda. The external application of Varuna (Crataeva nurvala Buch-Ham) patra kalka with ghrita, following gomaya gharshana, holds significant potential and is supported by classical textual references for use in the management of striae gravidarum (Kikkisa). Despite this, the formulation has not yet been thoroughly evaluated. Hence, the present study aims to document and establish the specific therapeutic effects of this Ayurvedic remedy in the management of striae gravidarum, emphasising both safety and Ayurvedic principles. Aim: The aim of the present comparative study is to evaluate the efficacy of external application of Varuna (Crataeva nurvala Buch-Ham) leaf paste with ghee after cow dung rubbing; Varuna leaf medicated ghee; and Manjistha medicated ghee in the management of striae gravidarum. Materials and Methods: The present interventional, open-labelled, randomised controlled trial will employ a three-arm study design from June 2025 to September 2026 at Mahatma Gandhi Ayurved College, Hospital and Research Centre, Salod (Hirapur), Wardha, Maharashtra, India. Sixty female participants aged 25-45 years with a history of striae gravidarum will be randomly assigned to one of three treatment groups. Group A: Varuna patra kalka with ghrita after gomaya gharshana; Group B: Varuna patra siddha ghrita, and Group C: Manjistha ghrita. Treatments will be administered over 8 weeks, with biweekly assessments. Parameters will include subjective evaluations {such as kandu (itching), vidaha (burning sensation), twak bheda (skin tearing), rekha swaroopa / twak sankocha (linear stretch marks), and vaivarnya (discolouration)}, and objective assessments {such as photographic documentation, lesion count, lesion dimensions, and the Patient Scar Assessment Scale (PSAS)}.