Table of Contents : Journal of clinical and diagnostic research : 2024 - August - 18

Diagnostic Utility of Dermoscopy in Angiokeratoma of Fordyce: A Case Report

Keerthana Rachamadugu, Sabiha Quazi, Bhushan Madke, Rajesh Domakunti, Naga Nitya Vangala Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Angiokeratomas are benign, rarely occurring vascular lesions characterised by marked ectasia of thin-walled blood vessels in the superficial dermis. Angiokeratoma of Fordyce is the second most common type. It is more frequent in men and usually presents as multiple bright red papules on the scrotum, occasionally on the penis, buttocks, and abdomen; it can also occur in females mainly over the vulvar region. Here, a case of a 70-year-old patient who presented with multiple asymptomatic elevated skin-coloured lesions over the scrotal region for six months is presented. Based on the clinical and dermoscopic findings, a diagnosis of angiokeratoma of Fordyce was made. Treatment involved proper counselling and reassurance about the benign nature of Angiokeratoma.

An Intricate Case of Pyopneumothorax with Trapped Right Lung Requiring Swift Adaptation and Multidisciplinary Collaboration

Vipul Sharma, Jayant Bhatia, Preeti Raj Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Pulmonary Tuberculosis (PTB) is a significant cause of morbidity, especially in patients with underlying health conditions. The present case highlights the complex management in a patient with intricate medical history, marked by tuberculosis, multiple Intercostal Chest Drain (ICD) procedures, and pyopneumothorax with long-standing diabetes mellitus and a history of smoking, adding to the uniqueness of the case. The authors present a case of a 67-year-old male, admitted for a right Pneumonectomy (PE) due to a complex combination of pyopneumothorax, right trapped lung and post-decortication status. However, due to the fragile nature of the tissue and the existence of vascular adhesions, it was decided to choose “physiological lung exclusion” by separating the affected lung from the tracheobronchial tree by cutting the bronchus and tying off the pulmonary artery, without removing any lung tissue, while keeping the pulmonary veins intact. The present report highlights the challenges faced, the multidisciplinary approach employed, and the successful surgical outcome, underscoring the importance of collaborative management.

Progressive Paraparesis due to Extramedullary Haematopoiesis in Thalassaemia Intermedia Treated Successfully with Radiotherapy: A Case Report

Bithi Pal, Debottam Barman, Bodhiswatta Dutta Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Extramedullary Haematopoiesis (EMH), a rare complication of Thalassaemia Intermedia (TI), can present with pressure symptoms including Spinal Cord Compression (SCC) and can be treated using surgery, radiotherapy, hypertransfusion, or hydroxyurea. Hereby, the authors present a case report of a 20-year-old male young thalassaemic patient presented with progressive paraparesis. Neurological examination suggested SCC, and Magnetic Resonance Imaging (MRI) of the spine revealed paravertebral masses due to EMH. The patient was treated with radiotherapy to a dose of 30 Gy over three weeks. There was immediate, near-complete resolution of symptoms, and the patient could walk without assistance. He has been doing well since 1.5 years of treatment. So, in cases of TI, one should think of EMH as a differential diagnosis for paraparesis. Early clinicoradiological diagnosis of EMH-induced SCC is necessary and possible, as there is a high chance of complete remission of symptoms with radiotherapy, which is a non invasive and effective treatment option.

Successful Management of Rituximab Refractory Warm Autoimmune Haemolytic Anaemia with Splenectomy: A Case Report

Zuber Ansari, Suhail Akhtar, Anas Ahmed, Sumera Bhati Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Autoimmune Haemolytic Anaemia (AIHA) is a rare haematological disorder characterised by autoantibodies directed against autologous red blood cells. It can be idiopathic or secondary and classified as Warm type AIHA (WAIHA), cold, or mixed. The primary treatment for WAIHA is a long course of steroid administration, which has an early response rate of 80-90%. However, up to 20-30% of patients require second-line therapy. In the last decade, rituximab has replaced splenectomy as the first-choice therapy for refractory WAIHA patients due to its efficacy and safety. There is a paucity of reported cases of WAIHA refractory to both steroids and rituximab that have responded to splenectomy. This is a case of a 35-year-old female with a history of jaundice and anaemia for the past two years. The patient was diagnosed with WAIHA with a Direct Antibody Test (DAT) positive, IgG positive, and C3d negative results, and massive splenomegaly that was initially refractory to steroids and rituximab but responded to splenectomy. Significant splenomegaly may be an indication for choosing splenectomy over rituximab as a second-line treatment in steroid-refractory WAIHA.

A Case of Persistent Headache Leading to Diagnosis of Lung Adenocarcinoma: An Atypical Presentation

Manasi Harale, Arun Biju, Bhavya Sri Yammanuru, Sreevidya Yekkaluru Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Lung adenocarcinoma is a primary type of lung cancer and is classified as a non small cell lung carcinoma. Headache is a rare presentation of lung carcinoma. This case report found that early diagnosis and proper treatment can improve disease outcomes. The case describes a 36-year-old woman presenting with a persistent left-sided headache and non radiating pain. Despite normal vital signs and laboratory results, an Magnetic Resonance Imaging (MRI) revealed multifocal abnormalities in the brain, suggesting neoplastic metastasis. Further investigations, including Computed Tomography (CT) scans and Positron Emission Tomography-Computed Tomography PET-CT scans, confirmed lung adenocarcinoma with metastases to the brain, bone, and liver. Histopathology revealed an invasive, moderately-differentiated adenocarcinoma. The patient was recommended palliative radiation therapy, and after compliance with treatment, she was discharged. The present case underscores the importance of thorough diagnostic evaluation in unexplained symptoms, leading to the identification of advanced-stage lung adenocarcinoma with multiple metastases.

Cytodiagnosis of Spindle Cell Squamous Cell Carcinoma presenting as a Metastatic Lesion to Chest Wall: A Case Report

Garima Akhilesh Chandrakar, Arvind Bhake, Simran Khan Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Spindle cell carcinoma is a rare biphasic tumour composed of squamous cell epithelial and spindle cell mesenchymal components. This variant of squamous cell carcinoma masquerades as sarcoma with a high-risk of recurrence and metastasis. Metastatic lesions to the chest wall of squamous cell carcinoma from a distant primary are rare. The most common sites for metastasis from head and neck cancers are usually seen in the lungs, liver, bone, and brain. In this present case, the patient presented with complaints of an ulcerated mass on the left buccal mucosa with limited mouth opening. Despite wide excision of the mass and postoperative radiation, it resulted in distant metastases to the chest wall after a disease-free survival of four months. The metastasis of the chest wall appearing as red, inflamed, small, multiple, subcutaneous nodules is even rarer. The diagnosis of subcutaneous metastatic nodules of squamous cell carcinoma on Fine Needle Aspiration Cytology (FNAC) appearing in the literature is infrequent. The primary in this case was oral squamous cell carcinoma, which in follow-up after wide local excision of the mass with marginal mandibulectomy, presented as multiple inflamed appearing nodules on the chest wall. The primary site of the tumour showing classical squamous cell carcinoma and its metastatic lesion appearing on morphology as the spindle cell variant of squamous cell carcinoma are also infrequently reported in the literature. Herein, one such unusual case of subcutaneous metastasis on the chest wall cytodiagnosed on FNAC is reported.

Isolation of Salmonella Kentucky from Scrotal Abscess: A Rare Case Report

Parul Garg, Bani Rai, Rakesh Kumar Mahajan Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Infections due to Non Typhoidal Salmonella (NTS) are emerging as a major health problem for both humans and animals worldwide including in India. In humans, NTS infections routinely remain restricted to the intestinal tract and may or may not manifest as a clinical illness but in immunocompromised patients systemic involvement may result in frank bacteraemia or focal involvement depending on the site of localisation. A 70-year-old, male presented to the Emergency Department with complaints of pain for about five days, on the right side of the scrotum. A drained pus sample was received at the Department of Microbiology for culture and sensitivity. Salmonella kentucky was identified by standard microbiological techniques. Here the authors present a case of scrotal abscess caused by Salmonella kentucky in an old immunocompromised patient and this possibly appears to be the first case report of scrotal involvement from India. No single diagnostic approach may be able to identify the NTS up to the species level. To determine the identity of organisms in cases where individual labs may not have the necessary capacity to produce the results, it would be extremely sensible from a scientific standpoint to create a network of cooperating labs with varying diagnostic capacities.

Navigating Postcaesarean Challenges: A Case Report on Bladder Flap Haematoma with Haematuria

Khushboo Singh, Vaishali Korde Nayak, Priyanka Prashant Kamdar, Jaya Barla Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X A less common puerperal complication following a caesarean section is a bladder flap haematoma, characterised by the accumulation of blood in the vesico-uterine space. A young, unregistered primigravida was referred from a peripheral facility with preeclampsia and obstructed labour. Signs of obstructed labour were observed both before and intraoperatively, like dehydration, foetal distress, a stretched lower uterine segment, and oedematous bladder. The uterus was sutured in two layers to control bleeding, and the patient was closely monitored postoperatively. The diagnosis of haematoma was made by the increasing height of the uterus and a suprapubic bulge anterior to the uterus, along with postoperative haematuria. Imaging with ultrasonography and Computed Tomography (CT) helped to decide the management. The patient improved after exploratory laparotomy with haematoma drainage. No bladder injury was found during the cystoscopy. Early diagnosis and treatment were important in preventing complications such as haemodynamic instability, abscess formation, and sepsis. Authors present their experience in this patient with postcaesarean vesico-uterine haematoma, with frank haematuria, without an obvious bladder injury, who required re-exploration. The clinical presentation, course, and sonographic findings of this patient form the basis of this report.

Superficial Partial Thickness Burns Treated using Theruptor Novo, a Novel Antimicrobial Dressing: A Case Report

Jayanthinathan Sampath Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Burns are assessed by total body surface area and wound depth. Burn depth can range from Superficial Partial Thickness (SPT) to full thickness, where the epidermis, dermis, and sometimes underlying structures are involved. Scalds usually cause superficial or partial burns, which can blister and cause pain as well. A moist, pink, and shiny surface with brisk capillary refill times forms the basis for the clinical diagnosis of SPT. The goal of burn wound management is to minimise the formation of scars by adhering to fundamental principles. It is mandated that dressings be used on all occasions except for superficial burns. In the management of a patient with a history of accidental boiling water spillage over the left lower limb resulting in SPT burns, with complaints of pain and burning sensation for one month, Theruptor Novo (Healthium Medtech, India) dressing was utilised. The treatment aimed to protect the wound, maintain a moist setting, counteract burn wound infection, promote epithelisation, and minimise pain and discomfort. Theruptor Novo prevented infection, promoted wound healing, with good moisture effectively, and provided patient comfort.

Ayurveda Principles and Formulations in the Management of Alopecia Areata: A Case Report

Punam Sawarkar, Gaurav Sawarkar, Gauri Boharupi Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Alopecia Areata, known as Indralupta in Ayurveda, involves abrupt hair loss from various scalp regions, attributed to an imbalance of Vata, Pitta, Kapha, and Rakta (bio-humours involving blood). This condition is increasingly prevalent due to contemporary lifestyle factors. Conventional medical treatments typically involve steroids and antifungal shampoos, which, despite their efficacy, can lead to undesirable side-effects, prompting the need for alternative treatments in Ayurveda. This case report examines the effectiveness of specific Ayurvedic treatment modalities for a 25-year-old female patient presenting with 2-3 bald spots on her scalp’s parietal and occipital regions, enduring for 6-7 months without associated symptoms of itching or burning. The patient underwent a combination of internal and external Ayurvedic therapies. Internally, she was treated with Panchatikta Ksheer Vasti (a medicated enema prepared with milk and five herbal drugs) and oral medications, including Aampachak Vati, Rasapachak Vati, Panchtikta Ghrita Guggulu, Krumikuthar Rasa, and Panchtikta Ghrita. Externally, herbal head packs were applied, supplemented by dietary and lifestyle modifications recommended by Ayurvedic traditions. After three months of continuous treatment, the patient exhibited significant hair regrowth on the bald patches without any adverse effects or recurrence to date. This case report highlights the potential of both internal and external Ayurvedic treatments to effectively manage Alopecia Areata, offering a viable alternative to conventional therapies with minimal side-effects.

Unveiling the Uncommon: A Case of Parietal Rhabdomyosarcoma in a 60-year-old Woman

Jayashree Bhawani, Samarth Shukla, Sourya Acharya Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Malignant mesenchymal tumours are rare, aggressive neoplasms originating from mesenchymal tissues. These tumours are characterised by a high metastatic potential and pose significant diagnostic and therapeutic challenges. Mesenchymal tumours are of interest to oncologists because of their comparatively low occurrence, especially those with a high proliferation index. Authors report a case of a 60-year-old female who presented to the tertiary care rural hospital with persistent headaches, dizziness, and respiratory distress. Imaging studies revealed a heterogeneously enhancing soft-tissue density lesion in the right parietal region with extensive metastasis to both lungs. Histopathological analysis of the parietal lesion indicated features suspicious of a high-grade malignant tumour of muscular origin. Immunohistochemistry results were conclusive for Rhabdomyosarcoma. The patient was treated with radiation therapy for the primary tumour site and systemic chemotherapy, including doxorubicin and ifosfamide, for the metastasis. This case highlights the aggressive nature of malignant mesenchymal tumours and the complexities involved in their management. The high Ki-67 index and extensive metastasis indicate a poor prognosis. A multidisciplinary approach is crucial for symptom management and improving quality of life. Early detection, accurate diagnosis, and a comprehensive, multidisciplinary treatment strategy are essential for managing these challenging cases. Patients with such tumours typically have a bad prognosis since they have a significant chance of the tumour spreading to other organs, such as the liver, lungs, and bones. This case report aims to highlight the clinical presentation, diagnostic process, and therapeutic challenges associated with this aggressive tumour type, contributing to the limited but growing body of literature on rhabdomyosarcoma.

Wernicke Encephalopathy in a Patient of Acute Gastroenteritis: A Case Report

Jagannath Dhadwad, Anish Chitnis, Ramiz Kadiwala, Kunal Modi Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X An acute neurological disease known as Wernicke Encephalopathy (WE) is characterised by the clinical triad of symptoms: ophthalmoparesis with nystagmus, ataxia, and disorientation. Thiamine deficiency is the underlying cause of this potentially fatal condition, which mainly affects the central and peripheral nervous systems. Hereby, the authors present a case of a 47-year-old male who presented with multiple episodes of loose stools and altered consciousness to the emergency ward. He had hyperchloremic metabolic acidosis suspected to be due to acute gastroenteritis, which may have caused his altered consciousness. Despite correction of his metabolic acidosis, his sensorium did not improve. Later, he was diagnosed with WE using Magnetic Resonance Imaging (MRI) brain findings, which showed symmetrical subtle hyperintensities in the medial part of the thalami and periaqueductal grey matter, suggestive of WE; his consciousness improved after thiamine supplementation. There should be a high suspicion of WE for timely diagnosis and treatment. Prompt treatment would be rewarding as WE is reversible, if treated in time.

Anaesthetic Challenges in Paediatric Hepatoblastoma Resection: A Case Report

Fateh Pal Singh Gill, Chhaya M Suryawanshi, Smita Ubhe, Deepali Patil, Vipul Krishen Sharma Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X The most common primary liver tumour in children is hepatoblastoma, which is often diagnosed in the first three years of life. While the majority of hepatoblastomas are sporadic, some associations are reported with genetic disorders like Beckwith-Wiedemann syndrome and familial adenomatous polyposis. The annual incidence of hepatoblastoma in children has gradually increased during the past three decades. Babies born prematurely, weighing <1 kg, have been found to be significantly more likely to acquire hepatoblastoma. The most common symptoms with which children present are abdominal discomfort, easy fatigability, loss of appetite, and anaemia. The choice of treatment is surgical resection of the mass or surgical resection coupled with chemotherapy. Present case is of a seven-month-old, 7 kg infant who presented with a gradually increasing abdominal mass diagnosed as hepatoblastoma. Left hepatectomy was done under general anaesthesia and epidural analgesia. Liver resection is one of the major surgical procedures that carries a risk of blood loss and pulmonary embolism, but improved expertise in paediatric anaesthesia and surgical skills have reduced operative risk. The challenges in this case were securing vascular access, maintaining blood volume with considerable fluid and blood loss, and assuring haemodynamic stability. Maintenance of normothermia, glucose levels, and effective pain management were all crucial, necessitating careful planning and a multidisciplinary approach to maximise results and guarantee patient safety.

Parasurgical Management of Indralupta (Alopecia Areata) by Jalaukavcharana (Leech Therapy): A Case Report

Riya Rajendra Rathor, Renu Bharat Rathi Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Urdhwajatrugata Vyadhi (disease of the supra clavicular region) and Indralupta {Alopecia Areata (AA)} are characterised by patchy hair loss in the area that bears hair, such as the beard and scalp. According to Sushruta Acharya, vitiated pitta and vitiated vata together cause Indralupta (AA), leading to scalp hair loss. Additionally, vitiated Rakta and Kapha obstruct the hair follicles openings, limiting the growth of new hair. In contemporary science, these conditions are related to the clinical features of AA. A five-year-old female child presented to the Department of Kaumarbhritya with complaints of hair falling out in patches on the scalp gradually over six months. In her condition, the Raktamokshana therapy by using the jalaukavcharan vidhi technique was adopted for effective results. This age-old procedure described by Acharya Sushrut in Sushrut Samhita is still beneficial in treating the above aforementioned condition. The patient experienced relief from her symptoms after eight sessions and is continuing treatment. Raktamokshana, or therapeutic bloodletting, is one of the Ayurvedic therapy methods for Raktapradoshaja Vikara. Raktamokshana (Bloodletting) through leech treatment is one of the easiest methods to administer, especially for elderly patients, female patients, paediatric patients, individuals who are extremely shy, and those with sensitive constitutions like children. It resulted in fewer complications postprocedure and reduced the risk of symptom recurrence. The therapy was cost-effective, and within short span of three months, it produced positive outcomes in patients.

Paget’s Disease of Maxilla with Paranasal Sinuses: A Case Report

Amurtham Veeramani, RR Mahendra Raj, Saravanan Thalaimalai, Abirami Moorthy, Preethi Paramasivam Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Paget’s disease of bone is a chronic skeletal disorder affecting predominantly elderly individuals. The pelvic girdle is the most common site to be affected; however, other sites such as long bones, spine, and skull are also frequently affected. The diagnosis of Paget’s disease is made through careful radiographic, biochemical and histopathological analysis. Although involvement of the maxilla is common, the involvement of the paranasal sinuses is comparatively rare. Radiographic presentation of skull lesions ranges from osteolysis to cortical thickening, with characteristic cotton-wool radiopacities and diploe thickening. A rise in serum alkaline phosphatase without a significant elevation in serum calcium and vitamin D levels is regarded as a typical biochemical sign of the disease. Paget’s disease of bone often presents asymptomatically in most cases until deformity becomes apparent. It is successfully treated with bisphosphonates, a group of anti-resorptive drugs, thereby reducing the associated morbidity and mortality. In the present case, Paget’s disease of the skull involving the maxilla with obliteration of the paranasal sinuses was diagnosed in an elderly female who presented with swelling in the posterior maxillary region and markedly elevated serum alkaline phosphatase and parathyroid hormone levels, while calcium and phosphate levels are typically within normal limits. Hereby, the authors present a case report of 64-year-old female patient with Paget’s disease of bone with craniofacial involvement resulting in cotton-wool radiopacities of the skull and elevated serum alkaline phosphatase. The patient was under pharmacological management with bisphosphonates and calcium supplements.

Diving Deep into Diagnosis: Unveiling High Grade B-cell Lymphoma

Madhulika Laxmikant Mahashabde, Yash Rameshbhai Bhimani, Gaurav Ashok Chaudhary Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X The term “lymphoma” comprises a heterogeneous group of biologically and clinically distinct neoplasms that arise from cells in the lymphoid organs. Based on the identification of Reed-Sternberg cells (RS cells), it is divided into Hodgkin and Non-Hodgkin’s Lymphoma (NHL). Lymphadenopathy is a common presenting feature of lymphoma. Extranodal involvement may show gastrointestinal, cutaneous, neurological, or other symptoms. Hereby, the authors present a case report of 76-year-old male with non-Hodgkin’s lymphoma whose symptoms were masked by the abdominal pain of emphysematous pyelonephritis. Although the infection was treated, the patient continued to complain of dull, aching, persistent abdominal pain. As a result, the patient underwent additional radiological examinations, including a contrast-enhanced Computed Tomography (CT) scan of the abdomen-pelvis, which disclosed multiple lymphadenopathies. Hence, an endoscopic ultrasound-guided biopsy was performed from the lymph node between the portal vein and inferior vena cava, revealed High-grade B-cell Lymphoma (HGBL). The prognosis for HGBL with double- and triple-hit lymphomas is extremely bad. The patient that came to us had an early diagnosis of HGBL, which led to a favourable prognosis, in contrast to most cases of the disease, which usually manifest late in the course and are linked with a very grave prognosis.

Minimally Invasive Approach to Epiphrenic Oesophageal Diverticulum: A Case Report

Vaishnavi Reddy, Pushkar Galam, Dakshayani Satish Nirhale, Romi Gaudani, Pragna Puvvada Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X An oesophageal diverticulum is a relatively rare disorder of the oesophagus which results in the outpouching of the oesophageal mucosa through a weak portion within the oesophageal lining. Oesophageal diverticula occur in <1% of the population and are found in approximately 1-3% of those presenting with dysphagia. A 75-year-old male patient came to the surgical Outpatient Department (OPD) with chief complaints of difficulty in swallowing for 2-3 months, initially with solids which later progressed to difficulty in swallowing liquids. He was diagnosed on a Contrast-Enhanced Computed Tomography (CECT) scan with a large oesophageal diverticulum arising from the right lower lateral thoracic oesophagus just proximal to the oesophagogastric junction in the retrocardiac region with no filling defect or mucosal thickening. The patient was treated with transhiatal laparoscopic oesophageal diverticulectomy with cardiomyotomy and Dor fundoplication. For symptomatic patients, most often, minimally invasive myotomy and removal of the pouch endoscopically are advised, which may pose a surgical challenge due to the rarity of the disease.

Malignant Eccrine Tumours at Unusual Locations: A Report of Two Cases

Neha Singh, Rupinder Kaur, Fiza Chopra Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Eccrine carcinoma is a rare skin adnexal tumour that presents significant diagnostic challenges due to its uncommon occurrence and varied clinical presentations. This report discusses two unique cases of eccrine carcinoma in middle-aged females, occurring at atypical locations: the thigh and the anal region. It emphasises the importance of recognising such tumours for appropriate management. The first case describes a 53-year-old woman with a chronic, non healing thigh ulcer that was initially suspected to be a benign lesion but was later identified as spiradenocarcinoma through histopathological examination. This highlights the potential for benign eccrine lesions to undergo malignant transformation. The second case involves a 50-year-old woman presenting with rectal bleeding and a malignant growth at the anal verge, which was confirmed as eccrine carcinoma through comprehensive pathological analysis, including immunohistochemical staining. Both cases underline the crucial role of detailed clinical observation and advanced histopathological evaluation in diagnosing and managing eccrine carcinoma, particularly when presented in non traditional sites. This approach guides effective treatment strategies and improves patient outcomes.

An Atypical Midline Anterior Torus Mandibularis: A Case Report

Ranjan Rashmi Behera, Mohammad Jalaluddin, Bandana Panda Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Benign bony growths called tori can develop in various places throughout the mandible and maxilla, although their exact origin is still unknown. There have been numerous reports of unilateral or bilateral Mandibular Tori (MT); however, no reports of a midline anterior mandibular tori have been made yet. A 27-year-old female patient reported with a complaint of a bony growth on her lower jaw below the tongue. The tori are unusually situated at the midline on the lingual side of the mandibular central incisor. The elements shown to be causal were the gender of the male, the ethnicity of Asians, and developmental in origin. The cornerstone of treatment for Tori is surgical resection. After a year of follow-up, there was no recurrence. The present case highlighted the significance of etiological factors for bony exostosis management and recurrence, which, in conjunction with origin, gender, ethnic and racial factors, may account for the patient’s lack of recurrence.

An Unusual Presentation of Cemento-ossifying Fibroma in the Anterior Maxilla: A Case Report

Ankita Chavhan, Swati Patil, Alka Hande, Archana Sonone, Aayushi Pakhale Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Cementifying Fibroma (CF) is a benign fibro-osseous lesion with sharply defined and well-confined edges. It is slow-growing and has a radiolucent peripheral component. It is mostly seen in the mandible in the 20-39 years age group with a female predilection. Hereby, the authors present a case report of a 60-year-old woman who had a painless growth in the upper front region of her jaw for two months and visited Outpatient Department (OPD). Extraoral examination revealed facial asymmetry due to swelling in the upper front region of the jaw. Intraoral examination showed round to oval swelling in the 11 and 21 regions. On radiographic examination, a round radiolucency in the 11 region was appreciated. After excision, the tissue was sent to the laboratory, and histopathologically the diagnosis was confirmed as peripheral CF. The patient was kept in a 12-month follow-up postoperatively, which reported no recurrence.

Propanil Poisoning Presenting with Methaemoglobinemia: A Case Report

Abhijit Nanda, Dennis Martin David, Suna Denish Kumar, Joel Nanda, Alisha Jessy Kispotta Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Propanil is an uncommon cause of poisoning, and the incidence of it in India is unknown. It is a low to medium toxicity agent; however, severe poisoning can lead to death, especially in areas with limited medical facilities. Hereby, the authors present a case of 15-year-old girl who presented to Emergency Department after 72 hours of ingesting an unknown quantity of propanil. She was noted to have peripheral cyanosis, laboured breathing, and a room air saturation of 62%, for which she was intubated and ventilated. Methaemoglobinemia was suspected in the child, which is considered a complication of propanil poisoning, and methylene blue was administered within six hours of admission. Exchange transfusion was performed via a femoral central line catheter when there was no improvement with methylene blue. Sulfhaemoglobinemia was also considered as a differential diagnosis. On day 4 of the hospital stay, her saturation improved to 80%. She experienced complications of haemolysis, which were managed conservatively. She improved clinically and was extubated on day 5. Her room air saturation was 93% on day 9, and she was discharged. She had a follow-up appointment in the outpatient clinic after two weeks, where her saturation on room air was recorded as 97%, and her methaemoglobin levels were 8.7% in the postexchange transfusion sample. Propanil has the potential to cause severe, life-threatening clinical symptoms. Exchange transfusions can be lifesaving in situations of severe poisoning. Early transfer of patients to tertiary care Institutions should be considered as peripheral hospitals may lack intensive care facilities and exchange transfusion capabilities.

Paediatric Autoimmune Haemolytic Anaemia Presenting with Acute Kidney Injury: A Case Report

Anuj Barot, Aashna Verma, Dhara Gosai, Gargi Pathak Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Autoimmune Haemolytic Anaemia (AIHA) occurs when an individual’s immune system produces autoantibodies against antigens on Red Blood Cells (RBCs). It is a relatively rare haematological disease in the paediatric population. Case reports of paediatric warm AIHA are rare in general and are usually associated with other underlying conditions like haematological neoplasms, viral infections, and drug-induced conditions. This is a case report of a three-year-old male child with warm AIHA who presented with dark urine and decreased urine output for one day. Through laboratory and radiological investigations, it was found that this patient developed acute haemolysis following a bacterial lower respiratory tract infection. The patient was treated with corticosteroids, antibiotics, and Intravenous Immunoglobulins (IVIg). Peritoneal dialysis was also done. The patient was eventually discharged from the hospital on a maintenance dose of oral steroids, which was gradually tapered off. It was concluded that a bacterial lower respiratory tract infection can lead to warm AIHA in children. Even though this illness is rare, it may cause life-threatening complications if prompt treatment is delayed.

Anaesthetic Management of a Patient with Solitary Fibrous Tumour of Pleura with Postoperative Diagnosis of Doege Potter Syndrome: A Case Report

Bhavini Shah, Shilpa Kore, Pallavi Pratap Jagtap, Krusha Shah Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Pleural tumours represent a small yet significant subset of thoracic malignancies. Solitary Fibrous Tumours of the Pleura (SFTPs) are typically benign and account for 5% of all pleural tumours. Authors report a case of SFTPs excision with a postoperative diagnosis of Doege Potter Syndrome (DPS) in a 63-year-old male patient who was referred with complaints of chronic productive cough and breathlessness. Upon clinical and radiological evaluation, he was diagnosed with SFTPs. The patient experienced preoperative and intraoperative hypoglycaemic episodes, which were diagnosed as DPS during postoperative evaluation. This syndrome is a paraneoplastic condition associated with the secretion of Insulin-like growth factor-2 (IGF-II), observed in less than 5% of patients with SFTPs, with hypoglycaemia being a major symptom. Awake intubation and other procedures were performed with the patient in a propped-up position as he was unable to lie supine, which caused dyspnoea.

Postoperative Rare Presentation of Ventral Cervical Cord Herniation: A Case Report

Silky Taya, Vinod Chaudhary, Ullas V Acharya Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Cervical spinal cord herniation is a rare occurrence and is usually seen after C3-C5 fusion with C4 corpectomy using a posterior approach. Herniation in the cervical spine with an anterior approach is unusual and has only been reported in a few cases. Hereby, a case of a 53-year-old male who underwent C3-C5 fusion with C4 corpectomy for Ossification of the Posterior Longitudinal Ligament (OPLL) of the cervical spine is reported. Following surgery, the patient deteriorated, leading to re-exploration. Delayed postoperative Magnetic Resonance Imaging (MRI) shows ventral cord herniation with an anterior pseudo meningocele. Spinal cord herniation should be considered if neurological deficits occur after C3-C5 fusion with C4 corpectomy.

Management of Mandibular Anterior Demineralisation Associated with Myofunctional Appliance: A Case Report

S Advaitha Narayan, K Madhuram, K Shanmugapriya, Ashok Leburu, V Naveen Kumar Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Myofunctional appliances encompass a diverse range of intraoral devices that rely on the intrinsic forces of the orofacial musculature for their functionality. These appliances are typically designed to be removable and exhibit a passive mechanism of action. Caries and demineralisation are well known adverse side effects of myofunctional orthodontic appliances, with the most frequent reports relating to fixed appliance treatment. Hereby, the authors present a case report of a 12-year-old male patient with a slight neuromotor defect who developed significant caries and demineralisation of the permanent mandibular anteriors due to the consumption of large quantities of carbonated drinks and acidic fruits while wearing a twin block appliance for eight months and failing to return for regular orthodontic follow-ups. The patient was provided with strategies for oral health training and diet modification. Fluoride varnish was applied to treat the caries and pain caused by hypersensitivity. Additionally, at-home application of GC Tooth Mousse Plus, which is rich in Casein Phosphopeptide-Amorphous Calcium Phosphate Fluoride (CCP-ACPF), was utilised for remineralisation and dentinal tubule occlusion. The mandibular anteriors were restored with composite resin using an ultra-conservative 3D guided technique, alongside preventive care during the fluoride varnish application. The present case report emphasises the risk of decalcification of teeth during orthodontic treatment and the importance of regular dental check-ups.

Anaesthesia Management in Case of Placenta Accreta Undergoing Caesarean Delivery with Internal Iliac Artery Balloon Catheterisation and Embolisation

Monica Pandey, Shiv Mohan Chopra, Mona Bana, Madhuri Agrawal Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Abnormal invasion of the placenta into the uterine tissue during pregnancy is one of the most common causes of peripartum hysterectomy, as well as morbidity and mortality. A multidisciplinary approach is the best way to manage such cases in order to maintain perioperative haemodynamic stability, which leads to lower rates of complications and shorter hospital stays for both the parturient and the newborn. The authors hereby report the case of a 27-year-old female {Gravidity and Parity (G1P2)} at 36 weeks of gestation, diagnosed with central placenta accreta with bladder invasion. In the present case, authors performed a balloon-assisted caesarean delivery under general anaesthesia while avoiding hysterectomy. The patient had a history of a previous caesarean delivery 1.5 years prior. Placenta accreta was diagnosed during her ultrasound. All routine laboratory results were within the normal range, except for haemoglobin, which was 10.1 g/dL. An elective caesarean section with a consented hysterectomy under general anaesthesia was planned. Adequate blood and blood products (4 units of packed red blood cells and 2 units of fresh frozen plasma) were arranged before surgery. Bilateral internal iliac artery embolisation was performed to reduce perioperative bleeding. Flexible cystoscopy was conducted prior to surgery to confirm the extent of bladder invasion. The caesarean section was successfully carried out with the multidisciplinary team approach under general anaesthesia, and hysterectomy was not performed, allowing for a successful fertility-sparing caesarean delivery by our team. The patient was transferred to the Intensive Care Unit (ICU) after the surgery for proper vital monitoring and adequate pain management. She was moved to the ward on day 2 and discharged on day 3. In conclusion, balloon occlusion of the internal iliac artery is effective for haemostasis in most cases of patients with placenta previa.

Role of Phenol Epidural Neurolysis in Pain Management of Patient with Myxofibrosarcoma: A Case Report

Sheetal Jayakar, Hashika M Jani, Yashwant Nankar, Kshitija Bora, Panchajanya Reddy Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Myxofibrosarcoma is an aggressively malignant soft-tissue neoplasm of the upper or lower extremities that occurs in adults. At the time of diagnosis, upto 73% of cancer patients complain of varying degrees of pain. The ultimate goal of treatment is pain relief and functional recovery. The authors describe the case of a 59-year-old female patient who presented with complaints of excruciating brachialgia of the right upper limb. She had a pain score of 10 based on the Visual Analogue Scale (VAS 0-10). Her pain was initially managed conservatively with systemic analgesics but it failed to offer adequate relief. Often, there is an inadequate response to conservative treatment. These patients may benefit from various interventional modalities. Hence, epidural neurolysis with phenol was done by slowly injecting 2 mL of 6% aqueous phenol into the epidural space under Computed Tomography (CT) and fluoroscopy guidance. Upon follow-up, the patient’s Visual Analog Scale (VAS) was recorded as one, morphine consumption decreased with eventual discontinuation, and paraesthesia had reduced by 50%. This patient was suffering from chronic pain, which significantly reduced her Quality of Life (QoL). The injection of phenol into the appropriate space resulted in satisfactory sustained analgesia. She did not have any sensory or motor loss. Her pain was adequately controlled by paracetamol 500 mg as needed. The patient remained pain-free for five months after the procedure but eventually succumbed to her illness.

Androgen Insensitivity Syndrome: A Rare Cause of Primary Amenorrhoea

Madhulima Saha, Shalini Warman, Ritam Bhattacharya, Suneeta Singh, Vibhu Talwar Chatterjee Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Androgen Insensitivity Syndrome (AIS) is a rare X-linked Disorder of Sexual Differentiation (DSD) caused by a mutation in the Androgen Receptor (AR) gene, which is located on the X chromosome (Xq11-q12). It can present with a wide spectrum of phenotypes depending on different mutations of the AR gene. It is classified into mild, partial, and complete AIS. In this series of cases, authors describe patients who presented to tertiary hospitals over several years. Case 1 presented with inguinal masses and primary amenorrhoea, which upon investigations revealed complete AIS. Case 2 was a young child who underwent surgery for an inguinal hernia, and later histopathology and karyotype revealed a diagnosis of complete AIS. Case 3 presented with large adnexal masses to oncology, where intraoperatively absent Mullerian structures, histopathology, and karyotype gave the diagnosis of Complete AIS. Case 4 presented with hirsutism, primary amenorrhoea, and clitoromegaly. Upon investigation, imaging and karyotype with virilising features led to the diagnosis of partial AIS. The absence of Mullerian structures on imaging, chromosomal analysis, and the finding of undescended testicular masses in inguinal regions clinch the diagnosis. These patients should undergo gonadectomy after puberty to decrease the chances of malignancy. Therefore, when investigating the cases of primary amenorrhoea, patients with absent pubic/axillary hair and absent uterus/ovaries should raise suspicion of AIS. Also, any young female child with an inguinal hernia should be investigated for AIS.

Cutaneous and Nodal Histiocytic Sarcoma: A Series of Five Cases

Geeta Yadav, Manish Kumar, Kusum Yadav, Shalini Bhalla, Rashmi Kushwaha Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Histiocytic Sarcoma (HS) is an extremely rare haematolymphoid neoplasm that exhibits morphological and immunophenotypic features indicative of histiocytic differentiation. In most cases, it is misdiagnosed as Diffuse Large B-Cell Lymphoma (DLBCL) or anaplastic large cell lymphoma. HS is a diagnosis of exclusion, necessitating extensive immunophenotypic analysis to finalise the diagnosis. Hereby, authors present a case series of five cases diagnosed as HS based on histomorphology and an extensive Immunohistochemistry (IHC) panel. A total of five cases reported as HS over a five-year period (2018 to 2023) were diagnosed at the Department of Pathology. All demographic and clinical data, as well as treatment history, were collected from the patients and their family members. Paraffin-embedded blocks were retrieved from the archive, and routine Haematoxylin and Eosin (H&E) and special stains like Periodic Acid-Schiff (PAS) were performed. Microscopy revealed sheets of round to oval tumour cells with small round nuclei, inconspicuous nucleoli, and moderately microvacuolated cytoplasm. An extended IHC panel was applied to confirm the microscopic findings. All five cases exhibited intense immunoreactivity for Leukocyte Common Antigen (LCA) and showed strong positivity for the histiocytic marker CD68, while CD163 demonstrated variable cytoplasmic positivity. Dako R antibody at a dilution of 1:100 was used for the IHC analysis. This case series aims to highlight the importance of clinical, radiological, histological, and immunohistochemical properties of this rare neoplasm for early diagnosis and proper management.

Unveiling the Intricacies of Acute Aortic Syndromes through Imaging: A Case Series

Madhu Shankar Kikkeri, R Vidhya Rani, D Naveen, MR Akshay, S Leelashree Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Acute Aortic Syndrome (AAS) comprises of three distinct pathological conditions: Aortic Dissection (AD), Penetrating Atherosclerotic Ulcer (PAU), and Intramural Haematoma (IMH). Although AAS and its emergencies are not common occurrences, they are considered highly dangerous and potentially fatal. Clinically, differentiating between the various types of aortic syndromes can be challenging. The prognosis of these conditions significantly depends on speedy and precise analysis. Therefore, present study emphasised the critical role of radiology in the diagnosis of AASs, with Contrast-Enhanced Computed Tomography (CECT) being the quickest and most consistent imaging modality. In this case series, four cases of AASs are presented, comprising three cases of AD and a case of PAU in a patient with infrarenal aortic occlusion. Notably, one of the dissection cases was accompanied by renal ischaemia. Recognising acute aortic emergencies promptly is essential for saving lives.

Efficacy of Chandan Bala Lakshadi Tail Matra Basti as Adjuvant Therapy in the Anorectal Ailments: A Case Series

Abhishek Dattatray Mavale, Devyani Dasar, Naveen Singh Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Ayurveda mentions several anorectal ailments, among which are Bhagandara (Anal Fistula), Guda vidhradhi (Rectal Abscess), Parikartika (Anal Fissure), and Arsha (Haemorrhoid), which are the most common. These illnesses may have several underlying causes and may result in a wide variety of symptoms. Present case series discusses a total of five instances in which majority of the patients were between the ages of 20 and 80 years. Pain and burning sensations during and after defecation, as well as perineal haemorrhage and hard stools, were prevalent complaints among these patients. Through local and physical examination, three anorectal ailments were detected: Arsha (internal external haemorrhoids), Bhagandara (anal fissure), and Parikartika (fissure in ano). Ultimately, anorectal procedures were carried, such as haemorrhoidectomy and Lord’s anal dilatation with Kshara Sutra ligation. Anorectal concerns might impact a person’s quality of life as they are unsettling, painful, and occasionally even life-altering. In the early stages, current therapy includes the use of soothing creams, gels, oral analgesics, and stool softeners, as well as surgical interventions such as sphincterotomy, fissurectomy, and Lord’s dilatation. In anorectal conditions like Parikartika (anorectal fissure), Bhagandara (anorectal fistula), and Arsha (haemorrhoids), a more effective alternative treatment must be developed. Chandan bala Lakshadi Tail Matra Basti is beneficial in reducing irritation, spasm, and the perception of pain as well as bleeding per rectum and anal inflammation.

Multiple Coagulation Factor Deficiency: A Series of Eight Cases

Abhijith Lakshman, Febe Renjitha Suman, Gramani Arumugam Vasugi Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Multiple Coagulation Factor Deficiency (MCFD) is an uncommon haematological disorder characterised by simultaneous deficiency of multiple clotting factors, which leads to an increased risk of bleeding and compromised haemostasis. The present series aimed to provide a comprehensive analysis of MCFD, shedding light on its aetiology, clinical manifestations, and potential therapeutic interventions in a case-by-case manner, highlighting the individualised treatment options that are needed for many of these cases. A prospective combined clinical and laboratory study was performed on all patients who presented with bleeding tendencies and were subsequently diagnosed with MCFD. Clinical records and laboratory data of all these patients were reviewed to identify commonalities and variations among affected individuals. Haematological assays were performed to quantify the extent of coagulation factor deficiencies. The present series identified a diverse cohort of eight individuals (2 females and 6 males) with MCFD, showcasing variability in age of onset, severity of symptoms, and potential underlying genetic mutations. Clotting factor assays revealed deficiencies of Factor V and Factor VIII (F5F8D), Vitamin K-dependent clotting factor deficiency, and failure of synthesis of clotting factors of hepatic origin. Clinically, patients presented with a spectrum of bleeding phenotypes, ranging from mild to severe, requiring tailored therapeutic strategies. The present series provides an overview of some of the presentations of MCFD, emphasising the need for a multidisciplinary approach in its diagnosis and management. Clinicians should be vigilant in recognising the varied clinical presentations of MCFD and consider genetic testing for precise diagnosis and management.

Insights from Magnetic Resonance Imaging in diagnosis of Marjolins Ulcer

Saraswathula Bharadwaj, Nunna Bhagyasri, Ravishankar Patil, Pratap Singh Parihar Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X

Anomalous Origin of Right Coronary Artery from Ascending Aorta: MDCT Coronary Angiography Depiction Images

Siddhardha Kommuri, Kondampally Varsha Reddy, N Yeshwanth Raju, Senthil Kumar Aiyappan Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X

Acute Subdural Haematoma due to Ruptured Posterior Communicating Artery Aneurysm: A Rare Presentation

S Sambhaji Pawal, Riteshkumar Sahu, Rahul Arkar Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X

Antimicrobial Efficacy of Calcium Hydroxide with Different Herbal Additives: An In-vitro Study

Shakuntala Bethur Siddaiah, Pragna S Vijaya Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Microorganisms such as Enterococcus faecalis, Enterobacteriaceae, and Candida albicans are associated with persisting infections and can cause endodontic failure. The addition of herbal additives such as Triphala, Clove, and Activated charcoal to Calcium hydroxide enhances the microbial efficacy within the root canal. Aim: To evaluate and compare the anti-microbial efficacy of calcium hydroxide with various herbal additives against E. faecalis and C. albicans using Agar Diffusion Test (ADT) and Direct Contact Test (DCT). Materials and Methods: The present in-vitro study was conducted in Bangalore, Karnataka, between July 2023 and September 2023. Ethical clearance was obtained from the institution. Sabouraud Dextrose Agar (SDA) and Mueller-Hinton Agar were prepared and used to culture C. albicans and E. faecalis, respectively. In each plate, four wells were filled with groups (n=10): Group-I: Nanocalcium hydroxide (NCH)+sterile distilled water, Group-II: NCH+Nanoparticle Clove, Group-III: NCH+Nanoparticle Triphala, Group-IV: NCH+nanoparticle activated charcoal. The plates were incubated at 37°C, and zones of inhibition around the wells were measured on the first, third, and seventh day. DCT was evaluated in Colony Forming Units (CFUs)/ml by adding each bacterial suspension to four groups and inoculating on blood agar plates. One-way ANOVA test followed by Tukey’s post-hoc analysis was used to compare the mean Zone Of Inhibition (ZOI). Kruskal-Wallis Test followed by Mann-Whitney post-hoc test was used to compare the mean CFUs. Results: One-way ANOVA test showed that there was a significant difference in the mean ZOI between the four groups at p=0.005. The maximum mean ZOI against C. albicans was achieved by the combination of calcium hydroxide and clove with an average mean of 22.20±1.92 mm, 20±1.87 mm, and 17.20±2.28 mm on the 1st, 3rd, and 7th day, respectively. Calcium hydroxide with distilled water combination showed the highest mean ZOI against E. faecalis with an average mean of 18.20±0.84 mm on day 1, 17±1 mm on the 3rd and 7th day. The mean CFUs of E. faecalis and C. albicans showed a significant difference between the four groups at p<0.001. Conclusion: The addition of herbals to Calcium hydroxide increased anti-microbial activity against Candida albicans and Enterococcus faecalis.

Salivary Levels of S100A8, S100A9 and S100A8/9 in Periodontal Health and Disease: A Cross-sectional Study

Annie Kitty George, Sankari Malaiappan Vivek Narayan, Selvaraj Jayaraman, Nidhita Suresh Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Damage Associated Molecular Patterns (DAMPs) can initiate and amplify immune responses and can play an important role in the sustenance and progression of periodontal diseases. S100A8, S100A9 and their heterodimer, S100A8/9, are DAMPs or alarmins currently being evaluated for their potential as biomarkers in periodontal diseases. Aim: To quantify and compare salivary levels of S100A8, S100A9 and S100A8/9 in periodontal health, gingivitis or stage 1 periodontitis and stages 3 or 4 periodontitis. Materials and Methods: A cross-sectional analytical study was carried out in the Department of Periodontics, Saveetha Dental College and Hospital, Chennai, India, from December 2022 to February 2023. Periodontal examination and saliva sample collection were done for sixty-eight consecutively enrolled subjects who met the inclusion and exclusion criteria. Study subjects were categorised as group 1, which comprised participants with clinical periodontal health (n=20), group 2, subjects with gingivitis or stage 1 periodontitis (n=20), and group 3, which included patients with stages 3 or 4 periodontitis (n=28). Detailed clinical examination and periodontal charting were done in all study subjects. Saliva samples were processed and stored at -80°C, and enzyme-linked immunosorbent assay was done to quantify S100A8, S100A9 and S100A8/9. Data were analysed using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) software version 25.0. Salivary levels of S100A8, S100A9 and S100A8/9 were expressed as mean and standard deviation values. Mean values of the three salivary proteins were compared using the non parametric Kruskal-Wallis test. Bonferroni adjusted pairwise comparisons were also done. The p-values less than 0.05 were considered statistically significant. Results: The mean age of study participants was 38.97±7.62 years. Salivary levels of S100A8 were 41.34±14.34, 141.95± 185.25 and 901.37±65.60 pg/mL in groups 1, 2 and 3, respectively. A statistically significant difference was present among the three groups for mean salivary levels of S100A8 (p-value<0.001). Pairwise comparisons showed that salivary S100A8 values in group 3 were significantly higher than the values observed in clinical health (group 1) (p-value<0.001) and those seen in the gingivitis or stage 1 periodontitis group (group 2) (p-value<0.001). Mean salivary levels of S100A9 and S100A8/9 did not show any statistically significant differences between the groups. Conclusion: There is an altered expression of S100A8, S100A9 and S100A8/9 in periodontal diseases compared to clinical health. Salivary levels of S100A8 are markedly different in cases of advanced periodontal destruction than in periodontal health and early stages of periodontal disease. Salivary S100A8 merits potential as a biomarker for periodontal diseases.

Histopathology and Immunohistochemical Profile of Breast Cancer amongst Young Females below 40 years of Age: A Cross-sectional Study

Prakhar Garg, Amit Varma, Sasmal Prasanjit Rampada, Pooja Nathani, Syed Sarfaraz Ali, Kamal Malukani, Nancy Jain Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Breast cancer is a diverse and heterogeneous disease affecting women in both developing and developed countries. In 2022, Global Cancer Observatory (GLOBOCAN) reported 2.3 million cases of breast carcinoma, which accounted for 11.6% of all cancer cases worldwide. The incidence of breast cancer in India has been steadily rising and has surpassed cervical cancer as the most common cancer in women. Invasive ductal carcinoma is the most common histologic type found in all age groups. Grading is done according to Elston Ellis’s modification of the Scarff Bloom Richardson Scoring system. Hormonal {Estrogen Receptor (ER), Progesterone Receptor (PR)} and Human Epidermal growth factor Receptor-2 (HER2/neu) immunohistochemical expression are used for molecular typing of breast carcinoma. Young women account for up to 25% of all breast carcinoma cases in India. Aim: To assess the clinical symptoms, histological type, grade, Immunohistochemistry (IHC) profile (ER, PR, HER2neu), and their relationships in females below 40 years of age with breast carcinoma. Materials and Methods: An ambispective cross-sectional study with a total of 99 cases of breast carcinoma in young females were included in the study, which was conducted in the Department of Pathology at Sri Aurobindo Medical College and PG Institute in Indore, Madhya Pradesh, India, between April 2022 and March 2024. Biopsies, lumpectomy, and total or modified mastectomy specimens were fixed in formalin and paraffin embedded. Sections were stained with Haematoxylin and Eosin (H&E) and IHC markers ER, PR, and HER2neu using Estrogen Receptor Alpha Antibody (EP1), EP2, and EP3 antibodies, respectively, on a fully automated workstation. Carcinomas were classified according to the World Health Organisation (WHO) classification and graded based on Elston Ellis’s modification of the Scarff Bloom Richardson System Scoring. The proportion of tumour cells and intensity were studied, and evaluation was done with appropriate controls. Results: The most common symptom was a breast lump (84.84%), while Invasive breast cancer of {No Special Type (NST)} was the most common histologic type (96.96%) and histological Grade III was predominant (53.53%) in the majority of patients. ER, PR, and HER2neu were positive in 57.57%, 51.51%, and 33.33% of cases, respectively. HER2neu expression was negative in the majority of cases (66.66%). The most common molecular subtype was Luminal A (35.35%), followed by Triple-negative Breast Cancer (TNBC) (29.29%), Luminal B (22.22%), and the least common was the HER2neu enriched subtype (13.13%). Conclusion: Invasive breast carcinoma (NST) is the most common histologic type, with higher histologic grade and a greater number of triple-negative cases seen in young females (<40 years).

Role of Serial Serum Cholinesterase Levels in Clinical Outcomes of Patients with Organophosphorus Compound Poisoning: A Cohort Study

GN Swapna, T Neeraja Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Poisoning is caused, when a poisonous material is consumed, inhaled, or comes into contact with the skin, eyes, or mucous membranes like the mouth or nose. Poisoning by pesticides has long been considered a serious public health issue. The majority of poisoning cases reported to hospitals involve either an unknown type and quantity of Organophosphorus (OP) poisoning taken by the patient, which makes repeated serum Acetylcholinesterase measurements. Few studies have done the serial Serum Cholinesterase(SChE) tests in the early stages of poisoning. Aim: To evaluate the prognostic value of measuring serial SChE levels in patients with OP poisoning to predict clinical outcomes. Materials and Methods: This cohort study was conducted in the Department of Biochemistry and Therapeutics at Hassan Institute of Medical Sciences, Karnataka, India. Medical records of OP poisoning cases admitted during September 2023 and December 2023. A total of 40 patients were included in the study. Detailed demographic and clinical data, along with serial SChE levels at admission, day 2, and day 4, were recorded in the case record forms. Results: The mean age of the patients was 43.38±16.46 years. There was a significant decrease in serum SChE levels from day 1 to day 4 (p<0.0001). Furthermore, the mean SChE levels at admission in patients who survived were significantly higher (p<0.00001) than those in the group that expired. Conclusion: Significantly higher SChE levels were found to be associated with improved clinical outcomes, as indicated by improvements in mechanical ventilation and lower fatality rates after acute OP poisoning.

Dentinal Tubule Occluding Efficacy of Three Nano Biomaterials Containing Toothpastes on Simulated Hypersensitive Dentin: An SEM and EDX In-vitro Analysis

Neha Mundhada, Chetana Makade, Pratima Shenoi, Deepashri Tekam, Simran Gupta Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Dentin Hypersensitivity (DH) is a common dental issue characterised by sharp pain in response to stimuli. Desensitising toothpastes provide lasting relief by sealing dentinal tubules. In recent years, new home-use desensitising products incorporating nano biomaterials have been developed. Aim: To evaluate the efficacy of nano biomaterials such as Nano-hydroxyapatite (n-HAp), Novamin, and Pro-Argin in occluding dentinal tubules for the treatment of DH. Materials and Methods: An in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India, from October 2017 to April 2019. A total of 105 extracted maxillary premolars were divided into five groups: a no-treatment group (n=5), a control group (Sodium Fluoride) (n=25), and three experimental groups (n=25) using n-HAp, Novamin, and Pro-Argin, respectively. An Oral B cross-action toothbrush with a customised jig machine was used along with the experimental toothpaste for two minutes daily for two months. All samples were sectioned and subjected to Scanning Electron Microscope (SEM) and Energy Dispersive X-ray Spectroscopy (EDS) for chemical characterisation. The data were subjected to statistical analysis using one-way Analysis of Variance (ANOVA) for comparison of the mean number of dentinal tubules and Calcium to Phosphorous (Ca/P) ratio. Paired comparisons were carried out using Tukey’s post-hoc test. Results: It was observed that the n-HAp-containing toothpaste had the highest number of completely occluded tubules (546.00±49.96), and the Ca/P ratio of enamel (1.87±0.41) was higher than that of the other experimental groups (p<0.0001). Conclusion: The n-HAp-containing toothpaste reported the highest efficacy in occluding dentinal tubules followed by Novamin, Pro-Argin, and regular toothpaste at the end of two months. All three tested toothpastes containing nano biomaterials had remineralisation potential.

Expanding New Horizons in the Field of Physiotherapy

Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X

Quality of Life among Haemophilic Children in Central Madhya Pradesh, India: A Cross-sectional Study

Madhuri Tejwani, Pankaj Pal, Gaurav Kumar Prajapati, Vipin Thakur, Shweta Sharma Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Quality of Life (QoL) has recently become a focus of research in haemophilia, as children with haemophilia miss out on opportunities to reach their full potential during school and later in life. This leads to emotional and behavioural problems, family issues, and a decrease in Health-related Quality of Life (HRQoL). There is very limited data from the state of Madhya Pradesh, India, to assess the QoL in haemophilia patients. Aim: To study the clinical profile of haemophilic children and assess their QoL. Materials and Methods: The present hospital-based cross-sectional study was conducted in the Department of Paediatrics, Gandhi Medical College, Bhopal, Madhya Pradesh, India, from January 2019 to December 2019. A total of 49 children (Institutional incidence), aged from 4-12 years, with factor VIII/IX deficiency who presented in the Paediatric ward of the study Institution for factor transfusion, were included in the study. The study population was divided into two groups with children aged (group ) and children aged 8-12 years (group II). A detailed clinical history was obtained from the accompanying parent/guardian, and QoL was measured using the Haemophilia QoL (Haemo-QoL) questionnaire. Scores achieved in each dimension, as well as, the total score were combined on a scale ranging from 0 to 100. High values indicate high impairment in QoL. The meanings of different scales like Standardised and Transformed Scale Scores (TSS) of Haemo-QoL were analysed using the student’s t-test. Results: In the present study, haemophilia A was more common than haemophilia B. All patients who attended the paediatric ward for factor transfusion were males, with a mean age of 8.37±2.56 years. It was also observed that the proportion of patients who were diagnosed early was significantly higher in the 4-7 years age group compared to the 8-12 years age group of patients (p-value<0.05). The present study revealed that the mean overall scores on the Haemo-QoL for the age groups 4-7 years and 8-12 years were 41.92±17.95 and 51.84±16.36, respectively. The highest impairment was in the physical health, school and sports, and family dimensions of QoL. Conclusion: The QoL is poor among children in both age groups. The current study also showed that as age advances, the QoL of haemophilia patients becomes poorer.

A Clinicopathological Evaluation of Oral Cavity Lesions and the Role of Cytokeratin 8/18 as a Marker in Oral Premalignant and Malignant Lesions: A Hospital-based Cross-sectional Study

Nirmali Mattack, Balmiki Datta, Barnali Das, Gitali Devi Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: The oral cavity is affected by a wide range of pathologic lesions that may originate from squamous mucosa, salivary glands, mesenchymal structures and lymphoid tissue. Alterations in Cytokeratin (CK) patterns have been reported in oral potentially malignant and malignant lesions, and its expression is a hallmark of tumour progression. Aim: To evaluate different oral cavity lesions, with an emphasis on using Cytokeratin 8/18 (CK8/18) to differentiate between benign, premalignant and malignant lesions. Materials and Methods: The present hospital-based cross-sectional observational study was conducted in the Departments of Pathology and Otorhinolaryngology, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Guwahati, Assam, India, from September 2020 to August 2021. A total of 93 biopsied or resected specimens clinically presenting in the Otorhinolaryngology Department with oral cavity lesions were submitted to the Department of Pathology, Fakhruddin Ali Ahmed Medical College and Hospital for histopathological examination followed by Immunohistochemistry (IHC) with CK8/18 in all the tissue samples as per IHC protocol. Age, gender, clinical presentation and sites of lesions were also assessed, as well as, histopathological evaluation and IHC. All data were collected, compiled and subjected to suitable statistical analysis, such as one-way Analysis of Variance (ANOVA) and Fisher’s exact tests using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) software version 28.0. Microsoft Office Word and Excel 2019 were used to generate graphs and tables. Results: The age of the patients ranged from 9-90 years and mean±Standard Deviation (SD) age was 52.69±15.81 years. Males, 59 (63.4%), were more commonly affected than females 34 (36.6%), with a male-to-female ratio of 1.73:1. Among the 93 various oral cavity lesions, 24 were located on the buccal mucosa, making it the most common site in our study. Of the 42 malignant oral cavity lesions, the most frequent was moderately differentiated Squamous Cell Carcinoma (SCC) with a frequency of 21 cases (50%), followed by well-differentiated SCC with 18 cases, including one case of Verrucous carcinoma. Poorly differentiated SCC was the least frequent, with three cases (7.14%). CK8/18 was positive in 33 of the 42 malignant cases, four out of the 20 dysplasia cases, and all the benign cases were negative for IHC of CK8/18. The maximal intensity of CK8/18 was seen in 13/21 (62%) cases of moderately differentiated oral SCC. Conclusion: In conclusion, the present study on oral cavity lesions in the lower Assam region highlighted the significance of clinical, histopathological and immunohistochemical evaluations, particularly with CK8/18 staining. A predominance of lesions on the buccal mucosa was found, with moderately differentiated SCC being the most common malignant type. CK8/18 expression showed a notable association with malignant lesions, especially in moderately differentiated SCC, suggesting its potential as a diagnostic marker. These findings contribute to a better understanding of oral cavity pathologies and may aid in early detection and management strategies.

Correlation between Ankylosing Spondylitis Disease Activity Score and MRI Scoring in Patients with Ankylosing Spondylitis: A Cross-sectional Study

Binay Kumar Singh, Mohan Tiwari, Pavan Kumar Meena Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Ankylosing Spondylitis (AS) is an inflammatory disorder of unknown cause that primarily affects the axial skeleton, peripheral joints, and extra-articular structures. Typically, the condition starts in the second or third decade. Lower back pain lasting longer than three months, morning stiffness lasting more than 30 minutes, relieved by daily activities, are signs of disease onset. Aim: To establish a correlation between disease severity score Ankylosing Spondylitis Disease Activity Score (ASDAS) and Magnetic Resonance Imaging (MRI) scoring in patients with AS. Materials and Methods: This cross-sectional study was conducted on 66 patients attending the Medicine Emergency/Outpatient Department (OPD)/ward of ESIPGIMSR and ESI Hospital, Basaidarapur, New Delhi, India, who were diagonsed with AS based on the modified New York Criteria. Clinical assessments included ASDAS based on Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein (CRP), while MRI disease activity scores were determined using the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI scoring. The sample size was calculated with a coefficient limit of 10% and a confidence level of 95%. Data analysis was performed using Statistical Packages for Social Sciences (SPSS) version 21.0, a widely used statistical computing and graphics tool. Pearson’s correlation coefficients were computed to explore relationships between variables, including age, disease duration, ASDAS-ESR, and MRI changes. Results: In present study, a total of 66 patients were included, out of which 51 (77.3%) were males and 15 (22.7%) were females. The age group of patients included in present study was 33 years to 44 years with a mean of 37.96 years. In present study, the disease duration ranged from a minimum of two years to a maximum of 10 years with a mean of 5.4 years. The mean ASDAS CRP was 3.687 (minimum-2.80, maximum-4.60), and the disease activity as assessed by MRI score (SPARCC) had a minimum value of 8.85 and a maximum value of 26.2 with a mean of 16.359. In present study, the X-ray grading of sacroiliitis revealed that 19.7% of the subjects were classified as Grade-2, 60.6% as Grade-3, and 19.7% as Grade-4. Conclusion: The clinical disease activity index may not always reflect active inflammation, which is detectable by MRI. Incorporating MRI into diagnostic and treatment strategies for AS is crucial for the accurate assessment of disease severity and better patient outcomes.

Prevalence of Depression in Schizophrenic Remission Patients and its Impact on their QoL: A Cross-sectional Study

T Pallavi, Shabeeba Z Kailash, Kailash Sureshkumar, M Aravindh Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Schizophrenia is a major mental illness and a significant contributor to the global burden of disease. Around one-fifth of patients with Schizophrenia have significant depression during the phase of clinical remission. Aim: To evaluate the prevalence of depression in patients with Schizophrenia, the Quality of Life (QoL) of patients with depression in Schizophrenia, and to study the relationship between the two. Materials and Methods: This cross-sectional study was conducted at the Department of Psychiatry, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India. One hundred patients aged 18 to 59 years diagnosed with Schizophrenia as per International Classification of Diseases (ICD-11), operationally in remission for a minimum of one month, were included. The Calgary Depression Scale for Schizophrenia (CDSS) and the World Health Organisation Quality of Life Brief version (WHOQoL-BREF) scale were used to measure the presence of depression and QoL in patients with Schizophrenia. Data were analysed with t-test, Chi-square tests, and Pearson correlation using Statistical Package for Social Sciences (SPSS) software version 21.0. Results: The mean age of the study participants was 31.6±5.1 years. Of the total study population, 72% were male, 31% had a high school level education, 20% were unemployed, 64% were married, 46% were from a semi-urban background, and 45% belonged to a lower-middle socio-economic background. Twenty-two percent of patients with Schizophrenia in remission were found to have depression. A longer duration of untreated psychosis (mean=9.14±2.83 years) was significantly associated with the development of depression in patients with Schizophrenia. Patients with Schizophrenia and depression had significantly poorer QoL in all domains (physical, psychological, social, environmental; p<0.001). Conclusion: This study helps us understand the importance of monitoring for depression in at-risk patients with Schizophrenia in remission. Doing so can pave the way for early intervention, thus improving their overall QoL.

Cervical Cytology-Histopathology Concordance and Role of Dual Immunomarkers in Biopsy Samples of Uterine Cervix: A Cross-sectional Study from a Tertiary Care Hospital of West Bengal, India

Srimoyee Sen, Esha Mondal, Nazir Abdul Wasim, Manisha Sarkar, Asim Kumar Manna Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Cervical cancer is one of the leading causes of cancer deaths. Liquid-based cervical cytology enables the detection and diagnosis of the disease at an early stage. p40 is a specific immunomarker that distinguishes squamous cell carcinomas from other cervical carcinomas with glandular and neuroendocrine differentiation. Aim: To determine the role of Liquid-based Cytology (LBC) in the early detection of premalignant and malignant lesions of the uterine cervix and its concordance with histopathological findings. Materials and Methods: This cross-sectional study was conducted at the Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, West Bengal, India, over a period of one year and six months (from October 2020 to March 2022). Cervical samples were collected from a total of 200 females, and the materials were processed using the BD SurePath™ LBC method. The cytologically confirmed cases were biopsied, and histopathological concordance was established. Immunohistochemical (IHC) staining for p40 and p63 was performed using the peroxidase-antiperoxidase method to differentiate between premalignant, malignant squamous, and glandular lesions of the uterine cervix. For quantitative analysis, all cells were counted in 10 random fields at 400x magnification, and p63 and p40 were expressed as a percentage of positive cells per the total number of counted cells. Cases were considered positive if 5% or more of the tumour cell nuclei showed brown nuclear staining. The mean percentage positivity of p63 and p40 nuclear staining of all the cases in each category was calculated for non neoplastic and precursor/neoplastic lesions of the cervix. Results: Among the 200 cases evaluated by LBC, 169 (84.5%) were non neoplastic, and the remaining 31 (15.5%) were precursor/neoplastic lesions. The vast majority (126 cases, 63%) were inflammatory smears, followed by 20 cases (10%) that were Negative for Intraepithelial Lesion or Malignancy (NILM). Total of 40 cases were followed-up with biopsy and histopathology, and concordance with the cytological diagnosis was evaluated. Among 40 cases, 23 were precursor/neoplastic on histopathology, and seven cases that were non neoplastic on Histopathological Examination (HPE) had been correctly diagnosed on LBC, giving a concordance rate of 75%. The overall sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of LBC were 92%, 46.6%, 74.1%, and 77.7%, respectively, considering histological diagnosis as the gold standard. Regarding IHC expression on histopathology, the mean positivity of p40 and p63 for non neoplastic lesions was 9.40% and 10.06%, and for precursor/neoplastic lesions, 47.44% and 46.4%, respectively. Adenocarcinoma-in-situ and adenocarcinoma were negative for both p40 and p63. Conclusion: Cervical cytology is a less invasive, cost-effective, and simple procedure to diagnose cervical epithelial cell abnormalities. Cytological-histopathological concordance revealed that LBC is a sensitive diagnostic method. The comparison between non neoplastic and neoplastic lesions of the cervix revealed a statistically significant difference with respect to the mean percent positivity of p40 and p63 IHC staining. Both of these markers can be used to differentiate squamous cell carcinoma from adenocarcinoma of the cervix.

Diagnostic Accuracy of Tissue Transglutaminase and Combined Assay of Tissue Transglutaminase and Deamidated Gliadin Peptide in Children with Coeliac Disease: A Cross-sectional Study

Pankaj Kumar Yadav, Nisha Attri, Lalit Bharadia, Rajiv Kumar Bansal Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Coeliac Disease (CD) is a systemic immune disorder caused by gluten in genetically susceptible individuals. A serological screening assay for CD has been designed to detect Immunoglobulin A (IgA) and IgG anti-tissue Transglutaminase (a-tTG) and IgA and IgG Deamidated Gliadin Peptide antibodies (a-DGP) simultaneously. The seronegative gap can be closed when these two antigens are combined on a single solid phase. This is primarily because untreated CD children who are negative for antibodies of one of the antigens may exhibit a positive result for the other. Aim: To determine the diagnostic parameters {sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV)} of tTG-IgA and htTG-DGP (Coeliac fusion- a combination of IgA and IgG to human tTG and synthetic DGP) for the diagnosis of CD in clinically symptomatic children. Materials and Methods: This cross-sectional study was conducted at the Paediatric Outpatient Department (OPD) of Santokhba Durlabhji Memorial Hospital, Jaipur, Rajasthan, India from April 2023 to November 2023. The study population comprised 45 children (age >6 months and <18 years) showing clinical features of CD. Considering biopsy as the gold standard, the diagnostic parameters (sensitivity, specificity, PPV, NPV) of tTG-IgA and htTG-DGP were calculated with a 95% confidence interval for both tests. To determine the agreement between the two tests, Cohen’s kappa was calculated. A p-value less than 0.05 was considered statistically significant. Results: Out of the study population, 23 (46%) CD patients were in the age group of 3-6 years, while 13 (26%) patients were in the age group of 6-9 years. A total of 24 (53.3%) CD patients were males, and 21 (46.7%) were females. Chronic diarrhoea was the most common clinical feature in 31 (62%) patients. Considering duodenal biopsy as the gold standard, the study results showed that the anti tTG-IgA antibody test had a sensitivity of 91.1%, specificity of 80%, PPV of 97.6, and NPV of 50%. In comparison, the htTG-DGP antibody test had a sensitivity of 95.6%, specificity of 100%, PPV of 100%, and NPV of 71.43%. Conclusion: Currently, tTG-IgA is considered the best CD screening test. However, the inclusion of DGP IgG could increase diagnostic sensitivity, and a Combined IgA/G-DGP/tTG assay could be even better than tTG-IgA for the diagnosis of childhood CD.

Comparison of Physiochemical Properties and Biocompatiblity of Two Commercially Available Natural Xenogeneic Collagen Membranes: In-vitro Study

A Gnanamani, Vamsi Lavu, Reshma Achu Joseph, R Thilagam, SK Balaji Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Physical factors like stiffness and surface features are among the characteristics that affect the performance of barrier membranes and determine the results of regenerative processes. A perfect equilibrium between the membrane’s rigidity and mechanical stability guarantees effective periodontal regeneration. The study’s novelty lies in comparing the physical characteristics, namely morphology, tensile strength, wettability, and biological characteristics, namely biocompatibility and enzyme resistance properties, of the Fix-GideTM membrane against the gold standard membrane, Bio-Gide®. Aim: To explore the physical and biological properties of two commercially available barrier membranes in oral tissue regeneration. Materials and Methods: The present in-vitro study compared two commercially available membranes, namely Bio-Gide® and Fix-GideTM. Both membranes are bilayered resorbable membranes, with Bio-Gide composed of porcine dermis Type-I and III collagen and Fix-GideTM of bovine origin. The study was conducted at the Central Leather Research Institute, and the membranes were procured from Sri Ramachandra Institute of Higher Education and Research. Morphological characterisation was done using Scanning Electron Microscopy (SEM). Physical properties were evaluated using a tensile strength test, enzyme resistance test, and wettability measurement. Biocompatibility assessment was also performed. The Statistical Package for Social Sciences (SPSS) software was used to run the Mann-Whitney U test to analyse the statistical data obtained in the enzyme resistance test. Results: Biocompatibility assessment showed no cytotoxic profile of both membranes, portraying their biocompatible nature. Morphological analysis using SEM showed the surface of the Bio-Gide® membrane to be considerably smoother than the Fix-GideTM membrane. Both membranes, however, have fibrous and porous features on their inner surfaces. Tensile strength assessment found that the percentage of elongation was better with Bio-Gide (1.7±0.4 and 4.8±0.4) when compared to Fix-Gide (15.8±0.2 and 2.2±0.2) in both wet and dry states, respectively. The enzyme resistance test evaluated in dry and wet settings showed that the membranes, namely, Bio-Gide® membrane exhibited around 29±2% of degradation, whereas the Fix-GideTM exhibited only 18±2%. These mechanical profiles exhibited that the membranes has appreciable differences, although there wasn’t a statistically significant difference between them (p=0.68). According to wettability studies, Bio-Gide is hydrophilic, but Fix-GideTM is hydrophobic. Conclusion: The observations of the present study showed that Fix-Gide had comparable physio-biological properties to that of the Bio-Gide membrane. This supports the suitability of the use of both membranes for various oral tissue regeneration procedures.

Ligasure versus Traditional Suturing in Total Abdominal Hysterectomy: A Retrospective Observational Study

Pratap Pharande, Vikas Tambe, Urvashi Jainani, Radhika Dhedia, Chittampaly Sri Rukmini Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Gynaecological procedures may be performed via vaginal, abdominal, or minimally invasive approaches, such as laparoscopy, hysteroscopy, and robotic surgery. Abdominal hysterectomy, a prevalent major surgical intervention, is linked to significant complications, notably bleeding and postoperative pain. The invention of Ligasure represents a pivotal milestone in the field of gynaecology. Aim: To compare the effectiveness of Ligasure and traditional suturing during total abdominal hysterectomy. Materials and Methods: A retrospective observational study was conducted in Dr. D. Y. Patil Hospital, Pimpri, Pune, Maharashtra, India from March 2022 to September 2023. A total of 34 patients scheduled for elective abdominal hysterectomy were enrolled and divided into two equivalent groups comprising Ligasure (group A) and conventional suturing (group B). Comprehensive preoperative assessments and preparations were done for all participants. Subsequent documentation and comparison of operative and postoperative outcomes, focusing primarily on parameters such as surgical duration, blood loss, and postoperative complications, were done between the two groups. Student’s t-test was used to compare surgical time and blood loss between group A and group B. Results: The mean age of participants in the Ligasure group was 43±4.5 years, and in the suture group was 45±5 years. The difference in BMI between the two groups was not significant. The surgical duration in the Ligasure group was significantly shorter (p-value=0.0002) compared to the conventional suturing group (53.8±6.7 minutes and 64.3±7.62 minutes, respectively). Furthermore, the Ligasure group showed a significant reduction (p-value<0.0001) in blood loss (156.4±31.3 mL and 261.6±36.8 mL, respectively). There was no significant difference (p-value=0.2990) in postoperative haemoglobin levels (11.6±1.2 g/dL and 11.2±1 g/dL, respectively). Conclusion: The use of Ligasure proves to be an efficient approach in abdominal hysterectomy. A reduced duration of surgery and a significant decrease in blood loss were observed with this procedure.

Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X

Comparative Evaluation of Solubility of a Single Shade Resin Composite with Conventional Composite: An In-vitro Study

Pranauti Sonaje, Farhin Katge, Shilpa Shetty, Devendra Patil, Trisha Patel Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Resin composites have been commonly used in restorative dentistry over the years. The longevity of restorations depends upon various physical properties like as solubility. Composite solubility can lead to deleterious effects on the polymer structure. Aim: To evaluate and compare the solubility of a single shade resin composite in comparison to a conventional resin composite in artificial saliva. Materials and Methods: In the present in-vitro study, 44 pellets (10 mm × 1 mm) were prepared from each material. The pellets were divided into two groups (n=22) based on the immersion period of two days and seven days. They were incubated, weighed using an analytical balance, and then immersed in artificial saliva. Weighing was done again after the completion of the immersion period, and solubility was calculated. Paired and independent sample t-tests were used to compare the solubility of both materials after two days and seven days. Results: The differences of solubility values for the single shade composite and conventional composite at two and seven-day intervals were (p=0.031) and (p=0.019), respectively, which were statistically significant. On inter-group comparison, the difference in solubility of the single shade composite at two days was significantly lower compared to conventional composites (p=0.024). Whereas, no significant difference was observed in solubility values between both groups at seven days (p=0.102). Conclusion: The performance of the single shade composite in terms of solubility was better in comparison with conventional composite.

Comparison of Fracture Resistance of Endodontically Treated Human Mandibular Molars Restored with Paracore Dual-cure Composite and EverX Posterior Composite: An In-vitro Study

Rupankar Dey, Raghunath Sil, Priti Desai, Laboni Ghorai Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Endodontic treatment is an elective dental procedure that is performed when the dental pulp becomes irreversibly damaged or necrotic due to dental caries or trauma. Considerable loss of coronal tooth structure together with large cavity designs and access cavities compromise the mechanical behaviour of endodontically treated teeth, making them more susceptible to catastrophic fracture. Hence, following endodontic treatment, it is imperative to provide a suitable restorative material to avoid subsequent tooth fracture following occlusal loading. Aim: To assess and compare the fracture resistance of endodontically treated human mandibular first molars restored with dual-cure composite (Paracore) and newer short fibre-reinforced composite (EverX Posterior) in occlusal (Class-I) cavities. Materials and Methods: The in-vitro study was performed in January 2023 to February 2023 using 30 freshly extracted sound adult human mandibular first molars (divided in three groups) at Guru Nanak Institute of Dental Sciences and Research, Kolkata, West Bengal, India. A total of 10 intact teeth served as positive controls (Group-1). Class-I access cavity preparation followed by endodontic therapy was performed on the remaining 20 teeth, which were randomly divided into two groups (Group-2 and 3), which were coronally restored with Paracore dual-cure composite and EverX posterior composite, respectively. Teeth were mounted in acrylic resin, and subsequently, measurements of fracture strength were performed using a universal testing machine. Data were analysed statistically using One-way Analysis of Variance (ANOVA), Post-Hoc Tukey, and Chi-square tests, with a p-value of ≤0.05 considered as the level of significance. Results: The mean fracture resistance values (in kilonewtons) were as follows: Group-1 (1.5750 kN) > Group-3 (1.0450 kN) > Group-2 (0.6350 kN). Group-3 showed a significantly higher mean fracture resistance value (p=0.035) than the other experimental group. The levels of fractures were also evaluated, and a significant difference between the groups was noted (p=0.001), concluding that the frequencies of unfavourable fractures were significantly higher in Group-2 than in the other groups. Conclusion: Short fibre-reinforced composite (EverX) showed fracture resistance similar to that of a natural tooth and hence can be used as a direct core build-up material to reinforce the remaining tooth structure in endodontically treated teeth.

Fluid Electrophoresis as a Tool for Diagnosis in Ascitic Patients: A Cross-sectional Study

Yassir OA Sidahmed, Aimun AE Ahmed, Rehab OE Elhewaig, Yasir S Kaloda Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Ascites is a condition in which there is accumulation of pathological fluid within the abdominal cavity. It is a challenging problem for healthcare personnel due to different pathological causes. To make a differential diagnosis, many investigations are needed. These investigations mainly depend on the analysis of ascitic fluids. Aim: To determine electrophoresis patterns in ascitic fluid and to relate the findings to each established diagnosis. Materials and Methods: This was a cross-sectional hospital-based study conducted at Khartoum and Alshaab Teaching Hospitals in Khartoum state, Sudan, from May 2018 to August 2018. The study population included all patients who were confirmed to have ascites using ultrasound. Fresh ascitic fluid samples were obtained from a total of 35 patients. All safety and aseptic conditions were applied. Immediately after collection, the samples were brought to the laboratory for electrophoresis of ascitic fluids. Data were analysed using descriptive statistics in terms of frequency and percentage. Results: The study findings revealed that most of the patients were men 26 (74.3%) and were over 50 years old 16 (45.7%). The majority of them were diagnosed with Liver Cirrhosis (LC) (28.6%), while a few (5.7%) suffered from Periportal Fibrosis (PF), Hepatocarcinoma (HC), Ovarian Carcinoma (OC), Heart Failure (HF), or Peritonitis (PT). Different patterns of ascitic electrophoresis were detected in diagnosed patients with ascites. About 29 (82.9%) patients had specific electrophoresis patterns that helped with diagnosis, while only 6 (17.1%) did not. Conclusion: Liver cirrhosis, hepatocellular carcinoma, and hepatitis B bands were specific compared to normal serum patterns, while no changes in ascitic fluid electrophoresis were observed in HF.

Ultrasound-guided Transversus Abdominis Plane Block and Ultrasound-guided Erector Spinae Plane Block for Postoperative Analgesia in Caesarean Section: A Randomised Clinical Study

Sukhmanpreet Kaur, Amrita Ghosh, Manasij Mitra, Ranabir Pal, Maitraye Basu Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Pain is the most unpleasant subjective feeling comprising of innumerable emotional and psychological components that require medical advice for relief, regardless of the cause. Transversus Abdominis Plane (TAP) block and Erector Spinae Plane (ESP) block are effectively studied blocks that provide adequate pain control. Aim: To compare postoperative analgesic efficacy in pregnant women undergoing caesarean section under spinal anaesthesia with Ultrasound (USG)-guided TAP block and USG-guided ESP block. Materials and Methods: In this institution-based interventional randomised clinical study, two categories comprising 30 subjects in group I with USG-guided bilateral TAP block and group II with USG-guided bilateral ESP block using Ropivacaine were involved. Visual Analogue Scale (VAS) was used to compare analgesic efficacy. Other parameters for analysis included time of first rescue analgesia, total number of administrations of rescue analgesia within 24 hours, together with Adverse Drug Reactions (ADRs). Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 21.0. Student’s t-test and Chi-square test were used for data analysis. Results: Subjects in group I had a mean age of 24.9±4.66 years while those in group II were 25.5±3.99 years. The VAS score at 24 hours in group I was 7.22±0.89 and in group II was 6.8±0.83, which was statistically significant with a p-value of 0.0241. USG-guided ESP block was superior to USG-guided TAP block, providing analgesia for 24 hours. Following the first dose, there was a significant delay in rescue analgesia and a reduction in the total administration of rescue analgesia within 24 hours. The first rescue analgesia in group I was at 10.66±2.32 hours and in group II was at 16.66±2.53 hours, with a p-value of 0.0001 indicating a statistically significant difference. No ADRs were reported in either group of participants. Conclusion: ESP block provided a prolonged duration of analgesia, as shown by a decrease in the total VAS score. There was also a significant reduction in the total number of administrations of rescue analgesia within 24 hours when compared to TAP block, suggesting that ESP block provides superior analgesia. Hence, for pain relief in postcaesarean section individuals, ESP block can be regarded as a novel potent option.

Comparison of Balance Between Badminton and Volleyball Recreational Players with Chronic Ankle Instability: A Cross-sectional Study

Yashwitha Shetty, Saumya Srivastava Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Chronic Ankle Instability (CAI) is an injury that presents persistent instability and “giving way” symptoms. The higher rate of reinjury following an initial Lateral Ankle Sprain (LAS) is associated with the development of CAI, which affects athletic and functional performance. Impairment of musculotendinous receptors following an initial ankle sprain may result in recurrent ankle instability. Some studies have suggested an association between CAI and issues with static and dynamic balance. Comparisons of static balance between recreational badminton and volleyball players and dynamic balance between recreational badminton and volleyball players with CAI are required to provide athletes with the proper balance training exercises. Aim: To analyse the static balance of badminton and volleyball recreational players with CAI using the Balance Error Scoring System (BESS) and a Plantar Pressure Analysis System (PPAS), as well as the dynamic balance of those players using the Y Balance Test (YBT). Materials and Methods: A cross-sectional study was conducted where recreational players with CAI who play badminton and volleyball were screened using the Cumberland Ankle Instability Tool (CAIT), and 46 participants were selected based on inclusion and exclusion criteria. The study was conducted in the indoor and outdoor stadiums of NITTE (Deemed to be University), Mangaluru, Karnataka, India. The study duration was from March 2023 to March 2024. Ethical clearance was obtained from the same university for the study. Following this, static and dynamic balance of each group was assessed using BESS (number of errors), PPAS (sway velocity), and YBT (distance reached by the limb). The static balance between the groups and dynamic balance between the groups were analysed in Jamovi software using independent sample t-test. Results: Following the analysis, static balance between badminton and volleyball recreational players using BESS showed a non significant difference with a p-value of 0.282, while PPAS showed non significant differences with p-values of 0.174 for double leg stance and 0.063 for single leg stance. Similarly, dynamic balance between badminton and volleyball recreational players using YBT showed non significant differences with p-values of 0.467, 0.768, and 0.299 for anterior, posteromedial, and posterolateral directions, respectively. Conclusion: The study concluded that there was no significant difference in static as well as dynamic balance between badminton and volleyball recreational players with CAI. However, it is important to evaluate the static and dynamic balance of recreational players to enhance performance and prevent injuries.

Knowledge, Attitude, and Practice of Ethical Social Media Usage amongst Dentists: A Cross-sectional Questionnaire-based Study

Shravani Thanneeru, Neerja Mahajan, Harekrishna Jayendra Raval, Shreya Jain, Saruchi Saxena, Krishna Dave Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Social Media (SM) has proven to be a valuable tool in various fields, including healthcare. However, its improper use can result in several ethical problems. Aim: To evaluate the knowledge, attitude, and practice of ethical SM usage for professional purposes. Materials and Methods: A cross-sectional study was conducted in the Department of Prosthodontics and Crown and Bridge at K.M. Shah Dental College and Hospital Vadodara, Gujarat, India between October 2022 and March 2023. A total of 319 respondents, including dental postgraduates, academicians, and dental practitioners, participated in the survey online through various SM groups. The questionnaire was created by analysing previous literature and reviewed by experts for accuracy. The survey comprised nine questions with three subsections to evaluate knowledge, attitude, and practice of ethical SM usage The survey was distributed through Google Forms, and the statistical analysis of the results was conducted using the Chi-square test (p<0.05). Results: A survey found that 238 (75.3%) of users have used SM for over five years. The most commonly used platforms are WhatsApp, Instagram, and Facebook. A total of 153 (48.4%) knew about electronic protected health information, 156 (49.4%) knew about Digital Information Security in Health Care Act (DISHA), and 264 (83.5%) knew about consent’s importance. A total of 227 (71.8% ) of dentists saw SM as a potential risk to patient privacy, but 248 (78.5%) took consent before sharing and 252 (79.7%) used de-identification measures before posting images. A total of 197 (62.3%) of individuals have not participated in any awareness or sensitisation programs regarding the ethical implications of SM usage. Conclusion: The study found dentists understand and prioritise patient privacy on SM. Regular training and policy updates are crucial for sensitising them regarding ethical use.

Comparative Evaluation of Anti-bacterial, Anti-inflammatory Efficacy and Cytotoxicity of Triple Antibiotic Paste Modified Soft Liners with Conventional Soft Liners: An In-vitro Study

Dnyaneshwar Parekar, Sahana Selvaganesh, Thiyaneswaran Nesappan Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Soft-Liner is an acrylic temporary relining material for the temporary rebasing (relining) of acrylic dentures and tissue conditioning. The use of soft liner as a medium to deliver anti-bacterial and anti-inflammatory medications locally to the site enhances the healing of the soft tissues, further maintaining the mucosa healthy in the transitional healing period. Soft liners modified with Triple Antibiotic Paste (TAP) help in soft tissue healing and reduce post-surgical inflammation. Aim: To evaluate the anti-bacterial, anti-inflammatory efficacy, and cytotoxicity of TAP modified soft liners with conventional soft liners. Materials and Methods: The in-vitro study was conducted in the Gold Laboratory at Saveetha Dental College, Chennai, Tamil Nadu, India, in March 2023. A solution of TAP was prepared and mixed with Gas Chromatography (GC) soft liner material. The antibacterial efficacy against the strains of Staphylococcus aureus, Pseudomonas, and E. faecalis was assessed, and Mueller Hinton Agar was used to identify the zone of inhibition. The Kolmogorov-Smirnov test was conducted to assess the normality of the distribution, and non-parametric tests were performed for further analysis. A chi-square test was used to compare the cytotoxicity of TAP modified soft liners, which was assessed by a Lethality assay for brine shrimps over 24 hours. The Egg albumin denaturation assay was used to assess anti-inflammatory properties, with different concentrations of 10 μL, 20 μL, 30 μL, 40 μL, and 50 μL. Human Gingival Fibroblast (HGF) was used for the cell line study, and the isolation of HGF was performed by enzymatic digestion subjected to collagenase (900 u/mL) and dispase (400 u/mL) digestion at 37°C for one hour. Results: In comparing the modified TAP liners to commercially available liners on the basis of antibacterial efficacy, there was increased anti-bacterial efficacy in the TAP modified liners, which increased with increasing concentration, with the maximum being 40.25±14.87 mm for a 1:3 concentration against S. aureus and the least being 23±1.3 mm of unmodified soft liners against Pseudomonas and S. aureus. Different concentrations of 10 μL, 20 μL, 30 μL, 40 μL were used for the anti-inflammatory test, and as the concentration increased, anti-inflammatory activity also increased. The cytotoxicity of the material increased from 10% to 40% as the concentration of TAP rose from 5 μL to 80 μL. Conclusion: TAP shows a better response in managing postoperative inflammation and better soft tissue healing when incorporated into the soft liners. More precise studies are needed to understand the exact mechanism of TAP.

Unveiling the Promise of Bioactive Alkaloid Compound from Catharanthus Roseus: An In-vitro Computational Exploration of their Molecular Docking against a Target Protein for Type-2 Diabetes

A Mariappan, PK Jabir, D Alfred Solomon, Shyamaladevi Babu, Madhan Krishnan Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Molecular docking facilitates the exploration of interactions between bioactive alkaloid compounds and target proteins, offering insights into potential binding modes and affinity, crucial for drug discovery and understanding molecular mechanisms. Catharanthus roseus (C. roseus), renowned for its bioactive alkaloid compounds, emerges as a promising candidate for novel agents in diabetes management. Aim: To study the computational methods, including in-silico molecular docking, to elucidate the interactions between bioactive alkaloids from C. roseus and a Type-2 diabetic target protein. Materials and Methods: In this in-vitro study conducted in 2022 at the Department of Research, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Tamil Nadu, India. The research took place from July to October 2022. Computational techniques, particularly in-silico molecular docking, were utilised to analyse the binding affinities and potential mechanisms of action of bioactive alkaloids from C. roseus against a target protein associated with Type-2 diabetes. The study employed established computational protocols and software tools to predict and evaluate the binding interactions between the alkaloids and the target protein. Results: The analysis suggests Vinblastine, Ajmalicine, and Vindolinine from C. roseus as potential diabetes therapeutics. Vinblastine binds strongly to Human Pancreatic Alpha-Amylase (HPA), hinting at glucose metabolism regulation. Ajmalicine and Vindolinine also interact significantly with HPA, implying antidiabetic potential. Additionally, the present study findings suggest a potential role of Reserpine in modulating HPA activity and supporting its antihypertensive effects. Conclusion: In conclusion, the analysis highlights the potential of C. roseus compounds like Vinblastine, Ajmalicine, and Vindolinine in managing diabetes by interacting with HPA, indicating their potential as antidiabetic agents. Additionally, Reserpine’s effect on HPA activity suggests a role in hypertension management. These findings emphasise the therapeutic potential of natural compounds from C. roseus for diabetes and related conditions, warranting further clinical investigation.

Evaluation of Elastic Recovery of Elastomeric Impression Materials Subjected to Various Disinfection Methods: An In-vitro Study

Krishna Sravan Mangipudi, VVSN Raju Jampana, Sumeet Sharma, Jyothi Atla, Rama Krishna Alla, Sruthi Reddy Marthala Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Disinfection of impressions is essential to prevent cross-contamination from the operatory to the laboratory. Various methods have been employed to disinfect the impressions. These disinfection methods should not alter the physical and mechanical properties of impression materials. Aim: To evaluate the Elastic Recovery (ER) of elastomeric impression materials subjected to different disinfection methods. Materials and Methods: This was an in-vitro study conducted at KIMS Dental College and Hospital, Amalapuram, Andhra Pradesh, India and Vishnu Dental College, Bhimavaram, Andhra Pradesh, India over a period of 5 months from August 2022 to December 2022. A total of 120 impressions were made using three different types of elastomeric impression materials: Poly Vinyl Siloxane (PVS), Vinyl Poly Ether Siloxane (VPES), and Poly Ether (PE). A metal die was made as per American Society for Testing and Materials (ASTM) D412 and International Organisation for Standardisation (ISO) Specification 4823, containing a lower and upper member. These impressions were trimmed to the dimensions of a stainless steel stencil, measuring at points with uniform thickness. The impressions were then subjected to autoclave and chemical disinfection using 5% Glutaraldehyde (Korsolex) and Ethanol-2-Propanol (Bacillol). The samples prepared were fixed in the tensile grips of a Universal Testing Machine (UTM) and subjected to tensile loading at a crosshead speed of 10 mm/minute until tearing. The distance between the break ends was measured using a digital Vernier Callipers, and ER was measured. One-way Analysis of Variance (ANOVA) followed by Tukey’s post-hoc tests were used to analyse the obtained study data. Results: The PE impression material demonstrated more ER when subjected to different disinfection methods compared to the other materials. Significant differences were observed between the ER of impression materials with different disinfection methods (Autoclave: p<0.001, Korsolex: p<0.001, and Bacillol: p=0.007). Conclusion: For better ER, PVS can be sterilised with Bacillol and Korsolex. Korsolex should be avoided for disinfecting PE. VPES performed better with autoclave and Korsolex.

Oral Health-Related Quality of Life after Dental Treatment among Disabled and Non Disabled Individuals in Saudi Arabia: A Cross-sectional Study

Abdullah Ali H Alzahrani, Nagesh Bhat Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: The quality of life based on oral health has been a vital factor affecting health outcomes. It is an overall factor that influences functional well-being, as disabled individuals may have predisposing factors that could impact their quality of life. Aim: To assess Oral Health-Related Quality of Life (OHrQoL) in disabled and non-disabled individuals after receiving dental treatment in the Al-Baha region, Kingdom of Saudi Arabia. Materials and Methods: A cross-sectional study was conducted between September and December 2023. A total of 86 disabled and 129 non-disabled participants underwent clinical examinations, and dental treatments were performed. The Oral Health Impact Profile (OHIP-14) was utilised to evaluate OHrQoL using a validated Arabic version of the questionnaire. Data related to all variables in OHIP-14 were analysed in association with oral diseases using Statistical Package for Social Sciences (SPSS) Software version 20.0. Results: A total of 215 patients with and without disabilities were included in the study. Among these, 124 (57.5%) were females and 91 (42.3%) were males. Females reported significantly higher OHrQoL scores than males after dental therapy (p-value<0.001). No significant differences in OHrQoL were observed between patients with and without disabilities (p-value 0.389). However, quality of life significantly improved after dental treatment in disabled and non-disabled individuals across all sections or domains (p-value<0.05). Conclusion: Oral disorders had a negative impact on quality of life, as post-treatment OHrQoL scores were significantly lower than pre-treatment scores.

Correlation between Visceral Fat with Pulse Pressure in Young Offsprings of Hypertensive and Normotensive Parents: A Cross-sectional Observational Study

Arti Choubey, Vivek Verma, Sumit Kumar Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Increased Pulse Pressure (PP) and arterial stiffness are both associated with an elevated risk of Cardiovascular Disease (CVD). Raised PP is an independent prognostic marker for CVD not only in adults but also in young normotensive subjects. Normotensive Offspring of Hypertensive Parents (OHP) are more likely to develop future hypertension. Visceral obesity, closely tied to endocrine activity, magnifies susceptibility to hypertension and CVD development in young adults. Thus, understanding the association between visceral fat and PP assumes paramount importance in young adults. Aim: To study the correlation between visceral fat and PP in young offspring of hypertensive and normotensive parents. Materials and Methods: The cross-sectional study was conducted in the Department of Physiology, Government Medical College, Datia, Madhya Pradesh, India for eight months from June 2023 to January 2024 among 140 healthy young participants aged 18-25 years. The subjects were divided into two groups: Group-1 {Offspring of Normotensive Parents (ONP)} and Group-2 offsprings of Hypertensive Parents (OHPs). Body composition parameters and visceral fat levels were measured using a calibrated Karada scan. Detailed information regarding the history of hypertension in the family, alcohol intake, etc., was collected in a pre-defined proforma. Blood pressure measurements of subjects were taken using a standard electronic sphygmomanometer. Statistical analysis of the data was conducted using Statistical Package for Social Sciences (SPSS) Version 28.0 software. For correlational analysis, Pearson correlation test was used and a p-value <0.05 considered significant. Results: The findings revealed a significant positive correlation between visceral fat levels and PP levels (p<0.05, r=0.58 and 0.57) in the two groups. Visceral fat levels were significantly higher in OHPs than in ONPs. Conclusion: Visceral fat and PP showed a correlation within the young population, irrespective of hypertensive or normotensive parents. However, visceral fat and PP levels were higher in the OHPs. This study suggests that maintaining a healthy body fat composition rather than just body weight might be pivotal for long-term hypertension prevention.

Effect of Mulligan Calcaneal Taping on Dynamic Balance and Functional Performance in Subjects with Plantar Fasciitis: A Prospective Cohort Study

Chetna Jakhotiya, Riddhi Ashish Shroff, Pranita Ganjave Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Plantar fasciitis is the most common cause of heel and foot pain, leading individuals to use compensatory techniques to alleviate their pain, resulting in an antalgic gait. These compensations alter the feeling of joint position and muscle activation, making it challenging to maintain an upright posture within the base of support. According to Mulligan's concept, rigid tape allows painful or restricted movements with quick pain relief and increased range of motion while correcting positional faults and reducing tensile tension on the fascia, thereby decreasing inflammation and microscopic tears. Currently, there is a scarcity of data studying the effect of Mulligan’s calcaneal taping on dynamic balance. Aim: To evaluate the effect of Mulligan’s calcaneal taping on dynamic balance and functional performance in subjects with plantar fasciitis. Materials and Methods: The study was a prospective cohort study conducted at D.Y. Patil Hospital and Research Centre, Navi Mumbai, Maharashtra, India. It began in March 2023 and concluded in March 2024, spanning one year. Thirty-six subjects were randomly divided into group A (n=18) and group B (n=18). Subjects experiencing pain for more than six weeks, aged between 18-60 years, with a positive Windlass test, plantar medial heel pain, and abnormal foot posture index (between +6 to +9) were included in the study. The experimental group received Mulligan’s calcaneal taping along with conventional physiotherapy exercises, while the control group received only conventional physiotherapy exercises. Pre-post assessments were conducted using the star excursion balance test for dynamic balance assessment and the Foot Function Index (FFI) for functional performance. Results: Statistically significant differences were found among the medial (p-value=0.0212), posteromedial (p-value=0.0199), and posterior (p-value=0.0091) directions of the star excursion balance test. Both groups did not show statistically significant differences in the FFI score. However, with effect size, there was good clinical significance for the FFI score and all directions of the star excursion balance test except the posterolateral direction. Conclusion: Mulligan calcaneal taping has been shown to be more effective in improving dynamic balance in subjects with plantar fasciitis.

Comparison of Cognitive Performance, Stress, Body Mass Index, and Lung Functions in Exercising and Non Exercising Medical Students: A Cross-sectional Study

Ritish Reddy Ankireddy, T Bharath, Vijaya Vageesh Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Stress is an inherent part of the human experience, especially among medical students, due to academic pursuits and social commitments. The present study explores the intricate relationship of cognition with perceived stress levels, lung function, and Body Mass Index (BMI) in exercising and non exercising medical students. Aim: To find out and compare the levels of stress, cognition, BMI, and lung function in exercising and non exercising medical students. Materials and Methods: This cross-sectional study was conducted at the Department of Physiology, JSS Medical College, Constituent College of JSSAHER, Mysuru, Karnataka, India over a span of two months from February 2021 to April 2021. It included 110 participants categorised into an exercising group and a non exercising group. Stress and cognition were measured using the Perceived Stress Scale 10 (PSS-10) and the Modified Mini-mental State Examination (3MS), respectively. The BMI was calculated using Quetelet’s index. Pulmonary function was measured using a computerised spirometer. Associations were determined using a Student’s t-test, with p<0.05 considered significant. Results: The mean PSS-10 score for exercising students (11.36±3.67) was significantly lower compared to non exercising students (20.71±4.61). The 3MS score of exercisers (97.33±1.73) was significantly higher compared to non-exercisers (94.02±1.40). The mean values of pulmonary functions namely Forced Expiratory Volume 1 (FEV1) (3.43±0.71 L), Forced Vital Capacity (FVC) (3.88±0.76 L), and FEV1/FVC (87.94±2.73%) in exercisers, were significantly better than the values for non-exercisers: FEV1 (3.00±0.67 L), FVC (3.48±0.71 L), and FEV1/FVC (85.86±2.75%). The mean BMI of exercisers (21.45±1.43 kg/m²).) was significantly lower than that of non-exercisers (23.03±1.35 kg/m²). Conclusion: Participants who exercise regularly have better cognition, lower stress levels, a healthier BMI, and better lung function than their non exercising counterparts.

Comparative Analysis of Musculoskeletal Responses in Patellofemoral Osteoarthritis Patients: A Study on Retro-walking Treadmill Protocols using an Experimental Design

Chhavi Chaturvedi, Priyanka Rishi, Snigdha Tiwari, Saurabh Kumar Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Knee Osteoarthritis (OA) is a significant cause of disability globally and is rapidly becoming a major health issue. The part of the knee most affected by OA is the patellofemoral joint. This type of arthritis poses challenges for both patients and healthcare providers in managing symptoms and improving the quality of life for those affected. However, there’s a lack of data on specific therapies for the patellofemoral joint. Aim: To investigate if a varied frequency treadmill exercises protocol involving retro-walking has a greater impact on musculoskeletal responses, leading to better improvements in individuals with symptomatic Patellofemoral Joint Osteoarthritis (PFOA). Materials and Methods: The present study was an experimental research design i.e., between -subjects experimental design in which 60 participants with patellofemoral arthritis were enrolled based on the inclusion criteria. The study was conducted in the Department of Orthopaedics, SGT Medical College Hospital and Research Institute in Gurugram, Haryana, India for a duration of one year (May 2022- May 2023). Participants were randomly randomised to three distinct exercise program groups with varying intensity levels for retro-walking on a treadmill for six weeks, and all three groups received conventional treatment six days/week for six weeks. All participants were evaluated at three-time intervals of baseline, at the end of the third week, and after intervention (end of the sixth week) for the evaluation of several musculoskeletal parameters affecting patellofemoral arthritis. Statistical analysis was carried out using the IBM Statistical Package for the Social Sciences (SPSS) version 26.0. Comparison for within group differences between various outcome measures at various intervals of time was done using repeated measures of Analysis of Variance (ANOVA) and post-hoc analysis for mean values with Least Significant Difference (LSD) whereas for between group analysis One-way ANOVA and post-hoc Analysis for mean values was done with p-value set at <0.05. Result: Significant statistical and clinical differences were observed in musculoskeletal responses, Q-angle (p-value=0.001) and popliteal angle (p-value=0.001) in the high frequency group (group C) performing the protocol five times a week for six weeks leading to a better quality of life followed by group B and group A, respectively. Conclusion: The main finding of the present study suggested that the dosage for retro-walking on treadmill among patients with patellofemoral arthritis requires at least walking for five times/week for six weeks to get more clinical improvement in Musculoskeletal Disorders (MSD).

Knowledge, Attitude and Practices Regarding Marijuana usage among Medical Students: A Descriptive Cross-sectional Study

Bhushan Mhetre, Preetika Baghel, Mihir Kshirsagar, Hrishikesh Solunke, Aayushi Goel, Sanaa Gore Datar Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: The increment in marijuana use across the world is concerning and needs to be addressed. There has been a cultural change regarding the perception and use of marijuana medicinally and recreationally, even among medical students. This needs to be studied to understand the outlook towards marijuana among young adults, including future doctors, to help improve their awareness of the risks and pitfalls of marijuana usage. Aim: To evaluate the knowledge, attitude, and practices regarding marijuana usage among medical students. Materials and Methods: This cross sectional study recruited 159 medical undergraduate students from the tertiary healthcare institute, Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India via an online, anonymised, semistructured, self-designed questionnaire that was circulated over social media. The duration of the study was from October 2023 to February 2024. The study population was grouped into first-year and final-year MBBS students to identify differences, if any, in knowledge, attitude, and practices regarding marijuana usage among students between the start and end of their MBBS training. The responses to questions were compared to establish any statistical significance. Results: Out of the total 159 participants, 106 (66.67%) were first-year MBBS students, and 53 (33.33%) were final-year MBBS students. Most students from both groups reported that marijuana was illegal in India. Both groups responded affirmatively to questions regarding their awareness of the effects of marijuana and whether it could be used as a medical therapeutic drug. The majority of students, 81 (76.42%) and 32 (60.38%), respectively in both groups, agreed with the statement that marijuana impairs concentration and movement. A total of 88 (83.02%) and 41 (77.36%) participants, respectively, were largely in favour of legalising marijuana, with a greater proportion of respondents from both groups opining that marijuana should be legalised, be it for medical therapeutic use or as a recreational drug. Conclusion: Study results showed that the majority of students from both groups responded positively to the question about the legalisation of marijuana in India. Some interesting differences were found between the two groups with respect to marijuana use and the perceptions about its positive or negative effects. It is essential to educate medical students, as future physicians, on the adverse effects and implications of marijuana use.

Foetal Pulmonary Artery Derived Doppler Parameters for Foetal Lung Maturity Assessment: An Observational Study

Namdev Seth, Saumya Verma Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Neonatal Respiratory Distress Syndrome (RDS) is a major cause of foetal mortality and morbidity, especially in preterm labour because of concerns about foetal lung maturity. One of the method to assess foetal lung maturity is the Doppler assessment of the foetal Pulmonary Artery. Aim: To assess the accuracy of Doppler findings of the foetal Main Pulmonary Artery (MPA) in foetal lung maturity assessment and prediction of the development of neonatal RDS in preterm deliveries. Materials and Methods: A prospective observational study was conducted in the Department of Radiology, along with the Departments of Obstetrics and the Department of Paediatrics of Rama Medical College, Hospital, and Research Institute in Kanpur, India from May 2022 to December 2022. A total of 76 pregnant women with singleton pregnancies and gestational age <37 weeks were included. Clinical history and relevant clinical examination data were collected from the patients. Ultrasound examination began with a general survey of the gestational sac, foetal biometry, detailed anatomical evaluation for any evident anomalies, and then cardiac evaluation. The Doppler waveform of the MPA was confirmed by its characteristic ‘spike and dome pattern’. It was distinguished from the ductus arteriosus waveform, as it shows a triangular waveform with increased diastolic flow. Acceleration Time (AT) was measured from the start of the systolic wave to the first systolic peak. Ejection Time (ET) measurement included the entire systolic wave. The diagnosis of RDS was made by the paediatrician, who was blinded to the Doppler findings. Receiver Operating Characteristic (ROC) curves were drawn using Statistical Package for the Social Sciences (SPSS) software to assess the diagnostic ability of the Doppler findings and to find the cut-off values with maximum sensitivity and specificity. Results: Out of the 76 pregnant women included in this study, 14 were excluded due to inadequate Doppler measurements and not being able to give birth within one week of Doppler evaluation. The study assessed a total of 62 pregnant females who underwent preterm delivery following the Doppler study. In total, 28 neonates developed RDS. Doppler parameters of both groups were compared (the first group included pregnant women whose neonates developed RDS after birth, and the second group included pregnant women whose neonates didn’t develop RDS after birth) with the help of the ROC curve. The AT/ET ratio achieved the highest sensitivity and specificity, both at 82%. Conclusion: The AT/ET ratio has produced the best results among all foetal pulmonary artery-derived Doppler parameters and is a promising non invasive method for assessing foetal lung maturity.

Comparative Evaluation of Three-dimensional Skeletal and Dentoalveolar Effects of Sawangi Flexiforce Expander and NiTi Expander in Class II (vertical) Cases with Maxillary Constriction: A Research Protocol

Srushti Atole, Ranjit Kamble Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Maxillary constriction is a very common type of malocclusion found at any age. It is recommended to treat it as early as possible to avoid the worsening of the situation and to re-establish optimal function and aesthetics. Expansion of the maxillary arch is considered the best treatment procedure in a growing child. There are various appliances used for the expansion of the arch. The Nickel Titanium (NiTi) expander is considered the hallmark in orthodontics, but it has a few drawbacks. To overcome these drawbacks, the Sawangi Flexiforce Expander (SFE) has been introduced. The present study aims to evaluate and compare the effects of SFE against NiTi expander. Need for the study: The commercially available NiTi expander is very expensive. As most dental practices are located in rural areas, not every patient requiring arch expansion can afford it. Therefore, there is a need for an appliance that is as effective as the NiTi expander but affordable for everyone. Aim: To evaluate and compare the three-dimensional skeletal and dentoalveolar effects of SFE against the NiTi expander in class II (vertical) cases with maxillary constriction using the Finite Element Method (FEM). Materials and Methods: The present FEM study will be conducted in the Department of Orthodontics and Dentofacial Orthopaedics at Sharad Pawar Dental College in Wardha, Maharashtra, India. The study will take place from November 2023 to October 2024. A single patient with a vertically growing pattern will be selected for a Computed Tomography scan (CT scan) of the Nasomaxillary complex based on inclusion and exclusion criteria. The CT scan of the patient will then be converted into a 3D finite element model. The 3D models of the NiTi expander, SFE, and nasomaxillary complex will be studied to evaluate and compare the three-dimensional effects. Parameters such as stress distribution and displacement at skeletal, dental, and dentoalveolar landmarks of the nasomaxillary complex in three directions due to both expanders will be evaluated. An unpaired t-test will be used to determine significant differences between the two expanders and to compare the outcomes. The displacement at each landmark due to 1 mm of activation of both expanders will be correlated using the Pearson’s correlation test. A p-value <0.05 will be considered significant.

A Narrative Review on Jerusalem Syndrome: Exploring Diagnosis, Treatment and Cultural Impacts

Truptesh Patil, Bhagyesh Sapkale, Anjali Vagga, Sachin R Gedam Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Visitors to Jerusalem who are not religious may experience “Jerusalem Syndrome,” characterised by obsessive religious ideas and delusions that can lead to psychosis. There are three varieties of this disorder. However, it is not officially recognised: Type-I affects individuals who have already experienced psychosis; Type-II affects persons who held unusual ideas before travelling to Jerusalem; and Type-III affects people who were initially mentally stable but developed psychosis while in Jerusalem. The review explores the effects of Jerusalem Syndrome on mental health, drawing comparisons with “Paris Syndrome.” Notable similarities with schizophrenia point to different initiators related to Jerusalem’s significance. Jerusalem Syndrome is treated with individualised mental care that combines medication and psychotherapy.

Development of Interprofessional Education and its Implementation in Global and Indian Context: A Literature Review

Priyanka P Niranjane, Ved Prakash Mishra, Pallavi Daigavane, Khyati Gupta, Kushal Prakash Taori Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Integration of Interprofessional Education (IPE) into the health sciences curriculum has been recommended over the past several decades to prepare healthcare professionals for future collaborative practice. However, due to the disparity in the adoption of IPE, this literature review attempted to examine the development of IPE and its implementation in global and Indian contexts. IPE has evolved from being fragmented and isolated initiatives to entering into the mainstream of professional education. In terms of IPE implementation, the global scan revealed that IPE was implemented in several countries to varying degrees; however, developing countries lagged behind developed countries in implementing and sustaining IPE. Scarce evidence was found regarding the implementation of IPE in India. The literature review elaborates on the transformation of health professions education from the traditional system to IPE and discusses the gap in the adoption and implementation of IPE in developing countries, including India.

Oral Epithelial Dysplasia: A Narrative Review on Histological Grading, Computer-aided Diagnostics and Treatment Approaches

Taibur Rahman, Lipi B Mahanta Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Head and Neck (H&N) cancer represents a significant global health burden, ranking sixth among all cancer types worldwide, with a particularly high prevalence in developing countries. Oral cancer, a subset of H&N cancer, encompasses malignant growths within the oral cavity region. Oral Epithelial Dysplasia (OED) serves as a precursor lesion to oral cancer and is identifiable through histological examination by pathologists. While histological grading correlates with progression cancer risk, accurately predicting lesion advancement remains challenging due to limited research and study. Despite established grading criteria based on architectural and cytological changes in the oral cavity histological images, variability exists among pathologists in assessing OED presence and grade. The present article explores OED as a precancerous lesion, delving into various histological grading systems based on architectural and cytological changes. Additionally, it examines the role of Computer-aided Diagnostics (CAD) leveraging Artificial Intelligence (AI) in OED detection. Lastly, the paper discusses treatment modalities for oral cavity cancers.

Applicability of Various Intelligence Scales Utilised in Paediatric Population: An Overview

Anuja Satish Handargule, Amar Taksande, Revat Meshram, Poonam Uke Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Due to the imperfect development of the brain and the varied biological, environmental, and experiential elements that arise during childhood and adolescence, paediatric neuropsychology differs from adult neuropsychology. According to current theories, certain brain regions have a reciprocal effect on various neuro functioning systems, which, in turn, affects the child’s ability to think and perceive. The interaction of functioning systems most likely affects the child’s behavioural, psychological, and cognitive manifestation of a childhood condition. These days, parents worry about their children doing well in school. A variety of intelligence scores are utilised to evaluate children’s cognitive abilities. Intelligence research is important since it sheds light on the individual’s qualities, shortcomings, and special talents. Currently, a large number of standardised tests are used since intelligence is seen as a measurable commodity. When diagnosing dyslexia, attention-deficit/hyperactivity disorder, autism spectrum disorders, intellectual disability, and other problems in the paediatric population, intelligence scales play a critical role. It is vital to recognise that every exam has a unique set of constraints. This paper explores the benefits and drawbacks of the currently utilised intelligence measures while offering an overview of each. The goal of this evaluation is to make it easier to analyse different intelligence measures and decide which ones are applicable for what circumstances and needs.

Management of Pain in Children through Ayurveda: A Review of Literature

Prasad Gajanan Yewale, Swapnali Prabhakar Mate, Mohan Sahebrao Raut Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Pain is the feeling of discomfort, most of the time, it refers to physical discomfort. Children often suffer from various kinds of pain, including abdominal pain and pain due to sports injuries. Unrelieved pain may be detrimental psychologically and physically from the start. A child’s quality of life can be significantly impacted by pain if it is not addressed and treated at an early age, affecting their mood, sleep, hunger, attendance at school, academic performance, and extracurricular activities. Pain management in paediatric populations poses unique challenges, necessitating a comprehensive and holistic approach. However, the use of Ayurvedic therapies can be very effective in the management of pain in children, though it is not specifically defined by any authors or researchers. This paper offers a review of the literature with a particular focus on how Ayurveda, an ancient Indian medical system that emphasizes the harmony of the body, mind, and spirit, might be utilised to treat paediatric pain. This study includes the exploration of the historical roots of Ayurveda and its traditional applications for managing pain in children, including dietary guidelines and non pharmacological interventions like Abhyanga (oil massage) and Swedana (sudation therapy).

Assessment of the Effect of Moringa Oleifera Leaves Extract on Angiogenesis using the Novel Yolk Sac Model: An In-ovo Experimental Study

Amita Aditya, Sunil Mishra, Ramesh Bhonde Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: In recent times, the focus of cancer research has shifted to naturally occurring compounds derived from plants that may have the potential for anticancer activity. Moringa oleifera is a softwood tree whose fruits, roots, and leaves have been advocated for medicinal and industrial uses. Angiogenesis plays an important role in many physiological and pathological conditions and is considered a hallmark of tumour development and progression. An efficient anticancer drug is expected to have a significant inhibitory effect on angiogenesis. However, there are a limited number of studies reported to explore the anti-angiogenic activities of Moringa Oleifera Leaf extract (MOL). Aim: To assess the effect of MOL on angiogenesis using the Yolk Sac Model (YSM). Materials and Methods: A preliminary in-ovo study was conducted in the in the specialised Regenerative laboratory of Dr. D.Y. Patil Dental College and Hospital, Pimpri, Pune, Maharashtra, India, between September 2022 and February 2023 after obtaining necessary scientific and ethical permissions. The calculated sample size for YSM analysis was seven in each study and control group (total of 14); however, the authors used a total of 28 YSMs (seven in each of the three study concentration groups and seven in the control group). In this method, freshly fertilised White Leghorn chicken (Gallus domesticus) eggs, procured from the hatchery, were incubated and treated with different concentrations (10 μg/mL, 100 μg/mL, and 500 μg/mL) of the treatment substance (MOL) along with a control group (Avastin). The anti-angiogenic effect of MOL extract was determined by calculating vessel density, total vessel network length, total branching points, total segments, mean segment length, and width in the three groups compared to Avastin after 48 hours of treatment using WimCam software for analysing the images. Descriptive statistical analysis and one-way Analysis of Variance (ANOVA) were then applied to compare the parameters in the four groups. Results: Statistical analysis by one-way ANOVA showed a significant (p<0.05) percentage reduction in the number of blood vessels in each treatment group after 48 hours of treatment. Among the different concentrations of MOL used, 500 μg/mL showed greater anti-angiogenic capacity. Conclusion: The results indicate that MOL could suppress abnormal angiogenesis in a dose-dependent manner and may be considered a potential anti-angiogenic agent in various diseases, including cancer.

Microcrack Formation after Root Canal Instrumentation: A Narrative Review

Divya Naik, Amisha Saoji, Sumanthini Margasahayam, Anuradha Patil, Shouvik Ganguly Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X The development of rotary files and other endodontic instrument techniques have revolutionised treatment by enhancing canal preparation and producing rounder, smoother canals that are constructed of Nickel-Titanium (NiTi) alloy. There are two types of movements in these instruments: rotary continuous and reciprocating. Rotary continuous movements involve torsion and flexion, and can cause instrument fractures. An alternative approach to avoid the issue is proposed, which involves reciprocating movement. The present literature review compares the incidence of dentinal crack formation in root canal walls when using stainless steel and NiTi rotary systems. It highlights the potential complications, such as tooth fracture and increased bacterial susceptibility due to contact between instruments and dentinal walls.

Effect of Callisthenic Exercises vs Yoga on Health Related Quality of Life, Lipid Profile, Anthropometric Measurements and ultrasonography Findings in Polycystic Ovarian Syndrome: A Research Protocol

Ashwini Bulbuli, Vijay Kage, Manjunath Hukkeri, MB Bellad Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder, and individuals with this condition are at a risk of developing complications like metabolic syndromes throughout their lifetime. Not much is known about studies reporting the combined effects of calisthenic exercise with either aerobic exercise or progressive resistive exercises that have shown positive outcomes in PCOS. Need for the study: Extensive literature search has revealed gaps in reporting the individualised effects of calisthenic exercise in PCOS and its comparative effects with yoga. The present research article presents a study protocol comparing calisthenic exercises and yoga protocols prescribed for women with PCOS. Aim of the study: To evaluate and compare the effects of calisthenic exercises and yoga in women with PCOS. Materials and Methods: This research protocol is planned to conduct a randomised clinical trial in Belagavi, Karnataka, India, and will employ a randomised, open-label, parallel-armed, double-blinded clinical experimental design. The duration of the study will be near bout four years, from June 2022 to August 2026. A total of 102 females with PCOS, aged between 18 and 35, will be randomly allocated to either a yoga group (N=51) or a calisthenic exercise group (N=51). For a period of 1½ months (i.e., six weeks), group therapy sessions will be held five times a week. Ultrasonography scans, which will assess ovarian cyst count and size, ovarian volume, and total lipid profile, will be conducted twice (pre- and post-intervention). The PCOS Questionnaire (PCOSQ-26) will be utilised to assess health-related quality of life, as well as anthropometric measurements such as waist-hip ratio and Body Mass Index (BMI). These measurements will be assessed prior to the intervention, six weeks following the intervention, and at the 12-week follow-up. Inferential as well as statistical methods will be used to analyse the gathered data. A test for normal distribution will be conducted, depending on whether parametric tests (Z test and/or ANOVA) or non-parametric tests (Mann-Whitney U test or Wilcoxon signed-rank test) will be performed. A probability value of less than 0.05 will be considered statistically significant.

Effect of Plyometric Training versus Swiss Ball Training on Core Strength, Agility and Dynamic Balance in Recreational Badminton Players: A Research Protocol

Saylee Sunil Shedge, Swapnil Ulhas Ramteke Journal of clinical and diagnostic research : 2024 - August - 18:0973-709X Introduction: Badminton is a recreational, versatile, explosive sprint sport. The player needs core strength, agility, and dynamic balance. Resistance training used in plyometric activities helps to improve the athlete’s strength and fitness. Swiss ball training, a widely embraced method of functional exercise, enhances balance, core stability, flexibility, and overall strength. Need for the study: This study fills a gap in knowledge by exploring the effects of plyometric training and Swiss ball training on core strength, agility, and dynamic balance in recreational badminton players. It seeks to enhance on-court performance and prevent injuries by determining, which method is more effective. Tailored training programs can then be developed further based on individual responses to these methods. By providing evidence-based data, the study aims to support and guide the strength and conditioning coaches, trainers, and players in making appropriate decision about training approaches, ensuring optimal results and minimising injury risks in badminton. Aim: To find out the effect of Plyometric training versus Swiss Ball training on core strength, agility, and dynamic balance in recreational badminton players. Methodology: A non-blinded, randomised controlled parallel-group trial will be conducted for a period of one year from January 2024 to December 2024. Participants will be recruited from Wardha’s District Badminton Stadium and will sign a consent form after meeting inclusion or exclusion criteria. They will be randomly divided into Group-A- Plyometric training and Group-B-Swiss ball training by the primary researcher. Outcome measures will be assessed pre and post-intervention. The analysis will be conducted using the free version of R-software. Significance in mean baseline variables will be assessed using either the t-test or Mann-Whitney test for the two assessment periods. Pairwise comparisons between the two groups for significant differences will be conducted using either the paired t-test or Wilcoxon test. The p-value will be evaluated at a 5% level of significance (p≤0.05).