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

Haemorrhagic Cystitis in a Case of Secondary Pelviureteric Junction Obstruction: A Rare Case Report

Abhirudra Mulay, Suraj Bhondave, Amala Ghalsasi, Radhika Salpekar, Ujjwal Bhardwaj Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Haemorrhagic cystitis ranges in severity from a transient condition to a life-threatening condition which may quickly resolve or require intervention on a priority basis. It is characterised by bleeding from the bladder mucosa and diffuse inflammation. Case of fungal haemorrhagic cystitis with secondary Pelviureteric Junction Obstruction (PUJO) is relatively rare. Hereby, the authors present a case of 57-year-old male who presented to Emergency Department with painful haematuria and increased frequency of micturition, found to have bladder clots and right secondary PUJO on diagnostic investigation. Clot evacuation and bleeder fulguration with right Double J (DJ) stenting was done. Urine culture and sensitivity report was suggestive of budding yeasts. Uncontrolled diabetes mellitus, with an HbA1c of 8.1%, could explain it. He was discharged on postoperative day two with oral cephalosporins and oral antifungals with Foley catheter in-situ. It was followed by Diethylene Triamine Penta Acetic Acid (DTPA) scan 15 days later, which revealed an enlarged, poorly functioning hydronephrotic obstructed right kidney with Glomerular Filtration Rate (GFR) of 5.7 mL/min, and satisfactorily functioning hydroureteronephrotic left kidney with GFR of 54.6 mL/min. Right open simple nephrectomy was done through the 11th rib flank incision to prevent future complications. Haemorrhagic cystitis should be kept as a differential diagnosis in patients with haematuria not responding to conservative management with multiple co-morbidities. Management of underlying cause remains the key to treatment.

Familial Occurrence of Mycoplasma-induced Rash and Mucositis: A Case Report of Two Siblings

Roja Aepala, Satyanarayana Kavali, Srividya Devarakonda, Nikhil Dasari, Sai Goutham Manikyala Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Mycoplasma pneumoniae is a common pathogen responsible for respiratory infections, including community-acquired pneumonia, and up to 25% of patients develop extrapulmonary complications. Mycoplasma-Induced Rash and Mucositis (MIRM) is a recently identified clinical entity typically preceded by pneumonia-like symptoms such as fever and cough. The differential diagnoses for MIRM include Erythema Multiforme (EM), Stevens-Johnson Syndrome (SJS), Herpetic gingivostomatitis, Kawasaki disease and Toxic Epidermal Necrolysis (TEN). This condition primarily affects children and adolescents, with a mean age of 12 years and shows a male predominance. The authors report a rare occurrence of MIRM in two siblings, underscoring the condition’s rarity and clinical importance. The combination of prominent mucosal involvement at two sites, with sparse cutaneous findings, preceded by a prodrome of respiratory symptoms and the absence of a drug history, raised suspicion of Mycoplasma infection, which was confirmed by positive Mycoplasma IgM antibodies. Both siblings recovered well with a macrolide antibiotic and a short course of corticosteroids. While sporadic cases of MIRM are reported, familial occurrences in siblings highlight a genetic or environmental predisposition. Early recognition is crucial, as demonstrated by its occurrence in siblings, where prompt diagnosis led to favourable outcomes. Increased awareness among physicians can aid in accurate diagnosis, appropriate management and effective counselling.

Anastomotic Strictures after Whipple Procedure: A Report of Two Cases

Puvvada Prashanth, Sankareswaran Sugaprakash, Raju Prabhakaran, Chidambaranathan Sugumar Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Whipple procedure is a major surgery performed for periampullary cancers. With improved surgical techniques and intensive care, perioperative mortality has become a rare event, occurring in less than 2% of cases; however, morbidity remains common, occurring in 30-50% of cases. Hereby, authors present a case report of two patients who were operated on for periampullary cancer and have now presented with anastomotic site strictures, hepatolithiasis and pancreatitis. Case 1 was a 58-year-old male who underwent the Whipple procedure with pancreaticojejunostomy 13 years ago for periampullary growth. The patient now presented with pancreatitis, dilated Main Pancreatic Duct (MPD), hepatolithiasis and a peptic ulcer with stricture at all three anastomotic sites. A lateral pancreaticojejunostomy, revision of hepaticojejunostomy with removal of calculi and redo gastrojejunostomy were performed using the same Roux limb. Case 2 was a 58-year-old male who underwent the Whipple procedure with pancreaticogastrostomy four years ago for a serous cystadenoma of the pancreas and presented with pancreatitis, dilated MPD and pleural effusion. The patient was diagnosed with pancreatitis due to anastomotic stricture at the pancreaticogastrostomy site and laparotomy with lateral pancreaticojejunostomy was performed. Both patients were discharged uneventfully. While individual anastomotic strictures and their management have been discussed in the literature following the Whipple procedure, Case 1, which presented with strictures at all three sites simultaneously and Case 2, which presented with pancreatitis, are noteworthy and unique. Surgery is the best approach to managing anastomotic strictures, as it offers a one-time solution.

Thoracic Anaesthesia in a Patient with Mechanical Mitral Valve: A Case Report

Shilpa Sarang Kore, Reem Barkat Khatib, Shubhangi Humane Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Oesophageal diverticulum is a rare condition characterised by an outpouching of the oesophageal wall, often associated with dysphagia, regurgitation, and a risk of aspiration. Surgical resection, typically via thoracotomy, presents significant anaesthetic challenges, particularly in patients with pre-existing cardiac disease requiring One-lung Ventilation (OLV). Patients with Rheumatic Valvular Heart Disease (RVHD), Atrial Fibrillation (AF), and prosthetic mitral valves pose additional perioperative risks, including haemodynamic instability, anticoagulation management, and pulmonary complications. Hereby, the authors present case of a 49-year-old male with longstanding RVHD, Mitral Valve Replacement (MVR), and left ventricular systolic dysfunction (ejection fraction 35%) who presented with worsening dysphagia, regurgitation, and dyspnoea. Imaging confirmed a 50×49×86 mm oesophageal diverticulum with bilateral pleural effusion. Preoperative optimisation included anticoagulation management, rate control for AF, and pleural drainage. The patient underwent oesophageal diverticulectomy under general anaesthesia with a left-sided double-lumen tube and thoracic epidural analgesia. Intraoperative challenges included transient AF, hypotension requiring vasopressors and inotropes, and desaturation during OLV, all of which were managed with recruitment manoeuvres and apnoeic oxygenation. Postoperatively, anticoagulation was restarted, and the patient was extubated on day two without complications. The present case underscores the importance of meticulous perioperative planning, haemodynamic monitoring, and multidisciplinary coordination in managing complex cardiac patients undergoing thoracic surgery. A tailored anaesthetic approach focusing on oxygenation, cardiac stability, and balancing anticoagulation is crucial for optimal outcomes.

Rare Non-germ Cell Testicular Tumors: A Series of Three Cases

Vilas Pandurang Sabale, Ujjwal Bhardwaj, Deepak Mane, Vikram Satav, Abhirudra Mulay Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Testicular neoplasms are the most common malignancy among men aged 20-40 years. More than 95% are germ cell tumours and 5% are sex cord stromal tumours. The most common presentation is a painless scrotal lump. Sometimes, it may present as a painful lump, mimicking an inflammatory lesion. Case 1, a 34-year-old male presented with right testicular pain and a lump for one month, with normal tumour markers. Clinically, it appeared as a testicular malignancy, but with normal tumour markers, it mimicked an inflammatory lesion, creating a management dilemma. A Computed Tomography (CT) scan ruled out retroperitoneal lymph node metastasis. Right high inguinal orchidectomy with frozen section was performed, suggesting malignancy. Immunohistochemistry confirmed leiomyosarcoma. Case 2, an 82-year-old male presented with a painless right testicular lump for one month, with a history of acute urinary retention secondary to benign prostatic enlargement {treated with Transurethral Resection of the Prostate (TURP)}. Clinically, it was a hard lump suggestive of malignancy, confirmed on ultrasound, although tumour markers were normal. A CT scan was negative for lymphadenopathy. Right high inguinal orchidectomy was performed. Histopathological examination showed non-Hodgkin’s lymphoma; the patient subsequently underwent chemotherapy. Case 3, a 29-year-old male complained of right testicular pain. Examination revealed a tender nodule (1×1 cm) on the posterolateral aspect of the right testis, clinically appearing as a firm mass, confirmed on ultrasonography, although tumour markers were misleadingly normal. High inguinal orchidectomy was performed, with histopathological examination positive for intratesticular adenomatoid tumour. High inguinal orchidectomy was the treatment of choice in all three cases, followed by adjuvant chemotherapy or radiotherapy depending on histopathology. Conclusion: Testicular tumours may mimic inflammatory lesions, creating management dilemmas. Thorough clinical examination and investigations are required for planning and management. Normal serum tumour markers and ultrasound cannot rule out malignancy.

Multifaceted Role of the Acellular Dermal Matrix in Novel Wound Healing: A Case Series

Naveen Narayan, Dharini Kishor, Yashas Hosur Ramegowda Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Acellular Dermal Matrix, Matriderm^®, a collagen and elastin matrix, has emerged as a versatile tool in wound coverage, promoting healing and reducing scarring, thus offering numerous advantages in various clinical scenarios. The varied uses demonstrated here include concomitant application of the acellular dermal matrix while grafting with a full-thickness skin, application over bare bone in Split-Thickness Skin Grafting (STSG) and in the treatment of mucocutaneous fistulae in the oral cavity. The outcome with the use of Matriderm® in all these cases was satisfactory. Hereby, the authors present a case series of four patients that provide an understanding of Matriderm^®’s efficacy in promoting healing and regeneration in complex wounds. Matriderm^®, an acellular dermal matrix composed of collagen and elastin, supports tissue regeneration and reduces scarring, making it a valuable tool in complex wound management. The present case series highlights its versatility and potential in advancing wound care.

Follicular Carcinoma of Thyroid with Solitary Vertebral Metastasis

Jatin Nehra, Shaik Ishma Mustafa, Kirthi Sathyakumar, Senthil Kumar Aiyappan Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X A 48-year-old female presented with a one-month history of back pain radiating to both lower limbs, which had worsened over the past three days. The pain had an insidious onset and was gradually progressive, radiating from the upper back to the plantar aspect of the feet. She also reported gait instability for three days, rest pain and sleep disturbances. There was no history of recent trauma, fever, significant weight loss, chronic cough, or night sweats. The patient had a history of thyroidectomy for follicular carcinoma of the thyroid seven years back. The family history was unremarkable.

Keloid Scarring in the Earlobe: From Piercing to Treatment

Parindita Sarmah, Sagar Gaurkar, Prasad Deshmukh Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X A 48-year-old female office worker presented in Ear, Nose and Throat (ENT) Outpatient Department (OPD) with a progressively enlarging, painless mass on both her earlobes, which she noticed about eight months ago. Both the lesions started after she had an ear piercing several years ago; and initially were small but have grown over time. The patient reports occasional itching but no pain, drainage, or signs of infection. She is concerned about the cosmetic appearance of the mass. There is no history of recent trauma to the area, and the patient denies any changes in the surrounding skin. She has no significant medical history and no known allergies. Although her maternal aunt has a history of keloids, there is no family history of similar lesions in other areas of the patient’s body.

Right-sided Bronchial Collapse undergoing Dilation and Stenting

Subha Teresa Jose Vazhakalayil, Sakshi Gupta Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Dear Editor, The anaesthesiologist plays a critical role during tracheobronchial stenting in patients under general anaesthesia, as they are responsible for the safe induction and maintenance of anaesthesia, managing a shared airway and treating life-threatening postoperative complications (1). Here, a case of the successful management of anaesthesia during bronchoscopic stenting is discussed.

Efficacy of External Beam Radiotherapy with Concurrent Capecitabine versus Radiotherapy alone for the Treatment of Painful Bone Metastasis in Primary Breast Cancer Patients: A Prospective Interventional Study

Lucy Pattanayak, Tapan Kumar Sahoo, Manoranjan Meher, Pragyna Paramita Das, Tapas Kumar Dash Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: The development of widespread distant metastasis, including skeletal metastasis, is common among breast carcinoma patients, irrespective of multimodal treatment. Symptomatic skeletal metastasis is usually treated with External Beam Radiotherapy (EBRT). Capecitabine can act as a radiosensitiser antineoplastic drug and can be added concurrently with EBRT. Aim: To compare the safety and efficacy of EBRT with concurrent capecitabine against EBRT alone in pain control of painful bone metastasis. Materials and Methods: This prospective interventional study was conducted in the Department of Radiation Oncology at Acharya Harihar Postgraduate Institute of Cancer, Cuttack, Odisha, India from September 2022 to March 2024. Histologically proven breast cancer patients with painful bone metastasis were included and randomly assigned to group A, receiving palliative radiotherapy only (n=20), and group B, receiving palliative radiotherapy with concurrent capecitabine (n=22). Radiotherapy was administered at a dose of 30 Gy in 10 fractions at 3 Gy per fraction over two weeks. The patients were assessed once weekly during the treatment and at the end of the treatment, patients were evaluated every four weeks until 12 weeks. Response to treatment was evaluated using the Visual Analog Scale (VAS) and analgesic score. Statistical Package for the Social Sciences (SPSS) Version 21.0 (Armonk, NY: IBM Corp) was used for data analysis. Results: The mean age was 49.90 years for group A and 46.36 years for group B, respectively. The median pain score was 7 (4-10) in group A and 8 (5-9) in group B at baseline; at the end of 12 weeks, it was 2.5 (0-9) for group A and 0 (0-5) for group B (p-value=0.024). All the patients exhibited some level of response at the end of 12 weeks, with a Complete Response (CR) observed in 4 (20%) patients in group A, whereas it was seen in 14 (63.6%) patients in group B (p-value=0.004). Furthermore, there was a decrease in the consumption of analgesics in both groups from week 0 to week 4, with the median analgesic score changing from 2 (1-4) to 1 (0-3) in group A and from 3 (1-4) to 1 (0-2) in group B, without any significant difference between the groups (p-value=0.786). Conclusion: In comparison to radiotherapy alone, concurrent chemoradiation offers superior pain control and response rates in breast cancer patients with painful bone metastasis. Therefore, capecitabine administered concurrently with radiotherapy is safe for managing painful bone metastasis.

Impact of Clinical Pharmacological Intervention on Treatment Adherence among Adult Patients with Bronchial Asthma and COPD: A Randomised Clinical Study

Agnik Pal, Santanu Munshi, Santanu K Tripathi Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Adherence to the management of asthma and Chronic Obstructive Pulmonary Disease (COPD) is often suboptimal, which increases morbidity and mortality associated with these chronic respiratory diseases. The effectiveness of asthma and COPD education and self-management programmes on medication adherence and health outcomes is less well evaluated. Aim: To assess the impact of clinical pharmacological interventions, such as counselling and monitoring reinforcement, on treatment adherence in adult patients with asthma and COPD. Materials and Methods: This randomised clinical study was conducted in the Department of Clinical and Experimental Pharmacology, School of Tropical Medicine, Kolkata, Eastern India. Eighty screen-eligible patients were randomly divided into two groups: the Intervention Group (IG) and the Non Intervention Group (Non IG), and were followed-up bimonthly for one year. The intervention consisted of a basic introduction to asthma or COPD, factors causing exacerbations, prevention of attacks, appropriate inhaler use techniques, etc. The appropriateness of inhalation technique was assessed using a structured observation checklist and the Device Appropriateness Index (DAI). An 8-item Morisky Medication Adherence Scale (MMAS-8) was used to assess adherence. Additionally, the Adherence Index (AI) of the patients was calculated by multiplying the MMAS-8 score with the DAI score. Results: In the study, there were 29 (52.73%) males and 26 (47.27%) females in the asthma group, while the COPD group comprised 18 (72%) males and 7 (28%) females, with mean ages of 42.86±14.3 years in the asthma group and 51.12±8.6 years in the COPD group. The MMAS-8 score was found to be better in the IG compared to the Non IG, with statistically significant differences observed from the 4th follow-up visit onwards. By the 6th follow-up visit in the IG, 42.5% demonstrated high adherence and 57.5% showed moderate adherence, with no patients falling into the low adherence category. There was significant improvement in the DAI in the IG compared to the Non IG from the first follow-up visit onwards and this improvement persisted across all subsequent visits. Conclusion: The findings of the present study suggest that clinical pharmacological intervention is of great value in optimising treatment adherence among asthma and COPD patients, and it can be routinely incorporated into clinical care.

Insights into Disaster Management among Emergency Paramedical Staffs: A Cross-sectional Study at a Tertiary Care Hospital in Tamil Nadu, India

M Lavanya, K Bincy, Roshni Mary Peter, N Keerthana, MVM Pradeep Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Disasters can be natural (e.g., cyclones and earthquakes) or man-made (e.g., chemical spills). Unpredictable disasters and multifaceted damage necessitate that healthcare providers be prepared to manage victims with varying skills and care to mitigate the impact of these disasters. Aim: To assess various aspects pertaining to disaster preparedness and management among paramedical staff in the emergency department of a tertiary care hospital. Materials and Methods: A cross-sectional study was conducted in a tertiary care hospital in Chengalpattu, Tamil Nadu, India. Seventy paramedical staff members in the emergency department were included in the study and given a pretested semistructured questionnaire. The collected data was entered into Excel, and the associations between demographic factors and insights were measured using the Chi-square test in Statistical Package for the Social Sciences (SPSS) Version 27.0. Results: In this study, 44 (62.9%) participants were female. This study showed that 91.4% of the staff had adequate knowledge, while 82.9% demonstrated adequate practice. In the knowledge domain, there were no significant differences across demographic variables. However, in the practice domain, there was a significant difference based on gender (p-value<0.05). A significant association was found between knowledge and practice adequacy (χ²=26.91, p-value<0.001), indicating that staff members with adequate knowledge are more likely to practice adequately. Conclusion: This study concluded that the levels of knowledge and practice regarding disaster preparedness are adequate among the majority of staff. Management should organise medical education and training programs frequently to achieve standardised levels of preparedness.

Awareness of Stroke among the General Population of Arar City, Saudi Arabia: A Cross-sectional Study

Mohamed M Abd El Mawgod, Waleed Yousef Q Alanazi, Rakan Musharraf K Alanazi, Nasser Hamoud K Alanazi, Mohammed Fahad M Alfehaid Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Stroke is a critical global health problem. In Saudi Arabia, it is a major cause of morbidity and mortality that is becoming increasingly serious. Considering lifestyle changes that contribute to an increased risk of stroke in Saudi Arabia, a greater community understanding of stroke symptoms and risk factors may influence how promptly patients are treated. Aim: To assess the awareness of stroke symptoms, risk factors and complications among the study subjects. Materials and Methods: A cross-sectional study was conducted, including 500 adults from Arar City, the capital of Northern Saudi Arabia, from November 1, 2023, to April 30, 2024. The study was approved by the local bioethical committee of Northern Border University. Socio-demographic data, along with information on symptoms and risk factors, were collected. Statistical Package for the Social Sciences (SPSS) software version 26.0 was used for data analysis. The data was presented as frequencies and percentages. Results: A total of 500 respondents were included in the study; their mean age was 40.1±11.7 years, with about 299 (59.8%) being males. More than two-thirds were married (359, 71.8%), and the majority were university educated (445, 89%). Most respondents correctly identified that stroke can be haemorrhagic or embolic. Hypertension was the most frequently cited risk factor (456, 91.2%). Speech difficulty was the most reported symptom (359, 71.8%), followed by walking difficulty (358, 71.6%), disturbed vision (301, 60.2%), and sudden severe headache (288, 57.6%). Conclusion: The Northern Saudi population demonstrated a relatively good level of literacy regarding stroke risk factors, symptoms and outcomes. Awareness programs are suggested to improve the control of modifiable risk factors for stroke, such as hypertension, diabetes, obesity and smoking.

Surrogate Markers of Insulin Resistance to Predict the Prognosis of COVID-19 Disease: A Retrospective Analysis

Susmita Banerjee, Shuvankar Mukherjee, Sukla Mitra Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Coronavirus Disease-2019 (COVID-19) patients exhibit an extensive range of disease manifestations. Disturbances in metabolic and lipid profiles occur due to the release of cytokines. The lipid elements of the COVID-19 virus play a significant role in the fusion of the viral membrane to the host cell, in addition to replication. Although the COVID-19 scenario is multifaceted, high risks are observed in patients with co-morbidities such as Insulin Resistance (IR). Lipid ratios and the Triglyceride-Glucose index (TyG) could serve as simple biochemical markers of IR, thereby aiding in the assessment of prognosis in admitted COVID-19 patients, particularly those with comorbid conditions like IR. Aim: To assess the severity of COVID-19 infection based on lipid ratios and the TyG index. Materials and Methods: This retrospective study was conducted at Diamond Harbour Government Medical College and Hospital, 24 Parganas, West Bengal, India, data from 189 diagnosed COVID-19 patients, aged between 18 and 60 years in and around diamond harbour, were collected after obtaining the necessary ethical clearance. All the patients, including referred cases, were admitted to the COVID-19 ward of Diamond Harbour Government Medical College and Hospital. Data from biochemical tests, such as Fasting Blood Glucose (FBG), Total Cholesterol (TC), Triglycerides (TG), Low-Density Lipoprotein (LDL), High-Density Lipoprotein (HDL) and C-Reactive Protein (CRP), which were analysed using an autoanalyser (Transasia XL 640), were recorded. The lipid ratios and TyG index were calculated. The optimal cut-off values for all the above indices were derived from the point with the maximum Youden index by plotting the Receiver Operating Curve (ROC). Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) Software version 20. Results: The Fasting Blood Sugar (FBS), TG, TG/HDL, TC/HDL and TyG index levels were significantly higher in the severe COVID-19 patients (p<0.05). The optimal cut-off values calculated for the TyG index, TG/HDL and TC/HDL were 9.34, 3.55 and 3.83, respectively. Conclusion: In COVID-19 patients, a TyG index and lipid ratios of TG/HDL and TC/HDL exceeding 9.34, 3.55 and 3.83, respectively, could serve as early indicators of COVID-19 severity, thus assisting in the assessment of prognosis.

Comparative Analysis of Three Pain Scales for Evaluation of Procedural Pain in Neonates: A Cross-sectional Study

Preethi Subramanian, Sudharshan Raj Chitgupikar, Shreya Jalapu, Takreem Ilyas Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Neonates frequently undergo painful procedures in the Neonatal Intensive Care Unit (NICU), necessitating reliable Pain Assessment Tools (PAT). While various pain scales exist, no single tool is universally accepted due to differences in validity and clinical applicability. Aim: To compare the validity and internal consistency of Neonatal Infant Pain Scale (NIPS), Premature Infant Pain Profile Assessment Revised (PIPP-R), Douleur Aigue Nouveau-né (DAN) scale, for assessing procedural pain in neonates before, during and after a heel prick procedure. Materials and Methods: A cross-sectional study was conducted among 60 term neonates in a rural teaching hospital. The neonates underwent a heel prick procedure and pain scores were assessed using NIPS, DAN and PIPP-R at four time points: baseline, 30 seconds, two minutes and four minutes postprocedure. Construct validity was evaluated using repeated measures Analysis of Variance (ANOVA), concurrent validity by Pearson correlation and internal consistency by Cronbach’s alpha. Coefficient of variation was analysed to assess scale precision. Results: All three pain scales demonstrated peak pain scores at 30 seconds postheel prick, with a subsequent decline over time. NIPS and DAN exhibited high concurrent validity (r=0.939 at 30s, r=0.860 at 2 minutes). Cronbach’s alpha for NIPS, DAN and PIPP-R at 30 seconds was 0.808, 0.919 and 0.805, respectively, indicating high internal consistency. The removal of physiological parameters (heart rate, SpO2) from PIPP-R significantly improved its internal consistency (Cronbach’s alpha increased from 0.805 to 0.917 at 30s and from 0.822 to 0.906 at 2 minutes), whereas using only physiological parameters yielded low or negative alpha values. PIPP-R had the lowest coefficient of variation, indicating the highest precision, while DAN had the highest. Conclusion: NIPS and DAN have good concurrent validity between them. PIPP-R had the least coefficient of variation and hence most precise. DAN has high internal consistency across the timelines.

Morphometric Analysis of the Proximal and Distal Ends of Adult Dry Femur Bone: A Cross sectional Study in the Population of North Karnataka, India

Shilpa M Bhimalli, Agamdeep Singh Bedi, Mugdha Malik, Vinod Chandgadkar, Sheetal V Pattanshetti, Daksha Dixit Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Orthopaedic surgeons require anatomical knowledge of the proximal and distal ends of the femur when performing knee replacement or knee arthroplasty procedures. The application of morphometric analysis is advantageous to biochemical research. It enhances the understanding of many other factors that influence bone, such as its strength, structural integrity, and functions. Aim: To quantify the morphometric parameters of the proximal and distal ends of the adult femur, including measurements of size, shape, and angular relationships. Materials and Methods: A cross-sectional study on 102 adult dry femur bones of unknown gender and age collected from Department of Anatomy, JN Medical College, Belagavi, Karnataka, India from October 2024 to January 2025. The femur specimens were analysed using different methods. This includes osteometric board, Vernier caliper, Goniometer and thread. The data collected was statistically analysed using software International Business Machine (IBM) Statistical Packages of Social Sciences (SPSS) Statistics 27.0. Results: The current study found that the average femur length was 433±31.3 mm. The proximal part of femur showed femoral torsion averages 19.63±4.3 degrees, while the Neck Shaft Angle (NSA) has a mean of 125.35±16.86 degrees. Transverse diameter of head (in mm) measured 39.59±3.78 mm, and neck (mm) 25.65±3.42. Vertical diameter of head (in mm) is 40.01±3.69 and neck (in mm) is 29.44±4.07. The distal part of femur, showed bicondylar width (in mm), 66.41±7.46, intercondylar width (in mm) 21.32±5.03 and intercondylar depth (in mm) 24.97±2.54, medial condyle thickness (in mm) 23.84±3.86 and lateral condyle thickness (in mm) 23.93±3.16, medial condyle length (in mm) 56.06±4.77 and lateral condyle length (in mm) 57.29±4.21. Conclusion: The study’s measurements of the proximal and distal femur revealed population-specific values, particularly for North Karnataka. These findings have significant implications for forensic identification, anthropological studies, and clinical applications. Population-specific morphometric data enhances accuracy and relevance in these fields.

Impact of Intraoperative Colloid versus Crystalloid Administration on Postoperative Outcomes in Major Gastrointestinal Surgeries: An Interventional Study

Manoj Kumar, Jay Brijesh Singh Yadav, Himanshu Prince, Matendra Singh Yadav, Prashant Kumar Mishra, Purva Kumrawat, Meera Kumari, Raghvendra Singh Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Colloids and crystalloids are frequently used for fluid resuscitation. However, their differing physiological properties may impact postoperative outcomes in distinct ways. Emerging evidence indicates that these variations could play a role in influencing surgical morbidity. Aim: To evaluate the impact on postoperative outcomes using crystalloids and colloids intraoperatively in patients undergoing major surgeries. Materials and Methods: This double-blinded, interventional study was conducted from July 2019 to December 2020 at Department of Anaesthesiology, Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, Etawah, Uttar Pradesh, India. A total of 150 patients, aged 16-60 years, American Society of Anaesthesiologists (ASA) Grade I, II and III, undergoing elective major surgery were enrolled in the study and divided into three groups, with 50 patients per group: group RL (n=50), Group Hetastrach and Ringer’s Lactate (HS-RL) (n=50) and Group Tetrastarch and Ringer’s Lactate (TS-RL) (n=50). All patients received Ringer’s Lactate (RL) at a rate of 7.0 mL/kg/hour before induction. Intraoperatively, group RL received Ringer’s Lactate alone at a rate of 8.0 mL/kg/hour, group HS-RL received both Ringer’s Lactate and 6% hetastarch at a rate of 8.0 mL/kg/hour and group TS-RL received 6% tetrastarch and Ringer’s Lactate at a rate of 8.0 mL/kg/hour. The patients were observed for 8 days postoperatively for vital signs, Arterial Blood Gas (ABG) analysis, ambulation, Postoperative Nausea and Vomiting (PONV) and complications. The data were represented as mean standard deviations and percentages and analysed using the Statistical Package for Social Sciences (SPSS) version 20.0. A p-value of <0.05 was considered statistically significant. Results: Two patients were excluded from the study due to missing data in group RL (n=48). The demographic characteristics were statistically not significant among the groups (p-value>0.05). The proportion of patients who could ambulate independently or with assistance was higher in the HS-RL group 23 (46%) patients compared to the TS-RL group 16 (32%) patients, followed by patients in group RL (3 patients, 6.25%) (p-value <0.05). Intravenous fluids were administered to most patients for five days. Statistically, there was no significant difference among the groups (p-value=0.230). The data were represented as mean standard deviations and percentages and analysed using SPSS version 20.0. A p-value of <0.05 was considered statistically significant. Conclusion: Colloids are superior to crystalloids in terms of independent ambulation, ambulation with assistance, temperature regulation and reduction of nausea and vomiting. Overall, the present study concluded that colloids are able to effectively reduce postoperative complications more effectively than crystalloids without any serious side-effects.

Comparative Evaluation of Oral Melatonin versus Oral Alprazolam as Premedication in Patients Undergoing Tympanoplasty: A Randomised Control Study

Nupoor, Shikha Agarwal, Harsh Vardhan, Nikhil Nayar Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Preoperative anxiety is commonly experienced by patients who are admitted to hospital for any surgery and the role of premedication becomes important from an anaesthetist’s point of view, to relieve anxiety, provide sedation and ensure adequate analgesia. Aim: To compare the effects of oral melatonin versus oral alprazolam as premedication and their impact on postoperative recovery characteristics in patients undergoing tympanoplasty. Materials and Methods: In this randomised controlled study which was conducted from August 2022 to March 2024 at the Department of Anaesthesiology, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India, a total of 70 adult patients were randomly allocated into two groups. Group M (n=35) received oral melatonin 6 mg and group A (n=35) received oral alprazolam 0.50 mg 120 minutes before surgery. The objectives of the study were to compare anxiety, sedation, cognition and pain using the Visual Analogue Scale (VAS), Ramsay Sedation Score (RSS), Digit Symbol Substitution Test (DSST) score and Numerical Rating Scale (NRS), respectively. The Shapiro-Wilk test, Independent t-test, Chi-square test and Fisher’s-exact test were used for statistical analysis. Results: The age distribution, gender, body mass index, American Society of Anaesthesiologists (ASA) status and mean duration of surgery were comparable between the two groups. Mean VAS scores were significantly lower in group M at 60 minutes (3.03±1.29 vs 3.77±1.21) and at 120 minutes (2.17±1.12 vs 2.91±1.12). Even in the postoperative period, compared to group A, the VAS score was lower in group M after extubation at various time intervals. RSS scores were lower in group M compared to group A at 60 minutes and at 120 minutes of drug administration. In the postoperative period, compared to group A, group M had lower sedation scores after extubation at 30 minutes, 60 minutes, 90 minutes and 120 minutes (p-value <0.0001). Compared to group A, group M had statistically significantly higher DSST scores at various time intervals in both the preoperative and postoperative periods (p-value <0.0001). group M had significantly lower NRS scores after extubation at various time intervals (p-value <0.0001) compared to group A, indicating that pain was significantly lower in the postoperative period with the use of melatonin. Conclusion: Oral melatonin (6 mg) is shown to be an effective alternative to alprazolam (0.5 mg) as a premedication. Oral melatonin offered superior anxiolysis while inducing less sedation compared to alprazolam. In addition, there was better preservation of cognitive function with melatonin compared to alprazolam.

Evaluation of Chlorogenic Acid in Parkinson’s Disease Model: An In-vitro Study in 6-OHDA Induced SH-SY5Y Cell Line

Sunprakathi Alwarsamy Perumalsamy, Kranthi Karunai Kadal, Gowri Viswanathan, Kavitha Ramasamy Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Parkinson’s Disease (PD) is the most common neurodegenerative movement disorder. Mitochondrial dysfunction is a key pathological driver of PD. Pharmacological agents used in PD are not disease-modifying therapies and do not influence mitochondrial activity. Diets rich in polyphenols have been shown to prevent pathologies associated with ageing. Aim: To evaluate Chlorogenic Acid (CGA), a phenolic acid, for its neuroprotective effect against PD in a 6-Hydroxydopamine (6-OHDA) induced SH-SY5Y cell line using in-vitro assays. Materials and Methods: An in-vitro study was conducted at the Department of Pharmacology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India, from September 2023 to November 2023. The human neuroblastoma cell line SH-SY5Y was induced using 6-OHDA. The activity of CGA against cytotoxicity in the 6-OHDA induced SH-SY5Y cell line was evaluated using the MTT assay with different concentrations (3.125 μM, 6.25 μM, 12.5 μM, 25 μM and 50 μM). Mitochondrial Membrane Potential (MMP) was evaluated using flow cytometry and antiapoptotic activity was assessed using Cytochrome C immunofluorescence by fluorescence microscopy. One-way Analysis of Variance (ANOVA) with Tukey’s posthoc analysis was used to identify statistical significance at p-value <0.05. Results: The CGA exhibited the maximum protective concentration on the 6-OHDA induced SH-SY5Y cell line at 25 μM, with a restoration of cell viability of 43.04%. CGA also improved the mitochondrial membrane potential and reduced the levels of cytochrome C release thus maintaining the mitochondrial membrane integrity. Conclusion: The findings provide evidence that CGA may exert an anti-PD effect through its action on mitochondrial dysfunction and the release of pro-apoptotic factors. The observed action on neuronal cells makes CGA a potential candidate for anti-PD treatment.

Effect of Electrical Muscle Stimulation and Resistance Training on the Lipid Profile in Sedentary Type-II Diabetic Individuals: An Experimental Study

Vishwajeet Trivedi, Neelima Mishra, Kamran Ali Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Diabetes Mellitus (DM) is associated with dyslipidaemia, a major contributor to cardiovascular complications. Resistance Training (RT) is known to improve lipid metabolism, but adherence can be challenging. Electrical Muscle Stimulation (EMS) has emerged as a potential alternative, promoting muscle activation and metabolic improvements. Aim: To evaluate and compare the effects of EMS and RT on lipid profile parameters, including Total Cholesterol (TC), Low Density Liopprotein Cholesterol (LDL-C), High Density Liopprotein Cholesterol (HDL-C) and Triglycerides (TG), in sedentary individuals with diabetes. Materials and Methods: An experimental study with a pretest/post-test design was conducted in the Department of Physiotherapy at GD Goenka University, Gurugram, Haryana, India starting from October 2023 until September 2024. A total of 66 sedentary type II diabetic subjects (both males and females) with a fasting blood glucose level between 100 mg/dL and 250 mg/dL and on oral hypoglycaemic drugs, without any major systemic or diabetic complications, were included in the study. Subjects were assigned to three groups through a convenient sampling method: EMS, RT and a control group. The EMS group, with a mean age of 53.0±3.7 years, received Russian current stimulation on three alternate days per week for 12 weeks. The RT group, with a mean age of 52.0±4.84 years, performed progressive resistance exercises on three alternate days per week for 12 weeks, while the control group, with a mean age of 49.77±6.75 years, received standard patient education on diet and physical activity. Lipid profile parameters, including TC, HDL-C, LDL-C, Very Low Density Liopprotein Cholesterol (VLDL-C), TGs and cholesterol/HDL ratio, were assessed at baseline, postintervention (12 weeks) and after a three-month follow-up. The pre-post data for intervention groups were analysed using Analysis of Variance (ANOVA) at three time points with p-value <0.05. Results: Repeated measures ANOVA showed significant group-time interactions for TC (p-value <0.001, η²=0.348), LDL-C (p-value=0.003, η²=0.120), triglycerides (p-value <0.001, η²=0.213), HDL-C (p-value <0.001, η²=0.162) and cholesterol/HDL ratio (p-value=0.002, η²=0.194), while changes in VLDL were not significant (p-value=0.713). Pairwise comparisons indicated significantly lower TC, LDL-C and cholesterol/HDL ratio in the EMS and RT groups compared to controls (p-value <0.01), with no difference between EMS and RT (p-value >0.05). Triglycerides decreased significantly in both intervention groups (p-value <0.05), with EMS showing a greater reduction, though not statistically different from RT (p-value=1.000). HDL-C changes were minor and nonsignificant across groups (p-value>0.05). These findings suggest that both EMS and RT effectively improve lipid profiles, with RT favouring cholesterol modulation and EMS being more effective for triglyceride reduction. Conclusion: Both EMS and RT effectively improved lipid profiles in individuals with Type 2 Diabetes Mellitus (T2DM), with RT demonstrating superior benefits in reducing cholesterol and LDL-C, while EMS was more effective in lowering triglycerides. EMS may serve as a viable alternative for individuals with exercise limitations, offering a non pharmacological approach in managing diabetic dyslipidaemia.

Comparing Abdominal Circumference to Gastric Residual Volume for Assessing Feed Intolerance in Low Birth Weight Infants: A Prospective Cohort Study

B Sunil, R Sushmitha Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Babies with feed intolerance usually present with vomiting, abdominal distension and the presence of gastric residues. Feed intolerance can be clinically diagnosed through the assessment of prefeed Gastric Residual Volume (GRV), the colour of gastric aspirates, abdominal distension, emesis, bloody stools and increased apnoea and/or bradycardia. Aim: To evaluate prefeed Abdominal Circumference (AC) and GRV for feed intolerance in low birth weight infants and also to assess the time taken to achieve 150 mL/kg full feeds. Materials and Methods: This prospective cohort study was conducted in the Department of Paediatrics at the Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India, from January 2021 to June 2022. A total of 100 neonates weighing less than 2.5 kg were included in the study. Group 1 was subjected to measurement of prefeed AC, while group 2 was subjected to measurement of prefeed gastric aspirate as a measure of feed intolerance. Inferential statistics such as the Chi-square test, t-test and other appropriate tests were used whenever applicable. A p-value of less than 0.05 was considered statistically significant. Results: Between the two groups considered in the study, the mean age of infants in group 1 and group 2 were 34.48 days and 33.04 days, respectively, with a mean birth weight of 1.82 kg and 1.72 kg in group 1 and group 2, respectively. In the present study, nine infants were in group 1 and 14 infants were in group 2, both showing signs of feed intolerance. The mean time required to reach full feeds in infants of group 1 was 8.72 days, while in group 2, it was 10.88 days. Conclusion: Both AC and GRV are useful indicators of feed intolerance; however, AC shows better results in terms of achieving full feeds, feed tolerance and the period of recovery. Nonetheless, the results obtained in the AC group are not statistically significant compared to the results obtained from the prefeed gastric aspirate group.

Intralesional Bleomycin in Periungual Warts: A Prospective Randomised Controlled Study

Kallolinee Samal, Nibedita Dixit, Srigopal Mohanty, Debjit Kar, Siddhartha Dash, Manoj Kumar Nayak Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Periungual Warts (PW) are difficult to treat because of their challenging location, high recurrence rate and resistance to treatment. Bleomycin is a cheaper and readily available drug that has potential efficacy in treating warts, although limited data on its use are available in the literature. Aim: To study the efficacy and safety of Intralesional (IL) bleomycin in treating PW. Materials and Methods: A prospective randomised controlled study was conducted at the Department of Dermatology, SCB Medical College and Hospital, Odisha, India, from September 2019 to August 2020. A total of 56 patients with PW were randomised equally by block randomisation into two groups: Group A and Group B. Group A received 1 U/mL IL bleomycin, while Group B was given dH2O. Follow-up assessments were conducted at four, twelve and 24-week intervals. All follow-up visits included photographic documentation to confirm the cure rates before and after treatment. To evaluate the treatment’s safety and effectiveness, the number and size of wart lesions, as well as injection side-effects, were noted at baseline and during each follow-up visit. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 26.0 (SPSS Inc., Chicago, IL). The Chi-square test was used to compare the study and control groups and to conduct follow-up analysis. Statistical significance was set at a level of ≤0.05, with a confidence interval of 95%. Results: Group A and B patients had 54 and 42 wart lesions, respectively. The complete cure rate in Groups A and B was 74.1% (40/54 warts) and 4.8% (2/42 warts), respectively, after four weeks. After the second follow-up, at twelve weeks, the cure rate was significantly higher in the experimental group: 97.3% versus 4.76% (p=0.00001). All cases during the IL injection experienced pain at the injection site and haemorrhagic eschar was observed in every case within the first week of the IL injection. No significant systemic adverse effects were noted. Conclusion: Intralesional bleomycin is highly efficacious and safe for the treatment of warts. Systemic side-effects are negligible, making it an effective treatment option for clearing warts in difficult areas, such as PW.

Comparative Evaluation of Two Audio-analgesic Tracks on Reduction of Anxiety Level in Patients Undergoing Root Canal Treatment: A Randomised Clinical Study

Ajay Singh Rao, Namrata Bajpai, Nimisha Chinmay Shah, Deebah Choudhary, Meetu Mathur, Vishnu Pratap Singh Rathore, Ridhhi Vasa Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Patients often experience dental anxiety, which can range from mild apprehension to severe phobia. In addition to pharmacological treatments, methods like sedation, aromatherapy, behavioural techniques, and music therapy have proven effective in reducing anxiety. Music, in particular, has been well-studied in clinical settings. Aim: To compare the reduction in anxiety levels of patients undergoing endodontic therapy with two different audio-analgesic tracks. Materials and Methods: This randomised clinical study was carried out in the Department of Conservative Dentistry and Endodontics at KM Shah Dental College and Hospital, Vadodara, Gujarat, India, from May 2019 to November 2019. A total of 120 patients were enrolled in the study. Before initiating endodontic therapy, patients were assessed for baseline anxiety using the Visual Analogue Scale (VAS), along with measurements of Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Pulse Rate (PR). Participants were randomly divided into three groups: Group A: Om chanting music; Group B: weightless music; and Group C: control (no music). Vitals (SBP, DBP, PR) were recorded at three intervals: before treatment, at 30 minutes, and at one hour. The results were then statistically analysed using Statistical Packages of Social Sciences (SPSS) software version 22.0, employing the Analysis of Variance (ANOVA) test and Tukey’s Post-hoc analysis. Results: Out of the 120 patients, 82 (68.33%) were male and 38 (31.66%) were female, with a mean age of 35 years. The results indicated that SBP was significant during (p=0.004) and after treatment (p=0.002). Additionally, DBP was significant after treatment (p=0.037). PR was highly significant before, during, and after treatment (p<0.001 for all). The differences in SBP between groups B and C during treatment (p=0.003), as well as between groups A and C (p=0.004) and groups B and C (p=0.008) after treatment, were statistically significant. Additionally, a significant difference in DBP was observed between groups A and C after treatment (p=0.043). However, no significant differences in Heart Rate (HR) were found before, during, or after treatment among the groups (p>0.05). Conclusion: In the present study, both music tracks demonstrated clinically and statistically acceptable performance compared to the control group, with the Om chanting track having a more substantial influence on anxiety levels, SBP, and DBP than the weightless track. Additionally, there was a significant difference in HR, indicating the efficiency of music in reducing anxiety during dental treatment.

Factors Influencing Binge-watching Behaviour and its Impact on Loneliness among Undergraduate Medical Students: A Cross-sectional Study from Chengalpattu District, Tamil Nadu, India

R Suba Shree, P Kaveri, Roshni Mary Peter, VV Anantharaman, M Logaraj Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Binge-watching, a common behaviour among youth, is especially prevalent among medical students due to academic pressures and the accessibility of streaming services. This behaviour may lead to potential mental and physical health impacts. Aim: To assess the prevalence of binge-watching and identify associated risk factors among undergraduate medical students. Materials and Methods: A cross-sectional study was conducted among MBBS students in Chengalpattu, Tamil Nadu, India using multistage sampling. A total of 400 students were selected through simple random sampling. Socio-demographic details, including age, gender, family type, residence, year of study and risk factors for binge-watching (such as sleep duration, participation in recreational activities, Over-The-Top (OTT) platform subscription status, the number of OTT platforms subscribed to, frequency of binge-watching, devices used for binge-watching and consumption of snacks or junk food during binge-watching), were gathered using a pretested semistructured questionnaire. The University of California, Los Angeles (UCLA) Loneliness Scale and the Binge-watching Addiction Questionnaire assessed loneliness and binge-watching behaviour. Statistical analysis included mean and standard deviation, independent t-tests for continuous variables, Chi-square tests, univariate regression for categorical variables, and binary logistic regression for significant variables (p-value<0.05) to control for confounders. Results: The participants had a mean age of 20.71±2.04 years, with the majority being females (58.6%) and from nuclear families (86.1%). Most students (84.4%) had subscriptions to OTT platforms, with 50.8% binge-watching more than twice a week. The prevalence of binge-watching was 64% (381 participants). The overall mean binge-watching score was 33.14±13.012. Mild binge-watching was observed in 172 students (70.5%), moderate binge-watching in 53 students (21.7%), and problematic binge-watching in 19 students (7.8%). The overall mean loneliness score was 44.44±9.39. Univariate analysis identified significant associations between problematic binge-watching and being a hosteller, lack of recreational activities, OTT platform subscription and consumption of snacks or junk food. Binary logistic regression revealed significant associations between problematic binge-watching and factors such as the absence of recreational activities (AOR=2.298, p-value=0.012) and consuming snacks (AOR=2.518, p-value=0.006). Higher loneliness scores were significantly associated with problematic binge-watching (46.67±8.85) compared to mild binge-watching (43.51±9.47) (p-value=0.016). Conclusion: The study revealed a high prevalence of binge-watching among medical students, which was linked to loneliness and a lack of recreational activities. This emphasises the need for awareness and interventions to promote balanced media consumption.

Molecular Evidence of the High-risk Human Papillomavirus 56 Genotype in Cervical Abnormalities using Multiplex Nested PCR Assay: A Cross-sectional Study from a Tertiary Care Center in Puducherry, India

A Mashila, R Prabha, R Ramya, Rupal Samal, M Balasubramanian, S Sowmya, J Pradeep Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Human Papillomavirus (HPV) is a group of Deoxyribonucleic Acid (DNA) viruses linked to both benign and malignant diseases. High-Risk (HR) HPV genotypes, especially HPV 16 and HPV 18, are key contributors to cervical cancer. Aim: To determine the prevalence of HR HPV genotypes, including HPV 16, 18, 31, 45, 51 and 56, in cervical abnormalities in women by comparing cytological Pap smear results with in-house Multiplex Nested Polymerase Chain Reaction (PCR) to refine diagnostic protocols. Materials and Methods: A cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, tertiary care hospital and the Mahatma Gandhi Medical Advanced Research Institute, Puducherry, India over a period of six months, from November 2023 to May 2024. The study included 100 symptomatic women presenting with complaints such as vaginal discharge, abnormal bleeding and pelvic pain. OBG endocervical samples were cross checked against cytological pap smear and multiplex nested PCR. The PCR amplified products were further confirmed by bidirectional Sanger sequencing. The sequenced data were analysed and annotated using MEGA software version 10.0 and submitted to the National Centre for Biotechnology Information (NCBI) database. Results: A total of 100 samples were analysed, with 14 (14%) detected as HPV DNA in symptomatic women. HPV 16 was observed in four patients (28.57%), followed by HPV 56 in four patients (28.57%). HPV 18 and HPV 31 were detected in two patients each (14.29%), while HPV 45 and HPV 51 were observed in one patient each (7.14%). Symptoms such as abnormal vaginal bleeding, pelvic pain and vaginal discharge were predominant with specific HPV genotypes. The detection limit of Multiplex Nested PCR was higher than that of the Pap smear. Co-infections with organisms like Candida albicans and Trichomonas vaginalis were noted in HPV-negative cases. The sequenced samples were published with GenBank accession numbers PQ518860 – PQ518863. Conclusion: While nested PCR exhibited higher sensitivity compared to the Pap smear, this study concludes that routine HPV genotyping and cytology screening for HR HPV strains are essential to improve early diagnosis and prompt treatment outcomes in HR groups.

Assessment of Bite Force in Patients with Periodontitis Before and after Splinting in Anterior Teeth using Computerised Occlusal Analysis System: A Clinical Study

Sathyalakshmi Ravikumar, Dhanvanthraj Venkatesan, Tarunkumar Kanmani, Rajalakshmi Ashokkumar, Vamsi Lavu Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Bite force is a measure of the functional status of the masticatory system. It is determined by the combined activity of the jaw elevator muscles, which are influenced by reflex mechanisms and jaw biomechanics. Measuring bite force can yield valuable information for assessing the activity and function of the jaw muscles. Recording devices and techniques are important factors in obtaining bite force measurements. Aim: To compare the occlusal function in terms of changes in bite force parameters before and after the splinting of periodontally weakened anterior teeth using the NUPAI bite scan (Fuji™) method in patients with stage I and II periodontitis. Materials and Methods: This prospective clinical study was conducted in the Department of Periodontology at Sri Ramachandra Dental College and Hospital, Chennai, Tamil Nadu, India between May 2023 and February 2024. The bite force parameters assessed included pressed area, average pressure, and maximum pressure using the NUPAI bite scan (Fuji™) in a total of 25 individuals before and after extracoronal splinting of periodontally weakened anterior teeth. Statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) version 20.0, and data were summarised as mean and standard deviation. A paired t-test was conducted to find significant differences in the various variables within the group. A p-value of less than 0.05 was considered statistically significant. Results: Maximum bite pressure and average bite pressure were found to be greater after the procedure of extracoronal splinting compared to before splinting, with mean values of 26.59±4.32 MPa (before splinting) and 30.45±4.29 MPa (after splinting) (p-value=0.005), and 9.11±1.75 MPa (before splinting) and 9.86±1.83 MPa (after splinting) (p-value=0.015), respectively. However, the mean pressed area before and after the splinting procedure was 22.76±34.49 mm² and 19.00±19.40 mm², respectively, showing no statistically significant difference between them (p-value=0.323). It can be inferred that, without appreciably altering the contact area, the splinting technique successfully increased bite force by improving both maximum and average pressures. Conclusion: The present study concluded that the splinting procedure used in phase I therapy aids in improving the patient’s occlusal function, and the NUPAI bite scan system allows for quantitative recording of this improvement.

Correlation of Preoperative Scoring System with Intraoperative Scoring System for Predicting Difficult Laparoscopic Cholecystectomy: A Research Protocol

Amol Ashok Gupta, Swati Deshpande Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: Laparoscopic Cholecystectomy (LC) is the gold standard of care for benign gallbladder disease. The incidence of conversion from LC to open cholecystectomy is 14.3%. A high degree of anatomical variation exists in the cystic duct, cystic artery and gallbladder, making this surgery challenging at times, even in the hands of the most experienced surgeons. Need of the study: Understanding the correlation between the preoperative score and the intraoperative score early in the disease course can facilitate timely conversion to open surgery, thereby reducing the risk of inadvertent injury. Additionally, this approach can improve the efficiency of operating room scheduling and ensure that a more skilled laparoscopic surgeon is available. Furthermore, it can assist surgeons in managing complications or legal issues that may arise postoperatively. Aim: This study aims to assess the correlation between preoperative grading and an intraoperative scoring system to forecast difficulties in LC and the potential for conversion to open cholecystectomy. Materials and Methods: A prospective observational study will be conducted in the inpatient department of General Surgery at Acharya Vinoba Bhave Rural Hospital (AVBRH) in Sawangi, Wardha, Maharashtra, India, from March 2024 to February 2026. A total of 35 patients with cholelithiasis will be included in the study. Patients will be scored based on a preoperative scale (the Modified Randhawa scoring system) and counselled regarding the difficulty and possibility of conversion, which will then be correlated with an intraoperative score to assess their predictive value for the risk of conversion. The correlation between preoperative and intraoperative scores will be assessed using Pearson or Spearman correlation coefficients. For intergroup comparisons, the t-test or Mann-Whitney U test will be applied with a 5% significance level. Logistic regression models will be evaluated using the Hosmer-Lemeshow test and ROC curve analysis.

Melkersson-Rosenthal Syndrome: A Review of Clinical Presentation, Diagnosis and Management

Megha Tidke, Pramod Borghare, Piyush Pardhekar, Raza Salim Sheikh Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Melkersson-Rosenthal Syndrome (MRS) is a rare neuro-mucocutaneous disorder characterised by a triad of recurrent facial palsy, orofacial swelling and fissured tongue. The complete triad occurs in fewer than 25% of cases, complicating timely diagnosis and management. The present review focuses on the clinical features, diagnostic difficulties and management approaches of MRS, hence establishing its clinical relevance and treatment results. A literature survey is conducted based on case reports, clinical trials and MRS reviews. The approach towards the diagnosis and different modes of treatments with multidisciplinary management analysis, is done. MRS is a condition with some diagnostic difficulties because it often presents variably and even mimics other diseases like angioedema, Bell’s palsy and Crohn’s disease. The gold standard of histopathology is the presence of non caseating granulomas. The acute symptoms can be treated with corticosteroids, as early as 30 to 60 mg/day; however, long-term treatment has to be avoided because of complications such as osteoporosis. Immunocompressants, like methotrexate and azathioprine, are used in refractory cases. Some of the considerations and measures would be surgical interventions, cheiloplasty and nerve decompression. However, these are risky to be accompanied by scarring, nerve damage, recurrence of symptoms and so on. A multidisciplinary approach involving dermatologists, neurologists and psychologists is critical for improving patient outcomes and quality of life. In conclusion, MRS remains a diagnostic and therapeutic challenge because of its persistence and various presentations. Accurate and early diagnosis, immediate intervention and a multidisciplinary approach to treatment will be necessary to prevent complications. Future studies on the genetic and immunological basis of MRS will help develop better diagnostic and therapeutic options.

A Narrative Review on Microbial Biofilm Formation in Septicaemia due to Gram-negative Bacteria: A Cause of Concern

Akoijam Nisha Devi, Gargi Mudey, Dipika Shaw, Shahin Vishani, Anjali Patond Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Septicaemia, or bloodstream infection, is a serious condition associated with high morbidity and mortality. Gram-negative bacteria, particularly Enterobacterales, are the primary causative agents of septicaemia. Globally, there is an increasing prevalence of antibiotic-resistant gram-negative bacteria reported in bloodstream infections. One of the major mechanisms of antibiotic resistance in gram-negative bacteria is their ability to form biofilms. Biofilms facilitate the transfer of Antimicrobial Resistance (AMR) genes among the bacteria present within the biofilm. Biofilm formation poses a challenge for treatment management; additionally, biofilms protect the bacteria from antibiotics and the host immune response, thus helping the organisms to establish resistance to antibiotic agents. To date, no conclusive strategies or appropriate agents are available to combat bacteria in microbial biofilms formed inside the human host. The best way to fight biofilm-forming bacteria is to prevent infection and eradicate it before biofilms are formed by following proper preventive measures and using appropriate antibiotics. This review article aims to help readers understand the complex relationship between biofilm-forming ability and AMR among gram-negative bacteria causing septicaemia. Furthermore, the review explores the impact of biofilm formation on the pathogenesis of septicaemia and discusses strategies and agents to prevent and combat biofilm formation.

Applicability of Next-generation Sequencing Techniques in Assessing Non-alcoholic Fatty Liver Disease: A Comprehensive Review

Ali Mahzari Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Non-alcoholic Fatty Liver Disease (NAFLD) is a burgeoning global health concern, with a spectrum of severity ranging from simple steatosis to Non-alcoholic Steatohepatitis (NASH). While liver biopsy remains the gold standard for diagnosis, the need for non invasive alternatives has spurred interest in Next-generation Sequencing (NGS) technologies. NGS technologies enable the simultaneous sequencing of millions of Deoxyribonucleic Acid (DNA) or Ribonucleic Acid (RNA) fragments, providing a high-throughput approach to analyse genetic variations, gene expression and epigenetic modifications. A comprehensive literature search was conducted to identify studies investigating the use of NGS in NAFLD. Data extraction focused on NGS techniques, study design, key findings and clinical implications. NGS has demonstrated potential in unraveling the complex genetic and molecular underpinnings of NAFLD. The identification of genetic variants, epigenetic modifications and non coding RNA alterations has advanced our understanding of disease pathogenesis. Moreover, NGS-based approaches have shown promise in differentiating NAFLD subtypes and predicting disease progression. However, challenges related to data analysis, standardisation and clinical translation persist. NGS offers a promising avenue for improving NAFLD diagnosis, prognosis and management. While significant advancements have been made, further research is needed to fully realise its clinical potential.

Artificial Intelligence in Paediatric Urology: Transforming Diagnosis and Treatment

Wesam Khan Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Artificial Intelligence (AI) is revolutionising healthcare, including paediatric urology. Paediatric urology has played a crucial role in the development of clinically relevant AI models. This narrative review explores the applications, benefits and challenges of AI in paediatric urological diagnosis and treatment. It aims to determine the current state of AI in paediatric urology, identify key applications, evaluate their impact on clinical outcomes and explore potential future directions. The literature search was extensively conducted using the PubMed, Scopus and Web of Science databases. The findings from the literature search indicate that AI has the potential to significantly improve paediatric urological care by providing more accurate diagnosis, optimising treatment decisions and enhancing surgical outcomes. However, challenges such as data quality, model generalisability and ethical implications must be resolved for widespread implementation.

Phytotherapeutics for Wound Healing: A Systematic Review on Effectiveness of Indian Herbal Extracts in Rat Models

Nitesh Laxman Shambharkar, Pramod Khobragade Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Wound healing is a multifaceted process that encompasses a coordinated set of chemical and cellular events aimed at restoring the integrity of the skin and underlying tissues. Globally, many individuals turn to medicinal plants as an alternative therapy for this purpose. The present review focuses on evaluating the in-vivo wound healing activity of herbal plant extracts native to India, comparing them with povidone-iodine. Plant extracts show potential as promising wound healing agents due to their rich active compounds, wide availability and low risk of side-effects. Data were gathered from various sources, including scientific databases such as Google Scholar, PubMed and ScienceDirect. Keywords such as “wound healing,” “animal studies,” “herbal,” “Wistar albino rats,” “India,” and “Ayurvedic” were used to identify relevant articles, which were then analysed. The present review compiles data from articles published over the past 14 years on the in-vivo wound healing potential of medicinal plants in rats, with povidone-iodine consistently used as a reference in these studies. The findings highlight the potential of medicinal plants to contribute to drug discovery as effective wound healers, which may lead to the development of new, safe drug molecules. Further research is required, including novel formulations and targeted drug delivery systems, alongside clinical trials, to scientifically validate these findings and transition them from the laboratory to industry for broader societal benefit.

The Upbringing of Children with the Help of Ayurveda Principles: A Narrative Review

Arun Naphe Khatri, Rahul Jumle Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X In the contemporary world, parenting faces unique challenges due to technological advancements and lifestyle changes, leading to the need for a holistic approach to child-rearing. Ayurveda, an ancient system of natural medicine, offers valuable insights into enhancing children’s physical, mental, and emotional well-being. The present review explores how understanding a child’s Doshic constitution (Prakriti) can guide parents in providing personalised care, including tailored nutrition, daily routines, and activities that support optimal health. Ayurvedic practices, such as herbal remedies and mindfulness techniques, can help address common childhood concerns and promote balance and resilience. By integrating these principles into modern parenting practices, Ayurveda provides a time-tested framework that fosters the overall well-being of children.

Clinical Evaluation of Vajigandhadi taila matrabasti versus Sahacharadi taila matrabasti in the Management of Gridhrasi (Sciatica): A Study Protocol

Anil Ambadas Bhawade, Shweta Dadarao Parwe Journal of clinical and diagnostic research : 2025 - June - 19:0973-709X Introduction: In Ayurveda, Basti, or medicated enema, is recognised as a crucial component of Panchakarma, constituting half of the therapeutic approach. Matra Basti, a specific form of Basti Karma, is particularly effective in addressing disorders related to the nervous system, neuromuscular conditions and nutritional imbalances. Gridhrasi, commonly known as sciatica, is characterised by pain that extends from the lower back to the legs. These conditions frequently develop due to a variety of factors, such as poor sitting posture, excessive physical strain and a sedentary lifestyle. Need of the study: In Ayurvedic practice, different medicated oils are prescribed based on the patient and the specific disease condition. Both Vajigandhadi oil and Sahacharadi oil are Ayurvedic formulations recommended for the treatment of Gridhrasi (sciatica) through per rectal administration. However, the comparative efficacy of these two oils in alleviating sciatic pain remains unclear. To address this knowledge gap, the present study will be conducted. Aim: To compare the efficacy of Vajigandhadi taila matrabasti (a form of unctuous enema) with Sahacharadi taila matrabasti (another form of unctuous enema) for the management of Gridhrasi (sciatica). Materials and Methods: A randomised controlled clinical trial will be conducted at MG Ayurved College, Hospital and Research Centre located in Salod (H), District Wardha, Maharashtra, India, from December 2022 to December 2025. In this study, a total of 80 participants will be randomly assigned to two groups, each consisting of 40 patients. Participants in group A will receive a Vajigandhadi taila matrabasti (a type of unctuous enema) at a dosage of 72 mL, administered rectally after meals for 14 days. Conversely, group-B will receive a Sahacharadi taila matrabasti (an unctuous enema) at the same dosage and administration schedule. Parameters will be assessed on the initial day, the 14^th day and again after 30 days for follow-up purposes. Statistical analysis will be conducted using R (version 4.3.2) software. Objective parameters will be analysed using Independent t-tests, while subjective parameters will be analysed using Chi-square tests. Results will be presented as mean and standard deviation, with statistical significance at p-value <0.05.