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

Delayed Onset of Linezolid-induced Peripheral Neuropathy: A Case Report and Review with Symptom of Atypical Timeframes

Swapnil N Deshmukh, Ronak Agarwal, Vasu Agarwal Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Linezolid, a key drug in Multidrug-resistant Tuberculosis (MDR-TB) treatment, is known for its efficacy but is frequently associated with peripheral neuropathy, particularly with prolonged use. The authors hereby present a case of a 17-year-old young female diagnosed with extra-pulmonary MDR-TB, who developed delayed-onset peripheral neuropathy after five months of Linezolid therapy. She initially tolerated an all-oral longer regimen, including Bedaquiline, Linezolid, Cycloserine, Clofazimine, Levofloxacin and Pyridoxine. However, she later reported tingling and numbness in both lower limbs, with hyperesthesia. A neurological examination confirmed sensory axonal neuropathy. Linezolid was discontinued, leading to symptomatic improvement. To confirm, a rechallenge was performed, starting with 300 mg once daily and increasing to 600 mg once daily. Within a week, symptoms recurred, reinforcing the diagnosis of Linezolid-induced Peripheral Neuropathy (LIPN). The drug was permanently discontinued and replaced with Pyrazinamide as per Programmatic Management of Drug-resistant Tuberculosis (PMDT) guidelines. Despite its importance in MDR-TB management, there is a lack of standardised protocols for monitoring and mitigating LIPN. Future research should focus on dose-response relationships, adjunctive therapies and biochemical markers such as folate, homocysteine and oxidative stress indicators to refine treatment strategies. A balanced approach is crucial to ensuring efficacy while minimising neurotoxicity. The present case highlights the need for stringent neurological monitoring and individualised treatment adjustments in patients receiving prolonged linezolid therapy.

A Rare Case of Anti Neutrophil Cytoplasmic Antibody Associated Vasculitis Presenting as Pyelonephritis

Chetan Phadke, Shreeharsh Godbole Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Anti-Neutrophil Cytoplasmic Antibody (ANCA) Associated Vasculitis (AAV) is a condition affecting small and medium-sized vessels, predominantly impacting the kidneys. Microscopic Polyangiitis (MPO) is primarily associated with antibodies to myeloperoxidase. MPO frequently presents as glomerulonephritis, but pyelonephritis has not been mentioned hitherto in the literature as an initial presentation. Granulomatosis with Polyangiitis (GPA) is known to present as pyelonephritis, but not MPO. Such an unusual presentation may masquerade as an infectious condition when the underlying cause may, in fact, be an autoimmune one. This case report concerns a patient who presented with pyelonephritis. The patient also exhibited lung involvement that appeared to be pneumonia. Sepsis was suspected initially, and antibiotics were commenced. He also experienced renal failure and required haemodialysis. As the condition did not resolve, extensive investigations were conducted. An autoimmune panel and a renal biopsy revealed AAV as the underlying condition. Prompt treatment with glucocorticoids and rituximab resulted in a dramatic improvement in the patient’s condition. The patient did not require further haemodialysis, and he subsequently recovered and was discharged. The patient is on regular follow-up and requires only a small maintenance dose of prednisone. This case report demonstrates that pyelonephritis may not always have an infection as its underlying cause. A high index of suspicion for an autoimmune cause may result in early treatment and can be life-saving.

Diverticulitis Leading to Caecal Perforation with Retroperitoneal Abscess: A Case Report

Anuradha Dnyanmote, Saicharan Reddy Nagarla, Kuldip Patil Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Diverticulitis, a condition predisposing to inflammation or infection, presents with clinical similarities to acute appendicitis and is associated with an increased risk of perforation. This case report details a 25-year-old male presenting to the emergency department with a perforated appendix and suspected caecal perforation, diagnosed via Ultrasound (US) and Computed Tomography (CT) scans. Emergency surgery revealed gangrenous changes in the caecum, a base-of-appendix perforation, and a leaking retroperitoneal abscess. Surgical intervention involved resection of the appendix, caecum, and a segment of the ascending colon, with ileo-transverse anastomosis and a temporary ileostomy. Post-surgery, the patient showed symptomatic improvement. This case highlights the crucial need for prompt diagnosis and surgical intervention in managing complex scenarios involving retroperitoneal abscesses and associated complications.

Mini-Open Double-row Subscapularis Repair with Biceps Tenodesis for a Missed Lafosse Type 3 Subscapularis Tear with Biceps Subluxation: A Case Report

MJ Abhinand, B Vijayanand, S Karthikeyan, Tathagath Tiwari Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X The accuracy of diagnosing full-thickness Subscapularis (SSC) tendon tears depends on the presence or absence of Long Head of Biceps Tendon (LHBT) and subluxation is quite variable. This case report outlines a middle aged man with symptomatic medial dislocation of the long head of the biceps with associated rotator cuff injury. Magnetic Resonance Imaging (MRI) of the left shoulder reported hyper intensity of SSC tendon and long head of biceps tendon rupture. Patient successfully underwent diagnostic arthroscopy with mini-open double row repair of the subscapularis with biceps tenodesis at the base of the bicipital groove. Patient regained full and painless Range Of Motion (ROM) following six months of surgery. SSC tear can be easily missed even in MR imaging studies by radiologist. Clinical expertise is required for shoulder examination and when combined with MR study can help in identifying the lesion accurately.

Stenotrophomonas Maltophilia Pneumonia in a COPD Patient with Left Atrial Myxoma: A Case of Rare Clinical Presentation

Ronak Prakashkumar Shah, Parth Rohitkumar Shah Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Stenotrophomonas maltophilia (S.maltophilia) is an emerging multidrug-resistant pathogen, often implicated in respiratory infections in patients with chronic lung disease. The present case report presents a unique association between S. maltophilia pneumonia and an incidental left atrial myxoma, contributing to respiratory distress. Hereby, the authors present a case report of a 52-year-old male with Chronic Obstructive Pulmonary Disease (COPD) presented with bilateral lower limb oedema, progressive dyspnoea, productive cough, and intermittent fever for 15 days. Upon admission, he exhibited tachycardia, tachypnoea, and hypoxaemia (SpO2 88% on room air). Chest examination revealed bilateral wheezing and crackles. Investigations showed leukocytosis, elevated inflammatory markers, and an abnormal chest X-ray with fibrotic changes and minimal pleural effusion. Echocardiography identified a 3.5 cm left atrial myxoma prolapsing into the mitral valve, along with severe pulmonary hypertension. Contrast-enhanced CT (CECT) confirmed the myxoma and revealed emphysematous and pneumonic changes. The patient was initially managed as a case of acute community-acquired pneumonia with acute decompensated heart failure using broad-spectrum antibiotics, bronchodilators, steroids, and diuretics. Due to respiratory distress and type 2 respiratory failure, Bilevel Positive Airway Pressure (BIPAP) support was initiated. Sputum culture identified S. maltophilia, which was sensitive to Trimethoprim-Sulfamethoxazole (TMP-SMX), leading to a targeted antibiotic regimen. The patient showed significant clinical improvement, allowing for weaning from BIPAP and oxygen support. Once stabilised, he was referred for surgical resection of the left atrial myxoma. The present case emphasises the importance of early recognition and targeted treatment of S. maltophilia pneumonia in COPD patients. Additionally, it highlights the role of comprehensive cardiovascular assessment in patients with persistent respiratory symptoms.

An Unusual Presentation of Idiopathic Pulmonary Arterial Hypertension in a Young Male: A Case Report

Vishnu Prabhakar, KP Shaily, Sachinkumar Dole, Manosri Mandadi Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Idiopathic Pulmonary Arterial Hypertension (IPAH) is a progressive disease of the pulmonary vasculature without any known underlying risk factors. For the diagnosis Pulmonary Artery Hypertension (PAH), the mean Pulmonary Artery Pressure (mPAP) should be persistently more than 20 mmHg at rest. Early diagnosis, along with investigations like 2D Echocardiography (ECHO) and right heart catheterisation, and prompt treatment, are essential for the management of PAH. Drugs such as endothelin receptor blockers, phosphodiesterase inhibitors, and calcium channel blockers are used for treatment. Hereby, the authors reported an unusual case of IPAH in a young male, with haemoptysis being the predominant presenting complaint. A 24-year-old male patient presented with the primary complaints of streaky haemoptysis and dyspnoea. He had multiple hospital admissions for similar episodes of haemoptysis in the past, which had been managed symptomatically. After conducting a thorough investigation and detailed work-up, he was diagnosed with idiopathic PAH. The patient showed symptomatic improvement, with resolution of haemoptysis and dyspnoea, after initiating treatment.

Right Testicular Vein Draining into Right Renal Vein: A Case Report

Santanu Kumar Sarma, Alakesh Gogoi, Jayasri Devi Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X During routine dissection of an adult male cadaver about 50 years of age, the right testicular vein was seen to drain into the right renal vein at a right angle which is rare. At a 90° angle, the left testicular vein drain into the left renal vein. The caudal part of subcardinal vein is responsible for the development of gonadal vein and it drains into the supra-subcardinal anastomosis. In this exceptional case, the right supra-subcardinal anastomosis instead contributed to the formation of the right renal vein, which consequently received the right testicular vein. On the left side, the supra-subcardinal anastomosis is incorporated into the left renal vein, serving as the drainage site for the left gonadal vein. This pattern of drainage has to be kept in mind by the physicians as this may lead to varicocele on the right which may be implicated in male infertility.

Assessment of Knowledge, Awareness and Attitudes about the Risk of Periodontal Disease among Polycystic Ovarian Disease Patients Residing in Chennai, India: A Questionnaire based Cross-sectional Study

S Varsha, Jai Santhosh Manikandan, Makesh Raj, Sai Krishna, Hemalatha, Nanda Kumar, Pravina Fernando Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Polycystic Ovarian Disease (PCOD) has become one of the most prevalent conditions among females of reproductive age. Women with PCOD are at an increased risk of developing Periodontal Disease (PD). As PD may potentially lead to tooth loss, it is essential to create active awareness. Understanding the current levels of awareness among the public would help in formulating appropriate awareness protocols. Aim: To assess the knowledge, awareness and attitudes about the risk of PD among PCOD patients residing in Chennai. Materials and Methods: A descriptive cross-sectional survey was conducted in the Department of Oral Pathology at Tagore Dental College, Chennai, Tamil Nadu, India, from December 2022 to March 2023 with 375 female participants diagnosed with PCOD and living in Chennai. Purposive sampling was employed to select participants. Data were collected using both online and offline questionnaires over a study duration of five months after obtaining informed consent. The questions assessed the knowledge, awareness and attitudes regarding the risk of PD among PCOD patients. Data were collected using Excel and transferred to the Statistical Package for the Social Sciences (SPSS) version 24.0 for analysis. Categorical data were expressed in frequencies and percentages. Results: The study revealed that PCOD patients aged from 15 to 46 years, with a mean age of 22.25±5.03 years. Of the participants, 82.9% brushed their teeth once a day and 78.6% never flossed their teeth, indicating poor oral hygiene practices. Out of the 53 (14.1%) of participants who were aware that PCOD can affect oral health, about 29.3% received this information from their dentists and 26.8% received it from the internet. Approximately 93.6% of PCOD patients were not aware of the increased risk of PD due to PCOD and the majority (90.7%) did not believe they needed more frequent dental visits than non PCOD females, indicating relatively limited knowledge about the potential oral complications of PCOD. However, 97.1% of participants demonstrated a positive attitude toward adopting preventive measures to prevent PD/gum disease related to PCOD in the future. Conclusion: The results of the present study highlight significant gaps in the knowledge, awareness and attitudes regarding the risk of PD among women with PCOD in Chennai. The key findings indicate that while there is a general lack of awareness about the association between PCOD and PD, there is a notable positive attitude toward adopting preventive measures for oral health. There is a critical need to create awareness among women with PCOD regarding the risk of PD to improve their quality of life.

Ultrasonographic Evaluation of Uterine LSCS Scar and its Impact on Maternal Outcomes: A Cross-sectional Study

Hemant Deshpande, Rohit Dimbar, Shriraj Katakdhond, Saba Chaudhary Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: The evaluation of uterine scars following Caesarean Section (CS) is essential for predicting delivery outcomes, particularly in patients considering Vaginal Birth After Caesarean (VBAC) or those undergoing repeat Lower Segment Caesarean Section (LSCS). Ultrasonography has emerged as a valuable tool for assessing caesarean scars, providing insights into critical scar features such as thickness, shape, continuity, and echogenicity. These factors play a significant role in determining the risk of complications, including uterine rupture and scar dehiscence, and influencing the decision-making process for VBAC or repeat LSCS. Aim: The study focused on identifying critical scar features, including thickness, continuity, and echogenicity, and their impact on delivery outcomes, specifically VBAC success rates and complications during repeat LSCS. Materials and Methods: This hospital-based, cross-sectional study was conducted from February 2022 to January 2025 at a tertiary care hospital. A sample of 284 pregnant women, at a gestational age of over 35 weeks with a history of previous CS, was recruited. Participants underwent clinical evaluation, including a detailed history, physical examination, and ultrasonographic assessment of the LSCS scar. Scar parameters were measured transabdominally, including thickness, shape (triangular/ballooning), continuity, and echogenicity using transvaginal ultrasound imaging. Categorical variables were summarised as percentages, while continuous variables were expressed as mean±standard deviation. Results: The majority of patients (201, 70.77%) were in the 26-30 age group, with 249 (87.68%) patients falling between 150-160 cm in height and 139 (48.94%) patients weighing 56-60 kg. A high proportion (236, 83.1%) resided in rural areas, and 227 (79.93%) patients belonged to the lower socioeconomic class. Scar patterns indicated that 55 (98.21%) cases of vaginal deliveries had a triangular scar, with only 1 (1.79%) had ballooning pattern, while 180 (78.95%) cases of LSCS had a triangular scar and 48 (21.05%) cases exhibiting a ballooning pattern. Thinner scars (<3 mm) were associated with a higher incidence of repeat LSCS (195, 85.09%). Continuous scars were linked to successful VBAC outcomes in 52 (92.86%) cases. Hyperechoic scars were found in 56 (100%) of vaginal deliveries, whereas hypoechoic (46, 20.18%) and isoechoic scars (12, 5.25%) were more common in LSCS cases. Conclusion: Ultrasonographic evaluation of the LSCS scar plays a critical role in predicting delivery outcomes. Triangular scars and thicker scar measurements (>3 mm) were associated with higher success rates for VBAC, while ballooning patterns and thinner scars (<3 mm) were linked to higher rates of repeat CS.

Analgesic Effects of Intravenous Paracetamol versus Intravenous Magnesium Sulphate in Patients undergoing Major Abdominal and Upper Limb Surgeries under General Anaesthesia: A Randomised Clinical Study

Raj Bahadur Singh, Saurav Shekhar, Shivani Sinha, Siddharth Singh, Anand Dev, Mohd Asim Rasheed Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Effective postoperative pain management is essential for patient recovery and satisfaction. Intravenous (i.v.) paracetamol and magnesium sulfate are two options that have shown promise in reducing pain and opioid use. Aim: To compare the efficacy of intraoperative i.v. magnesium sulfate versus i.v. paracetamol on postoperative analgesic requirements in major surgeries under general anaesthesia. Materials and Methods: This prospective randomised clinical study was conducted in the Department of Trauma and Emergency at Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India, and included 100 patients classified as American Society of Anaesthesiologists (ASA) grade I and II. The patients were assigned to two groups: Group P received 20 mg/kg i.v. paracetamol, and Group M received 20 mg/kg i.v. magnesium sulfate in 100 mL of normal saline. Written consent was obtained from all the participants. Baseline parameters were monitored and a standardised general anaesthesia protocol was followed. Postoperatively, pain was assessed using the Visual Analog Scale (VAS) and analgesic requirements and adverse effects were recorded. Statistical analysis was conducted using the t-test via GraphPad Prism (Dotmatics, GraphPad Software, San Diego, California). Results: A comparison of pain scores revealed similar levels immediately after surgery (Group P: 7.1, Group M: 7.2) and at six hours postsurgery (Group P: 2.1, Group M: 2.0). At 12 hours, Group M reported higher pain (6.8) compared to Group P (6.2), but pain levels were comparable at 18 hours (Group P: 3.0, Group M: 3.1). There was no significant difference in the number of rescue analgesia injections used (Group P: 2.0, Group M: 1.9, p-value=0.348). Diclofenac consumption was higher in Group P (300 mg) compared to Group M (290 mg, p-value=0.00526). The time to the first rescue analgesic was longer in Group M (5.2 hours) compared to Group P (4.6 hours, p-value=0.023). Adverse effects such as nausea, vomiting, sedation and respiratory depression were similar between groups, with no significant differences. Conclusion: The i.v. paracetamol and magnesium sulfate provided comparable postoperative pain relief. Group P had lower pain levels at 12 hours, while Group M required less diclofenac and had a longer time to the first rescue analgesic. Adverse effects were similar, making both drugs effective options for pain management.

Long-term Efficacy of Aquatic Therapy on Balance and Gait in Older Adults: A Randomised Clinical Trial

Purnima Singh, Pratap Chandra Sarma Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Balance and gait issues significantly contribute to fall-related injuries in older adults. Aquatic therapy interventions, such as Clinical Ai Chi (CAC), Water-Specific Therapy (WST) and the Bad Ragaz Ring Method (BRRM), have shown short-term benefits in enhancing balance and gait. Nevertheless, it is uncertain whether these improvements can be maintained over a longer duration. Aim: To assess the long-term effectiveness of CAC, WST and BRRM in preserving balance and gait improvements 12 months after the intervention, with an emphasis on functional outcomes and the reduction of falls. Materials and Methods: This randomised clinical study was conducted at Bangalore, Karnataka, India which involved 69 participants who completed an initial eight weeks of intervention. The sustainability of the eight-week intervention’s impact on balance and gait was evaluated over 12 months, with periodic assessments using the Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Functional Reach Test (FRT), Timed Up and Go (TUG) test and Balance Confidence Scale (BCS). Data were gathered through clinical assessments, self-reported fall records and mobility diaries. Statistical analysis involved repeated measures Analysis of Variance (ANOVA) and post-hoc comparisons to investigate temporal trends and differences between groups. Results: A 12-month follow-up revealed that the CAC group maintained clinically significant improvements in BBS (p-value <0.01) and DGI (p-value <0.012) scores. The WST group exhibited a delayed but progressive improvement in FRT and TUG scores, indicating sustained long-term benefits. However, the BRRM group showed only marginal improvements, which diminished over time. Furthermore, the CAC group reported significantly fewer self-reported falls compared to both the WST and BRRM groups (p-value <0.05), and participants in the CAC group also expressed increased confidence and improved mobility in their daily activities. Conclusion: The study confirms the long-term efficacy of CAC in sustaining balance and gait improvements, reducing fall risk and enhancing confidence among older adults. WST showed delayed but beneficial effects, while BRRM exhibited limited long-term impact. Future research should explore tailored aquatic therapy protocols to maximise long-term benefits for diverse populations.

The Impact of a Novel Postural Supporting Device on Neuromotor and Behavioural Development of Premature Neonates: A Pilot Study

Dhwani Chanpura, Neha Mukkamala, Nalina Gupta Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Preterm neonates face significant challenges in neurobehavioural development compared to full-term neonates, as they often experience delayed motor coordination and cognitive development. Therapeutic positioning is an essential neurodevelopmental intervention in the Neonatal Intensive Care Units (NICU), as it supports the infant’s posture and movement. Aim: To develop a new postural supporting device and evaluate its impact on the neuromotor development of premature neonates. Materials and Method: This pilot study was conducted at level III NICU at Dhiraj Hospital, Vadodara, Gujarat, India, from April 2024 to July 2024. Nine medically stable preterm neonates, within the first 72 hours of life and with a gestational age between 30 weeks 0/7 days and 36 weeks 6/7 days, who were referred for physiotherapy, were included in the study. Conventional physiotherapy intervention, along with positioning in a novel postural supporting device, was administered. After one week, their neuromotor behaviour was assessed using the neuromotor behavioural assessment scale. Results: All nine preterm neonates demonstrated significant improvement when comparing pre- and post-outcomes, with p-values of 0.007 for neurological components, 0.007 for behavioural components, 0.011 for autonomic components and 0.016 for motor components. Conclusion: The present study shows that the “New Postural Supporting Device” has a positive impact on neuromotor and behavioural organisation in premature neonates.

Status of Oxidants and Antioxidants in Acne Vulgaris: A Cross-sectional Study

Astha Goyal, Sanjiv Kumar Bansal, Shikhar Ganjoo, Busi Karunanand Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Acne vulgaris is a multifactorial dermatological disease. The role of oxygen free radicals and antioxidant enzymes has been implicated in the pathophysiology of several skin diseases, including acne. However, the relationship between acne vulgaris and oxidative stress biomarkers lacks a clear consensus. Aim: To investigate the existence of oxidative stress in patients with acne vulgaris by measuring the levels of an oxidant, Malondialdehyde (MDA), and antioxidants such as Superoxide Dismutase (SOD), Catalase (CAT), and Glutathione (GSH). Materials and Methods: This cross-sectional study was carried out in the Department of Biochemistry in association with the Department of Dermatology and Venereology at the Faculty of Medicine and Health Sciences, SGT University, Budhera, Gurugram, India over a period of 12 months from July 2023 to June 2024. The study involved 200 patients with acne vulgaris and 50 healthy adults in the control group, aged 18-45 years. Five millilitres of venous blood was taken into gel separator tubes for the parameters such as SOD, CAT, GSH, and MDA, which were measured using Enzyme-linked Immunosorbent Assay (ELISA) kits. The values were compared with those of the control group. Student’s t-test was applied, and a p-value of <0.05 was considered statistically significant. Results: The mean age of the cases was 26.24±6.56 years, with 121 females and 79 males, while the healthy controls had a mean age of 25.80±5.45 years, with 29 females and 21 males. The serum levels of SOD (8.75±2.92 U/mL), CAT (0.22±0.08 ng/mL), and GSH (0.61±0.25 ng/mL) were found to be statistically decreased in patients with acne vulgaris compared to healthy controls, who had mean±SD values of 89.39±9.91 U/mL, 8.99±4.02 ng/mL, and 18.77±6.50 ng/mL, with a p-value of <0.001, respectively. Additionally, the serum MDA levels were found to be statistically increased in patients with acne vulgaris (7.72±2.11 nmol/mL) compared to healthy controls (2.51±0.97 nmol/mL), with a p-value of ≤0.001. Conclusion: The present study clearly demonstrated the existence of oxidative stress in patients with acne vulgaris, indicating its crucial role in the pathophysiology of acne alongside inflammation. Additionally, incorporating atleast one antioxidant-based medication into the combined acne treatment regimen may prove beneficial.

Cytological Profile of Solid and Cystic Lesions Arising from Various Sites in the Body: A Cross-sectional Study

Palaniappan Vellai, Pushpalatha Dharmarajan, Vamitha Panneerselvam Sampathkumar, Prathipa Krishnamurthy, Ravi Sivaraman, Reji Manjunathan Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Fine Needle Aspiration Cytology (FNAC) is a minimally invasive, cost-effective, and efficient technique for obtaining diagnostic cellular material with minimal discomfort and a low patient complication rate. Aim: To study various solid and cystic lesions in the body using FNAC, followed by histopathological examination for definitive diagnosis. Materials and Methods: The present cross-sectional Study was conducted on 383 patients who underwent surgery for cystic and solid lesions in the Department of Pathology at Chengalpattu Medical College, Chengalpattu, Tamil Nadu, India. over a period of one year from June 2022 to June 2023. Patients with various solid lesions (breast, thyroid, salivary gland lesions, lymphoma, etc.) and cystic lesions (epidermal cysts, ganglionic cysts, fibro-cystic breast disease, etc.) referred for cytopathological analysis were included. FNAC results were tabulated, and histopathological examination of surgically removed tissues was performed for definitive diagnosis. Results: The study shows that FNAC is useful for diagnosing solid and cystic lesions, with a concordance rate of 83.66% for solid lesions and 90.90% for cystic lesions when compared to histopathology. However, it also highlights difficulties in distinguishing between benign and malignant thyroid and breast lesions, emphasising the need for further testing in uncertain cases. Conclusion: The FNAC is a simple, non traumatic, safe, cost-effective outpatient procedure. It provides high diagnostic accuracy for many conditions related to both solid and cystic lesions, especially when combined with imaging guidance and expert cytological interpretation.

Rubber Band Ligation versus Injection Sclerotherapy for the Management of Grade I and Grade II Haemorrhoids: A Prospective Interventional Study

Kanika Sharma, Ramachandran Ponniah Iyyappan, Ponmani Agasthiya Manimaran, Sanniyasi Saravanan Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Several approaches are available for treating haemorrhoids, ranging from conservative in-office procedures to more invasive surgeries. Rubber Band Ligation (RBL) and Injection Sclerotherapy (SCL) are two widely used, minimally invasive techniques that can be performed in an office setting. While both methods relieve symptoms and enhance patients’ quality of life, they vary in mechanisms, techniques, and outcomes. Despite their popularity, there is limited comparative research on their efficacy, safety, and patient satisfaction. Aim: To compare RBL and SCL regarding post-procedural pain, bleeding, relief of symptoms, and recurrence. Materials and Methods: A prospective interventional study was conducted at Sri Ramachandra Institute of Higher Education and Research, Chennai, from July 2019 to July 2021. A total of 60 patients over the age of 18 years, with grade I or II haemorrhoids, undergoing RBL or injection SCL were included. Patients were recruited by convenience sampling and allocated alternately, i.e., RBL (n=30) or SCL (n=30), and systematically compared in terms of post procedural pain, bleeding, relief of symptoms, and recurrence. Data was analysed using IBM SPSS version 23.0 statistics software. The t-tests and Chi-square tests were applied and p-value of <0.05 was considered significant. Results: The mean pain score immediately post-procedure (30 minutes) was 2.6 and 1.7 in the RBL and SCL groups, respectively, p=0.024. The same trend was reported on day zero and mean pain score was significantly lower in the SCL group (0.37) as compared to the RBL group (0.93), p=0.008. In the first week, 53.3% of the RBL group presented with bleeding as compared to 20% of the SCL group, p=0.007. Patients in the RBL group reported better relief of symptoms (i.e., pain, bleeding, pruritus, sensation of mass per rectum) than patients in the SCL group, 93.3%, and 83.3%, respectively, though this data was not statistically significant. The RBL group had one recurrence (3.3%) and the SCL group had three recurrences (10%). Conclusion: The SCL group outperformed the RBL group regarding pain and bleeding in the first week post-procedure. However, clinically the pain experience was similar for both groups. While data beyond the first week was not statistically significant, SCL remains a safe and effective treatment for early haemorrhoids.

Evaluation of Micronucleus in Buccal Mucosa Samples as a Potential Biomarker for Early Diagnosis of Parkinson’s Disease: A Cross-sectional Study

Disha K Davis, Rajila Hannah Sugirthabai Rajendran Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Parkinson's Disease (PD) is the second most prevalent neurodegenerative disease as of 2024, with a global prevalence of 1.51 per 1,000 people in 2023. Micronuclei are small structures formed when chromosome fragments or whole chromosomes are not properly incorporated into the daughter nuclei during cell division. Their presence can signal genomic instability, which may be linked to neurodegenerative diseases such as PD. The buccal micronucleus assay is a cytogenetic test that examines micronuclei in cells from the buccal mucosa, offering insights into genetic damage or chromosomal instability, and it has been explored as a potential diagnostic tool for PD. Aim: To compare the presence of micronuclei in the buccal mucosa samples between individuals with PD and healthy controls, as a potential non invasive indicator for early PD detection. Materials and Methods: This cross-sectional study was conducted in the Department of Neurology at NIMHANS Hospital, Bengaluru, Karnataka, India from March 2023 to February 2024. A total of 170 participants, including both individuals with PD and healthy controls, were recruited from the Outpatient Department (OPD) and PD wards of NIMHANS Hospital. Buccal mucosa samples were collected using a moistened wooden tongue spatula, fixed onto glass slides with biofix spray and stained using the Papanicolaou (PAP) method. Microscopic images of these slides were then analysed quantitatively using an image analyser, focusing on the presence of micronuclei in the buccal epithelial cells. Results: The mean age of the healthy group was 66 years, while the mean age of the Parkinson’s group was 60 years, with an overall mean age of 63.14 years. The gender distribution in the healthy group included 38 males and 47 females, whereas the Parkinson’s group consisted of 55 males and 30 females. Among the study participants, the frequency of micronuclei occurrence was higher in Parkinson’s patients (69.4%) compared to healthy controls (11.8%). Conclusion: The occurrence of micronuclei was notably greater in individuals with PD when compared to healthy controls, suggesting a higher rate of genomic instability in PD patients. This observation reinforces the potential of micronucleus frequency as a useful biomarker for PD.

Effect of Acute Exercise on Pulmonary Function in Young Adults with Anaemia: A Quasi-experimental Study

K Roopashree, AN Jubin John, KC Devina Dilip, Prithika Shree Ragothaman, Aadhi Krishna Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Anaemia is a condition in which the Haemoglobin (Hb) level in the blood is below the reference range for age and gender. In India, mild anaemia is commonly found among medical students. Exercise capacity is limited by the ability to deliver oxygen to the muscles, and anaemia can impair this process by weakening the respiratory muscles, thus reducing pulmonary function. Pulmonary Function Tests (PFTs), combined with bicycle exercise testing, are useful for detecting occult cardiorespiratory limitations. Aim: To estimate the prevalence of anaemia among first-year medical students and to study the effect of exercise on pulmonary function in individuals with anaemia. Materials and Methods: This was a quasi-experimental study conducted in the Research laboratory of the Physiology Department, at Eastpoint College of Medical Sciences and Research Centre (EPCMSRC), Bengaluru, Karnataka, India between December 2023 and April 2024. The sample size was 136 with male and female, aged 18-23 years. Based on the level of Hb concentration, the participants were divided into a Normal group and an Anaemia group. After 10 minutes, PFT parameters, including Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), the FEV1/FVC ratio, and Peak Expiratory Flow Rate (PEFR) were recorded using a spirometer. Following this, exercise testing was performed using a bicycle ergometer (INCO). PFT was recorded again immediately after exercise and compared. An independent sample t-test was used to find differences between the groups, while a paired t-test was used to compare pre- and post-exercise values within each group. A p-value of <0.05 was considered significant. Results: The prevalence of anaemia was found to be 22.1%, with significantly lower PFT parameters observed in the anaemic group compared to the normal group before exercise (p<0.05). However, no significant changes in the parameters were noted after exercise in either group (p>0.05). Conclusion: Approximately, 22.1% of participants had anaemia. There was no significant change in pulmonary function after exercise in either the normal or anaemic group.

Journals’ Characteristics and Factors Associated with Retraction among Pharmacology, Toxicology and Pharmaceutics Journals: An Observational Study Based on Scimago Journal and Country Rank and Retraction Watch Databases

Ahmed Ibrahim Fathelrahman Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Retraction is a corrective practice intended to address serious research mistakes and violations of research ethics. Most studies on retraction describe the characteristics of retracted papers, the attributes of retraction notices, the reasons for retraction, and/or the rates/patterns of retraction geographically or chronologically. Some studies have addressed postretraction issues, such as how retracted papers are cited after being retracted. To our knowledge, no study has focused specifically on the characteristics of the journals that issue retractions. Aim: To describe the characteristics of journals and patterns of retraction, as well as to determine the factors associated with retraction occurrences among pharmacology, toxicology and pharmaceutics journals. Materials and Methods: This was an observational study examining the metrics and retraction history of journals based on the Scimago Journal and Country Rank and the Retraction Watch databases. Descriptive and comparative analyses were conducted. Student’s t-test, One-way Analysis of Variance (ANOVA) and the Chi-square test or Fisher’s exact test were used, when appropriate, to test for significant differences. Logistic regression analysis was performed, and adjusted Odds Ratios (ORs) with 95% Confidence Intervals (CIs) were computed. A p-value of <0.05 was considered as statistical significance. Results: Out of 116 journals in the subject category “Pharmacology, Toxicology and Pharmaceutics (Miscellaneous)”, 50 journals (43.1%) were indexed in Web of Science (WoS), 61 (52.6%) were open access and 106 (91.4%) were still classified as “active” under Scopus as of January 2025. Overall, there were retractions in 29 journals (25%), including 192 retracted articles. The maximum number of retracted articles was 110, with an average of 1.66 retracted articles per journal. Journals that were WoS-indexed and those in quartiles Q1 and Q2 were significantly more likely than their counterparts to have at least one retraction. Journals from Western Europe, North America, and the Pacific region were significantly more likely to have at least one retraction compared to other geographic regions. In this context, journals with at least one retraction had higher metrics than those without any retractions, including the H-index, total number of documents (2023), total number of documents (3 years), total number of references, total citations (3 years), and number of citable documents. Being WoS-indexed and the H-index were found to be significant independent predictors of retraction in the logistic regression model. Conclusion: The findings of the present study revealed that higher-quality journals (Q1 and Q2 journals, those with higher metrics and those indexed in WoS) experienced more occasions of retraction.

Immununohistochemical Analysis of Progesterone Receptor and Ki-67 in Meningioma: A Cross-sectional Study

Rathin Hazra, Saurabh Dash, Prasenjit Kumar Bar, Sarbari Kar Rakshit Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: The most common primary intracranial tumour is meningioma. It occurs mostly in middle-aged to elderly individuals. Differentiating meningiomas from other intracranial lesions and properly grading them is often a challenging task for pathologists. Meningiomas can cause significant morbidity, mortality, and recurrence, even after complete excision, which may lead to repeat operations and ultimately reduced survival rates. Meningiomas are categorised by the World Health Organisation (WHO) into three grades, primarily based on subjective methods that consider morphology, mitotic figures, and necrosis. Proliferative activity can also be assessed to some extent using these parameters. To minimise subjective biases, it is advisable to use Progesterone Receptor (PR) expression and Ki-67 Labelling Index (LI)-when feasible-as predictive markers for understanding tumour behaviour, which can also be useful for individualised management. Aim: To investigate the status of PR expression and the Ki-67 index in meningioma, along with their associations with age, gender, risk factors, histological types, and grading of meningiomas. Materials and Methods: The present study was a Institution-based retrospective cross-sectional analysis conducted in the Department of Pathology in collaboration with the Department of Neurosurgery at Nil Ratan Sircar Medical College and Hospital (NRSMCH), Kolkata, West Bengal, India. The study examined the correlation of PR expression with Ki-67 LI in 50 diagnosed cases of meningiomas following a retrospective review of all cases from March 2022 to February 2023. Primary ready-to-use antibodies were employed immunohistochemically to assess the immunostatus of these markers for prognostication of meningiomas. For statistical analysis, Statistical Package for Social Sciences (SPSS) version 27.0 was utilised, applying mean, Standard Deviation (SD), Analysis of Variance (ANOVA), and Chi-square testing. A p-value of less than 0.05 was considered statistically significant. Results: Among the 50 cases, there were 30 Females (F) and 20 Males (M), resulting in a ratio of M:F=1:1.5. The percentage distribution of grade I, grade II, and grade III cases was 37 (74%), 10 (20%), and 3 (6%), respectively. Meningothelial tumours were the predominant histomorphological subtype, accounting for 14 cases (37.83%). PR positivity was observed in 35 cases (70%). Most of the grade I cases demonstrated PR positivity (26 out of 37 cases, or 70.27%) and a low mean Ki-67 value of 4.16%. In contrast, the grade III cases primarily exhibited absent to weakly positive PR status (3 out of 3, or 100%) with a high Ki-67 value of 11%. The mean Ki-67 value was higher in PR-negative cases (n=15), at 7.18% with an SD of 4.26, while it was lower in PR-positive cases (n=35), with a mean of 3.64% and an SD of 4.17. Both PR expression and Ki-67 index showed a significant reduction and increase, respectively, with increasing WHO grades. The association of grade with PR and Ki-67 was significant (p-value=0.003 and p-value=0.004, respectively). An inverse correlation was observed between the Ki-67 index and PR score (R=-0.7561). The combined PR status and Ki-67 expression had a sensitivity of 96.67%, specificity of 100%, and an overall accuracy of 97.78%. Conclusion: The results indicate that middle-aged females are more likely to develop meningiomas, with the most common site being intracranial. Grade I tumours were the most prevalent, particularly the meninogothelial subtype. PR expression decreased, and Ki-67 index increased with higher grades. The mean Ki-67 value was greater in grade III meningiomas and PR-negative cases. The association between tumour grade and PR and Ki-67 was significant. The study of PR and Ki-67 immunohistochemical staining proved to be valuable supplements to routine histopathological assessments; thus, management strategies should be individualised.

Knowledge, Attitude and Acceptability of Human Papilloma Virus Vaccine among Undergraduate Medical Students in a Teaching Hospital of North Karnataka: A Cross-sectional Study

Apoorva R Deshpande, Sukanya V Badami, Vasundara S Gayakwad, Mahesh C Baragundi Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Human Papilloma Virus (HPV) is associated with a wide range of diseases and cancers globally, affecting both the genders, and can be effectively prevented by the HPV vaccine. As the literature on the knowledge, attitude, and acceptability of the HPV vaccine is limited, the present study was undertaken. Aim: To assess the knowledge, attitude, acceptability, and recommendations regarding the HPV vaccine among undergraduate medical students at Gadag Institute of Medical Sciences (GIMS) Gadag, and to suggest the appropriate recommendations as an effective measure to reduce the burden and mortality due to HPV-related cancers. Materials and Methods: present cross-sectional study was conducted from September to October 2024 among undergraduate medical students from first year to final year, as well as interns at GIMS, Gadag. A total of 620 students responded to the study.Informed consents were obtained, data was collected using a pre-validated, semistructured questionnaire about knowledge (Cronbach’s Alpha value-0.854), attitude, acceptability, and recommendations (Cronbach’s Alpha value-0.82) regarding HPV infection and the v accine. Assessment of knowledge of HPV infection and HPV vaccines was conducted by scoring 1 point for correct answers and 0 points for incorrect answers. The score of 50% or more was considered to indicate a good knowledge score, while those with less than 50% indicated a poor knowledge score. Assessment of attitude, acceptability, and recommendation-related questions was done using a 5-point Likert scale. The Chi-square test and Fisher’s exact test were used to assess the associations. Results: Amongst the participants, 435 (70.2%) students had good knowledge, and 505 (81.5%) demonstrated a positive attitude, believing that receiving the HPV vaccine would be beneficial for a teenage girl or boy’s future health. Additionally, 425 (68.6%) were willing to receive the vaccine. Students with a good knowledge score showed the significant association with vaccine acceptability (p=0.001) and recommendations to others (p=0.001). Conclusion: Our study revealed the knowledge and attitude gaps even among medical students that need to be addressed at the earliest. Therefore, we suggest Conducting more educational and awareness programmes on HPV infection and the vaccine, not only for medical students but also for those in primary and secondary schools, colleges, and public places by the experts can work as an effective tool to fill the gaps. Both government and non-governmental organisations should take the necessary steps to customise the cost and availability of the vaccine in health centers.

Association of Platelet Indices with Cardiac Enzymes and Left Ventricular Function in Patients with Acute Myocardial Infarction: A Cross-sectional Study

P Kireeti, Rajesh Singh Laishram, Mayanglambam Bijoy, Sunil Kumar Leishangthem, Rajkumar Ajaykumar, Keisham Jaya Chanu, Ningthoukhongjam Reema, Dhanaraj Singh Chongtham Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Myocardial Infarction (MI) is a leading cause of mortality worldwide. Platelet activation has been implicated in its pathogenesis, and platelet indices, which measure platelet hyperactivity, have been suggested as biomarkers of Coronary Artery Disease (CAD). However, the association of platelet indices with cardiac enzymes and Left Ventricular (LV) function in patients with Acute Myocardial Infarction (AMI) remains unexplored. Aim: To determine the association between platelet indices, cardiac enzymes, and LV function in patients with AMI. Materials and Methods: This hospital-based cross-sectional study was conducted at the Department of Medicine, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India from May 2022 to July 2024. The study included 55 patients with AMI, aged 18 years and above, who were admitted to the medicine ward and Intensive Cardiac Care Unit (ICCU) of RIMS. Data were collected on demographics, clinical history, vital parameters, lipid profiles, Electrocardiogram (ECG) findings, cardiac enzymes (Creatine Kinase Myocardial Band (CK-MB), hs Troponin I), and 2D echocardiographic findings. The platelet indices measured included Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Plateletcrit (PCT), and Platelet-large Cell Ratio (P-LCR). The data were analysed using the Statistical Package for Social Sciences (SPSS) version 26.0 and expressed as descriptive and inferential statistics. Results: The study population had a mean age of 65.14±13.38 years, with a male-to-female ratio of 1.8:1. The most common complaints were chest pain (90.3%) and shortness of breath (56.4%). The risk factors included smoking (78.2%) and hypertension (50.9%). The mean and standard deviation of MPV (fL) was 10.995±1.592, PDW was 16.107±0.436, PCT (%) was 0.255±0.082, and P-LCR (%) was 32.836±10.920, respectively. Key correlations observed included PDW, which was negatively correlated with the LV internal diameter in diastole (r-value=-0.286, p-value=0.034) and the LV internal diameter in systole (r-value=-0.314, p-value=0.020). Furthermore, MPV showed a possible negative correlation with Left Ventricular Ejection Fraction (LVEF) (r-value=-0.247, p-value=0.069). No significant correlation was observed between platelet indices and cardiac enzymes. Conclusion: The findings from present study highlight that elevated platelet indices, particularly MPV and PDW, play a crucial role in the prothrombotic environment seen in AMI and are linked to LV dysfunction and remodeling. These indices, when integrated into routine diagnostics, could improve the assessment of AMI severity, predict outcomes, and provide insights into post-AMI LV changes.

Outcome of Different Surgical Interventions in Management of Emphysematous Pyelonephritis: A Retrospective Cohort Study from Dharwad, India

Revanasiddappa Kanagali, Muralidhar Achar, Pramod Makannavar, Srinivas Kalabhavi Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Emphysematous Pyelonephritis (EPN) is a rare, life-threatening infection of the renal parenchyma characterised by gas formation within the kidney and surrounding tissues. When not promptly diagnosed and treated, this condition presents with a mortality rate ranging from 20% to 80%. Aim: This study aimed to evaluate the outcomes of different surgical interventions in managing EPN, focusing on minimally invasive interventions {Double J Stent (DJS), Percutaneous Nephrostomy (PCN), Percutaneous Drainage (PCD)} and nephrectomy. Materials and Methods: A retrospective cohort study was conducted at SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India, examining 80 cases of EPN over a 54-month period from January 2017 to June 2023. Data were collected from hospital records, including clinical notes, laboratory results, imaging studies, and surgical reports. The study assessed demographics, clinical presentation, laboratory investigations, imaging studies, treatment details, and patient outcomes. Descriptive statistics were used for demographic and clinical characteristics and Chi-square test was applied for categorical variables. A p-value of <0.05 was considered statistically significant. Results: The study included 80 patients with a gender distribution of 48.8% female and 51.2% male, with a mean age of 57.9±12.2 years. Flank pain (91.3%), fever (86.3%), and dysuria (36.3%) were the predominant clinical manifestations. Laboratory evaluation revealed significant findings, including anaemia (52.5%), renal dysfunction (56.3%), and sepsis (61.3%). Escherichia coli were the primary causative organism, identified in 34 patients (42.5%). Class 2 EPN was the most prevalent classification, occurring in 25 patients (31.3%). Hypotension (p-value=0.015), elevated Glycated haemoglobi (HbA1c) levels (p-value=0.018), and the need for dialysis (p-value=0.008) were significantly associated with mortality. Minimally invasive interventions were predominantly successful, with various drainage procedures employed: unilateral DJS (48.8%), bilateral DJS (27.5%), PCN (3.8%), and PCD (18.8%). Nephrectomy was required in only 5% of cases. Conclusion: This study supports the efficacy of minimally invasive intervention approaches for EPN, thereby reducing the necessity for nephrectomy. Prognostic indicators, including hypotension, elevated HbA1c, and the requirement for dialysis, warrant careful monitoring. Minimally invasive interventions, coupled with targeted antibiotic therapy, are validated as a preferred treatment for EPN.

Utility of Cell Blocks from Lymph Node Aspirates to Improve the Diagnostic Accuracy of Fine Needle Aspiration Cytology: A Cross-sectional Observational Study from Eastern India

Upajna Pal, Abhinandan Bayen, Debajyoti Nanda, Manisha Sarkar, Dipanwita Nag Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Fine Needle Aspiration Cytology (FNAC) has been the primary modality for diagnosing lymph node enlargement, although it comes with its own share of fallacies and pitfalls. Cell blocks can be prepared from material obtained in the same sitting as FNAC, providing morphological details and preserving architectural patterns such as cell balls, three-dimensional clusters, excellent cytoplasmic and nuclear details, and individual cell characteristics. Aim: To determine the utility of cell blocks in improving the diagnostic accuracy of lymph node aspirates. Materials and Methods: This cross-sectional observational study was conducted with 50 patients who presented with visible or palpable lymph node enlargement over a period of one year (January 2021 to December 2021) at the Medical College and Hospital, Kolkata, West Bengal, India. Patients underwent Fine Needle Aspiration (FNA) from the lymph nodes, followed by cell block preparation in the same sitting. Material for the cell block was obtained by an additional pass with a 16-18G needle and was prepared using the plasma thrombin method, followed by formalin fixation, routine processing, Haematoxylin and Eosin (H&E) staining, and immunohistochemical staining. Patients were subsequently followed-up for tru-cut and excision biopsies. FNAC and cell block slides were examined by two expert pathologists to reach a final diagnosis. The diagnostic validity of the cell block was reported in terms of sensitivity, specificity, and accuracy. The Cohen’s kappa statistical coefficient test was performed to represent diagnostic accuracy. A p-value of less than 0.05 was considered significant. Results: Out of the total 50 cases, 21 (42%) were diagnosed as infective or reactive lymphadenopathy, 9 (18%) cases were lymphoproliferative disorders, and 20 (40%) cases were metastatic deposits based on cytology and cell block morphology. One case of reactive lymphadenopathy underwent lymph node excision biopsy and was ultimately diagnosed as Non-Hodgkin’s lymphoma. Three cases (6%) were diagnosed as classical Hodgkin’s lymphoma (positive for CD15 and CD30) based on the cell block, 6 (12%) cases were Non-Hodgkin’s lymphoma and 20 (40%) cases were metastatic deposits identified on FNA cytology and cell block. The overall sensitivity of the cell block in diagnosing lymph node aspirates was 97.87%, with a specificity of 80% and an accuracy rate of 96.15%. Cohen’s kappa calculated for FNAC and cell block was 0.724, indicating substantial agreement (95.5% agreement). Conclusion: Cell blocks can be efficiently utilised from lymph node aspirates to improve the diagnostic accuracy of lymph node FNAC, even before an excision biopsy is performed in patients who are unfit for invasive surgical procedures. Immunohistochemistry (IHC) in cell blocks can also be effectively implemented to differentiate between lymphoma and metastatic deposits.

Prevalence and Associated Risk Factors of Visual Impairment among Children at Ibn Al-Haitham Eye Hospital in Baghdad,Iraq: A Cross-sectional Study

Baydaa Jaber Shamran, Zainora Mohammed, Hassenien Shuber, Mohd Harimi Abd Rahman, Norliza Mohamad Fadzil Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Childhood Visual Impairment (VI) extends beyond poor vision, affecting psychological wellbeing, educational progress and social development. These challenges can persist into adulthood, significantly influencing overall quality of life. However, data on childhood VI in Iraq remain limited. Filling this gap is essential for developing effective health interventions that can enhance outcomes for affected children. Aim: To determine the prevalence, causes and associated risk factors of VI among children aged 6 to 15 years. Materials and Methods: A cross-sectional study was conducted at the Ibn Al-Haitham Teaching Eye Hospital in Baghdad, Iraq from October 2023 to May 2024, which included children aged 6 to 15 years. The participants underwent a comprehensive vision assessment to determine visual status and refractive error. Those who had Best-Corrected Visual Acuity (BCVA) worse than 6/12 were referred to an ophthalmologist to determine the cause of reduced vision. Data on socio-demographic factors and risk factors for VI were collected using a structured questionnaire. These include age, gender, residential area, family income and family history (parents’ age, educational backgrounds and history of refractive error). Results: A total of 508 children, with a mean age of 9.31±2.69 years, were included in the analysis. VI was determined based on presenting visual acuity, with a prevalence of 95 (18.7%). The main causes of vision impairment were uncorrected refractive errors, cataracts and amblyopia. Multivariate analysis showed a high risk of VI among children living in urban areas (adj. OR: 2.50; 95% CI: 1.43-4.40; p-value=0.001). Meanwhile, lesser odds of VI were found among those whose fathers had a secondary education (adj. OR: 0.27; 95% CI: 0.14-0.53; p-value <0.001), tertiary education (adj. OR: 0.10; 95% CI: 0.04-0.21; p-value <0.001), or were myopic (adj. OR: 0.30; 95% CI: 0.17-0.52; p-value <0.001). Conclusion: This study revealed that uncorrected refractive error was the leading cause of VI among children in Iraq. The analysis of risk factors associated with VI underscores the significant impact of socio-demographic characteristics, particularly area of residence and parental education. Therefore, enhancing access to eye care services and implementing awareness programmes to encourage health-seeking behaviours are essential for improving visual health outcomes among children in Baghdad, Iraq.

Correlation between Pre-procedural Ultrasound-estimated and Actual Procedural Epidural Depth in Lumbar Epidural Anaesthesia Taking BMI into Consideration: An Observational Study

Minu Thomas, Derlin Thomas, John Varghese Thoppil, Paul Ovungal Raphael, Deo Mathew Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Ultrasound guidance has become a popular tool for regional anaesthesia due to its ease of use and ability to accurately identify anatomical landmarks. This technique has been shown to improve safety and reduce complications. In recent years, there has been growing interest in using ultrasound for lumbosacral regional anaesthesia, even as a preoperative assessment tool. However, the variability in the distance between the skin and the epidural space can make it difficult to accurately locate the space, thereby increasing the risk of complications such as nerve injuries, paresthesia, haematoma formation, and post-dural puncture headache. Aim: To evaluate the skin-to-epidural space distance using Ultrasound-derived (UD) measurements compared to the conventional Needle Depth (ND) using the Loss of Resistance (LOR) technique, and to investigate their correlation with Body Mass Index (BMI). Materials and Methods: This observational study was conducted in the Amala Institute of Medical Sciences, Kerala, India from November 2020 to November 2021 with 60 patients aged 18-70 years, classified as American Society of Anaesthesiologists (ASA) class 1-2 and having a BMI between 18-30 kg/m2, who were undergoing elective lumbar epidural anaesthesia. The epidural space depth was assessed using transverse axial plane UD, and the actual ND was measured using a sterile linear scale. The correlation with BMI was studied. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 23.0, and the agreement between UD and ND was evaluated using the Intraclass Correlation Coefficient (ICC). Results: The mean age of the patients was 50.77±9.12 years. The study revealed a strong agreement between UD and ND in assessing the epidural space, with an ICC of 0.963 (p-value=0.0001) and a Pearson’s correlation coefficient (r) of 0.960 (p-value=0.0001). A high correlation was observed between UD and ND in patients with a BMI of 18-22.9 kg/m² (ICC=0.983, p-value <0.0001) and 23-24.9 kg/m² (ICC=0.953, p-value=0.0001), while a moderate correlation was found in the BMI group of 25-29.9 kg/m² (ICC=0.627, p-value=0.008). Conclusion: The present study demonstrated a strong correlation between ultrasound-estimated and actual needle depths in patients with a BMI under 30 kg/m2. This correlation was associated with more accurate puncture site identification, higher success rates, fewer attempts for lumbar epidurals, and a reduced rate of complications.

Comparative Assessment of Efficiency and Patient Tolerance of Hybrid Arch Bar, Erich’s Arch Bar and Maxillomandibular Fixation Screw Placement in Treatment of Jaw Fractures: A Prospective, Single Blinded, Parallel Group, Controlled, Clinical Study

Sherwin Samuel, Kalyani Bhate, Akash Muralidharan, Manoj Bafna, Rushab Chordia Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Introduction: Intermaxillary fixation, otherwise known as Maxillomandibular Fixation (MMF), is a time-tested technique used to stabilise occlusion when one or both of the jaws are fractured. There are different methods available for MMF, among which Erich’s arch bar, MMF screws, and hybrid arch bars are the most commonly used. The presence of these different methods warrants a study to evaluate the efficiency, advantages, and disadvantages of each method. Aim: To assess the efficiency and patient tolerance of hybrid arch bars, Erich’s arch bars, and MMF screw placement in the treatment of jaw fractures. Materials and Methods: This prospective, single-blinded, parallel-group, controlled clinical study was carried out in the Department of Oral and Maxillofacial Surgery at Dr. DY Patil Dental College and Hospital, Pimpri, Pune, from April 2023 to December 2023. Three parallel groups were designed with 15 participants who had mandibular fractures requiring MMF in each group. Patients in Group A were treated with Erich arch bars, patients in Group B with MMF screws, and patients in Group C with hybrid arch bars. Factors assessed included gingival inflammation on the day of removal and seven days post-removal of the MMF appliance using the modified gingival index, time taken for placement and removal in minutes, and patient discomfort using a visual analog scale. The observed values were subjected to statistical analysis using ANOVA for comparison of means and the Bonferroni test for intergroup comparison, with the significance level set at p<0.001. Results: This was a prospective, single-blinded, parallel-group, controlled clinical study conducted on 45 patients, of which 37 were male and eight were female. All patients were within the age group of 22 to 62 years. The mean value for gingival inflammation on the day of removal of MMF was highest for the hybrid arch (3.14±0.0770) and lowest for MMF screws (0.57±0.6), with a p-value <0.001. The mean value for gingival inflammation seven days post-removal of MMF was highest for Erich’s arch bar (1.57±0.732) and lowest for MMF screws (0.29±0.4), with a p-value <0.001. The mean application time was highest for Erich’s arch bar (42.36±5.2 minutes) and lowest for MMF screws (20.57±2.8 minutes), with a p-value <0.001. The mean removal time was highest for the hybrid arch bar (18.14±1.5 minutes) and lowest for MMF screws (6.93±1.4 minutes), with a p-value <0.001. The mean patient discomfort was observed to be highest with Erich’s arch bar (6.21±1.4) and lowest for MMF screws (5.00±1.4), with a p-value <0.001. Conclusion: In terms of time efficiency during the placement of appliances, gingival inflammation, and patient comfort, the best choice would be MMF screws. Although Erich arch bars consumed more time during placement, they caused less severe gingival inflammation compared to the hybrid arch bar, making them the second-best option for dentulous or partially dentulous patients whose dental arches allow for their placement.

Comprehensive Physiotherapeutic Approach in Managing Lumbar Schmorl’s Node: A Case Report

Prince Rohilla, Rajeev Kumar Singh, Shazia Mattu, Nitika Roy Journal of clinical and diagnostic research : 2025 - May - 19:0973-709X Schmorl’s nodes are indicative of Intervertebral Disc (IVD) protrusion into the vertebral body, with epidemiological predominance of 76% amongst males. The condition is usually asymptomatic with rare presentation of pain in few cases, making Non steroidal Anti-inflammatory Drugs (NSAIDs) and physiotherapeutic management as typical line of treatment. Although physiotherapy is helpful in this condition, studies are scarce with set physiotherapeutic interventions lacking. This case report presents a 30-year-old male having lower back ache (LBA) with Schmorl’s nodes at the superior endplate of L3 vertebral disc. Therefore, this case report highlights the importance of a comprehensive physiotherapeutic approach including a combination of electrotherapy, manual therapy, exercise therapy, and education on posture as well as ergonomics. Significant improvement in Low Back Pain (LBP) {Numerical Pain Rating Scale (NPRS)}, strength of core and lower extremity {Manual Muscle Testing (MMT)}, functional outcome {Oswestry Disability Index (ODI)} and Quality of Life (QoL) {Short Form Health Survey (SF-36)} were noted after six weeks of intervention. Further research is warranted to validate the effectiveness of this approach in a larger patient population.